Cardiothoracic Surgery Fellowship: The Challenges Facing Reapplicants Amid the Fall in Match Rates

M. Burmistrova¹, N. Samadzadeh Tabrizi¹, P. Chan², T. Fabian^1
1Albany Medical Center, Albany, New York ²St. Elizabeth Medical Center, Utica, New York

Purpose: Cardiothoracic Surgery (CTS) Fellowship is an increasingly competitive surgical specialty. Match rates have steadily declined from a peak of 97.5% in 2012 to 59.4% in 2024. Unmatched candidates must then work to improve their curriculum vitae for subsequent reapplication. However, programs’ attitudes toward previously unmatched reapplicants are not understood.

Methods: To address this knowledge gap, we conducted a nationwide survey of traditional CTS Fellowship Program Directors (PDs). A list of PDs was obtained from the Accreditation Council for Graduate Medical Education website. A 32-question survey was distributed, including 10 general questions about the institution and the number of first-time match and reapplicant trainees that matriculated over the past five years (2018-2023), 18 questions assessing the performance of first-time match and reapplicants during training, included their technical skills, In-Training Service Examination (ITE) scores, and professional conduct, and 3 questions evaluating application variables that influenced the programs’ rank list, including variables that pertain specifically to reapplicants. The performance of the first-time match applicants was compared to their reapplicant colleagues. Statistical analysis was performed using Fisher’s exact test.

Results: Seventy-seven PDs were identified, of which 30 (39.0%) participated in the survey. Over the 5-year period (2018-2023), each program matched an average of 6.4 (range: 1-18) trainees, including 5.9 (range: 0-10) first-time applicants and 0.54 (range: 0-3) reapplicants. While 27/28 (96.4%) PDs frequently interviewed reapplicants and 24/28 (85.7%) ranked at least one reapplicant, only 9/28 (32.1%) matched one or more reapplicants (mean:1.67; range: 1-3). The majority, 19/28 (67.9%), did not match any reapplicants. Compared to first-time applicants, the technical performance of reapplicants was considered similar by 12/24 (50%), inferior by 9/24 (37.5%), and superior by 3/24 (12.5%) PDs. Programs that matched reapplicants were significantly more likely to rate the technical performance of reapplicant trainees as superior compared to programs that have not matched reapplicants [3/7 (42.9%) vs. 0/18 (0.0%); p = 0.025]. In order of preference, the most influential factors in ranking all applicants were interview performance, letters of recommendation from CTS faculty, and residency PD. When ranking reapplicants specifically, passing the American Board of Surgery examinations was the most important factor, followed by additional training following residency: 1) non-accredited CTS training, 2) trauma and/or critical care training, and 3) research fellowship, in order of importance, respectively (Figure 1).

Conclusion: Given the increasing number of reapplicants in CTS Fellowship programs, it’s imperative to adopt a supportive approach towards these candidates. Our findings indicate that reapplicants perform similarly to their first-time match counterparts. We believe that our findings can offer valuable insights for future reapplicants and the programs that assess them.

Identify the source of the funding for this research project: N/A