|Multnomah County Hospital residents and interns, circa 1925|
I've thought about this a bit, and have a few ideas. First, if the school is truly competency-based, just the fact that the student has been able to graduate should indicate that:
a) The student understands and applies the knowledge necessary to start as an intern,
b) The student clearly demonstrates the skills necessary to start as an intern
c) The student clearly demonstrates the professionalism necessary to start as an intern
To my mind (assuming the system will work as advertised), this is revolutionary. This means you don't have to guess as a residency director what you are getting. You don't have to read between the lines for the secret codes hidden in the letters of recommendation. This person is ready for residency
. End of line.
So, then what do you look for now? Now, as a program director, you can begin to look more at what other experiences and skills does this particular individual have that would help them thrive at any particular institution. Instead of trying to assure that the person had 'honors' in internal medicine, the medicine program director can sort applicants in all manner of ways. They could determine their program wants people who have above-average skill in quality-improvement, or they could decide they want residents who are particularly interested in medical education. They can rank based on how well they operate in a team-environment. They can look for students who have had particular experiences that would benefit them in their environment - say a lot of rural practice experience or many rotations in an under-served inner-city. Each program director can choose what they'd like to highlight, and I don't see a problem with letting students know what they are looking for in applicants. This makes the interview sessions even less about figuring out if this person can operate on the ward successfully, and more about does this person fit well with our system and our culture.
If competency-based education works, this may be something residency program directors will need to think about. We're all well on the way to competency-based education. So, program directors, prepare yourselves. I think it'll make interview season more fun actually.