We are sorry, you did not match to any position. – NRMP Staff
Despite more than one-quarter-million dollars in tuition and expenses at a top-notch medical school, several of my classmates received that stark e-mail on Monday. Most quickly began the SOAP (the new “scramble”) to find an unfilled position. Although many factors influence whether a medical student finds success in The Match, this week’s results suggest to me that the ability to quickly ingratiate oneself to evaluators (i.e. “playing the game”) is heavily weighted in medical school evaluations and residency applications. But should it be?
Interpersonal skills are vital for clinical encounters and allow health care teamwork to efficiently hum so medical students should be evaluated on social qualities in addition to their medical knowledge. But in practice, how are social skills measured? Not generally by attending physicians. They rarely directly observe medical student encounters with patients – more often judging students based on their public speaking skills during patient presentations. Residents commonly work closely with students during patient care. However, they typically have minor input in evaluations and given demands on their time, may be more interested in rewarding students who minimize questions and volunteer for “scut.”
Core evaluators such as course directors often have limited time with students – a coveted “honors” may be awarded because they quickly bonded with a student. For example, I served in the military before medical school and I often wonder whether my grades stem from respect for that service or my clinical performance. A more intelligent and clinically capable friend had limited success in part because he didn’t grasp the value of social cues toward evaluators such as smiling at attendings. But medical school evaluations are a marriage compared to the speed-dating process of residency applications.
Residency applicants are judged through paper and with any luck, a roughly eight-hour interview day. So how can hundreds of applicants be sorted in such a short amount of time? They may get little help from medical schools whose incentive is to match all students, which can contribute to a “White Coat Code of Silence.” Residency interviews may be perfunctory – one of my interviewers noted, “I think I’m just supposed to make sure you’re not an axe murderer.” (I appreciated his honesty.) Most interviews are a dialogue with an influential faculty member – quickness of charm and deference to authority are often rewarded, rather than durability of character.
Is there a better way? Medical schools could improve their evaluation process – one model could be the ACGME’s “360-degree feedback” program that incorporates input from peers, staff, and patients for resident evaluation. Medical school mentorship programs could also be improved – in the military, numerous superior officers and senior enlisted personnel made building my professional abilities their personal priority. In medical school, I can count my physician mentors on one hand. It’s a cultural change, but one that would benefit medical education.
For residency programs, there is limited room for change given the constraints of the interview day, but a move toward a more practical, dynamic evaluation may be beneficial. Some programs (and medical schools) have adopted the Multiple Mini Interview technique, in which applicants rotate through a circuit of interview stations based on discrete scenarios such as ethical dilemmas.
Regardless of the methods used to improve evaluation of medical students and residency applicants, the process should prioritize character and competence rather than charm and compliance.
In the meantime, best of luck to next year’s Match applicants. Remember to smile at your interviewers. Unless your smile is reminiscent of an axe murderer’s.
William Bain is a medical student.
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