How To Shorten The Pathway Of Becoming A Doctor In Canada

[LittleDaisy]

When you said that some people in the med-p program who complain about lack of maturity in their peers. I think that it is a minority of med-p or premed in the Quebec system. We could find a lack of maturity in all ages, having a bachelor degree does not mean automatically that one's more mature. It has to do with personal traits and family upbringing as well. 

 

If it is possible, the rest of English Canada could have more spots for 3rd UG. I heard that it is very competitive to get in after 3 years of undergrad, the chance is very slim compared to an applicant who has completed a 4 year bachelor degree. Would that have made a real difference in terms of one's maturity or quality to become a physician? 

Quebec is a system where there is direct and grad entry. It seems to work out okay for them but I know some people in the med-P program who complain about lack of maturity in their peers. Obviously, there are some applicants who are mature enough even from high school but it's not the majority. However, there is a chance that over the course of training, they will mature by the time they have any real responsibility.

When I was younger I wished training was shorter but I'm glad I took 4 years to do a bachelor and have 4 years for med. I think the system is okay the way it is because there's multiple ways to shave off a year here and there, making shorter training the norm might make people feel pressured to start earlier. This was just me, so I can't speak for others, but coming from a competitive high school and high pressure family, I was wondering if I should have applied to the UK like some of my classmates because at the time, I wanted to be a doctor as early as possible. Even in undergrad I regretted not being prepared to apply as a 3rd year and give it a shot. 

 

Just curious, OP, if you had the power to change the length of schooling, where would you make the cut? 

[_ _]

I have rephrased the question to broaden the scope of this discussion.

 

I think the pathway really needs to be shorter ....... at least for the sake of doctors if not for patients.

 

And if the pathway needs to be shorter, med school & residency years need to remain untouched or else we risk the quality of patient care going down.

 

Therefore, the cut should be made to undergrad.

 

Personally, I don't see how learning calculus will be of any use to a future doctor .......... and as far as I know only USA and Canada have this system in place ........ in everywhere else people go straight into med school without having to do undergrad.

 

And we could have the internship year back to give time to med students to breathe and really explore what they like in medicine.

 

The only real problem here is how are med schools going to evaluate applicants who apply straight from high school ............ probably they will all look the same ......... but med schools all over the world are doing it so I imagine it can't be impossible.

Do you realize the difference between UK and Canada/US high schools though? We learn nothing by comparision. The UK high school system is probably more equivalent to 2 years of CEGEP if anything

[LittleDaisy]

In Quebec cegeps, it is basically 2 years of concentration degree in health sciences. We take calculus, integral, vectors and matrices; university physic courses (mechanics, electricity, light and waves), and chemistry classes (solutions, organic chemistry I and II), cell biology and animal & plants biology; and also optional classes outside of health sciences. I don't think that it is close to UK high schools. 

Do you realize the difference between UK and Canada/US high schools though? We learn nothing by comparision. The UK high school system is probably more equivalent to 2 years of CEGEP if anything

[_ _]

I just want to  mention that in Québec, around 50% of med spots are reserved for cegep students (grade 11+ 2 years of health science concentration). I don't think that it makes you less competitive for med school in Québec, since there are quotas dedicated to cegep students. I don't think that cegep students are filling the bare minimum (IMO). We do have 1 additional year of premed at UdM and at McGill. At Laval, a lot of cegep students do their preclerkship in 3 years.. 

For people coming from less privileged families, doing a 4 year undergrad and writing MCAT could be a huge sacrifice to their family and socio-economic status. Having a shorter path of med school would allow some exceptional candidates to get in med school earlier. In my personal case, I am very happy that I could get into med school after cegep. Simply because my family circumstances won't allow me to do a 4 year undergrad and hoping to get into med school after a science undergrad. Probably cegep students and 3rd UG are less mature and have less life experiences, but after 5 years of med school, we acquire the same competencies as all other Canadian counterparts. 

I just think that opening more spots of 3rd UG in English Canada could allow some great, academically gifted candidates to save one year of undergrad, hence one year less of student loans lol

Probably you meant something else, Oshaku. I am sorry if I misinterpret your message.

On the other side, for people who are financially challenged, getting in after 3 years can pose some (unexpected) problems

 

For people like myself who are paying their own way, I literally had no way to salvage the extra cash in 3 years to apply, after working only 40 hrs/wk while I studied (and paid) for the MCAT the summer before 3rd year.

I worked 2 jobs this summer (pre-4th year) to come up with the extra 1000$ ish  needed for applications and travel (I'm still unsure about travel :S )

Although it would be a HUGE financial relief to get in after 3 years, it can be tough for other reasons

 

Either way, seems like there's no easy solution! I think the CEGEP model is great though, especially because it lowers costs so much before med school. I feel like more provinces need to adopt that

[sleeping_sickness]

the CEGEP model does lower costs but you can't forget that university tuition, both for undergrad and med school, is dirt cheap in QC (for IP students). I worked through undergrad and while I was a starving student, I was able to pay my rent/tuition without too much trouble. I was even able to save up a bit and only ended up dipping into my line of credit toward the end of med2. QC is a unique place in that respect. 

[SEAL]

Do you realize the difference between UK and Canada/US high schools though? We learn nothing by comparision. The UK high school system is probably more equivalent to 2 years of CEGEP if anything

That's true .......... it is written explicitly on the websites of some science schools (at least U of A) that GCSE Biology/ Chem/ Physics is equivalent to 1st year university introductory courses.

 

Hell, I know some people at SGU who went straight into medicine without having to do science or even the MCAT just because they were UK grads in high school.

[SEAL]

Quebec is a system where there is direct and grad entry. It seems to work out okay for them but I know some people in the med-P program who complain about lack of maturity in their peers. Obviously, there are some applicants who are mature enough even from high school but it's not the majority. However, there is a chance that over the course of training, they will mature by the time they have any real responsibility.

When I was younger I wished training was shorter but I'm glad I took 4 years to do a bachelor and have 4 years for med. I think the system is okay the way it is because there's multiple ways to shave off a year here and there, making shorter training the norm might make people feel pressured to start earlier. This was just me, so I can't speak for others, but coming from a competitive high school and high pressure family, I was wondering if I should have applied to the UK like some of my classmates because at the time, I wanted to be a doctor as early as possible. Even in undergrad I regretted not being prepared to apply as a 3rd year and give it a shot. 

 

Just curious, OP, if you had the power to change the length of schooling, where would you make the cut? 

I think the cut should be made to undergrad .......... med schools should drop the undergrad degree requirement and allow competitive applicants to apply directly from high school.

 

If it still becomes the norm to get into med school after finishing undergrad then so be it but it shouldn't be a requirement.

 

I am not a big fan of the maturity theory. Maturity is variable and doesn't necessarily increase with age.

 

What about high school grads who go join the army ? Should they be considered too immature to be protecting a whole country ?

 

Some people are just ready.

[SEAL]

The youngest doctor in the world is actually a palestenian named Igbal El Assad ........ she became a resident in the US at only 20 years old !

 

A resident ........ in the US ......... at 20 years old !!!

 

Look her up !!!

 

If you are smart enough to diagnose and treat a patient ..... then go ahead ....... what's the big deal ?

[oshaku]

When I was in undergrad, I was in such a rush to do everything.  I took 2nd-3rd year courses in first year, grad level course by 3rd year and crammed 150 credits in 4 years because I couldn't wait to do the things I wanted to do.  At the end of UG, I realized that 4 years passed surprisingly quickly.  In my pursuit of my goal, I had somehow made myself seem a lot more competent that I was and when I got to THE place, that place that I'd been dreaming of since I was 10 years old, or maybe as young as 6, I felt completely lost. Instead of feeling happy, I fell in to the deepest depression of my life.  It took 3 years pick up the pieces and find myself.

 

Many people graduate from university having no idea what they want to do.  Of the people in my high school class who wanted to go to med, half of them changed their mind in UG.  How many people get in to med only to realize they didn't want to be there at all? (That's a hard statistic to find because if you've made it in to med school.. how many would dare to say that they no longer wanted to be in med? That spot could've gone to someone else who wanted it more.) Studies estimate that between 20-50% of people enter University with an undecided major and up to 75% will change their major at least once prior to graduation.  Med schools can't afford to spend so much money to train students, only to have 75% of them change their minds.  

 

I guess when I said maturity, I was thinking along the lines of people getting a good enough feel of who they are, what they care about and what they want to do for the rest of their life.  I'm not saying no 17-18 year old is capable of that, but the majority aren't.  Even people who think they're sure... aren't completely.

 

 

The youngest doctor in the world is actually a palestenian named Igbal El Assad ........ she became a resident in the US at only 20 years old !

 

A resident ........ in the US ......... at 20 years old !!!

 

Look her up !!!

 

If you are smart enough to diagnose and treat a patient ..... then go ahead ....... what's the big deal ?

 

I'm glad Ms. El Assad became a resident at age 20.  We can always point to exceptional people and say "see, she/he did it", but that doesn't apply to the majority.  Hell, Bill gates dropped out of university and became one of the richest man in the world. Let's all drop out of university. Anyway, it goes without saying that smartness isn't what makes a good physician (or at least it doesn't correlate with patient satisfaction). 

 

I also in no way mean to say that everyone who entered med in cegep/3rd year are immature.  Obviously, the adcom choose you, so there must some quality that makes you fit to be a physician. 

I remember people talked about being a doctor in terms of 4 years UG, 4 years med school, and another 3-5 years of residency, that's more than 10 years!  Once you're in the process though, you realize how each of those years are important in shaping who you are (as a professional and as a person). It takes 10 years (and 10 000 hours) to become an expert at anything (or so they say).  If you want to be responsible for people's lives, why would you want to be anything less than an expert? (Unless you are an exceptional/genius type of person.. rules work differently for those.)

[567765]

Of course there shouldn't be direct entry from high school. There has to be limited access to the career (med/dent) and 4 year bachelor program is one way of doing that. If people were to get in straight from high school, then the excellent job stability and high pay med/dent associated with will be gone. Take engineering as an example, you get in from high school, but is the job stability and pay comparable to med/dent?

[amichel]

Of course there shouldn't be direct entry from high school. There has to be limited access to the career (med/dent) and 4 year bachelor program is one way of doing that. If people were to get in straight from high school, then the excellent job stability and high pay med/dent associated with will be gone. Take engineering as an example, you get in from high school, but is the job stability and pay comparable to med/dent?

I think your logic is a bit off here. You can still restrict entry, even if we were to have a 6 year direct entry program like Britain. Doesn't change anything really.

[567765]

You could sit and complain all day, it doesn't really change anything. Maybe someone on admission committee may see your post, but I highly doubt that

[amichel]

You could sit and complain all day, it doesn't really change anything. Maybe someone on admission committee may see your post, but I highly doubt that

What? I'm not complaining at all, I'm not even sure I think we should shorten any stage of training. I'm just trying to point out that it would be possible.

[Edict]

I think the undergrad stage could definitely be shortened. The UK doesn't have problems producing doctors and people talk about their 4 year undergrads as times when they matured, but the truth is you can still mature during medical school. 

 

Not too many people end up dropping out of medicine in the UK, more so than in Canada but its not significant and nowhere near the dropout rate of most undergrads in Canada. People are mature enough to make decisions at 17 or 18 and much more so at 19 or 20. 

 

By shortening any part of the process you will lose something. I don't really think its absolutely necessary to shorten the process, but if the process had to be shortened it should be shortened at UG. 

 

Programs like QuARMS if successful should be introduced at other schools, not in major amounts but i'm pretty confident that if you have 50 or so seats in Canada for this type of program you can fill them up with exceptional candidates and hopefully have doctors who can be productive for a few more years of their career. Especially with research, often the most productive time for most researchers is between 25-45, most researchers make their biggest accomplishments during that time. 

[commanderadama]

When you said that some people in the med-p program who complain about lack of maturity in their peers. I think that it is a minority of med-p or premed in the Quebec system. We could find a lack of maturity in all ages, having a bachelor degree does not mean automatically that one's more mature. It has to do with personal traits and family upbringing as well. 

 

If it is possible, the rest of English Canada could have more spots for 3rd UG. I heard that it is very competitive to get in after 3 years of undergrad, the chance is very slim compared to an applicant who has completed a 4 year bachelor degree. Would that have made a real difference in terms of one's maturity or quality to become a physician? 

 

You probably know more about the Quebec system than I do, so I'm sure it is just a minority of med-ps but I still thought it was worth mentioning. Maturity isn't necessarily dependent on age, as life experiences and upbringing do have an effect. However, I think that undergrad helps a lot of people mature because for many of them, its the first time they're independent from their parents (e.g. having a budget, dealing with debt and repayment, balancing school and chores). It's true that many going to med school usually come from wealthier families so they may not deal with all of the above issues or they life at home during undergrad, etc but it's still much different than being in high school. There isn't really a set number of spots for 3rd or 4th year UG AFAIK, though I can't say whether they're evaluated differently pre or post interview, I think it's just easier to get in as a 4th year because more grade forgiveness and longer time to do ECs. But no, I doubt a year makes a huge difference in physician quality but it may make a different in how well they interview or how strong their application is. At the end of the day, the adcoms only have so much information to go by when it comes to making a decision. I think it'd be harder for high schoolers to get the same clinical/shadowing experience that one can get in undergrad, so they may not know if they really like medicine or not. 

[NLengr]

What about high school grads who go join the army ? Should they be considered too immature to be protecting a whole country ?

 

Some people are just ready.

You actually need an undergrad degree to be an officer, which would be much closer to the role of a physician than the role a recent high school grad would have.

[Bambi]

In Quebec, where students are selected to study medicine both after receiving their undergrad and after 2 years of Cegep (college), there is no difference between the medical graduates and all go on to be excellent, competent physicians.  

[JohnGrisham]

That's true .......... it is written explicitly on the websites of some science schools (at least U of A) that GCSE Biology/ Chem/ Physics is equivalent to 1st year university introductory courses.

 

Hell, I know some people at SGU who went straight into medicine without having to do science or even the MCAT just because they were UK grads in high school.

I'm going to disagree a bit, my friend who's a EM attending in the US, openly admits that the 6 year med degree in the UK he did is significantly easier than 4 yr med in the US, and that matters more than if UK high school is slightly harder. Either way though you learn more during training anyways than HS, UG etc. it's all relative.

[SEAL]

I'm going to disagree a bit, my friend who's a EM attending in the US, openly admits that the 6 year med degree in the UK he did is significantly easier than 4 yr med in the US, and that matters more than if UK high school is slightly harder. Either way though you learn more during training anyways than HS, UG etc. it's all relative.

I don't get it ........... your friend repeated med school twice ? 

 

One in the UK & and one in the US ?

[ralk]

Our absolute requirements for length of medical training aren't actually much longer than other those of other countries. A person can be done medical school in Canada as early as they are in direct-from-high school programs in other countries. It's true that this isn't typical, but it's possible.

 

As other posters have pointed out, there are benefits to having a longer pre-medical education, including students who are more mature, who have gained unique knowledge and skills, and students who have had time to investigate other career opportunities. That last point is, I think, the main reason to keep medicine as a second-entry undergraduate program - there are lots of high school students who want to be physicians but who may not have the slightest idea as to what that means. In other countries, being a physician is much closer to a middle-class career than it is in Canada (lower working hours, lower pay, less competition for entry), so it makes sense to have medical education be more like those for other careers. We're not well set up to admit students straight from high school either, both on the high school side and on the medical side, so it's a bit of a moot point. QuARMs will probably do fine by skimming the absolute best high school students in a small sample, but it's questionable how well it would scale up.

 

We could allow people to enter medical school earlier. Most schools accept students after third year and we could certainly accept them after second year without difficulty. A few schools insist on or prefer more than three years of undergrad (Western, U of T), so removing or relaxing those requirements could shorten average training times. Most people would probably still get a full degree, but exceptional candidates could speed things up a bit. As long as everyone is competing on an even playing field, there shouldn't be too much potential for quality or maturity issues.

 

We could reduce medical school training to 3 years. We know this, because two schools already do this. In all honesty, pre-clerkship at four year schools seems to have enough inefficiencies or minimally useful subject matter that we could cut out a year of the curriculum without losing too much of major significance. I agree that the reduced time makes it difficult to explore careers, but 4 year schools aren't great on that front anyway - in both timelines, most people seem to pick their specialty in clerkship (support for career planning could be much, much better). In addition, most of the disadvantages to going to a 3 year school, which are fairly minor, are only disadvantages relative to 4 year schools. If everyone went to 3 year schools, those disadvantages would be significantly reduced.

 

Residency is a bit trickier. Ability is directly related to experience, especially at the early stages of practice - there is a large body of literature to support that. However, the pilot competency-based residency program demonstrated the possibility of cutting a year out of a 5-year program for some (though not all) residents. By the sounds of it, a lot of the gains were obtained by employing some established teaching techniques such as simulation, scaffolding, and regular feedback, simple things that many programs could make better use of. The research on this is still in the early stages, but with all residency programs slated to move towards the competency-based model, it remains a possibility for reducing training times.

 

The more immediate problem is the increasing requirement to do fellowships (or in some extreme cases, PhDs) for jobs that make minimal use of the expertise gained in those fellowships. It's a clear example of educational inflation with minimal gains for patients or physicians, but one which is much more challenging to address.

 

In any case, there are multiple ways in which we could speed up the training process in medicine if we wanted to.

[SEAL]

Anyways ........ I am having a hard time believing that an Oxford grad is somehow less qualified than a Toronto grad.

 

If anything, their system is better ...... students spend 6 years studying medicine + 1 year internship ...... here everything is crammed into 4 years and you have to decide which specialty you are going to practice in a much shorter time and limited exposure ......... because you wasted 4 years of your life that could have been better spent in actual medical school.

 

TBH, I really don't see the point of undergrad if a person really knows he wants to be a doctor. 

 

Thus, I think it should be dropped as a requirement ....... it should be optional.

 

I bet if the rules changed you would see people gunning for medical school from high school or even before that .... knowing that if they worked hard enough to prove to the adcom that they are fit and ready ...... they would be saving 4 years of their lives ...... and nobody would be working hard for something they are not 100% sure about.

 

And I also think we need the internship year back ...... more practice ........more exposure ..... more time.

 

At the end of the day .......... it is not about actually shortening the number of years required to become a doctor ........ it's about making time for what is important (med school) and cutting time from what is not (undergrad) ......... just to make the system more efficient.

 

The CEGEP system is a good model ....... QuRMS is also good.

 

I think more provinces need to adopt similar pathways in order to allow exceptional candidates to follow an accelerated route to med school ........ the ultimate goal.

 

Some people can achieve at age 20 what others achieve at age 30 ........ everyones has their own pace ........ and the system needs to be changed to embrace those differences.  

 

Just my opinion.

[Bambi]

^ Agreed. Not only would this be more efficient for the individual students (time wise) and government (saving financial resources and having doctors on stream faster), but society, the patient population would benefit.

 

This would require a change of mindset on many levels and would be a good thing.

[Edict]

Yeah I have to agree that for those who find their passion for medicine in undergrad, it helps, but for all those people who do a life sci degree only to not make it into professional school it often means they end up doing a degree they never wanted to do in the first place over an alternative they would have preferred or would have made them more employable. 

 

Plenty of life scis might have preferred a degree in engineering or business but because GPA's are harder in those majors they chose life sci. If they don't get into medical school which lets be honest with ourselves is a lot of them that is wasted talent. People who would have been amazing engineers are now left 4 years later with a degree that doesn't let them get a good engineering job. 

 

Too often do I hear people going into life sci because they don't know what they want to do or want professional school but have no concrete plan to make it through that competition. Only in Canada do you see the numbers entering life sci over 1000 at most schools each year. In the UK, the equivalent which is biology, biochem etc often have maybe 50-200 students entering each year. 

 

No one is saying removing the graduate entry medicine completely, but more direct from high school entry seems to make more sense in my opinion.  

 

In the UK medical school is less intensive as they spread out the information over 6 years rather than 3 or 4. That in my opinion reduces the burden and the stress levels on students. 6 years of medium intensive study in my opinion beats 4 years of intensive UG study just to achieve GPA and 4 years of intensive medical school. 

 

Also, we shouldn't fool ourselves into thinking people in life sci really love life sci as a career. The profs will tell you first hand this as well, most life scis want medicine or dentistry or some professional school. A minority actually are interested in basic science research, life sci profs might be able to have more dedicated and interested students if fewer people studied life sciences as a means to medical school and more studied it because of actual interest. 

[SEAL]

And let the adcom decide if you are mature enough or not 

[oshaku]

Too often do I hear people going into life sci because they don't know what they want to do or want professional school but have no concrete plan to make it through that competition. Only in Canada do you see the numbers entering life sci over 1000 at most schools each year. In the UK, the equivalent which is biology, biochem etc often have maybe 50-200 students entering each year. 

 

How would direct entry help address this problem?  Move the people in life sci who've no idea what they want to do or no concrete plans to achieve that they think they want to med school, I doubt they'd make good doctors.

 

And let the adcom decide if you are mature enough or not 

 

They sort of have by not accepting as many 3rd year UG applicants (in the school that accept 3rd year UG) compared to other applicant pools.