Thalamus Blog: The Ultimate Guide to Medical Residency

Experienced Program Coordinators: Here’s the Ultimate Guide for the Upcoming Season!

Posted by: in GME , Interview Tips , Medical , Post-Match , Program Coordinators , Thalamus , Tips

Date: July 30, 2019

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For those program coordinators who have devoted their careers to graduate medical education, September to March is formally known as recruitment season. It’s a lengthy and effort-intensive process that really begins just after onboarding is completed in July, as the next academic year cycle gets underway. Recruiting into graduate medical education is like no other industry; thousands of applications turn into hundreds of interviews to ensure the best match for the next class of interns/residents. Thus the future of the medical profession in the United States is assured.

We have written a guide for brand new coordinators to introduce them to the lingo and nuances of this process. However, for those experienced program coordinators who have been in the job from 2 years to 30+ years, optimizing recruitment season is about mastery of the processes and innovating to stay at the forefront of graduate medical education.  

Team Thalamus works closely with residency program coordinators, as they are the primary users of our software. Over the last half-decade, we’ve worked intimately with these hardworking individuals on the front lines of recruitment. We specialize in working with coordinators of all experience levels, but we also cherish the long-term relationships we’ve made with experienced program coordinators over the last five years (and counting!).

Here is our team’s best advice for those experienced program coordinators who’ve been the heroes of graduate medical education for multiple application and recruitment seasons. It is our specific, data-driven checklist; our ultimate guide for the experienced medical residency program coordinator with the hopes of producing the best application, interview and match process yet!

How the medical residency recruitment process works: the short version.

  1. The Electronic Residency Service (ERAS) opens and applications are reviewed in September.
  2. Interview invitations go out and scheduling occurs.
  3. Candidates are interviewed, evaluated and rank lists are formed.
  4. Candidates are matched through the National Resident Matching Program (NRMP) in March.
  5. Onboarding occurs throughout the summer.
  6. Newly matched residents are oriented to the program and start training on July 1st.
  7. Rinse and repeat!

While our guide for new coordinators covered process-specific terminology and key events, this guide will focus on optimization of the application, interview and match process including recent trends and best practice management.

Optimizing the residency recruitment process works: The longer version

Let’s break it down.

Pre-application season: how experienced program coordinators prepare for the upcoming year.

With the start of the academic year on July 1st, you will finalize onboarding your new interns. We know how busy this time is for residency programs—especially program coordinators. However, once your new interns start to settle into their roles (and learn where noon conference is… and how to complete… and then neglect to submit their duty hours…), it’s time to turn your attention to recruitment around mid-late July (or later).

Beyond the basics such as planning interview dates, the number of invitations, involved faculty, and scoring/ranking methodology, we recommend also solidifying the nuances of your recruitment strategy.  

With a limited candidate pool and many competitive programs nationally, application trends and the recruitment process itself have garnered significant press. Indeed, as of last year, the average domestic graduate applied to 60+ programs, and the average international medical graduate (IMG) applied to 150+ programs across all specialties.  These numbers are up fivefold in the last 20 years according to data compiled by ERAS/AAMC.

As much as possible, taking the time to understand what may or may not have worked for the year(s) prior can do wonders. The process itself is cyclical and repeats major events/deadlines each year (ERAS opening on September 15th, Match Day 3rd Friday of March, etc.).  

However, recruitment today is very different than recruitment even just five years ago. Millennials now make up the majority of the workforce (and are the residents you are now recruiting). Technology—including the online PDWS, interview scheduling software, video interviewing, and other software—has innovated the recruitment process.  

So, in addition to developing recruitment strategies and goals to be accomplished, you’ll need to ensure that your program is equipped with the tools to actively manage the process. Thalamus is one of these tools, falling into the category of interview scheduling and management software. 

Thalamus helps streamline the process of interview management by allowing applicants to self-schedule, cutting out hundreds to thousands of emails and phone calls. The software then manages all of your data, creates face sheets, and allows for scoring and ranking of candidates. It is an end-to-end solution designed to match your workflow. While we aren’t the only solution on the market, we are the most-preferred by program coordinators (and program directors, GME administrators and applicants too!). This is because we’ve had input from hundreds of coordinators over the years. In fact, several members of our team are current and prior program coordinators. Take a look at our How It Works page to learn more.  

Further, if you are needing some leverage to convince your program director to use such a helpful and time-saving tool, take a look at our tips for selling your program director on interview scheduling software.

The residency application process

As you likely know, the residency application process starts each year on September 15th. Medical students submit their applications via the Electronic Residency Application Service (ERAS)

Have questions about ERAS?  They provide an extensive setup guide with registration instructions, webinars, policy and software updates each year.

For those programs using SF Match, the AUA Match, or a 3rd party application system, please review the process-specific materials provided by each vendor. 

It is important to note that applying for residency training has become increasingly expensive for candidates. For instance, during the 2018-2019 application cycle, candidates collectively spent greater than $80 million on application fees alone. When factoring in the cost of travel, also paid for by candidates, total costs increase collectively to $1 billion, the majority of which is put on credit cards and additional student loans—up to $25,000 per applicant. This accounts for approximately 3% of all medical education debt.

For convenience and a greater understanding of the ERAS fees structure, we have included their fee schedule here, which included a percentage increase for the 2019-2020 application season. 

Programs per specialty:

  • Ten or fewer: $99
  • 11-20: $14 each
  • 21-30 $18 each
  • 31 or more: $26 each

It’s a little complicated, so here’s an example of the payment structure:

If a student were to apply to 22 Family Medicine programs and 15 Internal Medicine programs, they would pay $99 for both the first ten FM and first ten IM programs ($198), then $14 each for the next ten FM ($140), $18 each for the final 2 FM ($36), and $14 each for the next five IM ($70). Their total fee would be $444.

Interestingly, while the process has become significantly more expensive for candidates, and they have submitted a greater number of total applications, the total number of candidates has remained essentially fixed. This means the marginal probability of recruiting a single applicant to your program has gone down over time. And while the majority of programs have recognized this, the response has been to invite more candidates than in years prior. But, as more programs invite more candidates, the cost of interviewing has increased and your program’s probability of recruiting any single candidate still goes down.  

With all of this in mind, we recommend putting in place a recruitment strategy specific to your program. If you’re looking to recruit the best candidates, determine what “best” means with respect to your program. Does this mean you want to train the strongest academic leaders nationally? Or perhaps you want to train amazing physicians who will stay on and practice in an underserved area upon completing their training.

Whatever the strategy, the more that it aligns with your program’s marketing materials/website, recruitment practices, and overall goals, the easier it will be for candidates to recognize this and target those programs that match their interests. In other words, knowing what makes your program unique and successfully communicating this message to candidates is an important factor. It will ensure that such candidates will be the ones to match at your program in March.

Historically candidates have primarily been filtered by their performance on their United State Medical Licensing Exam (USMLE) Step 1 score, but this topic is being hotly debated throughout graduate medical education given the poor correlation of score report and clinical knowledge. Currently, the National Board of Medical Examiners (NBME) is considering proposals to make the test pass/fail through the Invitation Conference on USMLE Scoring (InCUS). However, this brings up additional challenges in determining the objective, distinctive, and continuous variables upon which to evaluate candidates. 

An entire blog post (and more) could be written on this topic alone. We recommend this article from the Journal of the American Medical Association (JAMA). 

At Thalamus, we support holistic reviews of applications and recommend this to our program users. This means taking the entirety of an applicants file into consideration when assessing their candidacy to your residency program. As has been mentioned, different programs are looking for different things, but we encourage you to speak with your program director/leadership regarding your application review strategies. 

The interview season part 1:  Things experienced program coordinators should remember when inviting and scheduling

Before sending out invites

As applications are reviewed by your program director, faculty, administrative staff, and yourself, your residency program will begin selecting qualified and competitive candidates to interview at your program.

The interview season extends from early October to mid-February depending on program and specialty.  This is the most critical and time-consuming part of the application season. Before sending out invites, it is important to have your interview strategy all mapped out to answer questions such as:

  • How many interview days will we complete?
  • Which days will those be?
  • How many applicants will we see per day?
  • How many applicants will we invite to interview?
  • Will we provide hotel accommodations?
  • How many pre-interview dinners or socials will we host?  When?
  • What information do we need to communicate to our applicants and when will we do so?
  • What will happen on interview days in terms of events?
  • Which faculty, staff, and residents will partake in interviews?
  • How will we score our candidates when they interview?
  • How will my program director and other leadership eventually determine which candidates to rank highly?
  • What is our ranking strategy in general?
  • How are we going to manage our interview season?  Will we be using interview scheduling software? How will we manage our data, scoring, and ranking?

It is essential that your program determines its particular interviewing strategy and has answers to these questions. 

For more tips regarding interview invitation strategy, we strongly recommend taking a look at our blog post laying out five of the most important questions we suggest you answer prior to sending out interview invitations. These questions explore the ease of applicant cancellation/withdrawal, the ideal number of applicants to interview given recent trends and best practices, what dates/days of the week to offer interviews, the importance of when invitations are sent out, and how Thalamus can help with this. 

Our observations are based on hundreds of thousands of interviews scheduled through Thalamus and what we have learned from the resultant data. There are definite trends and strategies that can be followed to help your program succeed, and our goal here is to communicate those strategies to you.

Experienced program coordinators, Inviting your candidates for interviewing just got easier!

To organize and schedule interviews en masse, your program likely uses Thalamus or another interview scheduling software—or rely on manual emails and phone calls. 

We recommend you discuss with your program leadership which option will be used. That said, we’re always here to provide support, answer any questions or happy to provide a demo at any time.

While various interview strategies may be employed, we recommend that you:

1) Do not rush sending out invites. With the mass adoption of interview scheduling software, candidates can and will schedule very quickly. 

2) Invite in waves to allow your top candidates adequate time to schedule. This will give your top candidates the most flexibility and make them feel valued.

3) Wait until after MSPE letters are released on October 1st to send invites. Inviting candidates before this is a giveaway to candidates that you didn’t review their application in full. Additionally, inviting too early may lead to cancellations as candidates cancel early invites to schedule with more desirable programs. Invites do not happen in a vacuum and your individual program’s performance is heavily dependent on when competitive programs (both regionally and nationally) also send out invitations and on what days they are interviewing.

4) DO NOT INVITE MORE CANDIDATES THAN YOU HAVE AVAILABLE INTERVIEW POSITIONS (at least initially)!  This will only frustrate candidates and result in higher cancellation rates. 

5) Clearly communicate with the applicants that they are being invited for waitlist positions in their interview invitation or other messaging if you are inviting candidates to a full or nearly full calendar.

Optimal and humane interview scheduling strategies are now highly-discussed topics which have gotten significant recent attention in academic publications, such as this recent article in the Journal of Graduate Medical Education (JGME).

Once candidates are invited to interview, responses by email/phone call or through interview scheduling software will occur very quickly (usually within minutes… or sooner!). Expect that throughout your season, candidates will continue to cancel or reschedule often, as each interview invitation received from another program will affect their overall scheduling and travel plans. A candidate changing their interview date with your program does not mean they are no longer seriously considering your program. However, multiple changes by a single candidate may be a red flag that they are placing your program in a lower priority. 

As interview dates approach, most scheduling software provides a “lockout” or “freeze” date, which prevents candidates from self-scheduling. While this interval is customizable by programs in Thalamus, we recommend setting it to allow for easy planning of specific interview days, while remaining flexible enough to allow candidates to reschedule.

 Candidates are met with having to pay and travel to many interviews, so the more flexibility your program allows in that regard, the greater the possibility of the candidate interviewing at your program. Forcing your applicants to attend your earlier interview events before extending additional interview days to later invited candidates may further prove suboptimal. If candidates are interested in your program, they will interview at your program—it’s best they can schedule and fit that interview in amongst their other invitations.

Similarly, 95%+ of candidates will behave in the expected professional manner and with the best of intentions. That said, do not be surprised if a candidate no-shows, relays untrue information, communicates poorly or tries to take advantage of the scheduling process. We are sure you’ve experienced at least one of these in prior interview seasons, and regardless of which technology is used, some candidates still will not follow the guidelines set for one reason or another.  Recognize that such signals are easy ways to eliminate candidates from consideration. They are colloquially known as “red flags.” The goal of your program, after all, is to optimize matching the best candidates, not optimizing the highest number of interviews. Eliminating a candidate due to a red flag means your program won’t have to interview that candidate or pay the costs associated to do so. It is certainly a cheap form of screening, freeing up yourself and your faculty to focus on other candidates. 

As candidates schedule and your season begins to fill, figure out when and what messaging will be sent. Many of the interview scheduling softwares, including Thalamus, include automated confirmation messaging. Additionally, surveys asking questions about candidate research/specialty interests, need for hotels, attendance at interview dinners, and dietary restrictions are used (all of which is part of the survey feature in Thalamus). Such tools allow you to maximize data and information collection to ensure your candidates have the best possible interview day.

The interview season part 2:  conducting interviews

Whatever itinerary and interview strategy your program chooses, be sure to standardize everything as much as possible to allow for comparison amongst the different interview days. Make sure your faculty evaluation and scoring methods are determined prior to the first interview day. 

Building your program’s candidate rank list

The NRMP Match checklist for programs contains essential information for those participating programs.

Key dates for the 2019-2020 application cycle include:

September 15th, 2019: Match Registration opens. 

*New coordinators and/or programs should create their accounts in the Registration, Ranking and Results (R3) system using the token link sent by email when the Match opens.

January 15th, 2020: Rank Order List Entry begins in NRMP R3 System.

January 31st, 2020: Quota change/withdrawal deadline, SOAP participation status deadline.

February 26th, 2020: Rank Order List certification deadline.

Dates for other years will be similar, and you can check the NRMP website for particulars.

For those programs that use the SF Match, information for that specific process may be found here.

Similarly, information regarding the Urology match may be found here.

During the period of rank order list creation, some candidates may send “love letters” about how strongly they desire to attend your program. As you are likely already aware, such communication between applicants and programs, and programs and applicants may border on match violations. Ensure that all key members of your program leadership review the Match Participation Agreement including the important rules and regulations by which they must abide. 

How exactly does the Residency Match Process algorithm work?

We find it is always worth reviewing this process year to year. The algorithm starts by attempting to match each applicant to their first-choice program. If there is a match with a residency program, the candidate is “tentatively” matched. This means that the candidate will match at that institution, as long as applicants ranked higher than that candidate at that particular institution do not occupy the available positions.

If an applicant’s first choice is already occupied by higher-ranked candidates or a “tentatively” matched candidate is subsequently displaced, the algorithm will attempt to match the displaced candidate to their second choice. And then to their third choice. And so on.

Once a candidate has matched into their most-preferred available choice, with no higher-ranked candidates securing remaining available positions, a “tentative” match becomes a “confirmed” match. This is the program where the candidate will complete their residency training.

Once rank choices for all candidates have been run through the algorithm, the match is considered final.  This leads to Match Week, the last stage of the residency match process.

Match Week and SOAP: The final hurdle

We’re sure you have this week circled on your calendar already, as it represents the end of recruitment season, but for those who haven’t yet, “Match Week” is the third week of March. It ends with “Match Day,” the third Friday of March. Here’s the basic schedule for the week:

On Monday of Match Week at 11 am EST, applicants are informed of whether they successfully matched into residency positions by email and through the NRMP R3 system—but not where they matched. At this time, program directors are also notified of whether their programs filled via the same process.

Applicants who have not matched and programs that have not filled become eligible for the Supplemental Offer and Acceptance Program (SOAP), which is an additional, accelerated supplemental matching process that takes place between Monday 3 pm EST and Thursday 11 am EST.

While we hope that your program fills completely in the match, for completeness, we’ve outlined the SOAP process for easy reference.

There is still opportunity for applicants to match to a program and for programs to fill. Unfilled residency program positions are offered to unmatched applicants via the following process:

1.   Candidates will have one hour after discovering that they are unmatched to research the programs with spaces available. At 12 pm EST, ERAS will open and they may submit a maximum of 45 applications to unfilled positions.

2.   Programs receive the list of SOAP applicants at 3 pm EST, and from these interviews build preference lists. Applicants are forbidden to contact programs until the program initiates contact. Programs will spend the Tuesday of match week reaching out to applicants and conducting phone interviews.

3.   There are three rounds in which programs offer places and applicants decide whether to accept or reject them. Each is two hours long. They take place on Wednesday at 12 pm-2 pm and 3 pm-5 pm EST, then on Thursday at 9 am-11 am EST.

4.   Applicant offers are extended through the R3 system simultaneously at the end of each round.

5.   Applicants may accept, reject or allow offers to expire. If accepted to multiple programs, accepting one offer rejects the others. An accepted SOAP offer is binding.

6.   The majority of positions fill in round one. The unfilled program list updates after each round.

7.   SOAP ends on Thursday at 11 am EST. Unmatched candidates and unfilled programs may then contact each other freely at 12 pm EST to fill any remaining positions via “The Scramble.”

And then Match Day occurs and recruitment ends!  Congrats!

Not much to say here, you’ve been through this celebratory day before.  We do find it important to recognize your accomplishments. You and your program likely just interviewed hundreds of candidates, requiring a tremendous amount of sacrifice and dedication. When you can, be sure to celebrate over a nice dinner, spa day or some other form of self-care. Wellness is important and will help revive you for the onboarding process to come.

Post-Match Day: What Experienced Program Coordinators Need to Know

After Match Day, your next residency class is set! 

Now it’s time to build your photo roster/composite and send it to your current residents and faculty. Then onboarding begins with your GME office, including completing resident contracts, health screens, background checks, and other onboarding/HR documents for your incoming trainees. Then orientation occurs 😊.

And with that, congratulations! You made it through another application and recruitment season. Time to now prepare for the following year. Isn’t graduate medical education fun?!?!

Making matching simpler

Laid out in its entirety, it’s obvious that the residency application and match process is a lengthy and involved one for even the most experienced medical residency program coordinator. The work doesn’t stop there, either. Once onboarding occurs and your candidates begin their training, there are site visits to prepare for and all of the other responsibilities to which a coordinator must attend.

Thalamus aims to make the whole process a little bit easier for applicants and programs alike. We manage interview scheduling and use automation to do it in a way that’s streamlined and cost-effective. Here’s how it works—take a look to see whether Thalamus could be right for you as a residency (or fellowship) program!

Written by: in GME , Interview Tips , Medical , Post-Match , Program Coordinators , Thalamus , Tips

Team Thalamus is a grassroots collaboration of applicants (past and present), program directors, program coordinators and other GME leadership who wish to share our collective journeys through managing and participating in years of residency application cycles. While we offer a byline to all of our contributors, many wish to write under a pen name, which we have collectively defined as Team Thalamus. Becoming a physician is a long and winding road, filled with sacrifice, dedication, complexity and uncertainty and our team is her to help!

Thalamus is the premier cloud-based interview management platform designed specifically for application to Graduate Medical Education training programs. We are the experts in the residency and fellowship application processes. Learn more about Thalamus.

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