Unmatched to First Choice Specialty in Year 2 and Backing Up

[unmatched2022]

This is a post, mostly rambling on the way that CaRMS works, especially in the past two years without visiting electives.

To begin with, I want to preface by saying I pplied for a competitive specialty, went unmatched despite many interviews, strong references and CV and then tried again. I chose an established, well-trodden pathway to try to re-match, and did all the right things on my CV to do so. Electives were impossible (my school made me graduate) and observerships were too ("COVID policies" in late 2022?).

In the end, I backed up with FM, and will be starting in FM soon. I don't refret backing up (I don't think) but do wish I matched.

The problem with the match is the complete feeling of a lack of control for students. I say "lack of control" because matching relies on so many factors that will be out of your control including:

• Your ability to do electives, with the right staff
• The number and strength of other applicants, at your school and elsewhere
• The unwritten policies of some programs and schools, i.e taking their own grads
• Possible applicants with connections to staff (family members, family friends, etc).
• The relationships of your staff writing your references to the selections committtee
• The make up and who is on the selections committee(s) themselves

I can go on and complain, but the system is the system. We have simply allowed ourselves to be a part of it. Complaining about it does no benefit, in the end.

The problem though, is that we start our path in pre-med with a clear formula of what is needed to be accepted to medical school. Some of it is published (GPA, MCAT, CASPer percentages in the rubrics) and some of it is unpublished (CV, general app writing tips) but it is well documented and passed down on websites like Premed101.

Here however, we're at the final stage of our medical education and now left with a system with no clear formula or option further. It is a decision here to accept that some things are out of our control, even despite our meticulous ability to finetune our applications when we were applying to get in.

It's all really quite random at some point (in specialties where each school has < 3 spots for example). Compound that with no electives, no in person interviews, and we have to admit more and more of the match is out of our hands.

I'm currently looking to expliore transfer options, but I'm realizing here still that this will depend on funding (ie, which programs have open spots or funding). Again, much of the future is out of my control.

I want to thank Premed101 and this community for getting me this far. I first posted nearly a decade ago as a first semester undergrad, asking for advice after doing extremely poorly in school and needed to figure out my GPA. I would not have made it this far without Premed101, and have made lifelong friends by connecting with people from this website. Someday, as staff in a given specialty, I hope to donate money to keep this website and its wisdom and culture alive.

In the end, I am disappointedwith not being able to make this last step of my medical journey work, even after being able to persist and persevere during the premed and med years thanks to the advice here. But maybe, simply, some things (hyper competitive CaRMS specialties during a pandemic) are not crackable, especially at the highest levels.

Not seeking any responses specifically, but just some thoughts that I hope some future Premed101 reader in decades can discover when they too, are going through a tough time.

[SpeakWhite]

Matching to family medicine is not a failure and doesn't mean your journey "didn't work". Everyone goes to medical school to become a physician - and as of now, there is a residency position available for every graduating medical student in Canada to become one. If you stay in medicine, you too will become a licensed physician who cares for their community and gives back.

In these situations, it's important to remember why one decided to train in medicine in the first place. Those who applied with the goal of only becoming pediatric oncologic neurosurgeons have a high risk of being unhappy about the outcomes - but those who applied because they wanted to help others, or for the love of the art and science of medicine, will be happy no matter what.

TLDR congrats on matching

[unmatched2022]

17 minutes ago, SpeakWhite said:

Matching to family medicine is not a failure and doesn't mean your journey "didn't work". Everyone goes to medical school to become a physician - and as of now, there is a residency position available for every graduating medical student in Canada to become one. If you stay in medicine, you too will become a licensed physician who cares for their community and gives back.

In these situations, it's important to remember why one decided to train in medicine in the first place. Those who applied with the goal of only becoming pediatric oncologic neurosurgeons have a high risk of being unhappy about the outcomes - but those who applied because they wanted to help others, or for the love of the art and science of medicine, will be happy no matter what.

TLDR congrats on matching

I completely agree @SpeakWhite - I admit it's pompous of me to think otherwise. A match is a match. Interestingly, it's more of a blow to my ego than anything. 

"but those who applied because they wanted to help others, or for the love of the art and science of medicine, will be happy no matter what."

This is good, lifelong advice. I guess my post is simply a reminder to applicants now and in the future about how tenuous this whole process is, and maybe to separate the outcomes from your effort. There is not a 1:1 correlation between the two in terms of odds of success in matching for some programs and specialties.
 

[bottleofrealfruitsours]

46 minutes ago, unmatched2022 said:

This is a post, mostly rambling on the way that CaRMS works, especially in the past two years without visiting electives.

To begin with, I want to preface by saying I pplied for a competitive specialty, went unmatched despite many interviews, strong references and CV and then tried again. I chose an established, well-trodden pathway to try to re-match, and did all the right things on my CV to do so. Electives were impossible (my school made me graduate) and observerships were too ("COVID policies" in late 2022?).

In the end, I backed up with FM, and will be starting in FM soon. I don't refret backing up (I don't think) but do wish I matched.

The problem with the match is the complete feeling of a lack of control for students. I say "lack of control" because matching relies on so many factors that will be out of your control including:

• Your ability to do electives, with the right staff
• The number and strength of other applicants, at your school and elsewhere
• The unwritten policies of some programs and schools, i.e taking their own grads
• Possible applicants with connections to staff (family members, family friends, etc).
• The relationships of your staff writing your references to the selections committtee
• The make up and who is on the selections committee(s) themselves

I can go on and complain, but the system is the system. We have simply allowed ourselves to be a part of it. Complaining about it does no benefit, in the end.

The problem though, is that we start our path in pre-med with a clear formula of what is needed to be accepted to medical school. Some of it is published (GPA, MCAT, CASPer percentages in the rubrics) and some of it is unpublished (CV, general app writing tips) but it is well documented and passed down on websites like Premed101.

Here however, we're at the final stage of our medical education and now left with a system with no clear formula or option further. It is a decision here to accept that some things are out of our control, even despite our meticulous ability to finetune our applications when we were applying to get in.

It's all really quite random at some point (in specialties where each school has < 3 spots for example). Compound that with no electives, no in person interviews, and we have to admit more and more of the match is out of our hands.

I'm currently looking to expliore transfer options, but I'm realizing here still that this will depend on funding (ie, which programs have open spots or funding). Again, much of the future is out of my control.

I want to thank Premed101 and this community for getting me this far. I first posted nearly a decade ago as a first semester undergrad, asking for advice after doing extremely poorly in school and needed to figure out my GPA. I would not have made it this far without Premed101, and have made lifelong friends by connecting with people from this website. Someday, as staff in a given specialty, I hope to donate money to keep this website and its wisdom and culture alive.

In the end, I am disappointedwith not being able to make this last step of my medical journey work, even after being able to persist and persevere during the premed and med years thanks to the advice here. But maybe, simply, some things (hyper competitive CaRMS specialties during a pandemic) are not crackable, especially at the highest levels.

Not seeking any responses specifically, but just some thoughts that I hope some future Premed101 reader in decades can discover when they too, are going through a tough time.

Many excellent applicants are victims of inconsistent, and often corrupt residency matching process. I really do hope this gets addressed in the future

[NutritionRunner]

Your bullet points could apply to practically any professional job, just the staff in question would not be physicians, but rather other professionals, and instead of electives you would have internships, informational interviews, participating in the right groups and professional activities, portfolios, and the like. Lots of professional positions aren’t even advertised; people get them through connections and networking. 

Medical education and residency in Canada are also designed to produce the types of physicians that are needed in Canada (although we clearly don’t produce enough primary care practitioners), and not designed to ensure every medical student gets their preferred specialty. Yes, it sucks for people who don’t get their preferred specialty and for those who leave medicine altogether. It really does. 

I can appreciate you must be very disappointed having done all the “right” things and not matching to your preferred residency. Sadly, you can do everything “right” and have a less than desired outcome. I hope you can find some contentment in family medicine

[shikimate]

I find your idea about "a system with no clear formula or option further" worth discussing.

Some see medicine as an "end", eg. my life goal is to become a surgeon and I want myself to be known as a surgeon.

Some see medicine as a means to an end, eg. medicine is a good job with good $ and once I've done my dues I can move onto something else.

In the first case I find there is a lot of burnout when that person over-work themselves in their specialty, and disappointment when they don't get the specialty they want. Maybe it's that "big expectation = big disappointment" thing.

In the second case, I find a lot of FOMO, eg. someone might not know when to call it quits or wind down; they practice until they've run out of time to pursue whatever else they wanted to pursue. This could be part of "sunk cost fallacy".

If you were an investor I'd recommend you don't put all your capital in 1 stock; most people would agree this is a good idea. But as a corollary, most people hope to lean their sense of vocational worth on 1 job or career and don't tend to question if that is a good strategy.

I've noticed similar phenomenon happen with military personnel and athletes. They tend to spend their youth in a highly competitive but relatively "closed" regimen. When they retire and suddenly have to find their niche in society, they tend to get lost quickly and run into problem with addiction etc.

[Pakoon]

2 hours ago, unmatched2022 said:

This is a post, mostly rambling on the way that CaRMS works, especially in the past two years without visiting electives.

To begin with, I want to preface by saying I pplied for a competitive specialty, went unmatched despite many interviews, strong references and CV and then tried again. I chose an established, well-trodden pathway to try to re-match, and did all the right things on my CV to do so. Electives were impossible (my school made me graduate) and observerships were too ("COVID policies" in late 2022?).

In the end, I backed up with FM, and will be starting in FM soon. I don't refret backing up (I don't think) but do wish I matched.

The problem with the match is the complete feeling of a lack of control for students. I say "lack of control" because matching relies on so many factors that will be out of your control including:

• Your ability to do electives, with the right staff
• The number and strength of other applicants, at your school and elsewhere
• The unwritten policies of some programs and schools, i.e taking their own grads
• Possible applicants with connections to staff (family members, family friends, etc).
• The relationships of your staff writing your references to the selections committtee
• The make up and who is on the selections committee(s) themselves

I can go on and complain, but the system is the system. We have simply allowed ourselves to be a part of it. Complaining about it does no benefit, in the end.

The problem though, is that we start our path in pre-med with a clear formula of what is needed to be accepted to medical school. Some of it is published (GPA, MCAT, CASPer percentages in the rubrics) and some of it is unpublished (CV, general app writing tips) but it is well documented and passed down on websites like Premed101.

Here however, we're at the final stage of our medical education and now left with a system with no clear formula or option further. It is a decision here to accept that some things are out of our control, even despite our meticulous ability to finetune our applications when we were applying to get in.

It's all really quite random at some point (in specialties where each school has < 3 spots for example). Compound that with no electives, no in person interviews, and we have to admit more and more of the match is out of our hands.

I'm currently looking to expliore transfer options, but I'm realizing here still that this will depend on funding (ie, which programs have open spots or funding). Again, much of the future is out of my control.

I want to thank Premed101 and this community for getting me this far. I first posted nearly a decade ago as a first semester undergrad, asking for advice after doing extremely poorly in school and needed to figure out my GPA. I would not have made it this far without Premed101, and have made lifelong friends by connecting with people from this website. Someday, as staff in a given specialty, I hope to donate money to keep this website and its wisdom and culture alive.

In the end, I am disappointedwith not being able to make this last step of my medical journey work, even after being able to persist and persevere during the premed and med years thanks to the advice here. But maybe, simply, some things (hyper competitive CaRMS specialties during a pandemic) are not crackable, especially at the highest levels.

Not seeking any responses specifically, but just some thoughts that I hope some future Premed101 reader in decades can discover when they too, are going through a tough time.

Congratulations on matching. You've given some very valid points here, for others going forward, would you mind sharing the specialty you applied for? I think years from now someone will see your post and it'll help give a more realistic sense of how competitive CARMs can sometimes be. 

I think we need to normalize saying what specialty someone applied as "competitive specialty" is often vague and can change the advice others should be giving. 

 

Best of luck with your journey, and I hope you can look back one day and be glad you ended up in FM!

[indefatigable]

5 hours ago, unmatched2022 said:

In the end, I am disappointedwith not being able to make this last step of my medical journey work, even after being able to persist and persevere during the premed and med years thanks to the advice here. But maybe, simply, some things (hyper competitive CaRMS specialties during a pandemic) are not crackable, especially at the highest levels.

Not seeking any responses specifically, but just some thoughts that I hope some future Premed101 reader in decades can discover when they too, are going through a tough time.

It's a great analysis and look a the system.  Although getting into med school does depend on luck or chance to some extent, at least there are some objective metrics to focus on.  

On the other hand, competitive specialties especially draw on almost random data, which to a large extent is subjective although almost justified/perceived to be objective.  Like you say relationships, connections become much more important which one has limited control especially with restrictions.  And of course it's not a level playing field with different opportunities etc..  Being competitive to some extent just reflects being in the right place at the right time, showing some ability & likeability and not dropping the ball.  Unfortunately, this is why dedication is necessary, but not sufficient.

And I personally think that's why to a large extent I've had  surprises when person X matches or person Y to specialty Z - because there's often little underlying difference between candidates except maybe who they happened to impress or had a chance to work with, or who had some weak eval or flag or who impressed more on interview day etc..  In fact I've been surprised by thinking that candidate X appears much stronger than candidate Y from my interactions with them but then have the opposite outcome when matches occur.    

All this to say, that try not to take things personally and keep going.  A great resident is a great resident in whatever specialty or program they are in.  Transfer do happen and congratulations on your match.

[Findanus]

If you feel like you don't find family medicine to be a career path in which you can find your niche after you've finished training, I advise applying to the USA. There are more choices, and there is a semblance of evenness to the competition although it was better when USMLE step 1 scores were numerical and not pass/fail. Step 2 still has scores and will probably be the great differentiator now. I see you were going for plastics, which is as difficult to get in the USA, but other fields there are a bit more open to applicants than in Canada.

It is hard to accept a result when it is due to an opaque system directing you somewhere, rather than a consequence of fair competition, win or lose.

It's easy to feel slighted, particularly after you notice how much you will lose in tax every year!

In any case, good luck.

[unmatched2022]

4 hours ago, indefatigable said:

It's a great analysis and look a the system.  Although getting into med school does depend on luck or chance to some extent, at least there are some objective metrics to focus on.  

On the other hand, competitive specialties especially draw on almost random data, which to a large extent is subjective although almost justified/perceived to be objective.  Like you say relationships, connections become much more important which one has limited control especially with restrictions.  And of course it's not a level playing field with different opportunities etc..  Being competitive to some extent just reflects being in the right place at the right time, showing some ability & likeability and not dropping the ball.  Unfortunately, this is why dedication is necessary, but not sufficient.

And I personally think that's why to a large extent I've had  surprises when person X matches or person Y to specialty Z - because there's often little underlying difference between candidates except maybe who they happened to impress or had a chance to work with, or who had some weak eval or flag or who impressed more on interview day etc..  In fact I've been surprised by thinking that candidate X appears much stronger than candidate Y from my interactions with them but then have the opposite outcome when matches occur.    

All this to say, that try not to take things personally and keep going.  A great resident is a great resident in whatever specialty or program they are in.  Transfer do happen and congratulations on your match.

@indefatigable as you astutely noted in your signature: "When we are no longer able to change a situation, we are challenged to change ourselves."- Viktor Frankl.

I recognize too that there's a chance to go to the US. When you've already been convinced at least once that re-trying could work, you begin to wonder if the opportunity cost is worth it to re-apply. You also question how a pass/fail medical school system has been touted as "more equitable" when in reality, it leaves a residency system open to subjective vagaries and corruption.

(I would also like to jokingly qualify my answers and posts by saying I have no red flags and am a well liked individual ).

My post is just a warning to the future generations of medical students, who will inevitably be as driven, motivated, and fearless as med students have been in generations prior. Ultimately, everything in life is a little bit of luck and skill - but it's almost impossible to reasonably determine how much is attributed to each.

CaRMS plays into a few psychological fallacies:

Fundamental attribution error:
"In social psychology, fundamental attribution error, also known as correspondence bias or attribution effect, is a cognitive attribution bias where observers underemphasize situational and environmental factors for the behavior of an actor while overemphasizing dispositional or personality factors."

• We ascribe our success (matching) to skill, and unmatching to bad luck. Both cases invariably depend on both.

Survivorship bias:

"Survivorship bias is a type of sample selection bias that occurs when an individual mistakes a visible successful subgroup as the entire group."

• We only have a sample of successful residents to reach out to. No one is labelled as a "former ______ gunner" for us to look at the whole pool. Furthermore, the % of successful applicants on the CaRMS website doesn't even count those that got 0 interviews (which can be high!).

The Problem of Induction:

"The problem of induction questions our reasons for believing that the future will resemble the past"

• This is a major mistake, one of which I believe is an issue for both applicants, programs, and CaRMS as a whole system. Applicants believe that based on past matches, a specialty will be equally competitive (with similar strength and # of applicants to prior years). With COVID, no real datapoints were available, as every year was anomalous in a different way. Other ways this is an issue is how programs rank (not ranking enough candidates), and even the number of spots available (programs having too many spots in certain locations or regions).
• The issue with this, is that med students begin their plan and chart their course early - data will develop but may be too late for an applicant to become competitive in another specialty, as well.

Sunk Cost Fallacy:

"The phenomenon whereby a person is reluctant to abandon a strategy or course of action because they have invested heavily in it, even when it is clear that abandonment would be more beneficial."

• The student who decides to double down and re-apply after a year off, even though there is beginning to be a clear opportunity cost to doing so.
• The med student who decides to follow through on applying to a specialty they don't love because they've already completed research in it.

I could think of many many more, including the halo effect, stereotyping, etc... Ultimately, candidates and programs are never making informed decisions. It's simply a gut feeling, and this has to be nebulous for both candidates and programs. Subjectivity in the match, while probably useful for ensuring the "right fit", has likely entirely changed thousands of lives and their career paths. To think that there is no way to address this is absurd.

Furthermore, giving students hope and then leading them to feel miserable when they don't match based on subjective criteria damages their self-worth. For re-applicants, I am certain that a concrete method to address their application deficiencies would be beneficial to them, and at least provide an answer on their approach. Instead, re-applicants are left wondering how to improve.

I believe that for medical students, especially those with mental health issues such as Robert Chu, a concrete approach would be more beneficial than a gradeless, nebulous system where students have no legitimate way to improve or address their application. At minimum, the selections criteria should be public. If a school values their home school applicants for residency (similar to NOSM with rural connections or Western with SWOMEN), at least let applicants know.

I would almost prefer to be told early that I lack the grades to apply to a specialty than to find out far later that I was excluded because my haircut rubbed someone the wrong way.

Maybe this is the beginning of a career in PGME selections reform for me.

 

 

[bearded frog]

4 hours ago, Findanus said:

I advise applying to the USA

This is bad advice. This person is YOG 2 (and will starting a residency program) and unfortunitely not compeditive in their (extremely compeditive) desired field. As you note, plastics is just as compeditive in the US, and even if they had dual applied from the outset we don't know if they would have been compeditive their either. Now with their YOG, they are now at a disadvantage, and they will need a letter from their current PD saying they were a resident in good standing (otherwise programs will assume they were kicked form their program) which they might have trouble doing if they are spending all their time to do the USMLE over the crucial first months of residency in time for applications in the fall.

I sympathise with OP, but they shot their shot and it didn't work out, as it doesn't for so many interested in derm/plastics/etc, but we cannot fault them for giving it their best shot in the circumtances. 

[Findanus]

32 minutes ago, bearded frog said:

This is bad advice. This person is YOG 2 (and will starting a residency program) and unfortunitely not compeditive in their (extremely compeditive) desired field. As you note, plastics is just as compeditive in the US, and even if they had dual applied from the outset we don't know if they would have been compeditive their either. Now with their YOG, they are now at a disadvantage, and they will need a letter from their current PD saying they were a resident in good standing (otherwise programs will assume they were kicked form their program) which they might have trouble doing if they are spending all their time to do the USMLE over the crucial first months of residency in time for applications in the fall.

I sympathise with OP, but they shot their shot and it didn't work out, as it doesn't for so many interested in derm/plastics/etc, but we cannot fault them for giving it their best shot in the circumtances. 

I did say that the American application should be done after residency if the OP does not like practicing FM.

I also implied that OP should pursue a different field than plastics.

I think my advice, given the context you may have missed, is sound.

[unmatched2022]

34 minutes ago, bearded frog said:

This is bad advice. This person is YOG 2 (and will starting a residency program) and unfortunitely not compeditive in their (extremely compeditive) desired field. As you note, plastics is just as compeditive in the US, and even if they had dual applied from the outset we don't know if they would have been compeditive their either. Now with their YOG, they are now at a disadvantage, and they will need a letter from their current PD saying they were a resident in good standing (otherwise programs will assume they were kicked form their program) which they might have trouble doing if they are spending all their time to do the USMLE over the crucial first months of residency in time for applications in the fall.

I sympathise with OP, but they shot their shot and it didn't work out, as it doesn't for so many interested in derm/plastics/etc, but we cannot fault them for giving it their best shot in the circumtances. 

Little hurt to think you think I was not "compeditive"

[SpeakWhite]

Quote

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I see that we have reached high-quality posting hours here in St-Pierre et Miquelon time

[zxcccxz]

Sorry to hear of your situation. I too applied to a speciality this cycle that is nearly as competitive as plastics, and went unmatched. Published lots of research, presented at conferences, got really strong references (referees sent them to me over the past week), and interviewed at a decent number of schools which all went well (IMO). At the end of the day, didn't make a difference.

One of my classmates got 2 interviews which didn't even include a home interview and still matched. Another classmate interviewed at nearly every school in the country and didn't match. Another classmate who has a PhD in this field and who was gunning the speciality since the beginning of med school got only 1 interview to begin with (home school) and then ended up in a FM residency that was outside of their top 10 ranked FM programs. Another classmate who decided on the specialty halfway through clerkship interviewed at 3/4 of the programs in the country and matched to their 2nd choice.

I personally never really appreciated the level of randonmess in this process until I went through it. As someone has already mentioned, so many applicants who you thought would get lots of interviews and match, don't. And many people who you don't think will match, get many interviews or even get a single interview and then end up matching.  

My school does have an option for extended clerkship, and every year we have 4-5 students who opt for that path. But after speaking to nearly a dozen students who have done it over the past 5 years and more importantly, looking at the outcomes - it seems that the match rate from this isn't great. Most still end up in an FM or another backup specialty on the the second try, and that's hearbreaking. Hence, my decision to pursue a FM spot in the second iteration instead.

I do think though that more opportunities exist than I previously thought to pursue a career similar to what you'd initially wanted. Every year plenty of people switch out of surgery and programs are desperate to fill those spots given how heavily the service depends on residents to run it. Not sure about plastics, but having seen the list of programs available for transfers, Gen Surg, Vascular, OBGYN, Ortho, and NeuroSx have been available over past few years. In fact, I spoke to one person who applied to Ortho last year, didn't match and backed up into family. Over the past year she's been contacted twice by the Ortho PD to ask if she wanted to transfer in as they had two dropouts - both times she declined because she realized she was happy in FM.

So that's all to say, it's not necessarily the case that the door is shut on surgery forever if that's what you really want and who knows maybe you'll end up liking FM if you give it a chance. 

[shikimate]

Anyone here know if the house officer system is more forgiving? Aka you start as a house officer and can apply to specialize later.

[1D7]

1 hour ago, shikimate said:

Anyone here know if the house officer system is more forgiving? Aka you start as a house officer and can apply to specialize later.

Our system offers (one of) the shortest specialty training periods. In the UK/AUS system you can train for several years as the equivalent of a senior resident/fellow. I've met people who are PGY-12 still trying to obtain consultant status (their version of a "staff physician"). Our system either gets you through, or shuts you out early so there isn't endless limbo.

[1D7]

The match system won't change much, because it's about as good as it gets. Once you're a competitive applicant it comes down to the ratio of applicants to positions. If there are 50 applicants for specialty 25 spots, inevitably half of the hardworking medical students will go unmatched.

Doing things like adding standardized exams or another metric doesn't really change anything except change the kind of medical student being selected for. If you browse American centric forums there are always posts about people with great board scores going unmatched. At the end of the day if there are 50 applicants for 25 spots, only half can get what they want.

[bearded frog]

16 hours ago, unmatched2022 said:

Little hurt to think you think I was not "compeditive"

I obviously know nothing about you or your qualifications. You applied twice with a dedicated app and did not match, therefore you were not compeditive for your extremely-competitive specialty these years. As I said in my post, this is not a disparagement of your character, only a statement of the facts. I would not have been compeditive for plastics or any of the other highly compeditive specialties either. v:/v

[Specialty]

15 hours ago, 1D7 said:

The match system won't change much, because it's about as good as it gets. Once you're a competitive applicant it comes down to the ratio of applicants to positions. If there are 50 applicants for specialty 25 spots, inevitably half of the hardworking medical students will go unmatched.

Doing things like adding standardized exams or another metric doesn't really change anything except change the kind of medical student being selected for. If you browse American centric forums there are always posts about people with great board scores going unmatched. At the end of the day if there are 50 applicants for 25 spots, only half can get what they want.

Of course adding standardized testing helps. Once you add standardized testing, atleast you know who to blame (no one but yourself) if you end up in the bottom half of applicants and don't match. And that internal locus of control is often reassuring for people and gives them the ability to move on and apply to a less competitive specialty if they know it's their own fault they didn't score well enough. What ends up destroying people's confidence (and often times driving people to kill themselves out of frustration) is when there's an external locus of control - e.g. you perform your absolute best but some nepotism/randomness in the system screws you over. 

Bring back standardized testing as the main decider for competitive specialties. They do this all around the world except for Canada for some stupid reason.

[Specialty]

The way applicants should be ranked should be 1. letters of reference and interview to screen out people with obvious red flags. Then once you meet that threshold, the ranking should all be based on standardized medical testing.

No more BS casper/FM-Proc tests, no more personal statements where people just make up crap and write the most "sexy" narrative on why they decided to pursue X competitive specialty when in reality, we know the most common reasons for competitive specialties are lifestyle, prestige, income, etc. Seriously, why do you think rads used to be one of the most undesirable specialties when it first came out, and then suddenly it's become the most competitive in the past decade.... Yea I'm sure it's because the applicant grew up playing "where's waldo" as a child and that resonated with them ever since... or whatever creative story the applicant decided to put on his app.

[unmatched2022]

1 hour ago, bearded frog said:

I obviously know nothing about you or your qualifications. You applied twice with a dedicated app and did not match, therefore you were not compeditive for your extremely-competitive specialty these years. As I said in my post, this is not a disparagement of your character, only a statement of the facts. I would not have been compeditive for plastics or any of the other highly compeditive specialties either. v:/v

True! This is valid.

[unmatched2022]

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Edited March 29, 2023 by unmatched2022
accidentally posted above

[Vendar]

1 hour ago, bearded frog said:

I obviously know nothing about you or your qualifications. You applied twice with a dedicated app and did not match, therefore you were not compeditive for your extremely-competitive specialty these years. As I said in my post, this is not a disparagement of your character, only a statement of the facts. I would not have been compeditive for plastics or any of the other highly compeditive specialties either. v:/v

I will have to respectfully disagree - depending on what we define as "competitive" Is it what's the CV? Or are we know taking in count connections, personality traits etc?

Clearly this individual is competitive on paper and has been for two years, given that he received multiple interviews. 

I believed that other factors definitely did influence the match things like who do you know in the program, what connections have you made with others internally, is your personality a "right" fit for the program etc... In my eyes these are some subjective qualities that an applicant may not be able to change. I could see someone who maybe super energetic, out-going, etc do better during an interview, which would make them more "competitive" 

[SpeakWhite]

1 hour ago, Specialty said:

The way applicants should be ranked should be 1. letters of reference and interview to screen out people with obvious red flags. Then once you meet that threshold, the ranking should all be based on standardized medical testing.

No more BS casper/FM-Proc tests, no more personal statements where people just make up crap and write the most "sexy" narrative on why they decided to pursue X competitive specialty when in reality, we know the most common reasons for competitive specialties are lifestyle, prestige, income, etc. Seriously, why do you think rads used to be one of the most undesirable specialties when it first came out, and then suddenly it's become the most competitive in the past decade.... Yea I'm sure it's because the applicant grew up playing "where's waldo" as a child and that resonated with them ever since... or whatever creative story the applicant decided to put on his app.

And what sort of standardized testing would you suggest? Are there any that are validated to predict success is residency? How would you apply it to small programs with few applicants? What about bias (e.g. towards those with a first language other than English, for standardized tests in English)? I think it would be very unwise for a program to rely on standardized testing to choose a trainee when fit and personality have a much greater impact on success in a given environment.

By the way, no one cares about personal statements because they are the same for all applicants.

I have a suggestion for a cheaper system that is perfectly fair: random assignment of residency positions.