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- Page navigation anchor for Addressing bias and lack of objectivity in the Canadian Resident matching processAddressing bias and lack of objectivity in the Canadian Resident matching process
The number of unmatched medical graduates has been steadily increasing and has become the focus of much attention in recent months, including in this recent article published in CMAJ, entitled “What to do about the Canadian Resident Matching Service”(1). The discussion has focused primarily on the number and distribution of training positions, with calls to increase the number of residency positions to 1.2 per medical graduate. Indeed, the Government of Ontario has recently funded a number of new positions in order to address this issue.
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What has received less attention however, are the problems with the existing resident selection process. Although there are few studies of the match, there is existing evidence of bias within the system. A study performed at the University of Calgary found that there is significant in-group bias when selecting residents, with preference for applicants from within the institution (2). In the 2017 match, while 80% of male applicants and 83% of female applicants were matched to their first choice discipline, only 62% of female applicants matched to their first choice if it was a surgical discipline, compared to 72% of male applicants (3). In fact, as of the 2016 cohort, there was one surgical residency program in Ontario that hadn’t taken a female trainee in 5 years, according to its website.
Behind closed doors, many students express frustration at a process they feel is too subjective. This is often attributed to the concept of...Competing Interests: None declared. - Page navigation anchor for RE: What to do about the Canadian Resident Matching ServiceRE: What to do about the Canadian Resident Matching Service
To the Editor:
I read this article on the Canadian residency match with great interest. As a candidate who was not matched to a program after both rounds of CaRMS in 2017, the intricacies and subtleties of the match are an issue near and dear to my heart.
I will state that I do not believe that the issues with the match lie inherently with the CaRMS system; rather, they seem to be in the overall culture of residency selection. This falls on not only the selecting programs, but also the candidates themselves.
During the application process, candidates canvas for reference letters, write elaborate letters of intent, submit CVs, and compile relevant awards, abstracts and publications. Schools provide programs with compilations of evaluations, with grades summarized as passed and failed rotations.
The elements of a successful match seem to be very unclear to all parties. During my conversations with many program directors and committee members, I have found that most do not know what to look for in an applying candidate. Frankly, the consensus is that much of the final selection, at least in smaller disciplines, falls to a gut feeling on the fit of the candidate. This, I must assume, is in large part due to the lack of objective measures of a candidate's overall quality.
Traditionally, objective measures might have included a candidate’s grades, but in today’s pass/fail culture of medical training, such measures do not truly exist. R...
Show MoreCompeting Interests: Unmatched CMG in 2017 CaRMS - Page navigation anchor for RE: Unmatched Canadian Medical GraduatesRE: Unmatched Canadian Medical Graduates
To the Editor:
The Canadian residency match is high stakes for Canadian medical students as it is the only in-country route into clinical practice for Canadian Medical Graduates (CMGs). There is an increasing number of unmatched CMGs in Canada. This trend is of grave concern to the Canadian Federation of Medical Students (CFMS), which represents over 8,000 medical students across Canada. The article by Wilson and Bordman entitled “What to do about the Canadian Residency Matching Service” provides only a glimpse into the complexity of the residency matching system, and we fear that it may lead some readers astray.
We are concerned with the claim that CMGs face direct competition from international medical graduates (IMGs). In most provinces, CMGs and IMGs apply for separate seats during the first iteration of the match, and direct competition only arises in the second iteration. What is left unclear in the available data is the number of CMGs who applied for each second round seat. Some CMGs in the second iteration might not apply to (or rank) seats, as a result of specialty availability, location of seats, or other factors. One cannot simply look at the numbers of IMG vs. CMG matches, and draw an accurate conclusion.
The CFMS supports increasing the ratio of 120/100 which facilitates greater student choice, greater flexibility in the system and will lead to less unmatched students. Even a number like this requires nuance; for example, one must consi...
Show MoreCompeting Interests: The authors are both final year medical students entering the R1 residency match in the 2017-2018 cycle. Sarah Silverberg is file lead, education committee Unmatched Medical Graduates, CFMS. Kaylynn Purdy is VP Medical Education, CFMS. - Page navigation anchor for What to do about the Canadian residency matching processWhat to do about the Canadian residency matching process
To the editor:
I read with interest the article published in the CMAJ on November 27, 2017 entitled What to do about the Canadian Resident Matching Service. I would like to start by stating that I agree with the importance of the issues raised in this article, and the need for discussion and collaboration around potential improvements in the resident matching system and its supporting structures.
It is true that the current system has its challenges, which can lead to uncertainty, anxiety, an increasing work effort on the part of everyone involved and, yes, a rising number of unmatched Canadian medical graduates in recent years.
The application, selection and matching process for more than 3,000 medical school graduates and postgraduate positions is high stakes. At the end of it all, an average 97% of Canadian medical school graduates begin postgraduate training in their year of medical school graduation, while more than 99% begin postgraduate training within the two years following medical school graduation. But there are also other outcomes that matter, and to address them we need to be looking at the entirety of the system. In this regard, we at CaRMS agree with our colleagues throughout the medical education community: together, we can and must do better for those for whom the system has not worked.
When we talk about the residency matching system in Canada, it is important to note that CaRMS is one of many entities that work together in thi...
Show MoreCompeting Interests: Chair, CaRMS Board of Directors - Page navigation anchor for RE: What to do about the Canadian Resident Matching ServiceRE: What to do about the Canadian Resident Matching Service
As a family physician who trains residents, I am expected to look at the residency applications for carms and rate them. This reminds me every year how Carms is also broken in a different way. The medical schools submit different formats of evaluation and it is cumbersome and sometimes impossible to interpret the different submissions. An "X" on a document in one school might mean the equivalent of a check mark, but often it's guesswork.
I think that the medical students should be encouraged to have a variety of electives in order to keep their education broad. They should be exposed to family medicine. They should be disallowed from taking only a single type of elective, for if they don't get their choice of residency program, they are seen to be very poor candidates indeed for other ones where they don't have the electives at all.
Competing Interests: None declared. - Page navigation anchor for RE: CaRMS and other forms of tortureRE: CaRMS and other forms of torture
I read this article with great interest as someone who has been the CaRMS process twice. While both times the match did result in a reasonable outcome, this is obviously not the case for all applicants, and I look back at the CaRMS process with almost PTSD-like tremor. It is a terrible, expensive, impersonal system, that has deviated far from what I understand to be the original goals of it's inception. Those goals being to provide a fair and equitable, for all parties, method of getting medical trainees into Canadian residency training programs. How much longer are we going to keep propping up a broken system? Is it time to consider that the rotating internship, with all its flaws, might actually be a better pathway for Canadian medical trainees?
Competing Interests: None declared.