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.     

Applicants to Canadian Medical Schools for 1966-67

An examination of applicants to Canadian medical schools for 1966-67 revealed that 4534 applications were received for the approximately 974 available places. The number of Canadian applications was 2866 and these were made by 1815 individual applicants, an increase of 48 over 1965-66. United States applicants declined from 1143 to 1013.Evaluations made by the schools concerning the acceptability of the Canadian applicants disclosed that 55 applicants who rated as “acceptable” by one or more schools failed to gain admission to any medical school in 1966-67 (as compared to 36 in 1965-66). However, of those applicants who did find a place 76 were evaluated as “marginal” or “unacceptable”, while another 126 were rated as “acceptable” by one school but “marginal” and/or “acceptable” by one or more other schools.These results were interpreted to imply that the Canadian medical schools were still experiencing difficulty in attracting well-qualified applicants for study in medicine.     

Council on Medical Services says medical rehabilitation must be under MD direction

The 1976-77 statistical study of medical school enrollment by the Association of Canadian Medical Colleges shows that total enrollment in Canadian medical schools had increased 103.8% since 1960-61, although the rate of increase had decreased to almost zero by 1976-77. Women accounted for 30.3% of the total enrollment in 1976-77 (for all years of the course), which represents an increase of more than 550% in the 17-year period; for the 16 schools the proportion ranged between 23.9% and 43.8%. Enrollment of foreign students had decreased from 340 in 1966-67 to 90 (1.2%) in 1976-77; 71 of the 90 students were American. For the entire nation the mean number of medical students per 10 000 population was 3.1, but in British Columbia the figure was only 1.5. Of the Canadian and landed immigrant students 94.5% were attending medical school in their home province.     

Applications and Enrolments at the Western Medical Schools: A Study of Medical Matriculants for 1964

All applicants and those who subsequently enrolled for the 1964-65 session in the Western medical schools were studied with the hope that it would encourage a national registration of applicants. Seven hundred and sixty-four applicants completed 865 applications for 288 places in four schools. Although the principal factor in selecting medical students in all Western schools is pre-medical performance, 49 “good-quality” (academically of good standing and under 30 years of age) resident applicants were not accepted in their own provincial school, and 49 places were filled with “poor-quality” students.The loss of good applicants to the Western medical schools and the 20% overlap of each school''s applicant pool with that of other schools suggests that objective standards of quality must be developed, and that a regular annual national assessment of applicants should be conducted by the Association of Canadian Medical Colleges.     

Medical Student Enrolment in Canadian Universities

Statistical returns from the 12 Canadian medical schools revealed in 1962, for the fourth consecutive year, a larger first-year enrolment (946, 970, 1006 and 1057). This is attributed to an increase in qualified applicants and expansion in size of the first-year class in the face of a physician shortage. The proportion of women graduates increased from 5.2% in 1958 to 10.1% in 1962 (U.S.A., 5.6%). The academic calibre of entering students showed little change over five years, 1957-61. Recent impressions indicate an upward swing. Loss from withdrawals and dismissals was chiefly in first year (9.1%, 7.6% and 9.0%: 1959-60 to 1961-62), 40% being attributed to “nonacademic” causes. Foreign students now comprise 12.6% of the medical student body. A decrease in American and an increase in Commonwealth student numbers was noted. Recommendations include attention to drop-outs before and after registration and provision for stand-by applicants; the general adoption of some objective measure of qualification, e.g. the Medical College Admission Test; an on-going registry of applicants to Canadian medical schools for later retrospective studies and re-examination of admission policies for non-residents.     

Canadian-Trained Medical Scientists View Canadian Academia From Their American Laboratories

Interviews with 98 Canadian-trained basic medical scientists currently employed in the United States reveal that they were attracted to the United States by the belief that greater career opportunities exist in the United States than in Canada.They attributed the failure on the part of Canada to attract scientists to Canada and to retain their own graduates to: (1) Poor recruiting methods and a failure on the part of Canadian employees to keep in touch with Canadian scientists in American graduate and postgraduate training positions. (2) Scarcity of research funds. (3) Lack of opportunity in Canada occasioned by the smaller number of medical schools and medical research institutions as compared to the United States. (4) The negative conservatism of Canadian academic circles occasioned by academic inbreeding, anti-Semitism, Anglophilia and the tight control of research, research funds and university appointments by an oldguard “establishment”.     

Canadian Applicants to Medical Schools in Canada for 1965-66

An examination of applicants to Canadian medical schools for 1965-66 revealed that 4660 applications were received by the 12 schools for approximately 900 places available; 2852 of these were from Canadians, but because many applicants applied to more than one school, these 2852 applications represented only 1767 individuals. Evaluations made by the schools concerning the acceptability of these applicants showed that only 36 persons rated as “acceptable” by one or more schools failed to gain admission to any Canadian school for 1965-66. Furthermore, 66 “marginal” applicants were accepted, as were 130 multiple applicants who were rated as “acceptable” by one school but “marginal” and/or “unacceptable” by one or more other schools. Of the 464 multiple applicants, only 40% received the same evaluation from all schools to which they applied. If those multiple applicants who were rated as acceptable by all schools to which they applied are added to single applicants rated as acceptable, the pool of these clearly acceptable candidates (40% of all Canadian applicants) is sufficient only to fill 78% of places available. It was thus concluded that it is erroneous to speak of a surplus of well-qualified Canadian applicants at the present time.     

Effects of rising tuition fees on medical school class composition and financial outlook

Background

Since 1997, tuition has more than doubled at Ontario medical schools but has remained relatively stable in other Canadian provinces. We sought to determine whether the increasing tuition fees in Ontario affected the demographic characteristics and financial outlook of medical students in that province as compared with those of medical students in the rest of Canada.

Methods

As part of a larger Internet survey of all students at Canadian medical schools outside Quebec, conducted in January and February 2001, we compared the respondents from Ontario schools with those from the other schools (control group). Respondents were asked about their age, sex, self-reported family income (as a direct indicator of socioeconomic status), the first 3 digits of their postal code at graduation from high school (as an indirect indicator of socioeconomic status), and importance of financial considerations in choosing a specialty and location of practice. We used logistic regression models to see if temporal changes (1997 v. 2000) among Ontario medical students differed from those among medical students elsewhere in Canada apart from Quebec.

Results

Responses were obtained from 2994 (68.5%) of 4368 medical students. Across the medical schools, there was an increase in self-reported family income between 1997 and 2000 (p = 0.03). In Ontario, the proportion of respondents with a family income of less than $40 000 declined from 22.6% to 15.0%. However, compared with the control respondents, the overall rise in family income among Ontario students was not statistically significant. First-year Ontario students reported higher levels of expected debt at graduation than did graduating students (median $80 000 v. $57 000) (p < 0.001), and the proportion of students expecting to graduate with debt of at least $100 000 more than doubled. Neither of these differences was observed in the control group. First-year Ontario students were also more likely than fourth-year Ontario students to report that their financial situation was “very” or “extremely” stressful and to cite financial considerations as having a major influence on specialty choice or practice location. These differences were not observed in the control group.

Interpretation

At Canadian medical schools, there are fewer students from low-income families in general. However, Ontario medical students report a large increase in expected debt on graduation, an increased consideration of finances in deciding what or where to practise, and increasing financial stress, factors that are not observed among students in other provinces.Since 1997 all 5 Ontario medical schools have increased tuition fees dramatically. At the University of Toronto, for example, tuition nearly tripled in 3 years, from $4844 in 1997/98 to $14 000 in 2000/01. Tuition fees at other Canadian medical schools have been relatively stable (Fig. 1).Open in a separate windowFig. 1: Medical school tuition and ancillary fees in Ontario and elsewhere in Canada (Quebec excepted), 1997–2000. Source: Canadian Medical Education Statistics.²¹The effects of increasing tuition have not been examined systematically in Canada; however, concern has been expressed that accessibility is being compromised.^1,2,3 A small number of studies in the United States have investigated the effects of increasing tuition;^4,5 several US commentators have also argued that high tuition may restrict access to medical education for those from low-income families, underrepresented minority groups and rural areas.^6,7 Moreover, recent editorials have emphasized the advantages of a diverse, representative medical student body.^8,9,10 Aside from issues of accessibility, medical student diversity may also be beneficial for pragmatic reasons. Students from underrepresented groups are more likely to treat ethnic minorities,^11,12 practise in rural communities^13,14 and work in socioeconomically depressed areas.^15,16,17We studied the effects of increases in tuition fees on the demographic characteristics and attitudes of medical students by comparing students in Ontario, where tuition fees increased rapidly, with students from a control group of Canadian medical schools in provinces that did not experience a rapid increase. Our main hypotheses were that the increases in fees would be associated with increases in family income and expected debt at graduation. We also hypothesized that students in Ontario who enrolled after the increase would feel more financial stress than control students and be more likely to feel that financial considerations would affect their choice of specialty or practice location.     

The Epidemiologist's Dilemma: A Position Paper on the Role of Epidemiology in Canadian Research

Canadian epidemiology is currently in transition from being primarily interested in infectious disease to becoming active in investigating causes of non-infectious disease. Generally, epidemiologists limit their work to “field”, “basic”, or “theoretical” epidemiology. In all three fields there appears to be a shortage of qualified personnel which is likely to become even more acute because of new roles that epidemiologists will probably play in the future. A minimum of 40 full-time epidemiologists is currently required in Canada.Departments other than departments of preventive medicine at medical schools and teaching hospitals are currently spending 79.5% of all funds allocated for non-microbiological epidemiological research in Canada. Since epidemiology is by its very nature population orientated, rather than clinically orientated, clinicians require consultative advice from epidemiologists at many stages of their research. Epidemiological facilities in departments of preventive medicine should therefore be strengthened in order to provide research training and didactic courses needed as the numbers of physicians, nurses and paramedical persons are increased.     

Canadian-Trained Basic Medical Scientists, 1946-47—1963-64

The number of master''s and doctoral degree holders who obtained their degree in a basic medical science under the supervision of a Canadian medical faculty between 1946-47 and 1963-64 was obtained from the medical schools. Of the total degree holders, 69% are currently residing in Canada, 23% in the U.S.A., and the remaining 8% in overseas countries.Questionnaire returns from doctoral degree holders revealed that citizenship status at the time of graduation is positively related to migration; migration rates were lowest for Canadian-born and highest for landed immigrants and foreign students. Geographic mobility during training was also found to be a significant factor which increased the propensity to migrate. One-half of those who took further postdoctorate training in the United States are currently living in the United States, compared to 15% of those who received all their training in Canada. Information on current type of employment revealed that only a quarter of the Ph.D. respondents are in a basic science teaching position in Canada.     

Medical Students in Canadian Universities: Report of Statistics, 1963-64 and 1964-65

Recognizing Canada''s urgent need of physicians Canadian medical faculties have continued to increase first-year enrolment for the sixth successive year. Returns from the 12 medical schools showed that 1133 students began medical studies in 1964 compared with 1086 the previous year. Firstyear female students showed a decrease for the first time since 1959: 124 compared with 146 in 1963. Every tenth graduate is a woman; six years ago this ratio was one in 20. Loss of students from withdrawals and dismissals in 1963-64 occurred chiefly in the first year (9.2% as compared with 8.7% in 1962-63). Almost half of the loss in all four years of the course was for non-academic reasons. A decrease in American and a slight increase in Commonwealth and foreign first-year students was noted. Total foreign student enrolment continued to decline from a high of 485 in 1959-60 (13.7%) to 400 in 1964-65 (10.3%).     

Buffeted by harsh economic winds,medical schools turn a wary eye to the future

All parts of Canada''s health care system are facing fiscal pressures these days, but they are particularly great at Canada''s medical schools. However, Dr. David Hawkins of the Association of Canadian Medical Colleges is optimistic that all 16 of Canada''s medical schools will remain open, mainly because of the huge impact they have on health care in their local communities. “We don''t just turn out students — we raise the standard of health care in a whole community,” he says.     

Canadian-trained Physicians in United States Internships and Residencies: “Operation Retrieval” and Report of Statistics, 1966-1968

In response to a shortage of medical teachers and scientists, A.C.M.C. began “Operation Retrieval” in 1967 in an effort to contact and to survey graduates of Canadian medical schools who are interns and residents in the United States. This paper describes the publications produced for these graduates, and the concerns of graduates as discovered by on-site visits to Los Angeles, Boston and New York. These concerns centre around difficulties in communication with Canada. This paper also gives a statistical report on the numbers of graduates who are interns and residents in the United States, and the locations, fields of specialization and years of graduation of residents. The decreasing numbers are believed to reflect improving Canadian facilities as well as difficulties associated with the American military draft.     

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.     

The Premedical Education of the First-Year Class in Canadian Medical Schools: 1965-66

The premedical academic records of the 1965-66 entering class of Canadian medical students were analysed. Ninety-six per cent of the class had taken their preparation in a Canadian institution, while 80% had taken it in the same university as the medical school in which they enrolled. Forty per cent entered without a degree, the remainder having at least a bachelor''s degree in arts or science.Thirty-six per cent of all courses taken by these students in their premedical education were in the physical sciences, 22% in the biological sciences and 41% in the social sciences and humanities. One-third of the students had taken no course in the behavioural sciences and another third had taken only one course.Analysis of the level of performance of the entering class showed that 10% had obtained an A average, 49% a B average, 41% a C average and 3% a D average. The grades of these students were higher generally in the natural sciences than in the social sciences or humanities.It was concluded that it could be questioned whether medical students received a premedical preparation which met the philosophy of a “broad, liberal education”.     

A Census of Residents in Canadian Hospitals Approved for Training by the Royal College of Physicians and Surgeons of Canada,April 1965

A census taken in April 1965 revealed that there were 3162 residents training in Canadian hospitals approved by the Royal College of Physicians and Surgeons of Canada. Thirty-one of the 151 approved hospitals had no residents in training, and another 43 hospitals each having 20 or more residents accounted for 85% of all residents training in Canada. Fifty-seven per cent of the residents in Canada were Canadian citizens, 19% were landed immigrants, and 24% were foreign trainees. Major teaching hospitals contained 65% of all residents; 70% of Canadian graduates and 60% of non-Canadian graduates were training in major teaching hospitals. Hospitals approved for full training in the specialty of the trainee contained 57% of all residents; 64% of Canadian graduates and 48% of foreign graduates were in such hospitals.     

A Decade of Experience with Medical School Applicants at the University of British Columbia

During the decade 1952-1961, 2060 students applied for admission to the University of B.C. medical school. Only 1664 fulfilled the pre-medical requirements. This cluster of eligible applicants changed in size and characteristics as the medical school grew older; in general, the academic calibre of applicant cohorts improved as mean age fell and length of pre-medical training increased. A decline in the number of British Columbia applicants was to some extent balanced by an increase in other applicants.Forty-three per cent of eligible applicants were accepted by the screening committee. In contrast to the applicant cluster, freshman classes contained a disproportionate number of B.C. residents. Acceptance, however, was strongly correlated with good pre-medical academic performance and all M.C.A.T. scores except those for “Understanding Modern Society”. Unfortunately, one-quarter of all accepted students withdrew before registration and had to be replaced.These observations are interpreted in terms of student recruitment and the efficiency of the screening committee.     

Genome-Wide Diversity and Phylogeography of Mycobacterium avium subsp. paratuberculosis in Canadian Dairy Cattle

Mycobacterium avium subsp. paratuberculosis (MAP) is the causative bacterium of Johne’s disease (JD) in ruminants. The control of JD in the dairy industry is challenging, but can be improved with a better understanding of the diversity and distribution of MAP subtypes. Previously established molecular typing techniques used to differentiate MAP have not been sufficiently discriminatory and/or reliable to accurately assess the population structure. In this study, the genetic diversity of 182 MAP isolates representing all Canadian provinces was compared to the known global diversity, using single nucleotide polymorphisms identified through whole genome sequencing. MAP isolates from Canada represented a subset of the known global diversity, as there were global isolates intermingled with Canadian isolates, as well as multiple global subtypes that were not found in Canada. One Type III and six “Bison type” isolates were found in Canada as well as one Type II subtype that represented 86% of all Canadian isolates. Rarefaction estimated larger subtype richness in Québec than in other Canadian provinces using a strict definition of MAP subtypes and lower subtype richness in the Atlantic region using a relaxed definition. Significant phylogeographic clustering was observed at the inter-provincial but not at the intra-provincial level, although most major clades were found in all provinces. The large number of shared subtypes among provinces suggests that cattle movement is a major driver of MAP transmission at the herd level, which is further supported by the lack of spatial clustering on an intra-provincial scale.     

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.