Transcript IMG Info Session

IMG/CSA Info Session
Sponsored by International Medical Health Organization
Speakers: Dr. Jonathan Bertram
Dr. Shivajan Sivapalan
Dr. Keerthiga Ravi
Why go abroad?
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In 2011, 10,500 medical students in Canada and about
3600 Canadians studying medicine abroad
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75% of Canadians studying medicine abroad say that they did
so because they were not able to obtain a spot in a Canadian
medical school
Pressure from parents:
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As reported in the Canadian Medical Association Journal
(CMAJ), 15.6% of today’s Canadian medical students have a
physician parent
In comparison, 21% of Canadians Studying abroad (CSAs)
have at least one parent who is a physician
Why go abroad?
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Despite 69.0% increase in medical school admissions,
admission rates are still low
Although there has been an increase in residency spots
in Canada:
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ONLY 25% of applicants are accepted
Compared with the States
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43% of applicants get into medical school
Limited positions in Ontario/B.C. and low admission
rates
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The largest number of CSAs come from Ontario and British
Columbia
Why not try other options?
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Why not do a Masters/PhD
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Time constraints/Age
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CSAs have a higher median age (73% are 26 to 30 years of age), and
have more education than medical students studying in Canada
Most have not applied to Canadian medical schools as many times as
the successful student studying in Canada (1.7 vs.. 2.5 times)
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Suggests that due to their age and higher education they opt to study
abroad and rather not wait several years to be successful
No guarantee of admission even after the completion of the
post-graduate degree
Where can I go?
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Majority of students decide between:
The Caribbean
 Ireland
 The UK
 India
 Poland
 Australia
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The Caribbean
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2000 Canadians are studying medicine in the Caribbean
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Top 4:
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1) St. George’s University
2) Ross University
3) American University of the Caribbean
4) SABA University School of Medicine
Pros:
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All accredited
Great USMLE pass rates and scores
Majority have affiliation with hospitals in Canada/US
Most of the lesser known Caribbean schools cannot apply to the
following states CA, FL, NJ or TX (this may vary from school to school)
Caribbean
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Duration: 4 year medical degrees
Admission Requirements: Based on undergraduate courses taken in the sciences and a
certain GPA or a bachelor’s degree attained from an accredited university
MCAT: Typically not required but recommended
How to apply: Online application
Information sessions are provided throughout the areas at various forums in North
America
Curriculum: North American standard
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Two years of basic sciences at their campus in the Caribbean, and courses usually include,
but are not limited to: Anatomy, Physiology, Pathology, Pharmacology, and Ethics.
Followed by two years of clinical clerkships in the United States and Canada.
Typical core clerkships include: Medicine, Surgery, Paediatrics, OB/GYN, Psychiatry, and
General Practice
Cost: average between $20,000 and $60,000 (CAD) per year
SGU: only Caribbean school that allows for core rotations to be done in Canada
(Psychiatry in Vancouver)
Australia
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Duration: Range from four to six years.
Admission Requirements:
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Four year degrees generally require a bachelor’s degree, MCAT or
GAMSAT and a certain GPA
Five and six year degrees are typically aimed at high school graduates and
require a certain overall average for admission
Basic sciences: Anatomy, Physiology, Biochemistry, etc
Core clerkships: Medicine, Surgery and Anaesthesia, Paediatrics
and Child Health, Obstetrics and Gynaecology, General Practice,
and Psychiatry
Cost: Medical degree from Australia is typically over $100,000
(CAD)
Clerkship rotations: within Australia
Obstacles in Australia
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In the state of Queensland
Priority ranking system for the intern positions that
all doctors need if they're to become fully registered
as medical practitioners
 Queensland Health guarantees intern positions only
for domestic graduates of the state's four medical
schools
 Australians from interstate schools are next in line,
ahead of international graduates of Queensland
schools
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Australia vs. Caribbean
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CaRMs reports:
CSAs studying in the Caribbean reported being the
most satisfied (93.6%) with their medical degree
program, while those studying in Ireland were also
highly satisfied
 Those from Australia were the most dissatisfied
 82.5% of Caribbean grads said it was difficult to
arrange a clerkship in Canada while only 48.9% of
Australian respondents felt the same way
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Australia vs. Caribbean
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CaRMs reports:
Graduates of medical schools in Australia and
Ireland were more successful than grads from the
Caribbean in arranging Canadian clerk ships, clinical
rotations, and post-graduate training opportunities in
Canada
 90% of respondents expressed frustration over the
perceived barriers to getting medical residencies in
Canada once their studies were over.
 Caribbean students were the most frustrated
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Ireland
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650 Canadians studying in Ireland each year
Ireland has six medical schools
Admissions: 85% overall average and a high
school transcript, or a bachelor’s degree and
MCAT or GAMSAT scores
Curriculum: Both basic sciences and clinicals are
taught in Ireland.
Cost: Ranges from approximately $40,000 to
$60,000 (CAD) per year
Poland
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10 medical schools
300 Canadians
All Polish medical schools offer a six year program with direct entry from
high school
Some offer graduate entry four year programs
Admission: High school diploma or a bachelor’s degree will allow for graduate
entry in schools which offer four year programs.
Curriculum:
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Basic sciences: Anatomy and Physiology; however it also includes Polish language
classes
Clinical rotations: Done in Poland, with the option of North American electives
Cost: substantially less than other international locations
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in some cases the entire education in Poland equals one year’s tuition in some of
the more expensive countries
UK
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Curriculum:
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Basic sciences: PBL
All of the medical schools in the UK are
accredited by the General Medical Council, UK.
Costs: Range from $23,000 to $43,000 (CAD)
per year
Clerkship rotations: UK and Europe
How to Decide?
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First: Where do you eventually want to practice
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i.e. the US, Canada, or staying abroad
The easiest option is staying abroad, which
means virtually any medical school you go to,
you can stay in there home country and practice
Returning to the US
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Residency/Practice in States
consider the school’s reputation in the States
 e.g. certain residency programs in the states do not
allow students from certain medical schools to apply
to them
 these lists are available online to the public
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ACGME
Is the school affiliated with ACGME (Accreditation
Council for Graduate Medical Education) hospitals
in the states - Accreditation is accomplished through
a peer review process and is based upon established
standards and guidelines
 It ensures standardization and by doing your clinical
rotations at these hospitals you can improve your
chances at matching into a residency program in the
states
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Visa and Insurance
Does the school provide adequate insurance and visa
coverage while you are doing your clinical rotations
in the states? - there are quite a number of schools
that require you to find your own malpractice
medical insurance and obtain your own visa
 Does the school have a good overall match rate – i.e.
how many students match into a residency program
in the states on their first try
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Residency in the US
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Examinations: Will need to complete USMLE
Step 1, Step 2 CK and CS
Typically CSAs require a higher USMLE cut-offs
than their American counterparts
Must consider J1 vs. H1B visas
H1B visas require USMLE Step 3 – most
students end up taking a year off to complete
their Step 3
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Research H1B visas do not need Step 3
Study Material For USMLE
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USMLE Step 1:
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USMLE Step 2 CS:
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First Aid Step 2 CS
USMLE Step 2 CK:
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USMLE World Step 1
First Aid Step 1
Kaplan Notes
Goljian Lectures
USMLE World Step 2
Crush Step 2
Kaplan Master of the Boards
Surgical Recall
Step Up to Medicine
USMLE Step 3:
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USMLE World Step 3
H1B vs. J1 Visas
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H1B visa sponsored by residency program
J1 visa sponsored by ECFMG
No moonlighting on J1 Visa
Both non-immigrant visas – H1B 6 years, J1 7 years
With J1, you must return to home country for 2 years
before re-entry
With H1, you can go to any country for 1 year and then
return for another 6 years
Green card processing can begin while on H1B but not
J1
H1B vs. J1 Visas
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J1 can only be converted to a visa if you take a
J1 waiver job in an underserved area in the states
Not an issue for Family medicine, internal medicine,
Psychiatry, OB-GYN
 Specialities have issues
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Marrying a US citizen does not change the status
Spouses of J1 visas can work anywhere in the
US, while those of H1B cannot work unless
they themselves get an H1B
Obstacles in the US
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A targeted increase of 30% in US undergraduate
admissions with no increase planned for
postgraduate training opportunities will lead to
fewer positions will be available to international
medical graduates, requiring these students to
explore different options for postgraduate
training
Returning to Canada
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Direct vs.. Indirect route back to Canada:
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Residency in the States/elsewhere and then practicing in Canada vs..
Directly doing residency in Canada
If you plan on coming back to Canada for residency, look at the
school’s history and see what their “match rate” was in the past
into Canada
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Does the school allow you to do rotations in Canada?
Is the school affiliated with Canadian hospitals/University Hospitals?
A total of 20.9% of CSAs in Ireland reported that they had done or
confirmed a clerkship in Canada
A total of 19.9% of CSAs in Australia also reported having done or
confirmed a clerkship in Canada
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Only 12.7% from Poland, 3.2% from the Caribbean and 4.3% from the
Middle East
Few Schools Offer
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Many schools list Canada as a possible
destination for clinical rotations but only SGU
has an official affiliation with Vancouver where
you can do one of your core rotations
Financial Constraints
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Medical School Region - Average Yearly Tuition:
($CAD)
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Ireland: 49,800
Caribbean: 25,608
Australia: 42,334
Canada: 12,214
The median debt for a medical student studying abroad
is $160,000 (CAD) compared to $71,000 (CAD) for a
Canadian medical student
Nearly $90,000 more debt than students in Canadian
medical schools
Financial Constraints
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Total Debt:
Ireland and Australia: $200,000 CAD
 Caribbean: $175,000 (CAD)
 Poland and Middle East: $70,000 (CAD) and
$90,000 (CAD)
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CANADIAN RESIDENCY
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Facts
Examinations
Keys to Success
Post-Match
Post-Residency
Facts
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Less than 10.0% reported that they do not intend to
return to Canada for postgraduate training
WHY A LOWER PERCENTAGE?
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61.0% reported not wanting to do Return Of Service (ROS)
work
Economic incentives to stay away
Limited opportunity to practice in my preferred location
Difficulty in obtaining recognition of training
Family considerations
Limited research funding available in my field
Examinations
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MCCEE (Medical Council of Canada Evaluating
Exam)- http://mcc.ca/en/exams/ee/
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4 HR computer-based examination offered in both English
and French 5x/yr
All students who want to practice in US OR Canada have
to write this
For US  Letter of Need from Canada  Visa
Cost: $1,550
Results: Standardized
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mean score of 500
a standard deviation of 100
pass mark ~ 303
Study Materials
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Toronto Notes
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Canadaqbank
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http://www.canadaqbank.com/index.php
STUDY HARD:
MYTH: Because MCCEE is Pass/Fail, SCORE does
not matter
 Score weighs greatly on your interview chances
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MCCQE Requirements
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New Changes:
New requirements as of last year regarding MCCQE
I & II (Canadian grads have to write these 2 exams
as well)
 Some programs require QE I & even II to be done
 USMLE I & II not enough as a substitute
 Not necessary to have completed the exams before
applying, but you have to complete them before the
end of residency
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Keys to Success
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Electives:
 Doing an elective rotation in Canada in the field you want to get into is
essential VS trying to cover your bases
 DO IT AT A UNIVERSITY AFFLIATED HOSPITAL OR WITH A
UNIVERSITY DOCTOR
 Do it at the program you want to get into if possible
 PREPARE DURING PRE-CLINICALS BY MAKING CONTACTS
 ASK PEOPLE AHEAD OF YOU!
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Current, recent grads are preferred
IMGs apply through a different stream VS Canadian graduates.
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Limited spots:
 E.g. there are 81 Family Medicine spots in Ontario
 Normally they only 300-350 of the thousands that apply
Keys to Success
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Personal Statement:
 Focus on the speciality you want to go into
 No ambiguity
 Answer all the questions that they ask for the
personal statement
 Have a professional editor read over it
 E.g. Checkedit (http://checkedit.com/index.php)
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Do not put all your eggs in one basket
 Apply to the US as well
Keys To Success
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Start early- Sept. 7th, 2011 CaRMS registration
http://www.carms.ca/eng/r1_registration_e.shtml
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Have your basic registration done before this date
Transcripts/documents late October
Program Selection mid-November
Letter of Reference mid-November
File Review December
National Interview Period January
Rank Order List Late February
Match Day Early March
2nd Match Day Early April (Interviews Mid-March)
Which Provinces are IMG Friendly?
Ontario –ROS Manitoba (University of Manitoba) ?ROS?
 Newfoundland (Memorial University) -ROS Nova Scotia (Dalhousie) –ROS Saskatchewan (University of Saskatchewan) –ROS*all have urban/rural
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Difficult Provinces:
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Quebec – must complete all Quebec exams
British Columbia – Separate assessment that takes a few
months to complete prior to applying
Alberta – only residents of Alberta can apply
IMG vs CSA
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Does it matter?
CSA PDF/website
Discriminating between services and resources
for IMG vs CSA
Family vs Specialties
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Ontario
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Manitoba/Saskatchewan
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Fair number of both
Nova Scotia…?
Newfoundland
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Specialty attainable but less available
Family more available, more competitive
Family
BC
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Few of both
Urban vs Rural
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Rural not always popular
?Less competition
But r/v committees are less trusting of your
true intentions (will you stay?)
Personal Statement/Electives/Home Address
Interview Process
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One Interview for all Family Medicine programs in
Ontario
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Normally held near the end of January/early February
Health Force Ontario has interview prep seminars
Do no prepare answers ahead of time
Be honest
Questions are straight-forward
On day of interview you will be asked to write an essay
Contacts
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About who you know
Keep connected going forward
CaRMS
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International Medical Graduate Information
Symposium at the Metro Toronto Convention
Centre onMonday, October 17th, 2011.
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$100.00
PRP/AVP (Ontario)
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Most provinces have a 1 month IMG orientation before starting
In Ontario, there is a Pre-Residency Program that can last from 6
– 12 weeks prior to you starting residency
2 separate parts:
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Part 1: Lectures discussing the Canadian medical system, Standardized
patients and oral presentations
Part 2: Shadowing of Canadian medical residents and Physicians
After the PRP session you are placed into an Authentication
Verification Period for 3 months
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This probation period is to allow for the program to find out if you are
compatible with them
These 3 months are not in addition to your residency program, they are
just the first 3 months of it
Approximately 80-85% of residents pass this AVP period
Return of Service (ROS)
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Return of Service:
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Every province has its own regulations but in general for
every year of residency you do in Canada, you have to do
a year of service in an underserved area.
Once you have completed residency
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Stigma:
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Will doctors and Canadian graduates look down at
you for being an IMG?
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In the end, you are treated equally to a Canadian
graduate.
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Patients don’t care where you did medical school,
they just want to be treated and cared for.
ROS- Ontario
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5 year minimum, regardless of residency length.
In Ontario specifically, they have defined the
underserved area as areas that touch the GTA,
e.g. Ajax, New Market, Richmond Hill, Milton,
etc.
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Markham and Vaughn for example are not
underserved.
Coming from the USA
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MCCQE exams
RCPSC exam
Fellowship transferable
Discrepancy of 1 year in many specialty
programs- individually reconcilable
We’ll have more people to comment on this in
the future
Thank you
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International Medical Health Organization
Reference
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CaRMs Study:
http://www.thebigwait.com/internationalmedical-graduates/carms-survey-canadianstudents-enrolled-in-medical-schools-abroadballons/