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To assess the relative importance of criteria used for residency selection in 21 medical specialties given current available data and competitiveness of specialties.In 2006, questionnaires were distributed to 2,528 program directors in university hospital or university-affiliated community hospital residency programs across 21 medical specialties. Responses were recorded using a five-point Likert scale of importance. Mean values for each item were calculated within and across all specialties. Mean scores for item responses were used to create rank orders of selection criteria within the specialties. To facilitate comparisons, specialties were grouped according to the percentages of positions filled with U.S. medical school graduates.The overall response rate was 49%. With the data from all specialties pooled, the top five selection criteria were (1) grades in required clerkships, (2) United States Medical Licensing Examination (USMLE) Step 1 score, (3) grades in senior electives in specialty, (4) number of honors grades, and (5) USMLE Step 2 Clinical Knowledge (CK) score.The top academic selection criteria are based on clinical performance, with the exception of USMLE Step 1 score. Indicators that reflect excellence in clinical performance are valued across the specialties by residency program directors regardless of competitiveness within the specialty. USMLE Step 2 CK ranks higher in the less competitive specialties, whereas research experience is more prominent in the most competitive specialties. The Medical Student Performance Evaluation was ranked lowest of all criteria by the program directors.