Pre-clerkship licensing exam in Canada

[leviathan]

I'm going to guess in advance that this would be a very unpopular idea, but what do you guys think about introducing a scored licensing exam in Canada that occurs before the start of clerkship? Do you feel that you have enough ability right now to differentiate yourself from other applicants when applying for residency, or would this help a lot? The USMLE step 1 is a big deal down south, and makes or breaks candidates.

[ellorie]

I think that NOT having one was great for my mental health during the first two years of medical school. I much prefer the lesser emphasis on numerical grades. If you don't know anything, it will show up in clerkship - and I think that's where you show that you can apply knowledge, and not just memorize. I think that not having that big exam allows for more self-directed learning towards areas of personal benefit, which I also think is good.

[rmorelan]

I'm going to guess in advance that this would be a very unpopular idea, but what do you guys think about introducing a scored licensing exam in Canada that occurs before the start of clerkship? Do you feel that you have enough ability right now to differentiate yourself from other applicants when applying for residency, or would this help a lot? The USMLE step 1 is a big deal down south, and makes or breaks candidates.

 

I am sure the schools with a less formally structured clerkship model (ie the 3 year programs) wouldn't like it that much

 

plus the USMLE is a rather silly test - covering topics that have no actually benefit to clinic medicine. I think our system has some advantages to the rigorous pursuit of testing for almost the sake of testing. That doesn't mean that someone couldn't come up with a better one of course.

 

adding one would the opposite of the philosophy of the pass/fail system - so I guess would add do you think that grades should just be reintroduced?

[thebouque]

It would be useless

[burrb]

plus the USMLE is a rather silly test - covering topics that have no actually benefit to clinic medicine. I think our system has some advantages to the rigorous pursuit of testing for almost the sake of testing. That doesn't mean that someone couldn't come up with a better one of course.

You must mean the Step 1. And while that's mostly true, I think understanding basically biochemistry, microbiology, pharmacology etc. does allow a deeper understanding of clinical medicine. It's not stuff you'd use on a day to day basis but it allows your knowledge of medicine to be more comprehensive.

 

I don't think there's much use to implementing Step 1 aside from encouraging students to study more, but we could do that by reimplementing honour-pass-fail system.

 

Step 2 CK/CS are pretty decent exams though and may add something to one's Carms application.

[NLengr]

You must mean the Step 1. And while that's mostly true, I think understanding basically biochemistry, microbiology, pharmacology etc. does allow a deeper understanding of clinical medicine. It's not stuff you'd use on a day to day basis but it allows your knowledge of medicine to be more comprehensive.

 

I don't think there's much use to implementing Step 1 aside from encouraging students to study more, but we could do that by reimplementing honour-pass-fail system.

 

Step 2 CK/CS are pretty decent exams though and may add something to one's Carms application.

 

Programs by and large will base rank order lists on your elective performance. Plus we have many less programs per specialty. You could do electives in the majority of programs for your specialty. A standardized test in non clinical topics will add very little to how your rank people.

 

Canada is much smaller than the states, with a much more tightly regulated med school/residency system. US policies may not fit well into the Canadian experience.

[rmorelan]

You must mean the Step 1. And while that's mostly true, I think understanding basically biochemistry, microbiology, pharmacology etc. does allow a deeper understanding of clinical medicine. It's not stuff you'd use on a day to day basis but it allows your knowledge of medicine to be more comprehensive.

 

I don't think there's much use to implementing Step 1 aside from encouraging students to study more, but we could do that by reimplementing honour-pass-fail system.

 

c are pretty decent exams though and may add something to one's Carms application.

 

You hear that argument a lot - study these areas and it may enhance your understanding of medicine. The counter argument is that instead of learning the krebs cycle or what not you could actually be learning clinical medicine instead and later if it is relevant to you go back and learn the subtle details (more top down approach). It isn't that learning the stuff is completely useless but the obsession at times in medicine with an entirely bottom up approach to things seems rather limited to me. It think that is why often in Canada that sort of thing is taught in a vastly more limited way.

 

If we were to write another exam like step 2 it probably would replace our end of 4th year exam or simply be the same test moved up (the purpose and content is similar after all). It does seem a bit strange to me to write a standardize test which is basically a review of all things in medical school prior to actually completing medical school though. What is the point of the rest of the year at least on paper

[mavrik13]

I'm going to guess in advance that this would be a very unpopular idea, but what do you guys think about introducing a scored licensing exam in Canada that occurs before the start of clerkship? Do you feel that you have enough ability right now to differentiate yourself from other applicants when applying for residency, or would this help a lot? The USMLE step 1 is a big deal down south, and makes or breaks candidates.

 

I see no purpose to this. I am a big proponent of P/F medical school. Ultimately, you have to ask yourself - is the person who scores 96% on some random written test actually better than the person who scores 86% (whether for a particular unit, or this standardized exam you are proposing)? I don't believe so.

[leviathan]

Haha, looks like the answer I thought I'd get. Well, I wondered if you Canadian med students had trouble separating yourself from the pack when applying for specialties, when everyone on paper has Pass for their grades and the usual comments on their ITER are "good work, strong student".

 

That's the main reason I wonder if it might be a good thing to have something objective that levels the playing field.

 

For what it's worth, there is a strong correlation between USMLE scores and knowledge base + clinical skills, and program directors in the states do place emphasis on it for that reason. It's usually used more as a cutoff to narrow down the applicant pool for a full file review +/- interview invite, and it has less importance when actually ranking applicants. Also, the US application process involves both Step 1 (basic sciences) and Step 2 (clinical knowledge), and I think most people probably put more emphasis on Step 2.

[spontaneouscombustion]

I think that NOT having one was great for my mental health during the first two years of medical school. I much prefer the lesser emphasis on numerical grades. If you don't know anything, it will show up in clerkship - and I think that's where you show that you can apply knowledge, and not just memorize. I think that not having that big exam allows for more self-directed learning towards areas of personal benefit, which I also think is good.

 

Really? If it wasn't for board exams, I think my knowledge was barely tested in clerkship.

 

I don't know about the USLME step 1, but maybe having done the MCC earlier would be useful for CaRMS applications.

[ellorie]

I definitely had preceptors make comments about my knowledge base compared to other medical students. It wasn't formally tested so much, but people definitely notice, in my experience.

[Renin]

I think that the smart students stick out, but an exam to trap the ones in the bottom might be a good idea and signal them out for extra work.

 

I sometimes feel stuck with the med students who are like ... oh ... that's your level? Hummm, what do I do with you now?

[Jochi1543]

I think if anything, we should get rid of LMCC part 1 altogether, rather than add more exams. Part 1 was a waste of money, fail rate is super-low, and you can still go on to residency AND retake. The people who have major academic problems will be identified way before 2nd year even rolls to an end. The people with professionalism issues continue to have these issues throughout med school, residency, and, I would suspect, also independent practice.

[NLengr]

Haha, looks like the answer I thought I'd get. Well, I wondered if you Canadian med students had trouble separating yourself from the pack when applying for specialties, when everyone on paper has Pass for their grades and the usual comments on their ITER are "good work, strong student".

 

That's the main reason I wonder if it might be a good thing to have something objective that levels the playing field.

 

For what it's worth, there is a strong correlation between USMLE scores and knowledge base + clinical skills, and program directors in the states do place emphasis on it for that reason. It's usually used more as a cutoff to narrow down the applicant pool for a full file review +/- interview invite, and it has less importance when actually ranking applicants. Also, the US application process involves both Step 1 (basic sciences) and Step 2 (clinical knowledge), and I think most people probably put more emphasis on Step 2.

 

Again, the US is much larger with many many more programs. They might need an extra screening step. In Canada, things are much smaller. Less than 20 centers. Generally people have rotated through any center they are really interested in. Programs have first hand experience with the candidates. That's what rank order list is base on

 

Besides, an exam only tests one of the big three (and I would argue the least important) that count for matching:

Work Ethic

Fit to Program

Knowledge

 

To top it off, USMlE Part one does a piss poor job of testing knowledge for residency. It's pre clerkship type stuff, not clinical knowledge. On top of that for many specialties, even a step 2/LMCC I exam is too general to be of much use.

 

Programs know applicants are smart. They made it through med school. A test that separates two people who are both capable of learning the residency material hardly seems helpful to make rank order lists.

 

For the record: I have participated in making rank order lists. USmLE Step 1 scores would not have changed anything.

[rmorelan]

I think if anything, we should get rid of LMCC part 1 altogether, rather than add more exams. Part 1 was a waste of money, fail rate is super-low, and you can still go on to residency AND retake. The people who have major academic problems will be identified way before 2nd year even rolls to an end. The people with professionalism issues continue to have these issues throughout med school, residency, and, I would suspect, also independent practice.

 

that test really is a complete waste of time - even the way it is structured just is so silly (various sections with vastly different amounts of knowledge required are just graded to be equally important). It appears to be mostly a revenue generating exercise.

 

Even the following second part is a bit silly - by that point we are all in our various specialties. My ability to do a shoulder or psych exam is probably not really all that important as a radiologist.

[shady]

I'm gonna agree with the other posters here. I don't see a deficiency in the current system that can be solved with an additional exam

[hamham]

I'm going to guess in advance that this would be a very unpopular idea, but what do you guys think about introducing a scored licensing exam in Canada that occurs before the start of clerkship? Do you feel that you have enough ability right now to differentiate yourself from other applicants when applying for residency, or would this help a lot? The USMLE step 1 is a big deal down south, and makes or breaks candidates.

 

Don't mean to be rude, but why ask questions when you already know the answer?

 

Our neighbours down south did not have as much difficulty in getting into med school (acceptance rates in the US are much higher than that in Canada, simply b/c there are more schools there).

 

Plus, there is so much variability in terms of training, and the good schools (harvard, hopkins etc) need some form of exam to select their desired candidates.

 

In Canada, there are fewer med schools, and isn't too much variability in terms of training (I believe you will get the true "Canadian" MD training, regardless of where you go for med). In addition, we want promote camaraderie among future physicians. The whole purpose of the P/F system is to allow med students to work effectively with one another without facing the burden to compete. Introducing such an exam will only serve to conflict what we have strived to achieve thus far.

[leviathan]

Don't mean to be rude, but why ask questions when you already know the answer?

No offense taken. If you think I knew the answer then I don't think you understood my question / I didn't get it across clearly for you. Whether or not people WANT to do an exam / if it's popular is besides the point; it's about necessity.

 

Also despite what you think / what you've been told, there is in fact quite a variety in knowledge levels of Canadian med students. Although I don't necessarily agree with the perception that Canadian med students are akin to ivy med schools, there is definitely variation in ability between Ivy league med students as well, for example. I think that should be self-evident just knowing your peers where some are a lot stronger than others. You're not even in clerkship yet, so it might be less obvious for you at this point.

 

An objective exam does help people stand out. Of course clinical knowledge is actually a less important factor for selecting residents (work ethic, and 'fit' are more important really), but it would still help as a cutoff to cut down the applicant pool to more manageable levels and cut down the amount of luck involved in the whole process when you're going for something competitive.

[leviathan]

Again, the US is much larger with many many more programs. They might need an extra screening step. In Canada, things are much smaller. Less than 20 centers. Generally people have rotated through any center they are really interested in. Programs have first hand experience with the candidates. That's what rank order list is base on

 

Besides, an exam only tests one of the big three (and I would argue the least important) that count for matching:

Work Ethic

Fit to Program

Knowledge

Having a smaller size might actually make more sense for why it's unnecessary. My perception was that there are still huge numbers of applicants for some of the more competitive fields, especially in more recent years where people have been applying a lot more broadly. This is definitely true even for internal medicine, where we've had record numbers of applicants to sift through.

[spontaneouscombustion]

Again, the US is much larger with many many more programs. They might need an extra screening step. In Canada, things are much smaller. Less than 20 centers. Generally people have rotated through any center they are really interested in. Programs have first hand experience with the candidates. That's what rank order list is base on

 

Besides, an exam only tests one of the big three (and I would argue the least important) that count for matching:

Work Ethic

Fit to Program

Knowledge

 

To top it off, USMlE Part one does a piss poor job of testing knowledge for residency. It's pre clerkship type stuff, not clinical knowledge. On top of that for many specialties, even a step 2/LMCC I exam is too general to be of much use.

 

Programs know applicants are smart. They made it through med school. A test that separates two people who are both capable of learning the residency material hardly seems helpful to make rank order lists.

 

For the record: I have participated in making rank order lists. USmLE Step 1 scores would not have changed anything.

 

This may be true for the smaller CaRMs programs that tend to know their applicants quite well, but for the larger programs (which tend to have a scope of knowledge more in line with the LMCC content anyways) I still think a tool like the LMCC can be useful.

[jock2doc]

This is an interesting debate. IMO, there are ways to help yourself stand out during pre-clerkship. Although schedules are quite busy, many students try to engage in some sort of research project in their desired field. I think introducing another standardized exam would shift their energies from projects to the exam, and be a detriment to learning more about their speciality of interest.

[Laika]

I still think a tool like the LMCC can be useful.

 

Have you actually written either LMCC exam? I've never heard anyone describe them with an adjective as complimentary as "useful."

[leviathan]

The LMCC part 1 is definitely a strange exam. As masochistic as it sounds, I did enjoy the USMLEs though. They're tough, but really well written questions that are fair.

[hamham]

No offense taken. If you think I knew the answer then I don't think you understood my question / I didn't get it across clearly for you. Whether or not people WANT to do an exam / if it's popular is besides the point; it's about necessity.

 

My bad if I had misinterpreted your words. I would like to think that the medical community is one that is capable of making mature (though difficult) decisions, and that under most circumstances, a decision is unpopular b/c it is not necessary.

 

Also despite what you think / what you've been told, there is in fact quite a variety in knowledge levels of Canadian med students. Although I don't necessarily agree with the perception that Canadian med students are akin to ivy med schools, there is definitely variation in ability between Ivy league med students as well, for example. I think that should be self-evident just knowing your peers where some are a lot stronger than others. You're not even in clerkship yet, so it might be less obvious for you at this point.

 

I believe that one does not need to be in clerkship in order to know that there is a certain variability among medical students (one can tell based on small group discussions like PBLs/interactions with med students from other schools during preclerkship electives).

 

I'm not saying that there is no variability among canadian med students. But does that variability warrant the establishment of a standardized exam like the USMLE? My personal answer is a vehement no.

 

An objective exam does help people stand out. Of course clinical knowledge is actually a less important factor for selecting residents (work ethic, and 'fit' are more important really), but it would still help as a cutoff to cut down the applicant pool to more manageable levels and cut down the amount of luck involved in the whole process when you're going for something competitive.

 

Though luck is definitely involved (in any process where you have so many awesome applicants competing with one another), I would like to think that if one is good enough or tries hard enough, one will get what he/she wants (call me an optimist if you like, but that's the mentality I have and it has helped me to get to where I'm thus far, and will continue to help me). As others have pointed out, you don't need a standardized exam to weed out weak applicants. You have other ways to do that (research, elective/rotation performance etc).

[thebouque]

There is variability, and fortunately I was one of the best ones