Premed 101 Forums

# Cap in number of Electives

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Good. French schools already do this. Let's standardize the process.

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I go to McGill and this was posted in one of our class Facebook groups... seems to be decent opposition and this was sent to our dean

I think this person's main argument is that the cap does not serve its purpose

Example: A candidate is interested in ENT, and in the past there would have been on aggregate 10 applicants per ENT residency spot. This candidate would have done as many weeks as possible (16 in any one specialty at McGill) in ENT to demonstrate his or her interest in the field. Having not backed up with another field (and therefore not being a serious candidate in the eyes of that other fields program directors), he or she would also prioritize ENT when ranking programs to CaRMS. Candidates in other fields would have done the same and assume for arguments sake that every field involves 10 applicants per residency spot (does not change the end math).

With a newly instituted cap, this candidate may back up with a related field, plastic surgery for example, to "increase" the odds of matching. Let's consider why this is mathematically not actually what can be expected.

Pre-cap, plastic surgery would have also been a 10 to 1 situation, with serious candidates uniquely spending time in plastics and only applying in plastics because that is the only field in which they would be considered "competitive". Now however, with the added interest/applications of students primarily interested in related fields (ENT), but backing up with plastics, the odds may change from 10:1, to 20:1 or to 30:1 (applicant to vacancy ratio, assume 20:1 for simplicity).

Satisfied with his or her backup plan, the candidate considers the likelihood of matching into any residency program come the end of the year. Pre-cap, he or she would have had a 10% (1/10) chance of matching (uniquely in ENT). Now, this candidate can expect a 5% (1/20) chance of matching in ENT and a 5% (1/20) chance of matching in plastics. On aggregate, the candidate would still have a 10% (1/20 + 1/20) chance of matching come CaRMS, but would have sacrificed the certainty of it being in his or her main area of interest. CaRMS was instituted in the first place to switch 1% odds of matching in each of 10 specialties (10% total) for 10% total odds of matching with relative certainty in one main field.

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22 hours ago, rmorelan said:

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.

With respect to second round matching,  there could be some unknowns.  It could that electives in a given specialty are after the initial CaRMS cut-off, but could make a difference in the second round.  Similarly, I doubt Dr. Ng thought after a MD/PhD that he would have difficulty matching - i.e. people can change their mind or have very unexpected results.  With more diversified electives, it could help people prepare for those situation and also make choices.

Although it's an interesting suggestion, I doubt adding a new round of CaRMS would be easily feasible logistically and could bring a lot of confusion - people already find they have to scramble for round two for example.  I think a cap on the number of electives is a much easier bureaucratic move.

I don't think any of the moves are intentionally singling out IMGs.  It's a challenging and often costly path - the problem is just supply and demand, same with medical school.  There's more demand than supply.  Also, to some extent IMG quota positions are a relic of the past: Canada doesn't need to bring in foreign trained medical graduates to fulfill manpower needs like it did in the 1970s.  In fact, there's now almost a surplus of CMGs to residency positions unlike when the quota was created.  Despite the high demand for residency seats, I noted yesterday that UBC had about 50 IMG spots in FM (compared to 120 CMG)  - but there could other factors at play like the attached ROS which provinces don't want to give up and which may not be attractive to CMGs (UBC seemed to have the highest number of IMG spots, mostly in FM, although UofT wasn't up yet).

3 hours ago, candycrush101 said:

I go to McGill and this was posted in one of our class Facebook groups... seems to be decent opposition and this was sent to our dean

I think this person's main argument is that the cap does not serve its purpose

Example: A candidate is interested in ENT, and in the past there would have been on aggregate 10 applicants per ENT residency spot. This candidate would have done as many weeks as possible (16 in any one specialty at McGill) in ENT to demonstrate his or her interest in the field. Having not backed up with another field (and therefore not being a serious candidate in the eyes of that other fields program directors), he or she would also prioritize ENT when ranking programs to CaRMS. Candidates in other fields would have done the same and assume for arguments sake that every field involves 10 applicants per residency spot (does not change the end math).

With a newly instituted cap, this candidate may back up with a related field, plastic surgery for example, to "increase" the odds of matching. Let's consider why this is mathematically not actually what can be expected.

Pre-cap, plastic surgery would have also been a 10 to 1 situation, with serious candidates uniquely spending time in plastics and only applying in plastics because that is the only field in which they would be considered "competitive". Now however, with the added interest/applications of students primarily interested in related fields (ENT), but backing up with plastics, the odds may change from 10:1, to 20:1 or to 30:1 (applicant to vacancy ratio, assume 20:1 for simplicity).

Satisfied with his or her backup plan, the candidate considers the likelihood of matching into any residency program come the end of the year. Pre-cap, he or she would have had a 10% (1/10) chance of matching (uniquely in ENT). Now, this candidate can expect a 5% (1/20) chance of matching in ENT and a 5% (1/20) chance of matching in plastics. On aggregate, the candidate would still have a 10% (1/20 + 1/20) chance of matching come CaRMS, but would have sacrificed the certainty of it being in his or her main area of interest. CaRMS was instituted in the first place to switch 1% odds of matching in each of 10 specialties (10% total) for 10% total odds of matching with relative certainty in one main field.

With respect to your example, the issue is what happens without a match in that preferred specialty?  Currently that's not well-adressed in the system and this proposal could potentially help with that.  The example from Dr. Ng above makes it clear that even having a PhD in the area doesn't guarantee a match in the field.  The argument is to maintain the status quo, when in fact the status quo isn't working.

While I understand the individual's worry, there's a lot of speculation.  The main concern seems to be lost time demonstrating interest - well PDs could still take that into consideration.  Many suggestions were considered in detail and outlined by the AFMC - I just don't think any of the provinces want to implement them.  Sure adding spots makes sense, but it costs money and provincial governments don't seem to want to pay.

Other suggestions like standardized testing wouldn't help in any obvious way improve global matching ratios - if anything could make the situation worse.  Despite the paradoxical situation, decreasing enrolment I doubt will be a politically popular move, when many places do face challenges with respect to access to care.  I also don't think the actual institution have that much control over that either.

I've mentioned that one of the intended goals of this policy could be to improve CMG matching ratios in both first and second round, since I think that actually keeping CMG/IMG streams separate in both rounds, which would be a provincial decision, also would not be acceptable to the provinces.

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Will this cap be for clerkship electives only, or will it also include pre-clerkship electives?

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On 10/6/2018 at 11:59 PM, sw604 said:

Will this cap be for clerkship electives only, or will it also include pre-clerkship electives?

Does not include pre-clerkship electives (post MF4 at McMaster and whatever the equivalent at Calgary is)

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I believe this cap is now official. They don't have all the details (like how it will be enforced). Im curious to know peoples strategies for elective planning.

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9 hours ago, ninja7292 said:

It is a forgone conclusion - official statements have set to be released but all 2021s at McMaster are acting as if it is a foregone conclusion based on what has been said by admin

Same, the last update we were given said Mcgill has agreed to it and I think they're just waiting on a couple more schools to confirm. We got proposed details of the cap but not sure if those will change once schools meet

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16 minutes ago, ninja7292 said:

Would you mind sharing those details? We haven't heard anything concrete details yet

"There are still some schools who haven’t made their decision at this time; it is expected to hear from all schools in early February."

The policy we got seems to be "of the new McGill electives policy" which is contingent on the acceptance by other schools. To me this sounds a bit confusing, but the highlights are:

·       Maximum eight weeks in any entry-level discipline - this corresponds to the list of R1 programs that you can apply to through CaRMS

·       Minimum of three disciplines (this is an old McGill rule, but is probably widespread with other schools have selectives)

• Research (in any specialty) is now considered a separate entry-level discipline

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UBC voted on it as well and confirmed it. No official statement from the faculty but we've heard from our student reps who were at the meeting. I think we were one of the last ones remaining.

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This will make CaRMS even riskier. For super competitive specialties there will be no way of knowing who has committed to the specialty. Furthermore, you will only be able to have FaceTime with 4 programs. For a discipline like plastics where in the current climate you can only expect to get interviews at schools you did electives at, this will make things much harder.

Finally i think an unintended consequence is that this will put the Quebec schools on a more even playing field which will allow them to better compete outside of Quebec. I suspect the numbers of applicants for conpetitive specialties is going to skyrocket as the barrier to entry is going to be much lower.

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35 minutes ago, Aetherus said:

This will make CaRMS even riskier. For super competitive specialties there will be no way of knowing who has committed to the specialty. Furthermore, you will only be able to have FaceTime with 4 programs. For a discipline like plastics where in the current climate you can only expect to get interviews at schools you did electives at, this will make things much harder.

Finally i think an unintended consequence is that this will put the Quebec schools on a more even playing field which will allow them to better compete outside of Quebec. I suspect the numbers of applicants for conpetitive specialties is going to skyrocket as the barrier to entry is going to be much lower.

UGME's counterargument for this is that it will have to force programs to change the way they assess candidates, ie not having done an elective there  I'm not sure if PGME has had anything to say about this

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30 minutes ago, Eudaimonia said:

UGME's counterargument for this is that it will have to force programs to change the way they assess candidates, ie not having done an elective there  I'm not sure if PGME has had anything to say about this

In theory this change will force programs to reconsider how they select candidates. Unfortunately, every new initiative makes each applicant seem more homogenous and makes it harder for the program to select the best candidates.

We now have a system with no objective way of ranking candidates. We haven’t had grades for a long time. Electives were at least a way for programs to infer commitment to the specialty. Now we take this away. I’m quite concerned this will force applicants to show commitment to the specialty by other means. I expect site visits will become more and more necessary to show interest to programs you were unable to do electives at. Possibly people will book laid back electives with a lot of free time to try and then take call shifts with their specialty of choice as a way to circumvent the cap. People will fudge electives to make them seem like another specialty: Neurology elective with a Neuro-Ophthalmologist, Burn ICU with a Plastic Surgeon etc.

I think this will also put more pressure on applicants to be productive in research in the field of choice to show commitment.

Overall, I think this will not have the intended results. This will have little effect for students going for general specialties and will make life way more difficult for people going for competitive specialties. This will have the unintended consequence of leveling the field for the Quebec school which will lead to a greater efflux out of Quebec which will further worsen the ratio of spots per candidate in the rest of Canada.

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14 hours ago, jfdes said:

UBC voted on it as well and confirmed it. No official statement from the faculty but we've heard from our student reps who were at the meeting. I think we were one of the last ones remaining.

Queen's confirmed it as well. Personally not keen on this cap, but guess there's nothing to be done at this point. Just glad that I'll be the second year with the implementation, not the first.

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2 hours ago, Aetherus said:

In theory this change will force programs to reconsider how they select candidates. Unfortunately, every new initiative makes each applicant seem more homogenous and makes it harder for the program to select the best candidates.

We now have a system with no objective way of ranking candidates. We haven’t had grades for a long time. Electives were at least a way for programs to infer commitment to the specialty. Now we take this away. I’m quite concerned this will force applicants to show commitment to the specialty by other means. I expect site visits will become more and more necessary to show interest to programs you were unable to do electives at. Possibly people will book laid back electives with a lot of free time to try and then take call shifts with their specialty of choice as a way to circumvent the cap. People will fudge electives to make them seem like another specialty: Neurology elective with a Neuro-Ophthalmologist, Burn ICU with a Plastic Surgeon etc.

I think this will also put more pressure on applicants to be productive in research in the field of choice to show commitment.

Overall, I think this will not have the intended results. This will have little effect for students going for general specialties and will make life way more difficult for people going for competitive specialties. This will have the unintended consequence of leveling the field for the Quebec school which will lead to a greater efflux out of Quebec which will further worsen the ratio of spots per candidate in the rest of Canada.

Good points. I do think the elective cap is a good idea though - there's so many specialties where there's this hidden expectation that you do almost all your electives in that specialty to show interest, which closes you off to other specialties.

Now it's possible to target your top 2 specialties, and not be scrutinized for it. I see the flaws in this as well, for example if your top 2 specialties are unrelated, splitting your electives may do more harm than good. However, I do think it's a step in the right direction, because it's just too risky to go all in for a specialty.

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On 2/2/2019 at 11:02 AM, Eudaimonia said:

Research (in any specialty) is now considered a separate entry-level discipline

What does that mean exactly? That you're only allowed 8 weeks of research, that if you do research in any field it counts towards 8 weeks in that field, or that research is a way to circumvent the 8-week cap...?

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53 minutes ago, sWOMEN said:

Personally I think the 8 week cap stinks, 2nd and 3rd years at Mac applying for the competitive surgical subspecialty I want to apply for were able to do electives at almost every English-speaking program Those that wanted to back up with Family were able to do so

With the new 8 week cap, I am at a loss as to what to do with myself for the remaining 8 weeks. I was planning on backing up with Family so I guess I will do 8 weeks of family? Or should I do some weeks in relevant subspecialties at sites I am unable to visit? Should I try to fudge my electives or do something easy at other sites and try to mooch with their residents and staff on call like @Aetherus  suggested? I wish we werent the first year that had to go through this - I have no idea how programs will react to this change but since the competitive specialties all have small number of applicants UGME doesnt really care about us

The match rates for this just started to pick up this year and will certainly go back to being in the 50s in my year with this change

surely there is a speciality that is relevant/useful to your desired speciality that you could do for those other weeks...

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Ex: imagine instead of the cap, that we would require every student to complete 4 weeks in Family Medicine in a rural area as part of their total elective weeks. As a student, I should have every right to know exactly what I am getting into and planning accordingly before I am expected to do so. You can bet that I'll be organizing and booking my electives differently should I know that I have to do 4 weeks in Rural Family Medicine. It doesn't matter if that's what I wanted to do all along, or if it is not at all what I want to pursue. You would not expect me to be told that halfway through booking my electives.

The haziness that surrounds the implementation of the cap is, to put it in polite terms, a par-for-the-course state of frustration created by administrative staff that hold their discussions and make their decisions behind closed doors. We have already passed the date of 26 weeks; we are being told to book our electives, when we don't even know how many we are allowed to book. At what point do the schools realize that it is unjust to say "assume that the cap is happening"? At what point do career advisors start suggesting to their students methods to circumvent the cap because they KNOW that it is a disadvantage to those applying to competitive specialities? At what point does it get through to someone that they cannot tell me about restrictions in the planning of my future after I have already planned it?

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1 hour ago, insomnias said:

What does that mean exactly? That you're only allowed 8 weeks of research, that if you do research in any field it counts towards 8 weeks in that field, or that research is a way to circumvent the 8-week cap...?

It's referring to a research elective where you spend X weeks of elective doing research instead of clinical work.

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Bad change. Number of spots doesn't change, meaning same # of students go unmatched. Only thing that changes is the match strategy.

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33 minutes ago, beeboop said:

surely there is a speciality that is relevant/useful to your desired speciality that you could do for those other weeks...

Unfortunately, the problem is not finding relevant specialties. Most highly competitive fields will have at least some other specialty that has some relevance.

None of this affects me as I have already matched to my specialty of choice last year.

However, my concern is that for highly competitive fields, the elective is used as an interview of some sort. You are much more likely to interview where you do an elective and you are much more likely to match where you did an elective. I can say with confidence that certain programs in certain fields, such as plastics, will only interview people who have done electives at the respective site.

The programs are slightly disconnected with what is going on at a UGME level, I suspect it will take 1-2 years before they adapt to this cap and in the interim, students will suffer.

The other concern is that the current system forces people to commit to a certain specialty if they are going for a competitive one. This allows to narrow down the numbers of applicants as you have to fully commit to the specialty. By putting an 8 week cap, I suspect that the amount of applicants for these specialties are going to increase significantly which will make it overall more difficult for someone to match to a competitive specialty.

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5 hours ago, Aetherus said:

This will make CaRMS even riskier. For super competitive specialties there will be no way of knowing who has committed to the specialty. Furthermore, you will only be able to have FaceTime with 4 programs. For a discipline like plastics where in the current climate you can only expect to get interviews at schools you did electives at, this will make things much harder.

Finally i think an unintended consequence is that this will put the Quebec schools on a more even playing field which will allow them to better compete outside of Quebec. I suspect the numbers of applicants for conpetitive specialties is going to skyrocket as the barrier to entry is going to be much lower.

It will make things fairer though, if those are the rules in plastics, it definitely disadvantages schools that do not have many electives like Calgary and some of the Quebec schools and it benefits schools like UBC that have a lot of elective time.

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24 minutes ago, Aetherus said:

Unfortunately, the problem is not finding relevant specialties. Most highly competitive fields will have at least some other specialty that has some relevance.

None of this affects me as I have already matched to my specialty of choice last year.

However, my concern is that for highly competitive fields, the elective is used as an interview of some sort. You are much more likely to interview where you do an elective and you are much more likely to match where you did an elective. I can say with confidence that certain programs in certain fields, such as plastics, will only interview people who have done electives at the respective site.

The programs are slightly disconnected with what is going on at a UGME level, I suspect it will take 1-2 years before they adapt to this cap and in the interim, students will suffer.﻿

The other concern is that the current system forces people to commit to a certain specialty if they are going for a competitive﻿ one. This allows to narrow down the numbers of applicants as you have to fully commit to the specialty. By putting an 8 week cap, I suspect that the amount of applicants for﻿ these specialties are going to increase significantly which will make it overall more difficult for someone to match to a competitive specialty.﻿﻿﻿﻿﻿﻿﻿﻿﻿

At the end of the day, CaRMS is going to be a zero sum game. For someone to win, someone is going to have to lose, unless we increase the total number of spots or something. I think the main purpose of having an electives cap is to level the playing field between schools, since some schools have more elective time than others. It also allows people to use electives to explore specialties as opposed to impress. For example, at Mac, the true number of post-core pre-carms electives is often 2-4 weeks in most clerkship streams. This would allow those students to spend some of their early clerkship electives exploring interests rather than try to impress while operating at a disadvantage.

The other benefit is that it will allow people to better prepare parallel plans without hurting their chances at their first choice specialty. Overall, I think this is a good decision. There are other ways to demonstrate interest in a specialty like plastics: ECs, research, shadowing, networking etc.

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53 minutes ago, Aetherus said:

Unfortunately, the problem is not finding relevant specialties. Most highly competitive fields will have at least some other specialty that has some relevance.

None of this affects me as I have already matched to my specialty of choice last year.

However, my concern is that for highly competitive fields, the elective is used as an interview of some sort. You are much more likely to interview where you do an elective and you are much more likely to match where you did an elective. I can say with confidence that certain programs in certain fields, such as plastics, will only interview people who have done electives at the respective site.

The programs are slightly disconnected with what is going on at a UGME level, I suspect it will take 1-2 years before they adapt to this cap and in the interim, students will suffer.

The other concern is that the current system forces people to commit to a certain specialty if they are going for a competitive one. This allows to narrow down the numbers of applicants as you have to fully commit to the specialty. By putting an 8 week cap, I suspect that the amount of applicants for these specialties are going to increase significantly which will make it overall more difficult for someone to match to a competitive specialty.

As a M4 who just finished the CaRMS tour, I would dare to say that some programs are VERY disconnected from what is going on at the UGME level. They have no idea how electives are obtained (i.e. that we have to apply through the portal, spending hundreds, sometimes thousands of dollars per block). They have no idea that different schools have different elective times/schedules, they unfortunately assume that every school follows something similar to their home school. Obviously I'm not familiar with most programs, so this may not apply everywhere.

Programs are already have trouble keeping up with the +++ number of applications they are receiving due to most applicants backing up or "parallel planning". This change makes it much easier to apply to multiple specialties and I 100% agree with Aetherus in that I believe this will only make things worse for competitive specialties where now any person can try their luck and shoot an application to these programs, as opposed to doing some due diligence and showing commitment via X number of electives.

29 minutes ago, Edict said:

At the end of the day, CaRMS is going to be a zero sum game. For someone to win, someone is going to have to lose, unless we increase the total number of spots or something. I think the main purpose of having an electives cap is to level the playing field between schools, since some schools have more elective time than others. It also allows people to use electives to explore specialties as opposed to impress. For example, at Mac, the true number of post-core pre-carms electives is often 2-4 weeks in most clerkship streams. This would allow those students to spend some of their early clerkship electives exploring interests rather than try to impress while operating at a disadvantage.

The other benefit is that it will allow people to better prepare parallel plans without hurting their chances at their first choice specialty. Overall, I think this is a good decision. There are other ways to demonstrate interest in a specialty like plastics: ECs, research, shadowing, networking etc.

See my response above. In my opinion, it will hurt applicants first choice specialty IF its a competitive one. Maybe I'm biased, because I am applying to a relative competitive specialty but I already find that programs struggle to figure out who to invite for interviews, and increasing the number of applicants to these small competitive programs will not help things.

Do you really want to force applicants to jump through even more hoops like publications, site visits, unofficial electives, etc to demonstrate interest? Most PDs will agree that its very hard to determine how interested an applicant is in a particular specialty and its unfortunate they use elective time a substitute measure. They realize its possible to have many different interests, but unfortunately they have to be pragmatic to cut down and sort through applications and elective time is one such way to do so. I'm not arguing that this is right or wrong, but simply trying to convey that this is the way it is, and I personally would rather commit to 1/2 specialties rather than find new and expensive ways to demonstrate my interest in a specialty.

Don't we have enough stress? Don't we already spend a considerably amount of money on the entire elective and CaRMS process?

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On 9/12/2018 at 1:59 PM, candycrush101 said:

I go to McGill and this was posted in one of our class Facebook groups... seems to be decent opposition and this was sent to our dean

I think this person's main argument is that the cap does not serve its purpose

Example: A candidate is interested in ENT, and in the past there would have been on aggregate 10 applicants per ENT residency spot. This candidate would have done as many weeks as possible (16 in any one specialty at McGill) in ENT to demonstrate his or her interest in the field. Having not backed up with another field (and therefore not being a serious candidate in the eyes of that other fields program directors), he or she would also prioritize ENT when ranking programs to CaRMS. Candidates in other fields would have done the same and assume for arguments sake that every field involves 10 applicants per residency spot (does not change the end math).

With a newly instituted cap, this candidate may back up with a related field, plastic surgery for example, to "increase" the odds of matching. Let's consider why this is mathematically not actually what can be expected.

Pre-cap, plastic surgery would have also been a 10 to 1 situation, with serious candidates uniquely spending time in plastics and only applying in plastics because that is the only field in which they would be considered "competitive". Now however, with the added interest/applications of students primarily interested in related fields (ENT), but backing up with plastics, the odds may change from 10:1, to 20:1 or to 30:1 (applicant to vacancy ratio, assume 20:1 for simplicity).

Satisfied with his or her backup plan, the candidate considers the likelihood of matching into any residency program come the end of the year. Pre-cap, he or she would have had a 10% (1/10) chance of matching (uniquely in ENT). Now, this candidate can expect a 5% (1/20) chance of matching in ENT and a 5% (1/20) chance of matching in plastics. On aggregate, the candidate would still have a 10% (1/20 + 1/20) chance of matching come CaRMS, but would have sacrificed the certainty of it being in his or her main area of interest. CaRMS was instituted in the first place to switch 1% odds of matching in each of 10 specialties (10% total) for 10% total odds of matching with relative certainty in one main field.

Plastics is not a back up to ENT. People need to realize that yes, ‘back up’ speciality is not necessarily their top choice, but a specialty that will prevent you from going unmatched. It sucks, and it’s stressful, but I think med students need to realize not every one can practice the field of choice in a geographical area of their choosing. I know it sucks, it’s unfair, but earlier you grasp that idea, the happier and less stressful you will be through carms, and reduce likelihood of going unmatched.  There is no profession in the world where everyone gets to have their ideal job

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