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BCMS – TOGETHER
WE STAND

founded, marking the 5th medical school in the US after which there days to get in contact with as many programs as possible to pander for
was an explosion of new medical schools opening up, many of which an unfilled position. This chaotic and stressful breakdown was changed
were done so by individual physicians with no affiliation to any hospital in 2010 with NRMP replacing it with the Supplemental Offer and Ac-
or university. States began to respond to the increase in medical schools ceptance Program or “SOAP,” where all forms of communication for
and decrease in education quality by creating medical examiner boards unfilled positions are done through the Electronic Residency Applica-
that required state exams to be taken for physician licensure, beginning tion Service (ERAS). Lastly, as of this year, 2022, supplemental appli-
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with the state of Connecticut in 1821 and culminating with the found- cations are being implemented in 15 specialties, up from only 3 last
ing of the American Medical Association (AMA) in 1847. year and United States Medical Licensing Examination (USMLE) Step
Around 40 years later in 1889, two men by the names of Dr. William 1 and Comprehensive Osteopathic Medical Licensing Examination
Halstead and Dr. William Osler devised the first residency programs (COMLEX) level 1 are pass and fail. 6
in the United States for surgery and medicine, respectively, at Johns
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Hopkins University. This concept would spread across the country To paraphrase the Greek philosopher, Heraclitus,
and laid the foundation for all modern residencies as we know it. Only “The only constant is change” and this holds true for not only the prac-
graduating medical students at the top of their class would have the tice of medicine, but also the journey to becoming a physician. There
privilege of being accepted to the early residencies and there was no have been many changes over the years in the process of training physi-
formal system in place to acquire a position. cians and it seems that there will continue to be for the foreseeable fu-
While American medical education suffered from its growing pains ture. There is now talk of increased use of exams such as Casper, which
due to events like the Flexner report, the state of medical residency ma- are designed to test “situational awareness” for use in residency applica-
triculation continued to deteriorate. Up until 1945, hospitals would tions among other things. As a current 4th year medical student in the
commonly scout medical students for residency, even into their second United States, I feel the process still needs major revisions, that at present
year of medical school and lock them into one sided contract, which are above my head, but moving forward with the knowledge of the past
students would take as the only other option was to risk graduating makes things a little more bearable by putting it all in perspective.
without a residency position. To finally combat the recognized problem
the Association of American Medical Colleges (AAMC) implemented References
the “Cooperative plan,” where medical schools would not release stu- 1. National Resident Matching Program, Results and Data: 2022
dent information until a specific date in their senior year. Although Main Residency Match®. National Resident Matching Program,
well intentioned, this led to residencies offering spots with a time limit Washington, DC. 2022.
on a reply, and by 1949 residency offers lasted less than 12 hours with 2. 2. Roth AE. The Origins, History, and Design of the Resident
some hospitals requiring an immediate reply via telephone. Match. JAMA.
To combat this new problem Dr. F.J. Mullun, the dean of students 2003;289(7):909–912. doi:10.1001/jama.289.7.909.
at UChicago School of Medicine proposed a rank-order list solicited 3. Cameron JL. William Stewart Halsted. Our surgical heritage. Ann
from students and residencies that would be used to produce a central- Surg. 1997 May;225(5):445-58. doi: 10.1097/00000658-
ized match. Thus in 1952, the first American medical residency match 199705000-00002. PMID: 9193173; PMCID: PMC1190776.
was performed. This of course was not without its own set of problems, 4. Roth AE. The Origins, History, and Design of the Resident Match.
biggest of all, was the match algorithm used for the first match which JAMA. 2003;289(7):909–912. doi:10.1001/jama.289.7.909
could lead to students losing all matches or matching very low on their 5. “Eras Soap® Information.” Students & Residents, AAMC, 2022,
list if they decided to pick a “reach” program as their top program. This https://students-residents.aamc.org/applying-residencies-eras/eras-
problem was fixed with the implementation of the Boston-Pool algo- soap-information.
rithm and then fixed again in 1998 with the switch to the Roth-Peran- 6. “Specialties Participating in the Supplemental ERAS® Application.”
son algorithm which prioritizes students lists over program’s ones. Students & Residents, 2022, https://students-residents.aamc.org
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More recently in the history of the Match, couples were officially /applying-residencies-eras/specialties-participating-supplemental-
able to match together starting in 1990 whereas before, in the 1970s, eras-application.
couples would ask permission from their schools’ dean to rank together.
The Match was extended to medical fellowships in the ‘80s and ‘90s Mark Andrew Tobias is a medical student at the University
leading to a more systematic approach to continued education. Before of Incarnate Word School of Osteopathic Medicine, Class of
2010, if one did not match during match day, they would enter a period 2023. He is interested in Psychiatry.
of time known as “The Scramble,” in which they would have hours to

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