Is National Resident Matching Program Rank Predictive of Resident Performance or Post-graduation Achievement?

10 Years at One Emergency Medicine Residency

Jessica Wall, MD, MPH, MSCE; Scott R. Votey, MD; Thomas Solomon, MD; David L. Schriger, MD, MPH


Western J Emerg Med. 2019;20(4):641-646. 

In This Article

Abstract and Introduction


Introduction: Each year residency programs expend considerable effort ranking applicants for the National Residency Matching Program (NRMP). We explored the relationship between residents' NRMP rank list position as generated at our institution and their performance in residency and post-graduation to determine whether such efforts are justified.

Methods: Faculty who were present for the 10 consecutive study years at an allopathic emergency medicine residency retrospectively evaluated residents on their overall performance, medical knowledge, and interpersonal skills. Residency graduates were surveyed regarding their current position, hours of clinical practice, academic, teaching and leadership roles, and publications. We compared match position to performance using graphical techniques as the primary form of analysis.

Results: Ten faculty evaluated the 107 residents who graduated from the program during these 10 years by class year. Eighty-four residents responded to the survey. In general, we found little correlation between NRMP rank and faculty rank of resident performance. There was also little correlation between position in the NRMP rank list and the probability of having an academic career, publishing research, or having a teaching or leadership role.

Conclusion: We found that the position on our NRMP rank list was of little value in predicting which residents would do best in residency or take on academic or leadership roles once graduated. Residencies should evaluate the processes they use to generate their rank list to determine whether the ranking process is sufficiently predictive to warrant the effort expended.


Each year residencies across the United States participate in a time-intensive application process with three principal purposes: 1) to educate graduating medical student applicants about the residency program in a way that is both positive and realistic; 2) to identify applicants who would be a poor fit with the program and should not be ranked in the match; and 3) to differentiate highly desirable applicants from less desirable ones. While the first two objectives are necessary and feasible, the third objective poses a challenge and, in our experience, is very time intensive. Existing evidence suggests that programs are not particularly successful at determining which of their best performing medical student applicants will continue to be top performers in residency and ordering their rank lists accordingly.[1–3] However, to our knowledge no study has explored the ability of the National Residency Matching Program (NRMP) rank to predict post-residency performance.

Our goal was to determine whether the NRMP applicant ranking process correlated with resident clinical performance, which has been studied on a few occasions,[1–7] and post-graduation outcomes. This study was based on the ranking process currently conducted at a dual site emergency medicine (EM) residency program. We believe that if programs are unable to show that the energy expended ranking residents in a detailed manner produces important benefits to the program, then the faculty hours freed up by a less time-consuming method of ranking applicants could be redirected toward activities that improve the resident experience.