Clinical

How to Build a Rank Order List

Osmosis Team
Published on Feb 16, 2024. Updated on Mar 7, 2024.

Match Week is upon us! It's an exciting and stressful time for you and your fellow medical students as you prepare to make the leap from medical student to resident physician. Whether it's curating a strong residency application, anxiously awaiting invitations from residency programs, or building a competitive rank order list, the Match process takes diligent effort. 

There's a lot to understand about the Match, and luckily, Osmosis has a helpful guide to make the process easier to navigate. 

Here's a quick overview of critical moments in the Match process: 

  • June - Match season begins  
  • September - Students submit residency applications  
  • October - Residency programs invite students for interviews  
  • February - Students submit rank order lists 
  • March - Match results revealed  

The goal of the Match is to fill both medical residency and fellowship spots in the United States. The National Resident Matching Program® (NRMP) is at the helm of this process and has a dedicated algorithm that pairs applicants and residency programs based on their rank order lists. The algorithm favors applicants' choices and attempts to place them in their preferred residency program based on their rank order list. If there isn't a match with one location, it continues down the list. For a match to occur, both the applicant and the program must have included one another on their lists. Check out this National Resident Matching Program video for details. 

Building a competitive rank order list and determining which residency programs feel like a great fit are critical aspects of the Match process. Once you match into a residency program, you should anticipate starting your internship year in July.

Navigating the Match may feel overwhelming. Fortunately, Osmosis has you covered with advice on ways to make the process easier to navigate. 

Prioritizing Preferences

When you begin preparing for the Match, take some time to ask yourself a few important questions, such as:
 
  • What are the most important characteristics you're looking for in a program? 
  • What part of the country would you like to train in? 
  • Would you prefer a hospital or community-based program? 
  • What type of program culture are you seeking? 
  • What are your career goals in your future specialty? 
  • Where would you like to practice medicine long-term? 
  • Would you like to complete a fellowship? 

You may not have all the answers right away, but setting aside time to consider your true desires is crucial as you begin program research for residency.  

Program characteristics, such as the number of residents per program, patient population, reputation of the program, hospital affiliations, family friendliness, and success of alumni, are all necessary elements to consider. Aside from residency program evaluation, consider where it is geographically. Evaluate whether you're comfortable with the cost of living, the weather, the distance from loved ones, and the level of diversity in the area because this residency program may be where you'll spend the next 3 to 7 years of your life. In addition, depending on what specialty you go into, you need to make sure it's the right residency program for you

Researching Residency Programs 

Now that you've contemplated your ideal residency program, geographical location, and career goals, it's time to check out the available residency programs. There are a few helpful resources to gather more information about each program, but a great place to start is at the individual program websites. They often outline their residency application requirements, curriculum, salary information, and benefits. 

Another great tool at your disposal is FREIDA, an online database that allows applicants to explore numerous programs, take notes, calculate potential application fees, and more. 

The Association of American Medical Colleges (AAMC) also has the Residency Explorer Tool for applicants to research and compare programs based on location, program size, and type of program. 

Gathering insights from current residents and alumni networks is also a great way to learn more about a program. Most program websites list their current residents as well as recent graduates. Find ways to connect with them and ask them about their experience in the program. Getting an insider perspective can provide a deeper understanding of the program and may spark ideas about questions to ask during the interview process.  

Assessing Program Fit 

While exploring residency programs, look at each program's curriculum, work-life balance, resident satisfaction, recent research, and mentorship opportunities, as these are also crucial in finding a program that feels like the right fit.

When considering the curriculum, understand that each phase of training comes with new educational goals. Figure out if those goals align with your interests in the field and if you'll receive well-rounded training. 

Research is another area to consider when exploring residency programs. Consider these questions: 

  • Are residents involved in furthering the field through research and publications?  
  • How much support is offered to residents pursuing research? 
  • Is there funding allocated to attend professional conferences?  

Make sure to inquire about mentorship as well. Find out if mentorship opportunities are available from attending physicians, more experienced residents, or other faculty members. A good mentor can help shape the trajectory of your career and offer valuable advice as you grow in the medical field.   

Lastly, remember that your peace of mind should be non-negotiable. Your residency can be stressful, and being in a program that makes you miserable won't make it any easier. Take the time to learn about other residents' well-being, satisfaction, and work-life balance. To be the best doctor you can be, you also need time to rest and enrich your life outside of the hospital walls. Researching these key areas will assist you in choosing residency programs wisely.  


Narrowing Down Choices 

Once you've completed your research about residency programs, meticulously crafted your application, and aced those Match interviews, it's time to create a shortlist based on preferences and deal-breakers. Hopefully, you've kept notes about each program throughout the process, as this will make creating a list much easier. You'll want to ensure that the list is well-rounded and includes a lot of your preferences. 

Match Strategy 

When optimizing your rank order list for residency, put your most desired program at the top of your list, even if you're unsure if that program will also rank you at the top. Remember, if a program extended an invitation to you, your application stood out, and they were curious if you'd be a fit as a resident in their program. Your rank order list should be designed based on how you feel about each program after comparing them, reviewing your notes, reflecting on your interview experience, and considering your personal preferences. It should not reflect where you think the residency programs will rank you. 

Now, if you had interview experiences that raised red flags or don't see yourself ever training at certain programs, consider leaving them off your list. When making this decision, ask yourself if you'd rather potentially go unmatched than train at those programs. Please note that if you didn't interview with a program, you should not rank them, as programs do not rank candidates they didn't interview. 

In general, your list should be a mix of competitive programs, less competitive options, and a safety program where you feel very confident that the program will rank you highly. Make sure to seek guidance from mentors and advisors when creating your rank order list. They can provide an unbiased review of your list and additional rank order list strategies.  

The NRMP also has an interactive tool that provides the top characteristics of applicants who've matched to their desired specialty. It won't predict if you'll match or not, but it can give you an idea of how competitive you are as an applicant.  

Building and Finalizing the Rank Order List 

Creating a rank order list relies on both intuition and strategy. Focus on prioritizing programs based on your preferences, but consider the areas where you can have some flexibility. You may change your order a few times before finalizing your rank order list. Before making hasty changes, consult your mentors and advisors for input, then make informed adjustments based on the feedback you receive. Fear and doubt may creep in, but don't make decisions based on those emotions. Working to balance your mindset between optimism and realism will be helpful throughout this process.

Keep in mind that you're a qualified applicant, and just as you're working to impress residency programs, they're also doing their best to market their programs to you.

While building your tentative rank order list, you may use the NRMP's Registration, Ranking, and Results (R3) system. This system manages all the NRMP matches. You can rank up to 300 residency programs, but after the first 20, there are additional fees.

Your rank order list must be submitted in February. Your list isn't complete until all the fees are paid and the list is certified. In the meantime, your applicant status will be listed as "ranking" and will change to "certified" once complete. Always pay attention to the exact date for your corresponding match season, as the date may change.  

Before the deadline, set aside time to self-reflect, review your list, and, once your list is done, trust your instincts. Most applicants regret last-minute changes to their list, so try to avoid the temptation of making alterations. However, if you decide to change your rank order list once you've certified it, you must re-certify it and submit it before the deadline to use it for the Match.

One of the most valuable recommendations you'll come across is to submit your list before the deadline. There may be technical issues, so submitting it early can help you avoid a last-minute crisis. Check out this NRMP R3 guide for more details on the features included in the R3 system and how to properly submit your rank order list. 

Post-Submission Strategies 

After you've certified your rank order list, the waiting period begins. Try to keep a positive mindset during this time; trust yourself and your preparation. Rather than being anxious about potential "what if" situations, prepare yourself for the possible outcomes and develop contingency plans. 

Ideally, everyone wants to match with their top choice, but what if you don't? Or what if you don't match at all? If you go unmatched, get organized for your next steps, such as contacting your medical school and participating in the Supplemental Offer and Acceptance Program® (SOAP).

SOAP provides unmatched applicants with the chance to secure an unfilled residency position. You can apply to a maximum of 45 positions. The process consists of four rounds during Match WEek where applicants can accept or reject any offers they receive. Learn more about this year's SOAP details here.  

If you don't obtain a residency spot through SOAP, it's time to take a deep, cleansing breath and consider how to strengthen your application for the next Match cycle. While this isn't any Match applicant's intended outcome, keep in mind that your dreams of becoming a physician don't end if you go unmatched. Take some time to process your emotions and begin taking steps to become more competitive for the next cycle.  

Conclusion 

A variety of factors play a part in having a successful match season. One of the major tasks is building an optimal rank order list. Thorough research on residency programs and reflecting on your preferred program characteristics will help you build a list you can feel confident in. Remember to consult with mentors and advisors for guidance in this process, pay attention to the deadline for your rank order list submission, and trust your instincts. Osmosis is also full of residency match advice for medical students; be sure to check it out!

Remember what's meant for you won't miss you. We wish you the utmost success in the Match process!

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