Journey of candidates who were unmatched in the Canadian Residency Matching Service (CaRMS): A phenomenological study

Abstract

Background: Each year, a number of medical students are unmatched in the Canadian Residency Matching Service (CaRMs) match. There is little information on the experiences of unmatched candidates. This study seeks to explore the experiences of applicants who were unmatched in the first iteration of their CaRMS applications
 Methods: We interviewed 15 participants who were previously unmatched, using a semi-structured interview guide to ask them of their experiences on the following domains: the overall unmatched experience; circumstances leading to their unmatched status; resources employed; barriers experienced; recommendations; and, their eventual career outcomes. We independently identified major themes from field notes to code the data using a phenomenology approach.
 Results: Our participants universally reported negative emotions, concerns regarding privacy and confidentiality breaches, and stigma faced (real or perceived). Systemic challenges included: lack of information, pressures faced from undergraduate medical education, and logistical issues such as financial challenges, licensing and scheduling issues. The utility of peer support differed for individual participants, but all those who had support from other unmatched candidates felt that to be useful.
 Conclusions: Our participants reported significant challenges faced after being unmatched. Based on these experiences, we identified four major recommendations to support candidates through their unmatched journey.

It's Time to Stop Pointing Fingers: The Role of GME in Addressing the Issue of Unmatched US Medical School Graduates

“…For example, Canada uses a standardized approach, with mental health counseling, peer support, a toolkit from previous unmatched students, an additional structured year of medical school, 3 match rounds, and a longer time period between initial match results and the final match round. [13][14][15][16][17][18][19] Canadian program outcomes, including career paths, physician supply, and costs, should be reviewed for relevance to the United States.…”

Virtual breakout rooms: an effective approach to offer guidance to medical students on residency applications

“…To normalize and destigmatize not matching, we included a resident who was previously unmatched. 4 The event began with introductions from eight resident panelists to attendees in one virtual room using a Zoom videoconferencing platform. Concurrently, event organizers arranged breakout rooms of seven students and one resident.…”

“…These virtual events employed small, non-recorded, cycling breakout rooms between residents and medical students, and comprised intentional panel diversity across specialties, genders, training sites, and experience with being unmatched. 4 This format may foster a safe environment with exposure to various mentors in a single event.…”

Saturating stable matchings

“…This is detrimental to the government two-fold: firstly, governments invest enormous sums into training medical students, even in private healthcare systems like the United States, and these funds are gone to waste in a sense if the student is unable to eventually practice; secondly, given the physician shortages in many countries, there is a clear need for more practicing physicians, and having medical students, equipped with all the knowledge of their preceeding decade or more of education, unable to practice is a loss to society. On a more individual level, being unable to obtain a residency position, or the fear thereof, has been documented to contribute to significant mental health issues in final-year and graduated medical students, for example by Okoniewska et al, who interviewed unmatched medical students [7].…”