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Everything posted by indefatigable

  1. The best performance predictor is based on NBME shelves (which most Canadian schools don't use) - the combined average seems to give the strongest overall prediction and is also correlated with Step 2 CK. Conversely, failing a NBME shelf gives a higher risk of failing the MCCQE-1. The two studies below had small sample sizes and were done for CMGs and not IMGs. I agree with JohnGrisham above that your friend should take a pause from the LMCC and focus on MLEs (Step 2 and Step 3) as the practice/review material is much better developed with higher chances of residency in the US. NB Pre-clinical grades, MCAT and GPA have less correlation with LMCC-1 performance. https://icre2011.files.wordpress.com/2011/11/escudero.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4830373/
  2. Choose people that choose you. Med school can be cliquish and even small differences between people in terms of background, life experiences or ethnicity can sometimes get exaggerated. There's usually an "in" crowd, but I'd suggest focusing on finding a few other people that genuinely accept you and want to spend time or really engage with you rather than trying to "fit in". Don't take it personally at all and just accept that people can be kind of superficial. Be open to having friends outside of medicine (or at other medical schools) as they can help provide balance to your medical school experience. Try and get into whatever activities you enjoy and basically chart your own course. Don't judge and be open to things changing, but don't expect things to change either. I understand the social challenge though, and believe it was one of the most disappointing factors for me personally too, although I am non-trad, with significant life experience and had linguistic (and related) challenges in Quebec, where almost everyone else was very homogenous and much earlier in their lives (I wasn't familiar with the region either). Plus the pre-clinical curriculum involved mostly individual study with limited immersion and interaction (which didn't help with my language challenges either).
  3. It's now been updated and translated. I agree that it seems that the MCCQE II has been somewhat redundant since the end of general licensure, and that there is a need to quickly address the licensing issue given the pandemic context. Perhaps Quebec will lead the way in confronting the status quo, which in the best of times seems a pricy inconvenience? It's surprising that the MCC has been so inflexible whereas even in the US, Step 2 CS has been completely suspended - large-scale testing is more of a mantra there.
  4. I really second this - the one thing we can never get back is time and relationships. Life happens while we're on the treadmill, grinding through pre-med, clerkship, residency, .. not to mention the constant uncertainty of where one will be for a longer term. Staff life is often better than residency, but marriages and children can get caught in the middle of continued professional and personal pursuits. I think it'd be hard to get through medicine without at least some interest and passion, but it really does get put on a pedestal with "cracks" appearing often only as one moves through training, with growing disillusionment where all of sudden further sacrifices seem harder to justify. I think I've had a challenging route in more than one way (probably not worth going over here), but there's a sort of resignation that sets in when one realizes that one is simply "existing", potentially fulfilling a useful and valued role in society - without feeling personally fulfilled on almost any other level and waking up knowing tomorrow will be very similar to today until years have gone by and being almost exactly in the same place. I imagine metaphorically being trapped in quicksand would feel similar - fully aware of one's immobility and unable to do much to change except make things worse. I did do something else previously - but, switching was something I more had to make, not based on calculating future potential earnings. My route was particular and I'm not sure I would have made the same choice, but that's not something I could have known at the time.
  5. Great analysis by @gogogo - it's easy to overlook all these other expenses and to focus on gross billings. Conservative estimates e.g. living expenses and PA pension with numerous non-economic factors to consider e.g. quality of life (OP has no overnight call now), geographic stability, uncertainty of medical school/residency etc..
  6. Mississauga, Ont. – As though the stress of taking an exam during a pandemic weren’t enough, some residents who took the College of Family Physicians of Canada exam this fall have had their test results lost. Prometric, the U.S.-based testing administration company handling the exams, told some residents in an email that it’s unable to retrieve and score their tests due to technical problems. As a result, it said, those residents will need to take the test again in its entirety. The college confirmed in an email to the Canadian Healthcare Network that 18 individuals from five testing centres were impacted by the glitch. This development comes after multiple reports from residents saying there were other glitches with the online exam process, including some being given less time than others and problems with highlighting functionality. “We started to pick up really early on that there was a large number of people . . . that were having these difficulties with timing on the exam,” says Dr. Paul Dhillon, one of the co-founders of the Review Course in Family Medicine, who observed residents airing grievances about the exam in a Facebook group. Commenting through the group, some residents reported getting only three hours and 45 minutes to complete the exam, while others received four hours and 15 minutes, with a further 15 minutes allotted for a break. “The issue, then, I was noticing was that there was no one there to answer right away,” added Dr. Dhillon. “And some people were off site, some people were on site. And then the amount of stress they went through, I can’t even imagine.” The inconsistency in time allotted was an error on Prometric’s part, where one of the multiple versions of the exam used was published with a 225 minute time limit, rather than the 255 minutes it should have been, noted a spokesperson from the college in an email. “We know that writing exams is stressful enough without adding technical glitches,” added Dr. Brent Kvern, director of certification and examinations. “The CFPC regrets the added stress that this situation has created. We will continue communicating with affected individuals.” Dr. James MacKinnon took the test at a location in Nova Scotia. When he started his exam, he noticed he was given three hours and 45 minutes to complete it. Thinking he may have misunderstood his allotted time, he decided to continue taking the exam without notifying the proctor because he didn’t want to risk wasting precious minutes. “If I go and put up an argument with somebody, I recognize that the exam time is just going to keep going and I’m not going to get that back and if I’m wrong, I’ll just lose that time and potentially I could damage the end result of the exam,” he says. After exiting the exam, he found out from a friend that other residents had experienced similar issues. After emailing his residency supervisor and the college, he thought it would only be an issue if his exam weren’t successful. But then, earlier this week, Dr. MacKinnon received an email from Prometric saying his was one of the exams that had been lost. “My first response, I was just nauseated. I mean today I just don’t know how I feel . . . whether it’s anger, frustration, disappointment.” “There have been so many exams that I’ve written over the past six years and this was really the light at the end of the tunnel. . . . And especially with the fact that it’s been postponed for the past six months, which I recognize is out of anyone’s control, it just hurts.” In an email to the Canadian Healthcare Network, a spokesperson for Prometric said it regrets any negative impact the technical problems have caused and that the college is taking the lead in assessing the needs of the residents who will need to retake the exam. “In the recent exam administration for the CFPC testing program, Prometric experienced a technical issue in our production environment that inhibited our ability to transmit, store and score the examination responses for 18 individual test takers,” the email said. “Upon our awareness of the issue, we immediately engaged our technical resources in an effort to retrieve the test taker results; our actions proved unsuccessful. We did identify the root cause of the issue and implemented a resolution that rectified the problem, so that future test takers would not see a recurrence of the issue.” Dr. Francine Lemire, the college’s executive director and chief executive officer added that the college has reached out to every affected candidate. “We will be offering those individuals support and establishing immediate re-writes of the exam. We are also continuing to discuss the required follow-up with our exam vendor.” https://www.canadianhealthcarenetwork.ca/physicians/news/company-handling-cfpc-exams-lost-some-residents-tests-60570?utm_source=EmailMarketing&utm_medium=email&utm_campaign=Physician_Newsflash
  7. The best prep is all the MCC material which is pricy imo, but I'd suggest working through all of that given your limited time. There isn't a great prep for the MCC - Canada Qbank is ok, but not great - they also have clinical cases. UWorld has some overlap too, but not that specific.
  8. I've seen people get really into (or not) a certain area whether it be neurosurg or anesthsia after rotating through it. To me that makes sense too - one actually then has experience in the area and can better tell likes or dislikes, whereas before knowledge of the field was based on interest. Ophtho and ortho are both surgery, but definitely somewhat different for example. Depends a little on clerkship structure and elective availability too, I think- too late with lack of any research or networking would make things very difficult too.
  9. From what I've seen there's a lot of luck and randomness involved - people that match or don't won't look that different on paper, often has more to do with fit, and letters, rather than how much research or interest is shown, but can vary by program for sure. I don't think gunning would hurt, and could help, but it's not as important as the impression and performance during electives (where prep can also help for sure).
  10. For sure, surgery is pretty different and there could be more initial disappointment - what's surprised me though is the number of surgery to FM transfers that I've seen including from ophtho and urology, probably because a lot of the factors that have been discussed above. There's probably even more that switch away from specialties like ortho before CaRMS.
  11. EXPLORATION Every xchange-rate play lets operators really attempt to invest on nervousness.
  12. EXCLAIMED Each X-ray contained light-levels and informed management, Ed declared.
  13. I don't think surgery is that high on the list of alternates first choice specialties for FM matches, at least in the first round. According to the link I put in the post above, 929/1193 FM (about 80%) matches had FM as first choice with the "top 5" alternates that I mentioned - emerg, IM, psych, peds, anesthesia accounting for 146/264 of the alternate top choices.
  14. For sure some do match to FM, not as their first choice, but about 80% first round FM matches last year had FM has first choice with emerg, IM, psych, peds, anesthesia.. being the top alternate first choices (source slide 26) and probably higher excluding Quebec (slide 28).
  15. On top of the "gatekeeper" rule difference, which also results in more US outpatient-focused internists, US FM education is longer (3 years) with lower renumeration than almost every other specialty. Given the much higher costs of US med ed, this creates pressure to pursue higher-paid specialties, where the job markets are often (but not always) stronger than Canada. Canadian med education is also more focused on the "GP model", whereas US has focused more on basic sciences and specialty education. There's also about almost twice as many IM residency positions in the US than FM, whereas in Canada there's about three times as many FM spots than IM, with FPs practicing as hospitalists in Canada, but much less in the US, as mentioned above. Historically, in both Canada and the US, FM has been seen as a "default" choice, although this has changed a lot, at least in Canada. Still, many often initially view FM as less prestigious and rewarding, although there's considerably more spots than most other specialties, which means many do ultimately end up in family. I think in Canada given the generally-speaking more difficult specialty job market, with longer training, and less pay differences, more ultimately may also end up choosing FM too.
  16. For sure there's a lot of individual effort to do well on Step 1, although there's no question that US schools need their students to do well too (with school curricular variations). Even though the LMCC Part I has essentially zero bearing on matching to residency for Canadian students, detailed analysis of student results is broken down by faculty and so Canadian faculties at least want their students to pass - one can imagine the pressure in the US is quite a bit higher given the stakes. My school did certainly seem to want students to succeed on the MCCQE I, despite its general lack of "importance". In the US, I think it was pretty clear that the "hidden curriculum" of Step 1 was really beginning dominate student focus (e.g. with board prep products), much more than even US faculties wanted, as most students realized that the single greatest factor to match was doing well on Step 1. No question there have been a lot changes that have occurred over the past couple decades, like the rise in IMG education, and so taking Step 1 out of the equation probably ensures US students have better matching opportunities, especially from well-known institutions. I'm not sure the transition to Step 2 CK will be immediate, across the board, although practically speaking I'm sure many PDs would like that to happen. Probably programs will very soon start to mention what they're looking for which will put pressure on people to write Step 2 CK well before residency applications which will eventually result in a systemic shift... all this in the middle of a pandemic!
  17. Honestly, it's really the first time I've done a standardized test (Step 1) and felt like I'd really not want to do that again - could be a lot of confounding factors - other stressor at the time, knowledge level at that point, time to prepare, other individual factors.. I think having to go back to do something like the MCAT would be psychologically easier for me, even though it's a lot further, although in retrospect Step 1 does seem much easier, I think it may be just where I was at the time (especially as it does overlap with Step 2 material). One thing that struck me then was how strongly one's knowledge is dependent on the educational system - the concepts emphasized and way of thinking was quite a bit different than what was taught in my pre-clinical curriculum, but I could see that ultimately later on things started to converge at the clinical level. I think it was a good decision to make Step 1 P/F, as I agree it's main purpose seemed to be serving as a resident selection filter, whereas Step 2 at least is grounded in clinical practice.
  18. No- that's exactly the point. Even in a non-Royal College year, finding time can be a challenge, at least according to some residents. Some people were able to do them early in residency. Maybe fellowship could give more time in some cases. Some programs would obviously be closer to the material. Yes - Step 2 CK can be done before Step 1, but the rest needs to be done in order. Yes - I agree with visa. It's more the suggestion that some were sort of stuck, because they couldn't "face" the US MLEs. I wouldn't normally think of surgeons as not being able to "face" a non-obstacle.
  19. You're right that the emphasis is different in most Canadian medical schools, but Step 1 stills covers all the organ blocks, which are usually covered throughout pre-clerkship, on top of a lot of basic sciences (biochemistry, immunology, genetics,..) . What can make Step 1 challenging is the level of detail for concepts that are less familiar/emphasized, including pharmacology (for HIV, cancer, biologics..) which are typically learned later on a as needed basis in most Canadian programs. Interesting - I've heard that Step 1 can be challenging, because of its non-clinical focus from senior residents - that finding time to study for Step 1 is tough even outside a Royal College Year. A poster on the thread below was suggesting that doing the US MLEs asap is important for surgery as it can become a barrier later on for fully trained surgeons. I'd imagine pathologists would find Step 1 much more straightforward - probably varies by program and individual. I'd imagine that "working backwards" could be helpful in some cases - i.e. Step 2 first, which is more clinical, and then Step 1 as there is some overlap.
  20. It's rumored that Step 2 will replace Step 1 for resident selection purposes. It's also considerably more clinically useful with overlap with the LMCC Part I, so I'd suggest focussing on Step 2 rather than Step 1 (which also fits in with NBME shelfs that are still used at some schools). Given the curricular differences, even getting a Pass on Step 1 will take quite a bit of work.
  21. Since it's typically irreversible, probably the biggest risk is branding: if the benefactor's name lose its shine but is now associated with the institution. Usually takes a relatively long time - e.g. McGill or Rhodes (slave-owning and colonialism,..), but can happen much faster. For example, the Sackler family made their fortune in part because of OxyContin and is now considered tainted - but there's already a medical school named after them in Tel Aviv. There could also be a feeling of lost opportunity - e.g Schulich (Western) renamed themselves for (a mere) $26M which was a fraction of the donation received at both UofT and McMaster. First step! Negotiations will probably intensify with the example from Toronto which will help sell to the academic community. Probably a question of price (my guess around $100-50 M) and whether Jean's kids, grand-kids, great grand-kids, etc.. would let it go through. Well, well.. a hold-out Yeah - McMaster seems to know how to negotiate - they know a captive benefactor when they see one.
  22. Only 12 opportunities left in Canada! Going fast - get your name immortalized while you can! Here's a list by donation size and year: Schulich (Western) $26M (2004) Rady (Manitoba) $30M (2016) Cumming (Calgary) $100M (2014) DeGroote (McMaster) $105M (2003) Temerty (Toronto) $250M (2020) Schulich and Rady had the best bargains, relatively speaking. DeGroote paid highly considering the donation was made 17 years ago. I think a school in Quebec may be next - UofT was a major precedent. Jean Coutu Faculté de Médecine maybe?
  23. YOUNGNESS Young ostriches’ underdeveloped neck girths need extra stretching, seriously.
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