Internship

[Guest Lorae]

I was talking with a friend of mine who is a general surgeon. He said that Canada will be moving back to the system of having a 1 year internship before your residency. He said it would be implemented in about 2 years....

 

i haven't heard anything else about this from anywhere... i've been checking the royal college site, etc.

 

anyone know anything about this??

 

As a slightly older applicant who is hoping to pursue a long specialty, I'm not too enthusiastic about adding years onto my timeline

Maybe it's just a rumour....

[Guest cheech10]

I think the proposal was to have a common first year to allow people some more leeway in switching specialties. I don't think an extra year would be added on. At any rate, I wasn't aware that this proposal was agreed on yet and that it would definitely be going through. Maybe others know more?

[Guest Kirsteen]

Hi there,

 

It's interesting that this topic should spring up here. This past eighteen months or so, primarily via work, I've been around a fairly diverse group of surgeons here and abroad. Over the past few weeks, the reintroduction of a rotating PGY-1 in Canada has arose in conversation numerous times. I've heard the idea coming from surgeons in a couple of different groups in Toronto. Often, I've heard the argument that it's a good idea since the years in residency offer hugely different experiences and views of specialties than do the clerkship years. I haven't heard though, that anything official is coming down. Anyone else? :rolleyes

 

Cheers,

Kirsteen

[Guest fox]

I am pretty sure no decisions about a common year have been made. I went to a seminar the other day about CAMRS and this question was raised and the general thought was that this common year, if it ever comes in, will not be in place any time soon.

[Guest aneliz]

I know that the CMA is pushing for the reinstatement of the common first year...and that they voted to support it as an organisation...but I am not aware that it has been adopted by any of the provinces so far. It would need to pass that step if it were to happen...and, seeing as none of us have heard of it happening, I would expect that implementation of the change in a year or two would be pretty optimistic in my opinion.

[Guest UWOMED2005]

That would be awesome. Heck, I wonder if I failed the rest of my clerkship rotations whether they'd let me repeat 3rd or 4th year often enough to fall under that system. (joking of course!)

 

The longer I'm in medicine the more I wished we were under the old internship system. Why? Because under the current system, you have to make decisions way to early. My class is currently in the process of setting up electives. . . which will almost surely decide what residency programs we match to. Thing is, we haven't even completed our rotations. . . for all I know, I'll get to either my peds or obstetrics rotations this summer and realize that is my life calling - but it'll be too late, because I missed the boat on electives. Worse, for some of the surgical sub-specialties, students are practically expected to start making themselves "competitive" during 2nd or even 3rd year. I really don't understand how my classmates who started doing weekly electives in Plastics in 1st year could decide that's what they wanted to do for the rest of their lives based on a few afternoons with a plastic surgeon and without seeing what else was out there.

 

Having an intermediate year would make so much more sense. 3rd year would be more about seeing a general survey of courses than having undertones of trying to impress in the specialty(ies) you are interested in. You could look at all the options before jumping at anything. And your competitiveness for residency programs would be based on the skillset you have during your internship at the end of your MD, rather than a 2 week rotation in 3rd year or whatever.

[Guest Lorae]

Thanks for the information. The common year sounds like it does have some benefits... and if it did add a year onto your residency it might not be that horrible - especially if it helps you choose what you want to do forever.

 

the surgeon I heard this from could very well be mistaken about the 2 year implementation date. He was also telling me that most residency programs "should" be extended by *at least* a year because so many residents have been griping about the hours of work. He said he worked 100 hours per week as a resident... and if the assosiations are going to enforce a 60h/week maximum... then residents technically owe more hours

 

i dont think i agree with that... 100 hours per week doesn't necessarily educate you any better. it just makes you so damn tired you kill someone or give up caring

 

just my 2 cents - sorry for the tangent

[Guest cheech10]

I wonder how it would work though. Would you apply to a school for CaRMS and then get a residency as a PGY-2, or would you still be set in your residency as it is now and just have a common first year (which doesn't help give you more time to decide on a career and seems a little pointless)? Or do you get a fifth year of med school at your home school and then apply for CaRMS? The logistics would be interesting and you could get some strategic applications involved (eg. apply to a weaker program as a PGY-1 so you're a more competitive applicant for that derm spot you want as a PGY-2).

[Guest 007]

I'm all for the 60hr week!!!! When I was little, even before I decided to become a doctor, I wanted to change the med school/resident schedule.

 

007

[Guest UWOMED2005]

Under the old system, residency was the same length: Gen surg was a 4 year residency program following the mandatory 1 year internship. . . or the same 5 year total it is under the PGY system. In some ways, the current PGY system isn't that different from the internship system: in many specialties, PGY-1s spend most of their time off-service learning a basic skill set required of all doctors.

 

The main difference, and main advantage of going back to a 1 year internship is that delays career selection until that internship year. That gives the students more time and experience to decide, and programs the chance to evaluate interns who have actually completed all of their training.

[Guest aneliz]

From what I understand of the previous system, you applied to an internship. At the end of your internship year, you had a general medical lisence....you could then go out and practice as a GP or you could apply to enter a specialty residency program. Many people took time to go work as a GP (earn some $$$, think about your life, etc) and then applied to enter a residency program a few years later. The older docs really liked the people that came back after a few years of general practice to enter a specialty because: they were definitely sure of what they wanted to do and were 'serious' about the specialty and they had more experience dealing with patients, better basic skills, etc.

[Guest bj]

To add another perspective:

 

The "specialty" that would be hit hardest by introducing a common first year is family medicine. Why? Because it would no longer have the aura of professionalism that comes from 2 years of intensive focus on treating families. . .it would be relegated to the residents who want to finish quicky after the common first year. I think that treating families can be damn hard and would hate to see it marginalized into essentially one year of specialization. The field has to struggle hard enough to maintain its status among the other specialities as it is.

 

bj

[Guest strider2004]

Family medicine has only been a specialty for the past ten years. The most important thing for it now is to have a sufficient number of physicians to sustain primary care. The quickest way to do that is to give everyone a common internship year so you can finish and get into the workforce. Let's face it - once you're working, it's hard to go back to train. So...more graduates would keep doing family medicine instead of going back into residency.

 

Aura of professionalism? What does that mean? The 2 years of family medicine residency are almost an exact repeat of clerkship - rotating through different specialties so that you get a good sense of all of them. There is no 'intensive focus' on treating families. It's generalized so that you get a broad view of medicine, not specialized so that you become the expert in treating families.

[Guest UWOMED2005]

I think increasing the respect for family docs by turning it into a specialty was a large part of the basis for going to the current system. Thing is, it didn't really work: most docs still refer to family physicians as GPs, and I'm still constantly asked "are you going to be a GP/FP or are you going to specialize."

 

I'd be a strong proponent though, if we returned to a one year internship, of keeping one extra year of training for family docs. The bunk thing about the old internship system was that docs spent most of their time in the hospital treating arrhythmias and GI bleeds, then would graduate to become a GP check sore throats and ears, doing pap smears, preventative medicine, well baby checkups and the like. . . HAVING SEEN ALMOST NONE OF THIS STUFF IN THE HOSPITAL.

 

Specialists love to insinuate family medicine is easy, but how many of you have actually looked in an ear and CORRECTLY decided whether to give antibiotics or not. It's not easy at all: Whether the drum is red or not is often very subjective, and even with the guidelines is often difficult to decide whether antibiotics are needed. No wonder you see so many docs should hear "earache," pretend to look in the ear, and hand out antibiotics like candy.

 

Personally, I find arrhythmias and GI bleeds much easier to handle - they're usually more straightforward: an SVT is pretty easy to pick up on EKG and the EKG is pretty conclusive, and if you can't identify melena then you must have some pretty outstanding pathology of you first cranial nerve!

[Guest cracked30]

But now family docs have no idea how to treat GI bleeds or arrythmias, so they don't recognize things and kill patients.

 

For all that clinic stuff you have time to look it up in a book and hell, those poeple could use a little home remedies better than see a doc.

 

Family docs, especially ones who work in the ER without extra training, are dangerous, they don't have the experience.

[Guest UWOMED2005]

Yes, unfortunately I have seen family docs working emerg who haven't been up to par. But I've also seen family docs working emerg as competent as any other MD I've seen. It's dangerous to generalize.

 

And I'd be the first to argue that we should be sending our brightest and best trained docs to work emerg in the peripheries, where they can't just triage and pass on to the medicine clerk/resident on call with a chart that reads "Unwell NYD." Often they're managing the patient all weekend, and backup means packaging the patient for up to a 2 hr trip (incl time prepping the transfer.) But then they'd probably have to earn the most pay. Would you like to contribute a portion of your future OHIP billings to pay for that?

 

Considering I don't think you'd like that solution, what's your proposal for something better?