More than 42,000 fourth-year medical students in the United States, the largest residency applicant pool in history, concluded a nail-biting week on Friday, March 17, 2017, with the simultaneous, ceremonious opening of the red envelope containing their “match.”

At precisely 11 a.m. CDT, experiencing the rite of passage known as Match Day, medical students from Indiana University School of Medicine, and across the nation, learned where they would spend the next three to seven years, depending on their specialty, to fulfill their residency training.

Students apply for residencies at medical schools seeking residency candidates early in their fourth year and then wait for invitations to interview. In February, after conducting multiple interviews, they log into the National Resident Matching Program (NRMP) database and rank their preferences. At the same time, medical schools select their preferred candidates. Thanks to a sophisticated computerized mathematical algorithm, student’s top choices are compared against the top picks of the respective programs and the matches are made, in a matter of seconds.

In sharp contrast, from a medical student’s point of view, matching to one’s top choice is a complex and strategic process that really begins as early as the end of the second year.

A strategic, rigorous road

Most of the 27 students who make up IU School of Medicine-Northwest-Gary’s Class of 2017 were among the sea of future physicians who chose to open their letter publicly among colleagues at Van Nuys Medical Science Atrium in Indianapolis.

Four of them shared their results as well as their journeys to match day – their strategies, their anxieties, their hopes and dreams.

Miracle Anokwute, an IU Northwest alumnus who completed the first two years of his medical education at IUSM’s Gary campus, is headed to the hospitals of Indiana University School of Medicine where he will spend seven years in training.

Anokwute’s chosen specialty, neurosurgery, is one of the more competitive programs. He applied to 50 programs and landed 23 interviews.

He described opening his match letter as “one of the best and most unforgettable moments of my life.”

“I will be at one of the strongest neurosurgical programs and in an environment with faculty that are supportive and genuinely care about seeing me achieve my career aspirations,” Anokwute said. “I am also very proud and happy for the rest of my classmates who matched this year and are going into all aspects of medicine all over the United States. I cannot wait to see what we will all accomplish.”

Asad Torabi, of Munster, will complete all four years of his medical education at IUSM’s Northwest campus in May. He ranked 11 programs in internal medicine, mostly in the Midwest, in hopes of remaining near his family.

“For me, it came down to the clinical experience being offered, my gut feeling about the program, and the location,” Torabi said.

When he opened his letter, he learned where he will spent his next three years: Indiana University School of Medicine in Indianapolis, one of his top choices. He said this is a good fit for him and there will be plenty of opportunities to prepare for a fellowship, perhaps in cardiology, which he anticipates will follow his residency.

Torabi shared that while there is no magic formula; students are advised to interview with at least eight programs. Anecdotally, this seems to be the threshold at which students will get a successful match.

David Dimitroff, a career-changer who did not embark on the medical school path until the age of 31, specializes in pediatrics. He has a long-term goal of sub-specializing in pediatric kidney disease.

After landing his top choice out of the 15 he ranked -- University of California Los Angeles (UCLA) -- Dimitroff is poised to do just that. He says he ranked UCLA first because of its reputation for producing leaders in medicine.

“They have a strong culture of teaching and medical education, phenomenal research opportunities, and many great mentors who are invested in leading us to our true potential as new physicians,” Dimitroff said. “The patient diversity in Los Angeles is almost second to none in the U.S. In addition, they have a very well-known pediatric nephrology service, so I thought that because this is my end career goal, it would be an incredible opportunity to get high quality, early exposure to the field. I was also very impressed with the program directors and immediately felt comfortable with them.”

Reflecting on his journey, Dimitroff knew he could not waste any time getting the application process underway. The Electronic Residency Application Service (ERAS) opens for submissions just after the start of the fourth year, in September. Dimitroff landed his first interview on the Monday after the applications opened.

Like most fourth-year students, Dimitroff spent much of the fall semester traveling to interviews, the most harrowing, he recalls, being the back-to-back interviews on the East Coast and West Coast. Nothing like having to travel extensively and put forth your best first impression, all in the midst of finishing medical school.

Dana Jones is a Gary native who completed all four years of medical school at the Northwest campus. She is headed to Rush University Medical Center in Chicago for her residency in obstetrics/gynecology. After applying to 32 Midwestern programs, Jones ranked the 11 interviews she attended. Rush was high on the list, indicating how well IUSM-NW-G prepared her for becoming a physician.

“Rush has a great program. The residents are a fun group. I enjoyed meeting them,” Jones said. “The program directors are invested in the education of the residents. It was a great interview day and I'm glad they had the same sentiments about me. I'm looking forward to great training, personal growth, and a new adventure the next four years.”

The road to residency

Amy Han, director of clinical education at IUSM-NW-G, works to ensure that all the pieces are in place for students to fulfill their many requirements and move through the process. She offers them a prescription to follow, keeping an eye on intricacies such as whether they are positioning themselves to get the best letters of recommendation, and more.

“They are really beginning to think about their residencies as early as the end of the second year,” Han said.

Summarizing the journey of a medical student, Han explained that the first two years are spent learning basic sciences. There is certainly a lot of classroom time, but the basic science years are integrated with clinical education right away. The third and fourth years are spent completing eight clinical clerkships in various specialties.

In the fourth year, there are three more requirements, a sub-internship in a specialty, along with two more clerkships in Emergency Medicine and Radiology. During this phase, students are doing more than just histories and physicals; they are working up entire plans under the supervision of a physician.

Anokwute said sub-internships are a month-long opportunity to really explore the program and see if you are a good fit for that specialty. Getting a good letter of recommendation to accompany your residency application is a primary objective. The experience also helped him formulate exactly what he wanted out of his residency training, which ultimately, is a pathway to the academic side of neurosurgery.

“After my away rotations and sub-internships, I knew I wanted a place with a high operative volume, where they were doing a lot of cases, good clinical work, good technical skills but also some form of research available to the residents that can lead to academic jobs later on,” he said.