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What happens when you match into a residency but it still feels like a loss? Kathleen Muldoon is a coach and medical educator with 20 years of experience partnering with medical students through some of training’s most high-stakes moments. In this episode, based on her KevinMD article “What Match Day teaches us about unexpected life paths,” she unpacks the hidden emotional weight of Match Day, the moment when a plain white envelope determines what kind of doctor you get to be. You will hear about the student who quietly told her “you won’t understand” because they did match but not into the future they had pictured, and why that subtle disappointment deserves just as much space as celebration. Muldoon explains how medical training conditions future physicians to perform success while hiding vulnerability, widening a gap between personhood and performance that fuels physician burnout later in careers. She shares coaching techniques that help students stop treating feedback as an indictment of identity and start treating it as useful data, a skill that translates directly to sitting with patients whose lab results bring unwelcome news. If you work with trainees or remember your own moment of tearing open that envelope, this conversation reframes disappointment as an invitation rather than a verdict.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Kathleen Muldoon, coach and medical educator. Today’s KevinMD article is “What Match Day teaches us about unexpected life paths.” Kathleen, welcome back to the show.

Kathleen Muldoon: Thanks for having me.

Kevin Pho: All right, so we are speaking in early April, and Match Day has passed about a few weeks ago. So tell us what your latest reflections about Match Day is about.

Kathleen Muldoon: Well, I wrote the piece as someone who has gone through several of these rituals now with the med students, having worked in this space for 20 years. One thing that really stuck out to me recently was the experience of walking around as everyone is holding their envelopes. These are just small little white envelopes, so plain, but hold the hopes of so many years of training.

And what stuck out to me this particular year was looking around as the envelopes are being torn, and seeing and recognizing that look of a near miss on a student. We know that that could mean not matching at the top program, matching in a different specialty than what they had expected. So it’s a gradient, right? And not just not becoming the doctor you thought you would be. But even if it’s your second or third choice, that can be a rupture experience very publicly amongst the performance of celebration.

And it can be both. I think what I wanted to write about was both the ways that we in medical training teach our physicians and future physicians to hide their own self and their own disappointment, even as we partner with patients in these most vulnerable spaces where we’re asking them to reveal that to us. At the same time as understanding that normal human reaction is important to sit with, as well as eventually see as an invitation about how you build the life that you have. So that is what I was hoping to bring out in that piece.

Kevin Pho: Now, you talked about a specific encounter with a student in your piece. And before talking about that, let’s talk about Match Day in general and give some context for those listeners who may not be familiar with it, because it really is a life-altering event for these future physicians, right? So give us some context about how important Match Day is to the students that you see.

Kathleen Muldoon: Match Day is when students get to find out where they continue their training. And that determines what kind of doctor they get to be. So in their fourth year of undergraduate medical training, medical students audition, which is like interviewing for different residency site trainings in different specialties. And they can dual apply to more than one specialty, or they can choose just one. But what happens is they rank their top choices of where they want to continue their training, at the same time as those training sites rank the students that they prefer to have join their training programs.

And all of that goes out into the ether in a way I don’t fully understand. But an algorithm puts it together in a way that is supposed to honor both of those choices and match people into the programs that best suit everyone’s preferences. And so it’s out there and out of your, it’s not like a traditional job search, and can determine so much.

So it could be that somebody does match, and actually now they learn if they match at all separately from the day where they actually open the envelope. So everyone who receives an envelope knows that they matched somewhere. But what they don’t know is where that could be. So for somebody who wanted to live in a big city, they could end up matching into a program that’s in a rural location that may not be a good fit for them, or their safety level, or all number of things that can go in the choices that people make about where they choose to live and build a life.

And for others who have dual applied, they can know that they match, but actually they don’t know what specialty they matched into until they open that envelope. So it can be any number of things that are revealed when they open that envelope. And the metric that is typically advertised, especially for different medical schools, is the match rate, which is usually just how many of those medical students find a spot in residency training programs.

But I do think that focus on metrics undercuts the very human experience of having your next step determined by an algorithm. And if you choose to engage in the ritual of opening it on a campus with other folks, you can also choose to just open an email. It becomes a performance, right? A performance of success. And I think that adds a lot of pressure.

Kevin Pho: So on social media, on Match Day, you always see what you call the performance of success. All these happy medical students matching into their first choice. But of course, that doesn’t tell the whole story. And you shared an encounter with a particular student where that student did not necessarily get their first choice. So tell us about that experience.

Kathleen Muldoon: So there is a lot of joy and tears and hugging, and parents there and children sometimes. And I am so happy to have had the experience of being involved in that. I am a coach and anthropologist, so I also like to hone my skills of observation. And as I was doing so, I did notice the mark of a near miss on a student that I know very well, and wanted to honor that and give space if they chose to, right amongst the celebration.

And I did go over and just ask, “How’s it going?” And they quietly said, “Dr. Muldoon, you won’t understand,” because they did match. Right. And the disappointment could be something much more subtle and personal. And I really connected with that because I think it’s important to note, and one of the things I really, truly work on is where humanity meets medical training. And what happens when the life you’ve trained for is not the life that you get.

And I think we all have those moments where what’s in the envelope doesn’t match what we expected. And I certainly do, and I’ve spoken about it here with you before, that as a caregiver to a significantly medically complex child, I have also had that experience where what I thought was going to happen didn’t happen.

And so I think that’s important because all of us have those experiences and we can all connect with that feeling of disappointment, even if on the surface of the thing, it is objectively good. Like this person is going to be a physician, and the culmination of all of this time and training comes to bear on that. And it’s going to look a little different than what they thought.

So I was offering that student space to, because the rush can be like, “But aren’t you happy? Isn’t this awesome?” In this case, because any kind of being a doctor is generally accepted as a good outcome, right? So yes, and it can also be disappointing when it wasn’t exactly what you thought.

So I think holding that space is an important, actually translatable clinical skill, because if we don’t recognize those parts in ourselves, if we hide them, then how can we be there, for example, for our trainees, our students, and our future patients to understand that life doesn’t always go the way we thought it would.

And even though so much of medical training is based on certainty and best-answer choice, and like one correct way and linearity, in actual truth is not like that. And I think that being mindful of that makes medicine more human.

Kevin Pho: You mentioned that word linearity, and for medical students to get to that point, it is a very linear path going from premedical to preclinical to clinical, all the way up to Match Day. And simply to get to that point, there just isn’t a lot of experiences where they face disappointment. It’s really success after success after success. And not matching at your first choice isn’t really considered a failure, like you said, because they still matched. It’s still going to become a doctor, but it just wasn’t their first choice. Now, are medical students offered any instruction, guidance, counseling, in terms of managing what could be their first episode of real disappointment?

Kathleen Muldoon: That is a great question, and I can’t speak globally. But I would say that it is something that is lacking in most training programs, and is a great space for coaching and for inserting humanity. How do you deal with disappointments? And just understanding that disappointments can be slight. They’re not all, they also may not be failures. And something might be considered, personally I don’t want to use the word failure, but your word, like disappointment, right? How do you meet that and move forward with it?

So this is a part of training that is not widely a part of how we mentor, not only med students, but I think residents, up through the early years of practicing medicine. And I think is really important because I do think that part of what we’re seeing in physician burnout is this widening gap between performance and personhood. And oftentimes it is something that is nuanced and could use some attention about how do you orient yourself to these things.

And I think in general, in the clinical part of undergraduate training for the rotations in third and fourth year, there isn’t a lot of support for how do you manage your own emotions around the hard things that you see.

Kevin Pho: Yeah. What you alluded to earlier about how these future physicians manage potential episodes of disappointment, it’s going to help with their empathy, because a lot of times when they see patients, not all the lab tests is going to come out the way they would like, and there are going to be inevitable episodes of disappointment. So kind of asking that last question again, just from a different standpoint, speaking as a coach, how should medical students manage episodes of disappointment? What are some ways that they can cope with that in a healthy, constructive way?

Kathleen Muldoon: I think that’s a great question, and it’s something that I work on a lot with my students in the coaching space. And I think that they experience it many, many different ways, right? Like you could be studying for your board exams and get feedback on a practice test score that doesn’t match what you feel is your effort coming in, or any number of things.

And so a coaching technique that I often use is, how do you get back to balance? What strategies can you use to take a disappointing score or result and realize that that’s not an indictment of you? Right? And instead it is an invitation, an opportunity to reassess what worked here, what didn’t work here. Even the question of examining your reaction and, am I tying this life event, which happens, we’re not always perfect, to my identity instead of just data that is coming back, that is actually useful for me to consider the ways in which I can move forward, right?

So I do everything from, sometimes I even bring in a balance board to my coaching spaces with a slack line, and I say, losing and refining your balance is a part of something that we all do every day. I mean, it’s even how thermostats work, right? It’s never exactly 68 degrees in your home. It’s always fluctuating up and down, up and down, above that, right? So it’s on average, how can you come back to that center and create a strategy for yourself that works for you, that allows you to understand that not every piece of feedback you get is an indictment of who you are, and instead is information that helps you move forward.

So I think that’s really important because it can be something like where you see in the clinic that somebody’s working really hard on getting their cholesterol down, and it’s just not the number that they thought that they would see, even though they’ve been working really hard. Right. So how do you recognize and validate that emotion and also say, keep going.

Kevin Pho: If you had the opportunity to talk to these medical students before they opened their envelopes on Match Day, knowing that some of them may not get the result that they would like to see, how would you counsel them before Match Day?

Kathleen Muldoon: And so I do this, right. So normally what I say is, no matter what’s in that envelope, it doesn’t say anything about your worth or even the kind of doctor that you’re going to be, right? And so just remember that everything that you’ve put into this moment is still with you in this moment and moving forward. So how do you meet that uncertainty and know that whatever is on the other side of that unfolding is going to be OK?

And so it’s just grounding, right? And especially for students who are wondering, OK, well, am I going to be an OB/GYN or a family medicine practitioner? Right? And I think it’s also important to remind medical students, when the path does seem so canalized and linear, that there are always opportunities to change, right? There are transitional years, there are reapplying to the match after you’ve had some experience. There are ways to incorporate reproductive health care into family practice, right? So it’s not always this one box or another.

And so I think just reminding students, number one, that it’s not their worth. And number two, that everything is changeable, and life is a journey. They don’t hear that enough. That’s what I try to instill.

Kevin Pho: Absolutely. And regular readers of KevinMD in this podcast know that there are just so many directions that physicians can go to, and this is the point where the path stops becoming linear, and again, just a lot of options that are available. So I do think that’s a great message that medical students should take away. We’re talking to Kathleen Muldoon, medical educator and coach. Today’s KevinMD article is “What Match Day teaches us about unexpected life paths.” Kathleen, as always, we’ll end with take-home messages they want to leave with the KevinMD audience.

Kathleen Muldoon: I just really think that these opportunities where we can examine, is it really true, the narrative in medicine that paths are linear, that there are certain, if we can examine that and just lean into the fact and accept that they’re not, and I think the more that we can open the conversation about the ways in which we can reclaim identity away from metrics, is actually protective for the workforce in medicine and create sustainability. And I just really hope that we can continue having these conversations.

Kevin Pho: Kathleen, as always, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show. I really appreciate it.

Kathleen Muldoon: Thank you so much.