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

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

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

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.. 2.5 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

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

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)

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)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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)

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

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

Examinations MCCEE (Medical Council of Canada Evaluating Exam)- http://mcc.ca/en/exams/ee/ 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

Study Materials Toronto Notes Canadaqbank STUDY HARD: 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

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

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 300-350 of the thousands that apply

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 (http://checkedit.com/index.php) Do not put all your eggs in one basket Apply to the US as well

Keys To Success Start early- Sept. 7th, 2011 CaRMS registration http://www.carms.ca/eng/r1_registration_e.shtml 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 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

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

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

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

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

Contacts About who you know Keep connected going forward

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

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

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.

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.

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.

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

Thank you International Medical Health Organization

Reference CaRMs Study: http://www.thebigwait.com/international-medical-graduates/carms-survey-canadian-students-enrolled-in-medical-schools-abroad-ballons/