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The conversion of general surgery residency (GSR) from a pyramidal to rectangular model required the creation of the Non-Designated Preliminary (NDP) residency. The Accreditation Council for Graduate Medical Education defines NDP residents as those "accepted into programs for one or two years of training without permanent positions in the current program or another program at time of acceptance.'' NDP positions are filled by candidates who either fail to match into categorical GSR spots or desire to improve their competitiveness for future attempts at residency placement. In this context, NDP training is a valuable launching pad for continuation of graduate medical education and surgical training.
A sizeable proportion of NDP positions are filled by International Medical Graduates (IMG). IMGs occupied 322 of 819 (39%) filled NDP positions in the 2013 Match.1 Several reasons account for this: 1) fewer positions are available to IMGs in GSR compared with historically IMG-friendly specialties like Internal Medicine (IM) or Pediatrics; 2) a majority of categorical GSR spots are filled by U.S. Graduates (USG)1; and 3) USGs typically perceive the NDP position as unfavorable. We investigated if IMGs had similar opportunities to continue post-NDP training as USGs and if a second year of NDP training was advantageous to IMGs.
After Institutional Review Board approval, a retrospective review of residents who completed NDP training at our institution between 2004 and 2012 was conducted. Demographic information, number of NDP years trained (1 or 2), and post-NDP placement of IMG and USG NDP residents were reviewed. Post-NDP programs were categorized as general surgery (GS)/surgery-related (GS, surgical subspecialties, or anesthesiology) and nonsurgical (IM, radiology, etc.), or university-affiliated and independent. All variables were examined as categorical data. Univariate analysis was performed to identify differences in residency placement between IMGs and USGs as well as between 2- and 1-year IMGs using the Fisher's exact test. STATA 12.1 (Stata Corp., College Station, TX) was used for data analysis. A P value of < 0.05 was considered statistically significant.
Seventy-seven residents...