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The Match

The first thing to be aware of when assessing the application process is the Match, how it works, and why it’s necessary. The Match is an algorithm designed to ensure that applicants and programs are correctly assigned to one another. Per the NRMP, the program ‘attempts to place an applicant (Applicant A) into the program indicated as most preferred on Applicant A’s rank order list. If Applicant A cannot be matched to this first choice program (because the program doesn’t also prefer Applicant A), an attempt is then made to place Applicant A into the second choice program, and so on, until Applicant A obtains a tentative match, or all of Applicant A’s choices have been exhausted (meaning Applicant A cannot be tentatively matched to any program on the ROL).’ It’s therefore important to note that the algorithm is designed to read an applicant’s desires first – in other words it is applicant-focused rather than program-focused.

A first step is the ‘tentative match,’ this being when an applicant has ranked a program that has also ranked the applicant, and one of the following is true:

  • ‘the program has an unfilled position (making room for the tentative match to Applicant A) or
  • the program is filled but Applicant A is more preferred by the program than another applicant (Applicant B) already tentatively matched. In such a case, Applicant B is “bumped” from the tentative match with the program to make room for Applicant A.’

The next consideration is an applicant being ‘bumped’ from their match due to a better applicant, they will then return to their list and the algorithm will attempt to match them with their next most preferred position. A tentative match will then become final when all applicants’ rank order lists have been taken into account and the matching algorithm is complete. Note that this will not result in all applicants matching.

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Match Numbers

Let’s consider the number of applicants who do successfully match. According to the NRMP, a successful match is one that correctly matches applicants and program directors – not just one that deals with significant volume – in other words, an efficient match rather than a large match. Looking at 2022 data, the overall position fill rate was 94.2%, which meant that 2262 of a total 39,205 positions were left unfilled after the matching algorithm was fully processed. There were an additional 96 positions left unfilled in programs that did not submit their rank order list. Of the unfilled places, 2262 were placed in SOAP, with 99 different programs taking part in SOAP, and only 151 positions unfilled at the conclusion of the SOAP process. SOAP is the post-Match process that allows unfilled places to be filled by those who have failed to match.

Trends in Match Numbers

There were 42,549 active applicants and these applicants were in competition for 36,277 first-year and 2,928 second-year residency positions. Of the applicants, U.S. MD senior students made up 19,902, which was 36 more than in 2021. The PGY-1 match rate for U.S. MD seniors was 92.9 percent. The overall number of registered applicants was 47,675, the second highest in the history of the Match.

What is the residency application?

A residency application is made up of various different materials. Together, these will demonstrate your suitability for the program in question, and in turn suitability for further medical training in general. The components are as follows:
– a copy of your CV
– letters of recommendation
– personal statement
– transcripts from your time at medical school
– your MSPE (Medical Student Performance Evaluation)
– your licensing exam transcript (the USMLE Step 1)

You will need to together the first three parts of the application yourself (your CV, your letters of recommendation, and your personal statement). The three other parts will be provided by your medical school – this will either be through you being given them to upload for yourself, or through the medical school itself uploading them to your application on your behalf. Check with your school, although this should be made clear in good time.

Remember that a number of students will begin to prepare parts of their residency application before they’ve actually decided on their choice of specialty or the programs to which they hope to apply. The AMA recommends that you begin to prepare the first three elements of your application before the residency application services are open to you – as early as the end of your third year. The very latest that you can complete the application and submit it is the beginning of fall of your final year. Remember that many programs will operate a first come, first served policy – meaning that those who apply first are more likely to receive interviews.

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Interviews for Residency Programs

Interviews begin in the fall and continue into the winter of your last year of medical school. Interviews are absolutely vital for a final decision, and are not only the best chance for the program to decide on your suitability, but also for you to decide on a program that fits your goals and aspirations. Only after you have interviewed will you be able to fill in the finalised version of your list of preferred programs – the rank order list – for the match process. The interview process is known to be time consuming and highly stressful, so ensure that you are well-prepared for it and that you make the most of each chance that you get. Remember that you may have dozens of interviews at different locations, or a mixture of online and offline.

Applying for Medical Residency as an International Student

International students should submit applications to at least 25 programs in order to maximise their chances of matching. Your first step should be to register with the NRMP (National Resident Matching Program), although some programs will also require that applicants apply through ERAS (Electronic Residency Application Service). You can find more information through the AMA, which should be your main source of knowledge as you begin looking at the process.

You must begin your application as early as possible to ensure that you produce a strong, well-written series of documents. Look to focus on unique qualifications or experiences that you are able to offer that might make you stand out from others. Bear in mind that whether you are registered for the Match or not will dictate whether you have an NRMP number. You must be ready to answer questions on your immigration status or visa status if you are not a US Citizen.

Lastly, you must gain experience in a healthcare facility in the US before you apply, and this will need to produce a letter of recommendation from the US healthcare facility. You should speak to individual programs to ascertain their demands in terms of how long you should have spent in a hands-on clinical environment in the US.

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