Activiteit

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.There is increasing concern amongst stakeholders over the high numbers of unmatched Canadian Medical Graduates (CMGs), yet little is known from the perspective of those who go unmatched. We present an opinion-based narrative analysis examining the matching process by reflecting on the pre- and post-match period and provide suggestions related to the Canadian context from the unmatched perspective. The challenge in the pre-match period was a lack of transparency around elective availability, resident selection criteria, and what happens after going unmatched. For the post-matched period, we were challenged with decision-making during a time-sensitive period, scheduling post-match electives, handling our finances, and improving our future residency applications without feedback. We have tried to identify the most impactful issues we encountered as applicants and unmatched students, and offered suggestions to improve the applicant experience. In addition to sharing our reflection in going unmatched, we also highlight the positive side of this formative experience.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 conflicting by learners who shift their focus away from learning towards performing in an effort to optimize their chance of matching to their program of choice. Moreover, the higher rates of unmatched students in recent years have likely contributed to this shift while at the same time bringing more stress and anxiety into the lives of medical students. I argue that there needs to be curricular consistency among all stakeholders including undergraduate programs, postgraduate programs, and other third-party organizations.

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.

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.

Forty-one percent of family medicine, 65% of internal medicine and 71% of pediatric programs explicitly stated having interest in applicants with scholarly experience. TVB3166 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 family medicine programs (100%) in Atlantic Canada mentioned scholarly activities but neither of the two Atlantic Canada internal medicine programs mentioned scholarly activities.

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.

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.

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.

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.

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.

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.

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.