Ch. xi - Preparing and Submitting Your Rank Listing

Throughout interview season, you should exist thinking almost your rank list, comparing and contrasting programs as you become. Try to come up with a draft rank listing and update it after each interview, placing the program you but visited in the list with your other programs and keeping notes nearly your thoughts on each program.

How Does the Lucifer Piece of work?

At the end of interview flavor, applicants submit a rank-guild listing of the programs at which they interviewed (and would want to match) from most to least preferred, and residency programs submit a rank-gild list of applicants from most to least preferred. From there, a Nobel prize-winning algorithm goes to work to find "stable marriages" between applicants and programs. The "stable union problem" is well-known in the fields of mathematics, economics, and computer science and is considered solved when there is no pair of matches by which both a program and an applicant would be ameliorate off than they are currently matched.1

Picture this: You rank a program No. 1, and your No. 1 programme has 12 spots bachelor for interns. If that programme ranks you in any of their top 12 positions, a match is made, and y'all volition not be considered for matches at any other programs. Alternatively, you could besides match at this program even if you were lower on their list; for example, let's say they ranked you 20th, but 8 people ahead ranked different programs at the superlative of their lists and those other programs ranked the 8 people alee of you loftier plenty to create matches — you would still match at your top choice!

To see a live example of a simulated match betwixt five applicants to 2 hospitals with ii positions each, visit NRMP.org/matching-algorithm.

It is critical to understand that the NRMP algorithm favors your preferences as the applicant. You lot should rank programs in the order in which you would truly prefer to match. Do not endeavour to "game" the system and rank programs based on where yous think you fall on their lists. Similarly, expressions of interest from a programme are not binding — interpret them with caution. Again, always rank programs in your guild of preference. The first program you rank should be your top selection, fifty-fifty if you call up information technology's a reach. Conversely, do not rank a "achieve" plan showtime on your list just to see if you lot can match there if it's not where you lot really want to terminate up. Overall, three-quarters of U.Due south. senior applicants will friction match at one of their top 3 choices. Unfortunately, across all specialties, 5% of U.S. seniors volition non match (Chapter 12: What If I Don't Match? explains what to exercise in that case).

FIGURE 11.1. Percent of Matches by Choice and Type of Bidder, 20182

Couples Friction match: To participate as a couple, both applicants must be entering  the same match and pay a "couples fee." The NRMP does not define who can couples match; y'all tin can couples match with a friend, spouse, partner, sibling, or anyone else who agrees to create a paired rank listing with you. For more information, visit: NRMP.org/couples-match-videos.

How to Build Your List—What Matters to You?

There is no single way to build your rank list; the "right way" to build information technology is based on what is right for you. Many factors play a role in this.

Reverberate on your professional and personal goals when prioritizing your list. Identify 3–5 things that matter most to you lot when comparing programs to rank.See Chapter 4 — Finding Your Fit: Learning the Landscape of EM for a list of factors that differentiate programs from i another. Some common elements to consider include:

  • Length of grooming (three- vs 4-yr program)
  • Location of grooming
  • Programs' affiliated hospitals
  • Residency rotation curriculum
  • Flexibility of elective fourth dimension

If you lot take already identified your interests in potential fellowship training, you may choose to weigh emergency medicine residency programs at sites that accept that fellowship more heavily. The flexibility and amount of elective time in residency may also be important if you harbor fellowship goals, because it volition facilitate dedicated scholarly time and research that will help you lot set up for futurity fellowship applications.

Couples Match: Prepare your rank lists separately, then together. As a couple, discuss your priorities (same institution, same urban center, geographic altitude, both partners matching at his/her superlative choice, etc). Are you willing to take one partner go unmatched? Avoid making a rank list in which i partner volition definitely be unhappy.

How Many Programs Should I Rank?

Most faculty and deans agree that you should rank all of the programs at which you interviewed, with rare exceptions. Recollect carefully before choosing not to rank a program where you interviewed. On 1 hand, it is risky to include a programme where you would not be happy training, because the match is binding for both applicants and programs. On the other hand, going unmatched puts you in a much more than challenging position if you wish to pursue a career in EM. There are few to no positions that go unfilled in the EM match, and so "scrambling" (now called SOAPing; encounter Chapter 12) into a position outside of the lucifer is highly unlikely. Only get out a program off your rank list if you would rather train in something other than EM, or not friction match at all, than train there.

A programme that you weren't sure about on interview mean solar day might surprise yous when you arrive to railroad train in that location. All EM residency programs will pb you to the end goal of becoming a competent emergency physician. It will about ever exist better to be matched and move frontwards with your career path than to go unmatched with a gap twelvemonth without structured clinical experience and patient intendance.

As mentioned in Chapter 9—Interview Season Logistics, with the exception of non-U.S. IMG applicants, ranking 11–12 programs volition give you lot a > 95% gamble of matching. The NRMP's Interactive Charting Outcomes in the Match tool3 and its ranking guidelinesiv tin be very helpful as yous determine how many programs you demand to rank in order to friction match, and how to rank them based upon your individual competitiveness.

FIGURE 11.2. Probability of Matching to Preferrred Specialty past Number of Contiguous Ranks3

Military Match: MODS will allow you to rank 5 programs. Given the express number of spots in the armed services match, you should rank ALL armed forces programs where you interview.

At-Risk Candidates: Rank ALL programs where yous interviewed. If you lot did non interview at plenty programs to attain a high likelihood of matching, you take hopefully already developed a proactive backup program with your academic advisor to apply to a 2d specialty or transitional internship.

How Practise I Submit My Rank List?

Creating your NRMP rank list requires creating registering for the Match at NRMP.org prior to the registration deadline, usually in tardily November. This is a different registration process than ERAS. If yous have trouble with registration, contact the NRMP help desk or enquire your dean for help. Resources abound at NRMP.org, including tutorials and videos explaining every step of the process.

In mid-January, you can showtime to rank programs in the NRMP's Registration, Ranking, and Results (R3) system. This website will use your credentials obtained when you registered in the fall. You should make sure you take the right plan identification numbers when you enter your rank list. Some schools/residencies have multiple plan codes for different types of applicants. You volition and so enter the programs into the R3 organization in your guild of preference.

After you enter your rank preferences, y'all will need to certify your listing. You must certify your list by the ranking deadline (February) to have information technology officially available for matching purposes. You will receive a confirmation email and encounter the status of your list change to "certified" when y'all have done this. You can re-rank and re-certify as many times as you want up until the NRMP'southward Rank Order Listing certification borderline! Certify your list each time yous make changes so you will always have an updated certified list in the system. The R3 system does non relieve onetime versions of your rank listing.

Currently, you are allowed 20 ranked unique programs before you have to pay additional (nonrefundable) fees.

Aid! Whom Should I Talk To?

Ask a friend, parent, pregnant other, or objective third party to assist y'all talk through the programs in which you're interested. If you're bringing a pregnant other forth during residency, exist sure the cities y'all prioritize volition accept opportunities for them. Yous should besides consult with your advisor to sympathise how dissimilar options may bear upon your career path.

Consider having a pretend Match Day!

  1. Place all programs at which you interviewed in a bowl.
  2. Have a friend pull a program out of the bowl and read the residency proper noun out loud.
  3. How did you feel when that proper name was read?
  4. Ask your friend nigh their perception of your reaction to each program. If y'all are taking notes or using a spreadsheet, record your thoughts/response next to each program.
  5. If you lot are still unsure, "endeavor on" a few programs and exercise your imagination. For 1 solar day, pretend you matched at Program A and see how you feel. Then the next day pretend you matched at Program B. This may help clarify your true preference.

Once yous have certified your terminal rank list, your piece of work is washed — and the waiting begins.

The Bottom Line

  • Start a draft of your rank list during the interview season, and proceed notes as you become to help yous every bit y'all finalize and certify your list.
  • With rare exception, it is to your advantage to rank all programs where you interviewed.
  • Understand that the match algorithm favors applicant preferences, so develop your rank list according to your true preference rather than trying to "game" the system based on what you lot think programs might practise.