CaRMS wackiness

When med students in Canada are entering their final year of study, they apply through CaRMS for their residency - the Canadian Residency Matching Service.

To put it mildly, it's a terrifying time for students in the 2011 classes across Canada. Some have been padding their resumes since they got their acceptance to med school oh so many moons ago. Others have just realized that they should have done research/picked a specialty/vaccinated a small country before now and are currently scrambling to fill their CV with astounding accomplishments. It's a bit goofy.

Back in the day, Canada had a brilliant way of doing things. Rather than being forced to choose our specialty right out of clerkship, medical students went into a year of internship. This was spent in a series of departments - like the clerkship year was for me - but with more responsibilities. Following this year, the students matched to their residencies where they focused their studies. Some docs went straight from this year to practice (general practitioner), while specialists specialized.

Problem was that eventually docs wanted to specialize early and did 'straight internships' that set them up for their specialty. Clerkship was developed to give medical trainees a way to see aspects of medicine they may not otherwise have access to. Unfortunately in the short amount of time allocated to students in clerkship per rotation, it is difficult to get a good idea of what the specialty is really all about. For example, my deliver room rotation is only 2 weeks long. We had 1 woman deliver a baby during business hours this week. I couldn't possibly decide I wanted to be an Obstetrician based on that.

This was a problem when the rotating internship year was in practice too, now it's moved forward a year or two.

While I accept that the one year of rotating internship is insufficient to train a modern physician to be able to practice anything, having just one year to choose our future is also insufficient.

At my school we have four months in our last year that is just for electives, a way to pad our CaRMS resume and discover more about the specialty we have chosen to pursue or rule out. My classmates started setting up these fall electives in January to ensure their application to residency would be shiny.

This is a great system for those students who are born knowing precisely what they want to do AND are correct. Some in my class however found out half way through (or later) in their clerkship year that they were not pursuing the path they should. They fell in love with a new specialty and are scrambling at the last minute to get electives and research set up in this new specialty.

I don't have a solution to this aside from starting our residency years split into two camps, medicine and surgery. Set up a rotating year based on this, then apply after our R1 year to the specialty of choice.