The National Resident Matching Program (NRMP) was established in 1952 to remedy the increasingly competitive process of applying for internships, one in which high-pressure tactics essentially forced medical students to accept appointments as early as their second year of school.1 Now, participants make decisions on a uniform schedule, without time pressure, and matches are made with an algorithm that allows participants to rank their actual preferences without affecting the probability of matches lower on their list. The NRMP requires that all members sign a Match Participation Agreement (MPA), which includes restrictions on persuasion. For example, applicants and programs may volunteer their interest in each other, but one party cannot solicit a commitment from the other or suggest that ranking is contingent on such a commitment. However, both my experience and the medical education literature suggest that this injunction is often violated.
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