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Medical Student Perspectives: The Match: What You Need to Know

In a few months the time will come for all students applying for residency to come up with a list of programs they like. These will be entered into a national database, which will then undergo a seemingly complicated algorithm in order to produce a list of applicants whose preferences are matched as faithfully as possible with those of the programs. This process is called the match, and here we will demystify its various elements in order to give students a better idea of how to get the most out of the system.

Rank Order Lists
All applicants interested in matching submit an ordered list of programs on the National Residency Match Program (NRMP) website. Because it is extremely unlikely for applicants to match to programs at which they have not interviewed, they should only rank those programs where they have interviewed. A rank order list should represent an applicant’s true preferences, not taking into account the applicant’s perceived likelihood of matching at various programs. This is encouraged because there is no disadvantage to ranking preferred programs highly, even if it is unlikely that an applicant will be highly ranked by those programs. Ranking a large number of programs is also to an applicant’s advantage, especially if the applicant has ranked very competitive programs. In fact, applicants should rank every program at which they feel they would be happy enough to accept a position.

The Algorithm
Let us say there is a residency applicant named John, and another named Sue. The national computer system first goes through John’s preferences, starting with his highest ranked program. If it cannot match him to that program, it will then evaluate John’s second program, and so on. When it comes to his third choice, US Residency Program (USRP), which has also ranked John, the system will tentatively match him to that program. It will then move on to Sue.

Sue’s top choice for residency is USRP. When the computer system comes to this program, it finds that USRP has ranked Sue higher than John. Therefore, it will bump John off the match list for USRP and replace him with Sue. This will be a tentative match for Sue. Next, the system will return to John and evaluate his entire rank list again in an attempt to make another tentative match for him. And so on.

If the system cannot find a single program with which to make a tentative match for an applicant, that applicant will remain unmatched.

The Scramble
Match day, when the match results are released to all applicants, occurs on a Thursday. On noon of the Tuesday before match day, all unmatched applicants are given a chance to contact programs with open positions that they did not originally rank in the hopes that they may be offered a position. This process is known as the scramble. Such applicants are sent a list of programs that have unfilled positions, and each applicant must contact programs independently. Those who procure positions this way are then considered matched on match day.

Couples Matching
Couples undergoing couples matching must register independently with NRMP and indicate the desire to be matched as a couple. The couple then ranks pairs of programs (one program for each individual), and these pairs are considered in the match process. Pairs of programs can consist of the same program for each individual, different programs in the same city, or different programs in different cities. The NRMP then matches couples using the same algorithm as it uses for individuals. Couples are encouraged to rank programs in the true order of their preferences and include all programs that would be acceptable to both parties.

Important Dates
This year, the NRMP registration deadline is November 30. Rank order list entry begins January 15 and ends February 25. The match runs on March 16, followed by the scramble on March 17. Match day is March 19!

More information on matching can be found on the NRMP website. Good luck!

Aliza Monroe-Wise, MSc
Council of Student Members Representative, Pacific Region
Stanford University School of Medicine, 2009
Email: aliza1@stanford.edu

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Back to November 2008 Issue of IMpact

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