How Do I Increase My Chances of Matching In Pediatrics?

Conrad Krawiec, MD; Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children’s Hospital 

In 2020, a record-high 2,864 pediatric categorical match positions were available with an overall fill rate of 98.2%. (1) As the number of residency positions remaining post-Match is decreasing, the pediatric residency match has grown more competitive. (2) An understanding of how to approach the pediatric match may assist potential candidates in strengthening their application and increasing their chances for success. 

The following opinion reviews suggested career planning strategies early in medical school training, the impact of standardized testing and clerkship grading, and barriers the at-risk candidate must overcome to avoid being un-matched.

The process of matching arguably begins early in medical school training. (3) After exposure to various specialties through specialty-interest groups, specialty-specific lectures, shadowing, and clinical clerkships, the student should be encouraged to have meetings with career-specific advisors as soon as possible. (3) 

These meetings may initially consist of a review of the rigors and requirements of pediatric residency as well as assistance in developing a 4th-year schedule to enhance not only specialty-specific education but to increase residency competitiveness. (2) 

While endorsed by the Liaison Committee on Medical Education, career-specific advising may vary and are often not assigned. (3) Thus, the pediatric residency candidate should be prepared to seek out advisors with experience in pediatric residency matching. These individuals could be academic leadership (i.e., pediatric program directors or clerkship directors), or they can be junior faculty members still familiar with the matching process.

After establishing a relationship with a career-specific advisor, the candidate should start to optimize specific aspects of their application. One area is the personal statement, a required part of the application that allows the candidate the opportunity to present their character and personality traits, express positive interpersonal and professional traits, and ensure that they are a “fit” within the specialty they are pursuing. (2) Personal statements must be well-organized, thought-out, time must be spent to ensure it is adequately completed, and it should be reviewed by a pediatric-specific career advisor. (4,5) 

Candidates should discuss potential writers of letters of recommendation from their clinical clerkships, how to establish/maintain a relationship with them post-clerkship, and should be assisted in ensuring that the letter writer not only meets the requirements of the residency but is able to highlight the qualities a residency program seeks in a potential candidate. (2) A copy of the candidate’s curriculum vitae should be provided to the advisor so that it is reviewed and optimized. 

During these meetings, candidates should determine their degree of competitiveness, ask for assistance in evaluating career options, and help construct a list of residency programs. (2) These individualized meetings should continue through the application and interview process until the rank list is developed.

Standardized testing through the United States Medical Licensing Examination (USMLE), even with its limitations, is still currently used by residency screening and selection. (2) Candidates with high scores and honors grades during clerkship are often advised to apply to high-caliber programs due to the high likelihood of matching to these programs. (2) 

In 2022, however, Step 1 will become primarily pass/fail. (6,7) Because Step 2 Clinical Knowledge still provides a numeric score, it may become a new screening metric for residency, but the implications of these changes are still unknown. (6,7) Until it is known how these changes will impact the pediatric residency matching process, potential candidates should at the very least ensure passing scores (i.e., avoid failing).

In addition to a candidate’s ability to academically perform well during medical school, residency programs may evaluate other aspects of the application. The Medical Student Performance Evaluation (MSPE) and personal statement were listed in the top 5 factors in a recent narrative review. (8) The MSPE (“dean’s letter”) is a tool that undergraduate medical education institutions use to communicate valuable information regarding a medical student’s performance. (9) 

In particular, the MSPE provides an academic progress section with narrative comments that summarizes areas of relative strength and areas of improvement from faculty summative evaluations (possibly from faculty members the student had worked with closely). (9) While subjective, this section may be reviewed by a residency director. Thus, the candidate should make every effort to demonstrate qualities sought in a pediatric resident in courses where narrative comments are utilized. 

For example, during the pediatric clerkship, the candidate should strive to be professional, reliable, accurate, responsive to feedback, demonstrate a work ethic, be an advocate for their patients, exhibit interpersonal skills with the pediatric patient as well as with parents, and have a team-based approach to clinical care. (10) While not guaranteed, consistent demonstration of these qualities to a faculty member responsible for a summative evaluation may result in not only a student performing well during the clerkship itself, but these qualities may also be highlighted in the narrative in a way that captures the attention of the program director.

Some students during medical school training may struggle to result in the course or standardized examination failures and professionalism concerns. (2) Students may be forced to take a leave of absence, require an extension in medical school training, repeat courses, or retake standardized examinations. If this should occur, the student is considered to be at high risk of not matching as these issues are disclosed in a candidate’s application. (2) 

Many medical schools offer services to assist these candidates in these situations; thus, taking advantage of this aid early on is highly suggested. (2) The candidate should also seek to be coached on how to optimize their application in the face of these difficulties, schedule regular meetings, ask for mock interviews, consider undergoing structured interview preparation, and ask for assistance in constructing a rank list that realistically matches their competitiveness. (2) 

The pediatric residency match has grown competitive in recent years. A focus on early career planning, academic performance, highlighting the desired qualities of a candidate, and the development of a well-rounded application may assist the potential pediatric residency candidate’s application. A career in pediatrics can be fruitful and rewarding; thus, every effort should be made to enhance the likelihood of matching.

REFERENCES

1. National Resident Matching Program. Main Residency Match Data and Reports. Results and Data: 2020 Main Residency Match. [Internet]. [cited 2021 Mar 5]. Available from: https://www.nrmp.org/main-residency-match-data/
2. Liao NN, Mahan JD, Scherzer R. The Pediatric Match Frenzy: An Overview and an Approach for Mentoring Medical Students. Acad Pediatr. 2020 Mar;20(2):152–6.
3. Ryan MS, Levine LJ, Colbert-Getz JM, Spector ND, Fromme HB. Advising Medical Students for the Match: A National Survey of Pediatrics Clerkship Directors. Acad Pediatr. 2015 Aug;15(4):374–9.
4. Naples R, French JC, Lipman JM, Prabhu AS, Aiello A, Park SK. Personal Statements in General Surgery: An Unrecognized Role in the Ranking Process. J Surg Educ. 2020 Dec;77(6):e20–7.
5. Babal JC, Gower AD, Frohna JG, Moreno MA. Linguistic analysis of pediatric residency personal statements: gender differences. BMC Med Educ. 2019 Oct 26;19(1):392.
6. Desai A, Hegde A, Das D. Change in Reporting of USMLE® Step 1 Scores and Potential Implications for International Medical Graduates. JAMA. 2020 May 26;323(20):2015–6.
7. Humphrey HJ, Woodruff JN. The Pass/Fail Decision for USMLE® Step 1-Next Steps. JAMA. 2020 May 26;323(20):2022–3.
8. Hartman ND, Lefebvre CW, Manthey DE. A Narrative Review of the Evidence Supporting Factors Used by Residency Program Directors to Select Applicants for Interviews. J Grad Med Educ. 2019 Jun;11(3):268–73.
9. Bird JB, Friedman KA, Arayssi T, Olvet DM, Conigliaro RL, Brenner JM. Review of the Medical Student Performance Evaluation: analysis of the end-users’ perspective across the specialties. Med Educ Online. 2021 Dec;26(1):1876315.
10. Holmes AV, Peltier CB, Hanson JL, Lopreiato JO. Writing medical student and resident performance evaluations: beyond “performed as expected.” Pediatrics. 2014 May;133(5):766–8.