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Making An Informed Decision About Mac

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First of all, congratulations to everyone who got accepted to Mac (and other schools), and good luck to everyone on the wait-list! Everyone has worked so hard to get here, so just take a moment to appreciate how far you’ve come.
 
I’m making this post so that people can have the most information about McMaster as they possibly can (because I did not know any of this when I chose to go to McMaster over Western). With that said, these views are mine alone and may not reflect the views of the class.
 
Here are some of the best things about the McMaster curriculum: 
 
- No “tests”! We have “concept application exercises”, but usually they are not to be stressed over because most tutors understand that students are there to learn. This creates a relatively relaxed preclerkship environment. However, and this is a big thing, if you like didactic learning and knowing what you need to know for a certain topic, this curriculum is radically different. Oftentimes, students are not quite sure if they have covered the material in-depth, at least compared to other schools. Of course, there is a debate to be had whether most of this preclerkship knowledge is even relevant in the first place, but I have heard of more than one instance of a physician in clerkship speaking about how poor Mac students are with anatomy and pharmacology. It’s a reputation that exists, even if it may not be founded completely in truth (the pharmacology stuff is true, though!). 
 
- More free time than other schools (with one big exception!). At Mac, we have very little time dedicated to didactic lectures – most of our preclerkship is spent in tutorials or prepping for tutorials. Students are often quite helpful with resources, and the attitude of the students is almost uniformly good. So, we have more free time in preclerkship to explore our interests (horizontal electives), but it comes with a cost that may or not be important to you. In-between “first” and “second” year, our summer break consisted of one week. Ultimately, this was fine for a lot of people, but I found that many of my classmates felt burnt out by the middle of clerkship. 
 
- 3 years! This is related to the other point. 3 < 4! Less tuition, less money paid to rent, etc. But without the extra year (and summers), it is more difficult to put together a research-heavy application, in my opinion. Obviously, this does not matter so much for something like family medicine, but if you are trying to become a dermatologist, there is just less time. I’ve found that the extra time we had in preclerkship did not overcome the fact that we had one less year to work with. Oftentimes in research, you are waiting a few weeks to hear from a supervisor, waiting another few weeks for someone else on the team to analyze results, so having 1-2 more hours of free time per day didn’t really impact my output. At the same time, if you have a family (and you want to finish med school as fast as possible) or you want a relatively noncompetitive specialty, Mac might be the best option for you. 
 
Now for my biggest issues about the program (some of which I believe are not adequately communicated to applicants beforehand):
 
McMaster makes students rank 16 streams (colour-coded) for clerkship and then a lottery happens in which an algorithm tries to give you what you ranked near the top. 
 
This process differs from the four-year programs in 4 key ways:
 
(1) Students have to have a good idea of what stream they want by the end of March (only 7 months after beginning medical school!), because that is when rankings are due. In other words, they have to know what specialties they’ve ruled in and out by then because some streams are way better for some specialties and way worse for others. 
(2) The streams are quite uneven for elective weeks, which is a huge deal for CaRMS. . Some streams have 12 weeks of electives before CaRMS, whereas some only have 8! And, statistically, there are the same amount of people in each stream, so some people are unlucky and have up to 4 fewer weeks of electives before the CaRMS deadline (just within the same school, let alone others).  
(3) The other schools go through all of their cores first before having to go through their electives. At McMaster, it is pretty much random. For some streams, person x may have surgery first, and then a few weeks of electives, and then pediatrics core, and some more electives, etc.  Person y may have psychiatry first, then a few weeks of electives, followed by OB/GYN, etc. So, you are not exposed to much at all before having to set up your electives (over 20 weeks ahead of time). What happens if you fall in love with anesthesia but it’s at the very end of your stream? Too bad. At the other schools, they complete all of their cores before doing any electives, which gives students a much better idea of what they want to do. I personally wish I had my internal medicine core before doing any of my electives because it would have given me a better knowledge base.
(4) Because of this system, every one of the streams has one or two cores post-CaRMS (one is during the CaRMS period, which makes it “not count” as well). So, if you get light blue stream, for example, you can forget about matching to surgery because the core is post-CaRMS. This does not happen at the 4 year schools. I know of a friend who originally wanted to do internal medicine and he ended up in a stream that had internal post-CaRMS. Can he still match to internal? Probably, but it will be a lot more difficult without the letter of reference from your 6-week core. It depends how comfortable you are with leaving your fate to an algorithm – many students 2 years ago were put into their 8th ranked stream!
 
- Match results. This year, around 20 students did not match from McMaster (first iteration), the worst year in Mac’s history, I believe. Now, there are a ton of confounding factors here – perhaps more people applied to competitive specialties this year than in the past. Maybe the students did not adequately back up, etc. We’ll never know, but it is worth considering that this was their worst year ever. With that said, perhaps it will inspire some change within the curriculum to make sure nothing like this happens again. 
 
- Anatomy and pharmacology. At the Hamilton campus, we don’t have cadavers for people to work on. There is a lottery (once again), so a handful of students get to do a workshop with cadavers. The bigger issue is pharmacology. For as long as I’ve been at Mac, students have complained about how poor their foundation in pharmacology is, and I don’t know if they are making any meaningful changes for the incoming class. If you have an understanding resident or physician in clerkship, it will probably be fine, but I’ve heard horror stories of people going to Toronto or Vancouver, and getting yelled at due to their lack of knowledge. 
 
Perhaps this is a case of the grass being greener on the other side of the fence, but I know a few people who feel like they were not properly informed of these things before making a decision (especially the clerkship lottery). I probably would have made a different choice if I had this information, so I thought I would provide it here. 

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Hey thank you so much for all of this information! I hope you don't mind me asking, but (if you went to a didactic school for undergrad) did you find the switch from didactic to self-learning difficult? One of my biggest worries is not having a 'standardized' database to learn from, which, as you mentioned in the post, may lead to not learning some key concepts that may be necessary. What happens during the 6 hours (or some other minimal amount) of lecture time that we get a week?

 

In addition, I was hoping you could clarify your comments on Anatomy and Pharmacology. By lottery, do you mean that only a handful of students will get to work on a cadaver at any given time, or only a handful of students will have the opportunity to work on a cadaver (i.e. is everyone eventually able to work with a cadaver or do some simply have bad luck and never work with one?)

 

Again, thank you so much for the insight, I really appreciate it <3 

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I found the switch from didactic teaching to self-learning pretty challenging, albeit not insurmountable. Many students share your concern about not having a standardized database, but Mac's philosophy is that you will have to do self-directed learning as a practicing physician, so why not build those skills now? Still, some people can slip through the cracks, and just not have a good understanding of the concepts. You really have to hold yourself accountable, and it is natural for students to feel anxious (can't speak for other schools). The 6 or so hours of lecture per week serve as an introduction to the basic concepts.

 

With regards to anatomy, only a handful of students will have the opportunity to work with a cadaver (I think ~ 90% of students at the Hamilton campus will not). I can't quite remember how Waterloo or Niagara do their anatomy sessions, but I don't believe each student (or pair of students like at U of T) have access to one. At Mac, there is one or two lotteries in which 8-10 students (I believe) are selected to work with cadavers. That's it.

 

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- Match results. This year, around 20 students did not match from McMaster (first iteration), the worst year in Mac’s history, I believe. Now, there are a ton of confounding factors here – perhaps more people applied to competitive specialties this year than in the past. Maybe the students did not adequately back up, etc. We’ll never know, but it is worth considering that this was their worst year ever. With that said, perhaps it will inspire some change within the curriculum to make sure nothing like this happens again. 
 

 

it was 16, and not really. a lot of other schools had it just as bad/worse this year in ontario. the match rate across all ontario schools has historically been more or less the same. 

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a7x: 

 

“you should consider, and rule out very early things like Anesthesia (November), the fact you possibly didn't says more about you than the program

 

Also, consider being knowledge being fresher for a surg gunner in pink stream etc. on elective than if it was at the very start”

 

I don’t think this is a very thoughtful response at all – just blame the applicant because of a weird elective process that isn’t even introduced until a month or two before having to rank the streams? None of this is mentioned at orientation, by the way. In fact, when I talked to my friends at other medical schools, it was clear that the Mac clerkship lottery is not that well-known. Also, do you know how difficult it was to even get a horizontal elective in some specialties? I was told to wait 4 months for an 8 hour horizontal. When you are told in May that you have to wait four months, and the elective window opens in a few weeks, what do you do?

 

Not to mention the fact that a day or two in a horizontal is not equivalent to completing your 6 week core in something. I don’t really see how it can be disputed that Mac students are at a disadvantage when it comes to competitive specialties in clerkship (one that can be overcome with strategy, hard work, and some luck). 

 

“Personally for me, having something i'm less interested in after CARMS is a plus because the evaluation will likely be not the same level as my interests and wont show up on my transcript”

 

Okay, but you didn’t really address what I said – you are spinning it. There are some students who have their #1 or backup choice post-CaRMS due to a lottery! That does not happen at other schools. There is also more standardization – all students have the same amount of elective weeks at other schools, whereas some students at Mac only have 8 weeks pre-CaRMS and others have 12. Let’s take an example:

 

Applicant A’s top three are (1) internal medicine, (2) Peds, (3) emerg. They rank the streams 7 months after getting into medical school and are matched to their 8th or 9th ranked stream, dark green. Dark green begins with 4 weeks of electives, and then peds core (good), but has medicine and emerg cores post-CaRMS (very bad!). It’s not really their fault, per se. After all, they ranked many streams above dark green. 

 

So now we have an applicant who must do their electives at away schools without having done their core, as well as an applicant who is potentially applying to a specialty without a letter of reference from their home school. For internal medicine, this is incredibly problematic! Quite simply, this does not happen at other schools. 

 

“ it was 16 students (including previous year students (2016 etc.) unmatched) in the first round, while not as stellar as our previous year, all ON schools seemed to have it hard this year.”

 

My apologies. Another poster corrected me with the right number, which I believe came out in the past few days.

Finally, I strongly agree that Mac has a good institutional culture.

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I feel like a lot of this information (while excellent to have) is very overwhelming for people who are trying to decide between schools, haha.

 

Just know that every school has their pros and cons when it comes to the clerkship process. Yes all schools have pre- and post-Carms electives. Yes there are pre-core electives at every school. Yes all schools select the order of their clerkship rotations via a lottery. Yes some observerships/horizontal electives will be difficult to arrange. Yes you might change your mind on your speciality half way through clerkship. The reality is that McMaster graduates are very strong and match to extremely competitive specialities regardless of which clerkship stream they are placed in. Yes, they have done studies to back this up (we did coin the term evidence-based medicine after all).

 

The other reality is that there will be good and bad things about every MD program but what stays the same is that this is a challenging (but extremely rewarding) field and program to be in! There will be long hours and a lot of hard work - so it's important to pick a school where you will have a strong support network. That can be formally offered through the program or in the form of friends and family close by.

 

At the end of the day, you will be very happy no matter which MD program you pick.

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I feel like a lot of this information (while excellent to have) is very overwhelming for people who are trying to decide between schools, haha.

 

Just know that every school has their pros and cons when it comes to the clerkship process. Yes all schools have pre- and post-Carms electives. Yes there are pre-core electives at every school. Yes all schools select the order of their clerkship rotations via a lottery. Yes some observerships/horizontal electives will be difficult to arrange. Yes you might change your mind on your speciality half way through clerkship. The reality is that McMaster graduates are very strong and match to extremely competitive specialities regardless of which clerkship stream they are placed in. Yes, they have done studies to back this up (we did coin the term evidence-based medicine after all).

 

The other reality is that there will be good and bad things about every MD program but what stays the same is that this is a challenging (but extremely rewarding) field and program to be in! There will be long hours and a lot of hard work - so it's important to pick a school where you will have a strong support network. That can be formally offered through the program or in the form of friends and family close by.

 

At the end of the day, you will be very happy no matter which MD program you pick.

 

 

 

Exactly what i needed to hear right now. The previous posts made me doubt Mac even though its such a great school. thank you!!!

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I feel like a lot of this information (while excellent to have) is very overwhelming for people who are trying to decide between schools, haha.

 

Just know that every school has their pros and cons when it comes to the clerkship process. Yes all schools have pre- and post-Carms electives. Yes there are pre-core electives at every school. Yes all schools select the order of their clerkship rotations via a lottery. Yes some observerships/horizontal electives will be difficult to arrange. Yes you might change your mind on your speciality half way through clerkship. The reality is that McMaster graduates are very strong and match to extremely competitive specialities regardless of which clerkship stream they are placed in. Yes, they have done studies to back this up (we did coin the term evidence-based medicine after all).

 

The other reality is that there will be good and bad things about every MD program but what stays the same is that this is a challenging (but extremely rewarding) field and program to be in! There will be long hours and a lot of hard work - so it's important to pick a school where you will have a strong support network. That can be formally offered through the program or in the form of friends and family close by.

 

At the end of the day, you will be very happy no matter which MD program you pick.

 

This information may be overwhelming, but I believe the benefit of having it outweighs the cons of the anxiety it may provoke. Choosing a medical school is a huge deal, so the more accurate information you can get about a school, the better, in my opinion.

 

I can only speak to my experience at Mac.

 

"Yes all schools select the order of their clerkship rotations via a lottery"

 

This is a little disingenuous. Other schools (like University of Toronto, for example) may have a lottery for their clerkship cores, but that is *very* different than the lottery Mac has. In third year (or whatever the equivalent is), the other schools have a lottery in which cores only are arranged in a specific order. This is very different from the Mac lottery in which

 

(1) cores and electives are all mixed in with each other, so the applicant is not exposed to "everything" before their electives. Someone at U of T will have done internal medicine, OB, psych, etc. before their electives whereas someone at Mac will be put in the position of completing a lot of electives before they even do their core.

 

To make this perfectly clear, the other schools will complete their cores before doing their electives -- students at Mac will not.

 

"Yes all schools have pre- and post-Carms electives."

 

Okay, but which schools have 2 cores during and after the CaRMS period? Someone above mentioned Calgary (another 3 year program), but I do not believe Ottawa, U of T, Western, etc. have this system. That is a huge issue that has not really been addressed here. The fact that an algorithm will pretty much rule out 2 specialties for someone is probably of interest. I have a few friends who had a way more difficult time putting together a competitive application because of this. 

 

I don't give this information to scare anyone away from Mac -- it is a great school. I give this information to inform people who are choosing to come here (or have solely been accepted to Mac) in order to prepare them for any school-specific challenges they may face. My advice: get involved early and be proactive about what you are interested in -- due to the truncated curriculum, it is of utmost importance. 

 

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Yes, I agree that this is all very important information, and it's great that you're sharing it. It will definitely impact someone's decision. I just think it's difficult for someone to compare the systems if they haven't been through both systems. I can only speak for McMaster when I say it's a great school and program : ) The other great thing about McMaster is that the administration is very attentive to student comments and are consistently looking for ways to improve the program based on feedback.

 

I also want to note that there are also consequences of having your core before your elective - especially if your home school is ranked very high on your list for residency. It's hard to erase a bad impression. It's a two way street.

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Hi, I have been accepted to both McMaster and McGill and I'm having a hard time deciding what school will be best for me. 

 

McMaster:

-excellent program and fully English, the class is also very diverse and unique

-close to home

-3 year program

-staying within Ontario's medical system, allowing me to build connections within the province

-issues with clerkship schedule is a little disconcerting, personally I want to go into paediatrics, but I also want to explore internal medicine and surgery as options

-PBL, I have always been used to didactic learning but the way I did it was going to lecture and absorbing content, but then going back home and trying to piece all the info together, supplementing my learning with other content to get a better understanding

-I have also heard the rumour that McMaster students don't know as much and underperform when going to other schools for electives

 

McGill:

-amazing reputation

-curriculum is strong, I like how they have a transition to clinical practice period after preclerkship

-all your core rotations are done in 3rd year

-need to be bilingual for certain rotations where you might be placed in a predominantly french-speaking area

-I do see a lack of diversity within the class at McGill

-living in Montreal is great, but is far from home

-Quebec medical system

-McGill has been under probation and I have spoken to many students who have said they have felt some negativity/condescension from preceptors

 

Both schools have great pros but there are also some flaws. I know medical school is a personal choice, but for me it is also a matter of which school will provide me with a strong education that will make me a better physician and able to attain a residency program that I like. For me it boils down to the issue of speaking French at McGill vs. the PBL/clerkship lottery system at Mac.

 

Are any McMaster students able to give some input on some of the issues with McMaster's program, it would be greatly appreciated! Thank you!

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Hi, I have been accepted to both McMaster and McGill and I'm having a hard time deciding what school will be best for me. 

 

McMaster:

-excellent program and fully English, the class is also very diverse and unique

-close to home

-3 year program

-staying within Ontario's medical system, allowing me to build connections within the province

-issues with clerkship schedule is a little disconcerting, personally I want to go into paediatrics, but I also want to explore internal medicine and surgery as options

-PBL, I have always been used to didactic learning but the way I did it was going to lecture and absorbing content, but then going back home and trying to piece all the info together, supplementing my learning with other content to get a better understanding

-I have also heard the rumour that McMaster students don't know as much and underperform when going to other schools for electives

 

McGill:

-amazing reputation

-curriculum is strong, I like how they have a transition to clinical practice period after preclerkship

-all your core rotations are done in 3rd year

-need to be bilingual for certain rotations where you might be placed in a predominantly french-speaking area

-I do see a lack of diversity within the class at McGill

-living in Montreal is great, but is far from home

-Quebec medical system

-McGill has been under probation and I have spoken to many students who have said they have felt some negativity/condescension from preceptors

 

Both schools have great pros but there are also some flaws. I know medical school is a personal choice, but for me it is also a matter of which school will provide me with a strong education that will make me a better physician and able to attain a residency program that I like. For me it boils down to the issue of speaking French at McGill vs. the PBL/clerkship lottery system at Mac.

 

Are any McMaster students able to give some input on some of the issues with McMaster's program, it would be greatly appreciated! Thank you!

 

It seems like you already have a really great list. The speaking French thing is a concern, not only for your education but also for the patient. Communication is key to great patient care and proper diagnosis. If your French is not strong, then not only are you affecting your own education but you're also potentially putting a patient at risk. Will you have translators on these rotations?

 

PBL is not a huge issue for most people as the program also have opportunities for didactic learners. You can always think of PBL as weekly opportunities to consolidate your knowledge and improve your communication/teamwork/problem solving skills for the clinic.

 

The clerkship system is not perfect, I agree. But often people have narrowed it down to their top 3 - 4 specialities by the time their enter the lottery and there will be at least 2 - 3 streams that will work for your interests. It does require you to be more proactive right from the start, but our flexible schedules allow plenty of time for exploring different specialities.

 

In terms of the rumours that McMaster students are not as strong on electives: I have heard those too and am determined to prove them wrong : P Not sure where they started but McMaster students have traditionally matched very well to other schools (there will always be more McMaster students matched to McMaster as is the case with all other medical schools).

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I will address the clerkship stream lottery, because I believe that is the most important concern one should have.

 

Okay, so your top three is (1) Peds, (2) Internal Medicine, (3) Surgery, so ideally you would want to complete those cores before your electives (not possible at Mac), and certainly before CaRMS! 

 

Let's take the class of 2019 schedule because it is the most updated, and the streams go through very few alterations every year. There are 16 "streams", but for all intents and purposes, there are 8. 

To explain, there are 2 grey streams, 2 orange streams, 2 dark blue streams, etc. The differences between the colours are *huge* (different number of elective weeks, different arrangement of cores and electives), but the differences within the colours are not that big (maybe a 2 week elective is in a different place, but all the cores are in the same order). So, for the purpose of simplifying things, let's work with the 8 colours.

 

For grey stream, internal medicine and peds are in the middle (after 8/10 weeks of your electives), and your surgery core is right before the CaRMS deadline. 

For orange stream, surgery is after ten weeks of electives (so hopefully you have decided on what you want to do before you complete any of the three cores -- not a problem faced at 4 year programs), and medicine and peds are after that.

For dark blue stream, internal medicine is after ten weeks of electives (so hopefully you already decided what you want to do), surgery is after that, and peds is post-CaRMS.

For green stream, peds is after 4 weeks of electives, surgery is more in the middle, and internal medicine is post-CaRMS.

 

For yellow stream, internal medicine is after 4 weeks of electives, peds is right after, and surgery is post-CaRMS.

 

For pink stream, surgery is after 4 weeks of electives, peds is right before CaRMS, and internal medicine is after CaRMS.

For light blue stream, peds is after 8 weeks of electives, internal medicine is in the middle, and surgery is post-CaRMS.

For red stream, peds is after 10 weeks of electives, surgery is right after, and internal medicine is right before CaRMS. 

It's good to have a real-life example like this. So, if you want to keep all three options theoretically open, that eliminates all of the streams which have the core post-CaRMS, so dark blue, green, yellow, pink, and light blue, leaving open grey, orange, and red.

For grey, orange, and red, your first core of interest (peds, internal, or surgery) is after 8 or 10 weeks of your electives (your stream will have 8 - 12 weeks electives pre-CaRMS total). That is, you will realistically have to decide which of the three specialties you want before having completed *any* of those cores. Once again, this is not a problem faced at other 4-year programs because they complete all of their cores first before any of their electives. 

So if you end up in orange (one of three viable streams for you), and you decide to do 8 or so weeks of your electives in peds, and then do your internal medicine core, and have a change of heart, well... Sorry. 

This is confounded by the fact that you do not get to choose which stream you want. You rank them, and a lottery happens. Students have been placed in their 8th and 9th ranked streams, which for you would automatically rule out one of your top three specialties. Also, this is a decision you have to make in March or April, just 7 months or so into medical school. Other students do not have to make this choice until midway through third year, if that!

For the purposes of disclosure, peds is also now competitive! For this year, the ratio was 0.77 (to compare, optho was 0.71). The most competitive are emerg, derm, and plastics (hovering between 0.52 and 0.57). 

This is a decision that you shouldn't take lightly. I cannot speak to McGill's curriculum as I am not too familiar with it, but I thank you for providing an example to walk through for the clerkship streams. 

I have also heard that the reputation Mac students have is that they aren't as strong on their electives. Well, is that really surprising? Many of us have not completed our core rotation in that specialty! Some of us don't do internal medicine until after CaRMS!

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I will address the clerkship stream lottery, because I believe that is the most important concern one should have.

 

Okay, so your top three is (1) Peds, (2) Internal Medicine, (3) Surgery, so ideally you would want to complete those cores before your electives (not possible at Mac), and certainly before CaRMS! 

 

Let's take the class of 2019 schedule because it is the most updated, and the streams go through very few alterations every year. There are 16 "streams", but for all intents and purposes, there are 8. 

 

To explain, there are 2 grey streams, 2 orange streams, 2 dark blue streams, etc. The differences between the colours are *huge* (different number of elective weeks, different arrangement of cores and electives), but the differences within the colours are not that big (maybe a 2 week elective is in a different place, but all the cores are in the same order). So, for the purpose of simplifying things, let's work with the 8 colours.

 

For grey stream, internal medicine and peds are in the middle (after 8/10 weeks of your electives), and your surgery core is right before the CaRMS deadline. 

 

For orange stream, surgery is after ten weeks of electives (so hopefully you have decided on what you want to do before you complete any of the three cores -- not a problem faced at 4 year programs), and medicine and peds are after that.

 

For dark blue stream, internal medicine is after ten weeks of electives (so hopefully you already decided what you want to do), surgery is after that, and peds is post-CaRMS.

 

For green stream, peds is after 4 weeks of electives, surgery is more in the middle, and internal medicine is post-CaRMS.

 

For yellow stream, internal medicine is after 4 weeks of electives, peds is right after, and surgery is post-CaRMS.

 

For pink stream, surgery is after 4 weeks of electives, peds is right before CaRMS, and internal medicine is after CaRMS.

 

For light blue stream, peds is after 8 weeks of electives, internal medicine is in the middle, and surgery is post-CaRMS.

 

For red stream, peds is after 10 weeks of electives, surgery is right after, and internal medicine is right before CaRMS. 

 

It's good to have a real-life example like this. So, if you want to keep all three options theoretically open, that eliminates all of the streams which have the core post-CaRMS, so dark blue, green, yellow, pink, and light blue, leaving open grey, orange, and red.

 

For grey, orange, and red, your first core of interest (peds, internal, or surgery) is after 8 or 10 weeks of your electives (your stream will have 8 - 12 weeks electives pre-CaRMS total). That is, you will realistically have to decide which of the three specialties you want before having completed *any* of those cores. Once again, this is not a problem faced at other 4-year programs because they complete all of their cores first before any of their electives. 

 

So if you end up in orange (one of three viable streams for you), and you decide to do 8 or so weeks of your electives in peds, and then do your internal medicine core, and have a change of heart, well... Sorry. 

 

This is confounded by the fact that you do not get to choose which stream you want. You rank them, and a lottery happens. Students have been placed in their 8th and 9th ranked streams, which for you would automatically rule out one of your top three specialties. Also, this is a decision you have to make in March or April, just 7 months or so into medical school. Other students do not have to make this choice until midway through third year, if that!

 

For the purposes of disclosure, peds is also now competitive! For this year, the ratio was 0.77 (to compare, optho was 0.71). The most competitive are emerg, derm, and plastics (hovering between 0.52 and 0.57). 

 

This is a decision that you shouldn't take lightly. I cannot speak to McGill's curriculum as I am not too familiar with it, but I thank you for providing an example to walk through for the clerkship streams. 

 

I have also heard that the reputation Mac students have is that they aren't as strong on their electives. Well, is that really surprising? Many of us have not completed our core rotation in that specialty! Some of us don't do internal medicine until after CaRMS!

 

yeah i think having three different specialties you're genuinely interested in might be a bit hard but two is doable. also not everyone wants their core before electives. (i.e. mac IM is a very sought after program if you want internal and you may not do your best on your IM core if its earlier)

 

your core is also a great time to get letters of reference for your discipline of interest. they're 6 weeks long so you'll have definite interaction with staff for 2-4 weeks. on some electives you might only see a staff for a week and have a hard time getting a letter. having your core early while you're still learning how to be a clerk may be difficult. there are multiple perspectives to consider. and if you put forth that the most critical part for success is to have your core before your electives, I truly do think you're overstating the value of that. at the end of the day the most critical thing is YOUR own learning skills and work ethic. 

 

its really no surprise that a three year program comes with needing to be a bit more pro-active. at the end of the day, the majority of mac students match to mac and toronto for residency (with more staying at the home school, which is the case across Canada). some more are scattered across ontario. a minority go OOP. these have been the CARMS stats replicated year after year 

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Peds, IM, and surgery are very different. Most people will have narrowed down surgery or not-surgery by the summer elective time comes. Lots of streams are ok for peds/IM and I know people who were still split on that late into clerkship. At least you have the summer elective times to test things out and maybe narrow things down to 2, but you need to have picked your stream before them... which is tough.

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In terms of the rumours that McMaster students are not as strong on electives: I have heard those too and am determined to prove them wrong : P Not sure where they started but McMaster students have traditionally matched very well to other schools (there will always be more McMaster students matched to McMaster as is the case with all other medical schools).

 

At the end of the day its a numbers game, many medical schools do their electives right before CaRMS like Western for example and as a result, they have done all of clerkship before they go to other schools, naturally they are going to be better than someone who just started clerkship. For the majority of McMaster streams, clerkship electives are front ended, which means you will do from 8-10 weeks of your 12-14 weeks of electives some at the very beginning of clerkship and some right after one core. You legitimately cannot compare someone who has only done 1.5 years of preclerkship and none of clerkship to someone who has done 3 full years of medical school already. As a result, Mac clerks just aren't going to have the knowledge. I have seen this already, with that being said, many preceptors are understanding when you explain to them your situation. Mac still matches well which shows you that it isn't all about this, but it cannot be denied that anxiety does exist over this issue.

 

One tiny positive thing is it is easier to book electives when no one else is doing them. September, October electives are very competitive to get.  

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Hey thank you so much for all of this information! I hope you don't mind me asking, but (if you went to a didactic school for undergrad) did you find the switch from didactic to self-learning difficult? One of my biggest worries is not having a 'standardized' database to learn from, which, as you mentioned in the post, may lead to not learning some key concepts that may be necessary. What happens during the 6 hours (or some other minimal amount) of lecture time that we get a week?

 

In addition, I was hoping you could clarify your comments on Anatomy and Pharmacology. By lottery, do you mean that only a handful of students will get to work on a cadaver at any given time, or only a handful of students will have the opportunity to work on a cadaver (i.e. is everyone eventually able to work with a cadaver or do some simply have bad luck and never work with one?)

 

Again, thank you so much for the insight, I really appreciate it <3 

 

Usually there is an introductory lecture to the unit, which covers the very basics. This is followed often by a number of clinical lectures that are mainly clinically focused i.e. cases followed by history, physical etc. Sometimes there will be out of hours lectures or student arranged sessions covering some clinical topics like antibiotics etc. There is essentially 0 histology (most people will like that) very little anatomy, very little pharmacology and a bit of physiology. The pace of McMaster's curriculum is very fast, if you don't keep up you will fall behind and you can slip through the cracks. There definitely is an expectation that you will learn a lot, learn and test yourself on your own and learn material not presented in lectures, so it is imperative that you do outside studying. 

 

The lottery is shared with BHSc, physio, OT and other students. I believe there are only 28 spots and usually around 10 people get in. The timing also sometimes overlaps with your tutorials unfortunately. 

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At the end of the day its a numbers game, many medical schools do their electives right before CaRMS like Western for example and as a result, they have done all of clerkship before they go to other schools, naturally they are going to be better than someone who just started clerkship. For the majority of McMaster streams, clerkship electives are front ended, which means you will do from 8-10 weeks of your 12-14 weeks of electives some at the very beginning of clerkship and some right after one core. You legitimately cannot compare someone who has only done 1.5 years of preclerkship and none of clerkship to someone who has done 3 full years of medical school already. As a result, Mac clerks just aren't going to have the knowledge. I have seen this already, with that being said, many preceptors are understanding when you explain to them your situation. Mac still matches well which shows you that it isn't all about this, but it cannot be denied that anxiety does exist over this issue.

 

One tiny positive thing is it is easier to book electives when no one else is doing them. September, October electives are very competitive to get.  

Thank you, Edict. What I've bolded is what I really neglected to highlight when going through the streams. The fact is that most of the clerkship streams begin with your electives (ie. what is most important in putting together a competitive application for residency). 

 

Out of the 8 coloured streams, grey has 10/12 weeks electives before the second core (that is, you will have done almost all of your electives with only one core completed: family). 

 

Orange, dark blue, pink, light blue, and red also have 10 weeks of electives before their second core. To be clear, the four-year programs do not do *any* of their elective weeks until they complete *all of their cores*. This is a major difference between schools and probably why Mac students do not have the same level of knowledge.

 

Dark green and yellow stream are the only ones in which your electives are a little more spread out, but in those cases:

For dark green, all of your electives are finished before exposure to Ortho, Anaesthesia, Internal medicine (post CaRMS), and Emerg (post CaRMS)

For yellow, all of your electives are finished before exposure to Family, OB/GYN, Surgery (post CaRMS), and Emerg (post CaRMS).

 

And those are the two streams with the "best" spread of cores and electives. This simply doesn't happen at 4 year schools.

 

I agree with our deficiencies in anatomy and pharmacology -- anatomy is not mandatory for students (which may be a plus for some), and Mac's philosophy in pharmacology is, "just learn it in clerkship". It's no surprise that one of the most requested improvements to the curriculum is more standardized pharmacology teaching. Will they actually do it, though? I'm not sure -- all I know is that it's been requested for a few years now. 

 

I think the Mac curriculum is ideal for a few people:

- Nontraditional students who feel intimidated by some of the "hard science" parts of medicine

- Those with a family or those who want to complete medical school as fast as possible for some reason

- Those who are 100% sure what they want to do. I would be cautious about this, though, as the vast majority of students change their mind after being exposed to different things

- Those who enjoy learning on their own by reading textbooks (or Toronto Notes) and watching videos.

 

I think the Mac curriculum may not be ideal for people who:

- Are flirting between two or three specialties, especially if one or two of them are competitive. You have to rank clerkship streams after 7 months of being in medical school, so you should be very proactive with shadowing and horizontal electives (like I said before, some of them take months to set up).

- Enjoy a very structured curriculum

- Want comprehensive anatomy teaching, or wish to work with a cadaver

- Want pharmacology teaching

 

I don't say this to dissuade anyone from coming to Mac, but merely to inform. As a volunteer on interview day (and also as someone who interviewed and was accepted here), I feel like certain things are downplayed by the administration to recruit as many students as possible. I do not know if they are always one year behind with the stats, but I was a little surprised when the Mac presentation used last year's CaRMS stats instead of this year's, when I believe the first iteration results were already out. I presume they will use this year's stats next year. I was also slightly put-off by the fact that there is no mention of how Mac's clerkship works compared to the other schools, and I believe this is intentionally done because the clerkship lottery is objectively worse.  Do students from Mac match to competitive specialties? Absolutely, but I think it presents a greater challenge.

 

Of course, these are sacrifices one should probably expect to make when you're condensing a four year program into three years, but it's one that was not made clear to me or my colleagues before choosing Mac. 

 

For those who have a choice in what school to go to, I hope this has better informed your decision (feel free to PM me if you have any questions). For those who were only accepted to Mac, I'm giving you this information upfront to help you and inspire you to be proactive about your education. Start doing horizontal electives and ruling in/out specialties as soon as you can. 

 

 

 

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Thanks for all of this information! Do you know how well the Mac curriculum prepares you for STEP? I am interested in doing a fellowship in the USA, and am worried about the limited time frame to study for the test and also the deficiencies in the curriculum (such as pharm and anatomy). With all of the above mentioned, I am leaning to going towards a more traditional school. Although 3 years sounds nice, the idea of leaving my future up to a lottery seems quite careless to me, especially after making so many calculated decisions thus far. It would be absolutely heartbreaking to be prohibited from matching to your desired residency because of sheer luck. That truly sounds like a nightmare! 

It is kind of crazy how most of this stuff is not known, and I am quite sure none of this was alluded to at all during interview day. This information may prevent a few catastrophes down the road. Or at the very least, it can better prepare students as to what to expect should situations like this occur. 

Cheers

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Writing the USMLE is incredibly tricky to do at Mac because most students write it at the end of their preclerkship, and we only have 14 months to do that, whereas the 4-year schools have 2 full years plus 2 long summer breaks.

 

Yeah, the lack of pharmacology and structured anatomy will be an issue as well, as will the complete disregard for the basic sciences. Put simply, you will absolutely not be prepared for STEP 1 by going through Mac's preclerkship, and will have to learn most of it on your own time. Students in the United States study for many months and usually put in 8-10 hour days for six weeks before their test -- I have no idea where that six-week block would fit in the McMaster timeline. 

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Mac will not at all prepare you for Step 1. In all fairness, American medical schools' preclerkship curricula are oriented around the content on the Step 1 exam and basically they teach to the exam. Mac's preclerkship is designed to prepare you for clinical exposure in clerkship, and preparing your for self directed learning in practice. Honestly, some of the stuff you learn in US preclerkship so that you can do well on step 1 will not be useful or high-yield for actual medical practice. So you will have to prepare on your own, and there isn't much time for that unless you really dedicate electives or all your free time to it.

 

Also, I have some classmates who took the Step 2 (clinical knowledge) at the same time as the MCCQE1, and anecdotally, clerkship and the review period doesn't prepare you well for the step 2 either. Although a lot of us used the Uworld prep for the Step 2 for our QE1 studying, the exams are fairly different. Step 2 has a larger proportion of internal medicine and tends to test on fairly niche topics, and based on Uworld, on infections and diseases you will never have heard of before during clerkship or review.

 

In summary, if your goal is US residency or fellowship, and you are deciding between Mac and a traditional 4 year program, understand that most other programs in Canada will not prepare you well for the Steps either, but you will have more time for self study during the summers, etc at a 4 year program.

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Props to those who have succeeded, but a 3 year curriculum would just make a difficult task even more challenging.

If you are strongly considering a small field (like neurosurg) or one that has difficult job prospects (like ortho), the USMLE may be a huge thing for you. 

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Thanks for all of this information! Do you know how well the Mac curriculum prepares you for STEP? I am interested in doing a fellowship in the USA, and am worried about the limited time frame to study for the test and also the deficiencies in the curriculum (such as pharm and anatomy). With all of the above mentioned, I am leaning to going towards a more traditional school. Although 3 years sounds nice, the idea of leaving my future up to a lottery seems quite careless to me, especially after making so many calculated decisions thus far. It would be absolutely heartbreaking to be prohibited from matching to your desired residency because of sheer luck. That truly sounds like a nightmare! 

 

It is kind of crazy how most of this stuff is not known, and I am quite sure none of this was alluded to at all during interview day. This information may prevent a few catastrophes down the road. Or at the very least, it can better prepare students as to what to expect should situations like this occur. 

 

Cheers

 

Fellowship in the USA is no problem as your Step 1 score does not matter for fellowship. Residency in the US is different however. If you are interested in residency in the US, go to a 4 year school. If you are interested in fellowship your school choice won't influence your chances of doing fellowship in the states. Fellowship is more of an informal application process. 

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