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AFMC student electives diversification policy

The purpose of medical school is to produce competent graduates who are ready to enter any entry-level residency program. The purpose of electives is to enable students to seek clinical experiences in a wide variety of disciplines to broaden their knowledge in all fields of medicine. Undergraduate programs recognize their dual responsibility to ensure students undertake a full educational experience that prepares them for any potential career choice, while also optimizing their ability to engage the increasingly competitive match process.

The AFMC Student Elective Diversification Policy, which will be implemented at all Faculties of Medicine in Canada, will ensure that student elective opportunities do not exceed eight weeks in any single entry-level discipline.  This will enable students to undertake a full educational experience that prepares them for a greater variety of potential career choices. The policy, which was approved by the AFMC Board of Directors in January 2019 will be implemented beginning with the Class of 2021.

AFMC Student Electives Diversification Policy: 

“Undergraduate programs recognize their dual responsibility to ensure students undertake a full educational experience that prepares them for any potential career choice, while also optimizing their ability to engage in the increasingly competitive postgraduate match process. Undertaking elective experiences exclusively in a single discipline is pedagogically unsound and fails to provide students with a full exposure to potential career options. Consequently, we commit that, beginning with the Class of 2021, student elective opportunities cannot exceed a maximum of eight weeks in any single entry-level discipline. An entry-level discipline is an Entry Route in the PGY-1 (R1) match. Each of these entry-level disciplines leads to specialty certification with either the RCPSC or the CCFP. Electives in subspecialties that are part of a PGY-3 (R3) match (such as the subspecialties in Internal Medicine and Pediatrics) are counted as separate disciplines. As such, electives in these subspecialties do not count towards the 8-week maximum in the general specialty”. 
 

Questions and answers

Q. Why are you making this change?

A. This change aims to align undergraduate (UG) policy with the current residency program landscape and UG program goals. The increasing number of unmatched Canadian Medical Graduates (uCMGs) increases pressure on students to use their electives strategically for career planning. Many students perceive that they must complete nearly all of their electives in a single discipline in order to be competitive in the residency match for that discipline. However, this does not allow electives to contribute to a well- rounded medical education, leaves students without a viable alternate career path, and is contrary to the advice offered by UG and Student Affairs (SA) Offices about reducing the risk of being unmatched. Furthermore, this new policy will reduce inequities in elective opportunities due to differences in curricula and policies between medical schools. Increasing electives diversity is one part of a bigger approach to reducing the number of unmatched Canadian Medical Graduates.
 

Q. What is an entry-level discipline?

A. An entry-level discipline is an Entry Route in the PGY-1 (R1) match. Each of these entry-level disciplines leads to specialty certification with either the RCPSC or the CCFP
 

Q. How will this affect electives in subspecialties?

A. Electives in subspecialties that are part of a PGY-3 (R3) match (such as the subspecialties in Internal Medicine and Pediatrics) are counted as separate disciplines. As such, electives in these subspecialties, as well as all other subspecialties, do not count towards the 8-week maximum in the general specialty.

This means that a student could do 8-weeks in General Internal Medicine and also do 8-weeks of Internal Medicine subspecialties, such as Cardiology, Nephrology, Rheumatology and Respirology; a student could do 8-weeks in General Pediatrics and also do 8-weeks of pediatric subspecialties, such as Pediatric Endocrinology, Pediatric Allergy and Immunology and Pediatric Gatroenterology.

In the case of other entry-routes that do not have a PGY-3 (R3) match, residents complete an entire 2-year family medicine program or 5-year specialty program before being eligible to do additional training in the form of a ‘fellowship’ and/or certificate of added competence (CAC) or area of focused competence (AFC).  Rotations in these disciplines are considered to be weeks in the entry-level discipline that leads to initial certification. For example, colorectal surgery, trauma or pediatric surgery electives are considered as part of the 8-week maximum in General Surgery; Maternal Fetal Medicine electives are considered as part of the 8-week maximum in Obstetrics & Gynecology; Child Psychiatry electives are considered as part of the 8-week maximum in Psychiatry. 

Pediatric surgery counts towards the 8-week maximum in General Surgery and not in Pediatrics because the route to becoming a pediatric surgeon is through a residency in general surgery first. You cannot become a pediatric surgeon by being a pediatrician first. Similarly, the route to becoming a Child and Adolescent Psychiatrist is through Psychiatry and not through Pediatrics.
 

Q. Does “Research” count as a separate discipline?

A. Yes, “Research” would be considered a separate elective discipline. Research elective weeks will count towards an 8-week maximum in “Research” rather than towards the 8-week maximum in the related clinical discipline as long as 100% of the time is spent doing research and none of the time is spent on clinical activities. Any elective that includes any clinical activities will count towards the 8-week maximum in the clinical discipline. Electives that involve clinical research count as research as long as all encounters with patients (e.g., history-taking, physical examinations, explanations regarding treatments) are purely related to research and are not part of the patient’s care.  
 

Q. Are all electives included in the 8-week “cap” or just electives before CaRMS?

A. All clerkship electives during the MD Program are subject to the 8-week maximum. This is true whether the elective occurs before or after the MSPR (Dean’s Letter) and before or after the rank order lists are submitted for the residency match through CaRMS. Pre- clerkship electives (observation, shadowing, or other experiences that do not include clerkship-level participation in patient care and are not assessed using clerkship assessment standards) are not included. Post-graduation clinical experiences and ‘Year 5’ experiences are not included.
 

Q. Some schools have selectives. Are these included in the electives cap?

A. Unlike electives, where a student plans the elective based on their educational needs and career goals, a selective is part of the required curricular weeks defined by the student’s school. For a selective, students have the opportunity to select (or in some cases rank preferences) from a limited, school-defined list of rotations that meet the school’s educational objectives for the rotation. The 8-week maximum in an entry-level discipline applies only to electives. Core rotation weeks and selective weeks are not included.
 

Q. My school already has an electives policy. Does this national policy replace it? 

A. All schools have agreed to adopt this Policy. MD Programs will be incorporating the AFMC Elective Diversification Policy into their existing electives policies and may have other rules related to electives. For example, in addition to including the national rule about a maximum of 8-weeks in any entry-level discipline, an MD Program may have rules about diversification, deadlines for registering for electives, eligibility to do electives at other schools and pre-clerkship electives. Every student should refer to their own school’s electives policy for full details.   
 

Q. Some students apply to the U.S. match. Does the policy still apply?

A. While the majority of medical students studying in Canada apply only to the Canadian residency match (through CaRMS), we know that some students also apply (or apply exclusively) to the U.S. residency match (through ERAS). This Canadian policy applies to all Canadian UGME programs, and all students enrolled in these programs are subject to the same policies. The 8-week maximum applies to all students, whether they are applying to residency through CaRMS, ERAS, or both – and even if they decide not to apply to residency at all.
 

 Q. Who will be ensuring that the policy is followed?

A. All 17 schools have committed to implementing the national electives policy. Students and programs share responsibility for ensuring that the electives policy is followed by all students. MD Programs must ensure that all students are aware of the policy and must monitor for infractions. Students must behave according to professional standards and must respect the policy. AFMC will also be following up with each faculty to ensure successful implementation.