Observational studyOtolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery2026
Trends in Otolaryngology Match Dynamics Before and After the USMLE Step 1 Pass/Fail Transition.
Observational study in Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo evaluate otolaryngology (ENT) residency match trends before and after the USMLE Step 1 transition to pass/fail. STUDY
designObservational longitudinal analysis of annual, publicly available specialty-level data (2010-2025).
settingNational Resident Matching Program (NRMP).
methodsData from 2010 to 2025 were used to calculate applicants per PGY-1 position, fill rate, and nonmatch-in-specialty rate. ENT was compared with plastic surgery, orthopedic surgery, neurological surgery, and general surgery. We used ordinary least squares (OLS), segmented regression with a 2023 breakpoint, and difference-in-differences (DID) models.
resultsFrom 2010 to 2025, ENT programs increased from 105 to 139 and positions from 280 to 394. Applicants per position ranged from 1.06 to 1.60 (mean 1.38). OLS showed no significant long-term trend in applicants per position (+0.002/year, P = .86), fill rate (+0.03 percentage points/year, P = .68), or nonmatch-in-specialty rate (+0.04 percentage points/year, P = .94). Segmented regression showed no significant post-2023 changes in applicants per position (slope change +0.03/year, P = .78), and no significant changes in applicant counts (P = .7). ENT had the largest 2022 to 2023 decline in this cohort, in both applicants (-14.1%) and applicants per position (-16.9%). However, in two-way fixed-effects DID models, there was no ENT-specific post-transition change in applicants per position (P > .05 in primary and sensitivity analyses).
conclusionENT remained highly competitive but trend-stable from 2010 to 2025. Although 2023 showed a notable drop in applicants, we found no consistent evidence of a sustained ENT-specific competitiveness shift after the Step 1 pass/fail transition. LEVEL OF EVIDENCE: 4:
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