A Research Program in Medical Education in Canada

The current interest in medical education and the proposed expansion of medical education facilities have stimulated the development of a research program by the secretariat of the Association of Canadian Medical Colleges. The projects planned and now in progress include: (1) studies of the cost of medical education in Canadian teaching hospitals and medical schools; (2) a study of the basic medical science departments in Canada with special reference to the occupational careers of scientists who have received M.Sc. and Ph.D. degrees in those departments; (3) establishment of a student registry to facilitate prospective studies of Canadian medical students; (4) a survey of the residents in training in Canadian hospitals to obtain their evaluation of their training experience.     

Academic family medicine in Canada.

Fifty years ago family practice in Canada had no academic presence. Stimulated by a number of general practitioners and with the support of the Canadian Medical Association, the College of General Practitioners of Canada (CGPC) was founded in 1954. In 1962, conferences on education for general practice attended by the Association of Canadian Medical Colleges and the CGPC led to pilot postgraduate residencies in family practice supported by Department of National Health and Welfare. The first certification examination was held in 1969 and, by 1974, all Canadian medical schools had a family medicine residency program. Today departments of family medicine contribute substantially to undergraduate education in all 16 schools. In Canada, the medical profession, governments and the medical schools have demonstrated the importance they place on appropriate education for family physicians.     

The Role of a Tutorial System in Undergraduate Medical Education

A tutorial system for first- and second-year medical students is now in its third year of operation at McGill University. The program was designed to meet the specific needs of McGill students. The aims and objectives were intentionally defined in a general way, application of detail being the responsibility of individual tutors and their groups of students. The main purpose of the program is the repeated exposure of students to the individual competence of outstanding teachers. A large majority of students and tutors favour the program. It has provided faculty members with insight into some of the problems of present-day medical education. The consensus is that, in the Faculty of Medicine at McGill University, the tutorial system serves an important role, complementing the normal curriculum.     

An American's view of Canadian medical education.

Undergraduate medical education in Canada and the United States is remarkably similar, except for the fact that Canadian medical schools are supported by their provincial governments. However, the systems diverge sharply at the postgraduate level. In Canada, the number and specialty mix of residents are negotiated by medical schools in response to educational and social needs; in the United States, these factors are largely determined by hospital service needs. The Canadian systems of accreditation, certification and payment for medical education after graduation are much simpler than those of the United States, and the accreditation and certification systems are more objective. In addition, the US system promotes subspecialization and a costly specialty imbalance, whereas Canada''s system has achieved an appropriate balance of specialists and generalists. In general, Canadian medical education appears to be simpler, more accountable and more socially responsive.     

Observations on a Medical Teacher Training Program

An increasing interest in educational science as applied to medical education is apparent in the past decade. Recently, a six-week teacher training program was held at the Center for the Study of Medical Education at the University of Illinois. Fifteen medical faculty members, including five Canadians, participated. During this period there was an opportunity to engage in discussions and independent study of several aspects of medical education, using the personnel from the Center''s four major divisions as resource people. Training in educational science is important for all teachers, and a centre to provide this type of instruction should be available in Canada.     

ACMC: past,present and future.

In this article, the president of the Association of Canadian Medical Colleges (ACMC) and its director of research review the issues that have confronted ACMC since its inception: the founding of ACMC; development of the clinical teaching unit; creation of the Medical Research Council and expansion of the research mission; the Royal Commission on Health Services and the founding of new faculties of medicine; ACMC''s in-house research program; accreditation and ACMC''s links with medical education in the United States; and French-language medical education in Canada. The review points out the perennial nature of many of these issues, and how often perceived solutions to the problems later become problems themselves. It ends on the optimistic note that ACMC can successfully meet the challenges of the future.     

An international basic science and clinical research summer program for medical students

An important part of training the next generation of physicians is ensuring that they are exposed to the integral role that research plays in improving medical treatment. However, medical students often do not have sufficient time to be trained to carry out any projects in biomedical and clinical research. Many medical students also fail to understand and grasp translational research as an important concept today. In addition, since medical training is often an international affair whereby a medical student/resident/fellow will likely train in many different countries during his/her early training years, it is important to provide a learning environment whereby a young medical student experiences the unique challenges and value of an international educational experience. This article describes a program that bridges the gap between the basic and clinical research concepts in a unique international educational experience. After completing two semester curricula at Alfaisal University in Riyadh, Kingdom of Saudi Arabia, six medical students undertook a summer program at St. Boniface Hospital Research Centre, in Winnipeg, MB, Canada. The program lasted for 2 mo and addressed advanced training in basic science research topics in medicine such as cell isolation, functional assessment, and molecular techniques of analysis and manipulation as well as sessions on the conduct of clinical research trials, ethics, and intellectual property management. Programs such as these are essential to provide a base from which medical students can decide if research is an attractive career choice for them during their clinical practice in subsequent years. An innovative international summer research course for medical students is necessary to cater to the needs of the medical students in the 21st century.     

Medical Students in Canadian Universities: Report of Statistics, 1965-66

Enrolment in the 12 Canadian medical schools in 1965-66 reached a new high of 4023, an increase of 3.8% over 1964-65. The percentage of women among medical students (11.4%) was close to that for the preceding two years. The decline in the numbers of students from outside Canada continued into the present year; in 1965-66, 9.1% of medical students were non-Canadian. This decline has been primarily in the number of students from the U.S.A. The number of students from Commonwealth countries has shown a steady increase over the seven-year period under review; in 1965-66 they make up nearly one-half of all non-Canadian students. It was noted that 27% of overseas students came to Canada under governmental or intergovernmental sponsorship. Of the Canadian students, 95% came from the “home” provinces of the medical schools.     

Medical Students in Canadian Universities: Report of Statistics, 1966-67

Enrolment in the 13 Canadian medical schools in 1966-67 reached a new high of 4230, an increase of 5.1% over 1965-66. The percentage of women among medical students (12.1%) was close to that of the preceding three years. There has been a levelling off in the decline of students from outside Canada in 1966-67, when 9.5% of medical students were non-Canadian. The decline had been primarily in the number of American students, which continues. The number of students from Commonwealth countries has shown a steady increase during the eight-year period under review; in 1966-67, they make up nearly one-half of all non-Canadian students. It was noted that 18.5% of overseas students came to Canada under governmental or intergovernmental sponsorship. Of the Canadian students, 94% came from the “home” provinces of the medical schools.     

Postgraduate clinical education — the Canadian experience

To obtain a quantitative measure of the extent to which graduate education and qualification for specialty practice have become an integral part of the total educational experience, samples of the graduating classes of 1960, 1964, 1968 and 1970 of Canadian medical schools were tracked through postgraduate educational training and into specialty certification. From the 1960 cohort 65% chose a career recognized by special certifying exams in Canada and/or the United States, entered a residency, completed it and achieved certification of special competence. From the 1970 cohort, by the end of 1972 approximately 50% had entered a recognized specialty training program leading to certification. The diminishing trend toward specialty practice is demonstrated by reviewing the comparative figures in the 1964 and 1968 cohorts. Evidence garnered in this study indicates a continuing strong motivation for specialty practice although family medicine and/or general practice appear increasingly attractive as career choices. Strong provincial educational forces as well as social and other forces will probably continue to modify career selection and may lead an increasing number of Canadian medical graduates into family practice.     

A quantitative ranking of Canada's research output of original human studies for the decade 1989 to 1998

BACKGROUND: Since 1987 research articles have been catalogued with the author''s affiliation address in the 40 databases of the Medical Literature Analysis and Retrieval System (MEDLARS) of the National Library of Medicine, Bethesda, Md. The present study was conducted to examine the Canadian entries in MEDLARS to interpret past and future trends and to combine the MEDLARS demographic data with data from other sources to rank Canadian research output of human studies both nationally and internationally. METHODS: The PubMed Web site of the National Library of Medicine was used to count medical articles archived in MEDLARS and published from Jan. 1, 1989, through Dec. 31, 1998. The articles attributed to Canadian authors were compared by country, province, city, medical school, hospital, article type, journal and medical specialty. RESULTS: During the study period Canadian authors contributed on average 3% (standard deviation [SD] 0.2%) of the worldwide MEDLARS content each year, which translated to a mean of 11,067 (SD 1037) articles per year; 49% were human studies, of which 13% were clinical or controlled trials, and 55% involved people aged 18 years or less. In total, 68% of the articles were by authors affiliated with Canadian medical schools; those affiliated with the University of Toronto accounted for the greatest number (8604), whereas authors affiliated with McGill University had the greatest rate of annual increase in the quantity published (8%). Over one-third (38%) of the articles appeared in Canadian journals. When counted by specialty, 17% of the articles were by authors with clinical specialties, 5% by those with surgical specialties and 3% by those with laboratory specialties. INTERPRETATION: The annual rate of increase in research output for Canada was more than 3 times higher than that seen world wide. Canada is now ranked seventh among countries contributing human studies to MEDLARS. The increase indicates that Canada''s medical schools are productive, competitive in making contributions to medical science and are supporting Canadian journals.     

Too Few,Too Weak: Conflict of Interest Policies at Canadian Medical Schools

Introduction

The education of medical students should be based on the best clinical information available, rather than on commercial interests. Previous research looking at university-wide conflict of interest (COI) policies used in Canadian medical schools has shown very poor regulation. An analysis of COI policies was undertaken to document the current policy environment in all 17 Canadian medical schools.

Methods

A web search was used to initially locate COI policies supplemented by additional information from the deans of each medical school. Strength of policies was rated on a scale of 0 to 2 in 12 categories and also on the presence of enforcement measures. For each school, we report scores for all 12 categories, enforcement measures, and summative scores.

Results

COI policies received summative scores that ranged from 0 to 19, with 0 the lowest possible score obtainable and 24 the maximum. The highest mean scores per category were for disclosure and ghostwriting (0.9) and for gifts and scholarships (0.8).

Discussion

This study provides the first comprehensive evaluation of all 17 Canadian medical school-specific COI policies. Our results suggest that the COI policy environment at Canadian medical schools is generally permissive. Policy development is a dynamic process. We therefore encourage all Canadian medical schools to develop restrictive COI policies to ensure that their medical students are educated based on the best clinical evidence available, free of industry biases and COI relationships that may influence the future medical thinking and prescribing practices of medical students in Canada once they graduate.     

The Teaching of Psychiatry as Applied to Pediatrics: Proposals Based on a Report Prepared by the Education Committee,Canadian Paediatric Society

With changing patterns of pediatric practice, the practising physician needs to acquire a deeper understanding of the emotional and intellectual development of the child. Skill is also required in the techniques of interviewing and counselling parents, and, with a knowledge of the origin of behavioural disorders, in treating these disorders. The Education Committee of the Canadian Paediatric Society was asked to survey the present teaching of psychiatry as applied to pediatrics in all Canadian medical schools. Based on this survey and other studies, a training program for undergraduate medical students and graduates is proposed.     

EvoS: A Prescription for What Ails Pre-Medical Education?

Pre-medical students are certainly a widely varied group, with different motivations and experiences, different skills sets and interests. However, they often tend to approach their undergraduate education as a necessary evil that they must endure in order to achieve their ultimate goals. This article summarizes recent literature addressing some of the questions that have been raised regarding pre-medical education programs. Are students prepared for the intellectual, emotional, and even physical challenges of medical training? What deficiencies are commonly seen in entering medical students? What are students’ perceptions of how well their pre-medical studies helped them? Many of these studies have resulted in a call for more science training, while some have advocated for less, but with an enhanced focus on humanistic studies. We supply a brief outline of our Evolutionary Studies (EvoS) program and reflect upon how participation in this program can enhance pre-medical students’ education. Importantly, we argue that EvoS can expand students’ depth of understanding of science, as well as nurture their ability to think about the needs of their patients and the context of their medical practice.     

Family planning/contraception

It is the position of the Canadian Medical Association (CMA) that family planning advice and assistance should be readily available to all residents of Canada. This is viewed as a responsibility of practising physicians that is to be shared with other health and educational agencies. CMA has recommended the establishment of facilities in addition to physicians'' offices for the dissemination of advice on family planning. These facilities should be developed in consultation with and under the supervision of the medical profession. CMA believes induced abortion should not be an alternative to contraception as a method of responsible family planning. In the event of an unwanted pregnancy, full counselling services should be provided. Within the context of preventive medicine, CMA supports the development of educational programs in family living and the promotion of sex education in the school system by knowledgeable persons sensitive to the needs of students.     

Administrative issues in the management of a sports medicine program.

Sports medicine is a subspecialty of medicine which has recently gained prominence in this country. It is usually practiced in conjunction with a specific program of sports medicine in an institutional setting, such as a university. This article describes the integration of sports medicine and the department of athletics at Yale University. The athletic medicine department, as it is called, treats both the injuries and other medical problems of students participating in the organized athletic programs, be they intercollegiate or intramural, which are organized by the University. Problems that arise both medically, such as when to play an injured player, and administratively, such as who should supervise trainers, are discussed. Guidelines are given for choosing the director of this program, as are examples of how to deal with problems between the physicians and the coaches.     

Improving physician performance by continuing medical education.

In 1973 the division of continuing medical education of the University of Saskatchewan initiated a 3-year study to determine the effect of hospital-based education on the prescribing accuracy of physicians. This study was undertaken in response to an urgent need to develop more effective methods of continuing medical education and improved techniques of measuring their effectiveness. The educational program focused on common prescribing problems that had previously been defined by experts in the field. Problem frequency was determined by the monitoring of hospital records prior to institution of the educational program and at 3, 6 and 12 months after the program had concluded; this was found to be a satisfactory method of identifying educational needs and is considered to provide a measure of the quality of medical care. Fifteen physicians at three rural hospitals participated in the study. Seventeen physicians at two similar hospitals served as controls. The average problem frequency for topics selected at the study hospitals was reduced by 63% (the percentage of possible improvement), whereas at the control hospitals the frequency of the same problems declined by 32% over the same period. The results of this study provide evidence that an intensive, problem-based program on therapeutics can improve physician performance.     

Ecole d'été de l'A.C.E.M.I.—Ha?ti

Six Canadian medical students record their experience at a summer school of tropical medicine in Haiti, sponsored by the Canadian Association of Medical Students and Internes. The social, economic and medical background is described, including “Voodoo” practices, language and Haitian art. Attention is directed to the occurrence of umbilical tetanus, diarrhea and malnutrition. From even a brief stay in a country such as Haiti one comes to appreciate that a public health program in an underdeveloped nation is not strictly a medical undertaking but must be seen in its social and economic contexts.     

Introducing Indonesian Medical Students to Rainforest Conservation and Community Health in the Field: A Practicum Experience in East Kalimantan

This article describes a practicum experience developed between a conservation organization (The Nature Conservancy) and a medical school (The Faculty of Medicine at Mulawarman University in East Kalimantan). Through this practicum, groups of medical students from Mulawarman have assisted with baseline and follow-up community evaluations in remote villages along the Kelay River, Berau District. These evaluations were done in conjunction with the Kelay Conservation Health Program, a program designed to improve health and healthcare for local people, mostly former hunter–gatherers, in an area of rainforest that the conservation organization seeks to protect. Besides gaining experience in community health assessment, through this practicum medical students also gained field experience and knowledge in rural and remote area health and healthcare in Indonesia and had an opportunity to explore linkages between conservation and health. At the conclusion of their time with the program, participating students also presented individual problem-based reports on relevant topics to students and faculty at the Medical School and to the District Health Department. This partnership between a conservation agency and a medical school in a developing country is unusual, but has been very well received by all stakeholders involved. Because of this, Mulawarman is now planning to make Kelay into a formal training site for its students. This experience may serve as a model for other groups interested in promoting ecosystem health education to future health professionals in the developing world.     

医学生科研创新能力培养“3+X”模式的探索与实践

针对长期以来培养医学生的科研创新能力主要依靠零散的课外科研活动、受众面窄、没有系统性课程教学及其相关制度保障、致使对医学生科研创新能力培养明显乏力低效这一共性瓶颈教学问题,自2002年起,汕头大学医学院生物化学与分子生物学教学团队,在“科教相辅相佐”、“以学生为中心”、“以问题为导向”等先进教育理念指导下,倚重汕头大学医学院“医者之心”系列课程与书院育人文化之特色,发挥汕头大学的生物学、基础医学和临床医学一级学科均拥有本/硕/博/博后完整人才培养体系之优势,联合其他相关专业教学团队,在建立充分体现医学生科研创新能力培养内涵,覆盖医学本科5年全过程的核心课程体系的基础之上,历经20载的不懈努力,补充修善,成功构建了“3+X”模式,着力培养医学生的科研创新能力。所谓“3”意指对医学生的“全人培养”、“全程培养”和“全方位培养”。所谓“X”意指针对“3+X”模式运行效能的若干个验证性维度,主要包括组织医学生参加各种形式的全国大学生创新实验研究大赛、国际大学生学术研讨会,由医学本科生作为第一作者撰写发表学术论文等。培养医学生科研创新能力的成效十分显著,为有效解决上述共性瓶颈教学问题提供了一个有重要借鉴价值的范例。