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Transforming Residency Challenges: The Success of RVU’s PDI and MPDI Programs


An unprecedented challenge…  

In 2021, during the height of the COVID-19 pandemic, RVU faced a new challenge—an unprecedented 11 students did not match into residency programs, resulting in a National Resident Matching Program (NRMP) placement rate of 95.8%, down from the university’s previous 5-year average of 99%. While still above the national placement average of 92%, the faculty and staff at RVU, driven by their commitment to excellence, sought to ensure that every student had the opportunity to reach their full potential. RVU created two innovative programs—the Predoctoral Internship (PDI) and the Master’s Predoctoral Internship (MPDI)—designed to help prepare students who did not match into a residency program to reenter the match process and successfully match to a residency program. Since their inception, both programs have achieved a remarkable 100% match rate for students who have chosen to reenter the match process after successfully completing the programs. 

Failure to match into a residency program fosters a multitude of challenges for medical students, including the inability to practice clinical medicine, the potential inability to meet student loan obligations, and added anxiety and stress from an already stressful environment. Due to this, RVU quickly mobilized and developed two programs within 10 weeks: the predoctoral internship (PDI) and the master’s predoctoral internship (MPDI).  

The innovative solution  

The PDI and MPDI are rigorous, milestone-based programs designed to develop personalized experiences to meet the individual needs of an unplaced student to prepare them to reenter the match process and successfully match to a residency program. The key difference between the PDI and MPDI, outside of the curriculum structure, is that a student in the MPDI program will also be concurrently enrolled in an accredited master’s program of their choice at a different institution.   

Dr. Heather Ferrill, Dean of RVUCOM, shared how RVU’s Core Values shaped and guided the development of the programs, providing those initial conversations centered around compassion and innovation. RVU’s leadership knew it was imperative to support students during one of the most challenging moments of their academic lives and leadership wanted to formulate an innovative way to leverage RVU’s resources to tackle this problem. Dr. Amanda Brooks, Vice Provost of Research and Scholarly Activity, explained how feedback from residency directors led to internal discussions among RVU leadership about how to make RVU students the ‘best of the best’ when it comes time to matching with a residency program.  They found that a focus on developing better leadership and professionalism skills throughout the PDI and MPDI programs would bolster student residency applications and make these students better healthcare professionals overall. Both Dr. Ferrill and Dr. Brooks pointed to lessons learned from the book “Dare to Lead” by Brene Brown as playing a significant role in the incorporation of leadership and professionalism training into the PDI and MPDI programs.   

A resounding success, both expected and unexpected    

Both the PDI and MPDI programs have been resounding successes since their inception back in 2021. All 11 students who failed to match into a residency program during the 2021 cycle ended up matching after completing either program. Additionally, RVU has seen a 100% match rate for students who have entered the programs in subsequent years who have chosen to reenter the match process. While the hard data proves that these programs have had their desired effects, the programs have also enjoyed some additional unexpected victories. 

In a research article published in the Journal of Medical Education and Curricular Development for Sage Journals, both Dr. Ferrill and Dr. Brooks note that these programs have also led to a decrease in the anxiety and shame felt by the students that did not match into a residency, authoring, “In course evaluations, students reported a sense of support and less anxiety throughout the program and felt as though RVU as an institution truly cared for their well-being and future. Many of the students who have graduated from the PDI/MPDI have processed this experience in such a way that the shame and embarrassment they felt at the beginning of the process, which initially made them reluctant to let anyone know, has been transformed into a willingness to reach out to future unplaced students to reassure and mentor them.”   

When asked to elaborate on what led to these unexpected victories for the programs, Dr. Brooks offered that a driving force behind these programs is “to expand the focus beyond traditional metrics and focus on what each student needs to become a more rounded individual with a clearer focus. These programs go way beyond the typical day to day of “how do you match?” or “how do you improve your application?” and aim to really get to know the person, their struggles, and their situation. This expansion of focus has resulted in students reframing the story they tell themselves about what success looks like and helped them feel more confident in themselves and their abilities”.  

Incorporating these learnings into the curriculum 

The successes of these programs have spurred conversations about ways the university can incorporate components of the PDI and MPDI programs into the core curriculum of the COM to mitigate the need for such programs to exist. Both Dr. Ferrill and Dr. Brooks pointed to the complex structure of the COM as a potential roadblock to completely integrating certain components of the programs into the COM curriculum down the road. However, they noted that RVU has already refined its approach to career advising by implementing a more predictable model, enabling early intervention to prevent challenges from escalating. Additionally, the university has prioritized leadership and professionalism training, recognizing the pivotal role these skills play in developing well-rounded, confident future physicians. 

The development of both the PDI and MPDI programs highlights RVU’s impressive dedication to its core values. This innovative solution to an unprecedented challenge has not only resulted in a 100% match rate for students who choose to reenter the match process after the completion of one of the programs but has also led to a decrease in the anxiety and shame felt by students who do not match into a residency program.  

To learn more about the challenges that led to the development of these programs and their success, please read Decreasing the Anxiety and Shame of Medical Students Not Placing into a Residency Using an Innovative Fifth-Year Educational Intervention by Dr. Ferrill and Dr. Brooks.