Med school is almost finished and residency is looming, but first: CaRMS. Are you ready?
The match process can be one of the most stressful moments in your transition to residency, but we’re here to help you through it.
Navigating CaRMS and the R-1 Match
SPEAKER: Everyone who wants to become a physician in Canada will transition from medical school into residency. The process of securing a residency position is called the R-1 main residency match or R-1 match, and it's facilitated by the Canadian Resident Matching Service, or CaRMS. CaRMS is an organization governed by a board of directors and closely aligned with many major medical organizations. Their R-1 matching service as a national system that connects graduated medical students to residencies in every specialty and family medicine. CaRMS also has three additional match programs.
The Medicine Subspecialty Match is for residents currently in an internal medicine residency training program who are looking to apply for subspecialty training. The Family Medicine Enhanced Skills Match is for applicants who are completing or have completed residency training in family medicine in Canada and want to pursue and have skills training.
The Pediatric Subspecialty Match is for residents currently in a pediatric residency training program who are looking to apply for subspecialty training. There are several steps in the CaRMS process each year beginning in the fall and running into the spring.
One, CaRMS opens for applicants and program descriptions are posted on the CaRMS website. Two, applicants submit translation requests for references. Three, CaRMS opens programs for applicants selection. Four, medical schools submit transcripts and performance records to CaRMS. Five, referees submit references. Six, applicants finalize their application, ensuring all required documents have been submitted.
Seven, the file review period. Eight, programs offer interviews to applicants. Nine, programs conduct interviews with applicants. 10, the ranking period. Applicants and programs submit their rank order lists or ROLs. 11, preparing for match day. 12, match day. 13, second iteration and post-match options. 14, CaRMS closes for the year.
The only match timeline changes slightly from year to year. The timeline for this year's match is available on the CaRMS website. Year one match opens in the fall and applications are due in late fall to early winter each year. Residency programs then have a couple of weeks to review the applications. If you'd like to withdraw your application, you'll need to do so before this review period closes.
Following this, medical students are offered interviews by the medical school of their prospective residency, typically between February and March. After these interviews are conducted, applicants and programs indicate their preferences by creating a rank order list or an ROL. CaRMS goes through several processes in the matching process where the algorithm based system reviews applicant ROLs, program ROLs, and the number of available positions.
CaRMS always favors the applicant ROL over the programs. The algorithm attempts to match each applicant and program with their first choice for each position. When that is not possible. It moves down through the ROLs to find the next best match. After this period comes match day, where medical students are informed where they are being offered a residency. Some applicants may not match. This can be very difficult news to receive but there are various options available as next steps, which will be presented later in more detail.
Most medical students participating in the R-1 match apply individually. But there's also an option for couples match, which allows a pair of applicants to submit together. This can help couples looking to do residency together to secure two positions at the same location. However, applying for a couples match can lower the chances of a successful match because it requires two positions to be available. In the event that a couples match is not possible, CaRMS will proceed to find individual matches unless the applying couple indicates that one of the applicants will withdraw from the match if it is not possible for them to match together.
This process applies for Canadian medical graduates, sometimes called thre CMGs participating in the R-1 match. American medical graduates are referred to as USMGs, and there's a slightly different process to transition from American medical schools to Canadian residency programs. Other international medical graduates, IMGs, have another process for application. This video will focus on the process for Canadian graduates applying to Canadian residency programs. But resources are available for all medical graduates.
As you complete medical school and pass the required exams the first step in getting ready for the R-1 match is to begin preparing your application. Starting early as highly recommended. Applications require a lot of thought and work, so giving yourself ample time to prepare is essential.
You also need to prepare financially. For the 2023 R-1 match, the participation fee is about $300, and includes applications to four programs. Each additional program you apply to will cost an additional $57. In recent years, CMGs have typically applied to over 20 programs, with an average total cost of about $1,200. This means costs of around $1,500 for the typical Canadian medical graduate.
Before the COVID-19 pandemic, interviews for the R-1 match were conducted in person and many students faced additional costs of several thousand dollars for flights, hotels, and other travel expenses. As of 2021, interviews have been conducted virtually, greatly reducing costs and travel time. Should interviews again be conducted in person, you'll need to plan accordingly for these costs.
Before you start your application, you must decide on your preferred discipline. As you probably already know, there are many different specialties in which you could practice. You can apply to multiple disciplines, but ultimately you will want to select the ones that you would be interested in practicing for the rest of your career. This requires a lot of reflection, which can be supported by discussions with other medical students, residents, practicing physicians, professors, family, and friends.
[This slide includes a diagram reflecting different physician disciplines, organized into groups titled medical, surgical, procedural, mixed and diagnostic]
You may also be able to shadow a practicing physician if your medical school can arrange it and see what a day in their discipline is like. Some physicians do change their discipline during the residency or even afterwards, but proceeding with the highest confidence in your application will set you up for success in the near and long term.
Statistics about each discipline and medical school can be found in the current edition of the Canadian Federation of Medical Students match book as well as the [SPEAKING FRENCH]. These guys will help you understand your options and are essential resources to use when planning for your applications.
When selecting which residency program you're going to apply to, you should consider several factors in addition to the discipline. Be sure to ask yourself these questions, where is the residency? Do you have friends or family nearby? Is it easy for you to visit home? What is the culture like there? Does it have the amenities you might want? Do you have a partner or relationship that might be affected by where you would live?
What is the rotational structure like? Does it involve multiple sites? Are there research opportunities? What kind of lifestyle and career would you have in that discipline? Would the hours and work be satisfying to you? Would the setting, be it a hospital, clinic, private practice, et cetera, be right for you? Where would you like to be practicing as a physician? Are you looking for an urban or rural center? Is there a known demand for your discipline where you would like to practice?
By thinking beyond the application and even the residency, you can better set yourself up for satisfaction and success. Once you've considered these details, you can begin your application. When evaluating programs, consider if French or bilingual programs in rural or remote streams might be right for you. French and bilingual programs do require comfortable French speaking fluency for interviews as well as fluency in reading and writing in the program itself. Consider whether rural and remote settings would suit you.
Many programs provide opportunities for applicants to connect with current residents or program directors. This can help you learn more about the program and evaluate if they're the right one for you. Always check to see if there's communication opportunities available and take advantage of them. Not only can they give you more confidence in selecting the right program, you may learn some valuable tips on how to submit a stronger application.
The CaRMS website has a list of program descriptions and details that can help you customize your application. Be sure to note maximum word counts as well. If you don't respect word counts or you leave out required program specific details, your application may be filtered out.
Your application requires a general CV that includes your language skills, LMCC, or other licensed medical training, achievements, interests, undergraduate, or CEGEP education, graduate education, medical education, clinical electives, professional training, work experience, volunteer experience, scholarly activities, research, and more.
In addition to the general CV, some programs also allow you to provide tailored CVs. It's a good idea to start with a strong general CV and then tailor it to each program or at least each discipline that will accept a customized version. By customizing your CV appropriately, you can highlight the most relevant details for that program.
You will also need to submit personal statements which you should tailor to each program that you apply to. This is an opportunity for you to demonstrate your interest, motivation, and fit for each program. It also allows you to speak to your long-term career goals and how that particular residency program will help you fulfill them.
While your CV contains a list of facts, the personal statement puts them into context and helps tell the story of why you're a good fit for the program. It helps if your personality and enthusiasm for the program shines through. These details can help paint a Fuller picture of you as a person and as a candidate.
Making sure that your CV and personal statements are grammatically correct, well written, and appropriate to the programs is an essential step. Even though you may spend a lot of time working on the documents and feel that they are ready to go, it's a very good idea to have at least one other person review them before you submit it. It helps to ask someone who is a strong writer, familiar with the CaRMS process, or both.
Be receptive and grateful to the feedback and take any suggestions to heart. Ultimately, you decide on the content that you submit, but a good editor can help you elevate your work and make you look your best.
Another key component to your application is reference letters. These are letters attesting to your skills, drive, and experience that illustrates your fit for residency. When requesting letters of reference, make sure you approach people who have sufficient positive experience working with you and they can speak to your abilities and strong work ethic.
It takes time to write reference letters, so request them four to six weeks before the deadline. You can request them from physicians you worked with on your clerkship electives or shadowing, researchers you worked for, medical school, or graduate study professors you have impressed, trusted authorities you worked with in extracurricular activities, or employers that you've recently worked for.
It's important to start the application process early, because it gives you time to think carefully about all of these details. You'll do a great deal of learning while preparing your application and may revisit some of your earlier perceptions intentions or goals. It's OK to explore different paths and programs while you prepare your application, as long as you feel confident on the details you select when you submit it.
Talk with other medical graduates and residents. Invite and be receptive to feedback. Be mindful of what you submit. There is no perfect application. You may feel like you need more detail, but by giving yourself as much time as possible, you'll be able to submit your application with confidence. After the application deadline is passed, programs have an opportunity to review applicant files. During the file review period, program directors develop a list of the candidates that they're interested in.
The next step is the interview stage. The interview format varies by program and medical school. Common formats include the following. In one-on-one interviews, applicants answer questions from a single interviewer. In panel interviews, applicants answer questions from a group of interviewers, typically two or three.
In multiple mini interviews, or MMIs, applicants circulate through a series of interview stations, typically five to eight, each focusing on a different theme or scenario. Stations vary, but they commonly include standard interview stations similar to the one-on-one interviews. Less often, stations may include standardized patients or actors, riding stations or ethical scenarios.
In addition, interviewers may or may not have access to a range of information from your application. In closed file interviews, the interviewers do not have access to your CaRMS file. In this format, the interviewers will only know what you decide to share with them.
If there are aspects of your application that you'd like to highlight, you'll need to incorporate them into your answers. In semi-open file interviews, the interviewers have access to certain aspects of your CaRMS file such as your personal statement or your CV. Again, you should be prepared to highlight the most important parts of your file in the interview.
In open file interviews, interviewers have access to your full CaRMS file. With this format, it's important to ensure you remember all of the details of your application. The interviewers may probe regarding a specific experience referenced in your CV or an aspect of your personal statement. You'll be told before each interview what the format is and how much information from your file is available to the interviewers, so be sure to prepare accordingly.
In addition to the formal interviews, you may be able to participate in some non-interview events. These can help build your understanding of the programs, the interview details, and the people involved in the program. This can include the following, meetings with the program director may or may not be available, based on the size of the program and the number of applicants. Strive to be interested but not overbearing.
Some programs include a meeting with the program director as part of the interview day. Interview information sessions are events that enable programs to highlight and showcase aspects of their programs or sites. Programs are aware that most applicants are applying to multiple programs within the same specialty, and as such want to give applicants a sense of what they would experience if they were to successfully match to their program.
Interview socials are an opportunity to meet staff physicians, program administrators, residents, and fellow applicants in a social setting. It's imperative that you behave professionally in all interactions, as you won't know who is on the selection committee or from whom the selection committee may seek input.
Additionally, the Association of Faculties of Medicine of Canada offers CanPRePP, a Canadian Portal for Residency Program Promotion, which features a calendar of many preparatory events with residency programs. It can be accessed online at canprepp.ca. If you have an opportunity or receive an invitation to participate in a non-interview event, it is strongly recommended that you attend. If you don't attend, you may miss out on getting information you can leverage in your interview, and it can also be interpreted as a sign of disinterest in the program.
If you are unable to attend a non interview event because of an inflexible scheduling conflict, you should still respond to say that you would like to attend but are unable to because of the conflict not only is this respectful, but it also lets the program know that you're not disinterested in the program. Being organized and keeping an up-to-date calendar is essential during the interview period. It is very important to keep track of all interviews and non-interview events. Failing to attend an interview can reflect very poorly on you as an applicant.
If your interviews are across multiple time zones, be sure to note the times and ensure you have your schedule synced to the time zone you'll be in. During the interview, you will be asked a variety of questions to assess your fit for the program. While you may have a lot want to share, time constraints or question formats may not allow you to share everything that you'd like. Be sure to work your most important highlights and qualifications into the questions you're asked within the time that's allotted.
Question formats can include the following. Behavioral questions ask you to demonstrate behaviors, knowledge, skills, and abilities. Examples or questions that begin with, tell me about a time when, what do you do when, and give me an example of, situational questions focus on the future and ask how you would approach a hypothetical situation. Examples include, what would you do if and how would you manage--
Knowledge-based questions require some background knowledge or may probe medical or personal ethics. An example would be an interpretation of a common investigation, such as an ECG. These questions may also present as clinical scenarios. Getting to know you questions may have nothing to do with medicine or your medical training experience. For instance, you may be asked to talk about your favorite movie or TV show, to describe who you'd like to have dinner with, or to talk about your hobbies. Keeping your application and the program details in mind, you should be prepared to answer these types of questions and others.
Some interviewers may ask questions that seem unrelated or complex. They may be evaluating both your answer and how you provided it. You will be asked questions you haven't considered and different interviewers may interpret your responses differently. As such, developing a general approach is more useful than preparing exact responses. Keeping calm and confident throughout conveys that you have good demeanor for the program and as a physician.
When responding to questions, there are some guidelines that can help you provide strong responses. Take a moment to collect your thoughts. It is common and completely acceptable to take a few seconds before responding. Some candidates may elect to take a sip of water while others will simply say, I'm just going to take a moment to think about that question or pause in silence. This will not negatively affect your interview. It is more thoughtful and professional to pause briefly to come up with a plan than to proceed immediately and lose your sense of direction during the answer.
Ask for clarification when needed. Sometimes questions can be long, have multiple parts, or have unfamiliar phrasing. It is completely appropriate to ask the interviewers to repeat or rephrase a question to ensure that you've understood it. Keep it simple. In each answer, stick to one experience or role, unless specifically asked for more. This way, you can describe in more detail the relevant factors, thus providing a stronger case for the skills you've developed or the relevance of this experience.
Make the connection. Interviewers are not just asking questions arbitrarily. Assume there's an underlying connection between the question and a skill or experience that would demonstrate your fit for the program. Incorporating this in your response can make it easier for the interviewers to see you as a future colleague.
Demonstrate growth through failure. You will probably be asked to describe mistakes or challenges that you've experienced. It is important that you reflect on what you've learned from those mistakes or experiences and describe what changes you have made because of it. Diversify the experiences you mention. Candidates often have several remarkable experiences that they'd like to highlight in interviews. To help demonstrate the breadth of your experiential background, practice discussing different experiences in response to similar questions. This way you can discuss different ROLs during the actual interview to show diversity without repetition.
Use a framework that works for you. The internet has dozens of acronyms for ways to approach specific question styles. For example, STAR, where you identify the situation, task, action, and result. Generally, these involve potentially repeating the question, explaining the logistics or context surrounding the problem or experience, and then answering the specific prompt with the result and reflection at the end. There's no perfect way to answer, but it is important that you feel confident in the approach that you choose.
End strong your closing statements on a question are often the most important and remembered. Summarize your overall answer to ensure that you have discussed every point that you intended to. The interviews can often be the most stressful phase of the R-1 match process, while the application is a large body of work, it can be prepared in advance with support from peers. The interviews are conducted live and you will not have any external help while they're conducted, that is why preparation is the best thing you can do to perform while in interviews.
Mock interviews with peers, family, or friends is an excellent way to prepare. Here are some tips for mock interviews. Mimic the real interview setting. As much as possible, try to recreate the interview conditions. They should include virtual setup, location, clothing, and timing. This can help you become comfortable and adopt the mindset you will be required to have during your actual interview.
Have the interviewer take notes. It can be helpful if the mock interviewer takes notes during your responses as a real interviewer would. This allows you to identify the content that the interviewers might deem most relevant while receiving constructive feedback in the process.
Practice answering on the spot. Have your interviewer ask you questions that you've not practiced. Answer thoughtfully as if you were in a real interview. This will help you develop your approach to novel questions and learn how to think on the spot.
Practice full interviews. It's often appealing to practice question by question debriefing after each one. However, it's also valuable to practice pacing through the overall interview structure. For example, going through questions successively will help you learn how to introduce a different experience for each question and tell a cohesive story.
Arrange for multiple mock interviewers. Different interviewers will recognize different strengths and weaknesses. Practicing with friends, medical and non-medical, family, mentors, and school programs can provide you with diversified feedback.
Record yourself answering questions. This will show you how interviewers will see you. Reflecting on the recording can help you evaluate the structure and organization of your answers, as well as your body language. It's also important to hear how your answers sound and to determine if they reflect what and how you intended to communicate.
Mock interview your colleagues. Being on the other side of the interview process can help you relate to the interviewers' experience. It will help you understand the pertinent aspects of the responses that interviewers may focus on including nonverbal behaviors, appreciate how your colleagues tackle different questions, and can inspire your own approach.
Every year, the Canadian Medical Association offers a free and open CaRMS interview preparation program to help medical students in this area. This program connects you with residents who have successfully matched through CaRMS and know the interview process very well. It includes simulations, question and answer sessions, and constructive feedback. The CaRMS interview prep program does not impact your CaRMS application or interviews. It's a safe space to learn ask questions and build your confidence. The program runs from November to March each year and we warmly welcome you to participate.
You can sign up for the program on CMA.ca/CaRMS. Or if you're a member, you'll receive an invitation once registration opens. CMA membership is free to all Canadian medical students and residents and comes with many other useful perks. More information about membership and the program can be found online at CMA.ca.
As mentioned previously, CaRMS interviews were formerly conducted in person on site at the medical schools or their facilities. As of the COVID-19 pandemic, interviews have been conducted virtually. If you haven't done a virtual interview before, there are a few things to be mindful of. Use a reliable device with good video and sound quality, like a laptop or smartphone. It might be helpful to use external headphones or webcams. Disable any notifications on your device that may distract you during your interviews.
Find a private quiet location free of any distractions. If you live with others, ensure everyone is aware of your scheduled interviews to avoid disruptions. Ensure your background is appropriate and professional. Avoid virtual backgrounds when possible, as this may give an informal appearance. Test out lighting options before your interview to ensure your lighting is appropriate. Ensure your internet is stable and your speed is ample for video interviews.
When the interview begins, it's a good idea to ask the interviewers if you're coming through clearly. Provide your phone number and document the interviewers' contact details in case of technical troubles. As you would for an in-person interview, dress professionally from head to toe. You might think you only need to dress for what's onscreen, but you might end up standing up or moving around.
Ensure that your attire is professional but comfortable. It should give you confidence and feel natural to wear while you're interviewing. Make sure you're Fed hydrated and well rested before the beginning. Some light exercise and then a clean up into your professional attire can calm your nerves. Set aside some time to be feeling your best for the interview.
Interviewing can be stressful. Ample preparation is the best way to reduce stress and increase success. Take as much time as you need to feel ready, and don't be afraid to ask others for help. There are many resources and supports available to help you do your best. Regardless of the interview format, much of the advice is the same. Dress well, set yourself up for success, and feel ready and comfortable when you start the interview.
During your interview, you may feel that you are exclusively in a position of wanting to join the program. But remember, the program also needs you. While being interviewed, you are also interviewing the program. Asking thoughtful questions and getting a sense of what's involved is important. Not only can this address your concerns, but it also demonstrates initiative and thoughtfulness, which interviewers value.
Once you've concluded your interviews, the next step is to submit your rank order list or ROL. This is your ranked selection of programs. It can include multiple programs in medical schools as well as streams within each individual program. Keep in mind that you must only select programs that you would be willing to train in. If you renege on an offered match, you may incur penalties, which can include disqualification from participating in CaRMS for up to three years. Your application includes a contract and this should be taken very seriously.
When preparing your ROL, you should ask yourself the same questions as when you started your application to make sure that the programs you prioritize are right for you. You don't have to be a gastroenterologist to learn to trust your gut. If you've got a bad feeling or a good feeling about a particular program, it might be that there's details you can't identify but that are shaping your choices. Above all else, you should feel confident with the ROL that you submit.
If you are a couple looking for a placement together, you can request a couple's match. Being able to do your residency with your partner can enable you to spend more time together and reduce costs, but it can also slightly diminish your chances of securing a placement, because you're submitting an ROL jointly. A joint application increases the chance that one or both of you may go unmatched.
Make sure you have a backup plan and consider the possibility of doing your residencies in separate programs and cities. This can lead to disappointments but the nature of residency is such that you might not be able to be placed together. The CaRMS matching algorithm will attempt to match you to your programs of choice. It compares your ROL to the program ROL, noting the number of positions available. The algorithm always prioritize the applicants ROL over the programs ROL, aiming to ensure you receive your placements of choice. The CaRMS algorithm is typically very successful at placing applicants within their top three choices.
[This slide includes a diagram showing the flow of CaRMS running the match process, which includes the steps of confirm final data, run and confirm match, verify system, Match Day prep and Match Day.]
Once the calm system has analyzed and assigned ROLs and positions available, the next step is to inform the programs and applicants. The applicants are informed on what is known as match date, which is typically in March. The amount of preparation leading to match day can bring on strong waves of emotions, from joy to fear to excitement to a disappointment. Whatever you may be feeling, it's important to be kind and gentle with yourself.
Regardless of how confident you feel in your application and your interviews, the anticipation can be very stressful. It's very normal to feel overwhelmed. You may want to clear your calendar on the day or days beforehand and try minimize any external stresses or concerns. On match day, you'll receive all of your outcomes from the first iteration of matching.
There is a possibility of not being matched in the first iteration, which we'll discuss in more detail shortly. Even when you are matched it's understandable to feel disappointed if you did not receive your first choice of program. The algorithm has a high success rate, but program needs and availability as well as the strength of your application and interviews can also affect the outcome. You should prepare yourself for any and all outcomes to avoid disappointment and an increasingly negative response.
As with the anticipation leading up to match day, you may feel very emotional when you receive your outcomes, and some of your emotions may even feel contradictory. However, any way that you feel is valid. You should take the time to process your feelings.
When speaking with your medical graduate peers, be mindful of their emotions as well. They may be excited, disappointed, relieved, or remorseful or something else. Do not make assumptions about how they feel and be respectful if they're not ready to talk about their results yet. Choose your words mindfully. Even in positive scenarios, emotions about match results run high and it can be easy to upset someone.
If you receive notice that you are unmatched in the first iteration, remember that it's not the end of your medical career. It's not a reflection of your medical knowledge, skills, or competency. Many factors shape the match and some may be out of your control. Some programs can be extremely competitive or highly ranked and accordingly have few positions open.
Every year, there are many who go unmatched in the first iteration, but nearly all of the applicants persevere and become practicing physicians. Take a deep breath, allow yourself to feel the emotions you're feeling, and remember that you have options. After the first iteration, there is an option for a second iteration. You can participate in this, but be aware that there are significantly fewer programs available, the pool of applicants is very different, and there is a shortened timeline to proceed.
Before proceeding, consider the following, is there a position available in a program that you could see yourself training at? What might change to make you a more competitive applicant between now and a future match cycle? The unfortunate reality is that applicants are statistically less likely to match with each passing iteration after their first one. Brace yourself accordingly.
If your medical school gives you the option of deferring graduation to take a fifth year or fourth year for three-year schools, participating in a second iteration may be a prerequisite of this additional year option. Inquire and do your due diligence before deciding on how to proceed. As with the first iteration, a match result is binding. Only submit choices that you would like to fulfill.
Even if you participate in a second iteration but still go unmatched, there are still other options available. CaRMS offers a post-match process, PMP, that enables unmatched applicants to submit applications to programs still considering candidates. You must contact your postgraduate office to participate in this process. Available positions are listed in the post-match program descriptions on the CaRMS website and can be added or removed at any time. This process also has a defined and short timeline.
There are still other options beyond the iteration and PMP. The Canadian Armed Forces offers a medical officer training program, MOTP. This is available to medical graduates and residents and family medicine. In the MOTP, you would proceed with what is effectively a family medicine residency. Along with armed forces training, you'd receive a salary, benefits, and vacation during this period. You'd be required to serve with the armed forces for a period of time, but then you would have a choice to continue with the armed forces or practice as a family physician or general practitioner or pursue other residencies or trainings.
In the event that you go unmatched and the other options aren't ideal for you, you can reapply to CaRMS the following year. In the interim, you can continue your studies, conduct research projects, work in a health care related, field or pursue any other number of options. Going unmatched is not the end of your career as a physician unless you want it to be. There are options and supports to help you succeed and achieve your career aspirations.
Before, during, or after match day, you may feel more distressed than you can handle. There's no shame in this. You've put in a tremendous amount of work and the matching process certainly puts a lot of pressure on you. There are many free and accessible supports that you can reach out to for help, advice, or just a friendly person to listen to you. The CMA is a free confidential, bilingual, and 24/7 wellness support line available to you, tailored to each province and territory.
Additionally the CMFS has a directory of medical school specific wellness resources. The FMEQ also has links to wellness resources, including school specific links as well as unique supports for Quebec 1 medical students and physicians. Links will be provided in the description. The CaRMS matching algorithm has a high rate of success, and we hope that you'll receive the best news on match day.
While beginning your residency is important and this is a big step in your career as a physician, just remember that you will have the ability to change your residency, your specialty, and many other options for your career. Be sure to choose wisely in the CaRMS application process, as there may be penalties if you decline the program you match to.
But after you start your residency, you may decide you want to switch streams to become a family physician or a specialist or a researcher or perhaps work in Health Administration, or explore any number of fields and roles the medical school is prepared for you, and that's OK. The important thing is that you feel confident during the R-1 match process and know that you still have lots of time to chart your own path.
In conclusion, there are a number of important steps and activities that we strongly suggest for each medical graduate. Take note of the CaRMS are one match timeline for the year in which you'll be applying, and give yourself as much time as possible to complete the required activities. Make sure to register for the CMA CaRMS interview prep program to speak with residents practice interviewing and get direct answers about any questions you might have. Be sure to check out the CFMS match book and FMEQ give the residence or both. Your medical school may also have additional helpful resources.
Review the FMC virtual interview handbook, which is an excellent resource to prepare for your interviews. Explore the CaRMS website, which contains extensive and current details on every part of the process. Remember that at every step of your journey as a physician, from medical student to resident to practicing physician, the Canadian Medical Association is here to support you, advocate for you, and build a positive community of physicians and health care stakeholders.
For any questions at any stage of your career, don't hesitate to reach out. Our contact details, programs, and resources can all be found on CMA.ca.
As of the 2022 R-1 Main Residency Match, CaRMS has introduced a new fee structure that can greatly reduce application costs for most participants. Applicants pay a program application fee for each program over and above the four included in the match participation fee. For programs with multiple training sites at a university, the program application fee is charged for the first site an applicant applies to. Any other sites they apply to within the same discipline at that university are not subject to an additional program application fee. There is no minimum or maximum number of programs to which applicants must apply. Full details are available here: https://www.carms.ca/pdfs/2022-R-1-fee-change.pdf
The CMA would like to thank the Canadian Federation of Medical Students (CFMS), the Fédération médicale étudiante du Quebéc (FMEQ) and the Canadian Resident Matching Service (CaRMS) for their support, review and guidance in the production of this video.
- The Canadian Federation of Medical Students (CFMS)
- La Fédération médicale étudiante du Québec (FMEQ), including wellness resources
- The Association of Faculties of Medicine of Canada Virtual Interview Handbook
- The CaRMS R-1 match timeline
- CaRMS R-1 program descriptions
- The Medical Council of Canada’s examinations
- CFMS school-specific wellness resources
Playbook: Preparing for the CaRMS R-1 match
Members of the CMA Ambassador Program have put together a playbook to guide you through the entire CaRMS process, from start to finish. From the perspective of people who've been through the match themselves, it covers many key considerations that can help you to succeed at applying, interviewing and matching.
Part 1: Application and documents
Deadlines can sneak up on you quickly and there’s a lot of different paperwork to organize and write.
- The CaRMS match participation fee includes nine program applications. Be sure to make use of all of them! That being said…
- Apply only if you would actually want to join the program and the specialty. Your time is valuable, so don’t apply just for the sake of applying.
Be true to your values
- What qualities am I looking for in a program?
Is the cohort the right size for me? Is the balance between service and formal learning right for me? Will I be given opportunities to learn in different settings (e.g., rural versus urban, academic versus community) that align with my personal interests and that will support my career goals?
- What do I consider to be “deal-breakers”?
Am I willing to relocate? If so, how far am I willing to go? Among other things, consider proximity to friends/family and the amenities of the academic campus(es), hospital(s) and community/communities that you will be learning and living in.
Tailor each application
For each program you’re considering, review the CaRMS program description pages in detail, as well as the school and program’s websites, to individualize your application.
- The requirements will vary from program to program. Missing subtle differences could result in your application being filtered out.
- Be mindful of the maximum word count for applications, be sure to answer all questions and do not forget to proofread each application with the support of someone you trust — especially if you’re reusing parts of your statements.
If you have questions, do not hesitate to get in touch with the designated contact(s) for each program early.
- Many programs provide opportunities for applicants to connect with current residents. Try to take advantage of these offers to learn more about residents’ first-hand experiences.
- Some program directors are also willing to connect with applicants one on one. Ask the program contacts if this is offered.
Applying to French/bilingual programs:
- True fluency in speaking, reading and writing is an absolute must for these streams and you must be comfortable demonstrating your fluency during interviews.
- These programs are based in communities where a strong command of French is necessary not only for patient interactions but also for navigating the electronic medical records, functioning day to day within clinical environments, and integrating into the local community.
Applying to rural/remote streams:
- Be sure to familiarize yourself with each program’s application process for these streams. Some require additional materials or, in certain instances, a separate application altogether for each community to which you wish to apply.
Applying as an international medical graduate (IMG):
- There are a limited number of IMG residency positions at each university and within each specialty and program. Each year, there are far more IMG applications than IMG residency positions; therefore, IMGs are significantly less likely to match than Canadian medical graduates (CMGs). With this in mind, apply as broadly as you can and consider applying to programs in multiple specialties.
- Be sure to consider applying to French/bilingual programs (if you have the necessary language skills) or rural/remote streams if you feel that you may be a good fit and that you can succeed and learn well in them. These sites sometimes have fewer applicants (both IMGs and CMGs) and thus warrant additional consideration.
- If you have not already applied through the United States’ National Resident Matching Program (NRMP), you’re strongly advised to do so concomitantly with the CaRMS R-1 Main Residency Match. Although the matching process is the US is also highly competitive, the probability of IMGs matching there is higher because there are many more positions available.
Establish contingency plans early on
While you’re working to obtain a residency position, seek opportunities to gain clinical experience in Canada to stay current, build on your skill set and maintain your confidence. For example, you might apply to clinical assistant programs, obtain a clinical trainee licence or engage in clinical externship programs or clinical observerships, if you can secure appropriate supervision. Be prepared for the possibility that you may not be able to obtain a residency position in Canada, despite your dedicated efforts. The chances of successfully matching for residency in Canada may decrease with each passing year. Think about what you’ll do if you’re not able to practise medicine in this country.
Curriculum vitae and personal statements
Author: Amanda Chapman
University of Western Ontario
Your curriculum vitae (CV) and personal statement are the first introduction that programs have to you. Although it can be challenging to articulate in writing who you are as an applicant, both professionally and personally, and how you’re a good fit for a specialty or program (your “narrative”), this guide provides some practical tips and suggestions to help you in this process.
Remember that the documents serve very different purposes:
Showcases the breadth of your academic, professional and extracurricular experience, tailored to present your overall qualifications for a residency position
Demonstrates your motivation and commitment to a specialty and the specific program, including summarizing your “fit” for that specialty and program
When candidates write application documents, they often reread them so frequently that they begin to lose sight of the overall purpose. It can be extremely helpful to have someone you trust review your documents to understand how your narrative appears to someone else. Consider asking for feedback from peers, residents, faculty mentors, physician supervisors, university career services staff or friends who are not in medicine. You can even consider using a text-to-voice program to hear your personal statement read aloud.
Carefully consider the feedback, but don't take it as the final word.
- Each reader’s opinion of your documents will be based on their personal experiences, so there’s a large margin for individuality. Thoughtfully consider the feedback you receive and then decide how, or even if, you want to incorporate it.
Fix grammar and spelling mistakes promptly.
- As you edit and revise your documents, you will constantly be rewording statements and adding content. Promptly correct grammar and spelling errors.
Keep multiple drafts going.
- If you receive feedback that suggests changing a large portion of the text, consider keeping both the old and new versions to present to your next reviewer. When you rewrite content multiple times, you risk losing strong points in the process. Keeping past drafts can help you sift through the changes to determine which version best presents your desired narrative.
A personal statement is a less structured showcase of who you are than your CV. Personal statements often include stories to demonstrate applicants’ journey and experience in medicine thus far. Most importantly, your statement should present a cohesive argument that highlights your motivation and interest in that specialty, how you “fit” with the specialty on the basis of your clinical and personal experiences and why you’re interested in a specific program.
Things to reflect on
The following questions will help you to determine the story that you want your personal statement to tell and therefore what you want to include in it. Revisit these questions throughout the writing process.
What is your motivation to pursue this specialty?
- Consider past personal or clinical events that helped guide you in selecting the specialty.
What experiences and skills do you have that demonstrate that you are well equipped for this specialty?
- These can be formal or informal, clinical or extracurricular, and personal or professional.
- Do not consider only technical skills. Your soft skills (communication skills, flexibility, leadership, etc.) affect how you interact with your work environment, team members and patients.
Why are you and this program a good fit for each other?
- Customize each program-specific portion of your statement to demonstrate an authentic interest in the program. Do your research! Learn about the program, and then think carefully about why you want to be part of it. For example, speak to current residents or faculty, reflect on your experiences in the city and/or institution or while researching the program, think about the research opportunities the program offers and the demographics of the patient population it serves, and consider the personal or professional connections you already have with the program.
What are your career goals?
- You do not have to go into a detailed discussion of your career goals; rather, consider your overall goals within the specialty.
- Consider how specific features of the program can help you achieve your career goals.
Do you have any unique qualities or stories that are relevant to your application?
- Emphasizing your unique qualities will distinguish you from other candidates. These qualities could be what stand out and are often discussed during interviews.
Structuring your personal statement
The structure of your personal statement is up to you. Here is a sample format that you can use to help organize your thoughts into a cohesive and comprehensive statement:
In the first few sentences, introduce the overall theme of your statement with the goal of enticing the reader to keep reading.
- Applicants often include a personal anecdote, quote or memory that demonstrates their motivation for practising medicine or their interest in a particular specialty.
- Avoid simply chronologically listing how your interest in a specialty developed.
Why this specialty
Present a well-rounded argument that shows that you’ve seriously considered why you’re motivated and committed to join this specialty:
- Experiential motivators can include clinical or personal events.
- Logistical motivators can include patient population, scope of practice, procedures, work environment, team dynamics or lifestyle.
Why you for this specialty
Demonstrate how you’re an ideal fit for the specialty.
- When discussing your experiences, don’t list them like you would in a CV. Instead, selectively use them to tell a story about why you’re a good fit for the specialty.
- Look at the qualities emphasized in the program description, particularly the CanMEDS roles, and consider if you can give examples that demonstrate how you exemplified them.
- Applicants often reference objectives or ideals for their future career, including research, teaching, working in an urban versus rural setting, or opportunities for additional training.
Why this program
- Customize this section for each program by considering elective experiences, resident/faculty relationships, available support systems, program-specific qualities (schedules, supports, etc.) and city-specific qualities.
- Summarize your overall strengths and enthusiasm for the specialty and program.
- To create a full-circle and complete statement, it can be creative and enticing to link your ending to your initial hook, if possible.
When approaching your CV, ask yourself, “If I were reading this CV for the first time, what kind of inferences would I make about this candidate?” Although you cannot change the experiences you’ve had, you can influence how a reader is introduced to your background. Therefore, be strategic in how you organize your information, your word choices and the overall aesthetic appearance of your document.
The following list includes information that you can consider including in your CV. The topics should be clearly divided into distinct sections. Remember that you ultimately control what content is included, and these choices will shape your personal narrative.
- Leadership experience
- Teaching experience
- Work experience
- Research (including projects, presentations, publications)
- Community involvement
- Extracurricular activities
- Awards and achievements
- Professional development
- Interests and hobbies
Describing your activities and experiences
Accomplishment statements: Rather than simply stating your basic responsibilities in a role, phrase them in accomplishment statements that incorporate the skills you practised in that role and the overall impact you had with your success. For these, consider including one or two overall challenges or tasks you faced within the role, the specific action(s) you took to tackle them and the result or impact of your action. This helps demonstrate to the reader the value and relevance of the experience.
Action verbs: Start each statement with a strong action verb that relates to the skill used in the activity.
Correct terminology: For each role, ensure you include your position title, the organization, the location and the duration.
Be selective: Any content on your CV may be brought up during interviews, so only include things that you’re comfortable discussing.
Organizing your information
Start off strong: Generally, readers devote the most attention to the first page, and their attentiveness can decrease as they read, so ensure you put the most relevant sections of your CV at the beginning. Consider what experiences the specialty/program values and structure the order accordingly (e.g., research, leadership, community involvement).
Be selective and purposeful: To ensure you maintain the reader’s attention, your CV should ideally be between two and four pages long. Therefore, be selective about what content you include. To keep your CV from getting too long:
- Remove outdated and irrelevant activities.
- Provide activity descriptions only for activities in which you played a major role.
- Be flexible about formatting, section divisions and orders, and font sizes.
Tailor when possible: Although there’s not much room for customizing a CV for specific specialties, you can be selective about the order in which you place activities and how you title sections. You may wish to highlight certain aspects of your background with a “Specialty-specific experiences” heading or strategically order research projects, extracurricular activities or overall sections.
Use reverse chronological order: List your activities from most to least recent. Consider removing activities from high school unless they’re significant or continued during your undergraduate degree.
- Concise header: Limit your header to just your name, one phone number and a professional email (preferably school) — listing your postal address is optional.
- Consistency: Be consistent with fonts, sizing, alignment, bolding, italicizing, lines and the format you use to indicate the time frame of activities — this makes a more cohesive and readable CV.
- Balance: Keep everything well spaced out. Cramming too much text onto a page will make it difficult to read, but you should also avoid having so much blank space that the page looks empty.
- Full pages: Avoid leaving blank space at the bottom of your last page (if possible), as this can make your CV look unfinished or incomplete.
- Split content: Try to ensure that activity descriptions do not get split between pages.
- Bold your authorship: For publications and presentations, bold your name so your authorship stands out.
Letters of reference
Author: Harry Liu, MD
Dermatology Resident, University of British Columbia
Reference letters are one of the most important components of your application. Each program has specific requirements and preferences. However, when it comes to picking the right referees, there are a few tips that apply to most specialties.
Pick a referee who knows you well
When considering requesting a letter, ask yourself if the referee truly knows who you are, understands your strengths and appreciates your genuine commitment to the specialty to which you’re applying.
- Letters from clinical supervisors are often preferred over letters from research supervisors. It’s better to select referees who can speak to your clinical skill set, your ability to advocate for your patients, your willingness to learn and your collegiality working within a team.
- If you’re applying to a specialty in which you have not completed an elective rotation, consider asking staff physicians you worked with during your core rotation (if applicable) for that specialty.
Tips and tricks
When asking for a reference letter, it’s helpful to send referees your CV and your personal statement to help them tailor your letter.
- Do not hesitate to ask referees what will help them write you a strong and supportive letter.
- It may also be useful to share your rotation evaluation or notes on interesting cases you managed together to help remind referees of your time with them.
If you’re applying to multiple specialties, you can ask your referees to write a generic letter (i.e., that does not specify a particular discipline) so that you can use it to apply to multiple specialties.
Staff physicians are busy, so be sure to send out reference letter requests early (ideally at least 4–6 weeks before the deadline) to give them sufficient time to compose a strong letter on your behalf.
- It’s not uncommon for letters to be submitted by referees very close to the deadline, hence there may be certain instances where your letter is not submitted before the final deadline.
- Try to request additional letters from other supervisors that you can use in these unforeseen circumstances to meet the application requirements.
Part 2: Interviews
Unlike your CV and personal statement, your interview allows you to speak directly with program representatives and “pitch” yourself as a colleague they would want on their team for years to come. You should take time to reflect on your experiences and begin connecting them to the qualities you possess, with the aim of highlighting what makes you a good fit for specific programs. Below are some key considerations and advice to help you feel more confident going into your interviews.
- You probably will not be able to say everything you prepared for. With a compact schedule and predetermined questions, there is often not enough of an opportunity to discuss every activity, research project or clinical experience on your CV. This can be disheartening, but try to diversify your responses while focusing on your most impactful and relevant experiences.
- You will be asked questions you have not considered. It can be tempting to sit down with a hundred potential interview questions and practise exactly how you might respond to each, but it is more beneficial to develop a general approach to different question styles and to practise responding in real time to questions you are unfamiliar with.
- Every interviewer will interpret your responses differently. It is important to keep this in mind when practising as you will have to sift through the feedback you receive from different mock interviews and decide which suggestions to incorporate. Avoid changing your authentic answer to the point that you begin to feel disingenuous or unnatural, as this may show during the interview.
- Hindsight is 20/20. Try to avoid ruminating over your answers post-interview and contemplating better responses. High achievers in medicine often fixate on what they inaccurately believe to be their worst performances and forget to give themselves credit for their exceptional responses in these high-stakes circumstances. Be kind to yourself!
- Review your CV experiences. Whether the interviewers have seen your CV or not, you will be asked questions that relate to your experiences — including extracurriculars, leadership and research. Review the significant roles you have played and practise your quick “pitch” on your responsibilities, accomplishments and skills.
- Identify both successes and challenges. Classic behavioural-style questions call on you to “describe a situation when X.” Answers often involve either successes or challenges relating to different scenarios or skill sets (e.g., CanMEDS Framework). When you review your CV and clinical experiences, think of any unique or exceptional situations when you learned a new skill, overcame an obstacle or spent time reflecting on an event that will contribute to you becoming an outstanding physician.
- Nail your “Why this specialty?” response. This will come up in some way during your interview. Practise different ways of describing your motivations and decide which approach feels most authentic, honest and complete.
- Do your research. Make sure to research the specific programs and sites you are applying to. This will help you develop concrete reasons as to why you are interested in that specific program, similar to your response to “Why this specialty?”
- Develop questions for programs. When you come prepared with two or three specific questions about a program, it can demonstrate a genuine interest. Consider what aspects you are interested in learning more about (e.g., program logistics, resident experiences, research opportunities).
Approaching interview questions
- Take a moment to collect your thoughts. It is common and completely acceptable to take a few seconds before responding. Some candidates may elect to take a sip of water, while others will simply say “I’m just going to take a moment to think about that question” or pause in silence. This will not negatively affect your interview. It is more thoughtful and professional to pause briefly to come up with a plan than to proceed immediately and lose your sense of direction during your answer.
- Ask for clarification when needed. Sometimes questions can be long, have multiple parts or have unfamiliar phrasing. It is completely appropriate to ask the interviewers to repeat or rephrase a question to ensure you have understood it.
- Keep it simple. In each answer, stick to one experience or role (unless specifically asked for more). This way, you can describe in more detail the relevant factors, thus providing a stronger case for the skills you developed or the relevance of this experience.
- Make the connection. Interviewers are not just asking questions arbitrarily — assume there is an underlying connection between the question and a skill or experience that would demonstrate your fit for the program. Incorporating this into your response can make it easier for interviewers to see you as their future colleague.
- Demonstrate growth through failure. You will probably be asked to describe mistakes or challenges you experienced. It is important that you reflect on what you have learned from the mistake or experience and describe what changes you have made because of it.
- Diversify the experiences you mention. Candidates often have several remarkable experiences they like to highlight in interviews. To help demonstrate the breadth of your experiential background, practise discussing different experiences in response to similar questions. This way, you can discuss different roles during the actual interview to show diversity, without repetition.
- Use a framework that works for you. The Internet has dozens of acronyms for ways to approach specific question styles (e.g., STAR). Generally, these involve potentially repeating the question, explaining the logistics or context surrounding the problem or experience and then answering the specific prompt with the result and reflection at the end. There is no perfect way to answer, but it is important that you feel confident in the approach you choose.
Situation – set the stage of the event or challenge you faced
Task – what was your role and responsibility
Action – what steps did you take
Result – the outcome you achieved (and your associated reflections)
- End strong. Your closing statements on a question are often the most important and remembered. Summarize your overall answer to ensure that you have discussed every point you intended to.
- Mimic the real interview setting. As much as possible, try to recreate the interview conditions. This should include virtual set-up, location, clothing and timing. This can help you become comfortable and adopt the mindset you will require during the actual interviews.
- Have the interviewer take notes. It can be helpful if the mock interviewer takes notes during your responses as a real interviewer would. This allows you to identify the content that interviewers might deem the most relevant, while receiving constructive feedback in the process.
- Practise answering on the spot. Have your interviewer ask you questions that you have not practised. Answer immediately, while remaining thoughtful, as if you were in a real interview. This will help you develop your approach to novel questions and learn how to think on the spot.
- Practise full interviews. It is often appealing to practise question by question, debriefing after each one. However, it is also valuable to practise pacing through the overall interview structure. For example, going through questions successively will help you learn how to introduce a different experience for each question and tell a cohesive story.
- Arrange for multiple mock interviewers. Different interviewers will recognize different strengths and weaknesses. Practising through the CMA’s mock interview program, with friends (medical and nonmedical), family, mentors and school programs can provide you with diversified feedback. Use the checklist below as a guide.
- Record yourself answering questions. The benefit of virtual interviews is that video recordings of yourself answering questions will show you how interviewers will see you. Reflecting on how you answer various questions virtually can help you evaluate the structure and organization of your answers and your body language. It is also important to hear how your answers sound and to determine if they reflect what and how you intended to communicate.
- Mock interview your colleagues. Being on the other side of the interview process can help you to relate to the interviewer’s experience. It will help you understand the pertinent aspects of responses that interviewers may focus on, including nonverbal behaviours. Appreciating how your colleagues tackle different questions can also inspire your own approach.
Mock interview checklist
- Full name present
- Good lighting
- Candidate is centred on the screen
- Minimal Internet connection issues
- Audio quality, background noise and volume have been checked
- Optimal video quality
- Appeared relaxed and confident
- Natural but not distracting hand gestures
- Good eye contact
- Maintained good posture
- Facial expressions (friendly, enthusiastic, genuine, etc.)
- Tone of voice was appropriate
- Appeared to be listening and paying attention
- Question was answered in its entirety
- Relevant and specific experiences were discussed when appropriate
- Context surrounding experience or project was well explained
- Candidate connected answer to their “fit” for the specialty or program when appropriate
- Clear understanding of the program and specialty
- Referenced a breadth of experiences
- Appropriate language was used
- Finished responses strong
- Pacing was not too fast or slow
- Responses remained on-topic
- Logical storytelling, easy to follow
- Minimal filler words or phrases (e.g., uh, um, like, I mean)
- Spoke clearly, at an appropriate volume
- Responses were of appropriate length
Virtual interview best practices
(adapted from AFMC Virtual Interview Handbook for the Applicant)
- The equipment:
- Select a device with clear video and good sound quality. This may include using external headphones or webcams and choosing a computer or tablet over a phone.
- Change your device settings so you are not receiving distracting messages or notifications during the interview.
- The location:
- Find a private, quiet location free from any distractions. If you live with others, ensure everyone is aware of your scheduled interviews to avoid disruptions.
- Ensure your background is appropriate and professional. Avoid virtual backgrounds when possible, as this may give an “informal” appearance.
- Test out lighting options before your interview to ensure it is appropriate.
- Internet connection:
- Check your Internet speed and consider asking those you practised interviewing with if their experience was optimal.
- Consider keeping the interviewers’ and school’s phone contact information nearby, and sharing yours, in case there are unforeseen technical issues during the interview.
- Professional attire:
- As you would for an in-person interview, dress professionally from head to toe.
- You may contemplate dressing up for only what may be visible on camera, but consider the possibility that you may need to stand up or move around.
Author: Stephanie Fong, MD
Emergency Medicine PGY3, Dalhousie University
Author: Harry Liu, MD
Dermatology Resident, University of British Columbia
Interview formats will vary from specialty to specialty, from program to program or even from site to site. The CaRMS program descriptions will be your best guide on what format your interviews will probably take, but it is possible that you will not know a program’s specific interview format before the interview day. Regardless of the format, the interview is designed to evaluate oral communication, verbal and nonverbal skills, interpersonal skills, teamwork, relatability and critical thinking skills.
- One-on-one interview: Applicants answer questions from a single interviewer.
- Panel interviews: Applicants answer questions from a group of interviewers (typically two or three) rather than one.
- Multiple mini interviews (MMIs): Applicants circulate through a series (typically five to eight) interview stations, each focusing on a different theme or scenario. Stations vary, but they commonly include standard interview stations similar to one-on-one interviews. Less often, stations may include standardized patients or actors, writing stations or ethical scenarios.
Closed file interview vs. open file interview
- Closed file interview: The interviewer(s) do(es) not have access to your CaRMS file. In this format the interviewers will only know what you decide to share with them. Therefore, if there are aspects of your application that you would like to highlight, you will need to incorporate them into your answers.
- Semi-open file interview: The interviewer(s) has (have) access to certain aspects of your CaRMS file, such as your personal statement or CV.
- Open file interview: The interviewer(s) has (have) access to your full CaRMS file. With this format it is important to remember your application thoroughly. The interviewer(s) may probe regarding a specific experience referenced in your CV or an aspect of your personal statement.
- Meeting with the program director (PD): This opportunity may or may not be available for applicants. For larger programs it is challenging for the PD to meet with every interested applicant. Within smaller programs with fewer applicants, it may be feasible to connect with the PD before the interview. Strive to be interested but not overly keen. Some programs include a meeting with the PD as part of the interview day.
- Interview information session: The goal of these events is for programs to highlight and showcase aspects of their program or sites (e.g., urban vs. rural). Programs are aware that most applicants are applying to multiple programs within the same specialty and as such want to give applicants a sense of what they would experience if they were to successfully match to their program.
- Interview social: This is an opportunity to meet staff physicians, program administrators, residents and fellow applicants in a social setting. It is imperative that you behave professionally in all interactions as you never know who is on the selection committee or from whom the selection committee may seek input.
Types of interview questions
- Behavioural questions: These questions ask how you have demonstrated behaviours, knowledge, skills and abilities. Examples are questions that begin with “Tell me about a time when…,” “What do you do when…,” “Give me an example of…” and “Describe a situation where…”
- Situational questions: These are similar to behavioural questions but focus on the future and ask how you would approach a hypothetical situation. Examples include “What would you do if…” and “How would you manage…”
- Knowledge-based questions: Depending on the specialty, interviews may incorporate questions that require some background knowledge (e.g., approach to a common condition seen in that specialty, or interpretation of a common investigation such as ECG or plain film) or questions related to medical or personal ethics. These questions may also present clinical scenarios.
- Getting-to-know-you questions: Many programs ask questions that have nothing to do with medicine or your medical training experience. For instance, you may be asked to talk about your favourite movie or TV show, to describe who you would want to have dinner with or to talk about your hobbies.
Questions you should be comfortable answering:
- Tell me/us about yourself.
- Why are you applying to X specialty?
- Why do you want to come to X program/school/city?
- What are your personal strengths and weaknesses?
- How do you deal with and resolve conflict?
- How do you manage uncertainty or ambiguity?
- Describe a time you worked in a team environment.
- Talk about a time you made a mistake and how you managed the situation.
- Describe a challenging patient encounter and its impact on your learning.
Other tips and considerations
- Keep an up-to-date calendar of all CaRMS activities including interviews, information sessions and socials. Add videoconference/meeting links to your calendar and be sure to include the time zone (and account for daylight saving time) to minimize the risk of scheduling conflicts.
- Maintain professionalism in all interactions with programs. Although many of the individuals you interact with may not be on the selection committee (e.g., administrative staff, residents, staff), the selection committee may hear about poor interactions or red flags.
- Be yourself! Programs are hoping to choose residents who will fit well in their program. If you are not true to yourself during the process, you may find yourself feeling like an outsider throughout residency.
- Although the entire CaRMS process can feel like the control is in the program’s hands, remember that you as the applicant are also interviewing the programs. The match algorithm gives preference to the applicant’s choices. Just as you want to make a good impression on programs, the programs also want to make a good impression on you.
- If you know someone who previously interviewed for the program you are interviewing for, consider reaching out to them as they would have insight into the interview format and expectations of the program.
- Some applicants wonder whether they should disclose certain aspects of their personal life during the interview process. While programs are not allowed to ask about certain things (e.g., marriage status, what your partner does or where they work, if you are pregnant or have children), you are welcome to mention anything you feel could work in your favour. For example, if you have roots in Alberta (e.g., house, partner, family) and want to train and ultimately practise in Alberta, there probably would not be a downside to expressing this preference while interviewing in Alberta. It speaks to your commitment to the local community and the potential value of the program’s long-term investment in your training.
Part 3: Ranking programs and the match
Throughout the application process, as you have crafted your CV, written personal statements, practised for interviews and engaged in self-reflection during interviews, you have probably come to know yourself well. Use this knowledge to guide your ranking process. Below are nonexhaustive lists of things you might want to consider when determining your ranking order, including special considerations for IMG applicants and applicants considering the Couples Match. While you are reading this section, and before you rank programs, be sure to review the instructions on the CaRMS website. Try to keep these two key principles in mind:
- The match algorithm is applicant-proposing. Therefore, you should rank on the basis of your own preference, regardless of what you think the programs might do. You cannot “game” or “trick” the algorithm, so if you do not rank according to your true preference you may end up disappointed.
- Match results are binding. Therefore, you should only rank a program that you’re willing to train at for the duration of your residency. While it’s possible to transfer programs, this is not a straightforward process and is never guaranteed.
- Local health care system – Consider the differences between provinces and cities, including funding models, drug coverage, community resources and local supports.
- Provincial housestaff organizations – Consider salaries and benefits (CaRMS has collated this information here) and advocacy efforts.
- Language – Do you speak the primary language(s) of the region? If not, are you able and willing to learn it?
- Culture – How familiar are you with the region’s culture(s)?
- Urban vs. rural
- Urban programs tend to be hospital based and have higher volumes of patients, whereas rural programs are typically more community based.
- Urban programs tend to be larger and have a higher ratio of learners to supervisors, potentially leading to less individual interactions with staff, but they often offer more opportunities for diverse socialization and learning experiences. Rural programs are known for having smaller learner-to-supervisor ratios, allowing for more one-on-one time with staff.
- Urban programs tend to be more academic focused and may offer more opportunities in research or to see unique cases, particularly at tertiary care centres. Rural programs may offer a wide breadth and depth of experiences in a close-knit community that’s often less focused on research.
- Proximity to current location, hometown, family, friends and other supports
- Are you able and willing to adapt to being away from the people and places you’re comfortable and familiar with?
- Will travelling between sites be feasible?
- Working in a very small rural community or in your rural hometown may provide more ethical and moral challenges, as you will not be permitted to treat family members or friends.
- Amenities of the locale – Consider housing costs and availability, safety, access to food services (particularly if you have unique dietary needs or preferences), access to health services for yourself and your family, recreation options, education options and/or accessibility options.
- Block vs. horizontal rotations
- Mandatory rotations
- Do they align with the specialty itself?
- Do they align with your personal and professional interests and goals?
- Will they help you to become the kind of physician you wish to become?
- Are there multiple hospitals (requiring commute time) or are rotations primarily at one or two sites?
- Do learners have input into selecting supervisor(s) or clinical sites?
- Elective rotations
- How many blocks are available to residents each year? In total?
- Are there options for longitudinal electives?
- Can longitudinal research be conducted in parallel with residency?
- Are you able to take time away from residency to complete a graduate program?
- Are there local faculty members with similar research interests or who may be able to mentor you?
- Explore and try to connect with residents who are already in the program to inquire about options for support or their general impression of how supportive the program may be toward residents.
- How accessible and approachable are the program administrators, including the program director?
- COVID-19 precautions:
- How has the pandemic changed the resident learning experience?
- Are learners redeployed or required to provide service in COVID-19 designated units?
- Is learner input considered in redeployment options?
- What happens if a learner tests positive for COVID-19?
If you’re not truly keen on a program before Match Day, you still may not be by the time Match Day arrives. Try to connect with current residents and recent graduates of the programs to which you’re applying. Phone/virtual conversations with them can often yield more candid advice than email.
After careful consideration of these factors, if you find yourself without a clear ranking strategy, try narrowing down your choices with a coin flip! If you find yourself disappointed with the result, ask yourself why you feel this way and reconsider your choices. This may help prevent some disappointment on Match Day.
IMGs can be at a disadvantage compared with CMGs and therefore they must be very conscientious and mindful during this process. Consider learning more about the following program features:
- Orientation period, assessment verification period and/or probationary period
- How long does the period last?
- How are residents evaluated?
- What constitutes “failure” and what recourse do you have if you fail this period?
- Return-of-service (ROS) contracts
- Are these in place? If so, which regions/communities are involved?
- How many years of service are graduates expected to provide?
- What are the penalties for breaking ROS contracts?
- Are IMGs required to complete their ROS immediately after residency or is it permissible to do a fellowship program first, before fulfilling the ROS obligation to the provincial ministry of health?
Couples are highly encouraged to apply broadly to maximize their chances of matching to their first-choice programs. Remember that if you do not match as a couple, the algorithm does not consider your rank order list separately; therefore, you should rank, as a couple, every acceptable combination of outcomes. Ensure you start early and plan well in advance.
Things to consider:
- What is the backup plan?
- What specialties are you and your partner applying to?
- Is one of you willing to go unmatched?
- Are you willing to live in separate cities? What distance is acceptable? Are there nearby community or rural sites that you can also consider for ranking?
- Is it more important to match to the same location or for each of you to successfully match to your preferred specialties?
- Independently create your own rank order lists (both an individual and a couples one) before comparing them to create your couples list together.
- Create a weighted system that places greater importance on each person’s priorities and preferences (e.g., quality of education, local community, research opportunities) and then independently score each of the different criteria to create an “objective” score and rank.
- Create a list of deal-breakers to exclude from rankings, such as “living x distance apart” or programs one of you may be unwilling to train at.
Author: Allyson Dill, MD
Family Medicine, University of Ottawa
Match Day brings uncertainty. It has the potential to be one of the happiest days of your life or one of the most disappointing; don’t underestimate its impact. It’s common to feel a wide array of complex emotions. Even if you’re happy, there’s the possibility that some of your colleagues are not, because they matched to a lower ranked program or they didn’t match at all. Remember, it’s acceptable to feel happy and it’s understandable to be disappointed.
- Celebrate! You have worked hard to get to this point, and you’ve earned your success. Be mindful, however, about how you share the news as some of your colleagues may not have had a successful match.
Dealing with disappointment:
- You worked hard to get to this point in your career, so give yourself time to deal with the news of an unwanted match.
- Don’t let others to shame you into feeling grateful. It’s okay to be disappointed.
- Seek the support of someone you trust, such as a family member, partner, mentor or therapist who will listen to your feelings.
- Remember that although it’s not always simple and is generally discouraged, it may be possible to transfer into a different program.
- Do not assume how others feel regarding their own match. If you’re unsure how a colleague feels, consider asking “How do you feel about matching to x?” instead of “Congratulations on matching to x!”
- Similarly, saying “I knew you would match to x!” might cause someone to feel worse about their match if it’s not what they were hoping for.
Not matching is not a reflection of your medical knowledge or skill set, nor of your ability to be a competent resident. It’s often the outcome of a system that’s influenced by many factors beyond a candidate’s control. Remember that you’re not alone: the total number of unmatched applicants grows each year. Seek out supports specifically aimed at unmatched applicants for additional guidance and recommendations.
- Reach out to your family, friends, colleagues and mentors.
- Your medical school’s student affairs office or university student support office can be a good place to explore your options.
- Don’t forget to use clinical resources like your family physician or other mental health supports covered by your insurance plan.
The second iteration is essentially a highly condensed version of the first match, with the following differences:
- Significantly fewer positions and specialties available
- Significantly different pool of applicants, including unmatched CMGs and IMGs from the current year and previous years, transfer applicants and second-entry applicants
- Significantly shortened timeline
When weighing whether to participate in the second iteration, you may want to consider the following:
- Is there a position available in a program that you could see yourself training at?
- What might change to make you a more (or less) competitive applicant between now and a future match cycle?
- The unfortunate reality is that applicants are statistically less likely to match with each passing iteration after their first one, regardless of whether they participate in each one of those iterations or not.
- If your medical school gives you the option of deferring graduation to take a “fifth year” (or fourth year for three-year schools), participating in the second iteration may be a prerequisite of this additional year option. Inquire and do your due diligence before deciding how to proceed.
Rules of thumb:
- Apply early and broadly.
- Accept the very likely possibility that you may not match to your top choices.
- Remember that, just like for the first iteration, a match result is binding.
- Have contingency plans in the event that you do not match at all.
- Try to stay strong and be positive.
Unmatched after the second iteration
Reach out to your supports and consider your options. It’s important to remember that, in most provinces, you’re only allowed to see patients in clinical settings if you’re currently enrolled in a medical school and hold active liability insurance.
- Depending on your career goals and if this is offered at your school, you may want to consider deferring graduation to enrol in an additional year of medical school.
- Alternatively, you may opt to graduate and pursue other educational or career prospects, such as:
- enrolling in a master’s program
- seeking opportunities for clinical observerships or externships (e.g., British Columbia’s clinical trainee licence)
- exploring alternative nonclinical careers such as consulting, medical education or clinical research
- writing US examinations and applying to the US National Resident Matching Program (NRMP) next year
- looking into the American Medical Association’s FRIEDA (if you have already completed US examinations)
Author: Stephanie Fong, MD
Emergency Medicine PGY3, Dalhousie University
Applying for residency is a very stressful time both for applicants and for the people in their lives who will ultimately be affected by the match results. There are national, provincial and local organizations that offer resources to support learners during the match process, as well as at all stages of medical training.
Majid Hussain, MD
Family Medicine Physician, British Columbia
Odell Tan, MD
Psychiatry Resident, McMaster University
CaRMS Interview Prep Program
As a member of the CMA and your provincial or territorial medical association, you have access to a free program where you can practise your interview skills and hear tips and tricks from residents who were in your shoes not that long ago. They’ll ask you questions, give you constructive feedback and provide you with the knowledge you need to ace your interviews.
The program runs from November to March. Members will receive an email inviting them to sign up as soon as registration opens in their region.
Not a member? Join today to secure your spot.