CaRMS Mentorship Series | Life after CaRMS

Editor’s note: Another version of this piece previously appeared on Luckett’s own blog (“This Liminal Space“). We asked her to revise and add to it so that it might become a permanent part of the BoringEM CaRMS advice section. It was initially published on BoringEM on April 15, 2015 and is republished on the ‘Throwback Thursday’ following the release of the CaRMS results yesterday – TC

I remember submitting my CaRMS rank order list all too well. I remember pacing my apartment, biting my lips until they were raw while I talked through its ordering and re-ordering with my best non-medical friends. I remember the grumbling, low-level anxiety of the intervening weeks while I waited for Match Day, and the nail-biting anticipation of the day before the match was released.

Deciding on a rank order list was a matter of optimising specialty, opportunity, geography, and feel. I had kept careful notes on programs as I’d interviewed. Ultimately, I settled on a list that felt, if not right, then at least okay. Knowing that the CaRMS process is imperfect, I intellectually, if not quite emotionally, accepted that checks and balances existed to ensure I ended up in a program that was a good fit.

On Match Day, I took my computer into a stairwell at the hospital, sat on the steps, and logged into the CaRMS website. I discovered that I had not matched to my first choice program, nor to my second. It was a blow to my ego. I berated myself for my many failings. I now knew that I was not smart enough, not savvy enough, not interesting, charismatic, or talented enough to match to my first choice.

In my PGY1 year, I was honoured to meet CaRMS applicants to our program. It was fun and exciting to tell them all about my program and how much I love it.

That’s right; I love my program even though it wasn’t my first choice.

So, how do you get there? What do you do when you find yourself in a program that isn’t your first choice? How do you deal with the disappointment and turn it into excitement?

Here are a few things I found helpful:

1. Talking it out.

After the match, it seemed that each of my classmates had matched to his or her first choice programs and was filled with unmitigated joy at what lay ahead. I felt isolated and alone in my disappointment. Moreover, I knew I had matched to a competitive specialty, and felt guilty that I wasn’t happier about my good fortune.

There were a few notable exceptions. A few of my classmates looked glazed when I ran into them shortly after the match, and revealed their shock or uncertainty about their placements. With these peers, and with my close friends, I tentatively disclosed my disappointment at not matching to my first-choice program. As my feelings were validated, I began to be more open. In openly talking about my experience, I began to feel less isolated. Speaking with others made me realise both that I was not alone in my situation and that there were definite positives to matching to a program other than my first choice. Slowly, I began to adjust to the idea.

The feelings that come with matching to a program – even your first choice program – can be complex and difficult to deal with on your own. One of the most important things you can do is to talk out all the conflict and angst with someone you trust. This can help you gain clarity and perspective.

2. Learning my community.

I moved to my new community a month before starting residency. During that first month, I tried new restaurants, ran new routes, and got comfortable driving to surrounding areas (which was quite the feat, as the first time I was ever alone in a car was the day I moved to my new city!). I swam at recreation centres, and walked around in my neighbourhood. Eventually, I began to feel both comfortable with, and optimistic about, my new surroundings.

Putting down roots can help you feel at home in your new environment. Many people find exploring restaurants and local attractions, joining clubs, or getting involved in community organisations helps them feel happy and optimistic about their surroundings, and gives them an all-important sense of home.

3. Creating a home.

The first task I attacked after match day was finding somewhere to live. With the help of a great real estate agent, I began looking at properties for rental or purchase. I ultimately settled on renting a really lovely apartment in a converted school building, and I set about making it my home.

I hung photographs and art on my walls. At the head of my bed is a typographic exhortation to bloom where I am planted, a reminder that my location for the coming years is decided, and all that remains is for me to decide to be excellent exactly where I am. At the foot of my bed is encouragement to wake up and be awesome so that I remember to greet the day with enthusiasm. Over my couch are reminders to work hard and be brave, since I know that nothing will be asked of me so much as a dedication to hard work and bravery during this residency. In creating an environment that reflected my personality and was comfortable to come home to, I made a commitment to my new city and my new program. That made it easier to let go of the things that could have been and embrace exactly what was.

Settling into a comfortable home, organised and decorated to your tastes, is an essential part of starting a new residency. It lends a sense of ownership and permanence, but also gives you a space to host friends, be creative, reflect, and relax.

4. Meeting my fellow residents and getting involved.

Immediately upon my arrival, I met friendly co-residents and staff (and also some who are really, really intimidating!). Soon, I was offered an opportunity at BoringEM.org, and I became junior resident editor. Shortly thereafter, I began casually helping out with the Medical Education in Cases (MEdIC) series at ALiEM.com, and later began more seriously working on the series in editing, hosting, and writing roles. I began a research project. I sought out teaching and feedback and began to feel part of the community in my new program.

Seeing friendly faces, having purpose, and learning about the brilliant minds around you can help you settle into a new environment faster than just about anything else.

5. Staying connected with friends.

After the match, I was tempted to withdraw from friends both within and outside medicine. My closest friends outside medicine were well-acquainted with my goals for the match, and I was embarrassed that they knew I had failed. My friends within medicine were all so excited with their match prospects that I felt removed from them, and worried that my disappointment would taint their high spirits. I was fortunate that my friends would not take no for an answer. They reached out in the days following the match, and I was soon feeling positive and excited about my new program, largely due to their congratulations, encouragement, and positivity about my prospects.

Though we tend to withdraw when we are disappointed, ashamed, or upset, friends (and family, for some) are your best resource. Whether they are commiserating, encouraging, or just distracting you, the positive people in your life can help you get through matching to a second, third, or lower choice residency. Often, they are also the people most likely to kick your butt and adjust your attitude. A common refrain was, ‘Yeah, Luckett, you didn’t match to your first choice, but you are going to be an emergency physician! That’s what you wanted!’

I started my time in this new city with a commitment to making the coming five years productive, exciting, and fun. I dedicated myself to becoming an excellent clinician through practise, through welcoming feedback, and through embracing all that my program has to offer. I now cannot imagine myself anywhere but in this program. I cannot imagine what life would have been like in my first-choice program. I cannot imagine choosing any program over the very program where I am now. I have taken advantage of opportunities that I would never have been offered anywhere else. I have met co-residents, support staff, and attendings unlike anyone else I know. I am grateful that this program felt that I would be a good fit and welcomed me into their home.

Matching to a program that is not your first choice is a painful and disappointing experience, and one that can make you question your worthiness. It takes tenacity, optimism, and an open mind to make the best of a disappointing situation, but your tenacity, optimism, and open mind have already brought you this far; they can take you right across the finish line. Remember, life is 10% what happens to you, and 90% what you make of it.