1. IMG/CSA Info Session
Sponsored by International Medical Health Organization
Speakers: Dr. Jonathan Bertram
Dr. Shivajan Sivapalan
Dr. Keerthiga Ravi

3. Why go abroad?
In 2011, 10,500 medical students in Canada and about 3600 Canadians studying medicine abroad
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:
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

4. Why go abroad?
Despite 69.0% increase in medical school admissions, admission rates are still low
Although there has been an increase in residency spots in Canada:
ONLY 25% of applicants are accepted
Compared with the States
43% of applicants get into medical school
Limited positions in Ontario/B.C. and low admission rates
The largest number of CSAs come from Ontario and British Columbia

5. Why not try other options?
Why not do a Masters/PhD
Time constraints/Age
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 times)
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

6. Where can I go? Majority of students decide between: The Caribbean
Ireland
The UK
India
Poland
Australia

7. The Caribbean 2000 Canadians are studying medicine in the Caribbean
Top 4:
1) St. George’s University
2) Ross University
3) American University of the Caribbean
4) SABA University School of Medicine
Pros:
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)

8. Caribbean 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
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)

9. Australia Duration: Range from four to six years.
Admission Requirements:
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

10. Obstacles in Australia
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

11. Australia vs. Caribbean
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

12. Australia vs. Caribbean
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

13. Ireland 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

14. Poland 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:
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
in some cases the entire education in Poland equals one year’s tuition in some of the more expensive countries

15. UK
Curriculum:
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

16. How to Decide? First: Where do you eventually want to practice
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

17. Returning to the US 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

18. 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

19. 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

20. Residency in the US
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
Research H1B visas do not need Step 3

21. Study Material For USMLE
USMLE Step 1:
USMLE World Step 1
First Aid Step 1
Kaplan Notes
Goljian Lectures
USMLE Step 2 CS:
First Aid Step 2 CS
USMLE Step 2 CK:
USMLE World Step 2
Crush Step 2
Kaplan Master of the Boards
Surgical Recall
Step Up to Medicine
USMLE Step 3:
USMLE World Step 3

22. H1B vs. J1 Visas 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

23. H1B vs. J1 Visas
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
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

24. Obstacles in the US
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

25. Returning to Canada Direct vs.. Indirect route back to Canada:
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
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
Only 12.7% from Poland, 3.2% from the Caribbean and 4.3% from the Middle East

26. Few Schools Offer
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

27. Financial Constraints
Medical School Region - Average Yearly Tuition:
($CAD)
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

28. Financial Constraints
Total Debt:
Ireland and Australia: $200,000 CAD
Caribbean: $175,000 (CAD)
Poland and Middle East: $70,000 (CAD) and $90,000 (CAD)

29. CANADIAN RESIDENCY Facts Examinations Keys to Success Post-Match
Post-Residency

30. Facts
Less than 10.0% reported that they do not intend to return to Canada for postgraduate training
WHY A LOWER PERCENTAGE?
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

31. Examinations
MCCEE (Medical Council of Canada Evaluating Exam)-
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
mean score of 500
a standard deviation of 100
pass mark ~ 303

32. Study Materials Toronto Notes Canadaqbank STUDY HARD:
STUDY HARD:
MYTH: Because MCCEE is Pass/Fail, SCORE does not matter
Score weighs greatly on your interview chances

33. MCCQE Requirements 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

34. Keys to Success 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!
Current, recent grads are preferred
IMGs apply through a different stream VS Canadian graduates.
Limited spots:
E.g. there are 81 Family Medicine spots in Ontario
Normally they only of the thousands that apply

35. Keys to Success 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 (
Do not put all your eggs in one basket
Apply to the US as well

36. Keys To Success Start early- Sept. 7th, 2011 CaRMS registration
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)

37. 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
Difficult Provinces:
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

38. IMG vs CSA Does it matter? CSA PDF/website
Discriminating between services and resources for IMG vs CSA

39. Family vs Specialties Ontario Manitoba/Saskatchewan Nova Scotia…?
Specialty attainable but less available
Family more available, more competitive
Manitoba/Saskatchewan
Fair number of both
Nova Scotia…?
Newfoundland
Family BC
Few of both

40. Urban vs Rural 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

41. Interview Process
One Interview for all Family Medicine programs in Ontario
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

42. Contacts
About who you know
Keep connected going forward

43. CaRMS
International Medical Graduate Information Symposium at the Metro Toronto Convention Centre onMonday, October 17th, 2011.
$100.00

44. PRP/AVP (Ontario)
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:
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
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

45. Return of Service (ROS)
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.

46. Once you have completed residency
Stigma:
Will doctors and Canadian graduates look down at you for being an IMG?
In the end, you are treated equally to a Canadian graduate.
Patients don’t care where you did medical school, they just want to be treated and cared for.

47. ROS- Ontario 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.
Markham and Vaughn for example are not underserved.

48. Coming from the USA 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

49. Thank you
International Medical Health Organization

50. Reference
CaRMs Study: