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True to Reality or True to Ourselves? Rationalism vs Idealism for Matching Medical Students

Highet, Alexandra; Kurtz, Joshua B.; Spadafore, Maxwell

doi: 10.1097/ACM.0000000000002979
Letters to the Editor

Fourth-year medical student, University of Michigan Medical School, Ann Arbor, Michigan;; ORCID:

Fourth-year medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID:

Fourth-year medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID:

Disclosures: None reported.

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To the Editor:

As medical students soon to enter the Match, we appreciate the concerns Dr. Prober raised in his recent Invited Commentary.1 However, we disagree with the author’s suggestion that by targeting a “match” instead of a “fit,” we are not being true to ourselves.

We view residency not as an end point but as a stepping stone toward our goal of becoming physicians. Matching is not guaranteed. Approximately 5% of U.S. seniors do not match annually.2 Faced with this possibility, which throws our careers into question, we need to take steps to maximize our chances. We prioritize the items that we know residency program directors value across specialties: United States Medical Licensing Examination scores and clerkship grades. In the ideal system the author proposes, we would instead focus on qualities emphasized in the holistic review process for medical school admission, including teamwork and intellectual curiosity. Yet, the current residency application process undervalues such markers. The author fails to acknowledge the clear misalignment between fit and chance and idealism and realism that medical students navigate daily.

We agree with the author’s opinion that away rotations have value in the residency decision process. However, we would like to highlight the significant financial barriers away rotations pose. Each away rotation costs approximately $950, which “confers a perhaps unfair advantage on wealthier students who can afford to visit multiple sites.”3 Post-Match survey data from 2013 supported that the most common reason students chose not to pursue away rotations was their expense.4 Many of us, therefore, are prohibited from incorporating these experiences into our Match list decision making.

We are as frustrated by the residency selection process as faculty. Our mentors seldom report that we are “too smart” or “not smart enough”1 for various programs; instead, they shake their heads in empathic frustration toward a system that boils students’ years of hard work into the confines of a probabilistic model. We are hopeful that the value system behind the Match process will evolve, and we look forward to continuing this conversation. Yet, given the status quo and the incredibly high stakes, we remain unconvinced that medical students will shift their focus from traditional metrics for Match rankings to “fit.”

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1. Prober CG. The Match: To thine own self be true. Acad Med. 2019;94:317–320.
2. National Resident Matching Program. Results and data: 2018 Main Residency Match. Published 2018. Accessed August 15, 2019.
3. Winterton M, Ahn J, Bernstein J. The prevalence and cost of medical student visiting rotations. BMC Med Educ. 2016;16:291.
4. Griffith M, DeMasi SC, McGrath AJ, Love JN, Moll J, Santen SA. Time to reevaluate the away rotation: Improving return on investment for students and schools. Acad Med. 2019;94:496–500.
Copyright © 2019 by the Association of American Medical Colleges