Match Day was among the greatest days of my life. In one thrilling moment my loftiest dreams suddenly came true. Oh, the catharsis! So the following may be surprising: I wish Match Day had not been so wonderful; a large part of the ecstasy was the release of a tremendous amount of stress and anxiety built up over the preceding months and years.

Take a look at the picture of me on the next page. That is about 1 minute before I opened my letter. I think I look happy, yet absolutely terrified. Even better: look at the man-hug going on in the background. I’m actually not joking when I say that that’s just too much happiness!

Let me explain. If you are reading this, you probably experienced and well remember the match process. While difficult to endure, the rank list match algorithm is probably the most just system one can imagine for solving the problem at hand.

However, the process is startlingly opaque and I can’t see why certain aspects of this must continue to be the case, especially in the otherwise open and friendly field of emergency medicine.

So, yes, you read right: I wish Match Day had been less exciting because it would have meant that the process leading up to it had been less stressful and more transparent.

Of the various medical specialties, emergency medicine is among the least “malignant.” In the 11 departments where I have ever worked a shift, I have seen impressive collegiality and candor, originating among attendings and trickling down, affecting how fellows, residents, and students are treated both by their peers and higher ups.

There are refreshingly few “head games.” EM is indeed a sane field with helpful people. And yet just when the stakes get high during the residency application process, students are suddenly thrust into the dark.

One central problem: are students being recruited or judged? Both, of course. This makes it nearly impossible to gather information freely during an interview day, or in communications with programs.

Any given interview day, I had to balance fact finding against the need to avoid asking the “wrong” questions.

My recommendation for programs is to send out a PDF of Frequently Asked Questions to applicants who are granted interviews. It would be nice to have shift hour formats, salary, resident housing, amenities (ACEP dues, anyone?) prior to arrival.

Program directors may be reading this with a wary eye, thinking that this could start a kind of bidding war over what EM programs offer prospective students. Correct! Another major problem is that students apply to too many programs simply because they have to. I had no information other than hearsay as to whether I was competitive at certain programs. According to data from the National Residency Matching Program, once a student has garnered around 10 interviews, the odds of that student matching are better than 90%, assuming the student subsequently ranks all 10 programs on the certified list.

However, knowing how many programs to initially apply to in ERAS in order to secure a safe number of interviews (and how much money to spend) could be demystified if programs published a few pieces of information including interquartile range of the USMLE step 1 and 2 board scores of their interviewees (not necessarily those who matched into the program) over the past 5 years and whether strict cutoffs exist, and what percent of each intern class is typically drawn from students who rotated in the department (i.e. home students plus students who completed “audition” electives) or from local or regional medical schools.

Here is some advice for programs regarding recruiting:

Before interview day:

1. Use online interview broker software for scheduling. What a difference it makes for students!
2. Not interested in an application? Reject it! Especially early on when students can still apply to more programs. There are programs I never heard from – and some of them were not even “competitive.”
3. Publish data about the objective characteristics of our typical interview-ees and residents. It is no badge of dishonor not to have board score cutoffs (many top programs don’t) but if you do have cutoffs, let the students know so they can save time and money.

During interview day:

1. The tour guides matter. Put your best foot forward and train the guides well.
2. Keep the Power Points and Intros under 30-45 minutes. Instead, conduct more interviews per candidate. Research shows that a higher number of interviews leads to better inter-rater reliability. This cuts in your favor.
3. Like in the ED, flow matters; don’t make candidates wait for hours with nothing to do. It reflects on departmental organization and how well incoming residents are regarded.

During the interview itself:

• Don’t “pump” students. Asking applicants medical questions reveals more about your insecurity about your residents and your program than you could possibly learn about the applicant.
• Ask “why are you interested in our program,” but please don’t actually care about the answer in most cases. Medical students apply broadly because they have to (see above).

After interview day:

1. Don’t ask students to reveal whether your program is their first choice, even indirectly. This is especially onerous when quid pro quo is implied and is actually illegal. I think it is fair to express “serious interest” in both directions and leave it at that. At day’s end, some stress is inevitable to the matching process – not the least of which is the 3.5-week wait while the computer algorithm is checked for quality. However, I think many of my suggestions would lend greater transparency at key points, minimizing the accumulation of anxiety over the entire 6-8-month process.

Lastly, program directors, if you take nothing else from this, though, I’m sure we all agree that students are looking for a place to call home. So, please don’t skimp on the food and coffee!

Dr. Faust is an EM resident at Mount Sinai Hospital, New York, and tweets about mE.D.icine and classical music @JeremyFaust.