Mar 14, 2012

Enjoying the Milieu of Matching: Reflections from a First Year Intern

The fourth year of medical school is a rather strange mix. You spend much of the months of November to January travelling all over, living completely out of a suitcase, and wearing the same dark suit for days on end. This is followed by whatever method you might choose for ranking the places that you would like to complete residency. Some people make endless lists of pros/cons, others continue to research every possible detail about programs, hospitals, cities, and the like. All of this leads up to filling out the rank list with NRMP (National Resident Matching Program), checking it a few (possibly a dozen) times, submitting the list, and waiting for almost a month.

Then comes Match Week – probably one of the most unusual ways ever to find out about one’s first job (or at least the first as an MD/DO).

The second week of March is filled with a roller-coaster of emotions for fourth-year medical students across the country. There’s the universal anxiety about receiving the email from NRMP on Monday morning – “Did I match?” – followed by a week of anticipation. Medical schools seem to handle Match Day in one of two main ways. Most medical schools convene students (often for the first time in many months) to celebrate the achievements of the class. Some schools (like mine) have students announce where they will spend the next 3-7+ years in training one-by-one in front of a crowd of classmates, families, and friends. Other schools (so I’m told) have students open their match letters all at once, allowing for a bit more private experience. In both situations, the primary motive is to celebrate the achievement of students completing the four years of medical school now embarking on the next part of their training.

As I look back on my own Match Day, I’d encourage those of you reading this to make sure you take the chance to celebrate. Take a little time to reflect on what you have accomplished and to enjoy a day with the people with whom you have worked throughout medical school. In addition, celebrate with attendings, faculty, and mentors alike. Match Day, for many students, will be one of the very last times that you spend with your classmates. Some classes decide to celebrate on the morning before Match Day with a makeshift “tailgate” (caution: rumor has it this can be dangerous), while others host parties afterwards for students and faculty. In whichever way you choose, take the time to enjoy your individual and collective accomplishments. The next few weeks and months will be filled with final rotations, travels to find a new place to live, and hopefully at least a little time to relax. Graduation will find most people in the midst of life changes, marriages, babies, moving, and that day will come and go rather quickly. Take the time on Match Day to realize what you’ve accomplished and to re-connect with the people who were alongside you on the lengthy journey from the anatomy lab, through the classroom, and onto the wards. It’s an exciting week; make the most of it. Good luck!!

- Ross W. Hilliard, MD, Internal Medicine Intern, Rhode Island Hospital and The Miriam Hospital, Brown University/Lifespan

Mar 12, 2012

The Excitement, the Nerves, the Uncertainty … it’s Match Day!

Editor’s note: Joshua Liao, a fourth year medical student at Baylor College of Medicine, takes us inside his thought process as he prepares for Match Day or, in his words, one “massive job notification party.”

There is a common theme to the unique experience called Match Day: Unlike every other transition we’ve had as students—from high school to college and from college to medical school—we are forced to consider our options and everything important to us without any reassurance of acceptance. Unlike the college or medical school selection processes in which we could definitively know our options and choose from them, the Match forces us to process our goals using potential scenarios and possibilities (which can be taxing mental exercises). The complexities of this process can be further amplified by well-meaning, but anxiety-inducing, relatives and friends.

If nothing else, Match Day is an extremely unique way to find your first job. As applicants (“soon-to-be physicians”), we start the process off by applying to as many residency programs as we want and then awaiting interviews from all, or a portion, of those programs. We then invest an immense amount of our own time, money, and energy visiting those programs on strictly required, non-negotiable (as I unfortunately found out several times) in-person interviews.

After a brief lull, we rank the programs we visited and enjoyed, and each program, in return, ranks as many of us as they want. This massive collection of lists is then inputted into a central algorithm that pairs students with programs, culminating in a large grid of “matches.” The matches are released all at once, all over the nation, on one morning in mid-March (this year it is on Friday, March 16). The event, or “Match Day,” is essentially a massive job notification party for the majority of medical students.

For many of us around the country, it can be anxiety-laden for a number of reasons:
  • For some, elements of their academic records have been questioned during interviews and give them cause for concern
  • For others, interview experiences and Match statistics that ought to reassure still don’t
  • For others still, specific personal and/or academic reasons can cause anxiety about getting into specific programs
I was determined to avoid all this. I spent a great deal of energy choosing which programs to apply to and then, after doing my best to take stock of my goals and values, selecting which ones to visit on interviews. Afterwards, I resolved to fully engage every program that felt consistent with what I wanted and not to mislead those that were not. I asked increasingly specific questions (including many about the presence of patient safety/quality improvement opportunities!), and gradually, my rank list came together. I revisited it numerous times. I felt consistent and content.

But as we approached the date for final list submission (February 22nd), a few unexpected thoughts formed in my mind:
  • Had I ranked everything the right way?
  • Was a one- or two-day visit really enough to assess my favorite programs accurately?
In very specific situations, last-minute list changes can sometimes be beneficial for students. But that wasn’t the case for me. As time passed, it quickly became clear that I needed to stand firm in my original convictions, a decision that required much more courage than changing my list. There was an undercurrent threatening to disorient and panic me, but I was determined to resist it. I took a few more long looks at my rankings, calmed the urge to tweak them, and submitted.

Now, I await Match Day with a surprising measure of excitement, and I’m thankful I remained true to my values throughout. On one level, I certainly hope I get my first choice, like every student does. But on another level, I hope that regardless of outcome, I will be content knowing that I handled everything along the way with serious thought, careful reflection, and honesty.

Because while I’m not sure where I’ll be come July, I know one thing beyond a shadow of a doubt: Match Day is an extremely unique way to find your first job, but it’s an even more unique and important way to find out more about yourself.

By Joshua Liao, BA, BS, Baylor College of Medicine