This was a cross-sectional observational study of US OBGYN residency program websites. We examined programs listed on the Electronic Residency Application Service (ERAS) 2022 Participating Specialties and Programs website. All programs listed on March 22, 2022, were included. Data for whether the type or program was university-based, community-based university-affiliated, or community-based were obtained by searching for the program in the American Medical Association’s Fellowship and Residency Electronic Interactive Database Access System. Data for the census region and division of programs were determined based on the US Census Bureau Regions and Divisions with State FIPS Codes document.

Two authors (PMD and OA) collected data between November 2021 and March 2022. After obtaining the list of residency programs, we searched for a website associated with the program through a direct link from the ERAS list. In cases where a link was unavailable or incorrect, a Google search was conducted to attempt to find a website. Individual programs were not contacted directly by the study team.

The authorship group identified factors that would be useful for residency applicants. This group consisted of OBGYN faculty with education leadership roles, an OBGYN resident, and an OBGYN medical student applicant. The group used experiences from these roles to iteratively create a list of factors to consider, including program demographics and learner trajectories, application criteria including standardized testing metrics, residency salary and benefits, and diversity, equity, and inclusion mission statements and values. Variables described whether particular information was available on websites and were classified as yes or no. Variable information needed to be available on the program website and its website pages, or via a direct link from the program website and pages. Each website page linked from the main page of the residency website was reviewed for content, and direct links that were judged likely to be relevant were also opened. Data were entered in a Google spreadsheet for collection. In cases of ambiguity, PMD and OA discussed the content and agreed on the determination. To confirm accuracy and interrater reliability, after completing data collection, 10% of records as determined by random number generation were checked, with no systematic errors identified. Interrater reliability was not formally calculated; however, a few data entries were incongruent. All collected variables are described in Table 1.

Data were exported from the Google spreadsheet as an .xlsx file and uploaded into JMP Pro 17.0.0 (SAS Institute, Inc), which was used to conduct statistical analysis. Descriptive statistics and one-way ANOVA were performed to determine differences among the three types of programs using a significance level of .05. Post hoc comparisons used the Tukey-Kramer honest significant difference (global P=.05).

This study was considered by the University of Michigan's IRBMED institutional review board (study identification HUM00218409). The board determined that, in accordance with the board and federal regulations, the study did not require institutional review board approval because it considered publicly available data that could not be identified with a human subject.

Many OBGYN residency program websites lack information that is necessary for applicants to make informed decisions about where to apply and send program signals. When comparing types of programs, we found significant differences in website content, with many factors more often included by university-based programs than by community-based university-affiliated and community-based programs. Although this study was limited to OBGYN, these findings are relevant to all specialties, especially given the need for multiple intervention points for widespread residency application reform [3].

At this important educational transition point, applicants should ideally select residency programs that will enable them to thrive, both personally and professionally, during and after residency training. Many factors should be considered in learners’ self-reflection processes, including whether they want to practice in an academic or community setting, their goals for research and fellowship training, and their individual learning styles. For residency programs to facilitate this decision-making process, this information should be available on program websites, particularly given applicants’ reliance on this source [10-12]. Our work suggests that community-based university-affiliated programs and community-based programs currently lag behind university-based programs in several factors on their websites; consequently, applicants may miss an opportunity to learn about whether these programs align with their needs.

Our work is particularly salient given the widespread adoption of program signaling by many specialties. Transparency around application criteria is necessary if this meaningful residency application reform is to be successful. Notably, detailed standardized testing score guidance was not included on many program websites. These criteria are especially important for applicants who have historically applied to more residency programs and had lower match rates, such as osteopathic medical school and international medical graduate applicants [3,13]. About half of the programs did not include information about alumni trajectories, which can be valuable for applicants trying to determine whether their professional goals around practice setting or fellowship align with those of prior residents. Program signaling presents an exciting opportunity for equity, but it is important for applicants to have the opportunity to send signals to programs that will consider their applications and align with their goals.

Improving transparency could also reduce residency programs’ burden of reviewing large volumes of applications. By describing more criteria on websites, programs could communicate which applications will be considered—before applicants have spent resources on applying or signaling. In the National Resident Matching Program’s Program Director Survey results, OBGYN residency program directors reported that an average of over 45% of applications are rejected based on standardized screening tools, before holistic review [14]. Failing to transparently describe criteria for standard screening tools can perpetuate rising application numbers and costs if applicants unknowingly apply to programs where their applications are automatically screened out of consideration.

From this work, we propose best practices for residency program websites in Figure 1. The practices are informed by the authors’ perspectives as applicant, resident, and OBGYN faculty stakeholders in the residency application process. These practices include describing transparent application criteria to help applicants understand if they qualify for consideration, statements about values and outcomes that illuminate program priorities, and logistic considerations that can influence whether a program is a feasible option for an applicant. If applicants have access to this information, they may identify a more targeted list of programs to which they can apply and send signals, which will ultimately aid in improving the residency application process for applicants and programs alike.

The US residency application process needs multiple reforms to improve match rates and increase favorable outcomes for applicants [3]. Signaling may prove to be an important component of this reform, but signaling can only be successful if applicants can send informed signals to programs that align with their goals and values. One opportunity for residency programs to contribute to the success of this reform is sharing information, such as our residency website best practices, that help applicants determine whether the program aligns with their qualifications, desires, and goals.

Some programs may not control their website content; instead, they may follow graduate medical education or organization-specified templates. Nevertheless, our work provides important information for these groups to make choices about website content and we propose best practices to consider in Figure 1.

In this study, we collected data regarding USMLE Step 1 and COMLEX Level 1 examination scores. However, both exams have transitioned to a pass-or-fail grading system—USMLE Step 1 in January 2022 and COMLEX Level 1 in May 2022. Therefore, our data regarding USMLE Step 1 and COMLEX Level 1 scores may not apply to future applicants. Effects of a pass or fail grading system in the application process are yet to be determined, but other criteria, such as USMLE Step 2 and COMLEX Level 2 scores, may take on increasing importance. Websites must be updated to accurately reflect program requirements, so we suggest this is an excellent opportunity to provide increased information to applicants, such as clearly stating testing requirements, whether multiple attempts at exams are accepted, and if there are USMLE Step 2 or COMLEX Level 2 score thresholds or guidelines for applicants.

This work aligns with findings in other specialties and illustrates key findings that will be of value given the evolving state of residency application processes. OBGYN programs’ websites had rates of listing residents’ medical schools, salary, benefits, and rotation schedules that are similar to those of other specialties [15-20]. Application selection criteria were more difficult to compare because definitions varied across studies. However, like several other specialties, less than half of OBGYN residency programs included specific USMLE Step 1 score guidance [15-18,21]. Additionally, OBGYN programs, like several other specialties, do not universally indicate whether programs consider international medical graduate students and can sponsor visas [20,21]. However, some OBGYN program websites do stand out for including diversity, equity, and inclusion information and case numbers more often than some other specialties [16,22].

Our comparison of different types of programs is less common. Studies in two other specialties compared academic and non-academic programs and found academic programs included more of the characteristics they studied, which aligns with our findings in OBGYN [20,22]. Given the inherent value and differences in all programs, we believe that comparing types of residency programs presents an opportunity to understand which programs can improve in communicating with applicants.

In this competitive application landscape, it is crucial that applicants are provided equitable access to information that allows them to determine where to apply and send signals to optimize their success in matching at a program aligned with their values. Applicants use websites to determine residency program qualities, but the onus of deciphering the best fit should not rest entirely on them. A robust presentation of residency program personnel, curriculum, values, benefits, and application criteria can help applicants understand where their applications will be considered, and possibly where their signals are most strategic. Increased information sharing on program websites could contribute to an improved application process.