Sunday, January 13, 2013

Go with your gut

Interview season is winding down for many applicants which means you are actually going to have to start thinking about your rank list.  No more stalling.  It will be okay.

In all likelihood, if you have made it this far in medicine, you take pride in thoroughness and attention to detail.  This is a case where you may be over doing the analysis.  Right now this feels like a monumental decision with repercussions for the rest of your career.  That perception brings out your "inner internist" and makes you want more time to decide, and more data.

In the end, you are likely to make some decisions on your rank list that your scoring system won't agree with because of intangible factors that may be hard to put a point value or letter grade on.  In other words, you are likely to go with your gut.  Some applicants entrust the entire process to their "gut feeling", trusting in the ACGME to make sure that the program teaches everything needed.  These may not be the types of applicants seeking guidance on a web blog.  However, since Malcolm Gladwell re-named "going with your gut" as "thin-slicing", it is no longer perceived as being irresponsible.  Your gestault on how well a program fits your needs will often be more accurate than even a well designed scoring and ranking system.  Going with your gut is going to serve you well in this process, and in your future career as well.

I don't believe that I just convinced anyone not to over-analyze their rank list.  If you are going to spend a lot of time thinking about your list then you should know the most common misperception on how the match works.  How much a residency program likes you, expressed in how high they rank you, is not nearly as important as you think.  The mysterious match algorithm is "student weighted".  You will match to the program you rank highest that reaches your position on their list.  Here is an example:

Your rank list is Residency X #1 and Residency Y #2.  Both programs put 100 people on their list.  Residency X ranks you #50 (sorry), but Residency Y ranks you #1 (congrats!).  You will still match to Residency X (you ranked #1) so long as they go to spot 50 on their list.  That Residency Y ranked you higher has no effect on this.  This is why the match is considered "student weighted" and why most average to above applicants go to one of their top 3 programs.  

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