a few more details about The Match

The Match is next week.  I have a few family members and friends involved in it, so I decided to post details about how to prepare for it, as well as look into how it has changed since my husband matched.

Of course the best resource for information is http://www.nrmp.org/ - the actual website for the National Residency Matching Program.  But, I also found another article, Getting Into Residency: Most Important Factors, that lists a few key things that residency program directors look at when choosing who to interview and how to rank those that are interviewed for the match.  In order of importance:

1. Letters of reference from physicians in the applicant's desired specialty.
2. Step 1 and Step 2 scores (USMLE). 187 is passing.  A few examples of Step 1 average scores of those that matched into the following specialties:

• Dermatology: 221
• Orthopedic surgery: 217
• Otolaryngology: 224
• Plastic surgery: 221
• Pediatrics: 200
• Family medicine: 194
• Psychiatry: 197

60% of programs have "target scores" - or cut-off scores, (they won't even look at an applicant unless the applicant gets above a certain Step 1 score).  Also, almost a third of programs will not even consider an applicant who has failed Step 2.  The article emphasizes: aim for 227, the score that will almost certainly get you an interview, or a minimum score of 209.
3. Grades earned in the applicant's desired specialty (honors, AOA, etc.)
4. Medical school (relative depending on program and competitiveness of specialty)
5. Personal statement (often "used mostly as a screening tool" after the interview). Make sure it "fits" the specialty.
6. Volunteer and extracurricular activities, such as research, (though each program differs, research is very helpful for competitive specialties.
7. Away electives (rotations) - also very helpful for competitive specialties
8. Medical school performance evaluation (MSPE)

When programs rank applicants, the following are considered, in addition to the above mentioned points, in order of importance:
1. Residency interview.  Yes, that's all.  A lot of emphasis is placed on "interpersonal skills, professionalism, feedback from residents and house staff, perceived commitment to the specialty, ethics," etc. during the interview experience.

According to the article, the top three factors** involving how an applicant is ranked by a program are:
1. "Letters of reference from individuals within the specialty"
2. "Grades in clerkship in desired specialty"
3. "The most important factors are... evaluated during interview day"
(** For competitive specialties, research and away electives also weigh heavily.)

However, each program also differs in what type of applicant they are looking for.  There is an NRMP Program Director Survey where applicants can discover the specific goals and visions of residency program directors.  More information on that in the article referenced above (Getting Into Residency...).

Some good advice for applicants:
* Study the previous year's match results in order to determine the "highly competitive", "competitive" and "non-competitive" specialties.  You can find these at http://www.nrmp.org/.
*Find out how competitive the programs are that you are interested in.  Determine this by comparing test scores of graduates from previous years in a specialty's various programs.  These are usually posted on the website for that specialty's main group (i.e. American Society of _, or American Board of _)
* If your backup plan is to "scramble"into a less competitive residency program (i.e. pediatrics, family practice, psychiatry, internal medicine, etc.), just go ahead and apply in two specialties.  (Make sure letters of rec are not specifically recommending the applicant to only one specialty.)
* Spend a year in research and re-apply as a senior student.  Can do specialty-specific or a combined program such as MD/MBA, MD/MPH, MA/MD)
*Alternative training route - choose a specialty that can lead to the desired specialty
* Have a realistic "backup plan".
(Some of these ideas are from Dorothy Andriole, MD, Washington University School of Medicine St. Louis MO.)

BOTTOM LINE:
1. Develop strong relationships with individuals in the desired specialty and get awesome letters of rec from them.
2. Study a lot (get good test scores and good grades).
3. Develop your interpersonal skills (see #1).  Talk often with everyone around you that might have insights into programs, specialties and possibilities for your future, particularly your medical school counselor/mentor.

For applicants who do not match, things have changed since my husband was at that point.  Here is an article describing last year's match results, Highest Match Rate for U.S. Medical School Seniors in 30 Years.  There is now a computer program for applicants who did not match into a program, (much more appealing and effective than before, when individuals had to immediately start cold-calling residency programs and simply beg to fill one of their unfilled positions...)

Here is the description of the program from the article referenced above:
"For individuals who were not matched to a residency position, the NRMP debuted the Supplemental Offer and Acceptance Program℠ (SOAP℠), a new process developed in partnership with the Association of American Medical Colleges (AAMC) and in consultation with student affairs deans, residency program directors, resident physicians, and medical students.  Designed to help streamline, equalize, and automate the process for students who are not matched initially, SOAP replaces the “Scramble,” the unofficial name for the period of time during Match Week when unmatched applicants contact programs with unfilled positions.  Under SOAP, the NRMP makes available the locations of unfilled positions so that unmatched students can submit applications for these positions through the AAMC’s Electronic Residency Application Service^® (ERAS^®).  After receiving applications through ERAS, residency program directors create a list of candidates in order of preference and the NRMP offers positions in that order in a series of up to eight rounds.  Applicants are able to receive multiple offers in a single round; if an offer is accepted, it is binding."

Important note: I am not an authority on The Match.  I pulled all of the above information from the referenced websites and articles, my husband's opinions and random forums found via google.

And just remember during all of this fun stuff that residency is much, much, much, much, much more challenging and excruciating than medical school... (of which memories we now view longingly as a "PAR-TEE!!")