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Selecting IMGs for residency programs: Myths and shibboleths
Ms. Sandra Banner, Executive Director/CEO, CaRMS
Dr. Ian Bowmer, Executive Director, Medical Council of Canada
October 24, 2014
Je n’ai aucune affiliation (financière ou autre) avec une entreprise pharmaceutique, un fabricant d’appareils médicaux ou un cabinet de communication.
I do not have an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization.
Ms. Sandra Banner, Executive Director/CEO, CaRMS
Dr. Ian Bowmer, Executive Director, Medical Council of Canada
October 24, 2014
11/7/2014
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The International Conference on Residency Education | La conférence internationale sur la formation des résidents
Definition of an IMG
• An international medical graduate (IMG) is a student who has graduated, or will graduate, from a medical school that is not accredited by the CACMS/LCME. This term does not refer to citizenship or place of birth and is only an educational reference.
• Graduates of osteopathy schools in the US are considered IMGs.
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
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The International Conference on Residency Education | La conférence internationale sur la formation des résidents
Canadian graduates and available quota for R-1, 2002-2014
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Specialty positions Family Medicine positions # current year graduates
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The International Conference on Residency Education | La conférence internationale sur la formation des résidents
IMGs in the match 2008-2014
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
Year # of active applicants # who submitted a rank order list
# matched
2014 2,888 2,318 449
2013 2,962 2,329 499
2012 2,330 1,818 407
2011 2,232 1,920 380
2010 1,784 1,368 380
2009 1,742 1,387 392
2008 1,581 1,299 353
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+
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
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The International Conference on Residency Education | La conférence internationale sur la formation des résidents
FYI: the facts
• 1,193 (45%) of CMGs applied to only one discipline in 2013 match
• 652 or 55% of CMGs that applied to one discipline applied to only Family Medicine
• 968 (35%) of IMGs applied to only one discipline in the 2013 match
• 657 or 68% of IMGs that applied to one discipline applied to only Family Medicine
• IMGs applied to an average of 17 programs in 2.7 disciplines
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
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The International Conference on Residency Education | La conférence internationale sur la formation des résidents
Matched international medical graduates 2013 - MCC examination status
0
50
100
150
200
250
Passed MCCEE Passed MCCEE& QE1
PassedMCCEE, QE1 &
QE2
Passed NAC3OSCE
250IMGs
161IMGs
88IMGs
144IMGs
499 matched
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
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The International Conference on Residency Education | La conférence internationale sur la formation des résidents
IMG match results by region of graduation in 2013
0% 20% 40% 60% 80% 100%
South America
Oceania/Pacific Islands
North America
Middle East
Europe
Central…
Asia
Africa
Matched
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
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The International Conference on Residency Education | La conférence internationale sur la formation des résidents
Definition of a Canadian studying abroad (CSA)
• Canadian citizen/landed immigrant• Final year medical student• Canadian citizen or landed immigrant who had
undergraduate education in Canada• Canadian citizen or landed immigrant and obtained M.D.
from pre-defined CSA schools
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
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IMGs in the 2015 R-1 match
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
IMGs CSAs
Number of new applicants 331 472
Number of returning applicants 681 361
TOTAL 1,012 833
Numbers of international medical schools
438 145
Numbers of countries 102 62
Preliminary 2015 data: last updated October 17, 2014
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The International Conference on Residency Education | La conférence internationale sur la formation des résidents
INDIA
AUSTRALIA
GHANA
SENEGAL
REPUBLIC OF KOREA
SAINT MAARTEN
ANTIGUA & BARBUDA
NETHERLANDS ANTILLES CAYMAN ISLANDS
ARUBA
BELIZE
DOMINICA
GRENADA
DOMINICAN REPUBLIC
ANGUILLA
SAINT LUCIA
TRINIDAD & TOBAGO
SAINT EUSTATIUS
BONAIRE
SABA
FRANCE
CZECH REPUBLIC
BAHRAIN
POLAND
ISRAEL
AUSTRIA
GERMANY
HUNGARYROMANIA
UNITEDKINGDOMIRELAND
SLOVAKIA
MEXICO
COOKISLANDS
IRAN
EGYPT
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
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Canadians studying medicine abroad (CSAs)
The International Conference on Residency Education | La conférence internationale sur la formation des résidents
Number of CSA registrants
0
100
200
300
400
500
600
700
800
900
1000
2008 2009 2010 2011 2012 2013 2014
New CSAs
ReturningCSAs
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
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The International Conference on Residency Education | La conférence internationale sur la formation des résidents
Number of immigrant registrants 2009 – 2014 R-1 match
0
200
400
600
800
1000
1200
1400
1600
1800
2000
2009 2010 2011 2012 2013 2014
722 772826
666 791
575
NewImmigrants
Returningimmigrants
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
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Matched vs. unmatched CSA/IMG scores on MCC exams EE QE1 and QE2 in 2013
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
CSA IMGMatched Unmatched Matched Unmatched
# Score # Score # Score # Score
MCCEE 218 368 353 326 32 343 385 311
MCCQEI 38 487 93 455 123 481 548 453
MCCQEII 2 524 6 484 86 506 332 489
NAC3 19 77 32 71 125 78 426 78
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The International Conference on Residency Education | La conférence internationale sur la formation des résidents
Annual R-1 match results for CSAs and immigrant IMGs 2009 – 2014
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
CSA ImmigrantTOTAL
Matched Unmatched Total Matched Unmatched Total
2014 287 624 911 162 1,245 1407 2318
2013 258 518 776 241 1,312 1,553 2,329
2012 244 503 747 163 908 1,071 1,818
2011 182 291 473 198 1,249 1,447 1,920
2010 183 194 377 197 1,223 1,420 1,797
2009 136 171 307 256 1,090 1,346 1,653
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Matched location and elective location
• Of the CSAs that did at least one clinical elective and were matched:
• Same province • 54.6% did at least one elective in the same province as
where they matched• 45.4% did not do any elective in the same province as
where they matched
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
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Matched location and elective location
• Same university• 32.2% did at least one elective in the same university as
where they matched• 67.8% did not do any elective in the same university as
where they matched
• Same discipline• 47% did at least one elective in the same discipline as
where they matched• 53% did not do any elective in the same discipline as
where they matched
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
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CaRMS Online application
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
This page displays the following:
» Applicant name
» CaRMS ID
» Medical school: name, graduation date, accreditation type
» Citizenship status
» Current Canadian medical licensure
» Clinical practice: institution, start/end date
» Fellowship: discipline, institution, start/end dates
» Residency training: discipline, institution, current residency status, start/end dates
» MCC examinations: MCCEE, MCCQE1, MCCQE2
» NAC OSCE
» Snapshot of application status: required documents, application process
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Clinical practice experience
For the purposes of the CaRMS application, clinical practice experience is defined as actively practicing medicine as the physician of care, with an independent license without supervision. This may include paid or unpaid work.
» Country» Name of practice/institution» Primary language used when communicating with
patients» Start/end dates, or ongoing» Description
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
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Declaration
The declaration page contains questions on licensure to practice medicine and must be
completed in order to apply to programs.
» In order to begin postgraduate residency training, the applicant must obtain an
educational license/certificate from the medical Regulatory Authority (MRA) within
the province to which they have been matched. If they are unable to obtain an
educational license/certificate, their match will no longer be binding. The MRA will
require them to answer the following types of questions:
a. Have you ever been convicted of a criminal offence or have criminal charges
pending in Canada and/or elsewhere?
b. Have you ever been formally investigated or subject to formal disciplinary action by
another health regulatory body in Canada and/or elsewhere?
c. Do you have a health condition that may pose a risk of harm to a patient including
but not limited to: mental health conditions; physical health conditions; or blood-
borne infections?
d. Do you possess the essential skills and abilities required for the program to which
you have been matched?
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
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The International Conference on Residency Education | La conférence internationale sur la formation des résidents
Declaration
The declaration page also contains the following questions:
» Has there ever been any disciplinary findings of guilt made against you by a medical (or any professional) authority?
» Have you ever been found unfit to practice medicine or had restrictions placed upon your practice for cause by a medical regulatory authority?
» Have you ever been found guilty of academic misconduct by a postsecondary institution?
» Have you ever been disciplined or the subject of sanctions by a professional body responsible for evaluation or certification?
» Do you currently have a Return of Service (ROS) obligation relating to previous or current postgraduate residency training that limits your ability to accept a new residency position?
» Specify the date on which you last practices medicine in a clinical setting.
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
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Declaration
The declaration page also contains the following statement, to which the applicant
must choose to agree or disagree:
» I understand and agree that the Canadian Resident Matching Service (CaRMS) will collect, use and disclose the information provided in this application for the purposes of verifying credentials and attempting to match applicants with the residency programs of their choice. I specifically acknowledge and agree that this information will be distributed to the programs I designate and may be used for the purpose of selecting candidates for postgraduate residency training. I understand that CaRMS’ collection, use and disclosure of personal information shall only be done in accordance with the applicable applicant contract and CaRMS’ Privacy Policy, a copy of which is available on the CaRMS website. I have provided all information about my previous medical education, training and/or examinations to allow full assessment of my application. Any information that is falsified or deliberately inaccurate will be considered as grounds for immediate removal from the match process and a breach of this contract, rendering any match null and void.
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
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Medical Council of Canada examinations
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
MCC acknowledgment:• I authorize CaRMS to provide the Medical Council of Canada (MCC) with my
name, CaRMS ID, date of birth, MCC candidate code and LMCC number (if applicable) for the purposes of retrieving my MCC examination results from the MCC.
• Once I have shared my most recent results with CaRMS on the physiciansapply.ca “Examination Results and Document Sharing” page, the MCC will send CaRMS the standing, date and total score for the shared MCC examinations (e.g. MCCEE, MCCQE part I, MCCQE Part II, CSC-FM, NAC), regardless of whether or not I was successful at the examination; and/or information regarding my shared pending MCC examination(s). CaRMS will update my application with the information received from the MCC, including MINC and LMCC numbers, if applicable.
• I acknowledge that the score and standing for any examination I have shared, for which I am awaiting results, will be posted in my CaRMS Online examination section when available. Each MCC examination result will remain permanently in CaRMS Online unless an updated standing is retrieved from the MCC.
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Medical Council of Canada examinations
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
Sharing consent:• If you choose not to share your results, programs will see that the
examination has been taken but that you elected not to share the results. No score or standing will be attached. Your authorization to share or not share your results cannot be changed once file review opens or between first and second iteration.
• If you have taken this exam more than once, only the most recent examination will show to programs. This includes examinations with future dates, which will show to programs unless it is found that that examination was not taken. Examinations with future dates will be identified as “MCC Confirmation Pending” until they are taken; if the pending examination is a retake, it will be identified as such.
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2014 IMG match results by IELTS score > 6
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
Status# w/ IELTS
# IELTS > 6
%
CSA Matched 4 3 75%
CSA Unmatched 25 24 96%
IMG Matched 27 25 93%
IMG Unmatched 325 312 96%
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The International Conference on Residency Education | La conférence internationale sur la formation des résidents
2014 IMG match results by TOEFL score > 92
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
Status# w/
TOEFL# TOEFL >
92%
CSA Matched 10 9 90%
CSA Unmatched 44 41 93%
IMG Matched 92 92 100%
IMG Unmatched 593 559 94%
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The International Conference on Residency Education | La conférence internationale sur la formation des résidents
IMG MCC exams 2014
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
0100200300400500600700 0 100 200 300 400 500 600 700
PASSED EE + QE1
PASSED EE + QE1 + QE2
PASSED NAC
PASSED EE
Imm CSA
Unmatched Matched
# Applicants
68% 32%7% 93%
69% 31%13% 87%
81%,19%14% 86%
15% 85% 61% 39%
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2014 IMG match results by average NAC score
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
Status # w/ NAC NAC average
CSA Matched 63 78.9
CSA Unmatched 99 72.8
IMG Matched 112 85.0
IMG Unmatched 620 75.5
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Immigrants* by region of graduation
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
Region of graduation# final
participants # matched % matchedAfrica 338 38 11%Asia 441 33 7%Central America/Caribbean 51 12 24%Europe 206 31 15%Middle East 299 29 10%North America 6 2 33%Oceania/Pacific Islands 2 2 100%South America 64 15 23%TOTAL 1407 162 12%
* All IMGs except CSAs
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CSAs by region of graduation
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
Region of graduation
# final participants # matched % matched
Africa 20 2 10%Asia 21 2 10%Central America/Caribbean 477 119 25%Europe 272 115 42%Middle East 34 7 21%North America 3 1 33%Oceania/Pacific Islands 79 40 51%South America 5 1 20%TOTAL 911 287 32%
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Match results of Canadians studying abroad 2008-2014 R-1 match
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
0
200
400
600
800
1,000
2008 2009 2010 2011 2012 2013 2014
# Final CSA participants # CSA matched
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Annual match results for CSAs and immigrants 2010-2014
Selecting IMGs for residency programs: Myths and shibboleths | Ms. Sandra Banner and Dr. Ian Bowmer
CSAs ImmigrantsTOTAL
Matched Unmatched Total Matched Unmatched Total
2014 287 624 911 162 1,245 1,407 2,318
2013 258 518 776 241 1,312 1,553 2,309
2012 231 516 747 176 1,233 1,409 2,156
2011 183 302 485 197 1,238 1,435 1,920
2010 183 194 377 197 1,223 1,420 1,797
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