A primer on creating a rank order list for medical students applying to residency

Abstract

In 2024, over 50,000 applicants submitted their rank order list (ROL) to the National Resident Matching Program (NRMP, The Match), which uses these rankings to match candidates with residency programs. Recent years have shown that many applicants find emergency medicine (EM) a desired speciality. In 2024 and 2025, 95% and 98% of EM residency spots were filled, respectively. To match, applicants must understand every aspect of the application process, including rank order strategies. The ROL is an essential step in the residency application process where applicants rank programs based on personal and professional priorities. Applicants weigh both tangible factors—such as program size, location, and salary—and intangible factors—such as work–life balance, faculty support, and the overall “feel” of a program. Virtual interviews have limited opportunities to assess both tangible and intangible factors hindering the more comprehensive evaluation EM applicants previously had with in-person interviews. We offer strategic advice to medical students and their mentors, on an approach to creating a ROL, evaluating the intangible and tangible aspects of each program, additional considerations for less common scenarios, and effective communication with program directors.