Mastering SOAP Preparation: Your Essential Guide for Med-Peds Residency

Preparing for the Supplemental Offer and Acceptance Program (SOAP) can feel overwhelming, especially if your dream is a med peds residency and you’re suddenly navigating the uncertainty of an unexpected unmatched (or partially matched) outcome. The good news: with deliberate SOAP preparation, you can dramatically improve your chances of landing a strong medicine-pediatrics or categorical position that still aligns with your long-term goals.

This guide walks you step-by-step through SOAP preparation for Medicine-Pediatrics (Med-Peds), from understanding what SOAP is to building a realistic strategy, optimizing your documents, and executing during Match Week.

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Understanding SOAP in the Context of Medicine-Pediatrics

Before you can prepare effectively, you need a clear grasp of what SOAP is, how it works, and how it specifically interacts with med peds residency pathways.

What Is SOAP?

SOAP (Supplemental Offer and Acceptance Program) is the structured, time-limited process NRMP uses to fill unfilled residency positions after the main Match algorithm runs but before the public list of unfilled positions is released.

In practice, SOAP is:

• A four-round offer process conducted during Match Week (Monday–Thursday).
• Limited to applicants who are unmatched or partially matched and are SOAP-eligible per NRMP.
• Conducted entirely within ERAS and NRMP systems (no cold-calling programs, no mass emailing for positions participating in SOAP).
• A way for programs with unfilled positions to quickly screen and offer contracts to applicants using updated ERAS applications, specialty-specific documents, and rapid communication.

How SOAP Relates to Medicine-Pediatrics

Med-Peds is a relatively small but competitive combined specialty. Most applicants also apply to categorical Internal Medicine (IM), Pediatrics, or both. In the SOAP context, that has several implications:

1. Small number of Med-Peds positions in SOAP

   • Med peds residency spots rarely remain unfilled. When they do, it’s usually a handful at most, sometimes none.
   • You must assume there may be zero SOAP med-peds positions and plan accordingly.

2. Realistic SOAP strategy often involves categorical positions

   • Many unmatched Med-Peds applicants successfully SOAP into:
     • Categorical Internal Medicine
     • Categorical Pediatrics
     • Transitional Year (TY) or Preliminary Medicine (less ideal for Med-Peds goals, but occasionally strategic)
   • You should think in tiers of preference before Match Week:
     Med-Peds > Categorical IM/Peds > Other options (if relevant).

3. Long-term Med-Peds goals can still be attainable

   • Entering a categorical IM or Pediatrics program does not eliminate Med-Peds-style career paths.
   • You can pursue:
     • Med-Peds–like combined clinical careers (adult + pediatric hospitalist, complex care, etc.)
     • Fellowship options that align with dual interests.
   • Your SOAP strategy should be guided by how each backup path still gets you closer to your long-term objectives.

Eligibility and Timing Essentials

Key points for SOAP preparation:

• SOAP Eligibility
  You’re SOAP-eligible if:
  • You registered for the Match.
  • You are unmatched or partially matched when results release.
  • You are not withdrawn from the Match and have no existing accepted position starting that July.
• Match Week Timeline (Typical Pattern)
  • Monday 11:00 a.m. ET: You learn if you matched (but not where). If unmatched/partially matched and eligible, you enter SOAP.
  • Monday–Thursday:
    • ERAS opens for you to apply to SOAP-participating programs (up to 45 maximum).
    • Programs review, interview briefly, and submit preference lists.
    • Four offer rounds occur; you have a short window (usually ~2 hours) to accept or reject each offer.

Proactive SOAP preparation means you’re not learning “what is SOAP” on Monday at 11:01 a.m.—you already have a playbook.

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Pre–Match Week SOAP Preparation: Building Your Strategy

Strong SOAP performance in a med peds residency context is overwhelmingly determined before Match Week. This section outlines the foundational steps to take in the weeks to months leading up to Match.

Clarify Your Goals and Boundaries

Start with honest reflection:

1. Primary Goal

   • Do you still prioritize Med-Peds above all else?
   • Are you equally open to categorical IM or Peds if Med-Peds is unavailable?
   • Is location flexibility more or less important than specialty?

2. Minimum Acceptable Outcomes

   • Name your absolute boundaries:
     • Geographic (e.g., “I cannot move to X region due to family/visa constraints.”)
     • Program type (e.g., “I will not accept a prelim-only spot unless it clearly advances my specific plan.”)
   • Document these before Match Week so you’re not making emotional, impulsive decisions with a 2-hour clock ticking.

3. Tiered Preference List (Preliminary)
   Draft an ordered list of what you would accept, in descending preference. For example:

   1. Med-Peds residency (any region, ACGME-accredited).
   2. Categorical Internal Medicine programs with strong outpatient training and pediatrics exposure opportunities (e.g., medicine-pediatrics clinics nearby, Med-Peds faculty).
   3. Categorical Pediatrics programs (especially ones with robust complex care/transition-of-care initiatives).
   4. Transitional Year only if tied to a PGY-2 IM or Peds plan.

Having this prioritized is critical when offers arrive in rapid SOAP rounds.

Research Med-Peds and Categorical Backup Options

You cannot know in advance which specific programs will have unfilled positions, but you can prepare targeted shortlists of potential SOAP destinations.

1. Identify Med-Peds Programs of Interest

   • Review current lists of accredited Med-Peds programs (e.g., from the American Academy of Pediatrics Section on Med-Peds, ACGME, or FRIEDA).
   • Flag:
     • Programs where you interviewed but did not rank highly enough (or at all).
     • Programs you did not apply to initially but might consider in SOAP (e.g., less-known regions, community-based Med-Peds).
   • For each, note:
     • Size of program, typical fill rate, and whether they historically have unfilled spots (NRMP data can help).
     • Program strengths relevant to your goals (primary care, hospitalist track, global health, underserved medicine, etc.).

2. Build Robust Categorical IM and Peds Backup Lists

   • Internal Medicine:
     • Look for programs that:
       • Have Med-Peds faculty or combined clinics.
       • Support adult congenital heart disease, transitional care, cystic fibrosis, or complex care clinics.
       • Emphasize ambulatory continuity, community-based training, or generalist careers.
   • Pediatrics:
     • Seek programs with:
       • Strong subspecialty exposure.
       • Advocacy, complex care, transition of care, or adolescent medicine focuses.
       • Interactions with adult medicine teams or joint educational conferences.

3. Use Data Strategically

   • NRMP’s Charting Outcomes and Program Director Survey provide insight into:
     • What PDs value in SOAP candidates.
     • How often positions go unfilled in Med-Peds vs IM vs Peds.
   • Your medical school’s prior SOAP data:
     • Which specialties your school’s unmatched students successfully SOAPed into.
     • Which program types typically have unfilled positions in your region.

Document a shortlist of ~60–80 programs (Med-Peds, IM, Peds combined) that you’d be willing to consider. You will only be able to apply to 45 during SOAP, but having a broader pre-researched list lets you pivot quickly based on which actually have vacancies.

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Optimizing Your Application Materials for SOAP

During SOAP, program directors will likely spend even less time on each application than during the main cycle. Your documents must be clear, targeted, and immediately convey that you are a high-yield applicant who understands med peds–relevant medicine and pediatrics training.

SOAP-Focused Personal Statements

SOAP allows you to upload multiple personal statements and assign them to specific applications. For med peds residency–focused SOAP preparation, prepare at least three versions in advance:

1. Med-Peds–Specific Personal Statement

   • Emphasize:
     • Your integrated interest in both adult and pediatric medicine.
     • Experiences where you navigated care transitions (e.g., adolescents with chronic disease transitioning to adult care).
     • Longitudinal care across the lifespan (e.g., seeing the same patient in both medicine and pediatrics clinics).
   • Show that you understand:
     • The identity of Med-Peds physicians (flexible, systems-focused, comfortable with complexity).
     • The value of dual certification and how you plan to use it.

   Example focus paragraph:

   “Working with a 19-year-old with cystic fibrosis on the cusp of transitioning from pediatric to adult services crystallized my interest in Med-Peds. I saw how fragmented systems can jeopardize even the most resilient patients. I’m drawn to Med-Peds because it uniquely prepares physicians to bridge those divides—clinically, administratively, and emotionally—for patients whose needs span childhood and adulthood.”

2. Internal Medicine–Focused Statement (Med-Peds Framing)

   • Focus on:
     • Adult medicine interests (e.g., complex chronic disease, inpatient hospitalist work, primary care).
     • Your appreciation for transitions of care from pediatric to adult settings.
   • Subtly highlight that Med-Peds was your original goal but that categorical IM aligns strongly with your skill set and values.
   • Important: Do not sound like IM is second choice in a dismissive way. Program directors want someone excited to train in their discipline.

3. Pediatrics–Focused Statement (Med-Peds Framing)

   • Emphasize:
     • Your love for caring for children and adolescents.
     • Exposure to complex pediatric conditions, chronic illness, and family-centered care.
   • Convey readiness to commit fully to Pediatrics while also valuing your broader interest in lifespan and transition issues.

You can optionally prepare a fourth brief, generic but professional statement that could be adapted quickly for transitional/preliminary spots if they appear strategically important for you.

Letters of Recommendation (LoRs) for SOAP

You cannot add new letters during SOAP, but you can reassign existing letters to different programs more strategically. Plan ahead:

1. Ensure a Strong Mix Before Rank List Certification

   • For Med-Peds applicants:
     • At least one strong Medicine LoR (ideally from a core IM rotation or sub-I).
     • At least one strong Pediatrics LoR (core rotation or sub-I).
     • One additional letter that can be from:
       • Med-Peds faculty (ideal if available).
       • A subspecialist in IM or Peds.
       • A research mentor if clinically relevant.

2. Strategic Assignment During SOAP

   • For Med-Peds programs:
     • Use your strongest IM + strongest Peds + Med-Peds/neutral letter combination.
   • For categorical IM:
     • Prioritize two Medicine letters plus one additional that demonstrates longitudinal work, professionalism, or scholarly strengths.
   • For Pediatrics:
     • Prioritize two Pediatrics letters plus a third that shows your capacity for complex care, advocacy, or continuity.

Before Match Week, create a table indicating:

• Which letters are best suited for which kind of program.
• How you will assign them if you need to pivot quickly.

CV and Experiences: Emphasize Med-Peds-Relevant Strengths

Program directors often skim for:

• Clerkship grades and sub-I performance.
• USMLE/COMLEX scores (particularly any failures or upward trends).
• Evidence of reliability and professionalism (e.g., leadership, longitudinal roles).
• Interest in Med-Peds–type work (combined experiences, underserved populations, complex patients).

In your ERAS experiences section, be sure to highlight:

• Longitudinal involvement in:
  • Free clinics serving both adults and children.
  • Community organizations that span family life cycles.
• Experiences dealing with:
  • Transitional care.
  • Chronic disease spanning childhood and adulthood (diabetes, congenital heart disease, CF, sickle cell disease).
• Leadership or advocacy at the intersection of systems (school–hospital, pediatric–adult, community–clinic).

Even if your ultimate SOAP target is categorical IM or Peds, these experiences still paint you as a thoughtful, patient-centered future physician.

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Executing During Match Week: Day-by-Day SOAP Strategy

Once you enter Match Week, your prior SOAP preparation for medicine pediatrics match scenarios will pay off. The key is organized, decisive execution.

Monday: Discovering Your Status and Mobilizing

11:00 a.m. ET – Match Status Email

If you are:

• Unmatched: You enter SOAP if eligible.
• Partially matched (e.g., advanced position without a prelim or vice versa): You may still SOAP into appropriate PGY-1 or PGY-2 positions, depending on specifics.

Immediately:

1. Contact Your Dean’s Office / Advising Team

   • Many schools set up rapid-response SOAP teams.
   • They can:
     • Help you interpret the list of unfilled programs.
     • Flag med peds residency, IM, and Peds programs historically friendly to your school.
     • Review revised personal statements or quick updates.

2. Review the List of Unfilled Programs

   • Available via NRMP/ERAS to SOAP-eligible applicants.
   • Identify:
     • Any Med-Peds programs with vacancies (there may be none; prepare for that).
     • Categorical IM and Peds programs you pre-identified.

3. Select Up to 45 Programs

   • Prioritize:
     1. All Med-Peds options (if any).
     2. High-priority categorical IM/Peds options from your list that actually appear unfilled.
     3. Additional programs that are reasonable fits given your metrics, geography, and goals.

Remember, you can apply to a maximum of 45 programs total across all specialties. Use them wisely.

4. Assign Personal Statements and Letters
   • Carefully assign:
     • Med-Peds PS + appropriate LoR mix to Med-Peds programs.
     • IM-focused PS + IM-heavy LoRs to IM programs.
     • Peds-focused PS + Peds-heavy LoRs to Pediatrics programs.

Program Communication and Micro-Interviews

During SOAP, program contact rules are strict:

• You may not initiate contact with programs that are participating in SOAP.
• Programs may contact you through:
  • Phone calls.
  • Emails within the system.
  • Video or phone micro-interviews.

Preparation tips:

• Have a short, clear elevator pitch ready for each specialty, e.g.:

  Med-Peds pitch:

  “I’m an applicant who has consistently pursued training that bridges adult and pediatric care. My clinical evaluations highlight my work with complex, chronically ill patients and my interest in transitions of care. I’m seeking a Med-Peds residency where I can grow into a clinician-advocate for patients whose needs span the lifespan.”

  Categorical IM pitch:

  “Though I initially applied to Med-Peds, my experiences have shown me how much I enjoy the diagnostic reasoning and longitudinal relationships in Internal Medicine. I’m excited about the opportunity to train in a categorical IM program where I can care for complex adult patients and continue to develop my interests in transitional and primary care.”

• Be ready with 2–3 patient stories that illustrate:

  • Teamwork.
  • Resilience.
  • Insight into your Med-Peds style thought process.

Offer Rounds: Decision-Making Under Pressure

There are four SOAP offer rounds (Tuesday–Thursday). In each:

• Programs submit lists of preferred applicants.
• System sends offers to highest-ranked applicants who did not match in a prior round.
• You have a short window (usually ~2 hours) to accept or reject.

Essential strategies:

1. Know Your Priorities Before Offers Arrive

   • Use your pre-defined tier list:
     • Med-Peds > Categorical IM or Peds > TY/Prelim, etc.
   • Discuss with a trusted advisor or dean before the first round.

2. Accepting vs. Holding Out

   • If you receive an offer from a program that meets or exceeds your pre-set priority threshold, you should strongly consider accepting.
   • Waiting for “something better” in a later round is risky; unfilled spots shrink with each round.
   • Once you accept, you are contractually bound and removed from subsequent rounds.

3. Document Each Round

   • Keep notes: which programs contacted you, impressions, pros/cons.
   • This helps make rapid but thoughtful decisions if multiple offers come through in different rounds.

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Common Pitfalls and How to Avoid Them in SOAP Preparation

Medicine-pediatrics applicants face some specific challenges when they reach SOAP. Avoiding these common missteps can make an enormous difference.

Pitfall 1: Banking on SOAP Having Med-Peds Positions

Reality:

• In many years, there are zero unfilled Med-Peds positions nationwide.
• Even when there are a few, they may not align with your geography or visa needs.

Avoid it by:

• Structuring your SOAP strategy around categorical IM and Peds primarily.
• Viewing Med-Peds SOAP positions as a bonus opportunity, not the central plan.

Pitfall 2: Emotional Paralysis on Monday

Discovering you are unmatched can be devastating. But SOAP is fast and unforgiving.

Avoid it by:

• Grieving later, acting now. Give yourself a short window (e.g., 30–60 minutes) to process, then pivot to action mode.
• Lean heavily on:
  • Student affairs.
  • Mentors.
  • Prior SOAP roadmap you’ve created.

Pitfall 3: Generic or Conflicted Personal Statements

Some applicants reuse a generic Med-Peds personal statement for IM and Peds SOAP applications, leaving program directors uncertain about their commitment. Others appear openly disappointed or resentful.

Avoid it by:

• Having specialty-specific, genuinely enthusiastic essays ready.
• Honestly acknowledging that while your initial path didn’t pan out, you see real value and alignment with the categorical specialty you’re applying to.

Pitfall 4: Ignoring Red Flags in Your Application

If you are SOAPing, there is likely at least one element in your file that limited your main Match outcome (scores, failed attempt, weaker clinical evaluations, late specialty decision, etc.).

Avoid it by:

• Understanding your red flags in advance with a dean or advisor:
  • What will program directors notice?
  • How should you frame and address it if asked?
• Preparing concise, non-defensive explanations that highlight:
  • Insight.
  • Specific steps taken to remediate.
  • Evidence of subsequent improvement.

Pitfall 5: Overvaluing Transitional or Preliminary Positions

For Med-Peds–oriented applicants, a one-year transitional or preliminary IM spot may feel attractive as a “bridge.” However, it does not guarantee later entry into a Med-Peds residency and may leave you reapplying from a more complex position.

Avoid it by:

• Prioritizing categorical positions where possible.
• Only ranking/accepting a prelim/TY position if:
  • It clearly aligns with a realistic PGY-2 plan.
  • You have explicit, honest guidance that this is a beneficial path for your specific situation.

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FAQs: SOAP Preparation for Medicine-Pediatrics Applicants

1. If I SOAP into a categorical Internal Medicine or Pediatrics position, can I still become a Med-Peds physician later?

You cannot “convert” a categorical IM or Peds residency into formal dual certification. To be a board-certified Med-Peds physician, you must complete an ACGME-accredited Med-Peds residency.

However, SOAPing into categorical IM or Peds can still let you:

• Build a career that closely resembles Med-Peds (e.g., complex care, adult congenital, adolescent medicine, hospital medicine with crossover experiences).
• Apply for fellowships that allow you to focus on patient populations that span childhood and adulthood.
• Reapply for Med-Peds PGY-1 in a future Match if you and your program leadership agree and logistics (funding, positions) allow, although this is uncommon and not guaranteed.

2. Should I mention in my SOAP interviews that Med-Peds was my first choice?

Yes, but carefully and positively. Program directors appreciate honesty, but they want to be sure you will be fully committed to their specialty and program.

Effective framing:

• Acknowledge Med-Peds interest briefly.
• Then pivot to why categorical IM or Peds is genuinely attractive and aligned with your skills and values.
• Emphasize what you can contribute to their program and how you see your career thriving within their field.

3. How many SOAP programs should I apply to in each specialty?

It depends on how many unfilled positions exist and your individual competitiveness, but general guidance:

• Apply to all Med-Peds vacancies you would realistically consider (if any).
• Use the remaining slots on a balanced mix of IM and Peds programs where your metrics are in range and your interests fit.
• Avoid using all 45 applications on highly competitive academic programs alone; include community and less-known institutions that offer solid training.

Work with your dean or advisor on a program list tailored to your Step scores, clinical performance, and geographic flexibility.

4. What can I do now, before Match Week, to best prepare for SOAP?

Key steps:

• Meet with your dean/advisor to:
  • Review your application strengths and weaknesses.
  • Identify realistic backup specialties and program types.
• Draft and polish separate personal statements for Med-Peds, IM, and Peds.
• Confirm that your letters of recommendation cover IM and Peds adequately and are assigned correctly.
• Build a preliminary list of Med-Peds, IM, and Peds programs you’d consider if they appear in the SOAP list.
• Learn the SOAP schedule and rules so you’re not scrambling to understand “what is SOAP” when timelines are already running.

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Thoughtful SOAP preparation does not signal pessimism—it demonstrates professionalism and maturity. As a medicine-pediatrics–oriented applicant, you have a unique dual-lens perspective that is highly valuable across multiple specialties. By building a clear, data-informed plan ahead of time, you give yourself the best chance to land in a residency that will still move you toward the kind of integrative, lifespan-focused career you’ve been working toward.