NRMP Residency Rank List – Best Practices

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The vast majority of medical students are familiar with the residency match and creating a rank list. For those who may be less familiar, here is a brief explanation: when medical students apply for residency, a computer algorithm called “The Match” serves the role of matching applicants to programs, generating no more than 1 match for each applicant. In order for this process to occur, residency programs and applying medical students must each submit a rank list, which enumerates their choices in order of preference. Thus, applicants must decide which programs they want to rank and list them in order on their rank list.

As you might imagine, a fair bit of stress surrounds the task of creating a rank list. It requires applicants to critically evaluate each program they interviewed at and definitively chose their preferences. This is a very finite task and not an easy one by any stretch of the imagination.

To the fourth year medical students who are in the process of creating their rank lists: congrats! It is quite a feat to reach the position you are currently in, and this deserves recognition. Given the challenge that lies ahead, here are some key pieces of advice to help you finalize your rank list.

 

1 | Identify Your Priorities

When it comes to creating your rank list, the first and most important step is to determine what your priorities are. You must truly introspect and evaluate what is most important to you when it comes to the next 3-7 years you will spend training. While this is a very personal process, the most important point is to know that your rank list should be constructed based on your preferences/priorities and yours only!

Some may consider ranking certain programs higher because they expect to have a higher chance of matching at that particular program. I would not let this be a driver of your rank decisions, as your list should purely represent your preferences in sequential order. The NRMP match system prioritizes applicant rank preferences above those of programs. Furthermore, there is no safe or completely reliable way to determine what a program truly thinks of you in order base your rankings on that. It is in your best interest to create your own list of program preferences and stick to that, rather than ranking certain programs higher or lower based on your expected chances of matching there.

 

2 | What Components of a Residency Program are Most Important to You?

As mentioned before, these decisions are highly personal and will require some serious thought. With that said, I do think there are benefits to consulting with friends, family, or mentors. Ask individuals you trust who have been through the process what they found most important in their rankings. Do any of those factors resonate with you?

Ultimately though, it will be a personal decision based on your unique preferences. Most people will consider some combination of the following factors when evaluating programs:

Location

Proximity to family/friends

Prestige

Quality of clinical training

Quality of research experience/opportunity

I would argue that in addition, the following components are key aspects that one could consider:

Diversity of training sites and patient populations

People (part 1): the residents and colleagues you will be working with

People (part 2): the attendings and perhaps most importantly the program leadership

The tenets and values of the program which in turn will determine the culture (which should ideally align with your own goals, values, etc.)

 

3 | Decide How to Evaluate Your Priorities

The next step after deciding what is important to you is figuring out what to do with that information. Some choose to create a scoring system in which they select traits of programs and ascribe points based on their relative value or the program’s performance in that area. This can certainly be helpful in making the evaluation more quantitative, and may allow you create a rank based on hard numbers.

I would recommend, though, to not be too tethered to such results. Also do not feel compelled to create a numerical scoring system if it is not something that appeals to you. If you prefer a more qualitative approach driven by feel, that is 100% OK. If after creating your scoring system, your rankings are not fitting your heart’s desires, do not ignore that either. Make sure you acknowledge your gut feelings and desires. In the end, what is most important is that you find a system which you feel comfortable with and which serves your goals.

 

4 | Start Thinking About Your NRMP Rank List Early

Having adequate time to sift through this complex process is crucial. Making a rank list is not usually easy or accomplished overnight. While it is difficult to create a true rank list until you have interviewed at most or all of your programs, you will be evaluating each one along the way. One piece of advice that I think can be very helpful is to take brief notes about your experience after every interview day. Jot down your likes and dislikes about a program, what stood out to you and what might affect your decision-making later. It can be hard to remember all the details after completing 10-20 interviews (or perhaps even more), so having those notes may really help down the line.

When it comes time to actually make the rank list, try to complete it at least a week in advance of the deadline. If you can achieve this, you will allow time to sleep on your decisions and ensure that they hold up after a few days of reflection.

 

5 | Trust Your Process and Avoid Making Last-Minute Changes

Once you have made your list, after careful and thoughtful deliberation, trust that your process was sound. While I do not think it is wrong to change your rank list (I made a significant change to my own about 5 days before the deadline), I would avoid making large changes in the last couple of days. If your preferences truly change and you have a compelling reason, then of course you may have a sound argument to do so. In general though, last-minute jitters or cold feet may cloud weeks of prior thought and judgement. Trusting in your prior self may save you a hasty and potentially costly decision at the last minute.

 

Ultimately, by truly introspecting, prioritizing your own preferences, and trusting in your process, you will successfully make a rank list that is right for you. Do not hesitate to reach out to our team if you need assistance with this crucial component of the application process. Each person’s experience will be unique. Good luck to you all!

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