EXAMPLE - carms.ca

1 Applicant:Referee:Confidentiality of contentPlease indicate if the applicant had an opportunity to review the content of this letter before submission toCaRMS:The applicant did not have the opportunity to review the content of this letter before submissionto CaRMSThe applicant had the opportunity to review the content of this letter before submission toCaRMSC onflict of Interest"I declare that I have not, at any point during the time I have known this applicant, had a relationship withthis applicant that could be construed as a conflict of interest.

2 This may include but is not limited to being:related, a close friend, business associate or treating physician. I declare no conflict of interest;I may have a conflict of interestContext of Working RelationshipWhen did you work with this applicant?Start: [mm-yyyy]End: [mm-yyyy]At what stage of training did you work with this applicant?Pre-clerkshipPre-clerkshipEarl y clerkshipMid to late clerkshipMid to late clerkshipPost-clerkshipPost-clerkshipHow well do you know the applicant?Very wellVery wellWellWellSomewhat wellNot very wellNot very wellDo you feel you have had adequate exposure in a work environment to assess this applicantfairly?

3 YesYesNoFamily Medicine Structured reference LetterLast name, First name (CaRMS code)Title First Last name, DesignationField of practiceJob title / Academic positionInstitution / Medical School affiliationStreet addressCity, Province/State, CountryExampleIs your assessment of this applicant based on direct clinical observation?YesNoNoPractice Setting LocationPrimarily urban or suburbanPrimarily urban or suburbanPrimarily rural or regionalCombination of rural and urbanCombination of rural and urbanPractice Setting TypePrimarily clinic basedPrimarily clinic basedPrimarily hospital basedCombination of clinic and hospitalCombination of clinic and hospitalAssessment of ApplicantAnchors for the following questions.

4 Excellent (among the best, better than many R1s) Very good (functioning like an early R1) Good (ready for R1) Fair (teachable but still needs work to be ready for R1) Poor (below expected level despite practice opportunities, not ready for R1) Unable to assess (not observed)Applicant AttributesExcellentVeryGoodGoodFairPoorU nable toAssessDemonstrates appropriate knowledge data efficiently and to define problems and formulateappropriate management clinical uncertainty and avoidsconcrete compassion and is sensitive topatient effectively and is able to buildrapport with respect for all members of theteam including clinical and a positive learning attitude byseeking out and receiving feedback withoutdefensiveness or undue own limitations.

5 Asking for helpwhen needed without overly relying on reliability and responsibility byattending regularly, being punctual andavoiding leaving toAssessDemonstrates respect and responsibility bycompleting tasks as expected, communicatingissues appropriately and being responsive toemails or other honesty and integrity by takingresponsibility for their a positive learning attitude byseeking out opportunities and stamina and resilience whencoping with unexpected stressors appropriate procedural cultural and social sensitivityproviding a safe environment for all Have you observed any behaviours that cause you to have concerns about the following.

6 Collegiality ( conflict with staff, issue with other learner)NoYesClinical judgement ( over confident, dangerous decision, overly hesitant)NoYesPlease describe yourobservation:Patient-centred care ( disrespect, conflict, boundaries)NoYesReliability or responsibility ( excessive absences, incomplete records, missed calls)NoYesPlease describe yourobservation:Receiving feedback or maintaining professionalism ( disruptive behaviours that impede feedback ordisrupt clinic flow).NoYesOther observed behaviour(s) or trait(s), not otherwise described, that may impact this applicant ssuitability for a position in a Family Medicine NarrativeIn this section we invite you to highlight what makes this applicant stand out as a candidate forFamily StatementsDid this applicant demonstrate an interest in Family Medicine?

7 (Choose one best answer):Definitely yes! For EXAMPLE , the applicant specifically described how to apply this experience totheir future in Family For EXAMPLE , the applicant was interested in and curious about a career in Family For EXAMPLE , the applicant mentioned consideration of Family MedicineNot really but the applicant did not speak negatively about Family For EXAMPLE , the applicant demonstrated negative attitudes towards Family you believe this applicant demonstrates the skills and personality traits supportive ofsuitability for a rural family medicine residency?

8 These would include being self-directed,having a spirit of adventure, and demonstrating a tolerance for working in professionally orsocially isolated yes!YesI m not sureNoDefinitely in a position to adequately assessIf given the opportunity, would you want to work with this applicant for two years?Definitely yes!YesI m not sureNoDefinitely describeyour reasons:ExampleFinal StatementFinal Statement (choose one):I would strongly recommend this applicant for a Family Medicine residency would recommend this applicant for a Family Medicine residency would hesitate to recommend this applicant for a Family Medicine residency would not recommend this applicant for a Family Medicine residency would not recommend this applicant for any residency :This letter was submitted using CaRMS :October 7, 2022 Exampl