Preparing for Residency

What I wish I knew in medical school about Match rank-order lists

Brendan Murphy , Senior News Writer

For many medical students, creating a Match rank-order list is about balancing competing priorities and funneling advice—solicited and unsolicited—from faculty members, peers and resident physicians. That was the case for Haidn Foster, MD, when he was considering his options for the Match as a fourth-year medical student at the University of Cincinnati College of Medicine in 2022. In the end, Dr. Foster said, how one constructs a rank-order list is highly personal.

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“The whole process is so individualized to what means most to you as an applicant,” said Dr. Foster during an interview for the AMA. “Somebody who interviewed at the same programs but had slightly different priorities for residency may make an entirely different rank-order list and be just as happy with the outcome of the Match as I was.”

In advance of the Feb. 28 deadline for residency applicants to submit their rank-order lists—and with the caveat that the process is going to come down to one’s own instincts and priorities—Dr. Foster offered a few key insights about how he created his list and what he might have done differently with the benefit of hindsight.

Haidn Foster, MD
Haidn Foster, MD

“For me, choosing a residency program also meant thinking about my plans after residency,” said Dr. Foster, now a second-year internal medicine resident at Penn State Health who plans to subspecialize in hematology-oncology. “Because I knew I planned to pursue fellowship, I sought out residency programs that would help me prepare for a successful fellowship match.

“For applicants who are similarly interested in subspecializing, there are a lot of benefits to matching at a program that has your desired fellowship in-house. As a resident, I wanted to get a better feel for my chosen field and learn what it would be like to practice as a hematologist-oncologist, so it was important for me to rank institutions highly that had an associated hematology-oncology fellowship,” he added.

“Future plans aside, as a resident you’ll be in training for at least the next three to seven years, so having a residency program that is both a good cultural fit and responsive to resident feedback—backed up by specific and meaningful examples of program adaptation—were also critical aspects of how I evaluated the programs I interviewed at.”

“I interviewed at a healthy mix of academic and community programs,” Dr. Foster said. “When it came to ranking each program, at times, I was conflicted because of the connection I felt with some of the community programs. I wanted to highly rank the programs that spoke most strongly to my values—those with a demonstrated commitment to diversity, equity, inclusion, and to serving the underserved.

“Still, knowing that I had very clear-cut career ambitions with regards to my plans for fellowship, I knew that I would be best served by matching into an academic program. So I found myself ultimately ranking some programs lower despite having a strong emotional connection to their philosophy and leadership.”

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It is important to keep in mind which factors of a given program are deal-breakers for you, and which are not. What, in other words, can you live with for the duration of your residency? For Dr. Foster, geography was not a big factor in his rank-order list.

“I've had the perspective throughout medical training that I can live anywhere for a limited amount of time,” Dr. Foster said. “And so I was happy to move from my hometown near Seattle to Cincinnati for medical school, and then to move again to Pennsylvania for residency.”

Dr. Foster’s residency interviews were exclusively virtual due to the COVID-19 pandemic, but most interviews, post pandemic remain virtual. Having not visited a number of the schools with which he interviewed, there was a level of uncertainty in the process, he said.

“Some of the process is a leap of faith. I'd never been to Hershey. So that was a really interesting experience: matching to a program in a city I’d never visited, even signing a lease on an apartment sight unseen. It was all a real adventure, one that I’m thankful has turned out well.”

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“One of the mistakes I made during interview season was not being diligent enough keeping notes on the day of an interview,” Dr. Foster said. “Especially because interviews are virtual and you may be interviewing at multiple programs per week, everything really starts to blend together. Trying to recall specifics of each program towards the end of interview season can be difficult if you haven’t recorded those details around the time of your interview.

“The standout programs—whether exceptional or otherwise—are easy to recall and rank accordingly. But having a record of day-of observations is incredibly useful when stratifying residencies that fall in the middle of the pack.

“Another helpful aspect of some programs’ interview process was the facilitation of one-on-one conversations with current residents. When I had specific questions about a program or wanted more information about what it would be like as a member of an affinity group at that institution, being able to ask residents their opinions outside of a group setting was invaluable.”

“One of the considerations I gave too much weight when interviewing was the specifics of the intern year schedule,” Dr. Foster said. “In my field, internal medicine, you are going to have very full days, very full weeks.

“The rigors of a 60-to 80-hour work week are going to be the reality of pretty much any residency program,” he noted. “And whether that's accomplished through a consistent inpatient schedule of a 6 a.m.–6 p.m. workday versus a regular day, short-call day, long-call day, all those specific details come out in the wash and are not as big of a deal as I thought they were going to be.”

“The Match process truly prioritizes applicant preferences,” said Dr. Foster, an AMA member. “There is no downside to an applicant ranking their true No. 1 program as No. 1 in their rank-order list.

“Even if you feel like the odds of matching are low, ranking that program that’s perfect for you highly will not detrimentally impact your match,” he noted. “There is no gaming the system; just rank programs in the order that you actually prefer them.”

“Personally, I took a long time to make my list,” Dr. Foster said. “But then I put it into the system and pressed ‘Certify’ and put it out of my mind. I think going back and changing things after certification would have just added more stress. Then there's the legitimate fear of forgetting a step and not hitting ‘Certify’ a final time.”

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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