FAQS—4th Year

• You need to take a total of 27 elective credits throughout your four years of medical school. A limited number of credits taken earlier than your fourth year can be applied toward this graduation requirement.
• No more than 16 of those 27 credits can be within the same discipline (i.e have the same 4 lettered course assignments such as PEDS)
• No more than 12 of the 27 credits can be done extramurally (outside of Binghamton, Syracuse or Guthrie)
• 4 of those 27 credits need to be a basic science. (See course book for which courses meet this criteria)

NOTE: Neither Geriatrics nor Pathophysiology count toward your 27 elective credits that are needed for graduation. (4)

This is a FAIR method to give everyone equality in course selection for their fourth year. (4)

• The lottery runs in rounds. Each round you will have a different pick so that the average of everyone's picks in each of the rounds will be the same. For example if you pick first overall in the first round you will pick last overall in the second round. (BUT YOUR BEST CHANCE AT A PARTICULAR ELECTIVE IS WITH YOUR PICK IN THE FIRST ROUND)
• A round in the lottery does not equal periods of your fourth year
• Each round in the lottery allows each student the option to select one elective
• Round one of the lottery will begin by attempting to place you in the elective that you have selected in group A, line 1; in the period you have listed first.
  • Should that elective not be available during that period it will continue to read left to right in the desired period column until it either finds on opening or runs out of selected periods
  • Should all of the periods in Group A, line 1 be filled then it will jump to Group A, line 2 and again try to fit you in the desired period starting from left to right
  • This process will continue until you have found an opening from Group A
  • Note: If all of your group A selections are filled then the computer will jump to group B so that you do not waste your first round draft pick. This is highly unlikely.
    
• Round two of the lottery will begin with group B, line 1. The computer will try to place you in your desired period again from left to right. The same process listed above will then continue.
• Round three of the lottery will begin with group C line 1. And will work the same as groups A and B.
• Beginning with round 4 all remaining selections will come from Group D. The computer will start with line 1 and go left to right in the period column until it has a match. If no match occurs it will jump to line 2. If you match is line 1 of Group D for round 4 then round 5 will start with line 2 of group D.
• The process will continue until you have no selections remaining in group D or your credit requests have been fulfilled. (When you go through ISIS to fill out your lottery sheet you will be asked to fill in the total number of credits you wish the lottery give you) (4)

A hard copy of the course book will be available at the clinical campus at the student affairs office but you can also find a copy, in pdf format, of the course book online.

NOTE: Be sure that you are looking at the updated course book as the course book from the previous year may still be online and thus not updated yet. Course numbers can change from year to year. (4)

Yes! All electives that are listed as "by arrangement only," that are offered for multiple credits, that are concurrent, or that are at the Guthrie site can all be arranged outside the lottery before or after the elective lottery draft. You may also create a unique elective that can be added to your schedule before or after the elective lottery. (4)

Yes!

• Keep in mind this is only your initial schedule. You will likely change this many times before you actually take these electives.
• Keep in mind that geriatrics is already scheduled for a particular period per your 3rd year track selection schedule. There is some flexibility here, please inquire with student affairs. You may not want to schedule an elective at that time.
• Do not schedule any electives in periods 11 and 12. You will graduate in the middle of period 11.
• November (Period 5), December (Period 6) and January (Period 7) are interview months. Schedule wisely during those months.
• Don't waste periods and/or selections in the lottery with away electives. You may be certain that you have an away elective set up but if that should fall through for any reason you will be stuck with nothing. Use the lottery to fill that period with an intramural elective and once all the paperwork is submitted for the away elective you can always drop that intramural elective (You never know if your hepatitis B titer will be back in time for you to be able to do that away elective)(4)

You should complete an AI in your chosen specialty early in your fourth year (or late in the 3rd year if you schedule permits). This will be the evaluation that will be weighted heaviest in a residency programs assessment of you. (2)

This rotation will also be the best chance for you to get a letter of recommendation so be sure that you take it in July or August. You can take an AI in September and still get the letter of recommendation into your ERAS application in time but you will definitely need to speak with your letter writer about how sensitive time will be. (4)

This is not an absolute necessity unless you are getting into programs such as neurosurgery and orthopedics (here it is essentially an unwritten rule). Otherwise it can be a double edged sword. Sure you can go in and do what you have always done and shine and thus increase your chances of matching at that program. But you can also go in and be put under undo scrutiny because of your interest in that program and because you will be compared to medical students already at the institution. (They likely will not be better than you from a knowledge standpoint but they also will not be fumbling around lost in the new hospital trying to figure out a new computer system) The general recommendation is that you only do audition rotations if it is a program and/or specialty that is a long shot for you and you should probably try to avoid it if people from your university have already matched at that program because in that case the program likely has a good impression of your medical school. (2)

The Class of 2008 essentially was equally spaced out between September and February of their 4th years as far as when they took Step 2. (this includes both CK and CS) It was generally recommended however that you should definitely take them earlier, rather than later for the following reasons: (4)

• It is easier to do well on Step 2 than it was to do well on Step 1 and thus by taking it early you are likely to show residency programs scoring improvement. (4)
  • NOTE: The number one predictor of your Step 2 CK score though is your Step 1 score. (Biddle, W. Barry Ph.D.)
• You will absolutely lose all motivation after winter break to study sufficiently for Step 2 CK.
• The further you are from your clerkships, particularly medicine, the more you will have to re-learn. The third year of medical school combined with the shelf exams really is great preparation for Step 2 so take advantage of that by taking it as close to those clerkships as possible. (4)

Earlier would be defined as taking the exam in September, October, or even November. (4)

83% of the class of 2008 spent between 3 and 4 weeks studying for Step 2 CK. 80% of them were not taking any electives during their study time and 50% of them said that they would spend between 30-40 hours per week studying. (4)

If you study for more than 3 days for Step 2 CS it is significantly too much time. All that is necessary for this examination is reading through First Aid for Step 2 CS one time in order to get the "quirks" of the patients/differential diagnosis/exam requirements. Surprisingly enough the Practice of Medicine Course is a huge asset as far as being prepared for Step 2 CS is concerned. (4)

It is generally recommended that whatever study method you used for your clerkship shelf exams should be used in preparation for Step 2 CK. You will be surprised how quickly you will remember material that you have already studied. Use this method to promote efficiency. But, also get a review book because common questions tend to be repeated. Some suggestions for review books were provided by the Class of 2008 are as follows: (4)

• First Aid Step 2 CK
• First Aid Step 1
• Kaplan Review Books (included in your tuition)
• Crush Step 2
• Step 2 Secrets
• Step Up 2 Medicine
• Déjà vu Review for Step 2
  

First Aid USMLE Step 2 CS was the only recommended book by the Class of 2008 for the Step 2 CS exam. (4)

Generally this is considered a toss up. Both sources allow for computer based testing. Both sources are similar in writing style and content. Both provide excellent explanations for each of their questions. The general recommendation would be to use whichever suits you best. If you used one of the sources for Step 1 and liked that source then by all means continue to use it for Step 2. (4)

Now that Qbank is open all year, instead of a 3 month window as was the case in the past, it may be prudent to use Qbank to study for your shelf exams throughout your 3rd year and then use USMLE World to study for Step 2. (4)

ERAS is the Electronic Residency Application Service and is designed to make your life easier during the residency application process. Instead of filling out separate paper applications and making all of your letter writers send letters to all of the different residency programs the ERAS system creates a central location for all of this information that can then be sent to designated programs. In addition to your general application and letters of recommendation, your MPSE (Dean’s letter), school transcripts, and USMLE transcripts are also submitted via the ERAS system. (1)

ERAS provides significant flexibility to meet all of your application needs. If you are still undecided about specialty or you want letters of recommendation to be different for different programs for whatever reason you can easily do this through the ERAS site. You control which programs see which documents. (1)

The cost is $60.00 for the first 10 programs to which you want to apply and then there is an additional charge for each program that you add thereafter that will be different based on how many more programs you are applying to. For exact amounts consult the ERAS website at the following URL: http://www.aamc.org/students/eras/

Once you have started working on your application do not add any new programs to the mix (i.e. be prepared with your program list before you start) for this only confuse you and you are thus more likely to forget to assign a letter or recommendation or other important document to the added program. Also it is a good idea to only complete one item (i.e. transcripts, letter of recommendation, etc) for all programs at the same time. This will help prevent letting the paperwork spiral out of control. In other words start with your transcript and go through and assign that document to all programs. Then go to each letter of recommendation individually and assign that to all the programs before going to the next item. (2)

Don't overly concern yourself with formatting for this is not something that a residency program director is ever going to see. That does not however take away the importance of the CV. This is the document that will spur all conversation during your MSPE interview and will be the document that is given to the people that you ask to write letters of recommendation for you. The CV is also a great way to keep all of your academic and extracurricular activities organized so that when you fill out your ERAS application you will not forget anything. (4)

Regardless of what you have or don't have to put on a CV they should never be too lengthy (never more than 2-3 pages). If a person can't quickly pick out 2-3 reasons to choose you over someone else they will simply move onto the next candidate. (1)

For starters the CV should contain updated contact information including name, address (include mom or dad’s address if you think you will be moving), telephone number, and e-mail address. (1)

• Note: The e-mail address should be a professional e-mail address. (4)

There should be separate major categories for education, extracurricular involvement, honors and awards, volunteer work, research, and job experience. Education should be first as you are applying for an academic program but the remaining order should be determined by the strength of your application. If you have a lot of research then that should go second, if you haven't done any research at all or you have only one publication then perhaps it should not be on the CV at all or it should be listed last.(4)

All information included on a CV should be in reverse chronological order (i.e. start with the most recent events.) (1)

Under each of the recommended subtitles you should list the date and the accomplishment in bold faced print, perhaps with a larger font and then under this include a BRIEF explanation about the accomplishment. Getting too wordy will distract the reader from the actual accomplishment. (1)

Usually for academic purposes this would not be recommended unless you can site someone in a very important position or someone who is closely linked to the program that you would like to end up. In any event if you list someone on an academic CV they should be the people who wrote your letters of recommendation. (2)

Yes. If you are having difficultly deciding on a specialty sit down and try to write a personal statement for why you want to go into that specialty. That may help you narrow your decision very quickly. (Biddle, W. Barry Ph.D.)

Start early (April-May) and revise often. (2)

You will need help with this. Having this prepared well in advance of your MSPE (Dean’s Letter) interview is important. This way you can make appropriate changes beforehand and thus can present a good rough draft to your letter writer. You letter will change after the MSPE interview. The letter writer has the experience of what program directors want to see in a personal statement; use their advice! (4)

Basically this is a "why I want to be a (fill in specialty) when I grow up." (4)

Use the personal statement to convey to the reader how and why you are qualified for the position that you are attempting to obtain. (1)

Use the personal statement as the opportunity to get "wordy" about a particularly special part of your CV. (1)

Relate significant personal experiences only if they are prudent to the specialty that you are attempting to get into. (1)

Some programs require that specific items be included or addressed in the personal statement; if this is the case this information can be found at FRIEDA or on the web site of the institution in question. (3)

A program director wants to read your personal statement and come away saying “Here is a student who will never change specialties, who will never become bored with work and who will always be upbeat enough to bring the spirits up of everyone that they work with.” (2)

Don't use the personal statement to explain away weaknesses (that is why you have an interview). A personal statement is there to make you shine not fix what is wrong. (2)

Don't plagiarize. Use sample personal statements as a guide but do not include similar topics or similar wording. Everyone read the book you read with the same sample personal statements and the last thing you want to do is have the same personal statement as someone else. A program director will label you as lazy and may not rank you at all. (3)

Be creative but know who your target audience will be. A story about your favorite Tonka Truck may apply to Pediatrics but certainly is not a good topic for your Neurosurgery application. (4)

Avoid being cliché. (4)

Be prepared to talk about whatever experience you put into your personal statement. It will come up during your interview. (2)

You likely will copy and paste a word document into the ERAS site. Be sure to proofread after you have copied and pasted because some characters may not transfer well into the ERAS document and thus will need to be adjusted. These include but are not limited to semi-colons and quotation marks. All that you need to do is delete the “weird” character and replace it with the appropriate punctuation. (1)

This will vary from specialty to specialty and from program to program. Be sure to check with the FRIEDA website as well as the individual program websites to be sure that you have requested the proper number of letters. (4)

You can only submit a maximum of 4 letters to any one program. (2)

On average most programs require that you provide 3 letters. (1)

Do not send more letters than are requested because they likely will only take the ones that are in first and then ignore the rest and you don't want your best letter to be ignored. (1)

Consider having a back up letter in case one of your letters doesn't make it to the dean's office in time. (1)

Anytime you have had a significant clinical or research experience with an attending that knows you on a personal level and can write a strong letter about you, you should get a letter. This can include 3rd year rotations as well. (2)

Most people wait until the first and/or second rotations of their 4th year of medical school (when they are doing their acting internships). This is an excellent suggestion but by no means is the only time you can get letters of recommendation. Keep in mind however that rotations after September of your 4th year will not be acceptable alternatives as these letters would not be submitted in time to be included on your ERAS application. (4)

With that said make sure that you realize that the average letter writer takes about 4 weeks to complete a letter. (if deadlines are looming, be honest with the person when you ask them for a letter and if they cannot meet that deadline then respectfully find someone else) (2)

To expedite the process, be sure to give the letter writer a copy of your CV, personal statement, envelopes, postage, and the cover letter from ERAS with the signed waiver. (2)

Ask someone who admits they can write a strong letter for you, someone who knows you well in a clinical setting, someone who is well established in their field, someone who works in your specialty of choice, and/or someone who trained at a well known institution or at the institution that you are applying to. (2)

When in doubt, always error on the side of someone who knows you the best. (2)

Some programs may specify who (which dept or position) you need a letter from. Be sure to inquire at least through the FRIEDA site. (1)

Usually this will be in the form of department chair's letter. Be sure to specify in ERAS under Title/Dept that this is indeed that letter by including the proper and most senior title. (3)

Do not ask a resident or a fellow to write your letters. Though they may know the most about your clinical skills and intentions and know you personally it does not look good to program directors. Instead supply the attending who is writing your letter with the names of a resident or fellow that can help them write a better, more personal letter about you. (1)

Be sure to give the letter writer a copy of your CV, personal statement, envelopes, postage, and the cover letter from ERAS with the signed waiver. (2)

Remember, the cover letter is important because not only does it show the program directors that all of the praise from the letter writer was not from pressure from you, but it also will provide the instructions to the letter writer about how to format the letter and who to address the letter to. (4)

Providing a picture of yourself may help jog their memory about you. (You know their favorite student of all time) (4)

Using the ERAS site you can download printable version of the waiver to waive the right to see the letters prior to their submission. This sheet also will have specific instructions for the letter writer to know who to address the letter to and also where to send the letter once it is completed. If you are waiving your right to see the letter (and you should because it shows program directors that your writers were able to write an honest letter without your input) then be sure to include an addressed and postage paid envelope so that they can send your letter to the university. I'm sure they would be willing to pay for shipping to the university but the process will happen fastest if you minimize the amount of work the letter writer actually has to do. (4)

The MSPE letter is a standard letter that is produced similarly in every medical school in the country. The content of this letter includes personal background information, preclinical evaluations; clinical evaluations; special activities; and a summary paragraph. (2)

How do I choose who will write my MSPE or Deanís Letter?

Each campus will produce a list of available letter writers for that particular year. If you happen to have a personal relationship with one of the people on that list it would be a good idea to try to get that person to write your letter. The more personal feel a program director gets from your letter the more likely they are to be impressed by the letter. (That isnít to say that an impersonal letter penalizes you in any way . . . remember regardless of how well you know your letter writer the letter has to look the same as everyone elseís letter because this is a uniform process) In other words a more personal letter may help you but an impersonal letter will not hurt you. If you do not know any of the people on the list then the general recommendation is to try and choose the person who has the most impressive title. If you procrastinate and donít get the person that you know or get stuck with the person with the lowest title DONíT WORRY. The uniform nature of this letter has placed it much lower in the ranking of important parts of your application. Always keep in mind that these letters go out on November 1st and you will likely have a majority of your interview offers in by that time. (4)

The process begins long before you select who will write you letter because prior to selecting and/or meeting with your letter writer you must have begun the process of assembling you curriculum vitae, personal statement, and preliminary list of programs that you are interested (April ñ May). Then in early June of your 4th year you will be notified by the student affairs office that you can begin to sign up for who you would like to write your letter. Sign up early, especially if you have a strong preference. MSPE or Deanís Letter interviews will follow in June and July. This is basically a meeting where you will discuss your career choices as well as how competitive you will be in that field and how appropriate your preliminary list of residency programs is. The letter writer will also use this session to get to know you on a more personal level in order to add a more personal feel to the MSPE. (4)

You play an important but very limited role in the writing of the actual letter. Be sure to use the MSPE or Deanís Letter interview to the fullest extent. If you do not know your letter writer personally this interview will be a perfect opportunity to add a more personal feel to the summary paragraph at the end of the letter. It is also a good opportunity to talk about any particular negatives that will appear automatically in the letter (poor performance on a rotation etc.) and particularly to provide certain applicable explanations for these negatives. The letter writer may be able to put a positive spin on these negatives with your help. At the same time it is also important to highlight any positives that may not appear automatically on the letter. That volunteer experience or research experience that you have done and is very applicable to your chosen specialty is appropriate for the MSPE letter but may only be included if that information is given to your letter writer. (Hence the importance of a complete and accurate CV) Use the CV to spark conversation during the interview. FINALLY AND MOST IMPORTANTLY . . . be sure to ask for the opportunity to proof read your letter. Changing content, though not impossible, is extremely difficult but changing spelling or grammatical errors is encouraged. The student affairs office is responsible for every single studentís letter and they may accidentally make a mistake. If given the opportunity to proof read the document be sure to take it. This will be your only chance ever to see this document! (4)

Because it is a standard letter an enthusiastic letter may bolster an average applicant but is only likely to dilute a strong applicant and for this reason much less weight is placed on these in the application screening process. (2)

Probably, but only in a limited capacity. It is not a requirement for medical schools to allow you access to your letter but most of them will. If you are allowed to view the letter you will not be allowed to remove it from the student affairs office and you will only be allowed to view it in a proofreading role. Changing content, though not impossible, is extremely difficult but changing spelling or grammatical errors is encouraged. The student affairs office is responsible for every single studentís letter and they may accidentally make a mistake. If given the opportunity to proof read the document be sure to take it. This will be your only chance ever to see this document! (4)

After you send out your ERAS applications and the programs have begun sifting through all of the material from all of their applicants they will begin to send out, via e-mail, invitations to interview. This often occurs before all portions of your application are complete. In the e-mail that you receive from the program you will be given a list of available dates and you will be told to reply with the date that is most appropriate for your interview schedule. (2)

Be sure to reply as soon as you know that you are able to make it on one of the days. Interview days tend to fill up fast, particularly during peak interview times, and if you want to TRY to make a geographic interview swing it will be imperative that you move quickly to lock in that date that is best for you. (4)

There is no one ìbestî time to interview. If you read through First Aid for the Match, Strolling Through the Match (AAFP), or Roadmap to Residency (AAMC) they will tell you that interviewing in January is likely to provide you with the best chance of matching at a particular program because that is the time that is closest to their rank order deadline and thus the time when they will remember you better. Whenever you decide to interview it is recommended that you do a couple ìpracticeî interviews at less desirable programs before you get into the meat of your interview schedule at programs that are at the top of your list. It is also generally not recommended that you wait until the very end of your interview schedule to interview at your favorite program. The interview season is absolutely exhausting and you do not want to burn out before you get to your favorite program. In fact many people end up cancelling their last 2-3 interviews because of fatigue. (4)

It is worth noting though that you should take even ìpractice interviewsî very seriously. You never know how tight one program director is with another and a bad experience one place can result in lower ranking at another place. (2)

You interview schedule will be dictated largely by your 4th year elective schedule and study time needed for Step 2. Generally people will take off a full month (either in November, December, or January) strictly for interviews. Spread your interviews out as best you can during your time off. You likely will not be able to make a full geographic swing in one particular region because of limited availability of interview dates. (If you do get into a bind geographically you can call a program and ask about the opportunity to open an interview day for you at a time when you will be in that part of the country. Programs are sympathetic to the high costs of interviewing and will try to accommodate you as best they can) (4)

Donít schedule interviews too close together. This is a grueling and exhaustive process; give yourself some time to recover. In fact many applicants cancel interviews late in the season due to apathy or fatigue. Be sure to leave 1-2 days in between interviews for travel purposes. (2)

Create a folder of all your application material and bring it with you and be able to give it to an interviewer or program director if asked. They likely will not ask but it is always better to be prepared. (2)

Be ready to answer the question ìWhy have you applied to THIS program?î (2)

Be sure to research a program the night before the interview (FRIEDA is excellent for this) and have questions ready. You donít want to appear apathetic when they ask if you have any questions but you donít just want to make up some generic, run of the mill, question either. Show them that you care enough about the program to look into it a little bit beforehand. (4)

If you can make it to the pre-interview dinner with the residents then you should definitely take advantage of this opportunity. (many programs will even invite significant others that are traveling with you) Pre-interview dinners with residents are a good way to get good and honest answers to questions that you may not want to ask in front of the program director or other attending physicians. Be careful though, the house staff may be evaluating you as well. (2)

When you are scheduling your interview and when you arrive first thing in the morning be nice to the administrative assistants. They can really make or break you as a candidate. (2)

• Why have you chosen this field? (2)
• Why are you applying to this program? (2)
• What are your strengths and weaknesses? (2)
• Tell me about yourself/your career plans. (2)
• What are you looking for in a residency program? (2)
• Describe an interesting case? (2)
• Describe an ethical situation that you encountered and how you dealt with it? (4)
• What do you do in your free time? (1)
• Always anticipate areas of concern in your application and be prepared to answer questions in reference to them (Low Step scores; leave of absence etc) (3)
• Be prepared to discuss the topic of your personal statement. (4)

Takes notes immediately after the interview day. After 4 or 5 programs everything will blur together and you will forget which program had which down side or vice versa. (2)

Remember you are interviewing them just as much as they are interviewing you. Use your visit to see how compatible you are with a particular program. (1)

You will not remember this ìgut feelingî after you have interviewed at 4 or 5 other programs so take enough notes to remind you about ìthe feelî you got from a particular program. (4)

Unless specifically told otherwise always write a personal thank you letter to each interviewer and be sure to include a topic that you discussed during your interview to make it as personal as possible. (2)

Write thank you notes the day after the interview while the program and the interviews are fresh in your mind so that they are as personal as possible. If you wait and do a few interviews at a time then things will start to get mixed up and confusing and you risk thanking someone in one program for what they did for you at another. It is also a great idea to jot down a couple topics that were discussed in an interview right after each individual interview. The more personal you make the thank you notes the more the program will see how interested you are in them. Speaking of personal thank you notes: the thank you notes should probably be hand written on little thank you cards and mailed. If you are too lazy for this you can do e-mail but not only is it impersonal but you are giving the impression that you are too lazy to write thank youís and thus you will be perceived as a potential lazy intern. Thank you notes should at least be written to everyone that personally interviewed you and the program director. If you wanted to add a nice touch, send one to the administrative assistant who helped you during your interview day. You never know how much pull they will have in the decision process. (4)

Second looks are a double edged sword (1)

• Some programs look at it as you showing enthusiasm toward the program. (1)
• Some look at it as an insult that you even request one. (1)

Only go for a second look if you truly, truly need more information about the program and are very interested in going to that program . . . if you donít have the need for it then donít do it but tell the program director that in the thank you note that you send them. (4)

Many residency program directors recognize the high cost of travel associated with interviews and try to tell you that a second look will not have an effect one way or another on how they rank you. (4)

Some specialties do favor second looks and will only rank you if you have shown enough interest in the program to actually take a second look. This is particularly important in the fields of neurosurgery and orthopedic surgery. Be sure to inquire with student affairs whether or not this is required for your specialty. (4)

Registration cost is $65.00 and you must be registered with the NRMP for a program to even have the opportunity to put your name on their Rank Order List. As it says in the schedule section of this web site it is a good idea to register at the NRMP web site sometime in August. (2)

The match is a program designed to try and give everyone a fair shot at every residency. The program is designed to favor the applicants, not the residency programs, to try and place each applicant in their most desired program. (2)

The actual way the algorithm works is listed below. It is a confusing process so if you donít understand it please seek the advice of the student affairs office. (4)

In a random order the computer will try to match applicants. When the computer comes to your name it will try to place you into your #1 choice. If that program has ranked you and that program has an open spot you will get a temporary match in that program. You will also get a temporary match if that program does not have an open spot but has ranked you higher than someone who is already in one of those temporary spots. (i.e. you kick them out of their temporary spot because you were ranked higher on that programís list) (4)

This match is only temporary because if someone else has that program ranked #1 and that program has that person ranked higher than you then that person will kick you out and temporarily hold that spot. (4)

The computer will cycle through everyoneís name again and when the computer comes to you again it will try to place you in that #1 program again and if that program has an open spot or you are ranked higher than any one of their current temporary matches then you will get a temporary match. (4)

If the computer gets to you and attempts to place you in your #1 program and they are filled with people that are all ranked higher than you on the programís rank order list or you are not ranked at all on that programís list then it will jump down to your #2 choice and attempt to match you using the same rules as seen above. (4)

The algorithm continues until everyone matches with their highest possible choice. At this point the temporary label is removed. The match has been completed. (4)

The couples match works similarly in concept to the regular match and coincides with the regular match but is much more complicated. When attempting to couples match you and your partner will make many rank order lists. Person A will make a list of programs and for every program that person A has ranked person B will be required to make a different list. The computer will start with person A and try to match them as listed in the ìWhat is the match and how does it work FAQ?î When person A is matched at a program the computer will then enter person Bís list that had been made for that particular program that person A matched in and will try to find a match in the same way. If person B matches then the two people have temporarily matched. If one of you is displaced by people that were ranked higher on either one of your programís lists then you will both be kicked out and the computer will start again. (4)

Taking into consideration that separate lists must be made for each program that each other rank it seems more likely that a lesser qualified candidate will do more to pull down a higher qualified candidate than a higher qualified candidate will do to pull up a lower qualified candidate. (4)

That being said there are some definite benefits that program directors see when you are trying to match as a couple:

• You are more likely to be more stable if you are a couple and thus less likely to leave a position for any reason. (2)
• If you are a couple then chances are you will have a child or will establish roots in the particular region that you are training in and will be less likely to move after residency and thus will contribute to the faculty pool. (2)

This will vary based on your specialty, how competitive a candidate you are, and how realistic your rank order list was. In 2005 85% of US Seniors did match in one of their top 3 choices. (2) For similar statistics in your chosen specialty please consult the student affairs office.

This will depend on your specialty, geographic restrictions, and competitiveness of your application. A frank discussion with the Dean or Director of Student Affairs can help you realistically approach this question. (2) In general you will apply to more programs than you interview and you are likely to interview at more places than you rank. (4)

You will find out on Monday of match week whether or not you have matched via the e-mail account you registered with ERAS and the NRMP. You will not find out where you have matched but only whether or not you have matched. If you have matched then just relax as best you can until Thursday. If you did not match then you will need to contact the student affairs office immediately to begin the SCRAMBLE process. The student affairs office will be your best ally as you attempt to find an open position. If you did not match then at noon on Tuesday of match week you will be provided with a list of residency programs that have openings. It is a match violation for you to contact programs before this time on Tuesday as far as inquiring about positions. When that list is available you should be on site at the campus so that the student affairs office can provide the necessary equipment (multiple phone lines, fax machine, internet etc) and you should have a friend(s) with you for moral support. You will then go through the process of conducting phone interviews and maybe even flying to various programs with openings. (Some programs to require personal interviews during the scramble) The scramble is complete before Thursday at noon but you will be able to accept any offer for placement before that time. On match day your envelope will have the program that you scrambled into. (4)

Different people will have different expectations of a program and its location. It is appropriate to take into account any/all factors that would affect you/your familyís happiness in regards to a residency program. (4)

All people will have different things that are important to them but here is a list of things that you may not have thought were as important but may be crucial to your decision making. (3)

• Morale of current residents
• Current accreditation status
• Board passing rates
• Program quality
• Program size
• Educational structure including required rotations, formal curriculum(lecture schedule), informal teaching, support systems
• Clinical responsibilities (call schedule, supervisory structure)
• Opportunities for research
• Opportunities to teach
• Evaluation processes
• Program type (academic or community based)
• Opportunities to interact with other residencies at the institution
• Reputation of the program director and other faculty members
• Success of graduates in obtaining fellowships
• Location, housing, cost of living, proximity to family, spousal opportunities
• Salary, benefits, vacation

Take all of these suggestions that are important to you as well as anything else that is important in your decision and make an informational grid so that you can compare programs side by side using criteria that YOU think is important. (3) NOTE: It is imperative for you to consult with family and friends when making you decision about how to rank a particular program. In the end though, the decision is yours and yours alone. When in doubt go with your gut and be sure to use your MSPE or Deanís Letter writer as an excellent source for you to help you really focus on what is important and perhaps eliminate emotion out of the decision. That person will also be able to give a rough idea of how competitive you may be at one particular program. (4)

The length of a rank order list will depend on both your chosen specialty and your competitiveness as a candidate. Always remember that a longer list will never hurt you in any way. You will NOT be less likely to get one of your top choices because you ranked a few extra programs. (2)

Be sure to use your MSPE or Deanís Letter writer to help you with this process. They can provide data from past classes as well as data from candidates that have your similar credentials to see where you may fall. They can help determine if you need to add a few extra programs because either your field is very competitive or you are not as strong a candidate as you need to be for that specialty. (4)

Rank programs in their order of desirability. If it is a long shot you wonít know if you ever had a chance unless you rank it first. (2)

Rank all acceptable programs and donít rank any program in which you would not be willing to work. This is the best way to ensure that you will match appropriately. Be sure to consider the fact that it may be better to work at a less than ideal program then to try and scramble in the event that you donít match. (2)

Keep in mind that by ranking a program it is a binding contractual agreement that if you do match at that program that you will fulfill all residency requirements at that institution. (3)