Canadian Medical School Graduates Research Articles

Bridging the gap: how gender representation in obgyn residency programs compares to other specialties

The purpose of this study is to evaluate gender representation in OBGYN residency programs, compare it to other specialties and assess for change in gender disparity over time. Retrospective analysis. Data was collected from the AAMC Report on Residents 2018-2020, U.S. and Canadian Medical School Graduates. Information on the AAMC web page indicates the number of active male and female residents per ACGME-Accredited Specialty and Subspecialty. A series of Chi-square tests were conducted to test whether medical specialty is independent of gender in US and Canadian medical residents from 2018-2020 and to examine changes in gender proportion in these specialties over time. Out of the 33 major specialties outlined by the AAMC, 7 specialties were female-dominated, 23 specialties were male-dominated, and 3 specialties showed an equal proportion of male to female active residents. Results from OBGYN demonstrate female dominance, with 15% of residents being male and 85% female, p<0.001. This female predominance was also noted in other specialties such as Pediatrics (27% 73% p<0.001). In contrast, the majority of major specialties are male-dominated with Anesthesiology (66%, 34% p<0.001), Emergency Medicine (EM) (64%, 36% p<0.001), and Orthopedic Surgery (84%, 16% p<0.001). Gender representation between major specialties and their corresponding subspecialties was also compared. Gender proportion shifted for 17 subspecialties, with 13 subspecialties showing a shift from male specialty to female subspecialty predominance and 4 subspecialties showing a shift from female to male predominance. This includes Anesthesiology and EM, male-dominated specialties, showing subspecialties of Obstetric Anesthesiology (36%, 64%, p=0.007) and Pediatric EM(28%, 72%, p<0.001) being female-dominated. Family Medicine and Pediatrics, female-dominated specialties, showed their subspecialties of Sports Medicine (70%, 30%,p<0.001) and Clinical Informatics (71%, 29%, p=0.16), being male-dominated. Gender representation in major specialties and subspecialties was also analyzed over three years. In OBGYN, no gender disparity changes were noted, but Internal Medicine (p=0.048) and General Surgery (p<0.001) saw an increased proportion of female residents. In the female dominant specialties, the only specialty to demonstrate a change was Dermatology where the proportion of males increased (p=0.024). Gender disparity exists amongst the major specialties, with OBGYN being a female dominant specialty. However, the majority of specialties continue to demonstrate male dominance. In addition, specialties that demonstrate female predominance still show male predominance in subspecialty training. Although there has been some increased representation by females over the 3 years in some specialties (Internal medicine and General Surgery), the majority of specialties do not show a change over time.

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

A Longitudinal Study of Differences in Canadian and US Medical Student Preparation for Family Medicine

Background and Objectives: Previous research has found differences in preparation for entry into family medicine training between graduates of US and Canadian medical schools. However, this research was limited in that it utilized cross-sectional data to examine a longitudinal issue. This study aimed to examine these differences with a longitudinal data set. Methods: A comparison of the performance on the American Board of Family Medicine (ABFM) In-Training Exam (ITE) between 2014 and 2016 was conducted by examining the performance of Canadian medical school graduates and US medical school graduates longitudinally, as well as cross-sectionally, using independent t tests. Results: For first-year residents (PGY1), the Canadian 2014/2015 cohort showed significantly higher mean scores than US medical school graduates (USMG) and international medical school graduates (IMG). The Canadian 2015/2016 cohort showed no statistical difference from the USMGs, but did have a significantly higher mean than the IMGs. For second-year residents (PGY2), the Canadian 2014/2015 cohort showed a significantly lower mean than the USMG cohort, but had a significantly higher mean than the IMG cohort. The Canadian 2015/2016 cohort showed a statistically lower mean than the USMG cohort and no difference compared to the IMG cohort. Conclusions: Based on a comparison of ABFM ITE scores between 2014 and 2016, the Canadian medical school graduates performed as well as or better than the US graduates upon entry into residency, but performance was reversed for the second year of training. Our results also suggest an equity value of ACGME residency training independent of location of undergraduate medical training.

Predicting Future Physician Output for British Columbia, Canada

&lt;p&gt;&lt;em&gt;This study looks at data since 2002 and estimates a prediction for the health care output by physicians for British Columbia. The measure used to capture this output is full time equivalence (FTE), developed by the Canadian Institute for Health Information to capture an aggregate level of output by physicians through the value of their billings. The paper uses past data to estimate future physician numbers for the province based on Canadian medical school graduates, interprovincial migration, as well as estimates for the number of physicians leaving the workforce and the number of foreign educated physicians entering the province every year. Taking this prediction for future number of physicians, along with data on the age and gender distribution of doctors, BC population estimates, and previous FTE data, a regression model is developed to predict the level of FTE in BC for 2018 to 2020. This research ultimately predicts a steady, but modest rise in FTE for BC in the next few years. However, whether this growth will continue beyond 2020 is unclear, and a rise alone does not necessarily mean that it will better address future demand as BC is currently experiencing a shortage in physician services, and the demand for health care is expected to rise with the increasing proportion of seniors to working age individuals in the province. This paper suggests that changes should be put in place to increase the number of seats available in Canadian medical schools to address the shortage of physicians in the long term, and that BC will have to increase the number of foreign educated doctors in order to address shortages in the short term.&lt;/em&gt;&lt;/p&gt;

Results from the 2017 Survey of Radiation Oncology Residents in Canada

Previous Pan-Canadian surveys of Radiation Oncology (RO) residents performed in 2003 and 2009 identified job availability as a major concern, and characterized a perceived decline in employment opportunities for radiation oncologists in Canada. The Canadian post-MD education registry indicates that Canadian RO trainee levels rose from 130 in 2003 to reach a peak of 209 in 2009 before declining to approximately 130 in 2017. Recognizing that RO has entered another period of transition, we investigated resident perspectives among a more contemporary cohort of RO trainees in Canada. Surveys were distributed electronically to residents at each RO training program in Canada. Surveys consisted of 116 multiple choice and open-ended questions assessing center demographics, motivations for choosing RO, clinical experiences, didactic learning, research experiences, professional relationships, resident satisfaction, and career aspirations. Questions were constructed based on the 2003 and 2009 Canadian survey, and on previous Association of Residents in Radiation Oncology reports from the United States. Anonymized, aggregate responses from completed surveys were abstracted, and descriptive statistics were calculated. Out of 128 eligible residents, 84 completed the survey (65.6% response rate) with representative sampling from each training year (17.1% - 22.4% each year). Demographics reveal 52.6% were male, 68.4% were Canadian medical school graduates (CMGs), 22.4% held either a master’s degree or doctorate, and 2.6% held additional medical certification. Nearly all respondents (97.9%) were satisfied with their specialty and training program. The most frequently perceived weakness in training was feeling unprepared to be competitive in the job market (42.6%), and 78.7% plan to pursue a post-residency fellowship. Most CMGs (86.1%) plan to practice in Canada, but only 12.8% of respondents believe there is strong demand for RO in Canada. Few respondents believe they can obtain staff positions treating their preferred tumor sites (38.3%), and at their preferred geographic location (27.7%). The job market was perceived by 40.4% to be less competitive than it was 5 years ago, and 59.6% predict it will be less competitive 5 years from now. Canadian RO residents feel adequately trained as competent physicians, and a majority of trainees pursue post-residency fellowships, similar to prior surveys. Although current perceptions of the Canadian job market remain guarded, RO residents are highly satisfied with their choice of specialty and training program, and are more optimistic about their future job prospects. Our survey update provides continued insights into RO residency training in Canada, and identifies opportunities for improvement that could be addressed by the incoming competency-based medical education model for RO.

Physician Characteristics Associated With Ordering 4 Low-Value Screening Tests in Primary Care

Efforts to reduce low-value tests and treatments in primary care are often ineffective. These efforts typically target physicians broadly, most of whom order low-value care infrequently. To measure physician-level use rates of 4 low-value screening tests in primary care to investigate the presence and characteristics of primary care physicians who frequently order low-value care. A retrospective cohort study was conducted using administrative health care claims collected between April 1, 2012, and March 31, 2016, in Ontario, Canada. This study measured use of 4 low-value screening tests-repeated dual-energy x-ray absorptiometry (DXA) scans, electrocardiograms (ECGs), Papanicolaou (Pap) tests, and chest radiographs (CXRs)-among low-risk outpatients rostered to a common cohort of primary care physicians. Physician sex, years since medical school graduation, and primary care model. This study measured the number of tests to which a given physician ranked in the top quintile by ordering rate. The resulting cross-test score (range, 0-4) reflects a physician's propensity to order low-value care across screening tests. Physicians were then dichotomized into infrequent or isolated frequent users (score, 0 or 1, respectively) or generalized frequent users for 2 or more tests (score, ≥2). The final sample consisted of 2394 primary care physicians (mean [SD] age, 51.3 [10.0] years; 50.2% female), who were predominantly Canadian medical school graduates (1701 [71.1%]), far removed from medical school graduation (median, 25.3 years; interquartile range, 17.3-32.3 years), and reimbursed via fee-for-service in a family health group (1130 [47.2%]). They ordered 302 509 low-value screening tests (74 167 DXA scans, 179 855 ECGs, 19 906 Pap tests, and 28 581 CXRs) after 3 428 557 ordering opportunities. Within the cohort, generalized frequent users represented 18.4% (441 of 2394) of physicians but ordered 39.2% (118 665 of 302 509) of all low-value screening tests. Physicians who were male (odds ratio, 1.29; 95% CI, 1.01-1.64), further removed from medical school graduation (odds ratio, 1.03; 95% CI, 1.02-1.04), or in an enhanced fee-for-service payment model (family health group) vs a capitated payment model (family health team) (odds ratio, 2.04; 95% CI, 1.42-2.94) had increased odds of being generalized frequent users. This study identified a group of primary care physicians who frequently ordered low-value screening tests. Tailoring future interventions to these generalized frequent users might be an effective approach to reducing low-value care.

Admission factors associated with international medical graduate certification success: a collaborative retrospective review of postgraduate medical education programs in Ontario.

The failure rate on certification examinations of The College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (RCPSC) is significantly higher for international medical graduates than for Canadian medical school graduates. The purpose of the current study was to generate evidence that supports or refutes the validity of hypotheses proposed to explain the lower success rates. We conducted retrospective analyses of admissions and certification data to determine the factors associated with success of international medical graduate residents on the certification examinations. International medical graduates who entered an Ontario residency program between 2005 and 2012 and had written a certification examination by the time of the analysis (2015) were included in the study. Data available at the time of admission for each resident, including demographic characteristics, previous experiences and previous professional experiences, were collected from each of the 6 Ontario medical schools and matched with certification examination results provided by The CFPC and the RCPSC. We developed logistic regression models to determine the association of each factor with success on the examinations. Data for 900 residents were analyzed. The models revealed resident age to be strongly associated with performance across all examinations. Fluency in English, female sex and the Human Development Index value associated with the country of medical school training had differential associations across the examinations. The findings should contribute to an improved understanding of certification success by international medical graduates, help residency programs identify at-risk residents and underpin the development of specific educational and remedial interventions. In considering the results, it should be kept in mind that some variables are not amenable to changes in selection criteria.

Demographics, Debt, and Practice Intentions of Medical Residents Training in Canada

Many international medical graduates (IMGs) are unable to find residency positions in Canada. A growing proportion are “Canadians studying abroad” (CSAs) trying to return to Canada. We examine the characteristics and practice intentions of residents in Canada: IMGs excluding CSAs, CSAs, and Canadian medical school graduates (CMGs). CSAs and CMGs appear to be similar, but IMGs do not in key instances. IMGs are substantially less likely to state that they intend to practise where they trained or in Canada, controlling for characteristics. This adds support to previous findings indicating that regions relying on IMGs to provide health care may experience ongoing challenges.

Higher percentage of medical school graduates seek family medicine residencies

A third of Canadian medical school graduates have chosen family medicine for their residencies, a percentage that primary care advocates say is good but still not good enough. “I think we would be a lot more comfortable if we reached 40%,” says Dr. Cathy MacLean, president of the College of

The Psychiatry Institute for Medical Students: A Decade of Success

Recruiting medical students into psychiatric residency programs has received much attention. In the 1980s and 1990s, North American psychiatric residency programs experienced numerous barriers to recruiting highquality medical students (1–5). This remains a problem around the world. The literature suggests that experiences during medical school, personalities of applicants, and beliefs about the practice of psychiatry are all strongly associated with the decision to enter a psychiatric residency. Recruitment strategies have been widely recommended to bolster positive psychiatry-related experiences and to alter negative perceptions (6–9). In the mid-1990s, only about 4% of U.S. and 6% of Canadian medical school graduates chose psychiatry (10, 11). More recent studies focused on perceptions and attitudes of medical students about psychiatry careers (12– 17). While initial interest is still the most influential factor, positive experiences during psychiatry clerkships and electives have been described as “modifiable programmatic factors that could enhance recruitment to psychiatry” (17). The Psychiatry Institute for Medical Students at the University of Toronto in Ontario was initiated in 1994 as a novel recruitment strategy (18). To our knowledge, similar programs have not been reported. As an indication of how much the recruitment situation has changed in Toronto, the 2008 Canadian Resident Matching Service match was successful in filling all 28 postgraduate year 1 (PGY-1) psychiatric residency positions at the University of Toronto as well as two international medical graduate positions—a total of 30 spots, up from 24 spots 2 years ago (19). As of July 2007, the University of Toronto has 138 psychiatric residents from PGY-1 to PGY-5.

Performance during Internal Medicine Residency Training and Subsequent Disciplinary Action by State Licensing Boards

Physicians who are disciplined by state licensing boards are more likely to have demonstrated unprofessional behavior in medical school. Information is limited on whether similar performance measures taken during residency can predict performance as practicing physicians. To determine whether performance measures during residency predict the likelihood of future disciplinary actions against practicing internists. Retrospective cohort study. State licensing board disciplinary actions against physicians from 1990 to 2006. 66,171 physicians who entered internal medicine residency training in the United States from 1990 to 2000 and became diplomates. Predictor variables included components of the Residents' Annual Evaluation Summary ratings and American Board of Internal Medicine (ABIM) certification examination scores. 2 performance measures independently predicted disciplinary action. A low professionalism rating on the Residents' Annual Evaluation Summary predicted increased risk for disciplinary action (hazard ratio, 1.7 [95% CI, 1.3 to 2.2]), and high performance on the ABIM certification examination predicted decreased risk for disciplinary action (hazard ratio, 0.7 [CI, 0.60 to 0.70] for American or Canadian medical school graduates and 0.9 [CI, 0.80 to 1.0] for international medical school graduates). Progressively better professionalism ratings and ABIM certification examination scores were associated with less risk for subsequent disciplinary actions; the risk ranged from 4.0% for the lowest professionalism rating to 0.5% for the highest and from 2.5% for the lowest examination scores to 0.0% for the highest. The study was retrospective. Some diplomates may have practiced outside of the United States. Nondiplomates were excluded. Poor performance on behavioral and cognitive measures during residency are associated with greater risk for state licensing board actions against practicing physicians at every point on a performance continuum. These findings support the Accreditation Council for Graduate Medical Education standards for professionalism and cognitive performance and the development of best practices to remediate these deficiencies.

Analysis of International Migration Patterns Affecting Physician Supply in Canada

This paper analyzes the migration patterns of both Canadian medical school graduates and international medical graduates (IMGs), and the impact of these patterns on physician supply in Canada. Immigration patterns of IMGs have changed over time, with fewer physicians from the United Kingdom and more from South Africa. A large portion of IMGs who leave Canada (43%) return "home." Recently, the average duration of practice in Canada for these doctors has been three years, a finding that suggests many came for educational purposes or to acquire skills. The heterogeneity and complexity of international migration are highlighted in this paper.

Annual residency scramble near completion

Although a record 353 international medical school graduates found positions in the 2008 residency match as provinces slowly moved to fulfill commitments to expand slots for those educated or trained abroad, some 946 international graduates and an estimated 85 Canadian medical school graduates are

Career pathways of graduates of general surgery residency programs: an analysis of graduates from 1983 to 1990.

Approximately 1,000 individuals complete graduate surgical education in general surgery each year. Their subsequent career pathways have not been described but may have relevance to the supply of general surgeons available to provide a broad range of surgical care to the population of the USA. Data for this study were obtained from the American College of Surgeons's Surgery Resident Masterfile, developed for the annual Longitudinal Study of Surgery Residents, and the American Board of Medical Specialties's Official Directory of Board Certified Medical Specialists. For verification purposes, the American Medical Association's Physician Masterfile and the American Board of Surgery's certified database were searched. Yearly analyses of certified general surgery graduates from 1983 to 1990 were conducted, and rates of certification between US or Canadian medical school graduates and international medical school graduates (IMG) were compared. Ten to 18 years after completion of a residency program in general surgery, 93.6% of graduates had been certified in general surgery or by another American Board of Medical Specialties board. A total of 43.7% of the 8,068 graduates were certified, in addition, in a general surgery-based specialty. Overall, evidence of certification was not available for 6.4% of graduates. The certification rate for US or Canadian graduates was 95.8% of general surgeons and increased for IMG surgeons from 69.4% for 1983 graduates to 94.7% for 1990 graduates. The number of IMGs in general surgery residency programs declined from 19.7% of 1983 graduates to 7.8% of 1990 graduates. The rates of American Board of Surgery certification are 96.1% for male and 93.6% for female US or Canadian graduates; 79.2% of male IMG graduates and 83.7% of female IMG graduates became certified. Most surgeons who completed a general surgery residency program from 1983 to 1990 are certified and presumably have met high standards for knowledge and experience. More than half of the graduates specialize further.

Performances of U.S. osteopathic and Canadian medical school graduates on the American Board of Internal Medicine Certifying Examinations, 1984-1988

The performances of Canadian medical school graduates and U.S. osteopathic medical school graduates who first took the American Board of Internal Medicine Certifying Examination between 1984 and 1988 were compared with the performances, during the same period, of U.S. and foreign medical school graduates. Approximately 100 Canadian graduates took the examination each year; by 1988 the number of osteopathic graduates taking it was 102, double the number participating in 1984. Nearly all the Canadian graduates attended university or university-affiliated residencies, whereas half of the osteopathic graduates attended non-university-affiliated programs. For their overall clinical competence and for the eight components of clinical competence, the Canadian graduates were rated highest, followed by the U.S., osteopathic, and foreign graduates. The Canadians' average examination scores were also highest. The authors discuss the relatively low level of performance of the osteopathic graduates, but conclude that these graduates appear to be an untapped source of talented physicians for internal medicine residencies. The limitations of studying self-selected groups of candidates are also discussed.

Performance of US citizen Caribbean medical school graduates on the American Board of internal medicine certifying examinations, 1984 to 1987

Our purpose was to compare the certifying examination performance of graduates of Caribbean medical institutions with graduates of other medical institutions. Specifically, the performance of US and Canadian medical school graduates, non‐US citizen foreign medical school graduates, US citizen non‐Caribbean foreign medical school graduates, and US citizen Caribbean medical school graduates was compared for the 1984 to 1987 certifying examinations of the American Board of Internal Medicine. In addition, program directors’ ratings of candidates’ clinical competence were compared for these four groups. Results indicated that US citizen Caribbean medical school graduates did not perform as well as any of the other groups on the examination. This is consistent with the findings of other studies of Caribbean medical students, conducted earlier in their training. The current study expands on that work by indicating that deficits in medical knowledge, apparent in undergraduate examinations, are also evident at the...

Factors effecting the recruitment of residents: the residents' and residency directors' view.

A survey of the opinions of Canadian psychiatric residents (N = 199) and their residency directors (N = 13) was conducted regarding six hypothesized reasons for the decline in psychiatric career choice by medical students. The residents felt that the adverse effects of undergraduate education and the negative socialization experience in medical school were particularly important. Of less importance was the competition from family practice programs and medical school admission policies that pre-screened biosocial students out. Little importance was attached to the relatively low financial benefits of this specialty and to new immigration laws. The experience of negative socialization was found to be significantly more important to Canadian medical school graduates than foreign graduates. The residency directors placed less emphasis on the importance of undergraduate education than did the residents.

THE 1971 PRETEST OF THE AMERICAN BOARD OF PEDIATRICS

In July 1971 the American Board of Pediatrics decided to offer pediatric residency program directors an opportunity to pretest individuals entering their training programs by making available to them an examination prepared by the American Board of Pediatrics. The 1971 written certifying examination was selected to serve as the pretest. This was a 500-item, multiple-choice question examination. Ninety-two pediatric residency programs participated. From these programs, 584 individuals were examined: 528 of these were first core year trainees. The mean standard score for the first core year trainees was 217 or about 1.4 standard deviations below the minimal pass level on the written certifying examination. This is nearby 3 standard deviations below the mean for the peer reference group which is defined as American and Canadian medical school graduates who are taking the written certifying examination of the American Board of Pediatrics for the first time and who have just completed their two core years of residency training. Fifteen percent of the first core year group scored 350 or better and, therefore, performed well enough to have passed the written certifying examination of the American Board of Pediatrics before beginning any formal training.