Medical school in Canada

In Canada, a medical school is a faculty or school of a university that offers a 3- or 4-year Doctor of Medicine (M.D. or M.D.C.M.) degree. Although presently most students enter medicine having previously earned another degree, the M.D. is technically considered an undergraduate degree in Canada.

Admissions
Generally, medical students begin their studies after receiving a bachelor's degree in another field, often one of the biological sciences. However, not all medical schools in Canada require a bachelor's degree for entry. For example, Quebec's medical schools accept applicants after a two-year CEGEP diploma, which is the equivalent of other provinces' grade 12 plus the first year of university. Most faculties of medicine in Western Canada require at least 2 years, and most faculties in Ontario in require at least 3 years of university study before application can be made to medical school. The Association of Faculties of Medicine of Canada (AFMC) publishes a detailed guide to admission requirements of Canadian faculties of medicine on a yearly basis.

Admission offers are made by individual medical schools, generally on the basis of a personal statement, undergraduate record (GPA), scores on the Medical College Admission Test (MCAT), and interviews. Volunteer work is often an important criterion considered by admission committees. Francophone medical schools in Quebec, the University of Ottawa (a bilingual school), the Northern Ontario School of Medicine, and McMaster University do not require the MCAT.

The annual success rate for Canadian citizens applying for admission to Canadian medical schools for the academic years 2001/02 to 2005/06 ranged from 26.3% to 29.2%. Just over 2500 positions were available in first-year classes in 2006/07 across all 17 Canadian faculties of medicine. The average cost of tuition in 2006/07 was $12,728 for medical schools outside of Quebec; in Quebec (for Quebecers only), average tuition was $2943. The level of debt amongst Canadian medical students upon graduation has received attention in the medical media. 

Curriculum
Medical school in Canada is a 4-year program at most universities. Notable exceptions include McMaster University and the University of Calgary, where programs run for 3 years, without interruption for the summer. The first half of the medical curriculum is dedicated mostly to teaching the basic sciences relevant to medicine, such as anatomy, physiology, pharmacology, genetics, microbiology, ethics, and epidemiology. This instruction can be organized by discipline or by organ system. Teaching methods can include traditional lectures, problem-based learning, laboratory sessions, simulated patient sessions, and limited clinical experiences. The remainder of medical school is spent in clerkship. Clinical clerks participate in the day-to-day management of patients. They are supervised and taught during this clinical experience by residents and fully-licensed staff physicians. Typical rotations include internal medicine, family medicine, psychiatry, surgery, emergency medicine, obstetrics and gynecology, and pediatrics. Elective rotations are often available so students can explore specialties of interest for residency training.

Some medical schools offer joint degree programs in which a limited number of interested medical students may simultaneously enroll in M.Sc. or Ph.D. programs in related fields. Often this research training is undertaken during elective time and between the basic science and clinical clerkship halves of the curriculum.

Post-graduate medical education
Students enter into the Canadian Resident Matching Service (CaRMS) in the fall of their final year. Students rank their preferences of hospitals and specialties. In turn, the programs to which they applied rank each student. Both sets of rank lists are confidential. Each group's preferences are entered into a computerized matching system to determine placement for residency positions. 'Match Day' usually occurs in March, a few months before graduation. The length of post-graduate training varies with choice of specialty. Family medicine, or general practice, is a 2 year program accredited by the College of Family Physicians of Canada (CFPC). All specialty residencies are accredited by the Royal College of Physicians and Surgeons of Canada; most are 5 years long. Internal medicine and pediatrics are 4-year programs in which the final year can be used to complete a fellowship in general internal medicine or general pediatrics, or used towards a longer fellowship (e.g., cardiology). A few surgical residencies, including cardiac surgery, neurosurgery, and some general surgery programs, last 6 years. Subspecialty fellowships are available after most residencies. Family medicine programs often offer an optional third year of training in such fields as emergency medicine and care of the elderly (as opposed to Geriatrics, which is a subspecialty of internal medicine).

There are subtle differences between how residency training is organized in Canada as opposed to the United States. For example, M.D. graduates proceed directly into their residencies without the intermediate step of internship. However, this difference is somewhat superficial: for many residencies, the first postgraduate year (PGY1) in Canada is very similar to a rotating internship, with 1-2 month-long rotations in diverse fields. On the other hand, in Canada the graduate is often committed to a subspecialty earlier than a similar American graduate.

Some subspecialties are organized differently. For example, in the United States, cardiac and thoracic surgery are rolled into one fellowship (cardiothoracic surgery) following residency in general surgery. In Canada, cardiac surgery is a direct-entry residency (equivalent training can be obtained by pursuing a cardiac fellowship following residency in general surgery, but this route is far less popular). A fellowship in thoracic surgery can be pursued following residency in either cardiac or general surgery.

Unlike the United States and United Kingdom, in Canada there are no national guidelines for residents' call schedules or work hours. Each regional health authority in which residency training takes place negotiates such details as part of a collective agreement between the authority and the regional professional association of residents.

Continuing medical education
Both Canadian specialty colleges participate in mandatory continuing medical education (CME) schemes. Examples of CME activities include attendance at conferences, participating in practice-based small group learning, and taking courses such as advanced cardiac life support.

The CFPC program for family physicians is called MAINPRO, short for 'Maintenance of Proficiency.'  A certain number of credits must be obtained over 5 year cycles. There are different classes of credits depending on whether the CME activity is considered accredited (e.g., attending accredited workshops or conferences) or non-accredited (e.g., teaching medical students, preparing research papers for publication, reading scholarly journals).

The Office of Professional Development of the RCPSC runs a mandatory maintenance of certification (MOC) program as part of its strategy of continuous professional development. Its regime of credits, MAINPORT, is similar to the MAINPRO program. Fellows of the RCPSC must submit a certain number of credits per year and per 5-year cycle to maintain certification.

Evaluation
During the final year of medical school, students complete part 1 of the Medical Council of Canada Qualifying Examination (MCCQE), which is organized as a part-multiple choice, part-short answer computer-adaptive test. Upon completion of the final year of medical school, students are awarded the degree of M.D. Students then begin training in the residency program designated to them by CaRMS. Part 2 of the MCCQE, an Objective Structured Clinical Examination, is taken following completion of 12 months of residency training. After both parts of the MCCQE are successfully completed, the resident becomes a licentiate of the Medical Council of Canada. However, in order to practice independently, the resident must complete the residency program and take a board examination pertinent to his or her intended scope of practice. In the final year of residency training, residents take an exam administered by either the RCPSC or the CFPC, depending on whether they are training for specialty or family practice. They are then eligible to apply for full licensure with their provincial or territorial medical regulatory authority (i.e., provincial college).

Accreditation
Together with the Canadian Medical Association (CMA), the AFMC carries out accreditation surveys and rules on the accreditation status of all of the undergraduate medical programs in Canada, as well as all university-based continuing medical education. The Liaison Committee on Medical Education, jointly administered by the Association of American Medical Colleges and the American Medical Association, also accredits Canadian medical schools.

Research in Canadian Medical Schools
Research is increasingly an integral part of Canadian medical education at each of the undergraduate, post-graduate, and independent practice stages of a doctor's medical career. The CanMEDS program of the RCPSC identified 'Scholar' as one of the 7 integral roles a competent physician plays.

But most research in Canadian faculties of medicine is performed not by clinicians, but by professors of the basic sciences relevant to medicine and their graduate students and post-doctoral fellows.

Often these researchers obtain funding from the Canadian Institutes of Health Research, or from private sources such as pharmaceutical companies.

Language
As in the United States, postgraduate trainees are referred to as 'residents,' not 'registrars.' Occasionally the word 'intern' is used colloquially to describe a PGY1 trainee (not to be confused with 'internist,' which refers to a fully-licensed specialist in general internal medicine).

Although the terms 'consultant' and 'attending' are widely-used and universally understood, most Canadian trainees refer to their fully-licensed preceptors as 'staff' physicians or surgeons.

Clerkship-level medical students are referred to as 'clerks' or 'senior medical students,' although some name badges use ambiguous language such as 'student doctor.'