Mastering SOAP Preparation in OB GYN Residency: Essential Guide

Understanding SOAP in the Context of OB GYN

The Supplemental Offer and Acceptance Program (SOAP) is the structured process that allows unmatched or partially matched applicants to secure unfilled residency positions during Match Week. For students targeting OB GYN residency, SOAP can be both a safety net and a second opportunity to align with your long-term goals.

Before you can prepare effectively, you need to understand what SOAP is and how it works.

What is SOAP?

SOAP is an NRMP-managed process that:

• Occurs during Match Week (Monday–Thursday)
• Is open only to eligible unmatched or partially matched applicants
• Provides access to unfilled, NRMP-participating residency programs
• Operates through a series of application and offer “Rounds”, with strict timelines
• Is conducted entirely via ERAS (applications) and NRMP (offers and acceptances)

SOAP is not the “scramble” that existed before 2012; it’s an orderly, governed system with strict communication rules and deadlines.

When SOAP Matters in Obstetrics & Gynecology

OB GYN is a competitive specialty. Many applicants apply broadly and still do not match in the main obstetrics match. Reasons include:

• Limited number of categorical OB GYN positions
• Geographic or program “reach” lists
• Lower-than-average Step/COMLEX scores relative to the specialty
• Limited or late OB GYN exposure or letters of recommendation

SOAP is especially relevant if:

• You’re targeting OB GYN but are concerned about your competitiveness
• You ranked a relatively short or ambitious list of OB GYN programs
• You’re dual applying (e.g., OB GYN + Family Medicine) and want to maximize options
• You’ve had exam failures, academic leaves, or other red flags

Understanding the process now—before Match Week—is the most important part of SOAP preparation.

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Step 1: Pre–Match Week Preparation (3–6 Months Before)

Effective SOAP preparation in Obstetrics & Gynecology starts long before you find out whether you’ve matched. Think of it as risk management: hope for the best, prepare for all scenarios.

Know Your Risk Profile for OB GYN

Start by honestly assessing your profile relative to OB GYN residency norms:

• USMLE/COMLEX scores
  • Below-average scores or a failure, especially in Step 1 or Step 2 CK, increase SOAP likelihood.
• Number of OB GYN interviews
  • Fewer than ~10–12 interviews (for many U.S. MD/DO applicants) may elevate your risk, though competitiveness varies by year and profile.
• EM rotation performance & letters
  • Weak or generic OB GYN evaluations, no home or away rotation, or limited letter strength.
• Application red flags
  • Course/rotation failures, professionalism concerns, gaps, visa needs, or late degree completion.

Speak with your Dean’s office, academic advisor, or OB GYN mentor to get a realistic sense of match odds. This isn’t about pessimism—it’s about being prepared.

Clarify Your Hierarchy of Priorities

Before SOAP, you must know your hierarchy of goals if you do not match in OB GYN:

1. Is your top priority: Any OB GYN spot, regardless of location or program type?
2. Or is your priority: Any ACGME-accredited residency (e.g., Family Medicine, Internal Medicine) to stay in the physician pipeline?
3. Would you consider:
   • Preliminary surgical or transitional year positions?
   • Taking a research year and reapplying?

Your answers guide your SOAP strategy. Many strongly OB GYN–committed applicants focus on any remaining OB GYN positions first, then consider certain adjacent specialties like Family Medicine with women’s health focus.

Pre-Build Application Materials with SOAP in Mind

You cannot predict which programs will be unfilled, but you can make your ERAS application “SOAP-ready”:

1. Update your CV and ERAS entries

   • Ensure clinical experiences, OB GYN rotations, leadership, and volunteer work are fully described.
   • Double-check for typos, date inconsistencies, and incomplete entries.

2. Personal statements

   • Have an OB GYN–specific personal statement polished and ready.
   • Prepare a more general statement that can be quickly adapted to:
     • Preliminary surgery
     • Transitional year
     • Family Medicine/Internal Medicine with interest in women’s health

3. Letters of recommendation (LoRs)

   • Aim for at least 2 OB GYN–specific letters, ideally:
     • From a clerkship or sub-I director
     • From a faculty member who knows your clinical performance well
   • Have 1–2 more general letters (e.g., Internal Medicine, Surgery) available in case you SOAP into another specialty.

4. USMLE/COMLEX score reporting

   • Ensure all exams you want reported are in ERAS.
   • If you had a recent score that’s borderline, discuss with your dean whether to report it now or later.

5. Personal “SOAP portfolio” on your computer

   • PDF copies of your CV, personal statements, LoRs list
   • A document with:
     • Your key OB GYN experiences and talking points
     • Concise explanations of any red flags
     • A list of geographic constraints (if any) and where you’re flexible

This preparation allows you to react within hours, not days, once SOAP starts.

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Step 2: Logistics and Eligibility – Avoiding Technical Pitfalls

SOAP moves very quickly. Missing a requirement or misunderstanding the rules can cost you opportunities.

Verify SOAP Eligibility Early

To participate in SOAP, you must:

• Register for the NRMP Main Residency Match
• Submit a rank order list (even if very short)
• Be unmatched or partially matched at the beginning of Match Week
• Be not withdrawn or ineligible from the Match for policy reasons

Your NRMP status on Monday of Match Week will explicitly indicate if you are SOAP-eligible. Before that:

• Confirm your NRMP registration is complete and fees are paid.
• Ensure your ECFMG certification pathway (for IMGs) is on track.
• Confirm there are no outstanding professionalism or disciplinary issues with your school.

Understand SOAP Timeline and Phases

While exact times change slightly year to year, the general structure is:

• Monday, 11 AM ET – You learn if you’re matched, partially matched, or unmatched.
• Monday afternoon – List of unfilled positions released (only to SOAP-eligible applicants). ERAS opens for SOAP applications.
• Monday–Thursday – Multiple SOAP “Rounds” of offers and acceptances via NRMP.
• Thursday afternoon – SOAP concludes; post-SOAP contacts (“scramble”) may occur for any remaining positions.

In OB GYN, unfilled slots are often limited and tend to fill quickly in early rounds.

Get the Technical Setup Right

SOAP is stressful; don’t add tech chaos to it.

• Hardware
  • Use a reliable laptop/desktop. Have a backup device (tablet or second laptop) ready.
• Internet
  • Stable, high-speed connection. If home internet is unreliable, arrange backup access (school, library, trusted friend).
• Notification settings
  • Turn on NRMP and ERAS email alerts.
  • Check spam and filters. Whitelist NRMP, ERAS, and your medical school domain.

Have a quiet, private location arranged for:

• Rapid application revisions
• Phone or video interviews
• Real-time discussion with advisors or mentors

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Step 3: Strategy for OB GYN SOAP – Specialty Choices and Applications

On Monday of Match Week, once you see your unmatched status and the unfilled list, you must decide where OB GYN fits into your SOAP strategy.

Realistically Evaluating OB GYN SOAP Opportunities

OB GYN SOAP slots are often:

• Limited in number
• Geographically scattered
• At a mix of community-based and academic-affiliated programs

When the unfilled list appears, ask:

1. How many OB GYN positions are unfilled?
2. Are they categorical PGY-1, preliminary, or PGY-2 positions?
3. Do any programs match your:
   • Visa needs (for IMGs)
   • Geographic must-haves (family/health reasons)
   • Academic or training priorities (e.g., strong surgical volume, high-risk obstetrics)

You must also consider your competitiveness:

• If you had multiple OB GYN interviews, strong letters, and decent scores, you may remain competitive for OB GYN SOAP spots.
• If you had very few or no OB GYN interviews, major red flags, or exclusively top-tier applications, you may need a two-track SOAP strategy:
  • Apply to all viable OB GYN SOAP positions, and
  • Apply broadly to other specialties offering more unfilled positions.

How Many Programs Can You Apply To in SOAP?

NRMP/ERAS rules typically cap SOAP applications at up to 45 programs across all specialties. Confirm the current year’s limit, but plan as if you’ll need to allocate these wisely.

For an OB GYN–focused SOAP applicant, consider:

• Scenario A: Moderate number of OB GYN slots (e.g., 10–15)

  • Apply to all OB GYN programs for which you meet minimum criteria.
  • Use remaining slots for adjacent specialties with strong women’s health content (e.g., Family Medicine, Internal Medicine with women’s health tracks, Transitional Year if planning to reapply to OB GYN).

• Scenario B: Very few OB GYN slots (e.g., 0–3 nationwide)

  • If OB GYN is non-negotiable, still apply to any OB GYN positions.
  • But protect your overall career by also applying broadly in at least one other specialty.

• Scenario C: You are partially matched

  • For example, you matched a preliminary year but not a categorical spot in desired field.
  • Look for advanced, PGY-2 OB GYN positions (rare) or consider categorical positions in another field that align with future women’s health careers.

Specialty Alternatives for OB GYN–Committed Applicants

If OB GYN positions are scarce or your profile limits your chances, consider:

• Family Medicine (FM)
  • Many FM programs emphasize maternal-child health, women’s health clinics, office procedures (IUDs, contraceptive counseling), and even obstetrics tracks.
• Internal Medicine (IM)
  • While not obstetrics-focused, it offers women’s health subspecialty options (e.g., endocrine, cardiology in women).
• Transitional Year (TY) or Preliminary Surgery
  • Could be used as a bridge year while strengthening your profile for a future OB GYN reapplication (research, better letters, improved scores).

Make these decisions before SOAP starts so you’re not forced into a rushed, emotional choice.

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Step 4: Executing SOAP – Applications, Communication, and Interviews

Once SOAP begins, time management and disciplined decision-making are crucial.

Tailoring Your OB GYN SOAP Applications

For each OB GYN program you apply to:

1. Review program details quickly

   • Training sites (community vs academic)
   • Call structure, OB vs GYN balance
   • Safety of location, support systems

2. Customize your materials within reason
   A full rewrite is impossible, but you can:

   • Slightly adapt your personal statement opening to emphasize:
     • Resilience
     • Commitment to women’s health
     • Alignment with community-based/underserved care, if relevant
   • Ensure your experiences highlight:
     • OB GYN clerkships and sub-Is
     • L&D, gynecologic surgery, clinic experiences
     • Research in women’s health, maternal-fetal medicine, reproductive health

3. Select appropriate LoRs

   • Prioritize OB GYN letters and those that speak to:
     • Teamwork under pressure
     • Communication with diverse patient populations
     • Procedural skills and OR conduct

Remember: SOAP programs see many applications quickly. Clear, focused materials help you stand out.

Communication Rules in SOAP

The NRMP has strict rules during SOAP:

• You may NOT contact programs to solicit interviews or positions before they reach out to you.
• You may respond to program-initiated contact:
  • Answer questions
  • Provide requested information
  • Express interest and fit

Violating these rules can risk your eligibility and professionalism reputation.

Preparing for SOAP Interviews (Phone/Video)

Many OB GYN SOAP interviews are brief and focused. Expect:

• Short notice calls or video invites
• 15–30 minute conversations
• Direct questions about:
  • Why you didn’t match
  • Why you want OB GYN and this program specifically
  • How you’ve shown resilience and growth
  • How you handle high-acuity, high-stress situations
  • Comfort with nights, call, and surgical responsibilities

Have clear, concise responses ready:

1. “Why OB GYN?”
   Keep it grounded in specific clinical experiences:

   • A memorable labor and delivery patient encounter
   • The blend of surgery, continuity clinic, and acute care
   • Your dedication to women’s health advocacy

2. “Why do you think you didn’t match?”
   Own it without self-destruction:

   • “I applied mostly to highly competitive academic programs in limited regions.”
   • “My Step 1 failure affected my initial application, but since then I have passed Step 2 CK with improvement, demonstrated reliability on rotations, and strengthened my clinical evaluations.”

3. “What have you done since applying?”

   • Discuss ongoing clinical rotations, QI projects, or research
   • Talk about deliberate skill-building (simulation, ultrasound workshops, etc.)
   • Emphasize feedback you’ve sought and how you’ve incorporated it

4. “Why this program?”
   Even under time pressure, review:

   • Program website (patient population, mission, call structure, affiliated sites)
   • Any unique features: global health, robust gynecologic surgery exposure, strong L&D volume
   • Geographic ties or personal alignment with their mission (e.g., underserved care)

Keep notes by your workstation with:

• Bullet points for your main talking points
• A brief “program fit” note for each OB GYN program you applied to
• Key questions to ask (e.g., mentorship structure, case volume, support for research)

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Step 5: Managing Offers, Emotions, and Long-Term Planning

SOAP is not just about immediate logistics; it’s also an emotional and strategic challenge.

Understanding SOAP Offer Rounds

During SOAP Rounds:

• Programs submit rank lists of SOAP applicants.
• Applicants cannot rank programs; they only accept or decline real-time offers.
• You may receive:
  • No offers in one round
  • Multiple offers
  • Different offers in different rounds

Key rules:

• You can hold only one position at a time.
• If you accept an offer, you are committed to that program and cannot accept another.
• Not accepting any offer by the end of SOAP means you remain unmatched.

For OB GYN–driven applicants:

• If you receive any OB GYN categorical offer, carefully consider accepting, especially if your long-term identity is OB GYN.
• If the offer is from another specialty, weigh:
  • Your comfort with that specialty as a career
  • The feasibility and risk of reapplying to OB GYN later from another specialty or after a TY year

Balancing Ideal Fit vs. Opportunity

During SOAP, perfect alignment with your dream program is rare. When evaluating an OB GYN offer:

Consider accepting if:

• The program is ACGME-accredited with a solid case volume.
• The culture appears supportive and collegial.
• You can see yourself safely and realistically completing four years there.

Be cautious if:

• There are significant documented concerns about duty hours, toxic culture, or instability.
• There are structural issues (e.g., loss of key rotations or sites) that compromise training.

If the program is not OB GYN:

• Decide whether you can be genuinely content in that specialty.
• Discuss with mentors how realistic it is to:
  • Transfer into OB GYN later (rare and highly competitive)
  • Use the training for a different but still meaningful career in women’s health or primary care.

Emotional Health and Support

SOAP can feel like a crisis, especially if OB GYN has been your long-time dream. Common emotions include:

• Shame or embarrassment about being unmatched
• Fear of “settling” or failing
• Anxiety about long-term career prospects

Actionable steps:

• Stay connected with classmates, friends, or family—but choose those who are supportive, not competitive.
• Use your school’s wellness and counseling services if anxiety or depression intensifies.
• Keep perspective: many excellent physicians had nonlinear paths, including SOAP or reapplication.

And importantly: your value as a future physician isn’t determined by a single Match outcome.

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Step 6: After SOAP – Decompression and Future Planning

Regardless of how SOAP ends, you need a structured plan.

If You Secure an OB GYN Position Through SOAP

1. Transition quickly into “new resident” mode:
   • Complete onboarding paperwork.
   • Verify training dates, orientation, credentialing steps.
2. Reach out to your new program:
   • Send a concise, grateful email affirming your excitement to join.
   • Ask about any recommended reading to prepare for July 1.
3. Start preparing clinically:
   • Review core OB GYN topics: normal labor, preeclampsia, postpartum hemorrhage, contraception, abnormal uterine bleeding.
   • Familiarize yourself with ACOG bulletins and basic surgical instruments.

Your journey may not have followed the original script, but you’ve reached your specialty goal.

If You Match into Another Specialty

Reflect on:

• What aspects of this specialty genuinely appeal to you.
• How you can still incorporate:
  • Women’s health
  • Pregnancy care (e.g., FM with OB tracks)
  • Reproductive counseling
• Long-term satisfaction rather than comparison with peers.

If you’re considering future transfer or reapplication, talk early with:

• Your new program director
• An OB GYN mentor
• Your Dean’s office

Be transparent and ethical; do not secretly seek transfers without involving your current program leadership.

If You Remain Unmatched After SOAP

This is a painful but survivable outcome. Immediate steps:

1. Meet with your Dean or advisor:

   • Perform a detailed post-mortem of your application and interview performance.
   • Develop a 1–2 year plan: research, observerships, additional degrees, exam retakes, or strengthening clinical experience.

2. Clarify your long-term goal:

   • Maintain OB GYN as your target specialty with a realistic assessment of future competitiveness, or
   • Re-orient toward a different specialty that may better fit your profile and strengths.

3. Stay clinically and academically connected:

   • Engage in clinical research or assistant roles in OB GYN or related fields.
   • Maintain letters, relationships, and updated CV entries.

Strong SOAP preparation and a thoughtful response afterward can turn a setback into a strategic detour rather than a dead end.

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FAQs About SOAP Preparation in Obstetrics & Gynecology

1. Should I mention SOAP or not matching in my OB GYN SOAP personal statement?

You generally do not need to explicitly mention SOAP or not matching in your main personal statement. Instead, focus on:

• Your sustained commitment to OB GYN
• Key experiences shaping your interest
• Growth, resilience, and maturity

If you must address a specific red flag (e.g., exam failure, extended leave), do so briefly and positively, emphasizing what you learned and how you’ve improved. Detailed explanations are often better handled in interviews rather than in the personal statement.

2. How do I decide between taking a non-OB GYN position in SOAP vs. remaining unmatched and reapplying?

This is highly individual and should be discussed with mentors. Factors to weigh:

• Realistic future chances of matching into OB GYN (given scores, red flags, and competition)
• Your financial and visa situation
• Tolerance for another application year and its emotional/financial cost
• Appeal of the SOAP alternative specialty as a viable long-term career

For some, accepting a strong Family Medicine program with robust OB opportunities is a great path. For others, a dedicated research or transitional year with focused OB GYN engagement makes more sense.

3. Do OB GYN programs view SOAP applicants negatively?

Being in SOAP does not automatically mean you’re a weaker applicant. Programs understand:

• The Match is competitive and imperfect.
• Geographic limitations and program lists can lead to unmatched outcomes even for solid candidates.

What matters most is how you present yourself during SOAP:

• Professionalism and punctuality
• Self-awareness and insight about your application
• Clear, consistent commitment to OB GYN and patient care
• Evidence of growth since your initial application

Many excellent OB GYN residents and attendings entered their programs through SOAP.

4. How can I balance honesty about my weaknesses with putting my best foot forward?

Aim for measured candor:

• Acknowledge objective facts (e.g., exam failures, limited interviews).
• Provide concise, non-defensive explanations: medical, personal, or strategic factors.
• Emphasize corrective actions:
  • Improved study strategies and recent stronger scores
  • Enhanced clinical performance and feedback from supervisors
  • Additional experiences that show reliability and commitment

Programs are less concerned that you made mistakes or had setbacks and more interested in whether you’ve learned, grown, and can handle the demands of OB GYN residency.

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Thoughtful, early SOAP preparation tailored to the OB GYN residency landscape allows you to move through Match Week with purpose rather than panic. Whether you secure an OB GYN spot in SOAP, find a fulfilling path in another specialty, or plan a strategic reapplication, being informed and proactive is your best asset.