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sisphus last won the day on June 21 2019

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  1. Hi all, some good and interesting points from different perspectives. I was a little nervous to start this conversation as it might be contentious, but now I am glad to have done so. I will reply to what I can, but I recognize that my logic, knowledge, or experiences are limited and may not necessarily be applicable. I've noticed a few responses that have the same pattern. Yes, the system is imperfect. And there are and will be many flaws that can't all be addressed. These flaws are not limited to medicine or its admissions. However, does that mean that we shouldn't try to address them? It pains me to see that, since the time Queen's Medicine expelled its black students, during 3 generations, we are just barely starting to encourage indigenous, black, and low-SES students to apply in a few select programs in some schools across Canada. These populations and their difficulties have existed for a long time and it's not a current issue. With support, the majority of people can be trained to be competent at a procedure, and even do it extremely well. However, things like compassion and empathy are harder to train, if at all trainable. Is it ever possible to train somebody to truly understand what it's like for somebody working 2 jobs to support a family, unable to afford and adhere to their medication, living paycheck to paycheck, stressed from waiting every day for the other shop to drop (emergencies, sickness, etc.). I'd argue no, unless that training provides extensive living experience in their shoes. Why is this important? As their doctor, you are providing care that will need to be tailored to their circumstances, otherwise they will not be able to adhere to your treatment plan due to their circumstances getting in the way. No matter how hard they try. When the selection process is unfortunately biased in favour of selecting for those who are well-off, which is apparent when you see most current practicing physicians, this becomes a systemic problem. Yes, many selection systems naturally select for people who can jump through the predetermined hoops, no matter how arbitrary they may be. But does this truly assess a person's competency or their ability to be competent as a doctor? How well can you jump through a hoop if your leg is lame? Similarly, many people are afflicted with poor situational circumstances that prevent them from displaying so-called competency. Yes, Canada is blessed to have schools that try to recognize and serve their local population (Western with its SWOMEN program), including different eligibility criteria used. There may be a school that caters to each kind of applicant and they will have their niche of opportunity. Unfortunately, due to the sheer level of competition, applicants simply cannot afford to apply to that one school and realistically expect to get in. A successful applicant is usually the one who has the ability and the means to jump through as many hoops as possible and satisfy the criteria of many schools. Through attrition, this means that less fortunate applicants are lost as potential doctors, who may have provided a valuable perspective due to different experiences. Let me put it to you this way. A black kid grows up a poor neighborhood with a struggling family. Somehow, against all odds, they are convinced that they can be a doctor despite not being able to afford classes or time to study or the means to travel to volunteer. Due to their poor circumstances, they work under the table (illegally) doing odd irregular jobs (A McDonalds position would be lucky) to support their family, and consequently they have a low GPA in university and limited experiences that admissions likes or finds palatable. They can't afford to take the MCAT twice or the Casper. They never learned French. They decide to apply to UofT, which has a program for black students. However, due to the sheer number of people vying for the same spot, they don't get in. And so we lose a potential doctor who could have served their neighborhood and recognize what it's like growing up in their situation. Yes, my perspective is limited and I should not try to assess applicants by their involvement in one activity. They may have really given it all in other domains of their lives and were not able to do the same in mine. However, my point is that Medical Schools are vulnerable to that exact same bias. Many of these schools also view applicants through a similarly limited perspective (though better than mine), which does not fully capture the applicant's potential and activity. Ultimately, I am heartened to see recent changes like Ottawa's low SES initiative, but I'm concerned that medical schools are not adapting quickly enough to the needs of their communities.
  2. There are some things bugging me about the medical school application process, and I just wanted to share my thoughts what you think. I used to be part of a really involved community volunteer group, which coincidentally had a lot of students applying to schools of medicine. During my involvement in this group, I saw many of these people get into medical schools. But they were rarely the people I expected to get in off the bat. Why? While volunteering I got to know some people who demonstrated great character, resilience, and compassion for others. These people would volunteer for more responsibility when others couldn't, go beyond what was expected of them in terms of their volunteer role, would always be available to support others if they were going through hard times, and sacrificed their own time and energy to make the volunteer group and the community it was supporting better. These were people I always knew would have my back if something bad were to happen. In addition to their clear academic ability, their character told me clearly these people would definitely be accepted into schools of medicine and go on to become amazing doctors who would make patients feel well cared for. But they didn't. They were not interviewed or accepted. Needless to say, despite this they have gone on to be fulfilled and accomplished in alternate life paths. This in isolation would sit well with me, as it is a competitive process after all. However, what didn't sit well with me was the fact that there were other people who did the bare minimum, fulfilled their responsibilities and no more, and only stayed to volunteer until they achieved some sort of recognition or title. These were not the people who went out of their way to help when there was a crises, such as being short-staffed or staff/community members have difficult personal issues (e.g., addiction). If such an event occured, they quit not long after and moved on to other opportunities. These were not the people that I could depend on, that I felt comfortable asking for their help. However, THESE were the people who eventually got accepted for schools of medicine and are moving on to be doctors. Why does it matter? Well, if you had to pick a doctor from either group, which one would you prefer to look out for you and take care of you? I would resoundingly pick the former. I want somebody who just doesn't do the bare minimum and calls it a day after fulfilling their responsibilities. I don't want someone looking after my grandma, who just wants to tick off the checkboxes and call it a day. I want somebody who cares, goes out of their way, and is not satisfied with 'just enough'. I can already see the arguments against this. Burnout, someone who can meet their responsibilities as a doctor only is all that's required, doctors don't need to be saints, that I only saw one aspect of these people, other. But when I think about stuff like the Casper test, a test created to look for good character, maturity, sense of ethics, I am surprised to learn that people do well by compiling a thesaurus list of 'empathy' terms that they just word-vomit onto each question prompt in an effort to score well. Is this test really looking for people who would make good doctors, or people who are good at gaming the system? Isn't this just selecting for people who are good at faking compassion and empathy? When I consider other issues, like the high costs of the MCAT, or the susceptibility of extracurriculars/references to nepotism, or the ridiculous GPA requirements, I wonder if the whole process is just selecting for people who are either privileged (resources, status, connections, etc) or are extremely good at jumping through arbitrary hoops. I've seen rich high school kids whose parents are friends with a doctor get amazing work positions in medicine that others would need complete BScs or MScs, or extensive work experience, for. Undoubtedly, this will only help them gain better experiences to put on their resume. Ultimately, it wouldn't matter how they got it for the admissions people who are skimming through resumes. At the end of the day, is the process truly selecting for people who can recognize and serve the needs of a diverse patient population? Feel free to refute or support. Happy to hear either.
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