Elective choices?

[ontariomed0002]

I curious what any consensus is for electives regarding a specific specialty we want to go into. If say I want to go into Urology does it look good/bad/indifferent if you do as many electives as possible in urology or do programs like to see a good mix with a couple extra ones in the specialty you are interested in?

Thanks

[greengrassgrows]

My opinion - and it is ONLY an opinion - is that if you have a particular specialty in mind, you should do MOST of your electives in that specialty BUT ALSO 1 or 2 in related specialties.

 

Let's assume you can do 6-7 electives and you're gunning for...

UROLOGY: 4-5 Urology, 1 nephrology, 1 urogynecology, 1 gen surg

ORTHO: 4-5 Ortho, 1 radiology, 1 physiatry

GEN SURG: 4-5 Gen Surg, 1 anesthesia, 1 ICU

ANESTHESIA: 4-5 Anesthesia, 1 ICU, 1 cardiology/respirology

 

Make sense? I still think you're showing an obvious commitment to your specialty of interest but also that you're not too narrow minded. In general, I think this mostly applies to more competitive specialties. For example, if you really wanted family, I would probably only do 1-2 electives in family and the rest I would completely diversify (ex: derm, ENT, physiatry ---all thing that will give you clinical skills that will be super useful in family).

 

Just my opinion.

[greengrassgrows]

Anybody else have other (hopefully successful) strategies?

[ontariomed0002]

Thanks for the suggestion and the examples bring a lot of things into light a bit better as well - thinking about the related specialties that will have a bit of crossover and fill a couple electives with those as well. I'm not sure what others will think but that makes sense to me like if someone wanted to do Allergy and Immunology to maybe take electives in things like Derm, Rheum, and Pulmonology type thing too?

 

Thanks again

[A-Stark]

Allergy and Immunology is a medicine (or peds) subspecialty, so you should arrange electives in internal medicine or pediatrics.

 

For internal, any electives in general or subspecialty medicine would be reasonable. Non-IM electives could be in family, anesthesia, emerg - quite similar to a family med-oriented set of electives, though for IM it would be unusual to see obs/gyn or much surgery.

 

ETA: @greengrass - I think your elective suggestions for those specialties are very reasonable and appropriate.

[ellorie]

What I wonder is, what do you do for psychiatry? I guess family medicine is pretty cross-applicable.

[greengrassgrows]

What I wonder is, what do you do for psychiatry? I guess family medicine is pretty cross-applicable. Or is psychiatry non-competitive enough that you have free rein to just do whatever you want.

 

For Psychiatry, I would again do mostly psychiatry and then throw in a family, neurology and maybe even neurosurgery (but only if you're particularly interested). Neurology is pretty key though. Tons of research crosses over between neuro and psych.

[ontariomed0002]

Oh that's true that for any of those subspecialties to focus on the more general Internal Med/Peds rotations first since you are trying to first get into those and then later applying for the fellowship.

 

To greengrassgrows - what are your thoughts on some of the other stand alone (non-subspecialities) like says Optho and Derm?

[greengrassgrows]

To greengrassgrows - what are your thoughts on some of the other stand alone (non-subspecialities) like says Optho and Derm?

 

To greengrassgrows - what are your thoughts on some of the other stand alone (non-subspecialities) like says Optho and Derm?

 

You want my thoughts? I'm flattered! And again, this is just opinion, but I think for ultra competitive things like ophtho and derm, you need something that will set you apart from the other very qualified and competitive applicants. And I think you should go with what interests you here. It's all in how you spin it. People like to hear a good story. So make a story that works for you.

 

For example, I know someone who was interested in ophthalmology and peds. They were too scared to put all their eggs in 1 basket so they split their electives. At their ophtho interview (and probably in their personal letter), they justified the peds electives by saying that they ideally wanted to have a peds ophtho practice. Makes sense. And they matched (to ophtho which was their first choice). It's a little different from all the other ophtho gunners and it shows you have direction and are thinking past just matching to ophtho so you'll be rich.

 

So say you want Derm. And you have an interest in an academic career. Do 1 or 2 research electives (hard to get but not impossible if you ask the right people). You may need to set these up at your home school (because you may have less luck as a visiting student) but it can still be done. Then you have these super unique electives that you can talk about and probably nobody else will have them. Showing an interest in derm - check. Showing an interest in contributing to the specialty - check. Everybody wins. You can also try to set up electives with sub-specialists (ex. contact dermatitis if that's what you're itching for - heh). This too will make you stand out. Obviously don't go in to interviews saying that you're only willing to do "x-sub-sub-specialty"... but say you have a particular interest in it for x, y, z reasons and that's what drew you to pursue derm in the first place blah blah blah.

 

Does this make sense? I guess to summarize, for ultra competitive things, I would err on the side of having most (nearly all) of your electives in that specialty. And make your "diversity electives" contribute to your story in a unique way. But make it honest - it will shine through if you're genuinely passionate about something and that's what'll set you apart.

[greengrassgrows]

I just found this: http://medical-residency.ca/files/canadian-medical-residency-guide.pdf

 

Section C has some great tips as to what electives are recommended for each specialty.

 

For derm they seem to recommend internal, infectious diseases and rheumatology as good options. Makes good sense to me.

 

For ophtho, neurology and plastics pop up a lot. One program even says to do things other than ophtho so that you have a chance at matching to something else if you don't get into ophtho.......... intense.

[ellorie]

I guess it's kind of a conundrum because on one hand, if you put all your eggs in one basket, you look really committed BUT if you don't match you're screwed. If you split your electives, you have a back-up but you probably hurt your chances of matching to your first choice.

 

The only people who can really pull it off are people applying to overlapping fields.

 

It's like the most horrible political game ever - where and for how long to do away electives, how to choose your diversity electives, whether to back up. Yuck.

 

The irritating part is how programs INSIST that they are looking for students with a broad-based program, when it seems pretty clear that they are looking for exactly the opposite.

[rogerroger]

I think the degree of "commitment" needed is mostly program specific.

 

I'm in the camp that strongly believes that most med students should apply to two programs. I think the risks are too high not too. With that said I believe that ideally you want to apply to two programs which overlap at some level, for example anaesthesia, EM and to an extent FM make sense when paired together. The same with general Surgery, GI, plastics etc.

 

You need to strike a balance with logical career exploration while simultaneously allowing for a CaRMS safety net backup while also making a convincing argument of commitment to a desired speciality.

 

My first choice speciality which I matched into is one of the more competitive. I had a ratio of about 4 weeks of 1st choice speciality elective time for every 1 week of my backup speciality.

 

(A caveat if you are applying to FM... I wouldn't sweat to much about everything noted above. Just do a FM elective and apply away. I think if you can reasonably show some sort of interest in FM even on a ridiculously superficial level pretty much every program, even the competitive ones will interview you.)

[ellorie]

If I do back up, I will probably back up psychiatry with FM and spin that I would do a +1 psychotherapy year, although it's not my favourite career plan in the world since from what I understand GP psychotherapists are mainly only qualified to do supportive short term psychotherapy with the fairly-healthy. Although I suppose it's possible that on my way through clerkship I will find a career choice that I would like better than FM.

 

A bunch of psychiatrists have told me that it's not really necessary to back up psychiatry if you apply broadly and don't have red flags. Is that still true?

[justletmein]

A bunch of psychiatrists have told me that it's not really necessary to back up psychiatry if you apply broadly and don't have red flags. Is that still true?

 

Every time someone I know asks this question, I say to them:

"Let's say you only apply to Psych (or any other given specialty) -- If you went unmatched, would you scramble for an unfilled spot in FM? If that's the case, why WOULDN'T you back up with FM in the first place? If you think you would be ready to take a year off and reapply OR if you would prefer to take your chances that another desirable specialty may be available in the second round, then you probably shouldn't bother backing up"

 

But the bottom line is--> People telling you that psych is "not that competitive" is not reason enough to not back up, because the popularity varies so much year to year. (true of many different specialties)

[NLengr]

You should have no problems getting a psych position as long as you are willing to move around if needed. It's a very uncompetative specialty.

 

On the other hand, if you are applying to the ultra competative specialties, you need to max your in specialty electives. For these programs (I am a resident in one) elective time is essentially a prolonged interview. It's very difficult to match without an elective at that center. At the most, I would do one non specialty elective.

[ontariomed0002]

This is great and very helpful information!

 

Looking a full year ahead for me personally as I haven't been given any information on it yet but am just really curious ... how far in advance do you need to start looking into electives (whether at your home school or away) in order to get in with the people you are interested in? Is there some sort of standardized process that I'll eventually be introduced to or do you randomly e-mail physicians expressing your interest? - I'd feel bad if its the latter as I can only imagine how many emails the top physicians or heads of the residency programs get.

[ellorie]

Every school has its own application process for visiting students. They set their own limit on how far in advance you can apply - I think it's usually 9 months ahead of when the elective will start.

[rogerroger]

Every school has its own application process for visiting students. They set their own limit on how far in advance you can apply - I think it's usually 9 months ahead of when the elective will start.

 

Yeah most schools have an office you contact. Just search around google. There should be a centralized system for Canada, but there isn't sadly...

 

One big tip - Book early! Competitive spots fill up months in advance. Because electives are so key to CaRMS don't take your chances. The latest I would push applying is 6 months prior to the start date. Go earlier if you know what you want to do. UBC and Toronto are notoriously difficult to book if you are not from those schools. Booking early will be especially essential for the big cities.

[ontariomed0002]

That does seem odd that there's no centralized system like you are saying. Thanks for the advice about looking into it sooner than later. When you apply to these do they decide how long they can offer you an elective for, or do we purpose it based on however many weeks of electives we have?

 

I'm assuming there must be some planning/strategy to electives as well with regards to doing certain ones too soon when you may be inexperienced in a certain topic area and therefore not stand out as much, and also doing them too far in advanced where you are just a distant memory by the time CaRMS roles around?

[ellorie]

It depends - usually electives are between 2-4 weeks and most people recommend that for an audition rotation you do two weeks, and three at the most.

 

Some programs do have particular electives that are only offered for a certain period of time though. From what I understand, some McGill electives, and a couple I know of at UWO, are only offered in 4 week blocks, and some schools allow 2 and 4 week electives but not 3 week ones. I think you have to look into it school by school.

 

I think that many schools (including mine) are switching to a clerkship model where you do all your core rotations before your elective time, so I can't speak too much to elective planning in that respect - almost all of my time will be after my core rotations and pre-CaRMS.

[NLengr]

All my electives were post core clerkship in the fall of my CaRMS year. I did 3 weeks at my 2 top choice schools and 2 weeks at the others.

 

There was some talk of getting CaRMS to be a centralized elective planning body but I don't know the status of that anymore.

[A-Stark]

Planning is sort of a headache, but I don't think a centralized body is really appropriate. I think overarching policies that promote consistency among schools would be better - many, for example, restrict how many weeks can be done in a single discipline, or have other policies promoting a certain mix. There should be some standardization in this respect.

[goleafsgochris]

If I do back up, I will probably back up psychiatry with FM and spin that I would do a +1 psychotherapy year, although it's not my favourite career plan in the world since from what I understand GP psychotherapists are mainly only qualified to do supportive short term psychotherapy with the fairly-healthy. Although I suppose it's possible that on my way through clerkship I will find a career choice that I would like better than FM.

 

A bunch of psychiatrists have told me that it's not really necessary to back up psychiatry if you apply broadly and don't have red flags. Is that still true?

 

My advice with psych is to keep an open mind going into clerkship. I really thought I would want psych in pre-clerkship and this changed dramatically once I got in clerkship and realized how difficult it would be to stay in a totally non-medical field (if you dont realize how true this is of psych now, you will in clerkship). I ended up in neurology (am an R2 now).

 

People do like psych, not trying to discourage you, just--keep an open mind.

 

And it is still EXTREMELY non-competative. You can get into Queen's and Western as a CMG with no psych electives EVER lol, they cannot fill their spots. I know someone who last year got in in the 2nd round, by a phone interview, with no previous electives (he had been gunning for opthal)

[NLengr]

I believe at one point I described the difficulty as "can you go an hour without soiling yourself or punching the interviewer in the face? Then you'll match to psych somewhere".

[ellorie]

I am definitely keeping an open mind - but I am such a planner that I always have to be planning something or another. If I have to scrap it down the road, I can be okay with that too.

 

Though since I always did want to be a psychotherapist and sort of chose medical school as a route towards that, I think there's a good chance I'll stick. But I admit, also a reasonable chance that I won't.