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jnuts

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jnuts last won the day on December 30 2015

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  1. Medical students need to push for a better elective assignment process (maybe a mini-match with public outcome data collection like CaRMS) in order to mitigate all of the problems discussed in this thread.
  2. All of the above is likely true, and each program is different unfortunately. Unless there's a specific rule against it from the electives office, I'd recommend contacting staff directly and introducing yourself. Usually staff in surgical specialties (at least the programs I know) volunteer to take medical students. If you have inside information, target someone who is active on the selection committee. Again, there are limited things in this process under your control. Even the staff may have no control over which medical student they get beyond saying they have 'availability for a medical student'. There are lots of territorial fights between clinical staff and admin here. If things don't/can't happen then I'd suggest accepting the things you cannot change. Sadly, residency selection isn't about keeping medical students happy. Or anyone happy as far as I can tell.
  3. Theoretically, the elective is a prolonged interview and the staff are looking for future residents just as hard as you're looking for a residency. But, the limited number of staff who take medical students for electives (usually purely voluntarily) likely will not meet every applicant and will therefore push one or two from the limited pool they have met. See my previous post about randomness in this process. You went through this once with medical school selections. The class you're in are the best because they were selected; there's no evidence you're the best possible set of all applicants. Competitive residencies are a narrowed version of the same process.
  4. Hate to say it, but other than big intra-persona red flags; the process is mostly random. The biggest asset is having done a favorable rotation with staff active on the selection committee who will push for a given student when the final rank order decisions are made. The process is capricious.
  5. First barrier is that you must be a Canadian citizen or permanent resident to even apply. (Unless your from a country that funds spots independently--see last post)
  6. The above poster is correct in terms of Canadian citizens/permanent resident IMGs applying through CaRMS for provincially funded government spots. But, there's another pathway that she/he is missing for trainees who may not be Canadian citizens/PR and come to Canada with their home country's sponsorship and funding under an educational visa. https://www.saudibureau.org/en/inside.php?ID=17 Foreign government funded spots are purchased directly from the university and local hospital group -- they have no relationship with the provincially funded CaRMS spots. They have nothing to do with the CaRMS funded IMG spots. The applicants don't go through CaRMS and aren't captured in their statistics. I think the appeal to the University and training program is obvious. Theoretically, the reason these spots are offered (beyond international education 'altruism') is because excess training capacity, that our own provinces don't predict a future market need for/ can't afford, is going unused. More hands make lighter work within the programs themselves as well and the whole structure benefits financially. It's not talked about much as it's not relevant to most applicants. This stream (it used to be called 'Stream 3" I think) does bring many IMGs to Canada to train as residents and these doctors are fully integrated into our training program. Residents come from Middle Eastern/North African countries (Saudi and Libya were sending lots in the past), and some from South America I think. McMaster has definitely taken foreign funded IMGs into surgical residencies in the past though they stopped in about 2011 in most programs. I have no idea if they've started again. There are ongoing issues with this stream. Most notoriously recently you're subject to the whims of your home government: https://www.reuters.com/article/us-saudi-canada-doctors/saudi-trainee-doctors-set-to-head-home-from-canada-in-diplomatic-row-idUSKBN1KT2II Additionally, returning home versus staying in Canada at the end of training gets nasty sometimes--especially in tight job markets. A lot happens while these students are here and completely integrated into the residency for 5-7 years. Marriages, kids, lifestyle expectations, peer groups all change. Plus they pass the Royal College, are often very highly locally respected, and have tons of local professional connections. Many have stayed in Canada and enriched every level of our medical system. But again, the complications are self-evident both domestically and back in the country that paid for the training. Personally, I find it a bit funny how few people realize that this stream exists given that it's pretty obvious if you've spent any time with residents that the number of foreign grads doesn't line up with the CaRMS number (among other differences). It's also funny how Canadians perceive their relationship with the existence of these externally funded residency spots given that the Kingdom government pulled their students back as a retaliatory measure to punish Canada in the news story above.
  7. Sure. I'll make a few disclaimers. First, my view is through the lens of orthopaedics which may not be universally applicable. I'll also put in the caveat that I'm trying to be practical and not trying to impugn my training. I'm grateful for my opportunities. BUT my career path had a practical back-up plan. If that had not happened I'm not sure where I'd be now. I find it scary and somewhat problematic that the potential of a dead-end career after training in Canada was never frankly discussed when I was initially planning my career path or during residency when the market failed to improve. Surgical teaching staff generally act as though the relationship they have with residents is mostly educational with optional mentorship aspects. If the teaching staff were acting altruistically towards the latter ideal, training spots in fields with scarce job opportunities would be closed until the market changed as mentoring someone towards harm is ethically unacceptable. It's really not that hard to look five years down the road. To be fair, training spots in ortho have decreased but obviously no where near the level they should. Arguably, there's a freedom of personal choice involved where teaching staff simply fill trainees wish to learn and future extra-academic difficulties are irrelevant to the passing on of knowledge and skill. I'd buy that if there was no financial incentive and at least an open acknowledgement of the inherent risks but there is neither of those things. In actual fact, the relationship has a strong indirect (and sometimes direct) financial aspect as staff benefit economically through ward, clinic, and call coverage. There is absolutely no way a single provider will get through an 100+ patient clinic day without resident support. There is also secondary benefit to the university to keep residency spots filled to secure provincial funding. Given these competing pressures, it's very easy to see which priority has won out. I think that at very least, well meaning career advice from our mentors should come with a disclaimer. If I benefit financially from using a certain implant that's something I ethically have to disclose. How is this different? Saying "orthopaedics is great!" has a different tone when its followed by "WARNING I will profit off of your underpaid/unpaid labour for the next five years after which I have no further obligation to ensure the marketability of the skill set I'm offering you as compensation and all further risk is solely borne by you the trainee"
  8. Solutions exist but Canadian institutions are either maliciously self interested or moribund. 6 hours a year of business management during training isnt going to change that. I hate working in the USA for some reasons but the competitive market does produce some solutions to these problems. 1)advanced practice professionals (PAs and NPs) totally obliviate the need for resident recruitment just to keep up with the busy work. The time has more than arrived for Canadian MDs to stop protecting their own perceived interest in a professional monopoly on medical services. If there were this type of clinical support in the hospital, residency spots could be reallocated to fill market expectations more effectively and free residents to focus on relevant skills instead of 'right-of-passage' clerical support. Cost of provision of medical services might even drop (but what MD would willing encourage that...) 2)academic/administrative/clinical shared leadership roles--placing the ultimate emphasis on research is idiotic as NLengr states. However, grants are how the university keeps the lights on and advancement in the Canadian system is based on the academic side. Some programs are better at this than others, but it's very possible to split leadership responsibilities into shared diads and triads (as some hospitals down here do) with comanagement based on different individuals strengths. Anyway, these problems exist not because there aren't well established solutions. They're maintained because they're profitable to the controlling parties. Just like everything else right now, just ask yourself who benefits. You'll see quickly why the training and job market is the way it is and why medical students are misled just enough to consistently make irrational choices. And that's provided they have a choice, let's not get into the exploitation in the IMG stream.
  9. I'd say try; you never know how your application will be treated given your professional background. I would contact all the schools directly and ask if you'd qualify for "special consideration" --its an alternative admissions pathway which is formal or informal depending on the school. I know SC exists for this situation at UoT and McGill, but I'm not sure about other schools. There may even be some feeling of reciprocity as MDs are definitly treated differently for law school apps when they feel like a mid career change. Your situation is distinct enough that applying widely may pay off. In my opinion as an MD who's been on both medical school and residency admission committees, anyone with a grain of sense would value your very applicable professional success above something artificial like GPA. Residency is a cakewalk compared to 6 years as an associate (the pay is better in firms though :P) I agree with the poster above that in order to stand any chance you'll need to be out of the main stream of applicants.
  10. You may know more than I do; it's been a few years since I graded these. However, the last time I was briefed it was all either MDs or medical students and there was statistical analysis and standardization both intra- and inter- reviewer. You could read the CASPer group's research publications for an exact breakdown of the methodology. Even if what you are saying is accurate I don't think the specifics would change my advice. If you can't write for a specific reviewer, it makes strategic sense to target a stastically modal model reviewer.
  11. I've been a reviewer for CASPer as well. Unfortunately, they really mean what they say when the instructions state there is no correct answer. Reviewers are asked to score your answer based on their individual reaction to it. For example, it's not impossible that your reviewer started a relationship with a subordinate and may feel unexpectedly strongly about your answer if you take an overly aggressive position against that type of thing. You'd never know. On the other hand, your reviewers may have equally been a victim of that type of abusive relationship and will score any attempt to sympathize with the abuser with an automatic zero. Again, you'd never know. Your reviewers are ideally supposed to be a cross section of the current medical community, and the example above highlights the possible divergent opinions in that group (as does every case of a personal relationship forming in a professional power discrepancy that has been publicized lately) Multiple reviewers read each response. Scores well off the curve are supposed to be eliminated statistically. Given that all reviewers have been granted access to 'the club' there's a general bias toward ethical and moral frameworks taught in medical school and the mainstream Canadian political gestalt. But your particular set if reviewers may vary from the median to some degree. The CASPer prompts are selected to be controversial. Your safest bet is to take a nuanced and thoughtful approach that weighs both sides of the arguement. You do need to pick a side and often need to state what you would do in the situation (certainly don't forget to do that!). But spend the majority of your answer showing you can see both sides and PLEASE demonstrate some empathy. I personally looked for evidence of empathy and compassion above all else and scored overly academic answers poorly. When you do need to pick a side or take a course of action try to stay as close as possible to mainstream positions. Do not try to stand out. Unlike an in person interview, don't try to be funny or memorable; there's way too much risk of being misinterpreted. To stay close to the mainstream review the C2LEO resources published by the Medical Council of Canada https://mcc.ca/about/test-committee-resources/
  12. Same knowledge outcome with very minor cultural differences. But: 1. Bigger range of quality of school in the US. Canadian schools are VERY standardized at the mid-to-high quality level by US MD standards. All Canadian schools produce largely comparable outcomes. The US has objectively lower and elite tier medical schools with worse and better educational experiences as well as ultimate residency and career placement rates. 2. The USA has the osteopathic (D.O.) stream as well as the allopathic (M.D.). Canada is all allopathic. Though the US is harmonizing the two streams, D.O is still somewhat limiting and geared more towards family/community practice (with MANY exceptions). If your goal is matching in Canada D.O.s are considered IMGs, USMDs are not. 3. Emphasis on grades/test scores in US as mentioned above. The flip side is the emphasis on 'soft score' evaluations and dumb luck to generate positive references and contacts for residency matching purposes in Canada. In Canada there's no use of grades or scores for determining residency allocation; just references and reputation. I'd argue that there's just as much opportunity to mess up--and far less student level control--in the Canadian system. In general, going to the US with the intent to match back to Canada is like shooting yourself in the foot compared to attending a Canadian school. Even with less competitive residencies, your choices will be decreased if you go through the US route. Drastically reduced through USDO.
  13. H1b most commonly Very rarely O-1 (established elite practitioners) Very very rarely TN (academic only, clinical duties less than 10% of total employment duties)
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