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Elective choices may not matter for residency as much as medical students think

Caroline Mercer | Toronto, Ont. | May 22, 2018

Medical students receive conflicting advice on the best strategy for picking electives.

Facing tougher competition for residency positions, some medical students are focusing all their electives in a single specialty to impress residency programs, but it’s not clear this strategy works.

A narrow focus may backfire if a student’s preferred specialty doesn’t work out. It also runs contrary to the educational goal of electives. Electives are an “opportunity for career exploration,” said Maylynn Ding, education attaché for the Canadian Federation of Medical Students (CFMS). “We want an environment where we feel comfortable and able to do that.”

But as the odds of going unmatched increase, students are more likely to opt for whatever strategies they believe will strengthen their applications. When it comes to electives, the advice is often conflicting and anecdotal.

The CFMS matchbook includes recommendations from residents to “try as many programs as possible” and “think about your own education and having a well-rounded background.” But it also includes advice to do fewer, longer electives and treat them as interviews for residency.

On medical student forums, some posters warned that programs consider only students who complete electives at their sites and look down on those who split their focus between specialties. Others caution against an “eggs-in-one-basket” approach. “It’s wise to have back-up options,” wrote one forum member.

Some American studies suggest that electives may not have much impact on a student’s chances of matching. One study found that only a third of students matched to a program where they had taken an elective. Another found that students who did not take “audition” electives were just as successful in the match as those who did, if not more successful.

Carol Ann Courneya is part of a team of researchers at the University of British Columbia studying elective strategies in Canada. “For the first time ever, we’ve been able to say we have a pretty good idea of some general strategies students employ,” she said.

Unpublished results submitted to the Canadian Conference on Medical Education show that the majority of students take all or most of their electives in a single discipline. Most students who strategically “stacked” electives this way matched to general disciplines such as family medicine or internal medicine. However, these strategies also posed a risk of students matching to specialties other than their first choice or going unmatched if they only took electives in highly competitive disciplines like plastic surgery or dermatology.

Dr. Chris Watling, associate dean of postgraduate medical education at the Schulich School of Medicine and Dentistry, says that residency programs are “strongly discouraged” from expecting students to take all of their electives in one specialty. Medical schools are also considering limiting the number of electives students can do in a single discipline to “ensure an even playing field.”

“We all agree that students should do a diversity of electives in medical school, and that they must not be disadvantaged in the match for doing so,” said Watling.

Photo credit: sturti/iStock

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