• Mei Liang, Laurie S Curtin, Mona M Signer, and Maria C Savoia.
• M. Liang is director of research, National Resident Matching Program, Washington, DC.L.S. Curtin is chief policy officer, National Resident Matching Program, Washington, DC.M.M. Signer is president and chief executive officer, National Resident Matching Program, Washington, DC.M.C. Savoia is dean for medical education, University of California, San Diego School of Medicine, La Jolla, California.
• Acad Med. 2017 Jul 1; 92 (7): 991-997.

PurposeThe application and interview behaviors of unmatched U.S. allopathic medical school senior students (U.S. seniors) participating in the 2015 National Resident Matching Program (NRMP) Main Residency Match were studied in conjunction with their United States Medical Licensing Examination (USMLE) Step 1 scores and ranking preferences to understand their effects on Match outcome.MethodUSMLE Step 1 score and preferred specialty information were reviewed for U.S. seniors who responded to the 2015 NRMP Applicant Survey. Unmatched U.S. seniors were categorized as "strong," "solid," "marginal," or "weak" based on the perceived competitiveness of their Step 1 scores compared with U.S. seniors who matched in the same preferred specialty. The numbers of applications sent, interviews obtained, and programs ranked also were examined by Match outcome.ResultsStrong unmatched U.S. seniors submitted significantly more applications to achieve and attend approximately the same number of interviews as strong matched U.S. seniors. Strong unmatched seniors ranked fewer programs than their matched counterparts. As a group, unmatched U.S. seniors were less likely than their matched counterparts to rank a mix of competitive and less competitive programs and more likely to rank programs based on their perceived likelihood of matching. A small number of unmatched U.S. seniors would have matched if they had ranked programs that ranked them.ConclusionsU.S. seniors' Match outcomes may be affected by applicant characteristics that negatively influence their selection for interviews, and their difficulties may be exacerbated by disadvantageous ranking behaviors.

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