OMG it's match day!!!

I woke up this morning in a cold sweat before realizing its not my match day.

As is said about another well known, life changing lottery, may the odds be ever in your favour.


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Questions to ask residents at your family medicine interviews

There is increased traffic to my site looking for information about CaRMS. Welcome. This post's for you.

Coming up with questions to ask in your interview can be mortifying as you stumble over your words wanting to just leave the interview room now that your questioning is over. These are some questions I wish I'd asked.

How well organized do you think your program is?
Do you like the order of your rotations?
What is the formal teaching portion of the program like?
When you talk to people at other sites, how does yours compare to theirs?
Do your docs like to teach?
Do you get the impression that your teachers are well supported?
What sort of support do the residents receive?
How often do you get to see other residents and learners?
Do you see a wide variety of patients?
Do you get opportunities to teach?
Do you have time for a life outside of medicine?
How much time do you spend driving?
Are you happy here?

These are things that aren't covered on the website so you won't look like a goof by asking something obvious. Like I did.

Gah.

Good luck!!

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Apps and PodCasts for CaRMS

It seems like most of the random traffic I get to my blog comes from those looking for info on CaRMS, especially those wondering what will happen if they don't match. This post is for you guys. It's intended for the CaRMS tour, but if I wait until then to post it you won't be able to procrastinate now from writing personal letters.

Pod Casts can be a wonderful way of getting ready to speak with interviewers before you head in. The speakers are using doctor words eloquently and may bring up points that are interesting to you and could inspire a tangential chat between you and your interviewer. They can help you pass the time while waiting outside the interview room and since they require headphones, ensure the other candidates won't freak you out. To be honest, I just had a graphic novel with me that I read while waiting. That kept other candidates far away from me because they figured I was a weirdo.

White Coat Black Art is a fantastic pod cast that often gets at the things that we often think about but rarely talk about, in particular the errors that get made in medicine and how we deal with them and with our patients. These are downloadable from the CBC website or through iTunes.

You can also download the app ReachMD for free. This contains a large selection of pod casts ranging from short 10 minute clips to 3 part lectures that are over an hour long. They have a table of contents based on CME, programming series, specialties (you name it, it's there), Listener's favourites, new programming this week. It's an American radio station on XM satellite but they often have Canadian content experts speaking. This may give you an idea of some of the current topics in the specialty you are applying to that you hadn't thought of yet.

Bump is kind of awesome and fun. It's a way to share data between iPhone users. All I use it for is contacts but it has function for photos, apps, music, calendar and social networks. When you are on tour, you'll be meeting some fantastic people you will want to keep in touch with. Bump lets you share your contact information quickly by bumping your 2 phones together so you can text and meet for a beer after interviews. These are your future colleagues, not your enemies, get to know them. Free app!

Starbucks will be in every city you are applying to. Knowing how to get your coffee in the morning or find a place to chill out the night before will make you a much happier applicant. This app has a mapping feature that will help you find directions to the nearest store and includes valuable information such as hours, if they have wireless, if they're drive through and if they will warm your apple fritter for you. Also free!

There will be times when you are preparing for an interview that you want to know some specific information about the city you are applying to. WolframAlpha is the multi trivia app for you. If you ask about the population of the city in question, it has that info plus graphs on the growth of the city in the past 20 years. It will tell you what is nearby to avoid geographical errors in interviews and allows you to compare to other cities. It also has a scientific calculator, information on weather, people and history, music, words and linguistics, information on the local athletic teams. Everything you could possibly want to know to schmooze with the interviewers. $1.99

You want to have your personal letters and CVs with you at all times on the CaRMS tour. It's likely that at some point you will leave the stack of paper in your car or hotel or at home. Emailing it to yourself is a brilliant idea, but what if you can't get access to the internet in the dungeon the interviews are being held in? Am I the only one who plays out these disaster scenarios in my head? I uploaded all my info to Office2Plus. It lets me keep local files on my phone, create word documents there too while I'm feeling creative and connect with my GoogleDocs Cloud folder. You can keep everything in folders that work best for you. The ability to organize everything and the fact that it mimics my PC make me like this app most of all. The original app is free, but you need to purchase within the app for the kinds of files you are using.

The night before your first interview and your interview at your number one school can be brutal for sleep - relaxation is not going to happen. Still, try Andrew Johnson's Relax. This

is a guided relaxation that can make you feel rested. I love his accent. I used this during clerkship too when I had 20 minutes until handover and didn't get any sleep. It helped keep my going just a little bit longer. There's a free version, not sure about that one, but the one for $2.99 lets you choose if you want to wake up or go to sleep at the end of the relaxation time and has different options for the relaxation itself. If I'm extra wired, I go through the meat of the guide 2x.

xkcd has an app. This will keep your humour high during interviews. These are brilliant comics! omg it's free!

Need to put your life into perspective? FML (f my life) has stories of teenage woe that are rarely worth the curse in the title (free). I prefer TFLN (texts from last night), a series of texts that were sent that likely should not have been, more often than not under the influence of alcohol. This one is $0.99 and infinitely entertaining.

Advice from those more clever than me about CaRMS

At the end of our third year, we had a panel of residency directors and residents come talk to the class about CaRMS. I feverishly wrote everything down for a friend who was stressed about missing the day. Now that I'm moving, I've just found this again and want to pass it on before I just chuck it in the recycle bin.

This list is not well organized, but there's some good advice in here.

- take care of yourself during the entire process, you'll be less likely to try to jump off your balcony

(our school is one of the lucky ones that doesn't have call during CaRMS!)

- know who you are and what you are great at

- your rank order list is a wish list for your future

- safety first, don't put all your eggs in one basket

- don't rank your back up if you don't want to do it

- things to consider - income, overhead and available jobs at the end of your residency

- what if I have no idea what specialty to pick?

- avoid seduction (e.g. special toys used in the field)

- look at what the day to day life in the specialty is like

- How can I be competitive with a pass/fail system?

- references and their letters

- electives

- research is used as a surrogate for proving that you work hard, focus, problem solve and follow a project to completion

- How do I pick who will do my reference letters?

- someone who knows you really well

-something will something interesting/good to say

- nice to have, but not needed to have qualities of a reference:

- well known

- on the selection committee

- all electives in one area is not a good idea

- diversify

- longer electives --> better reference letters

- high risk/high yield strategy is "bad" (not my word)

- choosing between the programs:

- do their residents pass?

- do they have good employment rates on graduation?

- how happy are the alumni?

- location of the program

- personal factors (family, sports, etc.)

- don't just apply to Toronto

- there are not plenty of spots in the 2nd iteration

- only rank the program if you can see yourself doing it

- just b/c you applied, doesn't mean you need to rank it

- you can apply to as may programs as you want

from the resident:

- personal letter should address:

- why the specialty

- where the program is (I *love* the ocean, etc.)

- some ask specific questions

- pay attention to the word limit ranges

- don't send the wrong letter to the wrong program

- can do generic outline then answer their specific questions

- references:

- most programs ask for 3 - 5

- ask "do you think you'd be willing to write me a good letter of reference?"

- pick someone who knows you well, another who is in your program, and another who isn't from your home school

- as long as you're going to be happy with a back up, go with it

- setting up electives:

- "we're full" isn't always true, use gentle persistance

- 3 week electives are a good amount of time

- don't split your elective time between 2 competitive electives, it makes you look like you don't want either

- when on electives:

- people expect you to be dumb

- be nice and smile

- don't be tired

- be keen but not over the top

- don't be late

- stick around at the end of the day

- offer to do call

- offer to present a case at rounds

- take the time before electives start to get your immunizations up to date

- good general things to have; anesthesia, gen surg, family medicine

- bottom line, residents are chosen based on who they want to work with for the next 5 years

that's it - as I've said, not my advice, it's from people much more clever than me

Post Match

This week has been incredibly emotional so far.

The day of the match included celebrations, crying, disappointment, drinking, dancing, hugging, crying and screaming.

Did I mention the crying?

It's hard when you are a type A personality who is used to having everything that you've worked for given to you to suddenly be given your second, third or 39th choice. Or even worse, to not get any of your choices.

Your world suddenly falls apart. Things you thought were true are no longer true. The beautiful bubble of perfection you have been living in pops and everything comes crashing down.

For some of us, the crash was largely in our heads. There was little really wrong with what we have matched to, it just wasn't our first choice.

For others, it meant taking a position provinces away from their partners or not matching at all.

It's been difficult for some members of the class who matched to their number one spot. They want to jump up and down and scream and laugh and be happy all the time. But they feel constrained by their love of our class and not wanting to hurt anyone who is less happy.

It seems unfair that their joy needs to be constrained.

match celebrations

Match Day is a crazy day. Crazy.

I finally fell asleep at 4:30 and was late meeting my friend. We decided to check our match at Starbucks. It seemed like a nice neutral place - no other med students, no partners - just tasty beverages and sweet treats prn.

She logged in first and squealed almost immediately. She matched to her number one ranked program in a very competitive specialty. So fantastic.

Of course I couldn't log in. The stress was ridiculous at this point.

When I finally was able to log in (¹minute not the 20 it felt like), I found out I matched to my third choice. I was devastated. It was hard - I was happy for my friend, sad for me. So was she.

The lack of sleep and shock of not getting my number one or two threw me and I was upset for hours.

Then I got over it. And now I'm excited for my next steps.

'Twas the night before CaRMS Match

And final year medical students all across Canada are stressed, drunk, taking sleeping pills or oblivious.

Though I know that any of the programs I ranked will be fine, I really want my number one spot most. Anything in my top five will be OK. After that though, it's not as pleasant.

I know I can make a home anywhere and I can direct my own learning wherever I am to fulfill my own goals. But, I would really like to be near friends again, and in a comfortable community. I want to feel like I'm putting down roots not getting ready to move on again. I've always been one to live in the now, not assume that "my life will start after medical school" or at some other distant point in time. Life is what I'm living now. It's just time for me to also look to be planning a future. These are big, grown up, "I'm almost 40" thoughts.

And since everyone knows what my top pick is, will I be dealing with overly sympathetic eyes tomorrow if I don't match there? What if I do end up in my 24th spot? How will I tell everyone?

And they are keeping me awake tonight.

something else you won't hear at law school

"Oh ya, I'm excited about match day. I'm so excited I can't sleep. I keep having night mares of matching to programs that don't exist. Last night it was a neurology program but only for Spanish patients. I don't speak Spanish. They told me I'd have to learn it by July 1st. They didn't care I applied to Gen Surg. They just kept quoting the CaRMS binding contract."

Post Rank Stress

Now that our rank order lists for CaRMS are in you would expect the stress level in the class to decrease. It has not.

On the day the ROL was due, people were still flipping around their top three choices of programs. Some were even still deciding their top choice of specialty. It was a stressful afternoon. I was threatening to glue classmates' fingers to their bums so they couldn't change their choices again.

Some poor folks cried, others threw things, it just wasn't a good day for us.

Since then, we are trying to come up with as many things as we can think of to keep us busy at night to prevent us from losing our minds. It's hard to not second guess the choices we've made. How can we know that we've made the right choice?

13 days between submitting our ROL and finding out our results is cruel and unusual punishment.

rank list

it's in

despite knowing exactly what I wanted to do, still felt like vomiting after hitting submit

The Unmatched

So what happens if your letter to Santa, err, CaRMS comes back unfulfilled? What if you are one of the dreaded unmatched candidates??

Last year, 3.7% of candidates went unmatched - at least one per school.

The class of 2011 will find out on March 7, 2011 where we are going or if we are re-entering the CaRMS process.

Why candidates go unmatched can be for a number of reasons. If all the programs I apply to are filled up by the time I get that far down my list, it could be me (see “Ranking”). It’s not that I’m necessarily a terrible candidate, just that at some of the crucial points in the algorithm other candidates were better.
I’ve known candidates who did not receive interviews because of something as silly as their reference letters were not in on time.
Other candidates are incredibly specific about where they are applying to residency. If you only apply to one specialty in one program, you better be a crazy rock star or incredibly lucky.
Some candidates have made it through medical school despite being a menace to society - these are rare - and are found out by the residency committees who don’t rank the students to come to their school. The committees are trying to find people they can work with.
Last year, Gen Surg had the highest number of unmatched candidates (13), followed by Anesthesia (11). Family medicine, always touted as a safe bet, had 4 spots unmatched. (these numbers are looking at the first choice of specialty candidates were applying to).
58% of the vacant spots in residency last year were in Family Medicine (176). General surgery had 3 vacancies, anesthesia had 2. In these cases it can be that the programs were picky about their applicants or applicants hadn’t ranked the schools. Or any combination … voodoo!!

If you have ranked any programs, CaRMS will automatically enter you into the 2nd iteration. In this iteration, there are fewer candidates who are Canadian Medical Graduates, more International Medical Graduates and fewer spots overall you are competing for. As a rule, CMGs do better than IMGs if only because we understand how the Canadian Health care system works.

This is the summary of vacancies to be filled in the second iteration in 2010 Every year is a little different.

The 2nd iteration goes faster than the first but is otherwise the same. After finding out on Match Day that you are unmatched, you go over your portfolio to make sure everything is in, apply to the schools and away you go. I’m not sure you interview again, it’s not explicitly said on the CaRMS website Then your new Match Day is April 13.

If the gods are not smiling on you, as sometimes happens, you end up in the scramble. Essentially, CaRMS only takes you through the second iteration and it’s up to you to take it from there. Our Student Affairs office helps students who reach this point. The students find out which programs still have vacancies and talk to them directly about taking a spot. Again, it’s not just the duds who are left unmatched at this point, it’s also the incredibly unlucky and those who have just made poor choices.

I prefer to emphasize the unlucky though - I feel it will bolster my karma.

Rather than enter the 2nd iteration though, some candidates decide to do a year of research to beef up their resume. There are pros and cons to this. Obvious pro is a beefier resume. Cons include the fact that the longer you are away from clinical experience, the harder it is to match (can’t find the stats, just remember that being emphasized at a conference CaRMS talk I was at). When you are away from med school but not in residency yet, it’s difficult to have insurance covered and so you are not permitted to work with patients. Yuck.

What must be almost as bad as not getting the program you wanted, is having to tell your classmates that you’ve gone unmatched. One of the past year’s plays was about going unmatched. It’s a very scary, very real thing. So many assume that they will get everything they want - it’s been happening for them their entire lives, hard to imagine it would just stop now.

I hope that any folks in my class who do go unmatched feel supported by the rest of the class.

Ranking

Starting during the CaRMS interview period, we are able to rank our programs but CaRMS doesn't lock in our choices until February 22nd. We can stew in our choices and make changes until then.

This is where the voodoo really starts.

CaRMS insists that the student is always the one who comes out on top and that they are able to match most students with their number one choice. Last year, 64.6% got their top choice, 2.9% got their 7th or lower.


Here’s how I see it happening for my friends applying to urban family.
Friend 1 wants to rank Mac - Hamilton, Mac - Brampton, UofT - urban, UWO - London, UWO - Regional (that’s it, he’s ballsy and only applied to 3 schools).

He is a good applicant, not stellar though, and will likely show up on each of the school’s rank lists unless he told one of his jokes in the interview, then God have mercy on his soul...
For this friend, having a pool of potential partners is more important than the program. Fair enough given that most family programs are essentially the same, it’s just the location that is remarkably different.
He will rank 1 - UofT, 2 - MH, 3. UL, 4. MB, 5. UR

When CaRMS goes to match him, they will first put him in the pool of people who picked UofT urban. There are 106 spots available for Canadian Medical Grads, so his odds are good. But if more than 106 people ranked UofT Urban first, my friend needs for UofT to have ranked him higher than a bunch of the others applying. If he is ranked 120 and UofT gets to their 150 spot of applicants, he’s in. If UofT only gets to 110, my friend goes to his second choice instead.

Here’s how it happens with me applying to my many (many) rural programs. Because the rural programs are so small, it may be easier to understand. Also because they are so small, it’s absolutely terrifying for me.

I’m ranking 24 programs all together (at 6 different schools). My top 5 programs have 22 spots total. Very different from my friend’s top 5 which has almost 300.
A - 2 spots
B - 1 spot
C - 5 spots
D - 1 spot
E - 13 spots
So my top 5 programs span 2 schools who have ranked me. At the risk of sounding conceited, I’m a strong candidate. I’ve been to the conferences, done the FM research, sat on every FM committee I could plus all my usual extracurriculars. On the whole, not a sucky candidate. I’m hoping it’s good enough to make it into their top ten.

Program A has 4 people who, like me, are gunning for it and will definitely rank A as their #1. There may be more but my sources weren’t clear. If any 2 of the 4 rank higher than me, CaRMS will look at my number 2 spot. If I’m lucky, no one else will want B as number one and it will still be in the running. Then I’m competing against all others who have B as #2. If that school ranks me above all others with it as #2, I get B. If not, I’m moved on to C. And so on.

It’s easy to see that if this continues, given how small the rural programs are, I could potentially end up at my 24th choice.

The trick with the ranking though, is to ignore what the schools are going to do and rank the programs according to what you want. Easier with the big programs than the small in my opinion... The other trick is to only rank the programs you can honestly see yourself in. Even though I have a program ranked 24, it would still be a good program for me. It’s clearly not my favourite, but if sent there by my binding CaRMS contract, I’m OK with it.

There are some programs I’m just not ranking because I don’t want to be sent to them. Worst case scenario I’m sent to the 2nd iteration and start over again.

The Interview Tour

The interviews account for a certain percentage of our overall score that the schools use to rank us. How much they make up depends on the program and usually we have no idea. Personally, I think voodoo is involved.

The goal of our interviews (and everything to this point actually) is for the schools to want to rank ME number one. ME ME ME ME. That makes it much more likely that I will get the program I rank number one. I’ll explain this in a post about ranking.

Prep for the interviews includes collating all our best stories from our clinical experiences. We want to make sure we have examples of good and bad team interactions, leadership, earth shattering awareness that THIS is the specialty for us, strengths, weaknesses, difficult ethical experiences, conflict with a “superior” and anything that shows that we’re not the babbling idiots we usually feel like we are. We practice answering questions but have to be careful not to practice too much because it tends to make it sound too rehearsed.

We buy a suit, or two, and worry about which shirt to put underneath.

Then the actual interviews begin. CaRMS interviews take place in the last week of January to February. In Canada, winter can be less than reliable. Students in my class have had their flights and trains cancelled. Roads have been slippery. I haven’t heard of any interviews that had to be cancelled for weather, just plenty of stress in getting in on time.

The kind of interview you get depends on what specialty you are applying to. Since I want family, my questions usually went something like this:
1. why family?
2. what skills do you bring to family medicine?
3. what challenges do you see family docs may have?
4. challenges the residents may have?
5. tell me about a good/bad team experience and what you learned from it
6. tell me about a particularly difficult clinical encounter and how you feel it has shaped the doctor you will be
7. why this program?
8. tell me about this thing you wrote down on your cv...
9. tell me about your strengths and weaknesses
10. tell me about yourself (very few actually asked this)

Family is a very chill interview - they try to make it more like a conversation so they can get to know us and figure out if we are the kind of person they can work with for the next few years. I was always interviewed by a doc and a resident in a clinical exam room, except one where I was in a board room of a hotel. The interviews lasted 10-30 minutes, with an average of 20.

Friends in other specialties had different kinds of questions though. My friend applying to gen surg was asked “if you were a salad, what kind would you be” - what?? Another in obs gyne was asked multiple ethics type questions and had MMIs rather than just hanging out with the one group. Safe to say that the type of interview you will get really depends on to what discipline you are applying.

With family and some of the other disciplines, there is a morning orientation when they go over the program in detail and why the residents *love* to be there. Family is split into programs on multiple sites so we always get several lecturers to talk to us about the different programs available through the school. This can take hours and is why family med orientations take so much longer than the other specialties. On the upside, we often get at least one meal out of the deal, usually two.

The orientation is followed by the actual interviews. Having such a long introduction to the day has the odd benefit of lulling us into a close to coma state so we are not as stressed about the interview itself. Or maybe it’s just me.

The interview tour has brought out the best and the worst in some people.

Some are acting like competitive children, ignoring conversations started by students from other schools. Others are actively trying to psych one another out. Still others are so insecure in their own worth, they are lashing out at those around them.

The majority are just trying to get through interviews in one piece.

The best though are sticking up for one another. Sharing hotel rooms when the weather is terrible and requires colleagues to stay in the city an extra day. They are meeting the people from other schools and getting to know them as well. Some even help up clumsy candidates when they fall all over the ground...no one I know I’m sure...

They are being the genuinely nice people they are. These are the classmates I am incredibly proud to know.

I was definitely not immune to the stress. The night before one of my interviews I had a dream that the school had decided to get rid of the usual Q&A and make it a spaghetti eating contest instead.

I decided it would be easier to not rank that school than deal with the insanity.

Interview Invitations

Invites for our residency invitations begin coming out a day or two after our CaRMS applications are submitted. Some programs that don’t fill up regularly in the first iteration will send invites before even going over the apps. These are lovely to receive - to know that you will indeed get at least one or two interviews!

Then you wait for the programs you actually want to go to.

These are scary days. One program in particular was a bit evil to me. They sent out invites to one half of the alphabet before the second. Five days before. I thought for sure that despite all my efforts to learn as much as I could about Family Medicine and all the time I’d spent on research and picking electives, not to mention the application preparations, were all in vain. People who were, in my awful opinion, less worthy than I was for an interview. I was terrified to think that those people were getting interviews and I wasn’t. Did my references fail me? Was I an undesirable candidate after all?

Interview invites came in over a month or two. Some of the people in my class didn’t get invites until the week before the CaRMS interview period had begun. That’s scary.

Once the invites are in, you need to decide how to schedule them all efficiently. You can literally be flying from Halifax to Vancouver to Montreal to Calgary. Expensive, especially if you have more than one specialty you are applying to. Some of the people I know have close to twenty interviews. Trying to coordinate all these interviews in all these cities can be confusing and really make you wish you’d paid more attention in computational mathematics.

There are emails and phone calls to make to program secretaries as you beg them to fit you into another day to maximize the number of interviews you can get to. Online purchases of flights, train tickets, bus tickets, reservations of hotel rooms and B&Bs. Deciding whether or not to room with classmates - in the program or not? Will they stress you out or make you feel more confident? How much money will you save really?

Our credit cards all had an incredibly workout in the weeks leading up to the CaRMS interview period.

I mentioned before that I decided that going across the country was not as important for me as saving the money for a trip in the future. It was a difficult decision but enough people were doing the same thing that I felt convinced that it was going to be safe for me to just apply within Ontario. Especially since that’s where I plan to stay.

But I was lucky enough to get invites to each program I applied to. Not all my classmates were as lucky and needed to do the travelling.

They are becoming very competent travellers. One friend has perfected the art of packing to be able to pack all she needs for a two night stay and an interview into one backpack. Impressive no?

The CaRMS Process; Years 1-4 prep

For the uninitiated, CaRMS is a mysterious thing. For those of us going through it, it is also mysterious, but with the extra added benefit of being terrifying.

Here’s how it works...

In first year of med school, some of us decide what we want to be when we grow up. Others don’t. Some of us have known for ever. Some are gunners for their particular specialty and start doing research in the first year and setting up appropriate observerships. We all join clubs and go to conferences and speeches and try to learn as much as we can about what we can do in the future.

In second year, many students who hadn’t previously chosen what they wanted to do begin to have an inkling. Some of these students see what the gunners have been doing and freak out, thinking they need to get to work as well. Some of the gunners decide they must have been nuts and start to change their research focus to something else. Other students remain comfortable in not really knowing what they are going to do since that is the situation of so many others.

In third year, lots changes. We experience the clinical side of medicine and rotate through different core specialties. We also need to choose our ‘electives’ for fourth year which will display our desire for one specialty over another. It’s a stressful choice to make for most of us. We need to make sure that our faces are seen at all the programs we plan to apply to during CaRMS. But most exciting is when we figure out that everything we’ve been planning is for something we don’t even want to do anymore.

So many of my classmates figured out in the last few weeks before beginning electives that they were looking at the wrong specialty. This is exhilarating and terrifying. Electives need to be rearranged at the last minute across the country but doing so means that you are showing so much passion for a field of medicine they now love. It’s something that we are told will happen in first year but we never believe them until it happens.

In our final year, it’s time to enter the CaRMS process. We find consultants who will write us reference letters, then dwell on whether or not these consultants were the right choice. Will they say something that the programs will take the wrong way? Which consultant will put us in the best light? Did I really spend enough time with this person for them to know enough about me to write a good letter? Will they resent me asking?

We need to choose which specialty (s) we are applying to. Should we back up with a less competitive specialty just in case? Should we apply to all the schools in Canada? Am I planning on couples matching? Can I stand to live in these places for years?

We write letters and essays about why we’ve chosen our specialty, what we’ve learned about ourselves and why we want to be in the program we’ve applied to. Then we fret about whether or not we have said the right things, that our examples are beefy enough or that we have accidentally left the wrong specialty or program in the letter when we copy and pasted the lines from one letter to another.

We also need to chose which comments from our third year evaluations will best communicate the type of resident we will be. Which of the ‘code words’ used by the consultants are most flattering.

All those clubs, conferences and research need to be pared down into something that will fit into the CaRMS prescribed CV template. Choosing which should be included and which discarded is something else entirely. Anything included is fair game during the interview. We want to look well rounded but not flakey, responsible but still like we’d be fun to work with.

The week that we need to finally submit our application is terrifying as we go over everything again and again to make sure it’s all there. Birth certificate, photo. letters, essays, transcripts.

Submit.

Wait for the interview invitations to come.

things you hear when talking to people who usually wear scrubs or jeans

student 1: epic wipeout on my way in for interview, sprained my finger and probably my ankle
student 2: oh no! Is your suit OK?

student 3: Gah! I can't believe they want us to eat this breakfast! All I can think is "don't spill on the suit".
student 4: Maybe they're watching us - like a test in dexterity ...
student 3: Thank goodness I don't want to be a surgeon.

student 1: how the hell can I be expected to walk in these shoes!!?!?

student 4: teeth check! any breakfast left?

Back to Class

It's shocking to us how tiring it is to be back in classes for hours at a time. Some folks are here for 9 hours of class per day, no breaks. Gah.

After 2 hours, I fuzz out and have a difficult time concentrating on what is going on at the front of the class room. For example, right now I am in class. Half the class is reading the newspaper (on their laptops or paper versions), the rest are sometimes paying attention to the lecturer.

The OSCE last night went well enough. One of the downsides of being involved as heavily as I am in curriculum and the medical community, is that my examiners were all people I know from outside class. It's one thing to humiliate yourself in front of strangers, but another all together to do so in front of people you have been working with as a colleague for four years.

This morning I had my first residency interview. One of the out of province schools came to us to interview which is wonderful. I get to save money on a flight out there to apply, though, I have dumped all my out of province offers. Applying in the first place was terrifying and I was sure that I would be the person in the class who didn't get to match because I let the interviewing committee know that I'm just an impostor and don't really deserve to be here. Then I got interviews everywhere I applied. Not everyone did though so I realised that I really was a competitive candidate.

I've decided to save my money from the flights and go south on a cheap vacation while the rest of the class continues their interview tour around the country. This had the dangerous effect of making me feel *too* comfortable in my interview and talking quite loosely rather than following any sort of clear plan when answering questions. I hope I'll stay competitive anyway.

I feel a strong draw to the oceans of the Maritime provinces. There's something magical about practising medicine on the coast. The hospitals in the small communities are run by family doctors with other specialities acting as consultants only. This seems like real medicine to me. Dr. Quinn Medicine Woman real medicine. I would be able to learn an enormous amount of medicine in the short two year residency.

When the rank list is due, I'm going to have a very difficult time choosing how to rank my choices.

CaRMS is in

For my birthday my partner took me on an all inclusive trip to Cuba. Fantastic.

We left the Sunday before my residency applications were due which was a bit stressful but I felt like I was ready and had no concerns about my app.

The trip was brilliant - warm water, white sand, carefully screened sun and abundant rum.

The day my application was actually due, I logged onto the very slow, very expensive internet at the resort and checked in on my application. I've made it abundantly clear that rural medicine is for me. Imagine my shock to discover that my rural essay had not made it into CaRMS's hands. Horror of horrors. Seriously.

I ended up having to paste my essay into the small spaces available for me on the CaRMS website, sacrificing other aspects of my application to ensure that the program gets my wonderfully crafted essays about how I belong in the country. Gah.

But, in practice for the day that I will be a physician and need to leave bad days at the office, I finished, freaked out for 1/2 an hour, then jumped in the pool to enjoy the last few days of my vacation.

Stressful? Yes. But I think I'd finish my app early and leave the country again. It meant that I wasn't around while the rest of my friends were freaking out and causing me to stress.

Plus, of course, rum. Tasty tasty rum.

there are so many ways to avoid doing my essays for CaRMS

tonight it's silly movies

CaRMS is rapidly approaching.

While I know I should have no problem explaining why I want to be a family doc in my personal letters I still find myself lost for words. I blame not writing here. So this isn't procrastination it's work. M'eh whatever.

I've been working with docs who help Canadian newcomers and refugees. These patients are teaching me so much.

I'm learning to be patient. Our interviews take at least twice as long since all questions and answers are filtered through an interpreter. My vocabulary often doesn't match either the patient or their interpreter so I need to come up with new ways to describe what most Canadians are easily able to recognize (e.g. weight loss).

I'm learning that some things make language unnecessary. Making faces at children, laughing, smiling and drawing pictures of flowers, friends and homes.  

I'm learning to laugh. Try doing a cranial nerve exam on someone who has no idea what you're doing. Hilarity will ensue I assure you.

I'm learning that my life is brilliant. I've never been shot. My house still stands. I haven't watched while someone I love was beheaded.

Learning daily from my patients will be my favorite part of being a doctor.