Becoming an emergency resident

Letters

CJEM 2004;6(4):239

To the Editor: I read with interest the piece by Dr. McCauley regarding a program director's perspective on selecting residents.¹ I am happy to see attention being paid to an important topic and with welcome insights for prospective emergency medicine applicants.

In the spirit of "healthy rivalry" alluded to in the article, I feel that clarification and embellishment may be helpful in some key areas.

First, it is important for candidates to realize that selection strategies differ from program to program in important ways. For example, the University of Toronto places less emphasis on reference letters and more on the candidates' personal letters and experiences.² We also do not start over at interview time; scores on the CaRMS (Canadian Residency Matching Service) application are carried over to the final score and thus contribute to the ranking process.

Second, there is a body of literature developing that suggests that properly structured application assessment protocols can generate highly reliable ranking lists.^2-4 Programs may decide to interview extra candidates based on elective experience or local training. This can easily be justified based on the philosophies of maximizing opportunities for local talent, rewarding those who take the time to visit on elective, or minimizing risk by highly rating those with whom one has personal experience. It should be understood that these candidates are considered in spite of, not because of, objective selection criteria. This may not only reduce the objectivity of the process, but may provide an unfair advantage to those who either have the time and money to travel for elective time, or have been lucky enough to get into the local medical school.

Finally, I agree that the interview provides a program with valuable insights into a candidate's "fit" with the program. I would also suggest, however, that the candidates view the interview as a golden opportunity to determine how well the program fits with them. Again, I congratulate Dr. McCauley on shedding some light on this angst-ridden process.

Glen Bandiera, MD, MEd
Program Director
FRCP (EM) Residency Program
University of Toronto
Toronto, Ont.

References

1. McCauley B. Becoming an emergency resident: a program director's perspective. Can J Emerg Med 2004;6(1):53-4.
2. Bandiera GW, Regehr G. Reliability of a structured interview scoring instrument for a Canadian postgraduate emergency medicine training program. Acad Emerg Med 2004;11(1):1 27-32.
3. Aghababian R, Tandberg D, Iserson K, Martin M, Sklar D. Selection of emergency medicine residents. Ann Emerg Med 1993;22(11):1753-61.
4. Bandiera G, Regehr G. A structured application assessment instrument is a reliable tool for assessing applications to Canadian postgraduate training programs in Emergency Medicine. Acad Emerg Med 2003;10:594-8.