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Welcome New Med Students, Here's Some Discussion And Possible Advice

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Last year I posted a couple of tips re: what I wish I knew re: med school.  Now I'm in the summer between fourth year and starting residency, and I think I wanted to make a "top five" list of things that I wish I knew, things I wish I did better, or things I did well. (EDIT: it's a bit long actually so I'll add more on the way, and I invite others to add as well).  

 

A bit about me - I went to med school in a large city school.  I matched to a fairly competitive specialty (top 5), if specialty competitiveness is defined as how many people apply to said specialty receive a position .  I worked before I got into med school, and I was mainly focused on research, so I can't comment too much about other extracurriculars like CFMS or other things. 

 

Here's my best objective take on things that I think matter (more to come later): 

 

1) In regards to working hard in med school: I had an idea of what I wanted to do before med school, and because it was fairly competitive, I wanted to invest myself as much as possible into this specialty.  I think that has some benefits and drawbacks. The benefits are that if you start early, you get a sense of what you like and don't like about the specialty, what the people are like in terms of personality, and you can start building accomplishments and connections in that area. The drawbacks are that you can develop tunnel vision into ignoring fields that you would otherwise enjoy.  For instance, after I matched I realize how much studying psych and ER was kinda fun.  I didn't have that attitude sometimes in clerkship because I was really worried about whether or not I would match.  The other disadvantage is that you feel very "closed in"/"locked in" - so the pressures of worrying about other competitive applicants, seeing how far I needed to "be ahead", balancing school with EC's etc, is a very unhealthy pressure that has negative consequences on mental health. 

 

So I think that if that's something you struggled with getting into med school, this self-pressure needs to be adequately controlled and paced.  In my previous post last year I do think it's important to explore specialties as early as possible, because time to build a strong application maybe difficult. 

 

2) In regards to choosing a med school:  I got accepted to 5 schools and waitlisted at one when I applied.  I chose my med school based on living at home and saving a bit of money.  

 

Some things that you need to critically think.  A lot of people will say "oh yeah, I know someone who matched to specialty X from our school, so obviously there's nothing wrong with building an strong application" or "yeah we had x/y/z people match to specialty x from our school this year, so you can definitely match to what you want if you come here".  Raise your hand if you heard this before, because I heard it when I interviewed and I still hear it to this day.  I think there have been some posts here as well to the same tune.

 

With all due respect, that's a logical fallacy (i.e.: false cause, texas sharpshooter) that i'm surprised no one has written about. What sometimes this is interpreted as suggesting that this school can give you an advantage in terms versus others, and we all want an advantage when it comes to something competitive.  However, you have to step back and look at this objectively as well.  No one will provide you data on how individual people, from individual years, applying to specialty x from this particular school, matched. CaRMS will not provide it nor the school.  Without that data you CANNOT do an accurate statistical comparison, and thus you have to accept the null hypothesis that any school could or could not give you a good chance to matching to what you want. In addition, there are large differences in other variables between individuals from said school applying to said specialty. Connections, research, extracurriculars that you may or may not have participated in, reference letters - there are too many subjective variables at the individual applicant level for a specialty that cannot be correlated or linked to causation to the school attended alone.  Apples to Oranges to Pomegranates to Passionfruit.  

 

Think about it this way (cars is something I've been learning about more recently).  If a salesmen said that he "knows someone who had his life saved by driving model 2017 car X (the car he is trying to sell you)". Obviously you would go and try to see how Car X compared to Car Y,  safety ratings, reviews, etc before making the purchase.  You probably have tons of data on the internet, IIHS safety ratings, youtube, etc.  But let's say you have none of that data (see paragraph above).  All you know is that the salesman (who probably wants you to buy the car) said that someone had their life saved by driving Car X.  I dunno about you but I would be pretty skeptical. 

 

If you want to look through the CaRMS data, you will notice that there are large variations in terms of "schools that do/don't do well" in the match.  Like you, when I decided on a med school I partially took that into the play - someone from school y told me that school x "sucked" this year in terms of the match.  The next year my school "sucked" in the match, where by the level of "suckyness" is defined by how many people went unmatched. 

 

In CaRMS there are many different specialties, each with varying competitiveness.  Some specialties have unfilled spots after the first round, meaning that there are fewer people than there were spots. Some specialties have people who could not match to a position in said specialty, meaning there were more people than there were spots. So if a class of 100 people in school X had a higher proportion of people who wanted to more competitive specialties (not knowing anything about these individuals and their competitiveness for said specialties) than school Y, then school X runs a risk of having a higher unmatch rate than school Y.  But this is at the individual level in terms of individual choice, not the school.  There is no "gunner index" that applies to each individual entering class at each individual school, for each individual year that you can compare and predict or project, or even use to avoid.  Hence ANYONE saying to you "oh our school X is better than school Y because we had a better match rate" is giving you useless data.  The match rate for that particular year doesn't matter because individuals have cycled through now - your class may be more or less competitive, and no one knows that (again data at the individual level that you're not privy too, only the old gods and the new).  There is no pre-risk probability calculated year to year for attending school X compared to school Y at this particular time, and the data varies so much that you might as well use the divinations of a ping-pong ball.  Also remember that school sizes differ - if someone gives you an "absolute number of people unmatched versus school Y", ask them for the ratio because school Y might have a better relative unmatched ratio because they have more people.   

 

So look at it this way now - there are a lot of factors that could potentially drive someone's ability to match from one school or another, or schools that do better in the match versus another for a specific specialty.  At the end of the day, I think it's a harmful data point that gets thrown around that doesn't help anyone make a decision, because it might act as a false positive or negative.  I am really for taking away "data that doesn't help" and I think you shouldn't include this at all in terms of things you should include in your medical school decision. 

 

Things you definitely SHOULD include: proximity to family and friends, how the city is like, curriculum style, specific opportunities you are interested in unique to the city.  Those things can affect you at the individual level and is very helpful to your well-being.  Even the proximity to the nearest starbucks from your medical school building should have more weight than the matched/unmatched/"I know a guy who matched to X,Y,Z that was competitive".  I would take a nice ice frap over useless data any day of the week. 

 

TL;DR: Match performance of a school and people from said school for competitive specialties should not be factored into your decision to attend a medical school.  

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3: An unfortunate reality 

 

I think one thing that has been reiterated in many posts and  I’m going to reiterate here as well, is that there are a lot of medical student spots in 2017.   There has not been a proportionate increase in the number of residency spots.  This means for different specialties, there are more people who interested and applying for specialty spots (particularly in Ontario, where there have been residency spots cut).  

 

I am not sure about how other medical students at other schools felt this during fourth year, but I think that this had some effects that affected behaviour of applicants.  For the uninitiated, there is something called "backing up". This means that for instance, when you couldn't decide and equally wanted to do two different specialties.  You would apply for one specialty and then "back up" and also apply to the other specialty.  Most of the time what happens (with some exceptions) that someone applies to one more competitive specialty as their main choice, and then "backs up" with something less competitive.  

 

 

Knowing that this is true, I think the advice to "back up" is now limited.  This is my own analysis, but I think with more medical students programs now have more people to choose from.  This leads to some situations where people originally thought they would get interviews for their primary specialty AND their secondary specialty, but they ended up getting none from their secondary specialty and only for their primary specialty.  I am sorry that I do not have data publicly accessible from CaRMS that illustrates this, so I can only provide a case series of some of my classmates (n=6) and friends (hence you have to take my data sample with a heavy grain of salt).  For instance, one person applied to radiation oncology and backed up with internal medicine.  His application was more geared towards Rad Onc with more research, and he while he did receive RO interviews didn't receive any internal interviews.  For less competitive specialties (again specialties where there are more spots unfilled first round of CaRMS than there are spots) then backing up between less competitive specialties do yield interviews for both.  

 

This is now revving into the world of speculation and "advice".  I think for new med students, it's important to get exposure to a wide variety of things you want.  I think some good advice that someone told me was to consider "surgical vs non-surgical" first.  Afterwards, look at the lifestyle of the specialties that you're shadowing.  I don't think looking into compensation at this point is worth it, because compensation may change dramatically as well as technology over the next 5-10 years.  The question is - do you want to be PART of the change while doing the day to day work of the specialty?  

 

If you get to experience a lot in your first year, you can then start focusing on eliminating and building a CV for the fields that you are going to apply to.  Ultimately then you can decide by second or third year on what you would like to back up with or not, termed somewhat sardonically as "suicide matching" if you don't back-up.  My projection is that there may be more people who are deciding to go "all-in" to applying to specialties (I'm not sure if this data is available from CaRMS, I don't think there is but I may stand corrected).  People have to understand that with this strategy, there is a LOT of risk.  Just because you've worked hard and hustled and published etc. doesn't mean you will match.  You could have done everything right and still not match, which means that you will have to wait and do one year before applying again to the specialty of choice, and you still may not get in.  You have to be ok with that, and think about it long and hard.  If you are more risk-adverse, the option now is to back up as wide a spectrum of fields as possible.  However, it may be difficult to build a strong application for any one of those specialties (with some exception, for instance ER maybe likes people with some surgery interest, some ICU interest, some anesthesia interest).  

 

So you are stuck a bit between a rock and a hard place.  I don't think this is discussed enough sometimes in the curriculum - you really, really REALLY have to take this seriously.  Going unmatched is not the end of the world but as other posts in the forum (CaRMS 2017 thread) have mentioned it is a lot of burden, individual suffering, and sometimes and undeserved stigma.  A resident told me once that "the point of medical school is to match".  I looked upon him with some degree of skepticism and a pinch of scoff.  Now, I'm not so sure. 

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