Preparing for Residency

Match ranking advice: Trust your gut

Timothy M. Smith , Contributing News Writer

AMA News Wire

Match ranking advice: Trust your gut

Feb 19, 2024

AMA member Matthew Lecuyer, MD, MPH, is an attending physician at Children’s National Medical Center in Washington, D.C. Previously, he was a pediatric emergency medicine fellow at Brown University. He has gone through the Match twice—once for residency and again for the fellowship—and is thrilled with the results.  

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But he knows how stressful it is. Not because of the process of submitting a Match rank-order list, but because of the emotions and the churning thoughts leading up to Match Day. He has several pieces of advice for students about to go through Match ranking. The deadline for medical students participating in the 2024 Match to certify their Match rank-order list is Feb. 28.    

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Fourth-year stresses  

In terms of advice Dr. Lecuyer would offer, his first piece is probably what most medical students would like to hear: Follow your heart.  

Between the resources available at his medical school, University of Massachusetts, and those available from the National Resident Matching Program (NRMP), Dr. Lecuyer was confident he understood the Match ranking process—where to go to submit his rank-order list and when to do it. But he was less prepared for the stress of making his selections, waiting for the results, wondering if he would match and, if he did, where on his list he would end up.  

“Fourth year of medical school is filled with stress,” Dr. Lecuyer said. “You take your [USMLE] Step 2, which is your clinical knowledge … That’s stressful. And when it’s time to apply for residency, everyone asks themselves, ‘How many programs do I apply to? Am I a competitive applicant?’  

“Then you submit your application and you’re stressed out about interviewing. And you go on interviews and wonder, ‘Oh, did I say the right thing? Did I make the best first impression? Is this program going to want me as much as I want it?’ And then you get to the rank list, and you’re stressed out about that too.”  

Managing one’s stress is essential to getting through Match in one piece, and Dr. Lecuyer said it begins with knowing your must-haves in a residency program.  

“I had gotten a lot of advice from people in my subspecialty, as well as people who were not in my subspecialty, advisers, mentors, friends,” he said. “The piece of advice that was really useful was to think back on every interview you had and your interactions with the faculty, the residents, your co-interviewees, and think about yourself being in that environment and with that group of people.  

“Residency is the most intense, the most terrifying and the most amazing experience of your life. You might be moving across time zones or even across the country. You need to know you’re going to have a support system, and I think that’s especially important now with concerns about resident and fellow burnout. You need to really focus on your own wellness and make sure you can see yourself with those people, because you’ll be spending more time with them than you will with your own family.”  

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Figure looking at a winding road

Dr. Lecuyer acknowledged that there is a lot of pressure on students to reach for big-name programs, but he insisted that those programs should be held to the same standard.  

“Don’t rank a program because it’s the No. 1 program or because it has a great name,” he said. “At the end of the day, everyone in your subspecialty sits for the same board exam, and every accredited program has to go through the same set of regulations, so your education is 90% standardized. It’s that 10% that really is what is going to make or break your residency experience.  

“Trust your gut, because you know yourself better than anybody else, and you’ll know if you’re going to be happy in a program.”  

Dr. Lecuyer followed this advice and was matched for his residency with Lurie Children’s Hospital in Chicago.  

“I was ecstatic when I matched there because I remembered the people were wonderful,” he said. “It was a great experience—I loved it and hated it at the same time. It was stressful. It was scary. It was tiring. I was basically living at the hospital. That’s why it’s called a residency—you’re a resident of the hospital. But my co-residents and faculty were an incredible set of people. It was the most amazing three years of my life.”  

Here are some other things Dr. Lecuyer said to keep in mind.  

Enter your rank order sooner rather than later. “Don’t let it wait, because if the website crashes, then you’ll be going crazy the night it’s due.” This echoes advice from the NRMP.  

Be prepared to be matched with any program on your rank list. For about two weeks after submitting your rank-order list, there’s very little stress, he said. “Then all of a sudden, you say to yourself, ‘Oh my gosh, I could be at program one, program two, program three, or I could be at the one dead last on my rank list.’ You start picturing yourself there and how different your life is going to be from where you are right now, and you’re either excited or filled with dread.  

“What most people don’t consider is matching with a program somewhere in the middle of their list, and they open their envelopes and they’re not prepared for what they find. So don’t get caught up in where on your rank list you match, especially if you like all the programs you listed.”  

Make the most of Match week. “On the Monday of Match week, I got an email saying I matched. I knew that was coming. But I didn’t find out where I matched until later in the week. In the meantime, my mind went to a hundred different places as to where I was going to be, what I was going to do. I had trouble sleeping.  

“You just need to let it go and appreciate that you’ve matched. Enjoy the ride and try to distract yourself as much as you can that week, because it is probably one of the most stressful weeks of fourth year. Embrace it, and then celebrate.” 

The AMA Road to Residency series provides medical students, international medical graduates and others with guidance on preparing for residency application, acing your residency interview, putting together your rank-order list and more.

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