To the Editor:
Chimienti and colleagues’ Invited Commentary1 raises important points about the application, interview, and matching processes through which medical students obtain positions in U.S. graduate medical education programs. However, some of the authors’ information is either incomplete or outdated.
The authors rightly note the power imbalance between applicants and residency program staff. It is unfortunate that some programs take advantage of that imbalance by asking inappropriate questions. As the authors note, the National Resident Matching Program (NRMP) Match Participation Agreement2 historically has prohibited questions about applicants’ rank order lists. Today, the agreement bars programs from requiring applicants to reveal the names or identities of programs where they apply and from requesting specialty, geographic location, or other identifying information about applicants’ choices.3 Although comprehensive, the agreement addresses only the policies governing the NRMP and not questions that may be illegal under federal or state laws.
In 2012, the NRMP created the nonbinding Match Communication Code of Conduct4 jointly with the Organization of Program Director Associations. The code supplements the Match Participation Agreement by discouraging program directors (PDs) from asking illegal or coercive questions, soliciting or requiring postinterview communication, or requiring second visits, all of which are issues identified by the authors. Neither the agreement nor the code prohibits either party from volunteering ranking information, nor do they bar postinterview communication, as the authors suggest. To do so would be unrealistic. What if applicants have questions about the program or program staff have questions about applicants’ qualifications?
The NRMP is keenly aware of challenges associated with the resident recruitment process and is committed to ensuring integrity in all phases of the Match. Recognizing that applicants may fear repercussions, the NRMP created an online form in 2017 that allows applicants to anonymously report alleged program violations, a fact not mentioned by the authors. The NRMP vigorously enforces its policies, but breaches can only be investigated if they are reported. Moreover, the NRMP cannot by itself ensure that applicants and programs conduct their affairs in an ethical and professionally responsible manner. PDs must educate all faculty and staff who interview applicants about Match policies, and applicants have a responsibility to report questionable program behavior.
Mona M. Signer, MPH
President and chief executive officer, National Resident Matching Program, Washington, DC.
Laurie S. Curtin, PhD
Chief policy officer, National Resident Matching Program, Washington, DC; email@example.com.
1. Chimienti SN, DeMarco DM, Flotte TR, Collins MF. Assuring integrity in the Residency Match Process. Acad Med. 2019;94:321–323.
2. National Resident Matching Program. Match agreements & resources. https://www.nrmp.org/match-participation-agreements
. Accessed September 27, 2019.
3. National Resident Matching Program. 2020 Match participation agreement for applicants and programs. https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2019/09/2020-MPA-Main-Residency-Match-for-Applicants-and-Programs.pdf
. Published September 6, 2019. Accessed September 27, 2019.
4. National Resident Matching Program. Match communication code of conduct. https://www.nrmp.org/communication-code-of-conduct
. Published August 2013. Accessed September 27, 2019.