Production of this report has been made possible through a financial contribution from Health Canada.

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2 Production of this report has been made possible through a financial contribution from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada. Project team: Sandra Banner, team leader and site visitor; Ashley McKiver, project manager and researcher; Sara Rattanasithy, data analyst; Josephine Cassie, site visit collaborator; Christel Woodward, survey tool consultant; Rebecca Ford, editor.

3 TABLE OF CONTENTS BACKGROUND... 5 EXECUTIVE SUMMARY... 6 SUMMARY OF RESULTS... 7 RESULTS... 8 SAMPLE... 8 Table 1 Breakdown of 2010 sample by region... 8 Table 2 Medical school of respondents... 8 DEMOGRAPHIC INFORMATION... 9 Figure 1 Age by medical school region... 9 Figure 2 Age: CSA vs. CMG Figure 3 Gender by medical school region Figure and 2006 gender and age comparison Figure 5 Gender comparison: CSA vs. CMG MARITAL STATUS Figure 6 Marital status by medical school region Figure 7 Marital status by gender Figure 8 Marital status: CSA vs. CMG CSAs WITH PARENTS AS PHYSICIANS Figure 9 CSAs with one or more parents who are physicians Figure 10 CSAs with parents who are physicians by region Comparison of the 2010 CSA study to the 2010 Canadian medical graduate cohort PRE-MEDICAL EDUCATION Figure 11 Province of residence before moving abroad Projected number of CSAs by province Figure 12 Comparing province of residence of survey respondents to provincial medical school admission rates and provincial baseline statistics CANADIAN POST-SECONDARY EDUCATION Table 3 Top five reported post-secondary schools attended by CSAs Figure 13 Post-secondary education in Canada by medical school region Figure 14 Highest level of education prior to attending a medical school abroad Highest level of education by medical school region Figure 15 Highest level of education prior to attending medical school: CSA vs. CMG Figure 16 Number of times CSAs applied to Canadian medical schools prior to studying medicine abroad Figure 17 Number of times CSAs applied to Canadian medical schools prior to studying medicine abroad by region Comparison of the 2010 CSA study to the 2010 Canadian medical graduate cohort STUDYING MEDICINE ABROAD Figure 18 Motivation to study medicine abroad Figure 19 Criteria for choosing a medical school abroad Figure 20 How CSAs learned about medical school abroad Figure 21 Year of graduation from medical school Figure 22 Year of graduation by medical school region Figure 23 Satisfaction with medical degree program Figure 24 Satisfaction with medical degree program by medical school region CLERKSHIPS Figure 25 Difficulty in arranging a clerkship rotation in Canada by medical school region Figure 26 Number of clerkship rotations done or confirmed in Canada by medical school region Comparison of the 2006 pilot CSA study to the 2010 CSA study.. 22 FUNDING Table 4 Most popular funding types for medical school abroad Figure 27 Most popular funding types by medical school region Table 5 Top funding source by region and medical school DEBT Estimated total amount of debt Figure 28 Median debt by medical school region Comparison of the 2010 CSA study to the 2010 Canadian medical graduate cohort Figure 29 Satisfaction with cost of medical education Figure 30 Satisfaction with cost of medical education by medical school region Table 6 Annual tuition rates POSTGRADUATE PLANS Figure 31 Intention to return to Canada to pursue postgraduate medical training Figure 32 Intention to stay in Canada to practice medicine after Canadian postgraduate training Table 7 Year of graduation from medical school by intention to return to Canada to pursue postgraduate medical training Table 8 Region of medical school by intention to return to Canada to pursue postgraduate medical training Comparison of the 2006 pilot CSA study to the 2010 CSA study FIRST/TOP CHOICES Table 9 Intending to return for postgraduate training in Canada: first choice locations for postgraduate medical training in Canada Table 10 Intending to return to postgraduate training in Canada: top choice disciplines for postgraduate medical training in Canada Comparison of the 2006 pilot CSA study to the 2010 CSA study Table 11 Top five locations for postgraduate medical training in Canada (CSA vs. CMG) Table 12 Top five disciplines for postgraduate medical training in Canada (CSA vs. CMG) CANADIANS NOT INTENDING TO RETURN TO CANADA FOR POSTGRADUATE MEDICAL TRAINING Figure 33 Perceived barriers to returning to Canada for postgraduate training

4 Table 13 Reasons for not intending to return to Canada for postgraduate medical training by region Figure 34 Country (if not Canada) where CSAs intend to complete their postgraduate medical training Figure 35 Intention to return to Canada to practice medicine after postgraduate medical training abroad Figure 36 Perceived barriers to returning to Canada to practice medicine after postgraduate medical training abroad Comparison of the 2006 pilot CSA study to the 2010 CSA study INTERNATIONAL MEDICAL SCHOOL DATA BY MEDICAL SCHOOL CARIBBEAN Table 14 Caribbean medical school data website sources Table 15 Number of CSAs studying medicine in the Caribbean Table 16 General information Table 17 Admissions by medical school Table 18 Curriculum summary by medical school Table 19 Accreditation by medical school Table 20 Tuition by medical school Table 21 Clerkships by medical school AUSTRALIA Table 22 Australian medical school data website sources Table 23 Number of CSAs studying medicine in Australia Table 24 General information Table 25 Admissions by medical school Table 26 Curriculum summary by medical school Table 27 Accreditation by medical school Table 28 Tuition by medical school Table 29 Clerkships by medical school IRELAND Table 30 Irish medical school data website sources Table 31 Number of CSAs studying medicine in Ireland Table 32 General information Table 33 Admissions by medical school Table 34 Curriculum summary by medical school Table 35 Accreditation by medical school Table 36 Tuition by medical school Table 37 Clerkships by medical school POLAND Table 38 Polish medical school data website sources Table 39 Number of CSAs studying medicine in Poland Table 40 General information Table 41 Admissions by medical school Table 42 Curriculum summary by medical school Table 43 Accreditation by medical school Table 44 Tuition by medical school Table 45 Clerkships by medical school UNITED KINGDOM (UK) Table 46 UK medical school data website sources Table 47 General information Table 48 Admissions by medical school Table 49 Curriculum summary by medical school Table 50 Accreditation by medical school Table 51 Average tuition by medical school Table 52 Clerkships by medical school EUROPE/MIDDLE EAST Table 53 Europe/Middle East medical school data website sources Table 54 Number of CSAs studying medicine in Europe/Middle East Table 55 General information Table 56 Admissions by medical school Table 57 Curriculum summary by medical school Table 58 Accreditation by medical school Table 59 Tuition by medical school Table 60 Clerkships by medical school INTERNATIONAL MEDICAL SCHOOL DATA MEDICAL SCHOOL SURVEY RESULTS SURVEY RESPONDENTS Table 61 Location of survey respondents Table 62 Role of survey respondents MOTIVATION TO RECRUIT INTERNATIONAL MEDICAL STUDENTS REGIONS OF RECRUITMENT Table 63 Factors that influence the number of international students trained Factors that influence the number of international students trained by medical school region Table 64 Intention to change the size of international medical training programs Intention to change the size of international medical training programs by medical school region Table 65 Expected changes in legislation that will impact international medical training programs Expected changes in legislation that will impact international medical training programs by medical school region MEDICAL DEGREE PROGRAMS AND ADMISSION REQUIREMENTS BY MEDICAL SCHOOL REGION Table 66 Available medical degree programs and admission requirements by medical school region Admission procedures Table 67 Additional admission procedures by region of medical school Table 68 Do admissions criteria differ for international students versus national students? Admissions committee Table 69 Admissions committee representatives TUITION Table 70 Average yearly tuition POSTGRADUATE TRAINING REFERENCES APPENDIX ANALYSIS RESULTS

5 BACKGROUND Canada s doctor to patient ratio is among the lowest of any industrialized nation. 1 Despite a 69.0% increase in medical school enrolment, 2 Canadians continue to perceive a doctor shortage. The applicant pool for medical school remains unchanged in the last decade with four qualified applicants for every admitted medical school student in Canada. 2 Over the past decade, and perhaps due to these factors, there has been a recognized and increasing subset of Canadians who have chosen to pursue medical education abroad. Although these Canadians appear to be increasing in number and have begun to have a political voice, little is known about their true numbers, demographics, motivation to study abroad, general characteristics or whether they are interested in returning to Canada. This study was developed to provide a description of this potential resource and to help inform the provincial and federal governments for future physician resource planning. The definition of a Canadian studying abroad (CSA) recognizes that while these individuals are international medical graduates (IMGs), they are Canadians who left Canada to pursue their dream of medical education abroad. They are citizens born in Canada, or permanent residents. Almost all of them have done some of their earlier education in Canada, but choose to go abroad for medical education. This definition separates these individuals from other international physicians (IMGs), who graduate abroad prior to coming to Canada and becoming citizens or permanent residents. The Canadian Resident Matching Service (CaRMS) administers the match into postgraduate training in Canada. CaRMS was the first Canadian medical organization to identify this growing cohort of CSAs seeking entry into the Canadian healthcare system. In Sandra Banner, the Executive Director and CEO of CaRMS, conducted a brief survey of select CSA schools and applicants. This study was based only on informal discussions among some of the international medical schools identified at a point when the medical community estimated that there were approximately 400 students studying medicine outside of North America. The results of this survey estimated that there were approximately 1500 Canadian students studying medicine abroad. 3 Since 2006, the project team has identified additional international schools and an increasing number of CSAs who were used to form the study population for this report. Where possible, the results in this report are compared to data from the 2006 report. CSAs were identified using several data sources including: the CaRMS 2008 and 2009 applicant databases, a list of schools provided by the Medical Council of Canada (MCC), using data from graduates of international institutions applying for MCC s evaluating examination (a prerequisite for residency training in Canada). Using this methodology, 55 schools outside of North America were identified as having Canadian students studying at them. Each school was contacted and asked to distribute a letter to their Canadian students. The letter outlined the scope of the study and provided the online student survey link with password. The online student survey was available from August 2009 through to June Each institution was also asked to complete a school survey and if they were willing to host a site visit. 5

6 EXECUTIVE SUMMARY Canadians studying abroad are spread across the globe from Australia to China to the Netherlands. What they have in common is their desire to come home to Canada to practice medicine. Canadian students who are unsuccessful in being admitted to a Canadian medical school, and make the decision to go abroad to a foreign medical school do so largely because they believe there is a shortage of physicians in Canada, and there will be opportunities for them to return to Canada to practice medicine. While provincial health human resource planning regulates admission to medical schools in Canada, and federal citizenship and immigration regulates the number of immigrants to Canada, there are no regulations that will allow for a prediction of the number of Canadian students who will choose to study medicine abroad and return to Canada for postgraduate training and practice. The number of CSAs has grown exponentially since The estimated number has more than doubled since the first survey in As the majority of Canadians are enrolled in programs with a duration of four years, the output of these international medical schools could contribute almost 700 graduates per year (equal to the total number of graduates each year in all medical schools west of Ontario), or nearly 30% of the total Canadian medical school output. Furthermore, this study indicates that more schools are opening enrolment to international students each year. CSAs are studying medicine in schools all over the world today approximately 80 schools in almost 30 countries are identified as having Canadian students enrolled in medicine. However, most people are only familiar with schools in Ireland, Australia, the Caribbean and most recently, Poland. This study found that every year, new schools are emerging, offering international students the opportunity to study medicine. The majority of these programs target North American students, who are prepared to pay the high tuition fees for the opportunity to become physicians. The medical education they are receiving is as diverse as the countries themselves. There is no typical CSA, as there is no typical immigrant IMG. Both have studied medicine in education systems that have differing curriculums, resources and patient populations. Often, immigrant IMGs have graduated from the same schools that CSAs are graduating from. In countries where the native language is English, international students are integrated into classes with national students. Among the non-profit schools that were visited in this study, international students were valued for their diverse backgrounds, unique perspectives, and as a significant revenue source for the medical school. In some countries, international students are taught in English in a parallel curriculum to the national students who are taught in their native language. International students are given the opportunity to learn the language, but translators are provided during their clinical rotations so that they can experience direct patient contact in the hospitals and clinics. This is the case for schools offering international medical programs to North American students in Poland, the Czech Republic, Romania, Hungary and Bahrain, just to name just a few. Although most schools visited in the study had some sort of national accreditation, it varied considerably from a peer review, to a site visit of the curriculum, to a government-led overall education standard across all of the professional education institutions not specific to medicine. The educational curriculum varied across all schools visited, and the clinical component of the students undergraduate medical education did not usually offer the autonomy and direct patient care of the North American medical education model. Demographically, the majority of CSAs continue to be male, slightly older, single and with more post-secondary education than their medical student counterparts in Canada. CSAs on average have more debt than CMGs CSAs have nearly $90,000 more debt than students in Canadian medical schools, 7 though many cite funding from family savings as a source of support for their education. This study found that more CSAs have a medical doctor as a parent than were identified in a study of Canadian medical graduates (CMGs). 4 The majority of CSAs are residents of British Columbia and Ontario where the success rates of medical school applicants are the lowest. 5 While some students have entered into their international medical school directly from high school, most CSAs have not applied to Canadian medical schools as many times as the successful student studying in Canada. 5 This suggests that due to their age and higher education, CSAs opt to study abroad because they have decided they would not be successful in Canada, or would rather not wait several years to be successful in their Canadian medical school applications. CSAs express frustration in their attempts to arrange Canadian clinical rotations while in their undergraduate years abroad. The inability to obtain clinical experiences during their undergraduate education has increased between the survey in 2006 and 2010, 3 and may result from the increased domestic enrolment and the perceived lack of capacity to provide these experiences to anyone other than Canadians studying in Canada. The Caribbean school respondents reported the most difficulty, while respondents from Australia and Ireland continue to report some success, suggesting that a lack of capacity may not be the entire reason for not obtaining clerkship opportunities. While most CSAs (over 90%) want to return to Canada for postgraduate training, they report frustration with the perceived barriers to pursuing postgraduate education in Canada. These barriers include: choice of discipline, return of service, and the high competition for positions. While Canada has a ubiquitous shortage of family physicians, particularly in rural communities, only 21% of CSAs choose a career in family medicine. However, they have very few, if any, opportunities to complete postgraduate training in the country where they are studying medicine. None of the for-profit schools in the Caribbean have postgraduate training opportunities, and the schools that recruit Canadian students in Ireland, Poland, other European countries and Australia have little or no postgraduate opportunities available for international students. Admission data provided by the schools and the international Canadian student organizations led to an estimation of about 3500 Canadian students enrolled in medical schools abroad. 6

7 SUMMARY OF RESULTS Survey results 32 of the 55 schools (58.2%) agreed to distribute the student survey, 20 (36.4%) answered the institutional survey and 16 (29.1%) agreed to site visits. This represents a four times greater response rate than the original survey in students completed the online survey (approximately a 30.3% response rate, based on estimated enrolment). Students studying in Irish medical schools had the highest response rate (41.8%). The majority of CSAs (46.3%) were found in Caribbean schools. Cohort demographics Overall there was a higher percentage of male students (52.5%) enrolled in international medical schools than males in Canadian medical schools (41.8%). 5 Irish medical schools were the exception, with 57.0% female students, which is similar in composition to Canadian medical schools which average 58.2% female students. 5 Overall, CSAs are older than students in Canadian medical schools, 73.9% of CSAs are years old while only 46.4% of Canadian medical graduates (CMGs) are the same age. 6 A higher percentage of CSAs are single (83.1%) compared to students studying medicine in Canada (61.6%). 6 CSAs were more often children of physicians, with 21.0% reporting one or more of their parents as medical doctors compared to 15.6% of CMGs. 4 CSAs whose parents are physicians were more likely to attend medical school in Ireland. The majority of CSAs come from the provinces of British Columbia and Ontario. Entry into medical school 5.9% of CSAs entered medical school from high school. Despite some CSAs entering medical school directly from high school, more CSAs have advanced degrees than students in Canada, 13.1% of CSAs reported master s degrees, while 9.8% of CMGs reported the same level of education. 5 CSAs applied to Canadian medical schools an average of 1.76 times while CMGs applied 2.59 times before being successful % of CSAs had never applied to a Canadian medical school. The most frequently reported reason for choosing an international medical school was students felt they would be unable to secure a place in a Canadian school. Cost, debt and satisfaction The average annual tuition cost ranges from $12,250(CAD) in Poland to $66,369(CAD) in Australia. Site interviews revealed that international students are important revenue sources for not only the for-profit universities but also the non-profit state universities. In the latter cases, CSAs tuition supplements the national medical education costs. The CSA median debt is $160,000(CAD) compared to the 2007 CMG median debt of $71,000(CAD). 7 CSAs with lower reported median debt reported higher satisfaction with the cost of their medical education. Educational process, choices and perceived barriers to postgraduate education A smaller percentage of respondents in this survey reported success negotiating clinical type clerkship experiences than respondents in the 2006 survey. 3 Respondents from Australia and Ireland were more successful than the respondents from the Caribbean in arranging Canadian clerkships. 90.3% of the respondents reported a desire to return to Canada for a portion of their postgraduate medical education, and 24.8% reported a plan to return to Canada after postgraduate training abroad. Only 67.2% of respondents in the 2006 survey indicated their intention to return to Canada for postgraduate training. 3 In both the 2006 and 2010 surveys, the further away the respondents were from graduation, the more likely they were to respond that they intended to return to Canada. 3 The main barriers cited regarding the return to Canada for postgraduate medical training were: - The requirement to provide return of service for the postgraduate experience. - The choice of discipline was difficult to obtain. - The perception that they would have difficulty matching to a program in Canada. The top two career choices of CSAs continue to be Family Medicine and Internal Medicine, similar to the 2006 survey. 3 The top two university choices were the University of Toronto and the University of British Columbia. Limitations The following limitations have been identified: Respondent bias as analysis has been done on selfreported data. The findings are also subject to non-response bias, as well as low response bias. As an example, it was difficult to compare the Middle East to all other areas surveyed, as the response rate was much smaller. This made it difficult to project any true trends for that area. Non-participation the study was subject to the international medical schools willingness to participate. Without the aid of the schools, it proved to be very difficult to contact and recruit participation of Canadian students. The findings are limited by having little access to Canadian students from the Caribbean medical schools, especially those in their clinical years. Faculty and students likely wanted to present their schools in the best possible light. There was no incentive to complete the surveys. At the beginning of the study, only 55 of the more than 75 schools where Canadians are now known to be studying medicine abroad were identified, as more schools are discovered every day. 7

8 RESULTS SAMPLE Statistical analysis In total, 1082 CSAs completed the survey. From these respondents, a summary of demographic information was conducted, followed by an analysis of pre-medical education, current experience with medical education, and postgraduate plans. The respondents were also grouped according to the geographic region of their medical school to determine if there were notable differences across geographic regions. The Pearson chi-square test of independence was used to look for relationships between variables. Further, differences in proportions were tested using the z-test for proportions. A p value < 0.05 was regarded as being significant. TABLE 1 BREAKDOWN OF 2010 SAMPLE BY REGION Medical School Survey Estimation of CSAs Enrolled in Medical Region Respondents Schools Across all Years of Study Ireland* Poland** Caribbean Australia Middle East*** Totals * Three respondents listed as attending a medical school in the UK were included in this group as there were not enough respondents to create a separate group for analysis. ** Two respondents listed as attending a medical school in the Czech Republic and one survey respondent listed as attending a medical school in Romania were included in this group. ***Middle East group includes respondents attending a medical school in Bahrain and Israel. Note: one respondent was excluded from the regional analysis because they were from an international medical school not contacted for this study, and not within any of the regions contacted. TABLE 2 MEDICAL SCHOOL OF RESPONDENTS 8 Medical School Region n % St. George s University Caribbean % Saba University School of Medicine Caribbean % University of Queensland Australia % Royal College of Surgeons in Ireland Western Europe % University of Sydney Australia % Jagiellonian University Medical College Eastern Europe % Ross University Caribbean % Trinity College, University of Dublin Western Europe % University College Dublin Western Europe % University College Cork Western Europe % University of Limerick Western Europe % Poznan University of Medical Sciences Center Eastern Europe % Flinders University of South Australia Australia % RCSI Bahrain Middle East % Sackler School of Medicine Middle East % University College, Galway Western Europe % American University of the Caribbean School of Medicine Caribbean % Xavier University School of Medicine, Bonaire Caribbean % University of Wollongong Australia 8 0.7% University of Melbourne Australia 7 0.6% James Cook University Australia 6 0.6% Windsor University Caribbean 6 0.6% All Saints University School of Medicine, Dominica Caribbean 3 0.3% Continued on page 9

9 TABLE 2 MEDICAL SCHOOL OF RESPONDENTS Medical School Region n % International American University College of Medicine Caribbean 2 0.2% University of Sint Eustatius Caribbean 1 0.1% Spartan Health Sciences University Caribbean 1 0.1% IAU College of Medicine Caribbean 1 0.1% Medical University of Warsaw Eastern Europe 1 0.1% Medical University of Silesia, School of Medicine in Katowice Eastern Europe 1 0.1% St. Georges University Western Europe 1 0.1% University of Manchester Western Europe 1 0.1% University of Nottingham Western Europe 1 0.1% Other 4 0.4% Total % * Other includes schools in: Chile, Romania, and the Czech Republic DEMOGRAPHIC INFORMATION Age The average age of CSAs is 26 years old, with a range of 18 years old to 46 years old. AGE BY MEDICAL SCHOOL REGION 80% 70% 60% 50% 40% 30% 36.8% 54.4% 30.4% 59.5% 46.7% 43.5% 72.3% 39.1% 60.9% 24 & under & over 20% 10% 0% 10.2% 13.1% 8.1% 8.9% 7.6% 0.7% 1.3% 2.2% 4.4% Ireland Poland Carribean Australia Middle East Figure 1 Age by medical school region When examining the age of CSAs in relation to their region of study, it was found that Australia had a significantly older population than any other region. 9

10 Comparison of the 2010 CSA study to the 2010 Canadian medical graduate cohort AGE COMPARISON 100% 73.9% * Source: CaRMs 2010 CMG Cohort Data 50% 0% 10.6% CSA 14.8% 45.3% 46.4% 7.7% 0.6% 0.6% CMG Figure 2 Age: CSA versus CMG By increasing the age of the CSA respondents to reflect their true age at graduation, they could then be compared to the Canadian medical graduate cohort of It was found that only 10.6% of CSAs are under 25, compared to 45.3% of CMGs. While 91.7% of CMGs are under 30, twice as many CSAs are older than 30. Overall, the CSA cohort is older than the CMG cohort. Gender Overall, males made up 52.5% of the respondents and females accounted for the remaining 47.5%. GENDER BY MEDICAL SCHOOL REGION 60% 50% 40% 43.0% 57.0% 54.4% 45.6% 56.3% 43.7% 55.3% 44.7% 52.2% 47.8% Male Female 30% 20% 10% 0% Ireland Poland Carribean Australia Middle East Figure 3 Gender by medical school region A higher percentage of men studying abroad than women was found in every region surveyed, with the exception of Ireland, where there were 14.0% more women studying medicine than men. 10

11 Comparison of the 2006 pilot CSA study to the 2010 CSA study Gender and age comparison 2010 CSAS: GENDER BY AGE 2006 CSAS: GENDER BY AGE 100% 80% 60% 40% 20% 0% 51.3% 24 & Under 51.5% 48.7% 48.5% 58.9% 41.1% 70.0% & Over 66.7% 30.0% 33.3% 45 & Over Male Female 100% 80% 60% 40% 20% 0% 52.3% 47.7% 24 & Under 55.8% 44.2% 77.3% 22.7% 50.0% & Over 50.0% 100% 0.0% 45 & Over Male Female * Source: CaRMS 2006 CSA Report Figure and 2006 gender and age comparison In the 2006 pilot study, it was found that females were more likely to fall into the youngest age category while males where twice as likely to be 30 years of age or older. However, the 2010 study revealed that no significant differences existed in the age groups when compared by gender. Comparison of the 2010 CSA study to the 2010 Canadian medical graduate cohort Gender comparison GENDER CSA VERSUS CMG 100% 80% 60% 40% 20% 51.3% 51.5% 52.5% 48.7% 48.5% 70.0% 66.7% 58.9% 41.8% 41.1% 30.0% 33.3% Male Female 47.5% 58.2% CSA CMG* * Source: Canadian Medical Education Statistics 2009, The Association of Faculties of Medicine of Canada 0% 0% 24 & Under Male & Over 45 & Over Female Figure 5 Gender comparison: CSA versus CMG It is interesting that the proportions are nearly reversed in the two data sets. More men are studying medicine abroad, while more women are studying medicine in Canada. The only region that is similar in composition to Canada is Ireland, where 57.0% of students studying abroad were women. See the Appendix for full details of analysis results. 11

12 MARITAL STATUS The majority (83.1%) of CSAs are single, separated or divorced, while only 16.9% are married/living with a partner. The majority (81.5%) of CSAs did not have family members or a partner living abroad with them during their medical education. Only 18.5% of CSAs reported having family members or a partner living with them abroad full-time or occasionally during their medical education. MARITAL STATUS BY MEDICAL SCHOOL REGION 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 85.7% 82.3% 85.0% 70.9% 28.2% 91.3% 17.7% 14.3% 14.0% 8.7% 0.0% 0.0% 1.0% 1.0% 0.0% Ireland Poland Carribean Australia Middle East Single Married/Living with a partner Separated/ Divorced Figure 6 Marital status by medical school region Overall, Australia had the highest percent (28.2%) of Canadians studying abroad who were married/living with a partner. This may be a result of these students generally being older. See the Appendix for full details of analysis results. MARITAL STATUS BY GENDER 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 81.5% 83.5% Single 17.8% 16.0% Married/Living with partner 0.7% 0.6% Separated/ Divorced Male Female Figure 7 Marital status by gender This analysis concluded that neither males nor females are more likely to be married/living with a partner while studying abroad. 12

13 Comparison of the 2010 CSA study to the 2010 Canadian medical graduate cohort Marital status comparison MARITAL STATUS: CSA VERSUS CMG 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 83.1% CSA 16.9% CMG 61.6% 38.4% Single/Divorced Separated/Widower Married/Living with partner * Source: CaRMs 2010 CMG Cohort Data Figure 8 Marital Status: CSA versus CMG While only 16.9% of CSAs are married/living with a partner, theopposite trend is true for Canadian medical students, where a significantly greater proportion (38.4%) is married/living with a partner. CSAs WITH PARENTS WHO ARE PHYSICIANS CSAs WITH ONE OR MORE PARENTS WHO ARE PHYSICIANS 79.0% 17.2% 3.8% Yes, one parent Yes, both parents No CSAs WITH ONE OR MORE PARENTS WHO ARE PHYSICIANS BY REGION 90% 84.2% 81.1% 82.6% Yes 80% 77.2% No 70% 68.0% 60% 50% 40% 30% 32.0% 22.8% 20% 10% 15.8% 18.9% 17.4% n=1082 0% Ireland Poland Carribean Australia Middle East Figure 9 CSAs with one or more parents who are physicians Of the 21.0% of CSAs that have one or more parents as a medical doctor, 42.5% are family physicians, while 57.5% are specialists. Figure 10 CSAs with parents who are physicians by region Students who have one or more parents who are physicians are almost twice as likely to choose to study medicine in Europe specifically Ireland rather than the Caribbean. See the Appendix for full details of analysis results. 13

14 Comparison of the 2010 CSA study to the 2010 Canadian medical graduate cohort CSAs with one or more parents who are physicians As reported in the Canadian Medical Association Journal (CMAJ), 15.6% of today s Canadian medical students have a physician parent. 4 In comparison, 21% of CSAs have at least one parent who is a physician. PRE-MEDICAL EDUCATION 1.2% 18.6% 10.5% 1.9% 2.1% PROVINCE OF RESIDENCE BEFORE MOVING ABROAD 0.4% 2.8% 1.1% 3.6% 57.8% NL PE NS NB QC ON MB SK AB BC Figure 11 Province of residence before moving abroad 86.9% of Canadians studying abroad are residents of three of the 10 Canadian provinces, with 57.8% residents of Ontario, 18.6% residents of British Columbia and 10.5% residents of Alberta. Projected number of CSAs by province This survey indicates that there are approximately 3500 Canadian students studying medicine abroad, with as many as 500 coming from British Columbia and over 1500 from Ontario. 70% 60% 50% 40% 30% 20% 10% 0% COMPARING PROVINCE OF RESIDENCE OF SURVEY RESPONDENTS TO PROVINCIAL MEDICAL SCHOOL ADMISSION RATES AND PROVINCIAL POPULATION BASELINE STATISTICS NL PE NS NB QC ON MB SK AB BC Survey respondent s province of residence (%) Success rate of applicants (%) Population baseline** (%) * Source: Canadian Medical Education Statistics 2009, The Association of Faculties of Medicine of Canada ** Source: 2009 Population by Province, Statistics Canada Figure 12 Comparing province of residence of survey respondents to provinical medical school admission rates and provincial baseline statistics This graph shows that Ontario and British Columbia have the greatest population when compared to the other Canadian provinces. They also have the highest number of residents who choose to study medicine abroad. Furthermore, Ontario, British Columbia and Prince Edward Island have the lowest rate of successful medical school applicants. Therefore, the increased frequencies at which Ontario and British Columbia students choose to study medicine abroad may be a direct response to the lower success rates of medical school applicants, and larger population baselines in Ontario and British Columbia. 14

15 CANADIAN POST-SECONDARY EDUCATION Post-secondary education A total of 90.3% of CSAs attended a post-secondary institution in Canada prior to attending an international medical school. The University of Toronto was the most attended Canadian institution for post-secondary education among the survey respondents. TABLE 3 TOP FIVE REPORTED POST-SECONDARY SCHOOLS ATTENDED BY CSAS Post-Secondary School Province n % University of Toronto Ontario % The University of Western Ontario Ontario % The University of British Columbia British Columbia % McMaster University Ontario % McGill University Quebec % 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% POST-SECONDARY EDUCATION IN CANADA BY MEDICAL SCHOOL REGION 93.8% 98.1% 80.5% 83.5% 87.0% 19.5% 16.5% 13.0% 6.2% 1.9% Ireland Poland Carribean Australia Middle East Yes No Figure 13 Post-secondary education in Canada by medical school region Respondents from the Caribbean and Australia where more likely to have attended a post-secondary institution in Canada than those whose medical school was in Europe, where admission to medical school is available directly from high school. HIGHEST LEVEL OF EDUCATION PRIOR TO ATTENDING MEDICAL SCHOOL ABROAD Ph.D., or Equivalent Master s degree Bachelor s degree 3 years or more of university 2 years or less in university Post -secondary High school Other 1.6% 1.9% 2.8% 0.4% 5.9% 0.6% 13.1% 73.7% 0% 10% 20% 30% 40% 50% 60% 70% 80% Figure 14 Highest level of education prior to attending a medical school abroad In 2010, 88.4% of respondents indicated that they had a bachelor s degree, master s degree or Ph.D prior to attending an international medical school. Only 5.9% reported receiving only a high school diploma prior to studying abroad. 15

16 Highest level of education by medical school region When comparing the highest level of education of respondents based on the geographic region of their medical schools, Australian students and Caribbean students were the most likely to have completed a bachelor s degree prior to studying abroad. The proportion of students who had attained master s degrees was the highest in Australia (14.6%), comparable to the Caribbean where 13.4% of respondents had attained master s degrees and Ireland, where 13.6% have a master s. In Poland, just 5.1% of students reported having postgraduate degrees prior to studying abroad. Comparison of the 2010 CSA study to the 2010 Canadian medical graduate cohort HIGHEST LEVEL OF EDUCATION PRIOR TO ATTENDING MEDICAL SCHOOL 80% 70% 60% 50% 40% 30% 20% 10% 0% 5.9% 0.8% 0.4% 14.5% High School College 2.8% 3.7% 2 years or less in university (no degree) 1.9% 7.1% 3 years+ university (no degree) 73.7% 60.9% Bachelor s Degree 13.1% 9.8% 1.6% 2.9% 0.6% 0.3% Master s Degree Ph.D. or equivalent Other CSA CMG * Source: CaRMs 2010 CMG Cohort Data Figure 15 Highest level of education prior to attending medical school: CSA versus CMG Although a greater number of CSAs than CMGs enter medical school directly from high school, CSAs are significantly more educated than CMGs when entering medical school. APPLICATION TO CANADIAN MEDICAL SCHOOLS APPLICATION TO CANADIAN MEDICAL SCHOOLS 40% 35% 30% 25% 20% 15% 10% 5% 0% 26.7% Did not apply 37.0% 23.6% 9.3% 1.9% 0.9% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 1x 2x 3x 4x 5x 6x 7x 8x 9x 10x 13x Number of Times Applied Figure 16 Number of times CSAs applied to Canadian medical schools prior to studying medicine abroad. A total of 37.0% of CSAs applied only once to Canadian medical schools, while approximately the same number of CSAs applied two or more times to Canadian medical schools prior to studying abroad. Interestingly, 26.7% did not apply to any Canadian medical schools prior to studying abroad. Of the CSAs that did not apply to any Canadian medical schools before going abroad, there is a significant difference in their highest level of education. For CSAs that had a high school education before going abroad, 95.3% did not apply to any Canadian medical schools, while 20.8% of CSAs with a bachelor s degree did not apply to any Canadian medical schools. See the Appendix for full results. 16

17 APPLICATION TO CANADIAN MEDICAL SCHOOLS BY MEDICAL SCHOOL REGION 60% 50% 40% 30% 20% 38.2% 32.7% 29.0% 54.4% 29.1% 16.5% 23.6% 43.1% 33.3% 49.0% 34.8% 34.8% 31.6% 30.4% 19.4% Did not apply Applied once Applied 2x or more 10% 0% Ireland Poland Carribean Australia Middle East Figure 17 Number of times CSAs applied to Canadian medical schools prior to studying medicine abroad by medical school region Almost half of the respondents from Australia applied multiple times to Canadian medical schools prior to leaving to study medicine abroad. In contrast, 54.4% of the respondents from Poland had never applied to a Canadian medical school prior to deciding to study medicine abroad, 27.9% cited their reason as being able to enter medical school directly from high school, while 20.9% cited that they were unable to gain acceptance into a Canadian medical school. Comparison of the 2010 CSA study to the 2010 Canadian medical graduate cohort Application to Canadian medical schools Canadian students studying medicine abroad on average applied to Canadian medical schools 1.76 times prior to enrolling in a foreign medical school. In contrast, Canadian students studying at Canadian medical schools, on average, apply 2.95 times prior to being admitted. 5 STUDYING MEDICINE ABROAD MOTIVATION TO STUDY MEDICINE ABROAD 80% Unable to obtain a place in a 77.6% Canadian medical school 73.7% 70% Allowed me to enter medical school 60% 7.8% 60.9% directly from secondary school 50% Wanted to live in another country 6.6% 40% 30% Tuition costs were lower than Canadian medical school 1.8% 20% My family was living in this 14.5% 0.5% 13.1% 10% foreign country currently 9.8% 5.9% 0.8% 0.4% 2.8% 3.7% 1.9% 7.1% 1.6% 2.9% 0.6% 0.3% 0% Other 5.8% High School College 2 years or less in 3 years+ university Bachelor s Degree Master s Degree Ph.D. or equivalent Other university 0% 10% (no degree) 20% (no degree) 30% 40% 50% 60% 70% 80% CSA CMG Figure 18 Motivation to study medicine abroad Overall 77.6% of CSAs reported that their main reason for choosing to study abroad was because they were unable to obtain a place in a Canadian medical school. A total of 1.8% reported it was due to lower tuition costs. 17

18 CRITERIA FOR CHOOSING A MEDICAL SCHOOL ABROAD Reputation (n= 1082) Likelihood of obtaining some clerkships in North America (n= 1082) Course taught in a language I understand (n= 1082) 51.1% 77.4% 88.6% * Participants were able to select more than one answer. Cost (n= 1082) 35.6% Attractiveness of country (n= 1082) 32.0% Proximity to Canada (n= 1082)) Other (n= 1082) 8.2% 7.1% Figure 19 Criteria for choosing a medical school abroad 0% 20% 40% 60% 80% 100% Reputation was the most important factor in choosing a medical school abroad, while the opportunity for clerkships in North America came in a close second. This may be an advantage in recruitment strategies of medical schools in the Caribbean, where all of the medical schools make use of hospitals in the US for their clerkship training. HOW CSAs LEARNED ABOUT MEDICAL SCHOOL ABROAD From a friend/relative/graduate from school (n=1082) Searched on internet (n=1082)) Attended the school s presentation in Canada (n=1082)) School s advertisement posted in a university (n=1082) Newspaper/magazine article (n=1082) Other (n=1082)) 6.4% 4.2% 7.4% 18.0% 40.6% 72.7% * Participants were able to select more than one answer. 0% 10% 20% 30% 40% 50% 60% 70% 80% Figure 20 How CSAs learned about medical school abroad The majority (72.7%) of CSAs learned about their medical school from a friend/relative or graduate from the school, while only 18.0% attended the school s presentation in Canada. 18

19 YEAR OF GRADUATION FROM MEDICAL SCHOOL % % % % % % 0% 5% 10% 15% 20% 25% 30% 35% Figure 21 Year of graduation from medical school The vast majority of respondents are in a four year medical program. 72.8% of the respondents will be graduating between 2012 and 2014, which places them in the early years of their medical education. 19.1% are completing five or more years of study. This may reflect the 7.8% who chose a medical school abroad on the basis that they could enter directly from high school. It also speaks to the large proportion who did not apply in Canada at all. YEAR OF GRADUATION BY MEDICAL SCHOOL REGION 50% 45% 40% 35% 30% 25% 32.0% 28.3% 38.0% 25.3% 45.7% 27.2% 29.1% 35.9% 39.1%39.1% % 15% 10% 5% 0% 20.6% 17.6% 16.5% 14.0% 13.9% 11.8% 11.8% 11.2% 8.7% 8.7% 5.3% 4.6% 4.3% 3.8% 2.2% 2.5% 2.4% 0.4% 0.0% 0.0% Ireland Poland Carribean Australia Middle East Figure 22 Year of graduation by medical school region Overall, the Australian respondents were the closest to graduation ( ), while the majority of students in Ireland, Poland, and the Caribbean were further from graduation and expected to graduate between 2012 and The Caribbean had the lowest percent of respondents expected to graduate between 2010 and This may be due to the fact that the third and fourth year students attending medical school in the Caribbean are currently dispersed across the United States doing clerkships. It was difficult to find a clerkship coordinator to notify the clinical clerks about this survey. The exception was St. George s in Grenada, where the clerkship dean assisted in the notification of students. 19

20 SATISFACTION WITH MEDICAL DEGREE PROGRAM 1.9% 5.5% 51.4% 0.6% 40.5% Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied Figure 23 Satisfaction with medical degree program Overall, 91.9% of survey respondents reported being satisfied and/or very satisfied with the medical education they are receiving abroad. SATISFACTION WITH MEDICAL DEGREE PROGRAM BY MEDICAL SCHOOL REGION 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 93.4% 92.4% 93.6% 85.9% 87.0% 13.0% 4.4% 6.3% 8.7% 2.2% 1.3% 4.4% 2.0% 5.3% 0.0% Ireland Poland Carribean Australia Middle East Satisfied Neutral Dissatisfied Figure 24 Satisfaction with medical degree program by medical school region Canadians studying in the Caribbean reported being the most satisfied (93.6%) with their medical degree program, while those studying in Ireland were also highly satisfied (93.4%). A total of 92.4% of CSAs in Poland reported overall satisfaction, while 85.9% of CSAs in Australia reported the same satisfaction. Although students studying in Australia tend to be more critical of their medical education, some considerations leading to these results may be that they are older and slightly better educated. Proportionally, the Australian respondents were also further along in their medical education, either in their third or fourth years of study. 20

21 CLERKSHIPS Only 22.6% (n=244) of the respondents were in a clerkship year. Of these respondents, 69.1% (n=168) reported that they had tried to arrange a clerkship rotation in Canada. When surveyed on the difficulty of arranging clerkships in Canada, 55% found it difficult to very difficult, while only 18.6% reported it to be easy or very easy. The remaining respondents were neutral on the matter of arranging a clerkship in Canada. DIFFICULTY IN ARRANGING A CLERKSHIP ROTATION IN CANADA BY MEDICAL SCHOOL REGION 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 82.5% Easy Okay Difficult 44.8% 48.9% 41.7% 26.9% 28.4% 33.3% 25.0% 29.8% 17.5% 21.3% 0.0% Ireland Poland Carribean Australia Figure 25 Difficulty in arranging a clerkship rotation in Canada by medical school region Overall, 82.5% of respondents from the Caribbean reported that it was difficult to arrange a clerkship in Canada. A total of 48.9% of Australian respondents felt the same way. See the Appendix for full details of analysis results. NUMBER OF CLERKSHIP ROTATIONS DONE OR CONFIRMED IN CANADA BY MEDICAL SCHOOL REGION 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 11.0% 9.9% 79.0% 8.9% 3.8% 87.3% 1.4% 1.8% 96.8% 13.6% 6.3% 80.1% 4.3% 0.0% Ireland Poland Carribean Australia Middle East 95.7% Yes, done Yes, confirmed No Figure 26 Number of clerkship rotations done or confirmed in Canada by medical school region A total of 20.9% of CSAs in Ireland reported that they had done or confirmed a clerkship in Canada. A total of 19.9% of CSAs in Australia also reported having done or confirmed a clerkship in Canada, while only 12.7% from Poland, 3.2% from the Caribbean and 4.3% from the Middle East reported having done or confirmed a clerkship in Canada. These numbers are comparable to Figure 25 which shows how difficult it is to arrange a clerkship in Canada. Regions that reported a high difficulty in arranging a clerkship displayed the lowest numbers of clerkships done or arranged in Canada, while regions that reported having done or arranged clerkships in Canada felt they were easier to arrange. This result could be an indication of bias for students in Ireland and Australia over students in other regions. 21

22 Comparison of the 2006 pilot CSA study to the 2010 CSA study Overall, a lower percentage of respondents in 2010 reported having successfully arranged a clerkship in Canada. In 2010, students from Australia reported the most clerkships arranged or completed in Canada, while in 2006, CSAs studying in Europe were the most likely to have completed or arranged a clerkship in Canada. 3 The 2006 and 2010 studies both found that CSAs studying in the Caribbean were the least likely to have completed or arranged a clerkship in Canada. 3 FUNDING TABLE 4 MOST POPULAR FUNDING TYPES FOR MEDICAL SCHOOL ABROAD FUNDING TYPE % Family savings 70.3% Bank loan in Canada 69.1% Government grants Canada 37.6% Personal savings 31.2% Bank loan elsewhere 6.6% International scholarship (study abroad grant) 7.8% Other 6.8% The most popular type of funding for medical school reported by CSAs was family savings, followed by bank loans and government grants in Canada. However, as Table 4 shows, CSAs do not use just one source to fund their medical school abroad, but tend to use a combination of sources. When looking at the average CSA, 44.0% of their total funding to attend an international medical school is from a bank loan, 37.0% is from family savings, and only 1.0% is from an international scholarship. * Survey respondents were able to select more than one answer. MOST POPULAR FUNDING TYPES BY MEDICAL SCHOOL REGION 50% 40% 30% 20% 10% 0% Ireland Poland Carribean Australia Middle East Family Savings Bank Loan in Canada Government Grants Personal Savings International Scholarships Bank Loan Elsewhere Other Figure 27 Most popular funding types by medical school region Family savings was cited as the main funding source more frequently by CSAs in Europe and the Middle East than CSAs in the Caribbean or Australia. A higher percentage of CSAs in Australia and the Caribbean reported that they funded their education through a bank loan in Canada. TABLE 5 TOP FUNDING SOURCE BY REGION AND MEDICAL SCHOOL Region Medical School Top Funding Source % Average Yearly Tuition ($CAD) Ireland Royal College of Surgeons Family Savings 95.2% 63,051 Trinity College, University of Dublin Family Savings 78.3% 41,809 Poland Jagiellonian University Medical College Bank Loan in Canada 66.0% 15,780 Poznan University of Medical Sciences Center Family Savings 70.8% 12,911 Caribbean St. George s University Bank Loan in Canada 74.1% 62,232 Saba University School of Medicine Bank Loan in Canada 79.1% 27,178 Australia University of Queensland Bank Loan in Canada 71.9% 54,571 University of Sydney Family Savings 82.7% 53,112 Middle East RCSI Bahrain Family Savings 83.3% 38,245 Sackler School of Medicine Personal Savings 45.5% 28,644 22

23 DEBT Estimated total amount of debt Over half of CSAs reported their estimated amount of debt to be above $160,000 (CAD). In fact, the most frequent estimated amount of debt cited was $200,000 (CAD). However, 12.2% of CSAs did not expect to have any debt, 30.7% estimated their debt to be less than $100,000, 54.4% estimated their debt to be between $100,000 and $299,999 and 14.9% estimated their debt to be $300,000 or greater. MEDIAN DEBT BY MEDICAL SCHOOL REGION $250,000 $200,000 $150,000 $200,000 $175,000 $200,000 $100,000 $50,000 $70,000 $90,000 $0 Ireland Poland Carribean Australia Middle East Figure 28 Median debt by medical school region Overall, CSAs studying in Ireland and Australia reported the highest ($200,000 CAD) total estimated median debt at graduation, while $175,000 (CAD) was the median debt reported by CSAs studying in the Caribbean. A much lower median debt of $70,000 (CAD) and $90,000 (CAD) was reported by those studying in Poland and the Middle East. Comparison of the 2010 CSA study to the 2010 Canadian medical graduate cohort Median debt The median debt reported by CSAs in 2010 was $160,000 (CAD). In comparison, an article from Medical Education, which surveyed Canadian medical students in 2001 and 2007, reported the median debt of Canadian medical graduates as $71,000 (CAD). 7 The median debt of Canadians has risen $31,000 (CAD) since 2001, 7 however it is still $89,000 (CAD) less than the median debt of Canadians studying medicine abroad. SATISFACTION WITH COST OF MEDICAL EDUCATION 15.6% 31.6% 11.7% 22.7% 18.3% Very Satisfied 11.7% Satisfied 15.6% Neutral 22.7% Dissatisfied 31.6% Very Dissatisfied 18.3% Figure 29 Satisfaction with cost of medical education Almost 49.9% of CSAs reported being dissatisfied or very dissatisfied with the cost of their medical education. 23

24 100% 80% 60% 40% 20% 0% 1.5% 19.5% SATISFACTION WITH COST OF MEDICAL EDUCATION BY MEDICAL SCHOOL REGION 44.1% 43.0% 34.9% 35.4% 16.5% 5.1% 23.8%22.6%25.1% 26.7% 17.8% 10.8% 6.8% 1.0% 42.2% 23.3% 17.4% 4.3% 52.2% 21.7% Ireland Poland Carribean Australia Middle East 4.3% Very satisfied Satisfied Neutral Dissatisfied Very dissatisfied Figure 30 Satisfaction with cost of medical education by medical school region CSAs in Ireland and Australia were the most dissatisfied with the cost of their medical education. Coincidentally, these two regions also have the highest reported median debts. CSAs in Poland were the most satisfied with the cost of their medical education, and also reported the lowest median debt per any region surveyed. When significance testing was run, it was determined that the cost of medical education is related to reported satisfaction with a medical program. CSAs that were very dissatisfied with the cost of their education reported lower levels of satisfaction with their medical programs than CSAs that were very satisfied with the cost of their medical education. Comparison of the 2010 CSA study to the 2010 Canadian medical graduate cohort TABLE 6 ANNUAL TUITION RATES Medical School Region Avg. Yearly Tuition ($CAD) Range of Yearly Tuition Fees ($CAD) Lowest in Region Highest in Region Ireland $49,800 $41,809 $63,051 Poland $14,191 $12,250 $15,780 Caribbean $25,608 $9,017 $62,232 Australia $42,334 $18,894 $66,369 Middle East $26,336 $15,117 $38,244 Canada $12,214* $6,130* $18,586* * Source: Canadian Medical Education Statistics 2009, The Association of Faculties of Medicine of Canada,

25 POSTGRADUATE PLANS INTENTION TO RETURN TO CANADA TO PURSUE POSTGRADUATE MEDICAL TRAINING INTENTION TO STAY IN CANADA TO PRACTICE MEDICINE AFTER CANADIAN POSTGRADUATE MEDICAL TRAINING 16.9% 9.7% 73.4% Yes, all of my postgraduate training Yes, a portion of my postgraduate training No 0.7% 11.8% 87.4% Yes No Undecided Figure 31 Intention to return to Canada to pursue postgraduate medical training Overall, 90.3% of CSAs reported that they intended to return to Canada to pursue at least some of their postgraduate medical training. Less than 10.0% reported that they do not intend to return to Canada for postgraduate training. Figure 32 Intention to stay in Canada to practice medicine after Canadian postgraduate training A total of 87.4% of CSAs who intend to pursue postgraduate medical training in Canada also intend to stay in Canada to practice after this training. Of the 0.7% who stated they do not intend to stay in Canada after Canadian postgraduate training, reasons included: limited opportunities to practice in my preferred location (57.1%), economic incentives to leave Canada (28.6%), and family considerations (28.6%). TABLE 7 YEAR OF GRADUATION FROM MEDICAL SCHOOL BY INTENTION TO RETURN TO CANADA TO PURSUE POSTGRADUATE MEDICAL TRAINING Year of Graduation Intention to Return to Canada for Training Yes No Total n % n % n % % % % % % % % % % % % % % 4 3.1% % % % % Total For CSAs intending to return to Canada to pursue postgraduate medical training, there is a statistically significant difference between CSAs graduating in 2010 and CSAs graduating in The further CSAs are from graduating, the more likely they report that they plan on returning to Canada for postgraduate medical training. CSAs closer to graduation may be more realistic about the challenges of returning to Canada to pursue postgraduate medical training. 25

26 TABLE 8 REGION OF MEDICAL SCHOOL BY INTENTION TO RETURN TO CANADA TO PURSUE POSTGRADUATE MEDICAL TRAINING Region of Medical Schools Intention to Return to Canada for Training Yes No Total n % n % n % Ireland % % % Poland % % % Caribbean % % % Australia % % % Middle East % % % Total Significance testing revealed that all regions containing CSAs report an equal likelihood of planning to return to Canada to pursue postgraduate medical training. Comparison of the 2006 pilot CSA study to the 2010 CSA study Intention to return to Canada to pursue postgraduate medical training It is important to note that in 2006, only 67.0% of CSA respondents indicated their intention to return to Canada for postgraduate medical training 3. In 2010, 90.3% of CSA respondents indicated that they intended to return to Canada for postgraduate medical training. This is a significant increase (176%) in an intention to return home (z = 11.41, p <.001). Year of graduation from medical school by intention to return to Canada to pursue postgraduate medical training Both the 2010 and the 2006 pilot study noted that being further from graduation increased the likelihood of a CSA s intention to return to Canada for postgraduate medical training. 3 Region of medical school by intention to return to Canada to pursue postgraduate medical training Although in the 2010 study, no significant differences were found pertaining to CSAs intent to return home by the region of medical school they were enrolled in, the 2006 pilot study found that significant differences existed amongst the medical schools. Over three-quarters of CSAs in European medical schools were planning to return to Canada, compared to 57.0% (just over half) of those studying in Caribbean medical schools. 3 FIRST/TOP CHOICES TABLE 9 INTENDING TO RETURN FOR POSTGRADUATE TRAINING IN CANADA: FIRST CHOICE LOCATIONS FOR POSTGRADUATE MEDICAL TRAINING IN CANADA First Choice Locations n % University of Toronto % University of British Columbia % The University of Western Ontario % McMaster University % University of Manitoba % University of Calgary % Dalhousie University % University of Alberta % University of Ottawa % McGill University % University of Saskatchewan % Northern Ontario School of Medicine % Memorial University of Newfoundland % Queen's University 6 0.6% Not decided % Total* % The University of Toronto ranked first among 33.5% of CSAs as their first choice location for postgraduate medical training. The University of British Columbia was cited as the first choice location for 16.6% of CSAs. This corresponds with the increased number of CSAs declaring their province of residence to be Ontario and British Columbia. * Only includes respondents intending to return to Canada for all or part of their postgraduate training. 26

27 TABLE 10 INTENDING TO RETURN TO POSTGRADUATE TRAINING IN CANADA: TOP CHOICE DISCIPLINES FOR POSTGRADUATE MEDICAL TRAINING IN CANADA First Choice Discipline n % Family Medicine % Internal Medicine % Pediatrics % Emergency Medicine % General Surgery % Orthopedic Surgery % Obstetrics & Gynecology % Cardiac Surgery % Anesthesiology % Neurology % Psychiatry % Diagnostic Radiology % Neurosurgery % Radiation Oncology % Ophthalmology % Plastic Surgery 9 0.9% Dermatology 4 0.4% Urology 4 0.4% Otolaryngology 3 0.3% Physical Medicine & Rehabilitation 3 0.3% Community Medicine 2 0.2% General Pathology 2 0.2% Hematological Pathology 2 0.2% Neurology Pediatric 2 0.2% Anatomical Pathology 1 0.1% Laboratory Medicine 1 0.1% Medical Genetics 1 0.1% Other 4 0.4% Not decided % Total* % Family Medicine was the first choice residency discipline with (21.0%), followed by Internal Medicine (14.4%). Yet, 18.1% of respondents remained undecided on their residency discipline of choice. * Only includes respondents intending to return to Canada for all or part of their postgraduate training. 27

28 Comparison of the 2006 pilot CSA study to the 2010 CSA study Top choice disciplines for postgraduate medical training in Canada Family Medicine and Internal Medicine remained the top two discipline choices for CSAs. In 2006, Internal Medicine was the first choice discipline of 19.0% of respondents, followed by Family Medicine at 16.8%. 3 Conversely, in 2010, Family Medicine was the first choice discipline of 21.0% of respondents, followed by Internal Medicine with 14.4% of respondents. Comparison of the 2010 CSA study to the 2010 Canadian medical graduate cohort TABLE 11 TOP FIVE LOCATIONS FOR POSTGRADUATE MEDICAL TRAINING IN CANADA (CSA VS. CMG) CSA Top Five Locations n % Top Five Locations n % University of Toronto % University of Toronto % University of British Columbia % University of British Columbia % The University of Western Ontario % University of Montreal % McMaster University % University of Ottawa % University of Manitoba % University of Laval % Total % Total % * Source: CaRMs 2010 CMG Cohort Data The University of Toronto is the first choice among 33.5% of CSAs and 15.7% of CMGs. Both CSAs and CMGs also cite the University of British Columbia as a top choice. CMG* TABLE 12 TOP FIVE DISCIPLINES FOR POSTGRADUATE MEDICAL TRAINING IN CANADA (CSA VS. CMG) CSA CMG* Top Five Disciplines n % Top Five Disciplines n % Family Medicine % Family Medicine % Internal Medicine % Internal Medicine % Pediatrics % Pediatrics % Emergency Medicine % Anesthesiology % General Surgery % General Surgery % Total % Total % * Source: CaRMs 2010 CMG Cohort Data Four out of the five top residency choices for both CSAs and CMGs are the same. 28

29 CANADIANS NOT INTENDING TO RETURN TO CANADA FOR POSTGRADUATE MEDICAL TRAINING PERCEIVED BARRIERS TO RETURNING TO CANADA FOR POSTGRADUATE TRAINING I prefer not to do return of service work My first choice of residency is difficult to obtain in Canada The opportunity to do postgraduate training in my preferred location is limited I do not think that I have a reasonable chance to match in Canada I have personal commitments in another country 14.3% 46.7% 43.8% 57.1% 61.0% The cost of examinations is too high My career/residency is not found in Canada I do not think I have a reasonable chance of passing the Medical Council of Canada Evaluation Examination Other 1.0% 6.7% 5.7% 26.7% 0% 10% 20% 30% 40% 50% 60% 70% 80% * Respondents could select more than one answer. n=105 Figure 33 Perceived barriers to returning to Canada for postgraduate training Of the 9.7% of CSAs who do not plan to enter postgraduate medical training in Canada, 61.0% reported not wanting to do return of service work. The other major barriers reported were difficulty in obtaining a first choice residency, and/or location of residency. 43.8% of this group stated they did not intend to return to Canada because they didn t feel they had a reasonable chance of matching. This is similar to the 26.7% of CSAs who self-selected themselves out of the competition for admittance to undergraduate Canadian medical schools by never applying. Some of the barriers received in the Other category included: I think that there are more opportunities available in the States than in Canada especially for foreign medical graduates. The process seems too complex with too many steps. In the US, USMLE steps 1, 2 and 3 are easy to understand and follow. Poor working conditions as a doctor in Canada. In Australia, I will be paid for overtime and on-call work and earn more per hour than if I returned to Saskatchewan, which offers limited IMG positions. 29

30 Reason TABLE 13 REASONS FOR NOT INTENDING TO RETURN TO CANADA FOR POSTGRADUATE TRAINING BY REGION Medical School Region Ireland Poland Caribbean Australia Middle East Total n % n % n % n % n % n % I prefer not to do return of service work 10 20% 12 29% 22 21% 19 26% 1 17% 64 23% My first choice of residency is difficult to obtain 13 27% 10 24% 20 19% 15 20% 2 33% 60 22% in Canada The opportunity to do postgraduate training in 10 20% 8 19% 20 19% 10 14% 1 17% 49 18% my preferred location is limited I do not think that I have a reasonable chance to 7 14% 6 14% 24 23% 9 12% 0 0% 46 17% match in Canada I have personal commitments in another country 4 8% 0 0% 3 3% 6 8% 2 33% 15 5% The cost of examinations is too high 0 0% 0 0% 5 5% 2 3% 0 0% 7 3% My career choice/residency is not found in Canada 1 2% 1 2% 1 1% 3 4% 0 0% 6 2% I do not think I have a reasonable chance of passing 0 0% 1 2% 0 0% 0 0% 0 0% 1 0% the Medical Council of Canada Evaluating Examination Other 4 8% 4 10% 10 10% 10 14% 0 0% 28 10% The majority of respondents studying in Ireland who do not intend to return to Canada for postgraduate medical training cited a difficulty in obtaining their first choice of residency as their main reason not to return. Those studying in Poland and Australia prefer not to do a return of service, and those in the Caribbean do not think they have a reasonable chance of matching in Canada. Respondents in the Middle East also preferred not to do a return of service, and also cited personal commitments in another country as their reasons for not wanting to return. COUNTRY (IF NOT IN CANADA) WHERE CSAS INTEND TO COMPLETE THEIR POSTGRADUATE MEDICAL TRAINING 2.0% 2.9% 1.0% 77.5% INTENTION TO RETURN TO CANADA TO PRACTICE MEDICINE AFTER POSTGRADUATE MEDICAL TRAINING ABROAD 16.7% United Sates Australia Ireland 24.8% 53.3% Yes No Undecided Norway 21.9% n = 102 Figure 34 Country (if not Canada) where CSAs intend to complete their postgraduate medical training A total of 77.5% of CSAs that do not intend to return to Canada to pursue postgraduate medical training intend to pursue training in the United States. However, with a targeted increase of 30% in US undergraduate admissions and no increase planned for postgraduate training opportunities, fewer positions will be available to international medical graduates, requiring these students to explore different options for postgraduate training. 8 n = 102 Figure 35 Intention to return to Canada to practice medicine after postgraduate medical training abroad Of the 9.7% of Canadians who cited they did not intend to return to Canada for postgraduate medical training, 24.8% of them do intend to return to Canada after postgraduate training abroad, while 53.3% remain undecided. 30

31 PERCEIVED BARRIERS TO RETURNING TO CANADA TO PRACTICE MEDICINE AFTER POSTGRADUATE MEDICAL TRAINING ABROAD Economic incentives to stay away Limited opportunity to practice in my preferred location 52.2% 52.2% Difficulty in obtaining recognition of training 43.5% Family considerations 21.7% Limited research funding available in my field 8.7% Other 21.7% 0% 10% 20% 30% 40% 50% 60% n = 23 * Respondents could select more than one answer. Figure 36 Perceived barriers to returning to Canada to practice medicine after postgraduate medical training abroad This study found that CSAs choose not to return to Canada for postgraduate medical training and practice mainly due to economic incentives to stay abroad, and limited opportunities to practice in a preferred location. The level of difficulty in obtaining recognition of training was also cited as one of the main barriers for not intending to return to Canada to practice after postgraduate training abroad. Comparison of the 2006 pilot CSA study to the 2010 CSA study Perceived barriers to returning to Canada for postgraduate training CSAs in both the 2010 and 2006 studies cited the difficulty to obtain their first choice of residency as a common reason for not intending to return to Canada for postgraduate training. 3 Two additional reasons from 2006 were: Foreign-trained graduates are poorly treated and Restriction to the second iteration of CaRMS poses difficulties. 3 It should be noted that after the 2006 pilot study was completed, the rules changed, and for the first time, IMGs were allowed to compete in the first iteration of the CaRMS match. INTERNATIONAL MEDICAL SCHOOL DATA BY MEDICAL SCHOOL CARIBBEAN TABLE 14 CARIBBEAN MEDICAL SCHOOL DATA WEBSITE SOURCES Location Medical School Website Grenada St. George s University Dominica Ross University Netherland Antilles SABA University School of Medicine Saint Kitts Windsor University St. Maarten American University of the Caribbean School of Medicine Antigua American University of Antigua Antigua University of Health Sciences Antigua Continued on page 32 31

32 TABLE 14 CARIBBEAN MEDICAL SCHOOL DATA WEBSITE SOURCES Aruba All Saints University of Medicine Aruba Xavier University School of Medicine Belize Central America Health Sciences University Cayman Islands St. Matthew s University Dominica All Saints University of Medicine Netherland Antilles Saint James School of Medicine Netherland Antilles University of Sint Eustatius Nevis Medical University of the Americas Saint Kitts International University of Health Sciences (IUHS) Saint Kitts University of Medicine and Health Sciences (UMHS) Saint Lucia Spartan Health Sciences Saint Lucia International American University Trinidad and Tobago University of the West Indies TABLE 15 NUMBER OF CSAS STUDYING MEDICINE IN THE CARIBBEAN Location* Medical School Estimation of CSAs Grenada St. George s University ~ 660 Dominica Ross University ~ 270 Netherland Antilles SABA University School of Medicine ~ 320 Saint Kitts Windsor University ~ 200 St. Maarten American University of the Caribbean School of Medicine ~ 120 Antigua American University of Antigua Unknown** Antigua University of Health Sciences Antigua Unknown** Aruba All Saints University of Medicine Unknown** Aruba Xavier University School of Medicine Unknown** Belize Central America Health Sciences University Unknown** Cayman Islands St. Matthew s University Unknown** Dominica All Saints University of Medicine Unknown** Netherland Antilles Saint James School of Medicine Unknown** Netherland Antilles University of Sint Eustatius Unknown** Nevis Medical University of the Americas Unknown** Saint Kitts International University of Health Sciences (IUHS) Unknown** Saint Kitts University of Medicine and Health Sciences (UMHS) Unknown** Saint Lucia Spartan Health Sciences Unknown** Saint Lucia International American University Unknown** Trinidad and Tobago University of the West Indies Unknown** Estimated Total ~ 2000 * Only includes Caribbean medical schools known to have Canadian students. ** Unknown denotes locations where CSAs are known to study but no numbers were provided, an overall estimate was given for the region. Overall, 20 schools in the Caribbean were identified as educating Canadian students. Although various other schools offer medical education in the Caribbean, the CaRMS 2008 and 2009, as well as the MCC data only identified these schools as having current Canadian graduates. This study was able to estimate that at least 2000 Canadians are studying medicine in the Caribbean. 32

33 TABLE 16 GENERAL INFORMATION Medical School Year University Founded Year International Program Began St. George s University Ross University SABA University School of Medicine Windsor University American University of the Caribbean School of Medicine American University of Antigua University of Health Sciences Antigua Xavier University School of Medicine, Aruba Xavier University School of Medicine, Bonaire Central America Health Sciences University St. Matthew s University All Saints University of Medicine, Aruba All Saints University of Medicine, Dominica Saint James School of Medicine, Bonaire Saint James School of Medicine, Anguilla University of Sint Eustatius Medical University of the Americas International University of Health Sciences (IUHS) University of Medicine and Health Sciences (UMHS) Spartan Health Sciences International American University University of the West Indies Some of the oldest schools in the Caribbean, such as St. George s and Ross, continue to educate the most Canadians in the midst of new medical schools opening every year. TABLE 17 ADMISSIONS BY MEDICAL SCHOOL Medical School Programs Available Admissions Admission Requirements Fielded Through St. George s University Four year and BS/MD dual degree School - online application MD (four year): bachelor s degree, MCAT, specific coursework in: biology, inorganic chemistry, organic chemistry, math, English. BS/MD Dual Degree: high school diploma, courses in mathematics, science, biology or zoology, chemistry, English and one other course, strong GPA in science, and SAT. Ross University Four year School - online application Cumulative GPA, GPA in pre-med coursework (inorganic chemistry, organic chemistry, biology, physics, math, English), MCAT, graduate work and records, letters of recommendation, personal essay, work history, professional or volunteer experiences, and personal interview. Minimum three years of undergraduate studies or the equivalent of 90 semester hours or 135 quarter hours including premedical requirements (biology, general/inorganic chemistry, biochem/ organic chemistry) from an accredited college or university. A baccalaureate degree is recommended but not required. Preference will be given to applicants who have completed a bachelor s degree or higher. All applicants who are US citizens, nationals or permanent residents are required and all other students are strongly encouraged to take the MCAT. Continued on page 34 33

34 TABLE 17 ADMISSIONS BY MEDICAL SCHOOL Medical School Programs Available Admissions Admission Requirements Fielded Through SABA University School of Medicine Four year School - online application Applicants are expected to have a minimum of 50 hours of direct patient care experience to be eligible for admission to Saba University School of Medicine. This experience can come from volunteering in a hospital setting, shadowing physicians, working as an EMT, etc. Windsor University Four year and five year School - form to be mailed to US office Pre-med (five year) - applicants must be high school graduates with a minimum of 10 years of education from an American or internationally-recognized school. MD (four year) - undergraduates or students enrolled in undergraduate programs with one year of biology and chemistry after high school. Both four and five year programs consider: GPA, letters of recommendation, personal essays, interview, and professional or volunteer experiences. American University of the Caribbean School of Medicine Four year School - online application Baccalaureate degree from an accredited university to be obtained as a condition of matriculation, MCAT, college credits must include the following: biology, general chemistry, organic chemistry, general physics, and English. A generous exposure to mathematics, humanities, and social sciences is desired. Real life experience in the health care field is strongly recommended. A personal interview may be requested at the discretion of the Admissions Committee. AUC requires all applicants to consent to a background check. American University of Antigua Four year and six year School online application MD (four year) at least 90 credits of college courses. Strongly recommends that applicants earn a degree from an accredited undergraduate institution. Required courses: inorganic or general chemistry, organic chemistry, biology or zoology, physics, English, and calculus or statistics. It is strongly advised that applicants complete advanced science courses in biochemistry, anatomy/physiology, genetics, microbiology, etc. BHHS/MD (six year) - high school diploma with a minimum GPA of 3.0, and a combined score of 1100 on the SAT (verbal and math) or a 24 on the ACT. Applicants must have completed at least three years of science, English and mathematics courses. Both four and six year programs require: letters of reference, personal statement. University of Health Sciences Antigua Four year School - form to be mailed to US office At least 90 collegiate credit hours from accredited institutions. The following courses are required: inorganic or general chemistry, organic chemistry, biology or zoology, physics, English, mathematics. Letters of reference are also required. Continued on page 35 34

35 TABLE 17 ADMISSIONS BY MEDICAL SCHOOL Medical School Programs Available Admissions Admission Requirements Fielded Through All Saints University of Medicine, Aruba Four year and five year School online application MD (four year) - minimum of three years course work in an accredited college or university (minimum of 90 semester hours or 135 quarter hours). Preference will be given to applicants who have completed a baccalaureate degree or higher. Courses must include: biology, chemistry, physics, mathematics, English, and humanities. MD (five year) high school diploma. Both four and five year programs require: personal essay, letters of recommendation, MCAT score if available, TOEFL score if available. Xavier University School of Medicine Four year and five and a half year School - form to be mailed to US office MD (four year) - at least two academic years and 90 credit hours of undergraduate studies including the following subjects: inorganic or general chemistry, organic chemistry, biology, physics, English, and pre-calculus/calculus. MD (five and a half years) - high school diploma, GPA 3.0, SAT 1200 (old system) 1800 (new system) or ACT 26. Both four and five and a half year programs require: letters of recommendation, structured questions and personal essay, and interview. Central America Health Sciences University Four year School - form to be mailed to US office An applicant must have satisfactorily completed no less than 90 undergraduate semester hours (or equivalent number of quarter hours). Applicants are not required to have earned a bachelor's degree, but an undergraduate degree from an American, Canadian or internationally accredited college or university is recommended. The following courses must have been completed satisfactorily: biology, general chemistry, organic chemistry, physics, math, English. Letters of recommendation and a personal statement are required. St. Matthew s University Four year School online application Qualified candidates typically have earned an undergraduate degree from an approved college or university in the United States, Canada or a recognized international institution. St. Matthew's University will give consideration for admission to an applicant who has earned 90 or more college semester credit hours. Premedical studies should include the following courses: inorganic (general) chemistry, organic chemistry, biology, language arts, physics, English, humanities, and mathematics or computer science. Letters of recommendation, personal statement, and MCAT scores are required. All Saints University of Medicine, Dominica Four year and five year School online application MD (four year) minimum three years course work in an accredited college or university (minimum of 90 semester hours or 135 quarter hours). Preference given to applicants who have completed a baccalaureate degree or higher. Courses should include: biology or zoology, general inorganic chemistry or advanced chemistry, physics, mathematics, English, and humanities/social sciences. MD (five year) high school diploma. Continued on page 36 35

36 TABLE 17 ADMISSIONS BY MEDICAL SCHOOL Medical School Programs Available Admissions Admission Requirements Fielded Through Saint James School of Medicine Four year School online application Baccalaureate/bachelor's degree or a total of 90 credit hours (approximately three years of undergraduate education) at an accredited college or university is required. Courses should include: biology or zoology, general inorganic chemistry, advanced chemistry, physics, English, humanities/social sciences. University of Sint Eustatius Four year School online application Bachelor's degree or 90 college credits. Required courses: biology, inorganic chemistry, organic chemistry, physics, mathematics. Medical University of the Americas Four Year School online application At least three years of undergraduate studies (the equivalent of 90 semester hours or 135 quarter hours from an accredited college or university). Required courses: biology or zoology, inorganic chemistry, organic chemistry, English. MUA encourages students to complete courses in the arts, social sciences, philosophy, literature and the humanities. Students completing courses such as cell biology, anatomy and physiology, genetics, biochemistry, molecular biology, physics, mathematics, statistics and psychology/interpersonal skills and communication are given preference in admissions. International University of Health Sciences (IUHS) Four year Unknown Bachelor s degree in science or equivalent (90 to 120 semester or credit hours at the university/ college level). Courses should include: physics, general chemistry, organic chemistry, biology, mathematics/calculus. Additionally a biochemistry course is recommended. Courses in microbiology, cellular physiology, genetics, embryology while not required, are useful in providing some of the essential skills and knowledge required for medical education and assisting the Admissions Committee in assessing a candidates readiness to study medicine. Recommendations from professors and medical doctors, personal interview, personal statement, MCAT scores, practical work experience in the healthcare field. University of Medicine and Health Sciences (UMHS) Four year School online application A minimum of three years of study (90 semester credits) at an accredited college or university however, a bachelor s degree is highly recommended. Courses in inorganic or general chemistry, organic chemistry, general biology or zoology, physics, English, and mathematics. Applicants should have a broad background in the humanities and have completed at least credit hours in either the humanities and/or the social or behavioral sciences. It is recommended that additional sciences courses such as genetics, anatomy, physiology and biochemistry be taken. Standardized tests including SATs, ACTs, MCATs, GREs, USMLE Step I or any and all tests that will assist in evaluating application. A personal essay, letters of recommendation, and a personal interview are also required. It is also highly recommended that applicants have experiences in clinical settings, research, public health, or community outreach activities. Continued on page 37 36

37 TABLE 17 ADMISSIONS BY MEDICAL SCHOOL Medical School Programs Available Admissions Admission Requirements Fielded Through Spartan Health Sciences Five year School online application Minimum requirement for admission is three years of college or university level studies (90 semester credit hours). A baccalaureate degree is preferred. Courses should include: biology, physics, chemistry, organic chemistry or organic chemistry and biochemistry sequence accepted, mathematics. International American University Four year School online application At least 90 credit hours of undergraduate coursework but recommends the completion of a four year degree. Coursework should include the following: inorganic or general chemistry, organic chemistry, biology or zoology, physics, English, mathematics (preferably calculus or statistics). Personal statement, two letters of recommendation from academic or professional sources, and resume listing extracurricular or medical voluntary activities. University of the West Indies Five year School Applicants with first degrees from institutions other than the UWI are eligible provided that the program of study has been accredited by a relevant body or agency and is considered acceptable by the UWI. Course credits have been obtained in biology/zoology and chemistry. A minimum GPA of 3.0 or equivalent must be obtained, as well as an autobiographical summary outlining reasons for career choice, extracurricular activities outlined and original letters certified from principals, supervisors or employers for each activity. The university places emphasis on applicant s voluntary participation in community/social projects although consideration shall also be given to other extracurricular activities, experiences and abilities (such as music, sports, drama, and debating or proficiency in a foreign language). Applicants may also be required to attend an interview. The majority of the schools in the Caribbean offer four year medical degrees with admissions based on some undergraduate courses taken in the sciences and a certain GPA or a bachelor s degree attained from an accredited university. MCAT scores are typically not required but recommended by most schools. Applicants usually apply to Caribbean medical schools via an online application and can attend information sessions provided by the medical schools in North America. Caribbean medical schools handle their own admissions with the aid of their North American offices and do not make use of recruitment/admission agencies as other international medical education universities do. 37

38 TABLE 18 CURRICULUM SUMMARY BY MEDICAL SCHOOL Medical School Basic Science Curriculum Clinical Curriculum St. George s University Ross University SABA University School of Medicine Windsor University American University of the Caribbean School of Medicine American University of Antigua Two years: Anatomical Sciences, Behavioral Sciences, Biochemistry and Genetics, Bioethics, Clinical Skills, Microbiology, Pathology, Pathophysiology, Pharmacology, Physiology and Neuroscience, Public Health and Preventive Medicine, and electives. Two years: Developmental and Microscopic Anatomy I/II, Biochemistry and Genetics I/II, Doctor, Patient and Society I/II, Neuroscience, Gross Anatomy I/II Medical Physiology I/II, Microbiology and Immunology I/II, Pathology I: General, Pathology II: Systemic and Clinical, Medical Pharmacology I/II, Introduction to Clinical Medicine, and Behavioral Sciences. Two years: Cellular Biology, Embryology, Histology, Gross Anatomy with human cadavers, Biochemistry and Medical Genetics, Physiology, Epdiemiology, Microbiology, Neuroscience and Medical Psychology, Medical and Legal Ethics, Pathology, Pharmacology, Physical Diagnosis, and Clinical Pathology. Two years: Physiology, Biochemistry, Microbiology, Pharmacology, Anatomy, and Pathology. Two years: Anatomy/Embryology, Molecular and Cell Biology I/II, Histology, Physiology I/II, Immunology and Infection, Biostatistics, Introduction to Clinical Med/Clerkships 1/2/3/4/5/6, Pathology I/II, Medical Microbiology, Neuroscience, Pharmacology I/II, and Behavioral Science I/II. Two years: Gross Anatomy/Embryology, Histology/Cell Biology, Doctor, Patients, and Society, Neuroscience, Medical Physiology, Biochemistry, Genetics, Behavioral Science, Microbiology, Immunology, General Pathology, Pharmacology, Systemic Pathology, Introduction to Clinical Medicine, and Preliminary Clinical Training. Two years (80 weeks): Core clerkship year Medicine, Surgery, Pediatrics, Obstetrics/Gynecology, and Psychiatry. Senior year - Medicine Sub-Internship, Primary Care (Family Practice, Emergency Medicine, Outpatient Experience in General Medicine, General Pediatrics, or General Obstetrics/ Gynecology), Medicine elective, Pediatric elective or Sub-Internship, and additional electives. Two years (90 weeks): Advanced Introduction to Clinical Medicine, Medicine, Obstetrics/Gynecology, Pediatrics, Psychiatry, Surgery, Family Medicine, electives and research electives. Two years (72 weeks): core rotations - Surgery, Internal Medicine, Pediatrics, Psychiatry, and Obstetrics and Gynecology. Elective clinical rotations - student may select based upon their projected medical specialty. Two years (72 weeks): Internal Medicine, Surgery, Obstetrics, Gynecology, Pediatrics, Psychiatry, and elective rotations. Two years (72 weeks): Internal Medicine, Surgery, Pediatrics, Obstetrics and Gynecology, Psychiatry, and 30 weeks in clinical elective rotations. Two years (72 weeks): Family Practice I/Internal Medicine I, Internal Medicine, Surgery, Pediatrics, Obstetrics and Gynecology, Psychiatry, and Family Medicine. Electives - Anesthesiology, Immunology, Cardiology, Critical Care, Dermatology, Emergency Medicine, Endocrinology, Diabetes and Metabolism, Gastroenterology, Geriatric Medicine, Infectious Diseases, Nephrology, Neurology, Oncology, Ophthalmology, Preventive Medicine, Pulmonary Disease, Radiology, Rheumatology, Orthopedic Surgery, and Pathology. Continued on page 39 38

39 TABLE 18 CURRICULUM SUMMARY BY MEDICAL SCHOOL Medical School Basic Science Curriculum Clinical Curriculum University of Health Sciences Antigua All Saints University of Medicine Xavier University School of Medicine Central America Health Sciences University Two years: basic sciences and USMLE prep. Two years: Gross Anatomy, Histology, Medical Embryology, Medical Ethics, Biochemistry, Physiology, Genetics, Neurosciences, Microbiology and Immunology, Psychology, Pathology I, Pharmacology, Pathology II, Epidemiology and Preventive Medicine, Physical Diagnosis, and Introduction to Clinical Medicine. Two years: Gross and Development Anatomy, Histology and Cell Biology, Epidemiology and Preventative Medicine, Introduction to Info Medicine, Physiology 1, Gross and Development Anatomy II, Biochemistry and Molecular Medicine, Physiology II, Neuroscience, Pathology I, Microbiology/ Immunology, Medical Psychology and Ethics, Pathology II, Pharmacology, Physical Diagnosis, Introduction to Clinical Medicine, and Getting into Residencies. Two years: Gross Anatomy, Medical Physiology, Histology, Embryology, Biostatistics, Biochemistry, Microbiology, Neuroanatomy, Human Genetics, Immunology & Allergy, Behavioral Sciences, Epidemiology & Public Health, Nutrition, Pharmacology, General Pathology, ENT, Respiratory Medicine, Neurology, Fluid/Electrolytes & Renal, Endocrinology, Dermatology, Legal Medicine & Medical Ethics, Tropical Medicine & Parasitology, Psychiatry, Anesthesiology, Gastroenterology, Hematologym, Oncology, Orthopedics, Principles of Clinical Medicine, Radiology, Ophthalmology, Surgery & Orthopedic Surgery, Obstetrics & Gynecology, Pediatrics, Systematic Pathology, Geriatric Medicine, Child Abuse & Human Sexuality, Infectious Diseases, Molecular Biology, Cardiology, Physical Diagnosis, Forensic Medicine, Urology, and Rheumatology. Two years (78 weeks): Internal Medicine, General Surgery, Obstetrics and Gynecology, Psychiatry, and Family Medicine. Examples of electives: Family Practice, Cardiology, Emergency Medicine, Anesthesiology, Orthopedic Surgery, Otolaryngocology, Neurology, Radiology, Preventative Medicine/Infectious Disease, electives in General Surgery. Two Years (72-80 weeks): Internal Medicine, General Surgery, Obstetrics and Gynecology, Pediatrics, Psychiatry, Family Practice, and electives (student s choice). Two years (72 weeks): Family Medicine, Pediatrics, Obstetrics and Gynecology, Behavioural Medicine, Internal Medicine, Surgery, and electives (student s choice). Two years (56 weeks + electives): Internal Medicine, Obstetrics & Gynecology, General Surgery, Pediatrics, Primary Care, Family Medicine & Preventive Medicine, and Psychiatry. Electives: Anesthesiology, Dermatology, Family Medicine, Internal Medicine, Neurosurgery, Occupational Medicine, Orthopedic Surgery, Pathology, Pediatric Surgery, Physical Diagnosis/ Rehabilitation, Radiology (including radiation safety), Thoracic Surgery, Clinical Pathology, Emergency Medicine, Gynecology, Neurology, Obstetrics, Ophthalmology, Otorhinolaryngology, Pediatrics, Plastic Surgery, Preventive Medicine, Surgery, Urology, Cardiology, and Gastroenterology. Continued on page 40 39

40 TABLE 18 CURRICULUM SUMMARY BY MEDICAL SCHOOL Medical School Basic Science Curriculum Clinical Curriculum St. Matthew s University Saint James School of Medicine University of Sint Eustatius Medical University of the Americas Two years: Patient-Doctor Relations, Principles of Research and Evidence Based Medicine, Histology and Cell Biology, Developmental and Gross Anatomy, Patient-Doctor Relations II, Neuroscience, Biochemistry and Genetics, Physiology, Medical Spanish, Patient-Doctor Relations III, Medical Microbiology I, Medical Pharmacology I, Biostatistics and Epidemiology, Behavioral Sciences, Pathology I, Patient- Doctor Relations IV, Medical Microbiology II, Medical Pharmacology II, Pathology II, Clinical Therapeutics, Introduction to Clinical Medicine, and Fundamentals of Clinical Sciences. Two years: Histology, Gross Anatomy and Embryology, Medical & Legal Ethics, Physiology, Biochemistry, Neuroscience, Genetics, Research in Health and Medicine, Pathology I, Microbiology, Pharmacology, Medical Psychology, Research and Health and Medicine II, Pathology II, Epidemiology and Biostatistics, Physical Diagnosis & Clinical Medicine, and Research in Health and Medicine III. Two years: Professionalism & Patient-Doctor Skills I, Histology and Cell Biology, Public Health, Gross & Developmental Anatomy, Ethics & Patient-Doctor Skills II, Neuroscience, Biochemistry / Genetics, Physiology, Communication & Patient-Doctor Skills III, Medical Microbiology, Medical Psychology, Pathology I, Physical Diagnosis & Patient-Doctor Skills IV, Medical Pharmacology, Pathology II, Introduction to Clinical Medicine, and Fundamentals of Clinical Medicine. Two years: Gross Anatomy, Histology and Cell Biology, Informatics and Evidence-Based Medicine, Informatics and Evidence-Based Medicine, Biochemistry, Human Physiology, Medical Psychology, Medical & Legal Ethics, Microbiology and Immunology, Neurosciences, Medical Genetics, Epidemiology and Preventive Medicine, Pharmacology, Pathology I, Physical Diagnosis, Clinical Pathology II, Medical Board Review, and Introduction to Clinical Medicine. Two years (76 weeks): Internal Medicine, Surgery, Pediatrics, Obstetrics & Gynecology, Family Practice, and Psychiatry. Electives: Allergy and Immunology, Anesthesiology, Cardiology, Oncology, Critical Care, Dermatology, Pathology, Endocrinology, Preventive Medicine, Emergency Medicine, Pulmonary Disease, Family Practice, Radiology, Gastroenterology, Rheumatology, Gerontology, Ophthalmology, Neurology, Nephrology, Urology, Hematology, Infectious Disease, and Community Health Care. An elective in Neurology is required. Two years (96 weeks): Medicine, Surgery, Obstetrics & Gynecology, Family Practice, and Psychiatry. Electives: Allergy and Immunology Neurology, Cardiology Occupational Medicine, Critical Care Medicine Oncology, Dermatology Ophthalmology, Emergency Medicine Orthopedics, Endocrinology Psychiatry, Family Practice Pulmonology, Gastroenterology Radiology, General Medicine Rehabilitation Medicine, Hematology Rheumatology, Infectious Diseases Surgical subspecialties, and Nephrology Urology. Note: This is a partial list of possible elective rotations. Two years (72 weeks): Internal Medicine, Surgery, Obstetrics & Gynecology, Family Practice, Psychiatry, Pediatrics, and electives. Two years (72 weeks): Surgery, Internal Medicine, Pediatrics, Psychiatry, and Obstetrics & Gynecology, and electives. Continued on page 41 40

41 TABLE 18 CURRICULUM SUMMARY BY MEDICAL SCHOOL Medical School Basic Science Curriculum Clinical Curriculum International University of Health Sciences (IUHS) University of Medicine and Health Sciences (UMHS) Spartan Health Sciences Two years: Introduction to Basic Medical Science, Respiratory and Cardiovascular Systems, Endocrine & Reproductive Systems, Gastrointestinal and Renal Systems, Central and Peripheral Nervous Systems and General Principles of Psychiatry, Hematology, Muscular system, Dermatology, and the Febrile Exanthem, Musculoskeletal System and Eye, Ear, Nose and Throat, Major Infectious Diseases, Autoimmune Diseases including Vasculitis, and Congenital Anomalies, Review and Examination Preparation, and Introduction to Clinical Medicine. Two years: Anatomy, Histology, Cell and Molecular Biology, Physiology, Biochemistry, Genetics, Embryology, Pathology, Neuroscience/Neuroanatomy, Immunology and Microbiology, Behavioural Science, Pharmacology and Therapeutics, Biostatistics and Epidemiology, Introduction to Clinical Medicine, and Medical Ethics. Two years: Gross Anatomy, Medical Physiology, Histology, Embryology, Biostatistics & Medical Writing, Biochemistry, Microbiology, Neuroanatomy, Human Genetics, Immunology & Allergy, Behavioral Science, Epidemiology and Public Health, Nutrition, Pharmacology, General Pathology, Legal Medicine and Medical Ethics, Tropical Medicine and Parasitology, and Systemic Pathology. Pre-clinical: Infectious Diseases, Introduction to Medicine, Otorhinolaryngology, Respiration, Neurology, Cardiology, Fluids/Electrolytes & Renal, Dermatology, Endocrinology, Psychiatry, Anesthesiology, Introduction to Medicine II, Gastroenterology, Hematology, Oncology, Orthopedics, Principles of Clinical Medicine, Radiology, Physical Diagnosis, Ophthalmology, Surgery & Orthopedic Surgery, Obstetrics & Gynecology, Pediatrics, Geriatric Medicine & Pain Management, Child/Spousal Abuse and Human Sexuality. Two years (80 weeks): Internal Medicine, Surgery, Obstetrics & Gynecology, General Practice, Psychiatry, and Pediatrics. Electives: Allergy and Immunology, Anesthesiology, Cardiology, Colon and Rectal Surgery, Critical Care Medicine, Dermatology, Emergency Medicine, Endocrinology and Metabolism, Epidemiology, Family Medicine, Gastroenterology, Geriatric Medicine, Hematology, Infectious Disease, Neonatal Medicine, Nephrology, Neurology, Nuclear Medicine, Oncology, Ophthalmology, Orthopedics, Otolaryngology, Pathology, Pediatric Surgery, Physical Medicine & Rehabilitation, Plastic Surgery, Preventive Medicine, Pulmonology, Radiology, Respirology, Rheumatology, Sports Medicine, Thoracic Surgery, Urology, Vascular Surgery. Two years: Introduction to Clinical Medicine II, Biological Basis of Clinical Medicine, Internal Medicine, Surgery, Pediatrics, Obstetrics and Gynecology, Psychiatry, Family Practice, and electives. Two years (80 weeks): Internal Medicine, General Surgery, Surgical Sub-specialty, Obstetrics & Gynecology, Family Medicine, Psychiatry, Pediatrics, Radiology, and Clinical Pathology. Must include a minimum of three (3) or a maximum of five (5) from the following surgical electives: Anesthesiology, Geriatric Medicine, Neurosurgery, Ophthalmology, Otorhinolaryngology, Orthopedic Surgery, Pediatric Surgery, Plastic Surgery, Thoracic Surgery, Vascular Surgery, Urology, and Emergency Medicine including Trauma. Electives: Anesthesiology, Geriatric Medicine, Orthopedic, Surgery, Dermatology, Pathology, Emergency Medicine, Pediatrics, Family Medicine, Forensic Medicine, Gynecology, Internal Medicine, Neurology, Radiology, Obstetrics, Ophthalmology, Otorhinolaryngology, Occupational Medicine, Surgery, and Physical and Rehabilitation Medicine. Continued on page 42 41

42 TABLE 18 CURRICULUM SUMMARY BY MEDICAL SCHOOL Medical School Basic Science Curriculum Clinical Curriculum International American University University of the West Indies Two years: Biochemistry, Genetics & Nutrition, Microscopic Anatomy - Histology, Embryology, Cell Biology, Doctor - Patient - Society - Medical Ethics, Medical Law, Epidemiology, Biostatiscs, Gross Anatomy - Anatomy and Neuroanatomy, Physiology, Pathology - I - General Pathology, Microbiology & Immunology, Parasitology, Virology, Doctoring I - Behavioural Science, Geriatrics, Public Health and Preventive Medicine, Pathology - II - Systemic Pathology, Pharmacology & Therapeutics, Doctoring II - Physical Diagnosis and Clinical Medicine, and Introduction to Clinical Medicine. Two years: example of courses - Anatomy, Physiology, Biochemistry, Pathology, Pharmacology, and Community Health. Two years (76 weeks): Internal Medicine, General Surgery, Obstetrics & Gynecology, Family Practice, Psychiatry, Pediatrics, and electives. Core clerkships: Medicine, Surgery, Pediatrics, Obstetrics & Gynecology, and Psychiatry and Public Health. Typically, Caribbean medical schools base their curriculum off of the North American standard. Most offer two years of basic sciences at their campus in the Caribbean, and courses usually include, but are not limited to: Anatomy, Physiology, Pathology, Pharmacology, and Ethics. The basic sciences are then followed by two years of clinical clerkships which are taken in varying locations across the United States and Canada. Typical core clerkships include: Medicine, Surgery, Pediatrics, OB/GYN, Psychiatry, and General Practice. TABLE 19 ACCREDITATION BY MEDICAL SCHOOL Medical School Accreditation and Approvals (Domestic and International) St. George s University Ross University SABA University School of Medicine Caribbean Accreditation Authority for Education in Medicine and Other Health Professions (CAAM). HP, accredited by the Government of Grenada, approved by the New York State Education Department, recognized by the Medical Board of California, approved by the Florida Commission on Independent Education of the Florida Department of Education, the National Committee on Foreign Medical Education and Accreditation, the Bahamas Medical Council, the Bermuda Medical Council, DIKATSA (Greek Medical Licensing Authority), the Sri Lankan Medical Council, the Thailand Medical Council, the Government of Botswana, the Government of St. Vincent, the Medical Board of Trinidad and Tobago, the Association of Caribbean Tertiary Institutions, Inc. Caribbean Accreditation Authority for Education in Medicine and Other Health Professions (CAAM), HP, Commonwealth of Dominica, the United States Department of Education through the National Committee on Foreign Medical Education and Accreditation (NCFMEA), the state of New York, the state of California, the state of New Jersey, the state of Florida, the General Medical Council of Great Britain. Accreditation Commission on Colleges of Medicine (ACCM), the United States Department of Education, the NVAO, the Accreditation Organization of the Netherlands and Flanders, approved by the New York State Education Department, recognized by the Division of Licensing of the Medical Board of California, licensed by the Commission for Independent Education, the Florida Department of Education, approved by the Kansas State Board of Healing Arts. Continued on page 43 42

43 TABLE 19 ACCREDITATION BY MEDICAL SCHOOL Medical School Accreditation and Approvals (Domestic and International) Windsor University American University of the Caribbean School of Medicine American University of Antigua University of Health Sciences Antigua All Saints University of Medicine Xavier University School of Medicine Central America Health Sciences University St. Matthew s University All Saints University of Medicine Saint James School of Medicine University of Sint Eustatius Medical University of the Americas International University of Health Sciences (IUHS) University of Medicine and Health Sciences (UMHS) Spartan Health Sciences International American University University of the West Indies Medical Council and Board of Government of St. Kitts, the Educational Commission for Foreign Medical Students (ECFMG), the United States Medical Licensing Boards for taking board exams in basic and clinical sciences. Accreditation Commission on Colleges of Medicine (ACCM), the United States Department of Education, the Medical Board of California, the Texas Medical Board, the New York State Board of Medicine, the Florida Department of Education's Commission for Independent Education. New York State accreditation Ministry of Education of the Government of Antigua and Barbuda Chartered and recognized by the government of Aruba Unknown Chartered by the Government of Belize Accreditation Commission on Colleges of Medicine (ACCM) Government of the Commonwealth of Dominica Federal Government of the Netherlands. Unknown Department of Education of St. Christopher-Nevis The Government of St. Christopher and Nevis in the West Indies The Government of St. Christopher and Nevis in the West Indies The Government of St. Lucia Chartered and authorized by the Government of St Lucia, recognized by the Educational Commission for Foreign Medical Graduates (ECFMG), and recommended for approval with the New York State Education Department. Unknown Caribbean medical school accreditation is wide and varied. Because schools reside in different Caribbean countries, the accreditation is diverse. Most medical schools are accredited by the government, while some have also attained approvals from departments of education and specific states in the US. 43

44 TABLE 20 TUITION BY MEDICAL SCHOOL Medical School Total Basic Sciences Total Clinical Years Total Tuition Average Yearly Tuition ($CAD) Tuition ($CAD) ($CAD) Tuition($CAD) St. George s University $133,532 $115,397 $248,929 $62,232 Ross University $69,326 $113,378 $182,705 $45,676 SABA University School of Medicine Not available Not available $108, 714 $27,178 Windsor University Not available Not available $52,938 $13,234* American University of the Caribbean School of Medicine $84,870 $84,499 $169,369 $42,342 American University of Antigua $45,117 $76,982 $122,099 $30,525* University of Health Sciences Antigua Not available Not available $121,565 $30,391 All Saints University of Medicine, Aruba Not available Not available $71,021 $17,755* Xavier University School of Medicine $35,752 $49,013 $84,764 $21,191* Central America Health Sciences University $25,673 $38,192 $63,865 $15,966 St. Matthew s University $47,209 $52,779 $99,988 $24,997 All Saints University of Medicine, Dominica $31,800 $47,708 $79,508 $19,877* Saint James School of Medicine $23,339 $48,482 $71,822 $17,955 University of Sint Eustatius $41,374 $53,468 $94,843 $23,711 Medical University of the Americas Not available Not available $103,409 $25,852 International University of Health Sciences (IUHS) Not available Not available Not available Not available University of Medicine and Health Sciences (UMHS) $38,213 $75,219 $113,432 $28,358 Spartan Health Sciences $26,257 $18,831 $45,087 $9,017 International American University $35,009 $50,392 $85,401 $21,350 * School has more than one program. Average yearly tuition was calculated using four years. Attaining a medical degree in the Caribbean is quite costly. Many schools where Canadians are found studying average between $20,000 (CAD) and $60,000 (CAD) per year. While a few schools do report lower tuition costs, this is not typical. TABLE 21 CLERKSHIPS BY MEDICAL SCHOOL Medical School Clerkship Locations Clinical and Affiliated Hospital Locations St. George s University Ross University SABA University School of Medicine Windsor University US, UK, Canada Bahamas, Commonwealth of Dominica, US, Puerto Rico US, Canada US US: New York, New Jersey, Michigan, Connecticut, Maryland, California, Florida. Canada: Vancouver US: California, Connecticut, Washington DC, Florida, Illinois, Louisiana, Maryland, Massachusetts, Michigan, New Jersey, New York, Utah, Virginia, Washington, Wisconsin. US: Connecticut, New York, Illinois, Massachusetts, Maryland, Louisiana, Georgia. US: Chicago, Tennessee, Georgia, New Hampshire, Virginia, New York, Ohio, Connecticut, West Virginia. Continued on page 45 44

45 TABLE 21 CLERKSHIPS BY MEDICAL SCHOOL Medical School Clerkship Locations Clinical and Affiliated Hospital Locations American University of the Caribbean School of Medicine American University of Antigua University of Health Sciences Antigua All Saints University of Medicine, Aruba and Dominica Xavier University School of Medicine Central America Health Sciences University St. Matthew s University Saint James School of Medicine University of Sint Eustatius Medical University of the Americas International University of Health Sciences (IUHS) University of Medicine and Health Sciences (UMHS) Spartan Health Sciences International American University University of the West Indies US, UK US, Puerto Rico US, Canada, Puerto Rico US, Cuba, Mexico, India, or Canada. Clerkships are predominately in the US US, Puerto Rico Unknown US, UK US and Caribbean Clinical sites in over 30 states in the US US and Canada US, Canada, Mexico, Australia, India US, and Puerto Rico US Locations in Europe, Asia, and North America. Unknown US: Ohio, Louisiana, New York, Connecticut, California, Florida, Illinois, Maryland, Michigan. US: Connecticut, Washington D.C., Illinois, Los Angeles, Maryland, Michigan, New York, Ohio. Puerto Rico: San Juan US: Alabama, Georgia, Maryland, Montana, Los Angeles, California, Texas, Michigan, Pennsylvania, Indiana, West Virginia, Florida, Ohio, Virginia, Tennessee, Illinois, North Carolina, Wyoming, New Mexico, Connecticut, Kansas, New York, Colorado, Minnesota, Missouri, Arizona, Massachusetts. Canada: Niagara Falls region. Puerto Rico: Guayama, Bayamon, San Juan, Humacao. Unknown US: Georgia, Illinois, Los Angeles, Virginia, New York, Washington, Maryland. Puerto Rico: San Juan Unknown US: Colorado, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New York, North Carolina, Ohio, Virginia. UK: London, Barnsley, Stockport, Middlesex, Kent. Unknown Sample of US locations: Maryland, Colorado, Virginia, Arizona, Illinois, Los Angeles, North Carolina, Ohio. US: Los Angeles, Virginia, Georgia, Maryland, Illinois, New York, Utah, Connecticut. India: Andhra Pradesh, Mumbai. US: New York, Connecticut, Illinois, Georgia, Maryland, Michigan. Puerto Rico Unknown US: Los Angeles, Illinois, Maryland, Colorado, Georgia. Unknown Caribbean medical schools generally do not offer clerkship rotations within the Caribbean. Most clerkships are outsourced to the United States, Canada and occasionally the United Kingdom. 45

46 AUSTRALIA TABLE 22 AUSTRALIAN MEDICAL SCHOOL DATA WEBSITE SOURCES Location Medical School Website Australia University of New South Wales Australia Australian National University Australia Monash University Australia University of Adelaide Australia University of Notre Dame Australia University of Western Sydney Australia University of Western Australia Australia University of Tasmania Australia University of Queensland Australia University of Melbourne Australia Flinders University of South Australia Australia University of Sydney Australia Bond University Australia University of Wollongong Australia Deakin University Australia James Cook University Australia University of Newcastle TABLE 23 NUMBER OF CSAS STUDYING MEDICINE IN AUSTRALIA Location Medical School Number of CSAs Estimated Australia University of New South Wales < 10 Australia Australian National University < 10 Australia Monash University < 10 Australia University of Adelaide < 10 Australia University of Notre Dame Unknown* Australia University of Western Sydney Unknown* Australia University of Western Australia < 10 Australia University of Tasmania < 10 Australia University of Queensland ~ 230 Australia University of Melbourne ~ 20 Australia Flinders University of South Australia ~ 70 Australia University of Sydney ~ 140 Australia Bond University < 10 Australia University of Wollongong < 10 Australia Deakin University Unknown* Australia James Cook University < 10 Australia University of Newcastle Unknown* Estimated Total ~ 550 * Unknown denotes locations where CSAs are known to study but no numbers were provided. An overall estimate was given for the region. TABLE 24 GENERAL INFORMATION Medical School Year Year University International Founded Program Began University of New South Wales Australian National University 1946 unknown Monash University 1958 unknown University of Adelaide 1874 unknown University of Notre Dame 1989 unknown University of Western Sydney 1989 unknown University of Western Australia 1911 unknown University of Tasmania 1890 unknown University of Queensland 1909 unknown University of Melbourne 1853 unknown Flinders University of South Australia 1966 unknown University of Sydney 1850 unknown Bond University 1987 unknown University of Wollongong Deakin University 1974 unknown James Cook University 1970 unknown University of Newcastle Australian medical schools currently educating Canadians were typically founded long before the boom of international medical education. Overall, 17 medical schools were identified in Australia educating an estimated 550 Canadian students. 46

47 TABLE 25 ADMISSIONS BY MEDICAL SCHOOL Medical School Programs Admissions Fielded Admission Requirements Available Through University of New South Wales Six year MBBS School - online application As a minimum, undergraduate applicants will need to have a qualification considered to be equivalent to year 12 (completion of high school) in Australia. OSSD score of 92, International Baccalaureate of 36 to eligible for consideration/38 minimum for interview. Applicants with university results: applicants that have completed one year or more of tertiary studies at undergraduate level by the end of 2010 will be assessed on the basis of both their high school results and their tertiary results. These will be combined in the ratio of 50:50. They will be required to attain an academic rank of at least 97 to be eligible for consideration to UNSW Medicine. Please note that there is no separate quota for university students. Required: UMAT and interview. Australian National University Four year MBBS School mail in application or Australian Council for Educational Research (ACER) Bachelor s degree in any discipline, GPA, Graduate Australian Medical Schools Admission Test (GAMSAT) or Medical College Admissions Test (MCAT). A minimum overall result of 55 is required for GAMSAT, with no less than 50 for each section or alternatively for MCAT, a minimum of 8/8/M/8, and interview. Monash University Four year MBBS and Five year MBBS Victorian Tertiary Admissions Centre, Oztrekk, or school online application. Four year MBBS: completed three-year undergraduate degree or equivalent qualification (degree does not have to be medically or scientifically oriented), GAMSAT or MCAT scores, and interview. Six year MBBS: equivalent Australian Year 12. International Baccalaureate subject prerequisites: a score of at least 5 in English SL or 4 in English HL or 6 in English B SL or 5 in English B HL, and a score of at least 5 in chemistry SL or 4 in chemistry HL. Both four year and six year require: gaining the required result in one of the following tests of English language: IELTS score of 7.0 with no individual band score less than 6.5. TOEFL minimum test score of either; in the written TOEFL, 600 with a Test of Written English (TWE) score of at least 5.0; or in the Internet-based TOEFL, an overall score of at least 100 with at least 24 in the written section and no less than 20 in any other section. International Student Admissions Test (ISAT). University of Adelaide Six year School - application to be mailed to university or Australearn Provincial high school diploma (i.e. OSSD formerly known as Canadian Grade 13), International TER score of 90, and IELTS Total 6.5. University of Notre Dame Four year ACER GAMSAT, GPA minimum of 5.0 over three years of study, bachelor s degree, interview, and personal statement. Continued on page 48 47

48 TABLE 25 ADMISSIONS BY MEDICAL SCHOOL Medical School Programs Admissions Fielded Admission Requirements Available Through University of Western Sydney Five year UAC International Ontario Secondary School Diploma (Canada OSSD) - score based on Secondary School Diploma including six University Preparation Courses with minimum 65% average. Achieve a scholastic performance in the final year of secondary school equivalent to a New South Wales University Admission Index of 95 (International Baccalaureate 34) or higher. For those who have completed a three year or longer bachelor s degree, the GPA in the degree must be at least 5.5 on the 7 point scale. Have completed IELTS or equivalent examination (Academic Module) and achieve a minimum score of 6.5 in each of the four components, and an overall score of at least 7.0. University of Western Australia Six year School - form to be mailed to university, or UWA overseas representative Minimum International Baccalaureate of 37, and ISAT. University of Tasmania Five year School - forms to be mailed to university Chemistry at Australian year 12 level or equivalent, mathematics at Australian year 12 level or equivalent, Ontario Secondary School Diploma average 89, and ISAT score. University of Queensland Four year School - forms to be mailed to university Minimum bachelor s degree, minimum GPA 0f 5.0 out 7.0 scale or 2.8 out of 4 scale, and GAMSAT or MCAT, UMAT, ISAT. University of Melbourne Four year GMAC Online Admission System or direct to International Admissions at the University of Melbourne. Bachelor's degree, second year university courses in anatomy, physiology, and biochemistry, GAMSAT or MCAT, GPA, and interview. Flinders University of South Australia Four year School online application Bachelor's degree, and GAMSAT or MCAT. University of Sydney Four year Australian Council for Educational Research (ACER) or Australearn Bachelor's degree, GAMSAT, and interview. Bond University Five year School online application GPA 5.0 out of 7 scale or 2.8 out of 4 scale, and GAMSAT or MCAT. University of Wollongong Four year Australearn Bachelor s degree, GPA 5.0/7 or 2.8/4, GAMSAT or MCAT, portfolio, and interview. Deakin University Four year School online application IELTS score of 7.0 or undergraduate degree in English, MCAT 8/8/M/8 or GAMSAT score of 50, bachelor s degree, and GPA 5.0/7. James Cook University Six year QTAC A minimum score of 63% or better in the Ontario Secondary School Diploma based on the average of the best six OSSD or OAC subjects. Courses in mathematics and chemistry. University of Newcastle Five year Directly to school Year 12 studies or higher education qualifications or overseas qualifications considered equivalent to Australian qualifications, and UMAT. 48 Medical programs in Australia are varied and range from four to six years. Four year degrees generally require a bachelor s degree, MCAT or GAMSAT and a certain GPA. Five and six year degrees are typically aimed at high school graduates and require a certain overall average for admission.

49 TABLE 26 CURRICULUM SUMMARY BY MEDICAL SCHOOL Medical School Basic Science Curriculum Clinical Curriculum University of New South Wales Australian National University Monash University University of Adelaide Two years: MFAC1501 Foundations, MFAC1520 Society & Health, MFAC1521 Beginnings, Growth & Devl. A, MFAC1522 Beginnings, Growth & Devl. B, MFAC1523 Health Maintenance A, MFAC1524 Health Maintenance B, MFAC1525 Ageing & Endings A, MFAC1526 Ageing & Endings B, MFAC1527 Society & Health, MFAC1511 Phase 1 Portfolio Examination, MFAC1512 Phase 1 End-of-Phase Written Examination, MFAC1513 Phase 1 Clinical and Communications Skills Examination, MFAC2501 Society and Health 3, MFAC2502 Beginnings, Growth and Devl 3, MFAC2503 Health Maintenance 3, MFAC2504 Ageing and Endings 3, MFAC2511 Phase 2 Portfolio Examination, MFAC2512 Phase 2 Integrated Clinical Examination, MFAC4501 Independent Learning Project 1, MFAC4502 Independent Learning Project 2, and MFAC4503 Independent Learning Project 3. Two years: DNA to Death, Cardiorespiratory, Renal, Endocrine & Reproductive Health, Cardiorespiratory, Renal, Endocrine & Reproductive Health, Musculoskeletal, Neurosciences, Human Disease & Society, Research Project. Four year MBBS (two years): basic medical and behavioural sciences (Anatomy, Biochemistry, Genetics, Immunology, Microbiology, Pathology, Pharmacology, Physiology, Psychology and Sociology). In second year, the students will study integrated medicine and surgery, which will be taught together with a series of problem based and case-based learning sessions. Five year MBBS (two years): the first two years, blocks of systems-based sub-units will be presented with a mix of basic medical science content, patientbased presentations and discussions in small groups. These sub-units are set in appropriate clinical contexts, largely through the use of patientoriented learning. Topics include: Cardiovascular, Endocrinology, Gastrointestinal, Genomics, Human Behaviour, Human Development and Growth, Immunology and Infection, Metabolism, Molecules, Cells and Tissues, Musculoskeletal, Neurosciences, Nutrition, Renal, Reproduction, and Respiratory. Three years: Scientific Basis of Medicine. Two years (52 weeks): MFAC3501 Medicine, MFAC3502 Surgery, MFAC3503 Psychiatry, MFAC3504 Primary Care, MFAC3505 Obstetrics & Gynaecology, MFAC3506 Children's Health (Paeds), MFAC3507 Elective, MFAC3508 Emergency/Selective, MFAC3509 Selective, MFAC3510 PRINT, MFAC3511 Phase 3 Portfolio Examination, MFAC3512 Phase 3 Biomedical Sciences Viva Examination, and MFAC3513 Phase 3 Integrated Clinical Examination. Two years: General Medicine and Surgery, Integrated Community and Child Health, Elective, Senior Medicine and Surgery subspecialties in Medicine and Surgery, Psychological and Addiction Medicine, Women's Health, and Acute Care. Four year MBBS (two years): core clinical rotations in Women s and Children s Health, General Practice and Psychological Medicine. The final year of the course will be structured as a series of electives where students will choose to complete their degree by gaining wider experience in chosen disciplines and specific areas of interest through a range of metropolitan, rural and overseas settings. Five year MBBS (Three years): In third year, students will study integrated medicine and surgery which will be taught together with a series of problem-based and core-based learning sessions. The fourth year will be largely taken up with the core clinical rotations of Women s and Children's Health and General Practice and Psychological Medicine. The fifth year of the course is focused on facilitating the transition of students into the medical workplace as trainee interns and will be structured as a series of clinical rotations. Students will consolidate and enhance their knowledge, clinical skills and professional behaviours in five clinically orientated rotations: Aged Care, Emergency Medicine, Medical, Surgical, and Specialty. Three years: students will expand their knowledge, experience and skills within these three streams as they undertake placements within the teaching hospitals and in the broader medical community. Continued on page 50 49

50 TABLE 26 CURRICULUM SUMMARY BY MEDICAL SCHOOL Medical School Basic Science Curriculum Clinical Curriculum University of Notre Dame University of Western Sydney University of Western Australia University of Tasmania University of Queensland University of Melbourne Flinders University of South Australia University of Sydney Bond University Two years: Communication and Clinical Skills, basic Clinical Sciences, Population and Preventative Health, and Personal and Professional Development. Two years: Foundations of Medicine 1 & 2. Three years: Animal and Human Biology, Physiology, Biophysics, Clinical Chemistry, Anatomy, Elements of Anatomy, Physiology, Biochemistry, Pathology, Microbiology and Pharmacology. Two years: Foundations of Medicine (basic sciences, communication skills, ethics, information literacy, and community perspectives on health). Fundamentals of Clinical Science. Two years: basic, clinical, biological and social sciences, communication skills, ethics and professional development. Two years: Foundations of Biomedical Science, Fundamental Principles of Clinical Practice, and Student Conference. Two years: Clinical Performance, Knowledge of Health and Illness, Doctor, the Profession and Society, Doctor and Patient. Unknown Two years: problem-based learning cases in subject matter: Anatomy, Biochemistry, Imaging, Immunology, Microbiology, Pathology, Pharmacology, Physiology, Cardiovascular, Endocrine, Gastroenterology, Hematology, Musculoskeletal, Neurosciences, Renal, Respiratory, Sexual Health, and Skin. Communication and History Taking Skills, and Procedural Skills. Two years: disciplined based clinical placements i.e. Medicine, Surgery, Critical Care, etc. Three years: integrated clinical rotations. Three years: years four to six concentrate more heavily on the clinical aspects of medicine with hospitals and general practices, both urban and rural. In the penultimate year, 25 per cent of students spend the year at one of the ten rural clinical sites located throughout the state. The teaching is structured around blocks of General Medicine, Surgery, Obstetrics and Gynecology, Pediatrics, Psychiatry, General Practice and Emergency Medicine. Specialty clinical areas are also covered. In the final year this block (elective) may be taken in an overseas centre. Three years : the third year consolidates Fundamentals of Clinical Science and lays the foundations for clinical practice as students begin to apply their learning in the clinical setting. In fourth year, students will rotate through areas such as Medicine, Intensive Care, Obstetrics & Gynecology, Psychiatric Medicine, General Practice, Emergency Medicine, and Pediatrics & Child Health. The fifth year focuses on consolidating learning in preparation for hospital practice through a series of clinical placements, such as Medicine, Surgery & Emergency Medicine and buddying with interns. Two years: clinical rotations within clinical schools. Two years: Fundamentals of Clinical Practice, Scholarly Selective (research project), and Student Conference. Two years: clinical rotations (Medicine, Surgery and Anaesthesia, Pediatrics and Child Health, Obstetrics and Gynecology, General Practice, and Psychiatry) and electives. Unknown Two years: for most of year three and year four, students will be located in hospital and community clinical settings. In year four, there is also an elective term where students can spend time at any approved hospital post in Australia or overseas. 50 Continued on page 51

51 TABLE 26 CURRICULUM SUMMARY BY MEDICAL SCHOOL Medical School Basic Science Curriculum Clinical Curriculum University of Wollongong Deakin University James Cook University University of Newcastle Medical Sciences (Anatomy, Physiology, Biochemistry, Population Health or Behavioural Science, etc.), Clinical Competencies, Personal and Professional Development, Research and Critical Analysis, and Case-Based Learning. Two years: lectures, classes and clinical experience. Three years: Introduction to Integrated Medical Studies, Integrated Human System Pathophysiology, Independent Study, Introduction to Clinical Healthcare, and Integrated Pathology & Clinical Medicine. Students enroll in six courses in year one, four courses in years two, four and five, and three courses in year three. Unknown Two years: Intensive clinical training in health services in clinical schools. In year four, students are based at public, private hospitals, and general practices. Program concludes with two electives, a pre-internship hospital rotation and a further ambulatory rotation, and an elective that can be taken in Australia or overseas. Two years: integrated clinical practice and advanced clinical medicine. Clinical exposure begins in the first year and continues throughout the program. Although the exact content of the curriculum is based on the length of the medical program, all of the programs begin with a basic sciences component which educates students in subjects such as Anatomy, Physiology, Biochemistry, etc. Clinical training begins with clerkship rotations done in Australian hospitals, with the possibility of electives in North American hospitals. Core clerkships are typically done in Medicine, Surgery and Anesthesia, Pediatrics and Child Health, Obstetrics and Gynecology, General Practice, and Psychiatry. TABLE 27 ACCREDITATION BY MEDICAL SCHOOL Medical School University of New South Wales Australian National University Monash University University of Adelaide University of Notre Dame University of Western Sydney University of Western Australia University of Tasmania University of Queensland University of Melbourne Flinders University of South Australia University of Sydney Bond University University of Wollongong Deakin University James Cook University University of Newcastle Accreditation and Approvals Australian Medical Council (AMC) Australian Medical Council (AMC) Australian Medical Council (AMC) Australian Medical Council (AMC) Australian Medical Council (AMC) Australian Medical Council (AMC) Australian Medical Council (AMC) Australian Medical Council (AMC) Australian Medical Council (AMC) Australian Medical Council (AMC) Australian Medical Council (AMC) Australian Medical Council (AMC) Australian Medical Council (AMC) Australian Medical Council (AMC) Australian Medical Council (AMC) Australian Medical Council (AMC) Australian Medical Council (AMC) All Australian medical schools are accredited by the Australian Medical Council (AMC). TABLE 28 TUITION BY MEDICAL SCHOOL Medical School Total Tuition Average Yearly ($CAD) Tuition ($CAD) University of New South Wales $131,538 $21,923 Australian National University $193,824 $ 48,456 Monash University $213,952* $53,488 University of Adelaide $270,078 $45,013 University of Notre Dame $110,104 $27,526 University of Western Sydney $188,340 $37,668 University of Western Australia $259,908 $43,318 University of Tasmania $188,340 $37,668 University of Queensland $218,284 $54,571 University of Melbourne $226,008 $56,502 Flinders University of South Australia $163,104 $40,776 University of Sydney $212,448 $53,112 Bond University $331,850 $66,370 University of Wollongong $75,576 $18,894 Deakin University $187,556 $46,889 James Cook University $203,406 $33,901 University of Newcastle $168,000 $33,600 * School has more than one program. Total tuition was calculated using four years. The total cost for a medical degree from Australia is typically over $100,000 (CAD). 51

52 TABLE 29 CLERKSHIPS BY MEDICAL SCHOOL Medical School Clerkship Locations Clinical and Affiliated Hospital Locations University of New South Wales Australia Australian National University Australia Clinical teaching facilities within Canberra and in the southeast NSW region. Monash University Australia Locations throughout eastern and regional Victoria. University of Adelaide Australia Unknown University of Notre Dame Australia Unknown University of Western Sydney Australia Students will be rotating through clinical placements across the whole of Greater University of Western Australia Australia Unknown University of Tasmania Australia Unknown University of Queensland Australia Unknown University of Melbourne Australia Unknown Western Sydney and also possibly rural NSW. Flinders University of South Australia Australia Various locations in South Australia or the Northern Territory. University of Sydney Australia Unknown Bond University Australia Various locations in South Australia, Victoria, and Queensland. University of Wollongong Australia Unknown Deakin University Australia Unknown James Cook University Australia Unknown University of Newcastle Australia Unknown Clerkship rotations in the clinical years are typically done within Australia, however many schools confirmed that taking electives in North America is also a possibility. IRELAND TABLE 30 IRISH MEDICAL SCHOOL DATA WEBSITE SOURCES Location Medical School Website Ireland Trinity College Dublin Ireland University College Dublin Ireland Royal College of Surgeons Ireland (RCSI) Ireland University College Cork Ireland University of Limerick Sciences/Departments/Graduate_Medical_School/ Ireland National University of Ireland, Galway TABLE 31 NUMBER OF CSAS STUDYING MEDICINE IN IRELAND Location Medical School Estimation of CSAs Ireland Trinity College Dublin ~ 70 Ireland University College Dublin ~ 90 Ireland Royal College of Surgeons Ireland (RCSI) ~ 200 Ireland University College Cork ~ 70 Ireland University of Limerick ~ 50 Ireland National University of Ireland, Galway ~ 20 Ireland Additional Admissions in Sept 2010 ~ 150 Estimated Total ~ 650 Ireland has six medical schools, all of which offer medical education to international students. It is estimated that upwards of 650 Canadians are currently studying medicine in Ireland. 52

53 TABLE 32 GENERAL INFORMATION Medical School Year University Founded Year International Program Began Trinity College Dublin University College Dublin /2008 Royal College of Surgeons Ireland (RCSI) /2006 University College Cork /2008 University of Limerick Ireland National University of Ireland, Galway With the exception of one medical school, all schools in Ireland have been offering medical education to international students for over 30 years. TABLE 33 ADMISSIONS BY MEDICAL SCHOOL Medical School Programs Available Admissions Fielded Through Admission Requirements Trinity College Dublin Five year Atlantic Bridge Program Overall average 85%, minimum 80% or better on a minimum of six subjects over years 11 and 12, high school transcript, must have courses in English, math, and a second language. University College Dublin Four year and six year Atlantic Bridge Program Four year: honors bachelor's degree, and GAMSAT. Six year: high school diploma. Royal College of Surgeons Four, five and six year Atlantic Bridge Program Four Year: bachelor s degree, and MCAT or Ireland (RCSI) GAMSAT. University College Cork Four year and five year Atlantic Bridge Program Unknown Six year: high school transcript, 85% overall average, must have courses in biology, chemistry, physics, and math. University of Limerick Four year Atlantic Bridge Program Bachelor s degree, MCAT, and interview. National University of Five year and six year Atlantic Bridge Program General matriculation requirements of the Ireland, Galway university, English language requirements and health certificate. The majority of medical schools in Ireland offer direct entry to medical school out of high school, as well as graduate entry. Standard admission requirements are an 85% overall average and a high school transcript, or a bachelor s degree and MCAT or GAMSAT scores. All North American applications are fielded through the Atlantic Bridge Program. 53

54 TABLE 34 CURRICULUM SUMMARY BY MEDICAL SCHOOL Medical School Basic Science Curriculum Clinical Curriculum Trinity College Dublin University College Dublin Royal College of Surgeons Ireland (RCSI) University College Cork University of Limerick National University of Ireland, Galway Three years: Human Development and Behavioural Science, Evolution and Life, Human Form and Function, Molecular Medicine, Neuroscience, Aetiology, Mechanisms and Treatment of Disease I/II, Clinical Skills, Pharmacology and therapeutics, Evidence-Based Medicine, Clinical Medicine and Clinical Surgery. Two years: Physics, Chemistry, Cell Biology, Genetics, Anatomy, Physiology and Biochemistry of Healthy Cells, Tissues and Organ Systems, Patient Care in Community and Hospital Settings, Pathology, Microbiology and Pharmacology, and Diseased Organ Systems. Two years: Neuromuscular System, Haemapoietic & Immune Systems, Molecular Medicine, Health Behaviour & Society 1/2, Nutrition & Energy, Genitourinary System, Clinical Competencies 1/2, Cardiovascular & Respiratory Systems, Endocrine System, Neuroscience, Evidence Based Health, Biology & Epidemiology of Disease, Cardiorespiratory Systems, Gastrointestinal & Hepatology Systems, Renal, Endocrine, Genitourinary & Breast Systems, Central Nervous and Locomotor Systems, and Haematolymphoid Systems & Tropical Medicine Two/three years: Introductory Human Biology, Cardiovascular, Haematological and Respiratory Biology, Gastrointestinal, Nutritional and Metabolic Biology, Clinical Science and Practice I/II/III, Person, Culture and Society I/II/III, Neuroscience, Bone Metabolism, Renal Mechanisms of Homeostasis and Associated Anatomy, Medical Pharmacology, Mechanisms of Disease, Epidemiology and Public Health Medicine, General Practice, The Making of the Modern World: Developments in Art from the Renaissance to the 20th Century, Medicine (Ophthalmology), Psychiatry, and Surgery (Otorhinolaryngology). Two years: Musculoskeletal System, Rheumatology, Orthopedics, Trauma, Plastic Surgery, Skin & Dermatology Reproduction & Development, Child Health (Pediatrics), Obstetrics & Gynecology, Sexual Health, Ageing & Death, Alimentary System, Gastroenterology, Endocrinology, Renal Medicine, Urology, Nutrition, Immunology, Infection, Hematology, Oncology Preventative Medicine, Genito-Urinary Medicine, Cardiology/ Cardiovascular Surgery, Respiratory Medicine, ENT, Nervous System, Neurology/Neurosurgery, Vision & Ophthalmology, Psychiatry, and Psychology. Human Biology, Anatomy, Physiology, Biochemistry, Pharmacology) and cognitive sciences (Psychology, Behavioural Sciences, Medical Informatics, Ethics, and Health Promotion). Two years: rotations in Medicine, Surgery, Pediatrics, Psychiatry, Obstetrics and Gynecology, Community Health, General Practice and Ophthalmology/E.N.T. Two years: rotations in Medicine, Surgery, Obstetrics and Gynecology, Pediatrics and Psychiatry, and General Practice and Community Medicine. Two years: rotations in Medicine and Surgery, Medicine and Surgery of Childhood, Obstetrics, Neonatal medicine, Psychiatry, Family Practice, Ophthalmology, and Oto-rhino-laryngology. Two years: rotations in Medicine, Surgery, Obstetrics and Gynecology, and Pediatrics. Two years: rotations in General Practice/Primary Care, Obstetrics/Gynecology, Pediatrics, Psychiatry, Medicine & Related Specialties, and Surgery & Related Specialties. Medicine, Surgery, Obstetrics and Gynecology, Pediatrics, Psychiatry, Radiology, General Practice, the Subspecialties, the Clinical Laboratory Departments and the Specialist Diagnostic Units. Irish medical schools also divide studies into basic sciences and clinicals. Both stages of the curriculum are taught in Ireland. 54

55 TABLE 35 ACCREDITATION BY MEDICAL SCHOOL TABLE 36 TUITION BY MEDICAL SCHOOL Medical School Accreditation and Approvals (Domestic and International) Medical School Total Tuition Average Yearly ($CAD) Tuition ($CAD) Trinity College Dublin University College Dublin Royal College of Surgeons Ireland (RCSI) University College Cork University of Limerick National University of Ireland, Galway Irish Medical Council Irish Medical Council Irish Medical Council Irish Medical Council Irish Medical Council Irish Medical Council Trinity College Dublin $209,045 $41,809 University College Dublin $189,356* $ 47,339 Royal College of Surgeons $252,204* $63,051 Ireland (RCSI) University College Cork $211,476* $52,869 University of Limerick $207,700 $51,925 National University of $209,045** $41,809 Ireland, Galway All Irish medical schools are accredited by the Irish Medical Council. * School has more than one program. Total tuition was calculated using four years. ** School has more than one program. Total tuition was calculated using five years. The average cost to attend an Irish medical school ranges from approximately $40,000 (CAD) dollars to $60,000 (CAD) per year, making Ireland one of the more expensive places to study medicine internationally. TABLE 37 CLERKSHIPS BY MEDICAL SCHOOL Medical School Clerkship Locations Clinical and Affiliated Hospital Locations Trinity College Dublin University College Dublin Ireland Ireland, US, Malaysia St. James Hospital, Adelaide and Health Hospital-incorporating the National Children s Hospital, Tallaght (Dublin, Ireland). US: University of Pennsylvania, University of Kansas, University of California, San Diego, Emory University and Washington University, St Louis. Malaysia: Penang Medical College in Malaysia. Ireland: Mater Misericordiae University Hospital, St. Vincent's University Hospital, the National Maternity Hospital, the Coombe Women's Hospital, Our Lady's Hopsital for sick Children and the Children's University Hospital at Temple Street (Dublin, Ireland), Midlands Regional Hospital (Portlaoise, County Laois, Ireland / Tullamore, County Offaly, Ireland), Wexford General Hospital (Wexford Town, Wexford, Co Wexford, Ireland), St. Colmcille's Hospital (Loughlinstown), National Rehabilitation Hospital (Dún Laoghaire), Mount Carmel (Dublin). Royal College of Surgeons Ireland (RCSI) University College Cork Ireland Ireland Beaumont Hospital, The James Connolly Memorial Hospital, Routunda Hospital, National Maternity Hospital, Coombe Women's Hospital, Our Lady's Hospital Crumlin, Children's Hospital Temple Street, St. Brendan's Hospital (Dublin), Our Lady Lourdes Hospital (Co. Louth). Bon Secours Hospital, Cork University Hospital, Cork University Maternity Hospital, Mercy University Hospital, South Infirmary - Victoria University Hospital, St. Finbarr's Hospital, St. Mary's Orthopaedic Hospital, St. Patrick's/Marymount (Cork), Mid-Western Regional Hospital, St. John's Hospital, St. Munchin s Regional Maternity Hospital (Limerick), Mallow General Hospital (Mallow, Co. Cork), St. Stephen's Hospital (Sarsfieldscourt, Cork), Kerry General Hospital (Tralee, Co. Kerry), South Tipperary General Hospital (Clonmel, Co. Tipperary). Continued on page 56 55

56 TABLE 37 CLERKSHIPS BY MEDICAL SCHOOL Medical School Clerkship Locations Clinical and Affiliated Hospital Locations University of Limerick National University of Ireland, Galway Ireland Ireland Midlands Regional Hospital (Mullingar), Midlands Regional Hopsital (Tullamore), Mid- Western Maternity Hospital (Limerick Mullingar), Mid-Western Orthopaedic Hospital (Croom), Mid-Western Regional Hospital, St John s Hospital (Limerick), Mid-Western Regional Hospital (Ennis, Co Clare), Mid-Western Regional Hospital (Nenagh, Co Tipperary), St Luke s Hospital (Kilkenny), South Tipperary General Hospital (Clonmel). University College Hospital, Merlin Park Regional Hospital (Galway), Altnagelvin Hospital (LondonDerry), Letterkenny General Hospital (Letterkenny), Mayo General Hospital (Castlebar), Portiuncula Hospital (Ballinasloe), Roscommon County Hospital (Roscommon), Silgo General Hospital (Silgo), St. Mary s Hospital (Castlebar), St. Brigid s Hospital (Ballinasloe). While the majority of clinical training is done within Ireland, some Irish medical schools have official affiliations with hospitals located in North America and Malaysia. POLAND TABLE 38 POLISH MEDICAL SCHOOL DATA WEBSITE SOURCES Location Medical School Website Poland Medical University of Silesia Poland Jagiellonian University Medical College Poland Poznan University of Medical Sciences Poland Medical University of Bialystok Poland Medical University of Lodz Poland Pomeranian Medical University Poland Medical University of Warsaw Poland Wroclaw Medical University Poland Medical University of Lublin Poland Medical University of Gdańsk TABLE 39 NUMBER OF CSAS STUDYING MEDICINE IN POLAND Location Medical School Estimation of CSAs Poland Medical University of Silesia ~ 30 Poland Jagiellonian University Medical College ~ 90 Poland Poznan University of Medical Sciences ~ 90 Poland Medical University of Bialystok Unknown* Poland Medical University of Lodz Unknown* Poland Pomeranian Medical University Unknown* Poland Medical University of Warsaw Unknown* Poland Wroclaw Medical University Unknown* Poland Medical University of Lublin Unknown* Poland Medical University of Gdańsk Unknown* Estimated Total ~ 300 * Unknown denotes locations where CSAs are known to study but no numbers were provided. An overall estimate was given for the region. A total of 10 medical schools were identified providing medical education to Canadians within Poland. It is estimated that up to 300 Canadians are currently studying medicine in Poland. 56

57 TABLE 40 GENERAL INFORMATION Medical School Year University Founded Year International Program Began Medical University of Silesia Jagiellonian University Medical College Poznan University of Medical Sciences Medical University of Bialystok Medical University of Lodz Pomeranian Medical University Medical University of Warsaw Wroclaw Medical University Medical University of Lublin The Polish medical schools providing medical education to Canadian students have an established history of providing medical education in English to international students, with the newest program beginning in TABLE 41 ADMISSIONS BY MEDICAL SCHOOL Medical School Programs Admissions Fielded Admission Requirements Available Through Medical University Four year Hope Medical Four year: bachelor s degree of Silesia and six year Institute Six year: high school diploma All admission criteria are handled by HMI. Jagiellonian University Four year and University Four year: bachelor s degree, MCAT or GAMSAT, Medical College six year general or organic chemistry, biology, physics, calculus, humanities or social sciences, and telephone/personal interview. Six year: high school transcript must have courses in biology, chemistry, physics, math, admission based on entrance exam. Poznan University of Four year and University Four year: bachelor s degree, MCAT, courses in chemistry, biology, Medical Sciences six year physics, English, and entrance interview. Six year: high school diploma, courses in physics, chemistry, biology, mathematics and English, and entrance interview. Medical University Four year and Hope Medical Four year: official college transcript, high school of transcript, college Bialystok six year Institute level courses in chemistry, biology, and physics. Six year: high school transcript, high school level courses in physics, chemistry, biology and English. Medical University Six year University Unknown of Lodz Pomeranian Medical Six year Hope Medical Unknown University Institute Medical University Four year and University Four year: bachelor s degree, 1200 hours of pre-med courses in of Warsaw six year chemistry, organic chemistry, biology, physics, calculus, biochemistry, genetics, or anatomy. Six year: High school diploma and transcripts, good grades in chemistry, biology and physics. Continued on page 58 57

58 TABLE 41 ADMISSIONS BY MEDICAL SCHOOL Medical School Programs Admissions Fielded Admission Requirements Available Through Wroclaw Medical Six year Wroclaw University High school diploma, transcipt, high level grades in English, physics, University International chemistry, and biology. Recruitment Program Medical University Six year Hope Medical Six year advanced: bachelor of Science with the following courses: of Lublin advanced and Institute general chemistry, organic chemistry, general biology, general six year regular physics, and math/calculus. In exceptionally rare instances the university may consider for admission a well qualified applicant who completed three years of post-secondary education towards bachelor s degree (minimum of 90 credit hours of studies). Six year regular: high school transcript and diploma are required. All Polish medical schools offer a six year program with direct entry from high school, however some also offer graduate entry four year programs. Some admissions are handled by recruitment agencies while some of the universities handle the admissions themselves. At minimum, a high school diploma is required, while a bachelor s degree will allow for graduate entry in schools which offer four year programs. TABLE 42 CURRICULUM SUMMARY BY MEDICAL SCHOOL Medical School Basic Science Curriculum Clinical Curriculum includes Core Clinicals and Electives Medical University of Silesia Jagiellonian University Medical College Poznan University of Medical Sciences Medical University of Bialystok Gross Anatomy I/II, Histology I/II, Biophysics, First Aid, Environmental Health, Polish I/II, Immunology, Biochemistry, Genetics I/II, and Physiology. Anatomy, Clinical Anatomy, Histology I/II, Biochemistry, Medical Embryology, Physiology, Radiology, Neurosciences, Medical Genetics, Immunology, Medical Ethics, Intro to Clinical Sciences, Cell Biology, Medical Polish, Behavioral Sciences, Pathomorphology, Pathophysiology, Pharmacology, and Intro to Surgery. Gross Anatomy, Histology and Cell Biology, Biochemistry, Human Physiology, Biophysics, Neuroscience, Microbiology, Embryology, Law and Ethics, Medical Sociology, Pathology, Polish, Pathophysiology, Pharmacology, Public Health and Epidemiology, Immunology, Biostatistics, Behavioral Science, First Aid, Clinical Diagnosis, and Internal Medicine. Histology, Biophysics, First Aid/Nursing, Anatomy, Medical Polish, Physical Education, History of Medicine, Medical Psychology, Biochemistry, Sociology, Physiology, Intro to Internal Medicine, Disaster Medicine, Pathomorphology, Pathophysiology, Immunology, Pharmacology, Microbiology, Molecular Medicine, Hygiene and Epidemiology, Intro to Pediatrics, Neurology, Clinical Genetics, Emergency Medicine, Surgery, Radiology, Intro to Dentistry, and Toxicology. Psychiatry, Internal Medicine, Family Practice, Pediatrics, Surgery, Anesthesiology, Ophthalmology, Dermatology, Infectious Diseases, Rehabilitation, Emergency Medicine, Neurology, Neurosurgery, and Forensic Medicine. OB/GYN, Internal Medicine, Anesthesiology and Intensive Care, Surgery, Pediatrics, Neurology and Neurosurgery, Psychiatry, Family Medicine, Clinical Immunology, Emergency Medicine, Rehabilitation, Oncology, Ophthalmology, Otorhinolaryngology, Dermatology and Venereology, and Forensic Medicine. Pediatrics, OB/GYN, Surgery, Internal Medicine, Psychiatry, Laboratory Medicine, Family Medicine, Internal Medicine in Primary Care, Geriatrics, Medical Polish, Infectious Diseases, Neurology, Radiology, Forensic Medicine, Oncology, Palliative Care, Tropical Diseases, Laryngology, Ophthalmology, Orthopedics, Dermatology, Anesthesiology and Resuscitation. Internal Medicine, OB/GYN, Nuclear Medicine, General Surgery, Pediatrics, Pediatric Surgery, Gerontology, Oncology, Family Medicine, Orthopedics, and Ophthalmology. 58 Continued on page 59

59 TABLE 42 CURRICULUM SUMMARY BY MEDICAL SCHOOL Medical School Basic Science Curriculum Clinical Curriculum includes Core Clinicals and Electives Medical University of Lodz Pomeranian Medical University Medical University of Warsaw Wroclaw Medical University Medical University of Lublin Normal Anatomy, Chemistry, Biology, Bioorganic Chemistry, Biophysics, Physiology Pathomorphology, Pharmacology, Pathophysiology, Microbiology, Immunology, and Medical Psychology. Medical Biology, Medical Chemistry, Propedeutics of Medicine, Anatomy, First Aid with Elements of Nursing, Latin with Medical Terminology, Physical Education, Biophysics, Histology & Cytophysiology with Embryology, Computer Science and Medical Statistics, Sociology, Physiology, Biochemistry, History of Medicine, Psychology, Immunology, Medical Microbiology, Pathophysiology, Epidemiology, Pediatrics, Laboratory Diagnostics, Pharmacology, Parasitology, Oncology, Radiology, and Clinical Genetics. Anatomy, Biophysics, Physiology, Parasitology, Biochemistry, Histology, Embryology, Cytophysiology, Medical Biology, Medical Ethics, Behavioral Sciences, Immunology, Polish Language, Latin Language, Sport Training, Library Training, Pharmacology, Pathophysiology, Pathomorphology, Microbiology and Virusology, Neurobiology, Imaging Diagnostics, Pediatrics Radiology, Laboratory Diagnostics, Hygiene and Epidemiology, Surgery, Internal Medicine, and Medical Psychology. Medical Chemistry (Inorganic And Organic), Biophysics, Biology, Anatomy, Histology, Embryology, Genetics, Immunology, Cytophysiology, Biochemistry, Computing Techniques, Physiology, Latin, Physical Education, First Aid and Resuscitation, and Polish. Introduction to Biophysics, General Chemistry, General and Analytical Chemistry, Epidemiology, Public Health, Sources of Literature, Informatics, Introduction to Medicine, Medical Sociology, Medical Terminology, Latin, Polish, General Biology, Human Biology with Physiology, Molecular Biology, Organic Chemistry, Biophysics, Biostatistics, Introduction to Philosophy, Parasitology, Hygiene & Nutrition, Ethics, Medical Psychology, Introduction to Clinical Procedures, Human Anatomy, Biochemistry, Physiology, Histology, Embryology, First Aid, Microbiology/ Virology, Pathomorphology, Pathophysiology, Pharmacology, Genetics, Immunology, Clinical Biochemistry, Neuroanatomy, Neuropharmacology, Physical Diagnosis, and Introduction to Psychiatry. Internal Medicine, Pediatrics, Surgery, Neurology, Dermatology and Venerology, Endocrinology, and Infectious Diseases. Internal Medicine, OB/GYN, Neurology, General Surgery, Pediatrics, Pediatric Surgery, Gerontology, Oncology, Family Medicine, Orthopedics, and Ophthalmology. Diabetology, Internal medicine, Cardiology, Pulmunology, Gastroenterology, Surgery, Oncological Surgery, Thoracic Surgery, Vascular Surgery, Urology, Orthopedics and Traumatology, Obstetrics and Gynecology, Pediatrics, Nuclear Medicine, Endocrinology, Infectious Diseases, Nephrology, Rheumatology, Hematology, Oncology, Dermatology and Venerology, Anesthesiology and Intensive Care, Emergency Care, Family Medicine, Clinical Pharmacology, Forensic Medicine, Transplantology, Otolaryngology, Clinical Immunology, Ophthalmology, Pediatrics, Neurology, Psychiatry (including Child Psychiatry), and Clinical Genetics Pathology, Pathophysiology, Pharmacology, Microbiology, Internal Medicine, General Surgery, Pediatrics, Gynecology And Obstetrics, Neurology, Dermatology, Psychiatry, Ophthalmology, Radiology, Otorhinolaryngology, Urology, Pulmonology, Rheumatology, Forensic Medicine, Public Health Medicine, Anesthesiology, Medical Ethics, and Psychology. Surgery, Obstetrics/Gynecology, Pediatrics, Pediatric Family Medicine, Internal Medicine, Psychiatry, Neurology, Radiology, Nuclear Medicine, Infectious Diseases, Anesthesiology/ Intensive Care, Dermatology, Otolaryngology, Oncology, Ophthalmology, Orthopedics/ Rehabilitation, Family Medicine, Emergency Medicine, Forensic Medicine, and Propedeutics of Dentistry. The Polish medical curriculum is split into two sections: basic sciences and clinical rotations. The basic science curriculum includes standard courses such as anatomy and physiology; however it also includes Polish language classes. The clinical rotations are done in Poland, with the option of North American electives. During clinical rotations students are assisted by a Polish translator. 59

60 TABLE 43 ACCREDITATION BY MEDICAL SCHOOL Medical School Accreditation and Approvals (Domestic and International) Medical University of Silesia Jagiellonian University Medical College Poznan University of Medical Sciences Medical University of Bialystok Medical University of Lodz Pomeranian Medical University Medical University of Warsaw Wroclaw Medical University Medical University of Lublin ACPUMS & The Polish State Accreditation Committee ACPUMS & The Polish State Accreditation Committee, US Department of Education and Medical Board of California ACPUMS & The Polish State Accreditation Committee, The Medical Board of California ACPUMS & The Polish State Accreditation Committee ACPUMS & The Polish State Accreditation Committee ACPUMS & The Polish State Accreditation Committee ACPUMS & The Polish State Accreditation Committee ACPUMS & The Polish State Accreditation Committee ACPUMS & The Polish State Accreditation Committee All Polish medical schools are accredited by two separate accrediting bodies; some of the medical schools have additionally sought approval from US departments of education and individual state medical boards. * School has more than one program. Total tuition was calculated using four years. TABLE 44 TUITION BY MEDICAL SCHOOL Medical School Total Tuition ($CAD) Average Yearly Tuition ($CAD) Medical University of Silesia $61,500* $15,375 Jagiellonian University Medical College $63,120* $15,780 Poznan University of Medical Sciences $51,644* $12,911 Medical University of Bialystok $51,252* $12,813 Medical University of Lodz $89,016 $14,836 Pomeranian Medical University Unknown Unknown Medical University of Warsaw $61,480* $15,370 Wroclaw Medical University $73,500 $12,250 Medical University of Lublin Unknown Unknown The cost of medical education for international students in Poland is substantially less than other international locations; in some cases the entire education in Poland equals one year s tuition in some of the more expensive countries. TABLE 45 CLERKSHIPS BY MEDICAL SCHOOL Medical School Clerkship Locations Clinical and Affiliated Hospital Locations Medical University of Silesia Poland, US - About 60% all clerkships done in US: New York, Illinois, LA. US/Canada, 40% done in Poland with help of translator Canada: Saskatchewan Jagiellonian University Medical College Poland, US US: New York, LA, California, San Diego. Poznan University of Medical Sciences Poland, US, Canada Unknown Medical University of Bialystok Poland Unknown Medical University of Lodz Poland Seven teaching hospitals in Poland. Pomeranian Medical University Poland Unknown Medical University of Warsaw Poland Five affiliated teaching hospitals in Warsaw and 16 affiliated hospitals. Wroclaw Medical University Poland Unknown Medical University of Lublin Poland Unknown While a portion of all clerkships are done in Poland, students also have the opportunity to do rotations in US hospitals. 60

61 UNITED KINGDOM (UK) TABLE 46 UK MEDICAL SCHOOL DATA WEBSITE SOURCES Medical School Barts and The London School of Medicine and Dentistry University of Leicester University of Cambridge University of Edinburgh University of Aberdeen Warwick Medical School University of Leeds University of Nottingham University of Birmingham Imperial College London University of Manchester University of Glasgow Website www2.warwick.ac.uk/fac/med/ Number of CSAs studying medicine in the UK The number of CSAs studying in the UK are unknown; no schools participated directly in this study and therefore were not included in the estimated number of Canadians currently studying medicine abroad. TABLE 47 GENERAL INFORMATION Medical School Year University Founded Year International Program Began Barts and The London School of Medicine and Dentistry 1785 Unknown University of Leicester 1921 Unknown University of Cambridge 1209 Unknown University of Edinburgh 1583/1726 Unknown University of Aberdeen 1495/1497 Unknown Warwick Medical School 2000 Unknown University of Leeds 1904 >100 Yrs University of Nottingham 1948 Unknown University of Birmingham 1900 Unknown Imperial College London 1907 Unknown University of Manchester 2004 Unknown University of Glasgow 1451 Unknown Medical University of Lublin Unknown Unknown Information was not available on when medical schools in the UK began accepting international students. 61

62 TABLE 48 ADMISSIONS BY MEDICAL SCHOOL Medical School Programs Admissions Fielded Admission Requirements Available Through Barts and The London School of Medicine and Dentistry Five year and four year UCAS Degrees in any discipline are acceptable for five year program. Candidates must have at least an upper second class honours degree at 2:1. Candidates must be able to demonstrate that they have reached a satisfactory standard in chemistry and biology, at least equivalent to AS-level; or applicants must have achieved grades of BB in AS/A-level chemistry and biology before starting their degree; or applicants must be completing AS/A levels in chemistry and biology and achieve BB grades at the time of application. University of Leicester Five year UCAS International Baccalaureate: Pass Diploma with 36 points including chemistry and biology at higher level. Grade six required in all subjects. Other national and international qualifications welcomed. Mature students welcomed: alternative qualifications considered. University of Cambridge Five year UCAS Passes in three of the following: biology/human biology, chemistry, physics, or mathematics. One of the subjects must be chemistry and at least one pass must be at A level. University of Edinburgh Five year UCAS Unknown University of Aberdeen Five year UCAS, the associate dean, along with a team of members of staff, is responsible for managing the whole of the annual admissions cycle. UKCAT Check with medical admissions office if in doubt about suitability of a subject. A typical offer will be conditional upon achieving the minimum requirements for GCE* / SQA / IB / EB applicants or a minimum of the predicted grades. There may be an English requirement. Warwick Medical School Four year UCAS UCAS, UK Clinical Aptitude Test(UKCAT) University of Leeds Five year UCAS A Level qualification or equivalent. Minimum requirements are: 6.0 overall on IELTS, with at least 5.5 in listening and reading, and at least 5 in speaking and writing; 220 on computer-based TOEFL (550 on the paper-based version), with 4.0 on the essay rating (4.0 on the Test of Written English associated with the paper-based version); 83 on TOEFL ibt (internet-based), with minimum scores of 18 in listening, 20 in reading, 20 in speaking and 21 in writing. University of Nottingham Four year and five year UCAS Four year: bachelor's degree. Five year: UKAT, Advanced Diploma, International Baccalaureate 36. University of Birmingham Five year UCAS Five year: International Baccalaureate Diploma: minimum 36 points including HL chemistry and HL biology. Imperial College London Four year and six year UCAS Four year: honours degree or a PhD in a biological subject, and UKCAT. Six year: International Baccalaureate 38 points in total with a minimum of six points in each of chemistry and biology, and Biomedical Admissions Test (BMAT). Continued on page 63 62

63 TABLE 48 ADMISSIONS BY MEDICAL SCHOOL Medical School Programs Admissions Fielded Admission Requirements Available Through University of Manchester Five year and six year UCAS Five year: International Baccalaureate 37 points, Higher level in chemistry plus one from either biology, physics or math, plus one further subject. Six year: International Baccalaureate 33 points required overall, Higher Level 665, and Standard Level 655. University of Glasgow Four year and five year UCAS - There are only 18 places for candidates from non-eu countries Four year: bachelor's degree. Five year: UKAT, Advanced Diploma, and International Baccalaureate 36. There are a wide range of medical programs available in the UK; all admissions are fielded by a central admissions service: UCAS. TABLE 49 CURRICULUM SUMMARY BY MEDICAL SCHOOL Medical School Basic Science Curriculum Clinical Curriculum Barts and The London School of Medicine and Dentistry University of Leicester University of Cambridge University of Edinburgh Fundamentals of Medicine, Systems in Health, Cardiorespiratory, Metabolism, Locomotor (Musculoskeletal), Brain and Behaviour (neuroscience, psychology, psychiatry), Human Development (embryology, reproductive medicine, child health), and Systems in Disease. Laying the Foundations, Clinical Skills, Medical Sciences, Social and Behavioural Medicine, Learning How to Learn, Learning to Integrate, and Rational Practice. Three years: Functional Architecture of the Body Physiological Systems; Molecules in Medical Science, Preparing for Patients, Biology of Disease, The Mechanisms of Drug Action, Neurobiology and Human Behaviour Human Reproduction, Biological and Biomedical Sciences including Pathology, Physiology, Zoology, History and Ethics of Medicine, to subjects unrelated to medicine such as anthropology, management studies or philosophy. Two years: Principles of Practice (Anatomy, Physiology, Pharmacology, Pathology and Microbiology of a System, along with relevant social and ethical aspects of clinical practice). Integrated Clinical Studies, Systems (specialties), Preparation for Clinical Practice. Developing Your Skills, The Learning Environment, Elective, Preparing for Postgraduate Training, and Testing Your Skills: Assessment. Three years: Stage 1 Clinical Method Stage 2 The Life Course Stage 3 Preparation for Practice Three years: Process of Care Further clinical experiences develop skills in diagnosis and management, building on the foundation for Principles for Practice but biomedical and clinical sciences are also revisited and developed. Students undertake an eight-week elective in year five. Most split this into two four week blocks. Continued on page 64 63

64 TABLE 49 CURRICULUM SUMMARY BY MEDICAL SCHOOL Medical School Basic Science Curriculum Clinical Curriculum University of Aberdeen Warwick Medical School University of Leeds Two years: Science for Medicine (The Principles and Vocabulary of Biochemistry, Physiology, Anatomy, Genetics and other Biomedical Sciences). Integrated teaching of body systems (Systems II) that began with the Respiratory and Cardiovascular Systems in year one, Systems Teaching in Relation to Disease, and Medical Humanities. One and a half years: Attending lectures with your fellow students, work in small learning groups, guided, as appropriate, by clinicians or members of Warwick's academic staff. These groups contain students of different ages, background and experience, and this method of working enables everyone to bring their own skills and knowledge to the group so that students also learn from one another. Three years: preparing for clinical practice. Three years: Clinical Effectiveness, an apprenticeship year in which the student is a junior member of the healthcare team and develops the generic, professional skills required in the delivery of healthcare by the multi-professional team. There are four eight-week blocks which run simultaneously through the year: Medicine, Surgery, Community Health (Psychiatry or General Practice), Clinical Elective, and Professional Practice Block. Following the four eight-week blocks described above, this phase is completed before the final exams with a Professional Practice Block. The eight key themes are: Core Knowledge and Skills (with emphasis on nontechnical skills); Clinical Ethics and Law; End of Life; Prescribing; Handover and Communication; Dealing with Stress and Conflict; Professional Development (including careers), and WHO Patient Safety. Two and a half years: clinical attachments in acute hospital settings in Coventry, Nuneaton, Redditch, Rugby and Warwick. Experiences are also provided in primary and community care placements ranging from GP practices to outreach projects in the Coventry, Rugby, Leamington, Warwick and Alcester areas. Elective: students devise and undertake a medical project in a setting of their choice. The elective can be anywhere in the world, subject to suitable arrangements. Personal Development Plan: Throughout their time at Warwick Medical School, students will be asked to keep a Personal Development Plan (PDP). This is an opportunity for self-reflection - to think not only about being a doctor, but about how they fit into the general healthcare system. Two years: Clinical Practice in Context, Becoming a Doctor (communication with patients and other professionals, medicine in the community, ethics and law, information technology handling and management. Continued on page 65 64

65 TABLE 49 CURRICULUM SUMMARY BY MEDICAL SCHOOL Medical School Basic Science Curriculum Clinical Curriculum University of Nottingham University of Birmingham Imperial College London University of Manchester University of Glasgow Structure, Function and Pharmacology of Excitable Tissues, Molecular Basis of Medicine, Public Health Epidemiology, Behavioural Sciences, Human Development and Tissue Differentiation, Early Clinical and Professional Development, Clinical Communication Skills, Clinical Laboratory Sciences, Cardiovascular and Respiratory Systems, Hematology, Renal and Endocrine Systems, Human Development Structure and Function, Alimentary System and Nutrition, General and Biochemical Pharmacology, Functional and Behavioural Neuroscience, Using Epidemiology in Practice, up to two optional modules Research Methods, Honours Year Project, Infection, plus two taught modules. This involves case based learning following a structure similar to that used in the long established Maastricht problem-based learning course. Students will work on the cases as part of a group of about eight students with a tutor for each group. Each student will cover all aspects of the cases. The problems are grouped into four to six-week themed blocks covering basic science, Anatomy (including Prosection), Ethics, Medicine in Society, and Behavioural Science with all these aspects integrated into each of the cases studied. Over the year students will be working with different groups of students and with different tutors to prepare them for the way group working operates within the health service. Cellular and Molecular Science, Regional and Systems Anatomy, Systematic Physiology, Pharmacology and General Pathology, Introduction to Clinical Practice: Medical and Surgical Takes (receiving unselected emergency admissions), GP Teaching (basic clinical skills/methods in general practice), Patient Clerking, Consultant Teaching, and other teaching (outpatient clinic teaching, theatre sessions, endoscopy sessions, and anaesthetic sessions). Unknown Unknown Clinical Practice (Medicine and Surgery), Community Follow-up, and Therapeutics Obstetrics and Gynecology, Child Health, Healthcare of the Elderly, Psychiatry, Ophthalmology, Otorhinolaryngology ('Ear, nose and throat'), Dermatology, Special Study Module Medicine, Surgery, Musculoskeletal Disorders and Disability, Primary Care (General Practice), and Critical Illness and Critical Assistantship. Unknown Obstetrics and Gynecology, Pediatrics, Psychiatry, Oncology, General Practice and Primary Health Care, Radiology, Infectious Diseases/GUM/HIV, Dermatology, Rheumatology, Orthopedics, Critical Care, Teaching Skills Emergency Medicine, General Practice Student Assistantship, Cardiology, Neurology, Ears, Nose and Throat, Ophthalmology and, Renal Medicine. Unknown Unknown The UK also separates its curriculum by basic sciences and clinical rotations, however many of the medical schools use problem-based learning (PBL) in the basic science years. 65

66 TABLE 50 ACCREDITATION BY MEDICAL SCHOOL Medical School Accreditation and Approvals (Domestic and International) Barts and The London School of Medicine and Dentistry University of Leicester University of Cambridge University of Edinburgh University of Aberdeen Warwick Medical School University of Leeds University of Nottingham University of Birmingham Imperial College London University of Manchester University of Glasgow The General Medical Council, UK The General Medical Council, UK The General Medical Council, UK The General Medical Council, UK The General Medical Council, UK The General Medical Council, UK The General Medical Council, UK The General Medical Council, UK The General Medical Council, UK The General Medical Council, UK The General Medical Council, UK The General Medical Council, UK All of the medical schools in the UK are accredited by the General Medical Council, UK. * School has more than one program. Total tuition was calculated using four years. ** School has more than one program. Total tuition was calculated using five years. TABLE 51 AVERAGE TUITION BY MEDICAL SCHOOL Medical School Total Tuition ($CAD) Average Yearly Tuition ($CAD) Barts and The London School of Medicine and Dentistry $139,328* $34,832 University of Leicester $158,725 $31,745 University of Cambridge $253,560 $42,260 University of Edinburgh $216,590 $43,318 University of Aberdeen $146,940 $29,388 Warwick Medical School $143,996 $35,999 University of Leeds $115,275 $23,055 University of Nottingham $125,908* $31,477 University of Birmingham $138,158 $27,630 Imperial College London $257,380* $64,345 University of Manchester $174,380** $34,876 University of Glasgow $138,716* $34,679 Tuition costs in the UK are similar to those found in Ireland; they range from $23,000 (CAD) per year to upwards of $43,000 (CAD) per year. 66

67 TABLE 52 CLERKSHIPS BY MEDICAL SCHOOL Medical School Clerkship Locations Clinical and Affiliated Hospital Locations Barts and The London School of Medicine and Dentistry University of Leicester University of Cambridge University of Edinburgh University of Aberdeen Warwick Medical School University of Leeds University of Nottingham University of Birmingham Imperial College London University of Manchester University of Glasgow Great Britain Great Britain Great Britain Great Britain Great Britain Great Britain Great Britain Great Britain Great Britain Great Britain Great Britain, Europe Great Britain Royal London and Barts, the Homerton Hospital, Newham General and Whipps Cross University Hospital, as well as a number of other hospitals in Greater London and Essex. Glenfield Hospital, Leicester General Hospital, Leicester Royal Infirmary Addenbrooke's Hospital Royal Infirmary Edinburgh and Western General Hospital Dr. Gray's Hospital, Elgin and Raigmore Hospital, Inverness, and all students undertake hospital-based clinical placements outside Aberdeen. University Hospitals Coventry and Warwickshire NHS Trust General Infirmary adjacent to the Worsley Building, St James s University Hospital, Bradford Teaching Hospital. Students also spend time in other hospitals across West Yorkshire: Airedale hospital near Keighley, Calderdale (Halifax) and Huddersfield hospitals to the west, Pinderfields (Wakefield), Dewsbury and Pontefract hospitals just to the south of Leeds and Harrogate hospital, north of Leeds. General practices across West Yorkshire and beyond provide a variety of placements. Nottinghamshire, Derbyshire and Lincolnshire. Unknown Unknown Central Manchester, University Hospitals NHS Foundation Trust, Lancashire Teaching Hospitals NHS Foundation Trust, Salford Royal NHS Foundation Trust, University Hospital of South Manchester NHS Foundation Trust Unknown Clerkship rotations are done at affiliated hospitals in the UK and Europe. 67

68 EUROPE/MIDDLE EAST TABLE 53 EUROPE/MIDDLE EAST MEDICAL SCHOOL DATA WEBSITE SOURCES Location Medical School Website Lithuania Kaunas University of Medicine Romania University of Medicine and Pharmacy Iuliu Hatieganu Egypt University of Cairo Iran Islamic Azad University Bahrain RCSI Bahrain Israel Sackler School of Medicine Israel Ben-Gurion University of the Negev Israel Technion Israel Institute of Technology TABLE 54 NUMBER OF CSAS STUDYING MEDICINE IN EUROPE/MIDDLE EAST Location Medical School Estimation of CSAs Lithuania Kaunas University of Medicine Unknown* Romania University of Medicine and Pharmacy Iuliu Hatieganu Unknown* Egypt University of Cairo Unknown* Iran Islamic Azad University Unknown* Bahrain RCSI Bahrain ~ 50 Israel Sackler School of Medicine ~ 20 Israel Ben-Gurion University of the Negev Unknown* Israel Technion Israel Institute of Technology Unknown* Estimated Total ~ 70 * Unknown denotes locations where CSAs are known to study but no numbers were provided. An overall estimate was given for the region. Eight areas within Europe and the Middle East were identified as educating Canadian students, which led to an estimate of approximately 70 Canadians currently studying there. TABLE 55 GENERAL INFORMATION Medical School Year University Founded Year International Program Began Kaunas University of Medicine 1919 Unknown University of Medicine and Pharmacy Iuliu Hatieganu 1919 Unknown University of Cairo 1837 Unknown Islamic Azad University 1361 Unknown RCSI Bahrain Sackler School of Medicine Ben-Gurion University of the Negev 1969 Unknown Technion Israel Institute of Technology 1924 Unknown Most of the medical schools identified in Europe and the Middle East have been providing medical education in excess of 40 years. Although RCSI Bahrain was founded in 2004, it is a partner of RCSI located in Ireland, which is a well-established institution. 68

69 TABLE 56 ADMISSIONS BY MEDICAL SCHOOL Medical School Programs Admissions Fielded Admission Requirements Available Through Kaunas University Six year Unknown In-person interview required, physical exam/health records, transcript of Medicine and written application. University of Medicine Six year University based Unknown and Pharmacy Iuliu Hatieganu University of Cairo Six year Unknown Unknown Islamic Azad University n/a International Affairs Unknown of the Islamic Azad University RCSI Bahrain Five year and Unknown Five year program: bachelor's degree, and MCAT. six year Six year program: high school examinations with a minimum average score of 85% and competitive grades in biology, chemistry, physics and mathematics. Sackler School of Four year The New York City State/American Program. Medicine office of the Sackler Bachelor s degree, MCAT, courses in English, inorganic chemistry, School of Medicine organic chemistry, physics and biology. has sole responsibility for the admission of students into the New York Ben-Gurion University Four year Unknown Bachelor's degree, GPA, MCAT scores, extra-curricular experience, of the Negev recommendations, and interview assessments. Technion Israel Institute Unknown Unknown Unknown of Technology The majority of schools offer one medical program, however RCSI Bahrain offers two different streams. Admission is primarily based on high school transcripts, a bachelor s degree and MCAT scores. TABLE 57 CURRICULUM SUMMARY BY MEDICAL SCHOOL Medical School Clerkship Locations Clinical Curriculum includes Core Clinicals and Electives Kaunas University of Medicine Two years: theoretical disciplines on medicine such as Human Anatomy, Histology-Embryology, Physiology, both chemistry, physics, foreign languages, and philosophy are subjects of first and second year studies. Three years: clinical medicine subjects begin during third year studies and include such disciplines as Medical Diagnostics, General Surgery, patient care, and others. Fourth year studies cover such disciplines as Internal Diseases, Infectious Diseases, Dermato-Venerology, Psychiatry, and fifth year covers the following subjects: Surgery, Obstetrics-Gynecology, Nervous Diseases, Neurosurgery, Ophthalmology, Anesthesiology and Intensive Care. During last (sixth) year of undergraduate studies the program contains disciplines such as Pediatrics, Emergency Medicine, Social Medicine, Public Health, Family Medicine, and others. Continued on page 70 69

70 TABLE 57 CURRICULUM SUMMARY BY MEDICAL SCHOOL Medical School Clerkship Locations Clinical Curriculum includes Core Clinicals and Electives University of Medicine and Pharmacy Iuliu Hatieganu University of Cairo Islamic Azad University RCSI Bahrain Sackler School of Medicine Ben-Gurion University of the Negev Technion Israel Institute of Technology Unknown Two years: first year Anatomy, first year Medical Physiology, first year Medical Biochemistry and Molecular Biology, first year Histology, second year Anatomy, second year Medical Physiology, second year Medical Biochemistry and Molecular Biology, second year Histology, Computer; Psychology and Behavioral Sciences, Microbiology and Immunology, third year Community Medicine& Public Health; Medical Parasitology; Clinical Pharmacology, Pathology, Ear, Nose and throat (E.N.T.), Ophthalmology, Forensic Medicine and Clinical Toxicology. Unknown Neuromuscular, Biomedicine, Haemotopoietic and Immune Systems, Health Behavior and Society, Clinical Competencies, Molecular Medicine, Neuroscience, and Epidemiology. Biochemistry, Cell Biology, Genetics, Molecular Biology, Gross Anatomy, Embryology, Histology, Pharmacology, Microbiology, Neurology, Pathology, Epidemiology, Genetics, and Physical Diagnosis. Unknown Unknown Unknown Two years: fourth year Community Medicine & Public Health, fifth year Community Medicine & Public Health, Pediatrics, Internal Medicine, and General Surgery. Unknown Medicine and Surgery, OB/GYN, Neonatal Medicine, Psychiatry, Family Practice, Ophthalmology, and Otolaryngology. Internal Medicine, OB/GYN, Pediatrics, Psychiatry, Surgery, Emergency Medicine, Family Medicine, Neurology, and Medicine. Unknown Unknown The curriculum is broken up into basic sciences and clinical rotations as is the case with all other international medical schools. 70

71 TABLE 58 ACCREDITATION BY MEDICAL SCHOOL Medical School Accreditation and Approvals (Domestic and International) Kaunas University of Medicine Unknown University of Medicine and Pharmacy Iuliu Hatieganu Unknown University of Cairo Unknown Islamic Azad University Unknown RCSI Bahrain GCC Medical Schools Deans Committee Sackler School of Medicine Council for Higher Education, New York State Education Department, State of Israel Ben-Gurion University of the Negev Council for Higher Education Technion Israel Institute of Technology Council for Higher Education Accreditation is varied and dependent on the location of the medical school. TABLE 59 TUITION BY MEDICAL SCHOOL Medical School Total Tuition ($CAD) Average Yearly Tuition ($CAD) Kaunas University of Medicine Unknown Unknown University of Medicine and Pharmacy Iuliu Hatieganu $42,036 $ 7,006 University of Cairo Unknown Unknown Islamic Azad University Unknown Unknown RCSI Bahrain $191,225 $38,245* Sackler School of Medicine $ 114,576 $28,644 Ben-Gurion University of the Negev $ 60,468 $15,117 Technion Israel Institute of Technology Unknown $ 23,339 * School has more than one program. Average yearly tuition was calculated using five years. Tuition data was not available for all of the schools identified. The Israeli schools tended to have lower tuition rates while RCSI Bahrain was similar to rates found in Ireland. TABLE 60 CLERKSHIPS BY MEDICAL SCHOOL Medical School Clerkship Locations Clinical and Affiliated Hospital Locations Kaunas University of Medicine Lithuania KMUK, LITHUANIAN HPH Hospitals University of Medicine and Pharmacy Iuliu Hatieganu Romania Unknown University of Cairo Egypt Kasr Al Ainy Hospital Islamic Azad University Iran 24 hospital complex RCSI Bahrain Bahrain, International Locations King Hamad General Hospital Sackler School of Medicine Israel, US Teaching institutions whose departments are affiliated with Sackler include seven major medical centers, six psychiatric hospitals, 20 research institutes and a large rehabilitation center. Ben-Gurion University of the Negev Israel Unknown Technion Israel Institute of Technology Israel Unknown Clinical rotations are typically done within the country of medical education, although a couple of schools do state that international and US locations are available for a portion of the clinical rotations. 71

72 INTERNATIONAL MEDICAL SCHOOL DATA - MEDICAL SCHOOL SURVEY RESULTS The following data are derived from the 20 international medical schools that participated in the medical school survey. SURVEY RESPONDENTS TABLE 61 LOCATION OF SURVEY RESPONDENTS Country Medical School n Caribbean Ross University 3 Australia Flinders University of South Australia 1 Australia University of Sydney 2 Australia University of Queensland 1 Australia University of Wollongong 1 Australia James Cook University 1 Bahrain RCSI Bahrain 1 Ireland University of Limerick 1 Ireland Royal College of Surgeons in Ireland 1 Ireland Trinity College, University of Dublin 1 Ireland University College Cork 1 Ireland University College Dublin 1 Israel Sackler School of Medicine 1 Poland Jagiellonian University Medical College 1 Poland Medical University of Silesia, School of Medicine in Katowice 1 Poland Poznan University of Medical Sciences Center for Medical Education 1 Czech Republic Charles University 1 A total of 90.0% of the medical schools that responded to the school survey were those that were visited in person. This demonstrates that on-site visits played a critical role in this study. TABLE 62 ROLE OF SURVEY RESPONDENTS Role of Respondent n % Dean 4 20% Professor 8 40% Administration 2 10% Director of Curriculum Development 1 5% Clinical Associate Lecturer 1 5% Unknown 4 20% Total % Medical school deans and professors were the two most likely to answer the medical school survey. 72

73 MOTIVATION TO RECRUIT INTERNATIONAL MEDICAL STUDENTS Apart from fiscal reasons, when surveyed about motivation, a ride range of reasons were given as to why international medical students are recruited: Australia Adds to the breadth of backgrounds of students in the program - which is particularly good in a PBL format. Diversity of student population - as seen in Canadian applicant pool. We like the ethnic and cultural mix. Ireland To forge relationships with other countries. Poland Main goal is not to just send physicians back to Canada, but to send highly educated and good physicians back. Money is not the main reason for IMGs. Clinical opportunities, North American trained faculty. Middle East A desire to establish a long lasting connection for primarily (but not exclusively) Jewish-American and Canadian students with Israel. Caribbean There is a great need for doctors and schools within the USA and Canada have not been supplying enough to meet this need for decades. Since the number of positions available in medical schools in the US and Canada is limited, many well qualified and highly motivated students would otherwise be unable to study medicine. Schools like Ross provide students with that opportunity. Quality of faculty, accelerated program, beauty of island. Czech Republic It is a good motivation for teachers and our national students to have large spectrum of nationalities in our medical degree programs. Regions of Recruitment While over 50 countries were named, the most frequently chosen countries for recruitment were Canada and the United States. International student training capacity The main reasons cited that affect how many international medical students are trained abroad were the physical capabilities of training facilities and the limited number of faculty available to train students. On average, 17.8% of international medical school faculty are North American trained. TABLE 63 FACTORS THAT INFLUENCE THE NUMBER OF INTERNATIONAL STUDENTS TRAINED Factors n % Physical capacity (i.e. lecture halls) 10 34% Number of faculty available to train international students. 5 17% Accreditation limits 7 24% Other 7 24% Total % * Respondents were able to choose more than one answer. Factors that influence international student training capacity by medical school region: Ireland Number of faculty available to train international students (n =1). Accreditation limits (n = 3). Clinical resources (n = 1). Poland Physical capacity (n = 3). Availability of resources (n = 1). Caribbean Physical capacity (n = 3). Accreditation limits (n = 1). Australia Physical capacity (n = 3). Number of faculty available to train international students (n = 2). Accreditation limits (n =1). Staff teach block based (n =1). Government funding (n =1). Keeping small numbers for clinical placements & PBL (n = 1). Clinical, rural exposure (n = 1). Middle East Physical capacity (n = 1). Accreditation limits (n = 1). Number of faculty available to train international students (n = 1). Market factaors, supply and demand, ability to speak Arabic. (n =1). Czech Republic Number of faculty available to train international students (n = 1). Accreditation limits (n = 1). 73

74 TABLE 64 INTENTION TO CHANGE THE SIZE OF INTERNATIONAL MEDICAL TRAINING PROGRAMS n % Yes 8 50% No 8 50% Total % While some medical schools noted future expansion, including increasing the enrolment of Canadian students and opening new campuses, many cited a decrease in their international medical program due to government restrictions. Intention to change the size of the international medical training programs by medical school region: Ireland Reduce size (n = 2) Poland Expand program (n = 1). No change (n = 2). Australia No change (n = 3). Expand program (n = 2). Middle East No change (n = 2). Caribbean Expand program (n = 2). Reduce size (n = 1). Czech Republic No change (n = 1). TABLE 65 EXPECTED CHANGES IN LEGISLATION THAT WILL IMPACT INTERNATIONAL MEDICAL TRAINING PROGRAMS n % Yes 5 31% No 11 69% Total % Changes in residency, clerkships and rural rotations where domestic students are favoured over international students, was the main reason cited as impacting IMG training programs abroad. Expected changes in legislation that will impact international medical training programs by medical school region: Ireland No expected changes in legislation (n = 1) Poland No expected changes in legislation (n = 3) Caribbean No expected changes in legislation (n = 3) Australia No expected changes in legislation (n = 1) Expected changes in legislation (n = 5). - International students do not have access to 1 year rural remote location placement opportunities. - Closure of internships. - Increased competition for rural rotations as half of the placements must have 25% Aussies. - Permanent residents and citizens of Australia have priority for residency positions. - Program is currently provisional going to full accreditation in Middle East No expected changes in legislation (n = 2) Czech Republic No expected changes in legislation (n = 1) 74

75 MEDICAL DEGREE PROGRAMS AND ADMISSION REQUIREMENTS BY MEDICAL SCHOOL REGION TABLE 66 AVAILABLE MEDICAL DEGREE PROGRAMS AND ADMISSION REQUIREMENTS BY MEDICAL SCHOOL REGION Medical School Medical Degree Example of Admission Requirements Region Programs Ireland Four year Bachelor's degree, MCAT or GAMSAT, Health Professionals Admissions Test Ireland exam. Five year Overall average 85%, high school transcript, must have English, math, and second language. Six year High school transcript, 85% overall average, must have biology, chemistry, physics, and math. Admissions test (HPAT-Ireland). Poland Four year Bachelor's degree, college diploma, college-level courses in chemistry, biology, and physics. Six year High school transcript; high school level courses in physics, chemistry, biology and English. Caribbean Four year Bachelor's degree, MCAT or GAMSAT, courses in chemistry, biology, physics, math, English, MCAT, GPA, SAT/ACT. Five year Bachelor's degree, courses in chemistry, biology, physics, math, English, MCAT, GPA, SAT. Australia Four year MCAT or GAMSAT, GPA. Five year High school diploma, high school courses in English, chemistry and biology, ISAT. Six year High school cumulative average 85% or above, if have post-secondary education, GPA of 75% or above. Middle East Four year Bachelor's degree, MCAT, one year or six credits in English, inorganic chemistry, organic chemistry, physics and biology. Five year Bachelor's degree, MCAT. Six year High school examinations with a minimum average score of 85%, high school courses in biology, c hemistry, physics and math. Admission procedures When asked how applicants were selected, 46.0% of the schools cited an interview and 42.0% cited marks beyond having the basic admission requirements. TABLE 67 ADDITIONAL ADMISSION PROCEDURES BY REGION OF MEDICAL SCHOOL Medical School Region Admission Procedures Medical School Region Admission Procedures Ireland Marks (n = 2) Interview (n = 2) Applicants observed in group exercise (n = 1) No interview (n = 1) Poland Interview (n = 3) About 10% of applicants are rejected (n = 1) Caribbean Marks (n = 2) Interview (n = 2) Australia Marks (n = 3) Interview (n = 3) Middle East Marks (n = 2) Interview (n = 1) Czech Republic Marks (n = 1) Interview (n = 1) A total of 84.0% of the schools surveyed reported that their programs are competitive among international students; however, none of the medical schools reported international students competing against domestic students for medical school spots. Interestingly, 20.0% of the medical schools surveyed stated that the admission requirements were the same for both international and domestic students. 75

76 TABLE 68 DO ADMISSIONS CRITERIA DIFFER FOR INTERNATIONAL STUDENTS VERSUS NATIONAL STUDENTS? n % Yes* % No** % N/A % Total % * Schools that had different admissions criteria for international and national students: Ireland (n = 1), Poland (n = 2), Australia (n = 5), Middle East (n = 1). ** Schools that did not have different admissions criteria for international and national students: Caribbean (n = 2), Middle East (n = 1). Admission differences reported by region of medical school were: Ireland Irish/EU based on GM, top accepted. Poland Completely different, MCAT, undergrad GPA, interview, volunteer work. English program is not open to Polish students. Australia Domestic students must pass GAMSAT - Canadians or IMGs do not. Local students must sit the Australian admissions test, GAMSAT. International applicants may sit GAMSAT or MCAT. Marks for international students tend to be lower. Middle East Our national students undergo a day long process after initial screening with high school grades and a psychometric exam score. They have at least four methods of assessment including personal interview, group simulation, and individual simulation with SP's. Admissions committee TABLE 69 ADMISSIONS COMMITTEE REPRESENTATIVES n % Medical School Faculty 14 56% Deans of Medical School 4 16% Other 7 28% While 72% of the representatives on the admissions committees were cited as medical school faculty and/or deans, others included recruitment agencies such as The Atlantic Bridge Program for Ireland medical school admissions, and Hope Medical Institute for some Polish medical school admissions. Additionally, there were physician recruiters located in North America. TUITION When asked whether or not tuition costs differed for international students versus domestic students, 60% of the medical schools surveyed answered yes. The most commonly cited reason was financial gain, as a majority of the medical schools surveyed were located in countries were domestic medical students do not pay tuition, or pay a small amount and the remainder is subsidized by the government. TABLE 70 AVERAGE YEARLY TUITION Medical School Region Avg. Yearly Tuition ($CAD) Ireland $49,800 Poland $14,191 Caribbean $25,608 Australia $42,334 Middle East $26,336 76

77 POSTGRADUATE TRAINING Eight of the schools surveyed stated that they offer career counselling to assist students in finding postgraduate residency training. Availability of postgraduate training abroad: Ireland EU citizens get first priority. Poland Must speak Polish, requires separate examination that is not required for graduation, must be an EU citizen. Australia Australian citizens/permanent residents get first priority. Caribbean No postgraduate training available. Bahrain - No postgraduate training for CSAs. REFERENCES 1 Health Canada. OECD Health Data 2010, Statistics and Indicators. Available at : 2 The Association of Faculties of Medicine of Canada. Moving the Health Human Resource Agenda Forward, Submission to the House of Commons Standing Committee on Health From the Association of Faculties of Medicine of Canada (AFMC). December Collier R. Medical school admission targets urged for rural and low-income Canadians. CMAJ 2010; 182(8): The Association of Faculties of Medicine of Canada. Canadian Medical Education Statistics Volume 31. Available at: Accessed August CaRMS 2010 Canadian Medical Graduate Cohort Data. Accessed June-August Merani M, Abdulla S, Kwong JC, Rosella L, Streiner DL, Johnson IL. Increasing tuition fees in a country with two different models of medical education. Medical Education 2010; 44: Clark C. Increasing US Medical School Spots Won t Increase Physician Supply. Health Leaders Media Accessed August Available at: Increasing-US-Medical%20School 3 Banner S, Comeau M. Analysis of the 2006 Survey of Canadians Studying Medicine and the medical schools training Canadians Outside of Canada and the U.S.. Final Report to Health Canada 2006:

78 APPENDIX ANALYSIS RESULTS AGE BY MEDICAL SCHOOL REGION Medical School Region Age 24 and under and over Total n % n % n % n % n % n % Western Europe % % % 1 0.4% 1 0.4% % Eastern Europe % % 7 8.9% 1 1.3% % Caribbean % % % 9 1.8% 2 0.4% % Australia % % % 9 4.4% % Middle East % % % a) Chi-square test: Is there a relationship between age groups across medical school regions? Yes. A chi-square test of independence was done to see whether age groups are related to medical school region. The results of the test were significant,x 2 (20, n = 1082) = 96.07, p <.001. These results indicate that there are age differences across medical school regions. When the chi-square test of independence indicated an overall significant relationship between medical school region and age group, a z-test for proportions was done to test for significant differences in age across medical school regions. b) Significant differences in proportions: A z-test for proportions was done to test for significant differences in age across medical school regions. From the graph and tables, Australia seems to have a smaller group of CSAs in the 24 and under age group compared to other medical school regions. To test for significant differences a total of four comparisons were made in the 24 and under age group: Australia versus Ireland, Australia versus Poland, Australia versus Caribbean, and Australia versus Middle East. With the number of comparisons, a Bonferonni correction was applied to control for Type 1 error. For testing significant differences, all p values must be less than (.05/4) to be considered significant. For the 24 and under age group, there were significant differences between Australia and all other regions: Ireland (z = 6.51, p <.001), Poland (z = 4.003, p <.001), Caribbean (z = 8.423, p <.001), Middle East (z = 3.576, p <.001). Australia had a significantly smaller proportion of the youngest CSAs (10.2%) compared to other medical school regions for the 24 and under age group. AGE 2010 CSAS VERSUS CMGs Group Age (Years) Total n % n % n % n % n % CSA % % % 7 0.6% % CMG % % % % % Total a) Chi-square test: Is there a relationship between age and group (CSAs or CMGs)? Yes. The result chi-square test of independence was significant, X 2 (3, n = 2903) = , p <.001. These results indicate that there is a relationship between age and group. b) Significant differences in proportions: A z-test for proportions was done to test for significant differences in age groups across CSAs and CMGs. To test for significant differences a total of three comparisons were made in the following age groups: years, years, and years. A Bonferonni correction was applied to control for Type 1 error. For testing significant differences, all p values must be less than 0.02 (.05/3) to be considered significant. There were significant differences in all comparisons. There is a significant difference between CSAs and CMGs in the age group (z = , p <.001). There is a significant difference between CSAs and CMGs in the age group (z = 14.43, p <.001). There is a significant difference between CSAs and CMGs in the age group (z = 6.029, p <.001). 78

79 GENDER BY MEDICAL SCHOOL REGION Medical School Gender Region Male Female Total n % n % n % Ireland % % % Poland % % % Caribbean % % % Australia % % % Middle East % % % a) Chi-square test: Is there a relationship between the number of males and females across medical school regions? Yes. A chi-square test of independence was done to whether there is a relationship between genders across medical school regions. The results of the test were significant, X 2 (4, n = 1081) = 13.48, p <.05. These results indicate that there are gender differences across medical school regions. To provide more specific information about these gender differences across regions, a z-test for two proportions was conducted.. b) Significant differences in proportions: A z-test for proportions was done to test for significant differences in gender differences across medical school regions. A total of five comparisons were made across gender: Ireland, Poland, Caribbean, Australia, and Middle East. With the number of comparisons, a Bonferonni correction was applied to control for Type 1 error. For testing significant differences, all p values must be less than 0.01 (.05/5) to be considered significant. For gender, there were significant differences between the proportion of males to females in Ireland (z = 3.566, p <.001). In Ireland there are more females than males (30.2% versus 20.6%). There were no significant differences between males and females across the other medical school regions. GENDER 2010 CSAS VERSUS CMGs Group Gender Male Female Total n % n % n % CSA % % % CMG % % % Total a) Chi-square test: Is there a relationship between gender and group (CSA or CMG)? Yes. A chi-square test of independence was done to see whether gender is related to being a CSA or CMG. The results of the test were significant, X 2 (1, n = 2880) = 31.31, p <.001. These results indicate that there are gender differences by group. b) Significant differences in proportions: A z-test for proportions was done to test for significant differences in gender across the CSA or CMG group. To test for significant differences a total of two comparisons were made: differences in the proportion of males between the CSA and CMG group, and differences in proportion between females between the CSA and the CMG group. A Bonferonni correction was applied to control for Type 1 error. For testing significant differences, all p values must be less than (.05/2) to be considered significant. There were significant differences in the proportion of males between CSAs and CMGs (z = 5.559, p <.001). There were significant differences in the proportion of females between CSAs and CMGs (z = 5.559, p <.001). 79

80 MARITAL STATUS BY MEDICAL SCHOOL REGION Marital Status Region of Medical School Single Married/Living with a partner Separated/Divorced Total n % n % n % n % Ireland % % % Poland % % % Caribbean % % 5 1.0% % Australia % % 2 1.0% % Middle East % 2 8.7% % a) Chi-square test: Is there a relationship between marital status and medical school region? Yes. A chi-square test of independence was done to see whether marital status is related to medical school region. The results of the test were significant, X 2 (8, n = 1081) = 27.97, p <.001. These results indicate that there are marital status differences across medical school regions. b) Significant differences in proportions: A z-test for proportions was done to test for significant differences in marital status across medical school regions in the married/living with a partner category. To test for significant differences a total of four comparisons were made: Australia versus Ireland, Australia versus Poland, Australia versus Caribbean, and Australia versus Middle East. With the number of comparisons, a Bonferonni correction was applied to control for Type 1 error. For testing significant differences, all p values must be less than (.05/4) to be considered significant. For the Married/Living with a partner group, there were significant differences between the Australia and Ireland (z = 3.606, p <.001). There were also significant differences between Australia and the Caribbean (z = 4.345, p <.001) for the proportion of CSAs in the Married/Living with a partner category. Australia has a larger group of CSAs that are married or living with a partner than CSAs in Ireland and the Caribbean. There were no significant differences between Australia and Poland or Australia and the Middle East in the married or living with a partner category. MARITAL STATUS 2010 CSAS VERSUS CMGs Group Marital Status Single/Divorced/Separated/Widower Married/Living with partner Total n % n % n % CSA % % % CMG % % % Total a) Chi-square test: Is there a relationship between marital status and group (CSA or CMG)? Yes. A chi-square test of independence was done to see whether marital status is related to being a CSA or CMG. The results of the test were significant, X 2 (1, n = 2892) = , p <.001. These results indicate that there are differences. b) Significant differences in proportions: A z-test for proportions was done to test for significant differences in marital status across the CSA or CMG group. To test for significant differences between CSAs and CMGS a total of two comparisons were made across the marital status groups: Single/Divorced/Separated/Widowed status of CSAs versus CMGs, and Married/Living with partner status of CSAs versus CMGs. A Bonferonni correction was applied to control for Type 1 error. For testing significant differences, all p values must be less than (.05/2) to be considered significant. For the Single/Divorced/Separated/Widowed group there were significant differences between CSAs and CMGs (z = 12.12, p <.0001). There were significant differences in the proportion of those married/living with partner between CSAs and CMGs (z = 12.12, p <.0001). 80

81 CSAs WITH PARENTS WHO ARE PHYSICIANS BY REGION Medical School Parent(s) Medical Doctor Region Yes No Total n % n % n % Ireland % % % Poland % % % Caribbean % % % Australia % % % Middle East % % % Total a) Chi-square test: Is there a relationship between having a parent or both parents a medical doctor and medical school region? Yes. A chi-square test of independence was done to see whether parent(s) is a medical doctor is related to medical school region. The results of the test were significant, X 2 (4, n = 1081) = 28.91, p <.001. These results indicate that there are differences whether a parent(s) is a medical doctor or not across medical school regions. b) Significant differences in proportions: A z-test for proportions was done to test for significant differences across medical school regions. Looking over the graph, CSAs from Ireland seem to have a higher proportion of having a parent or parents as a medical doctor compared to other medical school regions. To test for significant differences a total of four comparisons were made: Ireland versus Poland, Ireland versus Caribbean, Ireland versus Australia, and Ireland versus Middle East. With the number of comparisons, a Bonferonni correction was applied to control for Type 1 error. For testing significant differences, all p values must be less than (.05/4) to be considered significant. For looking at whether CSAs in Ireland had a significantly larger proportion of parent(s) as a medical doctor than CSAs in other medical school regions, there were significant differences between Ireland and the Caribbean (z = 5.153, p <.001) and Ireland and Australia (z = 3.105, p <.01). There were no significant differences between Ireland and Poland or Ireland and the Middle East for whether CSAs in Ireland had a larger proportion of parent(s) as a medical doctor. CSAs in Ireland had a significantly higher proportion of a parent or parents as a medical doctor than CSAs in the Caribbean or Australia. POST-SECONDARY EDUCATION IN CANADA BY MEDICAL SCHOOL REGION Medical School Post-secondary Education in Canada Region Yes No Total n % n % n % Ireland % % % Poland % % % Caribbean % % % Australia % 4 1.9% % Middle East % % % a) Chi-square test: Is there a relationship between having a post-secondary education in Canada and medical school region? Yes. A chi-square test of independence was done to see whether having a post-secondary education or not is related to medical school region. The results of the test were significant, X 2 (4, n = 1081) = 55.76, p <.001. These results indicate that having a post-secondary education in Canada varies across medical school regions. b) Significant differences in proportions: A z-test for proportions was done to test for significant differences across medical school regions. To test for significant differences a total of four comparisons were made: Ireland versus Poland, Ireland versus Caribbean, Ireland versus Australia, and Ireland versus Middle East. With the number of comparisons, a Bonferonni correction was applied to control for Type 1 error. For testing significant differences, all p values must be less than (.05/4) to be considered significant. For looking at whether CSAs in Ireland had a significantly lower proportion of attending a post-secondary education in Canada compared to CSAs in other medical school regions, we found that there were significant differences between Ireland and the Caribbean (z = 5.553, p <.001) and Ireland and Australia (z = 5.721, p <.001). There were no significant differences between Ireland and Poland or Ireland and the Middle East in the number of CSAs having a post-secondary education in Canada. CSAs in Ireland had a significantly lower proportion of having a post-secondary education in Canada than CSAs in the Caribbean or Australia. 81

82 HIGHEST LEVEL OF EDUCATION BY MEDICAL SCHOOL REGION Highest Level of Education Ireland Poland Caribbean Australia Middle East n % n % n % n % n % High school % % 6 1.2% 4 1.9% 1 4.2% Post-secondary community college 1 0.4% 2 0.4% 1 0.5% 0 Some university (no degree) % % % 2 1.0% % Bachelor s degree % % % % % Master s degree % 4 5.1% % % % Ph.D. or equivalent 3 1.1% % 3 1.5% 1 4.2% Other 7 1.4% Total a) Chi-square test: Is there a relationship between CSAs highest level of post-secondary education in Canada and medical school region? Yes. A chi-square test of independence was done to see whether having a postsecondary education or not is related to medical school region. The results of the test were significant, X 2 (24, n = 1081) = , p <.001. These results indicate that the highest level of postsecondary education of CSAs varies across medical school regions. b) Significant differences in proportions: Of interest is the comparison of bachelor degrees across medical school regions. A z-test for proportions was done to test for significant differences across medical school regions. To test for significant differences a total of four comparisons were made: Australia versus Ireland, Australia versus Poland, Australia versus the Caribbean, and Australia versus the Middle East. With the number of comparisons, a Bonferonni correction was applied to control for Type 1 error. For testing significant differences, all p values must be less than (.05/4) to be considered significant. For looking at whether CSAs in Australia had a significantly higher proportion of having a bachelor degree compared to CSAs in other medical school regions, we found that there were significant differences between Australia and Ireland (z = 4.417, p <.001) and Australia and Poland (z = 2.688, p <.01). There were no significant differences in the proportion of CSAs having a bachelor s degree between Australia and the Carribean or Australia and the Middle East. CSAs in Australia had a significantly higher proportion education than CSAs in Europe. CMA AND CMG COMPARISON HIGHEST LEVEL OF EDUCATION PRIOR TO ATTENDING MEDICAL SCHOOL Highest Level of Education Prior to Attending Medical School Group Secondary Post Secondary 2 years or less 3 years or more Bachelor's Master's Ph.D., Other Total education (e.g. community in university of university Degree Degree Ed. D. or college) (no degree) (no degree) equivalent n % n % n % n % n % n % n % n % n % CSA % 4 0.4% % % % % % 7 0.6% % CMG % % % % % % % 5 0.3% % Total a) Chi-square test: Is there a relationship between highest level of education and group (CSA or CMG)? Yes. A chi-square test of independence was done to see whether the highest level of education prior to attending medical school is related to being a CSA or CMG. The results of the test were significant, X 2 (7, n = 2903) = , p <.001. These results indicate that there is a relationship between being a CMG or CSA and the highest level of education prior to medical school. b) Significant differences in proportions: The z-test for proportions was done to test for significant differences in highest level of education prior to medical school across the CSA or CMG group. To test for significant differences between CSAs and CMGS a total of five comparisons were made across the groups: High School, College, Bachelor s degree, Master s Degree, and Ph.D. or equivalent. A Bonferonni correction was applied to control for Type 1 error. For testing significant differences, all p values must be less than 0.01 (.05/5) to be considered significant. There were significant differences across four of the five comparisons. CSAs and CMGs were significantly different for: high school (z = 8.032, p <.0001), college (z = 12.65, p <.0001), bachelor s degree (z = 6.96, p <.0001), and master s degree (z = 2.72, p <.01). There were no significant differences between CSAs and CMGs for Ph.D. or equivalent (z = 2.08, p =.04). 82

83 APPLICATION TO CANADIAN MEDICAL SCHOOLS BY HIGHEST LEVEL OF EDUCATION PRIOR TO ATTENDING MEDICAL SCHOOL Highest Level of Education How Many Times High School College Some Bachelor's Master's Ph.D., Other Total Applied to Canadian university Degree Degree or Medical School (no degree) equivalent Before Going Abroad n % n % n % n % n % n % n % n Did not apply % % % % % 1 5.9% % 289 Applied once 2 3.1% % % % % % % 400 Applied 2x or more 1 1.6% 0 0.0% 2 3.9% % % % % 393 Total % 4 100% % % % % 7 100% 1082 a) Chi-square test: Is there a relationship between highest level of education and application to Canadian medical schools? Yes. A chi-square test of independence was done to see whether the highest level of education prior to attending medical school is related to the number of times a CSA applied to a Canadian medical school before going abroad. The results of the test were significant, X 2 (12, n = 1082) = , p <.001. These results indicate that there is a relationship between the number of times a CSA applied to a Canadian medical school before going abroad and their highest level of education. b) Significant differences in proportions: The z-test for proportions was done to test for significant differences in highest level of education prior to medical school for the CSA group that did not apply to any Canadian medical school. To test for significant differences in this group a total of two comparisons were made: Bachelor s degree versus high school, and bachelor s degree versus Master s degree. A Bonferonni correction was applied to control for Type 1 error. For testing significant differences, all p values must be less than (.05/2) to be considered significant. There were significant differences across both comparisons. For CSA that did not apply to a Canadian medical school, there is a significant difference between those with a bachelor s degree and those with a high school degree (z = 12.86, p <.001). There is also a significant difference between those with a bachelor s degree and those with a master s degree (z = 3.35, p <.001). In the Did not apply category, there were more CSAs with a high school degree than those with a bachelor s degree, and there were less CSAs with a master s degree than bachelor s degree. APPLICATION TO CANADIAN MEDICAL SCHOOLS BY REGION OF MEDICAL SCHOOL Number of Times Applied Medical School Region Did not apply Applied once Applied 2x or more Total n % n % n % n % Ireland % % % % Poland % % % % Caribbean % % % % Australia % % % % Middle East % % % % Total a) Chi-square test: Is there a relationship between the number of times a CSA applied to a Canadian medical school before going abroad by region? Yes. A chi-square test of independence was done to see whether number of times applied to Canadian medical schools is related to medical school region. The results of the test were significant, X 2 (8, n = 1081) = 59.40, p <.001. These results indicate that the number of times applied varies across medical school regions. b) Significant differences in proportions: A z-test for proportions was done to test for significant differences across medical school regions. To test for significant differences a total of eight comparisons were made. In the Did not apply category we compared Poland to the other regions (Ireland, Caribbean, Australia, and Middle East). In the Applied 2x or more category we compared Australia to the other regions (Ireland, Poland, Caribbean, Middle East). With the number of comparisons, a Bonferonni correction was applied to control for Type 1 error. For testing significant differences, all p values must be less than (.05/8) to be considered significant. For the Did not apply category, there were significant differences between Poland and Ireland (z = 4.038, p <.001), Poland and the Caribbean (z = 5.561, p <.001), and Poland and Australia (z = 5.677, p <.001). There were no significant differences between Poland and the Middle East for the Did not apply category (z = 1.422, p =.155). For the Applied 2x or more category, there were significant differences between Australia and Poland (z = 5.677, p <.001). There were no significant differences between Australia and Ireland (z = 2.302, p =.021), Australia and the Caribbean (z = 1.098, p =.272), and Australia and the Middle East (z = 1.446, p =.148). 83

84 SATISFACTION WITH MEDICAL DEGREE PROGRAM BY MEDICAL SCHOOL REGION Satisfaction with Medical Degree Program Medical School Region Satisfied Neutral Dissatisfied Total n % n % n % n % Ireland % % 6 2.2% % Poland % 5 6.3% 1 1.3% % Caribbean % % % % Australia % % % % Middle East % % 0 0.0% % Total a) Chi-square test: Is there a relationship between levels of satisfaction with medical degree program and region of medical school? Yes. A chi-square test of independence was done to see if satisfaction is related to region of medical school. The results of the test were significant, X 2 (8, n = 1081) = 17.10, p <.05. These results indicate that there is a relationship between region of medical school and levels of satisfaction with medical program. b) Significant differences in proportions: The z-test for proportions was done to test for significant differences in satisfaction between Australia and other regions. To test for significant differences between regions in the Satisfied category, a total of four comparisons were made across the groups: Australia versus Ireland, Australia versus Poland, Australia versus the Caribbean, and Australia versus the Middle East. A Bonferonni correction was applied to control for Type 1 error. For testing significant differences, all p values must be less than (.05/4) to be considered significant. There were significant differences across two regions. CSAs in Australia are significantly less satisfied than CSAs inireland (z = 2.56, p =.0106), and CSAs in Australia are significantly less satisfied than CSAs in the Caribbean (z = 3.16, p <.01). There were no significant differences in satisfaction between Australia and Poland (z = 1.29, p =.196) and between Australia and the Middle East (z = -0.18, p =.857). DIFFICULTY IN ARRANGING A CLERKSHIP ROTATION IN CANADA BY MEDICAL SCHOOL REGION Difficulty in Arranging a Clerkship Rotation in Canada Medical School Region Easy Okay Difficult Total n % n % n % n % Ireland % % % % Poland % % % % Caribbean 0 0.0% % % % Australia % % % % Total a) Chi-square test: Is there a relationship between levels of difficulty in arranging a clerkship rotation in Canada across medical school regions? Yes. A chi-square test of independence was done to see if there is a relationship between level of difficulty and medical school region. The results of the test were significant, X 2 (6, n = 166) = 19.52, p <.05. These results indicate that levels of difficulty in arranging a clerkship rotation is related to medical school regions. b) Significant differences in proportions: Of interest is whether there are significant differences across medical school regions for the Difficult category. A z-test for proportions was done to test for significant differences between the proportions. A total of three comparisons were made: Caribbean to Australia, Caribbean to Ireland, and Caribbean to Poland. With the number of comparisons, a Bonferonni correction was applied to control for Type 1 error. For testing significant differences, all p values must be less than (.05/3) to be considered significant. For the Difficult category there is a statistically significant difference across all regions. CSAs from the Caribbean found it more difficult to arrange clerkship positions than CSAs in: Australia (z = 3.033, p <.01), Ireland (z = 3.633, p <.001), and Poland (z = 2.426, p =.0153). 84

85 POPULAR FUNDING TYPE BY MEDICAL SCHOOL REGION Popular Funding Types Medical School Family Bank Loan Government Personal International Bank Loan Other Total Region Savings in Canada Grants Savings Scholarships Elsewhere n % n % n % n % n % n % n % n % Ireland % % % % 5 0.8% % % % Poland % % % % 2 1.3% 4 2.5% 2 1.3% % Caribbean % % % % % % % % Australia % % % % 9 1.8% 9 1.8% % % Middle East % % 4 8.7% % 1 2.2% 2 4.3% 1 2.2% % a) Chi-square test: Is there a relationship between popular funding types and medical school regions? Yes. A chi-square test of independence was done to see if there is a relationship between the types of funding that CSAs used towards their medical education and medical school region. The results of the test were significant, X 2 (24, n = 2483 = 91.44, p <.001. These results indicate that the most popular type of funding is related to medical school region. b) Significant differences in proportions: With family savings being the most popular type of funding over a majority of medical school regions, the z-test for proportions was done to test for significant differences. To test for significant differences in the Family Savings category a total of four comparisons were made across the groups: Ireland versus Poland, Ireland versus Caribbean, Ireland versus Australia, Ireland versus the Middle East. A Bonferonni correction was applied to control for Type 1 error. For testing significant differences, all p values must be less than (.05/4) to be considered significant. There were significant differences across two of the four comparisons. Ireland was significantly different from the Caribbean in the use of family savings to fund their medical education (z = 4.915, p <.0001). Ireland was significantly different from Australia (z = 3.651, p <.001). In both comparisons to CSAS in the Caribbean and Australia, family savings was more popular in Ireland than the Caribbean and Australia. Ireland was not significantly different from Poland (z = 1.087, p = 0.277). Ireland was not significantly different from the Middle East (z = 0.812, p = 0.417). SATISFACTION WITH COST OF MEDICAL EDUCATION BY MEDICAL SCHOOL REGION Medical School Region Satisfaction with Cost of Medical Education Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied Total n % n % n % n % n % n % Ireland 4 1.5% % % % % Poland % % % 4 5.1% % Caribbean % % % % % % Australia 2 1.0% % % % % % Middle East 1 4.3% % % % 1 4.3% % Total a) Chi-square test: Is there a relationship between satisfaction with the cost of medical education to medical school region? Yes. A chi-square test of independence was done to see if there is a relationship between level of satisfaction and medical school region. The results of the test were significant, X 2 (16, n = 1081) = , p <.001. These results indicate that levels of satisfaction with the cost of medical education are related to medical school regions. To provide more specific information about these differences, a z-test of proportions was conducted. b) Significant differences in proportions: Of interest is whether there are significant differences across medical school regions for the Dissatisfied category. A z-test for proportions was done to test for significant differences between the proportions. A total of four comparisons were made: Caribbean to Australia, Caribbean to Ireland, Caribbean to Poland, and Caribbean to Middle East. With the number of comparisons, a Bonferonni correction was applied to control for Type 1 error. For testing significant differences, all p values must be less than (.05/4) to be considered significant. For the Dissatisfied category there is a statistically significant difference between CSAs from the Caribbean and Ireland (z = 5.327, p <.001) and between CSAs from the Caribbean and Poland (z = 3.835, p <.001). CSAs in the Caribbean were not significantly different in their levels of dissatisfaction with CSAs from Australia and the Middle East. 85

86 SATISFACTION WITH MEDICAL PROGRAM BY SATISFACTION BY COST OF MEDICAL EDUCATION Satisfaction with Satisfaction with Cost of Medical Education Medical Program Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied Total n % n % n % n % n % n % IVery satisfied % % % % % % Satisfied % % % % % % Neutral 2 3.3% % % % % % Dissatisfied 2 9.5% 2 9.5% % % % Very dissatisfied % % % 7 100% Total a) Chi-square test: Is there a relationship between a CSAs satisfaction with their medical program and satisfaction with the cost of medical education? Yes. A chi-square test of independence was done to see if there is a relationship between level of satisfaction and medical school region. The results of the test were significant, X 2 (16, n = 1082) = 76.07, p <.001. These results indicate that satisfaction with their medical program and levels of satisfaction with the cost of medical education are related. The results indicate that higher levels of dissatisfaction with the cost of medical education are related to higher levels dissatisfaction with their medical program. b) Significant differences in proportions: Of interest is whether there are significant differences between CSAs that were very dissatisfied with their medical program and CSAs that were very satisfied with their medical program under the group of CSAs that were very dissatisfied with the cost of their medical education. For the Very Dissatisfied with the Cost of their Medical Education category there is a statistically significant difference between CSAs that were very satisfied with their medical program and CSAs that were very dissatisfied with their medical program (z = 2.742, p <.05). CSAs that were very dissatisfied with the cost of their education were also very dissatisfied with their medical program. YEAR OF GRADUATION BY INTENTION TO RETURN TO CANADA TO PURSUE POSTGRADUATE MEDICAL TRAINING Year of Graduation Intention to Return to Canada for Training Yes No Total n % n % n % % % % % % % % % % % % % % 4 3.1% % % % % Total a) Chi-square test: Is there a relationship between year of graduation with intention to return to Canada to pursue postgraduate training? Yes. The results of the test were significant, X 2 (5, n = 1082) = 33.25, p <.001. These results indicate that year of graduation is related to intention to return to Canada for postgraduate training. To provide more specific information about these differences, a z-test of proportions was conducted. b) Significant differences in proportions: A total of three comparisons were made. For CSAs intending to return to Canada we compared 2010 versus 2011, 2010 versus Comparisons to 2015 were not done due to the small number of CSAs graduating in that year. For CSAs intending not to return to Canada we looked at the significant difference between 2010 and With the number of comparisons, a Bonferonni correction was applied to control for Type 1 error. For testing significant differences, all p values must be less than (.05/3) to be considered significant. For CSAs intending to return to Canada to pursue postgraduate training, there is a statistically significant difference between CSAs graduating in 2010 and 2014 (z = 4.419, p <.001). The closer CSAs are to graduating the less likely they plan on returning to Canada for postgraduate training. There is no difference between the proportion of CSAs graduating in 2010 and 2011 in their intention to return to Canada. For CSAs intending to not to return to Canada to pursue postgraduate training, there is a statistically significant difference between CSAs graduating in 2010 and 2014 (z = 4.419, p <.001). Again, the closer CSAs are to graduating the less likely they plan on returning to Canada for postgraduate training. 86

87 REGION OF MEDICAL SCHOOL BY INTENTION TO RETURN TO CANADA TO PURSUE POSTGRADUATE MEDICAL TRAINING Medical School Intention to Return to Canada for Training Region Yes No Total n % n % n % Ireland % % % Poland % % % Caribbean % % % Australia % % % Middle East % % % Total Is there a relationship between intention to return to Canada to pursue postgraduate training and medical school region? Yes. A chi-square test of independence was done to see if there is a relationship between intention to return and medical school region. The results of the test were significant, X 2 (4, n = 1081) = 10.73, p <.001. These results indicate that CSAs across all regions plan on returning to Canada for their postgraduate training. 87