Original Article

National Resident Matching Program Rank Order and Performance in an Internal Medicine Residency

Authors: George D. Everett, MD, MS, Edward Maharam, MD, Fanchao, Yi MS


Objectives: Prospective first-year house staff and residency program leaders spend substantial time, effort, and expense preparing a rank order list for the National Resident Matching Program (NRMP). Previous studies have mostly shown minimal or no relation between rank order and subsequent resident performance, raising questions about the value of this process. Furthermore, no previous studies have been done with Internal Medicine residencies. As such, the purpose of this study was to compare NRMP rank order to multiple objective outcomes of an Internal Medicine residency.

Methods: A retrospective cohort of Internal Medicine residents from five consecutive graduating classes, trained between July 1, 2013 and July 31, 2020, were evaluated for five objective outcomes: Accreditation Council for Graduate Medical Education (ACGME) milestones, faculty rankings of quality, National In-Training Examination scores, chief resident attainment, and fellowship attainment. Outcomes were analyzed in relation to eight potential predictors: NRMP rank, medical school type and grades, immigration status, added qualifications, sex, age and US Medical Licensing Examination (USMLE) scores, using univariate and multivariate analyses.

Results: From a cohort of 61 residents, 56 were eligible. All eligible residents’ data were included, for a participation rate of 100% (56 of 56). There were no statistically significant univariate or multivariate predictors for the endpoint of fellowship attainment. Higher USMLE scores were predictive of chief resident status in univariate analysis only. NRMP rank was significantly correlated with ACGME milestones in the univariate analysis. The multivariate analysis revealed that higher USMLE score was statistically significantly predictive of more favorable milestones, faculty ranking, and National In-Training Examination score.

Conclusions: Higher USMLE score was statistically significantly associated with multiple favorable objective residency outcomes in an Internal Medicine residency. A better NRMP rank was correlated with favorable ACGME milestones in univariate analysis, but USMLE score emerged as the strongest predictor in multivariate analysis.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Wall J, Votey SR, Solomon T, et al. Is National Resident Matching Program rank predictive of resident performance or post-graduation achievement? 10 years at one emergency medicine residency. West J Emerg Med 2019; 20:641–646.
2. Eiff MP, Ericson A, Uchison EW, et al. A comparison of residency applications and match performance in 3-year vs. 4-year family medicine training programs. Fam Med 2019;51:641–648.
3. Van Meter M, Williams M, Banuelos R, et al. Does the National Resident Match Program rank list predict success in emergency medicine residency programs? J Emerg Med 2017;52:77–82.e1.
4. Breyer MJ, Sadosty A, Biros M. Factors affecting candidate placement on an emergency medicine residency program's rank order list. West J Emerg Med 2012;13:458–462.
5. Bent JP, Colley PM, Zahtz GD, et al. Otolaryngology resident selection: do rank lists matter? Otolaryngol Head Neck Surg 2011;144:537–541.
6. Olawaiye A, Yeh J, Withiam-Leitch M. Resident selection process and prediction of clinical performance in an obstetrics and gynecology program. Teach Learn Med 2006;18:310–315.
7. Pretorius ES, Hrung J. Factors that affect National Resident Matching Program rankings of medical students applying for radiology residency. Acad Radiol 2002;9:75–81.
8. Adusumilli S, Cohan RH, Marshall KW, et al. How well does applicant rank order predict subsequent performance during radiology residency? Acad Radiol 2000;7:635–640.
9. Sklar DP, Tandberg D. The relationship between National Resident Match Program rank and perceived performance in an emergency medicine residency. Am J Emerg Med 1996;14:170–172.
10. Lacy FA, Chen HX, Morrell DS. Dermatology residency applications: correlation of applicant personal statement content with match result. Cutis 2020;105:83–85.
11. Legato JM, Fuller DA, Kirbos C, et al. Matching into an orthopedic residency: which application components correlate with final rank list order? J Surg Educ 2019;76:585–590.
12. Papp KK, Polk HC Jr, Richardson JD. The relationship between criteria used to select residents and performance during residency. Am J Surg 1997;173: 326–329.
13. Accreditation Council for Graduate Medical Education. Internal Medicine milestones. https://acgme.org/acgmeweb/Portals/0/PDFs/Milestones/ InternalMedicineMilestones.pdf. Published 2020. Accessed September 2, 2020.