The Impact of the COVID-19 Pandemic on the Canadian Dermatology Residency Match

The COVID-19 pandemic introduced unprecedented challenges to the annual Canadian Resident Matching Service (CaRMS) process. Analyses of the American dermatology match found a significant increase in home school matches and minor increase in regional matches in 2020-2021. ^{1 -3} However, the impact of COVID-19 on CaRMS has yet to be explored.

According to a survey of American dermatology program directors, the most valued residency selection criteria were the interview and reference letters, followed by USMLE scores and grades (less applicable to the Canadian match) and an elective at their program. ⁴ Historical CaRMS data from 2013 to 2020 similarly shows that most successful applicants did a dermatology elective where they matched (72.4% to 87.5%). ⁵ Unfortunately, these criteria have been dramatically affected by COVID-19—interviews have become virtual and away electives have been restricted, increasing competitiveness for home rotations and making dermatology letters harder to obtain.

We analyzed Canadian medical graduate match data from all nine independently accredited dermatology programs across Canada (n = 178), including two Francophone programs. The 2020-2021 cohort (n = 23) was compared to a pre-pandemic control group of residents who matched in the last 5 years (n = 155) using chi-square test in Microsoft Excel. Significance was defined as P < .05. While separate analyses were conducted with all schools (Supplemental Table 1) and English-speaking schools alone (Supplemental Table 2), match trends were consistent across both analyses.

A non-significant increase was noted in home school matches compared to pre-pandemic (60.9%, 51.6%, P = .407). In-province matches increased significantly, with 91.3% of residents matching in-province in 2020-2021 compared to 72.3% previously (P = .050); this was still noted with Francophone schools excluded (P = .037). Additionally, there was a non-significant increase in match rates for students without a home dermatology program, with 17.4% of residents in 2020-2021 coming from schools without home programs versus 12.3% previously (P = .4934).

The results suggest geographic proximity may have become more important for both programs and applicants during the pandemic, to minimize uncertainty and risk in a year already fraught with uncertainty. Applicants might prefer to stay close to pre-existing support systems, and as COVID-19 restrictions varied by province, may have faced fewer barriers to research or mentorship with faculty from an in-province program. For programs, while there may not be the same degree of familiarity as with a home school candidate, in-province candidates are more likely to have reference letter writers and research supervisors known to the program where they matched.

The lack of significant change in home school matching does support the efforts programs are making to mitigate pandemic-related limitations out of applicants’ control. Dermatology programs nationwide have already made changes to the selection process including broadening guidelines for reference letters, extending more interview offers, and disregarding the number and location of dermatology electives when ranking.

As upcoming match cycles remain affected by COVID-19, with ongoing restrictions on electives and other activities, both programs and applicants must continue to adapt to rapidly changing external factors and a selection process very different from pre-pandemic norms. Ongoing review is needed to ensure that our resident selection processes remain rigorous and equitable.

Supplemental Material

Table S1 - Supplemental material for The Impact of the COVID-19 Pandemic on the Canadian Dermatology Residency Match

Supplemental material, Table S1, for The Impact of the COVID-19 Pandemic on the Canadian Dermatology Residency Match by Janis Chang and Carly Kirshen in Journal of Cutaneous Medicine and Surgery