Rationales for a Lottery Among the Qualified to Select Medical Trainees: Decades of Dutch Experience

Graduate medical education’s obsession with choosing the ‘‘best’’applicants, among many candidates for a finite number of positions, has produced a frustrating and timeconsuming recruitment process. That many applicants or programs may be disappointed by this process seems unavoidable. Medical schools and residency programs expend enormous amounts of time and effort as well. When no valid, rational choice among roughly equal candidates can be made, a random choice—a lottery—emerges. At a time when the selection for US residency programs can no longer rely on United States Medical Licensing Examination (USMLE) Step 1 scores as a filter—from 2022 they will only be reported pass/fail1–4—it may be worth considering the rationales for a lottery system.