Is the Canadian medical education system broken on both ends?

Betel Yibrehu is a medical student in the Class of 2020 at The George Washington University School of Medicine and Health Sciences in Washington, DC. She is interested in medical education, diversity in medicine, and global surgery.

 

Canadian medical students at home and abroad reflect on the record numbers of unmatched applicants in the Canadian Resident Matching Service.

For many, acceptance into medical school marks the culmination of years of hard work and the start of a secure path towards a career in a rigorous yet rewarding field. In reality, acceptance into and completion of medical school means nothing without securing a residency position. And unfortunately, obtaining a residency spot in Canada has become an increasingly difficult endeavour.

To begin, acceptance into a Canadian medical school is a uniquely challenging process. For a single spot there are five applicants, and this ratio is becoming increasing unbalanced. Admissions are no longer a question of qualifications, but one of availability.

For reasons including ease of acceptance and job opportunities, many Canadians choose to study medicine abroad. Approximately 700 Canadians opt for this route, a number representing around 30% of the yearly Canadian medical graduates. This excludes those training in the United States, suggesting an even larger number outside of Canada.

For those who choose to stay, the challenges of the medical education system persist. The tightening ratio between the number of fourth year medical students and available residency positions, when compounded with the mismatch between available positions in sought-after specialties and interested candidates, results in a growing number of Canadian medical students without a residency.

A 2018 report by the Association of Faculties of Medicine of Canada estimates that without intervention, 330 medical graduates may be without a residency position by 2021. These students are forced to reapply at the end of four arduous years of medical training, exacerbating an already-strained system through no fault of their own.

The ongoing discussion about the state of medical school acceptance and residency matching rates is often missing the voices of current Canadian medical students. Here’s what students from medical schools in Canada, the United States and the Caribbean had to say:

Mei Wen, third year at the University of Toronto Faculty of Medicine

Mei cites the quality of institutions in Canada, the ability to practice in a universal health care system, and the social supports as some of the many reasons to pursue medical school in Canada. Interestingly, she notes that “as gaining entrance into medical school becomes more and more competitive, the type A personalities that enter medicine also are, by self-selection, more competitive”. Furthermore, “in institutions where specialists are highly regarded” relative to primary care providers, “students feel pressured to also aspire for the most competitive specialties.” She notes that there must be honest reflection as to “what kind of physicians are needed by the Canadian population and what kind of physicians we are valuing in our culture in medicine.”

Anonymous, first year at St. George’s University School of Medicine

For this student, the decision to attend a Caribbean medical school was a challenging one. After two unsuccessful application attempts they were faced with the same dilemma many students are. “At the time, I was contemplating going abroad or doing a MSc... I realized doing a Masters for two years, knowing it’s not what I want to be doing would be unfair to myself, and I’d potentially be taking away a spot from someone else”. Generally, Caribbean schools are geared towards matching students in the United States, where there are more positions available than in Canada. Despite acknowledging a “misalignment between the number of residences, the number of medical students graduating each year, and where students want to do their residencies,” this student shares, “I’ll be taking all the steps necessary to apply for residency in Canada.”

Christina Pugliese, second year at The George Washington University School of Medicine and Health Sciences

Christina, approaching her third year, reflects on the challenges of applying to highly competitive Canadian medical schools. “Although staying in Canada for medical school would have been my preferred choice, I chose to apply to American schools to increase my chances of acceptance.” Christina plans on completing residency in Canada since she is “a strong proponent of universal healthcare” and notes that recent match statistics are “concerning and understandably anxiety-provoking for students... leaving students with the difficult choice of either graduating and beginning to pay back student loans or continuing to take electives while paying an additional year’s worth of tuition.” Christina urges the provincial governments and medical schools to continue working to incentivize pursuing specialties that are in societal demand.

Final thoughts

Canada is not short on talented, hardworking students who would make excellent physicians. Truly improving Canadian medical education will require analysis of each step of this process, in addition to continued collaboration with students, trainees, faculty, and other stakeholders in the system.

 


Note: Both Mei Wen and Christina Pugliese gave consent for their stories to be told.

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