In the medical residency match process, applicants' ranking decisions are influenced by multiple factors related to training, geography, and lifestyle expectations. Ranking decisions directly impact match results, with implications for emotional outcomes such as happiness and stress. The present study explored the decision factors considered most important by applicants when creating rank order lists (ROLs), and how match outcomes and program factors predicted happiness, enthusiasm, stress, and life satisfaction. Senior medical students (n = 182) at a large public university in California completed surveys at three timepoints, spanning from shortly before Match Day to several months into PGY-1. Study findings support that both program-related (e.g., training quality, program size) and non-program-related (e.g., geography, work life balance) factors are important to applicants when making ROL decisions. Applicants who matched with their top choice program initially experienced emotional benefits, but these emotional differences did not persist into PGY-1, where all matched applicants had similar levels of emotion and life satisfaction. The emotional cost and benefits of matching with programs of different ROL positions (e.g., matching with top-choice program or not) were most apparent shortly after matching but in the long-term, a stronger predictor of PGY-1 emotions was perceived person-program alignment. Person-program alignment (e.g., call schedule, patient caseload) also predicted burnout in the first few months of a residency program. These findings show that, when applicants are making ranking decisions, they undervalue factors that predict stress and burnout during residency.

The present investigation examined the potential benefits and costs of optimistic expectations about future events through the lens of error management theory (EMT). Decades of evidence have shown that optimism about the likelihood of future events is pervasive and difficult to correct. From an EMT perspective, this perpetuation of inaccurate beliefs is possible because optimism offers benefits greater than the costs. The present investigation examined this possibility for controllable important life events with a known time at which they would occur. College students taking their first exam (n = 1,061) and medical students being matched with residency placements (n = 182) reported their expectations and emotions weeks before the event and their responses after they knew the outcome of the event. Optimistic expectations predicted the quality of effort investment before an event occurred-students were more satisfied with their studying, medical students were more satisfied with their decision making, and optimism predicted better performance. Optimistic expectations also predicted less emotional distress before the event. There was no evidence that optimistic expectations related to longer-term greater distress when participants experienced an unexpected negative outcome; the valence of the outcome itself predicted distress. These results are consistent with the EMT-derived hypothesis that optimistic expectations have benefits for effort and emotion before an event occurs, with little cost after the outcome occurs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).