Ask the CaRMS Selection Committee member

[Monaco]

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).

 

This is an excellent point. For those students interested in Internal Medicine, get some experience before your core rotations. Then you'll look like a superstar next to your classmates. On my rotations, a couple of classmates had done this and they really were outstanding compared to the rest of us (who didn't want internal at all).

[jwp2000]

What is the value of electives at different sites? I'm primarily interested in internal meds at UofT (I'm a UofT student), but I think it'd be interesting to see how medicine works at different centres. However, from a carms perspective, would I be better off concentrating my limited elective time in Toronto just so that I get to know people in Toronto?

[Internist]

What is the value of electives at different sites? I'm primarily interested in internal meds at UofT (I'm a UofT student), but I think it'd be interesting to see how medicine works at different centres. However, from a carms perspective, would I be better off concentrating my limited elective time in Toronto just so that I get to know people in Toronto?

I would definitely recommend going away for at least some of your electives. Programs tend to rank people they know higher than people who are just a name to them. And, given that not everyone is going to get into U of T Int Med, it's very wise to have a back-up plan. Further, you will still have your core Int Med rotation at Toronto, so you should be able to get at least one reference from U of T anyway. Conversely, your only way of getting a letter from somewhere else is to go there (in most cases).

 

Beyond the pursuit of reference letters, I think there's another important reason to spend at least some of your elective time elsewhere - you may find that you actually really like what you see, and wind up choosing to go there for your core years (and beyond). And, even if not, the experience and insights you get during your stay there can be very valuable (with respect both to Int Med training specifically, and "life" in general).

 

Finally, a letter secured as a result of an elective taken out-of-town, so long as it's from someone "known and respected" by the selection committee (and most letters from academic internists will fit that description), is still very helpful at U of T.

[Silver Squirrel]

Hi

How is the integrated clerkship (offered at a few schools) considered by the committee? In some schools, integrated clerkship does not even have a compulsory CTU rotation. Students spend 1-2 weeks in each subspecialty of internal. Is this a bad thing?

 

Thank you

 

Thank you Internist for all this helpful information!

 

Can you please let us know your point of view on the integrated clerkship with respect to CaRMS ?

 

Thank you!

[blover]

Hi Internest-

 

1. thank you thank you thank you! I can't imagine why you would care enough to take all this time out of what I am sure is a busy enough schedule, but clearly you get how stressed out we all are.

 

2. how true is it that if one person "on committee" doesn't like someone, he or she is "blackballed". i.e., if someone has a really strong application, but someone on committee just doesn't like them for one reason or another (obviously not talking about an applicant who has clearly done something bad)- are they pretty much out?

 

thanks again

[thebouque]

Hey i know it's a new page in the thread but don't forget silver squirel and my questions

 

Thanks again!!

[Internist]

Hi

How is the integrated clerkship (offered at a few schools) considered by the committee? In some schools, integrated clerkship does not even have a compulsory CTU rotation. Students spend 1-2 weeks in each subspecialty of internal. Is this a bad thing?

Sorry for my tardiness. It's been wild at my end lately.

 

You know, and it pains me to say this, I don't think many, if any, people on the Committee appreciate this. At least, I can't recall EVER hearing even one allusion to it during our discussions. And, frankly, I was not really aware of it, though I did suspect it given the nature of some people's reference choices (honestly). Specifically, there are always letters from, say, a nephrologist or a community-based internist which, in their very first lines state that so and so did part of their "assigned" medicine rotations with them. The key word is 'assigned' which I took to be saying that they had no CTU rotation but this assigned rotation was in lieu of that. So, although I didn't know the specifics of the "intergrated" clerkship, I assumed that at least some people were not getting classical CTU rotations but, instead, had been shipped out to various sites for an alternative medicine clerkship experience. IIRC, this phenomenon seemed to be more the case out east, at either Dal or Memorial (I can't recall which, or whether it might have even been both).

 

Suggestion: Just to ensure that all the 'right' people DO understand the nature of the integrated clerkship' (and especially its effect on reference letters), and even though it won't help the current CaRMS cohort, it would be worth having the Assoc Dean Undergrad Educ from the relevant school(s) write the chairs of the various selection committees (that would be Heather MacDonald-Blumer at Toronto) and tell them explicitly a) that their school doesn't offer a CTU rotation (or maybe, at least, not to all their students) and ask them to please make sure the committee members at their school have been clearly apprised of that. Such a notification would have the most impact if it was devoted exclusively to those points and didn't dilute out the key message by talking about other stuff too.

 

One last point, basically restating something from earlier, is that even though I have emphasized that not having a letter from your CTU rotation is often a 'red flag', I wouldn't worry if that applies to you, i.e. most, maybe all, letter writers for people in such situations say that so and so was 'assigned' to them for (at least part of) their medicine clerkship. By doing so, it becomes fairly clear to the reader that there was no CTU rotation offered for that student, and that said assignment was as close as it comes for them to have a CTU rotation. Hope that makes sense. Bottom line is that applicants from places with integrated clerkships have probably not been hurt although I can't swear it's never happened.

[thebouque]

Thank you! You will probably see more and more people with an integrated clerkship background since it is offered at some French schools but also at Mcgill and at UBC. Thanks again!

[Jochi1543]

Thank you! You will probably see more and more people with an integrated clerkship background since it is offered at some French schools but also at Mcgill and at UBC. Thanks again!

 

We have an integrated clerkship option at U of A and U of C, as well.

[thebouque]

We have an integrated clerkship option at U of A and U of C, as well.

 

I'm sure you do, my enumeration was by no means exhaustive!

 

Peace

[Internal]

Internist, thanks for your detailed answers. To clarify something you said earlier, you said that the split between U of T students versus other students is 60:40 in your program. Does this mean you give preference to U of T students? Will this advantage still be there for U of T students even after converting to pass/fail?

[meshuga3]

Hi Internist, and thanks for doing this. I've already posted my question elsewhere in this forum, but I figure I might get a better response here. Here goes: With respect to letters of reference, I know CARMS officially discourages applicants from having seen them before they are sent off with applications. However, in every thread I've read on the topic, it seems that people are being advised to submit their best letters of reference- which makes sense, but suggests that most people will look at their letters and decide which to send. That's what I'd prefer to do, but I'm wondering- what impact does whether or not a student has seen a LOR have on the admissions committee's appraisal of that letter?

 

Thanks.

[Internist]

. . . pretty much anything you want. But, obviously, confidential stuff will have to be kept that way.

 

BTW, as my username probably suggests, I am on an Internal Medicine CaRMS selection committee so doubt I have anything of interest to say for people not applying to Internal (and, anything I *did* say about non-Internal Medicine programs would have to be taken with a *huge* grain of salt).

 

A suggestion, please - take a peek at this thread so far wherein many of your question and concerns are addressed if not answered.

 

I'm going to apologize in advance for any tardiness in responding. This is a pretty busy time for me and I doubt I'll be able to participate here more than a couple of times a week.

 

I'm all ears . . .

[tooty]

Internist, thanks a lot for your time. For the sake of keeping all your answers organized, let's continue with this thread instead of starting a new one every year. I edited your last post accordingly.

 

And if this thread gets buried, just bump it up.

[samsara]

Hello,

To start off, thank you very much for doing this. It is invaluable.

A few questions:

1) Is a candidate with the lions share of electives in his/her home province at a disadvantage when it comes to being granted an interview at your institution?

2) Are letters from general internists preferred over letters from subspecialists?

I ask because at our institution, we have a "core internal" rotation for 6 weeks followed by an "internal selective" in a subspecialty for 4. I happened to have better rapport/spent more time with the subspecialist and my reference letter choice reflects this. Please comment.

3) How are international electives viewed by the selections committee?

Thank you again,

Season's greetings!

[Internist]

1) Is a candidate with the lions share of electives in his/her home province at a disadvantage when it comes to being granted an interview at your institution?

No, at least not directly. However, by not having any electives with us specifically, there is no way, of course, that we can ever see first hand how excellent they are. So, even though they won't be penalized, they will, in fact, still tend to slip down the list a bit by virtue of the fact that others (who did do an elective with us, and did an outstanding job) will have been moved up.

2) Are letters from general internists preferred over letters from subspecialists?

Yes, if they are from a CTU rotation. Likewise, a specialist who knows the candidate by virtue of supervising him/her on a CTU (when they, the staff, were functioning as de facto general internists) makes an excellent choice for a reference

3) How are international electives viewed by the selections committee?

In my opinion, neither here nor there (pardon the pun). What counts is the reputation of the supervisor (or, what is much more often the case, our total lack of any knowledge about the elective supervisor/preceptor). So, for example, a reference arising from an elective taken in Asia or Africa with someone we've never heard of, and have no sense of, must be interpreted with great caution. By definition, such a reference won't be weighted heavily by us. Hence, it isn't usually a great choice. That being said, the very fact that a candidate wanted to go to, say, Africa, and put it together, speaks volume about his/her character and initiative and can be, therefore, a real plus. (How's that for equivocating?)

[lostintime]

Thanks again for taking the time to answer questions Internist! I was just wondering what's a good length of time for a CTU elective at Toronto and if there is enough time to get to know an attending to obtain a reference letter. For instance, how often do attendings change on CTU?

 

Also, are there any strategies in terms of scheduling electives? I heard many programs do not let you know until months after which means you could be left without any elective. If a CTU elective you pick fills up, will we be put into a subspecialty elective that is available or will we be left with no time to apply for anything else?

 

Happy holidays!

[Internist]

what's a good length of time for a CTU elective at Toronto and if there is enough time to get to know an attending to obtain a reference letter. For instance, how often do attendings change on CTU?

In my opinion (and I doubt there would be a general consensus by my colleagues on the Committee), at least two weeks are needed to show your skills and abilities to the point of providing a good basis for a reference letter. I, personally, don't give a lot of credence to letters written by someone who knows the student for just one week. The exception to this might be where the letter writer was one of several supervisors each in charge for, say, a week and where it's stated explicitly that the input of the other preceptors has been sought and incorporated into the letter.

Also, are there any strategies in terms of scheduling electives? I heard many programs do not let you know until months after which means you could be left without any elective. If a CTU elective you pick fills up, will we be put into a subspecialty elective that is available or will we be left with no time to apply for anything else?

I really don't know how this works. In fact, it's not even clear to me how this works in my own division, let alone elsewhere in the province (or country).

 

I agree, however, that it can be very difficult to get an elective arranged for a specific time and duration, and almost impossible to insure you get a specific preceptor. This is one reason why taking an elective with the "right" type of subspecialist may be preferable to the usual CTU elective, i.e. subspecialists can usually commit to specific dates and, critically, do not assign you to a colleague (or what's worse, a senior resident) if they can't do it themselves. If nothing else, it's far easier to get a straight answer from a subspecialist.

 

What is the "right" type of subspecialist for a reference letter? I'd say, and this is all just my opinion, that you're looking for as many as possible of the following:

 

1. he/she should be known and respected by the members of your centre's PGY1 selection committee (often this simply translates into it being someone senior and/or someone who was/is a Royal College examiner in Internal Medicine (not his/her subspeciality))

 

2. ideally he/she should attend on the CTUs (at least occasionally) and not just on his/her subspeciality

 

3. he/she should have some experience in writing these types of letters. Frankly, you don't want someone who's prone to understatement. Further, he/she should have some sense for what the Committee is looking for. Again, this may simply be another way of saying that you want someone senior, or more to the point, someone who's had LOTS of students over the years. By now, such a person will often seem to know intuitively the type of things to note in the letter (e.g. comparative assessments with other students he/she has had).

 

What is not emphasized enough in choosing references is (and as always this is just my opinion and experience) that many subspecialist letter writers feel compelled to address each and every point on the list of instructions provided by CaRMS. That almost always has the effect of diluting down the letter (since, for example, there are going to be some areas where the referee won't have much to say and then winds up sounding blase or unenthusiastic, at least with respect to those areas). The bottom line is that such letters will usually contain sections that sound very average. What you want is a letter that from beginning to end, and everywhere in between, is unequivocally positive, and in the strongest possible terms. The reader should have no doubt that you're excellent and it shouldn't matter where his/her eyes fall if they just skim the letter - they should "always" land on words of high praise (and not on, for example, some feeble attempt to describe your research abilities or ability to do procedures simply because the CaRMS instructions said that those areas should be addressed.) An experienced, and confident, referee, doesn't feel he/she must address every last area, eg. procedures. In fact, an experienced, confident letter writer often seems to pay no heed to the CaRMS instructions! But that can be a very good thing since it allows the writer to speak in free text about you, rather than in the stilted manner which usually results from addressing all the items in a list. It also allows much more readily for statements of praise to be included - again, it's not always easy to do so in a letter based on a formal list of areas to appraise and on which to report.

 

Don't quote me, but you may want to tell your referees that they can safely ignore the specifics of the CaRMS instructions. What matters is that they say who they are (rank, position, etc), how they know you and for how long (and, recall, only letters from people you've worked with clinically count for much), and speak to your knowledge and skills, intellectual ability, judgment, work ethic, reliability, enthusiasm, collegiality and team relationships, patient family interactions, and did I mention knowledge and work ethic? And how about knowledge and work ethic? And reliability? . . .

[ddocs]

Thanks for all the great insight Internist...very helpful indeed.

 

I was wondering whether you can shed some insight on IMG admissions to UofT's Internal Medicine??!! Cheers.

[hastin11]

Hey internist, thanks for all this!

 

How many total weeks of electives do you think should be done in the field you are applying to prior to the interview invites? For example, say you have 10 potential weeks of elective time before the interview invites, would 4 weeks of electives in the specialty be OK, if say 2 of the weeks are at the site you are applying to? What is your feel on this?

[AK81]

Hi, can you tell us how long the interview day will be for UofT and what type of questions they will ask?

[Averance]

Hi Internist,

 

First I'd like to thank you for taking your time answer all of these CaRMs questions that we constantly barrage you with. They are very insightful.

 

I'd like to as you a question regarding CaRMS interviews. After receiving word from all my interview programs, I was rejected from two interviews. One of the schools is one that I really want to attend (or at least have a shot) or attending.

 

I have heard hearsay about students previously contacting the program and appealing their case. What is your take on this?

 

Thanks.

[bigtymer]

Hey Internist,

 

I'm an IMG and I will be interviewing at Toronto for IM. I've read the forum and info you've put up regarding Canadian grads. Is the IMG selection process the same except for the fact that instead of a school academic record you use the Canadian board exams?

[Internist]

I was wondering whether you can shed some insight on IMG admissions to UofT's Internal Medicine??!! Cheers.

Sorry, that's not something I'm involved with. I'd just be guessing, and you don't want that.

How many total weeks of electives do you think should be done in the field you are applying to prior to the interview invites? For example, say you have 10 potential weeks of elective time before the interview invites, would 4 weeks of electives in the specialty be OK, if say 2 of the weeks are at the site you are applying to? What is your feel on this?

I'm not sure I understand. For Internal Medicine, everyone already will have exposure to the area through their own CTUs. If you are wondering whether it pays to demonstrate your interest in Internal by taking electives in it (or a specialty) in addition to your core rotation, yes, I think that helps. If nothing else it confirms you are committed. Further, as I think you are implying, it's a chance to get known by at a different university (or even by different people at the same one - this is important insofar as the more, and the more diverse, support you have at your own centre, the better off you'll be).

 

It's also good to take electives to simply improve. That can be a very wise thing if you can arrange the elective before your core CTU rotation. Doing so will cause you to arrive at the CTU with advanced skills and knowledge compared to your peers. Yes, I know that sounds a bit venal, but it IS after all your career on the line.

 

Electives in a medical subspecialty (e.g. rheum, cardio, or endo) are, of course, worthwhile in and of themselves. Still, from the CaRMS perspective, they're even better if you take such an elective with someone who is respected by the PGY1 selection committee(s) of where you want to go.

[Internist]

Hi, can you tell us how long the interview day will be for UofT and what type of questions they will ask?

Historically, the interview lasts about 20 to 25 minutes. Still, since there will be a resident available to chat while you're waiting for and when you're finished your interview, many people wind up staying for an hour or two (talking with said resident).

 

The questions will range from the obvious ('Why Internal Medicine'), to the less so. Be prepared to give your opinion on "ethics" type questions but don't worry at all about being asked the differential diagnosis for monocytosis! In other words, clinical questions are "never" asked. That being said, you may be asked to 'present' a case you had (just the major points of course). I better not say any more . . .

I have heard hearsay about students previously contacting the program and appealing their case. What is your take on this?

Absolutely, go for it. Ask them to reconsider; perhaps an error was made in reviewing your file. Or, suggest to them that you are certain that if only you could meet them in person, they'd see why you are right for them, etc. IOW, ask them for an interview even if you're initially rejected for one. Often, they will relent. Even if they don't, what's it cost you. Do it!

Is the IMG selection process the same except for the fact that instead of a school academic record you use the Canadian board exams?

As I said to your colleague (and I know you couldn't have seen that given that I replied only seconds ago), I'm sorry but I really don't know how the IMG process works.