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  • For medical school, you apply to multiple schools

  • hopefully get several acceptances, and choose the program that you like most.

  • For residency. It's not so straightforward.

  • Instead you'll be using the NRMP Match and it's Nobel Prize winning algorithm

  • Here's how it works.

  • Dr. Jubbal, MedSchoolInsiders.com.

  • To properly understand how the match works,

  • we first need to understand the issues that it addresses.

  • Before the National resident matching program or NRMP,

  • there was a straightforward traditional application system, just like you would use for applying to medical school.

  • Back then, hospitals benefited from filling positions as early as possible

  • and applicants benefitted from delaying acceptances.

  • These factors led to offers being made for positions up to two years in advance before starting residency.

  • In response, medical schools began to only release transcripts and letters of recommendation

  • during the students final year.

  • Competition then took another form, whereby programs issuedexplodingoffers,

  • requiring the medical students to accept or reject a residency offer within 24 to 48 hours

  • There were other problems too.

  • Competitive applicants would hold on to multiple program offers

  • or would renege on accepted offers when a better one came along

  • Programs were pressured to extend early offers to secure the best candidates.

  • In short, it was a mess.

  • Enter the NRMP Match, the aim of which was to promote an even playing field.

  • It's based on an algorithm first described in the 1960s

  • for which Lloyd Shapley and Alvin Roth were awarded the Nobel Prize in Economics in 2012.

  • Each September, 4th year medical students apply to residency using ERAS,

  • the Electronic Residency Applications Service.

  • From October to January, they'll be offered interviews at various residency programs.

  • In February, both the residency programs and the applicants will submit their Rank Order List (ROL).

  • A rank list is an ordered list, in decreasing preferences, of the programs an applicant would like to attend,

  • or a list of the applicants a program would like to recruit.

  • Let's take a look at how this works in real life.

  • Say we have five applicants and three residency programs and each of them submit their own rank lists

  • The algorithm is applicant-proposing, meaning it prioritizes what the applicants submit rather than the programs.

  • First, the algorithm will start John who ranked City first. City ranked him as well, at number two

  • He's now tentatively matched at City.

  • We say tentative because if there is another applicant who is higher ranked at the program,

  • the algorithm may bump the lower ranked candidate, depending on the number of seats available.

  • Next, we'll go to Charlene, who also ranked City first. city ranked her third, so she'll tentatively match there for now.

  • Zack ranked City first and City ranked him at number 5.

  • Since the two seats are already tentatively assigned to other applicants,

  • the algorithm cannot assign Zack to City.

  • Instead, it moves to his number two position, County.

  • County ranked him, so he's tentatively matched there for now.

  • Linda ranked Private first, but Private didn't rank her,

  • so the algorithm will go to her number two.

  • She ranked City next, but she's at number four, and the two seats are already claimed by applicants higher on City's list.

  • The algorithm moves to her third choice, County, and tentatively matches her there for now.

  • Mark ranks City first, and City ranked him first as well.

  • A match made in heaven.

  • This is a confirmed match, not a tentative match,

  • as there's no possibility for another applicant to be ranked higher at City.

  • But in doing so, Charlene got bumped off.

  • The algorithm will try to match her to a second program, but Private didn't rank her.

  • She ends up going unmatched.

  • In the end, this is what the final match results look like.

  • John and Mark both ended up at their number one ranked programs,

  • so big congratulations to them.

  • Zack and Linda didn't match at their number one picks,

  • but they still matched, and that's reason for celebration as well,

  • Unfortunately, Charlene and Private both ended up going unmatched.

  • You'll note that both had shorter rank lists. This isn't a coincidence

  • Generally speaking, you're less likely to successfully match with a shorter ranked list for two reasons.

  • First, statistically there are fewer opportunities for a match to occur with a shorter list

  • Second, more competitive and desirable applicants are usually offered more interviews.

  • Not only are they generally ranked higher on the program's list,

  • but because they attended more interviews they have longer lists as well.

  • Rank lists are submitted by both applicants and programs at the end of February

  • and Match Day occurs in the second half of March.

  • It's a formal celebration at all medical schools across the country.

  • Students open an envelope inside which is the residency program they will be training at for the next 3-7 years.

  • If you go unmatched, all hope is not lost.

  • During match week, you'll be part of a process called SOAP,

  • standing for Supplemental Offer and Acceptance Program.

  • During this time, unmatched applicants and unfilled residency programs will connect.

  • Oftentimes, these unmatched applicants will take on preliminary or transitional year residency positions,

  • which lasts only one year,

  • meaning they will apply again to residency during the next application cycle.

  • Now that you understand the basics of the Match and how the algorithm works

  • let's debunk some of the common myths that lead applicants astray.

  • first, Always Rank Every Program You Interviewed At.

  • Since matching at a program is a binding commitment,

  • It's important to rank only programs where you would be happy to train.

  • When I was applying to plastic surgery residency,

  • there were a couple programs I didn't rank because I knew I wouldn't be happy there.

  • It's ultimately a personal decision, and for me, I would have rather gone unmatched than trained at those programs.

  • It's also important to note that programs will only rank applicants they have interviewed,

  • so there's no benefit to listing programs at which you weren't offered interviews.

  • Number 2, The Algorithm Favors Residency Programs Over Applicants.

  • Prior to 1995, the NRMP matching algorithm favored residency programs over applicants

  • such that it proposed matches based on the program's rank order list rather than the applicants.

  • In a very small number of cases,

  • applicants ended up at lower ranked programs compared to if the algorithm was applicant-proposing.

  • So since then, the algorithm became applicant-proposing, which is good for medical students.

  • It's been this way for over 2 decades and it's time to quit with the conspiracy theories

  • Number 3, Changing Rank Lists Last Minute.

  • Don't wait until the last minute to make any changes to your rank list.

  • Similarly, don't wait until the last minute to finalize your rank list.

  • It's important to wait multiple factors to make the rank list that's gonna make you the happiest come Match Day.

  • If any part of the process is rushed, a rash decision has a high probability of leading to regret.

  • Number 4, Rank Programs Based On Them Ranking You.

  • The most pervasive myth is that the order of your ranked list

  • should be dependent on where you think you have been ranked highly

  • rather than your true order of preference.

  • By understanding how the algorithm works,

  • It becomes clear that you should rank programs in your order of preference,

  • meaning if you want to go to Prestigious Program X, rank them as number one,

  • even if you think they didn't rank you as highly.

  • Trying to outsmart the system by ranking a program higher because you think they also rank you higher

  • doesn't actually improve your match outcomes.

  • It's actually just more likely to result in you going to a program you're not as happy with.

  • The only time this sort of game theory actually comes into play is under two specific conditions,

  • both of which must be met.

  • First, you're applying to smaller specialties

  • like plastic surgery, ENT, interventional radiology, and several others,

  • where the faculty and programs are well connected.

  • And second, you or your advocate informs your #1 ranked program that you've ranked them as such.

  • There are several rules and restriction around this so only proceed with professional guidance.

  • Programs like matching with students who have ranked them highly,

  • and this sometimes can sway a program's rank list by a couple spots.

  • It will not move an applicant from the bottom of the list to the top

  • but it can move you from number 3 to number 2,

  • and that can be the difference between you matching there and not.

  • This is a much more advanced and high-risk topic that is dependent on multiple specific factors to each student,

  • and for that reason it's not something I'll be discussing further on video.

  • Rather, this sort of advanced theory and application of rank list strategies is best suited for 1-on-1 guidance

  • from a physician with real experience on residency admissions committees.

  • And that's where our team of top tier physicians at Med School Insiders comes in.

  • We've served on residency admissions committees,

  • worked with hundreds of faculty members and program directors

  • relentlessly studied the literature on the Match and optimizing outcomes,

  • and have honed the systems to help you succeed.

  • We'll help you optimize your whole application process,

  • from the personal statement, ERAS, helping you master your interview skills and even optimizing your rank list.

  • so you're ecstatic on Match Day.

  • Learn more at MedSchoolInsiders.com.

  • I'm hoping this clarifies much of the confusion about the Match and rank list.

  • For anyone who is applying to residency soon,

  • I wish you the best of luck.

  • If you enjoyed this video, leave us a thumbs up to keep the YouTube gods happy,

  • and Subscribe with the notification bell enabled if you want to see more content like this.

  • Much love to you all, and I will see you guys in that next one.

For medical school, you apply to multiple schools

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B2 rank ranked residency algorithm program list

NRMP Match Algorithm Explained (Residency Application Process)

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    Summer posted on 2020/07/30
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