Mastering Pre-Match Communication for MD Graduates in Med-Peds Residency

Pre-match communication in Medicine-Pediatrics (Med-Peds) can significantly influence how programs perceive you and, in some cases, how they rank you. As an MD graduate applying to Med-Peds, you are expected to communicate professionally, ethically, and strategically—without violating NRMP rules or crossing program boundaries.

This guide walks you through what to say (and not say), when to reach out, how to handle pre-match offers or early commitment pressure, and how to use communication to strengthen your position in the medicine pediatrics match.

---

Understanding Pre-Match Communication in Med-Peds

Pre-match communication is any interaction you have with a residency program outside of the interview itself and outside of the formal ERAS/NRMP systems. For an MD graduate residency applicant in Med-Peds, this typically includes:

• Emails before interview invites
• Communication to schedule or reschedule interviews
• Thank-you notes after interviews
• “Love letters” or update letters
• Clarification questions about curriculum, schedule, or visas
• Rarely, discussions about pre-match offers (in non-NRMP settings)

Why Med-Peds Is Unique

The allopathic medical school match for Med-Peds has a couple of nuances:

• Smaller community: Most Med-Peds programs know each other; word travels fast about applicants who are exceptionally strong—or problematic.
• Dual-focused training: Program directors often look for authentic interest in both internal medicine and pediatrics. Your communication is a key way to demonstrate this.
• High-value signals: Because there are fewer Med-Peds spots than categorical IM or pediatrics, strong, well-timed communication can help clarify your genuine interest and fit.

NRMP and Ethical Rules You Must Respect

If your program participates in the NRMP match (nearly all Med-Peds programs do), there are strict rules around pre-match offers and early commitment:

• Programs cannot:

  • Ask you to reveal your rank list
  • Ask you to commit to ranking them first
  • Offer benefits contingent on ranking them in a certain way
  • Pressure you into early commitment outside the match

• Applicants cannot:

  • Make binding promises about rank order
  • Ask programs to reveal their rank list
  • Engage in quid pro quo (“If you rank me highly, I’ll rank you first”)

You can, however, express interest and even say you intend to rank a program highly or first—if it’s true and done thoughtfully. The key is being honest, non-coercive, and clearly non-contractual.

---

Pre-Interview Communication: Setting the Tone

Thoughtful communication before interviews can help you stand out and open doors—particularly if you are a late applicant, couples matching, or have a unique background.

When It’s Appropriate to Email Before an Interview

As an MD graduate residency applicant, these are reasonable times to reach out:

1. After submitting ERAS but before interview season is in full swing, if:

   • You have a strong, specific interest in Med-Peds at that institution
   • You have a new update (USMLE Step 2 score, publication, new leadership role)
   • You have a geographic tie or personal connection (family, previous rotation)

2. If you are on a waitlist or have not heard from a program late in the season, and:

   • You would seriously consider ranking them highly
   • You can articulate a clear fit (e.g., academic Med-Peds, underserved care, global health)

3. To clarify logistical issues, such as:

   • US visa support
   • Prelim/TY year questions (if relevant)
   • Couples match logistics across institutions

How to Write a Strong Pre-Interview Email

Key principles:

• Short (5–8 sentences)
• Specific to Med-Peds and that program
• Professional subject line
• No entitlement or pressure

Sample structure:

• Subject: “Med-Peds Applicant – [Your Name], ERAS AAMC # – Continued Interest”
• One sentence: Who you are (MD graduate, school, Med-Peds focus)
• One to two sentences: Why this specific Med-Peds program (curriculum, combined training philosophy, location)
• One to two sentences: Brief high-yield highlight (e.g., Med-Peds sub-I, leadership, research)
• One sentence: Explicit, honest expression of interest
• One sentence: Appreciation and a low-pressure close

Example snippet:

I am an MD graduate from [School] applying to Med-Peds residency. I am particularly drawn to [Program] because of your strong continuity clinic model that integrates both adult and pediatric populations, as well as your emphasis on underserved urban communities.

I recently completed a Med-Peds sub-internship where I [1–2 brief outcomes], which further confirmed my desire to train in a combined program. If offered an interview, I would be very enthusiastic to learn more about how your residents develop careers spanning both internal medicine and pediatrics.

Use this type of communication sparingly; emailing every program repeatedly can harm your reputation.

---

Post-Interview Communication: Thank-You Notes and Updates

Once you begin interviewing, your primary pre-match communication becomes follow-up after interviews and occasional updates.

Should You Send Thank-You Notes?

Many programs explicitly state whether they welcome or do not require thank-you notes. As an MD graduate aiming for Med-Peds, a concise, individualized thank-you email is generally safe and often appreciated, especially:

• After an interview where you had particularly meaningful conversations
• When you genuinely feel the program might end up high on your rank list
• When you want to reinforce specific aspects of your fit or interest

If a program’s website specifically says do not send thank-you notes, follow that guidance.

Key elements of a strong thank-you email:

• Sent within 24–72 hours
• Directed to:
  • The program director
  • Or the interviewer(s), cc’ing or routing via the program coordinator per instructions
• Reference 1–2 concrete things you discussed
• Reiterate your interest without overcommitting

Example snippet:

Thank you for taking the time to speak with me during my Med-Peds interview day on [date]. I especially appreciated our discussion about how your residents split their time between the adult and pediatric continuity clinics and the opportunities for combined quality improvement projects.

Our conversation reinforced my impression that [Program] would be an excellent place to grow as a physician caring for patients across the lifespan. I remain very interested in your program and am grateful for the opportunity to interview.

When and How to Send Updates

Updates are appropriate when you have meaningful new information after your interview, such as:

• New Step 2 CK score if it’s a significant improvement
• A first-author publication accepted or published
• A national presentation, leadership role, or award
• A major clarification or change (e.g., couples match status, visa status, or geographic move)

Send updates:

• Once or at most twice, unless something truly major changes
• To the program coordinator (who can forward to PD) or to the PD if the program advises doing so
• With a clear subject line: “Update from Med-Peds Applicant [Name], AAMC #…”

Be brief and factual; avoid frequent, minor updates that risk annoying the program.

---

“Love Letters,” Rank Intent, and Early Commitment Language

This is the most confusing area of pre-match communication for many MD graduate residency applicants in Med-Peds: how to communicate your rank intentions ethically and effectively.

What You Can Say About Your Rank List

You are allowed to:

• Express that you are “very interested” in a program
• Say that a program is “one of your top choices”
• If it’s true and you are sure, state clearly that you “intend to rank them first”

However:

• Never say this to more than one program
• Only say it if you are genuinely committed to doing so
• Avoid wording that implies a binding contract

Example of an ethical, clear “rank 1” message:

After completing my interviews, I wanted to share that [Program] is my top choice for Med-Peds training. I plan to rank your program first on my NRMP rank list because of your commitment to underserved dual populations and the strong sense of community I observed among your residents.

Thank you again for the opportunity to interview and for considering my application.

This sort of communication is most effective:

• After you have completed most or all interviews
• Closer to the rank order list deadline (but not at the last possible minute)

What You Should Not Say or Do

Avoid:

• Telling multiple programs they are your “number one”
• Asking, “Where will you rank me?”
• Offering quid pro quo (“If you rank me highly, I will…”)
• Implying any contract: e.g., “I promise and guarantee I will rank you first” or “I commit legally”

Also avoid over-contacting; sending a new “you’re my top choice” email every few weeks looks insincere.

Love Letters vs. Strategic Updates

A “love letter” (an email explicitly expressing strong interest or rank intentions) can help in a tight medicine pediatrics match scenario, but only when:

• It is highly specific to that program
• It aligns with your actual rank strategy
• You aren’t using a copy-paste template for multiple programs

If you aren’t sure a program will be rank #1, it’s safer to write:

Your Med-Peds program remains one of my top choices, and I can easily see myself thriving in your combined curriculum and community.

That truthfully communicates strong interest without misrepresenting your rank order.

---

Handling Pre-Match Offers, Pressure, and Difficult Conversations

Most ACGME-accredited Med-Peds programs participating in the NRMP will not give formal pre-match offers. However, MD graduate residency applicants sometimes encounter:

• Subtle or explicit pressure to commit
• Vague suggestions of preferential ranking if they “show commitment”
• Non-NRMP institutional positions (rare for Med-Peds, more common in some specialties/regions)

Recognizing Problematic Program Behavior

Red flags in program communication before the match include:

• “If you tell us you’ll rank us first, we can guarantee you a spot.”
• “We expect our top candidates to commit to us before making their rank lists.”
• “We need written confirmation that you will rank us first; otherwise, we may not rank you.”

Such statements conflict with NRMP policies. If you are in the NRMP match, you are not required to agree or respond with a commitment.

How to Respond to Pressure for Early Commitment

You can respond in a professional, noncommittal way:

I really enjoyed learning about your Med-Peds program and appreciate your interest in my application. At this stage, I am still in the process of finalizing my rank list and intend to follow the NRMP guidelines by creating a list that reflects my true preferences. I remain very interested in your program and grateful for the opportunity to interview.

This:

• Acknowledges their interest
• Restates your adherence to NRMP match rules
• Avoids a binding or misleading promise

If you feel very uncomfortable or believe a serious rules violation has occurred, you can:

• Talk confidentially with your medical school dean or adviser
• Consult your school’s GME office
• Review NRMP policies and consider reporting serious violations if appropriate

Pre-Match Offers in Non-NRMP Contexts

A small number of community-based or non-standard programs might attempt to operate outside the NRMP or offer “out-of-match” positions (again, uncommon in Med-Peds in the U.S., but possible in certain settings).

If you encounter a pre-match offer:

• Clarify whether the program participates in NRMP
• Clarify whether accepting their offer excludes you from the NRMP match
• Assess whether this program genuinely fits your long-term career goals

You may hear phrases related to “early commitment”. Before agreeing to anything:

• Ask for all terms in writing
• Consult your dean’s office or mentor
• Remember: once you sign an out-of-match contract that conflicts with NRMP rules, you may be ineligible for the regular match that cycle

When in doubt, be cautious. One secure, aligned match outcome is better than an early agreement that locks you into a poor fit.

---

Best Practices for Professional Program Communication

How you communicate with Med-Peds programs before the match reflects your maturity, reliability, and professionalism as a future resident physician.

General Communication Etiquette

1. Be timely but not instant.

   • Aim to respond within 24–48 hours to program emails
   • It’s okay to take a few hours to compose a thoughtful reply

2. Use a professional tone and format.

   • Formal greeting: “Dear Dr. [Last Name],” or “Dear Dr. [Last Name] and Med-Peds Recruitment Team,”
   • Professional sign-off: “Sincerely,” or “Best regards,” with your name and AAMC ID

3. Avoid overly casual language or emoticons.

   • You can be warm and appreciative without slang or informality

4. Proofread for clarity.

   • Spelling the program name or director’s name wrong is memorable in the wrong way
   • If English is not your first language, consider having a mentor review important emails

5. Centralize your tracking.

   • Keep a spreadsheet of:
     • Interview dates
     • People you met
     • Messages sent or received
     • Key program features
   • This prevents duplicate or conflicting communications

Content to Emphasize as a Med-Peds Applicant

In any communication, it helps to subtly reinforce:

• Your genuine interest in caring for both adults and children
• Experiences that illustrate dual commitment:
  • Rotations that span IM and pediatrics
  • Continuity clinic with mixed-age populations
  • Research or quality improvement across the lifespan
• Alignment with specific aspects of that Med-Peds program:
  • Urban underserved vs. rural underserved
  • Global health, advocacy, primary care, hospitalist, or subspecialty pathways
  • Culture, mentorship, and Med-Peds identity

What to Avoid in Program Communication Before the Match

• Complaining about other programs or locations
• Comparing offers or saying, “Another program said they’d rank me highly—will you match that?”
• Excessively frequent follow-ups (“Just checking in again…” every week)
• Asking for special favors that don’t have a clear reason (e.g., trying to move up your interview date multiple times without extenuating circumstances)

In a small field like Med-Peds, a reputation for being respectful, thoughtful, and low-maintenance can help you in subtle but very real ways.

---

FAQs: Pre-Match Communication for MD Graduates in Med-Peds

1. Should I tell a Med-Peds program they are my first choice?

You can tell one program that they are your first choice if:

• It is true
• You are committed to ranking them #1
• You word it in a non-binding, NRMP-compliant way

This can help your medicine pediatrics match chances at that program, but it is not a guarantee. Do not send this message to multiple programs.

---

2. How many programs should I send “interest” or “love” letters to?

You may:

• Send short thank-you notes to many or all programs, if welcomed by their policies.
• Send strong “one of my top choices” messages to a small number (e.g., your top 3–5).
• Send a clear “I will rank you first” email to one program only, if you are certain.

More is not better. Overuse of “love letters” can dilute your sincerity.

---

3. Are pre-match offers common in Med-Peds for the allopathic medical school match?

In NRMP-participating, ACGME-accredited Med-Peds programs in the U.S., formal pre-match offers are uncommon and generally discouraged. Most Med-Peds positions go through the standard MD graduate residency and NRMP process. If anyone suggests bypassing the match or pressures you to commit early, seek guidance from your dean or adviser and ensure you understand NRMP policies fully.

---

4. Can I ask a program how likely I am to match there or where they will rank me?

You should not. NRMP guidelines discourage discussions about specific ranking positions. Programs may voluntarily say things like, “You are a competitive applicant,” or, “We will rank you highly,” but they cannot promise a match, and you should not request that information. Instead, focus your communication on expressing authentic interest and gathering the information you need to build your own rank list.

---

Thoughtful, ethical pre-match communication in Med-Peds is less about “gaming” the system and more about showing who you are: a reliable, reflective MD graduate who understands dual training and is ready for the responsibilities of combined internal medicine and pediatrics residency. If you approach every interaction with that mindset, your messages will strengthen—not jeopardize—your place in the medicine pediatrics match.