BACKGROUND: Graduate medical education has undergone economic and structural changes - changes that have placed increasing pressure on medical students and programs to match effectively. This study documents the experiences, perceptions, and ethical dilemmas of medical students with the 1998 match process. METHODS: Surveyed were 437 senior students from three medical schools. Students were questioned about: interviewing practices, communication with programs, commitments made, ethical dilemmas faced, and the match process itself. Data were analyzed using Student's t test, the chi- square test, and descriptive statistics. RESULTS: In all, 314 (72%) students responded. Programs expect postinterview communication from students (57%). Students perceive that programs are making 'informal' commitments (43%), lying to them (33%), and encouraging their unethical behavior in order to match (21%). Ethical dilemmas are related to requests for informal commitments. CONCLUSIONS: The NRMP's ruling that denounces prematch commitments is being broken by students and programs alike, resulting in the promotion of unprofessional behavior and gamesmanship.
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