Information on sub-specialties

[Kiel]

For registration in sub-specialty residency programs do you have to go through the CaRMS process? Can somebody give me some information on fellowship programs in internal medicine and surgery?

 

Just curious!

[Kirsteen]

For registration in sub-specialty residency programs do you have to go through the CaRMS process? Can somebody give me some information on fellowship programs in internal medicine and surgery?

 

Just curious!

Hi,

 

Currently, it appears that the only sub-specialty that is applied to via CaRMS is the Emerg Med fellowship for Family Med graduates. All other fellowship program application systems currently run independent of CaRMS.

 

Cheers,

Kirsteen

[crackers]

For internal medicine subspecialties, there is an R4 match; a website from U of A lists all the programs and spots, but it's not run by CaRMS; it's more like the second round "scramble" in the US, with interviews in October of R3 year and results by phone early in November.

[Rome]

Here is the site for the R4 IM subspeciality matches as mentioned above:

http://www.departmentofmedicine.ualberta.ca/r4match/

[ffp]

It's just like what Crackers said. There is an R4 match for IM subspecialties. Generally, the applications are due between Aug and Sept of PGY-3 with cardio being a bit earlier (our applications were due July 1st of PGY-3 in most cases).

 

Since it's not a centralized process, you have to contact all of the schools yourself and find out what is required for the application - usually application form, CV, reference letters, +/- transcripts from med school/undergrad, photos, personal letter.

 

Once that is done, you have to set up interviews. Unfortunately, for most people this involves flying around the country again just like CaRMS. Interviews take place in Sept/Oct of PGY-3. Cardio (different again!) has a centralized interview day where all programs meet in Toronto and interview over the course of 1-2 days in mid-Sept. There is a bit of controversy over this, since most programs overtly favor those who come for an on-site interview as well... seems a bit stupid since the whole point of the centralized interview is to spare the appllicants the time and $ it takes to travel around... but like all of these matching processes it's a game.

 

"Match day" takes place in early Nov. For me, it was Nov. 8, 2005 This is when programs put out their first offers. Unlike CaRMS, you don't just go where you get an offer. You can either accept the offer, reject it, or hold it. You can hold one offer indefinitely, or 2+ offers for 48h - at which point you have to accept or reject one.

 

The whole match period lasts for a total of 2 weeks, after which there is a "second round" for unfilled spots/unmatched applicants.

 

This is all coordinated through a centralized website. Somebody provided a link above for this year's website... but a different school hosts it every year. Queens hosted it the year I applied. By looking at this website, you can deduce who has received offers, who has accepted and who has rejected (it's a smaller applicant pool than CaRMS, and you tend to know people country-wide who are applying for your specialty).

 

It's a horrible and gut-wrenching process just like all of these stupid matches... but everyone I know over the past 5 years has gotten their 1st choice specialty (but not necessarily 1st choice location).

[Kyleh]

It's just like what Crackers said. There is an R4 match for IM subspecialties. Generally, the applications are due between Aug and Sept of PGY-3 with cardio being a bit earlier (our applications were due July 1st of PGY-3 in most cases).

 

Since it's not a centralized process, you have to contact all of the schools yourself and find out what is required for the application - usually application form, CV, reference letters, +/- transcripts from med school/undergrad, photos, personal letter.

 

Once that is done, you have to set up interviews. Unfortunately, for most people this involves flying around the country again just like CaRMS. Interviews take place in Sept/Oct of PGY-3. Cardio (different again!) has a centralized interview day where all programs meet in Toronto and interview over the course of 1-2 days in mid-Sept. There is a bit of controversy over this, since most programs overtly favor those who come for an on-site interview as well... seems a bit stupid since the whole point of the centralized interview is to spare the appllicants the time and $ it takes to travel around... but like all of these matching processes it's a game.

 

"Match day" takes place in early Nov. For me, it was Nov. 8, 2005 This is when programs put out their first offers. Unlike CaRMS, you don't just go where you get an offer. You can either accept the offer, reject it, or hold it. You can hold one offer indefinitely, or 2+ offers for 48h - at which point you have to accept or reject one.

 

The whole match period lasts for a total of 2 weeks, after which there is a "second round" for unfilled spots/unmatched applicants.

 

This is all coordinated through a centralized website. Somebody provided a link above for this year's website... but a different school hosts it every year. Queens hosted it the year I applied. By looking at this website, you can deduce who has received offers, who has accepted and who has rejected (it's a smaller applicant pool than CaRMS, and you tend to know people country-wide who are applying for your specialty).

 

It's a horrible and gut-wrenching process just like all of these stupid matches... but everyone I know over the past 5 years has gotten their 1st choice specialty (but not necessarily 1st choice location).

Where are you currently a cardiology fellow?

[mickey]

Hi ffp,

Thank you for your comprehensive reply I have a few questions regarding the R4 match:

1. Is there a selection bias at each centre based on where the applicant did his/her Internal Med PGY1-PGY3 years? How competitive is it compared to CaRMS? (i.e. about 50% of people at U of T postgrad attended U of T for their MD degree...is it similar for the R4 match?)

2. For a subspecialty in cardiology, what factors are most important in ranking applicants?

 

Thanks in advance for your help!

[ffp]

Mickey and Kyleh:

 

I'm a cardio fellow at U of S - where I did my IM... Stayed here mostly for personal reasons, but I also got offers from Dalh, Queen's and Western.

 

As far as home-school bias... well, programs always look more favorably on the applicants they know personally, but it's not nearly as bad as CaRMS, especially if you're applying to less-competitive subspecialties (ie. geriatrics, heme, general internal med). You should always try to do an elective in the program you want to match to (for them to get to know you, and for you to get to know them!!!). I do, however, know of strong applicants in all subspecialties who got offers from around the country, including programs where they did not do an elective. I had never done an elective at Western or Queen's.

 

Beware of problems with funding. Dalh has a stupid arrangement where only their own people get funding... The funding isn't released unless one of the Dalh residents goes somewhere else for PGY-4. when I applied, all Dalh residents chose to stay at Dalh for their fellowships... but nobody chose cardio. They called me up on the last day of the match to offer me a spot, but had no funding for me!!! Hence the reason I didn't go to Dalh. Similarly, both Alberta schools have an arrangement where ALL of their IM residents are guaranteed a subspecialty spot, so if they have enough internal applicants who want to stay, outside applicants are out of luck. That said, you should always apply across the country. You never know what is going to happen.

 

As far as what makes you a good applicant - it's basically the same things that make you a good applicant for CaRMS. Traditionally cardio, nephro and GI are most competitive.

 

- Show an interest early on. Do cardio electives, attend journal clubs and conferences, get involved in cardio research, and let people know you are interested! Impress them on your cardio rotations at your home-school, and try to do a couple electives away. If you start during med school, all the better.

 

- Have strong reference letters. One HAS to be from your IM program director, but try to get letters from cardiologists for the rest.

 

- Extracurricular activities are always important. Lots of programs put a great deal of weight on the fact that I was academic chief resident for IM.

 

- They still go back and look at marks... so if you got honours in med school, that works in your favor. Only a couple of programs wanted undergrad transcripts

 

- The interview is very important. Most of the cardio interviews are informal, but try to put your best foot forward. I helped out with the interviews this past year, and we left some people unranked based on their performance in the interview.

 

Hope this helps. Let me know if you have more questions.

[mickey]

Thank you so much, ffp! It's really helpful

[Satsuma]

Mickey and Kyleh:

- Extracurricular activities are always important. Lots of programs put a great deal of weight on the fact that I was academic chief resident for IM.

 

 

Just out of curiousity, do programs appreciate extracurriculars that are not related to your studies? I appreciate that academic chief resident for IM is something extra you didn`t need to do, but it is still entirely to do with your specialization. Do you think they would have appreciated your "extracurricular" as much if it was say, involvement in a sport?

 

Thanks

[ffp]

Yes, all extracurriculars are recognized. In fact, for our scoring form (both CaRMS and cardio), we had separate scores for extracurriculars outside of medicine and within. The "outside of medicine" ones carry half the weight of the within medicine ones, I think because it is easier to fake things outside of medicine. Sometimes these scores are fudged a bit if a candidate demonstrates very outstanding achievement in something. Some examples that I saw - athlete on national rugby team, published author of a fiction novel, drafted to play in the NFL, VERY extensive musical background (4 separate candidates, not just one superhuman). In those cases, they received a full score for extracurriculars, even though they really didn't do anything WITHIN medicine.

 

I think the reason the chief resident thing looked so good on the application is that it allowed me to pad my CV with all sorts of other things. ie) I had extra teaching experience and organized the academic curriculum and journal clubs, I was automatically a member of a billion committees (all of which went on the CV). It also says something about you academically (b/c academic standing is one of the requirements for the position), and the fact that you are elected by your peers says that you must be well-respected. So... it's a good thing to try for if you have the chance.

 

The BIG factor on the file review (at least for U of S... and from what I've heard most other schools as well) is the reference letters. In fact, they make up ~1/3 of the whole file review score.

[Talon01]

Mickey and Kyleh:

 

I'm a cardio fellow at U of S - where I did my IM... Stayed here mostly for personal reasons, but I also got offers from Dalh, Queen's and Western.

 

As far as home-school bias... well, programs always look more favorably on the applicants they know personally, but it's not nearly as bad as CaRMS, especially if you're applying to less-competitive subspecialties (ie. geriatrics, heme, general internal med). You should always try to do an elective in the program you want to match to (for them to get to know you, and for you to get to know them!!!). I do, however, know of strong applicants in all subspecialties who got offers from around the country, including programs where they did not do an elective. I had never done an elective at Western or Queen's.

 

Beware of problems with funding. Dalh has a stupid arrangement where only their own people get funding... The funding isn't released unless one of the Dalh residents goes somewhere else for PGY-4. when I applied, all Dalh residents chose to stay at Dalh for their fellowships... but nobody chose cardio. They called me up on the last day of the match to offer me a spot, but had no funding for me!!! Hence the reason I didn't go to Dalh. Similarly, both Alberta schools have an arrangement where ALL of their IM residents are guaranteed a subspecialty spot, so if they have enough internal applicants who want to stay, outside applicants are out of luck. That said, you should always apply across the country. You never know what is going to happen.

 

As far as what makes you a good applicant - it's basically the same things that make you a good applicant for CaRMS. Traditionally cardio, nephro and GI are most competitive.

 

- Show an interest early on. Do cardio electives, attend journal clubs and conferences, get involved in cardio research, and let people know you are interested! Impress them on your cardio rotations at your home-school, and try to do a couple electives away. If you start during med school, all the better.

 

- Have strong reference letters. One HAS to be from your IM program director, but try to get letters from cardiologists for the rest.

 

- Extracurricular activities are always important. Lots of programs put a great deal of weight on the fact that I was academic chief resident for IM.

 

- They still go back and look at marks... so if you got honours in med school, that works in your favor. Only a couple of programs wanted undergrad transcripts

 

- The interview is very important. Most of the cardio interviews are informal, but try to put your best foot forward. I helped out with the interviews this past year, and we left some people unranked based on their performance in the interview.

 

Hope this helps. Let me know if you have more questions.

Hello ffp!

 

What does your user name stand for?

 

I think you hinted that during CaRMS there tends to be a home bias (I assume programs select from individuals who graduated from their med school). Do you feel this is because you're more likely to be exposed to physicians in your home city than others? Is it because it's looked badly upon the school if they have a large % of unmatched students? The committee feels that applicant is most likely to stay on as a staff post-residency because they'd have spent 6-10 years there already (with med school and residency)? A combo of everything perhaps?

[0T6]

my vote's for fresh frozen plasma! talon didn't you already remediate cardio block once?

[ffp]

LOL. People always ask about the FFP thing. Actually, I was sitting in a waiting area prior to one of my CaRMS interviews reading a magazine article about leopards (in order to calm my nerves). The leopard was referred to by its scientific name: felidae felis pardus. Well, a while later, I needed a username for something, and "felidae felis pardus" stuck in my head... so now I always use "FFP". Bet nobody would have guessed that.

 

I think the only reason home applicants have a bias in CaRMS is because we already know most of them. They are ranked by the same criteria as everyone else, but sometimes you have an applicant who you know is stellar (in terms of their clinical skills and interpersonal abilities), but looks mediocre on paper. These candidates might get bumped up a bit in the ranking. Similarly, if you look like a superstar on paper, but all of the attendings/residents who worked with you on CTU think you are a lazy bum, you will be ranked lower than what your file score/interview suggest.

 

People who come from other schools to do electives have the same sort of "advantage", in that we know you as a real person and not just a paper file. Make sure when doing electives away, you arrange for a short meeting with the program director, and make it known that you want to apply!

 

In the R4 match, there is a lot more concern about ranking applicants who are most likely to go to a certain site. This is just because the match works a bit differently than CaRMS. Assume this scenario: Residents X,Y, and Z are the best applicants in the country. Resident A is a strong candidate, but not outstanding. Resident A was born and raised in Saskatchewan, though, and never wants to leave. Well... on the first day of the match, all schools make their first offers to residents X,Y and Z (the best applicants). They choose to hold a couple spots each for 48h, just because they can. Meanwhile, Resident A starts to panic because he hasn't been offered a spot yet. Suddenly he gets an offer from Manitoba and snaps it up right away, because he thinks he won't get another chance. Residents X,Y, and Z then turn down spots at U of S. U of S has now lost Residents A,X,Y and Z, as well as a bunch of other strong applicants who were already snapped up in the first 48h. A couple of years ago, Dalh missed out on their top two nephro candidates for exactly that reason.

 

When I went to the cardio interviews as an interviewer this year, I actually attended a meeting where the program directors argued over the ranking strategy - rank the best first, or rank the ones most likely to come to your program???? Their opinions are divided. The R4 match is not nearly as straightforward as CaRMS... and if we think it's a game for us as applicants, it's just as much a game for those who are ranking us

[Kyleh]

FFP, did you attend medical school at the U of S also?

[ffp]

No... I was born and raised in Calgary and did undergrad at U of C. I did my med school at U of A.

 

I ranked U of A #1 in my CaRMS match for IM. Honestly, I wasn't that impressed with U of A (or Edmonton), but I really didn't want to move since I was already getting married the summer after med school and had a wedding to plan.

 

I ended up ranking U of S #2, despite the fact that I had never even DRIVEN through Saskatoon prior to my interview. They really impressed me at the interview! The program director took 45 minutes just to talk with each applicant and answer questions. The residents I met threre were very nice and candid as well. The secretaries bent over backwards to ensure that everyone had a ride to the airport. I interviewed on a Thursday, so I got to attend academic half day. I was really impressed with what I saw.

 

Overall, I think that U of S IM program is a gem that nobody knows about. Sure... living in SK is not for everyone. There are LOTS of perks to the program, though:

 

- Very strong academic curriculum including daily noon rounds with lunch provided (paid for by faculty, not drug companies)

- Regular, organized bedside teaching sessions to prepare for Royal College Exam

- Not many subspecialty fellows, thereore LOTS of hands on as a junior (but always with appropriate supervision by seniors/attendings)

-Strong GIM division (many centres in Canada do not have enough general internists to support a strong internal medicine residency program).

 

There are also other bonuses to coming to SK:

- We are considered full-time students. Therefore, I am PGY-4 and have not repaid a cent of my student loans

- Our CMPA fees are paid

- LOW cost of living. Many residents are able to buy houses on their salaries

- Lots of moonlighting opportunities as a senior resident (maximum 72h/month at $100/hr... more than doubles my resident salary

- Lots of outdoor activities. We don't have mountains, but there's lots of cross-country skiing, hiking, and several lakes nearby

- nice place to start/raise a family. Lots of residents have kids.

 

Oh no!!! I am descending into my chief resident noon CaRMS spiel again I do think that if you are considering IM, and if you aren't the type of person who HAS to live in a big city, you should check out U of S.

 

let me know if you have questions.

[Talon01]

ffp, do you mind if I send you a PM? I've got a few questions!

[Kyleh]

No... I was born and raised in Calgary and did undergrad at U of C. I did my med school at U of A.

 

I ranked U of A #1 in my CaRMS match for IM. Honestly, I wasn't that impressed with U of A (or Edmonton), but I really didn't want to move since I was already getting married the summer after med school and had a wedding to plan.

 

I ended up ranking U of S #2, despite the fact that I had never even DRIVEN through Saskatoon prior to my interview. They really impressed me at the interview! The program director took 45 minutes just to talk with each applicant and answer questions. The residents I met threre were very nice and candid as well. The secretaries bent over backwards to ensure that everyone had a ride to the airport. I interviewed on a Thursday, so I got to attend academic half day. I was really impressed with what I saw.

 

Overall, I think that U of S IM program is a gem that nobody knows about. Sure... living in SK is not for everyone. There are LOTS of perks to the program, though:

 

- Very strong academic curriculum including daily noon rounds with lunch provided (paid for by faculty, not drug companies)

- Regular, organized bedside teaching sessions to prepare for Royal College Exam

- Not many subspecialty fellows, thereore LOTS of hands on as a junior (but always with appropriate supervision by seniors/attendings)

-Strong GIM division (many centres in Canada do not have enough general internists to support a strong internal medicine residency program).

 

There are also other bonuses to coming to SK:

- We are considered full-time students. Therefore, I am PGY-4 and have not repaid a cent of my student loans

- Our CMPA fees are paid

- LOW cost of living. Many residents are able to buy houses on their salaries

- Lots of moonlighting opportunities as a senior resident (maximum 72h/month at $100/hr... more than doubles my resident salary

- Lots of outdoor activities. We don't have mountains, but there's lots of cross-country skiing, hiking, and several lakes nearby

- nice place to start/raise a family. Lots of residents have kids.

 

Oh no!!! I am descending into my chief resident noon CaRMS spiel again I do think that if you are considering IM, and if you aren't the type of person who HAS to live in a big city, you should check out U of S.

 

let me know if you have questions.

Thanks very much!

[ffp]

Talon,

Sure, PM me your questions. I'm on call the next 2 days, so might not respond right away.

ffp