By David Anthony, MD, MSc, Alec Chessman, MD, Kristina Duarte, MD, ScM, Katie Margo, MD, of Medicine Jacob Prunuske, MD, MSPH, and Martha Seagrave, PA-C.
This is in response to a previous blog post, How Faculty Can Prepare Students for the Match.
In an effort to address the increasing challenge of assisting students in obtaining family medicine positions in the Match, Michelfelder et al recently published a set of recommendations derived from discussions at sessions presented at the Society of Teachers of Family Medicine (STFM) Conference on Medical Student Education (MSE) and the Association of Departments of Family Medicine Conference. We commend the authors on their important work, and we support many of their recommendations, including:
- Encouraging increased communication between medical school advisors and program directors
- Discouraging students who do not “see themselves as thriving as family physicians” from applying to family medicine programs
However, we take issue with one of their recommendations, and pose an alternate viewpoint.
The authors state that “Most clerkship directors recommend students apply to 20–40 programs to increase interview offers.” While this statement may represent the prevailing voiced opinion during the lecture discussion at MSE, we take issue with the claim that most clerkship directors recommend students apply to 20–40 programs, and we vigorously disagree with the recommendation. Broadly encouraging students to apply to such a large number of programs will worsen the challenges of students in obtaining interviews and residency positions.
From an individual student’s perspective, applying to more programs makes sense and increases his or her chance of a desired outcome. However, as career advisors we have a responsibility to consider the opportunities for all of our advisees when we make recommendations to individuals.
The spirit of Michelfelder et al’s recommendations is to aid the students for whom successful progress through the Match is thought to be at risk. However, we feel that the effect of recommending that all students apply to such a large number of programs will be that students who are below average (the 50% of students who are below the mean) will be blocked from obtaining interviews by the top half of students.
Programs will preferentially offer interviews to the strongest applicants in their pool. Due to resource limitations, there is a cap to which residency programs can reasonably increase the number of interviews that they offer to applicants. As such, a significant swath of good students, near but below the average, will find it harder to achieve the necessary first step in matching—the offer of an interview.
Through numerous conversations with clerkship directors and directors of medical student education both online and during the STFM Annual Spring Conference in San Antonio, TX, we have found near-unanimous concern over such a blanket recommendation. We admit that responding to a non-scientific claim with anecdotal information is problematic, and we recommend systematic study of clerkship directors’ and program directors’ views on this issue, perhaps through CERA surveys.
We also urge that medical student advisors make tailored recommendations to students regarding the number of programs to which to apply on the basis of each student’s individual characteristics (areas of academic interest, geographic preferences, etc). Students who are likely to be strong applicants need not apply to a large number of programs. In this way we can decrease the risk of injuring a significant portion of our advisees.
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I agree with the comments of Anthony, et. al. that recommendations to students should be individualized and that the stronger students need not apply to as many programs as students who below average. It is especially important to not clutter residency programs’ interview schedules nowadays when many students applying in competetive specialties are also applying in Family Medicine as their parallel plan. The only caveat I have to their staement: “Students who are likely to be strong applicants need not apply to a large number of programs” is that in providing guidance to such students, advisors should also take into account other factors such as where the applicant is applying as well as their interpersonal skills. A strong student who has a short list consisting of the most competetive programs is also a student at risk to not match. The same would be true about academically strong students whose interpersonal skills lead the advisor to suspect that they may not interview well.
I commend the authors for raising important issues about the match and the advice we should provide to students. Clearly the environment is changing as the number of graduating MD and DO students approaches the number of residency slots available. This “pressure cooker” needs to be managed carefully for all involved.
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