Lather, rinse repeat: What happens after SOAP

Context: The Supplemental Offer and Acceptance Program (SOAP) is part of the National Resident Matching Program (NRMP) and is the process for matching unmatched student applicants with unfilled residency programs. Little research has been done on the SOAP, on how these students perform in residency or what factors may have led programs to go unfilled.

Objective: The main objective of our study was to describe characteristics and outcomes of residents who went through SOAP; secondary objectives included identifying residency program factors that may contribute to SOAP and strategies for programs to prepare to SOAP.

Study Design: survey

Setting: Residency programs in the Family Medicine Residency Network (FMRN)

Population studied: 23 programs and rural training tracks from the FMRN who participated in the SOAP since its inception in 2012 (of 39 total programs) and the residents who were matched to those programs in the SOAP (54 of 1658 total residents)

Outcome Measures: Primary outcomes were resident performance, including graduation from residency, performance on key competency areas at the beginning and end of residency, likelihood to need remediation, likelihood to hold leadership positions, resident “fit” with program culture, and program director likelihood to recommend to a colleague for hiring. Secondary outcomes were around program experiences with SOAP, including program director perception of factors that led to the program SOAPing and suggestions for preparing other programs to participate in the SOAP process.

Results: We had a 100% response rate. Program Directors reported a largely positive experience with their SOAP residents, viewing them as mostly equal or more favorable to the average resident. Respondents offered a number of factors that may have led them to SOAP including being ill prepared, being a new program, location (rural), program director turnover, low morale, and potential program weaknesses. Program Directors shared advice for preparing for SOAP including clearing schedules during Match week, understanding the process, screening applicants and communicating with applicants.

Conclusions: Our findings help dissuade concerns programs may have about the quality of residents obtained through SOAP and confirm the assumption that rural training tracks are more likely to SOAP. Additionally, our findings offer guidance to programs for remediating potential issues that could lead them to SOAP and how to best prepare if they do SOAP.