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Ours is a medium-sized pediatrics residency program. Each year, we receive hundreds of applications. Less than a quarter of the applicants are chosen to interview. Less than two percent of the applicants will be chosen to be our new interns.

It is not just up to the program leadership to choose who our new interns will be. It is also up to the applicants to choose which programs they most want to join. Then the magical, mystical, messy Match occurs. With perhaps a dash of fate mixed in, a complicated computer algorithm pairs future pediatricians with their training programs.

In the end, the programs and the applicants submit their top choices yet don’t actually get to choose. Sure, the top applicants with the impressive USMLE scores and the glowing LORs and the class ranks in the first quartile are very likely to get their first choices. But their choices somehow matter more than those of the students with marginal USMLEs and bottom half class ranks and LORs that recommend them “without reservation.”

Program directors get to choose, in a sense, though our choices are limited by our ability to determine who will actually make good residents. USMLE scores do not predict who will be resilient and receptive to feedback and empathetic when talking with the same family for the 4th time in a shift. We cannot predict who will “get it” and complete their notes and to-do lists efficiently. Sometimes the USMLE scores are inversely proportional to the ability to perform these mundane daily patient care tasks.

As program directors, we do not take the “choosing” lightly. We want to give applicants the benefit of the doubt. We want to understand the context of the unique human who failed Step 1 on the first attempt but was dealing with a parent’s terminal illness or depression at the time. We fear that this failure may predict difficulty down the road with standardized tests and obtaining board certification, but we also know that a good pediatrician is much more than the sum of the USMLE scores and class rank.

In the end, we rely — perhaps too heavily — on the half-day we spend together. This year, the half-day is virtual and more tenuous than ever before. We want to choose the students who share our program’s values and who have a reasonable chance of being successful. We also want the applicants to choose our program and be happy with their Match results.

Many factors may impact an applicant’s rank list: geography, location of family, spouse’s job (if applicable), unique program characteristics, future career plans, and the intangible “you’ll know which program is right for you” interview-day feel. This year the virtual application process has thrown some wrenches into the traditional process. It may be harder to feel the “feels” of each program via Zoom. Additionally, I cannot comprehend what it would be like to consider moving to a city that an applicant has never visited, yet that is what is happening. We all wonder if more students will choose to stay at their local programs, but no one knows how it will play out in the end.

Regardless of the virtual nature of this year’s application process, some applicants and programs have more choices based on their qualifications, geography, and prestige. In the end, though, we all have the choice to make the best of our Match results. Next July 1st, our new interns will arrive, and we will be thrilled to have them! We hope they will feel the same way about us.

Lisa Sieczkowski is a pediatrician. 

Image credit: Shutterstock.com

Source: KevinMD

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