The international medical graduate odyssey

In 2006, St. Paul’s Hospital, a University of British Columbia family practice and residency site, established a program to determine why international medical graduates (IMGs) did not perform as well as Canadian medical graduates. The two groups worked together and were assessed on their in-training evaluation reports (ITERs). The categories evaluated and the results for both groups were reviewed.

The results showed that IMG residents performed as well as their Canadian medical graduates when comparing ITERs. However, only 58 per cent of those IMGs passed the Canadian Certification in Family Medicine from the College of Family Physicians (CCFP), compared to 97 per cent of the Canadian medical graduates in the same group. The CCFP is usually written in May of the second year of the two-year residency. The results were basically the same for IMGs educated in Canada and IMGs who were not.

Part of the reason IMGs have difficulty passing those exams is because international medical schools don’t always meet the same standards as North American medical schools. A second difficulty occurred when international residents encountered problems with the oral, clinical part of the examination; where examiners pose as patients, to see how the would-be doctors handle hypothetical cases presented to them. It seems many international medical schools did not teach that modern, North American medical approach and IMGs were exposed to it for the first time, on those grueling, summative evaluations. That, obviously, posed a serious disadvantage for IMGs. However, by improving that oral, clinical aspect, the overall IMG pass percentage rose to 83 per cent in 2009.

To become a doctor in Canada, you must first complete a four-year university degree, preferably in science and including any medical school pre-requisite courses. Then, you must pass the Medical College Admission Test (MCAT), to be accepted by a Canadian medical school.

Finally, you must pass the Medical Council of Canada Qualifying Examination (MCCQE) Part I, a multiple choice exam; and MCCQE Part II, a two-day in-person exam, to qualify for a residency. If you can get a residency match, successfully complete the residency and pass the CCFP exam, you gain an unrestricted license to practice in your area of competence.

The process is more arduous for IMGs, because they didn’t graduate from a Canadian Medical School. It begins with an application to the Medical Council of Canada to show they have graduated from an approved medical school. They must then pass the Medical Council of Canada Evaluation Examination (MCCEE). The MCCEE is a four-hour, computer-based examination, designed to assess the skills and knowledge level of new medical graduates from outside Canada. It is considered the most difficult exam medical students ever write and it is a pre-requisite for MCCQEs. Finally, like their Canadian counter-parts, they must pass the MCCQE Part I and MCCQE Part II to qualify for a residency.

Thankfully, changes are in the process! Some assessment has been eliminated, others revamped. Testing and retesting will occur more frequently.

Al Moore

Glace Bay