Copyright © 2019 International Anesthesia Research Society. Unauthorized reproduction of this article is prohibited. September 2019 • Volume 129 • Number 3 www.anesthesia-analgesia.org 847 DOI: 10.1213/ANE.0000000000004136 KEY POINTS • Question: During the residency interview process, how frequently do ranked-to-match can- didates who provide statements of strong interest, high rank, and guaranteed commitment actually end up matching to the program that received the statement? • Findings: Candidates who provided guaranteed commitment statements had a 95.7% match rate to the programs to which the statements were directed, in comparison to statements of high rank (25.6%), strong interest (14.6%), and a 5.9% match rate for those who provided no statement. • Meaning: While the ethical use of postinterview communication is debated, the strength of statements of commitment from ranked-to-match candidates was associated with an increased frequency of a successful match, particularly when candidates commit to rank a program #1. BACKGROUND: Despite the critical nature of the residency interview process, few metrics have been shown to adequately predict applicant success in matching to a given program. While evalu- ating and ranking potential candidates, bias can occur when applicants make commitment state- ments to a program. Survey data show that pressure to demonstrate commitment leads applicants to express commitment to multiple institutions including telling >1 program that they will rank them #1. The primary purpose of this cross-sectional observational study is to evaluate the frequency of commitment statements from applicants to 5 anesthesiology departments during a single inter- view season, report how often each statement is associated with a successful match, and identify how frequently candidates incorrectly represented commitments to rank a program #1. METHODS: During the 2014 interview season, 5 participating anesthesiology programs col- lected written and verbal communications from applicants. Three residency program directors independently reviewed the statements to classify them into 1 of 3 categories; guaranteed commitment, high rank commitment, or strong interest. Each institution provided a deidentified rank list with associated commitment statements, biographical data, whether candidates were ranked-to-match, and if they successfully matched. RESULTS: Program directors consistently differentiated among strong interest, high rank, and guar- anteed commitment statements with κ coefficients of 0.9 (95% CI, 0.8–0.9) or greater between any pair of reviewers. Overall, 35.8% of applicants (226/632) provided a statement demonstrating at least strong interest and 5.4% (34/632) gave guaranteed commitment statements. Guaranteed commitment statements resulted in a 95.7% match rate to that program in comparison to state- ments of high rank (25.6%), strong interest (14.6%), and those who provided no statement (5.9%). For those providing guaranteed commitment statements, it can be assumed that the 1 candidate (4.3%) who did not match incorrectly represented himself. Variables such as couples match, “R” positions, and not being ranked-to-match on both advanced and categorical rank lists were elimi- nated because they can result in a nonmatch despite truthfully ranking a program #1. CONCLUSIONS: Each level of commitment statement resulted in a progressively increased frequency of a successful match to the recipient program. Only 5.4% of applicants committed to rank a program #1, but these statements were very reliable. These data can help program directors interpret commitment statements and assist accurate evaluation of the interest of candidates throughout the match process. (Anesth Analg 2019;129:847–54) Do You Really Mean It? Assessing the Strength, Frequency, and Reliability of Applicant Commitment Statements During the Anesthesiology Residency Match Kenneth R. Moran, MD, FASA,* Randall M. Schell, MD, MACM,† Kathleen A. Smith, MD, FASA,‡ Mahmoud Abdel-Rasoul, MS, MPH,§ Robert W. Lekowski Jr, MD, MPH,║ Demicha D. Rankin, MD,* Amy DiLorenzo, MA,† and Matthew D. McEvoy, MD¶ From the *Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio; †Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, Kentucky; ‡Department of Anesthesiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; §Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio; ║Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts; and ¶Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee. Accepted for publication February 15, 2019. Funding: M.D.M. receives research funding from Edwards Lifesciences, Cheetah Medical, and the GE foundation for projects unrelated to this work. Copyright © 2019 International Anesthesia Research Society The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL cita- tions appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.anesthesia-analgesia. org). Listen to this Article of the Month podcast and more from OpenAnesthesia. org® by visiting http://journals.lww.com/anesthesia-analgesia/pages/ default.aspx. Reprints will not be available from the authors. Address correspondence to Kenneth R. Moran, MD, FASA, Department of Anesthesiology, The Ohio State University Wexner Medical Center, N417A Doan Hall, 410 W 10th Ave, Columbus, OH 43210. Address e-mail to kenneth. moran@osumc.edu. Section Editor: Edward C. Nemergut Medical Education