Piloting a Tool for Assessment of Person- organization Fit for Residency Applicants: Lessons from Organizational Psychology

The General Surgery residency application process has grown competitive, requiring medical students to apply to a greater number of programs. While there has been much discussion of how programs can select the best applicants, there are few resources to help applicants. Person-organization fit is an important determinant of job satisfaction, which itself is an important determinant of physician performance. Using a validated method from the field Organizational Psychology, we developed a formal tool to assist residency applicants in assessing personorganization fit in prospective programs.


Introduction
In the 2018 General Surgery residency match, 1351 US seniors applied for 1319 positions, with 314 unsuccessful in securing a categorical position (National Residency Matching Program 2018). Successful applicants ranked an average of 13.1 programs (National Resident Matching Program 2018). These figures suggest a competitive process, which is unlikely to remit as General Surgery positions grow slowly relative to other specialties (Hayek et al. 2018). As applicants attend more interviews, the process of evaluating and ranking programs becomes more intimidating. While numerous studies propose better methods for programs to evaluate candidates, there are few reciprocal tools for helping candidates evaluate programs (Bowe et al. 2017;Porter et al. 2017). Matching applicants who are satisfied with their outcome is in the best interest of programs and hospitals, as physician satisfaction correlates with quality of care (Wallace et al. 2009).
The concepts of person-organization fit, defined as the congruence between the norms and values of organizations and the values of persons, been studied extensively in the fields of organizational psychology and management  (Chatman 1989;O'Reilly et al. 1991;Scott et al. 2003). A strong understanding of the interactions between organizational and individual value profiles can be useful in predicting what kinds of behaviors to expect over time (Chatman,1989). Unfortunately for residency applicants, organizational culture can be difficult to define (Scott et al. 2003); what discreet factors define residency culture, and how can they be evaluated?

Methods and Results
We conducted a literature search for person-organization fit using multiple electronic databases available through our institutional subscriptions. Key search terms included "person-organization fit", "cultural fit", and "cultural fit healthcare". In our review, we found a structured tool developed to help business students assess their fit at prospective firms by assessing organizational characteristics and weighting these by degree to which individuals valued these characteristics (O'Reilly et al. 1991). The organizational values described were innovation and risk taking, attention to detail, orientation towards outcomes, aggressiveness, supportiveness, emphasis on growth, team orientation, and decisiveness. Subjects rated prospective employers on these values and generated a composite person-organization fit score weighted by the personal importance of each value to the subject. Subjects were then followed for the first year of their employment, with their person-organization fit score correlating with job satisfaction after regression analysis (O'Reilly et al. 1991).
Given the demonstrated validity of this method, we created an analogous tool tailored towards helping prospective residents judge their person-organization fit after interviews. Our adapted key organizational characteristics were location, research activity, didactic curriculum, case mix/volume, resident autonomy, and camaraderie. We organized this into an assessment tool that was provided to fourth year medical students entering the General Surgery match (see Appendices - Table 1.).
Although the person-organization fit tool described by O'Reilly et al created a numerical score used to rank prospective organizations (O'Reilly et al. 1991), we elected to omit this element. We believe that students will derive more benefit from the tool as a qualitative thought exercise than a numerical output. We developed an additional questionnaire intended to streamline students' evaluation process. These binary questions target key "make or break" features of residency programs: Can you see yourself as a resident in this program? 1.
Do you feel like the faculty you met could be your mentors? 2.
Do you think you would be happy in this program? 3.
Does this program have the appropriate resources to develop your clinical and research interests? 4.
Is this an environment in which you would feel comfortable challenging yourself? 5.

Discussion
These tools were offered in parallel with formalized individual mentoring according to the best available peerreviewed methods (Sng et al. 2017). To our knowledge, this is the first described tool to formally apply validated organizational psychology methods to assist in the residency application process. We believe that these resources will help our students navigate this complex process with improved clarity and satisfactory outcomes for both programs and applicants. Furthermore, we believe this method to be generally applicable to residency applicants outside of General Surgery, and an important shift in recognizing the importance of supporting applicants and encouraging introspection to facilitate ideal person-organization fit.

Take Home Messages
There is a dearth of resources available to help residency applicants make structured decisions about ranking 1.
programs. Person-organization fit is a well-studied concept in organizational psychology that predicts job performance 2. and satisfaction. Tools developed for business school students can be adapted to guide residency applicants in evaluating how 3.
well they fit in potential programs.

Notes On Contributors
William Rothstein is a General Surgery resident at Virginia Commonwealth University with an academic interest in medical education.
Alex Kremers is a medical student at the Virginia Commonwealth University School of Medicine, currently applying to General Surgery through the NRMP.
Stephanie Goldberg is an Associate Professor of Surgery in the Division of Trauma and Acute Care Surgery at the Virginia Commonwealth University, with an academic interest in medical education and formal mentorship.