Misunderstanding the Match: Do Students Create Rank Lists Based on True Preferences?


Congratulations to Kathleen Ulrich, MD (PGY3); Benjamin Schnapp, MD; Jamie Hess, MD; Aaron Kraut, MD; David Tillman, MD; and Mary Westergaard, MD (Vice Chair, Education) on the publication of their brief research report into the Western Journal of Emergency Medicine (WestJEM).

The study examines the “stable marriage” algorithm underlying the National Residency Match Program (NRMP) which has been shown to create optimal outcomes when students submit true preference lists. Previous research has shown students may allow external information to affect their rank lists. The objective of this study was to determine whether medical students consistently make rank lists that reflect their true preferences. 

Of 175 students surveyed, 140 (80%) responded; 63% (88/140) reported that their “perceived competitiveness” would influence their rank list at least a “moderate amount. Of 135 students, 31 (23%) moved a program lower on their list if they learned they were ranked “low” by that program, while 6% (8/135) of respondents moved a program higher if they learned they were ranked “at the top of the list.” Participants responded similarly (κ = 0.71) when presented with scenarios asking what they would do vs what a classmate should do.

Students’ hypothetical rank lists did not consistently match their true residency preferences. These results may stem from a misunderstanding of the Match algorithm. Medical schools should consider augmenting explicit education related to the NRMP Match algorithm to ensure optimal outcomes for students.

Print publication is pending, but the article can be read online here: online article

Or download the PDF here: download PDF