Medical School in Canada
I was recently contacted by Jessica, a 21-year old 2nd year medical student at the University of Alberta in Canada, offering to teach us about Medical Education in Canada! She complete 3 years of undergrad in Vancouver, BC – her focus of study was Microbiology. Jessica runs the blog Atalanta’s Antics and also tells me she’s a film nut, choir director, hockey pseudo-player, actor, pianist and BBC fan. This chick is the dictionary definition of well-rounded, y’all.
If you’re new around here, let me explain. This post is an extension of the Medical Education Mondays series I started a while back. In addition to random Med Ed information, I’ve had an array of fabulous guest bloggers share info on medical school in the United States, Belgium, United Kingdom, Spain, Egypt, Australia, Saudi Arabia, Greece, South Africa and the Dominican Republic. You can see these cool posts, as well as the rest of the Med Ed Monday series, here.
Jessica’s Talks Medical School in Canada (frank additions by me are in orange):
Getting In:
At what age does one typically begin medical school?
It varies. I started when I was 20, but I’m a bit young for my class since I got in after only 3 years of university. Technically, you only have to finish 2 years of undergrad to apply for the University of Alberta, but it’s extremely competitive at that point. Most people get in after finishing their Bachelor’s degree, so that makes them about 22-23 years old. There’s also a lot of Master’s and PhD students, as well as people who had a career before applying, so ages can range anywhere from 21 to 40. Other schools are different – some require a finished degree, while others essentially require a Master’s to be competitive.
What exams does one have to take to get in?
The big one is the MCAT, just like in the United States. It’s a 5-hour with 4 components:
- Physical Science (ex. physics, inorganic chem).
- Biological Science (ex. biology, organic chem).
- Verbal Reasoning (i.e. reading comprehension).
- Writing Sample.
The first 3 are multiple choice and each are bell-curved and scored out of 15 (i.e. one year, getting 49/52 may be a 14, another year may be a 12). The writing sample is ranked from J (lowest) to T (highest), so you end up with something like 10-9-10 R (29R). For the year I wrote it, I got a 11-11-11 Q (33Q), which was about the 86th percentile.
In addition to the MCAT, you also have to interview at each school you’re invited to, usually using the Multiple Mini-Interview (MMI) format. This consists of a series of stations, each with a different topic or ethical dilemma to discuss with an interviewer. So, you’re not judged solely on one interview by one panel, but rather on multiple topics by multiple people.
Is there any required pre-requisite coursework?
This also depends on the school. The U of Alberta requires some general chemistry, organic chem, biology, physics, English, statistics, and biochemistry. Other schools like the University of Calgary don’t have a set list of courses. That being said, you don’t have to be a science major to get in – in our class we’ve even got a photography major and a carpenter!
Is it a competitive occupation?
Yes. The acceptance rate is about 10% across the country, with about 50% of those getting interviews being accepted. Doctors are in extremely high demand right now, so they can make excellent money. It’s not uncommon for people to apply for several years before getting in. I applied to 3 schools and got interviews for all of them. However, I think due to my age, I was rejected from 2 and waitlisted for the school I’m in now. A few weeks later I was accepted, but there are a lot of excellent, intelligent people rejected each year.
What are you called at this stage of training?
Before getting in, you’re just an undergrad student. Some people identify themselves as “pre-med,” but given the 10% acceptance rate, I think it’s a bit presumptuous.
Being In:
How long is it?
Four years.
How are the years broken down?
- Pre-Clinical: The first two years include mostly classwork, labs, and some clinical skills and patient interaction. The year is broken down into system “Blocks” that vary by school. In first year my school has Infection Inflammation Immunology (Triple I), Endocrine, Cardiology, Pulmonary, and Renal blocks. In second year, we do Gastrointestinal, Reproduction and Urology, Musculoskeletal (MSK), Neurology, and Oncology. Throughout the year, we also have Patient-Centered Care (PCC) classes, cadaver lab, an elective, and clinical skills.
- Clinical: 3rd and 4th years are “clinical” years, where you do rotations in all the major fields: Pediatrics, General Surgery, Anaesthesiology, Internal Medicine, Psychiatry, Obstetrics & Gynecology, Urban and Rural Family Medicine, Emergency Medicine, Specialty Surgery, and Geriatrics. There’s also elective time and a bit of mandatory lecture.
If you opt for the Integrated Community Clerkship (ICC) option, you spend your entire 3rd year in a rural community with no rotations, just learning everything at once and getting lots of hands-on experience.
Describe your typical day.
Applicable to pre-clinical years: Class usually starts at 8:00 with lecture for a few hours, followed by Discovery Learning (DL) where we get into small groups and work our way through some cases relevant to the block from diagnosis to treatment to prognosis. After lunch may be more lectures or clinical skills, depending on the week. Cadaver lab is Friday mornings with PCC on Tuesday and Thursday afternoons – right now, being in repro block, we’re practicing how to take a sexual history. There’s a quiz every Friday, so we really have to keep on top of our studying!
If you choose a specialty, when do you have to decide by?
Residency matching (CaRMS) is late in 4th year, so most people have it figured out by the beginning/middle of 4th year.
What are you called at this stage of training?
The lowly Medical Student. 😉
Getting Out:
What exams do you have to take?
- At the end of 2nd year there’s a comprehensive exam and Objective Structured Clinical Exam (OSCE, i.e. interviews, clinical skills, patient interaction…) on all the pre-clinical stuff.
- At the end of 4th year, there’s the MCCQE Part I (Medical Counsel of Canada Qualifying Exam) – a multiple-choice and short-answer, all-day test on everything you’ve learned. You need to be able to draw on clinical experience and medical know-how to explain decision-making. This must be passed to move onto residency.
- The MMC part II is basically a 3-hour OSCE that determines if you can move onto independent clinical practice.
Do most people graduate?
Absolutely. It’s extremely expensive to train a physician, so the faculty does everything in its power to make sure everyone graduates. People don’t usually drop out because of the difficulty, it’s almost always for financial or personal reasons. At my school we have a tradition that if everyone that enters 3rd year graduates, the dean of medicine wears white gloves to the convocation.
When are you finally considered a “doctor?”
Once you finish 4th year and pass your MCC part I, you’re considered a physician.
Do you have additional training after MS or do you start working immediately?
Yes – there’s residency for every field. Residents are paid, but it’s not nearly as much as when you’re finished with residency. You can also do a fellowship after completing residency, which is extra specialized training. Often these are done if the community where you plan to work needs a specific skill or if there are no jobs available in your specialty (currently common in cardiothoracic surgery) and you want something extra to put on your CV.
What’s the average debt for attendance?
It varies a bit by school, but tuition is around $13,000 per year, and many students expect to accumulate upwards of $60,000 in debt by the time they hit residency. Some students I know have $100,000 lines of credit that they use to condense living and academic expenses.
What are you called at this stage of training?
Once you pass the MCC part I and complete, 4th year, congrats! You’re now a physician!
Being Out:
What’s the average salary?
It varies by specialty and province and the numbers given by the College of Physicians and Surgeons aren’t very accurate, since a lot of people work part time in certain fields. On average, though, family physicians make around $200K, specialists make around $250K, and surgical specialists make around $350K.
Is the job security good?
Generally, yes. Once you have a job, you can keep it for as long as you want. The trick is finding the jobs, sometimes. For example, right now we’ve got an excess of cardiothoracic surgeons, so it’s difficult for them to find OR time.
Can you switch specialties?
Yes, it’s difficult, though. There are a lot of hoops to jump through since you basically have to be re-matched (into a new residency). However, about 80% of medical students across Canada get their first choice in residency matching, so it’s rare for someone to want to completely switch fields. You need an extremely good reason and must not be leaving a gap in your specialty for the College to allow you to re-specialize.
What are you called at this stage of training?
Resident Physician until residency training is complete, then fully-certified Physician.
Overall, medical training in Canada seems to be almost identical to medical training in the United States. If you look through the other Med Ed Monday posts you’ll see that this is a drastic difference from the layout of medical school in many other countries around the world.