Clinical

Osmosis Ultimate Guide to the NRMP® Match

Osmosis Team
Published on Mar 6, 2020. Updated on Mar 1, 2021.

Another year, another Match Week—and it's coming up quickly! On March 19, 2021, tens of thousands of US medical students and international medical graduates (IMGs) from around the world will learn which medical specialty will be the focus of their residency, and where they’ll be living for the next few years. So many events lead up to this magical moment—many which can have a disproportionate impact on the match outcome itself!

In this Osmosis Ultimate Guide to the NRMP Match, we will provide an exhaustive breakdown of everything you need to know, including:

  • A comprehensive timeline of the events leading up to Match Week

  • Steps to submit your residency application

  • How to optimize your residency applications

Now, what is the NRMP Match, and how does it work?

What is the NRMP® Match?

On the third Friday in March each year, fourth-year medical students in the US and International Medical Graduates (IMGs) from around the world participate in an event called The Match. Run by the National Resident Matching Program®, or NRMP, the event ensures medical residency and fellowship programs across the US are adequately filled with the most appropriate candidates.

The whole Match process kicks off in June, and extends to the following March of every year. Here’s a high-level overview of the 2021 Match timeline:

  • June 8, 2020: Applicants begin registering on MyERAS® (Electronic Residency Application Service®) and get started with their applications for 2021. 

  • September 1, 2020: ERAS® registration opens. Applicants can now begin to submit applications to residency programs.

  • October 2020–February 2021: Applicants interview with prospective programs.

  • March 3, 2021: Deadline to submit Rank Order Lists

  • March 15, 2021: Applicants receive emails indicating their eligibility to participate in SOAP. (Receiving this email does not mean you didn’t match, so please don’t panic!) 

  • March 18, 2021: At 8 AM ET, applicants learn if they matched, but not where. Partially or fully unmatched applicants, who are eligible, can participate in SOAP®. They only have a few hours to apply—at 3 PM ET, SOAP ends.

  • March 19, 2021: Match Day! Applicant match results are now available and applicants find out which residency programs they accepted them.

Osmosis illustration of the NRMP® Match Week timeline for 2020–2021.

As you will see  by the sheer length of this guide, there’s a lot to tackle during the Match process, and every step is critical. To help you stay on track, the NRMP has a suite of useful checklist documents which we recommend you review before beginning the application process, and to help guide you during your applications too.

How does the Match work?

The Match is determined by a computerized algorithm called the Matching Algorithm which assigns applicants to residency programs. (To learn more about how this Nobel Prize-winning algorithm actually prioritizes applicants, check out the NRMP’s helpful video.)

The Matching Algorithm is applicant-proposing, meaning that, although it takes into account both the applicant’s choices and those of residency programs, the applicant’s rank choices are always prioritized. Because of this, there’s no real way to game the system. 

How applicants and programs rank each other

How should applicants rank medical residency programs? 

As an applicant, you should only rank residency programs for which you’ve interviewed. A Match can only occur if an applicant and a program rank each other, and programs only rank the applicants they’ve interviewed. 

How you choose to rank your selection of residency programs is completely up to you, but you may make your decision based on:

  • Where the program is located geographically

  • Quality of life considerations

  • Personal factors, like the significant others in your life

  • Your desired medical specialty

  • Clinical volume & diversity of the patient population

  • Research opportunities

  • Prestige and competitiveness

How do medical residency programs rank applicants?

In the months prior to Match Day, medical students fly all over the US for interviews at institutions they want to attend as a resident. There, you’ll be interviewed by a program director. In general, program directors screen applicants based on:

Because applicants and programs must have ranked each other for a match to occur, it’s especially important for applicants to make an excellent impression. If someone also matches at your program and they are deemed a better fit, you will get bumped down the list. To improve your chances, check out the section at the end of this article: How Can I Improve My Chances of Matching?

Submitting your residency applications

For students, the entire Match process starts around May, fourteen months before your intended start of internship. This is when you will generally begin researching residency programs, so you can make informed decisions about how you will eventually rank programs, as we’ve outlined above. During this time, you can contact potential residency programs to inquire about their criteria for eligibility, licensure requirements (which differ by state), and, if you’re an IMG, find out if there are any visa-specific policies you should be aware of.

How do I gather information about medical residency programs?

Before you put your applications together, you need to research residency programs to find out which ones will be the right fit for you. When considering residency programs, it’s important to ask yourself specific questions, such as:

  • How competitive is your desired specialty?

  • How far are you willing to move from family and friends?

  • What places would you consider living in long-term?

  • What will make you happy professionally? 

  • Do you want to be part of a bigger organization, or a smaller organization?

  • Will this be your last formal training or do you anticipate later applying to additional training (e.g. a fellowship)? 

Your expectations about a particular program could completely change once you’ve visited and interviewed, but asking yourself these questions beforehand will help you narrow down your options. For more advice on this topic, check out this article on the Osmosis Blog from Dr. Amin Azzam, Director of Open Learning Initiatives at Osmosis: 

What is FRIEDA™ and how can I use it to research medical residency programs?

The American Medical Association® (AMA®)’s Residency and Fellowship Database™, FRIEDA™, is a popular tool used by many medical students and IMGs to gather information on residency programs and fellowships. FRIEDA contains information on over 11,000 programs, and each one is accredited by the Accreditation Council for Graduate Medical Education® (ACGME®).

As a residency applicant, you can use FRIEDA to:

  • Explore different medical specialties and learn what they entail

  • Compare different residency programs

  • Identify vacant residency and fellowship positions

  • Plan your future career

FRIEDA is updated yearly using data from the GME Track/GME National Data census, so you can be sure it always contains the most current information about ACGME-certified residency programs.


What documents do I need for my medical residency applications? 

In July, the NRMP allows students to begin submitting their application documents through the MyERAS® (Electronic Residency Application Service®) online portal. By early September, your application should be complete, containing:

  • A Curriculum Vitae (CV)

  • A personal statement

  • Letters of recommendation

  • USMLE Transcript (for MD/DO students; optional, comes with an $80 USD fee)

  • COMLEX-USA® Transcript (for DO students; optional, comes with an $80 USD fee)

  • Medical Student Performance Evaluation (MSPE or “Dean’s Letter”)

  • Medical School Transcript

  • Photo (optional)

IMGs will also need the following additional document:

  • ECFMG Status Report

Medical students and international medical graduates applying to residency programs in California will need to submit a Post-Graduate Training Letter, or PTL (as of 2020, the Postgraduate Training Authorization Letter, or PTAL/California letter, is no longer required). You only need to apply for the PTL once you’ve secured a spot at a residency program in California.

For more details on your application documents and how you can optimize them to strengthen your application, check out the final section of this guide.

When do I submit my documents for medical residency applications?

The actual deadlines for residency application documents vary, so you will need to check with each program. However, you should aim to have everything ready by September 15, so you can submit all your applications as soon as ERAS opens. Residency programs will not receive the documents until October 21, so you do have some wiggle room, but the ECFMG recommends submitting no later than October 14

How expensive is the residency Match process?

Students submitting ERAS applications have to pay fees to use the service. The more programs you apply to, the more money you will spend. We’ve broken down the basic costs of ERAS applications below:

  • Programs per specialty:

    • Ten or fewer: $99

    • 11-20: $16 each

    • 21-30: $20 each

    • 31 or more: $26 each

There are some nuances to ERAS fees that are worth clarifying here. Application costs are per specialty, so if you apply to five anesthesiology programs and five radiology programs, you will pay $99 for each set of programs—that’s $198 total.

Let’s say you really, really wanted to become a radiologist, so you applied to 32 radiology programs. You would pay:

  • $99 for the first 10 applications

  • $160 for the next 10 (remember, they’re $16 each at this point)

  • $200 for the next 10 ($20 per application)

  • $52 for the last two ($26 each)

  • Grand total: $511

In another scenario, maybe you still really want to be a radiologist, but anesthesiology also interests you. You apply for 24 radiology programs and 8 anesthesiology programs. The cost breakdown would look like this:

  • $99 for the 8 anesthesiology applications

  • $99 for the first 10 radiology applications

  • $160 for the next 10 radiology applications

  • $80 for the final 4 radiology applications

  • Grand total: $438

As you can see, ERAS fees really add up, especially if you’re really focused on one specialty, and they’re only the tip of the iceberg in terms of what you’ll spend applying for residency. Beyond these basic fees, it’s possible to sink a lot of money into the application process. Be sure to think proactively and carefully about how and where you spend money through this match process.

For example, some areas, like New York City, are known to accept higher numbers of IMGs than others. If you’re on a strict budget, it’s worth doing research to ensure you’re spending money applying to programs you stand a chance of getting into it. 

That said, everyone's cut-off for how much money is worth spending is different. Some people will choose to apply even though their chances are extremely low. Remember, this is a two-step process (e.g. initial application costs and then the costs of attending the interview if you’re invited), so taking a shot at applying doesn’t mean you’re going completely all-in right away.

This brings us to our next topic: Interview season.

Interview season

Interview season lasts from early October to mid-February. It is one of the most stressful periods of the whole Match process—but it’s also very exciting. You will spend your time traveling around the country, visiting various programs you dream of attending (or returning to ones you had great experiences with already!) and forging connections with influential people in the medical field. 

In this section, we’ll explore the logistics and costs of booking your interviews, and talk through some tips on nailing your interviews.

How much should I expect to spend on medical residency interviews?

Before COVID-19, it was possible to spend a lot of money on residency applications. Depending on what programs you applied to, and where, you may have ended up booking a lot of flights around the country for residency interviews—many of them last-minute, which would drive up the cost even more. 

A silver lining of the pandemic is the fact that most residency programs are now conducting interviews online. This means that you no longer have to worry about spending money on flights, hotels, or AirBnBs, or meals out with faculty and current residents. We still recommend buying some nice clothes for the interviews (and yes, that does include pants). COVID-19 means many of the "hidden costs" of residency applications have been removed.

When you’re booking your interviews, try to cluster them by time zone, and do your best to confirm a date ahead of time. One final tip: check your email constantly if you are waiting on interview dates. Interview spots fill up extremely quickly, and the earlier you’re notified, the sooner you can plan.

Osmosis illustration of a student who has no money left after flying around the country for residency interviews.

How should I prepare for my medical residency interview?

Before you embark on the interview circuit, there are several things you can do to prepare for interviews.

Practice with a mock interview

Many programs will have resources that allow you to practice your residency interview skills with someone who’s familiar with the process. Every interview experience helps you sharpen this skill, so definitely practice whenever you have the opportunity. 

Recording yourself during the mock interview can be an effective way to learn how you might come across to others. Watching the mock interview on-camera can help you be more conscious of things like how quickly you’re speaking or what you’re conveying through your body language. 

Research what questions you will be asked (and which you shouldn’t be)

It’s not possible to anticipate every single question a program interviewer will ask you, but there are certain common questions that are likely to come up. Knowing what these are and preparing clear, confident, and intelligent responses can mean half of the interview is in the bag before you even walk through the door!

Also, you should be aware of questions that program directors are not allowed to ask you. The following topics are considered off-limits in interviews:

  • Relationship status (including questions asking if you’re a Miss, Ms., Mrs., etc.)

  • Whether or not you have children, or plan to

  • Details about your partner’s work situation

  • Anything related your age, racial background, sexual orientation, gender identity, physical ability

If an interviewer asks you about any of the above, politely decline to answer. You can do this by stating that you would prefer to stick to topics that are relevant to your professional identity, steering things back on track. Also, consider this a red flag!

Do your homework

Thoroughly research each program and come prepared with creative questions that show that you’re genuinely interested in what the program has to offer and what you can learn there. Relating to our last point about illegal questions, make sure your inquiries are appropriate and relevant to your potential candidacy as a resident in that specialty.


What should I expect on my medical residency interview day?

Your interview with the residency program director is one of the most important events in the whole Match timeline. It’s absolutely crucial that you come prepared to make an excellent, lasting impression.

Look the part

Arrive dressed for the part. A plain suit with a neutral tie is highly recommended. If you’re wearing a skirt, keep it below the knee. With residency applications currently happening over video, it may not be necessary to wear formal shoes (or any shoes!), but we encourage it anyway: dressing for the part will help you feel more confident and ready to perform at a high level. 

Bring only the essentials

You will be doing a lot of the talking during the interview, so keep a water bottle close by in case dry mouth strikes. Have a document open so you can take notes, and have your CV at the ready. Turn your phone off during the interview, and make sure nobody (human or animal!) disturbs you during the call.

Be courteous, kind, and professional

Interviews being on video means you probably may not interact with people other than the program director, but be prepared to do so. The program director might be making the final decision, but you need to make a good impression on everyone you meet during the call.

Try to relax

Interviewing for residency is a career-defining event, so it’s understandable if you feel a little stressed out. One way to get rid of those butterflies is to remind yourself how far you’ve come, and how much you’ve achieved already. Everything you’ve done up to this point is what landed you the interview in the first place.

Another thing to remember is, at this stage, you’re also using the interview to gauge whether that residency is right for you. Flipping the script and reminding yourself that you’re also interviewing them can be a helpful confidence boost—just make sure you’re not coming across as arrogant! It really is all about finding the best fit between you and a program.

Osmosis illustration of a residency interview taking place over video.

What can I do after my medical residency interview?

Write down some post-interview notes

Following each interview, you should take the time to write down some notes about how the interview went and what you learned about that program. When you’re creating your Rank Order List later, the notes you’ve taken will make it easier to remember pros and cons about each program, such as residents’ work satisfaction, your potential workload, and so on.

Follow up with a thank-you

Soon after your interviews, it’s considered polite to follow up with a thoughtful message thanking the program director for their time and, if applicable, reemphasizing your interest in the program. Similar to thanking your letter of recommendation writers, it’s a good way to reinforce the relationship and forge a lasting connection with someone who could be an influential figure in your career. After all, you’re entering the medical specialty that this same interviewer is in, and those worlds can be quite small. It’s never too early to “Spread Joy!”

Celebrate getting to this point

After you’ve finished with your residency interviews… Congratulations! You did it! You can finally take a bit of a breather and celebrate completing this phase of the Match. Your next step comes in February when it’s time to submit Rank Order Lists and prepare for Match Week in March.

What is the Rank Order List for medical residency applications?

Prior to Match Week, you need to submit a list of all the programs you’ve interviewed at, beginning with your top choice and working your way down. We recommend listing all of the programs you interviewed at, even your bottom-choice program, unless you have a really good reason to completely nix one of them.

We’ve included some recommendations on how you might consider ranking programs already, but if you don’t feel like scrolling all the way to the top again, here’s a refresher: 

  • Residency program location (“Do I want to live here for the next few years?”)

  • Quality of life considerations (“Will I be able to lead a balanced life in this program?”) 

  • Personal factors (“How does this impact my partner’s career plans?”)

  • Your desired medical specialty (“Do I want to be a radiologist, or an anesthesiologist?”)

  • Clinical volume & patient diversity (“What group do I most want to serve?”)

  • Research opportunities (“What medical advances has this institution pioneered?”)

  • Prestige and competitiveness (“Which of these clinics has the best reputation?”)

The deadline to submit Rank Order Lists is generally around late February before the Match, so make sure you’ve given plenty of thought to these questions by then!

How and when do I submit my rank order list?

Once you have an idea of which programs you want to attend in order of preference, it’s time to enter them into the NRMP’s R3 (Registration, Ranking, Results) System so the Match Algorithm can work its magic. Note that registering for the R3 system is a completely separate process from registering with MyERAS: you can sign up to rank your programs here.

If there are programs you applied to and interviewed at, but you’ve decided not to attend, do not rank them in the R3 system, as there’s a chance you will be matched with these programs, with no way to back out. 

Similarly, if there’s a program you want to attend, but you didn’t get an interview, don’t rank that either: residency programs will only rank candidates they’ve interviewed, and applicants and programs must have ranked each other for a match to occur

Finally, during the ranking process, the NRMP forbids applicants from contacting programs and vice versa, as it’s a violation of the Match Participation Agreement.

My partner and I are both applying for medical residency: can we be placed together?

If you’re in a relationship with someone who’s also applying for residency, you can apply for the Couple’s Match. This is a way for you to remain close with your significant other while pursuing residency. Applicants participating in the Couple’s Match may end up working at the same residency program, at different residency programs that are relatively close together, or even potentially splitting the responsibilities of a single residency position. 

For more information on Couple’s Matching, check out this guide from the NRMP.

Match Week

This year, Match Week runs from March 15–19, 2021. Here’s another quick timeline of events:

  • Monday, March 15, 11 AM EST: applicants find out if they matched, but not where. Students who did not match are eligible to enter SOAP.

  • Wednesday, March 17:

    • 12 PM ET: round 1 of SOAP offers are sent.

    •  3 PM ET: round 2 of SOAP offers are sent.

  • Thursday, March 18: 

    • 9 AM ET: round 3 of SOAP offers are sent.

    •  12 PM ET: round 4 of SOAP offers are sent.

    •  3 PM ET: SOAP applications close. Partially matched and unmatched applicants can begin reaching out to unfulfilled residency programs directly in a final attempt to secure a residency spot.

  • Friday, March 19: it’s Match Day! Students open their envelopes and finally learn where they’ll be pursuing their medical residency.

Osmosis illustration of the 2020–2021 NRMP Match timeline.

SOAP applications

Unfortunately, not every applicant will match with a program immediately during Match Week. However, failure to match does not mean it’s the end of your story—there’s still a chance to match with a program by enrolling in the Supplemental Offer & Acceptance Program, or SOAP.

During SOAP, unmatched applicants can submit up to 45 applications to unfilled residency programs. Interviews for these programs will usually take place over the phone or through a video call, unless they’re in your local area, in which case you may attend an interview in-person. 

If you end up being accepted to a program through SOAP, be absolutely sure about your decision to attend or not, as you cannot take back the decision in either case. If you don’t match through SOAP either, your final opportunity to score a residency will be by contacting unmatched programs directly. You can find a list of the unfulfilled programs on the main page of the NRMP’s R3 system.

→ What is SOAP, and why should you care?

I matched to a medical residency program! What now?

Once you’ve found out where you’re going to be pursuing residency, you can finally breathe a sigh of relief: you did it! Celebrate with your friends and family (responsibly, of course) and take stock of everything you’ve achieved up until this point.

A fun way to celebrate is through social engagement campaigns organized through the NRMP. Opening that envelope is truly a magical moment, and one you’ll want to document, whether or not you choose to share it on social media. If you do, feel free to tag Osmosis on social—we’d love the opportunity to help spread the Match Day joy!

In the days following the Match, it’s a good idea to send a thank-you card to the people who wrote you letters of recommendation. If you’re moving to a new state, you may wish to consider looking at rental properties, or even houses, if you’re looking to buy. Remember, medical residencies typically last at least three years and property values can spike following Match Week, so plan accordingly!

How can I maximize my chances of getting my ideal medical residency Match?

All right, so, you now know how the match works and the steps you need to follow to participate. Great! You’re set for next year. Now it’s time to start preparing for next year’s Match. So, what can you do to optimize your application, win over program directors, and get the Match you want? Whether you’re a US medical student or an IMG hoping to improve your chances of matching, here are some quick tips highlighting things you can do today

How do I improve my chances of matching as a US medical student?

Now that you have an idea of how the Match works and the general timeline of events, it’s time to look at some concrete ways you can build the strongest residency applications possible, whether you’re a US applicant or an IMG looking to practice medicine in the US.

Ace your clinical rotations

Strong performance during your clerkships will be a major asset for your residency applications, most especially on the services most closely aligned with your preferred specialty. Notes and feedback from the clinicians you work with on the wards can even influence other parts of your application, like the MSPE letter.

Osmosis has several resources to help you ace your clinical rotations and prepare for exams like USMLE® Step 2 CK, including:

  • Clinical practice videos that show you how to apply the knowledge you acquired for Step 1 during your clerkships and on exams like USMLE Step 2 CK.

  • Professional development videos providing expert advice from the Osmosis medicine team on important soft skills and other tips on how to provide the best care possible.

For IMGs, hands-on clinical experience at a US healthcare institution is especially important, and should be done at least six months ahead of the Match. Not all hospitals accept IMGs, but some have affiliations. Rotations and observerships can be very, very expensive, ranging from $2,500 to $5,000 and more per month. There are certain companies that assist in finding medical rotations for IMGs such as AmeriClerkships.

Secure strong letters of recommendation from professionals in your desired specialty

During your clerkships, you should be forging professional relationships with the specialists and attending physicians you’re learning from, especially those who work in the specialty you’re interested in pursuing. These connections will prove invaluable throughout your career. They’re also a great resource for the strong letters of recommendation you need to set you apart from other applicants both before and during the interview season.

When you’re securing your letters of recommendation, keep the following things in mind:

  • Ask early: not only is it irritating being asked to write a letter of recommendation last minute, but the fact is, a good letter of recommendation takes time to write. The more time you give someone, the better they’ll be able to communicate your strengths!

  • Ask a mentor: choosing someone you have a strong working relationship with will result in a well-rounded letter that speaks to the strength of your character in addition to your clinical skills.

  • Provide the letter-writer with your personal statement: doing this allows the letter-writer to really align what they write with what you’ve written. The last thing you want is contradictory information between your personal statement and what the letter-writer has to say about you!

  • Avoid featuring friends, family members: this goes without saying—it just looks unprofessional, and the program director will question the letter-writer’s biases, casting doubt on your application.

  • Waive your right to read the letter: you’re legally entitled to read your letters of recommendation, but pre-screening them will only make the program director question your decision: “Why did they need to read this? What do they need to hide?”

  • Say thank you: sending a thank-you card (Osmosis has some nice ones!) after you’ve matched is the polite thing to do, and your letter-writer will remember the courtesy, solidifying your already-strong relationship. 

There are no limits on how many letters of recommendation you upload to ERAS, but you can submit a maximum of four per residency program, and most programs require a minimum of two. If you have the luxury of more than four letters, you can then decide which “package of letters” best conveys your candidacy for that specific program.

Showcase your achievements in a well-rounded Curriculum Vitae

Your Curriculum Vitae is a complete summary of all of your achievements that you’ve deemed relevant for your residency applications, including:

Your CV should run about two pages, and should cover everything in reverse chronological order, beginning with your most recent accomplishments and moving backwards through time.

Excel on USMLE® & COMLEX-USA® exams

In 2020, the NBME® announced that USMLE Step 1 would be moving to pass/fail. Until now, this board exam has been seen as a crucial measure of an applicant’s Match prospects, particularly for IMGs. And, if you’re applying for the Match in the next year, it still will be.

Check out the Osmosis Ultimate Guide to USMLE® Step 1 to learn everything you need to know about preparing for and scoring high on this exam.


The general timeline to complete all four USMLE exams will vary from student to student, but in general, US medical students follow this timeline:

  • Second year, April–June: take USMLE Step 1

  • Fourth year, December: take USMLE Step 2 CK to be prepared for Match the following year

  • Following one year of residency: take USMLE Step 3 

Osmosis illustration of the USMLE boards timeline for US medical students.

For IMGs looking to take all of the USMLE board exams within a year before applying, we recommend:

  • August–December 2020: dedicated USMLE Step 1 prep period

  • January–March 2021: take USMLE® Step 1, schedule USMLE Step 2 CK

  • April–June 2021: take USMLE Step 2 CK

  • July–August 2021: take USMLE Step 3 to strengthen your application

  • September 2021: Step 2 CK results arrive; submit application on MyERAS, and begin Match process

Osmosis illustration of the timeline for IMGs to take all USMLE boards in one year.

With USMLE Step 1 becoming pass/fail and USMLE Step 2 CS being cancelled, it’s very possible that programs will place greater emphasis on your Step 2 CK score, which makes studying for this exam more important than ever. Fortunately, Osmosis has a full suite of Clinical practice videos to help you develop the clinical knowledge you’ll need to succeed during your clerkships and on this exam.
 

For DO students, the NBOME has made no announcements suggesting that COMLEX-USA® Level 1 will follow suit, although COMLEX-USA Level 2-PE has been cancelled. For now, you can continue with your current COMLEX-USA study plans, which will also help you prepare for USMLE Step 1:

Obtaining your USMLE® and COMLEX-USA® transcripts

You can authorize the release of your USMLE transcripts (which includes Step 1, Step 2 CK, and Step 3 if applicable) directly from the My Documents section of the MyERAS portal and paying a one-time fee of $80. The NBME® will then add your transcript to your profile. 

For COMLEX-USA, the steps are largely the same, with one exception: you have to list your NBOME® ID in the Personal Information section of your MyERAS application. After doing this, you can follow similar steps to authorize the NBOME® to release your COMLEX-USA transcripts (and pay another $80 fee). 

USMLE and COMLEX-USA transcripts are only official when released by their respective organizations, so don’t try to submit them independently. Not all programs require the release of these transcripts, but if you have particularly impressive scores, it’s worth sharing. 


Craft a winning personal personal statement

Your personal statement is a one-page essay where you communicate why you’re interested in a particular medical residency. There are endless directions you could take with your personal statement—so many that the topic probably warrants its own Osmosis Ultimate Guide—but in general, you should look at it as an opportunity to show how you stand out versus other applicants. 

In general, your personal statement should be about one page. A single page in the ERAS portal is about 3,000 characters, so you can use that as a baseline. It should cover:

  • Why you have chosen your desired specialty

  • How the program you’re writing the letter to can help you achieve your goals

  • The value that you will bring to that residency program (include a mix of hard and soft clinical skills)

  • A brief rundown of your professional aspirations and goals

Essentially, the personal statement is a high-stakes cover letter. As with cover letters, don’t simply reiterate what you’ve included on your CV. Your personal statement should provide additional context that gives the program director a sense of who you are as a human professional.

Because you’re going to be sending this letter out to more than one residency program, you may want to create a basic template or list of bullet points as a jumping-off point. This way, you can provide each program with a fairly unique personal statement while sparing yourself the headache of writing 20+ completely unique cover letters. If you’re applying to residencies in more than one specialty, you might want to write a list of bullets per specialty to cover your bases. 

Make strategic choices when securing your Medical Student Performance Evaluation (MSPE) letter

Once known as the Dean’s letter, the MSPE letter is a formal document from the Dean of your medical program. In this letter, the Dean objectively evaluates your performance throughout medical school. The actual content of the MSPE letter differs from school to school, but generally, these letters are templates that the Dean will fill in using notes from the various specialists you’ve worked with during your clinical rotations.

Some schools may require you to book time with a Dean of your choosing for a brief interview before they write the letter. If possible, try to pick a Dean with experience practicing medicine in the specialty you’re interested in. If none of your options match your chosen specialty, you may make your choice based on previous interactions with that Dean (i.e. pick someone who knows you), or consider asking for a letter from a Dean with experience in a specialty that requires similar skills to your desired residency. Finally, don’t be afraid to do some investigating on LinkedIn. It’s an easy way to scope out your Dean’s professional network, which is something else you may be able to leverage.

However you select your MSPE letter-writer, make sure it’s a strategic choice. Even small details can separate good applications from excellent ones. 

Demonstrate academic excellence

Your USMLE or COMLEX-USA transcripts may carry more weight if you score highly, but working hard during the school year and performing well on your exams demonstrates that you’re a smart person and dedicated to your goals. The work you put into your class exams will also pay off when you’re entering dedicated board prep, so it’s a good way to kill two birds with one stone. 

Your medical school transcripts also give program directors an understanding of what you’ve studied, for how long you studied each subject, and how you performed academically. Transcripts can be obtained from the registrar’s office at your institution—most US programs will actually submit the transcripts to ERAS on your behalf. If you need to request them yourself, it’s recommended that you ask for them to be printed on plain white paper so the documents are easily readable.

If you are an IMG and your medical school transcript is not in English, you must get it translated and have the translation verified. The verifier can be a government official, an official from your program (such as the Dean), or you can ask a professional translation service.

Seek out research and publication opportunities

Publishing academic research is a good way to win over residency program directors. It shows you’re actively contributing to your field, which is a boon for any institution. Attending and presenting at conferences can also be an effective way to boost your profile. 

To learn more about research opportunities and medical conferences, check out these blog posts:

Osmosis illustration of a conference booth.

Include a professional photograph

Submitting a headshot is not technically required as part of your residency applications, but it’s a good idea to include one. It’s helpful for program directors to be able to put a face to a name, and it makes your application more memorable. To make sure it’s memorable for the right reasons, be sure to:

  • Keep it professional (business or business casual attire)

  • Avoid wearing your white coat (you’re not going to wear this to the interview)

  • Make sure it’s well-lit (ideally, it should be a professional shot)

  • Only include yourself in the image (no family members, friends, or pets!)

  • Keep the background plain and free of distractions

  • Spread joy with a smile!

Osmosis illustration showing appropriate photo standards for medical residency applications.

ERAS photographs also come with specifications which you should take care not to exceed:

  • Size: 2.5 in. x 3.5 in.

  • Resolution: 150 dpi

  • Filesize: 100 kb

How do I improve my chances of matching as an IMG?

Much of the aforementioned information certainly applies to IMGs. However, as an IMG, it’s an unfortunate reality that you have fewer opportunities, both in terms of available residency spots, and potentially in terms of networking, too. As an IMG, checking off the following boxes will give you a huge leg-up against the competition: 

  • Hands-on clinical experience such as observerships or clerkships

  • A high Step 1 score (until it becomes pass/fail beginning in 2022)

  • A high Step 2 CK score

  • Strong Step 3 score (less impactful if you have strong Step 1 & 2 CK scores)

  • Strong letters of recommendation from a US-practicing physician

A note on the ECFMG status report

If you’re an international medical graduate who’s applying for residency in the US, you’ll need to submit all the documentation US applicants have to submit for residency, plus an additional document: the Educational Commission for Foreign Medical Graduates Status Report.

This report will confirm to program directors that you are ECFMG-certified and eligible to participate in the US Match. To obtain your status report, you need to visit the Certification Verification Service (CVS) Online and submit a request, which costs $55 USD. The ECFMG will submit the status report on your behalf.

You must have ECFMG certification by the time you participate in the Match, but ideally, you should try to obtain the certificate before you head out for interviews, so you can carry it with you. Knowing you’re ECFMG-certified already can make a big difference for residency program directors when they’re considering your applications.  

Get More Residency Application Tips from the Experts

Last year during Match Week, Osmosis hosted a Match Week discussion panel featuring medical experts, including:

Watch the video below to learn even more information about how you can succeed on the NRMP Match.


Now, go forth and Match!

Osmosis illustration of medical students who have successfully matched.

Congratulations! You made it to the end of the Osmosis Ultimate Guide to the NRMP Match. By now, you should feel much more ready to tackle this whole process and get ready for Match Day 2022. 

We hope you have found this Osmosis Ultimate Guide to the NRMP Match helpful—thank you for reading!



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The United States Medical Licensing Examination (USMLE®) is a joint program of the Federation of State Medical Boards (FSMB®) and National Board of Medical Examiners (NBME®). Osmosis is not affiliated with NBME nor FSMB. COMLEX-USA® is a registered trademark of the National Board of Osteopathic Medical Examiners, Inc. (NBOME). Osmosis is not affiliated with NBOME. NATIONAL RESIDENT MATCHING PROGRAM®, NRMP®, SUPPLEMENTAL OFFER AND ACCEPTANCE PROGRAM®, and SOAP® are registered trademarks of National Resident Matching Program. Match A Resident is not sponsored by, endorsed by, or affiliated with National Resident Matching Program. THE MATCH™ is a trademark of National Resident Matching Program® (NRMP®). Osmosis is not affiliated with the NRMP.