Are You Ready to Rank?
Students Offer Insights from Match Interview Trail
Jan. 26, 2024, David Mitchell — The applicant registration deadline for the National Resident Matching Program is Jan. 31, and ranking opens Feb. 1. Applicants have until Feb. 28 to finalize their lists. With those important dates in mind, AAFP News recently asked four fourth-year medical students for their insights on the process and advice they would share with their peers.
Has the process of building and narrowing your list been harder or easier than you expected?
Evan Starr, Rocky Vista University College of Osteopathic Medicine: It was easy at first, getting my list of programs I applied to. I felt pretty good about that. But now choosing which one goes not only No. 1, but numbers 2, 3 and 4, it’s tricky. That’s been a little harder than I thought. Every program has good things, but not a single program has everything I want. I’m trying to balance what I value, what I need and what my future plans are. It’s definitely harder than I anticipated.
Nidha Khan, M.P.H., Ohio University Heritage School of Medicine: I would like to be in specific geographic areas, so that narrows it down a lot for me. If I could go anywhere, I may feel more confused, but the fact that I have geographic areas that I really want to strive for makes it easier.
What resources helped you find, research and rank programs?
Derek Southwick, University of Washington School of Medicine: The AAFP residency search tool, the Freida Residency Calculator and the Expo Hall during the AAFP National Conference in Kansas City. The tools are fine for comparing programs, but nothing beats the conference. For the past three years, I have been attending National Conference, and it was there that I identified my criteria for a program and discovered the ones that align with my preferences. In fact, I stumbled upon one of my current top programs unexpectedly while I was on my way to another program. I happened to make eye contact with someone who turned out to have everything I was looking for, which was a delightful surprise.
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Tameka Lawrence, Ross University School of Medicine: Speak to people from your schools who are now at these residency programs. I reached out to a couple of people about their programs because the programs looked good on paper. But when I talked to them, they were like, “Don’t do that. What they have on the website is not the same as what they tell you. You’re going to be disappointed.”
Starr: It’s really easy to look at some of the online search tools and think, “Oh, they have everything I want.” And there were some programs that looked really good on paper, but then when I talked to them, I didn’t really get the vibe I wanted. But there were other ones that I had no interest in during my first couple of years of med school that moved way up as I talked to them, got a feel for their programs and spent time with them. Keep an open mind, and nothing beats first-hand experience.
Khan: The AAFP National conference has been so helpful. I was able to meet programs that interested me within my geographic areas of interest.
Additionally, I am interested in lactation medicine which is a niche field. Being involved with the AAFP’s Breastfeeding Medicine Member Interest Group was helpful because I was able to meet mentors who practice lactation medicine, learn about programs that offer lactation medicine electives, and what to ask potential residency programs about creating electives around lactation if they don’t already have one.
Derek Southwick
How are you tracking your interview notes and narrowing your list?
Southwick: I’m tracking my notes through a Google sheet I created to organize interviews, my rank list, qualities of programs, etc. The tool is weighted according to my interests in a program and helps calculate a rank list based on an objective score. I used my own instead of a standardized tool because I really needed to personalize it to what I truly care about, and I recommend all students do the same. Look at standardized tools and then use them to create your own personalized criteria.
Lawrence: I had a spreadsheet when I was looking at programs that I wanted to apply to. Once interview season started, I threw that away and haven’t looked at it since. For me, I make audio files about my thoughts after interviews and share them with a friend. We go back and we listen to it, and we say, “OK, we were happy here. You had a lot of inflection and emotion. You didn’t sound so good here. What was going on?” Based on that, I was able to pick my top two. For me, it was about not losing what I felt in that moment, what stood out to me about the programs and then having someone who knows me listen and be like, yes or no.
Khan: I started off with an Excel file but couldn’t keep up with it when I had several back-to-back interviews. However, I did have a mental note of the overall vibe I got from programs. Towards the end of my interviews, I had a list of things in a residency program that were important to me. For the programs that I liked, if I couldn’t remember anything from that list, I either reached out to residents to ask or I attended second looks. That helped me fill in the gaps for things I forgot to ask or didn’t think to ask on interview day. Now, I have been able to go back to that Excel file to keep track of things for each program I am interested in.
How many second looks are you doing?
Khan: Four or five. Some in-person and some were virtual.
Starr: I’m not doing as many. I was able to go beforehand and do a sub-internship and some of my interviews were live. With my schedule second looks didn’t make as much sense, and I don’t have a geographic preference. I’m applying everywhere, so it’s a little less feasible.
Southwick: I get emailed about informational meetings that sometimes I go to on Zoom, but like Evan, I took advantage of sub-Is or unofficial sub-Is to get to know the programs. I scheduled a couple that were pretty close to each other. I did a week sub-I. I did a month sub-I. I did a week at one of the programs I had in my top four. I did these for the sole purpose of evaluating the program and seeing if this was a place I would like to be for the next three years.
One of my top programs I really liked was a virtual interview, unlike the others which were in person, and it was far away. I felt really good about the interview. Everything was awesome, so I asked if I could come out and, they did an unofficial week sub-I with me. So for all of my top five, I spent at least a week if not more. It was all about me trying to figure out if I fit with the program. And if I like the residents, if I like faculty, if the hospital has windows, if the cafeteria serves good cookies. All of that is important, and I found out some of the cafeterias had some really good cookies and some don’t. All that in-person stuff is incredibly important. In fact, I would argue it was the most important thing I did prior to making my rank list.
Nidha Khan, M.P.H.
Evan Starr
What was the split between virtual and in-person interviews?
Starr: I’d say 80% of mine were virtual, and then a couple were live. It’s hard because I really appreciate the virtual interviews. It’s a lot easier for my bank account, my schedule and my family. But there is something you get seeing a program live and so, it’s just hard balancing all that.
How have your choices been impacted by the flexibility that family residencies have under the new program requirements that rolled out last year?
Southwick: With the flexibility in the curriculum, choosing a family medicine program that is “the right fit” or based on curriculum is very important to me. It’s the No. 1 one factor in forming my rank list. Not every program can offer the training I’m looking for and therefore I use residency tools to help narrow down programs that provide the curriculum I’m looking for.
Starr: It didn’t do much for me. Most programs share 85% of their curriculum in common, so it’s more about seeing the intangibles of a location, feel, fellow residents.
What are some of your key factors to rank programs? Are family, social and other needs besides training part of that?
Starr: I can start with this one because I had a very specific criteria developed with my wife. We went through what is important to us and it came down to Costco, Target, Trader Joe’s and an airport within two hours, and those are legitimately my criteria. Every program I apply to has proximity to all those things, so my wife, daughter and I know we can survive for a couple of years. It was really helpful because now I can focus on the programs. I can then see which ones offer me what I would need in my training since I’m interested in geriatrics.
Lawrence: I love it. I wish I would have picked things like that. For me, it was about who is going to give me rural, hands-on training with enough procedures. Then, proximity to home. It was definitely, can I get home by car within six to eight hours in a place that does not have snow? Is this a place that my support system will come to me when things are hard? That was legit. And they all know. I picked a place in Arkansas and asked them, is this too far? And they said no. I’m just making sure because I need them to know that they’re coming to me. Residency is hard.
Tameka Lawrence
Khan: I’m married with a young son, so being close to our support network is important. Our first consideration was mainly applying in cities where we have family or close friends that we can rely on. Then, my husband and I discussed which areas were important to him and would be best for his job search and career. Once we narrowed down those geographic areas, then I felt comfortable accepting any interviews I was interested in knowing that I could commit to any program that I liked. I just didn’t want to rank anywhere that I wouldn’t see myself, or my family, being happy and feeling well supported. The final consideration that is important to me is making sure that I feel like the residency program would champion my career interests, like lactation medicine. These are all considerations that are helping me form a rank list that I feel would help me accomplish all my personal and professional goals.
Southwick: Curriculum: A big part of knowing what the program offers is based on faculty expertise and how many residents are currently involved in said procedures and training. I want a program that offers training in endoscopy, acute care, procedures, POCUS, OB/C-section, etc.
Program fit: Do I get along with the residents, do they have families like I do, do they have similar interests?
Geographical: I have wife and kids and want to find a place generally close to family or a family-friendly area.
Cost of living: Is the area affordable with the program salary and benefits?
What is the biggest lesson from your experience so far that you would pass on to medical students matching next year?
Southwick: Don’t be pressured to apply to an excessive number of programs. For me, 10 was enough. If possible, try to schedule time to see a program in person, whether it is a sub-I, unofficial week or even just a day. Programs are more than willing to accommodate you. It doesn’t matter if it’s early before applications are submitted, during interviews or after interviews. The visit is for you to be able to gauge the program. Only do this with your top choices, but it will help to move the needle when you decide to make your rank list.
Lawrence: I definitely agree. Don’t be pressured to apply to an excessive number. I’m a Caribbean medical student, and they tell us 100, dual apply and all this crazy stuff. I didn’t do it. I did not listen at all. Don’t do that because it’s not worth it. You’re wasting money. You’re getting rejection letters. I know people say you just want to match somewhere, but do you really want to be unhappy for three years? Do you really want to be somewhere you already know that you might hate? I don’t know anything about snow, but I know there was no point of me applying to programs in New York, even though they take IMGs.
All you really need is one program to align with what you want. You pick them, and they pick you. I also want to say take advantage of National Conference. I can honestly say the interviews that I got were because I met these people at National Conference. I stayed in contact with them, and when my time came they reached out. They pulled my application and gave me the interview. Do your due diligence way before you get to fourth year, way before you get to Match.
Starr: I agree with getting involved at National Conference, but getting involved in family medicine organizations also was extremely helpful and gave me connections. I was involved with my local state chapter, the (American College of Osteopathic Family Physicians) as well as the AFP journal editorial board, and all were helpful in different aspects to get to where I am. Make any corrections as you see fit.
Keep an open mind. I had a program list from the time I started med school. I think a lot of people get too picky too soon. We’re like, “Oh, I can’t go there because ‘blank.’” There’s a time to be picky, and that’s when you’re applying and interviewing and making your rank list. But keeping an open mind initially is beneficial to be exposed to options that you wouldn’t have thought of. There are lot of programs that I was not initially interested in and then, because I kept an open mind, was able to consider them later.
My school told me to apply to, like 60 to 80 programs. I’m a fairly competitive candidate, and I was like, “No, I’m OK.” There’s a lot of noise and a lot of voices telling us what we need to do, how we need to apply and what matters, but it’s important to know what we value, what we want and then to make wise decisions within that.
Khan: As the interview season progressed, the programs started to blur together, especially the ones I interviewed with in the beginning. Then I remembered one resident I interviewed with told me to reach out if I had any questions, so I did, and she was super nice. We were only on the phone for a few minutes, but it gave me a lot of closure and it was refreshing to see how welcoming and nice everyone was. So, if there were residents who you really clicked with and they offer, “Shoot me an email if you have any questions,” don’t be afraid to actually reach out.
Also, don’t feel bad asking some of the harder questions about things that matter to you. It could be inpatient service, call schedules, research requirements, etc. I was nervous to ask that in the beginning but more and more residents were like, “That’s a really good question. I wish I would have asked that.” Those questions helped me have a better understanding of the programs and if I thought they would provide the type of training I look forward to.
If you have a No. 1 choice, how did you know that program was it for you? What was your “aha” moment?
Southwick: My “aha” moment came when visiting the program. Just visiting programs even for a week helped me discern which programs fit and which didn’t. My list completely flipped after visiting programs. Working with the faculty, residents, walking the halls of the hospital, seeing the patient panel and flow of the clinic was essential to helping me feel comfortable with my No. 1 choice.
Khan: It has been difficult because I enjoyed my top programs a lot, and they each have something unique to offer. I think my “aha” moments came when I was reviewing the program’s website before the National Conference, then meeting the program in person and on interview day and loving it even more. Having a consistently good feeling and positive interactions with a program helped make it feel like a more natural decision. Ultimately, I trust the process to align me with the program that would be a good fit both ways.
Lawrence: My No.1 program based on research and gathering information prior to the interview season is not my No. 1 program now. My interview at my current top program was in person. After the interview and before the dinner they were like, “Go explore,” so I went around the town and started exploring. I was like, “This feels like my hometown.” Everything vibed. The people I talked to, I really enjoyed. I was like, “This is it. This is where you’re going to match. We’re going to get a house. The big city is 45 minutes away, and if you need a bigger city, it’s two hours away. Sounds like home.”
Starr: It took me some time. I really enjoyed my top couple of options, and I still do. I think I’d be really happy at any of them. At the end of the day, it just came down to, “Where do I think I would be able to make the biggest impact and where will I get the training that I need to become the best physician in the future?” It’s different for every program. Each program has such wonderful things to offer, so it’s just a matter of aligning my values with theirs and hoping that we can find a match.
In the end, ranking is your decision, but who do you turn to for advice?
Khan: It’s mainly me and my husband. He’s been through this process, so I’ve been able to get a lot of input from him supplemented with other friends who have been through the Match and family members. I’m happy to hear varying perspectives to help me make the most informed decision I can make.
Starr: I had a hard time making my decisions and for different reasons. For a while it was just me talking to my wife about it. And after a while, she’s like, “We’ve talked about these things so many times. I’ve said my piece.” I opened it up, and I asked friends whose opinions I value and mentors along the way. Being able to get other people’s perspectives was helpful. Not all of them understand the context of my situation or understand everything, but anyone whose opinion I valued, I asked and I took what they said, and I weighed it and was like, “Well, they make a good point there.” I would say, ask as many people as you can because everyone’s got a different perspective, and it can help.
Lawrence: I’m quite the opposite. I didn’t ask a lot of people. I have like three people in my tribe, and so their opinion is what matters. We prayed about it. We’ve discussed it. They know me. I trust their opinion, and knowing my capacity and knowing what would be best for me. They were really a great sounding board.
What else do applicants need to know?
Lawrence: I think just knowing how to get started. You get so much information, and you’re overwhelmed. You’re still trying to complete electives and you’re trying to take exams.
I would say that Match should be something on your mind from the beginning. Where do I look? Do I have a local chapter? Where can I find support? I think that’s kind of a big thing. It definitely helped me on this journey because I could go to them and ask questions and get their perspective.
Starr: I feel like our class is kind of the guinea pig class. We’re the first with pass/fail Step 1. We’re the first to get to signal five programs. There are quite a few things that are new. So, I think being able to talk to other people, see what other people are doing is helpful.
To those two points: Signal programs that you’re interested in, not only ones that you feel like you would match at but ones that you are genuinely interested in. And Step 2 is important. Programs get a lot of applications, and sometimes if your score is below their threshold, they may not offer an interview even though other parts of your application are good. They might just not even see it because they get so many, so take Step 2 seriously.
And also don’t be afraid to send a letter of interest. I did that to a couple of programs after the first couple of rounds of interviews. There were a couple that I was still interested in that I just sent an email: “Hey, I haven’t heard back from you. I’m still very interested. Do you have any additional interview spots?” And that got me quite a few more interviews, and that was really good because they’re ones that I really enjoyed.
Southwick:Family medicine training varies, and now even more with the new requirements. You’ll have some programs that offer nearly nothing in obstetrics and others where you can graduate with 200-plus C-sections. You’ll have some programs that will allow you to have colonoscopy training and endoscopy training.
That’s something that I want to do, and I’ve only applied to programs which can offer me that. I would caution applicants to be specific in their questions to programs. Some programs told me they offer colonoscopies, but when I asked them specifically who at their residency program is currently doing them, I was told none of the residents.
Family medicine has such a variety of what you can do, but it is also based off the training you get. Every program is not going to put out the same exact type of family medicine doctor.
Geographical and financial considerations are important, but it’s just three years. I want to make sure I can get the training that I want. Take lactation or wilderness medicine as examples. Not every program is going to offer these, so you’re going to have to be very specific about what you really want. Dermatology, colonoscopy, outpatient procedures are also on the top of my list. Although family medicine can be full spectrum, few programs actually offer the ability to do it all. Figure out what you want to do and what your niche is, and that will help you. Nobody can really figure it out for me, but me.