View Full Version : competitive residencies
03-09-2002, 01:24 PM
Before I begin - Ian, I stuck this in this forum because it has to do with choosing a med school, not with choosing a residency. If you diagree, feel free to move it. :)
I just spent a few hours browsing the CaRMS website, and was looking at the match rates for different specialties. Basically, what I noticed, was that all of the residencies I'm interested in are very competitive - only about 50-60% of people match into their first choice discipline!
So, I'm curious as to what that means for choosing a med school. To be honest, I'm slightly more familiar with the US process, as I applied to more schools in the US than I did in Canada. But, now I'm pretty sure I'm going to stay in Canada and go to the University of Manitoba. Not to be arrogant or anything, but I'm pretty sure I'll get in. :) So, I know that what school you attend in the US has a big deal with your chance at getting a residency of your choice. Is it the same thing in Canada? Will I have a hard time getting into diagnostic radiology, say, as a graduate of Manitoba? I know it's sorta a middle-of-the-road school reputation wise.
Just wondering what everyone's opinion was, and whether this'll play a role in your decisions as to where you'll attend school...
03-09-2002, 03:20 PM
From what I've heard (just from med students, though), the school you go to shouldn't matter. But I guess if you go to school in the place you want to do a residency, you might get a chance to make connections with people (faculty, etc.) who could improve your chances of obtaining a residency there. However, you could probably just do an elective at that place in whatever you're interested, which could also provide you with connections. It'd be nice to get the opinions of people who have recently gone into residency and hear what they think...
03-09-2002, 03:39 PM
I've thought about this topic a good deal, given that I'm aiming to head for specialization. There are a number of factors that you need to consider in this scenario. If you're hoping to remain within Canada for your residency, then with respect to the quality of medical education, Canadian schools are on par with one another. However, looking at what you need to gain entry to a competitive specialty, there are a couple of additional factors: 1) research background (which seems to be an increasingly important factor for many specialties); 2) exposure to the people with whom you'd like to work; 3) exposure to a variety and depth of experiences in the area within which you'd like to work (via electives).
If you are in the position where you have identified your desired area of specialization as of day one of the application process, then it may help to be within a school which can easily provide a good mix of the above factors. For example, one of my pals, who is an Obstetrician/Gynaecologist, knew from day one that this was the route she wanted to take. She gained research experience in Reproductive Medicine at Mount Sinai, worked with a whole host of Obs/Gyn folks all over the world, but also, within the departments where she is now positioned, and managed to gain extensive Obs/Gyn electives experience (pre-residency she allocated all of her elective time to Obs/Gyn pursuits) at institutions which are renowned Obs/Gyn centres.
From my own point of view, I researched the specialties that I fancied relative to the facilities and opportunities that various medical school environments offered. It seemed that there were a couple which seemed to match what I was looking for by way of a good mix of the above factors; hence, I've only applied to those.
A big caveat here though: there's also great value to be found in having an open, flexible mind when it comes to meds. Although one area or another may be of immediate, passionate interest, we are going to be newly introduced to so many others. Overall though, once en route, there will be many, many people around who will be only too happy to provide guidance, help and insight and make the decision-making (no matter where we end up) a little easier.
Tell people your goals and people will help you attain them!
03-09-2002, 03:58 PM
I'm pretty sure I've been following SDN for longer than most, and that is where my knowledge of US schools comes from mainly. To get the competitive residencies in the US, I think the main factors from most to least important come down to: 1) Really strong away electives. 2) Really strong reference letters, preferably from bigwigs. 3) USMLE Step 1 scores. 4) High class ranking/AOA status. 5) Good quality research. 6) Quality of school attended.
I could, of course, be wrong. However, I think there's enough of a spread in most med school classes that the top person graduating from a lesser school (whatever that is) will usually be a stronger clinician than an average person from a great school. The reason I say this is because so, so much of your medical education is individual, and premised upon your own aptitude and work ethic. If you put a motivated individual into med school, they will prosper pretty much anywhere.
This is my feeling as far as Canadian schools go as well. You have a good shot of getting into most programs if you are a strong student, not because you came from some school that McLeans magazine ranked #1 last year...
However, as Kirsteen has mentioned, there is another side to the coin. In order to have strong away electives, and to get those research opportunities, you need to find a med school that can support those needs. For example, Calgary med school doesn't have an ENT residency program (at least, not mentioned in CaRMS). So, if you are a Calgary med student, you don't have access to residents to bounce questions off them regarding how to approach applying to ENT programs Canada-wide. You may not get as much exposure during your clerkship time as a result (purely hypothetical, I haven't checked up on Calgary), and even if you do, so much of your clerkship teaching is provided by the residents and not the attendings (because they simply don't have time).
As a result, I wouldn't choose a school based on its reputation, but rather if I had access to connections to the programs that I wanted.
HOWEVER, let me state right now for the record that I can guarantee that you'll find other specialties in med school that will fascinate you as well. A very large proportion of my class is now homing in on a specialty other than the one they had originally banked on as a premed student. Once you see the vast range of different specialties, and the personalities of the folks that are trained in them, you may well change your mind. Keeping an open mind is key in med school.
Oh yeah, and I think I'm going to move this to the Med Students forum. :)
UBC, Med 3
03-09-2002, 04:20 PM
I am leaning towards either radiology, cardiology, or maybe even neurology or radiation oncology. I'm pretty sure I don't want to do anything surgical, and I'm positive I don't want to do family practice. Anyway, all of the above have about a 50% match rate. I just want to make sure I'm in a position that when I decide what I want to go into, I'll have a decent shot at matching to that area. In other words, I want to be sure that all of the people who match into radiology didn't go to Toronto, UBC, or McGill!!
I interviewed at Duke a week ago, and they told us about their match rate a thousand times. I have been told that the reputation of your school is one of the important criteria (although, as you pointed out Ian, not the only important criteria!). Now that I've basically decided to stay in Canada, I realized I'd never considered that before. I suppose I'd just assumed that it wouldn't be a big deal.
So, what I'm basically hearing is that it doesn't really make all that big a difference what school you did your MD at when you apply to residency? I'm interested in research, and I know that they do have a fairly decent research program in all of those areas at Manitoba, so I'm not lacking there. And I have a feeling that I could do pretty well at Manitoba, so I'm hoping that grades won't be a problem.
I suppose I'm just worried that I'm making a decision right now that will hurt me four years from now when I'm applying for residencies. But I'm getting the feeling that I shouldn't be too concerned about it... Thanks!
03-09-2002, 05:02 PM
Western's first choice DISCIPLINE (not necessarily program at a specific center) match rate was 87% last year, I believe. I think that's pretty much standard across the country.
From what I know, Canadian Medical Schools are pretty equal across the country. . . if you're going to shine, you're going to shine anywhere. The key is to find a curriculum and school atmosphere that fits you - and keep up all of the extracurricular activities that helped you get into medicine in the first place. Beyond that - it's kind of a mystery. Basically, the way CARMS works is that you rank the programs you are interested in, the programs rank you (or leave you unranked, if they wouldn't accept you at all!). . . so it's all about getting the program you're interested in to rank you #1. How to do that depends greatly on the program. . . some look at marks first and foremost (difficult in this day and age where most schools are H/P/F, P/F, or even don't give a grade at all - Mac has a unique evaluation system), some count electives experience as a priority, others value research, and there's even been rumours that some residency committees are just looking for a good guy/girl to play golf & drink beers with (that's STRICTLY rumour - but the basis is that they have to spend 5 years with you so want someone they will enjoy being around for the 5 years.)
If someone could tell me how to 100% guarantee the residency of my choice I'd sure like to know. . .
03-09-2002, 06:01 PM
The match rates in Canada have in interesting story behind them, especially in the schools that tought them. Ottawa prides itself on having a very high first choice match rate(around 95%) and interestingly, they also have the highest percentage of students ranking family medicine first. I've seen a trend where the schools whos students rank competitive specialties first have lower overall match rates. Therefore in Canada, take the match rates of differents schools with a grain of salt. It's very unique to the students, not the school.
That being said, I believe that Queens has never had a student match to dermatology before. Part of it probably has to do with Queens not having any residency spots in derm. If you're looking specifically for a spot in Toronto, it might be best to do your undergraduate medical degree in Toronto because they preferentially select their own applicants(as most schools probably do). Students SHOULD have a better chance at their own schools because they've gotten to know the program directors a bit more.
Elective experience only helps you if they like you so you should try to make a good impression of yourself. In clerkship in Queens we're not marked H/P/F anymore, we're marked out of 5. This marking scale is also given to programs where we do our electives. Most directors will tell you that this clerkship mark is VERY important. For programs that aren't INSANELY competitive(plastics, derm), the first 2 years of med school aren't that important since there's so much variety across school systems. But you had better nail your clerkship.
03-09-2002, 10:08 PM
I strongly believe that elective experiences are #1, and of course, you have to perform strongly in them. I've had the opportunity to see visiting students on electives before (two in the last 30 days alone, with one from Alberta and another from Queens), and you can immediately tell sometimes if they are making a good impression or not.
Good elective experiences will be ones where you go into a new program, find your way around fairly rapidly, make a genuine contribution to the home med student/resident/attending team, and in general, show that you would make an excellent resident. My current impression is that grades may help get your foot in the door, but ultimately, the strong elective experience will really seal the deal. If you have a really good time on your electives, and the residents and attendings because of that can associate your face to your future CaRMS application, that's all it takes to get the interview (marks notwithstanding).
Of course, to get the good elective experiences, you've got to be a strong student. This means being fairly keen, knowing a bit about your specialty ahead of time so you can ask intelligent questions, having a good clinical skills base so that when you round on patients in front of the team, that you can relate to your patients and get the appropriate H&P done in an efficient and timely manner, getting all your work done without the residents needing to check up on you, etc. In other words, if you're already a good med student, your chances of performing well on those all-important away elective are much increased.
A poor med student isn't likely to have really strong away electives, unless they can really pull a good performance out of their hat. And yes, I think you can become a strong med student wherever you go, so Manitoba should not limit you. Of course, as mentioned before in my ENT example and Strider's Derm example, if your university lacks a particular program, you're gonna have a tougher time getting that good exposure before your away electives.
Even despite that, over the last two years, the one spot of UBC Derm has been filled by a non-UBC student (a McGill student this last year).
UBC, Med 3
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