Navigating Pre-Match Communication: A Guide for Preliminary Medicine Residents

Pre-match communication is one of the most confusing and anxiety-provoking aspects of applying for a preliminary medicine year. Between ambiguous emails, “we’re very interested” comments, and rumors about pre-match offers and early commitment, it can be difficult to know how to interpret messages from programs—and how to respond without jeopardizing your chances.

This guide breaks down what pre-match communication is, what it isn’t, and how to navigate it ethically and strategically as a prelim IM applicant.

---

Understanding Pre-Match Communication in Preliminary Medicine

Preliminary medicine positions sit at a unique intersection in the residency landscape. You’re often applying to prelim IM while also applying to advanced specialties (anesthesia, neurology, radiology, dermatology, etc.), which makes communication and timing even more complicated.

What is “Pre-Match Communication”?

Pre-match communication includes any interaction with a residency program after you submit your application but before the official Match Day, such as:

• Emails from program leadership or coordinators
• Phone calls or personal messages
• Post-interview thank you notes and replies
• Messages about your status (e.g., “you will be ranked highly”)
• Informal questions about your level of interest or intent

For a preliminary medicine year, this communication often focuses on:

• Clarifying whether you have an advanced (PGY-2) position
• Whether you are open to early commitment or pre-match offers (if relevant to your system)
• Your geographic flexibility and preferences
• How the prelim year fits into your long-term specialty goals

Distinguishing Communication From Commitments

It’s critical to separate friendly interest from binding commitments:

• “We enjoyed meeting you and think you’d be a great fit”
  • → Encouraging, but not a guarantee.
• “We plan to rank you highly”
  • → Positive, but still not binding.
• “We are offering you a position outside the Match (pre-match offer); are you willing to commit?”
  • → This may represent a true offer, but rules around this differ by country and system.

In the NRMP Match (U.S.), residency program directors and applicants must follow strict rules:

• Programs cannot ask you to reveal your rank list.
• Programs cannot guarantee that you will match.
• You cannot be required to promise to rank a program first as a condition of being ranked.

However, programs are allowed to express interest, and you are allowed to express genuine enthusiasm—as long as no one is asking for, or giving, a guaranteed outcome.

Key point: In the U.S. NRMP system, true “pre-match offers” for categorical and preliminary medicine positions are rare because programs are expected to participate in the Match. In some other systems (or special institutional agreements), early commitment can still occur—always verify the rules that apply to your context.

---

The Role of Communication in Matching to a Preliminary Medicine Year

Pre-match communication does not replace your application strength, but it can influence fine details—especially around borderline decisions or tie-break scenarios.

Why Programs Communicate Before the Match

Programs reach out before the Match for several reasons:

1. Gauge your level of interest

   • They want to know if you are likely to rank them, especially if you also have many advanced specialty interviews.

2. Assess how the prelim year fits into your long-term plan

   • For example, anesthesia-bound vs. derm-bound vs. undecided applicants may have different needs.

3. Improve their rank list strategy

   • Programs aim to fill all their positions; understanding applicant preferences helps reduce the risk of going unfilled.

4. Maintain relationships and professionalism

   • Communication is part of their culture and branding; some programs are highly communicative, others are very quiet.

Why It Matters More for Prelim IM Applicants

Prelim IM applicants often have two moving parts:

• A preliminary medicine year (PGY-1)
• An advanced specialty position (PGY-2+)

This creates distinct scenarios:

• You matched (or expect to match) into an advanced specialty that requires a prelim year at a specific location or region.
• You are uncertain if you’ll match to your advanced specialty and want a solid prelim year as backup.
• You are applying to categorical IM and prelim IM in parallel for flexibility.

Programs know this and may tailor pre-match communication to:

• Ask whether you already hold an advanced spot.
• Determine whether you will be present for just one year or might potentially stay on (in rare cases of internal transition to categorical slots).
• Clarify if you would accept a prelim IM position there even if your advanced specialty match is uncertain.

---

Common Types of Pre-Match Communication (and How to Respond)

Understanding the flavors of communication you might receive helps you react calmly and strategically.

1. Administrative Clarifications

Examples:

• “We are confirming that you are applying to our preliminary medicine year only, not categorical IM.”
• “Do you have or anticipate having an advanced position starting PGY-2?”
• “Can you confirm your visa status?”

How to respond:
Be prompt, precise, and factual:

• Answer each question clearly.
• Avoid additional narratives unless needed.
• Confirm understanding and appreciation for their time.

Sample response:

Dear Dr. [Name],

Thank you for your message. To clarify: I am applying to your Preliminary Medicine program only. I do not currently have an advanced position secured; I am applying in [Anesthesiology/Neurology/etc.] through the NRMP Match this cycle.

Please let me know if any additional information would be helpful.

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

2. “We’re Very Interested” or “You’ll Be Ranked Highly”

These can be exciting but also confusing. Emails or calls like:

• “You are among our top candidates.”
• “We plan to rank you highly.”
• “You would be an excellent fit for our prelim IM program.”

What this usually means:

• They liked your application and interview.
• They may indeed rank you highly—but you cannot know exactly where.
• This still does not guarantee a match.

How to respond:

• Express appreciation and interest if it is genuine.
• Avoid promising anything you don’t intend to do.
• You may state that you “plan to rank them highly” if true, but avoid lying or making absolute statements unless you are sure.

Sample response:

Dear Dr. [Name],

Thank you very much for your kind note and for the opportunity to interview at [Program]. I truly enjoyed meeting the residents and faculty and was impressed by the collegial culture and the strong general medicine training.

I remain very interested in [Program] for my preliminary medicine year and I anticipate ranking your program highly.

With appreciation,
[Your Name]

If you are certain a program is your top choice for your preliminary medicine year, you may ethically state that—once you’re sure.

“I intend to rank [Program Name] as my first choice for my preliminary medicine year.”

Be aware: program communication before match is not supposed to be used to pressure you. Use such statements only if honest; they are not required or expected.

3. Questions About Your Rank List or Commitments

Examples:

• “Will you be ranking us first?”
• “If we rank you highly, will you rank us highly as well?”
• “Can you commit to joining us if we offer a position?”

Under NRMP rules (U.S.):

• Programs should not ask you to disclose your rank order or to make a commitment.
• You are not obligated to answer such questions directly.

How to respond diplomatically:

You can acknowledge interest without violating rules:

Thank you again for the opportunity to interview at [Program]. I greatly appreciate your interest. I am currently finalizing my rank list but I can say that [Program] remains one of the programs I am strongly considering for my preliminary medicine year.

If a question feels uncomfortable or coercive, you can:

• Redirect to your general enthusiasm.
• Avoid commenting on ranking order.
• Document the interaction, especially if it seems to violate NRMP policies.

4. True “Pre-Match Offers” or Early Commitment Discussions

In some environments (e.g., non-NRMP systems, certain institutional arrangements, or other countries), programs may:

• Offer a position outright before the Match
• Ask whether you wish to accept immediately (often with the understanding you will withdraw from the Match or not rank other programs)

For U.S. NRMP-participating prelim IM programs, overt pre-match offers are uncommon and generally discouraged or prohibited. Always:

• Review the NRMP Applicant Agreement.
• Clarify if the program is participating in the Match.
• If unsure, consult your dean’s office or advisor before responding.

If you are in a system where early commitment is allowed:

Ask yourself:

1. Will this program meet my educational and professional needs for my preliminary medicine year?
2. How does this affect my advanced specialty plans (e.g., location, coupled training)?
3. Are you comfortable sacrificing the possibility of matching at other prelim IM programs?

If you are ready to accept:

Thank you for your generous offer to join [Program] for a Preliminary Medicine year starting July [Year]. I am honored by your confidence and am pleased to accept this offer. Please let me know the next steps regarding any paperwork and official confirmation.

If not ready:

Thank you very much for considering me for a position at [Program]. I am honored by your interest. At this time, I am still committed to participating in the Match process and finalizing my rank list, so I do not feel able to accept an early commitment. I hope to remain under consideration for your program through the standard Match process.

---

How to Communicate Effectively With Programs

Your own communication is as important as how you interpret emails from programs.

Before Interviews: Clarifying Interest and Logistics

• Respond to interview invitations promptly and professionally.
• If schedule conflicts arise (e.g., advanced specialty interview days), communicate early.
• If you are particularly interested in a program but have not received an interview, a polite interest update can be reasonable.

Example “interest” email (pre-interview):

Dear Dr. [PD Name] and [Coordinator Name],

I hope you are well. I am writing to express my continued strong interest in the Preliminary Medicine program at [Institution]. As someone pursuing [e.g., Anesthesiology], I am seeking a rigorous internal medicine foundation, and I was particularly drawn to your program’s [specific features: night float system, ICU exposure, research, mentorship, etc.].

I recognize how competitive this year is and understand if interview spots are limited. If any interview opportunities become available, I would be very grateful to be considered.

Thank you for your time and for your dedication to training future physicians.

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

After Interviews: Thank You Notes and Letters of Interest

While not mandatory, thoughtful and concise messages can reinforce your interest.

Post-interview thank you (short version):

Dear Dr. [Interviewer Name],

Thank you again for the opportunity to interview at [Program] on [date]. I appreciated our conversation about [specific topic] and was particularly impressed by [specific aspect of the program].

I believe your program would provide an excellent environment for my preliminary medicine year, especially in preparation for a career in [your specialty].

Sincerely,
[Your Name]

Letter of Intent (one program only, if genuine):

Use this sparingly; it should be truthful and reserved for the program you truly plan to rank first for prelim IM.

Dear Dr. [PD Name],

I am writing to express my sincere gratitude for the opportunity to interview with the [Institution] Preliminary Medicine program. After careful consideration, I have decided that [Program] is my top choice for my preliminary medicine year.

I intend to rank [Program] as my first choice on my NRMP rank list. I am especially drawn to [1–3 concrete reasons: strong ward teaching, supportive resident culture, exposure to sick and complex patients, alignment with your advanced specialty].

Thank you again for considering my application. It would be an honor to train at [Institution].

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

Tone, Timing, and Professionalism

• Tone: Courteous, concise, and specific. Avoid overly emotional or desperate language.
• Timing:
  • Within 24–72 hours for thank you notes.
  • Late season letters of interest/intent closer to rank list deadlines.
• Professionalism:
  • Correct titles and spelling of names.
  • Use institutional email if possible.
  • Avoid mass emails or generic templates that feel copy-pasted.

---

Strategic Considerations: Protecting Your Match Outcome

Balancing honesty, strategy, and rules can be challenging. For a preliminary medicine year, consider these strategic points:

1. Rank Programs Based on True Preference

The NRMP algorithm is applicant-optimal, meaning:

• You maximize your chance of getting your most preferred program by listing programs in the true order of your preference, not by gaming where you think you are more likely to match.

Do not:

• Rank a lower-preference prelim IM program first solely because you think it likes you more.
• Change your list based on minor wording differences in emails.

2. Align Your Prelim IM and Advanced Specialty Plans

When you’re applying for both a prelim medicine year and an advanced specialty:

• Geographic alignment matters: Matching far apart can complicate logistics (moving, relationships, support systems).
• Training fit matters: For certain advanced specialties, robust intern-year exposure to ICU, acute care, or specific subspecialties may be particularly helpful.

Use pre-match communication to:

• Clarify whether a prelim IM program has experience hosting residents in your advanced specialty.
• Understand call structure, rotation mix, and wellness resources (important for a demanding PGY-1 year).

3. Handle Conflicting or Multiple Expressions of Interest

You may receive encouraging messages from multiple prelim IM programs. To manage this ethically:

• Be honest but not oversharing.
• You can tell more than one program they are “among your top choices,” if accurate.
• Reserve explicit “you are my #1” statements for a single program and only if true.

If asked directly about other programs:

I am fortunate to have interviewed at several strong preliminary medicine programs. I am still in the process of finalizing my rank list, but your program remains one of the programs I am strongly considering.

4. Protect Your Integrity and Reputation

Residency is a small world. Program directors communicate.

Avoid:

• Making contradictory promises to multiple programs.
• Providing misleading or false statements about your rank list.
• Responding in a hostile or unprofessional manner, even if a program’s question seems inappropriate.

If you encounter a clear NRMP violation:

• Document date, time, and content of communication.
• Consult with your dean’s office or an advisor.
• You may report violations to NRMP if warranted.

---

Frequently Asked Questions (FAQ)

1. Does pre-match communication actually affect my chances of matching to a prelim IM program?

It can, but usually in subtle ways. Your application strength, interview performance, and genuine program fit remain the primary drivers. However:

• Thoughtful communication can reinforce your interest and keep you visible near decision time.
• Programs may be slightly more inclined to rank you higher if they believe you are likely to come.

That said, you should not rely on communication alone to compensate for significant weaknesses in your application.

2. Should I tell more than one program they are my “top choice” for a preliminary medicine year?

No. Explicitly stating that a program is your “#1” or that you will rank it first should be reserved for one program only, and only if it is true. Making that promise to multiple programs is unethical and can damage your credibility if discovered. You may legitimately tell multiple programs that they are among your top choices or that you plan to “rank them highly,” if accurate.

3. If a program tells me I’ll be “ranked to match,” does that mean I am guaranteed to match there?

No. The phrase “ranked to match” is frequently misunderstood. Even if a program plans to rank you high enough that you should match there if you rank them first, several variables remain:

• The Match algorithm considers all programs and all applicants simultaneously.
• If you rank another program higher and match there, you will not match at the “ranked to match” program.
• The program may change its list before the final deadline.

Consider such statements as strong interest, not a contract.

4. How often should I email programs after my interview?

In most cases:

• One round of thank you notes after the interview is sufficient.
• One update/interest letter later in the season (if you have something meaningful to add or want to express interest) is reasonable.
• Avoid repeated, frequent emails; they can be perceived as excessive or anxious.

If you have a major update (new publication, exam score, significant award) that strengthens your application, a concise update email is appropriate—but use judgment and avoid sending minor updates just for the sake of contact.

---

Pre-match communication in preliminary medicine can feel like a high-stakes guessing game, but you can approach it calmly and ethically by understanding the rules, reading messages in context, and responding with clarity and professionalism. Focus on building an authentic rank list based on where you will thrive during your preliminary medicine year, maintain integrity in your commitments, and use communication as a tool to clarify—not manipulate—your path to residency.