When a Canadian is not a Canadian: marginalization of IMGs in the CaRMS match

Recommendations for Improvement of Equity, Diversity, and Inclusion in the CaRMs Selection Process

Equity, diversity and inclusion (EDI) in the medical field is crucial for meeting the healthcare needs of a progressively diverse society. A diverse physician workforce enables culturally sensitive care, promotes health equity, and enhances the comprehension of the various needs and viewpoints of patients, ultimately resulting in more effective treatments and improved patient outcomes. However, despite the recognized benefits of diversity in the medical field, certain specialties, such as Radiology, have struggled to achieve adequate equity, diversity and inclusion, which results in a discrepancy in the demographics of Canadian radiologists and the patients we serve. In this review, we propose strategies from a committee within the Canadian Association of Radiologists (CAR) EDI working group to improve EDI in the CaRMS selection process. By adopting these strategies, residency programs can foster a more diverse and inclusive environment that is better positioned to address the health needs of a progressively diverse patient population, leading to improved patient outcomes, greater patient satisfaction, and advancements in medical innovation.

Is it really a challenge to find positive attributes for international medical graduates predictive of success in family medicine residency?

In their paper "Challenges with international medical graduate selection: finding positive attributes predictive of success in family medicine residency," (BMC Prim Care 23(256):2-9, 2022) the authors report on their research into qualitative attributes that positively correspond to success in residency with the objective of assisting in the selection of International Medical Graduate (IMG) residents most likely to achieve success in family medicine residency. The authors found that positive predictors of IMG residents' success were: presence of a positive attitude, proficient communication skills, high level of clinical knowledge, and trainability. The authors conclude that selecting IMG residents who possess these attributes will result in residents developing increased aptitudes for patient care. A careful reading of the paper raises a number of concerns. MacFarlane (Can Med Educ J 12(4):132-40, 2021) points out that IMGs are already marginalized in the residency selection process. Our concern is that this paper may contribute to this marginalization through a tone of negativity or bias against IMGs and the use of biased language throughout the paper that tends to cast IMGs as being inferior and somehow less well prepared for residency than Canadian Medical Graduates (CMGs). We argue that the proposed predictors are generic and equally relevant to both CMGs and IMGs. In focusing on these predictors in IMGs specifically, the paper appears to imply, without evidence, that IMGs are inadequate in the identified areas. After reviewing the paper's references, the existing literature, and an analysis of language used, we conclude that IMGs are capable candidates for residency, and that the qualitative attributes outlined in the paper offer little utility for the selection of IMG residents relative to CMG residents.

Alternative Careers toward Job Market Integration: Barriers Faced by International Medical Graduates in Canada

International Medical Graduates (IMGs), who completed their medical degree and training outside Canada constitute a notable portion of the skilled migrants of the country. However, due to a long and uncertain licensure process and limited opportunities many IMGs look for alternative career pathways where they can utilize their learned skills. Alternative careers in the health and wellness sector may offer such opportunities; however, IMGs' success in these pathways were also less evident despite their high potential. In this study, we investigated the barriers that IMGs stated to face when attempting alternative jobs in Canada. Eight focus groups with 42 IMGs in Canada were conducted. Using a thematic analysis approach, we identified that IMGs encounter these barriers in different stages of their resettlement journey in Canada, including both the pre-migration and post-migration phases. In the pre-migration phase, IMGs were not aware of the success rates of the licensing pathways and did not have sufficient information regarding potential alternative careers. In the post-migration phase, the lack of information continues to affect IMGs where IMGs exhaust their resources pursuing alternative careers without proper guidance and support. Further, IMGs struggle with taking preparation for alternative careers by obtaining further certifications and completing other prerequisites for some barriers, such as financial constraints. While looking for jobs, some IMGs perceived systemic discrimination such as non-recognition of their credentials and experience. Furthermore, the mismatch of expectations and limited growth opportunities offered by potential careers serve to disincentivize IMGs from pursuing an alternative career. Addressing the current employment inequity experienced by IMGs in Canada warrants research collaborations between organizations supporting IMGs and policymakers that target known barriers to the pursuit of alternative careers by IMGs.

Licensing exams in Canada: a closer look at the validity of the MCCQE Part II

The Medical Council of Canada Qualifying Exam (MCCQE) Part II aims to protect societal interests through examining recently graduated physicians using clinical scenarios with standardized patients. This position paper debates the role of the MCCQE Part II in the national licensing of physicians in Canada by focusing on the consequential validity evidence of this exam and considering future directions through discussing contemporary developments in high stakes examinations. Specifically, this paper compares both MCCQE Part I and Part II in their ability to predict future practice patterns of physicians and generalizability across specialties. In weighing up the evidence this paper considers commonly used counterarguments as well as the financial implications of this exam for both the candidates and the MCC. Finally, it concludes by providing recommendations for future licensing of physicians in Canada. The available consequential validity evidence for MCCQE Part II is limited. Though still limited, MCCQE Part I has more robust evidence that it is a better predictor of future practice patterns compared to with Part II. Combined with a lack of evidence that national licensing examinations lead to graduation of substandard doctors or an improvement of care, and the shift away from assessment of learning towards assessment for learning, the maximum impact of the MCC on safeguarding public's interests will lie in working closely with residency programs and specialty colleges to facilitate a robust assessment program of essential competencies and clinical skills during residency training and specialty certification.