Pre-Match Communication Guide for Med-Peds Residency Applicants

Understanding Pre-Match Communication in Med-Peds

Pre-match communication in Medicine-Pediatrics (Med-Peds) has always been nuanced, but recent changes to Match rules and evolving program cultures have made it even more important for applicants to understand what is appropriate, what is risky, and how to advocate for themselves ethically.

In Med-Peds, where programs are relatively small and communities are tight-knit, your emails, thank-you notes, and post-interview conversations can have a real impact on both how you are perceived and the information you receive. At the same time, there are strict National Resident Matching Program (NRMP) rules that protect the fairness of the process and prohibit coercive behavior, including certain forms of pre-match offers and early commitment pressure.

This guide will walk you through:

• What “pre-match communication” actually means in Med-Peds
• How NRMP rules apply to pre-match offers and early commitment
• How to communicate interest without crossing ethical lines
• How to handle ambiguous or uncomfortable program communication before Match
• Practical email templates, phrases, and timelines tailored to Med-Peds

Throughout, we’ll pay special attention to the unique features of Med-Peds residency: smaller class sizes, combined medicine and pediatrics training, and a culture that often values close mentorship and long-term relationships.

---

1. Core Principles and Rules: What’s Allowed and What Isn’t

Before thinking about strategy, you need a clear mental model of the rules and the ethical framework surrounding pre-match communication.

1.1 Key Definitions

• Pre-match communication: Any contact between you and a program (or its representatives) about residency before rank lists are certified. This includes emails, phone calls, second looks, social media messages, and conversations at conferences or virtual meet-ups.
• Pre-match offer: Any explicit or implicit indication from a program that they will rank you in a specific way in exchange for or conditional on your ranking them in a certain way or committing early.
• Early commitment: A request—stated or implied—for you to promise that you will rank a program first, withdraw other applications, or otherwise “lock in” your choice before Match Day.
• Program communication before Match: All forms of outreach from programs to applicants, including routine updates, invitations, and expressions of interest.

1.2 NRMP Rules That Matter to You

The NRMP Match Participation Agreement applies to both applicants and programs. Some of the most relevant rules include:

• No commitments outside the Match
  Programs and applicants cannot make binding or contingent commitments about ranking or placement outside the Match.

  • A program cannot say: “If you rank us #1, we will guarantee you a spot.”
  • You cannot say: “I promise to come to your program no matter what.”

• No asking about rank lists
  Programs cannot require you to disclose how you plan to rank them or other programs.
  You, similarly, should not try to extract explicit rank information from them.

• Non-binding statements of interest are allowed

  • You may tell a program: “I plan to rank your program highly” or even “You are my top choice.”
  • Programs may say: “We are very interested in you” or “We plan to rank you highly.”
    These statements must be understood as non-binding and not guaranteed.

• No pressure, no coercion
  Any communication that pressures you to rank a program in a certain way, withdraw from the Match, or avoid interviewing elsewhere can be reportable to NRMP.

The essential principle:
You and programs may express enthusiasm, but cannot exchange promises or conditions.

---

2. Typical Patterns of Pre-Match Communication in Med-Peds

Med-Peds has its own culture around pre-match communication that differs in subtle ways from larger specialties.

2.1 Why Med-Peds Feels More Personal

• Smaller programs, smaller applicant pools
  Many Med-Peds programs take 4–8 residents per year, and the national Med-Peds community is relatively small. Faculty often know each other, and your name may come up at multiple institutions.
• Long-term, mentorship-focused culture
  Med-Peds values continuity, teaching, and community engagement. Programs often truly want to get to know applicants as future colleagues.
• Wide range of program personalities
  Some programs are highly structured and “by-the-book,” with minimal post-interview contact. Others are very warm and communicative, with frequent outreach and “we’re excited about you” messages.

Because of this, you might:

• Receive more personal emails from Med-Peds PDs or APDs than you expected.
• See strong expressions of interest that feel almost like promises.
• Feel pressure—even unintentionally—from enthusiastic faculty who want you to feel wanted.

2.2 Common Types of Pre-Match Communication

You’ll probably encounter some combination of these:

1. Routine thank-you exchanges

   • Your thank-you emails after interviews
   • Brief replies from faculty or residents acknowledging your note

2. Program interest emails

   • “We enjoyed meeting you and are excited about your interest in our Med-Peds residency.”
   • “You remain a strong candidate for our program.”

3. Post-interview updates or “love letters” from applicants

   • Your emails to programs clarifying interest, updates on achievements, or signaling preferences.

4. Virtual or in-person second looks

   • Optional chances to meet more residents, see facilities, or explore the city.
   • These should be informational only, not evaluative.

5. Ambiguous or borderline communications

   • “If you come here, we would really rank you highly.”
   • “We’re hoping you’ll make the right choice about where you rank us.”

Recognizing these patterns helps you respond with confidence and maintain both professionalism and integrity.

---

3. Strategically Communicating with Med-Peds Programs

You can use pre-match communication to clarify your interest, strengthen relationships, and gather information—without violating rules or creating ethical concerns.

3.1 General Principles for All Written Communication

1. Be honest
   Do not claim a program is your top choice if you are unsure or if that might change. Your professional reputation in a small specialty matters long-term.

2. Be concise and specific
   Program leaders are busy. Aim for 2–5 sentence emails unless there’s a substantial update.

3. Be respectful of boundaries
   Expect that some programs will not respond to preference signals. That’s their policy, not a reflection on your candidacy.

4. Never ask for rank position or guarantees
   Avoid questions like “Will I be ranked to match?” or “Where am I on your list?”

3.2 Post-Interview Thank-You Emails

Many Med-Peds programs welcome brief thank-you notes, even if they state they are not required.

Timing: Within 48–72 hours after your interview.

Goals:

• Express gratitude
• Highlight a specific aspect of the program you appreciated
• Reinforce your sincere interest

Example (Program Director):

Subject: Thank you for the opportunity to interview

Dear Dr. Patel,

Thank you for the opportunity to interview with the [Program Name] Medicine-Pediatrics residency. I enjoyed learning more about your emphasis on transitions of care and the strong Med-Peds presence in both inpatient medicine and pediatrics.

I particularly appreciated the discussion about how graduates pursue combined hospitalist roles and primary care, which aligns closely with my career goals. I am very interested in your program and grateful for your time and consideration.

Sincerely,
[Your Name], MS4
[Medical School]

You can adjust for faculty or residents, focusing on something you discussed specifically with them.

3.3 When (and How) to Send “Interest” or “Update” Emails

After interviews are complete (often late December to early February), it is common and generally acceptable to send limited follow-up communication.

3.3.1 Types of Post-Interview Messages

1. Top-choice signal (if you genuinely have one top choice)
2. Strong-interest email (for programs you rank highly, but not #1)
3. Substantive update (new publication, award, major project, or board score release)

a. Top-Choice Email (Use Sparingly!)

Send this only if:

• You are confident the program will remain your #1
• You are comfortable standing by this statement if asked later in professional contexts

Example:

Subject: Continued interest in [Program Name] Med-Peds

Dear Dr. [PD Last Name],

I wanted to thank you again for the opportunity to interview with the [Program Name] Medicine-Pediatrics residency and to let you know how strongly I feel about your program.

After completing my interviews, I have reflected carefully on my priorities, including comprehensive combined training, strong Med-Peds identity, and opportunities in urban underserved medicine. Your program clearly stands out in all of these areas.

I plan to rank [Program Name] as my first choice in the Medicine-Pediatrics Match. Thank you again for your time and for considering my application.

Sincerely,
[Your Name]

Note: This is a non-binding expression of intent, which is allowed, as long as it is truthful.

b. Strong-Interest Email

For programs that you are ranking highly (e.g., top 3–5), but not necessarily first:

Subject: Ongoing interest in [Program Name] Med-Peds

Dear Dr. [PD Last Name],

I remain very interested in the [Program Name] Medicine-Pediatrics residency after completing my interview season. The combination of strong inpatient training, exposure to complex pediatric chronic disease, and the supportive resident culture are exactly what I am hoping to find in a training program.

I anticipate ranking [Program Name] highly on my list and would be honored to train there. Thank you again for your time and for all the thought your team puts into Med-Peds education.

Best regards,
[Your Name]

This language is accurate but does not claim that the program is first.

c. Update Email

If you have a meaningful new achievement, you can send a concise note:

Subject: Application update – [Your Name], Med-Peds applicant

Dear Dr. [PD Last Name],

I hope you are well. I wanted to share a brief update since our interview. My manuscript on transitions of care for adolescents with congenital heart disease was recently accepted for publication in [Journal Name]. This work has further confirmed my interest in caring for patients across the lifespan, which is why Med-Peds is such a meaningful fit for me.

I remain very interested in [Program Name] and appreciate your consideration of this update.

Sincerely,
[Your Name]

3.4 Communication Timeline: From Interview to Rank Submission

A reasonable communication plan for Med-Peds might look like:

• Within 2–3 days of each interview:
  – Send thank-you emails to PD and any key faculty you met one-on-one.
• Mid-season (optional):
  – Short update if you have major new information.
• After you’ve completed all interviews and reflected on your list:
  – One carefully considered email to your genuine top-choice program (if you have one).
  – Optional 1–3 strong-interest emails to other programs you would be thrilled to match at.

Avoid sending repeated, weekly, or “just checking in” emails; this can become counterproductive.

---

4. Pre-Match Offers, Early Commitment, and Red Lines

The phrases “pre-match offers” and “early commitment” can cause confusion, especially for applicants hearing mixed advice. In the Med-Peds context, you should be very clear about what is—and is not—acceptable.

4.1 What a True “Pre-Match Offer” Would Look Like

In an NRMP-participating specialty like Med-Peds, a true pre-match offer (as in “sign a contract and we’ll skip the Match”) would be a violation of NRMP rules.

Examples of inappropriate or reportable offers:

• “We’d like to offer you a guaranteed position if you agree not to enter the Match.”
• “If you send us a written commitment that you’ll rank us #1, we’ll guarantee to rank you to match.”
• “We expect you to cancel your other interviews if you want to stay competitive here.”

If you encounter something that feels like this, you should:

1. Pause and do not agree to any binding commitment.
2. Document the communication (date, time, person, exact wording).
3. Speak with your dean, Med-Peds advisor, or your school’s GME office.
4. Consider reaching out to NRMP for confidential guidance.

4.2 Recognizing Softer Pressure and “Grey Zone” Language

More often, pressure is indirect and couched in friendly language:

• “We’d really like to know if we’re your top choice before we finalize our list.”
• “We tend to rank applicants highly if they tell us we’re number one.”
• “It helps us a lot if you can promise you’ll come here if we rank you to match.”

This is problematic because it creates a conditional understanding:
“If you tell us X, we’ll do Y.”

You can respond professionally without compromising yourself:

“I’m very grateful for your interest and I’m strongly considering your program. I want to be transparent that I’m still in the process of finalizing my rank list, and I’m committed to following NRMP guidelines about non-binding preferences.”

You are allowed to express real enthusiasm without making promises.

4.3 How to Handle Explicit Questions About Your Rank List

Occasionally, someone may ask you directly:

• “Where are we on your list?”
• “Are we your number one?”

You are not obligated to answer this. Programs should not be asking, but if they do, try one of these approaches:

If they are your true #1 and you want to say so:

“I’ve thought carefully about my preferences, and I can share that your program is my top choice. I will be ranking [Program Name] first.”

This is allowed, as long as it is true and you understand it is not binding.

If you don’t want to disclose specifics:

“I’m still in the process of finalizing my rank list, but I can say that I’m very enthusiastic about your program and plan to rank it highly.”

If you feel the question is not appropriate:

“I prefer not to share the specifics of my rank list out of respect for NRMP guidelines, but I really appreciate your interest and remain excited about your program.”

4.4 Protecting Yourself Ethically and Professionally

In Med-Peds—where you may see the same faculty at conferences or collaborate on research later—your long-term credibility is priceless. Some key points:

• Never tell more than one program: “You are my #1.”
• Do not agree to withdraw from the Match or from other interviews as a condition of interest.
• If something feels wrong, trust your instincts and consult an advisor.

---

5. Using Pre-Match Communication to Your Advantage (Without Overdoing It)

You can leverage program communication before Match to clarify fit, strengthen relationships, and reduce anxiety—if you approach it thoughtfully.

5.1 When It’s Appropriate to Reach Out

Consider reaching out when you:

• Have a specific question (curriculum, call schedule, fellowship outcomes, geographic considerations, couples match logistics).
• Have a meaningful update (accepted manuscript, national presentation, new leadership position).
• Are trying to decide between two or three programs at similar ranking levels and need additional information to differentiate them.

Examples of appropriate questions:

• “Could you share more about how Med-Peds residents integrate into both categorical medicine and peds teaching services?”
• “What proportion of recent graduates pursued combined Med-Peds hospitalist roles versus fellowship training?”
• “Is there flexibility for Med-Peds residents to tailor their schedule if they’re interested in global health or community-based primary care?”

5.2 When NOT to Reach Out

Avoid sending emails that:

• Repeatedly ask for reassurance about your chance of matching.
• Pressure programs to share your rank position.
• Are essentially restatements of previous messages without new content.
• Are sent every few days “just to stay on their radar.”

Excessive emails can dilute the positive impression you made at interview.

5.3 Second Looks: Purpose and Pitfalls

Some Med-Peds programs offer “second look” opportunities—virtual or in-person.

Allowed and reasonable purposes:

• Tour facilities you couldn’t see during virtual interviews
• Meet more residents or see them in a more informal setting
• Learn more about the surrounding community, schools, or partner’s employment options

What second looks should not be:

• Additional interviews used for evaluation
• Opportunities for programs to exert pressure about ranking

If asked whether attending a second look affects your chances, programs should be clear that it does not. If you are concerned about cost, childcare, or travel, it is perfectly acceptable not to attend; this should not harm your medicine pediatrics match outcome.

---

6. Putting It All Together: A Practical Med-Peds Strategy

To bring the pieces together, here’s a step-by-step approach specific to Med-Peds applicants navigating program communication before Match.

6.1 Before Interviews

• Review NRMP guidelines so you know your rights and responsibilities.
• Set personal boundaries in advance:
  – You will not misrepresent your preferences.
  – You will not commit to more than one program as #1.
  – You will seek help if you encounter uncomfortable pressure.

6.2 During Interviews

• Be genuine, curious, and engaged.
• Ask thoughtful questions about Med-Peds identity, integration with categorical programs, and graduate outcomes.
• Note any concerning statements about early commitment or pre-match offers without reacting in the moment; debrief with an advisor later.

6.3 After Each Interview

• Send targeted, brief thank-you emails highlighting specific aspects of the Med-Peds residency that resonated with you.
• Document your impressions for later ranking decisions: strengths, concerns, interpersonal dynamics, and alignment with your career goals.

6.4 After Interview Season (Pre-Rank Submission)

• Reflect on your priorities: geographic needs, training environment, Med-Peds identity, fellowship goals, primary care vs. hospitalist ambitions.
• Draft your preliminary rank list before sending any “top-choice” emails.
• Send:
  • One truthful, well-thought-out email if you have a clear #1 choice.
  • 1–3 strong-interest messages if needed.

6.5 If You Receive Strong Signals from Programs

You might receive emails like:

• “We will be ranking you very highly.”
• “You would be an excellent fit for our Med-Peds residency.”
• “We hope to see you on our roster next year!”

These are non-binding expressions of interest. They can be reassuring, but:

• Do not rearrange your entire rank list solely in response to flattering language.
• Return to your own criteria: training quality, location, culture, fit.
• Remember that many applicants receive similar messages.

6.6 Finalizing and Certifying Your Rank List

• Rank programs in the true order of your preference, independent of what you think they will do.
• Trust the Match algorithm—it favors applicant preferences when you rank honestly.
• Once submitted, avoid second-guessing based on late emails or social media chatter.

---

FAQs: Pre-Match Communication in Med-Peds

1. Can I tell more than one Med-Peds program that they are my “top choice”?

You should not. While the NRMP doesn’t police honesty in preference statements, your professional integrity in a small field like Med-Peds is essential. Word can travel, and you may encounter these program leaders at conferences, in fellowship applications, or as collaborators. You can tell multiple programs you are “very interested” or “will rank them highly,” but reserve “you are my first choice” for one program, and only if it’s truthful.

2. Are pre-match offers ever legitimate in Med-Peds?

In the context of NRMP-participating Medicine-Pediatrics programs, true pre-match offers (guaranteed contracts outside the Match) are not appropriate and may violate Match rules. Some institutions may have separate non-Match positions (e.g., research years, preliminary medicine spots), but Med-Peds categorical positions should go through the Match. If a program suggests otherwise, get clarification, document the conversation, and discuss with your advisor or dean.

3. Will I hurt my chances if I don’t send any post-interview emails?

No. Many Med-Peds programs do not expect extensive pre-match communication beyond standard thank-yous, and some deliberately avoid factoring post-interview communication into their rank decisions. Good interview performance, letters of recommendation, clinical evaluations, and your application materials will always matter more. Thoughtful, limited communication can help clarify interest, but silence will not automatically harm your medicine pediatrics match outcome.

4. How should I respond if a program asks me directly where I’m ranking them?

You are not required to answer. You can respond professionally while maintaining boundaries, for example:

“I’m still finalizing my rank list in line with NRMP guidelines, but I’m very enthusiastic about your program and plan to rank it highly.”

If you feel comfortable and they are genuinely your #1, you may disclose that. If you feel the question is inappropriate or coercive, consider discussing it later with your dean or advisor, especially if there is a pattern of such behavior.

---

Handled thoughtfully, pre-match communication in Med-Peds can help you build authentic professional relationships, gain clarity about program fit, and reduce stress—without compromising your ethics or violating NRMP rules. Focus on honesty, professionalism, and your long-term reputation in the Med-Peds community, and let your true preferences guide your rank list.