Pediatric Neurology 50 (2014) 443e446
Contents lists available at ScienceDirect
Pediatric Neurology journal homepage: www.elsevier.com/locate/pnu
Historical Vignette
The Child Neurology Match: Where Have We Been and Where Are We Going? Harvey S. Singer MD * Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning. dWinston Churchill How it all began
As President of the Professors of Child Neurology (PCN) at the Miami Beach meeting in October 2003, I posed the following hypothetical question to the membership, “Does the Child Neurology Society (CNS) want to participate in a formal match?” To enhance the debate, I asked Phillip Pearl to speak in favor of the issue and Nina Schor against. At the conclusion of a spirited discussion, a straw ballot suggested that most program directors preferred to continue an open-access acceptance system. Two months later, however, a letter from the National Resident Match Program (NRMP) informed us of the Match Participation Agreement; a document signed by all NRMP applicants and by virtually all medical schools and institutions. This Agreement stipulates that if any of an institution’s programs participates in the Main Residency Match, all of the institution’s programs must offer positions to senior US allopathic medical students through a matching program. For child neurology (CN) programs, the requirement would start for applicants applying to begin neurology training in 2007, that is, there would have to be a match in 2005. In a joint letter, signed by myself and James Bale (then President of the CNS), the question we posed to child neurology program directors was not whether one “wanted” a match but “did they wish to accept US senior medical students into their programs?” The result: 33 yeas and 6 nays. The next step was for us to quickly gather information about the two existing match programs (NRMP and San Francisco [SF] Match)d“which would better serve the needs of pediatric neurology?” To assist in this momentous effort, I established a Child Neurology Match Program Committee with initial * Communications should be addressed to: Dr. Singer; Johns Hopkins Hospital; Rubenstein Child Health Building; 200 North Wolfe Street, Suite 2141; Baltimore, MD 21287. E-mail address: [email protected]. 0887-8994/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.pediatrneurol.2014.01.029
membership that included Donna Ferriero, Jin Hahn, Leon Dure, Jon Mink, Nina Schor, and Gihan Tennekoon. We spent many hours in discussions with administrators from both match organizations. For several reasons, including the ability to establish one’s own guidelines, match date flexibility, an inhouse central application service, and options for both medical students and pediatric residents, the Committee favored the SF Match. The Committee’s choice was approved unanimously by the Executive Boards of the CNS and PCN. One valuable lesson was, even though one must make a choice, try not to antagonize your second pick lest you need them in the future. The first several SF matches
It is always wise to look ahead, but difficult to look further than you can see. dWinston Churchill Preparing for the first match in January 2005 was a major challenge. The desire to have a transparent and audited process required that many aspects be developed, including a matching rules agreement for program directors, application forms, informational websites, and an audit process. The first match attracted 96 CN applicants for 165 available positions: 23 to start CN in 2005; 43 in 2006; and 99 in 2007 (see Figure and Table 1). Fifty-two percent (86/165) of the listed positions filled. Overall, the effort was deemed “very successful” (confirmed by applicant postmatch questionnaires). The next several years were focused on improving communication with the SF Match, developing a program directory, simplifying application forms, and establishing a completely electronic match. Succeeding SF matches in 2006-2010 proceeded with yearly growth in applicant numbers, increasing familiarity with the process, and diminishing concerns about the application and match procedures. Moving to the NRMP
It is a mistake to look too far ahead. The chain of destiny can only be grasped one link at a time. dWinston Churchill
444
H.S. Singer / Pediatric Neurology 50 (2014) 443e446
for 2-years in advance (Categorical and Advanced) and same year (Reserved) matches, as well as a couple’s match. After personally presenting all acquired data, in April 2011, the final selection of the NRMP was officially made by the Executive Committees of the CNS and PCN. After their unanimous approval of the NRMP, a small working group (Harvey Singer, Leon Dure, Sidney Gospe, and Steve Roach) was charged with the establishment of ground rules compatible with those of the NRMP and assisting with the transition. Many of these things were easier said than done. The change to the NRMP presented the new Match Committee with a variety of immediate challenges. How could we effectively inform and educate all medical schools, training institutions, potential applicants (national and international), and program directors (child neurology, NDD, pediatrics, adult neurology)? For many program directors and applicants alike, terms such as categorical, advanced, joint advanced, reserved, reversions, rank order lists, supplemental offer and acceptance program, etc. were confusing and difficult to comprehend (see Table 2). For some, the bewilderment persists. Waldo Wentz, at the NRMP, deserves recognition for assisting us with many of these issues. An additional predicament for the 2012 NRMP match was the lack of a formal application process. The Electronic Residency Application Service kindly let us use their application forms but claimed insufficient time to update their computers. After another frantic search (“does anyone know where to find a one-year only central application service?”), the Association of University Professors of Neurology (AUPN) agreed to assist with the application processing. A website to electronically distribute applications was quickly established; completed hard copies of the applications were mailed to the AUPN, copied, and distributed to applicant requested programs. It was not efficient, but we got through the first year. Thank you, Linda Scher, for all of your hard work.
FIGURE. Applicants submitting rank lists. US Seniors ¼ fourth-year students in a US medical school. US Grads ¼ graduates from a US medical school. IMGs ¼ international medical school graduates (for 2013 number includes 23 US citizen IMGs). DO ¼ US osteopathic school graduates. (Color version of figure is available online.)
All seemed to be progressing well, that is until June 2010, when I received a letter from the SF Match Director stating that their “newly installed software systems would no longer permit a three-tier match for clients.” In other words, if CN wanted to stay with the SF Match, we would be required to accept a match limited to US seniors and develop other options for existing pediatric residents. During the ensuing months, I had numerous interactions with the Director and his staff and even sent a personal representative (Paul Fisher) to the SF offices. Once it became clear they were inflexible, 6 years after my first contact, I again called Mona Signer, Executive Director of the NRMP, to discuss options offered by their organization. At the October 2010 CNS meeting in Providence, I presented the first of many talks entitled “The Child Neurology Match; a Time to Change?” These various lectures reviewed the advantages and disadvantages of our potential options. At the behest of the CNS Executive Board, in the early part of 2011, I prepared a document containing the different match opportunities, which was distributed to child neurology and neurodevelopmental disabilities (NDD) program directors for their input and selection. The results: 87% favored switching to the NRMP, which provided options
Latest updates
Success is not final, failure is not fatal: it is the courage to continue that counts. dWinston Churchill
TABLE 1. The number of positions and candidates over time
SF Match
Total positions offered Child neurology NDD Total positions filled, n (%) Child neurology NDD
NRMP
2005
2006
2007
2008
2009
2010
2011
2012
2013
165 e
202 e
169 8
169 11
173 8
174 13
170 12
146 10
160 10
86 (52) e
107 (53) e
113 (67) 3 (38)
91 (54) 5 (45)
112 (65) 2 (25)
113 (65) 6 (46)
133 (78) 5 (42)
119 (82) 7 (70)
136 (85) 7 (70)
Abbreviations: NDD ¼ neurodevelopmental disability NRMP ¼ National Resident Match Program SF ¼ San Francisco Total positions offered: SF Match: include same year, +1 year, and +2 year options; NRMP: include same year, (Reserved) and +2 year (Categorical and Advanced) options. Total positions filled: For 2012 and 2013, numbers include positions filled by SOAP. Data Source: National Resident Marching Program, Results and Data: 2013 Main Residency Match. National ResidentÒ. National Resident Matching Program, Washington, DC 20037.
H.S. Singer / Pediatric Neurology 50 (2014) 443e446
445
TABLE 2. Glossary of terms
Advanced: an NRMP match option that requires separate applications to CN/NDD and preliminary pediatrics. One must match into a CN/NDD program before the NRMP attempts to match the applicant into a 2-year preliminary pediatric position. Categorical: an NRMP match option for 5 years at the same institution; includes 2 years of preliminary pediatrics and 3 years of CN/NDD. ERAS: a service that transmits applications, letters of recommendation, Medical Student Performance Evaluations, medical school transcripts, USMLE transcripts, and other supporting credentials from applicants and their Designated Dean’s Office to program directors. Joint Advanced: similar to Advanced, except the preliminary pediatric training program will only accept the applicant if they match to a specific, typically the same institutions, CN/NDD program. NRMP: a nonprofit organization that manages the Main Residency Match and the Specialties Matching Service, which includes matches for more than 40 fellowship subspecialties. 1þ year match: a match option, only available from the San Francisco Match, that enabled applicants already in a pediatric residency training program to apply for a CN/NDD program one year in advanced. ROL: Applicants and program directors are required to provide a list of their preferences. Reserved: an NRMP match option for applicants who are already in (or completed) pediatric residency training. One starts neurology training in the “same year” as the Match. Reversions: a program director can arrange to redirect (revert) unfilled match options from one program to another, e.g., categorical to advanced. SOAP: unmatched and partially matched applicants may participate in SOAP during Match week to try to obtain an unfilled residency position. CN/NDD ¼ Child neurology/neurodevelopmental disability ERAS ¼ Electronic Residency Application Service NRMP ¼ National Resident Matching Program ROL ¼ Rank order lists SOAP ¼ Supplemental Offer and Acceptance Program USMLE ¼ United States Medical Licensing Examination
In March of 2013, we completed our second NRMP match without major incidents. In that match, there were 72 CN and 7 NDD training programs, offering 160 and 10 positions, respectively. As in every match since 2005, the number of applicants continued to increase: 208 for CN-only; 7 NDDonly; and 9 for both CN and NDD. Compared with the first NRMP match (2012), filled positions in the Categorical and Reserved matches increased by 22% and 73%, respectively, but decreased 19% in the Advanced option. Finally, a decade after its inception, it is worth noting that the Child Neurology Match program continues to evolve. The initial ad hoc Match Committee, created and selected by the author, is now officially the NRMP Oversight Committee with a defined formal advisory mission to the CNS and PCN Boards. The Committee’s goals now include the dissemination of information and working with the NRMP to address problems and complaints. The Committee has four regular members (currently Leon Dure, Howard Goodkin, Sidney Gospe, and Pedro Weisleder) and a chair (Harvey Singer). Two members each are appointed by the Presidents of the CNS and PCN, and the chair is appointed by the President of the CNS. Assessment of our progress
A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty. dWinston Churchill A formal match program has provided a major benefit for child neurology. As confirmed by the 133% (96 to 224) increase in applicants over the past nine matches (Figure), we now have a clear pathway into the field and a tracking system for our specialty. The NRMP provides an impartial venue that strives to place individuals into their highestranked available neurology training program. For those old enough to remember, the prematch open access selection system allowed programs to accept a candidate at any time during their medical school years, forced
students to make career decisions before experiencing a specialty, and occasionally required them to accept or reject an offer made at the time of their interview. The match process has also enabled the CNS to improve our relationship with pediatric colleagues. Pediatric directors have long been vocal in their opposition to residents leaving after only 2 years in their program, especially if they believed the individual matched for three years of training. NRMP’s requirement for a 2-year supplemental listing for preliminary pediatric training has to a large extent reduced this issue. Despite our successes, however, there remain several areas of ongoing concern. The first is the need to vigorously pursue interactions and discussions with Pediatric Training Program Directors. Unfortunately, an insufficient number of preliminary pediatric 2-year training positions are available for applicants using the Advanced match. After personal discussions with various pediatric leadership groups, it is clear that expansion of available NRMP preliminary pediatric training positions will require a concerted effort by all CN program directors. A second issue involves the ongoing belief of a few program directors that it is possible to fill positions outside of the match. Although there are a limited number of valid exemptions, all require submission of a formal written request to, and approval of, the NRMP Oversight Committee and the NRMP, which has implemented the All In Policy. Finally, for those who still desire a second option for pediatric residents (specifically the 1þ year match), this is extremely unlikely, both because of the relatively small number of prospective applicants and the fact that the NRMP will not offer that option. Advice
Courage is what it takes to stand up and speak; courage is also what it takes to sit down and listen. dWinston Churchill
446
H.S. Singer / Pediatric Neurology 50 (2014) 443e446
After a decade of participation in the match process, a few words of advice appear appropriate. For program directors
It is essential to determine which position type (categorical, advanced, or reserved) provides you with the best opportunity to fill available positions. Categorical positions, with 5 years of training at the same institution, are preferred by applicants, and there is a need to expand this opportunity. Advance positions provide pediatric program directors with greater direct control over the acceptance of applicants and guard against unfilled positions if reversions are created for both the child neurology and pediatric programs. The advanced match can, however, result in an individual matching into a neurology program but not being accepted into a preliminary pediatrics training position. If there are insufficient numbers of available preliminary pediatric positions at your institution, for either the Categorical or Advanced option, consider establishing allegiances with other local pediatric programs. Finally, rank lists
should be based on desirability, because the “true preference strategy” is virtually always optimal.1 For applicants
Consider ranking categorical programs first; recognize the potential risk in the advanced match, that is, matching to CN but not preliminary pediatric program, and don’t forget the option of completing a 3-year traditional pediatric training program and then applying for a CN position via the reserve match. Finally, several researchers have confirmed that the best strategy for any student is to order their rank list solely based on their own preference and not on perceived chances of matching at a program.1,2 References 1. Nagarkar PA, Janis JE. Fixing the “Match”: how to play the game. J Grad Med Education; 2012:142-147. 2. Gale D, Shapley L. College admissions and the stability of marriage. Am Math Mon. 1962;69:9-15.
Contents lists available at ScienceDirect
Pediatric Neurology journal homepage: www.elsevier.com/locate/pnu
Historical Vignette
The Child Neurology Match: Where Have We Been and Where Are We Going? Harvey S. Singer MD * Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning. dWinston Churchill How it all began
As President of the Professors of Child Neurology (PCN) at the Miami Beach meeting in October 2003, I posed the following hypothetical question to the membership, “Does the Child Neurology Society (CNS) want to participate in a formal match?” To enhance the debate, I asked Phillip Pearl to speak in favor of the issue and Nina Schor against. At the conclusion of a spirited discussion, a straw ballot suggested that most program directors preferred to continue an open-access acceptance system. Two months later, however, a letter from the National Resident Match Program (NRMP) informed us of the Match Participation Agreement; a document signed by all NRMP applicants and by virtually all medical schools and institutions. This Agreement stipulates that if any of an institution’s programs participates in the Main Residency Match, all of the institution’s programs must offer positions to senior US allopathic medical students through a matching program. For child neurology (CN) programs, the requirement would start for applicants applying to begin neurology training in 2007, that is, there would have to be a match in 2005. In a joint letter, signed by myself and James Bale (then President of the CNS), the question we posed to child neurology program directors was not whether one “wanted” a match but “did they wish to accept US senior medical students into their programs?” The result: 33 yeas and 6 nays. The next step was for us to quickly gather information about the two existing match programs (NRMP and San Francisco [SF] Match)d“which would better serve the needs of pediatric neurology?” To assist in this momentous effort, I established a Child Neurology Match Program Committee with initial * Communications should be addressed to: Dr. Singer; Johns Hopkins Hospital; Rubenstein Child Health Building; 200 North Wolfe Street, Suite 2141; Baltimore, MD 21287. E-mail address: [email protected]. 0887-8994/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.pediatrneurol.2014.01.029
membership that included Donna Ferriero, Jin Hahn, Leon Dure, Jon Mink, Nina Schor, and Gihan Tennekoon. We spent many hours in discussions with administrators from both match organizations. For several reasons, including the ability to establish one’s own guidelines, match date flexibility, an inhouse central application service, and options for both medical students and pediatric residents, the Committee favored the SF Match. The Committee’s choice was approved unanimously by the Executive Boards of the CNS and PCN. One valuable lesson was, even though one must make a choice, try not to antagonize your second pick lest you need them in the future. The first several SF matches
It is always wise to look ahead, but difficult to look further than you can see. dWinston Churchill Preparing for the first match in January 2005 was a major challenge. The desire to have a transparent and audited process required that many aspects be developed, including a matching rules agreement for program directors, application forms, informational websites, and an audit process. The first match attracted 96 CN applicants for 165 available positions: 23 to start CN in 2005; 43 in 2006; and 99 in 2007 (see Figure and Table 1). Fifty-two percent (86/165) of the listed positions filled. Overall, the effort was deemed “very successful” (confirmed by applicant postmatch questionnaires). The next several years were focused on improving communication with the SF Match, developing a program directory, simplifying application forms, and establishing a completely electronic match. Succeeding SF matches in 2006-2010 proceeded with yearly growth in applicant numbers, increasing familiarity with the process, and diminishing concerns about the application and match procedures. Moving to the NRMP
It is a mistake to look too far ahead. The chain of destiny can only be grasped one link at a time. dWinston Churchill
444
H.S. Singer / Pediatric Neurology 50 (2014) 443e446
for 2-years in advance (Categorical and Advanced) and same year (Reserved) matches, as well as a couple’s match. After personally presenting all acquired data, in April 2011, the final selection of the NRMP was officially made by the Executive Committees of the CNS and PCN. After their unanimous approval of the NRMP, a small working group (Harvey Singer, Leon Dure, Sidney Gospe, and Steve Roach) was charged with the establishment of ground rules compatible with those of the NRMP and assisting with the transition. Many of these things were easier said than done. The change to the NRMP presented the new Match Committee with a variety of immediate challenges. How could we effectively inform and educate all medical schools, training institutions, potential applicants (national and international), and program directors (child neurology, NDD, pediatrics, adult neurology)? For many program directors and applicants alike, terms such as categorical, advanced, joint advanced, reserved, reversions, rank order lists, supplemental offer and acceptance program, etc. were confusing and difficult to comprehend (see Table 2). For some, the bewilderment persists. Waldo Wentz, at the NRMP, deserves recognition for assisting us with many of these issues. An additional predicament for the 2012 NRMP match was the lack of a formal application process. The Electronic Residency Application Service kindly let us use their application forms but claimed insufficient time to update their computers. After another frantic search (“does anyone know where to find a one-year only central application service?”), the Association of University Professors of Neurology (AUPN) agreed to assist with the application processing. A website to electronically distribute applications was quickly established; completed hard copies of the applications were mailed to the AUPN, copied, and distributed to applicant requested programs. It was not efficient, but we got through the first year. Thank you, Linda Scher, for all of your hard work.
FIGURE. Applicants submitting rank lists. US Seniors ¼ fourth-year students in a US medical school. US Grads ¼ graduates from a US medical school. IMGs ¼ international medical school graduates (for 2013 number includes 23 US citizen IMGs). DO ¼ US osteopathic school graduates. (Color version of figure is available online.)
All seemed to be progressing well, that is until June 2010, when I received a letter from the SF Match Director stating that their “newly installed software systems would no longer permit a three-tier match for clients.” In other words, if CN wanted to stay with the SF Match, we would be required to accept a match limited to US seniors and develop other options for existing pediatric residents. During the ensuing months, I had numerous interactions with the Director and his staff and even sent a personal representative (Paul Fisher) to the SF offices. Once it became clear they were inflexible, 6 years after my first contact, I again called Mona Signer, Executive Director of the NRMP, to discuss options offered by their organization. At the October 2010 CNS meeting in Providence, I presented the first of many talks entitled “The Child Neurology Match; a Time to Change?” These various lectures reviewed the advantages and disadvantages of our potential options. At the behest of the CNS Executive Board, in the early part of 2011, I prepared a document containing the different match opportunities, which was distributed to child neurology and neurodevelopmental disabilities (NDD) program directors for their input and selection. The results: 87% favored switching to the NRMP, which provided options
Latest updates
Success is not final, failure is not fatal: it is the courage to continue that counts. dWinston Churchill
TABLE 1. The number of positions and candidates over time
SF Match
Total positions offered Child neurology NDD Total positions filled, n (%) Child neurology NDD
NRMP
2005
2006
2007
2008
2009
2010
2011
2012
2013
165 e
202 e
169 8
169 11
173 8
174 13
170 12
146 10
160 10
86 (52) e
107 (53) e
113 (67) 3 (38)
91 (54) 5 (45)
112 (65) 2 (25)
113 (65) 6 (46)
133 (78) 5 (42)
119 (82) 7 (70)
136 (85) 7 (70)
Abbreviations: NDD ¼ neurodevelopmental disability NRMP ¼ National Resident Match Program SF ¼ San Francisco Total positions offered: SF Match: include same year, +1 year, and +2 year options; NRMP: include same year, (Reserved) and +2 year (Categorical and Advanced) options. Total positions filled: For 2012 and 2013, numbers include positions filled by SOAP. Data Source: National Resident Marching Program, Results and Data: 2013 Main Residency Match. National ResidentÒ. National Resident Matching Program, Washington, DC 20037.
H.S. Singer / Pediatric Neurology 50 (2014) 443e446
445
TABLE 2. Glossary of terms
Advanced: an NRMP match option that requires separate applications to CN/NDD and preliminary pediatrics. One must match into a CN/NDD program before the NRMP attempts to match the applicant into a 2-year preliminary pediatric position. Categorical: an NRMP match option for 5 years at the same institution; includes 2 years of preliminary pediatrics and 3 years of CN/NDD. ERAS: a service that transmits applications, letters of recommendation, Medical Student Performance Evaluations, medical school transcripts, USMLE transcripts, and other supporting credentials from applicants and their Designated Dean’s Office to program directors. Joint Advanced: similar to Advanced, except the preliminary pediatric training program will only accept the applicant if they match to a specific, typically the same institutions, CN/NDD program. NRMP: a nonprofit organization that manages the Main Residency Match and the Specialties Matching Service, which includes matches for more than 40 fellowship subspecialties. 1þ year match: a match option, only available from the San Francisco Match, that enabled applicants already in a pediatric residency training program to apply for a CN/NDD program one year in advanced. ROL: Applicants and program directors are required to provide a list of their preferences. Reserved: an NRMP match option for applicants who are already in (or completed) pediatric residency training. One starts neurology training in the “same year” as the Match. Reversions: a program director can arrange to redirect (revert) unfilled match options from one program to another, e.g., categorical to advanced. SOAP: unmatched and partially matched applicants may participate in SOAP during Match week to try to obtain an unfilled residency position. CN/NDD ¼ Child neurology/neurodevelopmental disability ERAS ¼ Electronic Residency Application Service NRMP ¼ National Resident Matching Program ROL ¼ Rank order lists SOAP ¼ Supplemental Offer and Acceptance Program USMLE ¼ United States Medical Licensing Examination
In March of 2013, we completed our second NRMP match without major incidents. In that match, there were 72 CN and 7 NDD training programs, offering 160 and 10 positions, respectively. As in every match since 2005, the number of applicants continued to increase: 208 for CN-only; 7 NDDonly; and 9 for both CN and NDD. Compared with the first NRMP match (2012), filled positions in the Categorical and Reserved matches increased by 22% and 73%, respectively, but decreased 19% in the Advanced option. Finally, a decade after its inception, it is worth noting that the Child Neurology Match program continues to evolve. The initial ad hoc Match Committee, created and selected by the author, is now officially the NRMP Oversight Committee with a defined formal advisory mission to the CNS and PCN Boards. The Committee’s goals now include the dissemination of information and working with the NRMP to address problems and complaints. The Committee has four regular members (currently Leon Dure, Howard Goodkin, Sidney Gospe, and Pedro Weisleder) and a chair (Harvey Singer). Two members each are appointed by the Presidents of the CNS and PCN, and the chair is appointed by the President of the CNS. Assessment of our progress
A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty. dWinston Churchill A formal match program has provided a major benefit for child neurology. As confirmed by the 133% (96 to 224) increase in applicants over the past nine matches (Figure), we now have a clear pathway into the field and a tracking system for our specialty. The NRMP provides an impartial venue that strives to place individuals into their highestranked available neurology training program. For those old enough to remember, the prematch open access selection system allowed programs to accept a candidate at any time during their medical school years, forced
students to make career decisions before experiencing a specialty, and occasionally required them to accept or reject an offer made at the time of their interview. The match process has also enabled the CNS to improve our relationship with pediatric colleagues. Pediatric directors have long been vocal in their opposition to residents leaving after only 2 years in their program, especially if they believed the individual matched for three years of training. NRMP’s requirement for a 2-year supplemental listing for preliminary pediatric training has to a large extent reduced this issue. Despite our successes, however, there remain several areas of ongoing concern. The first is the need to vigorously pursue interactions and discussions with Pediatric Training Program Directors. Unfortunately, an insufficient number of preliminary pediatric 2-year training positions are available for applicants using the Advanced match. After personal discussions with various pediatric leadership groups, it is clear that expansion of available NRMP preliminary pediatric training positions will require a concerted effort by all CN program directors. A second issue involves the ongoing belief of a few program directors that it is possible to fill positions outside of the match. Although there are a limited number of valid exemptions, all require submission of a formal written request to, and approval of, the NRMP Oversight Committee and the NRMP, which has implemented the All In Policy. Finally, for those who still desire a second option for pediatric residents (specifically the 1þ year match), this is extremely unlikely, both because of the relatively small number of prospective applicants and the fact that the NRMP will not offer that option. Advice
Courage is what it takes to stand up and speak; courage is also what it takes to sit down and listen. dWinston Churchill
446
H.S. Singer / Pediatric Neurology 50 (2014) 443e446
After a decade of participation in the match process, a few words of advice appear appropriate. For program directors
It is essential to determine which position type (categorical, advanced, or reserved) provides you with the best opportunity to fill available positions. Categorical positions, with 5 years of training at the same institution, are preferred by applicants, and there is a need to expand this opportunity. Advance positions provide pediatric program directors with greater direct control over the acceptance of applicants and guard against unfilled positions if reversions are created for both the child neurology and pediatric programs. The advanced match can, however, result in an individual matching into a neurology program but not being accepted into a preliminary pediatrics training position. If there are insufficient numbers of available preliminary pediatric positions at your institution, for either the Categorical or Advanced option, consider establishing allegiances with other local pediatric programs. Finally, rank lists
should be based on desirability, because the “true preference strategy” is virtually always optimal.1 For applicants
Consider ranking categorical programs first; recognize the potential risk in the advanced match, that is, matching to CN but not preliminary pediatric program, and don’t forget the option of completing a 3-year traditional pediatric training program and then applying for a CN position via the reserve match. Finally, several researchers have confirmed that the best strategy for any student is to order their rank list solely based on their own preference and not on perceived chances of matching at a program.1,2 References 1. Nagarkar PA, Janis JE. Fixing the “Match”: how to play the game. J Grad Med Education; 2012:142-147. 2. Gale D, Shapley L. College admissions and the stability of marriage. Am Math Mon. 1962;69:9-15.
