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Unless something's changed, that is not always true by dulac89
You usually know what specialty, and you generally have it narrowed down to a couple places, but unless a place ranked you as one of their top spots and you ranked them number one, there are no guarantees.
For example, if a place has 8 residency spots, if the people that program ranked 1-8 all put it down as their #1 choice, then they should all match.
But tie breakers goes to the applicant, so an applicant who ranked the program first, but the program ranked 9th, would "bump" someone who ranked the program second, but the program ranked in their top 8.
Again, most people know within 3 schools where they'll be going, but there are definitely plenty of surprises on match day
To be fair, last I went through this was 20 years ago so it may have changed.