The National Resident Matching Program (NRMP®) Scramble is an oftentimes confusing process that tends to generate a lot of questions. The Scramble is a system used to fill unfilled residency positions. Some medical residency programs will have available residency slots even after the NRMP has completed the Match; these positions become available during the Scramble period so that those applicants who did not get a residency position can vie for them. Please see my article entitled, "What is the Scramble" for a complete calendar of the Scramble 2010.

Here’s a step-by-step plan for the Scramble:

1.In the weeks before, consider reworking your personal statement for a second field if you think you might Scramble into a second specialty. For example, if you are applying in Emergency Medicine and think you may not match, it might be worth reworking your personal statement for Family Medicine, if you would be happy in that field as well, as Family Medicine is less competitive. (Of course the problem with scrambling into another field is that your application as a whole will be focused toward the first specialty; however, it still might be worth a try, especially for a less competitive field.) You can upload the new personal statement to My ERAS before the Scramble without assigning it to a residency program.

2.On Monday, March 15, 2010 applicant matched and unmatched information is posted to the NRMP web site at 12:00 noon EST. If you find out then that you have not matched, plan to take the next day off.

3.Create a PDF file of your entire application for emailing and also have copies available for faxing.

4.Because, unfortunately, the Scramble occurs through two means – the official one, which is ERAS – and the informal one, which is faxing and phone calls to programs - it helps to organize a few friends and some supplies, including a phone line, a fax line and a computer, for March 16, 2010.

5.On Tuesday, March 16, 2010 at noon the NRMP's Dynamic List of Unfilled Programs is released. This list includes all of the residencies that have unfilled slots. Thus, after looking at the list, you select the programs to which you want to apply through ERAS. Remember an applicant may apply to a maximum of thirty new programs in addition to fifteen "old" programs (residencies to which s/he applied during the regular ERAS season). There is no charge for applying to programs during the Scramble.

6.Soon after selecting the programs to which you want to apply through ERAS, you begin calling your top choices, while trying to send out your PDF to those programs. This is the chaotic part of the Scramble. Knowing someone at a program can make a difference.

7.Hopefully, at the point you will connect with someone at a residency program who will offer you a phone interview. With luck, you will be offered a spot.

The Scramble system currently is rather turbulent. The best plan for the Scramble, of course, is to avoid it altogether. To improve your residency candidacy fully and thus improve your chances of matching, consider working with a professional. Because applicants can unknowingly undermine their chances of success with poorly compiled application materials and underdeveloped residency personal statements, a qualified, personalized residency admissions consultant provides a great advantage.

Residency consulting companies come in a variety of forms. Some are bigger businesses that focus on admissions to several types of graduate programs – not just medicine. Others are smaller and provide a medical focus, but have a pool of consultants of varying quality. Finally, elite companies offer both the medical focus and a highly experienced consultant who works one-on-one with clients. These professionals are ex-admissions officers from highly respected medical institutions. They have the inside knowledge of how residency admissions work, providing individualized guidance to optimize applicants’ personal essays, ERAS® and interview skills.

When choosing a residency admissions consulting company, a candidate should verify the company’s references and research its consultants. It is best if the company does not assign written materials to outside editors who cannot be evaluated. Elite companies that offer both the medical focus and a highly experienced consultant who works one-on-one with clients offer a large advantage for applicants, especially during these competitive times.