Rank List

Constructing and finalizing the optimal rank list for you as an individual applicant begins with taking advantage of the interview day. In addition to demonstrating your character as an outstanding potential future trainee, your primary mission during each interview is to learn about how the mechanics and the culture of each program will fit you and your goals as a future neurosurgeon.

Students have developed a variety of approaches to constructing their personal rank lists, most of which either involve general impressions regarding goodness-of-fit, and/or specific program features that they consider desirable (or not). Here are some suggestions to help you develop and finalize your rank list:

  • Take written notes after each visit. If you have specific criteria in mind, list them for each program in a standardized fashion, such as a spreadsheet or stereotyped list. Over months of interviewing, many program features will become indistinguishable, and your final decisions will be helpfully informed by detailed notes you can refer back to in January and February
  • Seek the advice of other students, in particular those whose home programs and sub-I rotations are of particular interest to you. They will give you a more “unfiltered” take on the strengths and weaknesses, which you can integrate into your own notes from the interview day
  • Many students will update their list as the move through interviews, but once you have put together a tentative version of the final list, sleep on it for a few days before committing to a given rank order. You may revisit it and find that you are anxious or regretful about the position of one or more programs, and you will have the benefit of integrating that emotional feedback before it is too late. Many applicants benefit from discussing their ranks with significant others or family members; however, remember that you are the only person who will be entering a neurosurgery training program, and so absent extenuating circumstances, your own goals should drive the rank list decision-making.
  • Rank all the programs you interviewed at unless you would rather not be a neurosurgeon than attend that program. If you have made the effort to interview at a program, there is no reason not to rank it unless you truly hated it. In neurosurgery we benefit from a small field populated by many excellent departments, and even the programs with the least noteworthy reputations have generated many talented and successful neurosurgeons. By the same token, if after an interview or visit you realize that a given program or location would be completely incompatible with satisfaction in your career, do not rank them, as breaking the match agreement and not accepting the assigned position could have catastrophic consequences for your career
  • Do not assume that because you have been told “you will be ranked very highly here at XXX” that you will match at that institution, even if they are your first rank. Being ranked #5 by XXX does mean that they ranked you highly, but others may still be more highly ranked, and the positions may go to them. Programs are not permitted to discuss specific rank order decisions with applicants and are explicitly prohibited from soliciting rank order information from applicants, or otherwise communicating with them outside of the conventional channels. Do NOT ask a program director how you will be ranked, as this constitutes a match violation, and also very poor judgment and professionalism. You are certainly encouraged to let PDs and chairs know that you are ranking their program very highly, as communicating your interest in a professional and appropriate fashion is only going to help your cause
  • When making your list, it is vital to know how the match algorithm works, typically by reading the NRMP Match Explanation. A common misconception is to think that placing a less competitive program higher on the list increases the odds of matching there. This is incorrect! The algorithm is biased in favor of applicant preferences, and each applicant will match at the highest place on their rank list that has an open position. Review the rank and match examples on the NRMP site, and make sure that you grasp the nuances, but the bottom line is that you should rank programs according to your preferences only, NOT how you anticipate that they will be ranking you.