Canadian Medical Education Journal

Postgraduate medical education selection in Canada: Opening the black box

2020-07-17T08:15:46-06:00

High dives and parallel plans: Relationships between medical student elective strategies and residency match outcomes

2020-07-16T18:11:04-06:00

Background: Medical students are anxious about not getting a preferred residency position. We described elective patterns of two recent cohorts and examined associated match outcomes.

Methods: We conducted a retrospective review of the final-year electives of all students who participated in the residency match (first iteration) at one school for 2017 and 2018. We categorized elective patterns and associated them with aggregated match outcomes. We examined high-demand/low-supply (HDLS) disciplines separately.

Results: We described three elective patterns: High Dive, Parallel Plan(s), and No Clear Pattern. Many students had High Dive and Parallel Plans patterns; only a few showed No Clear Pattern. Match rates for High Dive and Parallel Plan patterns were high but many students matched to Family and Internal Medicine. When we separated out HDLS predominance, the match rate remained high but a significant number matched to disciplines in which they did not have a majority of electives. Most High Dive and Parallel Plan students who went unmatched did so with HDLS discipline electives.

Conclusion: Many students chose High Dive and Parallel Plan strategies to both high-capacity and HDLS disciplines. Match rates were high for both patterns but students also matched to non-primary disciplines. Back-up planning may reside in the entire application, and not just electives selection.

Canadians studying medicine abroad and their journey to secure postgraduate training in Canada or the United States

2020-07-16T18:11:05-06:00

Background: From national and international workforce perspectives, Canadians studying medicine abroad (CSAs) are a growing provider group. Some were born in Canada whereas others immigrated as children. They study medicine in various countries, often attempting both American and Canadian medical licensure pathways.

Methods: Using data from the Educational Commission for Foreign Medical Graduates (ECFMG) and the Medical Council of Canada (MCC), we looked at CSAs who attempted to secure residency positions in both Canada and the United States. We detailed the CSAs’ countries of birth and medical education. We tracked these individuals through their postgraduate education programs to enumerate their success rate and categorize the geographic locations of their training.

Results: The majority of CSAs study medicine in one of 10 countries. The remainder are disbursed across 88 other countries. Most CSAs were born in Canada (62%). Approximately 1/3 of CSA from the 2004-2016 cohort had no record of entering a residency program in Canada or the United States (U.S.). Recently graduated CSAs were most likely to secure residency training in Ontario and New York.

Conclusion: Many CSAs attempt to secure residency training in both Canada and the U.S. Quantifying success rates may be helpful for Canadians thinking about studying medicine abroad. Understanding the educational pathways of CSAs will be useful for physician labour workforce planning.

Factors perceived to influence rural career choice of urban background family physicians: a qualitative analysis

2020-07-16T18:11:06-06:00

Background: Urban background physicians are the main source of physician supply for rural communities across Canada. The purpose of this study was to describe factors that are perceived to influence rural career choice and practice location of urban background family medicine graduates.

Methods: We conducted a qualitative, descriptive study employing telephone interviews with 9 urban background family physicians practicing in rural locations. Those who completed residency training between 2006 and 2011, were in rural practice, and had an urban upbringing were asked: when the decision for rural practice was made; factors that influenced rural career choice; and factors that influenced choice of a particular rural location. Emerging themes were identified through content analysis of interview data.

Results: We identified four themes as factors perceived to influence rural career choice - variety/broad scope of rural practice, rural lifestyle, personal relationships, and positive rural experience/physician role models. We also identified factors in four areas perceived to influence the choice of a particular rural practice location - having lived in the rural community, spousal influence, personal lifestyle, and comfort with practice expectations.

Conclusion: Decisions for rural career choice and rural practice location by practicing urban background family medicine graduates are based on clinical practice considerations, training experience, as well as personal and lifestyle factors.

Fundamental trends within falling match rates: Insights from the past decade of Canadian residency matching data

2020-07-16T18:11:07-06:00

Background: The number of unmatched Canadian Medical Graduates (CMGs) has risen dramatically over the last decade. To identify long-term solutions to this problem, an understanding of the factors contributing to these rising unmatched rates is critical.

Methods: Using match and electives data from 2009-2019, we employed machine learning algorithms to identify three clusters of disciplines with distinct trends in match and electives behaviours. We assessed the relationships between unmatched rates, competitiveness, rates of parallel planning, and program selection practices at a discipline level.

Results: Across Canada, growth in CMGs has outpaced growth in residency seats, narrowing the seat-to-applicant ratio. Yet not all disciplines have been affected equally - a subset of surgical disciplines experienced a consistent decline in residency seats over time. Applicants to these disciplines are also at disproportionate risk of becoming unmatched, and this is associated with lower rates of parallel planning as quantified through clinical electives and match applications. This, in turn, is associated with the program selection practices of these disciplines.

Conclusion: Long term solutions to the unmatched CMG crisis require more nuance than indiscriminately increasing residency seats and should consider cluster specific match ratios as well as regulations around clinical electives and program selection practices.

Analysis of factors affecting Canadian medical students’ success in the residency match

2020-07-16T18:11:08-06:00

Background: In North America, there is limited data to support deliberate application strategies for post-graduate residency training. There is significant interest in determining what factors play a role in Canadian medical graduate (CMG) matching to their first choice discipline and heightened concern about the number of students going unmatched altogether.

Methods: We analyzed matching outcomes of CMGs based on seven years (2013-2019) of residency application data (n= 13,499) from the Canadian Residency Matching Service (CaRMS) database using descriptive and binary logistic regression modeling techniques.

Results: The sample was 54% female, with 60% between the ages of 26 and 29, and 60% attended medical schools in Ontario. Applicants who received more rankings from residency programs were more likely (OR = 1.185, p < 0.001) to match. Higher research activities (OR = 0.985, p < 0.001) and number of applications submitted (OR = 0.920, p < 0.001) were associated with a reduced likelihood of matching. Number of volunteer activities and self-report publications did not significantly affect matching. Being male (OR = 0.799, p < 0.05) aged <25 (OR = 0.756, p < 0.05), and from Eastern (OR = 0.497, p < 0.01), or Western (OR = 0.450, p < 0.001) Canadian medical schools were predictors of remaining unmatched.

Conclusions: This study identified several significant associations of demographic and application factors that affected matching outcomes. The results will help to better inform medical student application strategies and highlight possible biases in the selection process.

Career decision making in undergraduate medical education

2020-07-23T16:18:17-06:00

Background: It is unclear how medical students prioritize different factors when selecting a specialty. With rising under and unemployment rates a novel approach to career counselling is becoming increasingly important. A better understanding of specialty selection could lead to improved career satisfaction amongst graduates while also meeting the health care needs of Canadians.

Methods: Medical students from the University of Toronto participated in a two-phase study looking at factors impacting specialty selection. Phase I consisted of focus groups, conducted independently for each year, and Phase II was a 21-question electronic survey sent to all students.

Results: Twenty-one students participated in the focus group phase and 95 in the survey phase. Primary themes related to career selection identified in Phase I in order of frequency included personal life factors (36), professional life factors (36), passion/interest (20), changing interests (19) and hidden curriculum (15). The survey phase had similar results with passion (83), lifestyle (79), flexibility (75), employment opportunities (60) and family (50) being ranked as the factors most important in specialty selection.

Conclusion: Personal factors, professional factors and passion/interest may be key themes for medical students when deciding which specialty to pursue. Targeting career counselling around these areas may be important.

Trends in Canadian ophthalmology residency match outcomes

2020-07-16T18:11:10-06:00

Background: To date, there exists no formal assessment of the competitiveness of the residency match for Canadian ophthalmology programs. The primary objective of this study was to use Canadian Resident Matching Service (CaRMS) data to describe trends in the number of positions, number of applicants and level of competition for the Canadian ophthalmology match.

Methods: The number of positions and the number of applicants for each ophthalmology program were received from CaRMS for each cycle of the match from 2006-2017. The level of competition was calculated by dividing total number of applicants by the total number of positions in any given year.

Results: The level of competition was consistently high with a median number of 2.0 applicants per anglophone Canadian Medical Graduate (CMG) position, 2.6 applicants per francophone CMG position and 32.5 applicants per International Medical Graduate (IMG) position. Over the study period, the level of competition decreased for francophone CMG and IMG positions and did not change for anglophone CMG positions.

Conclusion: Consistently there are a greater number of applicants than positions for Canadian ophthalmology residency programs and therefore CMG applicants should be encouraged to apply to more than one discipline. The trends in the number of residency positions can be used to update supply projections for ophthalmologists and guide human resource planning.

The relationship between regional medical campus enrollment and rates of matching to family medicine residency

2020-07-17T08:16:12-06:00

Background: The Michael G. DeGroote School of Medicine expanded its medical education across three campus sites (Hamilton, Niagara Regional and Waterloo Regional) in 2007. Ensuring the efficacy and equivalency of the quality of training are important accreditation considerations in distributed medical education. In addition, given the social accountability mission implicit to distributed medical education, the proportion of learners at each campus that match to family medicine residency programs upon graduation is of particular interest.

Methods: By way of between campus comparisons of Canadian Residency Matching Service (CaRMS) match rates, this study investigates the family medicine match proportion of medical students from McMaster’s three medical education campuses. These analyses are further supported by between campus comparisons of Personal Progress Index (PPI), Objective Structured Clinical Examination (OSCE), Medical Council of Canada Qualifying Examination-Part 1 (MCCQE1) performances that offer insight into the equivalency and efficacy of the educational outcomes at each campus.

Results: The Niagara Regional Campus (NRC) demonstrated a significantly greater proportion of students matched to family medicine. With respect to education equivalency, the proportion of students’ PPI scores that were more than two SD below the mean was comparable across campuses. OSCE analysis yielded less than 2% differences across campuses with no differences in the last year of training. The MCCQE1 pass rates were not statistically significant between campuses and there were no differences in CaRMS match rates. With respect to education efficacy, there were no differences among the three campuses’ pass rates on the MCCQE1 and CaRMS match rates with the national rates.

Conclusions: Students in all campuses received equivalent educational experiences and were efficacious when compared to national metrics, while residency matches to family medicine were greater in the NRC. The reasons for this difference may be a factor of resident and leadership role-models as well as the local hospital and community environment.

Journey of candidates who were unmatched in the Canadian Residency Matching Service (CaRMS): A phenomenological study

2020-07-16T18:11:12-06:00

Background: Each year, a number of medical students are unmatched in the Canadian Residency Matching Service (CaRMs) match. There is little information on the experiences of unmatched candidates. This study seeks to explore the experiences of applicants who were unmatched in the first iteration of their CaRMS applications

Methods: We interviewed 15 participants who were previously unmatched, using a semi-structured interview guide to ask them of their experiences on the following domains: the overall unmatched experience; circumstances leading to their unmatched status; resources employed; barriers experienced; recommendations; and, their eventual career outcomes. We independently identified major themes from field notes to code the data using a phenomenology approach.

Results: Our participants universally reported negative emotions, concerns regarding privacy and confidentiality breaches, and stigma faced (real or perceived). Systemic challenges included: lack of information, pressures faced from undergraduate medical education, and logistical issues such as financial challenges, licensing and scheduling issues. The utility of peer support differed for individual participants, but all those who had support from other unmatched candidates felt that to be useful.

Conclusions: Our participants reported significant challenges faced after being unmatched. Based on these experiences, we identified four major recommendations to support candidates through their unmatched journey.

Application rates to surgical residency programs in Canada

2020-07-16T18:11:12-06:00

Purpose: The purpose of this study is to identify if the previously reported declining interest in surgery amongst medical students persists, and also to provide more descriptive analysis of trends by surgical specialty and medical school. Our hypothesis is that the previously reported decreasing interest in surgery remains constant for some surgical disciplines.

Methods: The Canadian Resident Matching Service and the Association of Faculties of Medicine of Canada provided data for this study. Several metrics of interest in surgery, including overall application trends, applications by discipline, and rankings by school of graduation were evaluated. Descriptive statistics and linear regression modeling were used.

Results: Between 2007 and 2017 the number of non-surgical residency positions and Canadian medical graduates increased significantly. However, the number of surgical residency positions and applications to surgical programs did not change significantly. The number of rankings to orthopedic and vascular surgery decreased significantly. Likewise, applicants to general, orthopedic, plastic, otolaryngology, and vascular surgery decreased significantly. Vascular surgery saw a significant decrease in first choice rankings. Total rankings to surgical programs increased significantly at McGill, with no significant change at other Canadian institutions.

Conclusions: The findings of this study suggest that while the number of applicants to surgical residency positions has been consistent, it is not keeping pace with the growing number of both CMGs and non-surgical residency positions. Furthermore, by using other measures of medical student interest in surgical specialties, such as the total number of rankings to a specialty through the residency matching process, the total number of applicants applying to a surgical discipline and the total number of first choice ranks that each surgical discipline received, we have demonstrated that there is a possible declining interest in some surgical disciplines.

Post-CaRMS match survey for fourth year medical students

2020-07-16T18:11:14-06:00

Background: We aimed to analyze which medical school experiences contribute to success in an increasingly competitive CaRMS match.

Methods: We surveyed all matched University of Saskatchewan 2019 medical graduates on characteristics of their applications: number of program applications, interviews obtained, experiences (research, volunteer, leadership), awards and money spent on the residency match process, and qualitative reflections on the process. Using published CaRMS statistics based on number of positions versus applicants, specialties were divided into high availability/low demand (HA) (e.g. family and internal medicine) and low availability/high demand (LA) (e.g. dermatology and emergency medicine). Quantitative results were analyzed using descriptive statistics, chi-square and t-tests, and qualitative results thematically.

Results: Data from 27 of 94 matched students were included. LA applicants were more likely to report at least one research project on their CV (66.67% among LA vs. 15.38% among HA, n = 27, χ2 = 8.640, p = 0.013), with a greater number of research presentations (mean=3.75 presentations vs. 2.07, t (25) = -2.251, p = 0.033). LA applicants had more elective weeks outside Saskatchewan (mean 11.75 weeks vs. 7.40 weeks, t (25) = -2.532, p = 0.018). Other application variables were not different between groups. Some students endorsed broader electives strategies, others (especially in surgical disciplines) supported narrower ones. Students reported travel, financial burden, document submission, and uncertainty as the greatest match process stressors.

Conclusions: LA applicants cited more research projects and presentations, spent more elective weeks outside Saskatchewan, but were otherwise similar to HA applicants. Further studies should be done on student factors in the residency match process.

The current utility and future use of the medical student performance record: A survey of perceptions across Canada

2020-07-16T18:11:15-06:00

Introduction: The MSPR is a Canada wide tool that provides aggregate information on MD students’ performance during training and used widely as part of PG admissions. This survey study elicits the perceptions of PG admissions stakeholders on the current use and future utility of the MSPR in Canada.

Methods: PG admissions stakeholders across the faculties of medicine were convenience sampled for a 15-question online survey in the fall of 2018. Participants were asked how and when the MSPR is incorporated into the admissions process and perceptions and recommendations for improvement Data are summarized descriptively and thematically.

Results: Responses came from 164 participants across the 17 faculties of medicine. The MSPR was widely used (92%), most commonly in the file review process (52%) for professionalism issues. The majority of responses indicated that MSPRs were not fair for all MD students (60%) and required revision (74%) with greater emphasis required on transparency, professionalism, and narrative comments.

Discussion: The results indicate that though MSPRs are widely used in PG admissions their perceived value is limited to a few specific sources of information and to specific parts of the admissions process. There are significant concerns from PG stakeholders on the utility of MSPRs and future changes should align with the needs of these stakeholders while balancing the concerns of students and undergraduate programs.

Scholarly activity as a selection criterion in the Canadian Residency Matching Service (CaRMS): A review of published criteria by internal medicine, family medicine, and pediatrics programs

2020-07-17T08:16:36-06:00

Background: Undergraduate medical students seek as much information as possible as to how residency programs select candidates. The Canadian Residency Matching Service (CaRMS) website is one of their primary sources of information. Students may be more competitive in the match if they know whether scholarly activity is used in the selection process by their preferred programs, as described on the CaRMS website..

Methods: For all 17 Canadian faculties of medicine, 2019 R1 entry internal medicine, family medicine and pediatrics program descriptions were reviewed on the CaRMS website looking for keywords related to scholarly activity.

Results: Forty-one percent of family medicine, 65% of internal medicine and 71% of pediatric programs explicitly stated having interest in applicants with scholarly experience. In Western Canada, 80% of internal medicine and 60% of pediatrics programs included scholarly activity in their CaRMS description of criteria considered in ranking applications. Similarly, in Ontario, 66% of internal medicine and 83% of pediatrics programs mentioned scholarly activity as a valuable quality. In Quebec 100% of family medicine and 50% of pediatrics programs include scholarly activity in their descriptions. Pediatrics and internal medicine programs (100%) in Atlantic Canada mentioned scholarly activities but neither of the two Atlantic Canada internal medicine programs mentioned scholarly activities.

Conclusion: Undergraduate medical students can use this project to prioritize extracurricular activities and scholarly work to be competitive for application to family medicine, internal medicine and pediatrics residency programs.

Should I stay, or should I go?

2020-07-16T18:11:17-06:00

In this narrative, I explore the thoughts and emotions that drive the decision of whether to transfer residency programs. I focus on the difficulty of making a career decision with limited information, and the difficulty of exploring the possibility of a transfer while still remaining part of an ongoing residency program. Although residency transfers are a taboo topic, they are remarkably common. Many residents go through this process feeling alone; I hope to convey that these feelings are common. More understanding of the transfer process is needed, particularly in light of the ongoing unmatched Canadian medical graduate crisis and in light of high rates of burnout, to understand the drivers behind resident wellness and satisfaction.

A tale of two curricula: Learning and matching in the final year of medical school

2020-07-16T18:11:17-06:00

In this article, I highlight two curricula that I believe are most prominent during the final year of the Canadian medical school experience—that of learning and that of matching to residency. While these two curricula are not mutually exclusive, they can be perceived as contradictory by learners, shifting their focus away from learning towards performing well in an effort to optimize their chance of matching to their program of choice. Moreover, the increasing rates of unmatched students in recent years have likely contributed to this shift while increasing stress and anxiety associated with this final year. In addition to curricular reform, I argue that there needs to be curricular consistency among all stakeholders including undergraduate programs, postgraduate programs, and other third-party organizations.

"We regret to inform you that you did not match": Reflections on how to improve the match experience

2020-07-16T18:11:18-06:00

Background: With the increasing awareness and action amongst stakeholders in addressing the concerning rise of unmatched Canadian Medical Graduates (CMGs), little is known from those who go unmatched. We use our unmatched experience to contribute to this dialogue.

Methods: We present an issues-based examination of the matching process by reflecting on the pre- and post-match period, providing suggestions related to the Canadian context from the unmatched perspective.

Results: The challenge in the pre-match period was handling uncertainty in elective scheduling. This uncertainty was largely manifested from not knowing elective availability at the time of elective application submission, as well as not knowing what “strategy” we should follow in how to structure our elective schedule. For the post-matched period, we were challenged by making decisions during a time-sensitive period, deciding on career issues like scheduling post-match electives, handling our finances, and trying to improve our future residency applications without feedback.

Conclusion: Providing a real-time document of elective availability, providing focused feedback from our residency applications, and implementing and expanding upon extended curriculums for all medical schools to continue CMG training for their unmatched students for upcoming match cycles would greatly improve the unmatched experience.

CaRMS at 50: Making the match for medical education

2020-07-16T18:11:19-06:00

Entry into postgraduate medical training in Canada is facilitated through a national application and matching system which establishes matches between applicants and training programs based on each party’s stated preferences.

Health human resource planning in Canada involves many factors, influences, and decisions. The complexity of the system is due, in part, to the fact that much of the decision making is dispersed among provincial, territorial, regional, and federal jurisdictions, making a collaborative national approach a challenge. The national postgraduate application and matching system is one of the few aspects of the health human resources continuum that is truly pan-Canadian.

This article examines the evolution of the application and matching system over the past half century, the values that underpin it, and CaRMS' role in the process.

Student-initiated peer-to-peer information panel on the residency application process

2020-07-16T18:11:19-06:00

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Paresthesia of right encephalon creativity secondary to residency application anxiety

2020-07-16T18:11:20-06:00

Applying to residency programs is a stressful time for any medical student. The finances, worries about the future, fear of not matching and being unable to repay loans can cause fleeting crippling moments for some students. As a residency applicant myself this year, and someone who has a fondness and passion for all things artistic, I sometimes find that the anxiety associated with application season can intermittently numb the creative side of my brain. It can even make my creative mind smaller because it is sometimes feels as though it is overtaken by more logical and practical thoughts. In addition, the lack of irises and pupils in the portrait show how far removed one’s mind can sometimes be from constructive emotion during this tough season of life.

Fly or fall?

2020-07-16T18:11:21-06:00