Post-Interview Thank-You Communications Influence Both Applicant and Residency Program Rank Lists in Emergency Medicine

Corlin Jewell, MD; Tillman David, MD; Aaron Kraut, MD; Jamie Hess, MD; Mary Westergaard, MD; Benjamin H. Schnapp, MD, MEd


Western J Emerg Med. 2020;21(1):96-101. 

In This Article

Abstract and Introduction


Introduction: The National Residency Matching Program (NRMP) allows post-interview contact between residency applicants and residency programs. Thank-you communications represent one of the most common forms, but data on their value to applicants and program directors (PD) are limited. The objective of this study was to assess the effect of thank-you communications on applicant- and residency-program rank lists.

Methods: Two anonymous, voluntary surveys were sent after the 2018 NRMP Match, one to applicants who were offered an interview at a single academic site in the 2017–2018 Match cycle, and one to EM PDs nationwide. The surveys were designed in conjunction with a nationally-recognized survey center and piloted and revised based on feedback from residents and faculty.

Results: Of 196 residency applicants, 97 (49.5%) responded to the survey. Of these, 73/95 (76.8%) reported sending thank-you communications. Twenty-two of 73 (30%) stated that they sent thank-you communications to improve their spot on a program's rank list; and 16 of 73 (21.9%) reported that they changed their rank list based upon the responses they received to their thank-you communications. Of 163 PDs, 99 (60.7%) responded to the survey. Of those PDs surveyed, 22.6% reported that an applicant could be moved up their program's rank list and 10.8% reported that an applicant could move down a program's rank list based on their thank-you communications (or lack thereof).

Conclusion: The majority of applicants to EM are sending thank-you communications. A significant minority of applicants and PDs changed their rank list due to post-interview thank-you communications.


Applying for residency in emergency medicine (EM) is a highly consequential process that fourth- year medical students undergo every year in order to determine where they will undertake specialty training.[1] This, in many cases, sets the direction for the rest of their career. The current application process demands significant time and energy and, for the average applicant, costs more than $8000.[2] On average, each EM residency applicant sends out applications to 41 programs and attends 13 interviews.[3] After each interview day, many applicants set aside time for yet another task: sending thank-you communications to those programs at which they interviewed.[4]

The National Residency Matching Program (NRMP) allows post-interview contact between applicants and programs but requires that both parties follow a specific code of conduct.[5] Recognizing that applicants represent a potentially vulnerable population, the code states that programs may not engage in communication that reveals or influences rank lists. Despite this, post-interview communication has been shown on multiple occasions to influence how an applicant ranks programs.[4,6,7] Previous work has shown that most applicants were contacted in some form by programs and that they were glad to receive such communication.[8] Despite the absence of any clear evidence in favor of the practice, medical students applying to EM residency are usually advised by clerkship directors and faculty mentors to communicate their thanks to programs.[9] However, it is currently unknown whether the practice benefits applicants or programs.

While previous studies have examined the impact of post-interview contact (including return visits to an institution, or "second looks," phone/email correspondence, etc) from residency programs, no previous work has focused solely on the impact of post-interview thank-you communications in EM on both applicant and program rank lists. The goal of this study was to define current applicant thank-you communication practices, how these thank-you communications are perceived by program directors (PD), and whether applicants are influenced by responses to them.