Written by Shalini Reddy, M.D., Associate Dean of Student Programs and Professional Development at the Pritzker School of Medicine

Careers in Medicine

As an advisor, students frequently ask me how to interpret e-mails or phone calls from residency programs after interviews. They also ask whether to notify their top choice program of their ranking intention.

To answer the first question (we’ll come back to the second one later), a group of medical education researchers from around the country conducted a multi-institutional study of communication during the resident matching process.

Background

But first, a little history. The National Resident Matching Program (NRMP) was developed in 1952 to address widespread dissatisfaction among residency programs and applicants.

Before the match was instituted, programs competed for students by extending early offers, many of which expired in as few as 12 hours. Applicants had little time to explore their options or make informed decisions.

Applicants also backed out of their agreement with a program at the last minute when a better offer came along, leaving the initial program with an unfilled spot. The Match was created to level the playing field for applicants and programs.

The Match Participation Agreement

In addition to a matching algorithm, the NRMP requires an agreement that stipulates rules for interaction between programs and applicants to avoid coercion from either side.

An important part of the Match Participation Agreement (MPA): neither party can solicit a commitment from the other. This means that programs cannot ask applicants where they plan to rank the program nor can applicants ask programs where they will be ranked.

Further, neither party can make their rank order contingent on the other’s. Programs or applicants who violate this agreement are banned from participating in the Match for the subsequent two years.

Despite this strict rule about coercive communication, communication between programs and applicants after interviews is commonplace. Our recent study has shed some light on the nature of these communications.

The research

The study surveyed 564 students from seven medical schools. The findings reassured us that violations of the MPA were exceedingly uncommon; out of 564 students, only 27 were asked by a program to disclose where they planned to rank that program.

Overall, more than 85 percent of students reported some type of communication with the program, initiated by the applicant or the program. Most contact (78 percent) occurred with the program director. Competitive specialties such as dermatology were less likely to communicate with applicants.

During these communications, programs told applicants they’d “fit in well with the program,” “be ranked highly” or be “ranked to match.” About a quarter of all students surveyed changed their rank order list (ROL) based on these communications.

Further, about 20 percent of all students surveyed reported feeling they would match at a program based on these communications, so ranked that program first, but ultimately failed to match to that program.

As you might suspect, most students found post-interview communication—or lack thereof—a stressful part of the residency application process.

The advice

While encouraging to learn that few applicants told more than one program they planned to rank them first, the study didn’t specifically address whether applicants should inform their top program of their ranking intention (the second question students often ask). Because of my experience as an advisor, I have mixed feelings.

While informing a program that they’re the applicant’s top choice signals a commitment to the program, it also places the applicant in a tough position. Ultimately, applicants want to match—even at a program that’s not their No. 1 choice.

So the question then becomes, will programs rank an applicant lower because they never heard they were the applicant’s No. 1? We don’t know the answer to this question. Until we hear a more definite answer or experience a policy change from the NRMP, I suggest you ask your advisor in the specialty to which you’re applying whether you should inform your top program.

It’s risky (and dishonest) to tell more than one program they’re your top choice. Programs receive a list of where applicants on their ROL ultimately matched.

If an applicant told Program A and Program B he planned to rank the program No. 1, Program A may move the applicant higher on their ROL. Once Program A learns the applicant failed to match to their program and, rather, matched to Program B, Program A will recognize the deception. The medical education community is small, and students are often remembered for such poor behavior.

So what can you as an applicant take away from the study results? “Love letters” between programs and applicants are common. Accept them as compliments, but don’t base any decisions on them.

In addition, if you never receive a love letter from a program, don’t panic. That specialty may opt out of communicating with applicants after the interview—especially if they’re competitive. Some individual programs also follow that same practice.

Bottom line: Make your rank order list based on where you want to go, not on how much you think a program wants you.

References

1 Jena AB, Arora VM, Hauer KE, Durning S, Borges N, Oriol N, Elnicki DM, Fagan MJ,

Harrell HE, Torre D, Prochaska M, Meltzer DO, Reddy S. The prevalence and nature of postinterview communications between residency programs and applicants during the Match. Acad Med. 2012;87(10):1434–1442.