What kind of applicant DOESN'T match?

[hobbes4]

11 hours ago, Arztin said:

A BIG part of CARMS is just luck. You can be the most deserving, hardest working,  skilled me student functionning at an R2 level, with first author papers, but if you are unlucky and someone doesn't like you for whatever reason, someone seemingly less competitive candidate will get that spot. 

Here are some real reasons some random candidate seeming less competitive or deserving might get that spot and not you: A family member knows the selection committee and they will get that spot and not you. Someone might find a candidate more attractive than you and might pick them over you. Someone else is more of a smooth talker than you. Someone has the same hobbies as the PD. The PD has a different personality and doesn't want you around. A nurse trash talked behind your back, or you got bullied by nurses. A resident blacklisted you and you will never even know it, and it might not even be a legit reason.

There sure are things that you can do to max out your chances of getting unmatched. A few true examples (I have seen students or residents at some point doing a combination of things on this list):

- never admitting your mistakes

- lie

- thinking that you know more than your residents or your staff

- being arrogant

- absolutely no sense of what your limits are

- arrive late

- repetitively show that you have absolutely no common sense

- lazy and doesn't read the few things you ask them to

- not polite

- thinking you are somehow a superhuman and applying for only 1 uber competitive program like plastics or emergency medicine and thinking that you will get that spot, but not someone else

- treating other people like shit (other med students, residents, nursing etc...)

But honestly, most unmatched folks that I know don't fit with any of the above. They were:

- unlucky

- too many candidates for the number of spots

- someone else had connections

- someone else was more charming and was a better smooth talker

- had a bad interview

etc...

At the end of the day, the entire CARMS process is a whole lot of BS. A lot of it is still luck Most unmatched candidates are just fine people. Your worth shouldn't be based on your CARMS match. You can only work hard, do your best, and hope the process doesn't screw you.

Woah thank you very much for the good advices!! But I have a question, do you think that grades can bring you down? I mean my med school has F/P but is there a way for the CARMS to see my specific grades? I've seen on other trades that as long as you don't have F in your transcript you're fine... but here in Québec I don't know if it's different. 

Thank you :)!

[UdeMed]

8 hours ago, hobbes4 said:

Woah thank you very much for the good advices!! But I have a question, do you think that grades can bring you down? I mean my med school has F/P but is there a way for the CARMS to see my specific grades? I've seen on other trades that as long as you don't have F in your transcript you're fine... but here in Québec I don't know if it's different. 

Thank you :)!

In Quebec it used to be different about marks before P/F (it was introduced very few years ago in the French universities). However, now every program is P/F and your grade should not appear on your CARMS application. 

[jnuts]

On 11/3/2019 at 10:00 PM, keener12345 said:

I have a question: for electives do we get to choose the staff member we want to work with ?

Not usually.  

[jnuts]

On 11/3/2019 at 10:15 PM, procrastinating said:

how do you get someone to push for you if you've only known them for a week or two during rotations? 

Theoretically, the elective is a prolonged interview and the staff are looking for future residents just as hard as you're looking for a residency.  

But, the limited number of staff who take medical students for electives (usually purely voluntarily) likely will not meet every applicant and will therefore push one or two from the limited pool they have met.  See my previous post about randomness in this process.

You went through this once with medical school selections.  The class you're in are the best because they were selected; there's no evidence you're the best possible set of all applicants. Competitive residencies are a narrowed version of the same process. 

[procrastinating]

2 minutes ago, jnuts said:

You went through this once with medical school selections.  The class you're in are the best because they were selected; there's no evidence you're the best possible set of all applicants. Competitive residencies are a narrowed version of that process. 

This is what freaks me out, because the opportunity to apply again as a stronger applicant (or in a different pool) doesn't really exist for residency ... or does it?

 

How many staff encounters is considered solid for a reference/to make a positive impression, assuming you're a "good" clerk? 2? 3? more?

 

How do you know a reference might not be all that great? Do people agree to write letters that they know won't be a positive reflection of your character? (i.e. you ask someone if they can write you a letter, they agree, the letter turns out to be a testament to why you're NOT suited for X program)

 

[brady23]

Let's say you're interested in Surgery but don't vibe with your preceptor for 8 weeks

Well, it's going to look bad not having a letter from your core rotation, and they can make or break your application by writing a "mediocre" reference letter for you

That's what is scary for me about CARMS

[1D7]

Luck is a tiny bit overstated in this thread. Yes there is luck, but most luck factors can be controlled/mitigated, including reference letters and evaluations. The main one that you truly have no control over are the number of applicants to your specialty of choice in your year. The less you excel and the fewer skills you have, the more you leave exposed to luck. E.g. Someone with an excellent research background prior to medical school will be able to succeed in publishing some research if desired. Someone with no prior exposure at all will rely mostly on luck to find an opportunity and luck to succeed with the opportunity.

The system isn't quite as black and white as that but it's a similar idea. Soft skills (communication, observation, adaptability, resilience, personality, etc.) are the most important in setting up opportunities for excelling and thereby reducing luck. I think the situation is controllable to the extent that an excellent applicant, even the most competitive specialties, will certainly match somewhere in the preferred discipline. I have not met many such exceptional applicants but the ones I've known have all matched to their first choice—there is a vast gap between them and average applicants in their respective specialties of choice.

Just to be clear though, the opposite isn't true. Most unmatched applicants would make (or are) fine residents. Usually it was a combination of applying to match to a competitive specialty and not backing up that led them into that situation. The devastating part is that the system is unforgiving and going unmatched significantly decreases your future chances of matching; hopefully someone will finally improve the medical school-to-residency position ratio.

[procrastinating]

20 minutes ago, 1D7 said:

Luck is a tiny bit overstated in this thread. Yes there is luck, but most luck factors can be controlled/mitigated, including reference letters and evaluations. The main one that you truly have no control over are the number of applicants to your specialty of choice in your year. The less you excel and the fewer skills you have, the more you leave exposed to luck. E.g. Someone with an excellent research background prior to medical school will be able to succeed in publishing some research if desired. Someone with no prior exposure at all will rely mostly on luck to find an opportunity and luck to succeed with the opportunity.

The system isn't quite as black and white as that but it's a similar idea. Soft skills (communication, observation, adaptability, resilience, personality, etc.) are the most important in setting up opportunities for excelling and thereby reducing luck. I think the situation is controllable to the extent that an excellent applicant, even the most competitive specialties, will certainly match somewhere in the preferred discipline. I have not met many such exceptional applicants but the ones I've known have all matched to their first choice—there is a vast gap between them and average applicants in their respective specialties of choice.

Just to be clear though, the opposite isn't true. Most unmatched applicants would make (or are) fine residents. Usually it was a combination of applying to match to a competitive specialty and not backing up that led them into that situation. The devastating part is that the system is unforgiving and going unmatched significantly decreases your future chances of matching; hopefully someone will finally improve the medical school-to-residency position ratio.

I suppose one of the things I'm most afraid of is overestimating my position on the spectrum of awful → excellent; thinking I am excellent when indeed I am perceived as awful by my peers/superiors. I hear way too many accounts of overconfident medical students failing to match or getting bad reference letters or doing absolutely ridiculous things as clerks, and I can't help but wonder that if they are in medical school, then they must have been reasonable people, and if something like that could happen to them, then why can't it happen to me too? It's difficult to reliably assess your position/competitiveness when everything is so subjective--your own perception of yourself, others' perception of you, vested interests in helping you to either succeed or fail, the list goes on. Just feels weird knowing that yes, we can control many of the factors that can lead to a successful match, but none of us will ever know where we stood relative to others, even based on prior statistical models, until after the fact. For the years and years of work we put into becoming the kind of doctors we want to be, it really does feel like a shot in the dark. 

[Bambi]

3 hours ago, 1D7 said:

Luck is a tiny bit overstated in this thread. Yes there is luck, but most luck factors can be controlled/mitigated, including reference letters and evaluations. The main one that you truly have no control over are the number of applicants to your specialty of choice in your year. The less you excel and the fewer skills you have, the more you leave exposed to luck. E.g. Someone with an excellent research background prior to medical school will be able to succeed in publishing some research if desired. Someone with no prior exposure at all will rely mostly on luck to find an opportunity and luck to succeed with the opportunity.

The system isn't quite as black and white as that but it's a similar idea. Soft skills (communication, observation, adaptability, resilience, personality, etc.) are the most important in setting up opportunities for excelling and thereby reducing luck. I think the situation is controllable to the extent that an excellent applicant, even the most competitive specialties, will certainly match somewhere in the preferred discipline. I have not met many such exceptional applicants but the ones I've known have all matched to their first choice—there is a vast gap between them and average applicants in their respective specialties of choice.

Just to be clear though, the opposite isn't true. Most unmatched applicants would make (or are) fine residents. Usually it was a combination of applying to match to a competitive specialty and not backing up that led them into that situation. The devastating part is that the system is unforgiving and going unmatched significantly decreases your future chances of matching; hopefully someone will finally improve the medical school-to-residency position ratio.

Soft skills are absolute crucial, as is dumb luck! That has been my experience in any event. Luck played its role as my preceptor took an interest in me and in my appling to the program. Yes, I had the package of soft skills. I was considered a good fit. I was not a gunner, had no research experience and had no prior knowledge of this specialty before my elective. It is also important to apply where you do the elective, so they are not judging you from your paper trail and the interview.

[Aetherus]

50 minutes ago, 1D7 said:

Luck is a tiny bit overstated in this thread. Yes there is luck, but most luck factors can be controlled/mitigated, including reference letters and evaluations. The main one that you truly have no control over are the number of applicants to your specialty of choice in your year. The less you excel and the fewer skills you have, the more you leave exposed to luck. E.g. Someone with an excellent research background prior to medical school will be able to succeed in publishing some research if desired. Someone with no prior exposure at all will rely mostly on luck to find an opportunity and luck to succeed with the opportunity.

The system isn't quite as black and white as that but it's a similar idea. Soft skills (communication, observation, adaptability, resilience, personality, etc.) are the most important in setting up opportunities for excelling and thereby reducing luck. I think the situation is controllable to the extent that an excellent applicant, even the most competitive specialties, will certainly match somewhere in the preferred discipline. I have not met many such exceptional applicants but the ones I've known have all matched to their first choice—there is a vast gap between them and average applicants in their respective specialties of choice.

Just to be clear though, the opposite isn't true. Most unmatched applicants would make (or are) fine residents. Usually it was a combination of applying to match to a competitive specialty and not backing up that led them into that situation. The devastating part is that the system is unforgiving and going unmatched significantly decreases your future chances of matching; hopefully someone will finally improve the medical school-to-residency position ratio.

I understand the point of view that you are trying to portray. However, there are several factors you have omitted in your assessment that, in my opinion, point to luck playing a larger role than you are inferring.

When applying to an ultra competitive specialty (re Ophtho, Plastics, Derm), getting your desired elective at a specific site is challenging. Often times, people will be unable to secure electives at certain schools despite applying several times (sending in an application right as the portal opens for that select week for every 2 week elective slot they have). This is completely random and not in your control. Furthermore, schools will infer interest in the program based on your elective set (which you may have limited ability to decide). Now in ultracompetitive schools, they will only interview you if you have done an elective at the school. 

Now let’s talk about preceptors. You can be a super star medical student but if you don’t work with the right people, this won’t mean a thing. What do you do if during your elective the PD took a 2 week vacation? What if none of your preceptors are part of the ADCOM? These are all things that influence your ability to match that you have no control over. 

Now you have submitted your application. Maybe the person reviewing your application doesn’t value your hobbies, research etc. Maybe they are in a bad mood when they read your application...etc

The system we currently have has no objective measurements to compare students. We rely on subjective measurements that are easily influenceable by luck. We create an artificial rat race to try and select the ideal candidate, however I would argue that the criteria we use, often time have little to do with your ability to perform your job.

[JohnGrisham]

27 minutes ago, Aetherus said:

I understand the point of view that you are trying to portray. However, there are several factors you have omitted in your assessment that, in my opinion, point to luck playing a larger role than you are inferring.

When applying to an ultra competitive specialty (re Ophtho, Plastics, Derm), getting your desired elective at a specific site is challenging. Often times, people will be unable to secure electives at certain schools despite applying several times (sending in an application right as the portal opens for that select week for every 2 week elective slot they have). This is completely random and not in your control. Furthermore, schools will infer interest in the program based on your elective set (which you may have limited ability to decide). Now in ultracompetitive schools, they will only interview you if you have done an elective at the school. 

Now let’s talk about preceptors. You can be a super star medical student but if you don’t work with the right people, this won’t mean a thing. What do you do if during your elective the PD took a 2 week vacation? What if none of your preceptors are part of the ADCOM? These are all things that influence your ability to match that you have no control over. 

Now you have submitted your application. Maybe the person reviewing your application doesn’t value your hobbies, research etc. Maybe they are in a bad mood when they read your application...etc

The system we currently have has no objective measurements to compare students. We rely on subjective measurements that are easily influenceable by luck. We create an artificial rat race to try and select the ideal candidate, however I would argue that the criteria we use, often time have little to do with your ability to perform your job.

Came to say pretty much this. Many many colleagues had similar issues. Unable to get electives, or if the did get an elective being with dud preceptors who were barely around, oversubscribed services for learners (i.e. being on a team where theres 4 med students and you finish at noon for your rotation with little interaction). 

Theres huge variations, and I think downplaying the luck factor isn't helpful - just because some students may not have had that experience, doesn't mean there arent others who have had it. The ones i know who had those experiences, were rockstar applicants through in through - top of the class in academics(and I literally mean top 3-4 students), but also insanely sociable, likeable etc. Just were unfortunate to have a number of their electives end up being pretty much wastes of 2-4 weeks due to often frankly lazy or uninterested preceptors. They mostly all matched fine, not necessarily to their preferred locations, and one to a backup specialty.   

Luck is huge in so many ways. The whole point were are trying to make is, do your best, perform to the best of your ability, but don't beat yourself up if you get a lousy rotation, or dont even get the right rotations as lot of that is luck, or if you get a preceptor on an off week. One rotation I did, a classmate of mine also did and they had an amazing time, to me, it was the biggest waste of 2 weeks of my life - the preceptor was disorganized, learning was minimal etc. Same rotation, two wildly different experiences. The preceptor was bouncing multiple committments, being on call at a different service at the same time as this inpatient service, so on and so forth. 

[garlic]

41 minutes ago, JohnGrisham said:

Luck is huge in so many ways. The whole point were are trying to make is, do your best, perform to the best of your ability, but don't beat yourself up if you get a lousy rotation, or dont even get the right rotations as lot of that is luck, or if you get a preceptor on an off week. One rotation I did, a classmate of mine also did and they had an amazing time, to me, it was the biggest waste of 2 weeks of my life - the preceptor was disorganized, learning was minimal etc. Same rotation, two wildly different experiences. The preceptor was bouncing multiple committments, being on call at a different service at the same time as this inpatient service, so on and so forth. 

Could not agree more with @JohnGrisham and @Aetherus

To provide a different perspective to all the apparent doom and gloom: sometimes luck works in your favour too. I did an elective at a school that was not my desired location for an important, long, OOP 4 week slot. I didn't know anyone in the program or even have friends of friends who were in the city. There wasn't a schedule, and I was told to just pick a preceptor's clinic for the day...and repeat that for the whole month. I ended up getting along great with a guy who I later found out was the PD's fishing buddy. Another preceptor I randomly chose was subsequently named Head of Department. On my last day, one of the seniors pat me on the back and said, "looks like we'll be seeing you in january" (Whether that'll actually be true or not, I don't know, but I'll take it for now hahah)

It is understandable to have anxiety when the stakes are so high and you've worked so hard. I never believed upper years when they told me how random this whole selection process is. But now that I'm here, staring down the carms deadline, all I can say is that it's true.

[procrastinating]

With all this talk about electives going either amazing or awry, how do you feel things will change with the elective cap? The max # of weeks you can dedicate to any specialty is now 8 across Canada, which means 4x2-week electives. This will come into effect for the 2021 class. Does that mean all of the schools you couldn't do an elective at (just by chance) will rank you lower since they haven't had a chance to meet you? Or will elective experience begin to matter less? Or perhaps elective experiences will be better because they won't be plagued with as many keener students trying to become mini-derms/plastics/ophthos?  

[Arztin]

10 hours ago, procrastinating said:

With all this talk about electives going either amazing or awry, how do you feel things will change with the elective cap? The max # of weeks you can dedicate to any specialty is now 8 across Canada, which means 4x2-week electives. This will come into effect for the 2021 class. Does that mean all of the schools you couldn't do an elective at (just by chance) will rank you lower since they haven't had a chance to meet you? Or will elective experience begin to matter less? Or perhaps elective experiences will be better because they won't be plagued with as many keener students trying to become mini-derms/plastics/ophthos?  

TBH I think it's a good thing overall. Sure what you mentionned could happen, but currently, things are like this:

- all in on gen surg. Not taken in gen surg. But family thinks you are backing up so you end up unmatched

- split electives in gen surg and FM. Not taken in gen surg because they don't think you are serious. Not taken in FM because they think you are backing up with FM.

There was a girl in my class who went to a surgical residency interview and first question was: so you want X surgical field or you want FM?

Overall, I think it's a good thing because it makes things a bit more even (Some schools have a lot of elective time), and allows you to explore other things, and will allow people to have more viable backups and not end up unmatched.

 

[Aetherus]

1 hour ago, Arztin said:

TBH I think it's a good thing overall. Sure what you mentionned could happen, but currently, things are like this:

- all in on gen surg. Not taken in gen surg. But family thinks you are backing up so you end up unmatched

- split electives in gen surg and FM. Not taken in gen surg because they don't think you are serious. Not taken in FM because they think you are backing up with FM.

There was a girl in my class who went to a surgical residency interview and first question was: so you want X surgical field or you want FM?

Overall, I think it's a good thing because it makes things a bit more even (Some schools have a lot of elective time), and allows you to explore other things, and will allow people to have more viable backups and not end up unmatched.

 

I partially agree with your points, however I am concerned that your extra weeks will be required to be used in adjacent fields that have some overlap with the competitive field you are applying to. For example, an Ophthalmology candidate would be expected to complete a Neurology, Rheumatology, Infectious Disease elective. Plastics would be required to do Derm, ENT, Ortho hand, burn ICU etc to demonstrate interest.

I think this will simply force applicants to be more creative to demonstrate interest and I doubt that splitting your electives between two competitive fields will be seen as a viable matching strategy.

I think it will make it the process even more random at the ultra competitive end of things and make little difference to people going for less competitive things where they already do a variety of electives. 

It also has an unintended consequence of making the barrier to entry much less steep. In this current set up, people who are not fully committed are concerned of pursuing competitive specialties half hearted for the reasons you mentioned. However, by removing the barrier to entry, I suspect the numbers for these competitive fields will skyrocket. People will throw their name in the hat because, why not? I can still do a bunch of other electives and have a viable backup.

In summary, I think this is going to make it much much worse for competitive specialties and I don’t expect the upside to materialize.

[1D7]

Elective cap is really bad.

First of all it doesn't really change the number of unmatched because it is primarily a # English speaking spots:applicants imbalance. People will still be unmatched and in the same numbers. Backing up is not "more viable" because now everyone will have a back up.

Secondly for small programs if you bust your ass for 5 years you want to find some coresidents you like and at least a few staff you can see as future mentors. Programs and their culture can be very different, e.g. expectations to work postcall, research expectations. Now you can't see as many programs.

[Edict]

On 11/7/2019 at 7:45 PM, Aetherus said:

I partially agree with your points, however I am concerned that your extra weeks will be required to be used in adjacent fields that have some overlap with the competitive field you are applying to. For example, an Ophthalmology candidate would be expected to complete a Neurology, Rheumatology, Infectious Disease elective. Plastics would be required to do Derm, ENT, Ortho hand, burn ICU etc to demonstrate interest.

I think this will simply force applicants to be more creative to demonstrate interest and I doubt that splitting your electives between two competitive fields will be seen as a viable matching strategy.

I think it will make it the process even more random at the ultra competitive end of things and make little difference to people going for less competitive things where they already do a variety of electives. 

It also has an unintended consequence of making the barrier to entry much less steep. In this current set up, people who are not fully committed are concerned of pursuing competitive specialties half hearted for the reasons you mentioned. However, by removing the barrier to entry, I suspect the numbers for these competitive fields will skyrocket. People will throw their name in the hat because, why not? I can still do a bunch of other electives and have a viable backup.

In summary, I think this is going to make it much much worse for competitive specialties and I don’t expect the upside to materialize.

While I agree with the downsides, I do think the upsides will materialize. Look at the end of the day we are talking about a zero sum game here. It doesn't matter what we do, someone is going to be left unhappy with the match. I don't think this is what the reformers were trying to change anyways. 

The main benefit of this entire elective reform was to even the playing field between medical schools because as it stands, different medical schools get varying amounts of elective time. I don't think it was ever fair that Calgary had 10 weeks of electives while UBC had 24. 

 

[procrastinating]

1 minute ago, Edict said:

I don't think it was ever fair that Calgary had 10 weeks of electives while UBC had 24. 

 

Using Calgary and UBC as examples, have Calgary med students ever been looked down upon compared to UBC med students for having less elective time? Surely PDs/admissions are aware of this discrepancy ... so along the same lines, now Calgary and UBC med students can do an equal # of electives in X desired specialty, but UBC med students have more time to beef up their application/testament to their commitment to X specialty by doing more electives in related disciplines. I think the unfairness will just become somewhat less glaring but will shift and continue to exist nonetheless. 

Why do schools have varying amounts of elective time anyways? 

[Edict]

1 hour ago, procrastinating said:

Using Calgary and UBC as examples, have Calgary med students ever been looked down upon compared to UBC med students for having less elective time? Surely PDs/admissions are aware of this discrepancy ... so along the same lines, now Calgary and UBC med students can do an equal # of electives in X desired specialty, but UBC med students have more time to beef up their application/testament to their commitment to X specialty by doing more electives in related disciplines. I think the unfairness will just become somewhat less glaring but will shift and continue to exist nonetheless. 

Why do schools have varying amounts of elective time anyways? 

The discrepancy will still exist but will be reduced, which is better than what it is now. Not all PDs know about this, in big specialties where the PD job is a pretty big part of your career, they will, but in a smaller specialty where the PD job is small part of it, PDs might not really know. Certainly, having more electives in the specialty will mean more chances to get letters, better performance in said specialty by the end of your electives, and more networking which will help a lot in competitive specialties. I can't imagine this wouldn't have a positive impact for those from schools with more electives. 

[procrastinating]

So when people say that it's difficult to get an interview or be competitive at a school where you haven't done an elective for more challenging specialties - this probably won't be true anymore, will it? Because otherwise, you would only be "considered" at 4-5 programs max per specialty ... 

[Edict]

On 11/11/2019 at 3:23 PM, procrastinating said:

So when people say that it's difficult to get an interview or be competitive at a school where you haven't done an elective for more challenging specialties - this probably won't be true anymore, will it? Because otherwise, you would only be "considered" at 4-5 programs max per specialty ... 

It probably won't be true anymore. They may go regional though, they might look for at least one elective in the region. One of the strategies that is going to become bigger is to do an elective in a school in a related specialty and trying to have a meeting with the PD of the specialty they are actually interested in to demonstrate interest. 

[MDinCanada]

removed

[jnuts]

Medical students need to push for a better elective assignment process (maybe a mini-match with public outcome data collection like CaRMS) in order to mitigate all of the problems discussed in this thread.

[procrastinating]

1 minute ago, jnuts said:

Medical students need to push for a better elective assignment process (maybe a mini-match) in order to mitigate all of the problems discussed in this thread. 

Interesting idea, but curious as to how this mini-match would work - on what basis would schools rank their potential elective students? 

[MDinCanada]

1 hour ago, procrastinating said:

Interesting idea, but curious as to how this mini-match would work - on what basis would schools rank their potential elective students? 

CV, interview?

I think this has already been done in the US