CaRMS recommendations

[Guest YongQ]

I'm going to try to ask this question with as little padding as possible, so sorry if it sounds sprinkled w/ naivete: <!--EZCODE ITALIC START--> what minimum number of good CaRMS references would make someone a shoe-in for a spot in family? Internal? Surgery? Anything else?<!--EZCODE ITALIC END-->

 

I'm asking because I want as little pressure as possible to perform well for and suck up to people with whom I do electives. From what I've heard, networking is the greatest factor in determining how well you match when it really comes down to it. This really miffs me, because I think knowing a lot of people doesn't make <!--EZCODE ITALIC START--> you<!--EZCODE ITALIC END--> a better doctor - it's just an artifact of tradition. But in our world, it really has become a means to an end, hasn't it?

[Guest Ian Wong]

There isn't a minimum. There's so many other factors, including whether you are the type of person they are looking for (ie. academic vs clinical or whatever other arbitrary distinctions you choose to draw), whether you get along well with the people in the program, etc, etc.

 

I guess what I'm trying to say is that there's no defined threshold for guaranteeing anything in CaRMS, just as there's no guaranteed threshold for getting into med school. All you can do is try to stack the deck in your favour as much as possible.

 

Ian

UBC, Med 3

[Guest jennifer y]

I think that it depends on your looks, if you are personable, and if they like you. Be honest with yourself and ask yourself if you are a likeable person or not. Those years of schooling behind you should tell you something about how others view you.

[Guest YongQ]

But how many good references would you feel comfortable having? Or your colleagues? At least for applying to med school, all of us in undergrad knew that 3 strong references was a good minimum number to have. Of course, how well your personality fits your intended specialty is taken into consideration, and that is gauged in a one-on-one interview. But I'm not really talking about that, I'm talking about references specifically, because it's a point I think would stress a lot of people out, and in the opinion of many program directors has become the most important criterion for picking people.

[Guest Ian Wong]

Thought I'd bring this one back up to the top, seeing as we've got a few third year med students on the forums now.

 

I'm applying to Otolaryngology/ENT (Ear, Nose and Throat Surgery) this year in the CaRMS match, and will be submitting letters from the following doctors.

 

4 letters from otolaryngologists. (2 from Vancouver, and 2 from away electives)

1 letter from General Surgery

1 letter from Internal Medicine

1 letter from Pediatrics

1 letter from Psychiatry (both myself and my preceptor aren't sure if this letter will be of benefit to my application)

 

I am probably submitting more letters than the vast majority of applicants. In general, you should probably aim for 1-2 letters from doctors in the specialty you are applying to. Letters from Internal Medicine and General Surgery supposedly carry more weight than letters from other specialties as both IM and GS are very time-intensive and difficult rotations.

 

For that reason, since I did pretty well in both IM and GS, I have included those letters. I think every med student should aim to get a reference from both Internal Medicine and General Surgery. It can only open doors for you later.

 

I am submitting the Pediatrics letter because Otolaryngology (particularly general ENT and the subspecialties of pediatric ENT, and otology, all of which I am interested in) has a large base of pediatric patients.

 

I think I'll submit the Psychiatry letter because I think I work very well with patients, and I believe that this letter could help show that to program directors. Ultimately, I think there's a good chance that it will be of no benefit (and my referee warned me of this possibility as in his experience, surgeons don't care much for the opinions of psychiatrists), but it makes me and my application a little unique, and might be good for a conversation-starter at some of my interviews.

 

As an aside, I think it's important if you are a third year med student that you make every attempt to get a reference letter from each rotation that you enjoyed even a little. Third year should be all about keeping your options open. With the above set of reference letters, I could probably put together a reasonable application to General Surgery (GS letter + IM + ENT), Internal Medicine (IM letter + Peds + GS), Family Medicine (GS letter + IM + Peds), and Pediatrics (Peds letter + IM + ENT).

 

For the following specialties, I'd probably need a supplemental letter from a specialist in that field, but with that single additional letter, I could probably apply to Radiology (Radiology letter + GS + IM), Emerg (Emerg letter + GS + IM + Peds), Pathology (Path letter + GS + IM), Anesthesiology (Anes letter + GS + IM), you get the idea. Getting those IM and GS letters can really help out your application because they are such broad fields that carry relevance in basically all the other specialties out there.

 

For those hyper-competitive or hyper-focussed specialties like Derm, Plastics, Urology, Otolaryngology, Ophthalmology, you really need a minimum of 2 letters from that specialty (and probably 3-4 wouldn't hurt). These specialties are less likely to care about references from other specialties simply because the environment in Canada is so small that "everybody knows everybody else." If you are applying to Ophthalmology, and happen to have a letter from a former classmate/co-resident of the Ophthalmology program director, it has so much more meaning and impact than your General Surgery and Internal Medicine letters.

 

Of course, I haven't submitted my CaRMS application yet (so I could totally be full of it), but since I won't find out until the end of February whether my application "made it" or not, I figured I'd get this message up for those clinical clerks slogging their way through rotations right now.

 

Last point. You don't need to be a huge suck in order to get letters. In fact, being a huge keener/brown-noser will probably only work against you as you piss off your fellow classmates and residents.

 

If you want a good letter, just work hard, put in the long hours, read up on your patient's diseases, participate in the scutwork (write up good admission notes, never ever be late for rounds or anything else, be proactive and get the x-ray results and lab results for your patients), and be friendly with the entire heath-care team, and you'll make out just fine.

 

Oh yeah, and try to get your applications in for those away electives as early as you feel comfortable with your decisions! Organizing for away electives is a huge pain in the neck anyway, and it only gets worse the later you wait and all the time slots get snapped up by other med students.

 

Ian

UBC, Med 4

[Guest Lancet]

Hey Ian,

Do you ask for the reference letters in 3rd year, right after you've finished the rotation or do you wait until 4th year and then go back and ask? It would be preferable to get it as soon as possible while you are still fresh in their minds.

[Guest Ian Wong]

I didn't have the best strategy for reference letters, so you should learn from my mistakes! I asked all my references immediately at the end of the rotation, but because I hadn't updated my CV, I couldn't get them to write the letter until I had the CV and a short personal statement prepared. I got my CV up to date near the end of Med 3, which worked out reasonably well in that most of my reference letters actually came from my later rotations.

 

For the 1-2 doctors who hadn't seen me for a few months, I made an attempt to meet with them while I was dropping off my CV/reference letter forms to refresh their memory of who I was exactly.

 

The best course of action is to make sure that you have an up-to-date CV before Med 3 starts. Once you finish a rotation, ask your referee to write you a letter using that CV, and then get a sealed copy of the letter, but also ask your referee to hold onto the letter in electronic form. This will allow you to get a reference letter immediately while your referee has a really good sense of who you are.

 

Later on, as Med 4 begins and you start the process of applying to CaRMS (such as updating your old CV), you can contact the referee and ask him/her to update the old letter using the new CV you are going to supply him/her.

 

In this way, you get the best of both worlds: a reference letter that accurately describes your performance from way-back-when, and also mentions your most recent and current achievements.

 

It's a definite hassle asking doctors for reference letters, and it's something many people, including myself, feel a little guilty about doing. You just have to remember that they've all gone through a residency match at some point in their lives, have probably written lots of letters for medical students before you, and as a medical student, you've probably done quite a bit of work that helps them out in some way, so it's not as if you are asking a lot of them, and yet giving nothing in return.

 

I didn't get a single negative response from any of my referees when I asked them for a letter. Perhaps I just worked with a whole bunch of really cool and laid-back doctors, but more likely, the reason is that they've all been through it before, and they know what it's like to be in your shoes.

 

Ian

UBC, Med 4

[Guest Carolyn]

I have employed a similar strategy to Ian's

 

I have: 3 Emerg Letters (2 home, 1 away -- 2 are people that are very well-known in the field and know me well and 1 just really knows me well as I worked with him from 1st year on). I also have 1 Trauma/General Surgery Letter, 1 Internal Medicine Letter and 1 from Family Medicine. I will use the first 5 for my emerg application and for my back-up in Family I will send my Family, IM and one emerg letter.

 

I knew all of them quite well except the Trauma/general surgeon and those that I knew well offered to write me a letter at the end of my rotation before I even asked. I think that most supervisors know that you might want one and will offer to avoid the awkwardness. The Trauma/Gen Surg guy and I didn't work closely together but I worked with his residents a lot and as he is head of trauma, I decided to go out on a limb and ask him. The residents suggested it and helped me out a lot by writing very extensive qualitative evals for me. So when I asked him, I offered the evaluations which I guess he is using in my letter. That said, I still feel a little awkward about that letter whereas I'm more confident about the other letters.

 

The most frustrating part of all of this has been trying to nicely remind people that they are coming due... I hate that part! Balancing the making sure they remember part with not bugging them is hard. I will just feel so much more comfortable once there are enough references shown as received on the carms website... right now there is only one... ah the angst... ah the drama...

 

I can't wait for this all to be over... PiT in StOmACH!

[Guest Ian Wong]

I was told by all of my residents to bug their secretaries politely, and avoid bugging the doctors about it, which seemed to work pretty well. Of course, I also gave them all a deadline of October 31 to submit the letters by (since we are the first year of e-CaRMS, my referees were all used to writing and sending letters in by September anyway), which gave me the whole month of November to agonize about which referees I needed to follow up with.

 

Thankfully, each of my referees were really cool, and I'm now sitting with all but one of my reference letters authenticated with CaRMS, and that last letter (according to Expresspost tracking) has successfully been delivered to CaRMS a couple days ago. One referee even had the letter in within 4-5 days of me asking him to write it. Gotta love that.

 

That's the other thing. Make sure to supply your referees with a pre-paid and pre-addressed mailer, and for your piece of mind, at a minimum it should be the trackable Expresspost mailer that you get at any Canada Post outlet.

 

This way, even if the CaRMS site is down, or for whatever reason not showing your letters as being scanned in and authenticated, you can still check to see if Canada Post has delivered your letter. It's just one more step of redundant verification that can help you figure out just where your reference letter has ended up.

 

Ian

UBC, Med 4