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Transition time: Next steps in improving the medical education system

For medical education, this is one of the most wonderful times of the year as new medical graduates transition to residency. Convocations, graduation balls, weddings, vacations soon turn into packing, moving, unpacking, and prepping. This is a time of excitement, joy, mixed in with anxiety and fear of the unknown. That bridge you cross without really seeing what is on the other side. Some graduates may wonder if they made the right choice.  

Last year in my blog post Mission Impossible, I wrote about the Herculean feat medical students face when trying to figure out which of 30 different types of doctors they want to become. In December 2018, AFMC published Transition to Residency: A call to Action, which focused on three areas: capping student elective opportunities in any single entry-level discipline; reducing the number of unmatched Canadian medical graduates; and aligning entry routes to societal needs. This is a priority for the AFMC.

The AFMC Student Elective Diversification Policy was approved by the AFMC Board and will be implemented beginning with the class of 2021. 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.

This year’s match saw improvements, with 98 students going unmatched versus last year’s 169. AFMC spent the last year advocating and working collaboratively with partners to reduce the number of Unmatched Canadian Medical Graduates. However, there is still work to be done. During the Learner Forum at this year’s Canadian Conference on Medical Education (CCME), I asked the leaders of the Canadian learner organizations what was the most important thing AFMC could do to support learners.  Ms. Stephanie Smith, President of the Canadian Federation of Medical Students, responded that there must be no unmatched Canadian medical graduates. I heard her loud and clear. The AFMC vows to continue to call on provincial governments for 110 positions for each 100 graduates. Until governments ensure that we have more residency positions than graduates, we will not be able to fully optimize the match results.

The next area of focus for AFMC is on entry routes to residency. There are currently 30 different entry routes. The AFMC and Resident Doctors of Canada co-led the Entry-Routes Working Group (ERWG) which has identified areas potentially requiring adjustment that could support improved exposure for learners to entry routes, reduce strain on learners required to make career decisions too early in their training and promote generalism and generalist practice over subspecialisation. AFMC will be working with ERWG member organizations, include the Collège des médecins du Québec, the College of Family Physicians of Canada, the Royal College of Physicians and Surgeons of Canada as well as Learner organization, to continue to work on aligning entry-routes to societal need. We will also be engaging with medical education and medical specialities leadership from across the country.

AFMC has also been advocating for a Pan-Canadian transfer program for matched residents seeking to “transfer” from their current program and/or discipline. A 2018 Resident Doctors of Canada survey revealed 66% of responding residents have considered transferring into another specialty, with 70% of those wanting to transfer citing a desired change in career goals or specialty interest as their rationale. Residents require a more flexible system with a method of transfer across training programs.

As part of the social accountability mandate of our Canadian medical schools, AFMC must advocate for changes to the transition to residency that will lead to a medical education system that is responsive to the needs of the Canadian population. 

To all the medical graduates starting residency in July, I wish you all the best in the next phase of your journey.