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2018 CaRMS Second Iteration Interview Thread

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1 hour ago, marrakech said:

There's a lot of misunderstanding regarding where things are going and who is being unmatched (link):

" According to the AFMC’s calculations, if the first iteration was comprised only of current-year graduates of Canadian medical schools, the ratio between applicants and jobs would stay steady at roughly 1:1.056. But when you add in the unmatched graduates from prior years, “that ratio starts plummeting down,” says Genevieve Moineau, president and CEO of the AFMC, such that it is currently about 1:1.026, and is forecasted to dip to 1:0.99 by 2021. In other words, in 2021, for every applicant, there will be less than one training position available."

:...on pace to leave 82 students without a residency this year; by 2020, the number of unmatched is predicted to be 118. This is more than an entire class of students at most medical schools."

"..Nevertheless, it’s the key thing that needs to change, say Andy Ng, who graduated from the University of Ottawa’s MD/Ph.D. program in 2017. In his fourth year of med school, Ng applied to neurology programs across the country and received interviews at almost all of them. “I had a pretty good CV, I did really well in my clinical rotations, and I got very good references,” he says. He believes that most schools were speaking to 40 to 50 students—for two or three positions. Still, he was shocked when he didn’t match. In the second round, Ng applied for family medicine which seemed to him a likely match—there were several positions in Ottawa and Calgary (there were more in Quebec, but to meet the needs of French-speaking communities it was expected that physicians in those programs would speak French, which Ng did not.). In the end, only seven of the 14 U of O students who went unmatched in the first iteration found a spot in the second, and Ng was not one of them."

The article portrays IMGs as essentially immigrant IMGs  - the reality is most IMGs that match are CSAs.

The spill over effect is a major problem - even if you somehow believed that a razor thin extra number of canadian grads can somehow result in an exactly perfect match where everyone gets a spot, and every spot is taken (which is just completely unrealistic as medical students are not interchangeable lego pieces) then the overflow from the past just keeps hammering the system.  I know it adds public policy challenges (as the government wants people to go into particular fields for quite logical reasons) but the old standard was 1.1 to 1 positions to people - that seemed to work well for sometime. 

 

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29 minutes ago, rmorelan said:

The spill over effect is a major problem - even if you somehow believed that a razor thin extra number of canadian grads can somehow result in an exactly perfect match where everyone gets a spot, and every spot is taken (which is just completely unrealistic as medical students are not interchangeable lego pieces) then the overflow from the past just keeps hammering the system.  I know it adds public policy challenges (as the government wants people to go into particular fields for quite logical reasons) but the old standard was 1.1 to 1 positions to people - that seemed to work well for sometime. 

 

Why haven't they tied medical school enrolment more closely to residency spots? For example, when Ontario cut 70 residency spots in total in the past few years, why has the Ontario medical school enrolment stayed the same? Tying enrolment to residency spot movements is the only logical thing to do and this disconnect has basically erased the entire buffer. For every increase or decrease in residency spots, there should have been a commensurate change in medical school enrolment (at least on a provincial level). Each province looked at individually should have the 1:1.1 ratio as a minimum. 

The AFMC did propose to move over 1/2 of the IMG-designated spots in the first round for the next 2 years (i.e., time-limited basis) in order to ease the cascading effect. I am not sure if the provinces will go along with that - could have legal issues if this is too drastic?

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30 minutes ago, la marzocco said:

Why haven't they tied medical school enrolment more closely to residency spots? For example, when Ontario cut 70 residency spots in total in the past few years, why has the Ontario medical school enrolment stayed the same? Tying enrolment to residency spot movements is the only logical thing to do and this disconnect has basically erased the entire buffer. For every increase or decrease in residency spots, there should have been a commensurate change in medical school enrolment (at least on a provincial level). Each province looked at individually should have the 1:1.1 ratio as a minimum. 

The AFMC did propose to move over 1/2 of the IMG-designated spots in the first round for the next 2 years (i.e., time-limited basis) in order to ease the cascading effect. I am not sure if the provinces will go along with that - could have legal issues if this is too drastic?

Logical yes but two different government groups with different objectives. Universities really want high med school numbers - people want to go to medical school (hence the forum), and they bring in money is so very many ways. It is politically challenging to drop enrollment that sounds like a something that will cause wait times etc (which just got out of all the press on that from the 2000-2010 period). The governments never seem to come up with a perfect overall pattern - you cannot boost one part of the system without reinforcing the rest - the trouble is that costs money. 

Plus for the most part the public has very little idea how residency actually fits into to things. 

So much politics - some people think no IMG should get a shot at any spot until every CMG has a shot at all the spots and either not applied to one or rejected from it (basically add a 3rd round of CARMS. Some think each med school HAS to give a family medicine spot to any resident in their home school as a last stop measure (even if that means they are pulling funding from other unmatched 2nd round spots from other programs or other parts of the province - which would encourage the schools as well to make sure their spots are filled in the first round, as you may not even have funding for that spot in the second round. It also means that if that student is so bad that they shouldn't be a family doctor then the school should have dealt with that during their training (we still do graduate people who are well bad students and so red flagged they cannot match - very small minority and it is important to remember that when dealing with unmatched people as most often they are actually solid students.) And as hard as it is for people on the forum some people in the system simply don't care about unmatched students - even think that having some people fail is useful as it makes everyone else work that much harder (you can imagine the sort of conversations you would have with that sort of person ha).

 

 

 

Edited by rmorelan

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10 hours ago, hamham said:

He/she is not going to go unmatch forever. Majority of unmatched applicants who apply the following year will match, according to stats released by my school. So don't assume that all unmatched applicants will wind up with nothing. That assumption is, in your own words, most asinine, especially if it's coming from a staff physician. 

You're probably right but your flippant attitude here is unhelpful. People unmatched in the second iteration have to sit out the year and (hopefully) get some more experience and connections to try again in the first iteration the next year. That's an extremely stressful situation and for some of them even that won't work out. It can be a devastating thing. 

10 hours ago, DermJuly2018PGY1 said:

It is not a real spot. They will interview and not take you, already having another candidate in mind.

It is a very real spot. I know someone who interviewed. That doesn't mean it's not uncommon for programs to have their ROL more or less settled prior to interviews. 

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17 minutes ago, A-Stark said:

You're probably right but your flippant attitude here is unhelpful. People unmatched in the second iteration have to sit out the year and (hopefully) get some more experience and connections to try again in the first iteration the next year. That's an extremely stressful situation and for some of them even that won't work out. It can be a devastating thing. 

It is a very real spot. I know someone who interviewed. That doesn't mean it's not uncommon for programs to have their ROL more or less settled prior to interviews. 

just to add - objectively mostly will but by most we are talking as per the carms data about 60-70% in the following year. That means the possibility of not matching is real, and those people roll over and the process continues. 

and people fall of the tracks as well of course - every resident knows people like that. I know people that are in their 3rd and 4th attempts - small numbers but there none the less. 

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21 hours ago, Angry+Bitter+Unmatched said:

Thanks for the kind words....they are few in my life these days.  

I am a prior year graduate, I withdrew from my residency due to profound unhappiness.  I have four years of residency experience, including a year as chief resident, I also have a masters degree with three first author publications in peer reviewed journals.  I have been attempting to match for the last three years with nothing.....only because I withdrew.  I have excellent references, and over 200 pages of positive resident ITERs.  I have been on welfare for the last two years and forced to declare bankruptcy on my medical school loans.  It has been literally impossible for me to find employment despite having an "education" which is apparently otherwise useless.  I am only still here because of the kindness of my family giving me a place to live.  This has been the most humiliating experience of my life.  I literally feel like a disposable person.

I have in the past contacted my home medical school (not where I did my residency) and my local hospital for volunteer clinical work in any capacity only to be told no in both cases due to the fact that I am not registered with a program and I cannot secure malpractice insurance.  I can't even work for free to keep my skills up to date or improve my odds in the match.  I have literally no way to improve my odds. I was disgusted by my conversation with the University of Ottawa this morning and I have come to the conclusion that the match isn't even a fair contest.  I really could have used my welfare payment this month, but instead it went to this useless bullshit endeavor.

 

Man, I'm so sorry.  That is horrifying.  Its truly depressing what the take away from this story is: no matter how unhappy you are with your residency program, switch or stay in and never drop out.  Scary stuff.  Putting myself in your shoes I agree with the other poster who suggested USMLE--if Canada hasn't worked for 3 years (because of what sounds like bullshit, but regardless), I would think that's a pretty clear, although unappealing, next option.

The 2nd round stuff is still disturbing to me.  I really do see carms as fairly random, and I'm not what you would call an amazing interviewer--I can for sure see a version of events where I could have easily gone unmatched.  It becomes SO much tougher as soon as that happens.

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4 hours ago, rmorelan said:

honestly I am surprised how loose that can be it seems - at some point you have to worry some government agent is going to wake up and get aggressive.

I am as well. To some degree, I understand the "academic" post in Toronto and Ottawa thing. Just because someone is an IMG, I don't think we should force them into a community career path. However, I don't think it is fair that Richmond Hill, Hamilton, London etc is considered underserved when it comes to the RoS. 

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34 minutes ago, goleafsgochris said:

Man, I'm so sorry.  That is horrifying.  Its truly depressing what the take away from this story is: no matter how unhappy you are with your residency program, switch or stay in and never drop out.  Scary stuff.  Putting myself in your shoes I agree with the other poster who suggested USMLE--if Canada hasn't worked for 3 years (because of what sounds like bullshit, but regardless), I would think that's a pretty clear, although unappealing, next option.

The 2nd round stuff is still disturbing to me.  I really do see carms as fairly random, and I'm not what you would call an amazing interviewer--I can for sure see a version of events where I could have easily gone unmatched.  It becomes SO much tougher as soon as that happens.

The scary thing is, I'm not 100% on this but it would not surprise me if the US either knows or forces you to declare if you have ever "withdrawn from a residency training program" before in the NRMP match. 

I actually would consider the NRMP as well as a career in pharmaceutical or consulting. They do hire MDs and I feel like they are more forgiving than the residency authorities on this kind of issue. In business fields, few people have a straight and narrow career path without any hiccups and they will understand your situation better I would hope. 

 

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35 minutes ago, Edict said:

I am as well. To some degree, I understand the "academic" post in Toronto and Ottawa thing. Just because someone is an IMG, I don't think we should force them into a community career path. However, I don't think it is fair that Richmond Hill, Hamilton, London etc is considered underserved when it comes to the RoS. 

no it isn't - and not that I want to restrict people but it just seems like they basically aren't checking anything. That is very dangerous as they could spring at some point (at least in theory) the punishments of the contracts (which are huge) against people.

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1 hour ago, Edict said:

I am as well. To some degree, I understand the "academic" post in Toronto and Ottawa thing. Just because someone is an IMG, I don't think we should force them into a community career path. However, I don't think it is fair that Richmond Hill, Hamilton, London etc is considered underserved when it comes to the RoS. 

It's only 3-5 years of ROS, they could come back to academic hospitals later on.

Also, the ministry hasn't been checking at all the ROS contract, as there are quite a few IMG family physicians practising in Toronto straight out of residency, working in academic hospitals. Once they find out, the punishments could be quite huge. 

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8 hours ago, rmorelan said:

Logical yes but two different government groups with different objectives. Universities really want high med school numbers - people want to go to medical school (hence the forum), and they bring in money is so very many ways. It is politically challenging to drop enrollment that sounds like a something that will cause wait times etc (which just got out of all the press on that from the 2000-2010 period). The governments never seem to come up with a perfect overall pattern - you cannot boost one part of the system without reinforcing the rest - the trouble is that costs money. 

I have no idea exactly how much say universities have .  But there was a big jump from about 2005-2010 in the number of seats for some schools in Ontario, including the introduction in 2005 of NOSM.  Mac: 148->208 ; UofT: 204-> 247; Western: 133->171; UofO: 139->164 (source).  Queen's had no increase - it's been at 100 since 2002.  

Plus for the most part the public has very little idea how residency actually fits into to things. 

So much politics - some people think no IMG should get a shot at any spot until every CMG has a shot at all the spots and either not applied to one or rejected from it (basically add a 3rd round of CARMS. Some think each med school HAS to give a family medicine spot to any resident in their home school as a last stop measure (even if that means they are pulling funding from other unmatched 2nd round spots from other programs or other parts of the province - which would encourage the schools as well to make sure their spots are filled in the first round, as you may not even have funding for that spot in the second round. It also means that if that student is so bad that they shouldn't be a family doctor then the school should have dealt with that during their training (we still do graduate people who are well bad students and so red flagged they cannot match - very small minority and it is important to remember that when dealing with unmatched people as most often they are actually solid students.) And as hard as it is for people on the forum some people in the system simply don't care about unmatched students - even think that having some people fail is useful as it makes everyone else work that much harder (you can imagine the sort of conversations you would have with that sort of person ha).


That's maybe the system they went through - but it's misleading thinking on many levels.  First - to argue the success at CaRMS is a matter of work ethic seems completely off base from the reality of the CaRMS experience.  Second, even if it's the system they went through, the problem is - the world has changed.

 The stakes are much are higher now since both tuition and also LOC limits have gone way up.  The whole thing is out of control and risks collapsing - banks are going to cover themselves by tightening up loans and med school risks becoming even less accessible, especially if interest rates rise.  Not only is there a med school class equivalent of unmatched CMGs who will have to struggle to gain a residency position and have huge financial commitments, all other students will be directly or indirectly effected as well

That attitude is not only damaging to the affected CMGs, it's also detrimental to the profession.

 

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8 hours ago, rmorelan said:

Plus for the most part the public has very little idea how residency actually fits into to things. So much politics - some people think no IMG should get a shot at any spot until every CMG has a shot at all the spots and either not applied to one or rejected from it (basically add a 3rd round of CARMS. Some think each med school HAS to give a family medicine spot to any resident in their home school as a last stop measure (even if that means they are pulling funding from other unmatched 2nd round spots from other programs or other parts of the province - which would encourage the schools as well to make sure their spots are filled in the first round, as you may not even have funding for that spot in the second round. It also means that if that student is so bad that they shouldn't be a family doctor then the school should have dealt with that during their training (we still do graduate people who are well bad students and so red flagged they cannot match - very small minority and it is important to remember that when dealing with unmatched people as most often they are actually solid students.) And as hard as it is for people on the forum some people in the system simply don't care about unmatched students - even think that having some people fail is useful as it makes everyone else work that much harder (you can imagine the sort of conversations you would have with that sort of person ha).
 

I agree. No system is perfect for selecting the best future doctors. Doing well in undergrad doesn't always correlate with the type of physician you are. There are a very small number that slip through the cracks and should never match. That's not to say there aren't really smart and competent people that went unmatched for other reasons, but most of these people will eventually match as long as they don't have major red flags and express a genuine interest in the specialty. Not matching the first time sucks with lots of stigma attached but it can also be a very positive time to work on yourself, hobbies, and family before residency life. I also don't think most program director's or tax payers would want an unsuitable candidate over a well qualified IMG who stood out over thousands of applications. The process for IMG is very rigorous and people with poor English stand little chance. Those that do make it are exceptional.  

I also like to argue that removing IMG spots from first iteration would be an over-simplification to a problem that is deeply rooted in politics and funding. It used to be the case that IMG's could only apply for second iteration spots. As a result, we lost many talented physicians who would rather go to the states than apply for a second iteration position with limited choices, uncertainty, and poor location. I also think there would be a lot of backlash. Its a lot easier to deny something in the first place than to take away something. 

Lastly, the reality is that many of the IMG's spots go to CSA. The CSA's that do make it are well-rounded and intelligent. Some of them just realize later in life they wanted to do medicine or choose to focus on things early in life. Canada also under utilizes IMG's. There are thousands of well qualified doctors in their home country working non-medical jobs in Canada. I'm happy we have a system that offers a small and competitive window for talented individuals to come and to diversify the system and think it would be a bit sad if we went backwards and made it less attractive for IMGs. Also, Canada is a country of immigrants. There are some patients that just prefer to be treated by a doctor who understands their language and culture. We need some diversity. Were better off trying to increase funding for residency spots for CMGs or increasing the attractiveness of family medicine over specialties. 

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18 hours ago, shematoma said:

Some part of the process seems to depend on luck.

Places like Dalhousie sent out invites quickly, but for this round you either had to be a CMG or an IMG who already did the MMI in the first round, so there were relatively few applications to process. For Alberta, BC, only IMGs who previously passed tests in those provinces are eligible to apply, again cutting down the number of applicants that truly need to be screened. Hence if you apply to one of these places, your application is more likely to get a thorough review since they don't have that many to go through - most IMGs are excluded.

Other places like Ottawa that were totally deluged and might not have as strict a process of pre-qualifying IMGs... who knows what criteria they ended up using, as far as we know, they could just selectively pull a very few - local graduates, names they recognize, etc. Or just review every 5th application and throw out the rest. Even if you're a very strong applicant, if you don't have some kind of hook or name recognition within the program, you might be screwed because you're lost in an overwhelmingly large pile.

I interviewed with dal and I never did the MMI. 

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2 hours ago, psychiatry2017 said:

It's only 3-5 years of ROS, they could come back to academic hospitals later on.

Also, the ministry hasn't been checking at all the ROS contract, as there are quite a few IMG family physicians practising in Toronto straight out of residency, working in academic hospitals. Once they find out, the punishments could be quite huge. 

It would be tough to come back once you are out of the academic system for 3-5 years, due to competition for academic spots but especially if you are interested in research. You'll probably also realize that community is better haha and not want to deal with academics again. 

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13 hours ago, PetiteAgour said:

I also like to argue that removing IMG spots from first iteration would be an over-simplification to a problem that is deeply rooted in politics and funding. It used to be the case that IMG's could only apply for second iteration spots. As a result, we lost many talented physicians who would rather go to the states than apply for a second iteration position with limited choices, uncertainty, and poor location. I also think there would be a lot of backlash. Its a lot easier to deny something in the first place than to take away something. 

Lastly, the reality is that many of the IMG's spots go to CSA. The CSA's that do make it are well-rounded and intelligent. Some of them just realize later in life they wanted to do medicine or choose to focus on things early in life. Canada also under utilizes IMG's. There are thousands of well qualified doctors in their home country working non-medical jobs in Canada. I'm happy we have a system that offers a small and competitive window for talented individuals to come and to diversify the system and think it be a bit sad if we a system if we went backwards. Also, Canada is a country of immigrants. There are some patients that just prefer to be treated by a doctor who understands their language and culture. We need some diversity. Were better off trying to increase funding for residency spots for CMGs or increasing the attractiveness of family medicine over specialties. 

Right... Because the US is going to welcome IMGs with open arms, when even CMGs who are coming from LCME accredited schools will already be at a disadvantage?  

The big 4 Carribean schools are predatory degree mills - a graduate from there will be lucky to match to any remotely desirable program or location in the US or Canada.  It could be indeed that Australian and Irish schools offer a fine education, but not too many pre-meds have ~80K/year for tuition alone lying around.  It's my belief that excellent physicians can be found across the range of the SES spectrum.

Ultimately, ignoring the issue of unmatched CMGs will only serve to make things worse in the future - everyone will be affected, not only those very unfortunate CMGs.

 

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47 minutes ago, wonka_vision said:

I interviewed with dal and I never did the MMI. 

You're a CMG right? You either had to be CMG or an IMG who already did the first round MMI, and this criteria mainly prevented a deluge of new IMGs jumping in for second round from applying.

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2 hours ago, PetiteAgour said:

 That's not to say there aren't really smart and competent people that went unmatched for other reasons, but most of these people will eventually match as long as they don't have major red flags and express a genuine interest in the specialty. Not matching the first time sucks with lots of stigma attached but it can also be a very positive time to work on yourself, hobbies, and family before residency life. 

Not to hate (you are ofc entitled to your opinion) but IMO this is optimistic to the point of absurdity.  Unmatched individuals generally don't have a "positive time to work on themselves/family/hobbies"--this is a nice "Wanderlust" type sentiment but in reality the year is often a nightmare of stress and desperation, after the med student's career has fallen out from under them.  I also feel that the "youll be fine if you don't have red flags" is something we often say in retrospect now that were in residency.  I don't think it necessarily holds.  Its sort of like being told by your aunt who works at starbucks as a pre-med "don't worry youll get in youre smart."  

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20 hours ago, Starfish31415 said:

Agreed. For our school at least, whenever we asked about unmatched applicants from previous years, the faculty would blame either red flags (i.e. professionalism +/or extreme social awkwardness) or lack of strategy (i.e. not backing up, applying broadly, etc.) But now the whole process just seems confusing and nothing makes sense anymore. Either that or maybe I'm just a red flag and don't know it, hah.  Also, part of the issue is that as an unmatched applicant, you're completely left in the dark about what happened, whether you were close to the cut off and could consider trying again next year, or if most programs didn't even rank you at all. 

It would be amazing if AFMC can recommend some feedback to unmatched applicants from PDs, but due to multiple concerns like accountability, that's never going to happen. Some with close ties to the faculty/residents are able to get informal feedback, but for the rest of us there's really nothing to glean. 

It's true that I don't know the case for every single applicant unmatched from my school. Perhaps some do have red flags but I am damn sure the vast majority of the people are not in any way problematic. A few definitely did not back up.

And I entirely agree with every else you said.

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9 hours ago, rmorelan said:

So much politics - some people think no IMG should get a shot at any spot until every CMG has a shot at all the spots and either not applied to one or rejected from it (basically add a 3rd round of CARMS. Some think each med school HAS to give a family medicine spot to any resident in their home school as a last stop measure (even if that means they are pulling funding from other unmatched 2nd round spots from other programs or other parts of the province - which would encourage the schools as well to make sure their spots are filled in the first round, as you may not even have funding for that spot in the second round. It also means that if that student is so bad that they shouldn't be a family doctor then the school should have dealt with that during their training (we still do graduate people who are well bad students and so red flagged they cannot match - very small minority and it is important to remember that when dealing with unmatched people as most often they are actually solid students.) And as hard as it is for people on the forum some people in the system simply don't care about unmatched students - even think that having some people fail is useful as it makes everyone else work that much harder (you can imagine the sort of conversations you would have with that sort of person ha).

I definitely don't think problematic people should be in any way guaranteed a spot in any sort of residency, including family medicine. Failing a student is a whole other complex issue as you are aware. As you said, the vast majority of unmatched people are solid. 

I feel like some schools FM programs don't fill up all their spots in the 1st round and wait till the second round to try to fill up with their own unmatched students on purpose.

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2 hours ago, shematoma said:

You're a CMG right? You either had to be CMG or an IMG who already did the first round MMI, and this criteria mainly prevented a deluge of new IMGs jumping in for second round from applying.

Aah ok sorry. I took what you said to mean that both had to do mmi. 

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25 minutes ago, Arztin said:

I definitely don't think problematic people should be in any way guaranteed a spot in any sort of residency, including family medicine. Failing a student is a whole other complex issue as you are aware. As you said, the vast majority of unmatched people are solid. 

I feel like some schools FM programs don't fill up all their spots in the 1st round and wait till the second round to try to fill up with their own unmatched students on purpose.

I agree - with the point was that "problematic people" probably shouldn't even get through medical school at all. There is a lot of "someone will deal with it later" approach to things - and yeah it is quite hard of course, but right now there isn't a lot of pressure to get it right. I am sure both of us have see some medical students/residents and though wow someone should have fixed this way back when it was easier to fix (not specifically by failing them -there is a whole range of other things to do). If you aren't good enough to match to a spot why are you good enough to be moved along at all (adding more debit only to hit a brick wall at the end)? Instead someone should fix the problem. 

This only applies to small minority of course so not worth obsessing over - but if people are thinking somehow about a 100% match for everyone then that means that somehow the medical schools would have to make sure everyone is actually worth matching. 

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13 minutes ago, rmorelan said:

I agree - with the point was that "problematic people" probably shouldn't even get through medical school at all. There is a lot of "someone will deal with it later" approach to things - and yeah it is quite hard of course, but right now there isn't a lot of pressure to get it right. I am sure both of us have see some medical students/residents and though wow someone should have fixed this way back when it was easier to fix (not specifically by failing them -there is a whole range of other things to do). If you aren't good enough to match to a spot why are you good enough to be moved along at all (adding more debit only to hit a brick wall at the end)? Instead someone should fix the problem. 

This only applies to small minority of course so not worth obsessing over - but if people are thinking somehow about a 100% match for everyone then that means that somehow the medical schools would have to make sure everyone is actually worth matching. 

Exactly what I was thinking a few minutes ago. I do think med schools should take action BEFORE the person gets stuck with a worthless diploma and unmatched, not to mention bankrupt and pretty much screwed for life (or for a very long time). If someone clearly seems unfit for the profession, has obvious red flags and/or fails/near fails pile up, why let them finish med school at all??? Consider this: someone with this profile does match, what kind of a professional do you think this person will become? Yeah, someone will always come up with an exception, but as the saying goes "there's always an exception to the rule". However, in medicine, this shouldn't be enough...

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2 hours ago, goleafsgochris said:

Not to hate (you are ofc entitled to your opinion) but IMO this is optimistic to the point of absurdity.  Unmatched individuals generally don't have a "positive time to work on themselves/family/hobbies"--this is a nice "Wanderlust" type sentiment but in reality the year is often a nightmare of stress and desperation, after the med student's career has fallen out from under them.  I also feel that the "youll be fine if you don't have red flags" is something we often say in retrospect now that were in residency.  I don't think it necessarily holds.  Its sort of like being told by your aunt who works at starbucks as a pre-med "don't worry youll get in youre smart."  

I am that redflagged student. I am 1-3 years delayed and have a professionalism lapse due to a manic episode that can be considered on the level of "hi my name is 2018hopeful and welcome to Jackass".

My year(s) off are a blight following my manic episode. I've done everything right after being brought back in to finish clerkship. I don't have other options aside from matching. I am on the verge of bankruptcy only held off this year by me getting into bitcoin early. 

I understand I am redflagged for a valid reason, but I want to have some hope my entire life till this point is not for naught.

Some details changed to avoid self dox

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47 minutes ago, rmorelan said:

I agree - with the point was that "problematic people" probably shouldn't even get through medical school at all. There is a lot of "someone will deal with it later" approach to things - and yeah it is quite hard of course, but right now there isn't a lot of pressure to get it right. I am sure both of us have see some medical students/residents and though wow someone should have fixed this way back when it was easier to fix (not specifically by failing them -there is a whole range of other things to do). If you aren't good enough to match to a spot why are you good enough to be moved along at all (adding more debit only to hit a brick wall at the end)? Instead someone should fix the problem. 

This only applies to small minority of course so not worth obsessing over - but if people are thinking somehow about a 100% match for everyone then that means that somehow the medical schools would have to make sure everyone is actually worth matching. 

I agree. However, the system is set in a way that it is extremely hard to kick someone out. Also, in order for a student to have a remedial activity after a fail (rotation or homework of some sort), someone will typically have to insist on failing at least part of their rotation.

Multiple staff at this point told me that it is so incredibly hard to fail a student even if the student legit deserves a fail grade. The problem is that for the staff, they need to fill out so much more paperwork (like write 2 pages about why this student should get a fail grade). The students who fail will typically complain ad nauseam, and find some sort of excuses, and as a result, the staff will need to attend more meetings etc... As a result, unless if a student does something straight up dangerous, the supervising physician typically won't even bother.

Then there is the issue that in order to avoid all this, many staff physicians will just not teach too much to these students, and will write relatively "empty" evals. Ultimately, most of these students will still graduate, under the radar.

There's the story about this UdeM student a few years ago, who got in through CEGEP, and was a problematic student throughout the premed year, up till MS4. With multiple staff who complained and with multiple flags and completely inappropriate behaviours, only then they managed to kick the student out half way in med 4 year. It basically took 5 years to kick out this extremely problematic student. He actually sued UdeM. I didn't followed the results of that litigation (He didn't show up to most of his ER shifts during his ER block, didn't attend many teachings during clerkship, called his attendings dumb etc...)

Then, there is this story of a girl from McGill a few years ago, who stole a piece of brain from the anatomy lab, who later in clerkship posted a selfie in the OR with the face of the patient exposed, and as a result as initially excluded from McGill's MD program. The story I heard is that her parents sued the school, and ultimately the school still let her graduate, and eventually she matched to FM...

29 minutes ago, MDLaval said:

Exactly what I was thinking a few minutes ago. I do think med schools should take action BEFORE the person gets stuck with a worthless diploma and unmatched, not to mention bankrupt and pretty much screwed for life (or for a very long time). If someone clearly seems unfit for the profession, has obvious red flags and/or fails/near fails pile up, why let them finish med school at all??? Consider this: someone with this profile does match, what kind of a professional do you think this person will become? Yeah, someone will always come up with an exception, but as the saying goes "there's always an exception to the rule". However, in medicine, this shouldn't be enough...

Precisely what I'm thinking. Truly problematic people should just be dealt with earlier.

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48 minutes ago, rmorelan said:

I agree - with the point was that "problematic people" probably shouldn't even get through medical school at all. There is a lot of "someone will deal with it later" approach to things - and yeah it is quite hard of course, but right now there isn't a lot of pressure to get it right. I am sure both of us have see some medical students/residents and though wow someone should have fixed this way back when it was easier to fix (not specifically by failing them -there is a whole range of other things to do). If you aren't good enough to match to a spot why are you good enough to be moved along at all (adding more debit only to hit a brick wall at the end)? Instead someone should fix the problem. 

This only applies to small minority of course so not worth obsessing over - but if people are thinking somehow about a 100% match for everyone then that means that somehow the medical schools would have to make sure everyone is actually worth matching. 

I've seen the other side of this.  QC French schools  have only recently started moving away from the graded system - so the attrition rate has traditionally been multiples higher than in English-speaking faculties.  

 There's a sort of resignation that sets in seeing classmates having to leave the program or take time off, etc.. ...  I don't think is too great for moral.  I suppose maybe some people are identified who really couldn't make it through - although I'm not sure that's the case with all.  Plus with GPA the average tends to set in pretty quickly and not change too much after that.. no last 3 blocks etc for PD.  Pre-clinical is often considered as (or more) difficult as clerkship in terms of time.      

Do the top performers maybe work even harder? - Maybe?  I suppose I could see the value with an internal grading system but no obligatory external release for CaRMS purposes.  I guess H/P/F was a compromise but that's disappeared pretty much everywhere.

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