What Happens to Medical Students Who Don’t Match?

Evaluation Without Step 1

Evaluating medical students for residency is always challenging, but the next match will be the first with no Step 1 scores—and Step 2 scores can’t be far behind. How will programs evaluate medical students without this information?

“I don’t think our algorithm is going to change that much, except we’re probably going to have a slight preference for people who took Step 2 early and use that as a proxy,” says Cristina Cabrera-Muffly, MD, an otolaryngologist and residency program director at CU, adding that as her program does not have a cut-off score for the Step 1, its loss doesn’t change much.

I was still passionate about otolaryngology and wanted to give it one more shot so that I didn’t live with regrets. —Osama Hamdi, MD

What most frustrates Dr. Cabrera-Muffly, however, is the inability to compare medical school grades to one another because some have a pass/fail curriculum, whereas others have very clear grading scales that range from honors to non-satisfactory. “You also want to ensure that you have a statistical breakdown, because if 80% of students received ‘honors,’ then honors don’t mean much.” When she reviews applications, Dr. Cabrera-Muffly finds it easiest to batch them by institution to see how the school grades. She can then evaluate all of the school’s students at the same time.

Step scores and grades aside, when finding herself with 100 to 200 additional applicants each year who are great candidates, Dr. Cabrera-Muffly finds that there are a couple of things that make a difference. One is the use of preference signaling, the process instituted in 2020 that allows medical students to let up to five residency programs know that they are in their Top 5. The other is a geographic tie, such as family, a partner, or another loved one living near the residency location.

Emotional Well-Being and the Unmatched

In the immediate aftermath of not matching, experts recommend that medical students reach out to those who love and support them unconditionally, including friends, family, and very close mentors. Unmatched medical students may not only feel that they’re disappointed in themselves, but also that they have let down their families.

“Medical students put more pressure on themselves than most groups,” said Dana Crosby, MD, MPH, residency director and chair of otolaryngology at the Southern Illinois University School of Medicine in Springfield. “When they hear from those close to them that they are loved and supported regardless, it’s one of the first and most important steps of moving forward.”