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West J Emerg Med. 2012 Dec;13(6):458-62. doi: 10.5811/westjem.2011.1.6619.

Factors Affecting Candidate Placement on an Emergency Medicine Residency Program's Rank Order List.

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Christiana Care Health System, Department of Emergency Medicine, Newark, Delaware; Denver Health Medical Center, Department of Emergency Medicine, Denver, Colorado; University of Colorado School of Medicine, Aurora, Colorado.



Several factors influence the final placement of a medical student candidate on an emergency medicine (EM) residency program's rank order list, including EM grade, standardized letter of recommendation, medical school class rank, and US Medical License Examination (USMLE) scores. We sought to determine the correlation of these parameters with a candidate's final rank on a residency program's rank order list.


We used a retrospective cohort design to examine 129 candidate packets from an EM residency program. Class ranks were assessed according to the instructions provided by the students' medical schools. EM grades were scored from 1 (honors) to 5 (fail). Global assessments noted on the standardized letter of recommendation (SLOR) were scored from 1 (outstanding) to 4 (good). USMLE scores were reported as the candidate's 3-digit scores. Spearman's rank correlation coefficient was used to analyze data.


Electronic Residency Application Service packets for 127/129 (98.4%) candidates were examined. The following parameters correlated positively with a candidate's final placement on the rank order list: EM grade, ρ = 0.379, P < 0.001; global assessment, ρ = 0.332, P < 0.001; and class rank, ρ = 0.234, P = 0.035. We found a negative correlation between final placement on the rank order list with both USMLE step 1 scores, ρ = -0.253, P=0.006; and USMLE step 2 scores, ρ = -0.348, P = 0.004.


Higher scores on EM rotations, medical school class ranks, and SLOR global assessments correlated with higher placements on a rank order list, whereas candidates with higher USMLE scores had lower placements on a rank order list. However, none of the parameters examined correlated strongly with ultimate position of a candidate on the rank list, which underscores that other factors may influence a candidate's final ranking.

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