OPENING THE CARMS BLACK BOX: THE IMPORTANCE OF VARIOUS ASPECTS OF THE CARMS APPLICATION FOR CARDIAC SURGERY APPLICANTS

BACKGROUND This study aims to determine the most important criteria used by Canadian cardiac surgery residency program committees (RPCs) to select applicants and compare these criteria with the perceptions of Canadian medical students interested in cardiac surgery. METHODS AND RESULTS A 50-question online survey was developed and sent to all 12 Canadian cardiac surgery RPCs. A similar 52-question online survey targeted at students interested in applying to cardiac surgery residency programs was designed and distributed broadly across Canadian medical schools. Data from both surveys were analyzed using descriptive statistics. A total of 62% (66/106) of all RPC members across the country completed the 50-question survey. Committee members from all 12 programs (range: 1-12 members/program, 9%-100% response rate/program) and 67% (8/12) of program directors participated. The average experience of participating RPC members was 3.9±2.5 years, with 20% being relatively inexperienced (≤2 years on committee) and 30% being very experienced (≥7 years on committee). Forty-one Canadian medical students (22 pre-clerks [54%], two MD/PhD students [5%], and 17 clinical clerks [41%]) participated. Committee members considered the following criteria most important when selecting candidates: clinical performance during rotation(s) at the program's institution, performance at the interview, quality of reference letters from cardiac surgeons, and completing a rotation at the target program's institution. In contrast, the following criteria were considered less important: a candidate's desire to practice in the city or province of training, having a connection to the program location, and personally knowing committee members. This pattern was consistent between Quebec and non-Quebec programs and between inexperienced and experienced RPC members. Medical students' perceptions were concordant for the most important factors but overestimated the influence of the least important factors. Prospective candidates also overestimated RPCs' expectations concerning research performance. There was a significant difference between medical students' and RPC members' perceptions of the minimum number of first-author cardiac surgery publications (1.9 vs 0.8, p=0.001), total cardiac surgery publications (3.3 vs 1.7, p CONCLUSION Canadian cardiac surgery residency programs seek applicants demonstrating clinical excellence as assessed by clerkship rotations and reference letters from colleagues, as well as solid interview performance. Medical students are aware of the importance of these factors but overemphasize non-clinical characteristics — including the minimum number of research publications — as ways to increase competitiveness.