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What to do about CaRMS and matching in Canada

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5 hours ago, Coby said:

Most Img spots come with return of service. If those spots are opened up to cmgs with no return of service, could that create more of an issue for patient care  in less desirable locations to practise?

I would assume they keep ROS, or would hope anyways.  A CMG isn't too good for a ROS.

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28 minutes ago, Edict said:

To be perfectly honest, I don't think we should be giving a license to practice to those with only 1 year of internship. 

You are more optimistic about the utility of family med training than me.  From what Ive seen that extra (2nd) year adds fairly little.  Make it so the intern year requires some time in walk in clinics and I think a year is more than enough.  

I wasn't in medicine when this decision was made, but it seems insane to me that they got rid of the intern year to make family a "specialty."  How did they not predict a primary care shortage?  How could they not forsee that people would be screwed if they didn't get a residency?  How was anyone convinced to let that happen?

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10 minutes ago, PetiteAgour said:

Without getting into the IMG debate, touching IMG spots might be a hard sell politically this year. Since 2016,  Canada decreased the statement of needs for J1 Visa for most specialties but FM and Canadian IMGs are now only allowed to pursue 1 year subspecialties in the USA. This year, many IMGs who matched to the US found themselves unable to get a statement of need. Their effectively walking around with 200k to 400k debt. People are super angry as their livelihoods are ripped from them. Think you can imagine the backlash :( from families, and IMG who have nothing to lose. I could be wrong and overestimating the power of IMGs??

I think your view of the general population's opinion regarding CSAs/IMGs may be "a bit" distorted.

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1 hour ago, distressedpremed said:

The entire problem with the system now is that in order to practice general medicine, one has to “specialize” in family medicine. To do so is a career dead end, so students opt to specialize instead.

In the time before CaRMS, all graduating MDs were awarded a general license after completing a rotating internship. These doctors were then free to apply as many times as possible for specialty positions if they desired. Most did not want to re-train, and so the public’s access to primary care was better"

The rotating internship disappeared a few years before CaRMS came about, but the match itself is just a streamlining of a previously more haphazard application process. I completely agree that a return to general licensure and more flexibility in entering residency training would both support generalism and career development. This is the most problematic part of the current FM "specialty" era. 

34 minutes ago, Edict said:

To be perfectly honest, I don't think we should be giving a license to practice to those with only 1 year of internship. 

Why not? This debate has happened elsewhere, but more compressed training might be beneficial. You could certainly have a more apprentice-like "junior staff" role for the first year or two out from internship outside a formal residency program. Simply put, residency teaches you a lot but it doesn't teach you everything. 

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5 minutes ago, A-Stark said:

The rotating internship disappeared a few years before CaRMS came about, but the match itself is just a streamlining of a previously more haphazard application process. I completely agree that a return to general licensure and more flexibility in entering residency training would both support generalism and career development. This is the most problematic part of the current FM "specialty" era. 

Why not? This debate has happened elsewhere, but more compressed training might be beneficial. You could certainly have a more apprentice-like "junior staff" role for the first year or two out from internship outside a formal residency program. Simply put, residency teaches you a lot but it doesn't teach you everything. 

Truthfully, given that we have 3 year medical programs in Canada, having a 1 year rotating internship means only 4 years of medical training to make a licensed physician. This would be by far the shortest medical training time in the western world. Knowing the amount of training we get in a 3 year medical school, this worries me. You can disagree with me, but I do believe in medical training.

The idea of a junior attending role after a one year general internship sounds not dissimilar to what is already provided in family medicine programs.

I believe the simpler solution to this issue is to increase residency spots. Other solutions are creating problems to fix this current one. 

 

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And yet schools like Mac and Calgary existed as three-year programs even when rotating interships and general licensure existed. So I don't think your point is at all relevant. Medical schools elsewhere spent a lot of time on early attrition and MCAT-level basic science - and often allow admission direct from secondary school. 

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2 minutes ago, A-Stark said:

And yet schools like Mac and Calgary existed as three-year programs even when rotating interships and general licensure existed. So I don't think your point is at all relevant. Medical schools elsewhere spent a lot of time on early attrition and MCAT-level basic science - and often allow admission direct from secondary school. 

What worked in the past may not work today. 

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5 minutes ago, A-Stark said:

And yet schools like Mac and Calgary existed as three-year programs even when rotating interships and general licensure existed. So I don't think your point is at all relevant. Medical schools elsewhere spent a lot of time on early attrition and MCAT-level basic science - and often allow admission direct from secondary school. 

One could argue that psychosocial "non-clinical"  didn't exist as much + stronger basic sciences perhaps existed in the past? This is just a wild guess, but with the advent of pass/fail, i sometimes think that medical students may have tried more in the past...but i suppose one could equally argue that in present time there is far more information to obtain/synthesize(I mean, how many antibiotic choices even existed in the 90s!). 

Can see it from both sides.

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4 minutes ago, Edict said:

Like previously mentioned, what worked in the past may not work today. 

The whole idea that medical training is primarily a function of time spent needs to go. The fact that some medical schools are 3 years doesn't necessarily mean their actual training is inferior or that they don't acquire the same skills. And as we all know, a lot of time on rotations is spent doing things that have very little to do with learning skills needed to be a good doctor.

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6 minutes ago, shematoma said:

The whole idea that medical training is primarily a function of time spent needs to go. The fact that some medical schools are 3 years doesn't necessarily mean their actual training is inferior or that they don't acquire the same skills. And as we all know, a lot of time on rotations is spent doing things that have very little to do with learning skills needed to be a good doctor.

four year schools have no more reason to exist because mac and calgary do just fine with only three years.

make every student do a two year FM residency afterwards. there's your "internship"

everyone's happy.

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3 minutes ago, GrouchoMarx said:

four year schools have no more reason to exist because mac and calgary do just fine with only three years.

make every student do a two year FM residency afterwards. there's your "internship"

everyone's happy.

To be fair, 4 years schools generally have much longer breaks in between, and maybe a few extra rotations.  The nearby province 4 year school has 6-7 months of break b/w years 1,2,3 total, and then 3.5 months of dedicated "scholarly" activity time like research/voluntravelism.  Alot of fat that could be trimmed.

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6 minutes ago, PetiteAgour said:

4 year medical schools are good in that they allow students more time and exposure to figure out what specialty they want and seems mentally better if you have a family. 

Nah, I'm really glad I went to a three year school with a family. I started med school after my third year of undergrad, and I'm going into family med. Because of that, my total length of education will be 8 years (well, 8.5 because I'm taking mat leave later this year) from the start of undergrad to working independently. Works out great for me, and ultimately works out better for my kids. 

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1 hour ago, A-Stark said:

And yet schools like Mac and Calgary existed as three-year programs even when rotating interships and general licensure existed. So I don't think your point is at all relevant. Medical schools elsewhere spent a lot of time on early attrition and MCAT-level basic science - and often allow admission direct from secondary school. 

What schools allow admission direct from secondary school?

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What schools allow admission direct from secondary school?

Queens. But I think A-Stark was referring to other countries like the UK.

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1 minute ago, DermJuly2018PGY1 said:

What schools allow admission direct from secondary school?

I think Queen's has a program called QuARMS (sounds ironically like CaRMS lol) where 10 high school students get preselected. Calgary also has a program called Pathways to Medicine methinks.

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1 minute ago, la marzocco said:

I think Queen's has a program called QuARMS (sounds ironically like CaRMS lol) where 10 high school students get preselected. Calgary also has a program called Pathways to Medicine methinks.

I wish I  knew about this back in the day...

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1 hour ago, JohnGrisham said:

To be fair, 4 years schools generally have much longer breaks in between, and maybe a few extra rotations.  The nearby province 4 year school has 6-7 months of break b/w years 1,2,3 total, and then 3.5 months of dedicated "scholarly" activity time like research/voluntravelism.  Alot of fat that could be trimmed.

 

1 hour ago, GrouchoMarx said:

four year schools have no more reason to exist because mac and calgary do just fine with only three years.

make every student do a two year FM residency afterwards. there's your "internship"

everyone's happy.

This is a great idea. But, 3-yr programs are more like the exception to the rule in terms of duration amongst the entire population of LCME/CACMS accredited schools. While I agree a lot of fat can be trimmed, but what are the implications of this fundamental change?

Side question: Are 3-year CMGs disadvantaged in the NRMP match? Particularly interested in hearing from grads from Cal or Mac on their experiences with matching to the states. A handful of my friends in 3-yr prgrams actually take the 4th year as research year to make sure their app is "up to snuff" as they want to participate in NRMP in fear of the poor optics of a 3-yr program. I know the population is relatively small to draw any proper conclusions, but I have always wondered about that. 

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4 minutes ago, la marzocco said:

 

This is a great idea. But, 3-yr programs are more like the exception to the rule in terms of duration amongst the entire population of LCME/CACMS accredited schools. While I agree a lot of fat can be trimmed, but what are the implications of this fundamental change?

Side question: Are 3-year CMGs disadvantaged in the NRMP match? Particularly interested in hearing from grads from Cal or Mac on their experiences with matching to the states. A lot of my friends actually take the 4th year as research year to make sure their app is "up to snuff" as they want to participate in NRMP in fear of the poor optics of a 3-yr program. I know the population is relatively small to draw any proper conclusions, but I have always wondered about that. 

I don't believe many McMaster grads even apply to the US. It would be incredibly difficult to write your Step 1, Step 2CK, do US electives and Canadian electives as well as figure out your specialty in 3 years. 

If you look at CaRMS data you can see that Mac and Calgary grads rarely if ever match to the US. 

Mac at least allows people to take an enrichment year which they can use to complete a masters or just take the time to apply to the US. I just haven't seen anyone use it to apply to the US yet. 

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I guess one implication of switching to a 3 year program is a switch is a preference for older and more mature candidates. 3 year programs tend to select candidates that are more mature for their age or older in general because the cirriculum is so rigorous, less breaks, kinda got to know what you want to do a lot sooner. 

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29 minutes ago, PetiteAgour said:

I guess one implication of switching to a 3 year program is a switch is a preference for older and more mature candidates. 3 year programs tend to select candidates that are more mature for their age or older in general because the cirriculum is so rigorous, less breaks, kinda got to know what you want to do a lot sooner. 

I think 3 year programs will remain a niche market in the world of medicine. Despite their existence for decades now, no new schools have adopted the 3-year model for the most part. I'm glad it remains an option though.

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