Rank List

Constructing the right match list begins with taking advantage of the interview day. Truly, the most important aspect of each interview is to get a sense of the program. The character of each program will turn out to be a huge factor in making up your rank list. It is difficult to pinpoint exactly what you did and did not like about each place you visited, but your overall impression is extremely meaningful and can give you a sense of whether you would fit in. Keep in mind, however, that one day is not always an accurate representation of a program. Second looks or further communication with the program director may help to clarify questions.

When making your list, it is vital to know how the match process works. For good descriptions of the matching algorithm, read the National Resident Match Program (NRMP) Match Explanation. The most common mistake that people make about the match process is thinking that if they rank a less desirable, but more attainable, program higher on their rank list, they will increase their chances of matching there. This is false! Go through the examples on the NRMP site, and make sure that you grasp each nuance – you have spent innumerable years in school trying to understand things that are completely irrelevant, so spend 10 minutes understanding the match! Remember, ignore how you feel the programs will rank you, and rank the programs based on your desire to match with them.

In general, there are countless approaches to actually making up your match list, but most people fall into one of two camps: 1) A list of each quality you are looking for fulfilled by each program, or 2) The general impression you get from each program. Each method has its own merits, and, most likely, you already know which one suits your style. Regardless of which approach you take, you will find yourself, in the end, going largely with your gut instincts. You may be surprised to see how many factors other than the quality and reputation of the program play into your decision. You will be signing-on for a rigorous seven years, and you need to try and place yourself in a position in which you will look forward to going to work. Here are some suggestions to help you create your rank list:

  • Write some things down about each program immediately after your visit. If you have specific criteria in mind, list them for each program to see if the program meets your desires. Your interview days will begin to blend together very quickly.
  • As truthful as residents try to be, they inevitably are putting their best foot forward on behalf of their program for interview day. A reasonable way to obtain gossip is to ask residents what they hear about other nearby programs and vice versa.
  • Make friends with other students along the interview trail – they often have great insight into their home programs.
  • After you make your list, make sure you do not have any regrets about ranking certain programs above others. Sleep on it, and if you wake up relaxed, your list is in good shape. Every spot on the list matters – you truly never know where on your list you will end up.
  • Rank all the programs you interviewed at unless you would rather not be a neurosurgeon than attend that program. If you have made the effort to interview at a program, there is no reason not to rank it unless you truly hated it. Any program in the country will give you the training you need to become a successful neurosurgeon. However, if you absolutely do not want to be in a particular program, do not rank that program. You could wind up at that program, and participation in the match process constitutes a contract that you will accept the position given to you.
  • Do not assume that because you have been told “you will be ranked very highly here at XXX” that you will match at that institution even if you rank it No.1 on your list. Being ranked No. 5 by XXX does mean that they ranked you highly, but others may still be more highly ranked. Programs are not permitted to discuss specific rank order with applicants and are specifically instructed not to pressure or have conversations with applicants outside of the normal channels of the interview process. You should not ask a program director how you will be ranked. You can, however, communicate to a program director that you have found a specific program particularly appealing and that you would like to train there.
  • Discussing your rank order with mentors and advisors is important. Many students have ranked only the top rated programs and then found themselves without a residency. Be realistic about your qualifications and the likelihood that you will be ranked highly at a given institution. A balanced rank list gives you the best chance to match to a residency position and become a neurosurgeon.