If you:
(a) are in the
bottom-1/3 of your class, and
(b)
rotated at a program where they
liked you more than you liked them,
then have a serious talk with your dean before making your ROL.
The traditional (and generally solid) advice that you should rank programs in order of your preference might not apply to you.
The scramble this year was brutal. There were hundreds more people in it than there were available slots.
In my case, the dean said that the particular program where I rotated (where the residents seemed unhappy) wrote me a very strong recommendation letter, and that I likely would have matched there if they'd been at the top of my ROL rather than at the bottom of it. It is possible that he only said this to make me feel better. Talking with him about it before it was too late to do anything about it would've made be feel better, also, and I may have been able to match in the specialty I wanted.
This makes zero sense and is bad advice.
Please learn how the match works before you start posting horrible advice.
Before you guys make such strong statements, realize that YOU do not, beyond a shadow of a doubt, know how the match works.
The NRMP website gives us an idea of how the algorithm works, but NONE of us knows
what the algorithm is. I, and some others (as mentioned by Billy), suspect that there is a line in the current algorithm which might do something to the above effect.
[If tl;dr, skip to last paragraph]
The algorithm is mathematical, and works on a non-Nash Equilibrium (think: Beautiful Mind). Id venture to guess that most of us don't begin to understand the complexity of the mathemetics, myself included. But here's some tidbits of insight to make you think... and ultimately, the red statement above might actually hold some water.
Fact: Over the years there have been (at least) two different algorithms in use for the Match. The switch from the first to the second algorithm was made because it was determined that, with the large numbers involved, it did not matter where an Applicant ranked a program. Matches were computed and found to be in favor of the programs preferences. A second algorithm was devised which, according to the mathematics and probably simulations, better "favored the applicant"
For the next few thoughts, please think like a physicist. As the apocryphal physicist replied when asked to describe a cow he said, "consider a sphere...". Dont think in precise numbers - think in general terms. The Match is working with ever-increasing numbers of applicants, and mathematical algorithms work within a particular range of numbers. Even the algorithm which, at any given time, keeps your Facebook Wall nicely all-inclusive of all your friends, yet makes sure you see the "important" status updates, this algorithm starts to break down when you have >250 friends. So bear with me, if you'd like to understand the above suggestion.
Over the years, there has been an rapidly increasing number of Applicants in the match, and a relatively stable number of programs. It is possible that the mathematics, and non-Nash game theory, works differently in this situation. Think of it this way - Youve got, more or less, the same groups of Applicants interviewing at a handful of places. Top US grads keep seeing each other on interviews, Mid-tier grads keep seeing each other.... What you end up with is pockets of similar ROLs.
Now, take any one program - say JHU Internal Med. Say they interview 250 applicants. Say 200 of those applicants rank JHU at #1. Now, it simply
does not matter that these 200 applicants ranked JHU #1. JHU will fill based
solely on their own ROL.
Combine the three phenomena - similar pockets of applicants, and relatively similar ROLs, and coveted programs filling entirely under their own ROL. and see it like a physicist sees a cow. Each residency program can be pegged at #1 literally hundreds of times. But, Each residency program only has a single #1 Applicant. Realize that again, a similar phenomenon, of the Applicants ROL being inconsequential,
could occur in the mathematical output.... especially as the Applicant drops down on their ROL, the in-consequentiality could increase. "But the algorithm 'favors the applicant'", you say. Yes... all the applicants... equally... not just you.
I bring this up because I had a similar discussion with faculty. Faculty have noticed that in the last couple of years, students match within their top4 as per the usual ranking-advice and outcomes, OR, they match somewhere at 12-13-14. But, there seems to be nothing in between. It seems, that the applicants match where they want, or they match where they are wanted. But theres nothing in between. I brought up the usual ranking-advice... rank where you prefer, and you'll drop down one by one. The response was - "You wont match in the middle of your list because you didnt rank them high enough, but many others did." It followed that, the reason people seemed to match in the teens was only because the Program ranked them #1 or 2, and no applicant could unseat them. And so, the above advice in red was posited.
If you've bothered to read this long post. I'd urge you not to make the assumption that you know what the Match algorithm is, and that it will work the same with the recent increases in applications. The best advice for a mediocre applicant may in fact be - give some consideration to where you will be ranked.
As Billy suggested above - If you are an unimpressive applicant and would rather match low than have to scramble - Ranking a program that you think you've got a good chance with higher up might "lock you in". It might not be the case that you'd just as well have matched there even if you ranked them low. Remember: the current alogrithm was tweaked to "favor the applicant", when sheer numbers seem to favor the programs. That probably means - favor the applicants expressed choices, rather than match the most applicants. The usual thought that one will match if they were ranked high by the program (due to the second-pass of unmatched applicants unseating tentative-match holders from program where they are ranked higher) can not be so simplistic. Were it so simple, the 46.9K applicants would continue to bump each other off
until Match results resembled the mere 3.6K programs' ROLs. The current version of the Algorithm "favors the applicant".
So it must contain some branch in the decision tree which gives more weight to where the Applicant ranked the program - such that when an applicant ranks a program low, they don't match there, until & unless they are ranked very (~#1) high by the program.
