The ResCAS Disaster and Optimal Medical School Length

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We’re in the thick of Match season, where residency hopefuls apply for a training spot in their specialty. The culmination of at least 3-4 years of medical school (and a hefty 6-figure bill), it’s a high-stakes, high-stress time.

This year, Ob/Gyn added a twist: switching from ERAS (not the Taylor Swift concert) to ResidencyCAS for applications.

The American College of Obstetrics and Gynecology (ACOG) made the change as part of their Right Resident, Right Program, Ready Day One program, funded through the American Medical Association’s Reimagining Residency initiative.

ACOG cites benefits like:

Holistic review through advanced data processing
Lower costs for applicants (ResidencyCAS: $99 for 18 applications vs. ERAS: $99 for 10)
User and mobile-friendly interface

It hasn’t been a super smooth freshman season for the platform, to say the least.

There have been a handful of high-profile “glitches”:

COMLEX Scores Released

“On October 7, 2024, the NBOME was made aware of a technical issue that impacted the delivery of your COMLEX-USA Level 1 performance results … NBOME does not report 3-digit scores for Level 1, but a score was transmitted by NBOME to ResidencyCAS in error, and was available to program directors until this week.”

Gretta A. Gross, DO, MEd

Executive Vice President for Assessment & Chief Assessment Officer, NBOME

On October 7, 2024, the NBOME accidentally released three-digit COMLEX-USA Level 1 scores to ResidencyCAS instead of only sharing the intended pass/fail results (we covered some of the impacts of this in last week’s newsletter).

COMLEX-USA Level exams are the DO equivalent of the MD’s Step exams.

This error allowed program directors to see more detailed scores than applicants themselves could access, raising concerns about fairness in the evaluation of DO candidates.

To make things worse, those scores were never shared with the applicants themselves.

Since Program Directors aren’t universally knowledgeable about COMLEX-USA scoring, Dr. Bryan Carmody, self-proclaimed “sheriff of sodium”, MedEd thought leader, and associate professor at Eastern Virginia Medical School notes:

"Paradoxically, I think the NBOME's score leak mostly hurts DO applicants applying to 'DO friendly' programs," Carmody wrote. "If a [program director] who's used to evaluating/stratifying DO applicants sees the secret COMLEX Level 1 score -- especially if that score is very low -- they may not be able to 'unsee' it."

Bryan Carmody

Interview Decisions Leaked?

One of the RRR program improvements is the implementation of a universal interview invitation release date. This year, that date is October 29th.

Or is it?

There’s a not-so-secret Google Sheet used by Ob/Gyn applicants to crowdsource information about the application, interview, and Match process (other specialties have their own).

Amid discussions about interviews and statuses, some applicants started noticing something strange in their "My Programs" section on ResidencyCAS.

Applicants who checked the system before the official release date of October 29th saw their statuses as “Waitlisted” or even caught glimpses of specific interview dates. This discovery triggered confusion and worry among applicants:

“How can you tell if you've been waitlisted or not?” someone asked, noting that clicking "My Programs" showed the school name under "Waitlisted."
“I was put on the waitlist now :'(”, another applicant lamented.
“If I don't see this, does it mean I'm not getting an interview?” one asked anxiously.

Dr. Maya Hammoud, principal investigator of the RRR grant, and key leader in the transition to ResidencyCAS, tried to address the concerns by posting on the Sheet, in part:

“Some programs have been using the Interview Portal to schedule early interviews with their ‘home’ students and few others, so these students will have been able to see those programs and their active invitations in the Interview Portal – this is all expected behavior … Other programs have been actively sorting through applications and may have made some of those updates temporarily visible to students in the Interview Portal. Students should have no need to log in and review what is in the Interview Portal until they receive official communication from those programs on or after October 29th.”

Dr. Maya Hammoud

Truthfully, it’s a bit hard to figure out exactly what happened here, but from what I can tell:

Some programs are issuing early invitations to interview for ‘home’ students, instead of waiting for the Oct. 29th date.
Program Directors are reviewing applications and using labels in the ResidencyCAS system to categorize them in an ongoing manner, as they have in years past. Whether a software glitch or a user misunderstanding, applicants were able to see their categorization for a period of time, accidentally.

Other Bugs & Issues

Program directors have also pointed out other technical problems with ResidencyCAS that affected their ability to efficiently review applications:

Personal statements submitted by applicants appeared without proper formatting or paragraph breaks, making them difficult to read.
Sorting options were limited, making it harder for PDs to quickly filter applicants by criteria like state, school, or signal preference.
Reviewers’ notes didn’t save properly, causing some to lose their evaluations mid-process.
The system was prone to freezing or crashing on the first day of application reviews, especially when trying to open letters of recommendation.
Programs were incorrectly coded within the system, leading applicants to see unfamiliar programs under their "My Programs" list—programs they hadn’t applied to at all.

What’s Next?

We’ll have to wait and see how the rest of the application cycle goes.

But it appears that Ob/Gyn are just the first to make this switch: The Council of Residency Directors in Emergency Medicine just announced that Emergency Medicine will use ResidencyCAS next cycle.

Full disclosure: inspiration for this week's objective section came from the most recent episode of The Papers Podcast, "the podcast that keeps you up to date on the latest research in Health Professions Education (HPE)." 🎧

Is There Something Magical About 4 Years for Medical School?

Or could medical training be completed in 3? Or should it be 5? 🤔

A new paper published ahead of print in Academic Medicine gives us some data to chew on.

With rising student debt and physician shortages, the conversation around the ideal length of medical school is a deservedly hot topic. But can you really squeeze all the necessary training into three years and still produce well-prepared doctors?

Key Findings: Three vs. Four Years 🏥

The study by Santen et al. compared the performance of graduates from accelerated three-year programs (A3YP) with those from traditional four-year programs (T4YP) across several residency specialties.

The results were clear: there is no significant difference in residency performance between the two groups, even when it comes to essential milestones like patient care and medical knowledge.

At both 6 months and 1 year into residency, graduates from three-year programs performed just as well as their four-year counterparts in areas such as professionalism and communication.

While 5% of the three-year grads had at least one milestone rating of zero, compared to 2% of four-year grads, this difference was not statistically significant.

Weighing the Pros and Cons ⚖️

👍Pros of A3YP:

Lower Costs 💸
- Students save on tuition and living expenses by graduating a year earlier.
- Faster entry into the workforce means students can start earning an income sooner, potentially reaping a lifetime financial benefit of up to $250,000.
Addresses Physician Shortages 🏥
- These programs are designed to quickly produce doctors, especially in primary care fields, helping to fill gaps in the workforce.
Competency-Based Education Compatibility 📜
- Three-year programs fit naturally with competency-based education (CBE), which emphasizes mastering skills over simply spending a set amount of time in school.
Sufficient Residency Preparation 🏥
- The study found no significant difference between three- and four-year graduates in residency milestone achievements at six and twelve months, suggesting that three-year programs don’t compromise educational outcomes.

👎Cons of A3YP:

Less Flexibility and Exposure 🚪
- The condensed curriculum means fewer electives and less time for exploring different specialties.
Increased Pressure 😓
- With fewer breaks and an accelerated pace, some worry about burnout.
Potential Maturity Issues 🤔
- Accelerated programs may not allow enough time for the personal and professional development that comes with longer programs.
Limited Specialty Options 🔄
- While some three-year programs are expanding to more specialties, many are still focused on primary care, offering fewer options for students interested in other fields.

👍Pros of T4YP:

More Comprehensive Learning Experience 📚
- The longer duration provides more time for academic enrichment, including research opportunities, dual degrees, or more focused study in areas of interest.
Better for Undecided Students ❓
- For students unsure of their specialty, the extra year allows more time to explore and make informed decisions about their future.
More Opportunities for Flexibility 🎯
- A four-year program offers flexibility in scheduling and taking on electives, as well as the opportunity to earn some income during the program.

👎Cons of T4YP:

Higher Costs and Delayed Workforce Entry 💰
- The additional year of tuition and living expenses can significantly increase student debt and delay entry into the workforce, as three-year students can start earning earlier.
Potential Redundancy in the Fourth Year ⏳
- The fourth year is sometimes seen as less structured, with some students using it for electives that don’t necessarily contribute to their career readiness.
Longer Time Commitment 🕰️
- A bit obvious, but needs to be said!

Have thoughts on the three vs. four-year debate? Hit reply—I’d love to hear them!

What is the recommended maximum number of inpatient consultations trainees should perform per shift to avoid cognitive overload?

⏪Last Week’s Question:

Can medical students be named in medical malpractice suits?

Answer: Yes - Here’s a recent review of malpractice cases involving medical students

Plan: Upcoming Dates & Events

Oct 1 - Dec 2: Learn Serve Lead 2025: Call for Research in Medical Education (RIME) Papers
Nov 1: Abstracts Due for Society for Academic Emergency Medicine 2025
Nov 7-8: The Generalists in Medical Education Annual Conference
Nov 8-12: AAMC Learn Serve Lead Conference
Dec 2: Learn Serve Lead 2025: The AAMC Annual Meeting Call for Medical Education Proposals
Dec 15: Call for Submissions to Academic Medicine Disability Supplement
Jan 10-14, 2025: International Meeting on Simulation in Healthcare (IMSH) 2025 Conference

Want to share an upcoming event? Respond to this email directly with the date, title, and URL for more information.

"Time to riot"

COMLEX Scores Released

Interview Decisions Leaked?

Other Bugs & Issues

What’s Next?

Is There Something Magical About 4 Years for Medical School?

Key Findings: Three vs. Four Years 🏥

Weighing the Pros and Cons ⚖️

Plan: Upcoming Dates & Events

Responses

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