Date of Award

Fall 12-2023

Degree Type


Degree Name

PhD Health Sciences


Health and Medical Sciences


Genevieve Pinto Zipp, PT, EdD, FNAP

Committee Member

Deborah A. DeLuca, MS.Ch.E, JD

Committee Member

Kristen Blackmon PhD, MD


Residency, General Surgery, Decision-Making, Selection, Accreditation, Criteria, Applicant, Candidate, Program Director


Background: The goal of the General surgery residency selection process is to select residents who will transition easily from medical school to residency, complete the training program, pass their boards, practice surgery in a safe and effective manner, and contribute to the advancement of the specialty. Residency training programs receive thousands of applications annually from which they must choose a select few for an interview. The reality is, if medical students do not get into a residency training program, they can never practice as a physician. Pin-pointing match-worthy applicants from an increasingly deep and similar applicant pool is an extensive process because most medical students applying to residency programs in general are high performers. Throughout the interview selection process of applicants, the Program Director is the main player and leads the selection process and can make exceptions for recommended candidates who may not fit all the programs preferred screening or selection criteria. The Program Director and other interviewers then assess the candidates utilizing various decision-making practices. However, it is unclear if decision-making practices are consistent across programs and meet industry criteria of a successful selection system.

Purpose: The purpose of this study was to understand US Graduate Medical Education Program Directors decision-making practices regarding the selection of General Surgery Residency applicants for interview.

Methods: The study used a basic qualitative design with non-probability sampling/purposive convenience sampling methods. Data was collected via Microsoft Team interviews from US General Surgery Program Directors. A twelve-item semi-structured interview protocol was used with probes to conduct approximately 60 minutes’ interviews with each participant. Interviews were conducted until no new codes emerged. Interviews were audio recorded, with transcription function on and transcribed verbatim. The transcripts were coded using in-vivo and descriptive coding approaches. Inter-coder consensus was reached. Categories were developed from the codes for thematic analysis.

Results: The thematic analysis which emerged from responses to the interview guide questions, revealed that there is not one unifying decision-making practice for the selection of applicants for interview. Program directors noted using a variety of information as factors in their decision making. The study results indicate that General Surgery Program Directors base their decision-making for applicant interview selection on factors such as education, experience and judgement which is influenced by their organization's preferences and values along with stakeholders' preferences and values to formulate the applicant interview selection decisions.

Conclusion: Based on the participant responses in this study, General Surgery Program Directors engaged in diverse decision-making practices, with no consistent process amongst them. While this work suggests that Surgery Program Directors model a decision-making process, no one specific process has been validated or consistently used. Given the increasing numbers of quality applicants coupled with a relatively fixed number of residency positions makes residency selection a time and resource intensive process. Thus, improving the transparency in the residency selection process globally would benefit applicants, and the surgical field overall.