I still remember the morning of Monday, March 11th, 2019, with vivid clarity. I was on my last rotation of medical school. My medical ICU team was preparing for morning rounds. Vital signs and lab results suddenly seemed less important as my rotation friends, and I anxiously awaited “the email.” At precisely 10 a.m., we would learn if our years of hard work had paid off with a residency position. I was 100 percent confident my friends would be getting a positive email. I, however, was hesitant but hopeful about my own future. When I received an email at 9:49 a.m. from a school official notifying me to report to the office, I was simultaneously shocked and unsurprised. I had not matched. My nightmare had come true.
Fast forward one year to Monday, March 16th, 2020. I found myself nervously awaiting “the email” again. This time, I was in my research office, by myself, and not on a clinical rotation amongst my peers. Internally, I felt significantly different from last year. More confident, more hopeful, and overall happier knowing I was minutes away from a confirmation of my dream coming true. So, when I looked down at the email saying, “Congratulations, you have matched!” I felt a gush of excitement and relief. I was going to be an otolaryngologist! At that moment, I realized I had overcome a major challenge. I had to tell my story. Not only do I have advice to share, but my experience highlights how to maximize a non-traditional pathway to residency.
Otolaryngology-head and neck surgery, or ENT, has historically been one of the most competitive specialties. High board scores. AOA. Numerous extra-curricular experiences. Multiple research publications or presentations. These were the items required to gain entry into this field. Applicant numbers have fluctuated with this competition, with the 2018 match even having unfilled programs. However, this wouldn’t last. In the 2019 match, there were 462 total applicants and only 328 positions available. In looking back at this increase, combined with many missing elements of my own application, it makes sense why I became one of the unmatched 134 applicants. Without a home ENT residency program or academic faculty at my medical school, I lacked essential mentorship and sponsorship. Without ENT-specific research experiences, I failed to have meaningful interactions and stand out on the interview trail. Inner feelings of inadequacy rattled me from the start of my away rotations through to my disappointing match.
Despite these limitations, I wanted another chance to match into this specialty. While I was fortunate to have been accepted for a research fellowship at what had been my top choice ENT program, simply having this position wouldn’t be enough. I had to work extremely hard and build the relationships and experiences that would enable me to succeed.
When I started in June 2019, I set out to create a broad portfolio of research experiences, developing my own skills to conduct research independently, which would serve as an asset to any program I joined. However, I quickly realized the challenges of prospective clinical research, unbeknownst to many medical students. It’s easy to schedule a patient for surgery and research studies. It’s difficult to ensure adequate follow up, consistent data collection, and adherence to interventions. A patient dealing with high-grade head and neck cancer cares only about curing their disease, not participating in your nutrition or pain intervention. Explaining how to share the benefits of research, while staying mindful of patient priorities, is something I learned to balance.
I also made connections with multiple faculty in the department, showcasing my strong work ethic and willingness to help out in any way. My new mentors guided me through the re-application process and worked with me on better highlighting my new strengths. Maneuvering Institutional Review Boards, research protocols, and data collection software was straightforward. Actively managing patient registries, problem-solving issues affecting prospective trials, and collaborating with researchers across hospital systems were skills I mastered.
This year, when interviews came around, I was prepared with confidence and grit. I consistently had meaningful conversations about my experiences, failures, and goals with composure. In one encounter, I spent all 20 minutes talking with the interviewer about patient-reported outcome measures and qualitative research, concepts I first dabbled with only this year. My application was stronger, I had received more interviews, and I completed the 2020 match cycle as a better future Otolaryngologist. Even in a year with 505 applicants for 350 positions, I ended up matching at my #1 program.
I come away from this eager to share my story. But I also want to disassemble the stigma surrounding unmatched students and shed light on the value of post-graduate, non-residency work experiences. The skills I’ve honed this year will benefit my career; the lessons I’ve learned will make me a better physician. Here are my main takeaways from this year:
- If unmatched, do not give up hope. Reflect on why you did not match and how you can improve.
- Find and hold onto the people in your life that inspire you, drive you, and challenge you to be the best version of yourself. These may be mentors, loved ones, or colleagues. Surround yourself with as many of these people as you can.
- Be ready to give the next year (or more) your all. Seize every opportunity. Work hard to showcase to your mentors and colleagues – whether it’s during a research year, a year in a different specialty, or in doing something else – that you deserve to be there and achieve your goal.
- Be humble, be yourself, be respectful of those you work with. Most importantly, be a team-player who is willing to do anything. There is no work that is “beneath you;” whatever helps the team, and the process will help you. This work ethic and team mentality do not go unnoticed.
Not matching may be one roadblock on a medical student’s journey, but it is very possible to overcome.
Rohit Nallani is a physician.
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