Abstracts
Abstract
Background: In Canada, international medical graduates (IMG) consist of immigrant-IMG and previous Canadian citizens/permanent residents who attended medical school abroad (CSA). CSA are more likely to obtain a post-graduate residency position than immigrant-IMG and previous studies have suggested that the residency selection process favours CSA over immigrant-IMG. This study explored potential sources of bias in the residency program selection process.
Methods: We conducted semi-structured interviews with senior administrators of clinical assessment and post-graduate programs across Canada. We asked about perceptions of the background and preparation of CSA and immigrant-IMG, methods applicants use to improve likelihood of obtaining residency positions, and practices that may favour/discourage applicants. Interviews were transcribed and a constant comparative method was employed to identify recurring themes.
Results: Of a potential 22 administrators, 12 (54.5%) completed interviews. Five key factors that may provide CSA with an advantage were: reputation of the applicant’s medical school, recency of graduation, ability to complete undergraduate clinical placement in Canada, familiarity with Canadian culture, and interview performance.
Conclusions: Although residency programs prioritize equitable selection, they may be constrained by policies designed to promote efficiencies and mitigate medico-legal risks that inadvertently advantage CSA. Identifying the factors behind these potential biases is needed to promote an equitable selection process.
Résumé
Contexte : Parmi les diplômés internationaux en médecine (DIM) au Canada, il y a des diplômés immigrants et des citoyens ou des résidents canadiens qui ont fait leurs études de médecine à l’étranger (CEE). Ces derniers ont plus de chances d’obtenir un poste de résidence postdoctorale que les DIM immigrants. Des études montrent que le processus de sélection des résidents favorise les CEE au détriment des DIM immigrants. La présente étude explore les sources potentielles de biais dans le processus d’attribution des postes de résidence.
Méthodes : Nous avons mené des entrevues semi-structurées avec les directeurs de programme d’évaluation clinique et de programmes de formation postdoctorale de tout le Canada. Nous les avons interrogés sur leurs perceptions quant au parcours et au niveau de préparation des CEE et des DIM immigrants, quant aux méthodes utilisées par les candidats pour augmenter leurs chances d’obtenir un poste de résidence et quant aux pratiques qui peuvent encourager ou décourager les candidats. Les entretiens ont été transcrits et une méthode de la comparaison constante a été employée pour identifier les thèmes récurrents.
Résultats : Douze (54,5 %) des 22 gestionnaires sollicités ont participé aux entrevues. Les cinq facteurs clés susceptibles de procurer un avantage aux CEE sont : la réputation de la faculté de médecine où le candidat a obtenu son diplôme, la date récente d’obtention de ce dernier, la possibilité d’effectuer un stage clinique de premier cycle au Canada, la familiarité avec la culture canadienne et la performance à l’entrevue.
Conclusions : Bien que la sélection équitable soit une priorité pour les programmes de résidence, ils doivent également respecter des politiques visant l’efficacité et l’atténuation des risques médico-légaux qui avantagent involontairement les CEE. Il faut déceler les facteurs qui sous-tendent ces biais potentiels pour renforcer le caractère équitable du processus de sélection.
Appendices
Bibliography
- Banner S, McKiver A, Rattanasithy S, Cassie J, Woodward C, Ford R. Canadian students studying medicine abroad. Ottawa: Canadian Residency Matching Service; 2010 [Available from: https://www.carms.ca/pdfs/2010_CSA_Report/CaRMS_2010_CSA_Report.pdf [Accessed on Aug 18, 2021].
- Thomson G, Cohn K. IMG selection: independent review of access to postgraduate programs by international medical graduates in Ontario. Volume 2: analysis and background. Toronto: Ontario Ministry of Health and Long-Term Care and the Council of Ontario Universities; 2011. Available from: http://www.health.gov.on.ca/en/common/ministry/publications/reports/thomson/v2_thomson.pdf. [Accessed on Aug 18, 2021].
- Thomson G, Cohn K. IMG selection: independent review of access to postgraduate programs by international medical graduates in Ontario. Volume 1: findings and recommendations [Internet]. Toronto: Ontario Ministry of Health and Long-Term Care and the Council of Ontario Universities; 2011. Available from: http://www.health.gov.on.ca/en/common/ministry/publications/reports/thomson/v1_thomson.pdf. [Accessed on Aug 18, 2021].
- Mathews M, Kandar R, Slade S, Yi Y, Beardall S, Bourgeault I. Realization of entry-to-practice milestones of Canadians who studied medicine abroad and other international medical graduates: a retrospective cohort study. CMAJ Open. 2017;5(2):E476-82. https://doi.org/10.9778/cmajo.20160144
- Medical Council of Canada. Phasing out the MCCEE. MCC:2022. Available from: https://mcc.ca/news/phasing-out-of-the-mccee/ [Accessed on May 20, 2022].
- Medical Council of Canada. Application and eligibility. [Internet]. MCC:2022. Available from: https://mcc.ca/examinations/mccqe-part-i/application-information/ [Accessed on May 20, 2022].
- Canadian Residency Matching Service. Eligibility criteria. CaRMs: 2021 [cited 2021 Aug 05]. Available from: https://www.carms.ca/match/r-1-main-residency-match/eligibility-criteria/ [Accessed on Aug 05, 2021].
- Andrew RF. How do IMGs compare with Canadian medical school graduates in a family practice residency program? Can Fam Physician. 2010;56:E318-22.
- Bates J, Andrew R. Untangling the roots of some IMGs poor academic performance. Acad Med. 2001;76(1):43-6.
- Szafran O, Crutcher RA, Banner SR, Watanabe M. Canadian and immigrant international medical graduates. Can Fam Physician. 2005;51:1242-3.
- Giacomini M. The SAGE handbook of qualitative methods in health research. Bourgeault I, Dingwall R, De Vries R, editors. London: SAGE Publications Ltd.; 2010.
- Berg BL. Qualitative research methods for the social sciences. 2nd ed. Boston: Allyn and Bacon; 1995.
- Guest G, MacQueen KM, Namey EE. Applied thematic analysis. Los Angeles: SAGE Publications Ltd.; 2012.
- Campbell JL, Quincy C, Osserman J, Pedersen OK. Coding in-depth semistructured interviews: problems of unitization and intercoder reliability and agreement. Sociol Methods Res. 2013;42(3):294-320.
- Creswell JW. Research design - qualitative, quantitative and mixed methods approaches. 4th ed. Los Angeles: SAGE Publications Ltd.; 2014.
- Rowan M, Huston P. Qualitative research articles: information for authors and peer reviewers. CMAJ. 1997;157:1442-6.
- Saarjärvi M, Bratt E-L. When face-to-face interviews are not possible: tips and tricks for video, telephone, online chat, and email interviews in qualitative research. Eur J Cardiovasc.Nurs. 2021;20:392-396.
- The Association of Faculties of Medicine. DataPoint! International medical graduates and Canadians studying abroad. Ottawa. 2012 Available from: https://www.afmc.ca/web/sites/default/files/pdf/2012-DATAPOINT_EN.pdf [Accessed on Aug 18, 2021].
- Bandiera G, Abrahams C, Ruetalo M, Hanson MD, Nickell L, Spadafora S. Identifying and promoting best practices in residency application and selection on a complex academic health network. Acad Med. 2015;90(12):1594-601. https://doi.org/10.1097/acm.0000000000000954
- The Association of Faculties of Medicine. AFMC student portal 2021. Available from: https://www.afmcstudentportal.ca/ [Accessed on Aug 18, 2021].
- Bandiera G, Regehr G. Evaluation of a structured application assessment instrument for assessing applications to Canadian postgraduate training programs in emergency medicine. Acad Emerg Med. 2003;10:594-8. https://doi.org/10.1111/j.1553-2712.2003.tb00041.x
- Bandiera G, Regehr G. Reliability of a structured interview scoring instrument for a Canadian postgraduate emergency medicine training program. Acad Emerg Med. 2004;11(1):27-32. https://doi.org/10.1197/j.aem.2003.06.011
- Grierson LEM, Mercuri M, Brailovsky C, et al. Admission factors associated with international medical graduate certification success: a collaborative retrospective review of post-graduate medical education programs in Ontario. CMAJ Open. 2017;5(4):E785-90. https://doi.org/10.9778/cmajo.20170073
- Schabort I, Mercuri M, Grierson LEM. Predicting international medical graduate success on college certification examinations: responding to the Thomson and Cohl judicial report on IMG selection. Can Fam Phys. 2014;60:E478-84.
- Mathews M, Kandar R, Slade S, Yi Y, Beardall S, Bourgeault I. Examination outcomes and work locations of international medical graduate family medicine residents in Canada. Can Fam Phys. 2017;63:776-83.
- Robinett K, Kareen R, Reavis K, Quezada S. A multi-pronged antiracist approach to optimize equity in medical school admissions [online ahead of print 2021 Jun 26]. Med Educ. https://doi-org.qe2a-proxy.mun.ca/10.1111/medu.14589
- Novick G. Is there a bias against telephone interviews in qualitative research? Res Nurs Health. 2008;31(4):391-198.