A Complete Guide to the Residency Match Process | MedSchoolCoach

A Complete Guide to the Residency Match Process

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Posted in: Residency

A Complete Guide to the Residency Match Process

The months leading up to medical school graduation are an exciting time, but also the beginning of the next chapter: The Match. 

Applying to a medical residency through the match process requires plenty of forethought and planning. It’s also a key step in obtaining a medical license — you need to attend a postgraduate residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME).

We’ve created this guide to applying and matching to help medical students understand how to apply to residency training programs and get matched.

What is the residency match process?

The Match is an algorithm that takes the applicants’ rank order list (ROL) of preferred programs and compares them to the rank order lists the programs have created to rank the applicants. The algorithm attempts to pair these together as best possible, taking every applicant into consideration at the same time.

How it works: the program will attempt to place an applicant into a program until it finds a tentative match. A tentative match can happen when a program has an unfilled position, or if the program is filled, but the program prefers a new tentative match over a current match. In the latter case, the algorithm will attempt to match the bumped applicant to another program.

Tentative matches become final after the entire matching algorithm process has been completed.

To learn more about how the matching algorithm works from the NRMP, check out this helpful video.

This algorithm-driven process was invented to alleviate some pressure on residency program directors trying to fill their programs.

Prior to the Match, hospitals would reach out, extending offers to medical students as early as their 2nd and 3rd years of medical school. As the process became more competitive, it also became less fair.

Hospitals were the main beneficiaries of this chaotic system, connecting with their preferred students as early as possible. But many medical students who may not have been “standout” applicants right away struggled to get into residency programs they desired. Spots were already filled by a chosen few medical students, even those years away from residency.

The Nobel prize winning matching algorithm was created in the early 1950s to standardize and bring equity to pairing up applicants and programs. Now, this all happens in a medical student’s 4th year – for all students, equally — coming to a head on Match Day.

ERAS Timeline

Most residency positions are offered through the Electronic Residency Application Service, or ERAS. The timeline each year varies, but generally it starts in June, culminating with the Match in March of the following year, and ending the ERAS cycle in May. 

The 2023-2024 ERAS Residency Timeline according to AAMC.org are:

June 7, 2023ERAS 2024 season begins at 9 a.m. ET. You can now gain access to MyERAS.
Sept. 6, 2023You should have fine-tuned your application well before this date and started your interview prep. Residency applicants may begin submitting MyERAS applications to programs at 9 a.m. ET. 
Sept. 27, 2023Residency programs are allowed to start reviewing MyERAS applications and MSPEs in the PDWS at 9 a.m. ET. 
May 31, 2024ERAS 2024 season ends at 5 p.m. ET.

Programs typically start reviewing applications at the end of September into early October. Interviews are conducted from October through February.

The Match occurs over the process of one week in March, known as Match Week, and peaks on Match Day — Friday.

Match applicants are notified the Monday of Match Week to let them know if they matched or not, but they are not given specifics on where they match. If you find out on Monday that you did NOT match, then there’s more work to be done. You’ll need to work through the Supplemental Offer and Acceptance Program (SOAP).

Match Program Outliers

While most programs operate in this way, several programs operate outside of this structure or alongside it:

  • The Military Match – Applicants apply through ERAS as above, but complete a rank order list and match through a system called the Military Operational Data System, or MODS. Application to programs ends August 31st, and rank lists are due October 15th. Match results are released around December 12th. Notice, there is no involvement of the NRMP.
  • The Urology Match – Applicants apply through ERAS and rank lists are due in early January. Some programs use NRMP, and some use a urology match program. Match Day is towards the end of January or in early February each year.
  • Preventive Medicine – Applicants must contact individual programs to determine their process. Some use ERAS, and some use a preventive medicine residency application service. Most use a separate matching service outside the NRMP called the Standardized Acceptance Process, or SAP. However, some use NRMP. The SAP deadline for rank lists is around January 10th. Match Day is around January 20th.

The ERAS Application

Applicants should prepare their ERAS application well before ERAS opens in the beginning of June.

The application consists of:

  • Your personal and biographical information
  • CV (curriculum vitae)
  • Personal Statement
  • Letters of Recommendation
  • Medical Student Performance Evaluation (MSPE or “Dean’s Letter”)
  • Medical School Transcript
  • ECFMG Status Report (for international medical graduates only)
  • A photograph
  • Your USMLE and/or COMLEX-USA transcripts

Personal and Biographical Information

This is your basic demographic information and identity information. There is also a section for your NRMP match ID, which you will receive when you register for the NRMP Match.

If you have not registered for the NRMP Match, you can add this information later.

Curriculum Vitae

It is helpful to have a comprehensive CV (curriculum vitae) to use as a starting point for your sections and to provide in tandem with your application. Expand on each topic in your CV to write small paragraphs for each section of research, volunteer activity, clinical activities, and employment.

As you fill in the sections of the application, you can choose to use bullet points or paragraphs. If you choose bullet points, they should be concise. If you choose paragraphs, write complete sentences.

Consider that most applicants will have similar activities and you are trying to stand out. We prefer paragraphs to allow the applicant to be more reflective and highlight all the unique aspects of your application for this reason.

The application assumes you have completed your entire medical curriculum (or soon will). Therefore, it is not beneficial to write about rotations unless they were particularly meaningful. If you write about a rotation, pick just one.

Be sure to review the format for both the Activities and Personal Statement sections. You’ll also want to check the requirements as you create your list and rank programs.

What to write on your ERAS/residency personal statement?

Applicants should start writing their personal statement as far in advance as possible. When you know you want to be in a particular specialty, even if it is halfway through your second year, go ahead and start then. Do not wait until the application season to start your personal statement.

Pro tip: Keep a note on your phone or computer with notes about experiences from medical school you want to include in your personal statement. These notes can help you clarify and remember important points that will eventually go into the official statement.

ERAS allows for a personal statement about 5 pages long, but you should aim for about a page plus one paragraph. Admissions committees don’t want to read 5 pages. Describe why you want to pursue your residency of choice and what will make you exceptional at it.

If you will be applying to more than one specialty, you’ll need a separate personal statement for each program. You will have the option during submission to assign a specific personal statement to each program.

Writing a strong personal statement starts with structure. A clear format breaks the essay into manageable pieces for the reader to read and for you to write:

  • Introduction: Open with an anecdote, story, or other creative writing technique to draw the reader in. End this paragraph by introducing your theme(s) to be explored.
  • Body paragraphs 1 to 3: Explore your theme(s). Focus on traits that will make you a good physician or otherwise prepare you to excel. Do not tell more stories here, and do not rehash your resume or work and activities section. Introduce activities only to provide context to how they’ve shaped you. Use 2 activities per theme to prove that you possess the skill/trait. Demonstrate that the activities are an expression of yourself, not a simple lesson you learned from an experience.
  • Content: To make a personal statement truly unique, you need to look beyond your activities. Write about something you are passionate about. It doesn’t have to be medicine. Some of the greatest personal statements talk about the lessons the writer learned in other areas of their life, like as a dancer, a baseball player, or a teacher. They connected their learned humility, compassion, perseverance, diligence, patience, and all sorts of characteristics to medicine. Pick something that you’re passionate about, and demonstrate how it has woven into aspects of your life. The activity is an expression of the underlying characteristic.
  • Conclusion: Wrap it up on a catchy or more emotional note. If the introduction serves to draw the reader in, then the conclusion should leave a lasting impression on the reader.

A note on using AI in your writing: ChatGPT and similar tools can be helpful during the editing process for your ERAS personal statement. However, don’t let AI replace the unique stories that make you an attractive candidate. Don’t be tempted to let AI do your writing for you — use it only to tweak clunky sentences and improve the overall readability of your statement.

Collect Letters of Recommendation

A total of 2-3 Letters of Recommendation (LORs) satisfy most programs’ requirements. Do not wait until right before the application process to request letters.

If you connect with an attending and perform well, ask them if they would be willing to write a letter about 75% of the way through the rotation. Then, ask them for the letter at the end of the rotation.

Collect your letters right away through a 3rd party service like Interfolio so you can store them ahead of time and upload them when the application process opens.

To use ERAS to request letters, you’ll need to wait until the service opens in June. The applicant has to enter the LOR writer’s name and information and may then generate a letter request form to be sent to the letter writer.

After this step, the applicant must confirm the letter of recommendation.

Once the letter is received in ERAS, then they can assign it to the program of choice.

For more information, the Association of American Medical Colleges has details about the format of the letter, and this UCSF has great information on what to include in the letter.

Gather a Dean’s Letter/Medical Student Performance Evaluation (MSPE)

To begin the Dean’s letter, you’ll need to start by talking to your Dean. Each school has different policies on how this is conducted. The school will notify the applicant and generate the letter for you to upload to ERAS.

Most schools will automate this with set deadlines from the Dean. Your school will likely require you to attend a meeting before writing the Dean’s Letter/MSPE, where they will require you to present 3 noteworthy characteristics.

Here are the exact instructions for the Dean’s Letter/MSPE Instructions, as provided by AAMC:

Provide a maximum of three characteristics highlighting the most salient noteworthy characteristics of the student.

  • This section should be presented as a dot bulleted list (DO NOT NUMBER).

  • Each characteristic should be described in 2 sentences or less.

  • Information about any significant challenges or hardships encountered by the student during medical school may be included.

  • This section is written in third person.

  • The word count is 35-40 per bullet.

 

Medical School Transcript

The medical school transcript must be uploaded to ERAS directly from the applicant’s Designated Dean’s Office of their medical school.

ECFMG Status Report (IMGs only)

This report is for international medical graduates (IMGs) only. The Educational Commission for Foreign Medical Graduates (ECFMG) Status Report verifies the ECFMG Certification status. It contains the following information:

  • USMLE/ECFMG Identification Number
  • Applicant name
  • Birth date
  • ECFMG-certified: (Yes or No)
  • Certificate issue date
  • Exams passed for ECFMG Certification
  • CSA valid through date, if applicable
  • Medical school of graduation
  • Degree year
  • Medical Education Credential Status (complete or incomplete)
  • Explanatory notes (if applicable)

Optional Additions

You have the option to include a photograph with your application. The photo should be 2.5 x 3.5 inches, with a 150 dpi resolution, and file size of 150KB — or in digital terms, 375 pixels x 525 pixels.

We recommend including a photo. It is the first visual impression the programs will have of you, so make sure you convey the appropriate aesthetic in your photo.

You also may upload your USMLE and COMLEX Transcripts with your application. Including your transcripts is a great way to stand out if you had above average scores, but if you didn’t do as well as you hoped, don’t include them.

Get a free copy of our Complete Guide to Residency Applications 

ERAS Supplemental Applications

The main ERAS application consists of the personal statement and the activities, but there are also now supplemental applications for residency. In 2023/24, there are now 16 specialties that utilize the ERAS supplemental application.

These questions are very short. They are utilized to help applicants share more information about themselves with programs that they have shown interest in.

Related Read: Our Guide to the ERAS Supplemental Application

Sample ERAS Personal Statement

Here’s an example of a Personal Statement for your ERAS application:

“I began my family medicine clerkship in a community clinic dedicated to the less fortunate. There, I found a group of family physicians, each with their own niche, working together to form an incredibly comprehensive team. One physician in particular specialized in the behavioral sciences, amongst other things.

He saw the kinds of patients I found so fulfilling to treat on my psychiatry rotation, but he also saw just about everything else under the sun. From depression, to skin cancer, to a well-woman exam, I found the pace and surprise of the daily schedule invigorating.

What truly impressed me was how he applied the same principles of the one-on-one real, personal connection required in mental-health to every patient. He laughed, he joked, he hugged, he spoke with authority, and to me it seemed like every patient was a member of his own extended family. 

To me this is what family medicine really means and I will strive to make every patient leave feeling as though they were listened to, understood, and given the best possible medical care available.”

Note: Try to weave description and content together. Most applicants use a paragraph to tell a story, and then use a sentence or two at the end to reflect on it. This is perfect for a work/activities section, but not for a personal statement. When admissions committee members see this, they start skipping the story and reading the last sentence of each paragraph.

Don’t think activities. Think THEMES. Think YOU. Here are some questions to get you thinking:

  • What are you great at?
  • What are you passionate about?
  • What do you like to do?
  • What do you have that other applicants don’t have?
  • Do you have a unique approach to problem solving?
  • Do you have a unique way of thinking in general?
  • Do you have a unique perspective?
  • What values are important to you?

ERAS vs. NRMP

It is important to understand that the application process and the matching process are two separate entities. You’ll need to register for both systems for most residency applications to match.

ERAS allows you to package your application and get it to programs which, in turn, will offer you interviews.

NRMP allows you to make a program list ranked from most to least desirable, then submit that ranking so their algorithm can match you into a program. Each year, the NRMP publishes calendars with important dates and deadlines. In general, NRMP opens in September, the registration deadline is in November, and rank order lists are due in February.

Choosing a Specialty

Choosing a specialty is very straightforward for some students — you’re so drawn to one specialty that you choose one, then fill the rest of the list with “backup specialties.” 

For example, Applicant A may be particularly interested in dermatology, so they use a very contiguous list of preferred programs.

Applicant A:

  1. Derm program 1
  2. Derm program 2
  3. Derm program 3
  4. Family med 1
  5. Family med 2

Other students may have multiple specialty interests and use a non-contiguous list instead. 

Here’s what Applicant B’s list might look like.

Applicant B:

  1. Derm program 1
  2. Family med 1
  3. Derm program 2
  4. Family med 2
  5. Derm program 3

The term “contiguous ranks” refers to the number of specialties that appear in a row.

Both applicants have 3 Derm programs and 2 family med programs. 

Applicant A has 3 contiguous ranks for Derm and 2 contiguous ranks for Family Med. Applicant B has no contiguous ranks.

The number of contiguous ranks is very important. In previous years, dermatology applicants with 12+ contiguous ranks matched with a dermatology program 100% of the time. But applicants with only one contiguous rank matched only 30% of the time.

However, you can still rank for multiple specialties. The data of previous years has mixed results depending on the specialty. Carefully research the match data about the specialties you’re considering to make a decision on the specialty of choice and how to rank your list accordingly.

What are the odds of matching into residency? In 2023, the odds of matching into residency to a first-year position (PGY-1 position) was 81.1%. The odds of matching into residency of all positions offered was 93.3%.

Related Topic: Categorical vs. Preliminary vs. Advanced Residency Programs

How should I choose a rank list order?

Creating a rank order list is straightforward and requires important decision-making. Review exactly how the matching algorithm works for a better understanding of creating a rank list and how programs create their lists. 

Both the National Resident Matching Program and AAMC have made statements advising applicants to create your rank order list of your true preferences, not how you think you will match. While this is sound advice, it also stands to reason that you should not highly rank a program that you don’t have a realistic shot at attending as your first choice.

The final rank order list is due at the end of February to prepare for the match in March.

Residency Interview Questions

Interviews typically start around late fall to early winter. Aim to interview at as many programs as you can afford to attend. Preparing for interviews should start with becoming familiar with typical interview questions.

What type of questions are asked during the residency interview? You can expect to find these questions and prompts in a typical residency interview:

  • Tell me about yourself.
  • Why did you become a physician?
  • What makes you want to be a ____? (fill in the specialty)
  • What are your greatest strengths?
  • What are your greatest weaknesses?
  • Describe a time when you overcame a great challenge.
  • Where do you see yourself in 5 years? 10 years?
  • Describe a research project you were involved in?
  • Name 3 things wrong with the U.S. healthcare system and propose some fixes.
  • What is your interest in this program?
  • How do you manage stress?
  • How do you handle interpersonal conflict?
  • Describe a time where you disagreed with someone or something and how you handled it.
  • Describe an accomplishment you are most proud of.
  • What are you looking for in a residency program?
  • What do you like to do outside of medicine?
  • What other specialties did you consider?
  • What is the most interesting case you have encountered?
  • How would you handle a non-compliant patient?
  • What would you do if you saw a senior resident or attending do something wrong?
  • Please explain any gaps or discrepancies in your education.
  • What elements do you think make a great ____? (fill in specialty)
  • What 3 words would your patients describe you with?
  • What 3 words would your colleagues describe you with?

Stand out from equally qualified applicants during your interview to match with the residency of your choice — we can help.

General tips on interview day:

  • Attire: Dress professionally, and remember this is not a fashion show. If you happen to be up to date on the newest fashion trends, just remember that your interviewer might not be. Your clothes should be neat and presentable and should not distract from the content of your message. The same goes for jewelry — try not to wear anything that draws the attention away from you.
  • Stature: Sit upright and lean in, just like you would when speaking to a patient. Body language conveys interest, so leaning back with crossed arms may send the wrong message.
  • Framing: If you’re participating in a virtual interview, ensure that you look great in the frame by being well-dressed in a well-lit area. Make sure that the background behind you appears professional. Having interesting items in your room that are visible on camera can be excellent conversation starters.
  • Ask Questions: Every interview will end with the same question: “What questions do you have for me?” The only wrong answer is to walk away without asking questions. Be prepared with some questions of your own.
  • Letter of Intent: Send thank you notes to all interviewers. And, after you’ve completed your interviews, send a letter of intent to your top choice.

The Supplemental Offer and Acceptance Program

What is the SOAP program? The SOAP program is designed to fill in the gaps left by the algorithm for applicants that did not get paired up. The Friday before Match Week kicks off, applicants are notified if they are eligible for the SOAP. This has nothing to do with your match results.

To be eligible for SOAP, you must be:

  • Unmatched.
  • Registered in the main match through NRMP.
  • Available to start residency in June.

SOAP works in a completely different way than the NRMP. There is no algorithm for SOAP at this time. If you find out you don’t match on Monday of Match week, you obtain access to a list of all unmatched programs through the NRMP website. There, you can select and apply to as many as 45 programs.

The programs can then call and interview you over the phone over the next several days. You are not allowed to contact programs during this time. 

SOAP offers are extended in 3 rounds, starting with 2 on Wednesday morning and one round on Thursday. Most positions are filled in the first round. 

The offers during those rounds are valid for only 2 hours. You can either accept, reject, or do nothing. If you do not respond in those 2 hours, your acceptance will be forfeited and will not be extended to you in other rounds. 

On Thursday afternoon, the SOAP offers end. If you still have not matched by this point, you still have access to that updated list of unfilled programs. However, the rules change: You may contact the programs on that list and ask for interviews. They can extend an offer to you at any time. 

This process is available from Thursday of Match Week until May 1st.

Planning 3rd & 4th Year Rotations

When should I apply to get matched for residency? You should apply to get matched for residency in the late summer/early fall of your fourth year of medical school.

Before the application process begins, a successful bid for residency requires careful planning of the second half of third-year and the first half of fourth-year. The important parts here are away rotations and use of electives.

Away rotations are particularly useful for you to find out more about a program, while at the same time, showcasing your talents. These are essentially working interviews, or audition rotations. Away rotations should be chosen based on your interest in matching into one of these locations. As a bonus, you can use them as a required rotation. 

When using an away rotation as an elective or a sub-internship rotation (aka ‘Sub-I’), you’ll also get a free interview out of the rotation without having to travel back for another visit. Keep in mind that nearly every medical school has time set aside for you to do interviews in your fourth year, so don’t feel compelled to get all your interviews done through away rotations.

In general, it is unwise to do your first core rotation as an away rotation at a program you’re interested in. If you haven’t done internal medicine yet, don’t show up to an audition rotation for internal medicine. Sure, you’ll learn a ton about the program, but you won’t make a strong impression.

You want to show up to audition rotations at your best, so do a Sub-I or just an elective in that specialty late in your third-year or early in your fourth year.

Regarding timing, there is no right time to do your audition rotation, but there is a wrong time.

Early in your third year when you’re not strong clinically is not the best time. Another time to avoid is when your rank order list is close to being due in February. The ideal time anywhere from late Spring of your third year through the end of that calendar year.

Practically speaking, you cannot use all your electives and away time to do audition rotations. Your school will have limitations, and you don’t want to spend your whole fourth year doing the same rotations at different hospitals. 

Most applicants can afford to do 1-2 of these and get further exposure to these programs from interviews. Every school is different, so make sure you sit down with your deans to find out how many aways you can do, when you can do them, what specialties you can do them with, and how much time is set aside for electives.

A Note for International Medical Graduates

International medical graduates (IMGs) are inherently at a disadvantage compared to American medical graduates (AMGs) for multiple reasons. 

Most program directors are familiar with and confident about the medical education AMGs receive. IMGs are seen as somewhat of an unknown to many programs, who already have a large pool of applicants applying for a smaller group of positions. 

IMGs need to have more competitive stats. That means higher USMLE or COMLEX scores, more research, and more volunteer activities — anything that helps give an edge when applying. Other than that, all the same principles for a successful application apply to the IMG, whether you’re from the US or not. 

One note that is particularly important is selecting IMG-friendly states. Consider looking at the data to identify programs that tend to accept IMGs, and avoid programs that have a history of not accepting IMGs.

Once you’ve identified which states match IMGs into the specialty of your choice, the next step is to look at the Residency Explorer tool to specifically find out how many IMGs match into specific programs.

The residency application process is a long road requiring ample planning. From carefully selected audition rotations all the way until Match day, staying ahead of the curve by being prepared is the key to success!

Schedule a free consultation with a member of our enrollment team to see how we can help you nail your residency interviews.

Renee Marinelli, MD

Renee Marinelli, MD

Dr. Marinelli has practiced family medicine, served on the University of California Admissions Committee, and has helped hundreds of students get into medical school. She spearheads a team of physician advisors who guide MedSchoolCoach students.

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