Towards a Successful CaRMS Match: Ten Tips for IMGs

Over the years, many international medical graduates (IMGs) have asked me for tips on how to match into a Canadian medical residency program (yes, even before I matched!). I suppose that now is as good a time as any to review some general advice to be successful in CaRMS, seeing as it is the start of a new calendar year. It is also almost time for the interview segment of the application cycle. If you’re applying this year—and what a big difference, seeing as interviews will be held virtually—happy new year and best of luck!

1. Know the process

This means being familiar with the steps necessary and pathways available for a licensed practice in Canada. I cannot count the number of times I have been asked about which exams are necessary, in which order, and are there any options. Please do your own research and reading! Most information is available on official websites, and clarifications can easily be made by contacting these institutions either via phone or email. Important websites are Physicians Apply, the MCC, and CaRMS. If you’re not familiar with these acronyms, please look them up and learn them.

Why don’t I want to waste time on giving advice about the process itself? One reason is that information is readily available, and questions can easily and more accurately be answered by contacting the right people who are in charge. Even if they cannot answer you, they can most certainly redirect you to someone who can help. Second, the rules of the process change every so often. During the years I was doing my exams, you needed to do the MCCEE and you needed to do the series of tests in a certain order. Not so anymore. This is why getting into the habit of reading what’s on official websites and keeping yourself update with rule changes is important. Finally, the process can be different depending on the province in which you are residing, as well as on certain elements of your application status. For example, applicants to Family Medicine in Ontario have a strict OSCE cut-off, while applicants in British Columbia must have undergone their own provincial assessment program. Some applicants need to sit the IELTS, some don’t. Some programs need the CASPER test, some don’t. Knowing the rules that apply to your situation will streamline your preparations and prevent unnecessary effort.

2. Start the process as early as possible.

Yes, this means even as early as in medical school! Ideally, of course, if you already were a resident of Canada, you would have gone into medical school here instead of venturing overseas. However, whether you are an immigrant, thinking of moving, or simply decided to take your chances elsewhere, it is important to prepare your application as early as when you are in medical school. This means taking electives in Canadian medical schools to get that most-coveted Canadian clinical experience. I remember that the University of Toronto has an online system to register elective applications. Some universities may also allow organizing clinical rotations in partnership with your home university. Don’t be afraid to write and ask! Getting rotations in Canada even while in school will allow you to obtain stronger reference letters. Besides, getting clinical experience after you graduate can be difficult and expensive.

In addition, starting the process early maximizes your chances of scoring higher on exams, as you will just be barely out of school (if at all). This will also ensure that you have prepared the necessary (and lengthy) paperwork you may need to verify your identity, apply for exams, and eventually apply for residency.

You may ask: how about if I’m out of school and have just decided that I do want to pursue medical residency in Canada? Well, there is no better time to start than now!

“Knowing the rules that apply to your situation will streamline your preparations and prevent unnecessary effort.”

3. Decide which programs you are applying to and strengthen your CV accordingly.

Again, as in the first point, browsing through the programs and descriptions on CaRMS will inform you of the requirements of each program. From there, you can decide if you would like to apply to a particular program and/or specialty. This is important because this decision will tailor the many others you will make down the line as you improve your CV. For Family Medicine, for example, exam scores are very important, and most programs have a cutoff to filter the many applications they receive. This means that you must study hard and smart to score extremely well and give you a competitive edge. On the other hand, medical specialties may more deeply consider other aspects of your application, such as research and teaching experiences. This is not to say that one is more important than the other; this is simply an observation that most of those who match into Family Medicine have not needed to do graduate degrees in Canada, while it is quite rare for IMGs who have matched into specialties to not have done any form of research or advanced degree in their chosen specialty.

4. Apply broadly.

No matter how excellent you think your application is in one specialty, or even if you have a letter of recommendation from the program director of the Family Medicine program in your province, apply broadly across specialties in which you have a genuine interest. Remember that IMGs have already fewer dedicated spots, and it can be really difficult to tell if the program committee will rank you highly. (Some on the committee may do so, some may not.) The more programs you apply to, the higher the chances that you will get more interviews, and the greater the probability that you will match. Besides, the CaRMS application fee allows you to list up to 9 programs, so make the most of it!

I do not wish to comment on the ethics of applying to “backup” programs, as I understand the fear of not matching can outweigh simply getting it over with. Perhaps you think you can live with the specialty you’ve chosen, that you’re not really stealing a spot from someone who has a genuine interest in a field but has not been selected for interviews. You’ve put in the effort yourself anyway to make your application appealing even to your backup programs. In my opinion, as long as you like the programs you apply to, your skills match the specialties you’ve applied for, and the program likes you back, what does it matter if it’s a backup program?

Back when I started applying in CaRMS in 2016, while I was starting my Master’s of Science in Pathology at McGill, I only applied wholeheartedly to one specialty: ophthalmology. Only Toronto and Ottawa had spots dedicated for IMGs; Quebec had competitive spots, but I was not allowed to participate because I was not a Quebec resident. Every year, I landed an interview or two, and every year, I was told I had the best CV among the IMG applicants. It didn’t matter. For some reason or another, I didn’t match. During the interviews, one question was always there: what would I do if I didn’t match? Did I have backups?

I always said that I didn’t. I would simply try again the following year. But my application was getting stale, and my new research awards and new experiences didn’t seem to matter to the program committee. One faculty member advised me that they had an internal rule that after three attempts at an unsuccessful match, there likely wouldn’t be an interview invitation anymore.

For my fourth attempt, I took to heart what my graduate supervisor told me: I would do well in Pathology. I was working in the industry then and was out of the academe; my work entailed educating other health professionals, primarily compounding pharmacists about medical diseases, pathophysiology, and treatment. I started reading Pathology journals and found that I enjoyed the science of medicine. My personal situation at that time also prompted me to move towards Pathology. Even then, I didn’t apply broadly. I applied only to McGill, as I didn’t want to leave Montreal. I only had one interview that year: this program. I was so ecstatic when I matched!

My experience is one thing, reality is another. Most of my friends and the IMGs I know have applied broadly, so please do so to maximize your chances!

5. Strengthen the different aspects of your application by engaging in various endeavors.

I will give more details in a future post, but basically, I divided my application into clinical, research, and civic experiences. I made sure to add Canadian entries in all three aspects. My clinical experiences consisted of observerships in subspecialties across the country (and one in the United States) and of clinical traineeships in British Columbia. For research, I was a volunteer clinical trial coordinator, and I did my graduate degree and completed a thesis that covers the basic sciences. Being a graduate student also allowed me some teaching experience at university as a teaching assistant to undergraduate students. Finally, for civic experiences, I volunteered for health-related organizations, such as the Canadian National Institute for the Blind (CNIB) and, as a student, also had non-health related affiliations and activities.

All these made for a well-rounded application, so much so that one interviewer had doubted if I accomplished all these. One asked: how did I find the time do all of what I claimed to do?

6. Have an organized timeline and try to stick to it!

To the question above, this was my answer: I had a timeline and I stuck to it.

When I started my journey in 2014, I plotted out the many ways I could strengthen my application. I scheduled observerships, clinical traineeships, research, volunteering, exams, and a full-time job, breaking them down into to-do lists, throughout the months over the next 2 years. I knew I was going to start a research fellowship or a graduate degree in 2016, and because I applied early and had great credentials, was able to enter the program at McGill. I also was determined to finish my MSc in 18 months, the minimum time required, so that by the time residency started in July 2017, I would be ready.

Of course, I didn’t match in 2016. I was temporarily disheartened, but tried still to improve my CV. I did more research, more clinical experiences, networked better, and volunteered more. I won a second streak of research awards. Still I didn’t match, and my timeline was extending. I was convinced to maybe do a PhD, so I stayed in the laboratory for an extra year. When I still didn’t match, I knew it was time to leave and not pursue a PhD. My heart wasn’t in it, and I didn’t want to take a precious spot (and funding) from another more deserving student. But even while working at a multi-national company, I was still in the field of healthcare: learning, creating content, and teaching, ever building my CV.

When my original timeline burned out, I simply adjusted and made a new one. I never gave up.

“Mentoring is a brain to pick, an ear to listen, and a push in the right direction.”

— John Crosby

7. Network with colleagues.

Networking is a word thrown around often, but what does it mean? It means you, as an IMG, registering and attending conferences or even grand rounds (ask permission) and interacting with the people there. Ask questions, introduce yourself, make known respectfully that you are an IMG and try to glean opportunities from conversations. You never know if you can obtain an observership or research position, or even simply improve your chances, by making a good impression. At the very least, you will be learning updated clinical medicine, bonding over good food, and making new friends!

You can also network by asking people you already know to introduce you to other physicians with established practices. If you do know people who can help you, do not be afraid to ask! I started from scratch myself, cold-emailing possible supervisors. One time, I even hand-carried a copy of my CV and cover letter to a physician’s hospital mailbox. While I do not get any response most of the time, or it’s a ‘no’ sometimes, all the ‘yes’ I have received have paved the way for me.

8. Have a mentor who’s willing to bat for you.

I cannot emphasize enough the importance of a mentor throughout the application process. I have had many mentors throughout this entire journey. My former bosses in British Columbia, whom I worked for as an ophthalmic assistant, were supportive while I was preparing for exams, looking for research opportunities, and clinical experience. One even offered to call a friend of his who was a hospitalist so that this friend would agree to supervise me as a clinical trainee! (I said no, for reasons I will expound on in another post.) My mentor in Montreal was the one who gave me the chance to do a fully-funded graduate program, encouraged me through the difficulties, made it possible for me to take time off to do observerships all over the country, offered other options when all seemed dim, and celebrated with me when I matched.

Having a mentor does not guarantee success, nor does not having one mean failure. But it definitely makes the journey enjoyable, with nuggets of wisdom peppered along the way.

9. Be aware of other pathways available to you.

This is part of applying broadly and planning strategically. I’ve heard it said that one must not choose the road that leads to success; rather, one must choose so that all roads lead to success. That said, be aware that there are other ways to be able to practice in Canada. Some provinces have programs available to those willing to practice for a certain amount of time in underserved areas. You can also apply for the medical residency match in the US instead of here, and simply challenge the board exams here afterwards, should you want to practice in Canada. To apply in the US, however, you will likely need a different set of experiences, and you definitely have to sit a different set of exams. For those who have trained in specialties in their home countries and are not yet Canadian residents, you may opt to do a fellowship in Canada. I have heard stories of those who, after an excellent fellowship, were later recruited to join the hospital as staff.

Other possibilities include learning French and applying in Quebec, where residency spots are competitive, and a lot of spots are unfilled even after 2 rounds of CaRMS. Finally, you can opt to repeat your medical school. McGill and Dalhousie have programs where they take in 1-2 IMGs as students per year (or when positions are available) to repeat the last 2 years of medical school, after which a Canadian medical degree is awarded. There are stringent rules for applying, however; it’s still worth a shot.

10. Have fun with the process… and the interview!

You’re only going to do this process once, for better or for worse. Try not to make your entire life about matching into residency. Don’t forget to spend time with friends and family and to explore other interests you may have. This way, even if you think you have your heart set on practicing as a doctor here in Canada, you aren’t blindsided by other fabulous personal and career opportunities. I know friends who decided to not continue vying to match and have instead successfully started businesses or switched careers. As for myself, I was so bored with the sciences that I dabbled in classes in theology. I even published a paper in that discipline! I also had friends who weren’t in healthcare, eventually met my future husband, got married, and had a daughter. The process was long and sometimes felt arduous, but I wouldn’t have changed any moment of it.

As for the interview—I have the same simple advice. Be yourself, and have fun. I made it a point to enjoy the food and to not hold back smiles and laughter, even during the interview proper. Some people have advised me to appear more serious, as it seems more professional, and adds a sense of gravity. To me, the advice seemed strange, as it would mean not putting my best foot, rather a false foot, forward. Besides, how will I know if I’m fit for the program? I remember when I interviewed at Ottawa: I was quite at ease, and I knew that if I went there, I would enjoy training despite the difficulties. (I didn’t match there, however, so I guess my feelings were unrequited.) After interviewing at McGill, however, the clarity of my realization struck me.

“I belong here,” I told my husband then. “I didn’t need to fake anything, not even my awkwardness and quirks. The place and people are amazing.” (Thankfully, I matched here!)

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There you have it, ten tips for matching into medical residency in Canada. I will likely expound on some points and give more detailed advice in future posts. Note that my way is by no means the only way, but my suggestions include those recommended by friends and colleagues I have crossed paths with over the years. As for you, fellow traveler and bearer of the Rod of Asclepius, I look forward to seeing you on the other side. Best of luck on this adventure!