A medical student and I were discussing his experience with this year's resident matching process. He told me he had interviewed at 18 programs and ranked 17 of them. He matched to a categorical five-year general surgery position at his sixth choice hospital and was satisfied.

His assessment of the situation was that his somewhat below average USMLE Step 1 score might have affected his chances at his first five choices. [See my previous post on how residents are selected here.]

Then he said, "I was a little surprised as I had some really positive correspondence with programs at the top of the list with one even telling me they were ranking me very highly."

Even though he had been warned that this type of thing might happen, he said, "It is so hard to not fall into the trap. It feels so good to hear 'you're ranked highly.'"

He was disappointed that a program would tell him this and not follow through. He planned to tell future applicants to beware.

"I almost wish there was a 'no contact' policy," he said.

Other than hurt feelings, no real harm was done. The match algorithm favors the student. The fact that a program director would tell an applicant that he was ranked highly and then not do so does not affect the way the match process works.

The applicant's rank order list is queried sequentially by the computer until the first unfilled program that ranked him is identified, and that's where he will end up.

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