Mastering Pre-Match Communication in Emergency Medicine-Internal Medicine

Understanding Pre-Match Communication in EM-IM

Pre-match communication for Emergency Medicine–Internal Medicine (EM IM combined) programs sits at a complex intersection of enthusiasm, ethics, and strategy. Applicants want to show strong interest and potentially receive pre-match offers or clear signals of an early commitment, while programs must follow NRMP rules and maintain a fair process.

Because Emergency Medicine-Internal Medicine is a small, competitive combined specialty, communication before Match Day can feel especially high-stakes. You may rotate at a site that has an EM-IM program, receive encouraging emails after interviews, or wonder how much contact is “too much.” This guide walks you through the landscape: what is allowed, what is risky, and how to communicate strategically and professionally.

Key goals of this guide:

• Clarify the rules and norms around program communication before match
• Explain how EM-IM program size and culture influence communication
• Provide step-by-step strategies for emails, calls, and follow-up
• Offer sample messages and scenarios specific to emergency medicine internal medicine applicants
• Help you protect your integrity and your match outcome

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The Rules and Realities: What Pre-Match Communication Actually Means

Before discussing tactics, it’s essential to understand the framework that governs all communication: the NRMP Match Participation Agreement and individual program policies.

NRMP Rules: The Foundation

While exact enforcement can evolve, several core principles consistently apply:

• No coercion:
  Programs may not pressure you for a commitment, ranking promise, or agreement to list them in a certain position.

• No asking for ranking information:
  Programs should not ask, “Will you rank us #1?” or “Where will you rank our program?”
  Applicants also should not ask programs how they will be ranked.

• No contracts tied to the Match rank list:
  You should not sign anything that obligates you to rank a program in a specific way or withdraw from the Match.

• Voluntary communication allowed:
  You may tell a program honest preferences (“I plan to rank you highly”) and they may express interest, as long as neither side makes promises that contradict the Match process.

In short: expression of interest is allowed; binding promises are not.

How EM-IM’s Structure Shapes Communication

Emergency Medicine-Internal Medicine is unique:

• Fewer programs, smaller classes:
  Many EM IM combined programs take 2–6 residents per year. Faculty and coordinators often know applicants more personally, especially if you did an away rotation or EM or IM sub-internship there.

• Dual-department involvement:
  You’ll be interacting with both EM and IM leadership. The EM side may be accustomed to one culture of communication; the IM side may follow a slightly different set of norms. EM-IM leadership typically tries to harmonize these, but you might receive messages from multiple stakeholders.

• High interest-to-spot ratio:
  Because there are limited EM-IM slots, programs often receive more strong applicants than they can interview or rank highly. Genuine signals of interest can matter, especially when deciding between similarly strong candidates.

• Varying comfort with pre-match offers:
  Some institutions (particularly outside the Main Residency Match or in separate processes, like some military or early commitment tracks) may engage in formal pre-match offers. Most ACGME-accredited EM-IM programs participating in the NRMP Match, however, will not offer a separate early contract, but may send “signals” of enthusiasm.

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Types of Pre-Match Communication You May Encounter

Pre-match communication exists on a spectrum—from simple “thank you” messages to clear pre-match offers in non-NRMP pathways. Understanding these types helps you respond appropriately.

1. Standard Professional Communication

These include:

• Thank-you emails after interviews
• Requests for clarification on curriculum, schedules, or research
• Program updates on rotation structures, faculty, or clinical sites
• Administrative reminders or surveys

These are low-risk, routine, and expected. They do not typically influence ranking heavily, but they contribute to your professional impression.

2. Signals of Mutual Interest

Common examples:

• Program emails saying:

  • “You are an excellent candidate and will be ranked highly.”
  • “We hope to work with you next year.”
  • “You are a great fit for our EM-IM combined program.”

• Applicant emails saying:

  • “Your program is one of my top choices.”
  • “I plan to rank your emergency medicine internal medicine program very highly.”
  • “Your program is currently my first choice.”

These communications are allowed, but must remain non-binding. Programs cannot guarantee that you’ll match, and you cannot rely solely on friendly language when making rank decisions.

3. Semi-Formal “Early Commitment” Signals

In some EM-IM contexts, especially at institutions with strong internal pipelines (e.g., where you did a sub-I, research year, or transitional track), you may see:

• Mentors saying, “They really liked you. If you rank them highly, you have a very good chance.”
• Program leadership mentioning, “We are very interested in having you here. If you’re serious about EM-IM, please let us know your level of interest.”

These remain non-binding but can be informative. They can suggest how competitive you might be at that site, but you should still:

• Avoid overinterpreting “we liked you.”
• Rank based on your true preferences, not perceived odds.

4. Explicit Pre-Match Offers (Usually Outside NRMP)

True pre-match offers—a contract to join a program before the main Match—are uncommon in standard NRMP-participating EM-IM programs. They may show up:

• In certain non-NRMP pathways (e.g., some military match scenarios)
• For international graduates in countries with separate matching systems
• In the context of “institutional tracks” that offer early acceptance outside the main Match

If you receive an explicit pre-match offer in a U.S.-based NRMP-participating EM IM combined program, it is critical to:

• Clarify whether the program is participating in the NRMP for that track
• Understand your obligations if you accept
• Consult your school’s dean’s office or advisor

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How to Communicate Effectively with EM-IM Programs

Effective pre-match communication in EM-IM revolves around three pillars: clarity, professionalism, and honesty. Below is a structured approach you can adapt.

Step 1: Set Your Personal Communication Policy

Before sending any email, decide:

1. Will you tell one program it is your #1?
   Many advisors recommend you do this only if it is completely true and you are confident in that ranking.

2. How many programs will you tell “I will rank you highly”?
   It’s reasonable to send this to several programs you’d be genuinely excited to attend, but avoid sending identical messages to every program; it dilutes credibility.

3. How frequently will you contact programs?
   A typical, appropriate pattern might be:

   • Post-interview thank-you note
   • One follow-up or update message (for significant news or clarifications)
   • One final “interest/intent” email late in the season (if indicated)

Step 2: Write Strong, Clear Post-Interview Emails

Most EM IM combined programs expect a brief thank-you after your interview. Keys:

• Send within 24–72 hours.
• Address each interviewer or at least the program director (PD) and APD.
• Personalize: mention specific aspects of the EM or IM component or combined features that resonate with you.

Example (PD thank-you email):

Subject: Thank you for the EM-IM interview

Dear Dr. [Last Name],

Thank you for the opportunity to interview with the Emergency Medicine-Internal Medicine residency at [Institution]. I enjoyed learning how your residents balance critical care exposure in the ED with longitudinal internal medicine clinic, and I was particularly impressed by the [specific feature, e.g., dual-board preparation curriculum or EM-IM leadership structure].

Our conversations confirmed my interest in training in an EM IM combined program that emphasizes [e.g., resuscitation, leadership in academic medicine, or global health]. I appreciate the time you and your team invested in the interview day and in answering my questions.

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

At this stage, you do not need to declare ranking intentions.

Step 3: Strategically Share Updates and Interest

As the season progresses (typically December–February), you might:

• Receive a new publication, award, or leadership role.
• Clarify your career goals in EM-IM (e.g., critical care, ultrasound, hospital administration, academic leadership).
• Narrow down your top programs.

When to send an update:

• The update is meaningful (not minor activities).
• You are genuinely still interested in that program.
• You can connect your update to how you’d contribute to their EM IM combined track.

Example (update + interest email):

Subject: Update and continued interest in [Institution] EM-IM

Dear Dr. [Last Name],

I hope you are well. Since our interview in [month], I wanted to share a brief update and reiterate my interest in the Emergency Medicine-Internal Medicine program at [Institution].

I recently [e.g., had a manuscript accepted in Academic Emergency Medicine on sepsis resuscitation or completed a quality improvement project in the ICU]. This experience has reinforced my desire to train in an EM-IM environment where I can develop as both an emergency physician and internist, particularly in the care of critically ill patients across settings.

The structure of your program—especially the [e.g., combined EM-IM conference, dual mentorship model, strong ICU rotations]—aligns closely with my long-term goal of [e.g., practicing in academic critical care, leading ED observation units, or bridging ED and inpatient quality improvement].

Thank you again for considering my application. I remain very enthusiastic about the possibility of training at [Institution].

Sincerely,
[Your Name]

This communicates serious interest without overpromising your rank list.

Step 4: Communicating “#1” or “Ranked Highly” Intentions

If you have decided on your top program in emergency medicine internal medicine and are certain you will rank them first, a clear but honest message can be impactful—especially in a smaller specialty like EM-IM.

If you truly have a #1 program:

Subject: Strong interest in [Institution] EM-IM

Dear Dr. [Last Name],

I want to thank you again for the opportunity to interview with the Emergency Medicine-Internal Medicine program at [Institution]. After completing my interviews and carefully considering my goals, I have decided that your program will be ranked as my first choice on my rank list.

The combination of [specific EM features] and [specific IM features], along with the strong integration of the EM IM combined track, aligns perfectly with my plans to [briefly restate your career goals]. I would be honored to train at [Institution] and contribute to the EM-IM community there.

Thank you again for your time and consideration.

Sincerely,
[Your Name]

If you want to signal strong interest without a #1 claim:

Subject: Continued strong interest in [Institution] EM-IM

Dear Dr. [Last Name],

As I finalize my rank list, I wanted to express that your Emergency Medicine-Internal Medicine program remains among my top choices. The combined training environment you offer is exactly what I am seeking in EM-IM, and I would be very excited to match at [Institution].

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

Sincerely,
[Your Name]

Only send a “you are my #1” email to one program, and ensure it reflects your actual rank list to maintain your integrity.

Step 5: Handling Program-Initiated Contact

Programs may reach out to you in various ways:

• Friendly check-ins (“We enjoyed meeting you.”)
• Clarifying questions about your application
• Expressions of strong interest or that you fit the program well

How to respond:

• Remain professional and prompt.
• Acknowledge their message kindly.
• You can express enthusiasm but avoid making promises that conflict with your real intentions.

If a program appears to push boundaries (e.g., asking exactly where you will rank them):

• You may respond with something like:
  “I am still finalizing my rank list but can say that your EM-IM program remains one of my top choices, and I would be very happy to match there.”
• You are not obligated to disclose your exact ranking order.

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Common Pitfalls and How to Avoid Them

In a high-stakes season, it’s easy to misstep in program communication before match. Here are frequent pitfalls, especially relevant to the EM-IM community, and how to avoid them.

Pitfall 1: Overcommunication and “Spamming”

Sending multiple emails to the same program every week or after every minor update can:

• Annoy busy PDs and coordinators
• Make you appear anxious or unprofessional
• Dilute the impact of meaningful messages

Better approach:

• Consolidate updates into one or two well-timed emails.
• Prioritize quality (personalized, specific, concise) over quantity.

Pitfall 2: Copy-Paste Messages with No Personalization

Programs can often tell when a message is generic. This is particularly noticeable in a small EM-IM field where faculty share information.

Avoid:

• “Dear Program Director” with no name.
• Vague statements that could apply to any program (“Your program seems very strong.”).
• Copying the exact same text to multiple programs without editing.

Instead:

• Reference specific aspects of the EM IM combined curriculum, ED or IM rotations, research opportunities, or resident culture.
• Mention conversations from your interview day.

Pitfall 3: Dishonest or Conflicting Statements

Telling multiple EM-IM programs “you are my #1” or “you are my top choice” can:

• Create ethical conflicts if discovered (and faculty in small specialties talk).
• Damage your reputation early in your career.

Honor the spirit of the Match:

• Be honest in your communications.
• If you are unsure how to phrase your enthusiasm, use “rank you highly” instead of “you are my #1.”

Pitfall 4: Letting Communications Drive Your Rank List

It’s tempting to rank programs higher because they sent nice emails or implied you’d match there. This can backfire:

• You may overlook training environment, geography, support systems, or long-term goals.
• Warm communication does not guarantee a match, and silence does not mean disinterest.

Instead:

• Create your rank list based on fit and preference, not flattery or perceived odds.
• Remember that the Match algorithm favors your true preferences.

Pitfall 5: Ignoring Advisor Support

Many schools have advisors with deep experience in emergency medicine internal medicine or at least combined training and competitive specialties.

Use them to:

• Review your planned emails (especially a “you are my #1” message).
• Navigate confusing pre-match offers or early commitment language.
• Assess whether certain communications from programs are appropriate.

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Practical Scenarios Specific to EM-IM Applicants

To make this more concrete, here are common EM-IM–specific scenarios and suggested approaches.

Scenario 1: You Rotated at an EM-IM Site and Loved It

You completed an EM sub-I or IM sub-I with an EM-IM residency and developed strong mentorship connections.

Approach:

• Stay in touch with mentors through the season (occasional updates on interviews, your ongoing interest in EM-IM).
• After interviewing, send a personalized thank-you referencing your rotation experiences.
• If this site becomes your true #1, send them a clear, honest email communicating that.

Scenario 2: You Are Torn Between EM-IM and Categorical EM or IM

You may apply to EM-IM, categorical EM, and/or categorical IM, and receive encouraging communications from all sides.

Key points:

• Decide first what you really want your clinical life to look like long-term (pure EM, pure IM, or a blended pathway).
• Communicate clearly but non-committally with programs while you are genuinely undecided.
• Once you know your path, let your top EM-IM program know where they stand if you feel comfortable doing so.

Scenario 3: A Program Sends Strongly Encouraging Language

You receive an email from an EM-IM PD saying, “We were very impressed, and you will be ranked highly. We’d love to have you here next year.”

How to interpret:

• This is a positive sign, but not a guarantee.
• It should give you confidence that the program likes you, but you should still rank based on your preferences.

How to respond:

Dear Dr. [Last Name],

Thank you for your kind message. I greatly enjoyed learning more about [Institution]’s EM-IM program, and I appreciate the time you and your team took to speak with me. I remain very interested in your program and would be excited to train there.

Sincerely,
[Your Name]

Scenario 4: Confusing Pre-Match or Early Commitment Language

You receive a note like: “If you’re seriously considering us, please reach out to let us know your level of commitment so we can make decisions soon.”

Steps:

1. Re-read the email carefully for any mention of:
   • NRMP
   • Contracts
   • Early acceptance or pre-match offers
2. If unclear, respond with:
   • Appreciation
   • A genuine statement of your interest level (if high)
   • No binding promises.
3. If it sounds like a true pre-match offer for an NRMP-participating program:
   • Before agreeing to anything, talk to your dean’s office or an advisor.
   • Clarify in writing whether this affects your NRMP participation.

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FAQs: Pre-Match Communication in EM-IM

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

You should not tell more than one program that they are your #1 if that is not true. The EM-IM community is small, and conflicting statements can damage your credibility. You may, however, tell multiple programs that you will “rank them highly” if that accurately reflects your intentions.

2. Do programs expect a “love letter” or statement of intent?

Some EM IM combined programs appreciate a final expressions-of-interest email, especially from applicants who are highly enthusiastic. It is not mandatory, but can be helpful. Prioritize authenticity and concision; avoid dramatic or exaggerated language.

3. If a program doesn’t contact me after the interview, does that mean I won’t match there?

No. Programs vary widely in how much program communication before match they initiate. Some contact many candidates; others contact very few or none. Silence does not equal disinterest, and you should still rank programs in your true preference order.

4. How much can pre-match communication actually affect my chances in EM-IM?

In a specialty with smaller cohorts like emergency medicine internal medicine, communication can help distinguish you among similarly qualified applicants, especially if your interests align tightly with the program’s strengths. However, your interview performance, application content, and letters of recommendation remain the primary drivers. Use communication to reinforce fit and professionalism, not to replace a strong application.

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Thoughtful, honest, and well-timed pre-match communication can enhance your EM-IM application, clarify your own thinking, and help programs see how you’d fit into their unique combined training environment. When in doubt, center your decisions on integrity, genuine interest, and long-term fit—and let the Match algorithm work in your favor.