ON changes CaRMS second round for IMG/CMG

[jlkhhylyiluh6]

Quote

many countries have their students essentially just shadow (at best) during these rotations. 

the states does this too for the most part. They dont even let students write progress notes, lmao...

[medigeek]

38 minutes ago, beeboop said:

the states does this too for the most part. They dont even let students write progress notes, lmao...

I think it's variable. They tend to do practice notes on the EMR which don't count. Some places will let you write ones that count. But yeah definitely half the time there it's glorified shadowing. Their system is more about greater  book knowledge. 

[JohnGrisham]

4 hours ago, beeboop said:

the states does this too for the most part. They dont even let students write progress notes, lmao...

Very variable. Some schools are indistinguishable from Canada or have even more hands on rotations. I know plenty of CMGs who've never intubated or done deliveries.  

[ploughboy]

8 hours ago, JohnGrisham said:

 I know plenty of CMGs who've never intubated or done deliveries.  

boggle

Really?  We had to log our procedures as clerks:  x deliveries, y intubations, z foleys. Not just procedures, either:  end-of-life conversations,  newborn exams, etc etc .  There was a big list.  Not hard to collect them all, a bit of a pain to log them.

[medigeek]

37 minutes ago, ploughboy said:

boggle

Really?  We had to log our procedures as clerks:  x deliveries, y intubations, z foleys. Not just procedures, either:  end-of-life conversations,  newborn exams, etc etc .  There was a big list.  Not hard to collect them all, a bit of a pain to log them.

I think USA medical education is fragmented by region. Northeast generally sucks, but has some good ones I believe. The West is generally good. The south is quite good. Midwest is variable. A lot of the USA system is overcrowded with so many residents/fellows and they need X numbers which pushes med students down the priority list. Litigation is certainly a big factor too (hence northeast sucking). 

Advantage in Canada is that litigation happens over legit genuine malpractice rather than silly nonsense. 

 

Anyone have insight into how training is for foreign countries? Anyone who's rotated alongside an IMG from there? Generally heard it's veryyy shadowing heavy.

[NeuroD]

7 hours ago, ploughboy said:

boggle

Really?  We had to log our procedures as clerks:  x deliveries, y intubations, z foleys. Not just procedures, either:  end-of-life conversations,  newborn exams, etc etc .  There was a big list.  Not hard to collect them all, a bit of a pain to log them.

Same.

Mac?

[NeuroD]

6 hours ago, medigeek said:

I think USA medical education is fragmented by region. Northeast generally sucks, but has some good ones I believe. The West is generally good. The south is quite good. Midwest is variable. A lot of the USA system is overcrowded with so many residents/fellows and they need X numbers which pushes med students down the priority list. Litigation is certainly a big factor too (hence northeast sucking). 

Advantage in Canada is that litigation happens over legit genuine malpractice rather than silly nonsense. 

 

Anyone have insight into how training is for foreign countries? Anyone who's rotated alongside an IMG from there? Generally heard it's veryyy shadowing heavy.

I've rotated along students from Ireland, Scotland, Australia, New Zealand, and South Korea. They were wonderful people...but I think Canadian training is a blessing. Many of them had great book smarts...but let's just say that while rotating with them, my attendings loved me because I could follow up on a patient t and write a SOAP note lol.

[Edict]

11 hours ago, ploughboy said:

boggle

Really?  We had to log our procedures as clerks:  x deliveries, y intubations, z foleys. Not just procedures, either:  end-of-life conversations,  newborn exams, etc etc .  There was a big list.  Not hard to collect them all, a bit of a pain to log them.

I think it is school dependent placement dependent. Even within my school people who went to certain community sites did way more than people who went to other sites. And it is learner dependent, if you aren't really keen on newborn exams, you can easily get away with not doing them if you do inpatient peds. 

[goleafsgochris]

11 hours ago, ploughboy said:

boggle

Really?  We had to log our procedures as clerks:  x deliveries, y intubations, z foleys. Not just procedures, either:  end-of-life conversations,  newborn exams, etc etc .  There was a big list.  Not hard to collect them all, a bit of a pain to log them.

My school had these, but most people didn’t complete them, and no one ever checked.

[NeuroD]

48 minutes ago, goleafsgochris said:

My school had these, but most people didn’t complete them, and no one ever checked.

Mac has made them mandatory for rotation completion. Not sure what other schools are doing.

[indefatigable]

35 minutes ago, PhD2MD said:

Mac has made them mandatory for rotation completion. Not sure what other schools are doing.

It's 100% obligatory - if anything is missing it has to be made up, and progress is monitored.  

[JohnGrisham]

4 hours ago, Edict said:

I think it is school dependent placement dependent. Even within my school people who went to certain community sites did way more than people who went to other sites. And it is learner dependent, if you aren't really keen on newborn exams, you can easily get away with not doing them if you do inpatient peds. 

Exactly this. 

[JohnGrisham]

2 hours ago, tere said:

It's 100% obligatory - if anything is missing it has to be made up, and progress is monitored.  

I'm not at Mac, but Its required and obligatory too here. But 1 of each thing. Pretty easy to log one for most things. 

 

[indefatigable]

15 minutes ago, JohnGrisham said:

I'm not at Mac, but Its required and obligatory too here. But 1 of each thing. Pretty easy to log one for most things. 

To be clear, neither am I - for us, for some of the items that are sometimes missed there's a make up opportunity at the end.  

[heydere]

Is this for real? This would significantly limit the ability of those that want to transfer; they will be eligible for less spots and perhaps not for the specialty that may have been made available to them through one stream. 

[rmorelan]

3 hours ago, heydere said:

Is this for real? This would significantly limit the ability of those that want to transfer; they will be eligible for less spots and perhaps not for the specialty that may have been made available to them through one stream. 

seems so - it is like they are trading off the increasing the odds initially of getting what you want vs the odds of transfers. 

I actually do not know very many people that transferred that route - I wonder how common it actually is - most transfers seem well within the same school and bypass a lot of this I think.

[bearded frog]

I don't think this removes the non-CaRMS pgme/pgme program to program transfer, this just formalizes the option that residents previously had to apply had, to apply for a new residency spot in the second round of CaRMS, which they could have done before.

[jfdes]

Is this something the faculties decide, or the provincial government? In the AFMC report it says "Responsible: Faculties in consultation with provincial governments"
"

[la marzocco]

On 12/29/2018 at 8:29 PM, tere said:

"R-1 Second Iteration

There will be two parallel streams – CMG and IMG – with designated positions for each stream. There will be no crossovers or transfers between the two streams.

Residents in current PG positions can access the second iteration as a way of changing programs or specialties. CMG Residents can only apply to unfilled CMG positions. IMG Residents can only apply for unfilled IMG positions. Please review the national transfer guidelines for more information. AFMC National Transfer Guidelines"

https://www.carms.ca/match/r-1-main-residency-match/eligibility-criteria/ontario/

Meanwhile Quebec has gone the complete other direction in getting rid of streaming for both 1st and 2nd iterations. Granted the language barrier (minus McGill) prevents most IMG from applying anyway so maybe streaming wouldn't have mattered in Quebec. 

[indefatigable]

On 1/19/2019 at 4:44 PM, la marzocco said:

Meanwhile Quebec has gone the complete other direction in getting rid of streaming for both 1st and 2nd iterations. Granted the language barrier (minus McGill) prevents most IMG from applying anyway so maybe streaming wouldn't have mattered in Quebec. 

Exactly - that barrier is not a trivial one esp at the professional level.  Plus I think the degree approval process from the CMQ may take longer for the IMGs that do have an ability in French.

[la marzocco]

Looks like Alberta is following suit with Ontario in keeping the IMG/CMG separate in 2nd iteration. 

https://afmc.ca/blog/2019-02-07

[shematoma]

1 hour ago, la marzocco said:

Looks like Alberta is following suit with Ontario in keeping the IMG/CMG separate in 2nd iteration. 

https://afmc.ca/blog/2019-02-07

Alberta never matched any IMGs last year in the second iteration, and none of their second iteration spots were IMG to begin with. So the effect of this in the end is probably just to cut down on the number of applications that the Alberta schools have to review in the second iteration by cutting out IMGs from applying.

Ontario is a different beast because overall there is a deficit of CMG spots compared to CMGs, and you had some schools last year like Western leave IMG FM spots open and ended up taking quite a few of their own unmatched students. They won't be able to do that anymore and ON students will have to search further afield for second iteration spots.

The other provinces with significant unmatched spots in the second iteration - SK, MB, NS and NL, haven't followed suit unfortunately so in the end the effect of ON and AB doing this is in isolation is probably neutral or even mildly negative for CMGs.

[la marzocco]

35 minutes ago, shematoma said:

Alberta never matched any IMGs last year in the second iteration, and none of their second iteration spots were IMG to begin with. So the effect of this in the end is probably just to cut down on the number of applications that the Alberta schools have to review in the second iteration by cutting out IMGs from applying.

Ontario is a different beast because overall there is a deficit of CMG spots compared to CMGs, and you had some schools last year like Western leave IMG FM spots open and ended up taking quite a few of their own unmatched students. They won't be able to do that anymore and ON students will have to search further afield for second iteration spots.

The other provinces with significant unmatched spots in the second iteration - SK, MB, NS and NL, haven't followed suit unfortunately so in the end the effect of ON and AB doing this is in isolation is probably neutral or even mildly negative for CMGs.

Can't the gov't convert 1/2 of the IMG-designated spots to CMG-designated for the next few years until they come up with some plan for financing more spots? 

[jlkhhylyiluh6]

35 minutes ago, la marzocco said:

Can't the gov't convert 1/2 of the IMG-designated spots to CMG-designated for the next few years until they come up with some plan for financing more spots? 

the irony is that, given how insanely expensive everything involved in applying is for IMGs, reducing their spots (and therefore their applications) would likely LOWER the amount of money programs/the system gets...

[shematoma]

49 minutes ago, la marzocco said:

Can't the gov't convert 1/2 of the IMG-designated spots to CMG-designated for the next few years until they come up with some plan for financing more spots? 

This would be a totally logical thing to do but probably politically very difficult. We can't even get all the provinces to act in unison in eliminating the CMG/IMG streaming in the second iteration. How would we get them to reallocate 1/2 of the IMG spots? Any one province choosing to do this would get a lot of flack from IMGs (and their wealthy families), and unless every other province followed, the one province would be flooded with additional CMG applicants from across the country, and in the end might not benefit their own provinces' students. The political payoff to the provincial government is therefore questionable.

What WOULD make a difference is if schools started allocating in-province and out of province residency spots, just like they do for medical school seats. It's never made sense why provinces don't do this, since they make such a big deal of reserving medical school spots for in province residents - why bother if you're only going to lose them in residency because they can't match to your own province? That would benefit provinces like AB that have a relative abundance of residency spots and put pressure on ON which has a chronic deficit of residency spots.

13 minutes ago, beeboop said:

the irony is that, given how insanely expensive everything involved in applying is for IMGs, reducing their spots (and therefore their applications) would likely LOWER the amount of money programs/the system gets...

Interesting thought, but no. IMGs spend a lot of money on exams and certifications but ALL that money gets absorbed by the organizations doing those exams and certifications, such as the Medical Council of Canada. To think that the fees IMGs pay go into the residency system is to misunderstand how bureaucracy works. Money has a way of getting stuck and pilfered where it lands in bureaucracies. Any fees paid to CaRMS stay with CaRMS, for example, and go to run their "operational costs."