Residents: admissions, training and assessment

Abstract

Undoubtedly, residents play a very important role in the healthcare system of most countries. The process of admission of medical trainees into specialties, residency training and their assessment are key determinants of the future of healthcare. In Canada, according to the 2014–15 data, there were 13,439 residents (excluding Fellows) distributed in 42 specialties/sub-specialities.1 Every year, there are 3,280 positions in Canada. About 10% of these residents are International Medical Graduates (IMGs) or Canadians studying abroad (CSAs). Residents are subjects of various investigations exploring areas such as sleep deprivation, stress,2 medication errors to differences between Canadian Medical graduates (CMGs), IMGs and CSAs that can help with decisions of policy makers.3 Here I dwell on a two interesting examples of studies using residents as subjects. Philips and Barker who systematically examined the occurrence of fatal medication errors over 25 years in the US attribute a significant spike in medication errors in July to the entry of a new cohort of medical residents.3 Can changes in medical education have an impact on such medication errors? While this needs to be investigated, better orientation of final year medical students for entry into residency, closer supervision of new residents, and training of supervisors on providing feedback to residents are some measures that ought to be seriously considered. The introduction of Competency by Design (CBD) by the Royal College of Physicians and Surgeons is definitely an important step in this direction.4 A recent study by Curtis and Dube looked at the characteristics of CMGs, IMGs and CSAs in an era where measures are being taken to alleviate physician shortage.5 IMGs make up about 25% of practicing physicians in Canada. However, the scenario is changing, with more CSAs applying for residency positions. As of 2014, there were 3600 CSAs. These findings in particular have implications for policy: IMGs are less likely than CMGs to report that they intend to stay and practice in Canada; CSAs are less likely to report their willingness to practice in the region where they completed their residency. CSAs and IMGs are more likely to choose family medicine than CMGs. Given the paucity of residency positions in Royal College specialties, and less inclination of CMGs to choose family medicine, do changes have to be made to admit more CSAs and IMGs to fill family medicine positions? If that is done, how can IMGs be enticed to practice in Canadian regions where physicians are most needed? IMGs and CSAs are less likely to be females. How will this impact the diversity and equality that Canada tries to promote? These are interesting and complex questions that arise from the study.