4. Location Of Clinicians and Trainee Education At Dalhousie
(LOCATED)
Goal: Track Medical
Trainees’ career
choice and practice
location.
Where are Dal graduates going to
practice and in what career?
Did geographical placement during training affect
eventual practice location or career decision?
How do student demographics and characteristics affect career choice
and practice location?
5. LOCATED Project Methodology
Admission
Data Assessment tool
Data Sources
(ONE45)
Canadian Post M.D.
Education Registry
(CAPER)
Canadian
Medical
Directory
Geographic Information
System (GIS)
Statistics Canada
Integrated Longitudinal
Database
Demographic characteristics
Rural/Urban Background
Medical Training Placements
Discipline/Time spent
Practice & Career Choice
Census & Maps
Project Metrics
Large Centers (Pop >50,000)
Small Centers (10,000 > Pop < 50, 000)
Rural/Remote Communities (Pop <10,000)
7. Demographic Characteristics
37 %
Pre-Medical University Degree - Gender
Dalhousie University *Other Canadian Universities
28
DMNB Students
Ratio
1.8 : 1
Female : Male
Age Range
Admission Graduation
Youngest Oldest Youngest Oldest
20 38 24 42
Median Median
23.5 27.5
Permanent Residence (Admission Data)
100% *Canadian (New Brunswickers by Policy)
p =0.131
*p=0.034
*p < 0.001
63 %
37 %
68 %
32 %
3
LIC
8. Geographical Mapping
High School Locations
Pre-Medical University Locations
30
25
20
15
10
5
0
High School Experience Pre-Medical University Experience
Large
Centers
Small
Centers
Rural
Community
37%
31% 32%
89%
11%
Large Center
(Pop > 50,000)
Small Center
(10,000 < Pop < 50,000)
Rural Community
(Pop <10,000)
9. Average Time Spent at Communities during
Clerkship Clinical Placements
Med 4
(22wks)
**Residency Match Program :
Family Medicine (N=13)
DMNB Experience
Large Centers: 51.8 wks
Small Centers: 13 wks
Rural Communities: 4.1 wks
International: 1.2 wks
Unclassified: 0.2 wks
Missing Information: 0.4 wks
* Electives (On-site)
**Includes LIC Students (N=3)
Med 3
(48wks)
Med 1
(1.2wks)
Med 2
(On-site)
Average Total: 70.7 wks
10. Average Time Spent at Communities during
Clerkship Clinical Placements
Med 4
(22wks)
Residency Match Program :
Other Specialties (N=14)
DMNB Experience
Large Centers: 66 wks
Small Centers: 1.4 wks
Rural Communities: 4.3 wks
Unclassified: 0.1 wks
Missing Information:0.6
Med 3
(48wks)
Med 1
(1.2wks)
Med 2
(On-site)
* Electives (On-site)
Average Total: 72.3 wks
11. Residency Program Match’s Locations
– Heat Map
# of MD Graduates
per locations
Density of Residents
1 – Low Density
2
3
4
5
6
7
8
9 – High Density
12. Residency Program Match’s Locations per Career Choice
Family Medicine Medical Specialties
1
2
3 - 4
Surgical Specialties
48% Family Medicine 37% Medical Specialties 15% Surgical Specialties
3 – 4
14. Information Management Challenge
Challenges with Data Management
Longitudinal data:
Increased likelihood that
data can be missed, lost,
changed (e.g., last name
changes due to
marriage/divorce)
Policy Complexity
No existing
policies for
data
management
Non
standardized
due to multiple
input methods/
personnel
Data Integration
Access to Data
Variable,
inconsistent
nomenclature
/classifications
Ensuring
data are
used within
FoM and
provincially
Technology
Technology/
Data Acquisition
Nomenclature/
Specification
Data Input Data Storage/
Privacy/
Maintenance
Partnership
Agreements/
Access
15. Key Lessons Learned
Long Term Outcomes
• Historical data helped to advance trends that would take a long
time to be shown
• Do not draw conclusions from short term data
• Essential IT / GIS support
External Data
• Agreements were necessary for data sharing (Dal/ Canadian Post-M.D.
Education Registry (CAPER) by using a common identifier)
• Canadian Medical Directory annual reports addressed the CAPER time gap
Data Quality
• Make ‘essential’ information mandatory while collecting data
• Keep track of information over time (example: student name)
Policies
• Data standardization policies in the Faculty of Medicine are
necessary to effectively evaluate programs
• Access to information requires engagement of the
leadership/decision makers
• Information management policies are necessary for
longitudinal data maintenance
Outline:
Project Scope - Project Methodology - LOCATED Application Demonstration - Examples of Analysis - Challenges with Data Management - Lessons Learned
There is a complex data source (using internal administrative data, commercial database for training schedule and national databases) but no new data generated.
Which goes into integrated database and is categorized by population classification and displayed with a mapping system
A chi-square test showed that there is no significant difference in males and females, χ2 (1, N = 28) = 2.29, p = .131.
A chi-square test indicated that significantly more students listed Canada as country of permanent residence compared to the United States, χ2 (1, N = 28) = 24.14, p < .001.
When classifying prior university experience as Dalhousie or Non-Dalhousie, a chi-square test indicated that significantly more students did not go to Dalhousie (N = 19) than did go to Dalhousie (N = 8), χ2 (1, N = 27) = 4.481, p = .034.
An informal interpretation of a p-value, based on a significance level of about 10%, might be:
p =<0.01: very strong presumption against null hypothesis
0.01<p =<0.05: strong presumption against null hypothesis
0.05<p =<0.1: low presumption against null hypothesis
p>0.1: no presumption against the null hypothesis
Majority of the students were having high School in NON-Large Centers and Pre-Medical University in Large Centers
High School and Pre-Medical University locations concentrated in the Maritimes.
MD Graduates who had residency program match in Family Medicine had majority of their training in Large Centers,
Independent of their residency program match, LIC students were mostly in Small Centers while regular students (TBC) were having training in large centers
If someone asks:
ALL DMNB Students (N=28), independent of their residency program match, experienced
Large Centers: 59.1 wks
Small Centers: 6.6 wks
Rural Communities: 4.4wks Average LIC (DMNB) Total: 71.4 wks
International : 0.6 wks
Unclassified:0.20 wks
Missing Information:0.6 wks
Only LIC - Longitudinal Integrated Clerkship (N=3), independent of their residency program match, experienced
Large Centers: 12.9 wks
Small Centers: 53.3 wks
Rural Communities: 3.7 wks Average LIC (DMNB) Total: 74.1 wks
International : 4.3 wks
Only TBC - Traditional Block Clerkship (N=25) , independent of their residency program match, experienced
Large Centers: 64.6 wks
Small Centers: 1 wks
Rural Communities: 4.5 wks Average TBC (DMNB) Total: 71.1 wks
International: 0.1 wks
Unclassified: 0.2 wks
Missing Information: 0.7wks
Highest concentration of Residents in Halifax (N=9) and Fredericton (N=4), followed by:
Saint John, St John’s (N=3, each)
Moncton (N=2)
More Medical Specialties and Surgical Specialties in NS (Halifax), more Family Medicine in NB (Fredericton)
From those students who had high school experience in Large Centers, 86% were matched to residency locations in a Large Center and 14% in Small Centers;
From those students who had high school experience in Non -Large Center (Small Centers and Rural Communities) 100% were matched to residency locations in a Large Center;
Be matched to a Large Center for Residency Program was dominant, it represented 96% while to be matched to a Small Center represented 4%. None of the DMNB graduates were matched to a rural community for their Residency Programs.
In managing data, the greater the data collection the more important/complex policy is needed and domain policy become difficulty.
Caper data sharing is critical in cases where students change their name
