The Use of Holistic Review in Colon and Rectal Surgery Residency Applications

<b>Background:</b> Advice regarding application preparation is often anecdotal; there is limited information about how programs evaluate applicants. It is unclear if holistic review is being properly used in an increasingly competitive field. This study aims to describe desirable applicant characteristics and the application review process of CRS programs. <b>Methods:</b> A survey was distributed to all United States CRS Program Directors (PD) during the 2022 application cycle. The survey had questions regarding number of applicants received and the review process including which screening parameters were used and which criteria were valued when evaluating applications. Descriptive statistics are reported. <b>Results:</b> Thirty-six responses from the 67 CRS residency PD (54%) were received. Most (72%) characterized their review process as "holistic." The majority (58%) of PD classified their hospital setting as academic. The median number of applications reviewed per program was 100, with a median of 26% (IQR 20-31%) of applicants invited to interview. When deciding who to interview, in-training examination (ABSITE) score (92%), letter of recommendation (LOR) content (89%), LOR writer (83%), and research productivity (83%) were the most commonly considered criteria. The "Top 3 Criteria" cited by PD in choosing applicants to interview were LOR, ABSITE and Publications/Research. <b>Discussion:</b> CRS residencies continue to value traditional metrics such as ABSITE scores, publications, and LOR with both the content and identity writer appearing to be important. Despite many PDs claiming they use a holistic review process, our results indicate otherwise. Increased education providing the rationale behind holistic review should be provided.