Preparing for Residency

Why medical students aren't matching--and what happens next?


More than 250 of this year’s graduating seniors from U.S. allopathic schools did not match to a residency position, which has medical educators troubled amid growing concerns of a physician shortage. During a discussion at the 2015 AMA Annual Meeting, experts examined where these unmatched students are going and strategies for making sure they get to use their MDs.

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According to the Association of American Medical Colleges (AAMC), the top seven reasons this year’s seniors failed to match were:

  1. Had low scores on a United States Medical Licensing Exam (USMLE)
  2. Weren’t competitive for their first choice specialty
  3. Didn’t have an appropriate backup/alternative plan
  4. Didn’t follow guidance from their faculty adviser or dean’s office
  5. Had poor interviewing/interpersonal skills
  6. Did not rank enough programs
  7. Failed a USMLE exam

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Of these unmatched students, nearly one-half had been discussed in promotions committees at their schools, indicating they had performance problems, said Geoffrey Young, senior director of student affairs and programs at AAMC.

“The issue becomes, ‘How do you counsel students to think more realistically [about their options]?’” Young said.

AAMC data show most students who don’t match either re-enter the Match the following year or continue to seek a residency position. Others re-enter with a different specialty or take a research year.

Schools should explore how to better advise and counsel students for the Match, Young said. They also may need to re-examine their promotions standards, which may be a tough discussion.

“At some point, you need to help a student make an exit plan [from medical school],” he said.

But it’s important to remember how each of the 254 students who didn’t match this year felt when they got the news, said Kathleen Kashima, senior associate dean of students at the University of Illinois College of Medicine.

How one school is taking action

When a student has trained for years to be a physician, then sees a message on Match Day that says, “We are sorry, you did not match to any position,” they feel shocked, embarrassed and betrayed, Kashima said.

“They think, ‘Is my career over?’” she said.

Kashima’s institution decided to take action and ensure its students were as prepared as possible to match. To start, the dean of the University of Illinois College of Medicine started a residency preparedness initiative.

Part of the initiative is a course all medical students must take on career development, which requires them to develop a strategic plan for the Match or alternate career paths.

The school also started a loan assistance program. If a student graduates with medical school debt, has participated in the residency preparedness initiative and hasn’t secured a residency position through the Match, the college will assume the interest of the student’s medical school loans for up to one year.

These two initiatives demonstrate how committed the school is to ensuring its students go on to become physicians, Kashima said.