The Road Back Home...my CARMS experience (2014-2015)
A Few Tips (random ravings, stuff I wish I’d known) on applying to CANADA as a CSA/IMG studying in Ireland. I’m going to touch on the things that I most struggled with and that worked in my favour. If I haven’t answered all of your questions or any new ones come up, please feel free to message me.
EXAMS:
All these Registrations are done through the physiciansapply.ca website. But the MCC website is your best friend and has ALL the information you need. http://mcc.ca/about/mcc-and-route-to-licensure/licensure-process-for-imgs/
1) MCCEE - do this in March of the year you are planning to do CARMS (i.e. CARMS September 2015, do the MCCEE the same year. http://mcc.ca/examinations/mccee/
Resources: Step 2 CK Books, Toronto Notes, Canada QBank and the USMLE World Step 2 CK QBank
2) The NAC-OSCE - this is a clinical exam, similar to the Step 2 CS but the focus is on different things, more communication and critical thinking than coming up with a management plan.
Register late April of the year you are planning to write AFTER you have your MCCEE score.
We’re well trained for this exam with all the OSCEs we do, but it’s well worth your while to refine your clinical skills in 3rd and 4th year. Especially joint exams (knee and shoulder) and counselling regarding HRT, Paediatric Nutrition Advice, and Mood/Eating disorders
You NEED: A white coat + Stethoscope + Tendon Hammer everything else is provided if you need it.
It’s a LONG exam but it flies by. You get 12 stations (1-2 of which are pilot stations that don’t count towards your score but you have no way of knowing which these are. You get two minutes outside the door to read the scenario/instructions.
Each station is 11 minutes long = 8 minutes for EITHER a Focused History OR Focused Exam OR Counselling + 3 minutes of Questions (these are a mix of what’s your differential diagnosis, how would you treat this patient, analyst these lab results etc.)
Resources: Use your Talley & O’Connor, First Aid for the Step 2 CS, and the NAC OSCE - A Comprehensive Review (it’s handy for giving you sample scenarios to practice with but Note a lot of the drug doses are wrong) The best tip I have is practice, practice, practice. What they’re looking for is great, empathic communication, not just knowledge unlike the CS. http://mcc.ca/examinations/nac-overview/osce-station-therapeutics-descriptions/ http://mcc.ca/examinations/nac-overview/exam-day/ http://mcc.ca/examinations/nac-overview/ http://www.nacoscereview.com
My Black Box Warning: If you’re doing both the US and Canadian applications: You effectively complete 5 board exams in addition to the Intensity of Fourth year Exams, and two sets of comprehensive applications within the space of 12 months or less and it truly sucks! So take deep breaths, use your family/friends for support and if you’re coming apart at the seams; re-prioritise and re-evaluate. It was not easy for any of us and I’m happy to help in any way that I can if this is you next year.
The Rest of the Road:
From First-year to 3rd-year: Use your summers to relax, work, shadow/do observorships (MAKE CONTACTS back home) and/or do research (not vital to FM applicants but won’t hurt). Reach out to friends, family, and friends of friends and get in touch with previous graduates who may have done some cold calling and emailing themselves.
Warning! From the summer after 3rd year until graduation, there’s almost always some deadlines/ paperwork/exams/application things/elective things going on. So despite the huge learning curve that third year is. Try and take a few days at Christmas time to sort out your own priorities (Do you want to go back to Canada, the US, try for both, or Stay here?). Make a game plan but be kind to yourself and know your own limits.
In my experience it is infinitely better to do one application system well than to try for both (my US applications really suffered because I put all my eggs in a Canadian basket and in the end it was a bit of a waste of time and money). That being said if you aren’t sure what you want to do/where than keep your options open by doing an FM or IM observorship or elective. If you go rural, I think it gives you a good flavour of all the avenues open in Medicine.
The one thing you should probably decide on by the end of third year is whether you want to do Medicine or Surgery as these tracks are quite distinct. (If it’s the latter I’d say the US is a safer bet than Canada, more IMG spots available and get to know Ridgway and Conlon or other TCD surgeons who’ve done training in North America.) SCHEDULE YOURSELF DOWN TIME (don’t fill your summers with Medicine without giving yourself time with family/friends, you and your mental health will regret it!)
The CARMS Timeline:
The months correspond to the calendar year that you start your final year e.g. for me graduating in 2015 it was September 2014 that I did all this)
June/July - Once you have your MCCEE Score, look at the program descriptions from the previous year, they don’t change that much and it will give you a rough idea of what they’re looking for. NB! These change when your application opens in September so be sure to re-check all the criteria when working on your application later.
Mid-August - Request permision to Register (do this online via http://www.carms.ca/en/ residency/request-registration/) This has a registration fee, I would only do this if you are confident you can meet the requirements of the programs you want to apply to. As an IMG applying to Family Medicine this now means you need a strong MCCEE score (ideally over 300), AND a strong NAC-OSCE score (+80 is the rumoured target but there are exceptions to every rule) for all provinces.
Beginning of September (just after labour day) - You are emailed your Token which allows you to begin working on your application. First thing to do is put in your LOR information so that you can send them the cover sheets they need to write your letter.
End of October - The deadline I gave my LOR writers to either submit to CARMS themselves, send their letters to Rita Keane to upload, or I gave them a pre-addressed envelope which they sealed and gave back to me so I could send it by registered post to CARMS (allows you to track it and gives you peace of mind). In reality you have until late November for LOR submission. In the meantime start filling in all the various components (see below)
Mid-October - You can start picking programs, assigning documents etc. Third week of November CARMS’s online Application CLOSES and File Review begins.
Make these websites your most read/hated ones: http://www.carms.ca/en/ http://www.carms.ca/en/match-process/match-timelines/applicants/r-1-match-first-iteration/
Other parts of the CARMS Application (and yes the US one is similar with different headings)
You can begin uploading things into the online portal from September-November once you have your Application token.
The Categories include:
PROFILE: Personal Information & Language Skills (If you speak multiple languages fill them in!) LICENSURE: Licensure (Applies to those who’ve already done an intern year/worked as a physician) ACHIEVEMENTS & INTERESTS: These include academic achievements (e.g. awards and scholarships) and areas of interest (extracurriculars, society memberships), and feel free to go all the way back to undergrad if you think it’s relevant. I also would include notable personal achievements (e.g. Finishing a Marathon etc), and unique hobbies/passions (e.g. Bollywood dancing, being in a band, whatever you do that makes you you!) EDUCATION (Fairly self-explanatory)
Non-Medical Education (Undergrad + Masters etc) & Medical Education (Medical School/s)
Clinical Electives (Put in EVERYTHING from third-year onward) This is something you can do ahead of time. Keep a running list of all the clinical experience you do, which hospital, and under which physician/surgeon. Everything from third-year roations onwards forms your core clinical training and the formal electives you do back home go here!
Postgraduate Training/ Internships (If you do an Irish intern year or elsewhere that would go here)
Residency Electives (this is more for those who’ve done any other residency training elsewhere)
Non Clinical Training (This is where you include your BLS, TEAM, ALERT certifications etc. that you do in final year)
EXAMINATIONS (self-explanatory)
Medical Council of Canada - put in all your scores here including the up coming NAC-OSCE score
United States Medical Licensing Examination - if you do well on your USMLEs it is to your benefit in my opinion to include them as it may indicate your competitiveness as an applicant
LanguageAssessments
Other:
EXPERIENCE (there’s a box for everything but again the earlier you start to keep a list of things you do in Medical School/life, the easier it is to do this in the fall) •
Work
Scholarly Activities and Research
Observerships - any Canadian or U.S. clinical observorships - also sometimes referred to as shadowing opportunities - which you have participated in. For the purposes of this application an observorship is defined as a non-accredited experience in which you spent a period of time observing a physician in a clinical practice setting without direct patient contact.
Volunteer
Clinical Practice
Fellowships
Publications / Presentations - 2nd-year project, poster presentations here at TCD etc. all counts!
DOCUMENTS SECTION
Personal Letters - The KEY here is to PAY ATTENTION TO THE PROGRAM DESCRIPTIONS.
Each program has slightly different requirements/things they want you to touch on it is in your best interest to take the time to tailor your letters to what they are looking for.
Write a sort of MASTER letter with a paragraph or two that you can modify to meet individual requirements (usually why that program/place?)
In general if it’s one university with several streams the requirements are the same for all their sites.
For context I applied to 47 programs and had 17 separate Personal letters based on the program descriptions and specific strengths of the program that I was interested in. YES this is time consuming, yes this is a pain in the ass if you’re not a great writer but if like me you had pretty-good exam scores, and no real research experience. Take the time to learn to sell yourself on paper.
This is the one forum where you get to clearly, concisely (pay attention to word limits) express why they should interview you. I hated it and it took me forever and I spent many an evening agonising over sentences but I think it was worth it. DO get your friends, family, boy/girl-friends, to read it over to give you perspective. If you can, try and ask someone who writes for a living and doesn’t really know you. I had a distant family friend who helped me out with a Master letter that I then modified for the different programs. Get in touch with me if you wish as she will look over letters for a small fee.
Letters of Reference - 3 per program (they don’t have to be the same three). Be confident, and be smart about who you ask. FM is great because in general you get to work with one preceptor the whole elective so by the second week they’ll have a good feel for who you are. Spend the first week of your elective learning the ropes, try and show improvement every single day. By the second week, test the waters by asking “if they would be comfortable writing you a STRONG reference letter”. Explain what you’re applying for and if they would need any more information from you like a CV etc. Before/As you finish the elective confirm they are okay with writing you a letter, double-check their contact information (you can do this via email/with their secretary), and let them know you will be getting in touch again in September. AFTER November once applications are in or in Early December. I think it’s nice to say Merry Christmas and Thank them for their time. Keep in touch sporadically through the year so that on Match Day you can again thank them for their help, or ask them to help you again for 2nd round or next year
Other Documents you should include:
Passport/Photo ID information
Supplementary Feedback reports from your various exams
Any Certificates/Achievements you’ve received
FAIMER status - print from website
Current CV
Your school Dean/IMG coordinator will upload: Your MSPR and your transcripts
For the MSPR: I had scanned copies of all my elective evaluations, reference letters from paeds, obs/gyne, psych, and FM in fourth year, plus comments from observorship supervisors. This gives them the ability to more specifically speak to your clinical abilities and experience in your MSPR while being distinct from the official LORs that you submit. Your dean/international coordinator gets in touch with you to do this in June of the year that you go from 4th year to Final year.
Just for a little perspective and to show you that A- students match back home too, this is how I spent my 5 years here.
Summer after First-year: • Worked for Kaplan teaching MCAT courses and mostly romped around the Ottawa countryside with my partner • 3-week Observorship in Family Medicine/Geriatrics with a distant family-friend who was also a physician in Etobicoke, ON
Summer after 2nd year: • 2-week observorship in HIV/Infectious Disease at home in BC • More travelling
Summer after 3rd year: • 3-week elective in Family Medicine in Mill Bay, BC (self-organised but with a UBC preceptor) • Studied for Step 1 • 2-week elective in Emergency Medicine in Tallaght Hospital • Both of these electives I put in as Clinical electives because I was a licensed learner and provided patient-care
Fourth year: • Wrote Step 1 in October 2013 (pushed it back and ended up regretting it, try and just give yourself a hard/fast deadline and work towards that) • Scheduled Paeds/Obs Gyne first so that I could be more ready for the EE • Wrote the EE in March 2014 - got a 305 (not a great score to be honest. Do better than I!) • Ask for letters if you get on well with any of the physicians in fourth year (they’re all areas relevant to Family Medicine, and even if you don’t use the letters later on they can help with your MSPRs, since you see these)
Summer after 4th year: • Adult EM elective at Dalhousie, Nova Scotia - 3 weeks • Rural FM elective with MUN, Newfoundland - 3 weeks (if you want to do family medicine in Canada the big deficit is care is in rural areas so test the waters, see if you might like it, and get a good letter because it opens up more doors to you) • Inner-city FM elective in Toronto, ON - 2 weeks set this up myself using contacts from previous graduates, not official through U of T but he is a fabulous U of T preceptor. • Took two weeks off to be in my friends wedding and re-charge/work on my applications.
Final year: • FM-based Perinatal Addictions program in Vancouver, BC - 4 weeks • NB! UBC electives are only in 2-4 week blocks • This also served as my Final year elective, and allowed me the opportunity to stay home and enjoy my Mom’s cooking :) • Did the NAC-OSCE while home in Vancouver mid-September - pretty much practiced examining my family/friends • Did the Step 2 CS on my way back to Dublin at the end of September (I would advise doing the CS first if you’re doing both, as I would’ve been more prepared for my NAC) • Wrote the Step 2 CK in October 2014 • Submitted to ERAS in September and Submitted CARMS in November • Shockingly got interview invitations early-late December, so buy a good suit that will do you for interviews and Final Clinical exams.
I spent most of January skipping school (this is tricky to do but necessary) to do 6 separate interviews for 26 of the 44 programs that I applied to. Luckily Ontario and Dalhousie do one interview for all the sites. Unfortunately SK does its FM interviews separately for each stream so this can get very expensive very quickly but brace yourself and try to budget an extra $1500-$2000 for flights, accommodations, and rental cars.
I Did the Irish Intern application as well - quite a few people have done the intern year and then applied to CARMS and it seemed to work in their favour to have the clinical experience from what I saw on the interview trail. So even if you don’t match back home right away there are other options and if you’re a European citizen I would strongly consider Ireland/the UK they both have fantastic Family medicine training programs.
Match Day was March 201x
Finally Interview Preparation: Congrats on getting this far!
Make use of Healthforce’s Ontario FREE Interview prep sessions!!! It’s free to register and was infinitely useful no matter which specialty you apply to or where you are applying to. They will do them in person (if you can be in Toronto at least once, do this!) and over Skype. There’s also plenty of interview resources a short google search away. http://www.healthforceontario.ca/en/M4/Internationally_Educated_Health_Professionals/ IEHP_News/Interviewing_for_an_IMG_residency_position_in_Canada%3F
I hope this helped at least a little bit. It’s partially a combination of all the information I gleaned from those who went before me and I wanted to pay it forward especially seeing the stress on the elective students faces now that I’m a PGY2. Remember you’ve gotten this far and you’ll be a Doctor no matter where you end up working.
GOOD LUCK TO YOU!