Arthur H. Aufses, Jr. MD Archives Blog

Soon the Match will be upon the fourth year class and after months of deciding on a field, debating on various institutions, filling out paperwork and then smiling bravely through interviews, the new doctors will be on the resident staff of a hospital.  This complex system of ‘matchmaking’ began in 1952 and replaced the practice of individuals applying to various residency programs, perhaps being measured against changeable and very subjective criteria.

In the early years of the 20th century, The Mount Sinai Hospital had in place a rigorous testing program to help winnow the number of applicants, leaving the ‘best and the brightest’ to face additional testing.  Each year several hundred medical students would sit for the examinations that would lead to the selection of the twelve newest members of the house staff.  The first day’s written examination was number coded, with the individuals’ names hidden so favoritism could not occur. The next day, the top scores were posted, and the 60 highest scorers would return for oral exams given by the medical staff.  The questions were broad and usually designed to show a wide knowledge in the basic sciences and clinical medicine, as well as critical thinking skills. Questions on art or literature were not unknown, depending on the faculty member’s interests. The exam evolved over time to be more rigorous, and eventually recommendations from medical schools deans were also sought.

In 1930, these were some of the written questions the applicants were posed. How would you do?

1. In what stages of the following diseases would you terminate early pregnancy?  a. Tuberculosis of the lungs  b. Nephritisc. Diabetes  d. Valvular heart disease

2. Under what conditions would you select for anesthesia?  a. Chloroform b. Ether c. Nitrous oxide d. Spinal e. Local f. What special contra-indication for each?

3. In what illnesses may the joints be involved?

4. In what extra abdominal conditions may abdominal symptoms appear?

5. A patient has been operated upon for an acute gangrenous appendicitis with abscess. He had one chill prior to operation. Post-operative course is marked by fever of 102 to 104; high leucocytosis; polynucleosis. X-ray examination of the chest and right hypochondrium shows moderate elevation of right diaphragm. Discuss possible causes of the high temperature.