Now that ranking has begun for Match, medical students across the country are finalizing their preferences for their medical residencies.

The final deadline for certifying rank lists is March 4. But between now and then, medical students are doing a lot of reflection on their values as they prepare for the final ranking.

“What’s the best program for me?” is the over-riding question, but the answers are not always easy. That’s in part because so many factors come into play — program fit, class standing, cost of living, a feeling of ease and comfort with residents already in the program, and proximity to family and friends.

One thing experts agreed on: Do not make your choices in a rush or in a panic.

“Take a deep breath,” said Laurie Archbald-Pannone, MD, assistant dean of students at the University of Virginia School of Medicine, Charlottesville, Virginia. “Step back and think about what your goals are, and think about the big picture.”

Residency programs are doing the same thing, Archbald-Pannone and others said. Most have spread sheets or a similar tool with the names and notes on all the people they interviewed for their residency positions. Selection committees for the programs meet for hours to determine who to rank before their March 4 deadline.

While there’s much soul- and value-searching to do at this stage, there’s little a medical student can do at this point to enhance their chances of getting into a favorite program, the experts said. Sending emails and thank-you notes matter little, and some programs do not even allow them, program officials said.

Let It Ride

Other than communicating with program residents who might have shared their contact information to help a fourth-year student get a feel for the workload and life of a resident, “keep post-interview communication to a minimum,” said Diane M. Howell, MD, interim assistant dean for student affairs at the College of Medicine at the University of Florida, Gainesville, Florida.

“Some residency programs have chosen to say, ‘don’t send us a thank you,’” Howell said.

That’s because applicants, like applicants to all jobs, “are reading between the lines, analyzing to the nth word,” Howell said, trying to ascertain a positive indication that the program is interested in them.

So you send a thank-you note, an applicant feels good if they get a thank-you email back and take that as a good sign.

Don’t assume anything like that, Howell said, even if a program allows thank-you notes.

“Maybe I was trying to be pleasant and use the manners my momma gave me,” she said.

Manners — or courtesy, if you will — are important however. It’s just that this is not the time to be chatty and friendly. And a note to future applicants: be polite and courteous to all you meet and chat with in the program during the interview process, especially if you go in person.

“It’s the kiss of death to have been rude to the administrative staff,” Howell said.

While some programs do appreciate a letter of intent noting that the applicant has ranked that program at the top of the list, other programs do not, experts said. So make sure you know your program’s preference on letters of intent. And you must be absolutely sure that program is — and remains — your first choice. Back out from a letter of intent, and your career can suffer. Your word must be impeccable.

The one time when breaking the no-contact rule is if a student has had a big scholarly work published, or if that paper has been accepted for publication.

“But it needs to be an update of substance, not just a weak excuse to e-mail,” Howell said. Or it could relate a topic they discussed during the interview. Otherwise, avoid the outreach.

You’re All Trying to Make Matches

It’s important to remember that the programs are busy putting together their rank lists. And while they face different challenges than the applicants, they are taking the process just as seriously. They want the best fits for their programs.

And they would like to make their matches.

“Everybody from each side of the equation is working to avoid SOAP,” Howell said, referring to the Supplemental Offer and Acceptance Program for unmatched and partially matched students. “They (the programs) don’t want to have to scramble their slots, and the students don’t want to end up unmatched.”

Rather than contact the programs, utilize the advisers in your medical school, Archbald-Pannone said. It’s best if students have been communicating and working with them all along, but it’s never too late. Advisers can guide students based on standing, activities, and CVs and can give them an idea of how competitive a student is. And some students are obviously going to be less competitive than others. Meeting with your school’s advisers can help you understand things you can do — and to also prepare emotionally for not matching.

But one key piece of advice from Match chief Jeanette Calli: Don’t rank a program first based on where you think you might match instead of ranking where you truly want to go.

“There’s no point to that,” Calli, chief of match operations at the National Resident Matching Program, said. If there is a match with that first ranking, the program will stop, she said. The match is made, and your other choices are not considered.

To get to the point where she could home in on her ranking choices, Nkiruka Mokolo, MD, a first-year resident at Emory University in Atlanta, said she ranked her preferences after each interview. While it may be too late to do that now, it’s still important to go back to your notes for each interview. Make sure your questions about the program have all been answered — but seek the answers from resident contacts you may have and not from program officials themselves.

Mokolo placed a high value on the residents she would be working with, she said.

“Residency is not easy,” Mokolo said. “It’s important to factor in the camaraderie of the residents and program director. If I’m having hard days, I want to know can I reach out to other residents, to make sure you have someone to talk to.”

In Mokolo’s case, all the stars aligned on Emory for her number one choice.

Just to make sure she had done everything in her power to match where she most wanted to go, she did send an email to let them know she was ranking Emory number one. She also included an explanation of why.

While she realized it might not have had an effect on the selection process, it had an effect on her.

“It provided me peace,” Mokolo said, and a sense of knowing she had done everything possible to make the best match.

And how did she handle the waiting period?

“Honestly, just trust,” Mokolo said. “You’ve submitted your applications, you’ve put in the hard work. Just trusting that it will all turn out the way it’s supposed to is the only thing you can do now.”