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June 6, 2001

Residency Selection: Making a Match

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JAMA. 2001;285(21):2780. doi:10.1001/jama.285.21.2780-JMS0606-2-1

Medical school affords students the opportunity to gain exposure to the various fields of medicine en route to selecting a specialty. Each spring, the residency match process lights a fire under senior medical students. Interviewing applicants and residencies evaluate and rank each other prior to final placement by the National Residency Matching Program (NRMP). At many schools, the culminating event is a Match Day ceremony, where seniors gather to learn whether their efforts have merited entry into their program of choice. The agony and ecstasy of medical school crystallize into a single moment as the seal is broken on the envelope holding each graduate's match outcome. The result is met with elation and relief for many, disappointment for some. Most feel satisfaction at advancing closer to a career, perhaps mingled with regret at leaving other options behind. Even amid the jubilation, an undercurrent of anticipation and trepidation is palpable at the prospect of assuming real responsibilities.

In 2001, 93.7% of graduating allopathic US medical students matched into residency, accounting for 73.8% of the 18 354 positions filled by the NRMP.1 An additional 4215 positions were filled by US osteopathic applicants, US international medical graduates (IMGs) and non-US IMGs. Overall, available positions in primary and specialty care both showed an 89% fill rate, although entry into primary care was down 3.6% compared to 2000.1

Residency training is a relatively new development in medical education.2 In the early 1900s, medical school was considered adequate preparation for general practice. Expansion of information by the 1920s necessitated a "rounding out" year of internship. Specialty training (a privilege reserved for only the most promising candidates) was also launched around this time. Required to live on hospital grounds, these intrepid and typically unpaid souls were aptly dubbed "residents." Although much of their time was spent caring for patients, resident physicians also languished in laboratory and custodial work. The process could take many years, advancement was arbitrary, and attrition was high. Some physicians eschewed this pathway and sought specialty training abroad; others proclaimed themselves specialists after brief, unregulated study.

The quality of postgraduate education varied widely. The lack of standardization was addressed in the 1930s with the establishment of many specialty boards. By the 1950s, residents exceeded medical students in number and specialist physicians exceeded generalists. A match plan (similar to today's) was established in 1951. Further refinements included salaries for residents and relaxation of rules pertaining to personal life. The 1970s saw merging of internship and residency as well as proliferation of subspecialty and fellowship training. Electronic application was recently introduced. How will the residency selection process continue to evolve?

Not Available, National Resident Matching Program Web site. Available at: http://nrmp.aamc.org. Accessed April 2001
Ludmerer  KM Time to Heal: American Medical Education From the Turn of the Century to the Era of Managed Care.  New York, NY Oxford University Press1999;