One GME leader’s advice on thinking through your rank-order list

Jennifer Lubell , Contributing News Writer

It’s that time of year. Medical students are creating their rank-order lists for 2023’s Main Residency Match, gearing up for a March 1 submission deadline.

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For fourth-year medical students it can be a stressful time, acknowledges AMA member Louito C.  Edje, MD, MHPE, associate dean of graduate medical education and designated institutional official at the University of Cincinnati College of Medicine.

As M4s mull their choices, they should temper their expectations, advised Dr. Edje, a family physician who serves on the AMA Council on Medical Education.

There’s no such thing as a perfect match. However, “there is the best match possible for the programs that you ranked. There are so many things that go into determining what that is,” said Dr. Edje. In an episode of “AMA Update,” she offered advice on what fourth-year students can do to optimize their Match possibilities.

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It’s not always wise to go with your gut on rank-order lists, which are due March 1. Dr. Edje advised students to analyze their decisions thoroughly.

Have some intentionality in picking your programs and “align your values and your goals with those of the program.” Students should have a standard “question rubric” to apply across all programs.

Evaluate the responses that you receive from those programs, she suggested.

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.

M4s often struggle with ranking big-name programs that may be considered more competitive.

Depending on your specialty, it might not be the right fit for you, said Dr. Edje. A big-name institution, for example, might not offer a strong program in your specialty or even have a department in your specialty.

If something will cause you significant regret, leave it off your rank-order list, she continued.

On the flip side of ranking, programs are not allowed to tell students what ranking they received. Even if a program director tells a student they’re a shoo-in, “they can change their mind at the last minute and that’s in their purview,” said Dr. Edje.

About 80% of medical students usually match with at least one of their top four choices. While those are good odds, there are always a few who don't match. 

Medical students who find themselves in this position shouldn’t give up hope, said Dr. Edje. “Your associate dean of students should be able to provide support.”

Eventually, 96% of all applicants do end up matching within the subsequent year, she said.

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The COVID-19 pandemic disadvantaged a fair number of M4s, especially with respect to audition rotations at institutions where they might want to do their residency. Things have since opened up, said Dr. Edje. More facilities are allowing external rotators in their spaces.

“Applicants should be feeling a little bit more comfortable about their opportunities and their experience” this year, she said.

The 2023 Match may run into some challenges. Application inflation is a concern.

“We’ve had some folks that are applying to 75 different programs,” which is unnecessary in most specialties. “And,” Dr. Edje noted, such inflation “can be very debilitating to the program directors.”

Step 1 of the United States Medical Licensing Examination (USMLE) also changed from numerical to pass-fail scoring. The evidence shows the numerical exam score was a poor metric to assess applicants, Dr. Edje noted. Holistic reviews, which ask applicants about their leadership experience or engagement in their community, are more effective predictors of future success as a clinician than a test, she added.

AMA Update” covers health care topics affecting the lives of physicians and patients. Hear from physicians and experts on public health, advocacy issues, scope of practice and more—because who’s doing the talking matters. You can catch every episode by subscribing to the AMA’s YouTube channel or the audio-only podcast version, which also features educational presentations and in-depth discussions.