<p>The "match" is the National Residency Match Program. It's the process that determines not only which specialty you enter but also where. </p>
<p>During the fourth year of medical school, M4's begin applying to the programs they are interested during the fall. This is the point at which the students pick their future specialty. If you're like my roommate's boyfriend and don't have much of a clue what you want to do, you can apply to programs across a variety of fields (in his case - ophtho, anesthesia, psych, and radiology) and figure out what you want to do while the year progresses and you complete interviews. </p>
<p>Interviews occur Late Oct/Nov-Jan. In February, (actually pretty soon), students are required to submit their rank order lists (ROL), in which they've listed their choices in order. Residency programs then rank in order the students they've interviewed, and a computer goes through and places the student in the most favorable location. It's actually a process that is identical to the ways in which sororities process the preferences of new members. </p>
<p>The Match does benefit the student and is likely the most fair method of securing residency positions. In the days prior to the match, residency programs would search the medical schools for the top students during the M1 and M2 years, and offer them training spots (this was back in the 40's and 50's when there were much fewer pathways). This caused a lot of problems for students and programs. On one hand as a student it was nice to have an offer, but there was always the risk that something better might come along and you might have already signed a contract of some sort. Likewise programs had to take risks that they might have last minute defections or that if they waited they'd be left with the duds. So that's why they created the match.</p>
<p>There is a lot of competition to get into certain fields, but med students (for the most part) are pretty aware of the competition. To some extent, a lot of people realize early on that they aren't going to be competitive for certain fields and quickly adjust their career goals. People hoping to go into Derm know that it's the most competitive field (mainly because of how few spots there are), and as such have back up plans. </p>
<p>For Derm, ortho, ENT, RadOnc, and Plastics (the only fields in 2007 in which there were fewer available spots than US Seniors applying), these particularly specialties all require a transitional or prelim year before you actually enter in to the specific training of those fields. So it is possible to not match coming out of the 4th year of med school, and try going through the match again to get into your desired field. It's a risky position to be in, but for some people this re-matching decision is their back up plan. If you look at the 2007 Report of Charting Outcomes in the Match (on the AAMC website) you'll see that most people applying for derm or plastics have multiple specialties show up on their ROL's. A significant number of RadOnc applicants also ranked more than just RadOnc. So people know to hedge their bets.</p>
<p>As far as being competitive for these fields, board scores and grades during the 3rd year of medical school are the most important factors. Step 1 matters more in these fields than others, mainly because these people have scored so high, that they put off Step 2 as long as they can so that the score won't affect their match if possible. After those items, the Dean's letter and the LOR's are important. Honors like Alpha Omega Alpha can carry some weight, but generally are more likely markers of success rather than the actual honor being important. Research can be important, but probably is important on an institution by institution (and program by program basis within an institution) basis. Finally, pre-clinical grades and leadership experiences are less important. That's not to say they're irrelevant, and a student who knows how to sell their experiences can make good use, but on the whole, residency programs aren't preoccupied with them.</p>
<p>Remember though that the interview counts for a lot as well - the programs are looking at students as people they're going to be working with for the next 3-7 years. There's something to be said about being pleasant and enjoyable to work with, something that doesn't always go into college or medical school acceptance decisions. If you're personality doesn't mesh well, it's likely the applicant won't rank the program highly and vice versa. One of the things I see this really commonly come up is women and starting a family (or if they already have kids). A woman with 2 kids already and a 3rd on teh way, isn't going to be a good fit in a program in which no one has any kids and none of the women are pregnant. There certainly are programs where that's frowned upon, while at others, family life is very important.</p>
<p>All that said, the best predictor of matching into one's preferred specialty, according to the AAMC report is the number of contiguous programs from the preferred specialty one ranks on their ROL. In plain words, you have a better chance of matching if you rank Derm programs 1-10, than if you rank Derm programs only 1-6. Of course, you might end up at that #10th ranked program, but you do get to be a dermatologist. Whether this is simply a marker of tenacity or something else, the fact remains that all things being equal, the person who ranks more programs in a row increases the likelihood of getting into that field. </p>
<p>Now, it should also be pointed out that within each specialty, there are certainly places in which it's much more difficult to get into, more so than the average program in that field. Since I'm interested in Peds, I'll use that as my example. Average Step 1 score for someone interested in going peds is 217. But I guarantee that the average board score for a peds intern at Children's Hospital of Philadelphia (CHOP) is much higher than that, probably closer to 230. CHOP is pretty widely regarded as the top pediatrics program in the country, and so like anything, they have a lot of people who want to go there. Of course, there are also a lot of people like me who feel very different about residency prestige and are much more concerned about where they're going to live rather than going to a "top" program. You'd have to pay me a lot more than a resident's salary to get me to live in Philly or NYC or Boston. I have zero interest in living in those cities. So there are definite lifestyle issues that are very important in residency decision making.</p>
<p>So to recap:</p>
<p>-Student picks the specialty and applies to programs within that specialty.
-Match is designed in favor of the student, tries to match them to their top choice, not find the programs their top groups of residents.
-Competitive specialties do have many people who don't match, most people are realists, have a plan B.
-Step 1 > Clerkship grades > Dean's letter/LOR's > Research/pre-clinical grades > leadership/volunteering is the order of importance in things to make a student competitive for getting an interview invite
-Interview matters a lot.
-There are competitive programs in every field.
-Things like geography, family life, and so on are much more important to applicants than they ever are in college/med school decisions. People have actual lives when they get out of medical school and there are all sorts of things that may matter more than going to the #1 most amazing program in the world.</p>