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Student Notebook

Striking matches

By Sarah Dotters-Katz

When I finally heard my name called, I walked to the front of the auditorium, took a deep breath, and, with shaking hands, accepted an envelope. Inside was a piece of paper that would tell me where I will be working and what I will be doing for the next four years. No ifs, ands, or buts—if I want to be a doctor, I have to take the position that's on that piece of paper.

This process—the Match, or, more officially, the National Resident Matching Program—is how nearly all graduating medical students in the United States find out where they will do their residency.

Every Match Day at Dartmouth, students and their friends and families, plus professors and other mentors, crowd into an auditorium at DHMC to mark the near-completion of another year. Dr. Susan Harper, the assistant dean for medical education, stands at the front of the room with a stack of envelopes, each with a name written on it. One by one, she calls the names, and as students open their envelopes they find out where they will spend their residency. Sound scary? It is. But it is also exhilarating.

The Student Notebook essay offers insight or opinion from a Dartmouth student or trainee. Dotters-Katz is a DMS '10. Her residency at Duke University Medical Center, beginning in July, will be in obstetrics and gynecology. Dotters-Katz is also a former member of the Dartmouth Medicine Editorial Board, and she represented DMS recently by talking about medical education and health-care reform on the Vermont Public Radio call-in show, Vermont Edition; to listen to it, go to http://www.vpr.net/news_detail/88023/.

The Match is not as random as it appears. The residency application process is long and labor-intensive. The application includes a personal statement, three letters of recommendation, and test scores. I applied to 20 programs, which may seem like a lot, but I know of classmates who applied to as many as 65! After applying, we wait anxiously to be offered interviews. Applicants must be skilled planners to figure out how to maximize the number of interviews they can go on while minimizing the cost of traveling to them.

Ranking: After finishing their interviews, students have about a month to create, adjust, and submit their "rank list," a list of their first- through last-choice programs. Some people just know where they want to go, making their ranking easy. For others, it is a calculated and stressful process. They might toss a coin to decide between their first and second choices, or make color-coded spreadsheets to weigh their options. I originally created an elaborate spreadsheet to help me decide, but I ended up going with my gut feeling about programs despite what my spreadsheet said. No matter the process, once your list is in, the decision is out of your hands.

All residency programs also complete a rank list of most or all of the applicants they interviewed. Then a very smart computer program takes the rank lists from thousands of students and the rank lists from thousands of residency programs and makes optimal matches.

It sounds like an arcane process, but it's actually an improvement. Before the Match was established in the 1950s, applicants would interview for residencies and then wait to get a phone call offering them a position. When they got an offer, they had 24 hours to decide whether to take it, often resulting in a dilemma: Was it better to accept an offer from a program they liked, or to wait for an offer that might not come from a program they loved?

The Match process was created to put an end to that chaos and ensure that applicants had a place to go at the end of four years of medical school. And, honestly, the program does a good job. Most applicants find three or four programs where they would be happy and usually end up at one of those places.

After all the applications and interviews, then a very smart computer program takes students' rank lists and residency programs' rank lists and makes optimal matches.

Voodoo: DMS students tend to do very well in the Match, though occasionally they don't get into the program they're aiming for. That's where "Match voodoo" comes in. One student who graduated a couple of years ago had hoped to match in New York City, where her fiance lived. Instead, she matched to a program in Boston. When I ran into her on the interview trail a few months ago, she said, "I love it here. I guess it was meant to be." Another former DMS student was stunned to open her letter and find her second choice listed. She was devastated, but she had no choice but to go. Her first year there, she met and fell in love with a resident. "Everything happens for a reason," she says now.

This year, it was my turn. We opened our letters one at a time, cheering for each other and rejoicing in each other's successes. Our class added a new twist to the ceremony, allowing students to choose a theme song to play as we each walked down the aisle.

Community: When I heard my song—"Heads Carolina, Tails California," by Jo Dee Messina—I knew I was next. I was nervous, but also incredibly excited. I opened the envelope. "Duke," it read. My number-one choice! I started jumping up and down, waves of elation, excitement, and relief washing over me. I was equally happy to watch my closest friends get similar good news. The sense of community and family here at Dartmouth makes the ceremony that much more exciting. It is not just about the individual, but about the class—about all of us taking that next step together.

After surviving Match Day, we fourth-years celebrate with a party to which we invite all the Dartmouth medical students. Soon enough we'll have contracts to fill out, training documents to read, and instructions to follow as we start the next phase of our medical education. But in the meantime, we'll revel in well-earned glory.

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