Roadmap to Residency: - AAMC

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