The CaRMs Conveyor Belt

[ChemicalKid94]

Do any of you guys feel like upon entering med school you're put on this sort of "CaRMs conveyor belt" with an ever looming deadline approaching. 
Unlike our colleagues outside of North America we kind of only have one shot (save for the 2nd round and reapplying the following year).

Not a perfect system but do you guys think there'd ever be any hope of it improving? 

 

[Bambi]

The system is not perfect but it is definitely not a conveyor belt. The process works. There is subjectivity in the selection process and you need to be strategic in selecting your electives, in clerkship to work hard, be collaborative, friendly and stand out to the residents who have a role in the selection process and to the attending. 

[GH0ST]

People have to realize that the system works for a majority of people... not everyone. 

Some people won't match into their specialty, some won't match to the desired location...

Honestly at the end of the day the match is a competition. You aren't guaranteed whatever you want. 

- G

[ChemicalKid94]

You guys both bring up very good points that I completely agree with.

My argument isn't that carms doesn't work. I think it works for the majority of people, and lots people in medicine who either matched to something that wasn't their first choice specialty or location end up being able to make the most of it. Human beings can be quite resilient, I have no reservations about that.

I hope I don't sound entitled to a particular specialty or otherwise. Rather, the comparison to a conveyor belt was to illustrate the perspective that at least as a current med student, carms is an ever looming deadline that cannot be delayed or postponed. Every single day you move closer to your match day. Whereas in medical education outside of Canada, and the US, you can apply when you want, and as many times as you want to whichever specialty you please.
In my perspective being ushered along an axis of time to a particular date decided for you is very much akin to a conveyor belt. Not a bad one necessarily. But still a conveyor belt of sorts methinks. 

Carms is not an impossible game. Enough people go through the system successfully that we know it works. My question is, is there a way we could improve it? And if so, how?

[DrOtter]

13 hours ago, ChemicalKid94 said:

You guys both bring up very good points that I completely agree with.

My argument isn't that carms doesn't work. I think it works for the majority of people, and lots people in medicine who either matched to something that wasn't their first choice specialty or location end up being able to make the most of it. Human beings can be quite resilient, I have no reservations about that.

I hope I don't sound entitled to a particular specialty or otherwise. Rather, the comparison to a conveyor belt was to illustrate the perspective that at least as a current med student, carms is an ever looming deadline that cannot be delayed or postponed. Every single day you move closer to your match day. Whereas in medical education outside of Canada, and the US, you can apply when you want, and as many times as you want to whichever specialty you please.
In my perspective being ushered along an axis of time to a particular date decided for you is very much akin to a conveyor belt. Not a bad one necessarily. But still a conveyor belt of sorts methinks. 

Carms is not an impossible game. Enough people go through the system successfully that we know it works. My question is, is there a way we could improve it? And if so, how?

 

 

CaRMS is stressful for sure. But medical education outside of North America is not perfect either. In countries that don't have direct entry into residencies after med school, they have "foundation years" where you rotate through specialties and build your CV for future matching into training programs (registrarships ~ residencies). The fact is that entry into these training programs is difficult for anything other than general practice e.g. to be a derm in the UK, you probs need 3-4 foundation years before you can even be competitive to apply for the training program which itself is another 4 years. Same goes for things like EM and most surgical programs. There are people in these system who are stuck as HMO (house medical officers) who never enter specialty training at all and just work as hospitalists, earning so much less than what a specialist will make. And while you do get to apply as many times as you want, you are consistently losing out on your earning as a "consultant" level. In the UK, many docs just exit the public system altogether after foundational years and just work as unregulated "aesthetic doctors".

I'd rather go through the North American system where I get to enter the majority of specialties without having to extensively build my resume (save for a very select few) and then become certified staff. One thing I'd like to see for CaRMS though is some sort of intermediate license, in case someone didn't match, so they could still do clinical work and make use of their MDs rather than just doing free labour/research in the hopes of matching next cycle. 

[ChemicalKid94]

Thanks for your comment Dr. Otter. 
I wasn't really aware of how tough a process it is to apply to specialties outside of North America. Thanks for sharing that.

This is part of the reason why I wanted to start the dialogue. I've definitely got gaps in my knowledge, so it's cool to hear from you.

[rmorelan]

24 minutes ago, ChemicalKid94 said:

Thanks for your comment Dr. Otter. 
I wasn't really aware of how tough a process it is to apply to specialties outside of North America. Thanks for sharing that.

This is part of the reason why I wanted to start the dialogue. I've definitely got gaps in my knowledge, so it's cool to hear from you.

and just to add - part of the problem can never be fixed no matter what you do. There are simply always going to be more people wanting somethings than spots available - and sometimes by a large margin. Plus the people going for those spots are all very hard working, intelligent and motivated - so they are going to do whatever they can to become competitive. Nothing anyone can do will remove the stress of that. We can only logically try to control/minimize it. 

If you give people more time or resources to work towards exploring and building things up then some people will just use all of that time to prepare for the competitive thing they want by further increasing the baseline CV to apply to it - it becomes likely even more competitive, and it already is a lot of work to "gun" for somethings. 

If you reduce things too much, then there isn't enough time to explore and build up your CV - then program directors for residency spots have nothing to work with and selection becomes either random or even more dependent on subjective impressions. That isn't good. Plus you may pick of course something you don't like due to limited knowledge and be stuck in it. Anything we do to make you less stuck increase competition further (as you are saying you will let in the end more people apply apply for the same limited spots - and the spots cannot be increased as per below)

You cannot increase the spots - well not enough anyway to make a difference - in popular things because the spots are in large part based on the actual downstream job needs and they are expensive as hell to create. We are never going to be perfect there with respect to matching jobs to trainee - could do better mind you - but there is no point in training 100 people in residency for 50 jobs either (even if someone is willing to take that risk as it consumes resources. ). You would rather the painful event occur prior to starting the training - doing 5+ years in something and not getting a job in the end is a very bad outcome for you, for the profession, and for the government. We simply don't need everyone who wants to be type XYZ doctor in many cases to become one. That is a very harsh reality. 

 

 

 

[rmorelan]

On 9/4/2020 at 12:50 AM, ChemicalKid94 said:

You guys both bring up very good points that I completely agree with.

My argument isn't that carms doesn't work. I think it works for the majority of people, and lots people in medicine who either matched to something that wasn't their first choice specialty or location end up being able to make the most of it. Human beings can be quite resilient, I have no reservations about that.

I hope I don't sound entitled to a particular specialty or otherwise. Rather, the comparison to a conveyor belt was to illustrate the perspective that at least as a current med student, carms is an ever looming deadline that cannot be delayed or postponed. Every single day you move closer to your match day. Whereas in medical education outside of Canada, and the US, you can apply when you want, and as many times as you want to whichever specialty you please.
In my perspective being ushered along an axis of time to a particular date decided for you is very much akin to a conveyor belt. Not a bad one necessarily. But still a conveyor belt of sorts methinks. 

Carms is not an impossible game. Enough people go through the system successfully that we know it works. My question is, is there a way we could improve it? And if so, how?

a few points here

sure you can apply in the US in different ways (although they to have a match system and usually a single point of entry). In the US as education is privatized so people also don't has as much of a concern about having people unemployed in the end. That isn't the residency program's problem basically. In Canada the government funds the med schools, residencies and the end staff positions - so it is very much concerned with the entire pipeline. There are many US doctors that basically never practise (even when there is a shortage of doctors - because they can be trained in the wrong thing). They wouldn't care about that sort of thing - and there are entire industries that use the "by-product" doctors. 

again anything that increases flexibility in applying, increases competition for the spots simply because there are more applicants. You really don't ever want a system were it becomes more expected to have to apply for years just to get in (some fields in medicine kind of already approach that). Flexibility always sounds good but it is also always at a cost. 

Residency as it happens is just another conveyor belt I should mention as well. Replace CARMS with college exam ha and you get the idea. Same sort of endless reminders both subtle and gross of the impending examination and doom if you are not prepared. That probably will change a bit with competency education but I suspect it will still feel like an unstoppable process as well. It was worse than CARMS for me in that sense. 

   

Edited September 5, 2020 by rmorelan