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Cap in number of Electives

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There is some conversation going on at CFMS about the possibility of capping the number of electives you can do in one specialty:

“with the increasing competitive nature of the residency match and emphasis on importance of parallel planning, there has been extensive discussion around implementing a national policy for electives diversification by capping the total elective time students may spend in one specialty over the course of clerkship. Beginning with the Class of 2021, student elective opportunities cannot exceed a maximum of 8 weeks in any single entry-level discipline. This would only occur if all 17 medical schools across Canada agreed to enforce the cap, such that no students become disadvantaged during the match.”

What are your thoughts on this?

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My first instinct was that it's smart: if you have 16 weeks and spend all 16 in one specialty, then you can't realistically back up. If you have to spend the other 8 elsewhere, then you can back up

But on the other hand, I can see it not actually changing anything. If you have all 8 weeks in derm, and 8 weeks in family/internal, well, it's pretty clear what you're doing. You probably wouldn't be able to get away with <8 weeks in any one specialty at that point, unless maybe it's family.

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I think it's a great change.

Unfortunately, the reality is that some competitive programs will not consider unless you go all-in to their specialty because the candidates are just that good. 

With more and more unmatched students per year, it becomes more riskier applying to these competitive programs. With this elective cap, programs can't fault you for not doing 100% of your electives in their rotation and you're able to back-up with another specialty (so not putting all your eggs in one basket).

It's not perfect - because you can look not dedicated if you do your electives in 2 completely different specialties, but it's a step in the right direction imo.

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34 minutes ago, insomnias said:

My first instinct was that it's smart: if you have 16 weeks and spend all 16 in one specialty, then you can't realistically back up. If you have to spend the other 8 elsewhere, then you can back up

But on the other hand, I can see it not actually changing anything. If you have all 8 weeks in derm, and 8 weeks in family/internal, well, it's pretty clear what you're doing. You probably wouldn't be able to get away with <8 weeks in any one specialty at that point, unless maybe it's family.

True, this would make how student's decide to schedule their electives easier (forcing them to parallel plan), but it would still depend on how program directors view the student's interest based on this strategy

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32 minutes ago, beeboop said:

western already does this, you can only do 12 weeks in 1 speciality and have to do at least 3 different specialities.

Interesting. I wonder if competitive programs are aware of this when they have a hidden expectation of someone doing almost 100% of their electives in their specialty.

But 12 weeks is still about 85% of your electives - so not sure it does much if your elective distribution is 12 weeks, 2 weeks, 2 weeks

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2 hours ago, beeboop said:

western already does this, you can only do 12 weeks in 1 speciality and have to do at least 3 different specialities.

One aspect of this proposal also put forward is to consider all surgical disciplines as one instead of for example peds ortho and ortho counting as separate electives.

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I think it is trying to answer the wrong question. The biggest problem currently isn’t that people aren’t backing up/parallel planning but we do not have enough residency spots for every qualified English speaking graduate. 

Until there is a balance in supply and demand, or there is major restructuring in how medical education and licensure is carried out in Canada, these attempts are sugar packet solutions at best, if not diverting attention away from actually addressing the main issue. 

These are big systemic problems to tackle, but even starting small with an elective cap is not going to necessarily encourage “parallel planning”. Someone who has four electives in specialty A and one elective in each of specialties B-E gives off a different impression compared to the person with four of specialty A and three of specialty B and one of specialty C to “round out your education”. I don’t blame the residency directors for gauging interest using elective selection, and certainly the  elective cap does not change that mentality. 

What it will lead to is an even greater increase in residency applications for programs to sort through, especially the ones in primary care ie. FM. Judging applicants for interviews will be that much harder and ambiguous. 

So TLDR. No, not a fan. Change the elective system to max 1 per program, if you truly want to have a “well rounded education”. 

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3 minutes ago, sangria said:

I think it is trying to answer the wrong question. The biggest problem currently isn’t that people aren’t backing up/parallel planning but we do not have enough residency spots for every qualified English speaking graduate. 

Until there is a balance in supply and demand, or there is major restructuring in how medical education and licensure is carried out in Canada, these attempts are sugar packet solutions at best, if not diverting attention away from actually addressing the main issue. 

These are big systemic problems to tackle, but even starting small with an elective cap is not going to necessarily encourage “parallel planning”. Someone who has four electives in specialty A and one elective in each of specialties B-E gives off a different impression compared to the person with four of specialty A and three of specialty B and one of specialty C to “round out your education”. I don’t blame the residency directors to gauge interest using elective selection, and certainly the  elective cap does not change that mentality. 

What it will lead to is an even greater increase in residency applications for programs to sort through, especially the ones in primary care ie. FM. Judging applicants for interviews will be that much harder and ambiguous. 

So TLDR. No, not a fan. Change the elective system to max 1 per program, if you truly want to have a “well rounded education”. 

Good point - the proposed change doesn't really address the underlying problem and could actually create some unintended consequences.  To play devil's advocate though, it could be that more "well-roundedness" may improve 2nd round matching for unmatched CMGs.  There is, I seem to remember, a fairly close split between IMGs and CMGs in that round: it may be that some PDs now prefer IMGs instead of CMGs who may have only done electives in an unrelated specialty.  

I know at my school, electives in a single specialty are already capped and it sounds like it may be the case at some other places.  If only partially implemented, this rule could create exacerbate disadvantages/advantages for some, since PDs could interpret lack of single-choice electives as lack of interest in the specialty.    

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3 hours ago, tere said:

Good point - the proposed change doesn't really address the underlying problem and could actually create some unintended consequences.  To play devil's advocate though, it could be that more "well-roundedness" may improve 2nd round matching for unmatched CMGs.  There is, I seem to remember, a fairly close split between IMGs and CMGs in that round: it may be that some PDs now prefer IMGs instead of CMGs who may have only done electives in an unrelated specialty.  

I know at my school, electives in a single specialty are already capped and it sounds like it may be the case at some other places.  If only partially implemented, this rule could create exacerbate disadvantages/advantages for some, since PDs could interpret lack of single-choice electives as lack of interest in the specialty.    

It doesn’t make much sense to me if they indeed want to improve the second round matching rate instead of looking at the system as a whole. Regardless, the limiting factor is that it is mathematically impossible for everyone qualified to be matched into English speaking programs. That’s irrespective of how well rounded the applicants are, or how many different programs they applied to. 

Trying to improve individual chances of matching, ie in the case of backing up/parallel planning, is only an advantage when it isn’t something everybody does. When it is made mandatory in the setting of not enough spots, then it’s only a game of musical chairs. Your best bet is hoping that it isn’t you being left in the cold, but someone not unlike you will.

 

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3 hours ago, sangria said:

It doesn’t make much sense to me if they indeed want to improve the second round matching rate instead of looking at the system as a whole. Regardless, the limiting factor is that it is mathematically impossible for everyone qualified to be matched into English speaking programs. That’s irrespective of how well rounded the applicants are, or how many different programs they applied to. 

Trying to improve individual chances of matching, ie in the case of backing up/parallel planning, is only an advantage when it isn’t something everybody does. When it is made mandatory in the setting of not enough spots, then it’s only a game of musical chairs. Your best bet is hoping that it isn’t you being left in the cold, but someone not unlike you will.

 

Any IMG matching in the second round is matching into a spot a CMG could theoretically match into.  So, if the proportion of CMGs matching into the second round were increased, that would increase the effective number of chairs, in theory.  I’m not saying it’s a great solution, only that it could help, practically speaking.  

Edit:  Looking at the numbers, the CMG proportion jumped from about 50% in 2015 to 65% in 2017, leaving about 50 spots that weren't CMG matches, in the second round.  So bottom line, this may only have a small net effect UNLESS more residency positions are created, like what happened in Nova Scotia and the one-off in Ontario.  OTOH, given the tightness of the situation, where even the 10 NS FM spots could be helpful, a change like this could have some positive repercussions.   

source:    https://afmc.ca/sites/default/files/documents/en/Publications/AFMC_reportreducingunmatchedcdnmg_en.pdf

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I think it's great. At McGill, in our class year, we had up to 20 weeks of electives, and 24 for students who went to Gatineau.

The problem was that if you all in, you are pretty much screwed if you back up with anything, including fam med.

However, if you do electives in many fields, you will be seen as not serious to the eyes of some programs. I know people who got asked bluntly if they wanted that specialty because they didn't all in on that specialty.

At a time where match rates are brutal, where this catch 22 exists, I think it's great. It will help students who didn't match to have a viable option when it comes to backing up. Also, it sucks to only have 8 weeks, but then everyone would only have 8 weeks.

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22 hours ago, Eudaimonia said:

There is some conversation going on at CFMS about the possibility of capping the number of electives you can do in one specialty:

“with the increasing competitive nature of the residency match and emphasis on importance of parallel planning, there has been extensive discussion around implementing a national policy for electives diversification by capping the total elective time students may spend in one specialty over the course of clerkship. Beginning with the Class of 2021, student elective opportunities cannot exceed a maximum of 8 weeks in any single entry-level discipline. This would only occur if all 17 medical schools across Canada agreed to enforce the cap, such that no students become disadvantaged during the match.”

What are your thoughts on this?

I think it’s a terrific idea and makes sense, ensuring students are better positioned to make an informed choice. 

Back in the day, I applied to 3 fields, each in which I considered I could be a happy and fulfilled practioner. Of course, I had to rank them, but In my mind, I ranked them equally. One field was a competitive surgical specialty where I landed and I devoted way less than 8 weeks of electives to it. My lack of significant exposure was not considered a detriment, rather what proved more important was my fit based upon my soft skills. All the gunners interviewed were not selected notwithstanding their greater knowledge and exposure. 

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26 minutes ago, insomnias said:

One of the profs who's involved in career planning at the U of A mentioned this is 99% finalized and all schools seem to have agreed, so it seems specialty planning will become interesting

 

As long as the number of residency positions and graduating medical students stays where they are, a policy like this actually does nothing it purports to do with respect to CaRMS, everything ends up filled anyway because of supply and demand.

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2 hours ago, a7x said:

As long as the number of residency positions and graduating medical students stays where they are, a policy like this actually does nothing it purports to do with respect to CaRMS, everything ends up filled anyway because of supply and demand.

Completely agreed. The real root cause is insufficient residency positions. Until they fix this root cause, all these new 'policies' or 'rules' are nonsensical. 

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19 minutes ago, la marzocco said:

Completely agreed. The real root cause is insufficient residency positions. Until they fix this root cause, all these new 'policies' or 'rules' are nonsensical. 

I'm wondering if the change is motivated by the recommendation of keeping CMG/IMG streams separate in the second round (which was considered a medium/high impact move to solve the unmatched problem).  Since I'm guessing that won't go through, this might be a way to create better outcomes for CMGs in that position - or even decrease the chances of it occurring.  It was also suggested above that this could help CMGs make better choices when it comes to residency selection.  The recommendation was:

"2. Maintain the separation of Canadian medical graduate and international medical graduate streams in the 2nd iteration of the resident match." (source above)

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How is that supposed to really help? You likely have 12-16ish weeks of electives, not all of which may or in fact likely will be prior to the CARMS cut off and thus useful for impressing people/getting a LOR or exploring options. That leaves you with at most say 4-8 weeks that maybe and only maybe used on something else, and some of that is likely in required diversification electives anyway. You might have 4-6 weeks potentially in some other field if you are absolutely lucky to line everything up perfectly. Good luck with that. 

That may help for sure in some particular fields - mostly fields that are already relatively easy to get into. Most likely not all that useful in some other areas of moderate competitiveness - and to be clear you can have a bunch of head people state that people with X electives will not be disadvantaged but on the ground when they are looking at particular people that is extremely hard to actually enforce. Also there little question in my mind that gunners will do whatever they can to twist those other electives to be as close as possible to their target specialty and who can blame them ha. 

But even if all that works and somehow is pulled off. As people mentioned above it is a zero sum game. If you make everyone more competitive for more things it doesn't help overall with the problem. On some level it may make some things worse actually as now you have more people applying to multiple things and driving up the number of applicants for every program - when numbers jump things become more arbitrary in selection which is not what you really want. In the end though the same number of people will actually likely match in round one - or close to it - and then once again you are in second round hell with a good chunk of people. 

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9 minutes ago, rmorelan said:

In the end though the same number of people will actually likely match in round one - or close to it - and then once again you are in second round hell with a good chunk of people. 

I think this is what they're trying to change - by forced diversification, they're hoping match rates will go up in both the first and second round.  Currently a number of CMG quota positions are lost to IMGs in the second round - I believe this could be meant to address that (and it would decrease the number of unmatched CMGs, since this is built into their forecast model).  The idea of "informed choice" for CMGs was also mentioned above.   

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1 minute ago, tere said:

I think this is what they're trying to change - by forced diversification, they're hoping match rates will go up in both the first and second round.  Currently a number of CMG quota positions are lost to IMGs in the second round - I believe this could be meant to address that (and it would decrease the number of unmatched CMGs, since this is built into their forecast model).  The idea of "informed choice" for CMGs was also mentioned above.   

I mean I get that but that set of positions you mention is relatively small and I think the idea that those spots were not accessible because the candidate didn't have a diverse elective experience just a bit silly. Of the roughly what 230 spots in round one left over about 160 were family medicine, 20 internal, and 10 psych. Many of those were in Quebec where the problem is not elective experience but rather knowing the language. How would this really let more people access those spots - at least enough to be a reasonable solution?

We are almost at 1:1 CMG to carms spots. You can rearrange all the chairs all you want but is that really the problem? 

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32 minutes ago, rmorelan said:

I mean I get that but that set of positions you mention is relatively small and I think the idea that those spots were not accessible because the candidate didn't have a diverse elective experience just a bit silly. Of the roughly what 230 spots in round one left over about 160 were family medicine, 20 internal, and 10 psych. Many of those were in Quebec where the problem is not elective experience but rather knowing the language. How would this really let more people access those spots - at least enough to be a reasonable solution?

We are almost at 1:1 CMG to carms spots. You can rearrange all the chairs all you want but is that really the problem? 

I understand your frustration - there's clearly systemic problems which governments (outside QC) are not addressing.  I truly believe this is motivated by the idea that anything counts - governments seem reluctant to make any big changes, so if this means 30/50 of the CMG quota positions that are currently being filled by IMGs in the second round are now filled by CMGs in the first or second round, then this probably would be considered a significant step to solving the problem.  The forecast models are based on cumulative deficits, etc.  Since none of the provincial recommendations for solving the unmatched problem (except for the one-off from Ontario) have been implemented, I believed outside the military and NS adding residency spots this is one of the only steps that could actually be taken.  

Having diverse electives could be even more important in the second round.

And while I agree that in theory CMGs should be more easily filling second round positions, this isn't what's occurring.  I remember this from earlier this year:

"Nevertheless, it’s the key thing that needs to change, say Andy Ng, who graduated from the University of Ottawa’s MD/Ph.D. program in 2017. In his fourth year of med school, Ng applied to neurology programs across the country and received interviews at almost all of them. “I had a pretty good CV, I did really well in my clinical rotations, and I got very good references,” he says. He believes that most schools were speaking to 40 to 50 students—for two or three positions. Still, he was shocked when he didn’t match. In the second round, Ng applied for family medicine which seemed to him a likely match—there were several positions in Ottawa and Calgary (there were more in Quebec, but to meet the needs of French-speaking communities it was expected that physicians in those programs would speak French, which Ng did not). In the end, only seven of the 14 U of O students who went unmatched in the first iteration found a spot in the second, and Ng was not one of them."

(source: http://healthydebate.ca/2018/03/topic/medical-students-carms )

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1 hour ago, tere said:

I understand your frustration - there's clearly systemic problems which governments (outside QC) are not addressing.  I truly believe this is motivated by the idea that anything counts - governments seem reluctant to make any big changes, so if this means 30/50 of the CMG quota positions that are currently being filled by IMGs in the second round are now filled by CMGs in the first or second round, then this probably would be considered a significant step to solving the problem.  The forecast models are based on cumulative deficits, etc.  Since none of the provincial recommendations for solving the unmatched problem (except for the one-off from Ontario) have been implemented, I believed outside the military and NS adding residency spots this is one of the only steps that could actually be taken.  

Having diverse electives could be even more important in the second round.

And while I agree that in theory CMGs should be more easily filling second round positions, this isn't what's occurring.  I remember this from earlier this year:

"Nevertheless, it’s the key thing that needs to change, say Andy Ng, who graduated from the University of Ottawa’s MD/Ph.D. program in 2017. In his fourth year of med school, Ng applied to neurology programs across the country and received interviews at almost all of them. “I had a pretty good CV, I did really well in my clinical rotations, and I got very good references,” he says. He believes that most schools were speaking to 40 to 50 students—for two or three positions. Still, he was shocked when he didn’t match. In the second round, Ng applied for family medicine which seemed to him a likely match—there were several positions in Ottawa and Calgary (there were more in Quebec, but to meet the needs of French-speaking communities it was expected that physicians in those programs would speak French, which Ng did not). In the end, only seven of the 14 U of O students who went unmatched in the first iteration found a spot in the second, and Ng was not one of them."

(source: http://healthydebate.ca/2018/03/topic/medical-students-carms )

ha, fair enough - while I question the utility of the effort - as I am not convinced it will have the desired effect (you would still clearly be backing up with say family, and as always if you would take family medicine in round two you should have already applied to it in round one but ranked it after what you really prefer - a message that cannot be repeated enough), you would still have to be interested in something left over in the second round now (as those are the spots targeted by this, and that basically means family med, and to a lesser degree internal and psych number wise) and I worry it would actually weaken the chances of some people to get competitive things by potentially increasing the number of people applying to them (you could now do max or near max electives in two competitive things potentially and apply to both programs), and preventing people from hitting all the schools in their area that require an elective at their centre to match there (which is harsh but is still common and lowers your chances potentially), I am glad they are trying something and I truly mean that. I don't want sound like I am damning their efforts by faint praise in seriousness - it is easy to complain about things - but to point out the schools must take a more active role in addressing these issues more directly.  I also know that  making applications more suitable to get into family med as a key example is politically a safe bet for a school to do. We can do more, and we should do more.

To use the example above was Dr. Ng and all his efforts in a particular research stream to get a PhD. really doing himself or Canada as whole (who supported and paid for a ton of that training) to have him pushed into family medicine? Also Ottawa only has 10 weeks of electives pre CARMS so for him in particular it wouldn't make much difference - the 8 weeks would have gone to neurology, the one remaining one alone wouldn't really strengthen his application I suspect (but at other schools with different plans it might have).  

On a related note they could solve this to some degree by adding a new round of carms between the current first and second rounds if their goal is to solve this by putting more CMGs into the left over open pooled spots.   

and all of this in general doesn't really make me feel happy about anyone doing the IMG route. Everyone is actively trying to squeeze you out.  

Edited by rmorelan

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