How To Shorten The Pathway Of Becoming A Doctor In Canada

[ralk]

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. 

 

Uncertainty about what career pathway to take and how to get there affects most undergraduate education pathways, not just biology and life sciences programs. It's also a good reason to keep medicine as as second-entry undergrad, not a direct-entry from high school. Undergrads change their minds about career goals all the time and medicine is no exception to that. The people who want to be physicians in high school are frequently not the same people who want to be physicians even a few years later.

 

I agree that the current admissions process can scare people away from good programs like engineering, but the simpler solution would be to change how we evaluate those applying from undergrad. Evaluating high school students will create its own share of poor incentives for prospect applicants, and it's easier to address the known problems of the current system than it is to change up the whole system, introducing new problems.

 

Again, accepting students out of 2nd year would accomplish the same length of undergraduate training seen in other countries, without overhauling the current system or reducing the flexibility of pre-medical undergraduate education.

[NLengr]

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.

 

From most of the talk I have heard about Competency based residency (thank the Lord I'll be long done by the time that rolls out for my specialty) the plan is to have people do the exam in 4th year, and then the last year would be some kind of "supervised practice". So still 5 years in the end. It's just you get the extra kick in the balls of having passed the exam and proven yourself competent, but still get to be stuck in servitude. It'll really suck for non surgical specialties. At least for surgeons it would be a year to realyl focus on honing your surgical skills.

 

The thing is the system isn't going to let a full years worth of free labour go without a fight. To replace a whole cohort of residents with PAs or NP or staff is gonna cost the government a bomb. Hence, I highly doubt they will shorten anything, just rearrange the scheduling.

 

I agree that educational inflation is a huge issue in medicine right now. And it seems to be getting worse, not better.

[A-Stark]

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.

 

I liked undergrad. Compared to med school, to say nothing of residency, it was a chance to learn about stuff I enjoyed. And I had lots of time. It's amazing that people complain about the "intensity" of undergrad, but 15-20 hours of classes per week plus some studying was a pretty sweet lifestyle. 

 

As for calculus, I think the very least we can expect from future physicians is to have an understanding of rates of change, integrals, and functions. These are integral (no pun intended) concepts to any proper conception of human physiology and pharmacology. 

[amichel]

I liked undergrad. Compared to med school, to say nothing of residency, it was a chance to learn about stuff I enjoyed. And I had lots of time. It's amazing that people complain about the "intensity" of undergrad, but 15-20 hours of classes per week plus some studying was a pretty sweet lifestyle. 

 

As for calculus, I think the very least we can expect from future physicians is to have an understanding of rates of change, integrals, and functions. These are integral (no pun intended) concepts to any proper conception of human physiology and pharmacology. 

 

 

I think the mistake we are all (including me!) making is generalizing our own personal experiences to everyone. 

 

For example, you enjoyed undergrad, felt you had lots of free time, and feel it was a valuable experience for you.  I disliked undergrad (well, I didn't hate it, but I didn't love it either - med school is much better!), had no free time (because I felt pressured to work and keep up all the other "premed" activities), and don't really feel like it was necessary for me.

 

For that reason, I like Ralk's suggestion of simply allowing more people to be admitted after 2-3 years.  Then people can move at their own pace. 

 

I do like calculus though.  

[A-Stark]

I think the mistake we are all (including me!) making is generalizing our own personal experiences to everyone. 

 

For example, you enjoyed undergrad, felt you had lots of free time, and feel it was a valuable experience for you.  I disliked undergrad (well, I didn't hate it, but I didn't love it either - med school is much better!), had no free time (because I felt pressured to work and keep up all the other "premed" activities), and don't really feel like it was necessary for me.

 

For that reason, I like Ralk's suggestion of simply allowing more people to be admitted after 2-3 years.  Then people can move at their own pace. 

 

I do like calculus though.  

 

I think too many people go into undergrad with the "premed" mentality and study subjects they think are "necessary" for med school. So you end up with lots of bio majors studying stuff they see as a means to an end. But then I did an arts degree + math, decided on medicine a few months into a masters, finished off any prerequisites, and then got in. 

[oshaku]

I think the mistake we are all (including me!) making is generalizing our own personal experiences to everyone. 

 

For example, you enjoyed undergrad, felt you had lots of free time, and feel it was a valuable experience for you.  I disliked undergrad (well, I didn't hate it, but I didn't love it either - med school is much better!), had no free time (because I felt pressured to work and keep up all the other "premed" activities), and don't really feel like it was necessary for me.

 

For that reason, I like Ralk's suggestion of simply allowing more people to be admitted after 2-3 years.  Then people can move at their own pace. 

 

I do like calculus though.  

 

It's be an interesting survey of how many people liked undergrad as opposed to med.  I have heard of the opinion that med school is wayyyyy easier than undergrad.

 

There can be problems with the entry after 2-3 years too.  accepted after 2 years mean adcom only has one year of UG marks to evaluate.  Many people with great marks from high school end up doing horribly in first year (adjusting to living independently, new city/friends, new pace of schooling etc.).  Just look in the premed forum (with all the premed panicking they got < 3.6 in first year).  The current evaluation scheme, there are many grade forgiveness schemes availble for people who flunked first year, but showed academic excellence in later years.

[oshaku]

I think too many people go into undergrad with the "premed" mentality and study subjects they think are "necessary" for med school. So you end up with lots of bio majors studying stuff they see as a means to an end. But then I did an arts degree + math, decided on medicine a few months into a masters, finished off any prerequisites, and then got in. 

 

this. I don't believe in shortening the pathway because I didn't decide I wanted to do med till years after I graduated from UG.  The amount of personal growth that happened from leaving high school to deciding to apply to med could not have happened without all the life experiences in between.  I did my UG based on what I was crazy about, got involved in matters that were important to me and got in on my first application that wasn't even considered (by me and everyone around me) a serious attempt.

 

That was simply my personal experience, shaping my views about maturity. 

 

I also have the experience of knowing with every fibre of your body that you want to be something/someone for your entire life, only to find when you get to that profession that it wasn't at all what you wanted or what makes you happy.  My concern with early entry is those who enter may not have had enough time to introspect, reflect and to explore different personal interests.

[amichel]

I think too many people go into undergrad with the "premed" mentality and study subjects they think are "necessary" for med school. So you end up with lots of bio majors studying stuff they see as a means to an end. But then I did an arts degree + math, decided on medicine a few months into a masters, finished off any prerequisites, and then got in.

Nah, I wouldn't have changed my undergrad major even if I didn't want med. I just didn't like it. Never felt like I was getting the big picture like I do now.

[LittleDaisy]

Speaking from my personal experience,  med school is not easier than undergrad or cegep 

For my 2 years of cegep, it was fairly easy to have a great r score (or gpa) without doing too much work with science classes.

In medicine, I find it hard even to stay in the average of my classmates with full-time studying.  There are just so much materials and concepts to understand and to grasp. To be above the average of my med classmates, I have to put twice as much effort as I did in cegep. Once again, med students are academically strong gifted individuals! Also, you always need to integrate the physical exams and lab findings with each pathology. Each system is linked and I tend to forget blocks after a few months

Probably it's just me.

 

I still think that if some U2 or U3 applicants are dedicated to medicine and are academically strong, why wait 1 year or 2 years more for their med admissions?? It costs less in terms of tuition and if people are ready to get into medicine at the age of 20-21, I don't see a problem with that. Maturity doesn't come necessarily with ages in my humble opinion. It could be influenced by personal experiences and family upbringing. 

 

It's be an interesting survey of how many people liked undergrad as opposed to med.  I have heard of the opinion that med school is wayyyyy easier than undergrad.

 

There can be problems with the entry after 2-3 years too.  accepted after 2 years mean adcom only has one year of UG marks to evaluate.  Many people with great marks from high school end up doing horribly in first year (adjusting to living independently, new city/friends, new pace of schooling etc.).  Just look in the premed forum (with all the premed panicking they got < 3.6 in first year).  The current evaluation scheme, there are many grade forgiveness schemes availble for people who flunked first year, but showed academic excellence in later years.

[amichel]

It's be an interesting survey of how many people liked undergrad as opposed to med. I have heard of the opinion that med school is wayyyyy easier than undergrad.

 

There can be problems with the entry after 2-3 years too. accepted after 2 years mean adcom only has one year of UG marks to evaluate. Many people with great marks from high school end up doing horribly in first year (adjusting to living independently, new city/friends, new pace of schooling etc.). Just look in the premed forum (with all the premed panicking they got < 3.6 in first year). The current evaluation scheme, there are many grade forgiveness schemes availble for people who flunked first year, but showed academic excellence in later years.

Those grade forgiveness schemes would still exist, no one is suggesting only allowing entry after second year.

[amichel]

this. I don't believe in shortening the pathway because I didn't decide I wanted to do med till years after I graduated from UG. The amount of personal growth that happened from leaving high school to deciding to apply to med could not have happened without all the life experiences in between. I did my UG based on what I was crazy about, got involved in matters that were important to me and got in on my first application that wasn't even considered (by me and everyone around me) a serious attempt.

 

That was simply my personal experience, shaping my views about maturity.

 

I also have the experience of knowing with every fibre of your body that you want to be something/someone for your entire life, only to find when you get to that profession that it wasn't at all what you wanted or what makes you happy. My concern with early entry is those who enter may not have had enough time to introspect, reflect and to explore different personal interests.

I feel like what I said is being misinterpreted a bit. I know you're not directly speaking about me but I indirectly started this line of conversation. I didn't pick my major based on "premed" courses. I love science. Always have always will. I just didn't enjoy studying it at the undergrad level. And I felt strongly about/enjoyed all of my activities. I just probably would have done less, and/or focused more on the ones that were most important to me, had I not been applying to med school.

 

Nobody is suggesting that the non-trad route be eliminated. But some people are as sure as they are ever going to be after a few years of undergrad. And that's okay too.

[_ _]

We also need undergrad (at least 3 years of it) to preserve socioeconomic diversity. We need those kids who grew up on social assistance and took out full loans to get themselves though undergrad, because they will understand how much those people struggle when they seem them 10 years later as patients. 

We need to keep undergrad because those high school kids have no one telling them to finish grade 12, let alone go to university, let alone go to med school.

 

Becoming a doctor can feel like dream as likely as winning the lottery for the kids who grow up very poor, but undergrad gives them a chance to be equal to the kid to went to private school and comes from a family of doctors who support their dream.

And it's not just kids who grew up on social assistance: undergrad 'levels the playing field' so to speak for everyone

[amichel]

We also need undergrad (at least 3 years of it) to preserve socioeconomic diversity. We need those kids who grew up on social assistance and took out full loans to get themselves though undergrad, because they will understand how much those people struggle when they seem them 10 years later as patients.

We need to keep undergrad because those high school kids have no one telling them to finish grade 12, let alone go to university, let alone go to med school.

 

Becoming a doctor can feel like dream as likely as winning the lottery for the kids who grow up very poor, but undergrad gives them a chance to be equal to the kid to went to private school and comes from a family of doctors who support their dream.

And it's not just kids who grew up on social assistance: undergrad 'levels the playing field' so to speak for everyone

Once again, why can't we have both? People getting in earlier and people getting in later.

[Tacrolimus]

I really don't think the pathway needs to be shortened at all. Like others have mentioned, your grow as a person in the time spent in university before medical school. We can debate forever as to whether it is necessary or not, and clearly, there are some strong opinions on both sides, haha. I do agree with amichel on not enjoying sciences. I think the way U of A does it is perfect. Have ~25 spots for 2nd/3rd year students, and leave the rest ~135 for Bachelors/Masters/PhD students. 

[Edict]

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.

 

 

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. 

 

Well direct entry would solve the problem somewhat by rejecting them from medicine in the first place. Those who don't know what they want and go into life sci wouldn't make good doctors and probably wouldn't get into medicine in the first place. The idea is that people can move onto a different field earlier rather than force them into a 4 year degree in order to find out whether or not they could make it into medicine or not. In the UK, medicine is something you try once, twice and rarely three times before moving on, most people find out if they have a future in medicine by the age of 20 or earlier. In Canada, you don't really find out until 22 or later (sometimes earlier if your GPA isn't good enough or you change your mind).  

 

 

One thing about Canadian high school is that without standardized tests you just can't objectively evaluate high school candidates. The way high school grading in Canada works right now you can't actually determine a 97 at one school is the same as a 97 at another. So I wouldn't mind entry from 3rd year or from 2nd year. Or those med guarantee programs whereby you go into undergrad and as long as you maintain a specific average you can enter medical school after 2nd year. Basically, i'm in favour of the QuARMS approach and seeing how it goes and possibly expanding it to other schools in the future. At the very least if we keep this sort of 2+4 approach limited, we are still getting only the most dedicated and mature high schoolers. Besides, if you implement a minimum GPA threshold in the first 2 years of UG, you can also weed out anyone who doesn't really put enough effort in undergrad as well. 

 

I think what we are looking at is a hybrid approach that favours grad entry. So really only maybe 10-15% of all seats from high school or early UG. There is a slope, sure we can all agree that the average high schooler is more immature than the average university student, but we all know a few people in high school who were just more ready and capable. Some people just take longer to grow up and others shorter. 

[commanderadama]

Well direct entry would solve the problem somewhat by rejecting them from medicine in the first place. Those who don't know what they want and go into life sci wouldn't make good doctors and probably wouldn't get into medicine in the first place. The idea is that people can move onto a different field earlier rather than force them into a 4 year degree in order to find out whether or not they could make it into medicine or not. In the UK, medicine is something you try once, twice and rarely three times before moving on, most people find out if they have a future in medicine by the age of 20 or earlier. In Canada, you don't really find out until 22 or later (sometimes earlier if your GPA isn't good enough or you change your mind).  

 

 

One thing about Canadian high school is that without standardized tests you just can't objectively evaluate high school candidates. The way high school grading in Canada works right now you can't actually determine a 97 at one school is the same as a 97 at another. So I wouldn't mind entry from 3rd year or from 2nd year. Or those med guarantee programs whereby you go into undergrad and as long as you maintain a specific average you can enter medical school after 2nd year. Basically, i'm in favour of the QuARMS approach and seeing how it goes and possibly expanding it to other schools in the future. At the very least if we keep this sort of 2+4 approach limited, we are still getting only the most dedicated and mature high schoolers. Besides, if you implement a minimum GPA threshold in the first 2 years of UG, you can also weed out anyone who doesn't really put enough effort in undergrad as well. 

 

I think what we are looking at is a hybrid approach that favours grad entry. So really only maybe 10-15% of all seats from high school or early UG. There is a slope, sure we can all agree that the average high schooler is more immature than the average university student, but we all know a few people in high school who were just more ready and capable. Some people just take longer to grow up and others shorter. 

 

The GPA you need to maintain for QuARMS is a 3.5, which is pretty low. I'm sure that the students selected from QuARMS are of high calibre so they probably had something beyond the high averages a lot of people have going into undergrad, but I wonder if 3.5 is high enough to properly prepare them for the med school workload. However, the threshold might be on the low side to ensure that a rough transition from high school doesn't kick them out of the program (my first year was pretty low and took 2 years of damage control to be barely competitive for Ontario)... hard to say but I guess we'll see! For the sake of my future peers I hope this program works out well 

[older]

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. 

 

True.  It's been proven over and over again that one does not need undergrad degree to become a qualified doctor. But it is also true that whilst some people are mature at the age of 18, others are not. The beauty of the European systems is that you could do it either way - 5-6 year program after high school or 4 years GEP program for people with 3-yr degree.

 

In Canada, it is too  long. Add to it masters, 2nd degree, 2-3 times applications, and it is getting even more absurd.

If  we are thinking about cutting something, it should be undergrad. For people who don't know what they want to do when finishing high school, and for those who value undergrad for any reasons, there should be a path open for graduate entry. We are not all cut ffrom the same cloth, but we are hooked on one-size-fits-all solutions.  Lack of flexibility in our system really doesn't help the matters.  Quebec does much better job by allowing two streams, and some other schools are trying (Queen's med after 2 years), but the whole system is just too rigid and outdated. It's good that more and more people voice their concenns.