Medical education in Canada
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Medical education in Canada is available at seventeen (17) university-based medical schools (eight provinces / no territories) in a highly-decentralized educational system. Universities in Canada are independent legal entities. They enjoy great political and organizational autonomy, despite substantial government funding. Universities set out their own admission and graduation requirements. Fourteen (14) of Canada's medical schools provide instruction in English, and the remaining three medical schools do so in French. All three medical schools providing the MD degree are in Quebec. At the University of Ottawa Medical School, there are two separate streams for students, one in French and one in English.
Medical schools in Canada receive most of their financial support from governments and tuition fees. Both undergraduate and postgraduate medical education is the responsibility of medical faculties at Canadian universities. Continuing medical education (CME) is provided by medical schools thereby making medical education a part of the education continuum. Along geographic lines, the province of Alberta maintains two medical schools, Quebec four and Ontario has six; British Columbia, Manitoba, Saskatchewan, Nova Scotia and Newfoundland all have one each. New Brunswick and Prince Edward Island fund both undergraduate and postgraduate positions at medical schools in neighbouring provinces. Schools range in size from fifty-six students at Memorial University in Newfoundland to a massive three-hundred students at the University of British Columbia and University of Toronto.
Evidence-based medical education
The Best Evidence Medical Education (BEME) Collaboration (Harden et al., 1999) is an international group of individuals, universities and professional organizations committed to the development of evidence informed education in the medical and health professions. MedEdPORTAL is a free open-access publication and website that covers education in the health professions and is provided by the Association of American Medical Colleges (AAMC) in partnership with the American Dental Education Association and the American Psychological Association.
Problem-based learning (PBL) is an educational approach and format centred around clinically-based problems. The PBL model and framework encourages students to develop independent thought and learning. PBL provides medical students with enough time to practice their thinking through cases (see Case-Based Reasoning). In each case, students are expected to seek out answers and define gaps in their own knowledge. The PBL model encourages learners to seek a deeper understanding of material rather than a superficial account or rote memory work. Based on innovative programs introduced in the 1980s at the McMaster University, PBL has been incorporated into curriculum in medical schools around the world. Many schools in the US and Canada have introduced PBL and there is increasing evidence that students learn at least as much in a problem-based learning format as they do in a conventional formats. Small groups used in PBL encourage inquisitive and detailed examination of all issues, concepts and principles that arise within the problem. In addition, any time spent by students outside of their working group will help them to develop skills in literature retrieval, critical appraisal and balancing the opinions of peers and mentors. PBL encourages students to become more involved in, and responsible for, their learning. Medical students and faculty report that this is a highly enjoyable way to learn and teach.
For more background on PBL, see the entry regarding problem-based learning.
Most of Canada's medical schools offer four-year medical degree (MD) programs but McMaster University and University of Calgary offer three-year programs without interruption. In years I and II of medical school, students focus on basic science and subjects such as anatomy, physiology, pharmacology, genetics, microbiology, bioethics and epidemiology. The blocks within years I and II are often organized by disciplines, or organ systems. The learning activities in medicine often comprise a combination of problem-based learning, traditional lecture, laboratory, simulated patients and clinical experience. Most of the clinical experience comes during years III and IV of the MD program. Clerks participate in day-to-day management of patients during these formative years. Clerks are always supervised and mentored through their clinical experiences by senior residents, faculty and fully-licensed physicians. Typical rotations include internal medicine, family medicine, psychiatry, surgery, emergency medicine, obstetrics and gynecology, and pediatrics. Elective rotations are also available. A few medical schools offer joint degree programs such as the combined MD and PhD programs. These programs are rigorous, and combine research with clinical activities and can least anywhere from 7-9 years.
In year IV, medical students write the Medical Council of Canada/Le Conseil médical du Canada qualifying exams. The MCC exams are multiple choice, short answer computer-based tests. Part II, called the Objective Structured Clinical Examination (OSCE), is taken after year I of medical residency training. For information about the future of medical education in Canada, see the AFMC Reports. The Canadian Association for Medical Education (CAME) is a grassroots organization of medical educators who are dedicated to the success and improvement of medical education in Canada. See the many publications and learning objects on their website.
The move to PBL has given health librarians new opportunities to participate in curriculum planning and to contribute to student learning. A major opportunity for educators who introduce medical informatics into PBL is to get involved in MI programming. As health librarians support the information needs of medical programs, they spend a considerable amount of time helping students learn and manage biomedical information. Using computer technologies, they can take active roles in teaching information literacy, retrieval and management skills. MI in PBL is an important component of recent educational reform and poses special instructional and collection challenges for health librarians.
Clerkships and residencies
During the final year of clerkship (year IV), medical students enter into the Canadian Resident Matching Service (CaRMS) / Le Service canadien de jumelage des résidents (CaRMS) (also known as the Match). Medical students rank their interests in medical specialties and their hospital preferences; these preferences determine their residency placements. Family medicine is also called general practice, and is a two-year residency program matched through CaRMS. In year IV, medical students complete the Medical Council of Canada (MCC) exam so that they can be licensed for practice as physicians in Canada. Students are then awarded their MDs (an undergraduate not graduate degree) and register with the Royal College of Physicians and Surgeons of Canada. Thereafter, students commence further training as determined by the CaRMS match.