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I'm the spouse of one of the applicants and cannot wait until match day!!! This is pure agony!! We both love Toronto and my spouse loves the internal med program there!! Perhaps, for future reference, spouses should be invited to the interview!!! :D Hopefully we can call Toronto home very soon!! Thanks for your clarification on this forum!

 

Is the ranking sort of pre-determined prior to interviews? How much does the interview impact the ranking? Seems like some applicant's interviews were shorter and casual and some were longer with more questions.

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For prospective students, what are some of the criteria that the selection committee is looking for in terms of granting interviews? (besides what is posted on the CaRMs website)

 

What is the breakdown, if there is one (e.g. reference letters x %, personal profile y %, etc)? Is there a holistic mark given to the applicant or is it a sum of "checkmarks" (e.g. 10 points for having a publication, x points for strong reference letter, etc)?

 

Thanks!!

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Is the ranking sort of pre-determined prior to interviews? How much does the interview impact the ranking? Seems like some applicant's interviews were shorter and casual and some were longer with more questions.

Yes, there is a preliminary ranking list prior to the interview based on the applicant's review (by at least two committee members). However, the rank order of that prelim list can change, and does change, based on both the interview and on the "big" meeting, with all committee members present and participating.

 

Quite literally, essentially all applicants are discussed at the 'big' meeting, so there are really lots of opportunities to ensure that the process was fair and that all relevant factors were taken into account. That's the reason that the 'big' meeting typically lasts six+ hours.

 

I agree with your implication that the interview is not standardized. Maybe that will happen in 2011. FWIW, the interview will almost always be considered "in error" if there is a big disparity between a candidate's score on it and the one from the 2+ file reviewers. Bottom line, don't sweat the interview (too much ;) )

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For prospective students, what are some of the criteria that the selection committee is looking for in terms of granting interviews? (besides what is posted on the CaRMs website)

 

What is the breakdown, if there is one (e.g. reference letters x %, personal profile y %, etc)? Is there a holistic mark given to the applicant or is it a sum of "checkmarks" (e.g. 10 points for having a publication, x points for strong reference letter, etc)?

Caveat: I speak only for Toronto.

 

By and large, reference letters (from academic internists, especially preceptors from your CTU or other general medicine type experiences) count the most. Reseach counts for nothing except if you have a lot in which case it's a plus. But its absence does not hurt you one iota.

 

After reference letters, your academic record is next most important (as a rule). This refers to your performance in Years I, II, +/- III of med school, not pre-med marks. Of course, some schools make this easier to assess than others. It is DEFINITELY to your advantage to go to a school with H/P/F rather than just P/F.

 

Your score (and ranking) (before the interviews have been taken into account) IS holistic, despite all this. Still, it's heavily influenced by your refs and your marks (in med school).

 

You really aren't helped by an even outstanding letter from a family doc, psych, etc. It's not that we think such people are stupid, just that 1) they don't really know what we're looking for in an int med person and 2) we have no idea often if you're the first or hundred and first student they've worked with (same with a community internist).

 

Letters from people you've worked with on research, with no clinical exposure, or letters from people you worked with on committees, carry little, if any, weight.

 

How am I doing?

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I forgot to say that the absence of a letter from your CTU preceptor is a red flag. Be prepared to explain why that is on your interview. Even better, be sure to get a reference from at least one of your CTU preceptors.

 

And, I'll use this opportunity to note that your 'personal letter' is used mostly to understand things like why you took 12 surgery electives and none in Medicine. It really doesn't "count" for much at all re: your score. That being said, if it's typed in "CAPS, U NO, LIKE U R SHOUTING", and/or "u use l33t speak", that would get quickly noticed. And that's NOT a good thing.

 

In terms of reference letters, there is a certain gentleman at UWO who ALWAYS avers that so and so "was the best student he's had this year (or in years)". This is for EVERY letter he writes. Do not use him. His letters are no longer even read! (Obviously I won't name him explicitly here but if you ask around, you'll surely figure it out (i.e. who writes lots of letters, is a subspecialist, and not a CTU preceptor?))

 

A bit more info also in my posts here: http://www.premed101.com/forums/showthread.php?t=38877&page=2

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Of course, some schools make this easier to assess than others. It is DEFINITELY to your advantage to go to a school with H/P/F rather than just P/F.

 

Interesting...this is one of the first times I have heard this endorsed. I guess that makes sense since having earned Honours would demonstrate academic ability and distinguish you from others since at P/F schools basically everybody has a P.

 

Is it true that the Committee has access to specific evaluations from core GIM rotations for Toronto students? (e.g. the more indepth evaluations, marks on oral and written exams)

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No, as a rule we have only the "Dean's Letter", i.e. the "medical school performance record". This lists people's scores (out of 5) on stuff like knowledge, reliability, professionalism, etc. for their most recent complete year; year III (or year II). Basically, it contains little useful info with respect to ranking people (i.e. most people look about the same).

 

That being said, the reference writers may have been given in-depth ITER reports by the candidate, and that info may be alluded to in his/her letter.

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Thanks for the clarifications, that does help a lot! So if we go to a pass/fail school and don't win one of the top scholarships that goes to THE (i.e. #1) student, then how would the committee be able to tell us apart from the rest of the people who all pass their classes in med school? Isn't UT also operating on a pass/fail system now?

 

By a letter from CTU preceptor, do you mean from your home school during clerkship? Or just a CTU preceptor you've done an elective with at Toronto or all the other places you've done electives at in 4th year?

 

Are reference letters really that effective at telling apart candidates? I heard that for the most part, they are generally positive. Are extracurriculars or other internal med interests looked upon at all? Thanks!

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This right here is why I think we need to go back to the grade system in medical school. If H/P/F is better than P/F, one can extrapolate that having a grading system would be better than not having one. I really don't care if it stresses people out a bit more to have to keep grades up, its a better, more competitive system. As it stands, the only thing that decides your ability to get the residency you want is your schmoozing power.
There's an element of truth in what you say about "schmoozing", but I really do think it's more than that. I mean, if nothing else, there simply aren't enough rotations for all the people who do ultimately get in, for them to have schmoozed (does that even make sense?) Of far greater importance, note that a$$ kissing is a fine way to get yourself blackballed. No one wants to work with an adulating sycophant unless said sycophant is smart and good clinically (in which the schmoozing was just incidental).

 

Assuming you are truly on the committee
I really, truly, may-god-strike-me-down-if-I'm-lying, am on the committee :)
what you say about certain letters holding more weight than others isn't something that everyone assumes. I know there are a lot of schools that cordon off their students in rural areas for good portions of the clinical years, such as NOMS, making their opportunities to get actual academic letters of reference almost nil. Of course, the school will never admit that it puts the student at a disadvantage, in fact at my school they said that it likely won't matter as long as its a good letter. Clearly that was a steaming sack of fvck.
Sadly, you are 100% right, at least in terms of getting into U of T Internal Medicine. But, that is why the CTU letters are so important. Everyone gets a CTU rotation (I think - tell me if I'm wrong) and, even if not, for those keen to get into Int Med, it's not unreasonable to assume they'll have an elective on a CTU (or similar experience). BTW, such an elective can be taken anywhere. A letter secured as a result, is good as a reference in an application to the school where the elective was taken, of course, but at others, too (certainly it is at U of T).

 

You should name the UWO guy whose letters you don't pay attention to. What's the point of students working with him if they can't get a letter that you'll read? Save them the wasted time and just out the guy.
I really would like to, but that's not fair to him (he means well and public shaming is a pretty strong remedy). But it's not fair to you (collective) either not to know who he is. So, how about that I promise I will write him. Deal?

 

Anyway, the most important thing is connections. If you have a high-falutin physician in your family you'll be better off. Same if you have a very rich contributor to the university. I'm not sure how much sleeping with your attending helps (work those kegels!), but there's probably a short-term gain depending on how you time it relative to the match.
I can't emphasize how wrong you are about this (again, with the caveat that I am speaking only about Toronto). We have declined offspring of the most powerful in several different cohorts. You have to believe me when I say we are looking for "quality" (whatever that means ;)). Connections really don't play a role. And $$$? Not in Toronto (and not anywhere in Canada, I'd assume). Maybe in the US, sure. But not here.
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Thanks for the clarifications, that does help a lot! So if we go to a pass/fail school and don't win one of the top scholarships that goes to THE (i.e. #1) student, then how would the committee be able to tell us apart from the rest of the people who all pass their classes in med school? Isn't UT also operating on a pass/fail system now?
It does make it much harder to tell people apart. That's part of the reason we (at UofT) are a bit inbred (60/40 in favour of home-grown). And, yes, we will (unfortunately) be embracing P/F starting with the entry class of Sept 2010 (I think)

 

By a letter from CTU preceptor, do you mean from your home school during clerkship? Or just a CTU preceptor you've done an elective with at Toronto or all the other places you've done electives at in 4th year?
Any of those are good, but, as mentioned earlier, not having a letter from your own CTU preceptor can be a red flag (assuming your rotation was finished in time for your CaRMS package to be prepared).

 

Are reference letters really that effective at telling apart candidates? I heard that for the most part, they are generally positive. Are extracurriculars or other internal med interests looked upon at all? Thanks!
You are right insofar as no-one writes a bad letter (if they do, they are an idiot). Still, it's not that hard to get a pretty good sense of whether the letter writer thinks you're good or outstanding. I may be deluding myself, but I think I can do that pretty well. More importantly, many referees actually say stuff like "I estimate that so and so is in the top 20 percent of his peers" or "top 10 percent of students I've ever worked with". Those type of quantifications help. What you DON'T want, though, is for someone to think they're helping you by saying you're in "top third" of your peers. That is always interpreted as meaning a) you are right at that level, not above and B) is WAY worse than most letters where "top 20 percent" is actually below average, i.e. when letters mention a percentile, the average estimate is around top 10 or top 15 percent. My advice? Let your referee know that percentile estimates are good but, unfortunately, they tend to be inflated, and frankly that saying someone is in the top half of his/her class is the kiss of death.

 

Extracurricular interests, well-roundedness helps, especially in the gestalt. Personally, I bump up people who are accomplished (not in research, but in real life stuff) or who have unique talents/skills they'll bring to us (e.g. music, language, unique academic or social background, etc.). Again, speaking personally, I am not impressed by being active in student politics, e.g. various faculty committees.

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In terms of the average person being estimated in reference letters at around top 10 to 15 percent (when a numerical estimate is given), that is not as outrageous as it may seem at first.

 

Internal Medicine (at U of T anyway) is quite popular and attracts a lot of extremely good people. Around 25 people from U of T will be accepted. So, in a class of just under 200, that's around 10 to 15 percent.

 

Objective evidence includes the fact that average applicant, let alone a successful one, has honors overall in each of the first three years, and an 'H' in around 75 percent of the courses taken in years I, II and III.

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This is a broad question, but if I may ask:

 

What does U of T's Internal Medicine ideal candidate look like?

What would be some of the red flags that would blow the interview and result in a lower ranking?

How is it determined who interviews which candidates? Any method to that or are people just randomly assigned?

 

Moreover, could you just tell me where my spouse is ranked so I can get some sleep between now and March 8th?? ;)

 

Thank you again for taking the time to answer questions and clarify misleading information.

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In terms of the average person being estimated in reference letters at around top 10 to 15 percent (when a numerical estimate is given), that is not as outrageous as it may seem at first.

 

Internal Medicine (at U of T anyway) is quite popular and attracts a lot of extremely good people. Around 25 people from U of T will be accepted. So, in a class of just under 200, that's around 10 to 15 percent.

 

Objective evidence includes the fact that average applicant, let alone a successful one, has honors overall in each of the first three years, and an 'H' in around 75 percent of the courses taken in years I, II and III.

 

So how does an applicant compete with not having such a grading system, only P/F?? Wouldn't the evaluations on clinical rotations be equally as important? Rather than the first two years which are more textbook based?

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On the CaRMs website, it says that broad-based electives are recommended. Would applicants be at a disadvantage if they did all internal CTU electives at different sites (there's no guarantee they'll get in at a particular site) and then just the mandatory surgical electives?

 

I'm also curious about what characteristics beyond academic and clinical excellence that the committee is looking for. From what it sounds like, whether someone gets an interview is based on the assessment of 2 committee members. Besides getting a third assessor if there is a huge discreptancy in the scores, what other controls are to reduce personal preferences? E.g. You mentioned that you would bump up individuals with 'real life skills' -- would this be the same case for every committee member or would say, someone else ignore extraucrriculars and place much more emphasis on student politics and research/publications? I can see how there may not be much difference in the way different faculty evaluate the criteria for clinical capabilities (based on reference letters), but the rest of the 'soft factors' seem kind of hazy.

 

Thanks again!

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What does U of T's Internal Medicine ideal candidate look like?
Like me, but younger.

 

At the risk of sounding evasive, there really isn't one prototype. That being said, year after year, the people who get ranked most favourably tend to have the following in their package:

 

1. strong letters of reference from people that the Selection Committee respect (and believe). Further, the letters are consistent in their high praise. When I say "strong letters", I mean ones where words like outstanding are used (as opposed to 'very good') and where there is often a literal bottom line with sentiments to the effect of, "John is simply one of the very best. I've supervised trainees for over ten years and have no hesitation in stating that he is one of the most outstanding students I've ever encountered".

 

That being said, not everyone can get letters like that. Don't worry though, even "lesser" praise is fine. Many "ideal" candidates are described as functioning at the level of a PGY 1 (or sometimes PGY2's!) even if there is no explicit comparison to their peers (e.g. "top 10 percent") or bottom line statement as described.

 

I've mentioned earlier, or at least implied, that in addition to strong letters, "ideal" candidates have references from people we expect (and usually know) to be good judges of what we're looking for (i.e. academic internists who have considerable experience with students and aren't blown away by the only one they've worked with in the last two years).

 

2. outstanding academic achievement in Med School. By this, I'm getting at 'honours' (where possible), awards and scholarships for academic excellence, and unusually strong praise in verbatim text comments on their clerkship rotation evaluations (they are often summarized, or listed outright on those letters)

 

3. unique and impressive life accomplishments. This is, of course, quite vague but, as mentioned somewhere else in this thread, I'm talking about stuff like excelling (not just participating) in a sport or a hobby such as music. I'm also referring to things like overcoming adversity at some point in their life, or doing something 'special' while in Med school (e.g. started organization to bring health care to impoverished or disenfranchised group).

 

4. In my opinion (i.e. I am not speaking for others with respect to this point), an "ideal" candidate has worked with someone locally and was "clearly" superb. Obviously, this is most applicable to people from outside U of T. And, what does "superb" mean? Excellent knowledge, enthusiasm, reliable, clearly enjoys what she's doing, loved by patients, great team player, good sense of humour. I'm sure none of this surprises any of you.

 

What would be some of the red flags that would blow the interview and result in a lower ranking?
Evasiveness, skirting questions, over confident, zero knowledge of our program, failing to leave sufficient cash in the envelope, are all things that won't help a candidate. But it's awful hard to "blow" the interview, these things notwithstanding.

 

How is it determined who interviews which candidates? Any method to that or are people just randomly assigned?
Frankly, I'm not sure. To a large extent, given the "busyness" factor for all of us, it may largely be a matter of who's available that day.

 

Moreover, could you just tell me where my spouse is ranked so I can get some sleep between now and March 8th?? ;)
I could, but then I'd have to shoot you.

 

Thank you again for taking the time to answer questions and clarify misleading information.
It is my pleasure. You are most welcome.
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Thanks for the information do far Internist :)

 

If one is more on the P side of the H/P/F scale, are there things that can be done to make up for it?

 

Also, and this I'm not sure you would necessarily be able to answer, but do you know if this general selection criteria outline is indicative of IM programs at the other schools as well? How about other primary care residencies at UofT?

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Like me, but younger.

 

At the risk of sounding evasive, there really isn't one prototype. That being said, year after year, the people who get ranked most favourably tend to have the following in their package:

 

1. strong letters of reference from people that the Selection Committee respect (and believe). Further, the letters are consistent in their high praise. When I say "strong letters", I mean ones where words like outstanding are used (as opposed to 'very good') and where there is often a literal bottom line with sentiments to the effect of, "John is simply one of the very best. I've supervised trainees for over ten years and have no hesitation in stating that he is one of the most outstanding students I've ever encountered".

 

That being said, not everyone can get letters like that. Don't worry though, even "lesser" praise is fine. Many "ideal" candidates are described as functioning at the level of a PGY 1 (or sometimes PGY2's!) even if there is no explicit comparison to their peers (e.g. "top 10 percent") or bottom line statement as described.

 

I've mentioned earlier, or at least implied, that in addition to strong letters, "ideal" candidates have references from people we expect (and usually know) to be good judges of what we're looking for (i.e. academic internists who have considerable experience with students and aren't blown away by the only one they've worked with in the last two years).

 

2. outstanding academic achievement in Med School. By this, I'm getting at 'honours' (where possible), awards and scholarships for academic excellence, and unusually strong praise in verbatim text comments on their clerkship rotation evaluations (they are often summarized, or listed outright on those letters)

 

3. unique and impressive life accomplishments. This is, of course, quite vague but, as mentioned somewhere else in this thread, I'm talking about stuff like excelling (not just participating) in a sport or a hobby such as music. I'm also referring to things like overcoming adversity at some point in their life, or doing something 'special' while in Med school (e.g. started organization to bring health care to impoverished or disenfranchised group).

 

4. In my opinion (i.e. I am not speaking for others with respect to this point), an "ideal" candidate has worked with someone locally and was "clearly" superb. Obviously, this is most applicable to people from outside U of T. And, what does "superb" mean? Excellent knowledge, enthusiasm, reliable, clearly enjoys what she's doing, loved by patients, great team player, good sense of humour. I'm sure none of this surprises any of you.

 

Evasiveness, skirting questions, over confident, zero knowledge of our program, failing to leave sufficient cash in the envelope, are all things that won't help a candidate. But it's awful hard to "blow" the interview, these things notwithstanding.

 

Frankly, I'm not sure. To a large extent, given the "busyness" factor for all of us, it may largely be a matter of who's available that day.

 

I could, but then I'd have to shoot you.

 

It is my pleasure. You are most welcome.

 

Thank you!!! 2 weeks to go! :) And, thanks to your husband for being patient with those of us stealing your time to answer all the questions! :)

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On the CaRMs website, it says that broad-based electives are recommended. Would applicants be at a disadvantage if they did all internal CTU electives at different sites (there's no guarantee they'll get in at a particular site) and then just the mandatory surgical electives?
For Int Med (again, I speak for U of T only), that would be a fine set of experiences. One reason that, frankly, seems to be forgotten by referees, is that the more rotations you do on CTUs, the better you're going to perform on the later (CTU) rotations. I've seen this phenomenon many, many times, e.g. someone does an elective on a CTU, say, at St. Mikes. They then do another CTU elective at the TGH. Would you be surprised to learn that they were considered "outstanding" by the TGH CTU preceptor? Obviously not - they have had (at least) twice the CTU experience as their peers on the TGH rotation (usually).

 

I know this makes us sound parochial, but we do not put much value on either electives taken outside of Int Med or referee letters from outside of Int Med. In other words, taking only Int Med electives is a very good plan for an aspiring U of T Int Med applicant. The converse, of course, is not such a good idea.

 

I'm also curious about what characteristics beyond academic and clinical excellence that the committee is looking for. From what it sounds like, whether someone gets an interview is based on the assessment of 2 committee members. Besides getting a third assessor if there is a huge discreptancy in the scores, what other controls are to reduce personal preferences? E.g. You mentioned that you would bump up individuals with 'real life skills' -- would this be the same case for every committee member or would say, someone else ignore extraucrriculars and place much more emphasis on student politics and research/publications? I can see how there may not be much difference in the way different faculty evaluate the criteria for clinical capabilities (based on reference letters), but the rest of the 'soft factors' seem kind of hazy.
This is a tough question without an unequivocal answer. And, really, it goes to the heart of the notion that the selection process is inherently flawed, or at least non-standardized.

 

That being said, my sense is that most people on the U of T committee share my sentiment that real life accomplishments are worth something. How much that something is worth, is going to vary among members. Now, as to what constitutes a meritorious accomplishment, that's also going to vary. I think it's safe to say that most of us would say research achievements if accompanied by outstanding clinical characteristics, are certainly going to help. Likewise, and judging from the comments made by other committee members, most of us believe that if someone has persevered through and overcome some life challenge, or somehow found the time and energy to achieve 'something special' (especially if contemporaneous with med school), then that person is going to overcome the challenges of an Int Med residency.

 

One specific case of non-medical accomplishment deserves special mention. To wit, if someone has a unique way of looking at things, and has demonstrated that their way is a productive and/or innovative one, that can make a big (positive) difference for them. As an example, if an applicant was responsible for a quality control initiative in industry (perhaps as a coop student or even in a real job before med school) and says he/she has been observing the way patients are triaged in the E.R. and now has some (practical) ideas how to improve the quality and safety of that process, that would be a plus in many committee members' eyes (how's that for a run on sentence?).

 

But, back to your question, I really don't have a clear, uniformly agreed upon, answer.

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If one is more on the P side of the H/P/F scale, are there things that can be done to make up for it?
Implicit in your question is an absolutely critical point: A 'P' on your core Internal Medicine rotation is NOT the kiss of death. Many people get accepted into our program who got a 'pass', and not 'honours', on the penultimate year Internal Medicine rotation. How, why? They had reference letters that made it clear they were excellent, their 'P' grade in Int Med was one of only a few 'P's overall on their transcript, someone on the committee worked with them and could attest to their outstanding ability (and speculate that they must have had a bad day on the written exam and that was what brought their mark down into the 'P' range), or, importantly, it became apparent from reading their personal letter, or from their interview, that while they were doing their Int Med rotation, something 'stressful' was going on in their lives.

 

Also, and this I'm not sure you would necessarily be able to answer, but do you know if this general selection criteria outline is indicative of IM programs at the other schools as well? How about other primary care residencies at UofT?
Sorry, I honestly don't know the answer to either of those questions
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You should name the UWO guy whose letters you don't pay attention to. What's the point of students working with him if they can't get a letter that you'll read? Save them the wasted time and just out the guy.

 

this is hilarious! The preceptor in question does have a reputation for writing extremely positive reference letters for everyone, but I never realized that it was that bad to the point of programs discounting them! Lucky I didn't use his letter for U of T! I did at some of the programs out west and got interviews there though, maybe he is not as notorious there? Just ask anyone in the post-clerkship stages at UWO and they'll be able to guess who this is. I am not telling over the net so don't PM me. It's a pity if people don't want to work with him anymore because he's one of the best educators we have- all the students will agree on that. He also does do CTU at times, but I doubt you can request to not be on his team.

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