This month, our undergraduate learners graduate! While this is an exciting and rewarding time for most, it is a challenge for those students across the country who did not succeed in the CaRMS match. Through lobbying, medical students convinced the current Ontario government to provide additional training spots in areas of high need with a return of service requirement. This is leading to a scramble to settle these decisions before tomorrow (May 18), which is graduation day.
Students who chose family medicine matched in the first round in urban sites, and over 98% succeeded in their top choice. After the second round of the match, there were 78 spots still open nationally. A review of the remaining options shows that many unfilled positions are in rural family medicine in Quebec, which excludes candidates without French language skills. Other openings require a return of service, which is also limiting for some applicants.
CaRMS continues to be a challenge for both the students and our programs. One unintended consequence is that students excessively fear that they will not match. As much as we can show that over 97% of students match, and most in a top choice on the first round, the students are applying on average to 19 programs - one student applied to over 60 programs! As medical schools continue to support our students, we must help them to consider choosing fields that have needs. For example, the CAPER data shows that nearly 60% of vacant positions for physicians across Canada in 2017 were in Family Medicine. All other specialties combined made up the other 40% and less than 6% of these were in surgical specialties. Promoting our discipline as a valuable and worthwhile career choice must be a focus as we work toward resolving these imbalances.
The CaRMS match was a hot topic at the recent CCME held in Halifax. Congratulations to the many contributors from our Department, including Dr. Alison Eyre who received the CAME Certificate of Merit. The meeting theme was Competency Based Medical Education (CBME) and the keynote by Dr. Eric Holmboe was Cost, Safety, Quality: Is CBME the solution to driving Health System Transformation? Although our Department has successfully embraced many of the concepts of CBME, there is still work to be done to drive change in our health care system. His article, “Work-based Assessment and Co-production in Postgraduate Medical Training” promotes the concept of co-production. Originally described in relation to public service, it is defined in health care as, “interdependent work of users and professionals to design, create, develop, deliver, assess and improve the relationships and actions that contribute to the health of individuals and populations.”1 Our efforts to include patients on FHT boards and in our research goes some way to promote co-production in health care. The concept can further be developed in relation to PGME as, “interdependent work of learners, faculty, health professionals and patients to design, create, develop, deliver, assess and improve the relationships and activities that contribute to the effective assessment and professional development of learners.”1 In co-production, our learners must participate in informed self-assessment. This requires that learners, “proactively seek out assessment from faculty and members of the healthcare team, perform aspects of their own assessment such as clinical performance reviews or evidence-based practice and actively engage their assessment data for professional development as part of their own accountability.”1
To make these changes will be no small feat, and will require a culture change both for our own practices and for our approach to assessment. I encourage you to read the article. Without these changes, it seems unlikely we will reach our goal of a safe and effective health care system.
 Holmboe ES. Work-based Assessment and Co-production in Postgraduate Medical Training. GMS J Med Educ. 2017 Nov 15;34(5):Doc58. doi: 10.3205/zma001135. eCollection 2017.