146:. After applicants apply to programs, programs review applications and invite selected candidates for interviews held between October and February. After the interview period is over, programs and applicants each compile "rank order lists" that they submit to the NRMP. Programs list applicants, ranked in order from most to least preferred, whom they wish to train. Similarly, applicants rank programs where they wish to train. For applicants matching as a couple, the rank order lists include pairs of program choices that are considered simultaneously by the matching algorithm. Applicants' rank order lists can include a combination of categorical programs (training that is 3–5 years in length and begins in the first post-graduate year); preliminary programs (training that is one year in length and begins in the first post-graduate year); or advanced programs (training that is 3–4 years in length and begins after one or more years of preliminary training). For advanced programs on the rank order list, applicants can append a supplemental list of preliminary programs to attempt to match to a full course of training.
193:. Also, while there is no randomization in the NRMP algorithm—so it will always return the same output when given exactly the same input—different outcomes can be produced by changing trivial features of the data such as the order in which applicants and programs are processed. However, in initial testing of the algorithm over 5 years of residency match data and a variety of different initial conditions, the current NRMP algorithm always terminated quickly on a stable solution. Testing also showed that "none of sequencing decisions had a large or systematic effect on the matching produced"—the maximum number of applicants ever observed to be affected in a single run was 12 out of 22,938.
79:
medical schools formed the
National Student Internship Committee (NSIC) to discuss the findings of the NICI trial Match and consider an NICI proposal to replicate the Boston Pool Plan at the national level. NSIC petitioned to have the algorithm modified to more equitably represent applicants, and the modified algorithm was adopted and used for the first Match on 1952. That Match was a success, and the NICI recommended the creation of an organization to administer and oversee the running of the Match. The organization, known as the National Intern Matching Program (NIMP), was established in 1952 at the request of medical students.
51:
Match that in 2021 encompassed more than 48,000 applicants and 38,000 positions, the NRMP conducts
Fellowship Matches for more than 60 subspecialties through its Specialties Matching Service (SMS). The NRMP is sponsored by a board of directors that includes medical school deans, teaching hospital executives, graduate medical education program directors, medical students and residents, and one public member.
155:
applicant is tentatively matched to a program that has an open position and who prefers that applicant or all the applicant's choices on the ROL have been exhausted. This process is carried out for all applicants until each applicant has either been tentatively matched to the most preferred choice possible or all choices submitted by all applicants have been exhausted. Tentative matches then become final.
242:) matches. Out of the total active applicants, 51.27% (18,187) were graduates of conventional US medical schools; 93.8% (17,057) were able to find a match. In comparison, match rates were 80.3% of osteopathic graduates, 53.9% of US citizen international medical school graduates, and 50.5% of non-US citizen international medical schools graduates.
214:
not release the name of the program) and released a list of unfilled programs. Applicants then applied en masse to programs that had unfilled positions, frequently having to change their preferred specialty in the process. The
Scramble was widely recognized to be chaotic, disorganized, and lacking in transparency. The Scramble ended on
83:
noted that there always exists a stable solution when colleges are matching with students, but that it is possible to favor colleges as a group over applicants as a group (and vice versa). That is, Gale and
Shapley found that there is a college-optimal stable match and an applicant-optimal stable match.
284:
In 2002, 16 law firms filed a lawsuit on behalf of three residents seeking to represent all residents matching through the NRMP. The plaintiffs put forward a case which sought to show that the NRMP colluded with other national medical and medical education organizations and with residency-sponsoring
70:
From shortly after the first residency programs were formally introduced in the 1920s, the hiring process was "characterized by intense competition among hospitals for (an inadequate supply) of interns." In general, hospitals benefited from filling their positions as early as possible, and applicants
213:
It is possible for an applicant not to match to a program. Until the 2010 Main
Residency Match, applicants who did not obtain a position went through a process called the Scramble. At 12:00 p.m. on Monday of Match Week, the NRMP notified applicants whether they had matched to a program (but did
188:
Couples' rank order lists are processed simultaneously by the matching algorithm, which complicates the problem. In some cases there exists no stable solution (with stable defined the way it is in the simple case). In fact, the problem of determining whether there is a stable solution and finding
176:
It can be shown that for any instance of the problem, there is at least one valid solution. Under the old (pre-1995) NRMP algorithm that favored programs' preferences over applicants', programs could benefit in certain cases from lying about their preferences. This is no longer possible under the
154:
The matching process begins with an attempt to match an applicant to the program most preferred on that applicant's rank order list (ROL). If the applicant cannot be matched to that first choice program, an attempt is made to place the applicant into the second choice program, and so on, until the
129:. However, this description does not include the handling of couples (pairs of applicants who participate in a Match together, perhaps to stay in the same geographic location), second-year positions, or special handling of residency positions that remain unfilled. The full algorithm is described in
108:
Later researchers, such as
Marilda Sotomayor in 1983, Alvin Roth in 1984, and Klaus et al. in 2007, found that when couples are allowed to match together, there may exist no stable matching. However, Fuhito Kojima and Parag Pathak in 2009 demonstrated that if the market is large and the fraction of
78:
In the early 1950s, the
National Interassociation Committee on Internships (NICI) examined existing matching plans and chose the Boston Pool Plan, utilized at the time by Boston-area programs, as the model for a trial run of a new centralized system. In October 1951, student representatives from 79
50:
training programs located in United States teaching hospitals. Its mission has since expanded to include the placement of U.S. citizen and non-U.S. citizen international medical school students and graduates into residency and fellowship training programs. In addition to the annual Main
Residency
221:
After the 2010 Main
Residency Match, the Scramble was replaced by the Supplemental Offer and Acceptance Program, or SOAP. In SOAP, unmatched applicants are offered positions in unfilled programs through a series of rounds, creating a systematic way for applicants to find training positions without
75:
took on another form. Programs began to issue offers with a time limit for reply. The time limit rapidly decreased from 10 days in 1945 to less than 12 hours in 1950. Students were being issued "exploding" offers that required them to make a decision about training before hanging up the telephone.
112:
The NRMP algorithm saw only minor and incremental changes after its institution in 1952. However, in the fall of 1995 the NRMP Board of
Directors commissioned a preliminary research study to evaluate the current algorithm and recommend changes to be considered in its operation and description, as
74:
In 1945, medical schools decided not to release any transcripts or permit any letters of recommendation to be written until a particular date. In that way, they managed to move the date of residency selection back to the fourth year of medical school. However, the competition for residents simply
82:
Modifications to the algorithm proposed by students in 1951 were based on concerns that the matching process favored hospitals over applicants. The students believed the algorithm gave them incentives to misrepresent their true preferences. A publication in 1962 by David Gale & Lloyd Shapley
269:
In comparison, students and graduates from medical schools in the United States are bound to the graduation requirements of their individual schools. Both U.S. and foreign-trained applicants can participate in the NRMP while completing their final year of medical school before acquiring their
98:
A debate arose regarding whether the matching program was susceptible to manipulation or unreasonably fair to programs. Indeed, it was shown that in simple cases (i.e. those that exclude couples, second-year programs, and special cases for handling unfilled slots) that had multiple "stable"
204:
that allows the stronger applicant to somehow improve the desirability of the weaker applicant. (Of course, if the programs know prior to processing the matching algorithm that the stronger and weaker applicant are participating in the Match as a couple, they are free to change their lists
113:
well as a study comparing a new algorithm with the existing one. A new applicant-proposing algorithm was adopted in May 1997 and has been in use since its first application in March 1998, although the study showed that the net effect of the change on actual matches has been minimal.
218:, which was Thursday of Match Week. Most positions filled within the first few hours, and nearly all in the first 48 hours. Scrambling was extremely competitive: in 2008, roughly 10,600 applicants, many of whom were foreign-trained, scrambled for only 1,392 residency positions.
245:
In 2021, there were a total of 48,700 registered applicants. A total of 38,106 positions were offered in the match. 94.9% of them were filled. 92.8% U.S. MD seniors matched to PGY1 positions, while the percentage for U.S. DO seniors was 89.1%.
222:
the chaos of the Scramble. In SOAP, all appointments are made through the NRMP (no direct matching allowed, unlike the Scramble), and unmatched applicant data and unfilled program data are released at the same time on Monday of Match Week.
141:
The application process for residency training begins prior to the opening of the Main Residency Match in September. Applications usually are sent to programs through the Electronic Residency Application Service (ERAS), a service of the
200:, there is no way for an applicant to match into a better position by deciding to match as part of a couple. For example, if a very strong applicant and a very weak applicant match as a couple, there is no mechanism
165:, the basic goal is to match applicants to programs so that the results are "stable". "Stability" in this case means that there is no applicant A and program P such that both of the following are true:
180:
Under the current system, it also is impossible for an applicant to be harmed by including more residency programs at the bottom of a list if those programs are indeed preferable to not being matched.
71:
benefited from delaying acceptance of positions. The combination of those factors led to offers being made for positions up to two years in advance of the start of postgraduate training.
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956:
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ID. USMLE ID is not required for IMGs, but it can be entered. It is the same as the ECFMG ID. IMGs must not be completely ECFMG certified but many programs require
1536:
1592:
699:
Klaus B, Klijn F, Massó J. Some things couples always wanted to know about stable matchings (but were afraid to ask). Review of Economic Design 2007; 11:175-184.
125:; as a result, the solutions are very similar. A simplified version of the algorithm that is used to perform the matching process is described below and on the
1561:
559:
Peranson E, Randlett R. Comments on Williams' "A reexamination of the NRMP matching algorithm". Acad Med. 1995;70:490-494. (footnote at the bottom of page 492)
158:
To understand how the current NRMP algorithm works, it is helpful to begin by considering the simpler case where there are no couples or secondary programs.
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Shiller JG. An alum recalls the first matching plan. P&S: The Journal of the College of Physicians & Surgeons of Columbia University 1985; 5:29.
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NRMP International, a subsidiary of the National Resident Matching Program, was established in 2010 to provide medical matching services outside the
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Williams KJ, Werth VP, Wolff JA. An analysis of the resident match. N Engl J Med. 1981;304:1165-1166; correspondence in N Engl J Med. 1981;305:526
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current algorithm. Applicants cannot benefit by lying about their preferences, even if they have perfect knowledge of everyone's preferences.
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Of the 35,476 total active applicants who participated in The National Resident Matching Program in 2016, 75.6% (26,836) were able to find
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matchings, the algorithm would return the solution that preferred the preferences of programs over applicants. A correspondence in
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981:
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436:
344:: The MatchingTools API provides a free application programming interface for the Roth-Peranson algorithm used in the NRMP.
292:
In 2004, after a lobbying effort by the Association of American Medical Colleges and the American Hospital Association, a
1327:
960:
848:, p. 54 gives an example of a situation with no stable solution and states that proof of NP completeness comes from
663:
Roth, A.E. (1984). "The evolution of the labor market for medical interns and residents: a case study in game theory".
1007:
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Gale D, Shapley LS. College admissions and the stability of marriage. American Mathematics Monthly. 1962;69:9-15.
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1204:"The Redesign of the Matching Market for American Physicians: Some Engineering Aspects of Economic Design"
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that granted specific immunity to the NRMP was added to a pension act signed into law by President
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as proving that the pre-1995 algorithm is essentially the hospital-optimal algorithm described in
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P has a free slot or would prefer A over one of the other applicants matched to the program.
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in 1981 recognized that the algorithm in use was program-optimal for individual applicants.
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1103:
483:
458:
223:
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308:, Republican of New Hampshire. Subsequently, a federal district court dismissed the case.
8:
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644:, p. 41 demonstrates that the hospital-optimal algorithm is also applicant-pessimal.
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Williams KJ. A reexamination of the NRMP matching algorithm. Acad Med 1995; 70:470-476.
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A is unmatched or would prefer to go to P over the program to which A matched
88:
84:
55:
32:
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334:: The Roth-Peranson algorithm used in the NRMP is available as part of the
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Medical seniors hit interne plan. New York Times 1951; 22 Oct:25 (col. 1).
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couples is small, then a stable matching exists with high probability.
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US non-profit that matches medical students with teaching hospitals
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institutions to depress resident wages, operating in violation of
957:"The Residency Scramble: How It Works and How It Can Be Improved"
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Ronn, Eytan (June 1990). "NP-complete stable matching problems".
321:
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59:
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259:
1185:
1147:"Analysis of Stable Matchings in R: Package matchingMarkets"
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Antitrust Lawsuit Over Medical Residency System Is Dismissed
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Evaluation of changes to be considered in the NRMP algorithm
320:: A variant of the Roth-Peranson algorithm, as presented in
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595:"Are Medical Students Meeting Their (Best Possible) Match?"
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Matching applicants to programs is a generalization of the
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American Association of Colleges of Osteopathic Medicine
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459:"The Origins, History, and Design of the Resident Match"
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1118:"Matching: A Python library for solving matching games"
372:
311:
1562:
Accreditation Council for Continuing Medical Education
266:
Step 2 before "Rank Order List Submission Deadline".
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The Stable Marriage Problem: Structure and Algorithms
787:"Analysis of the National Residency Matching Program"
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Educational Commission for Foreign Medical Graduates
1547:
Accreditation Council for Graduate Medical Education
567:
565:
1237:Gusfield, Dan; Irving, Robert W. (1989). "1.1.1".
1115:
484:"THE MATCHING PLAN FOR THE APPOINTMENT OF INTERNS"
249:
1202:Roth, Alvin; Peranson, Elliott (September 1999).
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928:
198:once the programs' rank order lists have been set
1666:
982:"Frequently Asked Questions : U.S. Seniors"
562:
280:Jung v. Association of American Medical Colleges
1557:Commission on Osteopathic College Accreditation
1168:"matchingMarkets: Analysis of Stable Matchings"
959:. Studentdoctor.net. 2009-03-12. Archived from
418:, pp. 3–4. Description of market based on
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205:accordingly, which could affect the outcome.)
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1036:"2021 Main Residency Match® By the Numbers*"
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1116:Wilde, H.; Knight, V.; Gillard, J. (2020).
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300:. The provision was sponsored by Senators
1649:Issues in higher education inside the U.S.
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437:"The Theory and Practice of Market Design"
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1532:Association of American Medical Colleges
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144:Association of American Medical Colleges
936:"Using "SOAP" to Clean Up the Scramble"
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1685:Medical education in the United States
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1552:Liaison Committee on Medical Education
1309:Medical education in the United States
95:for their work on stable allocations.
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1154:Vignette to R Package MatchingMarkets
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1091:Antitrust Against the Resident Match
903:
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728:, by Alvin E. Roth. October 24, 1995
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312:Implementations in software packages
435:Roth, Alvin E. (December 8, 2012).
287:United States antitrust legislation
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13:
1654:Physician shortage inside the U.S.
1542:National Resident Matching Program
1273:A SIAM Mathematics Society article
21:National Resident Matching Program
14:
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304:, Democrat of Massachusetts, and
1567:American Osteopathic Association
789:. Tedlab.mit.edu. Archived from
189:it if it exists has been proven
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1122:Journal of Open Source Software
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938:. Studentdoctor.net. 2010-10-24
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254:To participate in the NRMP, an
250:International medical graduates
102:New England Journal of Medicine
1429:Doctor of Osteopathic Medicine
1403:International medical graduate
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324:, is available as part of the
256:international medical graduate
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91:, would go on to win the 2012
42:created in 1952 to place U.S.
1:
593:Robinson, Sara (April 2003).
360:
226:is now Friday of Match Week.
40:non-governmental organization
1527:American Medical Association
1377:Continuing medical education
1211:The American Economic Review
825:10.1016/0196-6774(90)90007-2
665:Journal of Political Economy
7:
1079:Residency Match Application
348:
10:
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1345:Graduate medical education
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919:December 26, 2011, at the
846:Gusfield & Irving 1989
774:Gusfield & Irving 1989
762:Gusfield & Irving 1989
750:Gusfield & Irving 1989
642:Gusfield & Irving 1989
638:Gusfield & Irving 1989
630:Gusfield & Irving 1989
416:Gusfield & Irving 1989
375:Retrieved on June 16, 2017
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355:National Matching Service
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1067:The Registration Process
898:Roth & Peranson 1999
886:Roth & Peranson 1999
874:Roth & Peranson 1999
862:Roth & Peranson 1999
738:Roth & Peranson 1999
714:Roth & Peranson 1999
632:, p. 64 references
581:Roth & Peranson 1999
131:Roth & Peranson 1999
93:Nobel Prize in Economics
1628:William Stewart Halsted
604:(3): 36. Archived from
163:stable marriage problem
123:stable marriage problem
386:"Match by the Numbers"
813:Journal of Algorithms
1223:10.1257/aer.89.4.748
1008:"Main match results"
1633:Andrew Taylor Still
1367:Board certification
1186:"MatchingTools API"
1131:10.21105/joss.02169
988:on December 2, 2011
740:, p. 752, 760.
611:on 18 November 2016
1593:Specialty colleges
1424:Doctor of Medicine
1145:Klein, T. (2015).
270:medical diplomas.
117:Matching algorithm
1662:
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1520:Regulatory bodies
1246:. The MIT Press.
446:. Nobel Media AB.
302:Edward M. Kennedy
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509:"About NRMP"
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322:Roth (1984)
196:In general
191:NP-complete
150:Simple case
87:along with
1669:Categories
1439:Comparison
1360:Fellowship
1350:Internship
1021:2019-06-14
967:2013-09-09
942:2013-09-09
797:2013-09-09
615:14 October
361:References
306:Judd Gregg
258:must have
161:As in the
89:Alvin Roth
37:non-profit
1602:Reformers
1372:Licensure
1355:Residency
1333:Clerkship
1172:R Project
850:Ronn 1990
833:0196-6774
673:CiteSeerX
634:Roth 1984
602:SIAM News
420:Roth 1984
224:Match Day
216:Match Day
48:residency
29:The Match
1386:Pathways
1052:19 April
1043:nrmp.org
1015:Nrmp.org
917:Archived
349:See also
338:package.
328:library.
326:matching
1492:Level:
1417:Degrees
1196:Sources
274:Lawsuit
230:Results
184:Couples
66:History
31:, is a
1642:Topics
1488:COMLEX
1464:Step:
1434:MD–PhD
1316:Stages
1250:
1228:23 Feb
1124:(48).
1017:. 2016
831:
675:
318:Python
137:Inputs
60:Canada
1581:Lists
1460:USMLE
1448:Exams
1244:(PDF)
1207:(PDF)
1150:(PDF)
1039:(PDF)
1011:(PDF)
609:(PDF)
598:(PDF)
518:6 May
493:6 May
468:6 May
440:(PDF)
398:6 May
389:(PDF)
294:rider
264:USMLE
260:ECFMG
1455:MCAT
1407:MBBS
1248:ISBN
1230:2016
1054:2021
1047:NRMP
994:2011
829:ISSN
617:2010
520:2021
513:NRMP
495:2021
488:JAMA
470:2021
463:JAMA
400:2021
393:NRMP
238:-1 (
58:and
25:NRMP
19:The
1504:2PE
1499:2CE
1476:2CS
1471:2CK
1219:doi
1126:doi
821:doi
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342:API
240:R-1
236:PGY
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