Dr. H had his 1st interview towards the end of October and his last one towards the end of January. The rank list was due mid-February, and match day was mid-March. About 1/2 way to 2/3 through his interviews we started to draft an informal rank list. As he completed the back 1/2 of his interviews we would edit the rank list as needed. I think, especially as a spouse, the hardest part of the process was feeling a lack of control. In typical job interview situations, you get a yes or no from all prospective jobs and make a decision based on the yes places. In residency, you don't have the luxury of definitely knowing how your highly ranked programs ranked you. However, there were a few strategies we employed to get the most control we could in an otherwise risky process.
Dr. H made an effort to let his top 4 programs know he was extremely interested and highly impressed with them. UT was his #1 choice- he went on that interview in late October. In mid-January, he connected with a mentor/attending at UW-Madison who had done his residency at UT and still had connections there. The mentor made a call on Dr.H's behalf to someone at UT involved in the interview process. The mentor basically said, Dr. H really liked the UT program- I think he would be a good fit there. The interviewer basically said, that's great to hear we really liked him too. In early February, after we decided on our final rank list, Dr. H emailed the program director informing them, "I loved the program, and have ranked it #1." This is by no means mandatory, and it is illegal for programs to directly ask a medical student how high he/she has ranked their program. But, if you have definitely made up your mind, you are free to disclose that information. I have no idea if it made a difference. We only took the advice of Dr. H's mentors and older medical student friends who had gone through the process as well.
For his #2-#4 programs he sent an email to the program directors expressing his interest, and saying he planned to rank the program high on his list. Do not, in any circumstance, tell a program you will rank it #1 if you don't plan on doing so! Most specialties are small and this could come back to bite you in the future when applying to fellowships, etc. He received an email in return from his #2 program saying "we liked you too". His #3 was Madison, and he already knew everyone so that was a bit different. We didn't hear anything back from his #4 choice. In terms of other programs, he received a couple hand-written notes and one phone call. So, in our experience we either got positive feedback or no feedback. The hardest part is not really knowing what "we really like you too" actually means.
After the rank list was submitted, we did the best we could to stay distracted. We did some weekend trips, Dr. H was on an away rotation, and I did A LOT of running/swimming/yoga to help me sleep at night. Again, this is only our experience and can vary widely depending on specialty. Talking to mentors and former medical students is the most advantageous thing you can do! If you're currently going or will go through the process I wish you the best of luck! The medical spouses I know are resilient, flexible people and have the amazing ability to make most any situation work.