When crafting a Match rank-order list, the only thing that is certain is there will be a measure of uncertainty in the process.
For residency applicants, the ultimate goal of a Match rank-order list is to secure a spot in a graduate medical education (GME) residency program that is going to allow for personal and professional growth. Which factors do applicants value most in finding residency opportunities that meet that goal? How effective are those areas of emphasis in predicting long-term satisfaction? A study published in Medical Education Online offers insight into those questions.
What drives Match ranking decisions
For the study of medical students from a large public university in California, researchers looked at factors students used when building their rank-order lists and compared them with which factors predicted happiness, stress and burnout after starting residency.
As part of the study, students were asked to complete three surveys—one prior to Match Day (after rank-order list submission), a second immediately after Match Day and a final survey three months into residency training—that tracked changes in respondents’ happiness, stress and satisfaction.
When initially asked which factors were most important in creating a rank-order list students rated program location, training quality, “gut feelings” related to fit and morale of house staff and current residents at the top of the list.
Data for the study was collected during the 2016 and 2017 Match cycles but it largely aligns with more recent data from the National Resident Matching Program about factors students cited as the most significant in building a Match rank-order list.
Match ranking factors students may overrate
Throughout the three surveys, researchers analyzed respondents’ self-reported levels of happiness, enthusiasm, stress and life satisfaction. Factors respondents consistently cited as important in ranking programs that didn’t offer a strong correlation with positive well-being outcomes included those related to geography and program prestige.
Maya Hammoud, MD, is a professor of obstetrics and gynecology who has done extensive work related to residency selection through a grant from the AMA Reimagining Residency initiative. In her work, she coaches medical students on making a Match rank-order list that reflects their priorities and values.
If medical students have a built-in support system in a region, that can be a key factor in prioritizing the geography of a residency program, she said.
“If I’m speaking with a student and they have family somewhere and they want to prioritize that in their rank-order list ... I do encourage them,” she said. “Residency is extremely stressful and that can help.”
When medical students prioritize geography for lifestyle reasons, “if they are saying they really want to be in Chicago, or New York, I ask them to reflect on the actual reason. And to make sure that this is really a key priority for them to be in that location.”
In terms of program prestige, Dr. Hammoud tells students that there are nearly 300 ob-gyn residency programs accredited by the Accreditation Council for Graduate Medical Education “and you will get good training wherever you go. You will grow wherever you are planted.”
The AMA has resources to serve as a collaborator in addressing the factors that cause resident burnout and stress, including the AMA Joy in Medicine® Health System Recognition Program, which empowers health systems to reduce burnout and build well-being so that physicians and their patients can thrive, and the AMA STEPS Forward®open-access toolkit “Resident and Fellow Burnout.”
Factors predicting satisfaction
In analyzing survey responses both immediately after Match Day and months into their residency training, researchers found the factors that centered on person-program alignment were the strongest predictors of lower stress, higher happiness and excitement and lower burnout. These factors were generally cited less frequently as key determinants of Match rank-order list composition.
The study’s authors noted that key factors in determining program-person alignment may include call schedule, caseload, work-life balance and rapport with leadership and peers.
Alignment factors might be hard to gauge in the application and interview process. Dr. Hammoud advised residency applicants to look at policies such as parental leave to gauge how supportive a residency program is during major life changes and benefits for house officers, such as time off or the availability of on-campus resources.
When it comes to well-being factors and ranking, applicants may end up “up using their gut feeling,” Dr. Hammoud said. “It is sometimes really hard to look at something on paper and know: Is this really going to be a good culture or not?”
“You can try your best to access that during interviews by asking about their culture and looking for it as a fit. There are programs that are honest and say to students: ‘We're a very busy program— you're going to be extremely, extremely busy here. If you don't want to work too hard, maybe you should not rank us.’ But in general, programs try to brag about their wellness culture.”
In looking to assess program fit, a tool from the AMA gives some residency applicants a new way to make values and career priorities a part of their residency-selection process.
The Alignment Check Index (ACI) is a tool that allows ob-gyn residency applicants to compare their experiences and characteristics to the domains that residency programs consider in their own assessment of their program’s values and interests.
