The Bottom Line
- The NRMP matching algorithm attempts to place applicants into their most preferred programs based on rank lists and available positions.
- NRMP guidance repeatedly emphasises: rank programs in your true order of preference (not “where you think you’ll get in”).
- Your job is to build an honest, safe rank list: only rank places you can and will train, and avoid trying to “game” the algorithm.
What the algorithm means in practice (IMG version)
For IMGs, the algorithm itself is not the enemy—poor list construction and incomplete preferences are. The algorithm rewards honest preferences; your leverage is interviewing breadth, program fit, and a complete, rational list.
How to build a rank list (practically, not emotionally)
1
1) Start with a “willing-to-train” filter
Never rank a program you would refuse. A rank list creates binding outcomes. If you cannot see yourself training there, do not rank it.
2
2) Rank by true preference, then validate your constraints
Preference includes: program culture, location, visa support reality, and personal constraints (family, finances). Verify these before certifying your list.
3
3) Expand the list where you have interviews
A common failure mode is a too-short list. If you can interview, you can rank; your goal is optionality.
4
4) Avoid “gaming” myths
NRMP guidance is clear that the algorithm tries to place you as high as possible on your own list. Build your list for you—not to predict other people.
5
5) Certify early, then audit your list once
Make one final review: all programs correct, order correct, no duplicates/omissions. Then certify with a buffer. Panic edits create errors.
Rank list audit checklist (before you certify)
1
2
3
4
5
Practice
Test your knowledge
Apply this concept immediately with a high-yield question block from the iatroX Q-Bank.