Got you, just ask if you have any further or additional questions and I'd be glad to provide my viewpoint!

There a few ways that I'm aware of, but they're all a combination of Research, Extracurriculars, and Electives. Every 5th year should have electives - a crucial difference between graduating and trying to match the year after as a "previous year grad", and doing a 5th year and then entering the match as an "unmatched 5th year", is that as a student you get insurance coverage through the school for electives to be arranged. Plus outside of everything else, logically a school would prefer you to have recent clinical experience and not be too rusty in practice by the time you're going to be a resident. 1. You can follow what the old de-facto route was, which was having a research project to work on during the year (organized at least partially by yourself), in addition to elective time similar to 4th year to further hone clinical skills and get reference letters. This adds to the CV, adds/substantiates research portion of application, provides for academic networking through conferences etc., in addition to things to discuss during interviews and personal statements etc. I think this is a great option if you have previous research or an interest in exploring research 2. Foregoing research and just doing electives. This can maximize your amount of letters, clinical experiences which result in experience/interview examples, and to get a great breadth of exposure into the fields you're considering that will be a part of the rest of your life. You have a whole year so you have A LOT of time. If the extra time is not going towards research, you should try to do other things like making your face known at conferences, leadership, charity work etc. something that can show you're using your time well, and doing things you enjoy can also be a good investment too (wellness related hobbies that can be noted on the app like Yoga cert). I am not a research person but think that the flexibility fo 5th year is so great, that you can do all of research, electives, extracurriculars, and networking at a pretty sustainable level. My advice would to choose a few things you are really interested in (and may carry that forward through your career) and delve into those, rather than a jack of all trades approach. I did the latter, and there is only so many experiences and components you can talk about in the Statement or Interview, so it's diminishing returns when it comes to the length of your resume. Your mileage may vary of course, but that's what I'd suggest. Excited to hear other opinions!

I definitely didn't broadcast the results early as I was ashamed and embarrassed, but reaching out and telling your close friends and family what's happening soon after you know can help avoid awkward conversations about results later. I knew i wasn't doing a second round attempt (no spots in my spec.), but if that is on the table I would agree to broadcast ASAP on your largest social media platform, because time may be of the essence in terms of re-editing personal statements and tweaking to a new specialty etc, so the more hands on deck you have the better. What worked well for met was to take a few days to grieve for yourself, and request to get your references from CARMS ASAP (can take 1-2 months to come back). Then I agree being honest with yourself and reflecting deeply is the next step. You need to find out a few things before you decide to do a 5th year OR enter the second round: 1. Did you really try your best this time? If you did your best personal statement, your best interview prep, applied broadly and payed attention and tailored each app to each school - your chances of matching next year aren't much better. Being a 5th year applicant will ding you a bit, and unless the pool for your spec was ESPECIALLY tough this year and not TRENDING up, then maybe it was only external factors that could change. 2. You need to be okay with matching in your second specialty as well, this is the most likely outcome from applying again (worst case scenario), and if you apply again in 5th year at least you can apply to all locations (IE. FM in major urban centres) rather than "settle" for what locations still have spots in the second round. 3. You need to do some real soul searching - is your 1st choice specialty really THAT important in the large scale of things? You are giving up a year of income AND paying a year more in tuition (no 4th year reimbursements for travel etc. as a 5th year so its full tuition), you have no guarantee of matching into your 1st choice spec, and you have more time to get more existentially lost without the direction of residency/formal training. How much can you approximate the benefit of your specialty, by tailoring a FM practice to what you enjoy in the specialty? (ie. Women's health in FM vs OB/Gyn, +1 or rural Emerge for EM, Psychotherapy/MH focus for Psych). 4. There are some other BENEFITS of doing a 5th year depending on how your school structures it- You have more flexibility for electives (have a lot more time than 4th year, your requirements for breadth etc are already filled, you can have gaps of 2+ weeks between them), can have more time to build relationships and do research which you can build on throughout training and in practice, and you also have a lot more time in general than people will EVER have. Think about it - in Med school you get in, pack your summers with studying/research/electives so you get into residency, match and have 2-3 months to travel and write LMCC then start residency, then you're not done until 2-5 years. After that you're trying to find a job, setting up practice, and have bills to pay and money to worry about. A 5th year is honestly the best time to unwind, learn new skills/passions, and be a well rounded person before your career takes off. This is selfish and a bit naive to think about, but it is a real tangible benefit to taking the year, even if in the worst case scenario you still don't get your first choice specialty. This all being said, for some of you on balance it will be worth it to try again. It is only one year compared to the decades in practice, and sometimes even the residency experience is important (ie. If you really don't want to do OB/Gyn again, some would rather reapply IM than do FM and do hospitalist work). These are all just things to consider and be realistic with yourself before idealistically pulling the trigger on another year. That being said only you know what's right for you, so make the call but just make sure you're making an informed decision. More than happy to chat in DM's if there are any other things you'd like to know.

More than happy to help others via DM from my experience going unmatched last year and matching to first choice specialty this year. No advice will be a guarantee that the same thing will happen if followed, so many individual factors and luck/stochastic yearly variability to be a guarantee, but there are always things to be done to increase marketability/preparation. My only ask is that you pay it forward if you are able to match in the future, the system isn't very supportive in my opinion so we need to be making up that gap through peer-to-peer support. We all went into this to help others to one degree or another, so let's put our money where our mouth is and start with our own professional circle <3