Exploring Home Field Advantage: Do Interns From the Same Institution Perform Better on the Milestones

Background and Objectives: Applicants to residency have reported preference for staying within their graduating institution, citing possible “home field” advantages. Surveys of program directors have been mixed, with some prioritizing academic qualifications, while others noting preference for graduates from their institution. However, whether the “home field” advantage impacts performance has been unexplored. This study examines intern performance for graduates from the same institution, relative to interns from other institutions using a national cohort of Emergency Medicine (EM) residents and the Accreditation Council for Graduate Medical Education (ACGME) Milestones.

Methods: Data from entering EM cohorts in 2021 and 2022 were used. A list of all medical schools and matching residency programs was obtained and coded based upon affiliation. Residents were considered “home field” if they matriculated into a residency program listed as their graduating institution's primary affiliation. Data were merged with postgraduate year (PGY)-1 ACGME Milestones ratings at Mid- and End-Year reporting periods. Analyses were aggregated at the ACGME Core Competency level. Mixed-effects regression and mixed-effects logistic regression models evaluated differences in Milestones performance, including whether residents were considered ready for supervised practice.

Results: Data from 5,905 PGY-1 residents were used from 275 EM residency programs. Overall, 509 (8.6%) residents (2021: 9.1%; 2022: 8.1%) matched to residency programs identified as primary affiliates of their medical school. Results showed modest differences in performance favoring “home field” residents in two ACGME Core Competencies: Interpersonal Communication Skills (ICS) at Mid-Year (β = .05, P = .002) and Patient Care (PC) at End-Year (β = .04, P = .002). At the Mid-Year reporting period, “home field” residents were more likely to be rated as ready for supervised practice (not rated “Not Yet Completed Level 1") in ICS (OR = 2.24, P = 0.014) and PC (OR = 2.57, P = .003).

Conclusion: Findings empirically demonstrate benefits of the “home field” advantage, particularly for ICS and PC competencies during the first six months of training. While differences in Milestones ratings were modest, there were substantial differences in readiness for supervised practice. Further research should investigate factors contributing to the perceived “home field” advantage.

Presenter:

  • Sierra A. Hajdu, MD
Authors

  • Sierra A. Hajdu, MD

    University of Cincinnati Medical Center/College of Medicine

    Dr. Sierra Hajdu, MD is a third-year emergency medicine resident at the University of Cincinnati. She will serve as one of her program's Chief Residents for the upcoming academic year. Originally from New York, she obtained her undergraduate degree at the University of Notre Dame and subsequently moved to Ohio where she completed medical school at the University of Cincinnati College of Medicine. Her interests include graduate medical education and social emergency medicine.

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