Taylor Witt, St. Georges University, MS4

Part 1: What is The Match?

For 4th-year medical students, residency application season is a time of competing emotions: stress, confusion, and elation. In March, these ups and downs culminate in the long awaited Match day, when the product of students’ four years of hard work is revealed. With this article, “Navigating The Match,” the SIR Med Student Council hopes to alleviate some the confusion surrounding The Match process.

In Part 1 of this article, we will give a brief overview of the history and process of The Match. In Part 2, “Creating a Rank Order List,” we will discuss the different factors each applicant should weigh when considering how to rank their programs and, more specifically, the factors to consider when evaluating Interventional Radiology programs.

History of The Match

What do John Nash (the famous mathematician whose life was chronicled in the movie A Beautiful Mind) and the creators of The Match have in common?

Both have received the Nobel Prize in Economics.

In 2012, Drs. Alvin E. Roth and Lloyd S. Shapley were awarded the Nobel Prize for their work in understanding decision making within multifarious fields. Long before Alvin and Shapley’s work won a Nobel Prize, it was first applied to help solve the problematic United States residency selection process. Up to that point, the process was plagued with market disequilibrium between the supply of newly-minted doctors and the demand for residency positions. Their collaborative effort resulted in the National Residency Match Program, as known as The Match. Started in 1952, the NRMP is an algorithm-based residency selection program that uses preferences of applicants and residency programs to create the most preferred pairings for both parties.

How The Match Works

Part of the anxiety surrounding The Match stems from a limited understanding of how the algorithm matches applicants to their desired residency spots. We recommend watching the NRMP’s video for a brief but informative lesson on how The Match works, found here: http://www.nrmp.org/match-a-to-z/video-tutorials/about-the-matching-algorithm-tutorial/

For applicants, the Rank Order List (ROL) is the most important part of The Match. The ROL is an applicant’s list of programs where 1) an applicant received an interview and 2) where they would like to train.

The most important thing to remember when creating your ROL is that you should rank programs according to your preference, not according to how highly you think a program will rank you. The reason for this is that The Match algorithm is “applicant proposing.” This means that the algorithm will always first try to match an applicant based on his or her preferences before considering the program’s preferences. For example, two applicants John and Sam interview at Program A which has only one spot. John ranks program A as #1 on his ROL and Sam ranks program A as #2 on his ROL. Program A ranks Sam #1 and John #2 on its ROL. The Match will first look at the applicant’s ranks and see that John ranked Program A as his first choice. It will then look to see if Program A has put John on its ROL. If John is on program A’s ROL, it will match John to that program because no other applicants listed before John (i.e. Sam) ranked Program A as highly as John did. For a more in depth explanation please view the matching algorithm video listed in the first paragraph of this section.

For more information, you can use the following resources:

  • Read Part 2 of Navigating the Match at NRMP.org
  • The Match PRISM® app: PRISM (Program Rating and Interview Scheduling Manager), is a free app from the NRMP that enables Match applicants to track programs during the interview process and create program ratings that can be used to generate a rank order list in the NRMP’s web-based Registration, Ranking, and Results® (R3®) system. Available for IOS and Android.
  • The American College of Physician’s article on creating a ROL <click here>

Part 2: Creating your Rank Order List

The factors to be weighed

We will cover the general factors to consider when ranking residency programs and then go into the specifics of the IR match.

There isn’t an absolute best residency program as each applicant weighs each factor differently. This means that the most prestigious program might not be a good fit for every candidate.  Recalling his experience in the IR Fellowship Match, one of my attendings emphasized this, saying, “I was immature and naive only caring about prestige when I should have been concerned with case variety and case load.”

It is unreasonable to expect a residency program to be the best at everything.  Just as applicants are heterogeneous, some being excellent test takers, some heavily involved in research, and others better leaders, residency programs, too, are a mix of strengths, weaknesses, and unique features.

Ultimately, the highest ranked programs on your ROL should possess characteristics that will enable you to achieve the vision and goals set out in your personal statement.

Now, on to the factors that all applicants should consider when ranking programs.

The bare necessities

  1. Only rank a program where you are willing to train
  2. Rank programs based on your preference, not your likelihood of matching


General considerations

  1. Academic medical center vs community-based program
  2. Faculty supervision and resident autonomy balance
  3. Career paths of recent program graduates
  4. Cost of living
  5. Geographic location
  6. Morale of residents in the program
  7. Flexibility for electives
  8. Quality of educational curriculum
  9. Quality of faculty
  10. Quality of hospital facility
  11. Quality of residents in program
  12. Size of program
  13. Social and recreational opportunities of the area
  14. Work/life balance


Interventional Radiology-specific considerations

  1. Diagnostic education

Being a good interventional radiologist takes both procedural and diagnostic skills. Look for a program that will provide a strong foundation in image interpretation.

  1. Opportunities for growth

A lot can change in the 6-year adventure we are embarking upon. Look for a program that has room to grow with this rapidly expanding field.

  1. Case variety

With so many different opportunities to specialize within IR, it is hard to predict what your practice will entail. Don’t limit your future endeavors based on your current interests. Instead look for a program that offers a well-rounded education in all sub-specialties.

  1. Case Load

ACGME requires a certain number and variety of procedures to be completed during your training. Look for a program that has the case load to support these requirements.

  1. Opportunities for ESIR pathway

Not everyone that desires an Integrated IR residency will get one. For those of you who may end up in a DR program, some offer an ESIR track that will give early exposure to IR procedures during your DR residency. Look for programs that are already ESIR approved or planning to be.

  1. Relationship to other specialties

Many IR practices are dependent on referrals from other specialties. Look for a program that has great relationships with Ob-Gyn, Surgery, Oncology, etc. This will not only help with case load and case variety but equip trainees with specific knowledge for different organ systems.

  1. Opportunities for research in IR

Research forms the foundation for future clinical practice. Thus, is it important to look for programs that offer opportunities to advance the frontier of the field and have academic leaders who are enthusiastic about mentoring residents.

  1. Attendings and mentors

Depending on what aspect of IR you are interested in, you may want to pick an institution with attendings who have a strong background in that specific area. Conversely, it is important to remember that physicians move institutions. Don’t set all your hopes and dreams on one physician training you to be the next Charles Dotter.

We hope that the information provided in this article will assist you in creating your rank order list. This is not an easy task and we encourage you to continually seek the advice of your attendings, and residents who have gone through the process.

The SIR Medical Student Council wishes you the best of luck as you embark upon interview season and finalize your ROL.