Roadmap to Residency: - AAMC

Roadmap to Residency:From Application to the Match and BeyondSecond EditionLearnServeLeadAssociation ofAmerican Medical Colleges

Roadmap to Residency:From Application to the Match and BeyondSecond Edition

© 2007 Association of American Medical CollegesAll rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or byany means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of theAssociation of American Medical Colleges.Second EditionISBN 978-1-57754-063-2Available from:Association of American Medical CollegesCustomer Service and Order Fulfillment2450 N Street, NWWashington, DC 20037Phone: 202-828-0416 Fax: 202-828-1123www.aamc.org/publicationsPrint versions of this publication are available in packs of 10 only; $15 per pack, plus shipping.PDF versions of this publication are available for free download at www.aamc.org/publications.

Roadmap to Residency: FromApplication to the Match and BeyondAcknowledgementsJanuary 2007This handbook is intended for use by all applicants to U.S. graduate medicaleducation programs, whether they be enrolled in, or graduates of, medical schoolslocated in the United States or in other countries. It results from a collaboration overmany months among staff members at the Association of American Medical Colleges(AAMC), the American Medical Association (AMA), the National Resident MatchingProgram (NRMP), and the Educational Commission for Foreign Medical Graduates(ECFMG), as well as with officers of the Organization of Program DirectorsAssociations (OPDA).Major contributors to the text of this document at the AAMC included MoiraEdwards, Robert Sabalis, Ph.D., and Mona Signer. AMA staff contributors includedSarah Brotherton, Ph.D., Fred Donini-Lenhoff, and Paul Rockey, M.D. OPDA officersCarlyle Chan, M.D., and Sterling Williams, M.D., made significant contributionsduring the planning phase for this document. Gerald Whelan, M.D., of the ECFMGstaff reviewed the final draft of the document and made very helpful suggestions formodifications, clarifications, and additions.This document was updated by AAMC and NRMP staff in December 2006 in orderto reflect changes in policies, procedures, and practices that occur in the processesassociated with application to U.S. residency programs.iiiAssociation of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondTable of ContentsI. Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1A. Allopathic medicine residency programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1B. Osteopathic medicine residency programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1II. Being a Candidate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2A. Candidacy requirements for ACGME-accreditedallopathic medicine GME programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21. Graduates of U.S. and Canadian medical schools accreditedby the Liaison Committee on Medical Education (LCME)2. Graduates of U.S. colleges of osteopathic medicine accredited by theAmerican Osteopathic Association (AOA)3. Graduates of medical schools located outside of the U.S. and Canada…A. Who have received a currently valid certificate from the ECFMG prior toappointment to a residency program or a full and unrestricted license topractice medicine in a U.S. licensing jurisdiction in which they areenrolled in a residency training programB. Who have completed a Fifth Pathway program provided by anLCME-accredited medical school4. “Students” vs. “graduates”5. United States Medical Licensing Examination (USMLE)6. Educational Commission for Foreign Medical Graduates (ECFMG)III. Specialty Choice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5IV. Residency Program Selection Criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6A. Understanding the training path for the chosen specialty . . . . . . . . . . . . . . . . 6B. Residency program selection criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6V. Matching Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7A. The National Resident Matching Program (NRMP) . . . . . . . . . . . . . . . . . . . . 7B. The San Francisco Matching Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9C. The Urology Match . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10vAssociation of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondD. The American Osteopathic Association (AOA)Intern/Resident Registration Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10E. Canadian Resident Matching Service (CaRMS) . . . . . . . . . . . . . . . . . . . . . . . 11F. Military matches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12G. Couple’s matching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12H. Match outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121. A binding commitment2. The “early matches”3. Unmatched “early match” applicantsVI. Preparing to Apply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14A. What information is needed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141. A completed application2. A personal statement3. Letters of recommendation4. USMLE and/or COMLEX score reports5. Medical Student Performance Evaluation (MSPE)6. Medical school transcript7. PhotographB. Waiving right to see letters of recommendations . . . . . . . . . . . . . . . . . . . . . . 16VII. Applying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17A. The Electronic Residency Application Service (ERAS) . . . . . . . . . . . . . . . . . 17B. Central Application System (San Francisco Match) . . . . . . . . . . . . . . . . . . . . 17C. Paper-based applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18D. Tracking applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18E. Ensuring completion of applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18F. November 1 release date for the Medical StudentPerformance Evaluation (MSPE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18viAssociation of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondVIII. Visiting Residency Training Programs . . . . . . . . . . . . . . . . . . . . . . . . . . 19A. Applicants’ assessment of programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19B. Assessment criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19C. Program visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191. Interview preparation2. Creation of an information grid for use in program assessment3. Completion of information grid for each program visited4. “Second visits”IX. After the Program Visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21X. Residency Application Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22A. Obligations of matched applicants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22B. “Early match” outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22C. “The Scramble” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22D. FindAResident and Other Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23XI. The Transition from Medical School to Residency . . . . . . . . . . . . . . . . 24A. Insurance programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24B. Financial aid processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24C. Visas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24D. Contracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25E. Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25F. Employment for spouses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25G. Schools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26H. Hospital credentialing and medical licensure . . . . . . . . . . . . . . . . . . . . . . . . . 26I. Orientation and program start dates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26J. Budgeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Appendix A: Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Appendix B: Webliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29viiAssociation of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondI. ProgramsMedical residency training programs inthe United States are of two types:programs in allopathic medicine andprograms in osteopathic medicine. Eachtype of program is accredited by adifferent organization.A. Allopathic medicine residencytraining programsAlmost all residency training (orgraduate medical education [GME]) inthe United States takes place inallopathic medicine programs. There areapproximately 100,000 residents andfellows currently training in about 8,000programs accredited by the AccreditationCouncil for Graduate Medical Education(ACGME, www.acgme.org). TheACGME accredits all initial U.S.allopathic medicine residency programsthat lead to primary board certificationby a member board of the AmericanBoard of Medical Specialties (ABMS,www.abms.org). Applicants with any ofthe following qualifications are eligiblefor appointment to ACGME-accreditedprograms:• Graduates of U.S. and Canadianmedical schools accredited by theLiaison Committee on MedicalEducation (LCME, www.lcme.org),the joint accrediting body of theAmerican Medical Association (AMA,www.ama-assn.org), located inChicago, and the Association ofAmerican Medical Colleges (AAMC,www.aamc.org), located inWashington, D.C.• Graduates of U.S. colleges of osteopathicmedicine accredited by theAmerican Osteopathic Association(AOA, www.osteopathic.org), locatedin Chicago.• Graduates of medical schools outsidethe United States and Canada who meetone of the following qualifications:º Receipt of a currently valid certificatefrom the Educational Commissionfor Foreign Medical Graduates(ECFMG, www.ecfmg.org) prior toappointment to a residencyprogram, orº Receipt of a full and unrestrictedlicense to practice medicine in aU.S. licensing jurisdiction in whichthey are enrolled in a residencytraining program.• Graduates of medical schools outsidethe United States who have completeda Fifth Pathway program provided byan LCME-accredited medical school.B. Osteopathic medicine residencytraining programsThe American Osteopathic Associationapproves U.S. osteopathic internship andresidency training programs (http://doonline.osteotech.org).To enroll in anAOA-approved program, one must be agraduate of an AOA-accredited college ofosteopathic medicine. Some residencyprograms are dually accredited by theACGME and AOA.1Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondII. Being a CandidateAs described in (I) above, most residencytraining programs in the United Statesare ACGME-accredited. This sectionexplains how a candidate can meetprograms’ requirements for candidacy.A. Candidacy requirements forACGME-accredited allopathicmedicine GME programs1. Graduates of U.S. and Canadianmedical schools accredited by theLiaison Committee on MedicalEducation (LCME)The LCME accredits educationalprograms leading to the MD degree inthe United States. The LCME alsoaccredits Canadian medical educationprograms in collaboration with theCommittee on Accreditation ofCanadian Medical Schools (CACMS,www.afmc.ca). The LCME is recognizedas the reliable accreditationauthority for MD programs by thenation’s medical schools and theirparent universities. It also is recognizedfor this purpose by the U.S.Congress in various health-relatedlaws, and by U.S. state, Canadianprovincial, and territorial medicallicensing authorities.Any individual who has graduatedfrom, or plans to graduate from, a U.S.or Canadian LCME-accreditedallopathic medical school is eligible toapply to an ACGME-accreditedresidency training program. A list ofLCME-accredited schools can befound on the AAMC Web site(www.aamc.org/medicalschools.htm).2. Graduates of U.S. colleges ofosteopathic medicine accreditedby the American OsteopathicAssociation (AOA)The American OsteopathicAssociation’s Commission onOsteopathic College Accreditation(AOA COCA, http://doonline.osteotech.org,Accreditation) isrecognized by the U.S. Department ofEducation as the sole accreditingagency for pre-doctoral osteopathicmedical education in the U.S..Any individual who has graduatedfrom, or plans to graduate from, aU.S. AOA-accredited osteopathicmedical school is also eligible toapply to an ACGME-accreditedresidency training program. A list ofAOA-accredited schools can be foundon the AACOM Web site(www.aacom.org/colleges).3. Graduates of medical schoolslocated outside of the United Statesand Canada…A. Who have received a standardECFMG certificate withoutexpired examination dates, ifapplicable, from the ECFMGprior to appointment to aresidency program or receipt of afull and unrestricted license topractice medicine in a U.S.licensing jurisdiction in whichthey are enrolled in a residencytraining programSince medical schools located outsideof the United States and Canada varyin educational standards, curricula,and evaluation methods, the ECFMG,through its certification process,assesses the readiness of internationalmedical graduates (IMGs) to enterU.S. ACGME-accredited residencyand fellowship training programs.International medical graduateswishing to enter a U.S. ACGMEaccreditedresidency or fellowshiptraining program must be certified bythe ECFMG prior to entering theprogram (http://www.ecfmg.org/creds/).International medical graduateswishing to take Step 3 of the threestepUnited States Medical LicensingExamination (USMLE,www.usmle.org) also must becertified by the ECFMG. In addition,ECFMG Certification is required toobtain an unrestricted license topractice medicine in any U.S.licensing jurisdiction.B.Who have completed a FifthPathway program provided by anLCME-accredited medical schoolA Fifth Pathway program is an academicyear of supervised clinical educationprovided by an LCME-accreditedmedical school to students who meet allof the following conditions:• Completion in an accredited U.S.college or university of an undergraduatepremedical education ofthe quality acceptable for matriculationin an accredited U.S. medicalschool2Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and Beyond• Study at a medical school outsideof the United States and Canadalisted in the International MedicalEducation Directory published bythe ECFMG’s Foundation forAdvancement of InternationalMedical Education and Research(IMED, http://imed.ecfmg.org/)• Completion of all formal requirementsof the foreign medical schoolexcept for internship and/or socialservice• Attainment of a score satisfactoryto the sponsoring medical schoolon a screening examination, and• Attainment of passing scores onSteps 1 and 2 of the United StatesMedical Licensing Examination(USMLE).Three U.S. schools currently offer thefinal year of supervised clinicaleducation required of Fifth Pathwaystudents: New York Medical College(www.nymc.edu/depthome/fifth.asp),Mt. Sinai School of Medicine of NewYork University (www.mssm.edu/medschool/fifth_pathway/), and PonceSchool of Medicine (www.psm.edu,[click on “Academic Affairs,” then“Programs”]). Additional informationabout the Fifth Pathway programcan be found on the AmericanMedical Association’s Web site (AMA,www.ama-assn.org/ama/pub/category/9306.html).Note: Fifth Pathway applicants whowish to use the Electronic ResidencyApplication Service (ERAS,www.aamc.org/eras.htm) to apply toresidency training programs mustobtain their electronic token (aunique access code) from theECFMG to access the MyERAS Website (www.aamc.org/eras).Note: To participate in the NationalResident Matching Program (NRMP,www.nrmp.org), Fifth Pathway applicantsmust have satisfied the medicalscience examination requirements forECFMG Certification (USMLE Step 1and Step 2 Clinical Knowledge [CK]and Clinical Skills [CS]), and theresults must be available by theNRMP rank order list (ROL)deadline. Applicants who have previouslypassed the former ECFMGClinical Skills Assessment (CSA) andachieved a score acceptable to theECFMG on an English languageproficiency test (e.g., the Test ofEnglish as a Foreign Language[TOEFL, www.ets.org/toefl/] or theformer ECFMG English test) can usethose passing performances to fulfillthe Step 2 CS requirement.4. “Students” vs. “graduates”ACGME regulations require thatphysicians beginning residencyprograms be graduates of the medicaleducation programs listed above.Individuals may apply for residencyprograms in their final year ofmedical school, with the expectationthat they will complete all programrequirements before beginningresidency training. If all of thoserequirements have not beencompleted, residency training mustbe deferred.For international medical graduates,the ECFMG notes that both medicalschool students and graduates maybegin the ECFMG Certificationprocess. However, since ECFMGrequires primary source, independentverification of the medical diplomaand receipt of a full transcript fromthe medical school, an applicant forECFMG Certification cannotcomplete the ECFMG Certificationprocess until he or she has graduatedfrom the medical school and actuallyreceived his or her diploma.For senior medical students enrolledin U.S. medical schools, the NRMPrequires that medical schoolsimmediately revoke the school’ssponsorship of any applicant who isdetermined by the school official tobe ineligible to enter a residencytraining program on July 1 in theyear of the Match and that schoolsnotify the NRMP of that action priorto the rank order list certificationdeadline.5. USMLEU.S. medical schools’ requirements ofstudents differ with regard to takingand achieving a passing score on theUSMLE Step 1 and USMLE Step 2Clinical Knowlegde (CK) and ClinicalSkills (CS) examinations prior tograduation. Students enrolled at U.S.medical schools will not be able tobegin their residency training untilthey have completed all degreerequirements and graduated fromtheir medical school. For more informationon each medical school’sgraduation requirements, see theAAMC’s Curriculum Directory(http://services.aamc.org/currdir/).3Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondSince many allopathic residencytraining programs recognize osteopathicmedical school education,senior students enrolled in andgraduates of colleges of osteopathicmedicine may not be required tocomplete USMLE examinations inorder to enter an ACGME-accreditedresidency program. However, sinceindividual programs can set theirown entrance requirements, somemay require documentation ofpassing scores on USMLE examinations.Other programs may require,instead, documentation of passingscores on the ComprehensiveOsteopathic Medical LicensingExaminations (COMLEX-USA),which are sponsored by the NationalBoard of Osteopathic MedicalExaminers (www.nbome.org).Interested individuals should checkwith each program regarding itsprogram requirements.Before entering a residency trainingprogram, international medicalgraduates must have achievedECFMG Certification, which includespassing scores on USMLE Step 1 andStep 2 CK and CS examinations, aswell as any other examinations thatthe ECFMG might require.6. ECFMGTypically, it takes some time to achieveECFMG Certification. To participatein the NRMP, international medicalgraduates and students enrolled ininternational medical schools musthave passed all examinations requiredfor ECFMG Certification, and theresults must be available by the NRMPrank order list deadline. The NRMPwill withdraw applicants who have notmet that deadline. For those reasons,appropriate and timely planning isessential.4Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondIII. Specialty ChoiceThe process of choosing one’s specialty ishighly personal and both a challengingand rewarding effort. To assist medicalstudents and their career advisors in thisprocess, the AAMC sponsors a structuredfour-phase career planningprogram, Careers in Medicine (CiM,www.aamc.org/careersinmedicine).Other resources regarding specialtyselection can be found in theBibliography (Appendix A).CiM Phase 1, Understanding Yourself,involves a self-assessment by the studentof his or her personal interests, skills,goals, and values. Phase 2, ExploringOptions, involves exploration of thevariety of specialties and medical careeroptions. Phase 3, Choosing a Speciality,involves a comparison of what waslearned during self-assessment with theinformation gathered about variousspecialties and medical career optionsunder consideration, leading to adecision about the specialty that will bepursued during residency training. Phase4, Getting into Residency, involves applicationto, and acceptance by, a residencytraining program.The CiM program provides extensiveinformation about specific specialty andresidency selection processes, including aproposed four-year timeline and voluminousdata about a broad range ofspecialties. The CiM Specialty Pages(www.aamc.org/careersinmedicine)contain general information about thenature of the work in each specialty,training requirements, the personalitycharacteristics of physicians practicing inthe specialty, current workforce andcompensation statistics, and links torelevant professional associations andinformation resources.Students enrolled at U.S. allopathic,selected osteopathic, and Canadianmedical schools also have access, througha password-protected CiM Web site, to avariety of assessment and decisionmakingtools to assist them in the careerplanning process, as well as to detailedinformation about all ACGME-accreditedspecialties. Students can receive an accesscode from their school’s CiM liaison, whois usually a staff person in the Office ofStudent Affairs or Academic Affairs.For each specialty, it is helpful todetermine the number of residencyprogram positions available in thedesired specialty and the number ofapplicants for that specialty in order toassess the competitiveness of the applicationprocess for that specialty. TheFREIDA Online® Web site, maintainedby the American Medical Association(www.ama-assn.org/go/freida), providesaggregate information on ACGMEprograms, including the total number ofresidents per specialty, average programsize, and average number of interviewsprovided per program, as well as informationon the number of graduates andtheir career choices.Applicants may also wish to review theAugust 2006 joint AAMC and NRMPreport entitled, “Charting Outcomes inthe Match.” This report provides informationfor each of 17 specialtiesregarding the following five characteristicsof matched and unmatched applicants:USMLE Step 1 score, number ofpublications, participation in researchprojects, length of rank order list, andmembership in Alpha Omega Alphamedical honor society. The report can beaccessed in PDF format on the AAMCand NRMP Web sites at:www.aamc.org/publications andwww.nrmp.org/matchoutcomes.pdf,respectively.5Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondIV. Residency Program Selection CriteriaResidency applicants should be knowledgeableabout the path for training in achosen specialty, as well as about thepersonal criteria they will employ inselecting a residency program.A. Understanding the trainingpath for the chosen specialtyInformation about the training paths formany specialties and subspecialties isavailable on the Careers in Medicine Website (www.aamc.org/students/cim/specialties.htm). The Graduate MedicalEducation Directory (the “Green Book”)published annually by the AmericanMedical Association (www.amaassn.org/ama/pub/category/3991.html)also lists contact information for 8,250ACGME-accredited and combinedspecialty programs and 1,700 graduatemedical education teaching institutions,data for and descriptions of all specialtiesand subspecialties, and American Boardof Medical Specialties medical specialtyboard certification requirements. Anotherkey AMA resource is FREIDA Online®(Fellowship and Residency ElectronicInteractive Database Access, www.amaassn.org/go/freida),an online databasecontaining information on 8,200+graduate medical education programsaccredited by the ACGME, as well as on200+ combined specialty programs.FREIDA permits comparison of specialtieson such factors as length of training,program size, number of faculty, work andeducational environments, and compensation,as well as on the career plans ofgraduates from various specialties asreported by their program directors.B. Residency program selectioncriteriaResidency applicants should consider inadvance the criteria by which they willinitially assess programs to determinehow many and to which programs theywill make application, as well as todetermine, after visiting programs atwhich they have been invited tointerview, those programs that they willplace on their rank order list (ROL). Atleast three different types of criteria canbe employed in this process: those aboutthe nature and quality of the educationalprogram, those based on personal preferencesand needs, and those based onresidency agreement and stipend issues.• Program issues:a. Morale of current residents (lookfor satisfied residents)b. Current accreditation statusc. Program qualityd. Program sizee. Educational structure: requiredrotations, formal curriculum,informal learning opportunities,support systemsf. Clinical responsibilities: callschedule, supervisory structure,ancillary supportg. Opportunities for research andteachingh. Evaluation processes: timing andstructure of resident evaluationi. Program type: academic orcommunity; hospital-based orambulatoryj. Opportunities for interaction withresidents in other residency trainingprogramsk. Reputation of program directorand faculty membersl. Success of graduates in obtainingfellowships.• Personal issues:a. Locationb. Housingc. Cost of livingd. Proximity to family memberse. Spousal and family opportunities.• Residency agreement and stipendissues:a. Stipendb. Leave: vacation, sick, andprofessionalc. Benefits: health, liability, anddisability insurance (including datesof initial coverage for newresidents)d. Other prerequisites.6Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondV. Matching ProcessesThis section explains the variety ofprocesses involved in obtaining a position inresidency programs in various specialties.Most U.S. medical students and otherapplicants to U.S. GME programs securepositions through a “matching program.”Although the largest matching programis the National Resident MatchingProgram (NRMP, www.nrmp.org),other residency matching programsinclude the San Francisco MatchingProgram (www.sfmatch.org) and thematching programs sponsored by theAmerican Urology Association (AUA,www.auanet.org/residents/resmatch.cfm)and the American Osteopathic Association(www.natmatch.com/aoairp). Inaddition, the various U.S. ArmedServices select applicants participating inmilitary programs at U.S. medicalschools for Armed Forces-sponsoredGME programs. Finally, the CanadianResident Matching Service (CaRMS,www.carms.ca) sponsors a two-phasedmatch for Canadian medical schoolstudents and other applicants.A. The National Resident MatchingProgram (NRMP)The largest of the several matches is theMain Residency Match (the “MainMatch”) sponsored by the NRMP. Eachyear, the Match provides services to morethan 25,000 applicants and 3,900residency training programs, offeringmore than 21,000 first-year (postgraduateyear 1 or PGY-1) and 2,500 secondyear(postgraduate year 2 or PGY-2)positions. More than three-quarters ofall applicants participating in the Matchobtain PGY-1 positions, and more than90 percent of all PGY-1 and PGY-2positions are filled each year. The NRMPannually publishes Match statistics in the“NRMP Results and Data Book,” whichis available for purchase on the AAMCPublications Web site(www.aamc.org/publications).The NRMP matching process uses theWeb-based Registration, Ranking, andResults (R3) System. Applicants andprograms register for the Match, submittheir rank order lists, and obtain theirMatch results using the Internet on theirown computers. Because all informationin the R3 System is in real time, applicantscan modify their rank order listsup until the rank order list submissiondeadline. Applicants and programdirectors must use their unique identificationnumbers to access the R3 System.The NRMP’s public Web site(www.nrmp.org) contains a wealth ofinformation about the Match. All applicantsare advised to review that informationbefore completing the registrationprocess. To register for the Match, clickthe “Register/Log In” link at the top ofthe NRMP home page. It is important tonote that registration for the MainResidency Match does not register anapplicant with the Electronic ResidencyApplication Service (ERAS,www.aamc.org/eras) or vice versa.The NRMP and ERAS are distinct,complementary programs. ERAS is amethod for applying to residencytraining programs, and the NRMP is amethod for matching applicants withavailable positions in those programs.Applicants must register separately forthe NRMP and for ERAS, which is thesystem used by the overwhelmingmajority of residency training programsparticipating in the NRMP. A singleregistration for the Match allows applicantsto rank any match-participatingresidency training program, regardless ofspecialty.The NRMP classifies applicants into twocategories:• “U.S. seniors,” in NRMP parlance, arestudents currently enrolled in U.S.allopathic medical schools. Themedical school “sponsors” thosestudents by verifying their medicaleducation credentials and ensuringthat they are not withdrawn inappropriatelyfrom the Match. A U.S. seniormay be withdrawn from the MainResidency Match only by an official ofhis or her medical school. Institutionsthat participate in the Main ResidencyMatch may offer positions to U.S.allopathic medical school seniors onlythrough the NRMP or anothernational matching program. Thisrequirement includes PGY-1 preliminarypositions for applicants whoobtain their PGY-2 positions throughanother match.• “Independent applicants,” in NRMPparlance, are those participants in theMain Residency Match who are notU.S. allopathic medical school seniors.This applicant category includes priorgraduates of U.S. allopathic medicalschools; osteopathic medical schoolstudents and graduates; Fifth Pathwayprogram participants; Canadianmedical school students and graduates;and students and graduates of internationalmedical schools, regardless ofwhether they are U.S. citizens or7Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and Beyondcitizens of other countries. Thecredentials of international medicalschool students and graduates areverified by the ECFMG. Independentapplicants may be offered positionsthrough the Match or outside of it,and they may withdraw themselvesfrom the Match at any time prior tothe rank order list deadline.Five types of positions are offeredthrough the NRMP Main ResidencyMatch:• Categorical (C) positions: PGY-1positions in programs that provide thetraining required for board certificationin a specialty• Preliminary (P) positions: PGY-1 oneyearpreliminary positions in transitionalinternal medicine or generalsurgery programs.• Categorical (M) positions: PGY-1primary care positions in combinedprograms in internal medicine andpediatrics• Advanced (A) positions: PGY-2positions in specialty programs thatbegin the year after the Match andsubsequent to one or more years ofpreliminary training• Physician (R) positions: Positions inspecialty programs that begin in theyear of the Match for physicians withprior graduate medical education.The NRMP uses a mathematicalalgorithm that employs the preferencesexpressed in the rank order lists submittedby applicants and programs to placeindividuals into positions. The processbegins with an attempt to place anapplicant into the program indicated asmost preferred on that applicant’s list. Ifthe applicant cannot be matched to thefirst-choice program, an attempt is thenmade to place the applicant into thesecond-choice program, and so on untilthe applicant obtains a tentative matchor all the applicant’s choices have beenexhausted. An applicant can be tentativelymatched to a program if theprogram also ranks the applicant on itsrank order list, and either (1) theprogram has an unfilled position or (2)the program does not have an unfilledposition, but the applicant is morepreferred by the program than anotherapplicant who already is tentativelymatched to the program. This process iscarried out for all applicants until eachapplicant has either been tentativelymatched to the most preferred choicepossible or all choices submitted by theapplicant have been exhausted. When allapplicants have been considered, thematching process is complete and alltentative matches become final.The NRMP issues guidelines for applicantsin preparing their rank order lists:• Applicants are advised to include ontheir rank order lists only thoseprograms that represent their truepreferences.• Programs should be ranked insequence, according to the applicant’strue preferences.• Factors to consider in determining thenumber of programs to rank includethe competitiveness of the specialty,the competition for the specificprograms being ranked, and theapplicant’s qualifications. In mostinstances, the issue is not the actualnumber of programs on the rankorder list, but whether to add one ormore additional programs to the list inorder to reduce the likelihood of beingunmatched.• Applicants are advised to rank all ofthe programs deemed acceptable, i.e.,programs in which they would behappy to undertake residency training.Conversely, if an applicant findscertain programs unacceptable and isnot interested in accepting offers fromthose programs, the program(s)should not be included on theapplicant’s rank order list.The NRMP matching algorithm alsoallows couples to link their rank orderlists so they will match to programssuited to their needs. Both partnersenroll individually in the Match andindicate in the NRMP R3 System thatthey want to be in the Match as part of acouple. The NRMP allows couples toform pairs of choices on their rank orderlists, which are then considered in rankorder in the Match. The couple matchesto the most preferred pair of programson their rank order lists where eachpartner has been offered a position.All participants in the Main ResidencyMatch must sign the Match ParticipationAgreement (MPA) during the registrationprocess. The MPA delineates allMatch rules; applicants should review itcarefully before submitting their8Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and Beyondelectronic signatures. The listing of anapplicant by a program on its certifiedrank order list or of a program by anapplicant on the applicant’s certifiedrank order list establishes a bindingcommitment to offer or to accept anappointment if a Match results. Failureto honor the match commitment byeither party may subject the party tosanctions as outlined in the NRMPViolations Policy that is posted on theNRMP Web site.Applicant registration for the Matchopens each year on August 15. Althoughthe early registration deadline isDecember 1, registrations are acceptedafter that date upon payment of a latefee. The ranking function opens onJanuary 15 and closes on the thirdWednesday in February.Match Week takes place during the thirdweek in March. On Monday of MatchWeek, applicants learn whether, but notto which programs, they have matched.On Tuesday, the NRMP releases a list ofthose positions that were not filled in theMain Match. The third Thursday inMarch is Match Day, when applicantslearn to which specific programs theyhave matched.Any applicant who does not match in theMain Match can seek a residencyposition during a post-Match processknown colloquially as “the Scramble.” AtNoon (EST) on Tuesday of Match Week,when the NRMP releases a list of thosepositions that were not filled in theMatch, unmatched applicants are free tocontact those programs and submitapplications for any unfilled positionsthat are posted on the NRMP’s secureWeb site. It is a violation of the MatchParticipation Agreement for an applicantwho matched to a residency position inthe Match to seek an alternative positionduring the Scramble.B. The San Francisco MatchingProgramFor 2007, the San Francisco MatchingProgram (www.sfmatch.org) offers PGY-2positions in specialties that do not participatein the NRMP: neurological surgery,child neurology, ophthalmology, andPGY4 positions in plastic surgery. It alsooffers fellowship positions in severalsubspecialties. Applicants are advised toreview carefully the information providedon the San Francisco Match Web site.Because the San Francisco Match doesnot offer PGY-1 positions, applicantsmust obtain their preliminary positionsoutside of the San Francisco Match.Some programs have designated preliminarypositions in the same institution forapplicants who match through the SanFrancisco Match; therefore, these applicantsdo not have to go through amatching program to obtain a PGY-1position. Other programs require applicantsto participate in the NRMP MainResidency Match to obtain a position forpreliminary training. Preliminarypositions for U.S. allopathic medicalschool seniors must be offered throughthe NRMP Main Residency Match.To participate in the San FranciscoMatch, applicants complete the onlineregistration form, print it, and mail orfax it along with the required payment tothe San Francisco Matching Program.Applicants are then mailed a certificateof registration, as well as additionalinformation on matching procedures.Most, but not all, of the programs participatingin the San Francisco Match usethe Central Application Service (CAS);programs in those specialties not usingthe CAS must be contacted directly fortheir individual applications. ERAS is notused by any specialties participating inthe San Francisco Match. It is importantto note that registration for the SanFrancisco Match does not register anapplicant for the CAS or vice versa.Information about the CAS can be foundon the San Francisco Match Web site.The ranking function for the SanFrancisco Match is also paper-based.Applicants complete the form that isposted on the San Francisco Match Website and send it by overnight mail, U.S.Postal Service, or fax to the SanFrancisco Match office. Receipt will beconfirmed by mail or telephone. Aseparate form must be completed ifchanges are made to the rank order list.As with the NRMP, the San FranciscoMatch uses an “applicant-proposingalgorithm,” and all matches are tentativeuntil the matching process has beencompleted, with the outcome determinedby the rank order lists submittedby programs and applicants. All matchesare binding commitments.Registration for the San Francisco Matchbegins in May, and the target date forreceipt of CAS applications is lateAugust. The period for submitting rankorder lists is December through mid-January, and Match Day is at the end ofJanuary. Unfilled positions are posted onthe San Francisco Match Web site inearly February.9Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondC. The Urology MatchThe American Urological Association(AUA, www.auanet.org/residents/resmatch.cfm) sponsors a match forresidency positions in urology only. Eachyear, about 350 applicants compete forapproximately 235 positions, virtually allof which are filled through the AUAMatch. AUA Match statistics, as well asgeneral information about the AUAmatching process, can be found on theAUA Residency Match Web site.Applicants are advised to review thisWeb site information carefully.The prerequisite training for a prospectiveurology resident is one or two years,preferably in a general surgery program.Because the Urology Match does notoffer PGY-1 positions, applicants obtaintheir preliminary positions outside of theAUA Match. Some programs have designatedpreliminary positions in the sameinstitution for applicants who matchthrough the Urology Match; therefore,those applicants do not have to gothrough a matching program to obtain aPGY-1 position. Other programs requireapplicants to participate in the NRMPMain Residency Match to obtain aposition for preliminary training.Preliminary positions for U.S. allopathicmedical school seniors must be offeredthrough the NRMP Main ResidencyMatch.The registration form and fee for theAUA Match are submitted using anonline form that can be accessed on theAUA Web site. The Web site also listsparticipating programs and indicateswhether each uses ERAS or anothermethod for receipt of applications. It isimportant to note that registration forthe AUA Match does not register anapplicant with ERAS, or vice versa.The AUA Match ranking function ispaper-based. Preference lists must besubmitted to the AUA Match by the firstweek in January, and they cannot bechanged after the deadline date. A samplepreference list form can be printed fromthe AUA Match Web site, but it must besent by U.S. Postal Service or fax to theAUA Match office. As with the NRMP,the AUA Match uses an “applicantproposingalgorithm,” and the AUAMatch outcome is determined by applicants’and programs’ preference lists. Allmatches are binding commitments.Applicants can register for the AUAMatch as early as the spring of the yearprior to the AUA Match; the final registrationdeadline is the first week ofJanuary. The period for submitting rankorder lists is December through the firstweek of January, and Match Day is in thethird week in January. Vacancies availableafter the AUA Match may be listed on thephone-in AUA vacancy hotline.Unmatched applicants may makeindividual arrangements with programsthat have vacant positions.D. The American OsteopathicAssociation (AOA) Intern/Resident Registration ProgramThe AOA Intern/Resident RegistrationProgram (IRRP) is a matching programthat places applicants in U.S. osteopathicmedicine internship and residencytraining positions. It is sponsored by theAOA and administered by NationalMatching Services, Inc. (NMS,www.natmatch.com/aoairp). Additionalinformation also may be found on theAOA Web site (http://doonline.osteotech.org/index.cfm?PageID=sir_matchprotocol).New graduates of colleges of osteopathicmedicine must complete an AOAapprovedOGME-1 year in order to beeligible for certification by an osteopathicspecialty board, to continue postdoctoralosteopathic medical training, and toapply for future credentialing.The AOA's Council of PostdoctoralTraining has restructured the available firstpost-graduate year of training (OGME-1).These restructured three options include:• Option 1: Trainees completing thefirst year of residency in approvedspecialties will also meet the AOAapprovedfirst-year requirement.The specialty colleges approving thisoption include: anesthesiology,family practice, internal medicine,internal medicine/pediatrics, obstetrics/gynecology,otolaryngology facialplastic surgery, and pediatrics.• Option 2: Trainees must complete anAOA-approved internship as a prerequisitefor residency training. This yearof training will not be used to fulfill thePGY-1 requirement of residency.Specialty colleges approving this optioninclude: emergency medicine, generalsurgery, internal medicine/emergencymedicine, neuromusculoskeletalmedicine/osteopathic manipulativemedicine, neurology, neurosurgery,ophthalmology, orthopaedic surgery,pathology, psychiatry, radiology,radiation oncology, and urology.• Option 3: Trainees must complete anAOA-approved traditional rotatinginternship for consideration of a10Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondF. Military matchesPositions in US military residencytraining programs are open only toapplicants who are graduates of theUniformed Services University of theHealth Sciences (USUHS), medicalstudents with an individual militarycommitment through the HealthProfessions Scholarship Program(HPSP), and participants in the ReserveOfficers Training Corps (ROTC).Although applicants and programssubmit rank order lists, and applicants toArmy and Navy programs apply throughthe Electronic Residency ApplicationService (ERAS) as their civilian counterpartsdo, only the Army uses a computerizedmatching process similar to theNRMP matching process to selectresidents. The Navy and the Air Forceemploy a scoring board, using applicantand program rank order lists to maketheir selections. Decisions are made inearly December, and results are sent tothe NRMP so that applicants who registeredfor the NRMP Main ResidencyMatch, but who obtained a militaryresidency training position, can bewithdrawn from the NRMP. Applicantswho have been notified by the military inearly December that they are authorizedto seek civilian deferred residencytraining can participate in the NRMP oranother appropriate civilian matchingprogram.G. Couple’s matchingSome matching programs, including theNRMP, the IRRP, and CaRMS, offer theopportunity for two partners to linktheir rank order lists so that bothresidency applicants can match toprograms suited to their needs. Thepartners enroll individually in the matchand indicate that they want to be in thematch as a couple. They form pairs ofchoices on their rank order lists, whichare then considered in rank order in thematch. The couple matches to the mostpreferred pair of programs on the rankorder lists for which each partner hasbeen offered a position.No matching program has access toinformation from another matchingprogram. Applicants, therefore, shouldnot accept advice to try to find out aboutanother match under the guise ofcreating a “couple’s match,” since thatattempt would represent a matchviolation. More specifically, a matchingprogram may advise an applicant that itoffers a “couple’s match” when a couple’smatch is not possible. When twopartners participate in differentmatching programs, they cannot linkrank order lists between matches. If onematching program requests that anapplicant’s partner contact a residencyprogram that participates in anothermatch in order to inquire about thelikelihood of matching, the partner isbeing asked to violate the terms of thatmatch. Almost every match contractprohibits applicants and programs frominquiring about how one plans to rankthe other. Consequently, when partnersparticipate in different matches, the onlyway to ensure that both partners willmatch to programs in the samegeographic region is for the partnerparticipating in the later match to rankonly programs in the same geographicarea in which the partner in the earliermatch obtained a position.H. Match outcomes1. A binding commitmentIt is the policy of every matchingprogram that a match between anapplicant and a program is a bindingcommitment. Failure to honor thatcommitment is a violation of thecontract signed during the registrationprocess. Penalties for violationsvary among the matches. Somematches permit applicants to seek awaiver of their match commitment,either by mutual agreement of theapplicant and program or bycontacting the match office directly.The applicable rules are available oneach match program’s Web site.2. The “early matches”Applicants participating in some earlymatches — the San Francisco Matchand the AUA Urology Match — receivetheir match results in January or earlyFebruary. In some cases, a preliminaryposition will be “held” by the sameinstitution to which the applicantmatched. In other cases, applicantswho obtained positions through theearly matches will be required toregister for the NRMP Main ResidencyMatch to secure a position for theirpreliminary training. (In all cases, U.S.allopathic medical school seniors mustparticipate in the NRMP for theirpreliminary positions.) Applicants whoobtain positions in the AOA Internand Resident Registration Programhave a commitment for their firstpostgraduate year and need not participatein the NRMP Main ResidencyMatch for a preliminary position.12Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and Beyond3. Unmatched “early match” applicantsApplicants who do not match in oneof the early matches may seekpositions after the match concludes,using the list of available positionsthat is typically posted on the relevantmatching program’s Web site.The San Francisco Matching Programuses a Vacancy Information Systemthat lists vacant post-Matchpositions, as well as positions thatbecome available throughout theyear. Applicants must complete the“Applying to Post Match Vacancies”form that is posted on the SanFrancisco Match Web site(www.sfmatch.org).The AUA Urology Match postsvacancies in urology on its Web site(www.auanet.org/residents/resmatch.cfm) after the AOA Matchconcludes and throughout the year.Applicants must contact programsdirectly.At the conclusion of the AOAIRRP Match, the procedures to befollowed by unmatched applicantsand institutions with availablepositions are posted on the IRRPMatch Web site(www.natmatch.com/aoairp).The NRMP begins to release theresults of the Main Residency Matchon Monday of Match Week, whenapplicants are told whether, but not towhich programs, they have matched.At Noon EST on Tuesday of MatchWeek, when the NRMP releases thelist of unfilled programs, “theScramble” begins. Information aboutvacant positions is posted to theNRMP R3 system (www.nrmp.org) ina “dynamic” format so that programscan delete positions from the list asthey are filled. The list indicates howthe program will receive applications:through ERAS or by e-mail or fax. TheList of Unfilled Programs remains onthe NRMP Web site until May 1.After May 1, services such asFindAResident (www.aamc.org/findaresident) provide a continuouslyupdated list of residency vacancies.13Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondVI. Preparing to ApplyThis section provides an outline of thevarious components required for theresidency application process.A. What information is needed?A full application to residency usuallyconsists of the following items:1. A completed applicationMost residency training programs,and a growing number of fellowshipprograms, use ERAS to receive theirapplications. The ERAS CommonApplication Form (CAF) is used inapplying to ERAS-participatingprograms. The application worksheet,which gives a preview of the data thatwill be required, is available in PDFformat on the ERAS applicant Website (www.aamc.org/students/eras).Programs not participating in ERASmay request a printout of the ERASapplication in lieu of completing acustom application form for thatprogram.Programs participating in the SanFrancisco Matching Program use theCentral Application Service (CAS) toreceive applications(www.sfmatch.org).Some programs use the UniversalApplication for Residency form. Acopy can be obtained directly fromthe program, or from the program’sWeb site. A copy is also available onthe NRMP Web site (www.nrmp.org,Application Processes).Some programs have developed theirown Web site or processes for onlineapplications. Check with individualprograms for more specific information.2. A personal statementThe personal statement describes theapplicant’s individual motivations fora career in medicine, and includesinformation about how the applicantbest “fits” the specialty to which he orshe is applying.In ERAS, an applicant may create asmany personal statements as desired.Thus, an applicant can use thepersonal statement to customize theinformation sent to each individualresidency training program. Someprograms request that specific itemsbe included or addressed in thepersonal statement. Check eachprogram’s Web site for more information.Although applicants may use variousservices and Web sites to obtain hintson how best to construct theirpersonal statements, they are stronglyadvised not to take text directly fromsample personal statements. Programstaff have noticed the same textoccurring repetitively in personalstatements from different applicants,and they do not look favorably uponthis practice. At best, programs mayconsider such applicants to beunmotivated and not offer them theopportunity for an interview withprogram representatives. At worst,they may consider this to be plagiarismand unprofessional conduct, andmay report offending applicants toERAS, the NRMP, the ECFMG, or theAmerican Board of MedicalSpecialties (ABMS, www.abms.org)for investigation.A personal statement typicallyconsists of information about one’sprofessional background, a summaryof academic and clinical qualifications,how the decision was made topursue medicine and the chosenspecialty as a career, and career goals.The personal statement also shouldreflect information about one’spersonality and style that is relevantto residency training in the selectedspecialty, but the personal statementshould not be an exhaustive autobiography.It is an opportunity toshowcase one’s unique qualities,talents, and professional passions andto explain how they might beexpressed in a career in medicine andthis specialty.Many students consult withpersonnel in their medical school’sstudent affairs office or universitywriting center for assistance increating a succinct and effectivepersonal statement.3. Letters of recommendationMost programs require a minimumof three letters of recommendationfrom each applicant. In ERAS, theapplicant may assign and send up tofour letters to each program. Thefourth slot is available for thosedocuments required by programs thatare considered legitimate ERASdocuments. These include the socalled“California letter” (theApplicant Evaluation Status Letterfrom the Medical Board ofCalifornia), which internationalmedical graduates must submit whenthey apply for residency training inthe state of California. ERAS also14Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and Beyondallows this slot to be used to transmita military evaluation form when anapplication is being submitted tomilitary residency programs.Some programs may request that oneof the letters of recommendation befrom the department chair in therespective specialty at the applicant’smedical school. The applicant shoulddesignate that this letter is from thedepartment chair when filling in theletter writer’s “Title/Department” inERAS.Ideally, the applicant will have metpersonally with each letter writer andwill have provided specific instructionsto him or her before the letter iscomposed and submitted. It is notinappropriate, in requesting a letterof recommendation, for an applicantto ask the letter writer whether he orshe would be able to write a goodletter for the applicant. If the letterwriter is in any way unable to providethis assurance, then it might be bestfor the applicant to select anotherindividual to serve as a reference.The applicant should ensure that theletter writer is familiar with what isrequired in a letter of recommendationfor a residency training programapplication; letters that are too briefand too generic may detract from anotherwise competitive application.The letter writer should be provided,in advance, with a copy of theapplicant’s resume for referencepurposes. The applicant should alsofollow up with the letter writer toensure that the letter of recommendationhas reached its destinationprior to the deadline date.4. USMLE and/or COMLEX scorereportsThe National Board of MedicalExaminers (NBME, www.nbme.org)and the ECFMG (www.ecfmg.org)charge a fee for unlimited electronictransmittals of an applicant’s USMLEStep score reports via ERAS. TheNational Board of OsteopathicMedical Examiners (NBOME,www.nbome.org) charges a fee forunlimited electronic transmittals ofthe applicant’s COMLEX scorereports via ERAS. These fees includesending the score report to additionalprograms subsequently applied to, aswell as updating the score report withany new scores.For programs not participating inERAS, applicants should visit theUSMLE (www.usmle.org) andNBOME (www.nbome.org) Web sitesfor additional information onrequesting a paper score report.5. Medical Student PerformanceEvaluation (MSPE)A formal evaluation from theapplicant’s medical school usuallyaccompanies his or her residencyapplication. For students at andgraduates of U.S. allopathic and osteopathicmedical schools, the dean ofstudent affairs or a school official in acomparable position typicallycompiles the Medical StudentPerformance Evaluation (MSPE),previously known as the “Dean’sLetter.” For applicants to ACGMEaccreditedresidency trainingprograms, MSPEs are released on orafter November 1 of each applicationseason.The MSPE represents an evaluation ofa medical student’s performanceduring the process of medicaleducation; it is not intended to be arecommendation or a prediction offuture performance. The MSPE shoulddescribe, in a sequential manner, thestudent’s performance relative to hisor her peers through three full years ofmedical school and, as much aspossible, the fourth year. The MSPEshould include an assessment of boththe student’s academic performanceand professional attributes.The MSPE, as an institutionalassessment, should be considered acomponent of the student’spermanent record, and thus shouldbe available for a student’s review.The student should be permitted tocorrect factual errors in the MSPE,but not to revise evaluative statements.The AAMC document, “AGuide to the Preparation of theMedical Student PerformanceEvaluation,” can be found on theERAS Web site(www.aamc.org/students/eras,Resources to Download).International medical graduates orstudents can request that an appropriateofficial at their medical schoolwrite an evaluation equivalent incontent and format to the MSPE.International medical graduates whowill not be able to provide an MSPEor its equivalent should indicate thatfact on the Miscellaneous tab of theERAS application.15Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and Beyond6. Medical school transcriptSchools typically issue an applicant’smedical school transcript to residencytraining programs in September orOctober. Students can request thatupdated copies be transmitted, asnecessary, to reflect new information.International medical graduates orstudents who will not be able toprovide a medical school transcriptshould indicate that fact on theMiscellaneous tab of the ERASapplication.7. PhotographThe applicant’s photograph is usuallyan optional part of the residencyapplication. However, most programsprefer to see a photograph, and it isgood practice to include one withother application materials. Thephotograph should be clear, and itshould present a professionaldemeanor and depict the applicant inappropriately professional attire.In ERAS, applicants may assign thephotograph as a supportingdocument for specific programs.Thus, applicants control whichprograms receive a photograph, andwhen. Once it has been received,programs cannot view the photographuntil after the applicant hasbeen invited to interview.B. Waiving right to see letters ofrecommendationsWhen an applicant requests a letter ofrecommendation in support of his or herresidency application from a medicalschool faculty member, the facultymember may request the applicant towaive the right to see that letter. Bywaiving the right of access to a letter ofrecommendation, the applicant permitsthe letter writer to be candid andstraightforward in a written assessment,and the reader of the letter is reassuredthat the applicant has not unduly influencedthe letter writer in terms of theletter’s content. Many persons involvedin the resident selection process wish toknow whether or not an applicant haswaived the right to see the content of aletter written on his or her behalf, sincesome believe that letters to which theright of access has been waived providemore reliable, valid, and straightforwardinformation than those to which accesshas not been waived. For this reason,most letter of recommendation forms(including those used by ERAS)document whether or not the applicanthas waived his or her right of access tothe letter.The final decision about waiving theright to see a letter of recommendationis that of the applicant. If access has beenwaived, an applicant should not read theletter at any time, even if provided anopportunity to do so. Residency programdirectors should be aware that revealingthe content of such a letter, eitherpurposely or accidentally, could impairthe relationship between the letter writerand the residency program. Programdirectors should consider letters ofrecommendation to be confidential.Revealing the content of a confidentialletter during a program’s application andinterview process could result in thatrecommender being unwilling in thefuture to provide substantive informationabout residency applicants to theprogram, thus decreasing the program’sability to assess applicants’ personalcharacteristics and qualifications.16Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondVII. ApplyingThis section explains the multiple proceduresrequired to apply to residencyprograms in various specialties.A. The Electronic ResidencyApplication Service (ERAS)ERAS is used by 57 residency and fellowshipspecialities. A full list of participatingspecialities and programs is available athttps://services.aamc.org/eras/erasstats/par.Program participation in ERAS isvoluntary. Of those specialities that useERAS, 95 percent of programs typicallyare ERAS participants. The other fivepercent of programs are listed in ERAS,but they cannot be selected for ERASapplication. Contact those programsdirectly for application information.Programs list different types of trainingoffered in ERAS, such as Preliminary,Categorical, Advanced, and Reserved. SeeSection V, Matching Processes, for definitionsof the different types of positions.It is important to investigate programsbefore applying by contacting theprograms, reviewing their Web sites andbrochures, and considering program andspecialty information available at theACGME (www.acgme.org) and AMAWeb sites (www.ama-assn.org).The ERAS application can be completedon the MyERAS Web site(www.aamc.org/eras). An ERASelectronic “token” (a 16-character onetime-useaccess code) is required foraccess to the MyERAS Web site, and thetoken must match the school of graduation.A token can be obtained from themedical school for applicants who arestudents in, or graduates of, U.S.allopathic and osteopathic medicalschools; from the ECFMG for internationalmedical graduate applicants; orfrom CaRMS for applicants fromCanadian medical schools.Please note again that registering forERAS is not the same as registering forthe NRMP, and vice versa. There areseparate registration processes andrequirements for each service.Registration for ERAS opens on July 1for all applicants.Once ERAS registration has beencompleted, applicants have the ability towork on their applications before the ERASPostOffice opens. The opening of the ERASPostOffice permits applicants to send applicationsto programs, schools to transmitsupporting documents, examining boardsto transmit scores, and programs to receiveapplications. Once the ERAS PostOfficeopens, the application can be submitted toERAS and, through ERAS, to residencyprograms of interest. The ERAS PostOfficeopens annually for the majority ofresidency positions on the first working dayin September, and for osteopathic medicineinternships on July 15.Registration for the NRMP(www.nrmp.org) opens on August 15 ofeach year and continues until the rankorder list deadline, although anadditional late registration fee appliesafter December 1.Residency program applications shouldbe provided to residency programs wellin advance of the programs’ deadlines.Since delays in the arrival of supportingdocuments for an application can affectwhether a residency training programconsiders the application to be complete,last-minute applications should beavoided. In general, an ERAS applicationshould be submitted to programs inSeptember or early October.For ERAS, the Common ApplicationForm (CAF) and the applicant’s personalstatement can be completed on theMyERAS Web site. Applicants candesignate the supporting documents thatwill be supplied for their applications(e.g., USMLE or COMLEX scoretranscripts, letters of recommendation).Applicants should investigate and selectprograms of interest and, mostimportant, assign appropriatesupporting documents to each program.Applications to programs are finalized bysubmission of the application fee toERAS. Following fee payment, the ERASapplication and personal statement willbe available to programs within twohours. Supporting documents will betransmitted to programs as they areprocessed by the medical schools andexamining boards.B. Central Application System (SanFrancisco Match)Applications for programs in specialtiesusing the San Francisco Match must besubmitted using the Central ApplicationSystem (www.sfmatch.org). Registrationfor the San Francisco Match opens inMay of each year. Central ApplicationSystem materials are distributed in Mayor June.Residency applications should beprovided to residency programs well inadvance of program deadlines. Sincedelays in the arrival of supportingdocuments for an application can affectwhether a program considers the appli-17Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and Beyondcation to be complete, last-minute applicationsshould be avoided. In general, theCAS application should be submitted toprograms by mid-August.C. Paper-based applicationsSome residency training programs usethe paper-based “Universal Applicationfor Residency” form, a copy of which canbe obtained directly from the programor from the program’s Web site. Copiesalso are posted on the NRMP Web site(www.nrmp.org, Application Processes).Some programs have developed theirown Web sites or processes for onlineapplications. Check with the individualprograms for additional details.D. Tracking applicationsFor applications made through ERAS, itis possible to track the delivery of theapplication using the ApplicantDocument Tracking System, which isaccessible from the MyERAS Web site.When mailing paper applications, applicantsshould request a return receipt orshould track delivery in some otherreliable manner.ERAS includes a Message Center, whichcontains copies of e-mails sent byprograms to residency applicants, ifthose e-mails were transmitted via theERAS system. Applicants should log intoMyERAS to monitor their MessageCenter on a regular basis.E. Ensuring completion ofapplicationsIt is the applicant’s responsibility toensure that his or her application iscomplete at residency training programsof interest. If a faculty member or otherletter writer has not yet submitted aletter of recommendation, the applicantshould follow up with the letter writer ina timely manner or request a replacementletter from another reference.F. November 1 release date forthe Medical Student PerformanceEvaluation (MSPE)U.S. allopathic medical schools haveagreed upon a common release date ofNovember 1 for the Medical StudentPerformance Evaluation (MSPE). AllMSPEs transmitted via ERAS areautomatically held until November 1.Paper copies sent by schools are notmailed before November 1.Osteopathic medical school applicantsapplying to ACGME-accreditedprograms are also subject to theNovember 1 MSPE release date.Prior year graduates applying to PGY-1or PGY-2 positions that are open tocurrent U.S. medical school seniors arealso subject to the November 1 MSPErelease date.Osteopathic medical school applicantswho are applying to osteopathicmedicine internships are not subject tothe November 1 release date. TheirMSPEs are transmitted as they areavailable.Prior year graduates applying toimmediately vacant PGY-2 positions orto other positions that are not open toU.S. medical school seniors are also notsubject to the November 1 MSPE releasedate. MSPEs for these applicants may besent outside of ERAS as soon as they areavailable.18Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondVIII. Visiting Residency Training ProgramsThis section provides information andsuggestions regarding applicants’ preparationfor visiting residency programs ofinterest.A. Applicants’ assessment ofprogramsResidency applicants have multiplesources of information available to them,including:• The Careers in Medicine Specialty Pages(www.aamc.org/careersinmedicine),which contain both residency traininginformation and physician workforceand salary data.• The AMA’s FREIDA Online(Fellowship and Residency ElectronicInteractive Database Access), an onlinedatabase (www.ama-assn.org/go/freida)containing information on 8,000+graduate medical education programsaccredited by the ACGME, as well ason 200+ combined specialty programs.FREIDA Online permits comparisonof programs on such factors as lengthof training, program size, number offaculty, work and education environments,and compensation andbenefits, as well as on the career plansof graduates from various specialties asreported by their program directors.• The AMA Graduate MedicalEducation Directory and the GraduateMedical Education Library on CD-ROM(www.ama-assn.org/go/mededproducts).Users can search programs usingdifferent criteria, and AMA studentmembers can save their searches andprint program mailing labels.• The AMA Minority AffairsConsortium Transitioning toResidency: What Medical StudentsNeed to Know (www.ama-assn.org/ama/pub/category/6672.html)• The AAMC Organization of ResidentRepresentatives (OSR) brochure, Don’tForget to Ask: Advice from Residents onWhat to Ask During the ResidencyInterview (www.aamc.org/members/osr/residencyquestions.pdf)B. Assessment criteriaFor the vast majority of applicants, theprimary criterion on which decisions aboutthe rank ordering of programs are made isbased on the quality of the educationalprogram in relation to the applicant’sfuture professional plans. Numerous othercriteria also should be assessed by theapplicant, both prior to a program visit andduring the actual visit; these are referencedin Section IV, B, above.C. Program visits1. Interview preparationa. Be prepared to discuss yourbackground and career goals,including:• Your own application and itscontents• Clerkship experiences and otherexperiences relevant to theresidency and specialty• Your prior research efforts• Your ideal career path.b. Be prepared to answer succinctlythe following question: “Tell meabout yourself.”c. Other issues you should beprepared to discuss:• Your resume, prior correspondence,and your references for theprogram• Your strengths and weaknesses• How you might contribute to thisspecialty or program.d. Review the program’s contract,which should be available to applicantson the program’s Web site.e. Know the specialty area and thespecific residency program;become knowledgeable about:• The specialty: trends in workforceand practice environments, trainingrequirements, etc.• The program: mission and goals,affiliated clinical facilities, clinicaland research interests of the faculty,information on the program Website, etc.f. Interview logistics:• Know when and where you aresupposed to arrive• Plan to arrive early to resolve anyproblems that may develop (e.g.,traffic, parking, etc.)• Get a good night’s sleep beforehand• If possible, make a “trial run” to thesite of the interview.19Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and Beyonde. Attire and appearance:• Dress appropriately and professionally• Maintain a professional and politedemeanor with everyone youencounter; some programs affordthe departmental secretary a voteon the selection committee• Avoid distracting elements in yourattire, appearance, grooming,jewelry, etc.f. Rehearse, if possible:• “Try out” answers to questions withyour advisor or a trusted friend• Attend any available interviewworkshops presented at your school• Develop your interview skills,poise, and presentation withpractice.g. Expect the unexpected and potentiallydifficult questions:• Anticipate areas of concern in yourapplication (e.g., a grade, USMLEscore, or leave of absence) andprepare, in advance, an effective,nondefensive ways of addressingthem.h. Ask good, relevant, and importantquestions:• Assess the strengths and challengesof the program in relationship toyour individual professional plans• Inquire about training options,recent program successes, assessmentpolicies and practices, andplans for the future• Avoid asking faculty membersmundane questions (focusing onstipend, call schedules, leavepolicies, parking, etc.)• Focus on substantive questionsabout mutual benefits – how theapplicant and program would bothbenefit from a successful match.2. Creation of an information grid foruse in program assessmentCreate an information grid for usein program assessment and includeall factors that are crucial to yourresidency training programselection.3. Completion of the information gridfor each program visitedComplete the information gridimmediately after each visit byassessing relevant factors for thatprogram in comparison withprograms previously visited.4. Second visits• Student affairs officers and residencyprogram directors are currentlydiscussing the advisability of secondvisits to residency training programs• Program directors are consideringimplementation of a proposal fromthe student affairs community that asingle visit to a residency trainingprogram by an applicant be consideredthe standard for both the applicant’sassessment of the program and theprogram’s assessment of the applicant• Although this standard would notprohibit voluntary second visits by anapplicant for any purpose, a secondvisit would not become a requirementof the assessment process for anyresidency applicant.20Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondIX. After the Program VisitThis section provides information andsuggestions regarding follow-up activitiesfor applicants after their visits toresidency programs of interest.program directors may regard anapplicant’s statement of commitmentto a program in a thank-you note asdisingenuousAfter each program visit, it is recommendedthat the applicant:• Complete an assessment for eachfactor on the information grid for thisprogram, including both factual informationand personal perceptions of fitwith the program• Synthesize information and perceptionsabout all programs by comparingrelevant factors for each programvisited; maintain an up-to-dateranking of all programs visited• Prioritize programs of interest byrefining choices, based on the assessmentdata entered in the informationgrid following each program visit;begin the process of rank orderingthose programs of continuing interest• Send a thank-you note to programstaff after the visit, emphasizing theappealing characteristics of theprogram, but be aware that some• Begin rank-ordering residencyprograms on the basis of the datacollected and resulting personal preferences;consult with residency advisorsabout these ratings• Factors to be considered in determiningthe number of programs torank include the competitiveness ofthe specialty and of the specificprograms being ranked, as well as theapplicant’s qualifications• Applicants are well advised to rankonly those programs that theyconsider acceptable, i.e., thoseprograms where they would be happyto undertake residency training• Applicants are also well advised not toinclude on the rank order list anyprogram deemed unacceptable for anyreason• Complete, submit, and certify the rankorder list prior to the deadline.21Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondX. Residency Application OutcomesThis section addresses applicants’ responsibilitiesand opportunities based on theoutcome of their match participation.A. Obligations of matchedapplicantsIt is the policy of every matchingprogram that the match between theapplicant and the program is a bindingcommitment for both sides. Failure tohonor that commitment is a violation ofthe contract signed during the registrationprocess. Penalties for violations varyamong the different matching programs.Some matches allow applicants to seek awaiver of the match commitment, eitherby mutual agreement of the applicantand program or by contacting the matchoffice directly. The “rules” are availableon each match’s Web site.B. “Early match” outcomesApplicants participating in some “earlymatches”—the San Francisco MatchingProgram and the Urology Match—receive their match results in January orearly February. In some cases, a preliminaryposition will be “held” by the sameinstitution to which the applicantmatched. In other cases, applicants whoobtain residency positions through theearly matches will be required to registerfor the NRMP’s Main Residency Matchto secure preliminary training. (U.S.allopathic medical school seniors mustparticipate in the NRMP for theirpreliminary positions.) Applicants whoobtain positions in the AOA Intern andResident Registration Program have acommitment for their first postgraduateyear and need not participate in theNRMP Main Residency Match for apreliminary position.Applicants who do not match in one ofthe early matches may seek residencypositions after that match concludes,using the list of available positions thattypically is posted on the match’s Website. The San Francisco MatchingProgram uses a Vacancy InformationSystem that lists post-Match positions, aswell as positions that have become vacantthroughout the year. Applicants mustcomplete the Applying to Post MatchVacancies form that is posted on the SanFrancisco Match Web site to participatein post-Match searches for vacantpositions.The Urology Match posts vacancies onits Web site after the match hasconcluded and throughout the year.Applicants must contact those programswith vacant positions directly.At the conclusion of the AOA Intern andResident Registration Program (IRRP)Match, the procedures to be followed byunmatched applicants and institutionswith available positions are posted onthe IRRP Web site.The NRMP begins to release the resultsof the Main Residency Match onMonday of Match Week, when applicantsare informed whether, but not to whichprograms, they have matched. At noonon Tuesday of Match Week, when theNRMP releases the list of unfilledprograms, “the Scramble” begins.Information is posted on the NRMPWeb site in a “dynamic” format, so thatpositions can be deleted from the list asthey are filled. The list indicates theformat in which the programs willreceive applications: via ERAS or bye-mail or by fax.C. “The Scramble”On Monday of Match Week, the NRMPnotifies applicants whether they havebeen matched to a residency trainingprogram. The following day, the NRMPnotifies programs whether they haveunfilled positions and, if so, how many.Two days later, full details of the resultsof the Main Match are released, andmost U.S. schools hold Match Dayceremonies.“The Scramble” takes place during twodays between Noon on Tuesday andNoon on Thursday of Match Week. Thisperiod is designed to permit unmatchedapplicants to locate residency positionsin programs that have unfilled positionsso they can begin planning for thetransition from medical school toresidency and participate in Match Dayceremonies.Typically, residency training programsreceive Scramble applications after aninitial telephone call from the applicant.The application can be faxed, e-mailed,or sent via ERAS or FindAResident (seebelow). Many programs prefer to receivean initial exploratory phone call, as itmakes the application more personal andtangible. Programs continue to seek thesame caliber of applicants during theScramble as they did prior to the Match.Applicants may now consider programswhich they had not previously considered.Most programs at this stage of theScramble process do not have the timefor a leisurely review of an ERAS applicationor a faxed application. They areprimarily seeking applicants who displaya good attitude, a strong work ethic, andsufficient skills to complete residencytraining and the relevant specialty board22Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and Beyondexaminations; this type of importantinformation can sometimes be transmittedto them by means of a recommendationin the form of a letter ortelephone call from someone whoseopinion they trust (e.g., a facultymember, a department chair, a studentaffairs dean).Unmatched U.S. seniors should workclosely and collaboratively with theirschool staff members during theScramble. Many schools ensure thatknowledgeable faculty members anddepartmental personnel are available toprovide advice and support tounmatched students as they apply foravailable positions in residency programsin their chosen specialty.During the Scramble, internationalmedical graduates should target amanageable number of programs in aspecialty in which they have a realisticchance of being accepted. Preparation ofa good verbal introduction for use in aninitial telephone call to programs withunfilled positions is strongly recommended.Merely providing ERAS applicationmaterials or faxed applicationswithout first making personal contactwith residency program staff members isa less effective strategy for securing anavailable position during the sometimeshectic Scramble process. Residencyprogram staff are not likely to considerapplicants who use for-profit servicesthat claim to distribute applications tolarge numbers of programs or that create“personal” Web pages for applicants.D. FindAResident and OtherResourcesResidency training programs that do notfill all of their positions during “theScramble” are then able to invest time ina comprehensive review of submittedapplications. Many programs post stillvacantpositions on online Web sites,including that of the AAMC-sponsoredFindAResident program(www.aamc.org/findaresident). Someresidency programs choose to use theirspecialty association Web sites or otherWeb-based services for the samepurpose.FindAResident is an AAMC service thatassists training program personnel toidentify interested applicants for postmatchand ad-hoc vacancies that occurin residency and fellowship trainingprograms. FindAResident advertisesavailable positions on a year-round basis,although information about mostavailable positions is posted in themonths between Match Week and thestart of residency training on July 1.FindAResident permits applicants tosearch a database of available positions byspecialty and by location, to reviewprogram selection criteria, and to notifyprograms of their potential interest.FindAResident also permits residencyprogram applicants to create an onlineresume and to make this resume availableto residency programs with availablepositions. In this way, training programscan search for qualified applicants andnotify them of open positions for whichthey might be suitable candidates.The FindAResident subscription runs forone year, from September 15 toSeptember 14 of the subsequent year.Within that period, subscribers can makeunlimited notifications to residencytraining programs as positions becomeavailable.Information about subscription fees forFindAResident can be found at:www.aamc.org/FindAResident.Other resources of interest to applicantsseeking to identify open positions inresidency programs can be found in theBibliography (Appendix A).23Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondXI.The Transition from Medical School to ResidencyThis section provides advice and recommendationsfor easing the transitionfrom medical school to residencytraining.A. Insurance programsAfter Match Day, it is important forincoming residents who have graduatedfrom U.S. medical schools to review thespecifications of program- or institutionsponsoredinsurance plans to ensureuninterrupted health, disability, andother coverage between their graduationfrom medical school and enrollment inresidency-sponsored programs. Inparticular, new residents are well advisedto determine whether health and/ordisability insurance plans sponsored bythe residency training program or itsparent institution begin on the first dayof enrollment in the program or at somelater date, and whether those insuranceprograms exclude coverage for preexistingconditions for a specified periodfollowing initiation of coverage. If suchexclusions exist, the temporary extensionof medical school-sponsored insuranceprograms (which may involve thepayment of additional insurancepremiums) might be advisable.B. Financial aid processesMedical students who have receivedfinancial aid from the federal Staffordloan program are required by federalregulations to attend, prior to graduation,a financial aid exit interview. In thatsession, students are provided with informationon the terms of their loans(interest rates, interest capitalization,grace periods, deferment, forbearance,repayment, and consolidation) and ontheir rights and responsibilities.Financial aid administrators alsotypically provide graduating studentswith a summary and/or history of theirstudent loan borrowing. An excellentsource for tracking down informationabout federal student loans (for thosewho borrowed during college orgraduate studies prior to attendingmedical school and who cannot findtheir loans) is the National Student LoanData System (www.nslds.ed.gov).Graduates are well advised to informeach of their loan servicers of their newcontact information as soon as theyknow it, and to verify with their loanservicers the status of each of their loans(i.e., the length of the grace period; thenumber of months before the expirationof any grace period; and the qualifications,application process, and relevantdeadline dates for deferment). Manyloan servicers also provide Web-basedaccess to loan information that affordsborrowers access to their account informationon a 24-hour-per-day, seven-daya-weekbasis. Residents are also encouragedto take advantage of those services.Federal Stafford Loan interest rateschange annually on July 1. The newinterest rates are announced at the endof May. In a rising interest rate environment,residents are encouraged to payclose attention to the May rate changeannouncement. Residents also canbenefit from the AAMC MONEYMAT-TERS listserv, which alerts residents tochanges in student loan programs ofimportance to residents. Residents cansign up for the listserv atwww.aamc.org/debthelp. An impendingsignificant interest rate increase mayresult in residents’ wanting to consolidatetheir federal student loans in orderto lock in a lower interest rate.C. VisasInternational medical graduates who areneither U.S. citizens nor permitted by theU.S. Citizenship and Immigrant Servicesbureau of the U.S. Department ofHomeland Security (http://uscis.gov/) toreside permanently in the United States(i.e., as a permanent resident or greencard holder) must apply for and obtainappropriate visas for themselves and anyaccompanying family members prior toparticipating in a residency trainingprogram.The J-1 visa, a temporary nonimmigrantvisa reserved for participantsin the Exchange Visitor Program, is onevisa type commonly used by foreignnational physicians for this purpose. TheExchange Visitor Program was establishedby the U.S. Department of State toenhance international exchange andmutual understanding between thepeople of the United States and othernations.The duration of stay for Exchange VisitorProgram physicians is limited to the timetypically required to complete a graduatemedical education program. ExchangeVisitor Program physicians with J-1 visasare required to return to their homecountry for at least two years followingcompletion of their residency trainingprogram before being eligible for certainother U.S. visas. The U.S. Department ofState has designated the EducationalCommission for Foreign MedicalGraduates (ECFMG, www.ecfmg.org) asthe sole visa sponsor for all J-1 ExchangeVisitor Program physicians who participatein clinical training programs in theUnited States. In this capacity, ECFMG isresponsible for ensuring that physicians24Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and Beyondholding J-1 visas and their host institutionsmeet the federal requirements forparticipation. ECFMG does not sponsorphysicians for other U.S. visa types.Information about general eligibilityrequirements for the Exchange VisitorProgram can be found at:www.ecfmg.org/evspAn H-1 visa, a visa for a temporaryworker sponsored by an employer, isanother option for international medicalgraduates seeking training in a U.S.residency program. The U.S. Citizenshipand Immigrant Services bureau grantsH-1B visas to temporary professionalworkers who are required to have aprearranged job, either temporary orpermanent, in a professional field beforethey receive a visa. There is an initialadmissions period of three years, withthe possibility of extending one’s stay fora second three-year period. After stayingin the United States for the maximumsix-year period, a foreign citizen isrequired to live abroad for one yearbefore re-entering the United States inan H or L visa category.In ERAS, applicants have the option toenter both their current visa status andthe visa status they expect to hold duringresidency training. This allows applicantsthe opportunity to indicate an expectedvisa change.International medical graduates who areneither U.S. citizens nor permanentresidents are strongly urged to consultpromptly with the directors of theresidency training programs at whichthey are interviewed regarding relevantvisa issues.D. ContractsIt is National Resident MatchingProgram (NRMP) policy that residencytraining programs “are expected toprovide complete and accurate informationto interviewees, including a copy ofthe contract the applicant will beexpected to sign if matched to theprogram and all policies of the institutionregarding eligibility for appointmentto a residency or fellowshipposition. This information must becommunicated to interviewees in writingprior to the relevant rank order list certificationdeadlines.”It is very important that residency applicantscarefully review the contract of anyresidency training program in whichthey are interested prior to finalizingtheir rank order lists because theapplicant will want to be reassured thatthere is mutual compatibility betweenthe institution and the applicant andbecause the match is contingent uponthe applicant being able to meet theinstitution’s requirements.E. HousingSoon after the announcement of matchresults, most future residents begin theprocess of identifying and arranging forhousing near their residency trainingprogram.Depending on their financial circumstances,some residents, knowing thatthey will be residing in the same area fora minimum of three to five years, chooseto purchase a home during the period oftransition from medical school toresidency. Other residents decide to rentrather than purchase so they can familiarizethemselves with the region prior tomaking such a significant investment.Various individual and personal considerationsmust be taken into account byincoming residents as they consider theirhousing options. These include theamount of time available during thealready challenging PGY-1 year toperform home- and yard-related chores,the amount of personal or family disposableincome available for mortgagepayments, and the fact that somegraduates do not have an income sourceduring the transition from medicalschool to residency training.For some residents and in somelocations, a home can be a good investmentduring residency training; for otherresidents and in other locations, therental option is a more reasonablechoice. At the very least, care must betaken to ensure that all relevant financialconsiderations are taken into account inreaching this decision.F. Employment for spousesFor residents with spouses or domesticpartners, the transitional period betweenMatch Day and the beginning ofresidency training provides an opportunityfor the identification of suitableemployment for spouses or partners.Although some programs and theirsponsoring medical schools or hospitalsare able to provide formal or informalassistance in identifying such employmentopportunities, provision of thistype of assistance is often not available.In any event, it may be advisable tosubscribe to the local paper to read joblistings.25Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondG. SchoolsIncoming residents with school-agedchildren also may use the time betweenMatch Day and the beginning ofresidency training to investigate educationalopportunities for their children inthe new location. Residency programstaff who have children of their own arefrequently good sources of informationabout the quality of individual schoolsand school districts in the region.Identifying an appropriate school districtand school can strongly influence thechoice of preferred housing location fora resident and his or her family. Finally,the fact that residency training programsusually begin on July 1 permits sufficienttime for the enrollment of children inschool and the provision of thedocumentation (e.g., immunizationrecords, records from schools previouslyattended) required to begin school in thefall term.H. Hospital credentialing andmedical licensureThe residency program director andmembers of his or her staff usuallyprovide incoming residents with informationabout what will be required ofthem with respect to hospital credentialingand medical licensure, includingapplication materials for any requiredtraining license. It is important to reviewthis information promptly after it arrivesand to be familiar with hospital and statemedical board policies. It is imperativethat all materials requested by theresidency training program be completedand submitted promptly; failure to do somay result in a delay in beginningresidency training.Incoming residents should be aware thatsome hospitals and some states requireresidents to undergo a criminalbackground check prior to beginningresidency training. Additional informationabout this and other requirementsfor residency training can be obtainedfrom the program director.I. Orientation and programstart datesThe majority of residency trainingprograms begin annually on or aboutJuly 1. Most include an orientationperiod at the beginning of the program,although the length and content oforientation programs vary from institutionto institution. Since orientationprograms may begin in mid- to late-Junerather than on or after July 1, incomingresidents should check with residencyprogram staff regarding expectationsabout program orientation and startdates.J. BudgetingSince the first paycheck for a newresident may not arrive until August 1 orthereafter, beginning first-year residentsare strongly encouraged to set asidemoney, if possible, from fourth-yearmedical school financial aid disbursementsor monetary graduation gifts inorder to ease the financial transition inthe months between medical schoolgraduation and receipt of the firstresidency paycheck. Ensuring thatstudent loans are either in grace or indeferment, if applicable, or in forbearancealso results in peace of mind for thenew resident.Some programs provide incomingresidents with the opportunity to requestan advance on their contract stipend (upto a specified maximum amount) toassist with the financial transition frommedical school to residency training,with their subsequent bi-weekly ormonthly paychecks adjusted accordinglyover the next several months of theirPGY-1 year to repay the advance. Iffinancial circumstances make this anappealing option, check with theprogram director following Match Dayto determine whether this or a similarprogram may be available.Some residents have also reported thatthe services of an independent financialplanner are beneficial at this time intheir lives. In addition, minimal use ofcredit cards and continuing to live wellwithin their means have served manyresidents well at this crucial time.26Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondAppendix ABibliographyAdditional resources available from theAmerican Medical Association:The Residency Interview:A Guide for Medical StudentsThis online resource guide, available toAMA members, is published by the AMAWomen Physicians Congress (AMAWPC), a special interest groupcomprised of physicians and medicalstudents who are advocates for women’shealth issues and the professional and lifebalancing issues affecting women inmedicine. This resource addresses thefollowing topics:• Handling gender-based questions• Couples matching• Shared and part-time residencies• Preparing for interviews• Interview questions to ask• Common and uncommon questionsthat will be asked• What to bring to the interviewAMA Women Physicians Congress515 N. State St.Chicago, IL 60610312-464-5622312-464-5845 FaxInformation about ordering this resourcecan be found at: www.ama-assn.org/ama/pub/category/10757.htmlAMA Find a Residency orFellowship Web siteIn response to requests from medicalschool graduates seeking unfilledpositions in residency programs, theAMA Resident and Fellow Section(AMA-RFS) offers a Web-based list ofopen residency and fellowship positions.Postings on the Find a Residency orFellowship Web site include a shortdescription of the position and theprogram, as provided by programofficials, as well as contact information.The site also provides links to specialtysocieties that offer information onresidency vacancies. Information aboutthis resource can be found at: www.amaassn.org/ama/pub/category/6920.htmlAdditional resources available fromthe Association of American MedicalColleges:Careers in Medicine (CiM) Student Guides.This student guide to the AAMC Careersin Medicine career planning program isissued to all incoming students at U.S.allopathic, participating osteopathic, andCanadian medical schools.Additional resources available fromother sources:CareerMDThis Web site, dedicated to informationon institution-sponsored graduatemedical education programs, providesinformation on residency and fellowshipprograms, as well as listings for residencyand fellowship vacancies.Information about this resource can befound at: www.careermd.com27Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondResident WebThis service provides discussion groups,career advice, and other information formedical graduates. Registered users canaccess residency and fellowship searchdatabases.Information about this resource can befound at: www.residentweb.com/default.aspSpecialty Web sitesMany of the larger specialties host jobbanks or vacancy clearinghouses on theirnational specialty association Web site.These services are generally free forapplicants to explore and apply. The typeand amount of information and searchfeatures for these sites vary widely.Alliance for Academic InternalMedicine Job Bankhttps://secure.med.edu/jobbankAmerican Psychiatric Associationwww.psyccareers.comSociety for AcademicEmergency Medicinewww.saem.org/services/resvacan.htmAssociation of ProgramDirectors in Surgerywww.apds.org/residency_positions_open.htm28Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondAppendix BWebliographyAccreditation Council for GraduateMedical Education (ACGME)www.acgme.orgAmerican Board of Medical Specialties(ABMS)www.abms.orgAmerican Medical Association (AMA)www.ama-assn.orgAMA GME E-letterwww.ama-assn.org/go/gmenewsAMA International MedicalGraduates Sectionwww.ama-assn.org/go/imgsAMA Medical Student Sectionwww.ama-assn.org/go/mssAMA Resident and Fellow Sectionwww.ama-assn.org/go/rfsAmerican Osteopathic Association (AOA)www.osteopathic.orgAmerican Osteopathic Association(Accreditation)www.do-online.osteotech.orgAmerican Osteopathic AssociationIntern/Resident Registration Program(IRRP)www.natmatch.com/aoairp/index.htmAmerican Urology Association ResidencyMatching Program (AUA)www.auanet.org/residents/resmatch.cfmAssociation of American MedicalColleges (AAMC)www.aamc.orgAssociation of American MedicalColleges Publicationswww.aamc.org/publicationsCanadian Resident Matching Service(CaRMS)www.carms.caCareers in Medicine Program (AAMC)www.aamc.org/careersinmedicineCitizenship and Immigrant Services, U.S.Department of Homeland Securityhttp://uscis.gov/Committee on Accreditation ofCanadian Medical Schools (CACMS)www.afmc.caCurriculum Directory (AAMC)www.services.aamc.org/currdir/Educational Commission for ForeignMedical Graduates (ECFMG)www.ecfmg.orgElectronic Residency Application Service(ERAS)www.aamc.org/erasExchange Visitor Program (ECFMG)www.ecfmg.org/evsp/Federation of State Medical Boardswww.fsmb.orgFindAResident Program (AAMC)www.aamc.org/FindAResidentFifth Pathway Program Informationwww.ama-assn.org/ama/pub/category/9306.htmlFREIDA Online (Fellowship andResidency Electronic InteractiveDatabase)www.ama-assn.org/go/freidaGraduate Medical Education Directory(the AMA “Green Book”)www.ama-assn.org/go/mededproducts29Association of American Medical Colleges, 2005

Roadmap to Residency: FromApplication to the Match and BeyondInternational Directory of MedicalEducation (IMED)http://imed.ecfmg.org/Liaison Committee on MedicalEducation (LCME)www.lcme.orgMONEYMATTERS listserv (AAMC)www.aamc.org/debthelpMt. Sinai School of Medicineof New York University(Fifth Pathway Program)www.mssm.edu/medschool/fifth_pathway/National Board of Medical Examiners(NBME)www.nbme.orgNational Board of Osteopathic MedicalExaminers (NBOME)www.nbome.orgNational Resident Matching Program(NRMP)www.nrmp.orgNational Student Loan Data System(NSLDS)www.nslds.ed.govOrganization of Resident Representatives(AAMC)www.aamc.org/orrDon’t Forget to Ask: Advice fromResidents on What to AskDuring the Residency Interviewwww.aamc.org/members/osr/residencyquestions.pdfPonce School of Medicine(Fifth Pathway Program)www.psm.edu (click on AcademicAffairs, then Programs)San Francisco Matching Programwww.sfmatch.orgSpecialty Pages(Careers in Medicine Program)www.aamc.org/careersinmedicineTest of English as a Foreign Language(TOEFL)www.ets.org/toefl/United States Medical LicensingExamination (USMLE)www.usmle.orgNew York Medical College (FifthPathway Program)www.nymc.edu/depthome/fifth.asp30Association of American Medical Colleges, 2005