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Dr. Brian Radvansky and Dr. Mike Stephens contributed to this post.

Interview season is ending. Some are relieved to be finished with endless traveling, hotels, dry cleaners, and plane tickets. You can finally get back home, resume a predictable schedule, and play catch-up on that which you left untended at home.

Others might lament returning to “normal life,” saying goodbye to jet-setting, and getting wined and dined all over the country by programs trying to garner your interest.

No matter which camp you fall into, when interview season ends, it is time to form a rank list! All your work since last summer (and since you started medical school) will be distilled into this list that will decide your fate.

The residency application process and especially generation of your Rank Order List (ROL) at the end of interview season is for many the culmination of dedication and hard work throughout medical school. We’re going to discuss here how to navigate this final part of the long process and make sure you know how to do it right.

How to form your residency rank order list at the end of interview season:

1. Know what to expect, especially when it comes to deadlines.

The first date you should know is February 1, which is when the National Residency Matching Program (NRMP) allows you to input and certify your ROL.

You should go ahead and put in a preliminary rank order list as soon as you can; you simply put in the program codes in order from most preferred to least preferred and select the option to certify. You can then recertify your ROL as many times as you would like, all the way until the deadline of March 2 at 9 pm Eastern Time.

Programs simultaneously follow an identical process and will input their rankings for the applicants they interviewed up until the same date and time.

It can’t be stressed enough how important the Match deadline is. To reiterate, the deadline to submit your rank list is March 2 at 9 pm Eastern Time. If someone waits and does not have their list submitted in time, that person will without exception go unmatched.

Don’t take chances and wait until the last minute only to have your internet go out or to forget entirely. Once the deadline has passed, rankings of applicants by programs and of programs by applicants are both finalized and the algorithm takes over. The NRMP works hard to ensure the integrity of the process and to create an arrangement where everyone ends up in the best program.

As an aside, you should register for the Match before January 1. Please know this is different from your ERAS application! It’s not a big problem if you didn’t know this or didn’t register in time: You will incur a late fee but otherwise the consequences are minimal.

 

2. We'll say it again: finalize and certify your residency rank list. Do it NOW.

It would be the greatest travesty if a clerical error kept you out of residency. DO NOT put yourself in a position where certifying your rank list is something you will “get around to,” or plan to do in the 11th hour on the day of the deadline, only to find your internet is down or your reminder didn’t go off.

When you are done interviewing, put a preliminary list together and certify it. Do it today. Even after certification, you can rearrange your list and re-certify. You are better off certifying a tentative list and revising it than putting ANY possibility of not having a certified rank list by the deadline. 

 

3. Leave the residency pros and cons list at the door.

Of course, organizing your rank order list is a big decision, and you want to make the best decision you can with the information that you’ve got. This decision should not be made based on small pros and cons about one program versus another. 

The thing that matters most for arranging your rank list is the feeling you got when you interviewed at that program. 

There is no greater guide than your gut and heart when deciding where you want to train.

From a big picture perspective, your criteria should be pretty simple. You want to find a program where you will get the best possible training, in a city you can tolerate (or even better, have a strong desire to live in) for the duration of training, in a stable program with satisfied residents and engaging faculty.

Don’t overlook the volume of time you will spend with the cadre of residents and attendings you meet at the interview and pre-interview dinner. You’ll be spending more time with them than you do with family, so gelling with their personalities to some degree is relatively essential to your well-being. 

You should be able to ascertain how the programs on your list size up on these huge and simple criteria. While simple, it might not be easy. There might be a program which you absolutely love in a place you aren’t keen on moving to. Maybe the training in your dream locale is a little less robust than the former. These decisions can be tricky, and it’s surely important to bring significant others and family into these conversations. 

Don’t worry about salary differences, cafeteria ratings, or hospital call room accommodations. Keep the big picture at the forefront.

 

4. Go with your gut.

The decisions involved in making your rank order list are big ones that you should make based on your circumstances, geographic preferences, and career goals.

What can’t be stated enough, though, is the impression of the program you developed from your interview day. You will be spending the majority of your awake hours for the next three to seven years with faculty and peers you met during your interview day. How well you integrate into the dynamic of a given institution is far more important than its cafeteria, discounted parking, or resident salaries.

Conversely, what should not factor into this is concern that you might go unmatched or that you need to angle your ROL in a way that might “optimize” your chances of matching. There’s no need for intricate strategies in how you craft your list. In fact, the algorithm is actually aligned toward applicants over programs.

 

5. Don’t share your NRMP login data with anyone.

We’ve all heard the urban legend of the applicant’s fiancee who surreptitiously logged into their rank list, and reorganized it to their own liking. While things like this aren’t happening left and right, it is best to have the piece of mind that for something as important as your rank list, you are the only one who has access to it. 

 

6. Don’t let your chances of matching at programs influence your rank order.

The match algorithm is built in such a way that your desires of where you’d like to match outweigh the program’s desires of whom they’d like to match. What this means for you is that you should simply rank the programs in the order you’d like to attend them.

There’s no need for advanced strategies, or trying to figure out how a program is going to rank you. Just put your favorite as number one, second favorite as number two. It couldn’t be simpler. 

Naturally, you don’t want to rank any places that you don’t want to attend. If you had a terrible interview somewhere and truly desire to not match there, just don’t put it on your rank list. 

Submitting a rank list can be a stressful thing, but it needn’t be. Follow your heart, certify early, and get your programs in order. In one more month, the charade will be over, and it will be time to cruise through the rest of fourth year on the way towards finally becoming a doctor.

Special Considerations When Making Your Rank Order List

1. Couples matching

If you and your partner are both applying into the Match, couples matching optimizes your opportunity to live in the same geographic area. Your ROL is paired with that of your partner and then the algorithm will proceed to make a Match if both applicants match at their paired program.

If both individuals do not each match at their first choice of paired programs, it will move to the next set of paired programs in the list. The programs do not necessarily have to be in immediate geographic proximity; you can control how far away you are willing to be from your partner during your training with the way you make the pairings. You can also rank the same program for yourself multiple times paired with different programs for your partner and vice versa on your linked ROL.

2. Supplemental rank lists

Certain specialties like dermatology, radiology, anesthesiology, ophthalmology, and physical medicine and rehabilitation require an initial preliminary year, often in medicine or surgery. When you are applying through ERAS, you will have to send your application to, and interview at, “advanced” programs for your specialty of interest and “preliminary” programs for this first year.

When you are putting together your ROL, you will rank your advanced programs the standard way. Where it gets more sophisticated is with the preliminary programs.

For each entry in your primary rank order list for advanced programs, you will generate a supplemental ROL of preliminary programs. When the Match algorithm is run, you will be assigned an advanced program which will then trigger the algorithm to run a second time for the supplemental ROL to determine which preliminary position you will have.

You can make this a non-issue if where you end up doing your specialty training will not influence your choice of preliminary program by submitting the same supplemental ROL for every program on your primary ROL. However, if as an example you want to do your preliminary training in the same city as your advanced training, you can tailor every supplemental ROL so that your first choice on each supplemental ROL is in the same place as the associated program entered in the primary ROL.

 

After the deadline for certification has passed, managing nerves leading up to Match Day isn’t always easy, but you should trust the algorithm to find the best program you’ll thrive in. Spend time with family and friends, taking care of yourself, and celebrating the accomplishment of reaching such an important milestone in your medical career!

 

 

Further reading:

How to Choose a Medical Residency Program That's Just Right


Image by Steve Johnson from Pixabay 

Residency Advisement with MST
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