If you’re a medical student or graduate applying to residency this year, you might be wondering what the significance is of being granted an interview. In addition to the flood of excitement when you receive your first long-awaited residency interview invite, there may also be a little bit of dread, or self-doubt that starts to seep in. What if you do poorly in your interview? On the other hand, maybe you’ve got some weaknesses in your application, but view the interview as your chance at redemption.

If you’ve received an interview invite, does that guarantee you a spot on the program’s rank list? After all, why would a program spend resources or time on an applicant who they don’t see a future with?

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Do residency programs rank everyone they interview?

Well, the short answer is no. The long answer is that it’s incredibly complicated. There are various methodologies that residency programs utilize to rank their applicants. The guidelines for ranking applicants include both objective and subjective measures and can vary wildly between specialties and even programs within the same specialty.

Even within one residency program, the system to screen, interview, and rank applicants is constantly evolving, especially as interviews have shifted to the virtual realm and as leadership turns throughout the years. The programs I am familiar with have residency admissions committees that adopt a numerical scoring system for their applicants in order to have a more objective way of evaluation. This system comes with its own set of growing pains and learning curves, though with that said, there are no hard and fast rules for what to expect from any given program.

It is important to keep in mind that programs are trying to optimize their application cycle. They purposefully select the proper number of applicants for interviews in order to match every spot without having to spend too many superfluous resources and time on interviews. They also generally try to hedge their bets and account for the fact that some invitees will not show up to the interview, and they may end up with fewer applicants than they wanted to ideally rank. In order to gauge how many interview invites they need to send, program leadership refers to data and analytics from previous cycles. However, the dynamics of the match can change year-to-year.

How many applicants do residency programs rank?

The 2022 NRMP report on rank order lists (ROLs) shows that the average lengths of ROLs in filled and unfilled programs have increased every year. In 2022, programs that filled all their spots ranked an average of 15 applicants per opening. Note the two years of the pandemic have resulted in steep increases in the average length of rank lists for both filled and unfilled programs. This translates into more applicants being ranked per position as there have become more unfilled spots. 

Seeing as the purpose of the interview process is to gain perspective on the person behind the application, interviews can be quite revealing as to an applicant’s true nature. In any given program, there will most likely be a few interviewing applicants who, for some reason or another, make it onto the “DNR” list—the “Do Not Rank” list.

How do you improve your chances of being ranked during the interview?

Remember, reasons for ranking applicants ultimately depend on the program. A good rule of thumb is to be kind, professional, and personable on interview day. Try to approach the interview in a natural way that highlights the positives of your personality. Practice your interview skills beforehand so you know how to handle unexpected situations. You may want to refer to our post, “Residency Interview Tips & Tricks: The Ultimate Guide,” which walks you through the interview process step-by-step.

You’ll also want to avoid any displays of unprofessional behavior and general unpleasantness during your interview day and pre-interview social events. This sounds simple enough in the age of virtual interviews. Back in the days of in-person interviews, students would trade horror stories of an applicant who acted poorly at the airport en route to the interview and ended up being spotted by the program chair who was on the same flight. Though I never got verification for this story, the possibility certainly elicits fear. More commonly told are stories about an applicant who was rude or dismissive towards a program coordinator or receptionist. Word inevitably got back to the program, earning that applicant a spot on the DNR list.

I was always told that every step you take out of your house and on the way back to and from an interview was your “on” time. This may be a hyperbolic approach, but it ensures that you always take extra care to be professional and polite to absolutely everybody you encounter on the interview trail.

Even if you manage to avoid a massive snafu on interview day, however, that still doesn’t guarantee you a spot on the rank list. Other behaviors, such as dressing inappropriately on interview day, answering difficult questions in a defensive or combative manner, or having terrible interview skills and failing to maintain eye contact or appear interested could potentially cause you to come across as unprofessional, difficult to work with, or blasé.

This does not mean that you have to be absolutely perfect on your interview day. The expectation is not that you’re a machine who answers every question immaculately and solves the dilemma of our modern healthcare system. I would emphasize that you should be yourself and be genuine, but keep in mind that you want to avoid becoming memorable in a negative way. The shared stories are not meant to scare you, but to give a reminder to be mindful of the way you come across to other people.

Should you write a thank you note after your interview?

Many students often ask if there’s anything that they can do after interview day to improve their position on the rank list. Do you write the program a love letter or not? Again, this largely depends on the program. Some programs tell you explicitly not to send one—in those cases, listen and do not send a letter. The last thing you want to do is come across as someone who blatantly disregards instructions.

Some programs express they are open to fan mail, and for those programs, it’s useful to send a thank you letter, and maybe be more open in your intentions. If a program doesn’t say anything, either way, a simple thank you letter will suffice. Be sincere. 

How does the rank process work?

The ranking system is somewhat of a black box. Generally, everybody involved in the application and recruitment committee convenes, usually shortly after any given interview day, to discuss the candidates who interviewed. The committee involves the Chair, Program Directors, faculty interviewers, and often the Chief Resident or resident interviewers.

Many programs use their own scoring system as a way to score applicants. These systems can vary, but involve interview performance among other factors such as academic performance, letters of recommendation, research and work experience, personal statement, and a unicorn factor (a unique feature of the applicant that helps an applicant stand out).

Apart from the score, some people on the committee may hold veto power (such as the Program Chair) or take strong objections from residents or program coordinators into consideration. If strong objections exist, an applicant with a high “objective” score could potentially be bumped to a lower position on the rank list—or off the rank list entirely. 

The interview day is an important part of your overall score but of note, it is not the end all be all. It is considered within the context of your entire application. A bad interview result can, however, hurt your chances. The good news from all of this is that if you come across as an approachable, friendly, and reasonable person on interview day, you improve your standing.

The best thing you can do to prepare yourself for any given interview day is to practice your residency interview skills and focus on presenting your best self, which includes having thoughtful explanations of any red flag baggage you may carry. Connect with us at Blueprint if you want dedicated interview prep from experienced counselors. Hopefully, this overview of the general approach gives you some guidelines and motivation to work on being the best interviewee you can be to get ready for your big day. Remember that programs want to match you, after all, they need their slots filled by qualified resident physicians!