Okoniewska Basia, Ladha Malika A, Ma Irene W Y
Department of Family Medicine, University of Calgary, Cumming School of Medicine, Alberta, Canada.
Division of Dermatology, Department of Medicine, University of Calgary, Cumming School of Medicine, Alberta, Canada.
Can Med Educ J. 2020 Jul 15;11(3):e82-e91. doi: 10.36834/cmej.69318. eCollection 2020 Jul.
Each year, a number of medical students are unmatched in the Canadian Residency Matching Service (CaRMs) match. Blog posts from previous unmatched students suggest that being unmatched is associated with significant stress. However, no studies have explored the collective experiences of candidates who are unmatched. This study seeks to explore the experiences of Canadian students who were unmatched in the first iteration of their CaRMS applications.
This was an interview-based qualitative study using a phenomenology approach to explore the perspectives of 15 Canadian participants from seven universities who had previously experienced being unmatched between 2011 and 2017 in CaRMS. Telephone interviews were conducted using a semi-structured guide focusing on the experiences in the following domains: the overall unmatched experience; perceived reasons leading to their unmatched status; resources employed; barriers experienced; recommendations; and, their eventual career outcomes. Field notes were analyzed independently by all authors using thematic analysis and authors independently identified major themes. To reconcile divergent impressions and better situate qualitative impressions of our participants, we used publicly available quantitative data from CaRMS to calculate relevant odds ratios.
Our participants universally reported negative emotions, concerns regarding privacy and confidentiality breaches, and stigma faced. Systemic challenges faced by our participants included: lack of information, pressures perceived from undergraduate medical education to apply in the second iteration to specialties that they did not want, 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.
Our participants reported significant challenges faced after being unmatched. Based on these experiences, we identified key areas of support needed for candidates through their unmatched journey.
每年，都有一些医学生在加拿大住院医师匹配服务（CaRMs）中未成功匹配。往届未成功匹配的学生发布的博客文章表明，未成功匹配会带来巨大压力。然而，尚无研究探讨未成功匹配的候选人的总体经历。本研究旨在探索在CaRMs首次申请中未成功匹配的加拿大学生的经历。
这是一项基于访谈的定性研究，采用现象学方法，以探究来自七所大学的15名加拿大参与者的观点，这些参与者在2011年至2017年期间曾在CaRMs中经历过未成功匹配。使用半结构化指南进行电话访谈，重点关注以下领域的经历：总体未成功匹配的经历；导致其未成功匹配状态的感知原因；所采用的资源；遇到的障碍；建议；以及他们最终的职业结果。所有作者使用主题分析独立分析现场笔记，作者们独立确定主要主题。为了调和不同的印象并更好地定位我们参与者的定性印象，我们使用了CaRMs公开的定量数据来计算相关的优势比。
我们的参与者普遍报告了负面情绪、对隐私和保密性被侵犯的担忧以及所面临的污名。我们的参与者面临的系统性挑战包括：信息缺乏、本科医学教育带来的压力，即在第二轮申请他们不想要的专业，以及后勤问题，如经济挑战、执照和日程安排问题。同伴支持的效用因个体参与者而异，但所有得到其他未成功匹配候选人支持的人都认为这种支持是有用的。
我们的参与者报告了未成功匹配后面临的重大挑战。基于这些经历，我们确定了候选人在未成功匹配过程中所需支持的关键领域。
