Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.
In today’s COVID-19 Update, a discussion about the National Resident Matching Program's upcoming Main Residency Match, what medical students need to know about matching during the pandemic, and the difficulties that international medical graduates (IMGs) are facing.
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- Kristina Diaz, MD, MBA, chief academic officer and program director, Yuma Regional Medical Center
- Adrian Jones, JD, associate dean, student affairs, Florida International University
Unger: Hello, this is the American Medical Association's COVID-19 Update. Today we'll discuss the National Resident Matching Program, or NRMP, upcoming Main Residency Match and what medical students need to know about the matching process during the pandemic. I'm joined today by Dr. Kristina Diaz, chief academic officer, program director and DIO at Yuma Regional Medical Center in Yuma, Arizona. And Adrian Jones, associate dean of student affairs and assistant professor at Florida International University Herbert Wertheim on College of Medicine in Miami. I'm Todd Unger, AMA's chief experience officer in Chicago.
This is the first match that's going to reflect the impact of COVID-19. Mr. Jones, we've read a lot about different places, not medical schools, but big, big difference in results for applications this year in undergraduate institutions. With this virtual process for matching this year, what are you seeing? How do you advise students?
Jones: Thank you, Todd. This has been an interesting year. Most of the variables that we use in the past have kind of just changed, they're gone out the window. We have seen a significant increase in the amount of applications, both in the undergraduate medical education, as well as in the graduate medical education process, which is where the match is going. We have seen a significant number of our students increase the volume of interviews or applications to different programs because there's some stress. There's tension and they're worried that if they don't do that, something is going to go wrong. And as a result, we have seen a spike in the number of applications and I worry about my program directors. We have seen all these additional applications in terms of how they're going to be able to process all those applications and review them.
Unger: Besides stress, what else is driving it? Is it just that they don't have to travel anymore? Kind of what are the other key characteristics that are driving this kind of increase and the programs that people are applying to?
Jones: I think it's fear. I think there's anxiety. I think with the variables that students can't actually see with all of their senses, these different programs. The fact that they can't visit these different sites, they can't go to these cities. They can't meet the individuals that they will be working with, has created a significant amount of stress. Now it has given students a lot more flexibility to interview at programs that they might have not have done before. But the issue is that now they can't really have the information that they would have used in the past to make informed decisions about what's the right fit for them.
Unger: Dr. Diaz, Mr. Jones mentioned, on the other end of this, all of these program directors, how are you approaching resident selection this year, given this kind of massive increase in what you're seeing in people applying?
Dr. Diaz: You're right. We started this season thinking exactly that. How many applications were we going to see? And what was going to be coming our way? And we really have needed to identify what's important for our program? And then really spending a significant amount of time really addressing things for the applicants and making sure that we do this holistic review that everybody's really been talking about recently, because we've had to focus and find people that want to come to Yuma versus just somebody that applied just to check us out.
Unger: And what kind of processes do you put in place to kind of ferret that out?
Dr. Diaz: Sure. Well, we did a lot of training for our staff in general. We had to go through bias training. We wanted to make sure that we were checking ourself before we started looking at all the applicants. And then we really wanted to identify what culture and what type of applicant we were looking for to serve in the Southwest here in Yuma. I really had to take the time to really sift through every single application this year where previously, we may have leaned a little bit more on what data and what filters could have come through. With some of that being absent this year, as you know, we really had to take the time to find the people that wanted to come our way. There is that big fear for all of us program directors that this select view of applicants interviewed at all 400 plus medical programs in our area. We really had to be careful with who we asked to come.
Unger: If you look into your crystal ball, how do you see the match, the big picture, the match playing out this year?
Dr. Diaz: It's going to be a surprise, I think. Every year I open that email the same way that the applicants open the email, with a little bit of anxiety and a little bit of fear. Do I need to go into the SOAP? But I think that's going to be a true test to see how well we did with screening applicants that want to come to Yuma. I think it'll give us a little bit of insight on the process that we did put in place for the first time ever. And I also think, I honestly have to tell you, I'm worried that we're going to go a little bit further down our list than we have in the past.
Unger: Why is that?
Dr. Diaz: Just the applicants were pretty open with us. Applicants that had interviewed at several programs would say, "Hey, this was neat. I've interviewed at 15 other programs that didn't do this." Or, "Hey, I have an interview a little bit later." And they just were a little bit more open with us about what was going on. And while I appreciate that, it does lead me to think that some applicants really did end up interviewing at more programs than they otherwise would have and may put others at a disadvantage just because they, I won't say hoarding slots, but they were able to kind of test the waters on a more broad scale.
Jones: Dr. Diaz, that's a good point because what we have seen is sort of this disparity in interviews. We have seen a bunch of students who've gotten a ton of interviews and we've had some students where I scratch my head and they haven't gotten as many as we thought. And the problem, I guess, the fear that we have is when you're talking about ranking, how many are those programs going to rank those safety students? And then at the end, there's going to be a ton of students where they don't rank. And these students rank all these same programs, we don't know what the outcome is going to be this year. That kind of fear factor that I think we both are experiencing on both sides.
Dr. Diaz: Absolutely. And we reviewed thousands of applications this year and there are amazing students out there who we have to really pick, well, where do you fit? Do you fit with us? Do you fit with someone else? And then we don't have an unlimited amount of time to do interviews. We only still have the same shortened interview season as everyone else around the country. We couldn't just decide to interview a 1,000 applicants. We really had to be careful with those slots. And I have to tell you, lots of schools, great applicants. The people that I think are going to have the hardest time matching are that middle crew. They're applicants, but they're not as strong on paper as maybe someone else, but they're amazing people and will make amazing physicians, they just didn't come to the top of this year.
Unger: I'm curious if you think this is a temporary thing or will kind of subside post-pandemic?
Dr. Diaz: I have to tell you, I feel in my gut that there's going to be a hybrid, no matter what. The students really did appreciate not having to spend thousands of dollars traveling and we didn't have to spend as much money going through dinners and hotels and different recruiting processes. For resource management, this has been a good thing. I would be very surprised if next year we just turn on a full back to a full 100% in person interview season. Don't you think Mr. Jones? I think we're going to end up doing a hybrid again next year.
Jones: I agree. I think with change, sometimes these swings allow us to learn about different things. And I think this has given a lot more flexibility so that programs can probably interview students they may not have done for and expose students to programs that they've never seen before. But in the same token, there's also this competitive part of it. And the anxiety that students have of wanting to physically see something, and programs wanting to physically see that person, how do they interact with the staff? How do they interact with the team? What is the environment like? Those questions are hard to do virtually. There's going to have to be a combination of this, but I think this flux, this new wave is probably going to be a part of our process moving forward. We just have to figure out how to adjust to it.
Dr. Diaz: I agree, 100%.
Unger: Mr. Jones, you talked a little bit about rank order and those lists need to be submitted, a rank order list by March 3rd. Given the situation you both described, what ranking advice can you offer students to help increase their chances of matching?
Jones: This year I have told students, "Rank every program and not to leave anything to chance." And normally, unless there's a program that you just know you don't want to go to. At this point, there's nothing, you shouldn't leave anything to chance. And it's difficult because you just are not sure what the outcomes is. And with that conversation, it also leads to some students who have not gotten a number of interviews, in terms of how do you rank those different programs and potentially how do you prepare for the SOAP process? We've tried to do have a very aggressive stance with all of our students. I've met with couples who were trying to figure out their couples matches. I met with students probably more this year than I've done in the past, in terms of just walking them through with the information that we've had. Having to meet with program directors and chairs. Just trying to gather enough information that they can make an informed decision that they think will be best for them.
Unger: Dr. Diaz, any other insight?
Dr. Diaz: I have to tell you my one thing, and I tell all applicants that come in and interview with us, please rank us if you like us. I urge you to rank us in order of how you think you will fit at a program. Please do not try to read my mind on where I'm going to place you on my rank list. Likewise, me as a program, I should not be wondering, oh well, they live in Maine. Maybe they don't want to come to the Southwest because they'll have to do hot summers and that'll not be their thing. I need to make sure to not make assumptions on behalf of the applicant and make sure that I'm ranking them depending on how I think they will rank and fit with our program. I ask the applicants to do exactly the same.
If you have a program that you're passionate about, that goes number one, without question. And if you have a program that you don't like and you will hate life if you go there, do not rank them. That would honestly be my advice. But I would tell you that if you kind of are going to be okay with them, I do think Mr. Jones has the right advices to make sure you do rank as many programs as you can. If there's an absolute hard no, you rank, there's an opportunity you could go there. Our list that if we do not like someone and I know a 100% that we are not going to get along, they fall off our rank list. We only rank applicants that we want to come to Yuma. But my 100% advice for everybody, programs and applicants, is never try to guess what the other side is doing and really rank depending on how they're going to fit with you.
Unger: What great advice. Well, Dr. Diaz, you have a unique vantage point as an international medical graduate. And I want to ask you about the differences this year. I just read an article over the past weekend that really pointed out difficulties. What are the factors that IMGs and programs need to consider this year that's different than ever?
Dr. Diaz: Well, I think if you think pre-COVID, IMGs in general already had a somewhat small disadvantage here just because of the school bias. And then also their type of clinical rotations that they may or may not have had. They can sometimes vary from the consistency that you might get at a U.S. grad. But so post-COVID, this has been a really difficult thing for some IMGs because they may have lack of support. And so through this COVID pandemic, potentially a lot of their rotations may have been virtually or they may not have had the instruction that otherwise could have been compared at a U.S. medical school. Plus they still have that bias of the school.
My advice to both the IMGs and to programs, is you have to know that we've found some of our best residents through an IMG school and through that pool of IMGs. And so we just need to make sure that we're not leaving great candidates on the table without giving them the opportunity. I know that there are great applicants out there. Allow for the application to speak for itself and not judge the person solely on where they went to school.
Unger: Is there any kind of advice you would give, any errors or kind of common mistakes in an applicant, an IMG applicant, that they could avoid to have?
Dr. Diaz: Well, the first and foremost thing is I see IMGs not being confident enough. One of the things they come to our program or come to meet us at different recruiting conferences is the first thing they ask is, "Do you take IMGs?" Or, "I know I'm an IMG, but." Have that confidence and know that you've done a good job and us as programs, we've likely identified schools that have a good track record for candidates and have good training and so we'll really be trying to pick out who we have a good relationship with in the school background and as well as what we know in the IMG training. Be confident and know that you've done a good job and make that shine through so that your application gets the opportunity to speak for itself.
Jones: But that advice goes to almost any student, both IMG as well as our domestic. The challenge that a lot of our students have. What COVID has done this year has really taken away a lot of the information opportunities and the connections. There were a lack of students doing externships at different programs around the country where they can do these audition interviews. There's a lack of opportunity so that they could go to Dr. Diaz's program and just sit down with her for a few weeks and work with her. That has really had an impact overall on the decision making process, not from a program standpoint, but also from a student standpoint. And so this year, a lot more both programs and students are going into this process with a lot less information and using a lot more information online, what they see in terms of websites, what they hear from word of mouth, what people know about something, which is a lot less information than in the past, where they can actually see, visit, touch, taste and have all their senses working for them when they visit a program.
Dr. Diaz: I agree with you. On a typical year, we have someone coming from all over the country, doing some form of sub-internship in their fourth year or doing audition rotation with us constantly. And this year, we've only had one. And so because we weren't accepting people from outside of the institution or from our affiliated locations. You really just have to know that everybody, yes, IMGs are going to have the bias of the school, but everybody has been out of the clinical setting in some form in ways that they otherwise would have been.
Unger: Well, let's talk again or talk about, there's a word that keeps popping up in this conversation, which is fear. And I think one of the biggest thing that a medical student fears in this process is not matching. Mr. Jones, why don't you start? What advice do you have for students who find themselves in this situation and what do they do to prepare now?
Jones: It's an interesting dilemma that we've been in this year and I've actually been more proactive with what I call high-risk students. The way the process works with SOAP is that the Friday before match week, they get a notification saying that you're eligible. Now that freaks students out because they're thinking that they're going to be matching or SOAPing. And I'm like, "Relax. It's just an email saying you're eligible." On Monday morning, they get that wonderful email, you have matched, but some of them don't. And those are the students that we worry about.
And so what we are doing this year actually is being preventative. My high-risk students, I'm meeting with them right now and saying, "Okay, there's a chance based on the the number of interviews you've had, that the possibility may not be there. What do we do now? What's your next best? What's your pivot point? What's your next specialty?" I start getting them prepared with a new personal statement. I start getting letters of recommendation. If they have to be in SOAP then the transition is a lot easier because it is a shock to the system. It's like jumping in a cold pool. You have to get the student ready and transition them to a new career almost instantly and so we do a lot of counseling. We try to get them to change real quickly, but if they have the information, if we have all of it, all they then need to do now is just go in through the SOAP process.
Monday at noon, they start submitting applications. They start doing interviews Monday afternoon, Tuesday. Wednesday, the first round starts. That's when they get their first offers and for programs just like us, they're trying to find good students in this process and so having the correct information and having information ready by that week makes it a lot easier for students to at least have an opportunity for success.
Unger: Do you think that given the large number of applications, we talked about how you're imagining how this will play out, that there'll be more folks that are going into the SOAP process? Or is that just limited in a different way?
Jones: I pray that, that's not the case, but I'm preparing for the worst.
Unger: Dr. Diaz, do you have any advice for students?
Dr. Diaz: I have to tell you as the program director view for those students that don't match, it's not the end of the world. Don't think it's going to categorize you in our eyes that you're a bad applicant in any means. And actually those programs that don't fill, are in the same book you're in. They're out looking for good places to have people come to them, just like you're looking for a place to go to. And know that we open that email, like I said, with the same anxieties that you all open the email, the applicants do. And we're going to slow down, take our own pulse and then really try to figure out how to get our team ready so that we can start getting the right people in with us. If you don't match, don't get frustrated, stay calm. I need you to take a moment, and reflect and just know that you've been through an amazing journey and how far you've come.
You need to start meeting with mentors and trusted leaders like Mr. Jones at your school, having somebody scrubbing your application for you and know that every year there are so many qualified applications for each spot that we have, that you just need to take the next year, if you end up not matching, demonstrating your passion so that your CV and your personal statement starts yelling at all of us, "This is my thing. This is my passion." And I really think that you're going to be okay. This year is going to be a wonky year, but we're all going to do it together.
Unger: Well, that's great. Thank you so much. This has been an excellent conversation, Dr. Diaz, Mr. Jones, thanks for being with us and sharing your thoughts and for all the work that you're doing to make this a strange year, a better process. That's it for today's COVID-19 Update. For those that are looking at their residencies, make sure to check out AMA's FREIDA program and tool at freida.ama-assn.org. And check out our Road to Residency video series to learn more. We'll be back with another COVID-19 Update shortly. Thanks for joining us. Please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.