The Match Experience: Part 2 – The Solutions
Written by Andrew Woods
Welcome back! In Part 1, we talked about the increasing pressure that applicants feel as the application and interview process continues to become more competitive. In my beloved specialty of Physical Medicine and Rehabilitation (PM&R), the data has proven this trend, and while it is incredibly exciting for a small community, it also means a lot of dreams are not being realized. So this begs the question, what steps can the Graduate Medical Education (GME) community take to increase equity amongst applicants and allow everyone to shine? Let’s dive in!
Pre-Application Steps: Remove the limitation on away rotations, increase the transparency of program interview standards, and participate in the AAMC ERAS Application Pilot Study
For the 2021 and 2022 Match cycles, applicants were restricted from traveling to different programs, with 2021 applicants having their rotations pulled entirely, while the 2022 class in many different specialties was restricted to one or two away rotations. While COVID is still here, a significant argument can be made that these restrictions adversely affect students without a home residency program, primarily DO and IMG applicants. It also gives students whose home institutions do not adhere to the guidelines laid forward over those whose schools require them to sign contracts stating they will not complete more than the guidelines of their specialty organizations. These restrictions also place programs at an advantage compared to applicants because there are no such restrictions placed on them by ACGME, so they can have the same number of visiting students as they did pre-COVID.
We have discussed “application fever” ad nauseum so I will not rehash those issues here, but one of the catalysts to increased application numbers is the lack of individual program data surrounding the averages for applicants that receive an interview. While the NRMP releases data each year about the specialties as a whole, there is little information about the individual program, quantifiable information like cutoff scores, volunteer or research activities, etc. This lack of transparency likely drives applicants to pay for applications for programs that they already do not qualify for, as evidenced in the most recent cycle by applicants receiving interview rejections less than 6 hours after applications were made available for review. By programs releasing their averages, or even the minimums and maximums, for applicants that were offered an interview for the last 3 application cycles, it will enable programs to present a more holistic picture of their own program while allowing applicants to gain a more realistic assessment of their own competitiveness for programs, thus limiting application bloat.
Lastly, the AAMC ERAS Application Pilot Study, more affectionately known as the Supplemental ERAS Application, was greeted by the 2022 Match class with skepticism, but I believe that it was ultimately a good thing. Although I only got to experience the Supplemental Application for Preliminary-Medicine programs, I enjoyed the ability to present a more holistic view of myself while also signaling to programs I was especially interested in. Of the five signals I used, I received an interview with three of them and wound up matching at one for my PGY-1 year. Causation and correlation comments aside, a supplemental application took just a couple of hours of my time to hopefully boost my chances of matching, which is well worth it…in my opinion!
Pre-Interview Steps: Universal interview release dates with multiple rounds, restrictions from offering more interviews than slots for, 48-hour response windows for scheduling, and a “final status” update
This is where my passion truly is in the application and interview reform, as I believe this has the best opportunity to make the process more compassionate. For almost six weeks, after the applications were released for review, interviews came in as a trickle. In today’s connected world, that meant applicants knew whether they received an interview offer in the “first round” of a programs review, but also were left to wonder if this would be the only release of interviews from said program. Some programs released interviews over seven different days spread across those six weeks, while other programs released interviews on just one day. In addition, some programs released more interview offers than they had spots for, meaning a student that was scrubbed into a four-hour surgery could get to their phone only to see that all the interview spots had been filled. In an already stressful time, this only added to those stresses and as a GME community that has become more cognizant of mental health, we have to begin practicing what we preach.
One way to fix this is to institute a universal interview release date, allow a 48-hour window to respond and schedule the interview, and then have additional “rounds” of offers until all of a program's interview slots have been filled. By scheduling this first release date far enough out, programs would have enough time to perform their holistic review while providing applicants with a known date for interviews. In addition, it would likely assist applicants to avoid interview hoarding as they would likely receive enough interviews on the first release date to either decline some or cancel others. Finally, providing a “final status” to applicants by a defined date would allow applicants to know when they are done receiving interviews, which could drive them to apply to other specialties as a backup plan in the event they aren’t comfortable with the amount they have received. While these solutions could certainly be debated and picked apart, I believe they are a small step to providing some semblance of organization to the application and interview process, which would hopefully reduce the stress levels of applicants while also allowing programs to continue performing a holistic review for interview offers…in my opinion!
Post-Interview Steps: Ban post-interview communication
This is likely the most controversial recommendation and it is meant to be. Post-interview communication, while incredibly nice and validating to receive as an applicant, truly complicates the ranking process and drives applicants, especially those who did not receive a “love letter” from one of their top programs, to overthink the entire process. In addition, a massive debate exists in the applicant community about what “ranked to match” truly means, and whether it means different things to different programs. Verbiage like “highly impressed,” “great fit,” “ranked to match,” and numerous other phrases designed to avoid match violations feel great at the time, until you don’t match at a program you received that from and that you ranked number one. Every day on the PM&R Google Sheet, applicants discussed and nitpicked every little indication received, whether it was a “love letter” that was or was not received, a “swag package” that included a hand-written letter or not, or even whether an email was sent to everyone or just a select few (and yes, these are all examples from the past Match cycle). While I loved communicating with programs after the interview, I believe the only way to fix this (aside from the unreasonable recommendation that applicants stop nitpicking everything) is to ban all post-interview communications outside of letters of intent and legitimate questions of clarification. This would level the playing field for all and preserve the integrity of the Match…in my opinion!
Closing Remarks
I made a point to close all recommendations with “in my opinion” because, at the end of the day, this was just an exercise of brainstorming born out of personal experiences and listening to others. More than anything, I believe an open conversation within each specialty needs to occur to facilitate greater changes than can be mutually beneficial to applicants and programs.
