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Inge Schabort
McMaster University, IMG Pre-Residency IMG Program
Plenary IV: Research on Impacts and
Outcomes
Plenary IV
Research on Impacts and Outcomes
Touchstone Symposium:
Perspectives on Successful Transitions for
Internationally Educated Health Professionals.
Dr Inge Schabort MB ChB CCFP FCFP
Associate Professor, IMG Coordinator
McMaster University
Schabort
Conflicts
• I am an IMG
• None other
Schabort
Objectives
• Chronological tour of Ontario IMG literature
and research
• A few significant IMG outcome research
studies
Schabort
Dealing with Discrimination
Schabort
Ontario commissioned Thomson and
Cohl Judicial reports 2011
• 33 recommendations
• Most recommendations accomplished since
Schabort
http://www.health.gov.on.ca/en/common/min
istry/publications/reports/thomson/v1_thoms
on.pdf
Schabort
Schabort
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Thomson Working Group Struck
• 33 recommendations worked through since
2011
Schabort
Schabort
The selection of international
medical graduates to
residency programs
What selection information best
predicts success at college
certification exams?
Inge Schabort, Sharon Cameron &
Lawrence GriersonSchabort
Schabort
Background
• Due to the physician shortage, more IMG’s than ever before are admitted
to residency programs in Canada.
0
500
1000
1500
2000
2500
1998 2004 2009
IMGsenteredintogradauteprograms
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COLLEGE EXAM PASS RATE
(FMEC IMG report)
FAMILY MEDICINE
YEAR CMG IMG
residency
trained
2007 90.4% 66.0%
2008 74.0%
2009 64.0%
2010 51.0%
ROYAL COLLEGE PRIMARY SPECIALTY
EXAMS first attempt
YEAR CMG IMG
2005-2009 96% 75%
Walsh A, Banner S, Schabort I, Armson
H, Bowmer I, Granata B. International
Medical Graduates - Current Issues.
Members of the FMEC PG consortium;
2011.
Schabort
Literature Review
• IMG Predictors for Success
– Age (Kanna 2009)
– Time since medical school graduation(Bates 2001),
(Bates 2000), (Bessant 2006)
– Recent clinical experience (Part and Markert 1993)
– Performance on Standardized exams (Kanna 2009)(
Part and Markert 1993), (Shiroma 2010),(Perez 2009)
– Variable undergraduate education amongst IMGs (Van
Zanten and Boulet 2008)
– English Language proficiency
– Doing a clerkship in Canada before residency
(MacLellan 2012)
Schabort
More predictors
• Medical School attended
• Country of training as predictor for college
complaints
Schabort
Hypotheses
• Age; Time since graduation/last practice (Kanna, 2009;
Bessant, 2006)
• Language and Cultural Difficulties (Bates, 2000; 2001)
• Differences in medical education (vanZanten & Boulet,
2008)
• Professional Experience (clinical, internship, research)
(MacLellan, 2012)
Schabort
Purpose
• As a first step in untangling the various proposed
factors/mechanisms that impact IMG certification success this
study reports the information that is available to the
McMaster University residency program at the time of the
Canadian Residency Matching Service (CaRMS) that predicts
IMG success at the college certification exams.
Schabort
Methods
• Linear and logistic regression analyses determined the degree to which
the information available at the time of residency selection predicts the
performance of McMaster University IMG residents on the CFPC (n = 69)
and RCPSC (n = 85) certification examinations between 2005 and 2011.
• Regression models accounted for:
– Demographics (age, nationality, first language)
– Education (country of medical schooling, years since
graduation)
– Experience (internship, residency, professional, research)
• MCC-EE scores were correlated with certification exam scores
Schabort
Results
• Demographic Factors
– CFPC IMGs that do not speak English as a first language
performed about 4 points better on the SOOs, ß = 4.4, p = .05.
– CFPC IMGs born outside of Canada did about 3.5 points better
on the SAMPS than Canadians who studied abroad, ß = 3.4, p =
.049.
– Although not significant, age was a negative predictor for CFPC
IMGs, odds ratio = .86, p = .122, and RCPSC IMGs, odds ratio =
.84, p = .13. With each year older, CFPC IMGs and RCPSC IMGs
were 14% and 16% , respectively, less likely to pass their overall
certification exams.
Schabort
Results
• Education Factors
– For every unit increase of the Human
Development Index of the country of medical
schooling, CFPC IMGs' scores on the SOOs
increased by 18 points, ß = 17.8, p = .046.
– Years since graduation was not a significant
predictor
Schabort
Results
• Experience Factors
–For CFPC IMGs, professional experience had a significant
negative relationship with outcomes on the Simulated Office
Orals (SOOs), ß = -5.1, p = .042, and Short Answer
Management Problems (SAMPS), ß = -4.4, p = .045.
– RCPSC IMGs that participated in a previous internship increased their odds of
passing the RCPSC certification exam by 4 times; odds ratio = 4.1, p = .02.
– The impact of professional experience on CFPC IMGs’ overall CFPC Certification
outcomes wasn't significant. However, the analysis does indicate that those with
professional experience were approximately 60% more likely to be unsuccessful,
odds ratio = .39, p = .18.
Schabort
Results
• MCC-EE scores were positively correlated with CFPC IMGs’
performances on the SAMPS (r = .481, p < .001) and overall
certification success (r = .317, p = .018) as well as RCPSC IMGs’
certification success (r = .264, p = .027).
Schabort
Narrowing the Hypotheses
• Age
– Age-related decline or associated factors?
• Differences in Medical Education
– Which Schools in which Countries?
– Normalizing Transcripts…an HDI by transcript algorithm?
• The Role of Previous Experience
– The cultural implications of practice experience?
• …And the seemingly less relevant…
– Time Since Medical School Graduation
– Language Difficulties
Schabort
Limitations and/or Next Steps
• Single Institution Data Set
– Collaborative data analysis across institutions
• Limited Test data
– MCC inclusion of QE1 and QE2 scores
– REB approval has just been obtained
Schabort
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• Book: Women in Medicine 2017
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Surveys of IMGs -Themes identified
Schabort
Schabort
Schabort
Schabort
Schabort, Cervin, Bandiera
Schabort
Schabort
Schabort
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MMI and professionalism
• Hoffmeister found that “there is evidence that
the MMI offers a reliable and valid assessment
of professionalism in IMG doctors applying for
Canadian family medicine residencies and that
this clinically situated MMI assessed facets of
competency other than those assessed by the
OSCE.”
MMI’s
• MMIs have several strengths: they can be
designed to best fit relevant competencies, e.g.
teamwork, communication skills. Studies suggest
that MMIs are a reliable measure of non-
cognitive attributes such as empathy, cultural
sensitivity, advocacy and communication skills
which are all important attributes for a doctor
which can be observed in a specific context.
Inferences may be made that MMIs help to
protect patient safety as candidates are being
observed and rated on doing a work sample.
MMI better predictor than OSCE
• Eva et al. (2004b) and Reiter et al. (2007)
found MMIs to be a better predictor of
performance on OSCEs than more established
methods of selection (e.g. GPAs and
traditional interviews). MMIs cannot be
coached for as there is not one formulaic
answer and therefore security breaches in the
selection process would not affect the
performance of the candidate (Reiter et al.,
2005 and Griffin et al., 2008).
MMI Costs
• MMIs are initially costly and time consuming
to set up in terms of person hours and
expense (e.g. development of the blueprint of
competencies and scenarios, training the
raters/interviewers and hiring the number of
rooms required for the stations). However the
value in terms of the reliability and validity
over more traditional unstructured interviews
may outweigh these initial costs.
Computer based non-cognitive pre-
interview test
• Dore et al explored the development of a non-
cognitive pre-interview screening test that
correlates with the well-validated MMI and
performs multiple sample evaluation of non-
cognitive skills (CMSENS) .This has possible
future implications for IMG evaluation eg. to
be administered remotely using the computer
platform currently used for eg the MCCEE
where the IMG can perform the assessment at
any of the multiple sites outside of Canada.
However…
Schabort
Questions?
• ischabo@mcmaster.ca
Schabort
References• Examindation Results, Medical Council of Canada. Retrieved from www.mcc.ca/en/NAC/examination_results.shtml
• Akl EA, Izuchukwu IS, El-Dika S, Fritsche L,Kunz R, Schunemann HJ. Integrating an Evidence-Based Medicine Rotation into an Internal Medicine Residency
Program. (2001) Acad Med. Sep;79(09):897-904.
• Al-Amaie, Sameeh M,Al-Baghli N,Barriers Facing Physicians Practicing Evidence-Based Medicine in Saudi Arabia. Journal of Continuing Education in the
Health Professions 24(3) 163-170.
• Allan GM, Manca D, Szafran O, Korownyk C. (2007) EBM a challenge for international medical graduates. Fam Med. Mar;39(3):160.
• Allan GM, Korownyk C, Tan A, Hindle H, Kung L, Manca D. (2008) Developing an Integrated evidence-based medicine curriculum for family medicine
residency at the University of Alberta. Acad med. Jun;83(6):581-7.
• Altmaier, E. et al., (1989). Cross-Institutional Stability of Behavioral Criteria Desirable for Success in Radiology Residency. Investigative Radiology, 24(3),
pp.249-51
• Andrew, R. (2010). How do IMGs compare with Canadian Medical Graduates in a Family Practice Residency Program? Can Fam Physician, 56e:318-22.
• Bates J, A. R. (2000). Program for Licensure for International Medical Graduates in British Columbia - 7 years experience. CMAJ, 162(6): 801-3.
• Bates J, A. R. (2001). Untangling the roots of some IMGs' poor academic performance. Acad Med, 76(1):43-6.
• Bell, J., Kanellitsas, I., & Shaffer, J. (2002). Selection of Obstetrics & Gynecology Residents on the Basis of Medical School Performance. American Journal
of Obstetrics & Gynecology , 186:1091-4.
• Bessant, R., Bessant, D., Chesser, A., & Coakley, G. (2006). Analysis of Predictors of Success in the MCRP (UK) PACES examination in candidates attending a
revision course. Postgraduate Medical Journal , 82:145-149.
• Blonski, J., & Rahm, S. (2003). The Relationship of Residency Performance to Match Status and US versus International Medical Graduates. Family
Medicine, 35(2): 100-4.
• Blouin, D., & Dagnone, J. (2008). Performance Criteria for Emergency Medicine Residents: A Job Analysis. Canadian Journal of Emergency Medicine , 10(6):
539-44.
• Boulet, J., McKinley, D., Rebbecchi, T., & Whelan, G. (2007). Does Composition Medium Affect the Psychometric Properties of Scores on an exercise
Designed to Assess Written Medical Communication Skills? Advances in Health Sciences Education , 12:(2): 157-167.
• Boulet, J., Rebecchi, T., Denton, A., McKinley, D., & Whelan, G. (2004). Assessing the Written Communication Skills of Medical School Graduates. Advances
in Health Sciences Education , 9:(1);47-60.
• Boulet, J., Swanson, D., Cooper, R., Norcinii, J., & McKinley, D. (2006). A comparison of the characteristics and examination performances of US and non-
US citizen international medical graduates who sought Educational Commission for Foreign Medical Graduates certification. Acad Med, 81 (10 Suppl):
S116-9.
• Brotherton, S., & Etzel, S. (2007). Graduate Medical Education. Journal of American Medical Association , 298(9):1081-1096.
• Brown, C., Wakefield, S., & Bullock, A. (2003). The Selection of GP trainees in the West Midlands: Second Audit of Assessment Centre Scores by Ethnicity
and Country of Qualification. Medical Teacher , 25 (6) 649-653.
• Cartwright CA, Korsen N, Urbach LE. (2002) Teaching the Teachers: Helping faculty in a family practice residency improve their informatics skills. Acad Med
May;77(5):385-91.
• Chamberlain, T.C., Catano, V.M. & Cunningham, D.P, (2005). Personality as a predictor of professional behavior in dental school: comparisons with dental
practitioners. Journal of Dental Education. 69(11), pp.1222-37.
• Chamorro-Premuzic, T., Furnham, A. & Ackerman, P.L., (2006). Incremental validity of the typical intellectual engagement scale as predictor of different
academic performance measures. Journal of Personality Assessment. 87(3), pp.261-8.
• Dirschl, D., Dahners, L., Adams, G., Crouch, J., & Wilson, F. (2002). Correlating Selection Criteria with Subsequent Performance as Residents. Clinical
Orthopaedics and Related Research , 399:265-271.
• Dore, K. L., Reiter, H. I., Eva, K. W., Krueger, S., Scriven, E., Siu, E., et al. (2009). Extending the Interview to All Medical School Candidates - Computer-Based
Multiple Sample Evaluation of Noncognitive Skills (CMSENS). Academic Medicine, 84:10 pp S9-S12.
• Eva, K., Reiter, H., Rosenfeld, J., & Norman, G. (2004). The ability of the multi-mini interview to predict preclerkship performance in medical school.
Academic Medicine, 79(10 Suppl), pp. S40-2.
• Eva, K., Reiter, H., Rosenfeld, J., & Norman, G. (2004). The relationship between interviewers' characteristics and ratings assigned during a multiple mini-
interview. Academic Medicine, 79(6), pp 602-9.
Schabort
References Continued
• Korenstein D, Dunn A, McGinn, T. Mixing it up: Integrating evidence-based medicine and patient care. Acad Med Jul;77(7):741-2.
• Lee, A., Golnik, K., Oetting, T., Beaver, H., Boldt, H., Olson, R., et al. (2008). Re-Engineering the Resident Application Process in Opthalmology: A
Literature Review and Recommendations for Improvement. Survey of Opthalmology , 53 (2) 164-176.
• MacLellan, A., Brailovsky, C., Rainsberry, P., Bowmer, A., & Desrochers, M. (2010). Examination outcomes for International Medical Graduates
pursuing or completing Family Medicine Residency training in Quebec. Can Fam Physician, 56:912-8.
• McClintock, J., & Gravlee, G. (2010). Predicting Success on the Certification Examinations of the American Board of Anesthesiology. Anesthesiology ,
112:212-9.
• Papadakis, M., G, A., Holmbee, E., & Lipner, R. (2008). Performance during Internal Medicine Residency Training and Subsequent Disciplinary action
by Stat Licensing Boards. Annals of Internal Medicine , 148(11); 869-876.
• Part, H., & Markert, R. (1993). Predicting the first year performances of international medical graduates in an internal medicine residency. Acad Med,
68(11): 856-8.
• Perez JA, Greer ES. (2009) Correlation of United States Medical Licensing Examination and Internal Medicine In-Training Examination performance.
Adv in Health Sc Educ 14;753-758
• Pilotto LS, Duncan GF and Anderson-Wurf J. (2007). Issues for clinicians training international medical graduates: a systematic review. Medical
Journal of Australia; 187(4):225-228.
• Poole, A., Catano, V.M. & Cunningham, D.P. (2007). Predicting performance in Canadian dental schools: the new CDA structured interview, a new
personality assessment, and the DAT. Journal of Dental Education. 71(5), pp.664-76.
• Posthuma, R., Morgeson, F., & Campion, M. (2002). Beyond Employment Interview Validity: A Comprehensive Narrative Review of Recent Research
and Trends Over Time. Personnel Psychology , 55:1-81.
• Quintero, A., Segal, L., King, S., & Black, K. (2009). The Personal Interview: Assessing the Potential for Personality Similarity to bias the Selection of
Orthopaedic Residents. Academic Medicine , 84:1364-1372.
• Rao, N., Meinzer, A., Primavera, L., & Augustine, A. (1991). Psychiatry Residency Selection Criteria for Maerican and Foreign Medical Graduates.
Academic Psychiatry , 15:69-79.
Schabort
References Continued
• Griffin, B., Harding, D., Wilson, I., & Yeomans, N. (2008). Does practice make perfect? The effect of
coaching and retesting on selection tests uses for admission to an Australian medical school. Med J.
Aust, Oct 6;189(7):416.
• Hall P, Keely E, Dojeiji S, Byszewski A, and Marks M. (2004). Communication skills, cultural
challenges and individual support: challenges of international medical graduates in a Canadian
healthcare environment. Medical Teacher 26(2):120-125
• Hayden, S., Hayden, M., & Gamst, A. (2005). What Characteristics of Applicants to Emergency
Residency Programs Predict Future Success as an Emergency Medicine Resident? Academic
Emergency Medicine, 12 (3) 206-10.
• Hofmeister, M., Lockyer, J., & Crutcher, R. (2009). The multiple mini-interview for selection of
international medical graduates into family medicine residency education. Medical Education,
Volume 43, Issue 6 pages 573-579.
• Illing, J., Campbell, M., Kergon, C., Thompson, N., Burford, B., Morrow, G., et al. (n.d.). Selection
Methods for Foundation Programme: A Literature Review. Retrieved November 14, 2010, from
www.medschools.ac.uk/aboutus/projects/documents/appendix%20K%20Newcastle%20Literature
%20Review.pdf
• Kanna, B., Gu, Y., Akhuetie, J., & Dimitrov, V. (2009). Predicting Performance using Background
Characteristics of International Medical Graduates in an inner-city University-Affiliated Internal
Medicine residency training program. BioMed Central, 9:42.
•
Schabort
2017 Perspectives Symposium
March 2, 2017
#Perspectives2017

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Perspectives 2017: Inge Schabort

  • 1. Inge Schabort McMaster University, IMG Pre-Residency IMG Program Plenary IV: Research on Impacts and Outcomes
  • 2. Plenary IV Research on Impacts and Outcomes Touchstone Symposium: Perspectives on Successful Transitions for Internationally Educated Health Professionals. Dr Inge Schabort MB ChB CCFP FCFP Associate Professor, IMG Coordinator McMaster University Schabort
  • 3. Conflicts • I am an IMG • None other Schabort
  • 4. Objectives • Chronological tour of Ontario IMG literature and research • A few significant IMG outcome research studies Schabort
  • 6. Ontario commissioned Thomson and Cohl Judicial reports 2011 • 33 recommendations • Most recommendations accomplished since Schabort
  • 10. Thomson Working Group Struck • 33 recommendations worked through since 2011 Schabort
  • 12. The selection of international medical graduates to residency programs What selection information best predicts success at college certification exams? Inge Schabort, Sharon Cameron & Lawrence GriersonSchabort
  • 14. Background • Due to the physician shortage, more IMG’s than ever before are admitted to residency programs in Canada. 0 500 1000 1500 2000 2500 1998 2004 2009 IMGsenteredintogradauteprograms Schabort
  • 15. COLLEGE EXAM PASS RATE (FMEC IMG report) FAMILY MEDICINE YEAR CMG IMG residency trained 2007 90.4% 66.0% 2008 74.0% 2009 64.0% 2010 51.0% ROYAL COLLEGE PRIMARY SPECIALTY EXAMS first attempt YEAR CMG IMG 2005-2009 96% 75% Walsh A, Banner S, Schabort I, Armson H, Bowmer I, Granata B. International Medical Graduates - Current Issues. Members of the FMEC PG consortium; 2011. Schabort
  • 16. Literature Review • IMG Predictors for Success – Age (Kanna 2009) – Time since medical school graduation(Bates 2001), (Bates 2000), (Bessant 2006) – Recent clinical experience (Part and Markert 1993) – Performance on Standardized exams (Kanna 2009)( Part and Markert 1993), (Shiroma 2010),(Perez 2009) – Variable undergraduate education amongst IMGs (Van Zanten and Boulet 2008) – English Language proficiency – Doing a clerkship in Canada before residency (MacLellan 2012) Schabort
  • 17. More predictors • Medical School attended • Country of training as predictor for college complaints Schabort
  • 18. Hypotheses • Age; Time since graduation/last practice (Kanna, 2009; Bessant, 2006) • Language and Cultural Difficulties (Bates, 2000; 2001) • Differences in medical education (vanZanten & Boulet, 2008) • Professional Experience (clinical, internship, research) (MacLellan, 2012) Schabort
  • 19. Purpose • As a first step in untangling the various proposed factors/mechanisms that impact IMG certification success this study reports the information that is available to the McMaster University residency program at the time of the Canadian Residency Matching Service (CaRMS) that predicts IMG success at the college certification exams. Schabort
  • 20. Methods • Linear and logistic regression analyses determined the degree to which the information available at the time of residency selection predicts the performance of McMaster University IMG residents on the CFPC (n = 69) and RCPSC (n = 85) certification examinations between 2005 and 2011. • Regression models accounted for: – Demographics (age, nationality, first language) – Education (country of medical schooling, years since graduation) – Experience (internship, residency, professional, research) • MCC-EE scores were correlated with certification exam scores Schabort
  • 21. Results • Demographic Factors – CFPC IMGs that do not speak English as a first language performed about 4 points better on the SOOs, ß = 4.4, p = .05. – CFPC IMGs born outside of Canada did about 3.5 points better on the SAMPS than Canadians who studied abroad, ß = 3.4, p = .049. – Although not significant, age was a negative predictor for CFPC IMGs, odds ratio = .86, p = .122, and RCPSC IMGs, odds ratio = .84, p = .13. With each year older, CFPC IMGs and RCPSC IMGs were 14% and 16% , respectively, less likely to pass their overall certification exams. Schabort
  • 22. Results • Education Factors – For every unit increase of the Human Development Index of the country of medical schooling, CFPC IMGs' scores on the SOOs increased by 18 points, ß = 17.8, p = .046. – Years since graduation was not a significant predictor Schabort
  • 23. Results • Experience Factors –For CFPC IMGs, professional experience had a significant negative relationship with outcomes on the Simulated Office Orals (SOOs), ß = -5.1, p = .042, and Short Answer Management Problems (SAMPS), ß = -4.4, p = .045. – RCPSC IMGs that participated in a previous internship increased their odds of passing the RCPSC certification exam by 4 times; odds ratio = 4.1, p = .02. – The impact of professional experience on CFPC IMGs’ overall CFPC Certification outcomes wasn't significant. However, the analysis does indicate that those with professional experience were approximately 60% more likely to be unsuccessful, odds ratio = .39, p = .18. Schabort
  • 24. Results • MCC-EE scores were positively correlated with CFPC IMGs’ performances on the SAMPS (r = .481, p < .001) and overall certification success (r = .317, p = .018) as well as RCPSC IMGs’ certification success (r = .264, p = .027). Schabort
  • 25. Narrowing the Hypotheses • Age – Age-related decline or associated factors? • Differences in Medical Education – Which Schools in which Countries? – Normalizing Transcripts…an HDI by transcript algorithm? • The Role of Previous Experience – The cultural implications of practice experience? • …And the seemingly less relevant… – Time Since Medical School Graduation – Language Difficulties Schabort
  • 26. Limitations and/or Next Steps • Single Institution Data Set – Collaborative data analysis across institutions • Limited Test data – MCC inclusion of QE1 and QE2 scores – REB approval has just been obtained Schabort
  • 30. • Book: Women in Medicine 2017 Schabort
  • 32. Surveys of IMGs -Themes identified Schabort
  • 42. MMI and professionalism • Hoffmeister found that “there is evidence that the MMI offers a reliable and valid assessment of professionalism in IMG doctors applying for Canadian family medicine residencies and that this clinically situated MMI assessed facets of competency other than those assessed by the OSCE.”
  • 43. MMI’s • MMIs have several strengths: they can be designed to best fit relevant competencies, e.g. teamwork, communication skills. Studies suggest that MMIs are a reliable measure of non- cognitive attributes such as empathy, cultural sensitivity, advocacy and communication skills which are all important attributes for a doctor which can be observed in a specific context. Inferences may be made that MMIs help to protect patient safety as candidates are being observed and rated on doing a work sample.
  • 44. MMI better predictor than OSCE • Eva et al. (2004b) and Reiter et al. (2007) found MMIs to be a better predictor of performance on OSCEs than more established methods of selection (e.g. GPAs and traditional interviews). MMIs cannot be coached for as there is not one formulaic answer and therefore security breaches in the selection process would not affect the performance of the candidate (Reiter et al., 2005 and Griffin et al., 2008).
  • 45. MMI Costs • MMIs are initially costly and time consuming to set up in terms of person hours and expense (e.g. development of the blueprint of competencies and scenarios, training the raters/interviewers and hiring the number of rooms required for the stations). However the value in terms of the reliability and validity over more traditional unstructured interviews may outweigh these initial costs.
  • 46. Computer based non-cognitive pre- interview test • Dore et al explored the development of a non- cognitive pre-interview screening test that correlates with the well-validated MMI and performs multiple sample evaluation of non- cognitive skills (CMSENS) .This has possible future implications for IMG evaluation eg. to be administered remotely using the computer platform currently used for eg the MCCEE where the IMG can perform the assessment at any of the multiple sites outside of Canada.
  • 49. References• Examindation Results, Medical Council of Canada. Retrieved from www.mcc.ca/en/NAC/examination_results.shtml • Akl EA, Izuchukwu IS, El-Dika S, Fritsche L,Kunz R, Schunemann HJ. Integrating an Evidence-Based Medicine Rotation into an Internal Medicine Residency Program. (2001) Acad Med. Sep;79(09):897-904. • Al-Amaie, Sameeh M,Al-Baghli N,Barriers Facing Physicians Practicing Evidence-Based Medicine in Saudi Arabia. Journal of Continuing Education in the Health Professions 24(3) 163-170. • Allan GM, Manca D, Szafran O, Korownyk C. (2007) EBM a challenge for international medical graduates. Fam Med. Mar;39(3):160. • Allan GM, Korownyk C, Tan A, Hindle H, Kung L, Manca D. (2008) Developing an Integrated evidence-based medicine curriculum for family medicine residency at the University of Alberta. Acad med. Jun;83(6):581-7. • Altmaier, E. et al., (1989). Cross-Institutional Stability of Behavioral Criteria Desirable for Success in Radiology Residency. Investigative Radiology, 24(3), pp.249-51 • Andrew, R. (2010). How do IMGs compare with Canadian Medical Graduates in a Family Practice Residency Program? Can Fam Physician, 56e:318-22. • Bates J, A. R. (2000). Program for Licensure for International Medical Graduates in British Columbia - 7 years experience. CMAJ, 162(6): 801-3. • Bates J, A. R. (2001). Untangling the roots of some IMGs' poor academic performance. Acad Med, 76(1):43-6. • Bell, J., Kanellitsas, I., & Shaffer, J. (2002). Selection of Obstetrics & Gynecology Residents on the Basis of Medical School Performance. American Journal of Obstetrics & Gynecology , 186:1091-4. • Bessant, R., Bessant, D., Chesser, A., & Coakley, G. (2006). Analysis of Predictors of Success in the MCRP (UK) PACES examination in candidates attending a revision course. Postgraduate Medical Journal , 82:145-149. • Blonski, J., & Rahm, S. (2003). The Relationship of Residency Performance to Match Status and US versus International Medical Graduates. Family Medicine, 35(2): 100-4. • Blouin, D., & Dagnone, J. (2008). Performance Criteria for Emergency Medicine Residents: A Job Analysis. Canadian Journal of Emergency Medicine , 10(6): 539-44. • Boulet, J., McKinley, D., Rebbecchi, T., & Whelan, G. (2007). Does Composition Medium Affect the Psychometric Properties of Scores on an exercise Designed to Assess Written Medical Communication Skills? Advances in Health Sciences Education , 12:(2): 157-167. • Boulet, J., Rebecchi, T., Denton, A., McKinley, D., & Whelan, G. (2004). Assessing the Written Communication Skills of Medical School Graduates. Advances in Health Sciences Education , 9:(1);47-60. • Boulet, J., Swanson, D., Cooper, R., Norcinii, J., & McKinley, D. (2006). A comparison of the characteristics and examination performances of US and non- US citizen international medical graduates who sought Educational Commission for Foreign Medical Graduates certification. Acad Med, 81 (10 Suppl): S116-9. • Brotherton, S., & Etzel, S. (2007). Graduate Medical Education. Journal of American Medical Association , 298(9):1081-1096. • Brown, C., Wakefield, S., & Bullock, A. (2003). The Selection of GP trainees in the West Midlands: Second Audit of Assessment Centre Scores by Ethnicity and Country of Qualification. Medical Teacher , 25 (6) 649-653. • Cartwright CA, Korsen N, Urbach LE. (2002) Teaching the Teachers: Helping faculty in a family practice residency improve their informatics skills. Acad Med May;77(5):385-91. • Chamberlain, T.C., Catano, V.M. & Cunningham, D.P, (2005). Personality as a predictor of professional behavior in dental school: comparisons with dental practitioners. Journal of Dental Education. 69(11), pp.1222-37. • Chamorro-Premuzic, T., Furnham, A. & Ackerman, P.L., (2006). Incremental validity of the typical intellectual engagement scale as predictor of different academic performance measures. Journal of Personality Assessment. 87(3), pp.261-8. • Dirschl, D., Dahners, L., Adams, G., Crouch, J., & Wilson, F. (2002). Correlating Selection Criteria with Subsequent Performance as Residents. Clinical Orthopaedics and Related Research , 399:265-271. • Dore, K. L., Reiter, H. I., Eva, K. W., Krueger, S., Scriven, E., Siu, E., et al. (2009). Extending the Interview to All Medical School Candidates - Computer-Based Multiple Sample Evaluation of Noncognitive Skills (CMSENS). Academic Medicine, 84:10 pp S9-S12. • Eva, K., Reiter, H., Rosenfeld, J., & Norman, G. (2004). The ability of the multi-mini interview to predict preclerkship performance in medical school. Academic Medicine, 79(10 Suppl), pp. S40-2. • Eva, K., Reiter, H., Rosenfeld, J., & Norman, G. (2004). The relationship between interviewers' characteristics and ratings assigned during a multiple mini- interview. Academic Medicine, 79(6), pp 602-9. Schabort
  • 50. References Continued • Korenstein D, Dunn A, McGinn, T. Mixing it up: Integrating evidence-based medicine and patient care. Acad Med Jul;77(7):741-2. • Lee, A., Golnik, K., Oetting, T., Beaver, H., Boldt, H., Olson, R., et al. (2008). Re-Engineering the Resident Application Process in Opthalmology: A Literature Review and Recommendations for Improvement. Survey of Opthalmology , 53 (2) 164-176. • MacLellan, A., Brailovsky, C., Rainsberry, P., Bowmer, A., & Desrochers, M. (2010). Examination outcomes for International Medical Graduates pursuing or completing Family Medicine Residency training in Quebec. Can Fam Physician, 56:912-8. • McClintock, J., & Gravlee, G. (2010). Predicting Success on the Certification Examinations of the American Board of Anesthesiology. Anesthesiology , 112:212-9. • Papadakis, M., G, A., Holmbee, E., & Lipner, R. (2008). Performance during Internal Medicine Residency Training and Subsequent Disciplinary action by Stat Licensing Boards. Annals of Internal Medicine , 148(11); 869-876. • Part, H., & Markert, R. (1993). Predicting the first year performances of international medical graduates in an internal medicine residency. Acad Med, 68(11): 856-8. • Perez JA, Greer ES. (2009) Correlation of United States Medical Licensing Examination and Internal Medicine In-Training Examination performance. Adv in Health Sc Educ 14;753-758 • Pilotto LS, Duncan GF and Anderson-Wurf J. (2007). Issues for clinicians training international medical graduates: a systematic review. Medical Journal of Australia; 187(4):225-228. • Poole, A., Catano, V.M. & Cunningham, D.P. (2007). Predicting performance in Canadian dental schools: the new CDA structured interview, a new personality assessment, and the DAT. Journal of Dental Education. 71(5), pp.664-76. • Posthuma, R., Morgeson, F., & Campion, M. (2002). Beyond Employment Interview Validity: A Comprehensive Narrative Review of Recent Research and Trends Over Time. Personnel Psychology , 55:1-81. • Quintero, A., Segal, L., King, S., & Black, K. (2009). The Personal Interview: Assessing the Potential for Personality Similarity to bias the Selection of Orthopaedic Residents. Academic Medicine , 84:1364-1372. • Rao, N., Meinzer, A., Primavera, L., & Augustine, A. (1991). Psychiatry Residency Selection Criteria for Maerican and Foreign Medical Graduates. Academic Psychiatry , 15:69-79. Schabort
  • 51. References Continued • Griffin, B., Harding, D., Wilson, I., & Yeomans, N. (2008). Does practice make perfect? The effect of coaching and retesting on selection tests uses for admission to an Australian medical school. Med J. Aust, Oct 6;189(7):416. • Hall P, Keely E, Dojeiji S, Byszewski A, and Marks M. (2004). Communication skills, cultural challenges and individual support: challenges of international medical graduates in a Canadian healthcare environment. Medical Teacher 26(2):120-125 • Hayden, S., Hayden, M., & Gamst, A. (2005). What Characteristics of Applicants to Emergency Residency Programs Predict Future Success as an Emergency Medicine Resident? Academic Emergency Medicine, 12 (3) 206-10. • Hofmeister, M., Lockyer, J., & Crutcher, R. (2009). The multiple mini-interview for selection of international medical graduates into family medicine residency education. Medical Education, Volume 43, Issue 6 pages 573-579. • Illing, J., Campbell, M., Kergon, C., Thompson, N., Burford, B., Morrow, G., et al. (n.d.). Selection Methods for Foundation Programme: A Literature Review. Retrieved November 14, 2010, from www.medschools.ac.uk/aboutus/projects/documents/appendix%20K%20Newcastle%20Literature %20Review.pdf • Kanna, B., Gu, Y., Akhuetie, J., & Dimitrov, V. (2009). Predicting Performance using Background Characteristics of International Medical Graduates in an inner-city University-Affiliated Internal Medicine residency training program. BioMed Central, 9:42. • Schabort
  • 52. 2017 Perspectives Symposium March 2, 2017 #Perspectives2017

Editor's Notes

  1. Human rights tribunal ruled against
  2. March 2010: 1916 IMGs in postgrad training in Canada. (FMEC PG) The failure rate for IMGs in the end of residency College exams is significantly higher than for Canadian medical school graduates. Many IMG’s also need remediation during residency.
  3. Limited information is available about which factors available to us at the time of the CaRMS selection, can serve as predictors for success during residency training. Tools that could assist with the selection of the IMG candidates most likely to succeed during postgraduate training in Canada are needed.
  4. Although there has been NO comprehensive effort – i.e., across factors and institutions - to determine the true predictive value of these factors.
  5. SO we grouped the predictors into hypotheses Although the results of our investigation are presented in light of some of the popular hypotheses, because these positions are often generated on anecdotal evidence this work can be best thought of as a hypothesis generating exercise. For example, while it may be sufficient to identify age as an important factor in IMG success, it is more relevant to know why age is a factor.
  6. Mention the HDI Index here
  7. Key point – AGE Nationality and First Language had relatively small effects w/rr/t/ actual impact.
  8. Key Point – Schools in some countries are better than others. - Years since graduation was NOT a factor.
  9. Key Point – The role of previous experience is differential depending on the medical specialty – at least at the distinction of family physician and specialist.
  10. Key point - As we know performance predicts performance; so this isn’t terribly surprising. Yet MCC-EE scores are accounting for only around 30% of the variance…need to look deeper…at QE1 and QE2 scores. Lowest Passing Scores – RC (260); CF (254)
  11. Age (regardless of years since graduation/last practice) Age-related decline Age-related factors (i.e., financial and family responsibility)