On the morning of Friday, March 16, Brian Henick, 26, a fourth-year medical student at the University of Medicine and Dentistry of New Jersey was a nervous wreck. The past seven years of his life had been spent preparing for that day, when his fate would come in a sealed envelope during a ceremony in the school’s auditorium.

“I got mine probably half an hour before the time came to open it,” said Henick. “I just kind of went numb and forgot what I was doing and sat around holding it. It was completely surreal.”

After students received their envelopes, everyone counted down together and then ripped them open. “It was so hectic, people just started jumping up for joy, and I thought ‘Oh my god, I need to get out of here,’ and bolted for a study room that was quiet,” Henick recalled. When he opened the envelope, his eyes went straight to the bottom of the page where the answer lay: Yale University’s internal medicine program, his number one choice. “I started crying, I couldn’t help it. Then I went to call my family and friends,” he recalled.

Henick is one of approximately 25,000 applicants who received the long-awaited news of where they will spend their residencies in what is known as Match Day. Here is what it’s all about.

When did Match Day begin?

The tradition began in 1952 with the establishment of the National Resident Matching Program, a private non-profit corporation that oversees and coordinates Match Day. Before 1952, residency programs simply gave out offers to students at their discretion, and students could choose to accept or deny admission.

Why did Match Day begin?

When hospitals and students negotiated directly, there was limited oversight and regulation: hospitals sometimes made offers up to two years in advance in order to fill positions as early as possible, while students tended to delay acceptance for as long as possible. Due to dissatisfaction with the system and the frequent use of informal channels, five medical organizations came together and created the National Resident Matching Program.

When do students begin applying to residency programs?

Medical students begin applying at the beginning of their fourth year. Students apply for programs in their specialization of choice, with some students applying to as many as 60 residency programs.

What are the most popular specializations?

Based on total applications by U.S. graduates in 2011, the top choices were Internal Medicine, Family Medicine and General Surgery.

What happens after students submit initial applications?

Residency programs review applications and invite students for interviews based on exam scores, grades, research experience and extracurricular activities. Between the months of October and February, interviewees tour school campuses and facilities, meet with staff, and interview with senior residents.

Then, students send their “rank-order list” of preferred residency choices to the National Resident Matching Program, and residency programs submit a list of their top choices of applications. Neither party sees the other’s list. A computer system analyzes the lists and matches students with programs using an algorithm to identify the optimal matches based on the two parties’ preferences.

What do students consider when ranking residency programs?

For some students like Chika Anekwe, 28, who graduated from the University of Connecticut’s medical school in 2010, the process was merely a matter of putting down her top choices.

“I just ranked where I wanted to go without considering where I thought I might get in,” she said. Anekwe got matched at her third-choice program for pediatrics at New York University.

For other students, the process can be more complicated and involves a great deal of strategy. Alex Hirsch, 26, a fourth-year medical student at the Perelman School of Medicine at the University of Pennsylvania, recently matched at The Boston Combined Residency Program in Pediatrics for his pediatrics training. While Boston, one of the top programs in the country, was his number one choice, he deliberated about ranking it at the top because he had a better chance to be on the list of selected applicants at less prestigious programs.

“It was a very difficult decision for me to decide which program to rank number one,” said Hirsch via email. “I ultimately decided that I should rank programs based on my own preferences rather than where I knew I had the best chance of matching.”

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