How competitive are emergency medicine residency programs

Residence (medicine) - Residency (medicine)

Post graduate medical education

The internship or the postgraduate education is specifically a phase of medical training. It refers to a qualified physician (one who holds the degree of MD, DO, DPM, MBBS, MBChB) who practices medicine registered in that specialty, usually in a hospital or clinic, under direct or indirect supervision a senior medical clinician as an attending physician or consultant. In many countries, successful completion of such training is a prerequisite for obtaining an unrestricted license to practice medicine and, in particular, a license to practice a selected subject. A person attending such training may qualify as a Residents , Registrar or Trainee become. The residency training can be followed by fellowship or sub-specialty training.

While medical school provides physicians with a wide range of medical knowledge, basic clinical skills, and supervised experience in practicing medicine in a variety of fields, medical education provides thorough training in a specific area of ​​medicine.


A Assistant doctor is more commonly referred to as resident , Senior house officer (in Commonwealth countries), or alternatively one Senior resident doctor or House officer . Residents have completed an accredited medical school and a medical degree (MD, DO, MBBS, MBChB). The residents together are that Domestic staff of a hospital. This term arises from the fact that resident doctors traditionally spend most of their training "in the house" (ie in the hospital).

The length of stay can be between three and seven years, depending on the program and subject area. Depending on the program, a year of residence begins between the end of June and the beginning of July and ends one calendar year later. In the United States, the first year of residency is referred to as an internship, and these doctors are referred to as "interns." Depending on the number of years that a specialty takes, the term can change Junior resident refer to residents who have not completed half of their stay. senior citizens are residents in their last year of residence, although this may vary. Some residency programs refer residents to their senior year as a Main resident (usually in surgical branches). Alternatively, a Main resident a resident describe who has been chosen to extend his or her residence for a year and organize the activities and training of other residents (typically in internal medicine and pediatrics).

When a doctor ends a residency and decides to continue his education on a fellowship, he is referred to as a "Fellow". Doctors who have fully completed their training in a specific area are classified according to the attending physicians, or Consultant (in Commonwealth countries). However, the above nomenclature only applies to educational institutions where the training period has been set in advance. In private, untrained hospitals in certain countries, the above terminology may reflect a doctor's level of responsibility rather than their level of education.


The stay as an opportunity for further training in a medical or surgical field developed at the end of the 19th century from short and informal programs for additional training in a special area of ​​interest. The first formal residency programs were established by Sir William Osler and William Stewart Halsted at Johns Hopkins Hospital. The residences in other locations were then formalized and institutionalized for the main specialties at the beginning of the 20th century. But even in the middle of the century, the stay was not considered necessary for general medicine, and only a minority of general practitioners took part. By the late 20th century, very few new doctors in North America were moving straight from medical school to independent, unsupervised medical practice, and more state and provincial governments required one or more years of postgraduate training for medical approval.

Residences are traditionally located in hospitals, and by the mid-20th century residents often lived (or "stayed") in hospital-supplied apartments. "Call" (hospital night shift) was sometimes as frequent as every other night or third for up to three years. The payment was minimal, apart from room, board and laundry services. It was believed that most young men and women trained as doctors had few commitments outside of medical training at this stage in their careers.

The first year of practical patient care training after medical school has long been known as an "internship". In the middle of the 20th century, most doctors went to primary care after one year of internship. The residencies were separate from the internship and were often held in different hospitals, and only a minority of doctors completed residencies.


In Afghanistan there is a residence (Dari, تخصص ) from three to seven years of practical and research activities in the field selected by the candidate. Medical students do not need to complete the residency as they study medicine and graduate as a general practitioner in six years (three years for clinical subjects, three years for clinical subjects in hospital) and a one-year internship. Most students don't do the residency because it's too competitive.


In Argentina there is a residence (Spanish, Residencia ) from three to four years of practical and research activities in the field selected by both the candidate and already graduated doctors. Special areas such as neurosurgery or cardiothoracic surgery require longer training. During these years, consisting of internships, social services and occasional research, the resident is classified as R1, R2, R3 or R4 according to their year of residence. After the last year, the "R3 or R4 Resident" receives the specialty ( especialidad ) in the selected field of medicine.


Specialist training to become a registrar is carried out in Australia. The term “resident” is used synonymously with “Hospital Medical Officer” (HMO) and refers to non-specialized postgraduate doctors prior to specialist training.

Entry into a specialist training program takes place after completing one year as an intern (postgraduate year 1 or "PGY1"), then for many training programs a further year as a resident (from PGY2). The duration of the training can be between 3 years for general medicine and 7 years for pediatric surgery.


In Canada, Canadian Medical Graduates (CMGs), which include medical students in their final year and unmatched medical graduates in the previous year, apply for residency through the Canadian Resident Matching Service (CaRMS). The first year of residency training is known as Postgraduate Year 1 (PGY1).

CMGs can apply to many postgraduate medical education programs, including family medicine, emergency medicine, internal medicine, general surgery, obstetrical-gynecology, neurology, and psychiatry.

Some residency programs are direct entry programs (family medicine, dermatology, neurology, general surgery, etc.), which means that CMGs who apply for these specialties do so directly from medical school. In other residences there are sub-specialty matches (internal medicine and pediatrics), in which residents complete their first two to three years before completing a secondary match (Medical Subspecialty Match (MSM) or Pediatric Subspecialty Match (PSM)). After completing this second game, the residents are referred to as scholarship holders. Some areas of subspecialty matches include cardiology, nephrology, critical care, allergy and immunology, respirology, infectious diseases, rheumatology, endocrinology and metabolism, and more. Direct entry specialties also have scholarships, which, however, with the exception of family medicine, are completed at the end of the stay (usually 5 years).


In Colombia, fully licensed doctors are eligible to apply for seats in residency programs. To obtain a full license, one must first complete a medical education program, which typically lasts five to six years (varies by university), followed by a year of medical and surgical internship. A national medical qualification exam and, in many cases, an additional year of unsupervised medical practice as a social doctor is required during this internship. Applications are made individually from program to program and are followed by a postgraduate medical qualification exam. The results during medical studies, medical training, the curriculum vitae and, in individual cases, the recommendations are also assessed. Dormitory adoption rates are very low (~ 1-5% of applicants in public university programs), doctor-based offices have no salaries, and tuition fees reach or exceed $ 10,000 per year in private universities and $ 2,000 in public universities. For the above reasons, many doctors travel abroad (mainly Argentina, Brazil, Spain, and the US) for postgraduate medical training. The duration of the programs varies between three and six years. Public universities and some private universities also require you to write and defend a medical paper before you can get a degree.


In France, students attending clinical practice are called "interns" and newly qualified practitioners who are trained in hospitals are called "interns". The residency with the name "Internat" lasts four to six years (depending on the subject) and follows a competitive national ranking test. It is common to delay the submission of a thesis. As in most other European countries, many years of practice at junior level can follow.

French residents are often referred to as "doctors" during their stay. In the truest sense of the word, they are still students and only become MD at the end of their stay and after submitting and defending a thesis in front of a jury.


In Greece, licensed doctors can apply for a position in a residency program. To be a licensed doctor, one must complete a medical education program that lasts six years in Greece. Compulsory rural medical service (internship) for one year is required to complete internship training. Applications are made individually in the prefecture where the hospital is located and applicants are positioned based on availability. The duration of the residency programs varies between three and seven years.


In Mexico, doctors must pass the ENARM (National Medical Residence Test) (Spanish, Examination Nacional de Aspirantes a Residencias Medicas ) lay down to have the chance of a medical stay in the field they specialize in want . The doctor is only allowed to apply for one specialty each year. Around 35,000 doctors apply and only 8,000 are selected. The doctors selected will bring their certificate of admission to the hospital they wish to apply for (almost all hospitals for medical stay come from government institutions). The certificate is only valid once a year. If the resident decides to terminate the residence permit and try to enter another subject, she has to take the test again (unlimited attempts). All host hospitals are affiliated to a public / private university and this institution is responsible for awarding the "Specialist" degree. This degree is unique but is the same as the MD used in the UK and India. For the qualification, the trainee must submit and defend a thesis project.

The length of the residences is very similar to the American system. The residents are divided per year (R1, R2, R3, etc.). After completing the course, the trainee can decide whether to sub-specialize (equivalence with the scholarship), and the usual duration of the sub-specialized training is between two and four years. The term "companion" is not used in Mexico.

Residents are paid around $ 1,000 to $ 1,100 (paid in Mexican pesos) by the host hospital. Foreign doctors are not paid and in fact are required to pay an annual fee of $ 1000 to the university facility that the hospital is affiliated with.

All specialties in Mexico are board certified and some of them have a written and an oral component, which makes these boards the most competitive in Latin America.


In Pakistan, after completing an MBBS degree and further completing a 1 year house job, doctors can enroll in two types of postgraduate residency programs. The first is the MS / MD program run by various medical universities across the country. It is a 4-5 year program, depending on the subject. Second is the fellowship program that is called Fellow of College of Physicians and Surgeons Pakistan (FCPS) through the College of Physicians and Surgeons Pakistan (CPSP). It's also a 4-5 year program, depending on the subject area.

There are also post-fellowship programs offered by the College of Physicians and Surgeons Pakistan as a second scholarship for subspecialties.


All Spanish medical students must pass a competitive national exam (called "MIR") in order to gain access to the specialized training program. This exam gives them the opportunity to choose from among the hospitals in the Spanish Health Hospitals Network, both the specialty and the hospital in which they will train. Currently, medical specialties last 4 to 5 years.

It is planned to change the system of the training program in a similar way to the UK. There has been some discussion between the Department of Health, the Medical College of Physicians, and the Medical Student Association, but it is not clear what this change process will be like.


Requirements for applying for a specialist training program

A doctor practicing in Sweden can apply for a specialist training program (Swedish: Specialisttjänstgöring ) apply. In order to obtain a license through the Swedish education system, a candidate must go through several steps. First, the candidate must successfully complete a five and a half year bachelor's program consisting of two years of pre-clinical studies and three and a half years of clinical secondment at one of Sweden's seven medical schools - Uppsala University. Lund University, the Karolinska Institute, the University of Gothenburg, Linköping University, the University of Umeå, or the University of Örebro - after which a degree of Master of Science in Medicine (Swedish: Läkar exam ) is awarded. The degree enables the doctor to apply for an internship (Swedish: Allmäntjänstgöring ) between 18 and 24 months apply .

The internship is regulated by the National Health and Social Welfare Office and consists of four main positions with at least nine months, regardless of the workplace, divided into internal medicine and surgery - at least three months in each position - three months in psychiatry and six months in general medicine. In many hospitals it is customary to send interns for the same time in surgery and internal medicine (e.g. six months each). An intern is expected to care for patients with a degree of independence, but under the supervision of older doctors who may or may not be on-site.

During each clinical assignment, the intern is assessed by older colleagues and, if they have skills that correspond to the goals set by the National Health and Welfare Agency, receives all four assignments individually and can then take a written test on the subject of "Together" case presentations in in the areas of surgery, internal medicine, psychiatry and general medicine.

After passing all four main positions of the internship and the written examination, the doctor can apply to the National Health and Social Welfare Office for approval as a doctor of medicine. Upon request, the doctor must pay a license fee of 2,300 SEK - approximately 220 EUR or 270 USD based on the exchange rates on April 24, 2018 - out of pocket as this is not and is not considered to be an expense directly related to the medical school covered by the state.

Doctors with a foreign medical degree can apply for a license in various ways, depending on whether or not they are licensed in another EU or EEA country.

Special selection

The Swedish specialty medical system will consist of three different types of specialties as of 2015. Basic specialties, sub-specialties and additional specialties. Every doctor who wants to specialize begins with training in a basic specialty and can then train in a sub-specialty that is specific to his or her basic specialty. Additional specialties also require prior training in a basic specialty or a subspecialty, but are less specific in that, unlike subspecialties, they can be completed over several different previous specialties.

In addition, the basic specialties are divided into eight classes: pediatric specialties, imaging and functional medical specialties, independent basic specialties, internal medical specialties, surgical specialties, laboratory specialties, neurological specialties and psychiatric specialties.

The prerequisite is that all basic training programs last at least five years. Frequent reasons for basic training that lasts longer than five years are paternity or maternity leave or simultaneous doctorate. Studies.

Basic specialties and sub-specialties

Additional specialties


To be trained in the additional specialty allergy, a doctor must first be a specialist in general medicine, occupational and environmental medicine, pediatric allergology, endocrinology and diabetology, geriatrics, hematology, dermatology and venereology, internal medicine, cardiology, clinical immunology and transfusion medicine, pulmonology, medical gastroenterology and hepatology, nephrology or otorhinolaryngology.

Occupational medicine

In order to be trained in the additional specialty of occupational medicine, a doctor must first be a specialist in one of the specialties of the pediatric class, one of the specialties of the independent class (excluding clinical pharmacology, clinical genetics, forensic medicine and social medicine), one of the specialties of internal medicine Medicine, one of the specialties of the neurological class (excluding clinical neurophysiology) or one of the specialties of the psychiatric class.

Addiction medicine

In order to train the additional specialty of addiction medicine, a doctor must first be a specialist in child psychiatry or psychiatry.

Gynecological oncology

In order to learn the additional specialty of gynecological oncology, a doctor must first be a specialist in obstetrics and gynecology or oncology.

Nuclear medicine

In order to train the additional specialty of nuclear medicine, a doctor must first be a specialist in clinical physiology, oncology or radiology.

Palliative medicine

To train in the additional specialty of palliative medicine, a doctor must first be a specialist in one of the specialties of the pediatric class, one of the specialties of the independent class (excluding occupational and environmental medicine, clinical pharmacology, clinical genetics, forensic medicine and social medicine), one one of the specialties of internal medicine, one of the specialties of the surgical class, one of the specialties of the neurological class (excluding clinical neurophysiology) or one of the specialties of the psychiatric class.

School health

In order to train in the additional specialty of school health, a doctor must first be a specialist in general medicine, pediatrics or child psychiatry.


To train the additional specialty of pain medicine, a doctor must first be a specialist in one of the specialties of the pediatric class, one of the specialties of the independent class (excluding clinical pharmacology, clinical genetics, forensic medicine and social medicine), one of the specialties of internal medicine, one one of the specialties of the surgical class, one of the specialties of the neurological class (excluding clinical neurophysiology) or one of the specialties of the psychiatric class.

Infection control

In order to learn the additional specialty of infection control, a doctor must first be a specialist in infectious diseases or clinical microbiology.

Geriatric psychiatry

In order to learn the additional specialty of geriatric psychiatry, a doctor must first be a specialist in geriatrics or psychiatry.

Application process

There is no central selection process for internship or residency positions. The application process is more similar to that of other positions on the market, ie the application using a cover letter and résumé. However, both types of positions are usually advertised publicly, and many hospitals have nearly synchronous recruiting processes once or twice a year - the frequency of recruiting depends mainly on the size of the hospital - for their internship positions.


Aside from the requirement that candidates be graduates of approved medical programs and be admitted as doctors in the event of residency, there are no specific criteria an employer must consider when hiring for an internship or residency. This recruitment system has been criticized by the Swedish Medical Association for its lack of transparency and the delay in the time it takes to obtain specialist certification for doctors.

However, there are factors that most employers will consider. The most important one is how long a doctor has been in active practice. After completing nine of a total of eleven semesters of the medical faculty, a student can work temporarily as a doctor - e. B. during the summer vacation at the university. This rule enables medical graduates to work as doctors without a license after completing their studies in order to gain experience and ultimately be hired for an internship. According to a 2017 survey by the Swedish Medical Association, interns across the country had worked as doctors for an average of 10.3 months before starting their internship, from an average of 5.1 months for interns in the Dalarna region to an average of 19.8 months for interns in the Stockholm region.

When hiring internships, less emphasis is often placed on the number of months a candidate has worked after completing their internship. However, it is common for doctors to work some time between internship and internship, similar to how between medical school and internship.

United Kingdom


In the UK, house clerk posts were optional for those entering general practice, but almost essential for advancement in hospital medicine. The Medical Act of 1956 required satisfactory completion of a year as a house clerk to move from provisional to full medical registration. The term "intern" was not used by the medical community, but the general public was made aware of it by the US television series "Dr. Kildare". They were usually called "housemen", but the term "resident" was also used unofficially. However, in some hospitals, the Resident Medical Officer (RMO) (or Resident Surgery Officer, etc.) was the oldest of the medical staff in the specialty.

The pre-registration officer posts lasted six months, and it was necessary to complete a surgical post and a medical post. Obstetrics could be substituted for either. In principle, general practice in a "health center" was also allowed, but this was almost unknown. The positions didn't have to be in general medicine: some teaching hospitals had very specialized positions at this level, allowing a new graduate to study neurology plus neurosurgery or orthopedics plus rheumatology for a year before having to do more general based work. The pre-registration items were nominally overseen by the General Medical Council, which delegated the practical task to the medical schools, which left it to the advisory medical staff. The educational value of these positions varied greatly.

The on-call work in the early days was full-time, with frequent night shifts and weekends on call. One night in two was common and later one night in three. This meant that standby weekends started at 9:00 a.m. on Friday and ended at 5:00 p.m. (80 hours) on Monday. In less acute areas such as dermatology, juniors could be permanently on call. The European Union's controversial Working Time Directive contradicted this: First, the UK negotiated an opt-out for a number of years, but working hours had to be reformed. On call time was unpaid until 1975 (the year of the house officials' one-day strike) and depended on certification by the advisor in charge for a year or two - some of them refused to sign. The standby time was initially paid at 30% of the standard tariff. Before a paid on-call service was introduced, several housekeepers were "in the house" at the same time, and the housekeeper "second on call" could go out, provided he kept the hospital informed at all times via his telephone number.

A "pre-registration house clerk" would serve as a "senior house clerk" for at least a year before seeking a registry. SHO vacancies could last six months to a year, and junior physicians often had to travel across the country every six months to attend interviews and move while building their own general practitioner or hospital specialization training program. Locum posts could be a lot shorter. Organized programs were a later development, and do-it-yourself rotations became rare in the 1990s. Outpatients were usually not the responsibility of a junior house clerk, but such clinics formed a large part of the workload of older trainees, often with little real supervision.

Registrar posts lasted a year or two, and sometimes much longer outside of an academic setting. It was common to move from one registrar post to another. Areas such as psychiatry and radiology were registered earlier in the registration phase, but the other registrars would normally have passed the first part of a higher qualification such as: B. Royal College membership or scholarship prior to entering this grade. Part two (the full qualification) was required before receiving a position as a chief registrar, usually associated with a medical school. However, many left the hospital practice at this point, rather than waiting years to be promoted to counseling positions.

Most UK clinical diplomas (requiring a year or two of experience) and membership or fellowship exams were not tied to specific training grades, although the length of training and the type of experience could be specified. Participation in an approved training program has been required by some royal colleges. The sub-specialty exams in surgery, now for the Royal College of Surgeons Fellowship, were originally limited to senior registrars. These rules prevented many people without a school leaving certificate from qualifying for progress.

As a Senior Registrar, depending on the area of ​​expertise, it can take one to six years to appoint a permanent advisor or senior lecturer. It may be necessary to get an MD or Ch. M. Degree and having extensive published research. The transfer to general medicine or a less preferred specialty could be made this way at any point: Lord Moran referred to general practitioners as those who "fell from the ladder".

There were also permanent positions outside of training at the sub-counselor level: previously head hospital doctor and medical assistant (both obsolete) and now staff, specialist and associated specialist. The regulations did not require much experience or higher qualifications, but in practice both were common and these grades had high proportions of overseas, ethnic minority and women graduates.

Research fellows and PhD students were often clinical assistants, but some were senior or specialist registrars. A large number of "trust grade" posts were created for routine work by the new NHS trusts and many juniors had to spend time in these posts before moving between the new levels of education, even though no education or training credits were available for them given. Holders of these positions may work at different levels and share their responsibilities with a middle or intermediate level practitioner or a consultant.

After 2005

The structure of medical education was reformed in 2005 when the Modernizing Medical Careers (MMC) reform program was introduced. House officials and the first year of senior domestic service were replaced with a mandatory two-year basic training program followed by competitive entry into a formal, subject-based training program. Registrar and senior registrar grades were merged with regular local evaluations in 1995/6 as Special Registrar (SpR) grades (after a longer period as Senior House Officer, after obtaining a higher qualification and duration of up to six years). Panels play a major role Role. After the MMC, these positions were replaced by StRs, who, depending on the specialist area, can be in office for up to eight years.

The structure of the training programs varies by subject area, but there are five broad categories:

  • Topic specialties (A&E, ITU and anesthetics)
  • Surgical specialties
  • Medical specialties
  • psychiatry
  • Continuous specialties (e.g. general medicine, clinical radiology, pathology, pediatrics)

The first four categories all have a similar structure: The trainee first completes a two-year structured and broad-based core training program in this area (e.g. medical core training), which makes them eligible for competitive entry into an associated special training program (e.g. gastroenterology, when basic medical training has been completed). The basic training years are referred to as CT1 and CT2, and the specialist years are ST3 until completion of the training. The basic training and the first or second year of special training correspond to the old jobs as Senior House Officer.

It is common for trainees in these areas to take their membership exams (e.g., the Royal College of Physicians (MRCP) or the Royal College of Surgeons (MRCS)) to progress and apply for certain sub-specialization programs that are attractive are a national training number as specialist training year 3 (ST3) and beyond - up to ST 9 depending on the specialist training subject.

In the 5th category, the trainee immediately begins the special training (ST1 instead of CT1), which rises to the consultant level without interruption or further competitive application process (continuous training). Most pass-through programs relate to stand-alone specialties (such as radiology, public health, or histopathology), but there are also some traditional surgical specialties that can be entered directly without undergoing basic surgical training - neurosurgery, obstetrics and gynecology and ophthalmology. The duration of this training varies, for example general practice is 3 years while radiology is 5 years.

The UK equivalent of a US Medical / Surgical Subspecialty Scholarship Holder is Specialty Specialist Education Level (ST3 - ST9), while US Scholarship programs typically last 2 to 3 years after completing their stay in the UK Trainees spend 4-7 years. This generally includes the provision of services in the main specialty; This discrepancy lies in the competing requirements of NHS service delivery and postgraduate education in the UK, which stipulates that even specialist registrars must be able to address general acute medical care - almost synonymous with the performance of dedicated internists in the UK USA (they are still only minimally monitored for these tasks).

United States

In most states in the United States (e.g., Arkansas, Georgia, Minnesota, Mississippi), U.S. medical school graduates can obtain medical license and practice unsupervised medical practice after completing one year of postgraduate education (that is, one year of residency) . before 1975 and often referred to as "internship"), although most states require international medical graduates to have longer training periods in order to obtain a license. Those in residency programs with a medical license can practice medicine unsupervised ("moonlight") in facilities such as emergency centers and rural hospitals. However, in fulfilling the requirements of their residence, residents are supervised by attending physicians who must approve their decisions.

Special selection

Different subject areas differ in the duration of the training, the availability of residences and the options. Attendance is required for special residency programs that range from three years for family medicine to seven years for neurosurgery. This period does not include scholarships that may need to be completed after the stay in order to further specialize. In 2015 there were almost 7,000 positions in internal medicine compared to around 400 positions in dermatology. In terms of options, specialty residency programs nationwide can range from over 400 (internal medicine) to as little as 26 integrated thoracic surgery programs.

Here is a list of some of the medical specialties:

Application process


There are many factors that can help an applicant to be more or less competitive. According to a 2020 survey by the NRMP of directors of the residency program, the following three factors were identified by directors as being most effective more than 75% of the time:

  • Score for step 1 (90% versus 82% in the 2012 survey)
  • Letters of recommendation in specialty areas (84% versus 81% in 2012 survey)
  • Personal statement (78% versus 77% in the 2012 survey)
  • Step 2 CK score (78% versus 70% in 2012 survey)
  • Faculty of Medicine Performance Assessment (MSPE / Dean's Letter) (76% versus 68% in 2012 survey)

Between 60% and 75% also mentioned other factors such as the core grade of the legal clerkship, the perceived commitment to the subject area, the elective / rotation in your department, every failed attempt in the USMLE, the class ranking / quartile, the applicant's personal prior knowledge and the perceived interest in programming and passing USMLE Step 2 CS.

These factors often surprise many pre-clinical years students who often work very hard to get good grades but fail to realize that only 45% of directors cite basic science performance as an important measure.


Applicants begin the application process with ERAS (regardless of their matching program) at the beginning of their fourth and final year of medical school.

At this point, students select specific residency programs to apply for and often include both the specialist and hospital systems, sometimes even subtracks (e.g. the categorical program for internal medicine residency Mass General or San Francisco General Primary Care Track).

After applying for programs, the programs review applications and invite selected candidates for interviews between October and February. As of 2016, schools will be able to view applications from October 1st.


The interview process includes separate interviews in hospitals across the country. Often the individual applicant pays the travel and accommodation costs, but some programs can subsidize the applicant's costs. Generally, an interview begins with a dinner the night before in a relaxed "meet-and-greet" setting with current residents or employees. Formal interviews with participants and seniors will take place the next day, and the applicant will tour the facilities of the program.

Interview questions mainly relate to the applicant's interest in the program and subject area. The purpose of these assignments is to put pressure on an applicant rather than testing their specific skills.

In order to cover the cost of residency interviews, social networking sites were developed where applicants with shared interview data can share travel expenses. However, additional "residence and relocation" loans are often required.

International medical students can also participate in a residency program in the United States, but only after completing a program established by the Education Commission for Foreign Medical Graduates (ECFMG). As part of its certification program, the ECFMG assesses the willingness of international medical graduates to participate in residency or scholarship programs in the United States that are accredited by the Accreditation Council for Medical Graduate Education (ACGME). The ECFMG does not have jurisdiction over Canadian MD programs that the relevant authorities believe are fully equivalent to U.S. medical schools. This, in turn, means that if Canadian MD graduates can obtain the required visas (or are already U.S. citizens or permanent residents), they can enroll in U.S. residency programs on the same basis as U.S. graduates.

The game


Access to graduate medical education programs such as B. Residencies is a competitive process called a "match". At the end of the interview period, the students submit a "ranking list" to a central matching service, which depends on the residency program for which they are applying:

  • Most specialties - the National Resident Matching Program (NRMP) through February (the AOA match used to be a separate option for DOs but was merged with the NRMP match after 2020).
  • Urology Residency Match Program
  • SF Match (Ophth / Plastics)

Similarly, residency programs send a ranked list of their preferred applicants to the same service. The process is blinded so that neither applicant nor program see each other's list. You can find aggregated program rankings here and are tabulated in real time based on the anonymously submitted ranking lists of the applicants.

The lists of the two parties are combined by an NRMP computer which uses an algorithm to create stable (a proxy for optimal) matches of residents with programs. On the third Friday in March of each year ("Game Day"), these results are announced in game day ceremonies at 155 US medical schools in the country. Upon entering the match system, applicants are contractually obliged to participate in the residency program of the institution with which they were compared. The same applies to the programs; They are obliged to accept the applicants who suit them.


On the Monday of the week that includes the third Friday in March, the NRMP will tell the candidates whether (but not where) they agree. If they do match, they will have to wait until match day, which takes place the following Friday, to find out where. In 2019, the matchday was on March 16.

Supplementary offer and acceptance program

The Supplemental Offer and Acceptance Program (SOAP) is a process for partially matched and fully mismatched applicants during the match. Prior to the creation of SOAP, applicants had the opportunity to contact the programs through the vacancies in a process known informally as a "scramble". This hectic, loosely structured system forced aspiring medical school graduates to select programs within minutes that were not on their original match list. In 2012, the NRMP introduced the organized SOAP system. As part of the transition, the matchday was also moved from the third Thursday in March to the third Friday.

The SOAP occurs during game week. First of all, the applicants who are eligible for SOAP are informed that they did not secure a match position on the Monday of the game week. The locations of the remaining vacant residency positions will be communicated to the inconsistent applicants on the following day. Programs then contact applicants for interviews, which usually take place over phone calls. The programs then create lists of applicants and the vacancies are individually offered by each program to the best applicant on its list. The applicant can accept or reject the offer. If the offer is rejected, it will be forwarded to the next applicant in the program list in the next SOAP round. There were four SOAP rounds during the 2021 game year.

Change of residence

Inevitably, there will be discrepancies between the student's preferences and the programs. Students can be tuned into programs that are very low on their ranking, especially when the highest priorities are in competitive specialties such as radiology, neurosurgery, plastic surgery, dermatology, ophthalmology, orthopedics, ENT, radiation oncology, and urology. It is not uncommon for a student to stay in a residence for even a year or two and then switch to a new program.

A similar but separate osteopathic match existed previously and announced its results to the NRMP in February. However, the osteopathic match is no longer available as the ACGME has now combined both in a single matching program. Osteopathic Physicians (DOs) can participate in both games and fill either MD positions (traditionally held by physicians with an MD degree or an international equivalent including the MBBS or MBChB degree) accredited by the Accreditation Council for Medical Graduate Education (ACGME) , or DO positions accredited by the American Osteopathic Association (AOA).

Military residences are filled in a similar fashion to the NRMP, but at a much earlier point in time (usually mid-December) to allow mismatched students to switch to the civilian system.

In 2000-2004, the adjustment process was attacked as anti-competitive by general practitioners represented by class-action lawyers. See e.g. B. Jung v Association of American Medical Colleges et al., 300 F.Supp.2d 119 (DDC 2004). Congress responded by drafting a specific antitrust exception for medical residence. Please refer Pension Fund Equity Act 2004, Section 207, Pub. L. No. 108-218, 118 Stat. 596 (2004) (codified at 15 USC § 37b). The lawsuit was later dismissed under the authority of the new law.

The matching process itself has also been examined to limit the employment rights of medical professionals, which requires medical residents to accept any terms and conditions of employment imposed by the health care institution, facility or hospital under the matching rules and regulations.

The USMLE Step 1 or COMLEX Level 1 Score is just one of many factors that residency programs consider when selecting applicants. Although it varies from subject to subject, selection of prospective residents takes into account Alpha-Omega-Alpha membership, clinical traineeship grades, letters of recommendation, class rank, research experience, and graduation school.

History of long hours

Medical stays traditionally require long hours on the part of their trainees. Early residents literally lived in the hospitals and often worked in unpaid positions during their education. During this time, a resident can always be "on call" or share this duty with just one other practitioner. More recently, 36-hour shifts were separated by 12 hours of rest for more than 100-hour weeks. The American public and medical education institute recognized that such long hours were counterproductive as sleep deprivation increases the rate of medical errors. This was found in a landmark study on the effects of sleep deprivation and error rate in an intensive care unit. The Accreditation Council for Medical Graduate Education (ACGME) has limited the number of working hours to 80 hours per week (over 4 weeks on average), the frequency of overnight calls to no more than one night every third day and a 10-hour break between shifts. However, a review committee may grant exemptions for individual programs for up to 10% or a maximum of 88 hours. Until the beginning of 2017, the hours of service for the first postgraduate course may not exceed 16 hours per day, while residents of the second postgraduate course and those in subsequent years can have a maximum of 24 hours of uninterrupted service. After the beginning of 2017, residents can work up to 24-hour shifts every year. Although these limits are voluntary, compliance has been mandated for accreditation purposes, although non-compliance with hourly restrictions is not uncommon.

Most recently the Institute of Medicine (IOM) built according to the recommendations of the ACGME in the December 2008 report Resident Duty Times: Enhancing Sleep, Surveillance, and Security . While the ACGME's recommendations for an 80-hour workweek are held for an average of 4 weeks, the IOM report recommends that duty hours should not exceed 16 hours per shift unless one is used in shifts of up to 30 hours 5-hour uninterrupted sleep rest provided hours. The report also suggests that residents receive varying amounts of downtime based on the timing and length of the shift to allow residents to catch up on sleep each day and to compensate for chronic sleep deprivation on days off.