PubMed abstract / permitted excerpt

OBJECTIVE: Investigate and characterize outcomes of unmatched otolaryngology applicants and the corresponding pathways. STUDY DESIGN: Retrospective cohort study. SETTING: National, web-based analysis of applicants participating in the Otolaryngology Program Directors Organization (OPDO) preference signaling process. METHODS: Applicants who participated in OPDO preference signaling during 2 consecutive application cycles (2020-2021 and 2021-2022) were identified. First-time applicants were analyzed for initial match outcomes. For those who did not match, gap-year activities and reapplication outcomes were determined using publicly available web sources. Subsequent match rates were compared between reapplicants who completed a research year and those who completed a clinical gap year. RESULTS: The first-time applicant match rate was 65%. A total of 218 (20%) first-time applicants did not secure a categorical position. Gap-year activity was identified for 151 of 218 (69%). Among the unmatched cohort, 113 of 218 (52%) re-signaled and reapplied to otolaryngology, of whom 64 of 113 (57%) matched on reapplication. Reapplicants who completed a research year matched more often than those who completed a clinical gap year (38 of 54 [70%] vs 21 of 45 [47%]; P = .036). CONCLUSION: Among first-time applicants who did not initially match, reapplication after a research year was associated with higher subsequent match rate compared with a clinical gap year. Cautious use of this data may guide mentors and unmatched applicants. However, recommendations should be individualized to reflect each candidate's circumstances. LEVEL OF EVIDENCE: Level 4.