General surgery program directors' perceptions of the match.

To identify expectations of general surgery program directors (PDs) for recruitment behavior, and to document the experiences, perceptions, and ethical dilemmas they experienced with the 1998 National Resident Matching Program (NRMP).Two hundred sixty-five general surgery PDs were asked to complete a 30-item written questionnaire. Questions inquired about PD perceptions of students' interviewing practices, how communication with applicants is conducted and interpreted, and overall perceptions of the match.A total of 77.7% of PDs responded. A total of 44% of PDs found nothing wrong with students interviewing in multiple specialties and conceded legitimate reasons for doing so; yet, 75% of PDs felt this practice negatively affected students' rank order. A total of 46.6% of programs told students to keep in touch to be ranked; only 8.7% of PDs believed students' stated interest, and 76.6% of PDs said these affirmations had no effect on students' rank. A total of 36.5% of PDs felt students made informal commitments to them, and 90.4% felt students at least sometimes lied to them. A total of 51.7% of PDs felt the match was a reasonable process that needed no changes.As long as the stakes are high and there are no repercussions for unethical behaviors and practices during residency recruitment, gamesmanship will continue to be the accepted culture.