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Akshay Rajaram

Fri, 03/08/2019 - 21:35

Dr. Archer, thank you for sharing your insights and ideas on this complex topic. I think there are many opportunities for change as you've identified. I offer some of my thoughts below.

1. Increase residency positions - I personally don’t think we need to increase residency positions. As you’ve identified, I think we need to spend more time in medical school exposing students to different specialties and delaying selection of career tracks until the first year of residency (a rotating internship would be ideal). Folded into all of this is convincing more graduates to consider a career in family medicine. Many of my colleagues who have aptitudes and potential for various disciplines were dissuaded from family medicine (“you’re too bright for family medicine”) when their broad base of talents are what the field desperately needs. We need to more actively address this hidden curriculum and promote primary care as a specialty (relationships, information coordination, advocacy).

2. Limit external electives - I believe this is already underway with both internal and external changes. Internally, the UGME is restricting the number of electives that may be undertaken in a single direct entry discipline to increase students’ exposure to different rotations. My understanding is that other schools and the AFMC are taking similar stances. The likely impact of these changes is going to more protectionism, with Queen’s clerks doing more electives at Queen’s in order to ensure that they’re at least competitive at their home school. Folded into this issue is addressing the cost of electives as it contributes significantly to the debt loads of students.

3. In addition to these points, I was struck by your comments about the existence of numerous distractors in medical school and the number of required accreditation standards. Having completed a Master’s in Management and worked for 2.5 years prior to beginning medical school, I’ve noticed a number of inefficiencies over the course of my training. Borrowing a framework from auto manufacturing, Gray Moonen, Dr. Sanfilippo and I co-authored a piece proposing a new approach to undergraduate medical education curriculum review to identify and classify these inefficiencies to assist with addressing them:

We welcome your feedback and the comments of other readers.

Akshay Rajaram
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