FAQ about residency interviews & matching.

Hi everyone! The final results from the poll I conducted on Instagram and Twitter *drum roll please* most votes were for Frequently asked questions about residency and examinations. I will split this into two sections as there were many questions that were asked. Thanks guys for sending them in!

Today I will be writing about interviews & matching into residency. We will be covering family medicine, psychiatry, pediatrics, physical medicine & rehabilitation. Several amazingly talented colleagues of mine were able to answer your questions. I want to thank Dr. Viji (@life.of.viii), Dr. Anne (@sweetrunmd) & Dr. Lakshmi for the information. We are all IMGs with our fair share of struggles to get into the system and we wanted to give back to our IMG community!

I am hoping to collaborate in the future with anyone from internal medicine, surgery and several other specialties as well. If anyone who matched into these specialties wants to send me a message to share their story/info that would be great!

What we have covered for you is information about scores, clinical experience, recency of graduation, clinical research & interviews.

Disclaimer: The views expressed here are our own and do not reflect the views of the respective programs that we matched at.

Family Medicine

Scores: I can speak for Ontario and BC as these are the two places I had continued to apply and interviewed at. In Ontario the expected scores are clear cut and written on their CaRMS description. I will be straightforward in saying if you don’t meet the cut offs for Ontario, don’t apply because it would have been a waste of $$. I believe the initial filtration process is probably using some computer program. That being said, there is still some what of a mystery when people who are above the cut off still get rejected. Then what exactly are they looking at? At the moment Ontario is no longer using the EE score. They will be looking at NAC (NAC score > 75, completed in 2018 or earlier, or > 413 or for NAC completed in 2019 and after.) The QE1 cut offs are yet to be determined.

In British Columbia, at the time I applied, moderate to high scores in your EE, QE1, NAC and CAP exam (quartile) were important in receiving an interview. The EE now has been phased out, but competitive scores for sure will likely get you an interview. Do well on your CAP exam, they really consider that highly to determine whether to call you for an interview (1st and 2nd quartile). As you will see from what others have said, it doesn’t hurt to do your best in all your exams!

Clinical experience: This will be looked for in your CaRMS application/CV and also at the interview. So YES it is important. I understand it is hard to find but keep looking around and asking doctors. Do observerships (I had a friend who matched with only oberverships), do clinical traineeships in BC (very valuable and seen as worthy in Ontario). In my interview I spoke a lot about my traineeship and my responsibilities. They want to see whether you have experience in the Canadian health care system. Also, you get letters of rec from Canadian docs, this is important for your application.

Recency of graduation: I think this differs from program to program but I know of so many people who are not recent graduates (including myself who was 8-9 years out) who matched! The importance once again is, how are you staying connected to medicine? How are you staying up to date with your medical knowledge? What experience are you getting?

Volunteering / Clinical research: I could be wrong in saying this but I personally felt that clinical research was not weighed heavily in family medicine applications for CaRMS but important in internal medicine it is important. That being said, if you are pursuing clinical research, get something meaningful out of it – like a publication! I had clinical research in family medicine but no one wanted to know more about it in my interviews.

Volunteering on the other hand, definitely important! Volunteer with an underserviced population (homeless, refugees, Indigenous populations, LGBTQ communities, women’s shelter etc.). I would suggest contact a group and sign up. If you can spare a couple hours a month it would be helpful. I had signed up with a group that assists First Nations communities. Through them I got HIV certification, naloxone training etc. I learned a lot!

Interview prep: Oh goodness gracious. I have been through many interviews and truly, I felt I didn’t match because I sucked at interviews! I was not confident enough and didn’t have convincing answers. Well, the more experience I got over the years the more “solid stuff/fluff” I had to share with my interviewers. More importantly, HOW I delivered my answers was crucial. I practiced practiced practiced (attended mock interview sessions at several medical schools, reviewed my answers with physicians, residents & my best friend who is a nurse). I also recorded my voice and listened to it over and over and this helped me correct my answers. I also timed myself.

Final advice: It seems impossible when you have been trying for so long and not getting the result you want (MATCH). You don’t know the future, you don’t know whether all this would be worth it one day….sure all these thoughts may be going through your head but DON’T GIVE UP. Had I stopped applying after the first few years of no interviews, I wouldn’t be where I am today.

Now read on 🙂


Psychiatry

Scores: There is no cut off score for psychiatry like family medicine, however, when you look at the program descriptions, each program has its own unique cut off that would either say they look at the whole
application. Aim as high as you can. Especially for the NAC as this is one of the factors tell programs that as an IMG you are at the level of a CMG in terms of clinical skills. I have known individuals who have had scores similar to the Family Med cut off and were still not given an interview in psych. So high scores puts a good foot through the door and leaves many options.

Clinical experience: Important and definitely an asset (observership or a clinical rotation). It helps when you get LORs from Canadian psychiatrists you have worked with here. They can attest to your skills and why you would be a good fit for the program. I personally did research in psychiatry which I felt really helped me as it was something to talk about during interviews. Although it does not say research is mandatory, it wouldn’t hurt if you are able to do some if you have the time. This shows your passion for psychiatry

Recency of graduation: People have matched years after they have graduated. It’s been done, and it’s hard to tell if it helps your application. That being said, anything is possible, as long as you keep showing your interest in the field through volunteering, research and any clinical practice you can do.

Volunteering / Clinical research / Getting the interview: The cut off marks gets your application looked at, and volunteering, research etc. are the other small details that show your passion for psychiatry and can help get you that interview.

Motivational advice: one thing I’ve learned from this journey is to never give up and never listen to anyone that says it’s impossible.


Pediatrics

Scores: For EE – This exam is not going to be used any more for future cycles (CaRMS 2021 onwards). But when it was used before 2019, I called some programs and found out that if you have above 300, you will pass the cut-off. This again depends on the applicant pool and the program. Large programs eg; Sick Kids look for high scores.

For QE1 – For the past CaRMS 2020 cycle, having above 500 (old score QE1) was competitive. But again, the cut off changes based on applicant pool, and even after you pass the cut off, they start giving you points for various areas of your application. So, depending on that you may or may not get interview. A person may have high scores but not competitive Peds specific application and that person may not get invited. Whereas, a person who may have passed the cutoff with one single point would have Peds experience and get an interview.As for the new scores, I have no idea. I would say getting above the mean (which is currently 250) would make you minimally competitive.

NAC – The higher, the better. The past cutoff ranged from 70 for some programs and 75 for the others. To be safe, its important to get above 80 since I have noticed that a lot more people are getting above 80, even 85 and 90 these days. I’m not sure what the new scale would convert to.

Importance of Clinical experience: This depends on the program. Medium sized and small programs value clinical experience. Larger programs have points for Pediatrics specific or related field research. When I say related field, I mean if you are applying for Pediatric Neurology position, then any neuro research, be it in adults or pathology or lab based would be counted.

When I discussed this with a couple of admission committee people including some PDs, they say clinical experience is valuable because with a large applicant pool (250 for 1-2 spots), they filter out people without electives aka no interest in the field.

I would personally recommend doing both. At least 1 research activity (poster or publication or grand round presentation or any conference presentation), and then doing minimum of 2-3 observerships per year. For medical students, get atleast 2 – 4 weeks of Peds. Some have upto 2 months of Peds. For those going abroad for internships, try to get a rotation in Peds.

Importance of recency of graduation: This is a challenging question because no one knows the right answer and every program has a different policy that they change every year. For people who are reading this and have had someone tell them the cut off is 3-5 years for being out of practice, I think either they sometimes say it to stop you from asking ‘what can I do to make my application better’ or its only partly true because the policy is going to change the next year.
Cut-offs are put in place to reduce applications that need to be reviewed. Certainly being in practice and recency of graduation is valuable but its not the end! For recency, you can work as clinic assistant or telemedicine assistant and that counts as recent practice. Graduation date can not be changed but interest in the field can be shown through many observerships. People have matched into specialties with 4 – 5 years of no clinical practice. Some on the online forums have noted 10 years of no clinical practice but recent telemedicine work. It still can be achieved!

I know in Ontario and BC peds programs, the recency of practice/ graduation date is preferred but it is not strict. This is mentioned in the carms program description. Other aspects of your application can help to get interview even if you have no postgraduate training (intern or otherwise) after 5 years of graduation eg: high scores, multiple observerhsips in Peds, Peds research and publications etc.

How to do well on your peds interview? Prepare as you would for CaRMS interviews – personal, behavioural, ethical etc.Pay more attention to Peds specific ethical issues. Be comfortable with different interview stations just like for med school interviews For eg: ‘acting stations’ and ‘team work’ stations. Be comfortable with working with anyone across population groups.

Practice a lot. Keep answer simple and in short sentences. A majority of the programs do MMI or MPI interviews.

Most importantly, tell them how you are connected to the program. They want to know if they can train you. So highlighting an observership or research experiences is important. Even if you are not connected to the program, talk about specific strengths that will help them decide whether you are good fit to their program.

Programs say they want someone with good team work skills, someone who can reflect on their drawbacks and who is willing to learn. You don’t have to be perfect but even if you have held a consultant position for many years in a different country, they want you to become a student again and be open to learning and keep improving as a physician. Your chief resident will be younger to you but that should not stop you from working as a team and taking instruction from them.


Physical Medicine & Rehabilitation

General advice: The biggest thing is showing an interest but also a knowledge of the field through electives, observerships, or research. Many people don’t know what PMR is and then apply. You have to show that you know what the specialty is (similar to many other specialty applications I think!).

Scores: No idea. The programs unfortunately don’t tell you. But I’ve been applying with a less than stellar EE but my NAC was good. My guess is they’d want above average scores but who knows.

Clinical Research: important but I don’t think it’s key. I interviewed many times with little research experience. Clinical experience like I said above is really important in my opinion. Any kind of exposure really.

Recency of graduation: I interviewed 3-5 years after grad. So I think it’s all relative. Although I was informed that Mac wants you to be ideally 3 years out. Again, who really knows right?

Like most of CaRMS sadly everything is rather secretive and you don’t really know what programs are looking for. From my experience I think knowing people in the department helps too. It’s a very competitive specialty with only a handful (2-3 this year) of spots in Canada per year. Good luck to all the applicants!


Thank you once again to my colleagues for such helpful and detailed information. You guys rock! 🙂

Peace, health & happiness. Stay safe everyone.

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