Every March, final-year medical students in Canada face what for many is the single most stressful day of medical school, Match Day. It’s the day when they find out after years of education and months of applications and interviews if they will continue their training in their chosen speciality as residents after graduation.
Prospective doctors must complete residency training to practice medicine in Canada. A globally recognized algorithm tries to match each student to a specific program.
On Match Day six years ago, Amit Persad found himself sitting in his car in disbelief. He had dreamed of becoming a neurosurgeon but when he logged into the results page on his phone, he saw the devastating news – he had not been matched with a residency program. He recalls repeatedly refreshing the screen in the hope that the words would change.
Persad had very little time to process his shock before he had a life-altering decision to make: whether to give up on neurosurgery and apply to another field in the second round, which occurs a few weeks later and allows unmatched students to apply for unfilled positions, or wait until the following year and reapply to neurosurgery.
That year, 166 Canadian medical school graduates out of 2,810 found themselves in a similar situation. The following year was expected to be even worse because Ontario had decreased the number of available residency positions.
It was obvious that better supports for unmatched students were needed, says Kaylynn Purdy, director of education for the Canadian Federation of Medical Students (CFMS) at the time.
The federation came up with a system in which unmatched students would be paired with a mentor who had previously gone unmatched for advice and support. About 30 mentors signed up to be part of the CFMS’s Unmatched Peer Mentorship Network, says Purdy.
The predictions proved correct, with a record 198 medical students unmatched after the first round in 2018. Although Purdy declined to provide exact numbers because of privacy reasons, she says demand was so high that each mentor was matched with more than one student.
“A lot of people don’t talk about not matching,” Purdy says. “It seems that there’s a lot of stigma, that (people think) it’s only bad medical students who don’t match, which we know is not true. It’s usually just bad luck.” A student might have applied for a residency in a specialty for which there are fewer places than there are suitable candidates, for instance.
Purdy notes that unmatched students say it is helpful to have someone to talk to “without judgment, who’s been through this before and is now having a successful career in medicine.”
For many unmatched students, Persad has become that “someone.” He is now just a few months away from becoming a practicing neurosurgeon, having found a position four months after he initially went unmatched. Each year since the network’s creation, he has helped unmatched students navigate what he says is probably the “No. 1 thing that has ever gone wrong in their academic career.”
Though Persad went unmatched for months, he says he came to view the experience as an opportunity for growth.
“It made me much stronger, not just as a doctor, but as a person in terms of resilience and wellness. It primes you to be ready to deal with the idea that you might not be perfect all the time.
“Just because you aren’t the only transcendental human who has never made a mistake doesn’t mean you’re a failure. We all make mistakes. Medicine is a hard job. Sometimes you do everything right and it still doesn’t go well and that’s very humbling.”
We all make mistakes. Medicine is a hard job.
The first thing Persad does when he connects with an unmatched student is to listen to what the student is feeling and to offer comfort because going unmatched can be devastating. At least one unmatched student has died by suicide, he says, which is a huge tragedy.
Next, he reminds students that outside of medicine, the concept of “you didn’t get the job” is common, and to consider honestly whether there’s anything in the application that could be improved.
“Sometimes you don’t get the job, and that doesn’t say anything about you,” Persad notes, explaining that he thinks the match system itself is flawed. In his year, for example, 31 students applied for 15 positions in neurosurgery.
“The other thing is to say, ‘This is just another obstacle in the road and you’ve got to find your way around it,’” he says. “There’s always a way forward.
“And then the most important thing that we all forget in academia, especially in medicine, is to remember to not attach the match to your own personal value as a human being.
“Success with the match has nothing to do with an individual’s value as a human being. It doesn’t mean that they’re worthless. It doesn’t mean that somebody else is better than them. It just means that they didn’t match.
“We need to normalize it.”
Persad has written articles for medical journals about his experience and possible solutions, including the option of a rotating internship for unmatched students that would help prepare them to reapply to be matched with additional experience and skills. He says he hopes his writing will help break the stigma around going unmatched.
Since 2018, the peak in the number of unmatched students, about five per cent each year, have gone unmatched on Match Day.
Danielle Judd, CFMS’s current education director, says that as awareness of the network has spread, the number of mentors and unmatched students reaching out has grown steadily. She sees significant progress in terms of normalizing discussions around what it means to go unmatched.
Rob Cianfarani, an education officer with CFMS, agrees that the culture seems to be shifting.
“The older culture is about not talking about it. If you have something that you’re going through that’s difficult, you keep it to yourself,” he says. “Now, it’s moving in the right direction, where there are organizations like CFMS that can provide support.
“The fear and the stress are still there, but the resources available are a little bit better and people who have gone unmatched are more willing to talk about it.”
In addition to the mentorship network, CFMS provides other resources for unmatched students, such as financial support for the second round, a webinar and a written toolkit. It also advocates for systemic changes such as increasing the number of residency positions.
Several CFMS-supported recommendations were included in the Association of Faculties of Medicine (AFMC) of Canada’s 2018 report on the high numbers of unmatched students. In particular, the AFMC called for a minimum ratio of 1.1 residency positions for each Canadian medical graduate. According to data provided by the AFMC, that ratio has risen from 1.014 in 2018 to 1.06 in 2022.
“The desired endpoint is that all graduates of Canadian medical schools, who have been supported by taxpayer dollars to the tune of about a quarter million dollars to train an MD and get them to graduation, should be able to match into a residency program upon graduation, to continue their training so they can actually care for patients,” says Geneviève Moineau, AFMC president and CEO.
“We have moved some way forward, but we need to continue to move in that direction.”
Although statistics for this year’s match are not yet available, Judd says that five to ten unmatched students had already reached out to her within a few hours of the match results being posted.
Once again, Persad has made himself available to unmatched students. “I’ll always be there for the unmatched kids,” he says. “It’s just so important.”