Lies students tell
CMAJ 1997;156:1265
See response by: T.A. Young
I am responding to the article "Teaching medical students to lie" (CMAJ 1997;156:219-22 [full text / en bref]), by Dr. Tara A. Young, which focused on the use of "deception, dishonesty and outright lies" in the resident-application process. I was intimately involved in the organization of the PGY-1 surgical match, a forerunner of the current Canadian Resident Matching Service (CaRMS) match, and I must take issue with the negative and despairing tag she has placed on the current process. I believe we were faced with a difficult situation and have responded with an imperfect but fair process.
With the current emphasis on fiscal restraint, the reality of applying for a job -- and that is exactly what the prospective resident is doing --can seem rather bleak. When the number of graduating students is high and the number of jobs, especially with health care restructuring, is decreasing, the competition becomes intense. In many other professions, such as law, a large proportion of graduates simply do not find jobs. As in law, the problems facing medicine do not lie in the application process but in the numbers game.
At the root of our collective conundrum is our inability to use an application or even an extended interview to determine who will ultimately be a successful practitioner in a particular specialty. We employ many criteria every year, but proven criteria are scarce. Regardless, candidates still attempt to judge which are the "best programs," just as program directors strive to find the "best applicants."
Young implies that the application process means that future residents can appear absolutely committed to a variety of subspecialties. I disagree with that in part, for the CaRMS application process has a place for 3 specific referees; although some applicants do provide literally dozens of reference letters that become part of their file, the 3 primary letters often indicate what the real career choice is. Every applicant must also detail the number of electives taken, and this helps define the commitment of a student to a particular specialty. Young should know that, although the interview process is important and we value the personal contact (however brief) with individual applicants, we generally pay more attention to what people have done than to what they say they will do.
Just as a marriage proposal is not prudent on the first date, so the commitment to a resident by the program and to a program by the resident is more comfortably made after daily exposure during an elective. That kind of contact is far more valuable than any number of interviews or letters of reference from people the program director does not know.
Young entered a much-sought-after program and was obviously very well qualified. The number of programs she applied to does not reflect the dishonesty of the system as much as her insecurity about being accepted. That is a trait possessed by almost every applicant to every job in the 1990s, and it will not soon change.
Meanwhile, we will continue with a flawed but fair system in which, human nature being what it is, candidates will self-aggrandize and flatter programs and programs will self-aggrandize and flatter candidates. In the end, however, the vast majority of students will be placed in programs high on their lists.
Bryce R. Taylor, MD
Chair
Division of General Surgery
Associate Chair
Department of Surgery
University of Toronto
Toronto, Ont.
 |
Send a letter to the editor responding to this letter
Envoyez une lettre à la rédaction au sujet de cette lettre |
Letters