AAMC Roadmap To Residency

Roadmap to Residency:
From Application to the Match and Beyond
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Association of
American Medical Colleges
Roadmap to Residency:
From Application to the Match and Beyond
© 2006 Association of American Medical Colleges
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Roadmap to Residency: From
Application to the Match and Beyond
Acknowledgements
October 2005
This handbook is intended for use by all applicants to U.S. graduate medical
education programs, whether they be enrolled in, or graduates of, medical schools
located in the United States or in other countries. It results from a collaboration over
many months among staff members at the Association of American Medical Colleges
(AAMC), the American Medical Association (AMA), the National Resident Matching
Program (NRMP), and the Educational Commission for Foreign Medical Graduates
(ECFMG), as well as with officers of the Organization of Program Directors
Associations (OPDA).
Major contributors to the text of this document at the AAMC included Moira
Edwards, Robert Sabalis, Ph.D., and Mona Signer. AMA staff contributors included
Sarah Brotherton, Ph.D., Fred Donini-Lenhoff, and Paul Rockey, M.D. OPDA officers
Carlyle Chan, M.D., and Sterling Williams, M.D., made significant contributions
during the planning phase for this document. Gerald Whelan, M.D., of the ECFMG
staff reviewed the final draft of the document and made very helpful suggestions for
modifications, clarifications, and additions.
It is the intention of the authors that this document be updated annually in order to
reflect changes in policies, procedures, and practices that occur in the processes
associated with application to U.S. residency programs.
iii Association of American Medical Colleges, 2005

Table of Contents
I. Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
A. Allopathic medicine residency programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
B. Osteopathic medicine residency programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
II. Being a Candidate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
A. Candidacy requirements for ACGME-accredited

allopathic medicine GME programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
1. Graduates of U.S. and Canadian medical schools accredited

by the Liaison Committee on Medical Education (LCME)
2. Graduates of U.S. colleges of osteopathic medicine accredited by the

American Osteopathic Association (AOA)
3. Graduates of medical schools located outside of the U.S. and Canada…
A. Who have received a currently valid certificate from the ECFMG prior to
appointment to a residency program or a full and unrestricted license to
practice medicine in a U.S. licensing jurisdiction in which they are
enrolled in a residency training program
B. Who have completed a Fifth Pathway program provided by an

LCME-accredited medical school
4. “Students” vs. “graduates”
5. United States Medical Licensing Examination (USMLE)
6. Educational Commission for Foreign Medical Graduates (ECFMG)
III. Specialty Choice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
IV. Residency Program Selection Criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
A. Understanding the training path for the chosen specialty . . . . . . . . . . . . . . . .6
B. Residency program selection criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
V. Matching Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
A. The National Resident Matching Program (NRMP) . . . . . . . . . . . . . . . . . . . .7
B. The San Francisco Matching Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
C. The Urology Match . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
v Association of American Medical Colleges, 2005

D. The American Osteopathic Association (AOA)

Intern/Resident Registration Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
E. Canadian Resident Matching Service (CaRMS) . . . . . . . . . . . . . . . . . . . . . . .11
F. Military matches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
G. Couple’s matching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
H. Match outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
1. A binding commitment
2. The “early matches”
3. Unmatched “early match” applicants
VI. Preparing to Apply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
A. What documents are needed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
1. A completed application
2. A personal statement
3. Letters of recommendation
4. USMLE and/or COMLEX score reports
5. Medical Student Performance Evaluation (MSPE)
6. Medical school transcript
7. Photograph
B. Waiving right to see letters of recommendations . . . . . . . . . . . . . . . . . . . . . .16
VII. Applying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
A. Registration for ERAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
B. Central Application System (San Francisco Match) . . . . . . . . . . . . . . . . . . . .17
C. Paper-based applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
D. Tracking applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
E. Ensuring completion of applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
F. November 1 release date for the Medical Student

Performance Evaluation (MSPE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
vi Association of American Medical Colleges, 2005

VIII. Visiting Residency Training Programs . . . . . . . . . . . . . . . . . . . . . . . . . . .19
A. How to assess programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
B. Assessment criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
C. Program visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
1. Interview preparation
2. Creation of an information grid for use in program assessment
3. Completion of information grid for each program visited
4. “Second visits”
IX. After the Program Visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
X. Residency Application Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
A. Obligations of matched applicants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
B. “Early Match” outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
C. “The Scramble” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
D. FindAResident and Other Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
XI. The Transition from Medical School to Residency . . . . . . . . . . . . . . . .24
A. Insurance programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
B. Financial aid processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
C. Visas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
D. Contracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
E. Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
F. Employment for spouses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
G. Schools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
H. Hospital credentialing and medical licensure . . . . . . . . . . . . . . . . . . . . . . . . .26
I. Orientation and program start dates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
J. Budgeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Appendix A: Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Appendix B: Webliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
vii Association of American Medical Colleges, 2005

I. Programs
Medical residency training programs in • Graduates of U.S. and Canadian º Receipt of a full and unrestricted
the United States are of two types: medical schools accredited by the license to practice medicine in a
programs in allopathic medicine and Liaison Committee on Medical U.S. licensing jurisdiction in which
programs in osteopathic medicine. Each Education (LCME, www.lcme.org), they are enrolled in a residency
type of program is accredited by a the joint accrediting body of the training program.
different organization. American Medical Association (AMA,
www.ama-assn.org), located in • Graduates of medical schools outside
A. Allopathic medicine residency Chicago, and the Association of the United States who have completed
training programs American Medical Colleges (AAMC, a Fifth Pathway program provided by
www.aamc.org), located in an LCME-accredited medical school.
Almost all residency training (or
graduate medical education [GME]) in Washington, D.C. B. Osteopathic medicine residency
the United States takes place in • Graduates of U.S. colleges of osteo- training programs
allopathic medicine programs. There are pathic medicine accredited by the
approximately 100,000 residents and The American Osteopathic Association
American Osteopathic Association accredits U.S. osteopathic internship and
fellows currently training in about 8,000 (AOA, www.osteopathic.org), located
programs accredited by the Accreditation residency training programs (http://do-
in Chicago. online.osteotech.org). To enroll in an
Council for Graduate Medical Education
(ACGME, www.acgme.org). The • Graduates of medical schools outside AOA-accredited program, one must be a
ACGME accredits all initial U.S. the United States and Canada who meet graduate of an AOA-accredited college of
allopathic medicine residency programs one of the following qualifications: osteopathic medicine. Some residency
that lead to primary board certification programs are dually accredited by the
by a member board of the American º Receipt of a currently valid certificate ACGME and AOA.
Board of Medical Specialties (ABMS, from the Educational Commission
www.abms.org). Applicants with any of for Foreign Medical Graduates
the following qualifications are eligible (ECFMG, www.ecfmg.org) prior to
for appointment to ACGME-accredited appointment to a residency
programs: program, or
1 Association of American Medical Colleges, 2005

II. Being a Candidate

As described in (I) above, most residency 2. Graduates of U.S. colleges of Since medical schools located outside
training programs in the United States osteopathic medicine accredited of the United States. and Canada vary
are ACGME-accredited. This section by the American Osteopathic in educational standards, curricula,
explains how a candidate can meet Association (AOA) and evaluation methods, the ECFMG,
programs’ requirements for candidacy. through its certification process,
The American Osteopathic assesses the readiness of international
A. Candidacy requirements for Association’s Commission on medical graduates (IMGs) to enter
ACGME-accredited allopathic Osteopathic College Accreditation U.S. ACGME-accredited residency
medicine GME programs (AOA COCA, http://do- and fellowship training programs.
online.osteotech.org, Accreditation
1. Graduates of U.S. and Canadian and Program Approval) is recognized International medical graduates
medical schools accredited by the by the U.S. Department of Education wishing to enter a U.S. ACGME-
Liaison Committee on Medical as the sole accrediting agency for pre- accredited residency or fellowship
Education (LCME) doctoral osteopathic medical training program must be certified by
The LCME accredits educational education in the U.S.. the ECFMG prior to entering the
programs leading to the MD degree in program (http://www.ecfmg.org/creds/).
Any individual who has graduated International medical graduates
the United States. The LCME also from, or plans to graduate from, a
accredits Canadian medical education wishing to take Step 3 of the three-
U.S. AOA-accredited osteopathic step United States Medical Licensing
programs in collaboration with the medical school is also eligible to
Committee on Accreditation of Examination (USMLE,
apply to an ACGME-accredited www.usmle.org) also must be
Canadian Medical Schools (CACMS, residency training program. A list of
www.afmc.ca). The LCME is recog- certified by the ECFMG. In addition,
AOA-accredited schools can be found ECFMG Certification is required to
nized as the reliable accreditation on the AACOM Web site
authority for MD programs by the obtain an unrestricted license to
(www.aacom.org/colleges). practice medicine in any U.S.
nation’s medical schools and their
parent universities. It also is recog- 3. Graduates of medical schools licensing jurisdiction.
nized for this purpose by the U.S. located outside of the United States B.Who have completed a Fifth
Congress in various health-related and Canada… Pathway program provided by an
laws, and by U.S. state, Canadian LCME-accredited medical school
provincial, and territorial medical A. Who have received a standard
licensing authorities. ECFMG certificate without A Fifth Pathway program is an academic
expired examination dates, if year of supervised clinical education
Any individual who has graduated applicable, from the ECFMG prior provided by an LCME-accredited
from, or plans to graduate from, a U.S. to appointment to a residency medical school to students who meet all
or Canadian LCME-accredited program or receipt of a full and of the following conditions:
allopathic medical school is eligible to unrestricted license to practice
apply to an ACGME-accredited medicine in a U.S. licensing juris- • Completion in an accredited U.S.
residency training program. A list of diction in which they are enrolled college or university of an under-
LCME-accredited schools can be in a residency training program graduate premedical education of
found on the AAMC Web site the quality acceptable for matricu-
(www.aamc.org/medicalschools.htm). lation in an accredited U.S. medical
school

• Study at a medical school outside Note: To participate in the National verification of the medical diploma
of the United States and Canada Resident Matching Program (NRMP, and receipt of a full transcript from
listed in the International Medical www.nrmp.org), Fifth Pathway appli- the medical school, an applicant for
Education Directory published by cants must have satisfied the medical ECFMG Certification cannot
the ECFMG’s Foundation for science examination requirements for complete the ECFMG Certification
Advancement of International ECFMG Certification (USMLE Step 1 process until he or she has graduated
Medical Education and Research and Step 2 Clinical Knowledge [CK] from the medical school and actually
(IMED, http://imed.ecfmg.org/) and Clinical Skills [CS]), and the received his or her diploma.
results must be available by the
• Completion of all formal require- NRMP Rank Order List (ROL) For senior medical students enrolled
ments of the foreign medical school deadline. Applicants who have previ- in U.S. medical schools, the NRMP
except for internship and/or social ously passed the former ECFMG requires that medical schools
service Clinical Skills Assessment (CSA) and immediately revoke the school’s
achieved a score acceptable to the sponsorship of any applicant who is
• Attainment of a score satisfactory determined by the school official to
to the sponsoring medical school ECFMG on an English language
proficiency test (e.g., the Test of be ineligible to enter a residency
on a screening examination, and training program on July 1 in the
English as a Foreign Language
[TOEFL, www.ets.org/toefl/] or the year of the Match and that schools
• Attainment of passing scores on
former ECFMG English test) can use notify the NRMP of that action prior
Steps 1 and 2 of the United States
those passing performances to fulfill to the rank order list certification
Medical Licensing Examination
the Step 2 CS requirement. deadline.
(USMLE).
4. “Students” vs. “graduates” 5. USMLE

The only U.S. school currently
offering the final year of supervised U.S. medical schools’ requirements of
ACGME regulations require that
clinical education required of Fifth students differ with regard to taking
physicians beginning residency
Pathway students is New York and achieving a passing score on the
programs be graduates of the medical
Medical College (www.nymc.edu/ USMLE Step 1 and USMLE Step 2
education programs listed above.
depthome/fifth.asp). Additional Clinical Knowlegde (CK) and Clinical
Individuals may apply for residency
information about the Fifth Pathway Skills (CS) examinations prior to
programs in their final year of
program can be found on the graduation. Students enrolled at U.S.
medical school, with the expectation
American Medical Association’s Web medical schools will not be able to
that they will complete all program
site (AMA, www.ama-assn.org/ama/ begin their residency training until
requirements before beginning
pub/category/9306.html). they have completed all degree
residency training. If all of those
requirements have not been requirements and graduated from
Fifth Pathway applicants who wish to
completed, residency training must their medical school. For more infor-
use the Electronic Residency
be deferred. mation on each medical school’s
Application Service (ERAS,
graduation requirements, see the
www.aamc.org/eras.htm) to apply to
For international medical graduates, AAMC’s Curriculum Directory
residency training programs must
the ECFMG notes that both medical (http://services.aamc.org/currdir/).
obtain their electronic token (a
school students and graduates may
unique identification number) from Since many allopathic residency
begin the ECFMG Certification
the ECFMG to access the MyERAS training programs recognize osteo-
process. However, since ECFMG
Web site (www.aamc.org/eras). pathic medical school education,
requires primary source, independent
senior students enrolled in and

graduates of colleges of osteopathic 6. ECFMG

medicine may not be required to
complete USMLE examinations in Typically, it takes some time to
order to enter an ACGME-accredited achieve ECFMG Certification. To
residency program. However, since participate in the NRMP, interna-
individual programs can set their tional medical graduates and students
own entrance requirements, some enrolled in international medical
may require documentation of schools must have passed all exami-
passing scores on USMLE examina- nations required for ECFMG
tions. Other programs may require, Certification, and the results must be
instead, documentation of passing available by the NRMP rank order list
scores on the Comprehensive deadline. The NRMP will withdraw
Osteopathic Medical Licensing applicants who have not met that
Examinations (COMLEX-USA), deadline. For those reasons, appro-
which are sponsored by the National priate and timely planning is
Board of Osteopathic Medical essential.
Examiners (www.nbome.org).
Interested individuals should check
with each program regarding its
program requirements.
Before entering a residency training

program, international medical
graduates must have achieved
ECFMG Certification, which includes
passing scores on USMLE Step 1 and
Step 2 CK and CS examinations, as
well as any other examinations that
the ECFMG might require.

III. Specialty Choice

The process of choosing one’s specialty is The CiM program provides extensive For each specialty, it is helpful to
highly personal and both a challenging information about specific specialty and determine the number of residency
and rewarding effort. To assist medical residency selection processes, including a program positions available in the
students and their career advisors in this proposed four-year timeline and volumi- desired specialty and the number of
process, the AAMC sponsors a struc- nous data about a broad range of applicants for that specialty in order to
tured four-phase career planning specialties. The CiM Specialty Pages assess the competitiveness of the applica-
program, Careers in Medicine (CiM, (www.aamc.org/students/cim/ tion process for that specialty. The
www.aamc.org/students/cim). Other specialties.htm) contain information FREIDA Online® Web site, maintained
resources regarding specialty selection about the nature of the work in each by the American Medical Association
can be found in the Bibliography specialty, training requirements, the (www.ama-assn.org/go/freida), provides
(Appendix A). personality characteristics of physicians aggregate information on ACGME
practicing in the specialty, current programs, including the total number of
CiM Phase 1, Understanding Yourself, workforce and compensation statistics, residents per specialty, average program
involves a self-assessment by the student and links to relevant professional associ- size, and average number of interviews
of his or her personal interests, skills, ations and information resources. provided per program, as well as infor-
goals, and values. Phase 2, Exploring mation on the number of graduates and
Options, involves exploration of the Students enrolled at U.S. allopathic, their career choices.
variety of specialties and medical career selected osteopathic, and Canadian
options. Phase 3, Choosing a Speciality, medical schools also have access, through
involves a comparison of what was a password-protected CiM Web site, to a
learned during self-assessment with the variety of assessment and decision-
information gathered about various making tools to assist them in the career
specialties and medical career options planning process, as well as to detailed
under consideration, leading to a information about all ACGME-accred-
decision about the specialty that will be ited specialties. Students can receive an
pursued during residency training. Phase access code from their school’s CiM
4, Getting into Residency, involves appli- liaison, who is usually a staff person in
cation to, and acceptance by, a residency the Office of Student Affairs or Academic
training program. Affairs.

IV. Residency Program Selection Criteria

Residency applicants should be knowl- B. Residency program selection i. Program type: academic or
edgeable about the path for training in a criteria community; hospital-based or
chosen specialty, as well as about the ambulatory
personal criteria they will employ in Residency applicants should consider in
selecting a residency program. advance the criteria by which they will j. Opportunities for interaction with
initially assess programs to determine residents in other residency training
A. Understanding the training how many and to which programs they programs
path for the chosen specialty will make application, as well as to
determine, after visiting programs at k. Reputation of program director
Information about the training paths for which they have been invited to and faculty members
many specialties and subspecialties is interview, those programs that they will
available on the Careers in Medicine Web l. Success of graduates in obtaining
place on their rank order list (ROL). At fellowships.
site (www.aamc.org/students/cim/ least three different types of criteria can
specialties.htm). The Graduate Medical be employed in this process: those about • Personal issues:
Education Directory (the “Green Book”) the nature and quality of the educational
published annually by the American program, those based on personal prefer- a. Location
Medical Association (www.ama- ences and needs, and those based on
assn.org/ama/pub/category/3991.html) b. Housing
residency agreement and stipend issues.
also lists contact information for 8,250
c. Cost of living
ACGME-accredited and combined • Program issues:
specialty programs and 1,700 graduate d. Proximity to family members
medical education teaching institutions, a. Morale of current residents (look
institutional and program requirements for satisfied residents) e. Spousal and family opportunities.
for 121 specialties and subspecialties, and
b. Current accreditation status • Residency agreement and stipend
American Board of Medical Specialties
issues:
medical specialty board certification c. Program quality
requirements. Another key AMA a. Stipend
resource is FREIDA Online® (Fellowship d. Program size
and Residency Electronic Interactive b. Leave: vacation, sick, and profes-
e. Educational structure: required
Database Access, www.ama-assn.org/go/ sional
rotations, formal curriculum,
freida), an online database containing
informal learning opportunities, c. Benefits: health, liability, and
information on 8,000+ graduate medical
support systems disability insurance (including dates
education programs accredited by the
ACGME, as well as on 200+ combined of initial coverage for new
f. Clinical responsibilities: call
specialty programs. FREIDA permits residents)
schedule, supervisory structure,
comparison of specialties on such factors ancillary support d. Other prerequisites.
as length of training, program size,
number of faculty, work and educational g. Opportunities for research and
environments, and compensation, as well teaching
as on the career plans of graduates from
h. Evaluation processes: timing and
various specialties as reported by their
structure of resident evaluation
program directors.

V. Matching Processes
This section explains the variety of positions are filled each year. The NRMP majority of residency training programs
processes involved in obtaining a position in annually publishes Match statistics in the participating in the NRMP. A single
residency programs in various specialties. “NRMP Results and Data Book,” which registration for the Match allows appli-
is available for purchase on the AAMC cants to rank any match-participating
Most U.S. medical students and other Publications Web site residency training program, regardless of
applicants to U.S. GME programs secure (www.aamc.org/publications). specialty.
positions through a “matching program.”
Although the largest matching program The NRMP matching process uses the The NRMP classifies applicants into two
is the National Resident Matching Web-based Registration, Ranking, and categories:
Program (NRMP, www.nrmp.org), Results (R3) System. Applicants and
other residency matching programs programs register for the Match, submit • “U.S. seniors,” in NRMP parlance, are
include the San Francisco Matching their rank order lists, and obtain their students currently enrolled in U.S.
Program (www.sfmatch.org) and the Match results using the Internet on their allopathic medical schools. The
matching programs sponsored by the own computers. Because all information medical school “sponsors” those
American Urology Association (AUA, in the R3 System is in real time, appli- students by verifying their medical
www.auanet.org/residents/resmatch.cfm) cants can modify their rank order lists education credentials and ensuring
and the American Osteopathic Association up until the rank order list submission that they are not withdrawn inappro-
(www.natmatch.com/aoairp/index.htm). deadline. Applicants and program priately from the Match. A U.S. senior
In addition, the various U.S. Armed directors must use their unique identifi- may be withdrawn from the Main
Services select applicants participating in cation numbers to access the R3 System. Residency Match only by an official of
military programs at U.S. medical his or her medical school. Institutions
schools for Armed Forces-sponsored The NRMP’s public Web site that participate in the Main Residency
GME programs. Finally, the Canadian (www.nrmp.org) contains a wealth of Match may offer positions to U.S.
Resident Matching Service (CaRMS, information about the Match. All appli- allopathic medical school seniors only
www.carms.ca) sponsors a two-phased cants are advised to review that informa- through the NRMP or another
match for Canadian medical school tion before completing the registration national matching program. This
students and other applicants. process. To register for the Match, click requirement includes PGY-1 prelimi-
the “Register/Log In” link at the top of nary positions for applicants who
A. The National Resident Matching the NRMP home page. It is important to obtain their PGY-2 positions through
Program (NRMP) note that registration for the Main another match.
Residency Match does not register an
The largest of the several matches is the applicant with the Electronic Residency • “Independent applicants,” in NRMP
Main Residency Match (the “Main Application Service (ERAS, parlance, are those participants in the
Match”) sponsored by the NRMP. Each www.aamc.org/eras) or vice versa. Main Residency Match who are not
year, the Match provides services to more U.S. allopathic medical school seniors.
than 25,000 applicants and 3,900 The NRMP and ERAS are distinct, This applicant category includes prior
residency training programs, offering complementary programs. ERAS is a graduates of U.S. allopathic medical
more than 21,000 first-year (postgrad- method for applying to residency schools; osteopathic medical school
uate year 1 or PGY-1) and 2,500 second- training programs, and the NRMP is a students and graduates; Fifth Pathway
year (postgraduate year 2 or PGY-2) method for matching applicants with program participants; Canadian
positions. More than three-quarters of available positions in those programs. medical school students and graduates;
all applicants participating in the Match Applicants must register separately for and students and graduates of interna-
obtain PGY-1 positions, and more than the NRMP and for ERAS, which is the tional medical schools, regardless of
90 percent of all PGY-1 and PGY-2 system used by the overwhelming whether they are U.S. citizens or

citizens of other countries. The individuals into positions. The process the competitiveness of the specialty,
credentials of international medical begins with an attempt to place an the competition for the specific
school students and graduates are applicant into the program indicated as programs being ranked, and the
verified by the ECFMG. Independent most preferred on that applicant’s list. If applicant’s qualifications. In most
applicants may be offered positions the applicant cannot be matched to the instances, the issue is not the actual
through the Match or outside of it, first-choice program, an attempt is then number of programs on the rank
and they may withdraw themselves made to place the applicant into the order list, but whether to add one or
from the Match at any time prior to second-choice program, and so on until more additional programs to the list in
the rank order list deadline. the applicant obtains a tentative match order to reduce the likelihood of being
or all the applicant’s choices have been unmatched.
Five types of positions are offered exhausted. An applicant can be tenta-
through the NRMP Main Residency tively matched to a program if the • Applicants are advised to rank all of
Match: program also ranks the applicant on its the programs deemed acceptable, i.e.,
rank order list, and either (1) the programs in which they would be
• Categorical (C) positions: PGY-1 happy to undertake residency training.
positions in programs that provide the program has an unfilled position or (2)
the program does not have an unfilled Conversely, if an applicant finds
training required for board certifica- certain programs unacceptable and is
tion in a specialty position, but the applicant is more
preferred by the program than another not interested in accepting offers from
• Preliminary (P) positions: PGY-1 one- applicant who already is tentatively those programs, the program(s)
year preliminary positions in transi- matched to the program. This process is should not be included on the
tional internal medicine or general carried out for all applicants until each applicant’s rank order list.
surgery programs. applicant has either been tentatively
The NRMP matching algorithm also
matched to the most preferred choice
• Categorical (M) positions: PGY-1 allows couples to link their rank order
possible or all choices submitted by the
primary care positions in combined lists so they will match to programs
applicant have been exhausted. When all
programs in internal medicine and suited to their needs. Both partners
applicants have been considered, the
pediatrics enroll individually in the Match and
matching process is complete and all
indicate in the NRMP R3 System that
tentative matches become final.
• Advanced (A) positions: PGY-2 they want to be in the Match as part of a
positions in specialty programs that The NRMP issues guidelines for appli- couple. The NRMP allows couples to
begin the year after the Match and cants in preparing their rank order lists: form pairs of choices on their rank order
subsequent to one or more years of lists, which are then considered in rank
preliminary training • Applicants are advised to include on order in the Match. The couple matches
their rank order lists only those to the most preferred pair of programs
• Physician (R) positions: Positions in programs that represent their true on their rank order lists where each
specialty programs that begin in the preferences. partner has been offered a position.
year of the Match for physicians with
prior graduate medical education. • Programs should be ranked in All participants in the Main Residency
sequence, according to the applicant’s Match must sign the Match Participation
The NRMP uses a mathematical true preferences. Agreement (MPA) during the registra-
algorithm that employs the preferences tion process. The MPA delineates all
expressed in the rank order lists submitted • Factors to consider in determining the Match rules; applicants should review it
by applicants and programs to place number of programs to rank include carefully before submitting their

electronic signatures. The listing of an Participation Agreement for an applicant Most, but not all, of the programs partic-
applicant by a program on its certified who matched to a residency position in ipating in the San Francisco Match use
rank order list or of a program by an the Match to seek an alternative position the Central Application Service (CAS);
applicant on the applicant’s certified during the Scramble. programs in those specialties not using
rank order list establishes a binding the CAS must be contacted directly for
commitment to offer or to accept an B. The San Francisco Matching their individual applications. ERAS is not
appointment if a Match results. Failure Program used by any specialties participating in
to honor the match commitment by For 2006, the San Francisco Matching the San Francisco Match. It is important
either party may subject the party to Program (www.sfmatch.org) offers PGY-2 to note that registration for the San
sanctions as outlined in the NRMP positions in specialties that do not partici- Francisco Match does not register an
Violations Policy that is posted on the pate in the NRMP: neurological surgery, applicant for the CAS or vice versa.
NRMP Web site. child neurology, ophthalmology, and Information about the CAS can be found
PGY4 positions in plastic surgery. It also on the San Francisco Match Web site.
Applicant registration for the Match
opens each year on August 15. Although offers fellowship positions in several The ranking function for the San
the early registration deadline is subspecialties. Applicants are advised to Francisco Match is also paper-based.
December 1, registrations are accepted review carefully the information provided Applicants complete the form that is
after that date upon payment of a late on the San Francisco Match Web site. posted on the San Francisco Match Web
fee. The ranking function opens on Because the San Francisco Match does site and send it by overnight mail, U.S.
January 15 and closes on the third not offer PGY-1 positions, applicants Postal Service, or fax to the San
Wednesday in February. must obtain their preliminary positions Francisco Match office. Receipt will be
outside of the San Francisco Match. confirmed by mail or telephone. A
Match Week takes place during the third separate form must be completed if
week in March. On Monday of Match Some programs have designated prelimi-
nary positions in the same institution for changes are made to the rank order list.
Week, applicants learn whether, but not As with the NRMP, the San Francisco
to which programs, they have matched. applicants who match through the San
Francisco Match; therefore, these appli- Match uses an “applicant-proposing
On Tuesday, the NRMP releases a list of algorithm,” and all matches are tentative
those positions that were not filled in the cants do not have to go through a
matching program to obtain a PGY-1 until the matching process has been
Main Match. The third Thursday in completed, with the outcome deter-
March is Match Day, when applicants position. Other programs require appli-
cants to participate in the NRMP Main mined by the rank order lists submitted
learn to which specific programs they by programs and applicants. All matches
have matched. Residency Match to obtain a position for
preliminary training. Preliminary are binding commitments.
Any applicant who does not match in the positions for U.S. allopathic medical Registration for the San Francisco Match
Main Match can seek a residency school seniors must be offered through begins in May, and the target date for
position during a post-Match process the NRMP Main Residency Match. receipt of CAS applications is late
known colloquially as “the Scramble.” At August. The period for submitting rank
Noon (EST) on Tuesday of Match Week, To participate in the San Francisco
Match, applicants complete the online order lists is December through mid-
when the NRMP releases a list of those January, and Match Day is at the end of
positions that were not filled in the registration form, print it, and mail or
fax it along with the required payment to January. Unfilled positions are posted on
Match, unmatched applicants are free to the San Francisco Match Web site in
contact those programs and submit the San Francisco Matching Program.
Applicants are then mailed a certificate early February.
applications for any unfilled positions
that are posted on the NRMP’s secure of registration, as well as additional
Web site. It is a violation of the Match information on matching procedures.

C. The Urology Match the AUA Match does not register an found on the AOA Web site (http://do-
applicant with ERAS, or vice versa. online.osteotech.org/index.cfm?PageID=
The American Urological Association sir_matchprotocol).
(AUA, www.auanet.org/residents/ The AUA Match ranking function is
resmatch.cfm) sponsors a match for paper-based. Preference lists must be New graduates of colleges of osteopathic
residency positions in urology only. Each submitted to the AUA Match by the first medicine must complete an AOA-
year, about 300 applicants compete for week in January, and they cannot be approved osteopathic internship in
approximately 220 positions, virtually all changed after the deadline date. A sample order to be eligible for certification by
of which are filled through the AUA preference list form can be printed from an osteopathic specialty board, to
Match. AUA Match statistics, as well as the AUA Match Web site, but it must be continue postdoctoral osteopathic
general information about the AUA sent by U.S. Postal Service or fax to the medical training, and to apply for future
matching process, can be found on the AUA Match office. As with the NRMP, credentialing. Five state medical
AUA Residency Match Web site. the AUA Match uses an “applicant- licensing authorities (see Federation of
Applicants are advised to review this proposing algorithm,” and the AUA State Medical Boards, www.fsmb.org)
Web site information carefully. Match outcome is determined by appli- deny licensure to osteopathic physicians
cants’ and programs’ preference lists. All who have not completed an AOA-
The prerequisite training for a prospec- matches are binding commitments. approved internship. In addition to
tive urology resident is one or two years, internship-only programs beginning in
preferably in a general surgery program. Applicants can register for the AUA the year of the AOA IRRP Match, some
Because the Urology Match does not Match as early as the spring of the year programs are internship/residency
offer PGY-1 positions, applicants obtain prior to the AUA Match; the final regis- programs that combine an osteopathic
their preliminary positions outside of the tration deadline is the first week of graduate medical education (OGME-1)
AUA Match. Some programs have desig- January. The period for submitting rank internship position that begins in the
nated preliminary positions in the same order lists is December through the first year of the AOA IRRP Match with an
institution for applicants who match week of January, and Match Day is in the OGME-2 position that commences the
through the Urology Match; therefore, third week in January. Vacancies available following year.
those applicants do not have to go after the AUA Match may be listed on the
through a matching program to obtain a phone-in AUA vacancy hotline. The AOA accredits three kinds of
PGY-1 position. Other programs require Unmatched applicants may make internships:
applicants to participate in the NRMP individual arrangements with programs
Main Residency Match to obtain a that have vacant positions. • Traditional rotating: Institutions have
position for preliminary training. flexibility in designing these intern-
Preliminary positions for U.S. allopathic D. The American Osteopathic ships, and students should negotiate
medical school seniors must be offered Association (AOA) Intern/ directly with the institution about the
through the NRMP Main Residency Resident Registration Program specialty curricula that will be
Match. included.
The AOA Intern/Resident Registration
The registration form and fee for the Program (IRRP) is a matching program • Special emphasis: The focus is within a
AUA Match are submitted using an that places applicants in U.S. osteopathic particular specialty, but the internship
online form that can be accessed on the medicine internship and residency does not reduce the total number of
AUA Web site. The Web site also lists training positions. It is sponsored by the years of required postdoctoral specialty
participating programs and indicates AOA and administered by National training. Special emphasis internships
whether each uses ERAS or another Matching Services, Inc. (NMS, can be offered in anesthesiology,
method for receipt of applications. It is www.natmatch.com/aoairp/index.htm). emergency medicine, family medicine,
important to note that registration for Additional information also may be osteopathic manipulative medicine,

general surgery, psychiatry, and Match will have their IRRP match status students and about 700 “independent”
diagnostic radiology. communicated to the NRMP and will be applicants (including former graduates of
withdrawn automatically for concurrent Canadian schools, U.S. medical school
• Specialty track: The internship may year positions. Applicants who do not students and graduates, and students and
reduce the total number of years of match through the IRRP are provided graduates of international medical schools)
postdoctoral training, and can be with information about programs with compete for approximately 200 positions.
offered in internal medicine, internal available positions.
medicine/pediatrics, obstetrics/ CaRMS receives directly from the
gynecology, otolaryngology/facial Applicants participating in the IRRP Canadian medical schools a list of
plastic surgery, pathology, pediatrics, submit their rank order lists via the NMS current year graduates and automatically
and urological surgery. Specialty tracks Web site using the Rank Order List Input sends them a token to access the
can be offered only by institutions and Confirmation (ROLIC) System. A Applicant Webstation. Independent
with existing AOA-approved residen- unique match code number and password applicants must complete the online
cies in those specialties. are used to access the ROLIC System. request for registration. Once eligibility
Rank order lists may be modified at any has been confirmed by CaRMS, an access
Each year, NMS sends to every osteo- time until the rank order list deadline. token is sent by e-mail. Registration for
pathic medical school a personalized the First and Second Iteration Matches
information package to be distributed to The IRRP also allows couples to link opens in August, and the application
its senior medical students. Applicants their rank order lists so they will match process continues through the fall. The
who are not enrolled in an osteopathic to programs suited to their needs. The Applicant Webstation opens for First
medical school or who do not receive the partners enroll individually in the AOA Iteration Match participants in August,
personalized agreement can download IRRP Match and indicate in the ROLIC and for those in the Second Iteration
the application from the NMS Web site System that they want to be part of a Match in December. For the First
(www.natmatch.com/aoairp/index.htm). couple. Couples form pairs of choices on Iteration Match, the ranking function
The agreements should be returned to their rank order lists, which are then opens in mid-January and closes in mid-
NMS by October 15. On November 1, considered in rank order in the AOA February, and Match Day is March 1. For
the programs participating in the AOA IRRP Match. The couple matches to the the Second Iteration Match, the ranking
IRRP Match will be listed on the NMS most preferred pair of programs on the function is open from the third week in
Web site, and by November 30 registered rank order lists where each partner has March through the first week in April,
applicants will receive instructions for been offered a position. and Match Day is in mid-April.
submitting their rank order lists. The
rank order list deadline is in late January, Most osteopathic internships now use CaRMS also allows couples to link their
and the results of the AOA IRRP Match ERAS to receive applications rank order lists so they will match to
are announced in mid-February. (www.aamc.org/eras). Note that registra- programs suited to their needs. The
Institutions must send a contract to each tion for the AOA IRRP Match does not partners enroll individually in the
matched applicant within 10 business register an applicant for ERAS. CaRMS Match and indicate in the
days after receipt of the AOA IRRP E. Canadian Resident Matching system that they want to be part of a
Match results, and the matched applicant Service (CaRMS) couple. Couples form pairs of choices on
must return the signed contract within their rank order lists, which are then
30 days. The IRRP considers a match to CaRMS (www.carms.ca) is a two-phased considered in rank order in the CaRMS
be a binding contract, and releases from match. The First Iteration Match is open Match. The couple matches to the most
the AOA IRRP Match obligation can be only to the approximately 1,400 preferred pair of programs on the rank
achieved only through a written release Canadian medical school seniors who order lists where each partner has been
by mutual consent. Applicants who compete for approximately the same offered a position.
match through the IRRP and who also number of positions. In the Second
have registered for the NRMP Main Iteration Match, unmatched Canadian

F. Military matches and indicate that they want to be in the H. Match outcomes
match as a couple. They form pairs of
Positions in U.S. military residency choices on their rank order lists, which 1. A binding commitment
training programs are open only to are then considered in rank order in the
applicants who are graduates of the It is the policy of every matching
match. The couple matches to the most
Uniformed Services University of the program that a match between an
preferred pair of programs on the rank
Health Sciences (USUHS), medical applicant and a program is a binding
order lists for which each partner has
students with an individual military commitment. Failure to honor that
been offered a position.
commitment, and participants in the commitment is a violation of the
Reserve Officers Training Corps (ROTC). No matching program has access to contract signed during the registra-
Although applicants and programs information from another matching tion process. Penalties for violations
submit rank order lists, the system is not program. Applicants, therefore, should vary among the matches. Some
a true match because residency program not accept advice to try to find out about matches permit applicants to seek a
representatives meet to make their selec- another match under the guise of waiver of their match commitment,
tions rather than using an impartial creating a “couple’s match,” since that either by mutual agreement of the
computerized process. Selections are attempt would represent a match applicant and program or by
made in early December, and results are violation. More specifically, a matching contacting the match office directly.
sent to the NRMP so that applicants who program may advise an applicant that it The applicable rules are available on
registered for the NRMP Main Residency offers a “couple’s match” when a couple’s each match program’s Web site.
Match, but who obtained a military match is not possible. When two
2. The “early matches”
residency training position, can be partners participate in different
withdrawn from the NRMP. Applicants matching programs, they cannot link Applicants participating in the early
who do not match in the military or for rank order lists between matches. If one matches — the San Francisco Match,
whom there is no military residency matching program requests that an the AUA Urology Match, and the
training program in their desired applicant’s partner contact a residency AOA Intern and Resident
specialty can participate in one of the program that participates in another Registration Program — receive their
other matches. To enhance their likeli- match in order to inquire about the match results in January or early
hood of success, such candidates should likelihood of matching, the partner is February. In some cases, a prelimi-
seek a deferment of their military obliga- being asked to violate the terms of that nary position will be “held” by the
tion for the duration of the civilian match. Almost every match contract same institution to which the
residency training program. prohibits applicants and programs from applicant matched. In other cases,
inquiring about how one plans to rank applicants who obtained positions
G. Couple’s matching the other. Consequently, when partners through the early matches will be
participate in different matches, the only required to register for the NRMP
Some matching programs, including the
way to ensure that both partners will Main Residency Match to secure a
NRMP, the IRRP, and CaRMS, offer the
match to programs in the same position for preliminary training. (In
opportunity for two partners to link
geographic region is for the partner all cases, U.S. allopathic medical
their rank order lists so that both
participating in the later match to rank school seniors must participate in the
residency applicants can match to
only programs in the same geographic NRMP for their preliminary
programs suited to their needs. The
area in which the partner in the earlier positions.)
partners enroll individually in the match
match obtained a position.

3. Unmatched “early match” applicants The NRMP begins to release the

results of the Main Residency
Applicants who do not match in one Match on Monday of Match Week,
of the early matches may seek when applicants are told whether,
positions after the match concludes, but not to which programs, they
using the list of available positions have matched. At Noon EST on
that is typically posted on the Tuesday of Match Week, when the
relevant matching program’s Web NRMP releases the list of unfilled
site. This information is available programs, “the Scramble” begins.
only to registered match participants. Information about vacant positions
The San Francisco Matching Program is e-mailed to all registered NRMP
uses a Vacancy Information System applicants and is posted to the
that lists vacant post-Match NRMP R3 system (www.nrmp.org)
positions, as well as positions that in a “dynamic” format so that
become available throughout the programs can delete positions from
year. Applicants must complete the the list as they are filled. The list
“Applying to Post Match Vacancies” indicates how the program will
form that is posted on the San receive applications: through ERAS
Francisco Match Web site or by e-mail or fax. The List of
(www.sfmatch.org). Unfilled Programs remains on the
NRMP Web site until May 1.
The AUA Urology Match posts
vacancies in urology on its Web site
(www.auanet.org/residents/
resmatch.cfm) after the AOA Match
concludes and throughout the year.
Applicants must contact programs
directly.
At the conclusion of the AOA

IRRP Match, the procedures to be
followed by unmatched applicants
and institutions with available
positions are posted on the IRRP
Match Web site
(www.natmatch.com/aoairp/).

VI. Preparing to Apply

This section provides an outline of the 2. A personal statement A personal statement typically
various components required for the consists of information about one’s
residency application process. The personal statement describes the professional background, a summary
applicant’s individual motivations for of academic and clinical qualifica-
A. What information is needed? a career in medicine, and includes tions, how the decision was made to
information about how the applicant pursue medicine and the chosen
A full application to residency usually best “fits” the specialty to which he or
consists of the following items: specialty as a career, and career goals.
she is applying. The personal statement also should
1. A completed application In ERAS, an applicant may create as reflect information about one’s
many personal statements as desired. personality and style that is relevant
Most residency training programs, to residency training in the selected
and a growing number of fellowship Thus, an applicant can use the
personal statement to customize the specialty, but the personal statement
programs, use ERAS to receive their should not be an exhaustive autobi-
applications. The ERAS Common information sent to each individual
residency training program. Some ography. It is an opportunity to
Application Form (CAF) is used in showcase one’s unique qualities,
applying to ERAS-participating programs request that specific items
be included or addressed in the talents, and professional passions and
programs. The application worksheet, to explain how they might be
which gives a preview of the data that personal statement. Check each
program’s Web site for more infor- expressed in a career in medicine and
will be required, is available in PDF this specialty.
format on the ERAS applicant Web mation.
site (www.aamc.org/students/eras). Although applicants may use various Many students consult with
Programs not participating in ERAS services and Web sites to obtain hints personnel in their medical school’s
may request a printout of the ERAS on how best to construct their student affairs office or university
application in lieu of completing a personal statements, they are strongly writing center for assistance in
custom application form for that advised not to take text directly from creating a succinct and effective
program. sample personal statements. Program personal statement.
Programs participating in the San staff have noticed the same text 3. Letters of recommendation
Francisco Matching Program use the occurring repetitively in personal
Central Application Service (CAS) to statements from different applicants, Most programs require a minimum
receive applications and they do not look favorably upon of three letters of recommendation
(www.sfmatch.org). this practice. At best, programs may from each applicant. In ERAS, the
consider such applicants to be applicant may assign and send up to
Some programs use the Universal unmotivated and not offer them the four letters to each program. The
Application for Residency form. A opportunity for an interview with fourth slot is available for those
copy can be obtained directly from program representatives. At worst, documents required by programs that
the program, or from the program’s they may consider this to be plagia- are considered legitimate ERAS
Web site. A copy is also available on rism and unprofessional conduct, and documents. These include the so-
the NRMP Web site (www.nrmp.org, may report offending applicants to called “California letter” (the
Application Processes). ERAS, the NRMP, the ECFMG, or the Applicant Evaluation Status Letter
American Board of Medical from the Medical Board of
Some programs have developed their Specialties (ABMS, www.abms.org) California), which international
own Web site or processes for online for investigation. medical graduates must submit when
applications. Check with individual they apply for residency training in
programs for more specific information. the state of California. ERAS also

allows this slot to be used to transmit 4. USMLE and/or COMLEX score The MSPE represents an evaluation of
a military evaluation form when an reports a medical student’s performance
application is being submitted to during the process of medical
military residency programs. The National Board of Medical education; it is not intended to be a
Examiners (NBME, www.nbme.org) recommendation or a prediction of
Some programs may request that one and the ECFMG (www.ecfmg.org) future performance. The MSPE should
of the letters of recommendation be charge a fee for unlimited electronic describe, in a sequential manner, the
from the department chair in the transmittals of an applicant’s USMLE student’s performance relative to his
respective specialty at the applicant’s Step score reports via ERAS. The or her peers through three full years of
medical school. The applicant should National Board of Osteopathic medical school and, as much as
designate that this letter is from the Medical Examiners (NBOME, possible, the fourth year. The MSPE
department chair when filling in the www.nbome.org) charges a fee for should include an assessment of both
letter writer’s “Title/Department” in unlimited electronic transmittals of the student’s academic performance
ERAS. the applicant’s COMLEX score and professional attributes.
reports via ERAS. These fees include
Ideally, the applicant will have met sending the score report to additional The MSPE, as an institutional assess-
personally with each letter writer and programs subsequently applied to, as ment, should be considered a
will have provided specific instruc- well as updating the score report with component of the student’s
tions to him or her before the letter is any new scores. permanent record, and thus should
composed and submitted. It is not be available for a student’s review.
inappropriate, in requesting a letter For programs not participating in The student should be permitted to
of recommendation, for an applicant ERAS, applicants should visit the correct factual errors in the MSPE,
to ask the letter writer whether he or USMLE (www.usmle.org) and but not to revise evaluative state-
she would be able to write a good NBOME (www.nbome.org) Web sites ments. The AAMC document, “A
letter for the applicant. If the letter for additional information on Guide to the Preparation of the
writer is in any way unable to provide requesting a paper score report. Medical Student Performance
this assurance, then it might be best Evaluation,” can be found on the
for the applicant to select another 5. Medical Student Performance
Evaluation (MSPE) ERAS Web site
individual to serve as a reference. (www.aamc.org/students/eras,
A formal evaluation from the Applicant Support).
The applicant should ensure that the
letter writer is familiar with what is applicant’s medical school usually
accompanies his or her residency International medical graduates or
required in a letter of recommenda- students can request that an appro-
tion for a residency training program application. For students at and
graduates of U.S. allopathic and osteo- priate official at their medical school
application; letters that are too brief write an evaluation equivalent in
and too generic may detract from an pathic medical schools, the dean of
student affairs or a school official in a content and format to the MSPE.
otherwise competitive application. International medical graduates who
The letter writer should be provided, comparable position typically
compiles the Medical Student will not be able to provide an MSPE
in advance, with a copy of the or its equivalent should indicate that
applicant’s resume for reference Performance Evaluation (MSPE),
previously known as the “Dean’s fact on the Miscellaneous tab of the
purposes. The applicant should also ERAS application.
follow up with the letter writer to Letter.” For applicants to ACGME-
ensure that the letter of recommen- accredited residency training
dation has reached its destination programs, MSPEs are released on or
prior to the deadline date. after November 1 of each application
season.

6. Medical school transcript B. Waiving right to see letters of opportunity to do so. Residency program
recommendations directors should be aware that revealing
Schools typically issue an applicant’s the content of such a letter, either
medical school transcript to residency When an applicant requests a letter of purposely or accidentally, could impair
training programs in September or recommendation in support of his or her the relationship between the letter writer
October. Students can request that residency application from a medical and the residency program. Program
updated copies be transmitted, as school faculty member, the faculty directors should consider letters of
necessary, to reflect new information. member may request the applicant to recommendation to be confidential.
waive the right to see that letter. By Revealing the content of a confidential
International medical graduates or waiving the right of access to a letter of
students who will not be able to letter during a program’s application and
recommendation, the applicant permits interview process could result in that
provide a medical school transcript the letter writer to be candid and
should indicate that fact on the recommender being unwilling in the
straightforward in a written assessment, future to provide substantive informa-
Miscellaneous tab of the ERAS and the reader of the letter is reassured
application. tion about residency applicants to the
that the applicant has not unduly influ- program, thus decreasing the program’s
7. Photograph enced the letter writer in terms of the ability to assess applicants’ personal
letter’s content. Many persons involved characteristics and qualifications.
The applicant’s photograph is usually in the resident selection process wish to
an optional part of the residency know whether or not an applicant has
application. However, most programs waived the right to see the content of a
prefer to see a photograph, and it is letter written on his or her behalf, since
good practice to include one with some believe that letters to which the
other application materials. The right of access has been waived provide
photograph should be clear, and it more reliable, valid, and straightforward
should present a professional information than those to which access
demeanor and depict the applicant in has not been waived. For this reason,
appropriately professional attire. most letter of recommendation forms
(including those used by ERAS)
Applicants may assign the photo- document whether or not the applicant
graph as a supporting document for has waived his or her right of access to
specific programs. Thus, applicants the letter.
control which programs receive a
photograph, and when. Once it has The final decision about waiving the
been received, programs cannot view right to see a letter of recommendation
the photograph until after the is that of the applicant. If access has been
applicant has been invited to waived, an applicant should not read the
interview. letter at any time, even if provided an

VII. Applying
This section explains the multiple proce- allopathic and osteopathic medical considers the application to be complete,
dures required to apply to residency schools; from the ECFMG for interna- last-minute applications should be
programs in various specialties. tional medical graduate applicants; or avoided. In general, an ERAS application
from CaRMS for applicants from should be submitted to programs in
A. The Electronic Residency Canadian medical schools. September or early October.
Application Service (ERAS)
Please note again that registering for For ERAS, the Common Application
ERAS is used by 52 residency and fellow- ERAS is not the same as registering for Form (CAF) and the applicant’s personal
ship specialities. A full list of participating the NRMP, and vice versa. There are statement can be completed on the
specialities and programs is available at separate registration processes and MyERAS Web site. Applicants can
https://services.aamc.org/eras/erasstats/par. requirements for each service. designate the supporting documents that
Program participation in ERAS is will be supplied for their applications
Registration for ERAS opens on July 1 (e.g., USMLE or COMLEX score
voluntary. Of those specialities that use for all applicants.
ERAS, 95 percent of programs typically transcripts, letters of recommendation).
are ERAS participants. The other five Once ERAS registration has been Applicants should investigate and select
percent of programs are listed in ERAS, completed, applicants have the ability to programs of interest and, most
but they cannot be selected for ERAS work on their applications before the ERAS important, assign appropriate
application. Contact those programs PostOffice opens. The opening of the ERAS supporting documents to each program.
directly for application information. PostOffice permits applicants to send appli- Applications to programs are finalized by
cations to programs, schools to transmit submission of the application fee to
Programs may list different types of supporting documents, examining boards ERAS. Following fee payment, the ERAS
training offered in ERAS, such as to transmit scores, and programs to receive application and personal statement will
Preliminary, Categorical, Advanced, and applications. Once the ERAS PostOffice be available to programs within two
Reserved. See Section V, Matching opens, the application can be submitted to hours. Supporting documents will be
Processes, for definitions of the different ERAS and, through ERAS, to residency transmitted to programs as they are
types of positions. programs of interest. The ERAS PostOffice processed by the medical schools and
opens annually for the majority of examining boards.
It is important to investigate programs
before applying by contacting the residency positions on the first working day B. Central Application System (San
programs, reviewing their Web sites and in September, and for osteopathic medicine Francisco Match)
brochures, and considering program and internship on July 15.
Applications for programs in specialties
specialty information available at the Registration for the NRMP using the San Francisco Match must be
ACGME (www.acgme.org) and AMA (www.nrmp.org) opens on August 15 of submitted using the Central Application
Web sites (www.ama-assn.org). each year and continues until the rank System (www.sfmatch.org). Registration
The ERAS application can be completed order list deadline, although an for the San Francisco Match opens in
on the MyERAS Web site additional late registration fee applies May of each year. Central Application
(www.aamc.org/eras). An ERAS after December 1. System materials are distributed in May
electronic “token” (a 16-character one- or June.
Residency program applications should
time-use access code) is required for be provided to residency programs well Residency applications should be
access to the MyERAS Web site, and the in advance of the programs’ deadlines. provided to residency programs well in
token must match the school of gradua- Since delays in the arrival of supporting advance of program deadlines. Since
tion. A token can be obtained from the documents for an application can affect delays in the arrival of supporting
medical school for applicants who are whether a residency training program documents for an application can affect
students in, or graduates of, U.S.

whether a program considers the appli- MyERAS to monitor their Message Osteopathic medical school applicants
cation to be complete, last-minute appli- Center on a regular basis. who are applying to osteopathic
cations should be avoided. In general, the medicine internships are not subject to
CAS application should be submitted to E. Ensuring completion of the November 1 release date. Their
programs by mid-August. applications MSPEs are transmitted as they are
It is the applicant’s responsibility to available.
C. Paper-based applications
ensure that his or her application is Prior year graduates applying to
Some residency training programs use complete at residency training programs immediately vacant PGY-2 positions or
the paper-based “Universal Application of interest. If a faculty member or other to other positions that are not open to
for Residency” form, a copy of which can letter writer has not yet submitted a U.S. medical school seniors are also not
be obtained directly from the program letter of recommendation, the applicant subject to the November 1 MSPE release
or from the program’s Web site. Copies should follow up with the letter writer in date. MSPEs for these applicants may be
also are posted on the NRMP Web site a timely manner or request a replace- sent outside of ERAS as soon as they are
(www.nrmp.org, Application Processes). ment letter from another reference. available.
Some programs have developed their F. November 1 release date for
own Web sites or processes for online the Medical Student Performance
applications. Check with the individual Evaluation (MSPE)
programs for additional details.
U.S. allopathic medical schools have
D. Tracking applications agreed upon a common release date of
November 1 for the Medical Student
For applications made through ERAS, it Performance Evaluation (MSPE). All
is possible to track the delivery of the MSPEs transmitted via ERAS are
application using the Applicant automatically held until November 1.
Document Tracking System, which is Paper copies sent by schools are not
accessible from the MyERAS Web site. mailed before November 1.
When mailing paper applications, appli- Osteopathic medical school applicants
cants should request a return receipt or applying to ACGME-accredited
should track delivery in some other programs are also subject to the
reliable manner. November 1 MSPE release date.
ERAS includes a Message Center, which Prior year graduates applying to PGY-1
contains copies of e-mails sent by or PGY-2 positions that are open to
programs to residency applicants, if current U.S. medical school seniors are
those e-mails were transmitted via the also subject to the November 1 MSPE
ERAS system. Applicants should log into release date.

VIII. Visiting Residency Training Programs

This section provides information and • The AMA Minority Affairs b. Be prepared to answer succinctly
suggestions regarding applicants’ prepa- Consortium Transitioning to the following question: “Tell me
ration for visiting residency programs of Residency: What Medical Students about yourself.”
interest. Need to Know (www.ama-assn.org/
ama/pub/category/6672.html) c. Other issues you should be
A. Applicants’ assessment of prepared to discuss:
programs • The AAMC Organization of Resident
Representatives (OSR) brochure, Don’t • Your resume, prior correspondence,
Residency applicants have multiple Forget to Ask: Advice from Residents on and your references for the
sources of information available to them, What to Ask During the Residency program
including: Interview (www.aamc.org/members/
• Your strengths and weaknesses
osr/residencyquestions.pdf)
• The Careers in Medicine Specialty
Pages (www.aamc.org/students/cim/ • How you might contribute to this
B. Assessment criteria
specialties.htm), which contain both specialty or program.
residency training information and For the vast majority of applicants, the
d. Review the program’s contract,
physician workforce and salary data. primary criterion on which decisions about
which should be available to appli-
the rank ordering of programs are made is
• The AMA’s FREIDA Online cants on the program’s Web site.
based on the quality of the educational
(Fellowship and Residency Electronic program in relation to the applicant’s e. Know the specialty area and the
Interactive Database Access), an online future professional plans. Numerous other specific residency program;
database (www.ama- criteria also should be assessed by the become knowledgeable about:
assn.org/go/frieda) containing infor- applicant, both prior to a program visit and
mation on 8,000+ graduate medical during the actual visit; these are referenced • The specialty: trends in workforce
education programs accredited by the in Section III, B, above. and practice environments, training
ACGME, as well as on 200+ combined requirements, etc.
specialty programs. FREIDA Online C. Program visits
permits comparison of programs on • The program: mission and goals,
such factors as length of training, 1. Interview preparation affiliated clinical facilities, clinical
program size, number of faculty, work and research interests of the faculty,
a. Be prepared to discuss your
and education environments, and information on the program Web
background and career goals,
compensation and benefits, as well as site, etc.
including:
on the career plans of graduates from
f. Interview logistics:
various specialties as reported by their • Your own application and its
program directors. contents • Know when and where you are
supposed to arrive
• The AMA Graduate Medical • Clerkship experiences and other
Education Directory, 2005-2006; the experiences relevant to the • Plan to arrive early and allow time
Graduate Medical Education Library residency and specialty for resolution of problems that may
on CD-ROM, 2005-2006; and the develop (e.g., traffic, parking, etc.)
GMED Companion: An Insider’s • Your prior research efforts
Guide to Selecting a Residency • Get a good night’s sleep beforehand
• Your ideal career path.
Program, 2005-2006 (www.ama-
• If possible, make a “trial run” to the
assn.org/ama/pub/category/3991.html)
site of the interview.

e. Attire and appearance: • Assess the strengths and challenges 4. Second visits
of the program in relationship to
• Dress appropriately and professionally your individual professional plans • Student affairs officers and residency
program directors are currently
• Maintain a professional and polite • Inquire about training options, discussing the advisability of second
demeanor with everyone you recent program successes, assess- visits to residency training programs
encounter; some programs afford ment policies and practices, and
the departmental secretary a vote plans for the future • Program directors are considering
on the selection committee implementation of a proposal from
• Avoid asking faculty members the student affairs community that a
• Avoid distracting elements in your mundane questions (focusing on single visit to a residency training
attire, appearance, grooming, stipend, call schedules, leave program by an applicant be considered
jewelry, etc. policies, parking, etc.) the standard for both the applicant’s
f. Rehearse, if possible: assessment of the program and the
• Focus on substantive questions program’s assessment of the applicant
• “Try out” answers to questions with about mutual benefits – how the
your advisor or a trusted friend applicant and program would both • Although this standard would not
benefit from a successful match. prohibit voluntary second visits by an
• Attend any available interview applicant for any purpose, a second
2. Creation of an information grid for visit would not become a requirement
workshops presented at your school
use in program assessment of the assessment process for any
• Develop your interview skills, residency applicant.
Create an information grid for use
poise, and presentation with
in program assessment and include
practice.
all factors that are crucial to your
g. Expect the unexpected and poten- residency training program
tially difficult questions: selection.
• Anticipate areas of concern in your 3. Completion of the information grid

application (e.g., a grade, USMLE for each program visited
score, or leave of absence) and
Complete the information grid
prepare, in advance, an effective,
immediately after each visit by
nondefensive ways of addressing
assessing relevant factors for that
them.
program in comparison with
h. Ask good, relevant, and important programs previously visited.
questions:

IX. After the Program Visit

This section provides information and program directors may regard an
suggestions regarding follow-up activi- applicant’s statement of commitment
ties for applicants after their visits to to a program in a thank-you note as
residency programs of interest. disingenuous
After each program visit, it is recom- • Begin rank-ordering residency

mended that the applicant: programs on the basis of the data
collected and resulting personal prefer-
• Complete an assessment for each ences; consult with residency advisors
factor on the information grid for this about these ratings
program, including both factual infor-
mation and personal perceptions of fit • Factors to be considered in deter-
with the program mining the number of programs to
rank include the competitiveness of
• Synthesize information and percep- the specialty and of the specific
tions about all programs by comparing programs being ranked, as well as the
relevant factors for each program applicant’s qualifications
visited; maintain an up-to-date
ranking of all programs visited • Applicants are well advised to rank
only those programs that they
• Prioritize programs of interest by consider acceptable, i.e., those
refining choices, based on the assess- programs where they would be happy
ment data entered in the information to undertake residency training
grid following each program visit;
begin the process of rank ordering • Applicants are also well advised not to
those programs of continuing interest include on the rank order list any
program deemed unacceptable for any
• Send a thank-you note to program reason
staff after the visit, emphasizing the
appealing characteristics of the • Complete, submit, and certify the rank
program, but be aware that some order list prior to the deadline.

X. Residency Application Outcomes

This section addresses applicants’ respon- Applicants who do not match in one of the format in which the programs will
sibilities and opportunities based on the the early matches may seek residency receive applications: via ERAS or by
outcome of their match participation. positions after that match concludes, e-mail or by fax.
using the list of available positions that
A. Obligations of matched typically is posted on the match’s Web C. “The Scramble”
applicants site. This information is available only to On Monday of Match Week, the NRMP
It is the policy of every matching registered match participants. The San notifies applicants whether they have
program that the match between the Francisco Matching Program uses a been matched to a residency training
applicant and the program is a binding Vacancy Information System that lists program. The following day, the NRMP
commitment for both sides. Failure to post-Match positions, as well as positions notifies programs whether they have
honor that commitment is a violation of that have become vacant throughout the unfilled positions and, if so, how many.
the contract signed during the registra- year. Applicants must complete the Two days later, full details of the results
tion process. Penalties for violations vary Applying to Post Match Vacancies form of the Main Match are released, and
among the different matching programs. that is posted on the San Francisco Match most U.S. schools hold Match Day
Some matches allow applicants to seek a Web site to participate in post-Match ceremonies.
waiver of the match commitment, either searches for vacant positions.
by mutual agreement of the applicant “The Scramble” takes place during two
The Urology Match posts vacancies on days between Tuesday and Thursday of
and program or by contacting the match its Web site after the match has
office directly. The “rules” are available Match Week. This period is designed to
concluded and throughout the year. permit unmatched applicants to locate
on each match’s Web site. Applicants must contact those programs residency positions in programs that
B. “Early match” outcomes with vacant positions directly. have unfilled positions so they can begin
At the conclusion of the AOA Intern and planning for the transition from medical
Applicants participating in the “early school to residency and participate in
matches” (i.e., the San Francisco Resident Registration Program (IRRP)
Match, the procedures to be followed by Match Day ceremonies.
Matching Program, the Urology Match,
the AOA Intern and Resident unmatched applicants and institutions Typically, residency training programs
Registration Program Match, and the with available positions are posted on receive Scramble applications after an
military selection process) receive their the IRRP Web site. initial telephone call from the applicant.
match results in January or early The NRMP begins to release the results The application can be faxed, e-mailed,
February. In some cases, a preliminary of the Main Residency Match on or sent via ERAS or FindAResident (see
position will be “held” by the same insti- Monday of Match Week, when applicants below). Many programs prefer to receive
tution to which the applicant matched. are informed whether, but not to which an initial exploratory phone call, as it
In other cases, applicants who obtain programs, they have matched. At noon makes the application more personal and
residency positions through the early on Tuesday of Match Week, when the tangible. Programs continue to seek the
matches will be required to register for NRMP releases the list of unfilled same caliber of applicants during the
the NRMP’s Main Residency Match to programs, “the Scramble” begins. Scramble as they did prior to the Match.
secure preliminary training. (U.S. Information is e-mailed to all registered Applicants may now consider programs
allopathic medical school seniors must NRMP applicants and is posted on the which they had not previously consid-
participate in the NRMP for their NRMP Web site in a “dynamic” format, ered. Most programs at this stage of the
preliminary positions.) so that positions can be deleted from the Scramble process do not have the time
list as they are filled. The list indicates for a leisurely review of an ERAS appli-
cation or a faxed application. They are

primarily seeking applicants who display D. FindAResident The FindAResident subscription runs for
a good attitude, a strong work ethic, and one year, from September 15 to
sufficient skills to complete residency Residency training programs that do not September 14 of the subsequent year.
training and the relevant specialty board fill all of their positions during “the Within that period, subscribers can make
examinations; this type of important Scramble” are then able to invest time in unlimited notifications to residency
information can sometimes be trans- a comprehensive review of submitted training programs as positions become
mitted to them by means of a recom- applications. Many programs post still- available.
mendation in the form of a letter or vacant positions on online Web sites,
telephone call from someone whose including that of the AAMC-sponsored Information about subscription fees for
opinion they trust (e.g., a faculty FindAResident program FindAResident can be found at:
member, a department chair, a student (www.aamc.org/FindAResident). Some www.aamc.org/FindAResident.
affairs dean). residency programs choose to use their
specialty association Web sites or other Other resources of interest to applicants
Unmatched U.S. seniors should work Web-based services for the same seeking to identify open positions in
closely and collaboratively with their purpose. residency programs can be found in the
school staff members during the Bibliography (Appendix A).
Scramble. Many schools ensure that FindAResident is an AAMC service that
knowledgeable faculty members and assists residency training program
departmental personnel are available to personnel to identify interested appli-
provide advice and support to cants for post-match and ad-hoc
unmatched students as they apply for vacancies that occur in residency and
available positions in residency programs fellowship training programs.
in their chosen specialty. FindAResident advertises available
positions on a year-round basis,
During the Scramble, international although information about most
medical graduates should target a available positions is posted in the
manageable number of programs in a months between Match Week and the
specialty in which they have a realistic start of residency training on July 1.
chance of being accepted. Preparation of
a good verbal introduction for use in an FindAResident permits residency
initial telephone call to programs with program applicants to search a database
unfilled positions is strongly recom- of available positions by specialty and by
mended. Merely providing ERAS appli- location, to review program selection
cation materials or faxed applications criteria, and to notify programs of their
without first making personal contact potential interest. FindAResident also
with residency program staff members is permits residency program applicants to
a less effective strategy for securing an create an online resume and to make this
available position during the sometimes resume available to residency programs
hectic Scramble process. Residency with available positions. In this way,
program staff are not likely to consider residency programs can search for
applicants who use for-profit services qualified applicants and notify them of
that claim to distribute applications to open positions for which they might be
large numbers of programs or that create suitable candidates.
“personal” Web pages for applicants.

XI.The Transition from Medical School to Residency

This section provides advice and recom- typically provide graduating students C. Visas
mendations for easing the transition with a summary and/or history of their
from medical school to residency student loan borrowing. An excellent International medical graduates who are
training. source for tracking down information neither U.S. citizens nor permitted by the
about federal student loans (for those U.S. Citizenship and Immigrant Services
A. Insurance programs who borrowed during college or bureau of the U.S. Department of
graduate studies prior to attending Homeland Security (http://uscis.gov/) to
After Match Day, it is important for reside permanently in the United States
incoming residents who have graduated medical school and who cannot find
their loans) is the National Student Loan (i.e., as a permanent resident or green
from U.S. medical schools to review the card holder) must apply for and obtain
specifications of program- or institution- Data System (www.nslds.ed.gov).
appropriate visas for themselves and any
sponsored insurance plans to ensure Graduates are well advised to inform accompanying family members prior to
uninterrupted health, disability, and each of their loan servicers of their new participating in a residency training
other coverage between their graduation contact information as soon as they program.
from medical school and enrollment in know it, and to verify with their loan
residency-sponsored programs. In servicers the status of each of their loans The J-1 visa, a temporary non-
particular, new residents are well advised (i.e., the length of the grace period; the immigrant visa reserved for participants
to determine whether health and/or number of months before the expiration in the Exchange Visitor Program, is one
disability insurance plans sponsored by of any grace period; and the qualifica- visa type commonly used by foreign
the residency training program or its tions, application process, and relevant national physicians for this purpose. The
parent institution begin on the first day deadline dates for deferment). Many Exchange Visitor Program was estab-
of enrollment in the program or at some loan servicers also provide Web-based lished by the U.S. Department of State to
later date, and whether those insurance access to loan information that affords enhance international exchange and
programs exclude coverage for pre- borrowers access to their account infor- mutual understanding between the
existing conditions for a specified period mation on a 24-hour-per-day, seven-day- people of the United States and other
following initiation of coverage. If such a-week basis. Residents are also encour- nations.
exclusions exist, the temporary extension aged to take advantage of those services.
of medical school-sponsored insurance The duration of stay for Exchange Visitor
programs (which may involve the Federal Stafford Loan interest rates Program physicians is limited to the time
payment of additional insurance change annually on July 1. The new typically required to complete a graduate
premiums) might be advisable. interest rates are announced at the end medical education program. Exchange
of May. In a rising interest rate environ- Visitor Program physicians with J-1 visas
B. Financial aid processes ment, residents are encouraged to pay are required to return to their home
close attention to the May rate change country for at least two years following
Medical students who have received completion of their residency training
financial aid from the federal Stafford announcement. Residents also can
benefit from the AAMC MONEYMAT- program before being eligible for certain
loan program are required by federal other U.S. visas. The U.S. Department of
regulations to attend, prior to gradua- TERS listserv, which alerts residents to
changes in student loan programs of State has designated the Educational
tion, a financial aid exit interview. In that Commission for Foreign Medical
session, students are provided with infor- importance to residents. Residents can
sign up for the listserv at Graduates (ECFMG, www.ecfmg.org) as
mation on the terms of their loans the sole visa sponsor for all J-1 Exchange
(interest rates, interest capitalization, www.aamc.org/debthelp. An impending
significant interest rate increase may Visitor Program physicians who partici-
grace periods, deferment, forbearance, pate in clinical training programs in the
repayment, and consolidation) and on result in residents’ wanting to consoli-
date their federal student loans in order United States. In this capacity, ECFMG is
their rights and responsibilities. responsible for ensuring that physicians
Financial aid administrators also to lock in a lower interest rate.

holding J-1 visas and their host institu- D. Contracts iarize themselves with the region prior to
tions meet the federal requirements for making such a significant investment.
participation. ECFMG does not sponsor It is National Resident Matching
physicians for other U.S. visa types. Program (NRMP) policy that residency Various individual and personal consid-
Information about general eligibility training programs “are expected to erations must be taken into account by
requirements for the Exchange Visitor provide complete and accurate informa- incoming residents as they consider their
Program can be found at: tion to interviewees, including a copy of housing options. These include the
www.ecfmg.org/evsp the contract the applicant will be amount of time available during the
expected to sign if matched to the already challenging PGY-1 year to
An H-1 visa, a visa for a temporary program and all policies of the institu- perform home- and yard-related chores,
worker sponsored by an employer, is tion regarding eligibility for appoint- the amount of personal or family dispos-
another option for international medical ment to a residency or fellowship able income available for mortgage
graduates seeking training in a U.S. position. This information must be payments, and the fact that some
residency program. The U.S. Citizenship communicated to interviewees in writing graduates do not have an income source
and Immigrant Services bureau grants prior to the relevant rank order list certi- during the transition from medical
H-1B visas to temporary professional fication deadlines.” school to residency training.
workers who are required to have a
prearranged job, either temporary or It is very important that residency appli- For some residents and in some
permanent, in a professional field before cants carefully review the contract of any locations, a home can be a good invest-
they receive a visa. There is an initial residency training program in which ment during residency training; for other
admissions period of three years, with they are interested prior to finalizing residents and in other locations, the
the possibility of extending one’s stay for their rank order lists because the rental option is a more reasonable
a second three-year period. After staying applicant will want to be reassured that choice. At the very least, care must be
in the United States for the maximum there is mutual compatibility between taken to ensure that all relevant financial
six-year period, a foreign citizen is the institution and the applicant and considerations are taken into account in
required to live abroad for one year because the match is contingent upon reaching this decision.
before re-entering the United States in the applicant being able to meet the
institution’s requirements. F. Employment for spouses
an H or L visa category.
E. Housing For residents with spouses or domestic
In ERAS, applicants now have the option partners, the transitional period between
to enter both their current visa status Match Day and the beginning of
Soon after the announcement of match
and the visa status they expect to hold residency training provides an opportu-
results, most future residents begin the
during residency training. This allows nity for the identification of suitable
process of identifying and arranging for
applicants the opportunity to indicate an employment for spouses or partners.
housing near their residency training
expected visa change. Although some programs and their
program.
International medical graduates who are sponsoring medical schools or hospitals
Depending on their financial circum- are able to provide formal or informal
neither U.S. citizens nor permanent
stances, some residents, knowing that assistance in identifying such employ-
residents are strongly urged to consult
they will be residing in the same area for ment opportunities, provision of this
promptly with the directors of the
a minimum of three to five years, choose type of assistance is often not available.
residency training programs at which
to purchase a home during the period of In any event, it may be advisable to
they are interviewed regarding relevant
transition from medical school to subscribe to the local paper to read job
visa issues.
residency. Other residents decide to rent listings.
rather than purchase so they can famil-

G. Schools that all materials requested by the ments or monetary graduation gifts in
residency training program be completed order to ease the financial transition in
Incoming residents with school-aged and submitted promptly; failure to do so the months between medical school
children also may use the time between may result in a delay in beginning graduation and receipt of the first
Match Day and the beginning of residency training. residency paycheck. Ensuring that
residency training to investigate educa- student loans are either in grace or in
tional opportunities for their children in Incoming residents should be aware that deferment, if applicable, or in forbear-
the new location. Residency program some hospitals and some states require ance also results in peace of mind for the
staff who have children of their own are residents to undergo a criminal new resident.
frequently good sources of information background check prior to beginning
about the quality of individual schools residency training. Additional informa- Some programs provide incoming
and school districts in the region. tion about this and other requirements residents with the opportunity to request
Identifying an appropriate school district for residency training can be obtained an advance on their contract stipend (up
and school can strongly influence the from the program director. to a specified maximum amount) to
choice of preferred housing location for assist with the financial transition from
a resident and his or her family. Finally, I. Orientation and program medical school to residency training,
the fact that residency training programs start dates with their subsequent bi-weekly or
usually begin on July 1 permits sufficient monthly paychecks adjusted accordingly
The majority of residency training
time for the enrollment of children in over the next several months of their
programs begin annually on or about
school and the provision of the July 1. Most include an orientation PGY-1 year to repay the advance. If
documentation (e.g., immunization financial circumstances make this an
period at the beginning of the program,
records, records from schools previously appealing option, check with the
although the length and content of
attended) required to begin school in the program director following Match Day
orientation programs vary from institu-
fall term. to determine whether this or a similar
tion to institution. Since orientation
program may be available.
H. Hospital credentialing and programs may begin in mid- to late-June
medical licensure rather than on or after July 1, incoming Some residents have also reported that
residents should check with residency the services of an independent financial
The residency program director and program staff regarding expectations planner are beneficial at this time in
members of his or her staff usually about program orientation and start their lives. In addition, minimal use of
provide incoming residents with infor- dates. credit cards and continuing to live well
mation about what will be required of within their means have served many
them with respect to hospital creden- J. Budgeting
residents well at this crucial time.
tialing and medical licensure, including Since the first paycheck for a new
application materials for any required resident may not arrive until August 1 or
training license. It is important to review thereafter, beginning first-year residents
this information promptly after it arrives are strongly encouraged to set aside
and to be familiar with hospital and state money, if possible, from fourth-year
medical board policies. It is imperative medical school financial aid disburse-

Appendix A
Bibliography Additional resources available from the AMA Find a Residency or
American Medical Association: Fellowship Web site
The Residency Interview: In response to requests from medical

A Guide for Medical Students school graduates seeking unfilled
positions in residency programs, the
This online resource guide, available to AMA Resident and Fellow Section
AMA members, is published by the AMA (AMA-RFS) offers a Web-based list of
Women Physicians Congress (AMA open residency and fellowship positions.
WPC), a special interest group Postings on the Find a Residency or
comprised of physicians and medical Fellowship Web site include a short
students who are advocates for women’s description of the position and the
health issues and the professional and life program, as provided by program
balancing issues affecting women in officials, as well as contact information.
medicine. This resource addresses the The site also provides links to specialty
following topics: societies that offer information on
residency vacancies. For information on
• Handling gender-based questions
positions in a given specialty, applicants
• Couples matching for positions may also wish to contact
the appropriate specialty society; a list of
• Shared and part-time residencies specialty societies is available in the
GMED Companion: An Insider’s Guide
• Preparing for interviews
to Selecting a Residency Program.
• Interview questions to ask
Information about this resource can be
• Common and uncommon questions found at: www.ama-assn.org/
that will be asked ama/pub/category/6920.html
• What to bring to the interview Additional resources available from other

sources:
AMA Women Physicians Congress
515 N. State St. CareerMD
Chicago, IL 60610
This Web site, dedicated to information
312-464-5622
on institution-sponsored graduate
312-464-5845 Fax
medical education programs, provides
Information about ordering this resource information on residency and fellowship
can be found at: www.ama- programs, as well as listings for residency
assn.org/ama/pub/category/10757.html and fellowship vacancies.
Information about this resource can be

found at: www.careermd.com

Resident Web Alliance for Academic Internal

Medicine Job Bank
This service provides discussion groups, https://secure.med.edu/jobbank
career advice, and other information for
medical graduates. Registered users can American Psychiatric Association
access residency and fellowship search www.psyccareers.com
databases.
Society for Academic
Information about this resource can be Emergency Medicine
found at: www.residentweb.com/default.asp www.saem.org/services/resvacan.htm
Specialty Web sites Association of Program

Directors in Surgery
Many of the larger specialties host job www.apds.org/residency_positions_open.
banks or vacancy clearinghouses on their htm
national specialty association Web site.
These services are generally free for
applicants to explore and apply. The type
and amount of information and search
features for these sites vary widely.

Appendix B
Webliography Accreditation Council for Graduate Canadian Resident Matching Service
Medical Education (ACGME) (CaRMS)
www.acgme.org www.carms.ca
American Board of Medical Specialties Careers in Medicine Program (AAMC)

(ABMS) www.aamc.org/students/cim
www.abms.org
Citizenship and Immigrant Services, U.S.
American Medical Association (AMA) Department of Homeland Security
www.ama-assn.org http://uscis.gov/
AMA GME E-letter Committee on Accreditation of

www.ama-assn.org/go/gmenews Canadian Medical Schools (CACMS)
www.afmc.ca
AMA International Medical
Graduates Section Curriculum Directory (AAMC)
www.ama-assn.org/go/imgs www.services.aamc.org/currdir/
AMA Medical Student Section Educational Commission for Foreign

www.ama-assn.org/go/mss Medical Graduates (ECFMG)
www.ecfmg.org
AMA Resident and Fellow Section
www.ama-assn.org/go/rfs Electronic Residency Application Service
(ERAS)
American Osteopathic Association (AOA) www.aamc.org/eras.htm
www.osteopathic.org
Exchange Visitor Program (ECFMG)
American Osteopathic Association www.ecfmg.org/evsp/
(Accreditation)
www.do-online.osteotech.org Federation of State Medical Boards
www.fsmb.org
American Osteopathic Association
Intern/Resident Registration Program FindAResident Program (AAMC)
(IRRP) www.aamc.org/FindAResident
www.natmatch.com/aoairp/index.htm
Fifth Pathway Program Information
American Urology Association Residency www.ama-assn.org/ama/pub/
Matching Program (AUA) category/9306.html
www.auanet.org/residents/resmatch.cfm
FREIDA Online (Fellowship and
Association of American Medical Residency Electronic Interactive
Colleges (AAMC) Database)
www.aamc.org www.ama-assn.org/go/frieda
Association of American Medical Graduate Medical Education Directory

Colleges Publications (the AMA “Green Book”)
www.aamc.org/publications www.ama-assn.org/ama/pub/
category/3991.html

Graduate Medical Education Directory Organization of Resident Representatives

Companion: An Insider’s Guide to (AAMC)
Selecting a Residency Program, 2005-2006 www.aamc.org/osr
www.ama-assn.org/ama/pub/
category/3991.html Don’t Forget to Ask: Advice from
Residents on What to Ask
International Directory of Medical During the Residency Interview
Education (IMED) www.aamc.org/members/osr/
http://imed.ecfmg.org/ residencyquestions.pdf
Liaison Committee on Medical San Francisco Matching Program

Education (LCME) www.sfmatch.org
www.lcme.org
Specialty Pages (Careers in Medicine
MONEYMATTERS listserv (AAMC) Program)
www.aamc.org/debthelp www.aamc.org/students/cim/
specialties.htm
National Board of Medical Examiners
(NBME) Test of English as a Foreign Language
www.nbme.org (TOEFL)
www.ets.org/toefl/
National Board of Osteopathic Medical
Examiners (NBOME) United States Medical Licensing
www.nbome.org Examination (USMLE)
www.usmle.org
National Resident Matching Program
(NRMP)
www.nrmp.org
National Student Loan Data System

(NSLDS)
www.nslds.ed.gov
New York Medical College (Fifth

Pathway Program)
www.nymc.edu/depthome/fifth.asp

AAMC Roadmap To Residency

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Roadmap to Residency:

From Application to the Match and Beyond

iii Association of American Medical Colleges, 2005

A. Allopathic medicine residency programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

B. Osteopathic medicine residency programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

II. Being a Candidate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

A. Candidacy requirements for ACGME-accredited

1. Graduates of U.S. and Canadian medical schools accredited

2. Graduates of U.S. colleges of osteopathic medicine accredited by the

3. Graduates of medical schools located outside of the U.S. and Canada…

B. Who have completed a Fifth Pathway program provided by an

4. “Students” vs. “graduates”

5. United States Medical Licensing Examination (USMLE)

6. Educational Commission for Foreign Medical Graduates (ECFMG)

III. Specialty Choice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

IV. Residency Program Selection Criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

A. Understanding the training path for the chosen specialty . . . . . . . . . . . . . . . .6

B. Residency program selection criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

A. The National Resident Matching Program (NRMP) . . . . . . . . . . . . . . . . . . . .7

B. The San Francisco Matching Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

C. The Urology Match . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

v Association of American Medical Colleges, 2005

D. The American Osteopathic Association (AOA)

E. Canadian Resident Matching Service (CaRMS) . . . . . . . . . . . . . . . . . . . . . . .11

F. Military matches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

G. Couple’s matching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

H. Match outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

2. The “early matches”

3. Unmatched “early match” applicants

VI. Preparing to Apply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

A. What documents are needed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

4. USMLE and/or COMLEX score reports

5. Medical Student Performance Evaluation (MSPE)

6. Medical school transcript

B. Waiving right to see letters of recommendations . . . . . . . . . . . . . . . . . . . . . .16

VII. Applying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

A. Registration for ERAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

B. Central Application System (San Francisco Match) . . . . . . . . . . . . . . . . . . . .17

C. Paper-based applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

D. Tracking applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

E. Ensuring completion of applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

F. November 1 release date for the Medical Student

vi Association of American Medical Colleges, 2005

VIII. Visiting Residency Training Programs . . . . . . . . . . . . . . . . . . . . . . . . . . .19

A. How to assess programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

B. Assessment criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

C. Program visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

2. Creation of an information grid for use in program assessment

3. Completion of information grid for each program visited

IX. After the Program Visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

X. Residency Application Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

A. Obligations of matched applicants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

B. “Early Match” outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

C. “The Scramble” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

D. FindAResident and Other Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

XI. The Transition from Medical School to Residency . . . . . . . . . . . . . . . .24

A. Insurance programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24

B. Financial aid processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24

F. Employment for spouses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

H. Hospital credentialing and medical licensure . . . . . . . . . . . . . . . . . . . . . . . . .26

I. Orientation and program start dates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26

Appendix A: Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

Appendix B: Webliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29