Foreign doctors not passing Canada's certification exams: study Read more: http://ww

[aqm]

Tom Blackwell, National Post · Sunday, Oct. 3, 2010

 

With Canada’s doctor shortage still dire, medical authorities are under constant pressure to let more foreign-trained medical graduates work here as physicians. But two new studies point to a significant roadblock: close to half of those who make it past rigorous screening and into family-medicine post-graduate training fail to pass their certification exams.

 

Researchers say the reasons may lie with the quality — or teaching approach — of overseas medical schools, which sometimes instill a more traditional, doctor-knows-best philosophy.

 

And the performance of those offshore schools is also an issue for the growing number of Canadian-born students who are getting their medical degrees overseas, after failing to be admitted to schools here, researchers say.

 

“I was surprised to see the facts,” said Dr. Anne-Marie MacLellan of the Quebec college of medicine, the province’s physician regulator, and author of a study on Quebec’s situation. “The international medical graduate who really wants to make Canada the place to immigrate, they need to know there can be some difficulties.”

 

Researchers and officials stress that the findings do not suggest Canada should turn its back on foreign-trained MDs who settle here — especially since they save taxpayers the substantial cost of medical school education — but that more needs to be done to help them become full-fledged Canadian physicians.

 

Although the two studies, just published in the journal Canadian Family Physician, are the first to expose the problem widely, the phenomenon has been well-known within the medical community, doctors say.

 

“If you take somebody new to the country and new to the system and throw them into post-graduate training, it’s kind of like throwing them into the deep end of the pool,” said Dr. Paul Rainsberry, education director with the College of Family Physicians of Canada.

 

Nevertheless, the author of one of the studies said a Vancouver team is already starting to pull up international medical graduates’ (IMGs) success rates by helping them better prepare for the exams.

 

Dr. MacLellan suggested that Canada also consider emulating a U.S. decision announced last week: Starting in 2023, the country will accept international graduates only from schools that have been accredited according to globally accepted standards.

 

In Canada, only graduates of medical schools in this country and the United States are considered automatically qualified for a residency — the taxpayer-funded, two years of on-the-job training required to become a family doctor and five years to become a specialist.

 

Others must pass a screening process that typically includes exams and language testing, designed to ensure they have at least the same level of medical knowledge as Canadian graduates.

Dr. MacLellan’s study looked at IMGs and graduates of Canadian schools who made it into residency programs from 2001 to 2008 and their results on the final, certification exams to determine if they can practice. The average pass rate for international graduates was 56%, versus 93.5% for the Canadians.

 

A separate study at Vancouver’s St. Paul’s Hospital, where a special program was set up for IMGs in 2006 to help them perform better, found the internationals did as well as Canadians on assessments during the training, but that their final exam pass rate was a “disappointing” 58%, compared to 97% for the Canadians.

 

It is estimated that 1,500 Canadians are now studying at overseas medical schools, and are considered IMGs when they come back. They often fare poorly in residency exams, too, said Dr. Rod Andrew, who headed the study. “That’s because many of them are going to medical schools that are just not up to par.”

 

The international residents’ problems lie in the oral, clinical part of the tests, where examiners pose as patients, and see how the would-be doctors handle the hypothetical cases presented them. It seems many of their medical schools did not teach them the modern North American medical approach, where doctors are encouraged to get patients to “buy in” to their diagnosis and treatment.

 

“Many international medical graduates … are trained to say, ‘I’m the doctor, this is what you do,’ ” Dr. Andrew said.

 

The good news is that further work on that aspect of the exams helped bring up IMG pass rates in the two years since the end of the study period,to 74% in 2008 and 83% in 2009, he said.

 

 

Read more: http://www.nationalpost.com/news/canada/Foreign+doctors+passing+Canada+certification+exams+study/3617664/story.html#ixzz11RUuYecE

[leviathan]

You mean doctors who struggle with English have trouble communicating to their simulated patients in OSCEs and communicating in oral exams? That's a shocker.

[seeking1]

“Many international medical graduates … are trained to say, ‘I’m the doctor, this is what you do,’ ” Dr. Andrew said.

 

Yeah, I read this article too, and this line really caught my eye. If its true....man, that kind of attitude does not fly here anymore.

[aqm]

-the fact that there are no scientific studies/recommendations/guidelines from CMA/AMA re: carib/east European medical schools shows the highly unorganized, irresponsible attitude from US/CAD medical associations re: advocacy and protection of public health. It also illustrates the desperate need for medical practitioners (and hence the hesitancy to ban FMG/IMG/CArib graduates all together). I have yet to find a single govt organizational website that talks abt the statistics/legal requirements/prospects/pros&cons/residencies of those graduating from the Carib. Something like the MSAR but a comprehensive one including the Carib (an NOT valueMD.com) . The number of ppl going there and the number retuning to practice in CAD/US is significant and growing exponentially. The govts should be more actively involved in regulating/providing guidelines in topics ranging from admission to convocation to exam competencies to specialties. By regulating I mean that they do not ban/close the carib school, but rather work with them to meet the CAD/US standards...this way dreams of becoming a medical practitioner are fulfilled while the US/CAD meet its shortages in a dignified way. I have worked with carib interns/residents and they are gifted qualified ppl (with some bad luck, socioeconomic reasons, poor decision making at a young age).

 

-once in a while the newpapers print a random highly questionable report about the IMG/FMG but NEVER pin-point the source of the issue (prime example is the national post article). If it is the Carib schools - please say that it is: at least prospective students can make an informed (yet equaly risky) decision rather than basing it on word of mouth (I personally know about 12 ppl in the carib who totally brag abt their universities but still have to see one successfully practicing).

 

-if English is the issue: its the most BS excuse I have ever heard. Prominent ppl in prominent positions cant speak a word of English or have such heavy accents you would wonder how they got so far. Plus, those not 'knowing' English usually do work in regions/demographics that they are fluent in - and do an excellent job serving their specific community. I speak 3 languages and am fluent in English - makes me a prime candidate as compared to US born & bred only English speaking kids. Also, my multicultural background helps me relate better to people of many colors/races. Why,then, pick on ppls inability to be an expert in English when despite not being an expert in English had wider advantages & broader implications.

 

-the issue in this article seems to be that non US/CAD schools prepare students according to the traditional 'doctor is right, patient knows nothing philosophy'. I am a current nursing student certainly do agree with the more patient-focused approach. however, I have witnessed a billion times the top-down approach. Not to defend that approach, but to PICk on FMG/IMG's incompetency on that aspect (which i do question...) rather that focus on the dire need for physicians and the millions without family physician, and those waiting up to 6 hrs to see a doctor at a walking/ER, and those dying WAITING to see a doctor............considering these dire states....the govt *may compromise* on a less relevant aspects such as 'mr. patient...........soooooooooooo what do yooouuu thinkkkkkkkkk"?

 

 

anyway....my pre-CRNE rant....gota go back to studies....becoming an RN tomrrow!!!!

 

if any one of you knows of a more reliable guide to carib schools rather than valuemd.com.............plsssss let me know............i have applied to mcmaster but chances are slim and i may end up in the carib....with these random reports i am freaking out...i don't want to be jobless after spending tonnes of time and money and making familial sacrifices..........

 

 

ciao

[aqm]

Yeah, I read this article too, and this line really caught my eye. If its true....man, that kind of attitude does not fly here anymore.

 

Funny thing is that it very much so DOES.....................as a nuring student I have witnessed it in 98% of nurse-doctor or doctor-patient interactions. I am not defending that it is right...what I am saying is that if indeed FMG do behave that way, that reason is not GOOD enough to rate them worse than CAD/US grads - based solely on that.

 

We need health practitioners VERY desperately - if IMG/FMG are skilled and competent at everything besides relating with the public.....they will still make excellent doctors. We need to give them a chance. And if the US/CAD govt does not think that it can (its loss really), then they least they can do is regulate IMG/FMG schools such as the Carib schools to ensure that certain minimum standards re: pleasing the pt are met.

 

Beggers cant be chooser - the US/CAD gota take the IMG/FMG supply and work with it rather than let its public wait upto 6 hrs to see a doctor/die in the ER waiting/have no family physicians etc. Really, would one prefer to go to a NP led clinic than go to a FMG? Seriously?

[future_doc]

becoming an RN tomrrow!!!!

 

Congrats!!

[leviathan]

Good luck with your CRNE exam. I've heard from friends they felt it was tough and thought that they failed, but they still passed in the end.

 

You won't find a reliable guide to schools in the Caribbean, but the decision is simple. California, NY, Texas medical boards have much more stringent requirements about which medical school grads they allow to practice in their states. These states have done site visits and offered accreditation to only 4 Caribbean medical schools, so only those schools should be in your consideration. Even those schools are no longer an option because of the progressively decreasing number of residencies available for international students to match. That's all you really need to know.

[moo]

I don't know if it's the medical school or the person who is to blame.

 

Face it, the vast majority of people who go overseas do it because they couldn't get into a CAD/US school. Most of the time it's because of academics. Some of these folks are actually bright but because of personal circumstances, finance, etc. had low grades and just want to be given a second chance.

 

Others however, had this dream of becoming a doctor but just can't hack it--either intellectually or did not have the stamina/drive to do well in school. They got into the Caribbean or overseas and got through med school somehow but still can't pass the Canadian exams.

 

The third group is the FMG who immigrated here and are lucky enough to get into a residency program, yet still fail because of the English language problem. The CCFP exam has a significant oral component. All Royal College exams do as well.

 

It's hard to imagine that 5 years of a RC residency or 2 years of a CCFP residency are inadequate to prepare you for an exam. After all, where do you learn your specialty? In residency! Med school teaches you the basics of medicine. You really learn in residency.

 

If anything, there are 3 explanations for this:

 

1) The Canadian residency programs are not preparing IMGs well enough for their Canadian exams. This is likely false because C/AMGs who go through Canadian residency programs can still pass with great success.

 

or

 

2) The candidate just isn't up to snuff despite having trained in Canada. This is more likely for Canadians who went abroad for school.

 

or

 

3) You are an FMG who immigrated here and have trouble with the language.

 

Rather than blaming overseas medical schools and saying their standards are not up to ours, let's put the blame where it really should lie--on the individual. I know plenty of competent IMGs from all over the world--Ireland, Aus, Caribs, etc. I also know plenty of C/AMGs who are incompetent and would not let touch me or my family with a ten foot pole. Statistically speaking though, those who go overseas do so because they are academically weaker. So it makes sense that they do poorly on exams when all is said and done.

[aqm]

Totally agree on all points with you.

[cardiomegaly]

moo, you're awesome. Thank you for always giving such an insightful yet realistic perspective. None of this sugar coating "you can do it with the right determination anyone can make it as a doctor" BS. It's so untrue.

 

I don't have much sympathy for any Canadian born who chooses to leave the country and do medical school. Once you leave we have no obligation to make sure you can come back. The standards are high and should be high for a reason. Plus there are a TON of Canadian medical students...with all the expansions the first and second year meds now are totally, utterly screwed for CARMs. They will barely have the residency positions to cover CMG students.

 

Some IMGs are great, some IMGs are less than desirable. I've had patients tell me that they are thankful they get to talk to/get treatment from Canadian trained medical students. One patient complained that his serious chronic disease was misdiagnosed and lead to complications by an IMG who clearly did not have the same quality of training as CMGs. Obviously this isn't the case for everyone...but there's a reason why so many fail the LMCC's part II - partly due to communication and partly due to lack of proper training. One of the doctors I know has sat as an examiner for the Medical Council for many years and he's says the difference between Canadian residents and IMG residents is extremely apparent. At that point you're obligated to fail them too, not like in med school where they give you a pat on the back and let you try again.

 

Edit: that being said, the Canadian born IMGs who make it to fairly competitive residencies successfully probably have a strong work ethic- they have to be the absolute best of the best to actually match.

[leviathan]

I don't have much sympathy for any Canadian born who chooses to leave the country and do medical school. Once you leave we have no obligation to make sure you can come back. The standards are high and should be high for a reason. Plus there are a TON of Canadian medical students...with all the expansions the first and second year meds now are totally, utterly screwed for CARMs. They will barely have the residency positions to cover CMG students.

I agree 100% that you are on your own if you leave the Canadian system, BUT the standards are unrealistically high in Canada. The majority of my classmates have GPAs and MCAT scores that could have gained admission to a US medical school if they were American, but couldn't get into Canadian schools. I don't think anyone would say the American med schools have standards that are too low.

 

One patient complained that his serious chronic disease was misdiagnosed and lead to complications by an IMG who clearly did not have the same quality of training as CMGs.

While I don't disagree with the notion that IMGs from some schools may have inferior training, the above statement is an assumption that it was the medical school that offered inferior training and not the IMG him/herself. It could have just as easily been a Canadian-trained physician who mismanaged the condition and you wouldn't be blaming the school. It COULD have indeed been that the training they received was inferior, but it's unfortunate that this is the automatic assumption anyone makes when they find out where someone did medical school.

 

All that being said, I've heard from some docs who teach residents that IMGs from certain countries are CONSISTENTLY bad and do not function at the level of an MD, which would give more support to the notion of training being inferior.

 

Obviously this isn't the case for everyone...but there's a reason why so many fail the LMCC's part II - partly due to communication and partly due to lack of proper training. One of the doctors I know has sat as an examiner for the Medical Council for many years and he's says the difference between Canadian residents and IMG residents is extremely apparent. At that point you're obligated to fail them too, not like in med school where they give you a pat on the back and let you try again.

While you may get a pat on the back and a second chance at a Canadian medical school, it isn't that way in the Caribbean schools which have attrition rates up to 50%. That said, I'm not sure how it works at the Aus/Irish schools but I've heard they are a bit more forgiving if your pockets are deep.

 

Edit: that being said, the Canadian born IMGs who make it to fairly competitive residencies successfully probably have a strong work ethic- they have to be the absolute best of the best to actually match.

Which is why I find it hard to believe that any Canadian-born IMGs getting into Canadian residencies are failing the LMCCs, but I'd love to see some data (if it exists) on this population of physicians. As a Canadian-born IMG that would worry me a bit, because my current feelings are that I can finally take a big deep sigh of relief once I get into a residency position.

[Fueren]

I think Canadians and Canadian medical students have been brainwashed into thinking that the Canadian system is superior to any other developed countries. Better than many developing countries? Sure. But the restrictions placed on other developed countries with similar or superior systems (ie. Australia, New Zealand, the UK etc) are eventually going to come back and hurt the entire country. The best doctors I know are British and American (I'll leave out Australia because I know many more there), not Canadian.

 

Some IMGs are great, some IMGs are less than desirable. I've had patients tell me that they are thankful they get to talk to/get treatment from Canadian trained medical students. One patient complained that his serious chronic disease was misdiagnosed and lead to complications by an IMG who clearly did not have the same quality of training as CMGs.

 

I've also heard from many Australian patients that it's nice to speak with someone who's an Australian, until I tell them I'm Canadian, and then they tell me that it's actually because they can understand me and they don't want to be racist. Having worked in hospitals in Canada I've seen much the same. It may not be acceptable to us to be racist or xenophobic but dealing with the general public, many are, and they just want someone who doesn't speak English as a second language.

 

I'm sure many IMGs don't have training up to Canadian standards, it's just a shame that those that are trained in similar systems are lumped in with the inferior ones.

[moo]

Like I said above, it's not necessarily the school that is bad. I think you can learn undergraduate medicine anywhere. Residency is where you learn to function as a doctor and where you learn enough to pass your boards (other than the LMCC). It is the individual that is to blame.

 

Where you went to school plays only a small role in how you function as a resident. People who get into good schools tend to be hardworkers to begin with. Hence, they probably tend to study harder for exams and will more easily pass. Canadian IMGs tend to go offshore because they don't work as hard or had poor study habits. Hence, if those habits haven't changed by the time they get back, they still will fail, despite having spent time doing residency in the Canadian system.