Clerkship pathway: a factor in certification success for international medical graduates.

OBJECTIVE: To identify factors that help predict success for international medical graduates (IMGs) who train in Canadian residency programs and pass the Canadian certification examinations. DESIGN: A retrospective analysis of 58 variables in the files of IMGs who applied to the Collège des médecins du Québec between 2000 and 2008. SETTING: Quebec. PARTICIPANTS: Eight hundred ten IMGs who applied to the Collège des médecins du Québec through either the "equivalency pathway" (ie, starting training at a residency level) or the "clerkship pathway" (ie, relearning at the level of a medical student in the last 2 years of the MD diploma). MAIN OUTCOME MEASURES: Success factors in achieving certification. Data were analyzed using descriptive statistics and ANOVA (analysis of variance). RESULTS: International medical graduates who chose the "clerkship pathway" had greater success on certification examinations than those who started at the residency level did. CONCLUSION: There are several factors that influence IMGs' success on certification examinations, including integration issues, the acquisition of clinical decision-making skills, and the varied educational backgrounds. These factors perhaps can be better addressed by a regular clerkship pathway, in which IMGs benefit from learner-centred teaching and have more time for reflection on and understanding of the North American approach to medical education. The clerkship pathway is a useful strategy for assuring the integration of IMGs in the North American health care system. A 2-year relearning period in medical school at a clinical clerkship level deserves careful consideration.

Sociodemographic variables as predictors of adverse outcome in SARS-CoV-2 infection: an Irish hospital experience.

INTRODUCTION: Our hospital found itself at the epicentre of the Irish COVID-19 pandemic. We describe the organisational challenges faced in managing the surge and identified risk factors for mortality and ICU admission among hospitalised SARS-CoV-2-infected patients. METHODS: All hospitalised SARS-CoV-2 patients diagnosed between March 13 and May 1, 2020, were included. Demographic, referral, deprivation, ethnicity and clinical data were recorded. Multivariable regression, including age-adjusted hazard ratios (HR (95% CI), was used to explore risk factors associated with adverse outcomes. RESULTS: Of 257 inpatients, 174 were discharged (68%) and 39 died (15%) in hospital. Two hundred three (79%) patients presented from the community, 34 (13%) from care homes and 20 (8%) were existing inpatients. Forty-five percent of community patients were of a non-Irish White or Black, Asian or minority ethnic (BAME) population, including 34 Roma (13%) compared to 3% of care home and 5% of existing inpatients, (p < 0.001). Twenty-two patients were healthcare workers (9%). Of 31 patients (12%) requiring ICU admission, 18 were discharged (58%) and 7 died (23%). Being overweight/obese HR (95% CI) 3.09 (1.32, 7.23), p = 0.009; a care home resident 2.68 (1.24, 5.6), p = 0.012; socioeconomically deprived 1.05 (1.01, 1.09), p = 0.012; and older 1.04 (1.01, 1.06), p = 0.002 were significantly associated with death. Non-Irish White or BAME were not significantly associated with death 1.31 (0.28, 6.22), p = 0.63 but were significantly associated with ICU admission 4.38 (1.38, 14.2), p = 0.014 as was being overweight/obese 2.37 (1.37, 6.83), p = 0.01. CONCLUSION: The COVID-19 pandemic posed unprecedented organisational issues for our hospital resulting in the greatest surge in ICU capacity above baseline of any Irish hospital. Being overweight/obese, a care home resident, socioeconomically deprived and older were significantly associated with death, while ethnicity and being overweight/obese were significantly associated with ICU admission.

Examination outcomes for international medical graduates pursuing or completing family medicine residency training in Quebec.

OBJECTIVE: To review the success of international medical graduates (IMGs) who are pursuing or have completed a Quebec residency training program and examinations. DESIGN: We retrospectively reviewed IMGs' success rates on the pre-residency Collège des médecins du Québec medical clinical sciences written examination and objective structured clinical examination, as well as on the post-residency Certification Examination in Family Medicine. SETTING: Quebec. PARTICIPANTS: All IMGs taking their examinations between 2001 and 2008, inclusive, and Canadian and American graduates taking their examinations during this same period. MAIN OUTCOME MEASURES: Success rates for IMGs on the pre-residency and post-residency examinations, compared with success rates for Canadian and American graduates. RESULTS: Success rates on the pre-residency clinical examinations remained below 50% from 2001 to 2008 for IMGs. Similarly, during the same period, the average success rate on the Certification examination was 56.0% for IMGs, compared with 93.5% for Canadian and American medical graduates. CONCLUSION: Despite pre-residency competency screening and in-program orientation and supports, a substantial number of IMGs in Quebec are not passing their Certification examinations. Another study is under way to analyze reasons for some IMGs' lack of success and to find ways to help IMGs complete residency training successfully and pass the Certification examination.

The Future of Postgraduate Medical Education in Canada.

The Future of Medical Education in Canada Postgraduate (FMEC PG) Project was launched in 2010 by a consortium of four organizations: the Association of Faculties of Medicine of Canada, the Collège des Médecins du Québec, the College of Family Physicians of Canada, and the Royal College of Physicians and Surgeons of Canada. The FMEC PG study set out to review the state of the Canadian postgraduate medical education (PGME) system and make recommendations for improvements and changes. The extensive process included literature reviews, commissioned papers, stakeholder interviews, international consultations, and dialogue with the public and learners. The resulting key findings and 10 recommendations, published in a report in 2012, represent the collective vision of the consortium partner organizations for PGME in Canada. Implementation of the recommendations began in 2013 and will continue beyond 2016.In this article, the authors describe the complex process of developing the recommendations, highlight several recommendations, consider implementation processes and issues, and share lessons learned to date. They reflect on the ways in which the transformation of a very complex and complicated PGME system has required many stakeholders to work together on multiple interventions simultaneously. Notwithstanding the challenges for the participating organizations, changes have been introduced and sustainability is being forged. Throughout this process, the consortium partners and other stakeholders have continued to address the social accountability role of all physicians with respect to the public they serve.

Residents' duty hours in the province of Quebec, Canada.

The author describes the five decades of efforts by residents in the medical schools of the province of Quebec, Canada, to negotiate scientific, cultural, social, and economic issues that affect them as trainees. At present, the residents' association, the Fédération des Médecine résidents du Quebec negotiates collective agreements on working conditions and other issues with the Quebec Ministry of Health, not the hospital association. The federation has become recognized as an important body throughout Canada, and its representatives regularly participate in meetings concerning the country's health care system. The author describes the duty hours provisions of the current collective agreement (1996-2002), and remarks that in general, the agreement's regulations are helpful to residents, prevent the possibility of abusive work schedules, and, among other benefits, provide generous time off for conferences, examinations, and study time. However, some residents, particularly those in surgical disciplines, believe that the work-hours provisions are too restrictive, as they wish to maximize their acute-care surgical experiences in the operating room via frequent on-call hours. At present, residents in all disciplines are allowed to remain in the hospital to attend to patient care duties as much as they wish, but they may not be on official call more than is stipulated by the collective agreement. These agreements have also created some difficulties in providing coverage for patients; the author discusses various solutions to this problem.

Coming of age as communicators: differences in the implementation of common communications skills training in four residency programmes.

OBJECTIVES: To determine thematic similarities and differences in the implementation of common-content communications skills training (CST) in medicine, surgery, paediatrics, and obstetrics and gynaecology residency programmes. METHODS: Communications skills training based upon the Kalamazoo consensus statement of communication skills in the clinical encounter was implemented in 4 residency programmes. Field notes of the CST sessions in each programme were analysed and coded for themes, considering the domains of Context, Input, Process and Product ('CIPP' methodology). Immediate learning outcomes were quantitatively assessed using retrospective pre/post methodology. RESULTS: Important differences were noted in the implementation of CST in the 4 disciplines. The 2 surgical disciplines showed relatively less reflective language and greater concentration on straight skill acquisition, whereas the 2 medical disciplines concentrated on the residents' role as teachers of communication skills for buy-in. Thematic similarities between disciplines included similar challenges to being good communicators in practice, as identified by residents (e.g. inadequate time and space), as well as lack of formal training. Quantitative learning outcome data from the educational intervention were significant in all groups (P < 0.05). CONCLUSIONS: Common material in CST can be adapted to different disciplines. By analysing for thematic similarities and differences in implementation in the 4 disciplines, a picture of different pedagogic 'subcultures' emerged, with different behavioural norms and values related to the doctor's role as communicator. In shared core competency training, it may be useful to consider these differences in planning, so that the training may be both sensitive to the behavioural norms of different disciplines, and effective.