Mastering Pre-Match Communication in Emergency Medicine Residency

Understanding Pre-Match Communication in Emergency Medicine

Pre-match communication in emergency medicine residency has become more complex and more scrutinized with each passing application cycle. Between ERAS messages, emails, phone calls, and social media, applicants often feel pressure to interpret every word and subtext—while also worrying about violating Match rules or inadvertently committing to an “early deal.”

In emergency medicine (EM), where culture, fit, and interpersonal dynamics are central, the tone and content of communication before Match Day can feel especially loaded. Applicants wonder:

• Is this email a sign they’ll rank me highly?
• Can I tell them they’re my top choice?
• What’s the difference between a strong signal and a pre-match offer?
• How do I protect myself from pressure to make an early commitment?

This guide walks you through what pre-match communication really is, what it is not, how it fits into the EM match process, and how to navigate it ethically and strategically.

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1. The Rules: What’s Allowed (and What Isn’t) Before the Match

Before you can decide how to respond to pre-match communication, you need a clear grasp of the NRMP rules and common interpretations within emergency medicine.

1.1 The NRMP Framework

The National Resident Matching Program (NRMP) sets strict policies that apply to all participating specialties, including emergency medicine residency programs.

Key points:

• No contracts or guarantees: Programs participating in the Match cannot make binding offers or require commitments outside the official Match process.
• No asking for ranking commitments: Programs may not ask you:
  • How you will rank them
  • To provide written or verbal promises about your rank list
  • To state that you will rank them “#1” as a condition of ranking you
• You can volunteer information: You, as the applicant, are allowed to tell a program how you plan to rank them, as long as:
  • You are honest
  • You understand that this is non-binding
• No coercion or undue pressure: Any behavior that pressures you to change your rank list or make an early commitment is a violation of Match policy.

Important: The NRMP emphasizes that the Rank Order List should reflect your true preferences—not pressure, perceived obligations, or fear of losing an offer.

1.2 How This Looks in Emergency Medicine

In emergency medicine, programs care deeply about fit, professionalism, and communication skills. As a result, pre-match communication is common—but it typically stays within the allowed gray zone:

Common, allowed behaviors:

• Thank-you emails from programs after interviews
• Applicants sending thank-you messages to interviewers
• Programs expressing non-binding interest (e.g., “We were very impressed with you”)
• Applicants expressing interest or intent (e.g., “You are one of my top programs”)
• Clarifying information about schedule, curriculum, benefits, or culture

Potentially problematic behaviors:

• Program explicitly saying: “If you tell us we’re #1, we’ll rank you highly”
• Asking you to sign a pre-commitment document
• Suggesting you withdraw from other interviews or the Match
• Implied threats (e.g., “We only rank people who tell us we are their first choice”)

If communication feels like a quid pro quo (“If you say X, we’ll do Y”), that’s where it starts to clash with NRMP rules.

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2. Types of Pre-Match Communication You Might Encounter

Applicants often use the phrase “pre-match offers” loosely, but in NRMP-participating EM programs, true pre-match contracts are not permitted. What you’re more likely encountering are different forms of pre-match signals, interest, and relationship-building.

2.1 Routine Communications

These are normal and expected in an EM match season and do not imply any special status:

• Interview invitations

  • Typically formal and standardized
  • May include language about your file being strong or impressive

• Logistical emails

  • Schedules, instructions, links, parking info
  • Post-interview surveys and feedback requests

• Generic follow-up emails

  • “It was a pleasure meeting you.”
  • “We enjoyed learning more about your background.”

Interpretation: These are courtesy communications, not signals of rank position.

2.2 Post-Interview Interest Signals

After interviews, some programs send messages that sound more enthusiastic. Examples:

• “We were very impressed with your application and interview.”
• “We believe you would be an excellent fit for our program.”
• “We hope you will strongly consider us when you create your rank list.”

In emergency medicine, such emails are common and may be:

• Sent to many applicants (sometimes almost everyone)
• A way to maintain relationships and show that they value you as a candidate
• Not a guarantee of high ranking, and certainly not a promise of matching

Interpretation: These indicate genuine interest, but you should still rank based on your true preferences.

2.3 Strong Positive Signals (“Love Letters”)

Some programs may go a step further and send what applicants call “love letters.” Examples:

• “You are one of the strongest applicants we interviewed.”
• “We intend to rank you highly.”
• “We plan to rank you in a position where we anticipate you could match here.”

These messages tiptoe up to the edge of NRMP guidelines but are generally considered allowable if they avoid guarantees.

Considerations:

• They do not bind programs to rank you in a certain position.
• They do not guarantee you will match there.
• Programs may send similar language to many applicants.

Interpretation: Encouraging, but still not a contract. Use as one data point while prioritizing your own preferences.

2.4 Improper “Pre-Match Offers” and Early Commitment Pressure

True pre-match offers—such as asking you to sign a contract or promising you a guaranteed spot if you make a verbal or written commitment—are not allowed in NRMP-participating EM programs.

Examples of concerning language:

• “If you commit to ranking us #1, we will ensure that you match here.”
• “We expect you to cancel other interviews.”
• “We are willing to offer you a position if you verbally agree now.”

If this occurs in emergency medicine:

• It likely violates NRMP policy.
• It places you at risk if you comply and later decide differently.
• It should prompt you to seek guidance (e.g., home PD, Dean’s office, or NRMP).

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3. How to Communicate with Programs Before the Match

You cannot control what programs send you, but you can control how you respond and how you initiate professional, ethical communication that supports your EM match goals.

3.1 General Principles of Program Communication Before Match

Across emergency medicine residency programs, these habits are consistently viewed favorably:

• Be professional: Clear, concise, polite, free of spelling/grammar errors.
• Be honest: Do not misrepresent your ranking intentions or level of interest.
• Be measured: Avoid excessive or frequent messaging that could feel like lobbying.
• Be specific: When expressing interest, mention concrete reasons (curriculum, mentorship, patient population, etc.).
• Respect boundaries: Don’t push for inside information about their rank list or selection process.

3.2 Thank-You Notes: Are They Necessary?

In EM, practices vary, but:

• Many programs do not require or expect thank-you notes.
• Some explicitly say they do not factor thank-you notes into ranking.
• A well-written, succinct thank-you email can still reinforce professionalism and interest.

If you choose to write:

• Send within 24–72 hours.
• Address specific discussion points (e.g., ultrasound, toxicology, community outreach).
• Keep it to a short paragraph per interviewer.

Example thank-you email (brief):

Subject: Thank you for the opportunity to interview

Dear Dr. Smith,

Thank you for taking the time to speak with me during my interview at [Program Name] on [date]. I appreciated our discussion about the department’s approach to critical care in the ED and the opportunities for residents to be involved in quality improvement. The collegial atmosphere and strong EM culture I observed align closely with what I am seeking in an emergency medicine residency.

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

3.3 Expressing Genuine Interest (Without Overdoing It)

It’s appropriate—and often helpful—to communicate interest to programs that are truly high on your list.

Possible reasons to reach out:

• Clarifying questions about curriculum, schedule, or resident life
• Follow-up on a particular area discussed (e.g., EMS, ultrasound, global health)
• Expressing that they are one of your top choices or similar language

Good approaches:

• “Your program is among my top choices because…”
• “I remain highly interested in training at [Program] due to…”
• “I would be very excited to match at [Program].”

Avoid:

• Emailing every single program multiple times “just in case”
• Using identical “you are my top choice” language for multiple programs
• Overly emotional or effusive content that may feel insincere

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4. Signaling Rank Intentions: What You Can (and Should) Say

Applicants worry a lot about whether—and how strongly—to signal their ranking intentions, especially to EM programs they love.

4.1 What the Rules Allow You to Say

The NRMP allows applicants to:

• Volunteer that a program is your #1 choice.
• Say that a program is a top choice or very high on your list.
• Express strong enthusiasm about matching there.

Caveats:

• You must be truthful. Telling more than one program they are your definitive #1 is unethical and can damage your reputation.
• You must recognize that this is not a binding contract—for either party.

4.2 When to Tell a Program They Are Your #1

Consider telling a program they are your true first choice when:

• You have completed most or all of your interviews.
• You’ve carefully weighed:
  • Clinical training
  • Program culture and wellness
  • Geographic factors
  • Personal and family considerations
• You are confident you will rank them #1 even if other programs show strong interest.

Timing: Typically late January to mid-February, after most interview seasons close and before rank lists are finalized.

Sample email to a true #1 program:

Subject: Ranking Intent – [Your Name], EM Applicant

Dear Dr. [PD Last Name],

I wanted to thank you again for the opportunity to interview at [Program Name] and to learn more about your emergency medicine residency. After completing my interviews, I have decided that [Program Name] is my top choice, and I will be ranking your program #1.

The combination of your high-acuity clinical environment, strong bedside teaching, and evident support for resident well-being makes [Program Name] the place where I believe I will grow into the emergency physician I hope to become. I would be thrilled to join your team and contribute to your department.

Thank you again for your consideration.

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

4.3 What If You Just Have “Top Tier” Programs?

If you have several programs clustered near the top:

• It’s acceptable to use less definitive language:
  • “Your program is among my top choices.”
  • “I anticipate ranking your program very highly.”
• Use this sparingly—reserve such messages for programs where you are genuinely interested and could realistically see yourself matching.

Example:

“After completing my interviews, [Program Name] remains one of my top choices, and I anticipate ranking your program very highly.”

This is accurate and ethical if you have multiple programs in your top 3–5.

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5. Handling Ambiguous or Pressured Pre-Match Communication

Sometimes, pre-match communication from EM programs can feel confusing or even coercive. How you respond can protect both your integrity and your match prospects.

5.1 When a Program Hints at Reciprocity

Language you might hear:

• “We tend to rank applicants highly who express strong interest.”
• “We are very interested and hope you will rank us highly.”
• “We will be finalizing our rank list soon and are curious about your interest level.”

How to respond:

1. Stay honest and non-committal beyond your true feelings.
2. Focus on enthusiasm and fit, not rank positions.

Example response:

“Thank you for reaching out. I remain very interested in [Program Name] and believe it would be an excellent place for my emergency medicine training due to [brief reasons]. I am still in the process of finalizing my rank list, but your program is under strong consideration.”

If they directly ask, “Will you rank us #1?” it’s appropriate to respond:

“Per NRMP guidelines, I’m not able to make any binding commitments about my rank list. I can say that I am very interested in your program and think it would be an excellent fit.”

5.2 If You Feel Pressured to Make an Early Commitment

If a program implies or clearly states that you must:

• Cancel other interviews
• Withdraw from the Match
• Promise a #1 rank position

…this crosses into problematic territory.

Steps to take:

1. Pause. Don’t commit in the moment.
2. Document the communication: save emails or write down details of phone calls.
3. Seek guidance from:
   • Your home EM advisor or PD
   • Student Affairs/Dean’s Office
   • An EM advising organization (e.g., CORD, EMRA resources)
4. If necessary and appropriate, consider contacting the NRMP for clarification or to report a violation.

In practice, emergency medicine programs—especially academic ones—usually avoid explicit rule-breaking. However, gray-zone pressure still exists, and you have the right to protect yourself.

5.3 Red Flags in Program Communication Before Match

Be cautious if you encounter:

• Disparaging remarks about other programs or applicants
• Statements suggesting you should “trust them” instead of the Match process
• Unwillingness to put important logistics (salary, benefits, time off) in writing
• A pattern of inconsistent or unprofessional communication

Remember: You’re not just trying to match anywhere; you’re trying to match at a healthy, supportive EM program. Poor communication now can foreshadow poor culture later.

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6. Strategic Tips for Navigating EM Pre-Match Communication

Putting all of this together, here are practical strategies to help you navigate program communication before the EM match confidently and ethically.

6.1 Rank Based on True Preference, Not Noise

Despite all the emails, calls, and signals, the most important principle of the EM match—and the Match algorithm overall—is:

Rank programs in the order you genuinely prefer them.

Do not:

• Rank a program lower just because they didn’t send a “love letter.”
• Rank a program higher only because they showed strong interest if you wouldn’t actually prefer to train there.
• Try to “game” what you think programs might do with their lists.

6.2 Use a Simple Communication Plan

To avoid confusion and over-communication, consider this structured approach:

• After each interview: Optional short thank-you email(s).
• Early–mid January:
  • Reach out to 3–5 programs you’re seriously considering near the top.
  • Ask any remaining questions you need to finalize your preferences.
• Late January–mid February:
  • Send one clear, honest #1 email to your top program.
  • If appropriate, send non-committal but positive messages to 2–3 other high-ranking programs.

Keep a spreadsheet or list to track:

• Which programs you’ve contacted
• What you said
• Any responses you received

6.3 Maintain Professional Boundaries and Self-Care

The EM match process is intense, and pre-match communication can amplify anxiety.

To stay grounded:

• Limit how often you check email—set specific times of day.
• Lean on mentors—especially EM faculty who know the culture of the specialty.
• Talk with peers, but remember that anecdotal stories can distort your perception.
• Remind yourself: Many successful matches happen with minimal or no strong pre-match signals.

Emergency medicine values resilience, judgment, and composure under stress. How you navigate this phase is part of building those skills.

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FAQs: Pre-Match Communication in Emergency Medicine

1. Do I hurt my chances in the EM match if I don’t send any thank-you emails?
Not necessarily. Many emergency medicine residency programs state that thank-you notes do not affect their rank list. Professional, concise messages can leave a positive impression, but not sending them is unlikely to be a deal-breaker. Focus first on performing well on interviews and aligning your rank list with your genuine preferences.

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2. A program told me they plan to rank me highly. Does that mean I’m guaranteed to match there?
No. “We plan to rank you highly” is a positive sign, but it’s not a guarantee. Programs may give similar feedback to multiple applicants. Whether you match there depends on both your rank list and theirs, as well as how many positions they have and how other applicants rank them.

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3. Can I tell multiple emergency medicine programs that they are my #1 choice?
You should not. Telling more than one program they are your definitive #1 is dishonest and unethical. It can damage your reputation with faculty and within the EM community, which is relatively small and well-connected. You may tell multiple programs they are among your top choices, as long as that’s true—but reserve the explicit “#1” language for a single program.

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4. What should I do if I think a program violated NRMP rules with a pre-match offer or pressure?
First, do not feel obligated to agree or respond immediately. Document the interaction (save emails, summarize calls). Then speak with your home EM leadership, Dean’s Office, or an experienced advisor for guidance. If there appears to be a serious violation—such as explicit offers to circumvent the Match—you can contact the NRMP directly. Their role is to protect the integrity of the Match and support applicants facing inappropriate program behavior.

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Navigating pre-match communication in emergency medicine residency requires professionalism, honesty, and a clear understanding of the rules. If you keep your rank list true to your preferences, communicate ethically, and avoid being swayed by pressure or noise, you will give yourself the best chance to match at a program that truly fits you—and to start your EM career on solid footing.