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Tony Sanfilippo

Fri, 02/15/2019 - 12:01

Hello Steve,
Your comments, as usual, are insightful and well presented. You've certainly touched on a number of topics that have been troubling the medical education community in this country for some time. A few additional thoughts.
The process for determining the number and distribution of residency training is largely contained within the provincial ministries who fund the positions. Each does it in it's own way, largely driven by available funding, perceived future medical workforce needs (something akin to predicting the weather) and "politics". The requests for input from the medical education community, and the receptiveness to that input, varies with the political leadership of the day and the appointed administrative leadership of the time. Over the past decade, the number of positions available has not expanded. In fact, it's contracted in the face of increasing numbers of applicants from within and outside Canada which, as you point out, has led to the increased competitiveness of the match.
It's been argued by some that residency positions should be openly available based on career intentions of medical school grads and to let the marketplace deal with the issue of needs. That approach has been panned largely because of expense and a governmental sense of responsibility to address perceived deficiencies in certain specialties.
The issue of electives relates directly to the match issue. Students feel they require electives at particular schools to be considered and, although that shouldn't be the case, they are responding to what they're hearing, not only from their peers, but also from faculty who are involved in selection committees.
I think it's also important to recognize that CaRMS itself is often seen as the problem, but I think that's largely unjustified. CaRMS is simply the process and algorithm by which matches are made. It does not determine available positions nor the criteria by which decisions are made, which is still in the hands of functionally independent selection committees. If the system is to improve (which I heartily agree it should), it will require deliberate and unified efforts on the part of the 17 medical schools, and acceptance (or at least compliance) on the part of program selection committees.
I couldn't agree more that the process of transition from UG to PG has evolved in a maladaptive and rather random way and requires major thought and a fresh approach. In fact, the Future of Medical Education in Canada initiatives have supported that need. The potential role of an earlier, graduated selection process or a return to something like the rotating internship would be great starting points for that discussion. The major obstacle to developing solutions has been that there are a great many entities and organizations for whom this issue is critical and would have to be very much involved and agreeable to any solution, including our 17 medical schools, Medical Council, specialty accrediting bodies, provincial and territorial regulators, students and residents. I'm pleased to see that efforts to have such discussions have been and continue to occur, but remain a long way from resolution. Those efforts will certainly be encouraged by interest and thoughtful perspectives from respected leaders like yourself. So, many thanks for your dedication to education and for speaking up.


Tony Sanfilippo
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