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Introducing NRMP’s Rank Order List Lock Pilot

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In October I wrote a blog entry about the benefits of virtual interviews. One issue that has come up is the concern that those who choose to do in-person interviews may have an advantage compared to candidates who interview virtually. The NRMP has noted this worry and is, consequently, instituting a voluntary Program Rank Order List Lock pilot for internal medicine, pediatrics, and vascular surgery for the 2026 Main Residency Match cycle.

The idea is that programs can choose to finalize their certified Rank Order Lists and then provide time for interviewed applicants to come in-person, thus reassuring candidates that visiting or not visiting will not affect their candidacies.

Here is a statement from NRMP regarding the voluntary pilot. It’s an interesting idea, and I’m curious to see how it will play out.

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Your Residency Application: Five Factors to Prioritize When Creating your Rank List

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Creating your Match rank list can be absolutely agonizing because it feels like so much is at stake. Sometimes it helps to step back and look at the big picture. Below, I briefly note a few important considerations when making your list:

1. Make sure you understand how the NRMP algorithm works. See my previous blog post regarding errors to avoid at all costs. The key is to rank in the order you want – first goes first, second goes second, etc.

2. Consider your happiness and life balance. Blasphemy perhaps, but I would argue that they are more important than the strength of the training program.

3. Reflect on the culture, geography, size, and even maturity/age of the program. Think about whether you will fit in.

4. Consider whether you could spend your whole life at the institution or in that program’s location. It’s a lot to grapple with, but many residents graduate and stay for the rest of their careers.

5. Decide whether you liked the program director, chairperson, and faculty generally. They could make or break your happiness and success.

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Responses from Program Directors are as Valuable as the Email They’re Written On

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A residency candidate asked me to review an email a program director (PD) had sent him after interview day. The candidate wanted to know if I had any insights into the PD’s intent: Was the PD sending a generic note or was he really interested in the applicant?

I told the applicant honestly: Who knows and who cares?

I wasn’t trying to be dismissive. The point is that it’s impossible to know what a PD is thinking. Unfortunately, I’ve seen applicants heartbroken by false hope they read into a PD’s comments. More importantly, what a PD says should not affect your rank list anyway. The algorithm requires you to put your first choice first and your second second, etc. (More on that in an upcoming January blog post.)

As they say, kisses aren’t contracts and presents aren’t promises. Don’t put deep thought into those PD notes because they don’t guarantee a thing and, as we say in clinical medicine, they don’t change management.

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Medical School Admissions and Residency Applicant Rankings: It’s Not Personal

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When I was in my second year of medical school, a third-year student (who later also went into emergency medicine, as I did) came to speak to our class about being on the wards. He gave an animated talk about how important it was to recognize that when residents, attendings, or nurses hollered at us on our clinical rotations, 99% of the time, it wasn’t personal. He likened the situation to Boston traffic – how drivers lean on their horns for little cause because they are simply frustrated about their days. 

It’s not personal, he said.

I say the same to those I mentor. Candidates get an interview at one highly ranked institution but rejected at what is considered a lesser one with no clear cause. Faculty interviewers mix applicants up with one another. Some turn up wholly unprepared – reading students’ applications for the first time during the interview itself. Remember: It’s not personal. This process is arduous and long, and most candidates, faculty, and program coordinators are tired and doing their best. 

When things are rough, give others the benefit of the doubt. It will help you get through this stressful process with your sanity intact. 

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About Dr. Michelle Finkel

Dr. Michelle Finkel

Dr. Finkel is a graduate of Stanford University and Harvard Medical School. On completing her residency at Harvard, she was asked to
stay on as faculty at Harvard Medical School and spent five years teaching at the world-renowned Massachusetts General Hospital.
She was appointed to the Assistant Residency Director position for the Harvard Affiliated
Emergency Medicine Residency where she reviewed countless applications, personal statements and resumes. Read more

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