Canadian Medical Graduates Research Articles

Disparities in cataract surgical training at the University of Toronto based on sex and medical school graduate type

ObjectiveTo compare sex and medical school graduate type differences in cataract surgical training volumes at Canada's largest residency program, the University of Toronto (UoT). DesignRetrospective cohort study ParticipantsOphthalmology residents completing cataract surgical training from 2015 to 2020. MethodsData collected from surgical logbooks at the main cataract surgical teaching site at UoT were analyzed from July 1, 2015, to June 30, 2020. Data collected included stage of resident training and degree of participation for each case. The main outcome measure was mean number of complete cataract cases as a function of resident sex, medical school graduate type, and level of training. ResultsThirty-five (19, 54.3% female) residents completed cataract surgical training during the study period. There were 24 (68.6%) Canadian medical graduates (CMGs) and 11 (31.4%) international medical graduates (IMGs). Female residents performed a lower mean number of complete cataract cases compared to males (464.2 versus 504.8, respectively). IMGs completed on average 110.0 (22.8%) fewer cataract cases compared to CMGs. Compared to all residents, female IMGs had the lowest number of complete cataract cases (mean of 380.8 versus 465.7, respectively). The greatest difference occurred between male CMGs and female IMGs, with male CMGs performing 153.8 (40.4%) more complete cases (534.6 vs 380.8, respectively). ConclusionThe greatest difference in surgical volumes occurred between CMGs and IMGs. Female IMGs had the lowest complete cataract case volumes compared to all residents. Our study highlights novel medical school graduate type disparities in cataract surgical training warranting further exploration.

The accreditation transition of Canadian medical schools: Possible implications for graduates applying for residency positions in the United States

The Liaison Committee on Medical Education (LCME) has accredited Canadian medical schools for over 50 years. This agency also serves as the accrediting body for medical colleges in the United States. Thus, graduates of Canadian medical programs seeking residency training in the United States are not considered international medical graduates. Due to this fact, degree holders of Canadian medical programs who wish to pursue residency training in the United States do not require Educational Commission for Foreign Medical Graduate (ECFMG) certification to attain medical licensure. By mutual agreement with the Committee on Accreditation of Canadian Medical Schools, the LCME accreditation of Canada’s 17 medical schools will end on June 30th, 2025. Beyond this date, Canadian medical graduates seeking training within the United States will be considered international medical graduates. As a result, this will require ECFMG certification to enter postgraduate training. Possible implications of this decision could mean fewer Canadian graduates attaining competitive specialties and the social stigma of being labeled an international medical graduate.

Differences between international medical graduates and Canadian medical graduates in a medical learning environment: From matching to residency and beyond.

To determine the differences between international medical graduates (IMG) and canadian medical graduates (CMG) in the medical learning environment (MLE) as there is progression from matching to residency and beyond. A narrative literature review was done using the search engines pubmed, medline and embase on publications from 2000 to 2021 comparing IMG to CMG and those that compared IMG to non IMG in international publications were also considered. The IMGs are offered less residency program positions compared to CMGs during the CaRMS selection process and specifically less in specialty programs. Amongst the article, 66% of IMGs compared to 90% of CMG were successful in the certification examination of the college of family physicians of Canada. A US article on the other hand found similarities in performance of USMGs and IMGs in a surgical residency program. A lot of IMG face several challenges including perceived systemic and individual discrimination, lack of mentorship and poor ability to navigate after immigration even after they are matched into a Canadian residency program. These are significant issues that should be dealt with to enable increase success and survival of IMGs in the MLE.

The race that never slows: Otolaryngology - Head and Neck Surgery residency applicant parameters over time.

There has been an increasing number of Canadian medical graduates who have gone unmatched in the residency selection process. Medical students have been engaging in extracurricular activities outside the formal curriculum which may help to distinguish themselves from their peers in the selection process. To understand how competitiveness in residency selection shapes applicant demographic characteristics and behaviours, this study set out to explore the demographic characteristics and prevalence of reported extra-curricular activities by applicants to Canadian Otolaryngology - Head & Neck Surgery (OTL-HNS) residency across time. A retrospective, descriptive study reviewed specific sections of the curriculum vitae (CV) of applicants to OTL-HNS programs in Canada. These sections were self-reported, and included research productivity, involvement in volunteer and leadership activities, membership in associations, and honours or awards granted. Data was quantified and analyzed descriptively. Between 2013 to 2017, a total of 267 applicants reported a median of 12.6 research publications, 9.6 volunteer activities, six leadership activities, six association memberships and 9.8 honours/awards. Applicants were younger over time, with proportions of applicants over 30 years old decreasing from 56% in 2013 to 9% in 2017. Applicants to Canadian OTL-HNS residency programs are reporting consistently high numbers of extracurricular activities and were of increasingly younger ages. Medical students are investing significant time and energy to pursue these activities which are above and beyond the formal curriculum, possibly contributing to decreased diversity in applicants for competitive residencies, increasing the likelihood of misrepresentation in residency applications, and likely contributing to medical student burnout.

Oral cancer screening knowledge and practices among dental professionals at the University of Toronto

IntroductionOpportunistic oral cancer screening during visits to the dentist is a non-invasive and accessible option for detection of pre-malignant lesions and early-stage malignancies. The objective of this study was to investigate the knowledge, practices, and attitudes towards oral cancer screening among dentists.MethodsA 42-item survey was sent to 650 dental professionals affiliated with the University of Toronto. Data regarding training/practice characteristics, knowledge of oral cavity cancer, current screening practices, attitudes towards screening, and remuneration were collected.ResultsNinety-one dentists responded. Most obtained their dental degree from Canada (71.4%) and were practicing in large urban centers (87.9%). Most dentists correctly identified the oral tongue (87.8%) and floor of mouth (80%) as the two of most common sites of oral cavity cancer but only 56% correctly identified the most common presentation. 91% performed intra/extra oral examinations at every patient visit. Only 9.9% of dentists discussed the risk factors of oral cancer and 33% were not familiar with resources for smoking cessation and alcohol abuse. International medical graduates were more likely to discuss risk factor management than Canadian medical graduates (p < 0.01). Over 80% of dentists referred to a specialist when a suspected lesion was found. The greatest barrier for oral cancer screening was lack of time. Almost all dentists (98.8%) reported that their screening practices do not differ depending on the patient’s insurance status and 63.8% reported compensation would not influence their decision to perform oral examinations.ConclusionMost dentists have a good knowledge of the presentation and risk factors associated with oral cavity cancer. Most dentists perform screening with every patient, with no influence from compensation and insurance status. Dentists are therefore an excellent first contact for oral cavity cancer screening for the general public and for high-risk populations.

Fifteen-Year Trends in Canadian Female Medical Student Interest in Radiation Oncology

<h3>Purpose/Objective(s)</h3> The proportion of female radiation oncology residents in Canada remains disproportionately low. The objective of this study was to examine 15 years of resident match data to assess trends in gender-specific medical student interest and match characteristics in radiation oncology (RO). <h3>Materials/Methods</h3> Public Canadian Residency Matching Service (CaRMS) data between 2007-21 were compiled. Gender-based analysis focused on Canadian medical graduates (CMGs) ranking RO as their first-choice discipline in the first iteration of the match. Gender data were not available for applicants and match characteristics for second iteration outcomes. Pearson's chi-square test was used to compare 15-year average female medical student interest in RO versus all training programs. Paired t-test was used to compare total, female, and male applicant numbers over five-year increments (2007-11; 2012-16; 2017-21). Statistical analysis was performed using statistical software. <h3>Results</h3> Total applicants to RO programs ranged between 24-51 per year over the study period. The mean number of applicants ranking RO as their first-choice discipline significantly decreased from 24 (range: 20-27) in 2007-11 to 16 (12-18) in 2012-16 (p<0.01), with an increase to 22 (9-28) in 2017-21 (p<0.05). The 15-year average of female RO applicants was 9 per year, ranging from 2/9 (22%) in 2017 to 12/18 (67%) applicants in 2015. Female applicant numbers were lower in 2012-16 (mean 7; 4-12) compared to 2007-11 (mean 14; 11-16; p<0.01). Female applicant numbers in 2017-21 (mean 7; 2-10) were comparable to 2012-16 (p=0.46), but remained lower than 2007-11 (p<0.01). Male applicant numbers were similar (p=0.12) in 2007-11 (mean 10; 9-12) and 2012-16 (mean 8; 5-11), but increased in 2017-21 (mean= 15; 7-20) compared to 2007-11 (p=0.03) and 2012-16 (p=0.01). Overall, 308 CMG applicants ranked RO as their first choice over the past 15 years; 141 females (46%) and 167 males (54%). Over the same period, 56% (24472/43667) of CMG applicants who participated in the CaRMS match were female. Female CMG application rates to RO were significantly lower compared to application rates to all specialties combined (p<0.01). <h3>Conclusion</h3> Despite increasing male applicant numbers, the number of RO-preferring female medical students remains disproportionately low. Female medical student interest in RO over the last ten years has also fallen significantly from 2007-11 levels. These findings highlight the need for early exposure of female medical students and improved mentorship efforts. A deeper understanding of factors influencing female medical students' career selection and CaRMS ranking decisions is required to improve female representation in RO. These data have led to a special interest group proposal for women in RO, now being considered by the Canadian Association of Radiation Oncology.

Ten-year trends in Canadian female medical student interest in radiation oncology: an analysis of data from the Canadian Resident Matching Service (2012-2021)

<h3>Background</h3> Canadian medical student (MS) interest in Radiation Oncology (RO) residency training has varied over the last decade. Concerns related to post-training job availability, employment location flexibility, and extended fellowship training may have affected MS perceptions of RO, potentially deterring past applicants. With recent job market improvements, there has been increased MS interest in the specialty. However, despite recent years showing no gender differences in successfully matching to first-choice overall nonsurgical disciplines, the number of women entering RO residency remains low. This study examines 10 years of resident match data to assess trends in gender-specific interest and match characteristics in RO. <h3>Methods</h3> Publicly available Canadian Resident Matching Service (CaRMS) data from 2012 to 2021 were compiled. Gender-based analysis focused on Canadian medical graduates (CMGs) ranking RO as their first-choice discipline in the match's first iteration. No applicant gender data were available for the 1 to 8 first-year residency positions carried over to the second iteration that occurred in 7 out of 10 matches over the study period. Pearson's chi-square test was used to evaluate whether the number of female applicants differed significantly from what could be expected if RO applicant gender breakdown reflected Canadian CaRMS participant demographics. <h3>Results</h3> Numbers of applicants ranking RO as their first-choice discipline have recently increased. 2018-2021 saw 23-28 RO-preferring applicants, while 2012-2017 saw 9-18. Total applicants ranged from 24-51 per year over the study period. Numbers of female RO-preferring applicants have remained largely unchanged, with a 10-year average of 7 women per year, ranging from 2/15 (13%) in 2016 to 12/27 (44%) RO-preferring applicants in 2018. Overall, 190 CMG applicants ranked RO as their first choice over the last 10 years, comprising 73 females (38%) and 117 males (62%). During this period, 56% (17696/31618) of CMG applicants who participated in the CaRMS match were female. ​​Rates of female applicants to RO were significantly lower compared to rates of female applicants to all specialties combined (p < 0.01). <h3>Discussion</h3> While recent years have had more RO-preferring applicants overall, numbers of RO-preferring female applicants have remained low, and disproportionately less than rates of female CaRMS participants. Findings highlight the need for greater understanding of the factors influencing female medical students' career selection and CaRMS ranking decisions to develop strategies to improve female representation in RO.

Canadian fellowship experience: the different challenges and emotions faced by an International Medical Graduate and mitigation strategies

Acknowledging the mental remodeling that a foreign physician goes through and attempting to mitigate the difficulties of this process is crucial to achieving better outcomes in education and patient care. Canada's Healthcare System offers Clinical Fellowship Programs that allow physicians specialists to obtain advanced expertise in a chosen subspecialty. In a Clinical Fellowship, Canadian Medical Graduates (CMGs) practice alongside International Medical Graduates (IMGs); however, there is evidence that they undergo different challenges in the learning experience. IMGs usually have a higher cognitive load during the adaptation period, which can be due to multiple factors, such as the transition to practice in a foreign country, language, level of supervision, teaching methods applied, feeling disconnected from home, and other competing needs fellows face outside of the clinical context. We propose strategies that may help mitigate the transition to practice process that IMGs undergo when starting a Canadian fellowship, such as Self-Efficacy Encouraging Approach, Thinking Framework Across Cultures, and Social Engagement and Wellbeing.

15 2020 CaRMS Residency Match Confirms Popularity of Pediatrics

Abstract Primary Subject area Medical Education Background Longitudinal data about the interest in, and competitiveness of, pediatric postgraduate training in Canada has not been reported. Objectives 1. To describe the results of the 2020 CaRMS pediatric residency match with respect to application rates, first-choice discipline choices, and succesful match rates by gender. 2. To examine the trend of these indices over the past decade. Design/Methods Data from the 2020 Canadian Residency Matching Service (CaRMS) pediatric residency match was evaluated and compared over the past decade. Residency match data from other programs was also used for some comparison reporting. Results Of a total pool of 2998 Canadian medical graduate (CMG) applicants in 2020, 305 (10.2%) applied to pediatrics, and 17 of these latter applicants (5.6%) applied solely to pediatrics. In the first iteration CaRMS match, pediatrics was the first-choice discipline for 177 CMG applicants (6.0% of all first choices). Pediatrics has been consistent as a first-choice discipline over the years: 5.9% (2017), 5.5% (2015), and 6.1% (2013). Of the 155 first-year positions offered in pediatrics this year, all were filled. Of those CMGs who matched to pediatrics in 2020, the specialty was the first-choice discipline for 128 applicants (92.8%) and the second-choice discipline for 9 applicants (6.5%). There were clear gender differences noted. Pediatrics accounted for 8.3% of female and 3.2% of male first-choice disciplines. Of the 135 females whose first-choice discipline was pediatrics, 101 matched to that first choice (74.8%). Of the 41 males whose first-choice discipline was pediatrics, 26 matched to that first choice (63.4%). Since 1995 (at CaRMS’ inception), the rates of first-choice discipline choice by gender have been quite stable (Table 1), with females consistently higher than males, while the first-choice discipline matching rate by gender have varied (Figure 1). Forty CMG applicants whose first-choice discipline was pediatrics matched to an alternate discipline choice and nine went unmatched, suggesting that pediatrics continues to be a competitive discipline. The pediatric rate of first-choice discipline matching to another alternate choice of 22.6% (40/177) is comparable to Anesthesia (22.1%; 34/154), Ophthalmology (26.7%; 20/75), and Otolaryngology (20.9%; 9/43). Conclusion Pediatrics continues to be a top specialty choice for graduates of Canadian medical schools, according to data from the 2020 CaRMS match. There are gender differences noted in the choice of pediatrics as a first-choice discipline, and in the successful match rate to pediatrics programs. The rate of successful first-choice discipline matching by gender have varied over time, with the past two years showing significantly greater matching success for females. These trends in the CaRMS pediatric data have implications on discipline recruitment and the pediatric workforce in Canada, and merit further exploration.

Capturing the impact of cultural differences in residency

BackgroundPostgraduate training is a period in which residents develop both their medical competency and their professional identity in an environment of apprenticeship. As situated learning suggests, a critical dimension of such apprenticeship is the mode through which trainees can legitimately participate in the practice before they become experts, in this case physicians. One source of barriers to participation is cultural difference between learner and the clinical environment.ObjectiveTo assess the extent cultural differences create barriers for residents, particularly but not exclusively for international medical graduates (IMGs).MethodsIn 2014–15 a questionnaire was developed with subscales assessing areas such as sense of hierarchy, individuality versus teamwork, and risk tolerance. We refined the instrument by subjecting it to a review panel of experts in postgraduate education followed by “think aloud” sessions with residents.ResultsPiloting this instrument yielded a Cronbach’s alpha of 0.675. When administered to a larger group of residents and faculty representing many specialties, the Impact of Cultural Differences on Residency Experiences (ICDRE) questionnaire revealed a few items for which the Canadian Medical Graduates and International Medical Graduates differed in their mean opinion. The groups were not substantially different overall, but we did observe an interesting diversity of cultural beliefs within each group.ConclusionsWe suggest that the ICDRE may be useful in identifying beliefs which may present challenges to an individual resident or in capturing trends in a resident population so that a specialty program can address the trends proactively. The instrument also provides language with which to anchor preceptors’ evaluations of residents’ professionalism and may serve as an interventional coaching tool.

The Glaring Gender Bias in the Operating Room: A Qualitative Study of Factors Influencing Career Selection for First-Year Medical Students

Despite greater female than male-identifying Canadian medical graduates, women continued to be underrepresented in surgical specialties. The aim of this study was to explore the role of lifestyle challenges and gender-specific considerations in career selection for first-year medical students following early exposure to surgery through an immersive surgical program. A single institution, qualitative study consisting of structured focus groups before and after completion of a 2-week surgical program was used to explore medical student perceptions of surgery. The program consisted of shadowing, surgeon-led talks, and surgical skills workshops in all direct-entry surgical specialties within the Department of Surgery at the University of Toronto. Six entry and exit interviews were conducted by 2 authors. Interviews were recorded, transcribed, and coded for thematic analysis. Teaching hospitals affiliated with the University of Toronto, Canada PARTICIPANTS: Thirty first-year medical students with interest in surgery participated in the program and the focus groups. Four prominent themes emerged: gender imbalances in the work environment, the importance of female mentors, gender-specific challenges of parenting, and the importance of flexible work hours for both male and female students. Greater exposure to female surgeons improved the outlook of medical students on work-life balance. Medical students are concerned with the challenges of pregnancy in a surgical profession. Both male and female students consider parenting, supportive partners, and flexibility of work hours in their career selection. This study demonstrates the prevalence of gender bias in surgical specialties, raising gender-specific challenges that impact career selection for first-year medical students. In an effort to address these perceptions, this study supports efforts to implement formalized mentorship programs for women in surgery early in medical education. Furthermore, concerns surrounding childbearing further support the need for well-established parental leave policies in the Canadian postgraduate medical education system.

Trends in Representation of Female Applicants and Matriculants in Canadian Residency Programs Across Specialties, 1995 to 2019

Disparities in representation between sexes have been shown at multiple career stages in medicine despite increasing representation in the overall physician workforce. To assess sex representation of applicants to the Canadian R-1 entry match for postgraduate training programs from 1995 to 2019, comparing distribution between different specialties as well as applied vs matched applicants. This cross-sectional analysis of aggregate data provided by the Canadian Resident Matching Service between 1995 and 2019 analyzed aggregate data for the Canadian R-1 residency match from 1995 through 2019. Applicant sex as reported in the Canadian Resident Matching Service database. The sex representation of applicants was compared and the longitudinal trends in sex representation were analyzed by specialty between 1995 and 2019. The sex representation of overall applicants to the Canadian R-1 entry match were compared with matched applicants, and both were stratified by specialty. A total of 48 424 applicants were identified (26 407 [54.5%] female applicants), of which 41 037 were matched applicants. Using specialty groupings, female applicants were most highly represented in obstetrics and gynecology (1776 of 2090 [85.0%]) and least represented in radiology (658 of 2055 [32.0%]). Within individual subspecialties, female applicants had the lowest representation in neurosurgery (90 of 394 [22.8%]). While female applicants represented an increasing proportion of the overall applicant population between 1995 and 2019 (z = 2.71; P = .007), significant increases were seen in some, but not all, individual specialties. Differences by sex were found among Canadian medical graduate match rates to their top-ranked specialty: female applicants had a lower likelihood of being rejected for family medicine (rejection of male applicants: OR, 0.46; 95% CI, 0.39-0.54; P < .001) and psychiatry (OR, 0.59; 95% CI, 0.46-0.76; P < .001) and were more likely to be rejected for all-encompassing surgery (acceptance of male applicants: OR, 1.19; 95% CI, 1.10-1.28; P < .001). Increasing representation of female residency applicants over time was seen in some, but not all, medical specialties in Canada, and sex-based differences in successful match rates were observed in some specialties. The reasons for these disparities require further investigation for corrective strategies to be identified.

Diagnostic Radiology Residency Application Trends: Canadian Match Results From 2010-2020.

Rapid advancements in artificial intelligence (AI) have generated uncertainty about the future of radiology among medical students. However, it is unclear whether this has affected radiology residency applications. The purpose of this study was to evaluate recent trends in the Canadian radiology residency match. Canadian Resident Matching Service annual data reports from 2010-2020 were collected. Statistics were extracted for Canadian medical graduates applying to radiology in the R-1 main residency match and analyzed using linear regression. The number of available radiology residency positions decreased (P = .01); declining from 84 in 2010 to 81 in 2020 (mean = 83.1). The overall number of applicants did not change (P = .08, mean = 131.8). The proportion of applicants with radiology as their first choice decreased (P = .001); declining from 4.5% in 2010 to 3.1% in 2020 (mean = 3.4%). The number of applicants applying exclusively to radiology also decreased (P = .02); declining from 39 in 2010 to 16 in 2020 (mean = 23). Positions per applicant (P = 0.24, mean = 0.64), and positions per applicant with radiology as their first choice did not change (P = 0.07, mean = 0.91). While the overall number of students applying to radiology did not change, the number of applicants ranking radiology as their first or only choice decreased sharply. This analysis corroborates recent reports of increased workload, burnout, and declining reimbursement as well as uncertainty about the future of radiology due to advances in AI.

Recognizing and addressing implicit gender bias in medicine.

KEY POINTS For more than a decade, women have predominated among Canadian medical school graduates, according to data from the Canadian Post-M.D. Education Registry (CAPER). Although, as a profession, medicine still sees pervasive discrimination that disadvantages certain groups over others, one

General surgery in Canada: current scope of practice and future needs

The scope of practice of general surgeons in Canada is highly variable. The objective of this study was to examine the demographic characteristics of general surgeons in Canada and compare surgical procedures performed across community sizes and specialties. Data from the Canadian Institute for Health Information's National Physician Database were used to analyze fee-for-service (FFS) care provided by general surgeons and other providers across Canada in 2015/16. Across 8 Canadian provinces, 1669 general surgeons provided FFS care. The majority of the surgeons worked in communities with more than 100 000 residents (71%), were male (78%), were aged 35-54 years (56%) and were Canadian medical graduates (76%). Only 7% of general surgeons practised in rural areas and 14% in communities with between 10 000 and 50 000 residents. Rural communities were significantly more likely to have surgeons who were international medical graduates or who were older than 65 years. The surgical procedures most commonly performed by general surgeons were hernia repairs, gallbladder and biliary tree surgery, excision of skin tumours, colon and intestine resections and breast surgery. Many general surgeons performed procedures not listed in their Royal College of Physicians and Surgeons of Canada training objectives. Canadian general surgeons provide a wide array of surgical services, and practice patterns vary by community size. Surgeons practising in rural and small communities require proficiency in skills not routinely taught in general surgery residency. Opportunities to acquire these skills should be available in training to prepare surgeons to meet the care needs of Canadians.

Everyone Is Awesome: Analyzing Letters of Reference in a General Surgery Residency Selection Process.

The resident selection process involves the analysis of multiple data points, including letters of reference (LORs), which are inherently subjective in nature. We assessed the frequency with which LORs use quantitative terms to describe applicants and to assess whether the use of these terms reflects the ranking of trainees in the final selection process. A descriptive study analyzing LORs submitted by Canadian medical graduate applicants to the University of Ottawa General Surgery Program in 2019 was completed. We collected demographic information about applicants and referees and recorded the use of preidentified quantitative descriptors (eg, best, above average). A 10% audit of the data was performed. Descriptive statistics were used to analyze the demographics of our letters as well as the frequency of use of the quantitative descriptors. Three hundred forty-three LORs for 114 applicants were analyzed. Eighty-five percent (291 of 343) of LORs used quantitative descriptors. Eighty-four percent (95 of 113) of applicants were described as above average, and 45% (51 of 113) were described as the "best" by at least 1 letter. The candidates described as the "best" ranked anywhere from second to 108th in our ranking system. Most LORs use quantitative descriptors. These terms are generally positive, and while the use does discriminate between different applicants, it was not helpful in the context of ranking applicants in our file review process.

What affects medical students’ applications to five-year FRCPC emergency medicine programs?

Purpose: To compare the impact of institutional and epidemiologic factors on differences in application trends of Canadian medical graduates (CMGs) from different medical schools to FRCPC emergency medicine (EM) residency programs.&#x0D; Methods: This was a retrospective cohort study. Data from 2013-2018 were obtained from the Canadian Resident Matching Service (CaRMS) database and standardized questionnaires sent to Canadian medical schools.&#x0D; Results: CaRMS data were available for all schools and survey data was available for 76% schools. Five schools yielded significantly higher rates of applications to FRCPC-EM programs (8.8-13.1%, p&lt;0.05), and 5 schools had significantly lower rates compared to the national mean (2.9-5.1%, p&lt;0.05). Increased exposure to EM (a core rotation and/or elective rotation in EM in the third year of medical school at home-school) yielded 28-55% higher application rates (p&lt;0.001). The presence of an FRCPC-EM residency program at the applicant's home school, and a home school program with 5 or more CMG residency positions at a CMG’s increased the application rates by 39 and 17%, respectively (p&lt;0.05).&#x0D; Conclusion: These data demonstrate a significant difference in application rates of CMGs graduating from Canadian medical schools and certain factors may affect application rates. This information could be used by medical schools to modify curricula, increase exposure to EM, and contribute towards addressing the forecasted national shortage of EM physicians.

Delivering CaRMS Transparency: Applicant Review and Selection Process of a Single-Center Diagnostic Radiology Residency Training Program.

To report the current application review and selection process in our Canadian diagnostic radiology program at the University of Ottawa for both Canadian and international medical graduates. Submitted applications fulfilling institutional requirements were selected for a detailed file review after preliminary screening. A diverse group of file reviewers and interviewers was selected. Interviews were offered based on file review score sheet outcomes. Each interviewer generated a postinterview rank list. Applicants were reviewed and discussed from highest to lowest rank based on a preliminary compiled rank list generated from the average of the postinterview rank lists. Group discussion and a consensus model were used to create a final applicant rank list. We outlined our systematic, consistent selection process which aligns with current best practices. This description may inform other programs wishing to adopt or optimize strategies to improve candidate assessments and selection processes.

Intersectionality of Gender and Visible Minority Status Among General Surgery Residents in Canada

Within medical specialties, surgical disciplines disproportionately and routinely demonstrate the greatest underrepresentation of women and individuals from racial/ethnic minority groups. Understanding the role that diversity plays in surgical resident training may identify strategies that foster resident resiliency, optimize surgical training, and improve patient outcomes. To examine the implication of gender and visible minority (VM [ie, nonaboriginal people who are not White individuals]) status for resiliency and training experiences of general surgery residents in Canada. In this survey study, a 129-item questionnaire was emailed from May 2018 to July 2018 to all residents enrolled in all Canadian general surgery training programs during the 2017-2018 training year. Survey responses were extracted and categorized into 5 major themes. The survey was designed by the Resident Committee and reviewed by the Governing Board of the Canadian Association of General Surgeons. French and English versions of the survey were created, distributed, and administered using Google Forms. Survey questions were formulated to characterize resident diversity and training experience. Self-perceptions of diversity, mentorship, and training experience were evaluated using a 5-point Likert scale (1 for strongly disagree, 2 for disagree, 3 for neither agree or disagree, 4 for agree, and 5 for strongly agree) and open-ended responses. The frequency of perceived unprofessional workplace encounters was evaluated using a 5-point scale (1 for daily, 2 for weekly, 3 for monthly, 4 for annually, and 5 for never). Of the 510 general surgery residents invited, a total of 210 residents (40.5%) completed the survey. Most respondents were younger than 30 years (119 [56.7%]), were women (112 [53.3%]), reported English as their first language (133 [63.3%]), did not identify as a VM (147 [70.0%]), had no dependents (184 [87.6%]), and were Canadian medical graduates (178 [84.8%]). Women residents who identified as VM compared with male residents who did not identify as a VM were less likely to agree or strongly agree that they had a collegial relationship with staff, (21 [63.6%] vs 61 [89.7%]; P = .01), to feel like they fit in with their training programs (21 [63.6%] vs 56 [82.3%]; P = .003), and to feel valued at work (15 [45.4%] vs 47 [69.1%]; P = .03). Both female residents and female residents who identified as VM described significant concerns about receiving fewer training opportunities because of their gender vs their male peers (54 [48.2%] vs 3 [3.0%]; P < .001). Ninety-one of 112 female residents (81.2%) reported feeling that their medical expertise was dismissed because of their gender at least once annually, with 37 women (33.0%) experiencing dismissal of their expertise at least once every week (P < .001). In contrast, 98% of male residents reported never experiencing dismissal of their medical expertise because of their gender. Similarly, residents with VM status vs those without VM status reported at least monthly dismissal of their expertise because of their race/ethnicity (9 of 63 [14.3%] vs 1 of 147 [0.7%]; P < .001). In this study, female sex and VM status appeared to be associated with adverse implications for the training experience of general surgery residents. These findings suggest that new strategies focused on the intersectionality of gender and race/ethnicity are needed to improve the training experience of at-risk residents.

Clinical Learning, Didactic Education, and Research Experiences of Radiation Oncology Resident Physicians in Canada.

Changes in the field of radiation oncology (RO) impacts residency training. Assessing trainee experiences is essential to inform curriculum development. We aim to explore gaps and strengths in current Canadian RO training, as we move towards competency-based medical education (CBME). An online survey was distributed to residents at all Canadian RO training programs. Surveys consisted of 66 open-ended, Likert-scale, matrix-style, and multiple-choice questions, and assessed clinical exposure, didactic teaching, professional relationships, and research experiences. Statistics were calculated from anonymized, aggregate responses. Out of 128 eligible residents, 53 responded (41% response rate). Of these, 57% were male, and 77% were Canadian medical graduates. Senior residents (PGY-4 to PGY-5) perceived insufficient exposure to lymphoma and ocular malignancies, brachytherapy for breast and esophagus malignancies, and stereotactic radiotherapy of the pancreas, prostate, and adrenal gland. Half (51%) had training on image-guided radiotherapy (IGRT) challenges, and 43% had a formal staff mentor. Most residents presented at least one research project at conferences (77%) and authored ≥ 1 publications (66%) during residency. Canadian RO residents are satisfied with their clinical training and educational experience in high-volume tumor sites and high-volume brachytherapy procedures. Areas identified for potential improvement are (1) low-volume tumor sites; (2) low-volume brachytherapy procedures; (3) low-volume stereotactic radiotherapy sites; (4) IGRT challenges; and (5) mentorship opportunities. These findings will inform future CBME curriculum revisions.