It is that wonderful time of year again, where nearly every fourth-year medical student goes into panic mode as they begin the adventure of applying to residency. Yes, it is a grueling experience, but it is still one that nearly everyone looks back upon with some fondness. After all, you will explore new cities, have conversations with legends in your field, and make lasting friendships with your future colleagues. There is simply nothing else like it. So fear not, MS4s, and remember to enjoy the process! It will pass by far more quickly than you can ever imagine.
But for everyone that successfully makes it through the hurdles of ERAS and the zig-zagging across the country, there still lies the most daunting task of all: finalizing a rank list. For me, this was laying out my preferences for where to live and work for the next seven years! No matter how confident you are (or the length of your residency), hitting the “certify” button will always carry a weight of immeasurable finality.
So let’s start with the only rank list-making strategy you’ll need. And I do mean that in the singular sense because there is actually only one optimal strategy: the True-Preferences Strategy.
It may seem counter-intuitive, but there is nothing to be gained from submitting a rank list that is anything but an ordered list of your true preferences. Said another way, you should not rank an undesired program highly simply because you believe they will rank you highly. Google it, watch some YouTube videos — you will find that there is no way to game The Match.
Therefore, the sticky question of “how do I decide between all these great programs?” can be boiled down to “how do I define my true preferences?”—and if this still seems intimidating, I will make it easy for you!
Here is my foolproof guide to making a rank list (and a link to a cheat sheet workbook that I used to make my own rank list last year):
Start by making an exhaustive list of what is important to you in a program. Nothing is trivial (and you’ll soon see why).
For me, when evaluating neurosurgery programs, I thought of the following:
It is crucial to include everything that is even of potential importance. If the quality of the hospital cafeteria matters to you, write it down. If you want to work in a system that uses a particular EMR, put it on your list. The more you include, the more reliable this method will be for you.
2. Define a grading system for each parameter, and make it as granular as you want. For example:
3. Define a weight for each parameter. This is the most vital step. For me, location was the most important parameter I was factoring into my decision. Other parameters, such as the possibility of moonlighting, were less important. And if I absolutely had to choose between getting along really well with my co-residents vs. getting along really well with my attendings, I would choose the former. Be honest with yourself, and think about what constitutes a true “must-have” or “deal-breaker” for you.
The weights I used basically went like this:
Voila. Now you have a foolproof and detailed scoring system to methodically (and objectively) evaluate residency programs! All you need to do now is put this into a spreadsheet, and start adding data points as they come in.
To see what this looks like in action, I’ll provide a link to the spreadsheet that I used to make my rank list last year: you can safely download it here. Feel free to play around and adjust the parameters and weights. Remember, make your own list as exhaustive and as granular as possible.
You should never feel locked in — if something doesn’t feel right when you are looking at your rank list, now you have a framework by which to evaluate why that may be. So don’t be afraid to make changes as you go along (making a rank list is a dynamic exercise). Your experiences along the interview trail will educate you and help you to hone in on your true preferences.
Good luck everyone!
Dr. David Kurland is currently a PGY-1 resident in the Department of Neurosurgery at the NYU School of Medicine in Manhattan. He was born and raised in Baltimore, MD. You can connect with him on Twitter and Instagram.
Dr. Kurland is a 2018–19 Doximity Author.