My class got a quick and by no means thorough breakdown of our overall match results, where the most notable highlight was a complimentary breakfast ten times better than anything I'd been served throughout the prior 4 years. The other notable point concerned how our class did in the match. I'll pump up my cohorts here a bit - we had a lot of people match to some rather competitive specialties, especially surgical specialties. Otherwise our results were fairly typical for our school in terms of the overall unmatched. There's some very good soon-to-be physicians in that cohort of unmatched people at my school, so I'm really hoping they land somewhere acceptable in the second round, or match to their intended residency next year if nothing suitable is left available this year.
Getting a chance to be a bit more up-close-and-personal to the match process has reinforced a few things I had been told, as well as a few I hadn't thought of, when it comes to match strategy.
First and foremost, a good match strategy - applying broadly, backing up where it makes sense to - is still absolutely the way to go. Beggars can't be choosers and when it comes to CaRMS, we're all beggars.
Second, and a perhaps slight caveat to the first, elective choices matter. Splitting electives between competitive specialties is a great way to get neither. The odd person may be able to pull it off, but it's a gamble, even for well-qualified individuals. Backing up should be done when possible, but if a candidate can't give themselves a desirable, viable back-up option without significantly hurting their chances with their first-choice specialty, then maybe a back-up no longer makes sense. Programs shouldn't care about a candidate's exclusive interest in their specialty - the CaRMS algorithm is meant precisely to avoid that kind of thinking - but they do and it shows. Even for less competitive specialties, not showing a reasonable commitment can be a detriment to matching. Any elective set-up should be purposefully created, with a logic to it that fits with a reasonable set of match goals, taking into consideration the timing of CaRMS, the specialty or specialties being applied to, and any geographical restrictions.
Third, networking and playing the social game absolutely have an impact, particularly in smaller fields. Moreover, that factor may be justified. While we often want people to get ahead based on ability than who likes them, few jobs are performed in isolation and medicine is definitely a social job. An ability to get along with others amicably makes a difference in terms of the functioning of the whole group. Networking and playing the social game are the ways to prove that you're easy enough to get along with. Building off the prior point, electives are the ultimate networking opportunity, which is part of the reason they're so important.
Lastly, chance is still a huge factor. In any CaRMS cycle, there seems to be a set of individuals who are phenomenal, clearly desired by programs, and are near-locks to match. That they land their first-choice programs is no surprise. On the opposite end, there are a very small number of individuals who are unsurprisingly left unmatched, or who in some cases never make it through medical school to the match. Yet, most of us fall into the vast middle ground, where we're good, competent candidates without standing head-and-shoulders above the rest. There are differences between candidates in this substantial middle-of-the-pack group, certainly, but the differences end up being more like a difference in flavour than in quality. As a result, when someone ends up on the outside looking in after the first iteration, luck plays a significant role. With the match overall being more competitive than it has been in the past, someone has to go unmatched and it very often is someone who really didn't do anything wrong. Unfortunately people who go unmatched in the first round, or their first year, face a stigma of inferiority, one which is not deserved in many cases. I think this is the part of the CaRMS match that really hit home this year - while the way we approach our residency match does involve some merit-based stratification, outside the extremes it's far less about merit than we like to believe.
Overall, my feelings on a good approach to a match haven't changed much, but the overall importance of certain aspects has. I'm lucky to have had the outcome I did. If I had any new advice to give prospective residents, it'd be merely to emphasize the importance of being proactive with their electives and with developing contacts. Otherwise, stick to the tried-and-true strategies, they're standards for a reason.
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