2019 CaRMS unfilled spots

[Edict 603]

1 hour ago, TalsKnight said:

Yeah seriously....doesn't this amount to about 19% of the class going unmatched? That is worrisome for a Canadian medical school.

 

While I understand what you are saying, and I mean fair enough, there are some things I would like to point out. First, getting into medical school in Canada is extremely difficult. Much harder than the United States (I have American friend's who got into state MD schools with a GPA of around 3.5 and an average MCAT for example). Most of the time you need grades in the A to A+ range to have a real good chance in Canada. Having high standards is good. However,  this could be viewed as problematic because people from higher socioeconomic backgrounds will be at an advantage. Medical school here often requires tons of EC's, research, etc. People who don't need to work and/or take care of someone else can dedicate much of their time to handling a difficult full course load. They can afford tutors to guide them through material they might be struggling with. They don't need to worry about rent, tuition, etc. Not having to work means more free time to pursue activities medical schools will look upon favourably and by default most likely tilt the chances in their favour. So Canadians who go abroad to Ireland, Australia, or wherever because they truly feel medicine is their calling , I can sympathize with. Telling people to pick an alternate career over medicine because they are not having any luck with getting in here, or telling them to keep applying year after year after year until they find themselves in their late 20s or early 30s is brutal. I see this frequently on the forums and it's incredibly premature.

 

My position is that Canadians who decide to go abroad for medicine, not the Caribbean diploma mills, but Irish schools or maybe Aussie schools (University of Melbourne was ranked #17 I believe worldwide for medicine last I checked) and actually do well and finish the program, then they likely would have done just as well in a Canadian medical school. It's not right to consider them as "lesser" just because they are IMG's in the match.

You lost me when you used international rankings as an adjunct to clinical training . 

[TalsKnight 6]

Just now, Edict said:

You lost me when you used international rankings as an adjunct to clinical training . 

Haha, the main point I was making is that some of the schools Canadians attend outside of Canada are world class and provide an excellent medical education. I routinely see Canadian med students bash CSA's/question their credentials and education which I think is pretty shortsighted.

[JohnGrisham 1,457]

9 hours ago, robclem21 said:

Overall, looks better than last year, but definitely a really rough year for certain schools.

 

The fact that there are prior year graduates who have now gone unmatched Twice is scary. I pray for them truly, and that they can pick up a FM spot in round 2 and continue on with life. 

[JuniorDr90 6]

3 hours ago, tavenan said:

It's not a matter of who's better and who is not, it's a matter of having common sense policies. We are either a country or we are not, being Canadian has to mean something. It is pure madness to give any spots to IMG's when we have overly qualified Canadian graduates going unmatched. Being Canadian has to give you an advantage as our system is funded by Canadian tax dollars. No other country in the world treats their medical graduates this way. 

 

If being a doctor in Canada is so hard for IMG's, that should be something they consider in terms of whether they want to stay in their country or immigrate to Canada. As a country we have to give preference to our own citizens. I don't know how a rational person can accept a single IMG taking a residency spot when we have literally hundreds of excellent Canadian graduates going unmatched. I challenge you to find a single other first world country that faces this issue.

 

Maybe you can't see this problem clearly because, as you say, some of your friends and supervisor might be IMG's. I'm sorry that IMG's are suffering, but I would rather help Canadians first and then see what's left for IMG's. If we can fill every single residency spot in Canada with a excellent CMG, which I believe we can, then that's what we should do. 

Do you realize that IMGs who are allowed to apply for residency training should either be:

1- Canadian Citizen 

2- Canadian permanent resident. 

We are tax payers as much as yourself ! We invest money in Our country ! Discrimination against IMGs should be against everything that Canada represents! 

For your surprise as well there is very little difference in rights between a « Canadian » and a permanent resident (quoting https://www.canada.ca/en/immigration-refugees-citizenship/services/new-immigrants/pr-card/understand-pr-status.html ) 

What permanent residents can do

As a permanent resident, you have the right to:

• get most social benefits that Canadian citizens receive, including health care coverage,
• live, work or study anywhere in Canada,
• apply for Canadian citizenship,
• protection under Canadian law and the Canadian Charter of Rights and Freedoms.

You must pay taxes and respect all Canadian laws at the federal, provincial and municipal levels.

What permanent residents cannot do

You are not allowed to:

• vote or run for political office, 
• hold some jobs that need a high-level security clearance.

[Chels1267 97]

45 minutes ago, JohnGrisham said:

The fact that there are prior year graduates who have now gone unmatched Twice is scary. I pray for them truly, and that they can pick up a FM spot in round 2 and continue on with life. 

I know of one IMG personally, went to RCSI. Not sure which specialty he's trying to match to but I don't believe it's FM. This is his second (maybe third?) attempt through CaRMS. 

[rmorelan 2,095]

32 minutes ago, JuniorDr90 said:

Do you realize that IMGs who are allowed to apply for residency training should either be:

1- Canadian Citizen 

2- Canadian permanent resident. 

We are tax payers as much as yourself ! We invest money in Our country ! Discrimination against IMGs should be against everything that Canada represents! 

For your surprise as well there is very little difference in rights between a « Canadian » and a permanent resident (quoting https://www.canada.ca/en/immigration-refugees-citizenship/services/new-immigrants/pr-card/understand-pr-status.html ) 

What permanent residents can do

As a permanent resident, you have the right to:

• get most social benefits that Canadian citizens receive, including health care coverage,
• live, work or study anywhere in Canada,
• apply for Canadian citizenship,
• protection under Canadian law and the Canadian Charter of Rights and Freedoms.

You must pay taxes and respect all Canadian laws at the federal, provincial and municipal levels.

What permanent residents cannot do

You are not allowed to:

• vote or run for political office, 
• hold some jobs that need a high-level security clearance.

You are right - which is why the lumping of CSA/IMGs together is all based on accreditation. You can discriminate on the basis of education by law (otherwise you couldn't require someone to have a degree or specific training in something in order to hold a job - which doesn't make sense). 

I have always resisted for a number of reasons attempts to separate out CSA vs IMGs. It almost always doesn't make any logistical or legal difference. I also don't think changing anything there will radically change the match results if those two groups are broken out somehow. Permanent residents are just on the stepping stone pathway to becoming full citizens on top of that. 

I also hate the taxpayer line ha. It is a personal thing but it somehow to me implies someones worth is based on how much taxes they pay. Since most students are net consumers of tax dollars by a far margin as well I find it a somewhat weak argument to make (should students' opinion on public policy but ignored because they take vastly more tax dollars than they give? I don't think so). Plus everyone in the country pays tax in some fashion (unless something strange is going on) so who exactly is being excluded. Somehow we have gotten trapped into using that term all the time instead of citizen. I fully admit all that is just personal opinion and my dislike of it may be somewhat irrational. 

 

 

 

 

[thesupreme 18]

..

[JohnGrisham 1,457]

31 minutes ago, Chels1267 said:

I know of one IMG personally, went to RCSI. Not sure which specialty he's trying to match to but I don't believe it's FM. This is his second (maybe third?) attempt through CaRMS. 

The data above is for CMGs only. I know two IMGs(CSA) residents i've worked with who didnt match until 3rd attempt.  They didn't want to write the USMLEs, so that was their choice ha.

[Chels1267 97]

Just now, JohnGrisham said:

The data above is for CMGs only. I know two IMGs(CSA) residents i've worked with who didnt match until 3rd attempt.  They didn't want to write the USMLEs, so that was their choice ha.

Yeah I realized that's what you were referring to right after I posted haha

[icewine 16]

Good luck to those going through the second round.

On 2/27/2019 at 12:52 AM, medigeek said:

Europe/Australia do have shady clinical training though as anything outside of Canada/USA I'd be skeptical towards. 

1

Interesting statement. What are you basing this on? I'm asking as an Australian educated and postgraduate trained doc.

[medigeek 63]

2 hours ago, Chels1267 said:

I know of one IMG personally, went to RCSI. Not sure which specialty he's trying to match to but I don't believe it's FM. This is his second (maybe third?) attempt through CaRMS. 

very silly to not write usmles if you're an img

[JohnGrisham 1,457]

54 minutes ago, icewine said:

Good luck to those going through the second round.

Interesting statement. What are you basing this on? I'm asking as an Australian educated and postgraduate trained doc.

Not going to entertain their poor choice of words calling them shady, but may be referring to the different style of clinical training. At least the friends i know in australia, and residents ive met(now attendings), clinical training is more hands off in their experience during australian medical school clerkships compared to Canada/US.  At least some residents expressed the transition into a Canadian residency was a lot more difficult with the different expectations. Generally evened out after R1 though for them(trial by fire!).  

At the end it evens out, just different time points of snapshot comparisons.   

One could say that US rotations in medical school can be equally variable and less hands on compared to Canada.  Then you could again make the comparison of inter-Canadian programs and even different hospital sites within the same canadian school. Friends at other Canadian schools never had to do call-shifts during Obstetrics, and only had to do 4 weeks of surgery. But in general the expectations of the ideal clinical clerk experience in Canada, on average(not always), is noted that there is more responsibility and hands on experience compared to other models where you get that experience as a registrar after medicals school(as in the UK model).

[JohnGrisham 1,457]

Just now, medigeek said:

very silly to not write usmles if you're an img

They were willing to keep reapplying to CaRMs and hope to match. Not my cup of tea of risk tolerance, but they didnt want to have to go through the trouble apparently. It helped they went straight from high school to 6 year programs, so even the 2 years lost unmatched, they still came out ahead compared to the average CMG with a bachelors or masters etc.

[medigeek 63]

1 hour ago, icewine said:

Good luck to those going through the second round.

Interesting statement. What are you basing this on? I'm asking as an Australian educated and postgraduate trained doc.

Mostly anecdotes but a very high volume of anecdotes. It's not so much that every country overseas has poor clinical training. But that it's highly inconsistent. If you're doing a rotation in North America, pretty much any rotation, you will be actively engaged. You see patients on your own, you develop a plan etc etc. Most students perform procedures at various points and so on. Overseas it seems to be far more shadowing than actually doing and the "doing" is more limited to history taking and not much more. 

[medigeek 63]

4 minutes ago, JohnGrisham said:

Not going to entertain their poor choice of words calling them shady, but may be referring to the different style of clinical training. At least the friends i know in australia, and residents ive met(now attendings), clinical training is more hands off in their experience during australian medical school clerkships compared to Canada/US.  At least some residents expressed the transition into a Canadian residency was a lot more difficult with the different expectations. Generally evened out after R1 though for them(trial by fire!).  

At the end it evens out, just different time points of snapshot comparisons.   

One could say that US rotations in medical school can be equally variable and less hands on compared to Canada.  Then you could again make the comparison of inter-Canadian programs and even different hospital sites within the same canadian school. Friends at other Canadian schools never had to do call-shifts during Obstetrics, and only had to do 4 weeks of surgery. But in general the expectations of the ideal clinical clerk experience in Canada, on average(not always), is noted that there is more responsibility and hands on experience compared to other models where you get that experience as a registrar after medicals school(as in the UK model).

Yeah this is basically what I'm trying to say. Seems to be very hands off training overseas and if some places are hands-on, it's just inconsistent as a whole. 

I think the US thing may somewhat hospital dependent too but by the end of 4th year it's a safe bet they have fundamental skills down and the USMLEs are proof of sufficient knowledge. 

[Chels1267 97]

25 minutes ago, JohnGrisham said:

They were willing to keep reapplying to CaRMs and hope to match. Not my cup of tea of risk tolerance, but they didnt want to have to go through the trouble apparently. It helped they went straight from high school to 6 year programs, so even the 2 years lost unmatched, they still came out ahead compared to the average CMG with a bachelors or masters etc.

Time saved won't be worth it if they never match, just my 2 cents

[Edict 603]

8 hours ago, tavenan said:

It's not a matter of who's better and who is not, it's a matter of having common sense policies. We are either a country or we are not, being Canadian has to mean something. It is pure madness to give any spots to IMG's when we have overly qualified Canadian graduates going unmatched. Being Canadian has to give you an advantage as our system is funded by Canadian tax dollars. No other country in the world treats their medical graduates this way. 

 

If being a doctor in Canada is so hard for IMG's, that should be something they consider in terms of whether they want to stay in their country or immigrate to Canada. As a country we have to give preference to our own citizens. I don't know how a rational person can accept a single IMG taking a residency spot when we have literally hundreds of excellent Canadian graduates going unmatched. I challenge you to find a single other first world country that faces this issue.

 

Maybe you can't see this problem clearly because, as you say, some of your friends and supervisor might be IMG's. I'm sorry that IMG's are suffering, but I would rather help Canadians first and then see what's left for IMG's. If we can fill every single residency spot in Canada with a excellent CMG, which I believe we can, then that's what we should do. 

Not disagreeing with your point but in the UK, it isn't uncommon to not match to specialty training. Their training program is more pyramid like than ours. At every stage there are people who don't finish. In the UK people are more likely to pursue non-medical careers with an MD and they have special jobs for people who decide to get out of the climb towards consultancy. In the UK, they rely more on these doctors to act as mid-levels that we are typically hiring NPs and PAs for. Ours is more like a cylinder. 

 

[icewine 16]

48 minutes ago, JohnGrisham said:

Not going to entertain their poor choice of words calling them shady, but may be referring to the different style of clinical training. At least the friends i know in australia, and residents ive met(now attendings), clinical training is more hands off in their experience during australian medical school clerkships compared to Canada/US.  At least some residents expressed the transition into a Canadian residency was a lot more difficult with the different expectations. Generally evened out after R1 though for them(trial by fire!).  

At the end it evens out, just different time points of snapshot comparisons.   

One could say that US rotations in medical school can be equally variable and less hands on compared to Canada.  Then you could again make the comparison of inter-Canadian programs and even different hospital sites within the same canadian school. Friends at other Canadian schools never had to do call-shifts during Obstetrics, and only had to do 4 weeks of surgery. But in general the expectations of the ideal clinical clerk experience in Canada, on average(not always), is noted that there is more responsibility and hands on experience compared to other models where you get that experience as a registrar after medicals school(as in the UK model).

12

Gotcha, I see where you are coming from. Medical school clerkship in Australia is hands off, I agree. The senior medical students are not an integral part of the team, and will typically pass a rotation without too much effort. Postgraduate training however is of very high quality. The various postgraduate training colleges (RACS, RANZCOG, RACGP et al) have some of the highest standards in the world, and IMHO produces specialists easily equal to Canadian/American/British trained specialists. Interestingly Australia has similar issues to Canada when it comes to accessing postgraduate training spots and workforce planning.

[medigeek 63]

2 minutes ago, icewine said:

Gotcha, I see where you are coming from. Medical school clerkship in Australia is hands off, I agree. The senior medical students are not an integral part of the team, and will typically pass a rotation without too much effort. Postgraduate training however is of very high quality. The various postgraduate training colleges (RACS, RANZCOG, RACGP et al) have some of the highest standards in the world, and IMHO produces specialists easily equal to Canadian/American/British trained specialists. Interestingly Australia has similar issues to Canada when it comes to accessing postgraduate training spots and workforce planning.

To be fair you can pass a rotation over here without a crazy amount of effort too and even if you aren't an essential member - you're still doing work that makes you functional by the end. If you do anesthesia, you will learn the basics of airway management. If you do internal medicine, you know to admit and manage a patient. Can the same be said for overseas? Probably not. And hence you start ahead of others on day 1 of PGY1 year (internationally) and still have an intense postgrad training ahead. 

[icewine 16]

10 minutes ago, medigeek said:

To be fair you can pass a rotation over here without a crazy amount of effort too and even if you aren't an essential member - you're still doing work that makes you functional by the end. If you do anesthesia, you will learn the basics of airway management. If you do internal medicine, you know to admit and manage a patient. Can the same be said for overseas? Probably not. And hence you start ahead of others on day 1 of PGY1 year (internationally) and still have an intense postgrad training ahead. 

I'm a few years now removed from my own clerkship, but in my own experience - yes we did learn the basics so by the end of medical school we could function at an intern level. I think the difference (and please correct me if I'm wrong) is that in Canada the level of responsibility during clerkship is higher. For instance, if we take the internal medicine example - we learned how to admit patients and formulate management plans. Typically however that learning took place by shadowing the intern or resident, and only during and after intern year would we then be responsible for the actual admission/management. Whereas in Canada I believe medical students bear that responsibility from senior clerkship onwards. I think it would be fair to say that an Australian doctor at the end of intern year is roughly equivalent to a Canadian medical student at the end of medical school, with exceptions of course. 

[medigeek 63]

23 hours ago, Edict said:

I don't have a very strong opinion on this debate, but I would say. As someone who has written the steps I don't think they are the end all and be all. In fact, in some ways they are often somewhat outdated. The issue I see is if your school solely focuses on the USMLE, you will have knowledge gaps. The reason we like the steps is they are a good adjunct to studying clinical medicine otherwise.

There is a lot that the USMLE emphasizes that is not seen often in clinical practice and there is a lot of finer management details that are not seen in the USMLE. The USMLE tends to favour a lot of rare diagnoses, worst case scenarios and focuses almost entirely on diagnosis and investigations and really has a lot less on common cases (that you need to know the details for in order to succeed in clerkship) and treatment. Anyone who's taken the USMLE will know the huge emphasis on almost all aspects of TB, Syphilis and HIV as well as disproportionate attention to zebras like glycogen storage disorders, genetic disorders, NF I, II, Lesch-Nyhan syndrome etc. where in real life you will most likely not see any of these cases unless you specialized in that area. On the flip side, you will learn very little about the management of an MI, Pneumonia or CHF but you will see that everywhere on the wards. 

I agree that is does test you a lot on zebras but strongly disagree that you don't learn the common stuff in detail in the process of studying. Step 2 CK really tested me on the very detailed nuances of bread and butter common medicine topics. And it also tested on rare zebras which I have seen in real life too. There's pretty much no way you can do well on step 2 and 3 if you don't know the detailed management of MI PNA CHF lol. 

Also, recognize that knowledge of zebras is part of what separates us from midlevels. As protocols/guidelines/algorithms keep growing and as technology grows - it's not hard to imagine that midlevels have an easier time doing basic primary care + refer off anything remotely complicated. You separate yourself from that by having the in-depth knowledge of the grey area, the art of medicine and recognizing (and managing!) the rare conditions. 

[Edict 603]

10 minutes ago, medigeek said:

I agree that is does test you a lot on zebras but strongly disagree that you don't learn the common stuff in detail in the process of studying. Step 2 CK really tested me on the very detailed nuances of bread and butter common medicine topics. And it also tested on rare zebras which I have seen in real life too. There's pretty much no way you can do well on step 2 and 3 if you don't know the detailed management of MI PNA CHF lol. 

Also, recognize that knowledge of zebras is part of what separates us from midlevels. As protocols/guidelines/algorithms keep growing and as technology grows - it's not hard to imagine that midlevels have an easier time doing basic primary care + refer off anything remotely complicated. You separate yourself from that by having the in-depth knowledge of the grey area, the art of medicine and recognizing (and managing!) the rare conditions. 

Step 2 CK was more useful yes, but writing Step 1 and then doing clerkship I didn't feel like Step 1 fully prepares you to succeed in clerkship, perhaps Step 2 CK would have been a better test to study for in order to prepare for clerkship. 

My original point was that, I think if you purely focused on Step prep like they do in some caribbean schools, there will be some knowledge gaps without a doubt when you enter residency.

 

[medigeek 63]

1 minute ago, Edict said:

Step 2 CK was more useful yes, but writing Step 1 and then doing clerkship I didn't feel like Step 1 fully prepares you to succeed in clerkship, perhaps Step 2 CK would have been a better test to study for in order to prepare for clerkship. 

My original point was that, I think if you purely focused on Step prep like they do in some caribbean schools, there will be some knowledge gaps without a doubt when you enter residency.

 

Well end of the day, a lot of the practical learning you do during clerkship anyway. Step 1 I certainly agree may not be the most useful test but I believe there is strong data that shows it correlates very well to passing residency boards (in the US of course). 

What are you referring to by knowledge gaps exactly? 

[JohnGrisham 1,457]

1 hour ago, icewine said:

Gotcha, I see where you are coming from. Medical school clerkship in Australia is hands off, I agree. The senior medical students are not an integral part of the team, and will typically pass a rotation without too much effort. Postgraduate training however is of very high quality. The various postgraduate training colleges (RACS, RANZCOG, RACGP et al) have some of the highest standards in the world, and IMHO produces specialists easily equal to Canadian/American/British trained specialists. Interestingly Australia has similar issues to Canada when it comes to accessing postgraduate training spots and workforce planning.

Agreed wholeheartedly, hence why i said it evens out in the end    Some of my best preceptors have been australians.

[xiphoid 125]

7 hours ago, TalsKnight said:

Yeah seriously....doesn't this amount to about 19% of the class going unmatched? That is worrisome for a Canadian medical school.

 

While I understand what you are saying, and I mean fair enough, there are some things I would like to point out. First, getting into medical school in Canada is extremely difficult. Much harder than the United States (I have American friend's who got into state MD schools with a GPA of around 3.5 and an average MCAT for example). Most of the time you need grades in the A to A+ range to have a real good chance in Canada. Having high standards is good. However,  this could be viewed as problematic because people from higher socioeconomic backgrounds will be at an advantage. Medical school here often requires tons of EC's, research, etc. People who don't need to work and/or take care of someone else can dedicate much of their time to handling a difficult full course load. They can afford tutors to guide them through material they might be struggling with. They don't need to worry about rent, tuition, etc. Not having to work means more free time to pursue activities medical schools will look upon favourably and by default most likely tilt the chances in their favour. So Canadians who go abroad to Ireland, Australia, or wherever because they truly feel medicine is their calling , I can sympathize with. Telling people to pick an alternate career over medicine because they are not having any luck with getting in here, or telling them to keep applying year after year after year until they find themselves in their late 20s or early 30s is brutal. I see this frequently on the forums and it's incredibly premature.

My position is that Canadians who decide to go abroad for medicine, not the Caribbean diploma mills, but Irish schools or maybe Aussie schools (University of Melbourne was ranked #17 I believe worldwide for medicine last I checked) and actually do well and finish the program, then they likely would have done just as well in a Canadian medical school. It's not right to consider them as "lesser" just because they are IMG's in the match.

Everything you said in the first part is very true. Then you completely lost my support with the second part. Yes, people who do very well at UK and Aussie medical schools (not just passing, but in the top 10-20% let's say) likely would have done well in a Canadian system too. However, the fact that Canadian medical school admissions skews towards applicants with higher SES is not solved by Irish and Aussie schools. These schools have really high tuitions (made worse by the exchange rate in recent years) and few Canadian banks offer any sort of LOC for students pursuing medical school abroad. Generally, the people who are accessing medical school through this route are from high SES families (in my opinion, generally from higher SES than the average med student at a Canadian school) and many have parents or extended family practicing medicine in Canada. By your logic in the first part, these students are advantaged in gaining med school admissions already in Canada. Those are truly disadvantaged in Canada rarely have the means to pursue medicine abroad and do eventually end up pursuing alternate career paths after repeated attempts to get in here, even if they too, like their often wealthy CSA counterparts, "truly feel medicine is their calling".