Consequences of Legal Infractions on the General Surgery Residency Application Process.

Objective: Alcohol and drug-related legal infractions are common among college and medical students. The objective of this work is to quantify the influence of these legal infractions on program directors (PDs) when making decisions on applicants to general surgery residencies.

Design: A convenience sample of 72 PDs with publicly accessible email addresses were electronically sent a previously piloted survey tool. Data collected included demographic information about the PD, and the legal status of recreational marijuana in their state. A 5-point Likert scale (No influence - Would not select) was used to quantify the influence of various alcohol and drug-related legal infractions on an applicants' ability to match into their general surgery residency.

Setting: American general surgery PDs PARTICIPANTS: 61 general surgery PDs.

Results: Response rate was 84% or 18.4% of all accredited general surgery residencies. The consequences of legal infractions were more significant for medical students than college students, this included drunk and disorderly (p < 0.001), driving under the influence (DUI) (p < 0.001), possession of marijuana (p < 0.001), cocaine (p < 0.001), fentanyl (p = 0.003), and methamphetamine (p = 0.004). For both college and medical students, infractions distribute into 3 tiers of severity. The lowest tier is for drunk and disorderly and marijuana. These have minimal negative impact and are not different from each other. DUI is the second tier and is significantly more negative than the first tier infractions (p = 0.002, p < 0.001). Infractions involving cocaine, fentanyl, and methamphetamine, have the most negative impact; with each being significantly worse than tier 1 offenses (p < 0.001 for each) and DUI (p < 0.001 for each). For residencies located in states where marijuana was illegal, arrest for possession of marijuana as a medical student has a greater negative influence (p = 0.033), than where it is legal.

Conclusions: Legal infractions occurring during college are less consequential than those in medical school. Regardless of the timing, being arrested for drunk and disorderly or marijuana possession had less impact than a DUI, possession of cocaine, methamphetamine or fentanyl.