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OPINION

Applicant to Residency Program


Translation Guide
Lars J. Grimm, MD, MHS, Terry S. Desser, MD, Janet E. Bailey, MD, Charles M. Maxeld, MD
The National Resident Matching
Program (the match) was created to
provide a reliable way to match
medical students and residency programs [1,2]. Although the match may
be a fair system, it is incredibly (and
perhaps unnecessarily) stressful. It is
natural that applicants would seek
some reassurance that they will be
ranked competitively at their favorite
programs and do whatever is possible
to position themselves for a successful
match.
The National Resident Matching
Program allows communications between programs and applicants but
regulates what can be said, in an
attempt to prevent undue coercion. Its
policies state, Both applicants and
programs may express their interest
in each other; however, they shall
not solicit verbal or written statements implying a commitment [3].
Furthermore, neither party can suggest that its ranking is contingent on
any commitment from the other
party.
Some form of postinterview communication is nearly universal, as between 46% and 95% of residency
programs [4,5] report following up
with interviewed applicants, and
94% of applicants report contacting
program directors after their interviews [6]. These postinterview
communications are also important,
as they cause up to one-third of applicants to change their rank order

622

[6-8], and unpublished data collected


at our institution showed that 66% of
program directors considered postinterview communications when preparing their rank lists.
Although the informal thank-you
note is appreciated, it likely does not
change opinions. What can change
opinion (ie, ranking) is an e-mail stating
implicitly, I am ranking you number
1, as programs look favorably on
competitive applicants who express intentions to rank their programs rst.
Because barely half of applicants match
at their top-ranked programs, it is
important to solidify backup options
[9]. Unfortunately, there is little
perceived benet in notifying a program that it is ranked number 2, so
applicants create clever e-mails to
craftily give the impression that a program is ranked number 1, when in actuality it is not [10].
Although many program directors simply dismiss applicant
statements of intent, we instead
suggest that less savvy program directors simply learn the language of
obfuscation [5]. To help, we offer
this translation guide. All quotations listed are real-world postinterview communications from
applicants, and all translations represent the densely jaded views of
experienced, and slightly cynical,
program directors.
Quotation: You are the ideal
program for me.

Translation: You are an ideal


program for me. Or at least youre
good enough. Please rank me highly
in case I dont get my top choice.
Quotation: I cant overstate
what an amazing program you have
and how perfectly it ts my needs.
Translation: Obviously, I can
overstate my opinion of your program. In fact, I just did, hopefully to
my advantage.
Quotation: I am ranking you
in my top 2.
Translation: You are number 2
on my rank list. If you were number
1, I would have said that you were
number 1.
Quotation: I am ranking you
in my top 3.
Translation: I could get more
specic, but Im not going to.
Quotation: You are at the top
of my list.
Translation: If you consider that
my original list theoretically included
every radiology residency program in
the country, then certainly the top
could include 10 to 15 programs. If
even 1 program interprets this as a
number 1 ranking, Im ahead of the
game.
Quotation: You are the tippy
top of my list.
Translation: My advisor warned
me that everyone tells programs
theyre at the top of their list, so Ill
try to take it a step further and hope
you will interpret tippy top as

1546-1440/15/$36.00

2015 American College of Radiology


http://dx.doi.org/10.1016/j.jacr.2014.07.035

being even more exclusive. But Im


not ranking you rst. At the very
least, please appreciate the linguistic
acrobatics I am capable of in trying
to convince you that I am ranking
you number 1.
Quotation: I have been telling
everyone that Im ranking you #1!
Translation: See what Ive done
here? Im not telling you Im ranking
you number 1, so Im not misrepresenting anything. Ive told you
that I have been telling everyone that
Im ranking you number 1, which is
tough to verify, and may even be true.
Plus, I included an exclamation point
at the end for added emphasis!! But I
have no intention of ranking you
number 1.
We hope this short translation
guide will help less experienced
program directors interpret these

postinterview communications. We
also ask that that you understand the
applicants dilemma and appreciate
the creative wordsmithing at work.
That should be worth something.

REFERENCES
1. Roth AE. The origins, history, and design
of the resident match. JAMA 2003;289:
909-12.
2. National Resident Matching Program. The
matching process. Available at: http://www.
nrmp.org/match-process/match-algorithm/.
Accessed March 24, 2014.
3. National Resident Matching Program.
Match participation agreements and policies. Available at: http://www.nrmp.org/
policies/match-participation-agreements-andpolicies/. Accessed March 5, 2014.
4. Carek PJ, Anderson KD, Blue AV,
Mavis BE. Recruitment behavior and program directors: how ethical are their perspectives about the match process? Fam
Med 2000;32:258-60.
5. Anderson KD, Jacobs DM. General surgery
program directors perceptions of the
match. Curr Surg 2000;57:460-5.

6. Anderson KD, Jacobs DM, Blue AV. Is


match ethics an oxymoron? Am J Surg
1999;177:237-9.
7. Jena AB, Arora VM, Hauer KE, et al.
The prevalence and nature of postinterview communications between residency
programs and applicants during the match.
Acad Med 2012;87:1434-42.
8. Opel D, Shugerman R, McPhillips H,
Swanson WS, Archibald S, Diekema D.
Professionalism and the match: a pediatric residency programs postinterview no-call policy and its impact
on applicants. Pediatrics 2007;120:
e826-31.
9. National Resident Matching Program.
Results and data 2014 main residency
match. Available at: http://www.nrmp.org/
wp-content/uploads/2014/04/Main-MatchResults-and-Data-2014.pdf. Accessed May
6, 2014.
10. Association of University Radiologists.
AMSER guide to applying for radiology
residency. Available at: http://www.aur.org/
uploadedFiles/Alliances/AMSER/Medical_
Student_Resources/AMSER_Guide_to_
Applying_for_Radiology_Residency_Jan_
2013%281%29.pdf. Accessed March 24,
2014.

Lars J. Grimm, MD, MHS, and Charles M. Maxeld, MD, are from the Department of Radiology, Duke University Medical
Center, Durham, North Carolina. Terry S. Desser, MD, is from the Department of Radiology, Stanford University Medical Center,
Stanford, California. Janet E. Bailey, MD, is from the Department of Radiology, University of Michigan Health System, Ann Arbor,
Michigan.
Lars J. Grimm, MD, MHS: Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710; e-mail:
lars.grimm@duke.edu.

Journal of the American College of Radiology


Grimm et al n Opinion

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