For Santanna Hernandez, an Indigenous medical student and mother of four, the demographics of Match Day – the day students in their final year of medical school learn which residency program has accepted them from their ranked list – are personal.
But when she went looking for answers, she found none. A year later, she’s one of the catalysts in the search for greater transparency.
Hernandez is now in her second year of medicine at the University of Calgary and is president of the Canadian Federation of Medical Students (CFMS). It is in this capacity that she posed what should have been a rather simple question: Can the Canadian Resident Matching Service (CaRMS), the independent organization that facilitates matches between medical students and their placement opportunities, release demographic data on the students matched across the country?
But it turned out to be more complicated than expected – CaRMS did not, in fact, collect the data in question; it isn’t available in Canada at either the residence matching level or the medical student entrant level. “In my mind, I would have thought that that data was already collected,” she says
What little is available is piecemeal information released by specific universities on the demographics of their newly accepted classes, rather than on matching results for those in their final year. And, adds Hernandez, even that data may be incomplete as the universities do not break down the data by specific backgrounds.
Little did she know that on the other side of the country, someone was working on a solution to the data problem.
At Dalhousie University, Ian Epstein, director of the Core Internal Medicine residency program, had been thinking about how to improve his program for years. He’d begun implementing improvements to the program’s selection process in 2015, taking his lead from the University of Toronto’s Best Practices in Application and Selection report, but had yet to institute a formalized means to measure and improve diversity in the program.
The need for a stronger equity policy became apparent to Epstein with the Black Lives Matter movement in 2020 and the discovery of unmarked graves at residential schools in 2021 that happened with the COVID pandemic in the background.
“It was very, very crystal clear that now is time to act – there’s just no way you can put this off for another five years, to try to have another recommendation or report around this,” Epstein says. “Society is showing us why we need to do it. And we need to act now.”
Last spring, Epstein’s team sent out an optional self-identification questionnaire to the students being interviewed for residency placements at Dalhousie’s internal medicine program.
“The people that matched to our program seemed happy and proud that we had done that,” Epstein says, adding that his colleagues at Dalhousie immediately warmed to the process, including human resources staff, assistant deans and deans from other medical programs. “And (the questionnaire) actually made our job easier, in a way, because there’s so many great candidates, and we want to value diversity in the way we rank (them).”
Seeing the success of his program’s demographics transparency initiative, Epstein turned to his contacts at CaRMS, CEO John Gallinger and Client Experience Manager Ryan Kelly, and proposed that it be expanded to a national, independently administered and optional questionnaire run by CaRMS during the matching process. “Your timing couldn’t be any better,” they told him.
It takes careful construction to make people feel safe and comfortable.
“In fact, in the spring of last year, the CaRMS board had adopted a strategic goal around supporting our clients’ (equity, diversity and inclusion) mandates,” says Gallinger. “This was an organizational strategic priority that was heavily informed by postgraduate deans and learners looking for data.”
Developing a questionnaire around self-identification hasn’t been easy; it takes careful construction to make people feel safe and comfortable. Last summer, the team consulted with stakeholders – including organizations of educators and learners alike – and worked to adapt Dalhousie’s pilot questionnaire, taking guidance from a similar questionnaire from the Canadian Centre of Diversity and Inclusion.
“There’s a lot of fear around how to have that conversation about where disclosure is a good thing for you or not,” Hernandez says, “and that varies by program.”
In programs that openly talk about the value of equity and inclusion, it feels more comfortable to acknowledge when you come from an underrepresented background, she says. But in programs that don’t make a note of inclusion mandates, some students worry that disclosing their identities could prove to be a disadvantage. For Black and Indigenous students, who are underrepresented in medicine and against whom practitioners still hold significant racist bias, disclosing one’s race in the application process can be intimidating.
“(It’s) just self-preservation,” Hernandez explains. “Med school is, by far, the most traumatic environment I’ve ever had to exist in. And we, as Indigenous learners, experience daily micro- and macroaggressions of racism, with zero method for accountability.”
“Med school is, by far, the most traumatic environment I’ve ever had to exist in.”
Making the survey and the subsequent sharing of the information with residency programs optional has been essential to making sure already doubtful students didn’t feel forced into making a decision.
CaRMS rolled out a pilot version of its questionnaire during this year’s residency application cycle, asking about race and Indigeneity, immigration, ability, gender, sexual orientation and household income as a child.
Gallinger reports that 20 per cent of CaRMS applicants, or around 900 students, filled the questionnaire. Students could choose to opt out of any of the questions or forego the questionnaire as a whole. Eight medical programs at Dalhousie are part of the pilot project. The demographics data results will be shared at CaRMS’ annual forum later this spring.
As the survey becomes established, proponents hope that other universities will join; and as CaRMS receives feedback and consults with student groups and educators alike, the questionnaire may change.
Evidence of the trends in residency matching will empower people like Hernandez to be able to address issues of systemic racism head-on.
“Data is powerful,” she says. “And that’s how things change in medical education.”
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