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tere

ON changes CaRMS second round for IMG/CMG

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"R-1 Second Iteration

There will be two parallel streams – CMG and IMG – with designated positions for each stream. There will be no crossovers or transfers between the two streams.

Residents in current PG positions can access the second iteration as a way of changing programs or specialties. CMG Residents can only apply to unfilled CMG positions. IMG Residents can only apply for unfilled IMG positions. Please review the national transfer guidelines for more information. AFMC National Transfer Guidelines"

https://www.carms.ca/match/r-1-main-residency-match/eligibility-criteria/ontario/

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That's a bit of a surprising move. Considering how tight the ratio of spots to graduates is for CMGs in Ontario, not sure why the provincial government would want to lock in that ratio moving into the second round. There's no great stats on crossover of CMGs and IMGs to spots originally designated for the other stream, but from what numbers are available, I'd guess that it's close to even (that is, about as many CMGs end up in IMG spots as IMGs end up in CMG spots).

This should mean the net effect on match rates should be zero or at least fairly small, but it makes the system less flexible and I'm not sure I see an obvious upside. Programs now have a smaller pool of candidates to draw on for both CMG and IMG spots, meaning they're not going to get the optimal candidate as often. Hopefully there's a bigger plan here - it would be an interesting approach if more CMG spots were added, for example - but in a vacuum I see this change as introducing a few (relatively small) problems while solving none.

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Not that it affects me as a resident, but I'm curious why this overnight change. I'm sure it will have a large impact on many IMG applicants who would want to return to Ontario. Couldn't they, for example, give a year or 2 between announcement and implementation so students can plan for the change

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27 minutes ago, ralk said:

That's a bit of a surprising move. Considering how tight the ratio of spots to graduates is for CMGs in Ontario, not sure why the provincial government would want to lock in that ratio moving into the second round. There's no great stats on crossover of CMGs and IMGs to spots originally designated for the other stream, but from what numbers are available, I'd guess that it's close to even (that is, about as many CMGs end up in IMG spots as IMGs end up in CMG spots).

This should mean the net effect on match rates should be zero or at least fairly small, but it makes the system less flexible and I'm not sure I see an obvious upside. Programs now have a smaller pool of candidates to draw on for both CMG and IMG spots, meaning they're not going to get the optimal candidate as often. Hopefully there's a bigger plan here - it would be an interesting approach if more CMG spots were added, for example - but in a vacuum I see this change as introducing a few (relatively small) problems while solving none.

It was one of the recommendations by the AFMC for reducing the number of unmatched grads:  "2. Maintain the separation of Canadian medical graduate and international medical graduate streams in the 2nd iteration of the resident match.  "

It's nowhere near as good a solution as adding more spots, but across Canada it's IMGs that have matched more advantageously to 2nd round CMG vacancies than the other way around.  It could vary by program and location, however.  

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

image.png.6771c66f9bfa46b4143caeca52c2b708.png    

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8 hours ago, tere said:

It was one of the recommendations by the AFMC for reducing the number of unmatched grads:  "2. Maintain the separation of Canadian medical graduate and international medical graduate streams in the 2nd iteration of the resident match.  "

It's nowhere near as good a solution as adding more spots, but across Canada it's IMGs that have matched more advantageously to 2nd round CMG vacancies than the other way around.  It could vary by program and location, however.  

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

image.png.6771c66f9bfa46b4143caeca52c2b708.png    

Hmm, good stats there, that's very helpful. So, there would seem to be a real benefit if this were implemented nation-wide.

Wonder what the breakdown would be province-by-province though. When I looked at last year's numbers, it seemed as though there were about as many Ontario IMG spots left as there were IMGs matching to Ontario in the 2nd round (17 each). IMGs also gained some of that ground in less desirable locations (such as NOSM, which had no IMG spots left in the 2nd round but matched 4 IMGs), meaning CMGs correspondingly likely took some more desirably-located IMG spots that they now won't have access to.

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1 hour ago, ralk said:

Hmm, good stats there, that's very helpful. So, there would seem to be a real benefit if this were implemented nation-wide.

Wonder what the breakdown would be province-by-province though. When I looked at last year's numbers, it seemed as though there were about as many Ontario IMG spots left as there were IMGs matching to Ontario in the 2nd round (17 each). IMGs also gained some of that ground in less desirable locations (such as NOSM, which had no IMG spots left in the 2nd round but matched 4 IMGs), meaning CMGs correspondingly likely took some more desirably-located IMG spots that they now won't have access to.

I've never seen a province-by-province breakdown.  

The most useful Table I could see on the CaRMS website suggested there were 20 IMG quota positions left-over across Canada after the first round in 2018 (with 12/20 in FM):
https://www.carms.ca/wp-content/uploads/2018/06/r1_tbl14e_2018.pdf

I'd speculate the move was made since it was i) both a recommendation by the AFMC and ii) wouldn't mean more spending by the ON government.  
 
I'd hope there is more ON specific data to support the change.  

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15 minutes ago, ploughboy said:

For better or worse, this also will prevent programs from playing the "oh, we couldn't find a qualified IMG for our IMG spot in the first round, so we're going to take a CMG in the second round" game...

 

A likely consequence that they glossed over i'm sure.  Not sure how I feel about this policy. On the surface it seems like it *may* favour CMGs, but with what you just said as well, it's hard to figure out if anyone comes out ahead...or just evens out but a different mix.

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"Residents in current PG positions can access the second iteration as a way of changing programs or specialties. CMG Residents can only apply to unfilled CMG positions. IMG Residents can only apply for unfilled IMG positions. Please review the national transfer guidelines for more information. AFMC National Transfer Guidelines"

Would this potentially change how transfers work now for residents? Previously it was behind the scenes but now it seems it is official. 

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2 hours ago, Edict said:

"Residents in current PG positions can access the second iteration as a way of changing programs or specialties. CMG Residents can only apply to unfilled CMG positions. IMG Residents can only apply for unfilled IMG positions. Please review the national transfer guidelines for more information. AFMC National Transfer Guidelines"

Would this potentially change how transfers work now for residents? Previously it was behind the scenes but now it seems it is official. 

Hope that doesn't mean that the unofficial channels (ie setting things up on your own outside of CARMS) are disappearing. 

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50 minutes ago, friedchickendudeMD said:

interesting idea

Ha, although I would hate it to be THAT formal - as harsh as it sounds there really are Canadian grads from medical school that no program would want to accept (at least in the areas they want to go into). Rare of course but anyone that has gone through the system knows they are there. 

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53 minutes ago, rmorelan said:

Ha, although I would hate it to be THAT formal - as harsh as it sounds there really are Canadian grads from medical school that no program would want to accept (at least in the areas they want to go into). Rare of course but anyone that has gone through the system knows they are there. 

Why would no program would want to accept them? Can you give examples?

Most people I meet are well suited, qualified and are hard-working.

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16 minutes ago, medicine2019 said:

Why would no program would want to accept them? Can you give examples?

Most people I meet are well suited, qualified and are hard-working.

Most being the operative word, haha.

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3 minutes ago, PhD2MD said:

Most being the operative word, haha.

I meant 99% of people are well suited, qualified and are hard-working. I have met individuals who are always late or do not show up, but for most part, I think most of CMG are well qualified students.

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4 minutes ago, medicine2019 said:

I meant 99% of people are well suited, qualified and are hard-working. I have met individuals who are always late or do not show up, but for most part, I think most of CMG are well qualified students.

Things change a little bit when you become a resident. You become more attuned to the attitudes of clerks than before, and you really do start to see a difference between them. As a resident, I'm totally fine with a student who doesn't know something or needs to ask questions. Heck, even if you've done it before but can't remember, that's fine. What I can't tolerate is a student who shows up late, who messes up consults that you have to redo things from A to Z, and who interrupts people during rounds. Things of this sort make my job harder.

These people do exist, and I run into 1 or 2 every year. And I'm in a small specialty where we don't get that many students. So I can certainly understand when programs are reluctant to take certain people

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30 minutes ago, medicine2019 said:

 

 

9 minutes ago, medicine2019 said:

I meant 99% of people are well suited, qualified and are hard-working. I have met individuals who are always late or do not show up, but for most part, I think most of CMG are well qualified students.

 

5 minutes ago, shady said:

Things change a little bit when you become a resident. You become more attuned to the attitudes of clerks than before, and you really do start to see a difference between them. As a resident, I'm totally fine with a student who doesn't know something or needs to ask questions. Heck, even if you've done it before but can't remember, that's fine. What I can't tolerate is a student who shows up late, who messes up consults that you have to redo things from A to Z, and who interrupts people during rounds. Things of this sort make my job harder.

These people do exist, and I run into 1 or 2 every year. And I'm in a small specialty where we don't get that many students. So I can certainly understand when programs are reluctant to take certain people

No one disagrees. My experience with international clerks/IMGs suggests that the Canadian cohort is probably near the very top internationally. Even so, with >3000 CMGs each year, there's bound to be one or two that don't impress (shady provides good examples).

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55 minutes ago, shady said:

Things change a little bit when you become a resident. You become more attuned to the attitudes of clerks than before, and you really do start to see a difference between them. As a resident, I'm totally fine with a student who doesn't know something or needs to ask questions. Heck, even if you've done it before but can't remember, that's fine. What I can't tolerate is a student who shows up late, who messes up consults that you have to redo things from A to Z, and who interrupts people during rounds. Things of this sort make my job harder.

 

messing up consults how? like not being able to take a complete history or forgetting to ask important questions?

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5 hours ago, rmorelan said:

Ha, although I would hate it to be THAT formal - as harsh as it sounds there really are Canadian grads from medical school that no program would want to accept (at least in the areas they want to go into). Rare of course but anyone that has gone through the system knows they are there. 

then these grads should never get an MD degree but med school is based on bullshit so thatll never happen

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8 hours ago, GrouchoMarx said:

then these grads should never get an MD degree but med school is based on bullshit so thatll never happen

Well...people slip thru all kinds of cracks, especially when your dealingw with larger numbers. I definitely observed that on the academic PhD side. But that doesn't mean the whole system is BS!

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8 hours ago, GrouchoMarx said:

then these grads should never get an MD degree but med school is based on bullshit so thatll never happen

Ha as you know it is extremely hard to remove someone from medical school - particularly as it is hard to document and evaluate some of the more subjective aspects of professionalism. In some ways that is a good thing - schools are a form of dictatorship at times and you have to have some checks on that. 

It is exactly professionalism that is the problem usually - we are very good at admitting smart people. Problems when they occur are usually related to other things. Schools have tried - oh they have tried - but they are not very good at it at all. There are an infinite set of appeals, and then legal action.  

As much as residency is training and education, it is also a job. You cannot absolutely force a hospital to hire someone for 2-5 years that they feel cannot do that job particularly if they are worried about the safety of patients.

Now of course the vast major of people going on unmatched don't fall into that area at all.  We have a lot bigger issues as to why people don't match. 

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11 hours ago, brady23 said:

messing up consults how? like not being able to take a complete history or forgetting to ask important questions?

you will run into people that for whatever reason don't seem to educated properly in how to do particular parts of the job - that generally is correctable with more education. The real problems are personality. 

 

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16 hours ago, PhD2MD said:

 

 

No one disagrees. My experience with international clerks/IMGs suggests that the Canadian cohort is probably near the very top internationally. Even so, with >3000 CMGs each year, there's bound to be one or two that don't impress (shady provides good examples).

I would think only *some* EU grads (country dependent) and of course USA grads on par with Canadian ones. Everywhere else the clinical training ranges from abysmal to mediocre. Even in the EU, many countries have their students essentially just shadow (at best) during these rotations. 

 

Do you have any experience with Canadian IMGs on rotations? Specifically the carib/ireland cohort. Any anecdotes regarding how well prepared they seemed?

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