The Essential Guide to Pre-Match Communication for MD Graduates in Residency

Understanding Pre-Match Communication in Preliminary Medicine

For an MD graduate interested in a Preliminary Medicine year, pre-match communication can feel like a gray zone: essential, but poorly defined, and often anxiety‑provoking. You hear about “pre-match offers,” “early commitment,” and mixed advice on how much to email programs. Used strategically, though, pre-match communication can strengthen your candidacy, clarify expectations, and—occasionally—lead to earlier clarity about where you might match.

This article focuses specifically on MD graduate residency applicants from allopathic medical schools applying to Preliminary Medicine (prelim IM) programs. You’ll learn:

• What pre-match communication is (and isn’t)
• How it intersects with NRMP rules and the allopathic medical school match
• When communication is appropriate—and when it crosses a line
• How to write effective emails and convey genuine interest
• How to respond if you receive an early signal or “pre-match” type outreach
• Practical examples and templates you can adapt

Throughout, remember the core principle: you must always remain truthful and compliant with the NRMP Match Participation Agreement and your school’s policies.

---

1. What Is Pre-Match Communication in Preliminary Medicine?

1.1 Definitions and context

Pre-match communication refers to any contact between an applicant and a residency program after your application is submitted but before the official Match results are released. This includes:

• Emails to or from program directors (PDs) and program coordinators
• Thank-you notes and follow-up messages after interviews
• Phone calls or video meetings requested by the program
• Informal contact during second looks or virtual open houses
• Signals of interest or intent from either side

For Preliminary Medicine, pre-match communication has some nuances compared to categorical internal medicine:

• You’re often balancing multiple tracks (e.g., prelim IM + categorical in another specialty like neurology, radiology, anesthesiology).
• Your prelim year might be geographically tied (you want your prelim near your advanced program) or you may be open nationwide.
• Programs may be more willing to clarify logistics, workload, and culture early because the commitment is for one year, not three.

However, the overarching Match rules still apply, especially for MD graduates from allopathic schools participating in the allopathic medical school match managed by the NRMP.

1.2 NRMP rules and what they mean for you

The NRMP allows communication of interest but prohibits coercive behavior or binding commitments outside the Match. Key principles as they relate to pre-match communication:

• Programs and applicants may express interest (e.g., “You are ranked highly” or “I am ranking you highly”).
• Neither party may ask for, require, or offer binding commitments before the Rank Order List (ROL) deadline.
• No one can insist on knowing your exact rank list position; you may choose to share your intentions, but you’re not obligated.
• Programs may not guarantee that you will match at their program.

For MD graduate residency applicants using the NRMP, traditional “pre-match contracts” (common historically in some non-NRMP or SOAP-like processes) are not typically part of standard practice for prelim IM. What you are more likely to encounter is:

• Strong expressions of interest
• Implied or explicit statements such as “We plan to rank you highly”
• Conversations that feel like “early commitment” but are still non‑binding

Understanding this distinction will help you navigate pre-match offers that are more like enthusiastic signals than legal contracts.

---

2. Goals and Strategy of Pre-Match Communication

Before drafting any email or making any call, clarify your goals. Pre-match communication should be strategic, professional, and honest.

2.1 What you want to achieve

Especially in Preliminary Medicine, pre-match communication can help you:

1. Demonstrate interest and fit

   • Signal that their program is important to you (especially if it’s in the same city as your advanced program).
   • Highlight alignment with your career plans (e.g., “I will be doing radiology at X Program; your rigorous IM training would prepare me well.”).

2. Clarify program details

   • Call schedules, night float, ICU exposure.
   • Support for residents doing only a prelim medicine year.
   • Culture, wellness, and support for transition to your advanced specialty.

3. Strengthen your file

   • Address minor red flags (e.g., a leave of absence, USMLE/COMLEX issue) with context if programs raise them.
   • Update programs on new achievements (publications, awards, updated step scores if applicable).

4. Optimize your rank list

   • Use conversations to determine your true preference order among prelim IM programs.
   • Understand how well you might fit locally if your advanced program is in the same region.

2.2 When pre-match communication helps most

For a typical MD graduate residency applicant, targeted communication can significantly help if:

• You’re an MD from an allopathic medical school applying to both highly competitive advanced programs and multiple prelim IM sites, and you need to coordinate geography.
• You have a home institution prelim IM program and want to convey that you’d prefer staying there if possible.
• You’re aiming for a particular city or region because of personal constraints (family, spouse, partner’s job) and want to highlight your commitment to staying there.
• There are a few programs that stand out as top choices among your prelim options, and you want to make that clear to them.

Conversely, sending generic emails to every program on your list rarely helps and can even be counterproductive if they’re obviously mass‑produced.

---

3. Types of Pre-Match Communication and How to Use Them

3.1 Initial outreach before interviews

Most of your early program contact happens through ERAS and standard application channels. However, selective pre-interview communication may be appropriate in these situations:

• You have a strong tie to the region (grew up there, spouse’s job) but it doesn’t show clearly on your ERAS.
• You’re applying late in the season (e.g., after a delay) and need to explain timing.
• You need to clarify a program detail that may affect whether you rank them (e.g., visa sponsorship, specific scheduling restrictions).

Example: short pre-interview clarification email

Subject: Question Regarding Preliminary Medicine Position for 2025–2026

Dear Dr. [Last Name] / Dear Program Coordinator,

I recently applied to the Preliminary Medicine program at [Institution Name] through ERAS. I am very interested in your program, particularly because I will be starting an Advanced [Specialty] position at [Institution/City] in 2026 and hope to complete my preliminary year in the same region.

I had a quick question regarding [brief, specific issue—e.g., visa sponsorship for J-1 applicants, availability of specific rotation, scheduling constraints]. Would you be able to clarify whether [one-sentence question]?

Thank you very much for your time and consideration.

Sincerely,
[Your Name], MD
AAMC ID: [#######]

This type of email should be short, necessary, and respectful. Do not ask for an interview outright; instead, demonstrate professionalism and genuine interest.

3.2 Post-interview thank-you emails

Post-interview communication is the most common and most expected form of pre-match outreach. For prelim IM, your aim is to:

• Thank them for their time.
• Reiterate specific aspects you liked about the program.
• Briefly connect the program to your career path and/or advanced specialty.
• Maintain honesty regarding your level of interest.

Key principles:

• Send within 24–72 hours of the interview.
• Individualize each email—refer to a specific conversation, case, or presentation.
• You can send either one email to the PD (and CC the coordinator) or brief notes to select faculty who interviewed you.

Post-interview thank-you example

Subject: Thank You – Preliminary Medicine Interview on [Date]

Dear Dr. [PD Last Name],

Thank you again for the opportunity to interview for the Preliminary Medicine position at [Institution] on [date]. I appreciated learning more about your program’s strong inpatient training, especially the structured ICU experience and the emphasis on residents managing complex cases early in the year.

As an MD graduate planning to pursue [Advanced Specialty] at [Institution or City], I am particularly drawn to how your prelim IM year prepares residents with solid clinical fundamentals and close attending supervision. The collegial atmosphere I observed on rounds and in the resident Q&A reinforced my impression that [Institution] would be an excellent environment for my intern year.

I remain very interested in your program and would be honored to train at [Institution].

Sincerely,
[Your Name], MD
AAMC ID: [#######]

Note: You can signal high interest (“very interested” or “strongly considering”) without committing to ranking them #1 unless you are certain.

3.3 Follow-up emails and updates

Later in the season (often after January), you may have:

• New publications, presentations, or exam results.
• Clarified personal circumstances (e.g., spouse matched to a job).
• A clearer sense of your prelim IM preference order.

Sending one targeted update to your top 3–5 programs can be helpful. Avoid sending frequent or trivial updates to every program.

Update email example

Subject: Application Update and Continued Interest – Preliminary Medicine

Dear Dr. [Last Name],

I hope you are well. I wanted to share a brief update regarding my application and to reiterate my strong interest in the Preliminary Medicine program at [Institution].

Since we last spoke, I [have had a manuscript accepted in X journal / presented a poster at Y conference / completed an additional sub-internship in internal medicine]. These experiences have further solidified my commitment to building a strong foundation in internal medicine before transitioning to [Advanced Specialty].

I continue to feel that [Institution] offers an ideal environment for my preliminary year, particularly because of [specific aspects you learned on interview day—e.g., supportive faculty, night float system, resident autonomy].

Thank you again for your consideration.

Sincerely,
[Your Name], MD

3.4 Explicit signals of interest (e.g., “I will rank you highly”)

In the weeks leading up to the Rank Order List deadline, many applicants struggle with whether to send explicit signals of preference. Examples include:

• “Your program is among my top choices.”
• “Your program is my top preliminary medicine choice.”
• “I intend to rank your program very highly.”

These statements are allowed as long as they are truthful and not part of a coercive arrangement. If you tell a program “You are my #1 prelim IM choice,” you should mean it.

Strategy:

• Reserve explicit “#1” statements for only one prelim IM program (if any).
• For others, use softer (but still honest) language: “one of my top choices.”
• Remember that both sides understand that final ranking is a private decision.

---

4. Pre-Match Offers, Early Commitment, and NRMP Considerations

4.1 What are “pre-match offers” in this context?

Historically, “pre-match offers” referred to contracts outside the NRMP Match, where applicants were offered guaranteed positions before Match Day. In the current NRMP system for most MD graduates, especially in allopathic medical school match pathways, these are rare and typically not permitted for NRMP-participating programs.

However, you might encounter communication that feels like a pre-match offer:

• “If you rank us highly, you’ll almost certainly match here.”
• “We plan to rank you to match.”
• “We consider you one of our top candidates and hope you will strongly consider us.”

These statements are non-binding expressions of interest. They are legal under NRMP rules as long as they are not coercive and don’t require a promise of rank position.

4.2 Recognizing inappropriate or risky communication

Red flags that may conflict with NRMP expectations:

• A program asks you to state exactly where you will rank them.
• A program implies that your rank position must be contingent on something (e.g., promising that you’ll cancel other interviews, or not rank other places ahead of them).
• A program states or implies a binding guarantee outside the Match, especially accompanied by paperwork that looks like a contract for a position in an NRMP-participating program.

If you encounter this, you can:

• Politely deflect: “As per NRMP policy, my final rank list must remain confidential, but I can say that I am very interested in your program.”
• Consult your Dean’s office or GME advisor.
• Review the NRMP’s Match Participation Agreement and, if needed, contact NRMP for advice.

4.3 How to respond to strong interest without overcommitting

If a program sends you a message such as:

“We were very impressed with your application and plan to rank you to match. We hope you will seriously consider ranking us highly.”

You might respond:

Dear Dr. [Last Name],

Thank you very much for your kind note and for your consideration. I truly enjoyed my interview day at [Institution], particularly the opportunity to see how closely residents and faculty work together on the wards.

I continue to have a very strong interest in the Preliminary Medicine program at [Institution] and will certainly take your message into careful consideration as I finalize my rank list.

Sincerely,
[Your Name], MD

This acknowledges their interest, maintains professionalism, and does not overpromise. You retain full control of your rank list.

---

5. Communication With Programs Before Match: Best Practices and Common Pitfalls

5.1 Best practices for professional communication

1. Be concise and specific

   • One page or less per email.
   • State your purpose in the first few lines.
   • Avoid vague flattery—be concrete: rotations, curriculum, culture.

2. Use a professional tone and format

   • Proper salutations (Dr. [Last Name]) and sign-offs.
   • Include your full name and AAMC ID.
   • Check spelling, grammar, and the correct program name.

3. Individualize each message

   • Reference a specific experience or conversation.
   • Show that you understand the program’s unique features.

4. Stay honest

   • Never exaggerate your intentions (e.g., claiming they are your #1 if they’re not).
   • Don’t fabricate ties to a region or personal circumstances.
   • It’s fine to be enthusiastic; it’s not fine to be misleading.

5. Coordinate messages with your broader strategy

   • Especially if you are also communicating strongly with advanced programs in anesthesia, radiology, neurology, etc.
   • Ensure your stated preferences make sense (e.g., if you tell your advanced program you must be in City A, don’t tell multiple prelim IM programs in other regions they are your “top choice because of location”).

5.2 Common mistakes to avoid

1. Mass, generic emails

   • Programs can spot them immediately.
   • They add little value and can diminish your perceived professionalism.

2. Excessive communication

   • Multiple emails per week, or repeated “checking in,” is rarely helpful.
   • One thank-you + maybe one update for top choices is usually sufficient.

3. Overdisclosure or emotional appeals

   • Sharing extensive personal drama, financial details, or emotionally charged stories is rarely necessary.
   • Stick to relevant, concise explanations if personal circumstances directly affect your rank or location needs.

4. Violating or pushing against NRMP rules

   • Do not indicate willingness to sign contracts outside the Match for NRMP-participating prelim IM programs.
   • Do not agree to share your exact rank list.

5. Neglecting prelim IM communication entirely

   • Some MD graduates spend all their energy communicating with advanced specialty programs and ignore their preliminary medicine year.
   • Remember: your prelim IM experience will heavily shape your intern year and early career; programs value applicants who take it seriously.

---

6. Putting It All Together: A Stepwise Plan for MD Graduates in Preliminary Medicine

To make this practical, here’s a structured approach for MD graduate residency applicants targeting a preliminary medicine year.

Step 1: Before Interview Season

• Review NRMP policies on communication and pre-match rules.
• Identify your priority criteria for prelim IM (e.g., geography, ICU exposure, night coverage model).
• Draft template bones for emails (thank you, updates) that you can customize.

Step 2: During Interview Season

• Log each prelim IM interview:
  • PD name, coordinator, interviewers
  • Key strengths and concerns
  • Personal impressions
• Within 24–72 hours of your interview:
  • Send a concise, individualized thank-you email to the PD (and possibly select faculty).
• Take notes on:
  • How each program supports prelim-only residents.
  • Overlap with your advanced specialty (e.g., shared didactics, joint social events).

Step 3: After Interviews, Before Rank Lists

• Narrow down your top 3–5 prelim IM programs.
• Decide:
  • Is there one prelim IM program that is clearly your #1?
  • Are there any late updates (research, scores, life changes) that matter to programs?
• Send one carefully written update email to your top prelim IM choices, reiterating your interest.

Step 4: In the Final Weeks Before Rank List Deadline

• Decide whether you will send a clear #1 statement to your top prelim IM program.
  • If you do, be explicit and truthful.
  • Do this only for one prelim program.
• For others in your top tier, you may use language like:
  • “I will be ranking your program highly.”
  • “Your program remains one of my top preliminary medicine choices.”

Step 5: After Submitting Rank Lists

• Continue to respond politely if programs send you messages.
• Do not change your level of honesty—if you’ve already told another program they are your #1, do not contradict that.
• Avoid obsessively re-reading or overinterpreting program communications; remember that the algorithm favors your true preferences, so rank in the order you actually want.

---

FAQ: Pre-Match Communication for MD Graduates in Preliminary Medicine

1. Is it acceptable to tell more than one prelim IM program that they are my “top choice”?

It’s strongly discouraged. While it may be technically difficult for programs to verify, misrepresenting your intentions is unethical and potentially damaging if discovered. More importantly, it erodes your own decision-making clarity. Reserve phrases like “#1” or “top choice” for the single program that truly holds that spot. For other programs, phrases like “one of my top choices” or “I will rank your program highly” are more honest and still signal strong interest.

2. Do programs actually care about thank-you emails for preliminary medicine positions?

Many programs do not formally factor thank-you notes into ranking decisions, but they still contribute to your overall professional impression. In prelim IM, where many applicants might view the year as “just a stepping stone,” a thoughtful email can signal that you take the year—and the program—seriously. That said, a lack of thank-you email alone will rarely cause you to be ranked substantially lower; it’s more about professionalism and communication skills.

3. Can a program guarantee me a spot outside the Match for a prelim IM year?

If the program participates in the NRMP for that position, they should not be offering binding contracts outside the Match. Any “guarantee” you receive is not officially binding within the NRMP system and may put the program at risk of violating policies. If someone suggests an actual pre-match contract for a prelim medicine year in an NRMP-participating program, consult your Dean’s office or the NRMP. In most allopathic medical school match pathways, you should assume the Match is the only valid mechanism through which positions are filled.

4. How much communication with programs before Match Day is “too much”?

As a practical rule for an MD graduate:

• Appropriate baseline:
  • Thank-you email post-interview.
  • One update email to top choices if you have meaningful new information.
  • One clear interest signal (e.g., “top choice” or “ranked highly”) if you choose to use it.
• Likely excessive:
  • Weekly emails.
  • Multiple “just checking in” messages without new content.
  • Repeated efforts to get reassurance about your rank position.

Aim for purposeful, respectful communication, not constant contact. Quality and authenticity matter far more than volume.

---

Thoughtful pre-match communication can’t guarantee where you’ll match, but it can clarify your goals, enhance your professionalism, and ensure that your Preliminary Medicine year aligns with your long-term plans. As an MD graduate navigating the allopathic medical school match, focus on honesty, specificity, and strategic outreach, and let the Match algorithm do its work in your favor.