Residency Positions

[Guest Colm]

Hi Ian,

 

Great website! I'm a first time user, but happy see to a discussion forum where premeds can get their questions out there and throw some ideas around.

 

I've just received my acceptance to Mac and UofT yesterday (Whew!), and am still on the wait list for McGill. (Its my third time applying and so, as you might imagine, I'm thrilled my persistence paid off.)

 

Out of interest, are you aware if UofT students have a more competitive edge over Mac students in getting into a residency position of their choice, or vice-versa? Also, are you aware of any resources out there that discuss this issue?

[Guest Lindsey]

I'm also interested to know how hospitals pick residents. Is it based on the reputation of the school? Based on your resume (i.e. having done research in the field you want to go into)?

 

How do they choose?

 

thanks alot,

L

[Guest JaseJ]

Is it published anywhere, which schools get which residency positions? and which schools match the best for certain specialties?

 

I'm also trying to decide between schools and it is so hard.

[Guest Ian Wong]

Man,

 

An entire book could be written about all the internal politicking and stuff that goes on in getting yourself a residency. It's just like applying to med school all over again. I will try my best to give you a good reply tomorrow (I'm really busy at the moment), but here's a reference for a very popular US book about getting into a US residency.

 

Iserson, Kenneth. 2000. Iserson's Getting into a Residency. Galen Press, Ltd. Arizona. ISBN: 1-883620-27-9

 

Ian

UBC, Med 3

[Guest suovren]

Hello,

 

I came across this info would provide insight re. residency matching. Of particular interest are the statistics from the 1997 and 1998 match as these years have the number of out-of-towners matched to each particular residency program.

 

www.carms.ca/stats/stats_index.htm

[Guest Ian Wong]

Here we go. Please bear in mind that I'm not at the stage of med school yet where I've submitted any applications to CaRMS. That will happen about 1.5 years from now, and hopefully, this web-site will still be around to hear about it. Take this advice with as much salt as you need, because most of it is gleaned second-hand from my experiences talking with senior medical students.

 

Off the top, I'd like to state that there's very few internet resources out there regarding Canadian residencies, and the reason for that is that there simply isn't a lot of time at the Med 3 and 4 level to publish that sort of information. If you think about the relative lack of Canadian premed websites published by med students, most of those websites were put together during their free time before or during Med 1 and 2, when you aren't yet being worked to death.

 

By Med 3 and 4, you are working in the hospital, often with a call schedule that sees you in the hospital throughout the night every 3-4 days. In Med 4, when you actually put together your CaRMS apps, you will be travelling across the country doing your electives and interviews. As a result, your life is even more hectic in Med 3/4 than it was in Med 1/2, and it's no wonder that there simply isn't a lot out there on the internet regarding Canadian residencies. There just isn't the time to write stuff up and publish it.

 

OK, enough preamble. The first thing you should all do is check out Suovren's link, because http://www.carms.ca is the central point for the residency match. CaRMS is the Canadian Residency Matching Service, and is where you will submit your applications, for CaRMS to distribute out to the various programs. In that way, it functions like a central application agency, much like OMSAS. It is also where the matching algorithmns will be calculated to show you where, and to what specialty you "matched" into.

 

So, the first thing to remember about CaRMS, is that in many ways it resembles applying to medical school all over again. The residency director, and his/her committee are trying to select the best residents for the program. Residency is where you train following graduation of medical school, and training can last between 2 years for Family Medicine, up to 6 years for neurosurgery. Most residency programs work you fairly hard, with the surgical specialties being particularly hard.

 

For example, in UBC Urology, junior residents work a 1 in 3 call, otherwise known as Q3. This means that every third night you are on call, and potentially working throughout the night. This means that every third night could be an all-nighter, and the kicker is that you continue to work through the next morning and afternoon. Consider the fact that you could be doing this type of schedule for 1-2 years, and you start to get the idea that your personality starts to suffer. There's nothing like a 36 hour shift to kill your energy level! If you are grumpy after getting one night of bad sleep, imagine what it's like after you've been working Q3 for several months!

 

Why do they work residents so hard? Cheap labour. You could either pay a fully-qualified doctor to wake up in the middle of the night, and drive into the hospital to do something, or you could page the resident. Which will be cheaper...

 

As a result, the residency directors are looking for people who can handle the long hours, while retaining as much civility as possible. The last thing you want to do is select a resident who doesn't work well with other doctors, nurses, support staff, etc. One residency director for surgery came and gave our students a quick talk, and he mentioned the three A's he looks for when choosing his residents.

 

1) Availability: ie. is this person around, are they punctual, do they quickly answer their pages and get here soon...

 

2) Affability: ie. how is this person when you work with them, are they a team player, do they interact well with other health care workers and patients...

 

3) Aptitude: ie. do they have good common sense, do they know their stuff, will they admit to it when they don't know...

 

Naturally, the best candidates have all three qualities. As a residency director, you would have done a bad job if you selected a surgical resident who was extremely pleasant, yet knew no anatomy or microbiology. Similarly though, a know-it-all, backstabber would be a poor choice as a resident because there will quickly become a huge degree of animosity between that person, and fellow residents/nurses, what-have-you. Either way, the system breaks down, and patient care suffers.

 

So, let's pretend you are a residency director. What are your tools in assessing whether Candidate A is a better choice than Candidate B.

 

1) Transcript

2) Other Academic/Extracurriculars

3) Reference Letters

4) Interviews

 

1) Transcripts are a bit of a wash, because you'll discover that approximately half the medical schools in Canada use a Pass/Fail system, where only a P or F is visible on your transcript. The other half of the school's use an Honours/Pass/Fail system, where only an H, P, or F is visible. I think U of Sask might still have numerical/percentage grading, but they were looking into changing it a couply years back.

 

So, if you went to a P/F school, it's very difficult to determine your academic abilities unless your class ranking is also published. As far as I know, this isn't the case for most schools, because that would completely defeat the purpose of creating a non-competitive environment using the P/F system. Students look amazingly uniform on paper when they graduate from a P/F medical school.

 

If you went to an H/P/F school, this still doesn't help you that much. Most medical students tend to get an H here or there, with a minority of students getting a large proportion of H's. Therefore, is a student who got 3 H's on their transcript necessarily less qualified that someone who got 4 H's?

 

As a result, transcripts are not that useful...

 

 

2) Other Academic/Extracurrics

 

Research is a big thing for many of the competitive specialties. For some reason, it's supposed to show commitment to a specialty if you've gone and done extra research with a professor. Having other activities on your application can let the residency director know what your other skills are, that you will be bringing to that hospital.

 

Research can be either basic science stuff, which I think is generally rare, or clinically-based, such as a review of hospital charts, patient outcome analysis, etc.

 

However, my gut feeling is that research definitely trumps the other extra-currics in terms of usefulness. Of course, extra-currics can be fun things that you do for recreation eg. sports and hobbies.

 

 

3) Reference letters. Here's the big one, and in fact this one is CRUCIAL. When you go to CaRMS, you will quickly discover that for most, if not all specialties, they want a minimum of one reference letter from a Doctor in that specialty. Therefore, if you were applying to a Radiology residency, you would need a reference letter from a radiologist. A letter from a cardiac surgeon will not substitute.

 

In order to get those reference letters, you will usually need to do electives with those doctors. At UBC, the first half of Med 4 is reserved for electives so that you can spend that time working with doctors in whichever specialty. Research can be a positive double-whammy because not only could you get published, but you could also ask your supervisor for a reference letter, provided that they were a doctor in that specialty.

 

Oftentimes, you will do away electives at cities other than your home medical school. This could be because you want to do electives that aren't offered to a scope available at your home location (eg. You want to do Emergency Medicine, and you are at U of Sask. You'll definitely see different kinds of trauma patients if you do an away elective in Vancouver or Toronto), or away electives can also be done to make contacts in other cities, to improve your chances of matching there. More on that later.

 

Away electives, and electives in general are a very big part of getting your residency of choice.

 

 

4) Interviews. If the residency committees are interested in your paper application, they will invite you to an interview, usually done in the early part of the second half of Med 4 (eg. January). You'll fly out to the different cities, and be given interviews.

 

As interviews are the last phase of the application process, they also have a fair amount of weight.

 

 

 

So, does the medical school I attend affect where I can go for residency?

 

The answer: of course it does, to a degree.

 

If you look back on the criteria listed above, it should become apparent that securing a residency is just like getting a job. The higher-ups will look at your past record (transcripts), look for previous experience in that area (electives and research), and try to assess whether you would be a good fit personality-wise for that program (reference letters and interview).

 

Just like in getting jobs, there's a great way to improve your chances of matching at a certain location, namely <!--EZCODE BOLD START--> networking<!--EZCODE BOLD END-->.

 

A residency director is far more likely to select you if he/she has seen you in action on the wards, or heard good things about you from other physicians and residents. The way it works is through your away electives. When you go away to do an elective, say in plastic surgery, you will be spending a great deal of time with, and sharing call with the plastic surgery attendings and residents at that location.

 

Those people will be evaluating you constantly throughout your elective, and when your application comes through the door a few months later via CaRMS, your residents will say: <!--EZCODE ITALIC START--> "That guy was a prick, and I hated working with him. Ditch his application."<!--EZCODE ITALIC END--> or <!--EZCODE ITALIC START--> "Smart guy. He constantly read throughout the month, and learned a lot. Give him an interview"<!--EZCODE ITALIC END--> or <!--EZCODE ITALIC START--> "He's really good with patients. Doesn't ask a lot of dumb questions. I think he'd fit in well here with the rest of us"<!--EZCODE ITALIC END--> or etc, etc, etc.

 

These away electives are the great equalizer, and perhaps most importantly, give the admin the chance to see what you are like when you are working under residency-style conditions. After all, you will be working along-side residents, and if you are a strong team player, that will most certainly be noticed.

 

As a result, and this is true for UBC as well as U of Toronto, and most other medical schools that have a large residency training program, residency directors tend to pick students that they know the best, and with whom they are most familiar. It wouldn't make sense to pick a relatively less well-known applicant from an outside school over a home medical student who has been spending time on your service for the last several months, unless the outside applicant had clearly superior skills and background.

 

I don't think residency directors are necessarily biased against outside students as much as they show preference for applicants that they know well. And home medical students, by definition, have many more opportunities to work with those faculty members (as an outside medical student has only so many away electives).

 

This is also a major reason why I'm not a big fan of the 3 year medical programs. Basically, you have one less year to make those all-important connections with outside faculty, and to do research, etc, which would help improve your chances of matching to an away location.

 

Anyways, that's a quick summary of what I think residency directors look at when they are selecting their residents. They are looking for people who work well under pressure, and under sleep-deprivation , and who are qualified. They also tend to select people with whom they have worked with before, over applicants who have not done away electives at that location. Invariably, this gives an advantage to home medical students, who could theoretically start building those relationships on the first day of the first year of medical school, while outside medical students typically have to wait until Med 3/4 for their away electives.

 

I think it's also important to think about which location will make you most happy both when attending medical school, and doing residency. You are not necessarily going to get better specialty training in Toronto (where you will see lots of exotic diseases/patients) if you plan on working in a smaller, or more rural community. In fact, doing your residency training in a smaller community could be beneficial, as you will certainly be given more responsibility earlier (you will not be competing with as many other residents and doctors for your patients), and may give you more familiarity with the types of patients you will be treating in the future.

 

For example, if I thought that I wanted to specialize in geriatric medicine, and practise in a smaller community, Victoria would probably be a better locale than Vancouver, both because of the smaller size, and the more concentrated population base of seniors, even though Vancouver is hotbed for residency training.

 

Anyway, that's all for now. I'm gonna get some dinner! If there's other med students that would like to chip in their opinions, that'd be awesome too.

 

Ian

UBC, Med 3

[Guest Carolyn]

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[Guest Ian Wong]

Oh, a couple more details.

 

1) If you have access to a current medical student, you might want to bug him or her into finding out who the CFMS reps for his/her medical school are (Canadian Federation of Medical Students). The statistics published on the CaRMS web-site are a fraction of what is really out there. Our UBC CFMS student reps came back from a meeting in Ontario just a month or two back, and had a large booklet with very detailed breakdowns of individual specialties and individual medical schools. This booklet is for this last year's match, but similar statistics have been compiled for recent years.

 

I know that a copy for this year, and other year's, is available in our library attached to the hospital. If you live in a city with a medical school, you might want to try contacting their library and librarian for a copy of these detailed CaRMS stats. If they have them, it'll most likely be tucked away in a binder somewhere.

 

2) Rankings suck, and they don't really tell you anything. You've got to look at the big picture, and realise that if a residency director turns you down for an interview, it wasn't because "you went to a school with a lower Gourman ranking than this other candidate." They just aren't that superficial. The real reason is that the director either had more familiarity with that other student, or he/she had a better application profile (research, letters of rec, away electives) than you did.

 

However, realise that different schools are better for different things. Mac tends to put a large percentage of its classes into primary care. If you want to be a family doc, or perhaps a pediatrician/internal medicine doctor, then you'll learn how to keep up with new medical literature extremely well at Mac. On the other hand, if you are a hardcore person, and can see yourself doing stuff like trauma surgery, cardiac surgery, etc, then clearly you'll get a better background going to a medical school in a larger urban setting. If you aren't sure, then you'd likely be keeping your options open wider if you went with the urban setting. You can always down-size, but I think it would be hard to go the other way around.

 

Also remember that wherever you go to school, you will make a large number of contacts in your time there, as you will wherever you do your residency. That may have a big impact on you finding a place to practise once you are done all your training. I fully expect that I will have an easier time finding a job in BC after having done my medical school training, and hopefully my residency in this area.

 

Pick the medical school with the best location, curriculum, and student body for yourself, and which fits best with your personality, learning style, and future goals and expectations.

 

Ian

UBC, Med 3

[Guest Ian Wong]

Hi Carolyn,

 

You must have posted while I was busy typing out my response. Do you know what happened above?

 

Ian

UBC, Med 3

[Guest Carolyn]

Here are some stats from the 2001 CaRMS report:

 

What is most apparent to me is that it really doesn't make a Huge difference which school you go to... It is really up to you!

 

Matched to first choice discipline:

Mem: 88%

Dal: 87%

McGill 76%

Ottawa: 95%

Queen's: 89%

Toronto: 85%

McMaster: 92%

Western: 87%

Manitoba: 78%

Sask: 90%

Alb: 81%

Calg: 86%

BC: 84%

 

Memorial, McGill and Toronto have the highest proportion of their graduating class staying hoem for postgrad trainning, while Queen's Western and McMaster have the highest proportion of their graduates matched away for postgrad training.

 

The report also has a list of first choice disciplines by medical school - I won't write those out but if I write out family medicine, then you can probably get a good idea about how schools do in placing people in specialties when you combine them with the above scores...

 

Family Medicine as a First Choice by Medical School

 

Mem: 27.1%

Dal: 37.7%

McGill: 11.1%

Ottawa: 40.5%

Queen's: 17.8%

Toronto: 26.6%

McMaster: 32.3%

UWO: 27.1%

Manitoba: 22.2%

Sask: 31.6%

Alb: 34.3%

Calgary: 26.9%

UBC 35%

 

Interpret as you will and let me know if you want any specific #s... but please remember that you can get into any discipline you want from any school --- definitely!

[Guest Carolyn]

I would like to respectfully respond to Ian's email. Mac was used as an example of a school that is better suited if you are interested in Family Meds... that has long been the myth... however, as you'll see from the numbers Mac actually has fewer grads going into family meds than Dal, Ottawa, Alberta and UBC -> all larger, more urban cities! In fact, Mac students got some extremely competitive spots this year -> most of the people I know in third year are going into very competitive specialties like Emerg at Toronto, Surgery at Toronto, a number in Pediatrics etc.

 

I believe it is really important to go to a school where you get lots of opportunities to experience different disciplines right from day one. It will help you make a confident career decision early on in the game and then follow all of the advice that Ian gave you -> research, electives, away electives. You often hear of people that come into medicine with a set plan and end up doing a 180 halfway through clerkship when they realize that in fact that discipline is not for them...

 

I'm just finishing my 1st year at Mac. When I came in I thought probably pediatrics (I'd volunteered in a pediatric setting for a long time)... I even was thinking pediatric PM&R... I started an elective the 2nd week of September in Family Medicine and was surprised how much I enjoyed working with geriatrics... I've since done electives in Pediatrics (and quickly got sick of over-protective parents), Internal Medicine and Emergency Medicine. My experiences along with some really strong career counselling available to us here at Mac has helped me narrow down my choices to Emerg and Internal... I'm hoping to have decided my 1st choice by December and have a plan on what I'm going to do from now to then to help me make that decision. I'm doing electives and research in those areas over the next year and when I start clerkship in January will start to do some away electives and make myself "known" to the programme directors at those schools.

 

I think Ian has done an excellent job of explaining the "Game" of residency - I think it is absolutely most important to realize that it is totally up to you - not the reputation of your school to get yourself placed in the residency position of your choice.

 

On top of that it is very very important to realize that there are some specialties such as derm or plastics of which there are so few positions that if you end up being totally dedicated to those specialties and don't develop a good resume for a backup you can get screwed just by nature of the match and not because you aren't prepared for the discipline. Definitely develop a back-up which you know you'd be happy in.

 

Perhaps for me the most important part about this is choosing to go to a school that fits your learning style - where you'll learn information well enough to impress those programme directors...

 

All the best!

Carolyn

[Guest Ian Wong]

Thank you Carolyn for catching me on those errors. This is sort of what I envisioned, a premed and med student community where the individuals at each med school who know the most about their program can really help to educate us all.

 

The rumour about most Mac grads going into primary care is one that I've heard over and over again, mainly by UBC medical students in different years, and perhaps most surprisingly by one of my classmates, who did her undergrad at Mac! Needless to say, you've opened my eyes quite a bit today, and this oft-quoted statement is one I won't be repeating in the future.

 

Ian

UBC, Med 3

[Guest Colm]

Ian, Carolyn, and Suovern,

 

Thanks alot for your feedback, and providing some info to helping us make our med school choices easier.

 

Cheers,

Colm