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Year : 2021  |  Volume : 7  |  Issue : 2  |  Page : 156-158

How Do Residency Match Applicants Fight Battle Against COVID-19 Storm?

Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi, India

Date of Submission29-Sep-2020
Date of Acceptance14-Jun-2021
Date of Web Publication27-Aug-2021

Correspondence Address:
Dr. Vaibhav Aggarwal
Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), G-367, Preet Vihar, New Delhi 110092
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mamcjms.mamcjms_106_20

Rights and Permissions

Every year thousands of domestic and international medical graduates apply for a residency spot in the United States. This communication is an effort to qualitatively measure and describe the impact of the coronavirus disease 2019 (COVID-19) pandemic on the United States residency match application process. This communication tries to perceive a medical graduate who faces the challenges of being a health worker and an examinee at the same time. It is meant for international United States Medical Licensing Examination (USMLE) aspirants to apprise them of the changes that have taken place in the USMLE examinations as a result of the COVID-19 pandemic and advise on how to overcome the difficulties.

Keywords: COVID-19, match application, residency, USMLE

How to cite this article:
Aggarwal V. How Do Residency Match Applicants Fight Battle Against COVID-19 Storm?. MAMC J Med Sci 2021;7:156-8

How to cite this URL:
Aggarwal V. How Do Residency Match Applicants Fight Battle Against COVID-19 Storm?. MAMC J Med Sci [serial online] 2021 [cited 2023 Jun 9];7:156-8. Available from: https://www.mamcjms.in/text.asp?2021/7/2/156/324739

  Introduction Top

“The 2020 main residency match was the largest on record with 44,084 applicants” said the report of National Residency Match Program (NRMP).[1] Indeed every year thousands of domestic and international medical students and graduates apply to enter residency training in the United States in search of green pastures. Things changed in the afternoon of May 11, 2020 when World Health Organization declared coronavirus disease 2019 (COVID-19) a pandemic.[2] This marked the beginning of recognizing it as one of the world’s worst biological disasters. Unsurprisingly, it has affected millions of people worldwide leading to the shutting down of entire cities. Admissions and appointments of healthcare workers worldwide were delayed or suspended, and the United States residency match applicants are no exception. This communication is meant for international United States Medical Licensing Examination (USMLE) aspirants to apprise them of the changes that have taken place in the USMLE examinations as a result of the COVID-19 pandemic and advise on how to overcome the difficulties.

USMLE Step 1, Step 2 Clinical Knowledge (CK)

The USMLE grants physicians’ provisional license to practice in a postgraduate training program and to apply for medical licensure in the United States. It comprises three parts: USMLE step 1, USMLE step 2 CK and CS, and USMLE step 3. Step 1 and step 2 CK are objective assessment examinations and are conducted in prometric centers around the world. Most of the prometric centers were shut down to follow social distancing. Students were unable to give the examination even with a valid scheduling permit at hand. In support, USMLE and Educational Commission for Foreign Medical Graduates (ECFMG) had announced to extend the eligibility periods for these examinations through June 2021 without any additional fees.[3],[4] They are looking at alternate test delivery solutions through medical schools in their respective countries and postponed the planned content changes and allowable examination attempts in step 1 and step 2 CK by a few months.[3] In addition, prometric centers are being opened in a phased manner to resume testing.[3] The efforts made by them deserve applause. What more could be done for the examinees? Many eligible examinees are caring for and treating COVID-19 patients in their respective countries. They may not be mentally and physically fit to attempt such a competitive examination. Moreover, they would be competing against those who have already taken the examination. A provision of a repeat examination attempt without any additional fees within the eligibility period may help to elate examination anxiety among fresh candidates.

Step 2 Clinical Skill (CS)

Step 2 CS is a practically oriented pass/fail examination. It uses standardized patients to test examinees on their ability to gather information from patients, perform focused physical examinations, and communicate their findings.[5] This examination is conducted at test centers exclusively situated in the United States. Due to the temporary suspension of international travel, the examination committee had planned to deliver the test through telecommunication earlier.[3] But due to disruptions caused by the pandemic and given safety and expected delay in implementing alternate test-taking solutions, the Federation of State Medical Boards and National Board of Medical Examiners later on decided to suspend USMLE step 2 CS testing until further notice.[3] This decision applies to both domestic and international medical graduates. Undoubtedly, this was a bold decision and required thoughtful planning for special provisions to graduates who were to apply for a residency match program or medical licensure in 2021. ECFMG identified five different pathways along with an English language proficiency test for these “fresh” international medical graduates (IMGs).[6] Although this decision would have come as a bad surprise for already stressed examinees, I must reiterate the fact that assessment of examination and communication skills are the core component of the step 2 CS examination. Remote online communication could not have performed that appropriately. Implementing telecommunication could have defeated the core guiding principle of this important and unique examination. Therefore, this decision should be looked at positively.

US Clinical Experience

This forms an important aspect of a resident’s application. It aims to understand the practice and ethics of medicine in the United States. It also helps in obtaining positive letters of recommendation from attendings and faculties based in the United States. It is especially valued as an add on for IMGs. Due to the suspension of international airlines and lockdown, confirmed clinical elective/observership programs were cancelled or postponed for many months. Those with ongoing rotations had a premature termination of their clinical program. Even for domestic applicants, this was a big problem in specialties such as surgery where all elective surgeries were suspended.[7] As these are valued in match applications, these applicants will be at an obvious disadvantage compared to their previous counterparts. Moreover, it may increase dropout rates during residency training due to unfamiliarity with the joined program. To fulfill this deficiency, the USMLE committee and program director’s could provide a few weeks of compulsory elective in the specialty before officially appointing physicians in the intended program.

The Residency Interview

Many eligible international applicants were not able to attend their scheduled interviews which were held in October to December (the interview season). NRMP and program directors made arrangements for remote virtual interviews.[8] Informal meetings with residents and program directors to acquaint new residents with the program could also be arranged online. Match deadlines would need to be revised to suit the needs of the international health workforce for this year’s match. Program directors may adjust for lower step scores and less appealing match applications of this year’s fresh graduates in the interview compared to the previous year counterparts.

Applying and completing a residency match application is a costly affair. This includes costs involved in step examination, application fees, travel and living costs in the United States for step 2 CS, electives, observerships, and interviews. Most of the electives also charge tuition/elective fees. Many students, especially from low/middle-income countries, thus face financial challenges. On top of it, this pandemic has cost many people jobs and businesses. There would possibly be an increase in graduate admission times too for fresh graduates this year due to delays in completion of match application. It is important to consider the provision of subsidized loans or fees waiver to those in need.

Joining Residency Program

A total of 4222 IMGs were matched to post graduate year one (PGY-1) positions in 2020.[1] Amid the travel restrictions due to pandemic, most foreign national physicians seeking to join the US residencies were successfully able to do so on their intended start dates.[9] This would motivate future applicants to continue their efforts for the US residency match and would surely strengthen the much-needed healthcare system in this pandemic.

  Conclusion Top

Unfortunately, 2020 to 2021 is an extremely stressful period for all the match applicants with years of hard work and planning at stake. The USMLE committee, NRMP, and ECFMG have always worked hard to enhance the examination experience and the application process for their applicants and I can undoubtedly say they will continue to do so. In these difficult times, it is important to embrace and accept where our destiny takes us. At the same time, we must strive toward fighting this pandemic together in the best ways we can.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

New! NRMP Main Residency Match Report Shows Record-Highs in Registrants and Positions. The Match, National Resident Matching Program. Published May 7, 2020. Available at https://www.nrmp.org/press-release-mrm-results-and-data-2020/. Accessed May 13, 2020.  Back to cited text no. 1
WHO Director-General’s opening remarks at the media briefing on COVID-19–March 11, 2020. Available at https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19–-11-march-20. Accessed May 17, 2020.  Back to cited text no. 2
The United States Medical Licensing Examination | Announcements. Available at https://www.usmle.org/announcements/?ContentId=279. Accessed May 17, 2020.  Back to cited text no. 3
Supporting Physicians, Medical Educators, and Medical Regulators during COVID-19. Available at https://mailchi.mp/ecfmg.org/covid-19-newsletter-may7. Accessed May 17, 2020.  Back to cited text no. 4
United States Medical Licensing Examination | Step 2 CS (Clinical Skills). Available at https://www.usmle.org/step-2-cs/. Accessed May 20, 2020.  Back to cited text no. 5
Requirements for ECFMG Certification for 2021 Match. ECFMG. Available at https://www.ecfmg.org/certification-requirements-2021-match/. Accessed September 29, 2020.  Back to cited text no. 6
COVID-19: Elective Case Triage Guidelines for Surgical Care. March 24, 2020. American College of Surgeons. Available at https://www.facs.org/covid-19/clinical-guidance/elective-case. Accessed May 17, 2020.  Back to cited text no. 7
(Updated September 8) NRMP FAQs During COVID-19 Pandemic. The Match, National Resident Matching Program. Published August 31, 2020. Available at https://www.nrmp.org/covid-faqs-3/. Accessed September 29, 2020.  Back to cited text no. 8
COVID-19 (Coronavirus) Updates. ECFMG. Available at https://www.ecfmg.org/annc/covid-19-coronavirus.html. Accessed September 29, 2020.  Back to cited text no. 9


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