How did you navigate residency with respect to matching to a specific city/school?

Dear QMR,
How did you navigate residency with respect to matching to a specific city/school? 
Sincerely, 
How do I CaRMs

Dear How,

Ahh, the wonderful black box that is CaRMs …how lovely. Before we get started, there are few things that you need to know about the CaRMS process:
#1: Whether it takes you two years, five years, or fifteen years after medical school- you will be a doctor, and you will be okay.
#2: You will know people who go unmatched. If you are comfortable with it, reach out to them to make sure that they are doing alright. In your time of celebration, they may need you the most.

With that aside… There is no rulebook for CaRMS. Every school and every specialty evaluates candidates differently. By the time CaRMS rolls around, you will have shortlisted a single specialty, or a few specialties, that you would be happy matching to. The fact of the matter is that all QMed grads have the capability to do exceedingly well in a number of specialties.

You need to ask yourself what the most important thing to you is. Most times, people take some sort of combination of  “geography-centric” and “specialty-centric” approach to the rank order list. If you would only be happy in one specific specialty, you need to accept that you may need to spend many years away from the people and places you love to train in that specialty. 

If you care most about being in a specific place, then the first thing that you should do is secure an elective at schools in that place. You are more likely to be favourably ranked if the program knows you personally and has worked with you in the past. If you have a connection to the place, you should consider including that information in the personal letter that you write to the program, and also consider discussing it in your interview. That said, do not fret if you are unable to get an elective at that school; schools typically also keep track of people who have applied for electives, even if they do not actually obtain them. I also have colleagues who have done related electives at the school, and met with the program directors of the program that they are interested in, to at least put a face to a name.

At the end of the day, there are no rules and there are no rulebooks. Most of the time, your gut will be right. For more on this topic, check out the CMAJ Podcast episode with Dr. Jillian Horton from Jan 4, 2019. 

Sincerely,
I got 99 problems but CaRMS ain’t one