Navigating Pre-Match Communication for Emergency Medicine Residency

Pre-match communication is one of the most confusing—and anxiety-producing—parts of the residency application process, especially in emergency medicine (EM). As an MD graduate, you know how important professionalism and ethics are, but you may be less sure where the line is between appropriate enthusiasm and inappropriate “gamesmanship” before the Match.

This guide walks you through how to navigate pre-match communication for an MD graduate in emergency medicine, with a focus on the EM match landscape, ethical principles, example emails, and practical strategies you can implement right away.

---

Understanding Pre-Match Communication in Emergency Medicine

Pre-match communication refers to any contact between you and residency programs after your application is submitted but before rank lists are due—and before the Match results are released. This includes:

• Thank-you emails after interviews
• Letters of interest or intent
• Updates (new publications, Step 2 scores, awards)
• Program-initiated contact (check-ins, second looks, “we’re ranking you highly” messages)

For an MD graduate residency applicant coming from an allopathic medical school, this stage is especially important because:

• You’re competing in a national EM match that has grown more competitive and more variable across years.
• Allopathic medical school match outcomes in EM tend to favor applicants who communicate interest professionally and strategically (without violating NRMP rules).
• Programs are trying to distinguish between truly interested candidates and generic applicants who applied broadly.

How EM Programs Think About Pre-Match Communication

Emergency medicine programs receive hundreds, sometimes thousands, of applications. By the time pre-match communication begins:

• They’ve already scored applications and held interviews.
• They’re deliberating over their rank order list.
• They may use communication as one data point to gauge fit and genuine interest, especially for applicants in the middle of their list.

Your goal is not to “game” the system, but to:

• Reinforce your fit and enthusiasm.
• Clarify information and expectations.
• Maintain ethical, rule-compliant behavior under NRMP guidelines.

---

The Rules: NRMP and Ethical Boundaries for EM Pre-Match Communication

Before crafting any email or phone call, you need to understand what’s allowed and what’s not in the EM match environment.

Core NRMP Principles (Applies to EM and All Specialties)

Under NRMP rules (which govern the allopathic medical school match process):

• Programs cannot ask you to reveal your rank order list.
• You cannot ask programs to reveal their rank order list.
• Both sides may express interest (e.g., “we will rank you highly,” “you are my top choice”) but these are not binding commitments.
• Any suggestions of a “contract” outside the Match are not allowed in an NRMP-participating program.

In mainstream ACGME-accredited emergency medicine residency programs participating in the NRMP:

• True “pre-match offers” (binding positions outside the Match) are not permitted.
• What you might see instead are strong “signals”: programs telling you they are highly interested, or asking about your interest level, which can feel like early commitment pressure—but are not formal pre-match offers in the NRMP sense.

If you ever feel pressured into an early commitment or something that sounds like a guaranteed position outside the Match from an NRMP-participating EM program, that is a red flag. Consult your dean’s office or GME office immediately.

Typical, Rule-Compliant Behavior You May See

• Programs sending thank-you or follow-up emails after interviews.
• Programs saying: “We really enjoyed meeting you and will be ranking you highly.”
• Programs inviting you to second look events.
• Program directors or associate PDs answering your questions about schedule, education, wellness, or procedures.

All of this is legal and typical in the EM match.

---

Strategic Pre-Match Communication: What You Should Send (and When)

Even within a strict rules-based environment, communication can meaningfully influence how programs perceive you. For an MD graduate residency applicant in EM, here is a structured strategy.

1. Post-Interview Thank-You Emails

These are optional in some programs and expected in others, but they are low-risk and generally positive if done correctly.

Goals:

• Reinforce a positive impression.
• Highlight a specific program feature that aligns with your goals in emergency medicine.
• Show professionalism and gratitude.

Timing: Within 24–72 hours of your interview.

Example (short and effective):

Subject: Thank you – [Your Name], EM Interview on [Date]

Dear Dr. [Program Director Last Name],

Thank you for the opportunity to interview at the [Program Name] Emergency Medicine Residency on [date]. I especially enjoyed learning about your emphasis on resident autonomy in the trauma bay and the longitudinal ultrasound curriculum.

As an MD graduate with a strong interest in academic emergency medicine, I was particularly impressed by the mentorship structure and the volume of diverse pathology your emergency department serves. I would be excited to train at [Program Name].

Thank you again for your time and consideration.

Sincerely,
[Your Full Name, MD]
AAMC ID: [XXXXXXX]

You do not need to send detailed notes to every single interviewer; one or two messages (PD, APD, or coordinator) are usually enough unless explicitly invited to contact others.

---

2. Letters of Interest vs. Letters of Intent

These two terms often get mixed up, but they serve different purposes during EM pre-match communication.

Letter of Interest

• Sent to multiple programs, usually ones you’d be happy to attend.
• Conveys serious interest but not exclusivity.
• Appropriate if you want programs to know you are strongly considering them.

Use it when:

• You rank a program in your top tier but not necessarily #1.
• You interviewed earlier in the season and want to refresh their memory.
• You have a specific reason why you fit well there (geography, academic interests, patient population).

Sample structure:

• Brief reminder of who you are.
• Specific reasons that program is attractive to you.
• Statement of serious interest (without saying “#1”).

Letter of Intent

• Sent to only one program.
• States that the program is your unequivocal first choice—you plan to rank them #1.
• High-stakes: use only if you are genuinely committed to that statement.

Pros:

• Can positively influence a program’s perception of your commitment.
• Often appreciated, especially in competitive EM programs, when sincere.

Cons:

• Ethically problematic if sent to more than one program or if untrue.
• Does not guarantee a match result.

When to send a letter of intent:

• You are certain this EM program is your top choice.
• You would be happy and proud to train there regardless of other possible outcomes.
• You are close to the end of the interview season, usually 2–4 weeks before rank list certification.

Sample Letter of Intent Email (Emergency Medicine):

Subject: Letter of Intent – [Your Name], Emergency Medicine Applicant

Dear Dr. [Program Director Last Name],

Thank you again for the opportunity to interview at the [Program Name] Emergency Medicine Residency on [date]. After completing my interviews, reflecting on my priorities, and speaking with mentors, I have decided that [Program Name] is my clear first choice for residency training.

I am writing to let you know that I plan to rank [Program Name] as my number one choice in the upcoming NRMP Match. The combination of high-acuity emergency care, strong ultrasound and critical care exposure, and the supportive culture I experienced on interview day aligns perfectly with my career goal to become a well-rounded emergency physician prepared for both academic and community practice.

As an MD graduate from an allopathic medical school with a strong foundation in EM, I believe I would thrive in your program’s environment and contribute meaningfully to the residency community.

Thank you again for your time and consideration.

Sincerely,
[Your Full Name, MD]
AAMC ID: [XXXXXXX]

This is a classic, ethical way to communicate early commitment without implying a formal pre-match offer.

---

3. Update Letters: When You Have New Achievements

If, as an MD graduate, you:

• Receive a new publication or abstract acceptance.
• Get a significant award or leadership role.
• Improve your Step 2 CK score or gain additional EM experience.

You can and often should send a brief update letter to programs you are particularly interested in.

Timing: Within 1–2 weeks of the event; avoid sending weekly micro-updates.

Content tips:

• One short paragraph explaining the update.
• One paragraph reiterating interest in the program.
• Keep it under 250–300 words.

Example:

Subject: Application Update – [Your Name], Emergency Medicine Applicant

Dear Dr. [Program Director Last Name],

I hope you are well. I wanted to share a brief update to my application. Since our interview on [date], our project on ED-based sepsis screening has been accepted for presentation at the [Conference Name] and is in press with [Journal Name]. This experience has deepened my interest in quality improvement and clinical operations in emergency medicine.

I remain very interested in [Program Name] and believe your emphasis on ED operations and research would be an ideal environment for me to continue this work during residency. Thank you again for your consideration.

Sincerely,
[Your Full Name, MD]
AAMC ID: [XXXXXXX]

---

Handling Program-Initiated Communication, “Signals,” and Early Commitment Pressure

One of the most confusing parts of pre-match communication in EM is how to interpret what programs say to you—and what you should say back.

Common Types of Program Communication Before Match

You may see:

• “We will be ranking you highly.”
• “You are among the top group of candidates we interviewed.”
• “We hope you will strongly consider us on your rank list.”
• Invitations to second looks or informal meet-and-greet sessions.

These are not formal pre-match offers, and they are not binding. They are best interpreted as:

• Signs the program values your candidacy.
• Encouragement to express interest if you feel that way.

How to Respond Without Overcommitting

Scenario 1: Program You Like, But Not Your #1

Program email: “You are one of our top candidates and we plan to rank you highly. Do you have any questions about our program?”

Suggested response:

Dear Dr. [Last Name],

Thank you for your message and for your consideration. I truly enjoyed my interview day and remain very interested in [Program Name]. I was particularly impressed by [specific feature].

I am still finalizing my rank list, but your program is one I am strongly considering near the top of my list. I appreciate your time and am grateful to be considered among your top candidates.

Sincerely,
[Your Name]

This is honest, positive, and does not falsely imply #1 ranking.

Scenario 2: Your Genuine Top Choice

If your top-choice program reaches out with strong interest and you genuinely have decided to rank them #1, you can reply:

Dear Dr. [Last Name],

Thank you so much for your message. After completing my interviews and careful consideration, I have decided that [Program Name] will be my first choice on my rank list. I am very excited about the possibility of training in your emergency department and joining your residency community.

Thank you again for your support and consideration.

Sincerely,
[Your Name]

You are allowed to say this. Just make certain you mean it.

---

What About “Pre-Match Offers” and Early Commitment?

For MD graduate residency applicants targeting NRMP-participating emergency medicine programs, true pre-match offers are not permitted. However, you may experience:

• Strongly worded interest that feels like an early commitment request.
• Questions like “If we rank you highly, where do you think we would fall on your list?”

You should:

• Reiterate your interest without revealing your exact rank order list.
• Avoid language that commits you to something you don’t intend to do.
• Rely on the NRMP match algorithm—it is designed to favor your preferences.

If you are asked directly: “Are we your first choice?” and you are not sure or the answer is no, you can respond:

I’m still in the process of finalizing my rank list, but I am very interested in your program and it will be ranked highly.

This keeps you honest and professional while still signaling interest.

---

Practical Tips and Pitfalls: How to Communicate Effectively and Ethically

1. Match Your Communication to the Culture of EM

Emergency medicine values:

• Clarity and brevity.
• Teamwork, humility, and reliability.
• Calm under pressure and honesty.

Your pre-match communication should reflect these traits:

• Keep emails concise and specific.
• Avoid overly dramatic language or “love letters.”
• Demonstrate insight into what EM practice and training really involve.

2. Prioritize Quality Over Quantity

Don’t send:

• Weekly “check-in” emails.
• Long essays on why you’re interested.
• Generic messages copy-pasted to 20 programs.

Instead:

• Carefully target a few high-yield programs where you are a strong fit and genuinely enthusiastic.
• Send 1–3 well-timed communications:
  • Thank-you post-interview
  • One update or letter of interest
  • (Optionally) a letter of intent to your #1 program

3. Coordinate with Your Home Institution and Advisors

As an MD graduate from an allopathic medical school, you likely have:

• A dean’s office.
• An EM advisor or mentor.
• A career guidance office.

Use them. They can:

• Review your letters of interest/intent.
• Help you interpret program signals—especially for the EM match.
• Advise you on whether your communication plan makes sense given your Step scores, SLOEs, and application strength.

4. Maintain a Consistent, Ethical Story

Your words should match your actions:

• If you tell a program they are your #1, actually rank them #1.
• If you say they will be “ranked highly,” make sure that is true (e.g., realistically in your upper tier).
• Do not send multiple letters of intent to different programs—that undermines your integrity and can damage your reputation if discovered.

Emergency medicine is a relatively small specialty. Program directors and faculty talk to each other, attend the same national meetings, and may share impressions about applicants.

5. Remember: The Algorithm Favors You

The NRMP algorithm (used in the allopathic medical school match and EM match) is applicant-proposing. That means:

• You should rank programs in your true order of preference, not based solely on perceived interest from programs.
• A program’s email saying “we will rank you highly” does not help you if you don’t actually want to train there more than other options.

Let your authentic preferences drive your rank list. Use pre-match communication to clarify and express fit—not to override your actual goals.

---

Special Considerations for MD Graduates in Emergency Medicine

You May Be Viewed as “Day-One Ready”

As an MD graduate, especially from an allopathic medical school, EM programs may expect:

• Strong clinical readiness on the first day.
• Familiarity with ED workflow, triage, and interdisciplinary communication.
• Comfort with acute care and basic procedures.

In your communication, you can highlight:

• Concrete EM experiences: sub-internships, EM rotations, procedures (intubations, central lines, ultrasound).
• Your adaptability and teamwork in high-acuity settings.

Leveraging SLOEs and EM-Specific Experience in Communication

When writing to EM programs, it helps to refer briefly to:

• What you learned on your EM clerkships and sub-Is.
• How specific experiences reinforced your interest in EM (e.g., resuscitations, teamwork with nurses and techs, night shifts).

This reinforces that your enthusiasm is grounded in real clinical exposure, not an abstract idea of emergency medicine.

---

FAQs: Pre-Match Communication for MD Graduate in Emergency Medicine

1. Should I tell my top-choice EM program they are #1?

Yes, if and only if:

• You are completely sure they are your first choice.
• You plan to rank them #1 on your NRMP list.

A clear, honest letter of intent can be helpful. It does not guarantee a match, but it can positively influence how the program views your commitment. Never tell more than one program they are your #1.

---

2. How many programs should I send letters of interest to?

For most EM applicants:

• 2–6 programs is a reasonable range, focusing on those you would be genuinely happy to attend and where your fit is strong.
• Don’t email every program you interviewed at with the same generic message.
• Prioritize programs in your realistic match range and those important for geography, family reasons, or career goals.

---

3. Is it okay to ask a program where I stand on their rank list?

It’s allowed, but usually not helpful. Programs:

• May give vague or noncommittal answers.
• Are not allowed to provide specific rank positions under the spirit of NRMP guidelines.

A better question is:

“Do you have any advice for how I can strengthen my application or demonstrate my fit with your program?”

This keeps the conversation professional and focused on what you can control.

---

4. What if a program implies an early commitment or “pre-match offer” for EM?

For ACGME-accredited emergency medicine residencies participating in the NRMP:

• A true binding pre-match offer is not allowed.
• If a program hints at “guaranteeing” a spot outside the Match, that is a serious concern.

Steps to take:

1. Do not agree to anything verbally or in writing.
2. Contact your dean’s office or an EM advisor immediately.
3. Consider reporting the issue to NRMP if there is clear pressure to violate Match rules.

Most EM programs behave ethically and within the rules. When in doubt, protect your integrity and follow official channels.

---

Handled thoughtfully, pre-match communication in emergency medicine can strengthen your candidacy, clarify your preferences, and help programs see you as a future colleague—not just a name on a list. As an MD graduate, you bring valuable training and perspective; your job now is to communicate that clearly, honestly, and strategically while letting the Match algorithm do its work.