Carms 2010 Csa Report

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

The views expressed herein do not necessarilyrepresent 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.

BACKGROUND ..................................................................................... 5

EXECUTIVE SUMMARY ....................................................................... 6

SUMMARY OF RESULTS ...................................................................... 7

RESULTS ................................................................................................ 8

SAMPLE ................................................................................................. 8Table 1 – Breakdown of 2010 sample by region ............................ 8Table 2 – Medical school of respondents ........................................ 8

DEMOGRAPHIC INFORMATION ....................................................... 9Figure 1 – Age by medical school region ....................................... 9Figure 2 – Age: CSA vs. CMG .................................................... 10Figure 3 – Gender by medical school region.................................. 10Figure 4 – 2010 and 2006 gender and age comparison 2010 ...... 11Figure 5 – Gender comparison: CSA vs. CMG ............................... 11

MARITAL STATUS ................................................................................. 12Figure 6 – Marital status by medical school region ........................ 12Figure 7 – Marital status by gender ................................................ 12Figure 8 – Marital status: CSA vs. CMG ......................................... 13

CSAs WITH PARENTS AS PHYSICIANS ............................................ 13Figure 9 – CSAs with one or more parents who are physicians ..... 13Figure 10 – CSAs with parents who are physicians by region ....... 13Comparison of the 2010 CSA study to the 2010 Canadianmedical graduate cohort ................................................................ 14

PRE-MEDICAL EDUCATION ................................................................ 14Figure 11 – Province of residence before moving abroad ............. 14 Projected number of CSAs by province........................................... 14Figure 12 – Comparing province of residence of survey respondents to provincial medical school admission rates and provincial baseline statistics....................................................... 14

CANADIAN POST-SECONDARY EDUCATION ................................. 15Table 3 – Top five reported post-secondary schools attended by CSAs ............................................................................................. 15Figure 13 – Post-secondary education in Canada by medical school region..................................................................................... 15Figure 14 – Highest level of education prior to attending a medical school abroad ..................................................................... 15Highest level of education by medical school region...................... 16Figure 15 – Highest level of education prior to attending medical school: CSA vs. CMG.......................................................... 16Figure 16 – Number of times CSAs applied to Canadianmedical schools prior to studying medicine abroad........................ 16Figure 17 – Number of times CSAs applied to Canadian medical schools prior to studying medicine abroad by region .......... 17Comparison of the 2010 CSA study to the 2010 Canadian medical graduate cohort ............................................................... 17

STUDYING MEDICINE ABROAD ........................................................ 17Figure 18 – Motivation to study medicine abroad.......................... 17Figure 19 – Criteria for choosing a medical school abroad............ 18

Figure 20 – How CSAs learned about medical school abroad ...... 18Figure 21 – Year of graduation from medical school...................... 19Figure 22 – Year of graduation by medical school region.............. 19Figure 23 – Satisfaction with medical degree program.................. 20Figure 24 – Satisfaction with medical degree program by medical school region....................................................................... 20

CLERKSHIPS .......................................................................................... 21Figure 25 – Difficulty in arranging a clerkship rotation in Canada by medical school region.................................................... 21Figure 26 – Number of clerkship rotations done or confirmedin Canada by medical school region ............................................... 21Comparison of the 2006 pilot CSA study to the 2010 CSA study .. 22

FUNDING............................................................................................... 22Table 4 – Most popular funding types for medical school abroad..... 22Figure 27 – Most popular funding types by medical school region... 22Table 5 – Top funding source by region and medical school ......... 22

DEBT ....................................................................................................... 23Estimated total amount of debt ....................................................... 23Figure 28 – Median debt by medical school region....................... 23Comparison of the 2010 CSA study to the 2010 Canadian medical graduate cohort ................................................................ 23Figure 29 – Satisfaction with cost of medical education ................ 23Figure 30 – Satisfaction with cost of medical education by medical school region.................................................................. 24Table 6 – Annual tuition rates........................................................... 24

POSTGRADUATE PLANS .................................................................... 25Figure 31 – Intention to return to Canada to pursue postgraduate medical training ......................................................... 25Figure 32 – Intention to stay in Canada to practice medicine after Canadian postgraduate training .............................................. 25Table 7 – Year of graduation from medical school by intention to return to Canada to pursue postgraduate medical training ....... 25Table 8 – Region of medical school by intention to return to Canada to pursue postgraduate medical training........................... 26Comparison of the 2006 pilot CSA study to the 2010 CSA study ............................................................................... 26

FIRST/TOP CHOICES ............................................................................ 26Table 9 – Intending to return for postgraduate training in Canada: first choice locations for postgraduate medical training in Canada ..... 26Table 10 – Intending to return to postgraduate training in Canada: top choice disciplines for postgraduate medical training in Canada ... 27 Comparison of the 2006 pilot CSA study to the 2010 CSA study .................................................................................. 28Table 11 – Top five locations for postgraduate medical training in Canada (CSA vs. CMG) .................................................. 28Table 12 – Top five disciplines for postgraduate medical training in Canada (CSA vs. CMG) ................................................... 28

CANADIANS NOT INTENDING TO RETURN TO CANADA FOR POSTGRADUATE MEDICAL TRAINING.................................... 29

Figure 33 – Perceived barriers to returning to Canada for postgraduate training ...................................................................... 29

3CaRMS Report: 2010

TABLE OF CONTENTS

Table 13 – Reasons for not intending to return to Canada for postgraduate medical training by region ................................... 30Figure 34 – Country (if not Canada) where CSAs intend to complete their postgraduate medical training ............................... 30Figure 35 – Intention to return to Canada to practice medicine after postgraduate medical training abroad .................................... 30Figure 36 – Perceived barriers to returning to Canada to practice medicine after postgraduate medical training abroad ..... 31Comparison of the 2006 pilot CSA study to the 2010 CSA study .............................................................................. 31

INTERNATIONAL MEDICAL SCHOOL DATA BY MEDICAL SCHOOL ........................................................................ 31

CARIBBEANTable 14 – Caribbean medical school data website sources ......... 31Table 15 – Number of CSAs studying medicine in the Caribbean ... 32Table 16 – General information ....................................................... 33Table 17 – Admissions by medical school ....................................... 33Table 18 – Curriculum summary by medical school ....................... 38Table 19 – Accreditation by medical school ................................... 42Table 20 – Tuition by medical school .............................................. 44Table 21 – Clerkships by medical school ........................................ 44

AUSTRALIA ..................................................................................... 46Table 22 – Australian medical school data website sources .......... 46Table 23 – Number of CSAs studying medicine in Australia ......... 46Table 24 – General information ...................................................... 46Table 25 – Admissions by medical school ...................................... 47Table 26 – Curriculum summary by medical school ....................... 49Table 27 – Accreditation by medical school ................................... 51Table 28 – Tuition by medical school .............................................. 51Table 29 – Clerkships by medical school ........................................ 52

IRELAND ......................................................................................... 52Table 30 – Irish medical school data website sources..................... 52Table 31 – Number of CSAs studying medicine in Ireland ............ 52Table 32 – General information ....................................................... 53Table 33 – Admissions by medical school ...................................... 53Table 34 – Curriculum summary by medical school ....................... 54Table 35 – Accreditation by medical school ................................... 55Table 36 – Tuition by medical school .............................................. 55Table 37 – Clerkships by medical school ........................................ 55

POLAND ........................................................................................... 56Table 38 – Polish medical school data website sources ................. 56Table 39 – Number of CSAs studying medicine in Poland ............ 56Table 40 – General information ...................................................... 57Table 41 – Admissions by medical school ...................................... 57Table 42 – Curriculum summary by medical school ....................... 58Table 43 – Accreditation by medical school ................................... 60Table 44 – Tuition by medical school .............................................. 60Table 45 – Clerkships by medical school ........................................ 60

UNITED KINGDOM (UK) ............................................................... 61Table 46 – UK medical school data website sources .................... 61Table 47 – General information ...................................................... 61Table 48 – Admissions by medical school ...................................... 62Table 49 – Curriculum summary by medical school ...................... 66

Table 50 – Accreditation by medical school ................................... 66Table 51 – Average tuition by medical school ............................... 66Table 52 – Clerkships by medical school ........................................ 67

EUROPE/MIDDLE EAST ................................................................ 68Table 53 – Europe/Middle East medical school data website sources ................................................................................ 68Table 54 – Number of CSAs studying medicine in Europe/Middle East ......................................................................... 68Table 55 – General information ...................................................... 68Table 56 – Admissions by medical school ...................................... 69Table 57 – Curriculum summary by medical school ....................... 69Table 58 – Accreditation by medical school.................................... 71Table 59 – Tuition by medical school............................................... 71Table 60 – Clerkships by medical school ........................................ 71

INTERNATIONAL MEDICAL SCHOOL DATA – MEDICAL SCHOOL SURVEY RESULTS ............................................. 72

SURVEY RESPONDENTS .............................................................. 72Table 61 – Location of survey respondents .................................... 72Table 62 – Role of survey respondents ........................................... 72

MOTIVATION TO RECRUIT INTERNATIONAL MEDICAL STUDENTS REGIONS OF RECRUITMENT ................................... 73Table 63 – Factors that influence the number of international students trained ............................................................................... 73Factors that influence the number of international students trained by medical school region ................................................. 73Table 64 – Intention to change the size of international medical training programs ............................................................... 74Intention to change the size of international medical training programs by medical school region ............................................. 74Table 65 – Expected changes in legislation that will impactinternational medical training programs ......................................... 74Expected changes in legislation that will impact international medical training programs by medical school region ................ 74

MEDICAL DEGREE PROGRAMS AND ADMISSION REQUIREMENTS BY MEDICAL SCHOOL REGION ................... 75Table 66 – Available medical degree programs and admission requirements by medical school region .......................................... 75Admission procedures ................................................................... 75Table 67 – Additional admission procedures by region of medical school ................................................................................. 75Table 68 – Do admissions criteria differ for international students versus national students? .................................................. 76Admissions committee .................................................................. 76Table 69 – Admissions committee representatives ........................ 76

TUITION ........................................................................................... 76Table 70 – Average yearly tuition..................................................... 76

POSTGRADUATE TRAINING ........................................................ 77

REFERENCES......................................................................................... 77

APPENDIX – ANALYSIS RESULTS ................................................. 78

4CaRMS Report: 2010

5CaRMS Report: 2010

Canada’s doctor to patient ratio is among the lowest of any industrialized nation.1 Despite a 69.0% increase in medical schoolenrolment,2 Canadians continue to perceive a doctor shortage.The applicant pool for medical school remains unchanged in thelast decade with four qualified applicants for every admittedmedical school student in Canada.2 Over the past decade, andperhaps 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 tobe increasing in number and have begun to have a political voice,little is known about their true numbers, demographics, motiva-tion to study abroad, general characteristics or whether they areinterested in returning to Canada. This study was developed toprovide a description of this potential resource and to help informthe provincial and federal governments for future physician re-source planning. The definition of a Canadian studying abroad(CSA) recognizes that while these individuals are internationalmedical graduates (IMGs), they are Canadians who left Canadato pursue their dream of medical education abroad. They are citizens born in Canada, or permanent residents. Almost all ofthem have done some of their earlier education in Canada, butchoose 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) administersthe match into postgraduate training in Canada. CaRMS was thefirst Canadian medical organization to identify this growing cohort of CSAs seeking entry into the Canadian healthcare system. In 2005-2006 Sandra Banner, the Executive Director andCEO of CaRMS, conducted a brief survey of select CSA schoolsand applicants. This study was based only on informal discussionsamong some of the international medical schools identified at apoint when the medical community estimated that there were approximately 400 students studying medicine outside of NorthAmerica. The results of this survey estimated that there were approximately 1500 Canadian students studying medicineabroad.3 Since 2006, the project team has identified additional international schools and an increasing number of CSAs whowere used to form the study population for this report. Wherepossible, the results in this report are compared to data from the2006 report.

CSAs were identified using several data sources including: theCaRMS 2008 and 2009 applicant databases, a list of schools provided by the Medical Council of Canada (MCC), using datafrom graduates of international institutions applying for MCC’sevaluating examination (a prerequisite for residency training inCanada). Using this methodology, 55 schools outside of NorthAmerica were identified as having Canadian students studying atthem. Each school was contacted and asked to distribute a letterto their Canadian students. The letter outlined the scope of thestudy and provided the online student survey link with password.The online student survey was available from August 2009through to June 2010. Each institution was also asked to com-plete a school survey and if they were willing to host a site visit.

BACKGROUND

6CaRMS Report: 2010

EXECUTIVE SUMMARYCanadians studying abroad are spread across the globe fromAustralia to China to the Netherlands. What they have in commonis their desire to come home to Canada to practice medicine.Canadian students who are unsuccessful in being admitted to aCanadian medical school, and make the decision to go abroad toa foreign medical school do so largely because they believe thereis a shortage of physicians in Canada, and there will be opportuni-ties for them to return to Canada to practice medicine.

While provincial health human resource planning regulates admissionto medical schools in Canada, and federal citizenship and immigrationregulates the number of immigrants to Canada, there are no regulations that will allow for a prediction of the number of Canadianstudents who will choose to study medicine abroad and return toCanada for postgraduate training and practice.

The number of CSAs has grown exponentially since 2000. The estimated number has more than doubled since the first survey in 2006.3 As the majority of Canadians are enrolled in programswith a duration of four years, the output of these internationalmedical schools could contribute almost 700 graduates per year(equal to the total number of graduates each year in all medicalschools west of Ontario), or nearly 30% of the total Canadianmedical school output. Furthermore, this study indicates thatmore schools are opening enrolment to international studentseach year. CSAs are studying medicine in schools all over theworld—today approximately 80 schools in almost 30 countriesare 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 studyfound that every year, new schools are emerging, offering international students the opportunity to study medicine. Themajority of these programs target North American students, whoare prepared to pay the high tuition fees for the opportunity tobecome physicians. The medical education they are receiving isas diverse as the countries themselves. There is no typical CSA, asthere is no typical immigrant IMG. Both have studied medicine ineducation systems that have differing curriculums, resources andpatient populations. Often, immigrant IMGs have graduated fromthe same schools that CSAs are graduating from.

In countries where the native language is English, internationalstudents 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 themedical school.

In some countries, international students are taught in English ina parallel curriculum to the national students who are taught intheir native language. International students are given the opportunity to learn the language, but translators are providedduring their clinical rotations so that they can experience directpatient contact in the hospitals and clinics. This is the case forschools offering international medical programs to North Ameri-can students in Poland, the Czech Republic, Romania, Hungaryand 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 curriculumvaried across all schools visited, and the clinical component of thestudents’ undergraduate medical education did not usually offerthe autonomy and direct patient care of the North Americanmedical education model.

Demographically, the majority of CSAs continue to be male,slightly older, single and with more post-secondary educationthan their medical student counterparts in Canada. CSAs on average have more debt than CMGs—CSAs have nearly $90,000more debt than students in Canadian medical schools,7 thoughmany cite funding from family savings as a source of support fortheir education. This study found that more CSAs have a medicaldoctor as a parent than were identified in a study of Canadianmedical graduates (CMGs).4 The majority of CSAs are residents ofBritish 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 inCanada, or would rather not wait several years to be successfulin their Canadian medical school applications.

CSAs express frustration in their attempts to arrange Canadianclinical rotations while in their undergraduate years abroad. Theinability to obtain clinical experiences during their undergraduateeducation has increased between the survey in 2006 and 2010,3

and may result from the increased domestic enrolment and theperceived lack of capacity to provide these experiences to anyone other than Canadians studying in Canada. The Caribbeanschool respondents reported the most difficulty, while respon-dents from Australia and Ireland continue to report some success,suggesting that a lack of capacity may not be the entire reasonfor 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 highcompetition for positions. While Canada has a ubiquitous shortageof family physicians, particularly in rural communities, only 21% ofCSAs choose a career in family medicine. However, they have veryfew, if any, opportunities to complete postgraduate training in thecountry where they are studying medicine. None of the for-profitschools 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 postgraduateopportunities available for international students.

Admission data provided by the schools and the internationalCanadian student organizations led to an estimation of about3500 Canadian students enrolled in medical schools abroad.

7CaRMS Report: 2010

SUMMARY OF RESULTSSurvey 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 2006.3

• 1082 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 medicalschools which average 58.2% female students.5

• Overall, CSAs are older than students in Canadian medical schools, 73.9% of CSAs are 26-30 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 tostudents 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.5

• 26.7% 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 universitiesbut 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 respondentsin 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 wereto 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 Torontoand the University of British Columbia.

LimitationsThe following limitations have been identified:• Respondent bias—as analysis has been done on self-

reported data. • The findings are also subject to non-response bias, as well as

low response bias. As an example, it was difficult to comparethe 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 internationalmedical 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.

8CaRMS Report: 2010

RESULTSSAMPLE

Statistical analysisIn total, 1082 CSAs completed the survey. From these respondents,a summary of demographic information was conducted, followedby an analysis of pre-medical education, current experience withmedical education, and postgraduate plans. The respondents werealso 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 independencewas used to look for relationships between variables. Further, differ-ences 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* 272 650

Poland** 79 300

Caribbean 501 2000

Australia 206 550

Middle East*** 23 70

Totals 1081 3570

TABLE 2 MEDICAL SCHOOL OF RESPONDENTS

Medical School Region n %

St. George’s University Caribbean 233 21.5%

Saba University School of Medicine Caribbean 187 17.3%

University of Queensland Australia 114 10.5%

Royal College of Surgeons in Ireland Western Europe 104 9.6%

University of Sydney Australia 52 4.8%

Jagiellonian University Medical College Eastern Europe 50 4.6%

Ross University Caribbean 47 4.3%

Trinity College, University of Dublin Western Europe 46 4.3%

University College Dublin Western Europe 46 4.3%

University College Cork Western Europe 32 3.0%

University of Limerick Western Europe 30 2.8%

Poznan University of Medical Sciences Center Eastern Europe 24 2.2%

Flinders University of South Australia Australia 19 1.8%

RCSI Bahrain Middle East 12 1.1%

Sackler School of Medicine Middle East 11 1.0%

University College, Galway Western Europe 11 1.0%

American University of the Caribbean School of Medicine Caribbean 10 0.9%

Xavier University School of Medicine, Bonaire Caribbean 10 0.9%

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%

* Three respondents listed as attending a medical school in the UK were included inthis 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 andone survey respondent listed as attendinga medical school in Romania were included in this group.

***Middle East group includes respondentsattending a medical school in Bahrain and Israel.

Note: one respondent was excluded from the regional analysis because they were from an international medical school notcontacted for this study, and not within any of the regions contacted.

Continued on page 9

9CaRMS Report: 2010

DEMOGRAPHIC INFORMATION

Age The average age of CSAs is 26 years old, with a range of 18 years old to 46 years old.

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.

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 1082 100%

80%

70%

60%

50%

40%

30%

20%

10%

0%

Ireland Poland Carribean Australia Middle East

36.8%

43.5%39.1%

10.2%

30.4%

54.4%59.5%

46.7%

72.3%

60.9%

8.1% 8.9% 7.6%13.1%

0.7% 1.3% 2.2% 4.4%

24 & under

25-29

30-34

35 & over

AGE BY MEDICAL SCHOOL REGION

* Other includes schools in: Chile, Romania, and the Czech Republic

10CaRMS Report: 2010

Comparison of the 2010 CSA study to the 2010 Canadian medical graduate cohort

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 Canadianmedical graduate cohort of 2010. It was found that only 10.6% of CSAs are under 25, compared to 45.3% of CMGs. While 91.7% ofCMGs are under 30, twice as many CSAs are older than 30. Overall, the CSA cohort is older than the CMG cohort.

100%

50%

0%CSA CMG

20-25

26-30

31-40

41-50

10.6%

45.3%

73.9%

46.4%

14.8%7.7%0.6% 0.6%

AGE COMPARISON

GenderOverall, males made up 52.5% of the respondents and females accounted for the remaining 47.5%.

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, wherethere were 14.0% more women studying medicine than men.

60%

50%

40%

30%

20%

10%

0%


43.0%

56.3%52.2%55.3%54.4%57.0%

45.6%43.7% 44.7%

47.8%

Male

Female

GENDER BY MEDICAL SCHOOL REGION

* Source: CaRMs 2010 CMG Cohort Data


Comparison of the 2006 pilot CSA study to the 2010 CSA study

Gender and age comparison


Gender comparison

Figure 4 2010 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 aslikely to be 30 years of age or older. However, the 2010 study revealed that no significant differences existed in the age groups whencompared by gender.

* Source: Canadian Medical Education Statistics 2009, The Association of Faculties of Medicine of Canada

100%

80%

60%

40%

20%

0%24 &Under

25-29 30-34 35 & Over

45 &Over

Male Female

66.7%70.0%

58.9%51.5%51.3%

48.7% 48.5%41.1%

30.0% 33.3%

2010 CSAS: GENDER BY AGE

100%

80%

60%

40%

20%

0%24 &Under

25-29 30-34 35 & Over

45 &Over

Male Female

66.7%70.0%

58.9%51.5%51.3%

48.7% 48.5%41.1%

30.0% 33.3%

100%

80%

60%

40%

20%

0%

Male Female

52.5%47.5%41.8%

58.2%

CSA

CMG*

GENDER CSA VERSUS CMG

100%

80%

60%

40%

20%

0%24 &Under

25-29 30-34 35 & Over

45 &Over

MaleFemale

47.7%

52.3%44.2%

22.7%

50.0%

0.0%

55.8%

77.3%

50.0%

100%

2006 CSAS: GENDER BY AGE

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 morewomen are studying medicine in Canada. The only region that is similar in composition to Canada is Ireland, where 57.0% of studentsstudying abroad were women. See the Appendix for full details of analysis results.

* Source: CaRMS2006 CSA Report


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.

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.

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%Ireland Poland Carribean Australia Middle East

85.7% 82.3% 85.0%

70.9%

91.3%

14.3% 17.7%14.0%

28.2%

8.7%0.0% 0.0% 1.0% 1.0% 0.0%

Single

Married/Living with a partner

Separated/Divorced

MARITAL STATUS BY MEDICAL SCHOOL REGION

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.

100%90%80%70%60%50%40%30%20%10%

0%Single Married/Living

with partner

Male

Female81.5% 83.5%

17.8% 16.0%

Separated/Divorced

0.7% 0.6%

MARITAL STATUS BY GENDER


Figure 10 CSAs with parents who are physicians by region

Students who have one or more parents who are physicians are almosttwice as likely to choose to study medicine in Europe—specifically Ireland—rather than the Caribbean. See the Appendix for full details ofanalysis results.

CSAs WITH PARENTS WHO ARE PHYSICIANS

90%

80%

70%

60%

50%

40%

30%

20%

10%


32.0%

22.8%

15.8%18.9% 17.4%

68.0%

77.2%

84.2% 81.1% 82.6% Yes

No

CSAs WITH ONE OR MORE PARENTS WHO ARE PHYSICIANS BY REGION


Marital status comparison

100%90%80%70%60%50%40%30%20%10%0%

CSA CMG

Single/DivorcedSeparated/Widower

Married/Living with partner

83.1%

61.6%

38.4%

16.9%

MARITAL STATUS: CSA VERSUS CMG

n=1082

Yes, one parent

Yes, both parents

No

79.0%

3.8%

17.2%

CSAs WITH ONE OR MORE PARENTS WHO ARE PHYSICIANS

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.

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.




CSAs with one or more parents who are physiciansAs 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

Projected number of CSAs by province

This survey indicates that there are approximately 3500 Canadian students studying medicine abroad, with as many as 500 comingfrom British Columbia and over 1500 from Ontario.

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 andPrince 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.

NLPENSNBQCONMBSKABBC57.8%

3.6%

18.6%

10.5%

1.9%2.1%

1.1%2.8%0.4%

1.2%

PROVINCE OF RESIDENCE BEFORE MOVING ABROAD

COMPARING PROVINCE OF RESIDENCE OF SURVEY RESPONDENTS TO PROVINCIAL MEDICAL SCHOOL ADMISSION RATES AND PROVINCIAL POPULATION BASELINE STATISTICS

70%

60%

50%

40%

30%

20%

10%

0%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 Facultiesof Medicine of Canada

** Source: 2009 Population by Province, Statistics Canada

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 ofBritish Columbia and 10.5% residents of Alberta.


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 thosewhose medical school was in Europe, where admission to medical school is available directly from high school.

CANADIAN POST-SECONDARY EDUCATION

Post-secondary educationA 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 170 17.4%

The University of Western Ontario Ontario 105 10.8%

The University of British Columbia British Columbia 93 9.5%

McMaster University Ontario 88 9.0%

McGill University Quebec 68 7.0%

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%


80.5% 83.5%

93.8% 98.1%

87.0%

19.5%16.5%

6.2% 1.9%

13.0%

Yes

No

POST-SECONDARY EDUCATION IN CANADA BY MEDICAL SCHOOL REGION

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 internationalmedical school. Only 5.9% reported receiving only a high school diploma prior to studying 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%

13.1%

73.7%

1.9%

2.8%

0.4%

5.9%

0.6%

0% 10% 20% 30% 40% 50% 60% 70% 80%

HIGHEST LEVEL OF EDUCATION PRIOR TO ATTENDING MEDICAL SCHOOL ABROAD


Highest level of education by medical school region

When comparing the highest level of education of respondentsbased on the geographic region of their medical schools, Australianstudents and Caribbean students were the most likely to have com-pleted 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, where13.6% have a master’s. In Poland, just 5.1% of students reportedhaving postgraduate degrees prior to studying abroad.

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 educatedthan CMGs when entering medical school.

80%

70%

60%

50%

40%

30%

20%

10%

0%High

SchoolCollege 2 years or

less inuniversity

(no degree)

3 years+university

(no degree)

Bachelor’sDegree

Master’sDegree

Ph.D. orequivalent

Other

5.9% 0.8% 0.4%

14.5%

2.8% 3.7% 1.9%7.1%

73.7%

60.9%

13.1% 9.8%1.6% 2.9% 0.6% 0.3%

CSA

CMG

HIGHEST LEVEL OF EDUCATION PRIOR TO ATTENDING MEDICAL SCHOOL

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 twoor more times to Canadian medical schools prior to studying abroad. Interestingly, 26.7% did not apply to any Canadian medicalschools prior to studying abroad. Of the CSAs that did not apply to any Canadian medical schools before going abroad, there is asignificant difference in their highest level of education. For CSAs that had a high school education before going abroad, 95.3% didnot apply to any Canadian medical schools, while 20.8% of CSAs with a bachelor’s degree did not apply to any Canadian medicalschools. See the Appendix for full results.

40%

35%

30%

25%

20%

15%

10%

5%

0%Did notapply

1x 2x 3x 4x 5x 6x

Number of Times Applied

7x 8x 9x 10x 13x

26.7%

37.0%

23.6%

9.3%

1.9% 0.9% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1%

APPLICATION TO CANADIAN MEDICAL SCHOOLS

* Source:CaRMs 2010CMG CohortData


APPLICATION TO CANADIAN MEDICAL SCHOOLS


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 medicineabroad. In contrast, 54.4% of the respondents from Poland had never applied to a Canadian medical school prior to deciding to studymedicine abroad, 27.9% cited their reason as being able to enter medical school directly from high school, while 20.9% cited thatthey were unable to gain acceptance into a Canadian medical school.


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

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 aCanadian medical school. A total of 1.8% reported it was due to lower tuition costs.

80%

70%

60%

50%

40%

30%

20%

10%

0%High

SchoolCollege 2 years or

less inuniversity

(no degree)

3 years+university

(no degree)

Bachelor’sDegree

Master’sDegree

Ph.D. orequivalent

Other

5.9% 0.8% 0.4%

14.5%

2.8% 3.7% 1.9%7.1%

73.7%

60.9%

13.1% 9.8%1.6% 2.9% 0.6% 0.3%

CSA

CMG

Unable to obtain a place in aCanadian medical school

Allowed me to enter medical schooldirectly from secondary school

Wanted to live in another country

Tuition costs were lower thanCanadian medical school

My family was living in thisforeign country currently

Other

77.6%

7.8%

6.6%

1.8%

0.5%

5.8%

0% 10% 20% 30% 40% 50% 60% 70% 80%

MOTIVATION TO STUDY MEDICINE ABROAD

60%

50%

40%

30%

20%

10%

0%


29.0%

23.6%

34.8%

19.4%

54.4%

32.7% 29.1%

43.1%

31.6% 30.4%

38.2%

16.5%

33.3%

49.0%

34.8%

Did not applyApplied onceApplied 2x or more

APPLICATION TO CANADIAN MEDICAL SCHOOLS BY MEDICAL SCHOOL REGION


* Participants were able to select more than one answer.

Figure 19 Criteria for choosing a medical school abroad

Reputation was the most important factor in choosing a medical school abroad, while the opportunity for clerkships in North Americacame 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.

Reputation (n= 1082)

Likelihood of obtaining someclerkships in North America

(n= 1082)Course taught in a language

I understand (n= 1082)

Cost (n= 1082)

Attractiveness of country (n= 1082)

Proximity to Canada (n= 1082))

Other (n= 1082)

88.6%

77.4%

51.1%

35.6%

32.0%

8.2%

7.1%

0% 20% 40% 60% 80% 100%

CRITERIA FOR CHOOSING A MEDICAL SCHOOL ABROAD

* Participants were ableto select more than one answer.

From a friend/relative/graduatefrom school (n=1082)

Searched on internet (n=1082))

Attended the school’s presentationin Canada (n=1082))

School’s advertisement postedin a university (n=1082)

Newspaper/magazinearticle (n=1082)

Other (n=1082))

72.7%

40.6%

18.0%

6.4%

4.2%

7.4%

0% 10% 20% 30% 40% 50% 60% 70% 80%

HOW CSAs LEARNED ABOUT MEDICAL SCHOOL ABROAD

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.


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 mayreflect the 7.8% who chose a medical school abroad on the basis that they could enter directly from high school. It also speaks to thelarge proportion who did not apply in Canada at all.

2010

2011

2012

2013

2014

2015

0% 5% 10% 15% 20% 25% 30% 35%

11.7%

15.4%

28.0%

32.0%

11.9%

0.9%

YEAR OF GRADUATION FROM MEDICAL SCHOOL

Figure 22 Year of graduation by medical school region

Overall, the Australian respondents were the closest to graduation (2010-2012), while the majority of students in Ireland, Poland, and the Caribbean were further from graduation and expected to graduate between 2012 and 2014. The Caribbean had the lowestpercent of respondents expected to graduate between 2010 and 2012. 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.

50%

45%

40%

35%

30%

25%

20%

15%

10%

5%


11.8%

4.6%

27.2%

8.7% 8.7%

39.1%39.1%

4.3%

0.0%

29.1%

35.9%

5.3%

2.4%0.0%

11.2%

20.6%

16.5%

13.9%

38.0%

25.3%

45.7%

3.8%

17.6%

0.4%2.5%

14.0%

32.0%28.3%

11.8%

2.2%

201020112012

201320142015

YEAR OF GRADUATION BY MEDICAL SCHOOL REGION


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.

Satisfied

Very Satisfied

Neutral

Dissatisfied

Very Dissatisfied51.4%

5.5%

1.9% 0.6%

40.5%

SATISFACTION WITH MEDICAL DEGREE PROGRAM

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% ofCSAs 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, theAustralian respondents were also further along in their medical education, either in their third or fourth years of study.

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%


93.4% 92.4% 93.6%85.9% 87.0%

4.4% 6.3% 4.4% 8.7%13.0%

2.2% 1.3% 2.0% 5.3% 0.0%

Satisfied

Neutral

Dissatisfied

SATISFACTION WITH MEDICAL DEGREE PROGRAM BY MEDICAL SCHOOL REGION


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 triedto arrange a clerkship rotation in Canada.

When surveyed on the difficulty of arranging clerkships inCanada, 55% found it difficult to very difficult, while only 18.6%reported it to be easy or very easy. The remaining respondentswere neutral on the matter of arranging a clerkship in Canada.

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%Ireland Poland Carribean Australia

26.9% 28.4%

44.8%

33.3%41.7%

25.0%

21.3%

29.8%

48.9%

0.0%

17.5%

82.5% Easy

Okay

Difficult

DIFFICULTY IN ARRANGING A CLERKSHIP ROTATION IN CANADA BY MEDICAL SCHOOL REGION

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.

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 Australiaalso 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 howdifficult it is to arrange a clerkship in Canada. Regions that reported a high difficulty in arranging a clerkship displayed the lowest numbersof 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.

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%


11.0% 8.9%3.8%

87.3%

13.6%6.3%

80.1%

4.3%0.0%

95.7%

1.8%1.4%

79.0%

9.9%

Yes, doneYes, confirmedNo

96.8%

NUMBER OF CLERKSHIP ROTATIONS DONE OR CONFIRMED IN CANADA BY MEDICAL SCHOOL REGION



Overall, a lower percentage of respondents in 2010 reported havingsuccessfully arranged a clerkship in Canada. In 2010, students fromAustralia reported the most clerkships arranged or completed inCanada, while in 2006, CSAs studying in Europe were the most

likely to have completed or arranged a clerkship in Canada.3The 2006 and 2010 studies both found that CSAs studying in theCaribbean were the least likely to have completed or arranged aclerkship 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 wasfamily savings, followed by bank loans and government grants in Canada.However, as Table 4 shows, CSAs do not use just one source to fund theirmedical school abroad, but tend to use a combination of sources. Whenlooking 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.

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.

50%

40%

30%

20%

10%


Family Savings

Bank Loan in Canada

Government Grants

Personal Savings

International Scholarships

Bank Loan Elsewhere

Other

MOST POPULAR FUNDING TYPES BY MEDICAL SCHOOL REGION

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


DEBT

Estimated total amount of debt

Over half of CSAs reported their estimated amount of debt to beabove $160,000 (CAD). In fact, the most frequent estimatedamount 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 bebetween $100,000 and $299,999 and 14.9% estimated their debtto be $300,000 or greater.

$250,000

$200,000

$150,000

$100,000

$50,000

$0Ireland Poland Carribean Australia Middle East

$200,000

$70,000

$175,000

$200,000

$90,000

MEDIAN DEBT BY MEDICAL SCHOOL REGION

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.

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.

Median debt

The median debt reported by CSAs in 2010 was $160,000 (CAD).In comparison, an article from Medical Education, which surveyedCanadian 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) since2001,7 however it is still $89,000 (CAD) less than the median debt of Canadians studying medicine abroad.


Satisfied

Very Satisfied

Neutral

Dissatisfied

Very Dissatisfied31.6% 31.6%

22.7%

22.7%

18.3%

18.3%

15.6%

15.6%

11.7%

11.7%

SATISFACTION WITH COST OF MEDICAL EDUCATION


100%

80%

60%

40%

20%


1.5%

43.0%

1.0%4.3%

17.4%

52.2%

21.7%

4.3%6.8%

26.7%

42.2%

23.3%17.8%

23.8%22.6%25.1%

10.8%

35.4%

16.5%5.1%

44.1%34.9%

Very satisfied

SatisfiedNeutralDissatisfiedVery dissatisfied

19.5%

SATISFACTION WITH COST OF MEDICAL EDUCATION BY MEDICAL SCHOOL REGION

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 medicalprogram. CSAs that were very dissatisfied with the cost of their education reported lower levels of satisfaction with their medical programsthan CSAs that were very satisfied with the cost of their medical education.

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*

TABLE 6 ANNUAL TUITION RATES


* Source: Canadian Medical Education Statistics 2009, The Association of Faculties of Medicine of Canada, 2009


POSTGRADUATE PLANS

Yes, all of my postgraduate training

Yes, a portion of my postgraduate training

No73.4%

9.7%

16.9%

INTENTION TO RETURN TO CANADA TO PURSUE POSTGRADUATE MEDICAL TRAINING

Figure 31 Intention to return to Canada to pursue postgraduatemedical training

Overall, 90.3% of CSAs reported that they intended to return toCanada to pursue at least some of their postgraduate medicaltraining. Less than 10.0% reported that they do not intend to return to Canada for postgraduate training.

Yes

Undecided

No

87.4%

11.8%

0.7%

INTENTION TO STAY IN CANADA TO PRACTICE MEDICINE AFTER CANADIAN POSTGRADUATE

MEDICAL TRAINING

Figure 32 Intention to stay in Canada to practice medicine afterCanadian postgraduate training

A total of 87.4% of CSAs who intend to pursue postgraduatemedical training in Canada also intend to stay in Canada topractice after this training. Of the 0.7% who stated they do notintend 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%).

Year of Graduation Intention to Return to Canada for Training

Yes No Totaln % n % n %

2010 98 77.8% 28 22.2% 126 100%

2011 146 87.4% 21 12.6% 167 100%

2012 281 92.7% 22 7.3% 303 100%

2013 317 91.6% 29 8.4% 346 100%

2014 125 96.9% 4 3.1% 129 100%

2015 9 90.0% 1 10.0% 10 100%

Total 976 105 1081

For CSAs intending to return to Canada to pursue postgraduate medical training, there is a statistically significant difference betweenCSAs graduating in 2010 and CSAs graduating in 2014. The further CSAs are from graduating, the more likely they report that they planon 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.

TABLE 7 YEAR OF GRADUATION FROM MEDICAL SCHOOL BY INTENTION TO RETURN TO CANADA TO PURSUE POSTGRADUATE MEDICAL TRAINING


Region of Medical Intention to Return to Canada for TrainingSchools

Yes No Totaln % n % n %

Ireland 255 93.8% 17 6.3% 272 100%

Poland 65 82.3% 14 17.7% 79 100%

Caribbean 454 90.6% 47 9.4% 501 100%

Australia 182 88.3% 24 11.7% 206 100%

Middle East 20 87.0% 3 13.0% 23 100%

Total 976 105 1081

Significance testing revealed that all regionscontaining CSAs report an equal likelihoodof planning to return to Canada to pursuepostgraduate medical training.

Intention to return to Canada to pursue postgraduate medical trainingIt is important to note that in 2006, only 67.0% of CSA respondents indicated their intention to return to Canada for postgraduate medical training3. In 2010, 90.3% of CSA respon-dents 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 returnto Canada to pursue postgraduate medical trainingBoth 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 topursue postgraduate medical trainingAlthough in the 2010 study, no significant differences were foundpertaining to CSAs’ intent to return home by the region of medicalschool they were enrolled in, the 2006 pilot study found that significant differences existed amongst the medical schools. Overthree-quarters of CSAs in European medical schools were planningto return to Canada, compared to 57.0% (just over half) of thosestudying in Caribbean medical schools.3


TABLE 8 REGION OF MEDICAL SCHOOL BY INTENTION TO RETURN TO CANADA TO PURSUE POSTGRADUATE MEDICAL TRAINING

FIRST/TOP CHOICES

First Choice Locations n %

University of Toronto 327 33.5%

University of British Columbia 162 16.6%

The University of Western Ontario 59 6.0%

McMaster University 54 5.5%

University of Manitoba 36 3.7%

University of Calgary 31 3.2%

Dalhousie University 29 3.0%

University of Alberta 28 2.9%

University of Ottawa 27 2.8%

McGill University 24 2.5%

University of Saskatchewan 20 2.0%

Northern Ontario School of Medicine 11 1.1%

Memorial University of Newfoundland 10 1.0%

Queen's University 6 0.6%

Not decided 153 15.7%

Total* 977 100.0%

The University of Toronto ranked first among33.5% of CSAs as their first choice location forpostgraduate medical training. The Universityof British Columbia was cited as the firstchoice location for 16.6% of CSAs. This corresponds with the increased number ofCSAs declaring their province of residence tobe Ontario and British Columbia.

* Only includes respondents intending to return to Canada for all or part of their postgraduate training.

TABLE 9 INTENDING TO RETURN FOR POSTGRADUATE TRAINING IN CANADA: FIRST CHOICE LOCATIONS FOR POSTGRADUATE MEDICAL TRAINING IN CANADA


First Choice Discipline n %

Family Medicine 205 21.0%

Internal Medicine 141 14.4%

Pediatrics 86 8.8%

Emergency Medicine 66 6.8%

General Surgery 63 6.4%

Orthopedic Surgery 47 4.8%

Obstetrics & Gynecology 36 3.7%

Cardiac Surgery 19 1.9%

Anesthesiology 18 1.8%

Neurology 18 1.8%

Psychiatry 16 1.6%

Diagnostic Radiology 15 1.5%

Neurosurgery 11 1.1%

Radiation Oncology 11 1.1%

Ophthalmology 10 1.0%

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 177 18.1%

Total* 977 100.0%

Family Medicine was the first choice residencydiscipline with (21.0%), followed by Internal Medicine (14.4%). Yet, 18.1% of respondentsremained undecided on their residency discipline of choice.

* Only includes respondents intending to return to Canada for all or part of their postgraduate training.

TABLE 10 INTENDING TO RETURN TO POSTGRADUATE TRAINING IN CANADA:TOP CHOICE DISCIPLINES FOR POSTGRADUATE MEDICAL TRAINING IN CANADA


Top choice disciplines for postgraduate medical training in CanadaFamily 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 Medicinewas the first choice discipline of 21.0% of respondents, followedby Internal Medicine with 14.4% of respondents.




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 Universityof British Columbia as a top choice.

CSA CMG*

Top Five Locations n % Top Five Locations n %

University of Toronto 327 33.5% University of Toronto 285 15.7%

University of British Columbia 162 16.6% University of British Columbia 274 15.1%

The University of Western Ontario 59 6.0% University of Montreal 154 8.5%

McMaster University 54 5.5% University of Ottawa 135 7.4%

University of Manitoba 36 3.7% University of Laval 112 6.2%

Total 977 65.3% Total 1814 52.9%

TABLE 11 TOP FIVE LOCATIONS FOR POSTGRADUATE MEDICAL TRAINING IN CANADA (CSA VS. CMG)


Four out of the five top residency choices for both CSAs and CMGs are the same.

CSA CMG*

Top Five Disciplines n % Top Five Disciplines n %

Family Medicine 205 21.0% Family Medicine 614 33.4%

Internal Medicine 141 14.4% Internal Medicine 238 12.9%

Pediatrics 86 8.8% Pediatrics 113 6.1%

Emergency Medicine 66 6.8% Anesthesiology 98 5.3%

General Surgery 63 6.4% General Surgery 97 5.3%

Total 977 57.4% Total 1838 63.1%

TABLE 12 TOP FIVE DISCIPLINES FOR POSTGRADUATE MEDICAL TRAINING IN CANADA (CSA VS. CMG)


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 ofservice 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 undergraduateCanadian 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.”

CANADIANS NOT INTENDING TO RETURN TO CANADA FOR POSTGRADUATE MEDICAL TRAINING

I prefer not to do return of service work

n=105

61.0%

57.1%

46.7%

43.8%

14.3%

6.7%

5.7%

1.0%

26.7%

0% 10% 20% 30% 40% 50% 60% 70% 80%

My first choice of residency is difficult to obtain in Canada

The opportunity to do postgraduatetraining in my preferred location is limited

I do not think that I have a reasonablechance to match in Canada

I have personal commitments in another country

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 passingthe Medical Council of Canada Evaluation Examination

Other

PERCEIVED BARRIERS TO RETURNING TO CANADA FOR POSTGRADUATE TRAINING

* Respondents could select more than one answer.


Reason 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%

TABLE 13 REASONS FOR NOT INTENDING TO RETURN TO CANADA FOR POSTGRADUATE TRAINING BY REGION

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 prefernot 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 countryas their reasons for not wanting to return.

Australia

United Sates

Ireland

Norway

1.0%

n = 102

2.0%2.9%

16.7%

77.5%

COUNTRY (IF NOT IN CANADA) WHERE CSAS INTEND TO COMPLETE THEIR POSTGRADUATE MEDICAL TRAINING

Figure 34 Country (if not Canada) where CSAs intend to complete theirpostgraduate medical training

A total of 77.5% of CSAs that do not intend to return to Canada topursue 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 postgraduatetraining opportunities, fewer positions will be available to internationalmedical graduates, requiring these students to explore different options for postgraduate training.8

Yes

No

Undecided

n = 102

24.8%

53.3%

21.9%

INTENTION TO RETURN TO CANADA TO PRACTICE MEDICINE AFTER POSTGRADUATE

MEDICAL TRAINING ABROAD

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 toreturn to Canada for postgraduate medical training, 24.8%of them do intend to return to Canada after postgraduatetraining abroad, while 53.3% remain undecided.


Economic incentives to stay away

Limited opportunity to practicein my preferred location

Difficulty in obtaining recognition of training

Family considerations

Limited research funding available in my field

Other

n = 23

52.2%

52.2%

43.5%

21.7%

8.7%

21.7%

0% 10% 20% 30% 40% 50% 60%

PERCEIVED BARRIERS TO RETURNING TO CANADA TO PRACTICE MEDICINE AFTER POSTGRADUATE MEDICAL TRAINING ABROAD

* 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 economicincentives to stay abroad, and limited opportunities to practice in a preferred location. The level of difficulty in obtaining recognition oftraining was also cited as one of the main barriers for not intending to return to Canada to practice after postgraduate training abroad.

CSAs in both the 2010 and 2006 studies cited the difficulty to obtain their first choice of residency as a common reason for notintending to return to Canada for postgraduate training.3 Two additional reasons from 2006 were: “Foreign-trained graduatesare poorly treated” and “Restriction to the second iteration of

CaRMS poses difficulties”.3 It should be noted that after the 2006pilot study was completed, the rules changed, and for the firsttime, IMGs were allowed to compete in the first iteration of theCaRMS match.


Perceived barriers to returning to Canada for postgraduate training

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 http://www.sgu.edu/school-of-medicine/index.html

Dominica Ross University http://www.rossu.edu/medical-school/

Netherland Antilles SABA University School of Medicine www.saba.edu

Saint Kitts Windsor University http://windsor.edu

St. Maarten American University of the Caribbean School of Medicine www.aucmed.edu

Antigua American University of Antigua http://www.auamed.org/medical-school

Antigua University of Health Sciences Antigua www.uhsa.ag

Continued on page 32


TABLE 14 CARIBBEAN MEDICAL SCHOOL DATA WEBSITE SOURCES

Aruba All Saints University of Medicine www.asumaruba.org

Aruba Xavier University School of Medicine http://edu.xusom.nl

Belize Central America Health Sciences University www.cahsu.edu

Cayman Islands St. Matthew’s University http://www.stmatthews.edu/school-of-medicine.shtml

Dominica All Saints University of Medicine www.allsaintsuniversity.org

Netherland Antilles Saint James School of Medicine www.sjsm.org

Netherland Antilles University of Sint Eustatius www.eustatiusmed.edu

Nevis Medical University of the Americas www.mua.edu/mua/

Saint Kitts International University of Health Sciences (IUHS) www.iuhs.edu

Saint Kitts University of Medicine and Health Sciences (UMHS) http://www.umhs-sk.org/

Saint Lucia Spartan Health Sciences www.spartanmed.org

Saint Lucia International American University www.iau.edu.lc

Trinidad and Tobago University of the West Indies www.uwi.edu

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.


TABLE 16 GENERAL INFORMATION

Medical School Year University Founded Year International Program Began

St. George’s University 1977 1977

Ross University 1978 1978

SABA University School of Medicine 1993 1993

Windsor University 1998 1998

American University of the Caribbean School of Medicine 1978 1978

American University of Antigua 2004 2004

University of Health Sciences Antigua 1983 1983

Xavier University School of Medicine, Aruba 2004 2004

Xavier University School of Medicine, Bonaire 2003 2003

Central America Health Sciences University 1996 1996

St. Matthew’s University 1997 1997

All Saints University of Medicine, Aruba 2004 2004

All Saints University of Medicine, Dominica 2006 2006

Saint James School of Medicine, Bonaire 2000 2000

Saint James School of Medicine, Anguilla 2010 2010

University of Sint Eustatius 1999 1999

Medical University of the Americas 2001 2001

International University of Health Sciences (IUHS) 1998 1998

University of Medicine and Health Sciences (UMHS) 2008 2008

Spartan Health Sciences 1980 1980

International American University 2004 2004

University of the West Indies 1989 1989

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 newmedical schools opening every year.

TABLE 17 ADMISSIONS BY MEDICAL SCHOOL

Medical School Programs Available Admissions Admission RequirementsFielded Through

St. George’s University

Ross University

Four year and BS/MDdual degree

Four year

School - onlineapplication


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 othercourse, strong GPA in science, and SAT.

Cumulative GPA, GPA in pre-med coursework (inorganic chemistry,organic chemistry, biology, physics, math, English), MCAT, graduatework and records, letters of recommendation, personal essay, workhistory, professional or volunteer experiences, and personal interview.

Minimum three years of undergraduate studies or the equivalentof 90 semester hours or 135 quarter hours—including premedicalrequirements (biology, general/inorganic chemistry, biochem/organic chemistry) from an accredited college or university. A baccalaureate degree is recommended but not required. Prefer-ence will be given to applicants who have completed a bachelor’sdegree or higher. All applicants who are US citizens, nationals orpermanent residents are required and all other students arestrongly encouraged to take the MCAT.





SABA University Schoolof Medicine

Windsor University

American University ofthe Caribbean Schoolof Medicine

American University ofAntigua

University of Health Sciences Antigua

Four year

Four year and fiveyear

Four year

Four year and six year

Four year


School - form tobe mailed to USoffice


School – onlineapplication


Applicants are expected to have a minimum of 50 hours of directpatient 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, workingas an EMT, etc.

Pre-med (five year) - applicants must be high school graduateswith 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 chemistryafter high school.

Both four and five year programs consider: GPA, letters of recommendation, personal essays, interview, and professional orvolunteer experiences.

Baccalaureate degree from an accredited university to be obtainedas a condition of matriculation, MCAT, college credits must includethe following: biology, general chemistry, organic chemistry, generalphysics, and English.

A generous exposure to mathematics, humanities, and social sciences is desired. Real life experience in the health care field isstrongly recommended. A personal interview may be requested atthe discretion of the Admissions Committee. AUC requires all applicants to consent to a background check.

MD (four year) – at least 90 credits of college courses. Stronglyrecommends that applicants earn a degree from an accredited undergraduate institution. Required courses: inorganic or generalchemistry, 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 of3.0, and a combined score of 1100 on the SAT (verbal and math)or a 24 on the ACT. Applicants must have completed at least threeyears of science, English and mathematics courses.

Both four and six year programs require: letters of reference, personal statement.

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.




Medical School Programs Available Admissions Admission Requirements Fielded Through

All Saints University ofMedicine, Aruba

Xavier University Schoolof Medicine

Central America HealthSciences University

St. Matthew’s University

All Saints University ofMedicine, Dominica


Four year and fiveand a half year

Four year

Four year







MD (four year) - minimum of three years course work in an accredited college or university (minimum of 90 semester hoursor 135 quarter hours). Preference will be given to applicantswho have completed a baccalaureate degree or higher. Coursesmust include: biology, chemistry, physics, mathematics, English,and humanities.

MD (five year) – high school diploma.

Both four and five year programs require: personal essay, letters ofrecommendation, MCAT score if available, TOEFL score if available.

MD (four year) - at least two academic years and 90 credit hours ofundergraduate studies including the following subjects: inorganicor general chemistry, organic chemistry, biology, physics, English,and pre-calculus/calculus.

MD (five and a half years) - high school diploma, GPA 3.0, SAT1200 (old system) 1800 (new system) or ACT 26.

Both four and five and a half year programs require: letters ofrecommendation, structured questions and personal essay, and interview.

An applicant must have satisfactorily completed no less than 90undergraduate semester hours (or equivalent number of quarterhours). Applicants are not required to have earned a bachelor'sdegree, but an undergraduate degree from an American, Canadian or internationally accredited college or university is recommended. The following courses must have been completedsatisfactorily: biology, general chemistry, organic chemistry,physics, math, English. Letters of recommendation and a personalstatement are required.

Qualified candidates typically have earned an undergraduate degree from an approved college or university in the UnitedStates, Canada or a recognized international institution. St.Matthew's University will give consideration for admission to anapplicant who has earned 90 or more college semester credithours. Premedical studies should include the following courses: inorganic (general) chemistry, organic chemistry, biology, languagearts, physics, English, humanities, and mathematics or computerscience. Letters of recommendation, personal statement, andMCAT scores are required.

MD (four year) – minimum three years course work in an accreditedcollege or university (minimum of 90 semester hours or 135 quarterhours). Preference given to applicants who have completed a baccalaureate degree or higher. Courses should include: biology orzoology, general inorganic chemistry or advanced chemistry,physics, mathematics, English, and humanities/social sciences.

MD (five year) – high school diploma.





Saint James School ofMedicine

University of Sint Eustatius

Medical University ofthe Americas

International Universityof Health Sciences(IUHS)

University of Medicineand Health Sciences(UMHS)

Four year

Four year

Four Year

Four year

Four year




Unknown


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, advancedchemistry, physics, English, humanities/social sciences.

Bachelor's degree or 90 college credits. Required courses: biology,inorganic chemistry, organic chemistry, physics, mathematics.

At least three years of undergraduate studies (the equivalent of 90 semester hours or 135 quarter hours from an accredited collegeor university). Required courses: biology or zoology, inorganicchemistry, organic chemistry, English.

MUA encourages students to complete courses in the arts, socialsciences, 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 communicationare given preference in admissions.

Bachelor’s degree in science or equivalent (90 to 120 semesteror credit hours at the university/ college level). Courses shouldinclude: 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 providingsome of the essential skills and knowledge required for medicaleducation and assisting the Admissions Committee in assessinga candidates readiness to study medicine.

Recommendations from professors and medical doctors, personalinterview, personal statement, MCAT scores, practical work experience in the healthcare field.

A minimum of three years of study (90 semester credits) at an accredited college or university however, a bachelor’s degree ishighly recommended. Courses in inorganic or general chemistry,organic chemistry, general biology or zoology, physics, English,and mathematics. Applicants should have a broad background inthe humanities and have completed at least 12–16 credit hours ineither the humanities and/or the social or behavioral sciences. It isrecommended that additional sciences courses such as genetics,anatomy, physiology and biochemistry be taken.

Standardized tests including SATs, ACTs, MCATs, GREs, USMLEStep 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.




Medical School Programs Available Admissions Admission Requirements Fielded Through

Spartan Health Sciences

International AmericanUniversity

University of the West Indies

Five year

Four year

Five year



School

Minimum requirement for admission is three years of college or university level studies (90 semester credit hours). A bac-calaureate degree is preferred. Courses should include: biology,physics, chemistry, organic chemistry or organic chemistry andbiochemistry sequence accepted, mathematics.

At least 90 credit hours of undergraduate coursework but recommends the completion of a four year degree. Courseworkshould include the following: inorganic or general chemistry, organic chemistry, biology or zoology, physics, English, mathematics(preferably calculus or statistics). Personal statement, two letters ofrecommendation from academic or professional sources, and resume listing extracurricular or medical voluntary activities.

Applicants with first degrees from institutions other than the UWIare eligible provided that the program of study has been accreditedby a relevant body or agency and is considered acceptable by theUWI. Course credits have been obtained in biology/zoology andchemistry. A minimum GPA of 3.0 or equivalent must be obtained,as well as an autobiographical summary outlining reasons for careerchoice, extracurricular activities outlined and original letters certifiedfrom 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 proficiencyin a foreign language). Applicants may also be required to attendan interview.

The majority of the schools in the Caribbean offer four year medical degrees with admissions based on some undergraduate courses taken inthe 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 informationsessions provided by the medical schools in North America. Caribbean medical schools handle their own admissions with the aid of theirNorth American offices and do not make use of recruitment/admission agencies as other international medical education universities do.


TABLE 18 CURRICULUM SUMMARY BY MEDICAL SCHOOL

Medical School Basic Science Curriculum Clinical Curriculum


Ross University

SABA University Schoolof Medicine

Windsor University

American University ofthe Caribbean Schoolof Medicine

American University ofAntigua

Two years: Anatomical Sciences, BehavioralSciences, Biochemistry and Genetics,Bioethics, Clinical Skills, Microbiology, Pathology, Pathophysiology, Pharmacology,Physiology and Neuroscience, Public Healthand Preventive Medicine, and electives.

Two years: Developmental and MicroscopicAnatomy 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, PathologyI: General, Pathology II: Systemic and Clinical,Medical Pharmacology I/II, Introduction toClinical 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, Medicaland Legal Ethics, Pathology, Pharmacology,Physical Diagnosis, and Clinical Pathology.

Two years: Physiology, Biochemistry, Microbi-ology, Pharmacology, Anatomy, and Pathology.

Two years: Anatomy/Embryology, Molecularand Cell Biology I/II, Histology, Physiology I/II,Immunology and Infection, Biostatistics, Introduction to Clinical Med/Clerkships1/2/3/4/5/6, Pathology I/II, Medical Microbiology, Neuroscience, PharmacologyI/II, and Behavioral Science I/II.

Two years: Gross Anatomy/Embryology, Histology/Cell Biology, Doctor, Patients, andSociety, 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 (FamilyPractice, Emergency Medicine, Outpatient Experience inGeneral 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 Med-icine, 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 upontheir 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, CriticalCare, Dermatology, Emergency Medicine, Endocrinology, Diabetes and Metabolism, Gastroenterology, Geriatric Medicine, Infectious Diseases, Nephrology, Neurology, Oncology, Ophthalmology, Preventive Medicine, Pul-monary Disease, Radiology, Rheumatology, OrthopedicSurgery, and Pathology.






All Saints University ofMedicine

Xavier University Schoolof Medicine

Central America HealthSciences University

Two years: basic sciences and USMLE prep.

Two years: Gross Anatomy, Histology, MedicalEmbryology, Medical Ethics, Biochemistry,Physiology, Genetics, Neurosciences, Microbiol-ogy and Immunology, Psychology, Pathology I,Pharmacology, Pathology II, Epidemiology andPreventive Medicine, Physical Diagnosis, andIntroduction to Clinical Medicine.

Two years: Gross and Development Anatomy,Histology and Cell Biology, Epidemiology and Preventative Medicine, Introduction toInfo Medicine, Physiology 1, Gross and Development Anatomy II, Biochemistry andMolecular 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 & PublicHealth, Nutrition, Pharmacology, GeneralPathology, ENT, Respiratory Medicine, Neurol-ogy, Fluid/Electrolytes & Renal, Endocrinology,Dermatology, Legal Medicine & Medical Ethics,Tropical Medicine & Parasitology, Psychiatry,Anesthesiology, Gastroenterology, Hematol-ogym, Oncology, Orthopedics, Principles ofClinical Medicine, Radiology, Ophthalmology,Surgery & Orthopedic Surgery, Obstetrics &Gynecology, Pediatrics, Systematic Pathology,Geriatric Medicine, Child Abuse & Human Sexuality, Infectious Diseases, MolecularBiology, Cardiology, Physical Diagnosis, ForensicMedicine, 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, FamilyPractice, and electives (student’s choice).

Two years (72 weeks): Family Medicine, Pediatrics, Obstetricsand 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 radiationsafety), Thoracic Surgery, Clinical Pathology, EmergencyMedicine, Gynecology, Neurology, Obstetrics, Ophthalmology, Otorhinolaryngology, Pediatrics, PlasticSurgery, Preventive Medicine, Surgery, Urology, Cardiology,and Gastroenterology.






Saint James School ofMedicine


Medical University ofthe Americas

Two years: Patient-Doctor Relations, Principlesof Research and Evidence Based Medicine,Histology and Cell Biology, Developmentaland Gross Anatomy, Patient-Doctor RelationsII, Neuroscience, Biochemistry and Genetics,Physiology, Medical Spanish, Patient-DoctorRelations III, Medical Microbiology I, MedicalPharmacology I, Biostatistics and Epidemiol-ogy, Behavioral Sciences, Pathology I, Patient-Doctor Relations IV, Medical Microbiology II,Medical Pharmacology II, Pathology II, ClinicalTherapeutics, Introduction to Clinical Medi-cine, and Fundamentals of Clinical Sciences.

Two years: Histology, Gross Anatomy and Embryology, Medical & Legal Ethics, Physiol-ogy, Biochemistry, Neuroscience, Genetics,Research in Health and Medicine, Pathology I,Microbiology, Pharmacology, Medical Psychol-ogy, Research and Health and Medicine II,Pathology II, Epidemiology and Biostatistics,Physical Diagnosis & Clinical Medicine, andResearch in Health and Medicine III.

Two years: Professionalism & Patient-DoctorSkills I, Histology and Cell Biology, PublicHealth, Gross & Developmental Anatomy,Ethics & Patient-Doctor Skills II, Neuroscience,Biochemistry / Genetics, Physiology, Commu-nication & Patient-Doctor Skills III, Medical Microbiology, Medical Psychology, PathologyI, Physical Diagnosis & Patient-Doctor Skills IV,Medical Pharmacology, Pathology II, Introduc-tion to Clinical Medicine, and Fundamentals of Clinical Medicine.

Two years: Gross Anatomy, Histology and Cell Biology, Informatics and Evidence-Based Medicine, Informatics andEvidence-Based Medicine, Biochemistry,Human Physiology, Medical Psychology,Medical & Legal Ethics, Microbiology andImmunology, Neurosciences, Medical Genetics, Epidemiology and PreventiveMedicine, Pharmacology, Pathology I, Physical Diagnosis, Clinical Pathology II,Medical Board Review, and Introduction toClinical 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, Gastroenterol-ogy, Rheumatology, Gerontology, Ophthalmology, Neurology,Nephrology, Urology, Hematology, Infectious Disease, andCommunity 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, CardiologyOccupational Medicine, Critical Care Medicine Oncology,Dermatology Ophthalmology, Emergency Medicine Orthope-dics, Endocrinology Psychiatry, Family Practice Pulmonology,Gastroenterology Radiology, General Medicine RehabilitationMedicine, Hematology Rheumatology, Infectious DiseasesSurgical 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.





International Universityof Health Sciences(IUHS)

University of Medicineand Health Sciences(UMHS)


Two years: Introduction to Basic Medical Science, Respiratory and Cardiovascular Systems, Endocrine & Reproductive Systems,Gastrointestinal and Renal Systems, Centraland Peripheral Nervous Systems and GeneralPrinciples of Psychiatry, Hematology, Muscularsystem, Dermatology, and the Febrile Exanthem, Musculoskeletal System and Eye,Ear, Nose and Throat, Major Infectious Diseases, Autoimmune Diseases includingVasculitis, and Congenital Anomalies, Reviewand Examination Preparation, and Introductionto Clinical Medicine.

Two years: Anatomy, Histology, Cell and Molecular Biology, Physiology, Biochemistry,Genetics, Embryology, Pathology, Neuro-science/Neuroanatomy, Immunology and Microbiology, Behavioural Science, Pharma-cology and Therapeutics, Biostatistics andEpidemiology, Introduction to Clinical Medicine, and Medical Ethics.

Two years: Gross Anatomy, Medical Physiol-ogy, Histology, Embryology, Biostatistics &Medical Writing, Biochemistry, Microbiology,Neuroanatomy, Human Genetics, Immunology& Allergy, Behavioral Science, Epidemiologyand Public Health, Nutrition, Pharmacology,General Pathology, Legal Medicine and Med-ical Ethics, Tropical Medicine and Parasitology,and Systemic Pathology.

Pre-clinical: Infectious Diseases, Introductionto Medicine, Otorhinolaryngology, Respira-tion, Neurology, Cardiology, Fluids/Elec-trolytes & Renal, Dermatology, Endocrinology,Psychiatry, Anesthesiology, Introduction toMedicine II, Gastroenterology, Hematology,Oncology, Orthopedics, Principles of ClinicalMedicine, Radiology, Physical Diagnosis, Oph-thalmology, Surgery & Orthopedic Surgery,Obstetrics & Gynecology, Pediatrics, GeriatricMedicine & Pain Management, Child/SpousalAbuse 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, FamilyMedicine, 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, BiologicalBasis of Clinical Medicine, Internal Medicine, Surgery, Pediatrics, Obstetrics and Gynecology, Psychiatry, FamilyPractice, and electives.

Two years (80 weeks): Internal Medicine, General Surgery,Surgical Sub-specialty, Obstetrics & Gynecology, FamilyMedicine, Psychiatry, Pediatrics, Radiology, and ClinicalPathology.

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.





International AmericanUniversity

University of the WestIndies

Two years: Biochemistry, Genetics & Nutrition,Microscopic Anatomy - Histology, Embryology,Cell Biology, Doctor - Patient - Society - MedicalEthics, 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 theircampus in the Caribbean, and courses usually include, but are not limited to: Anatomy, Physiology, Pathology, Pharmacology, and Ethics. Thebasic 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)


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 bythe New York State Education Department, recognized by the Medical Board ofCalifornia, approved by the Florida Commission on Independent Education of theFlorida Department of Education, the National Committee on Foreign Medical Education and Accreditation, the Bahamas Medical Council, the Bermuda MedicalCouncil, DIKATSA (Greek Medical Licensing Authority), the Sri Lankan MedicalCouncil, the Thailand Medical Council, the Government of Botswana, the Governmentof St. Vincent, the Medical Board of Trinidad and Tobago, the Association ofCaribbean Tertiary Institutions, Inc.

Caribbean Accreditation Authority for Education in Medicine and Other Health Professions (CAAM), HP, Commonwealth of Dominica, the United States Departmentof Education through the National Committee on Foreign Medical Education and Accreditation (NCFMEA), the state of New York, the state of California, the state ofNew 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.





Windsor University

American University of the Caribbean School of Medicine

American University of Antigua


All Saints University of Medicine

Xavier University School of Medicine

Central America Health Sciences University


All Saints University of Medicine

Saint James School of Medicine


Medical University of the Americas

International University of Health Sciences(IUHS)

University of Medicine and Health Sciences(UMHS)


International American University


Medical Council and Board of Government of St. Kitts, the Educational Commissionfor Foreign Medical Students (ECFMG), the United States Medical Licensing Boardsfor 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 theEducational Commission for Foreign Medical Graduates (ECFMG), andrecommended 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.


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


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.





American University of the Caribbean School of Medicine

American University of Antigua


All Saints University of Medicine, Aruba and Dominica

Xavier University School of Medicine

Central America Health Sciences University


Saint James School of Medicine


Medical University of the Americas

International University of Health Sciences (IUHS)

University of Medicine andHealth Sciences (UMHS)


International American University


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 UnitedStates, Canada and occasionally the United Kingdom.


AUSTRALIA

TABLE 22 AUSTRALIAN MEDICAL SCHOOL DATA WEBSITE SOURCES


Australia University of New South Wales http://www.med.unsw.edu.au/

Australia Australian National University http://cmbe.anu.edu.au/

Australia Monash University http://www.med.monash.edu.au/schools.html

Australia University of Adelaide http://health.adelaide.edu.au/school_medicine/

Australia University of Notre Dame www.nd.edu.au

Australia University of Western Sydney www.uws.edu.au

Australia University of Western Australia http://www.meddent.uwa.edu.au/

Australia University of Tasmania http://www.medicine.utas.edu.au/

Australia University of Queensland http://www.uq.edu.au/study/program.html?acad_prog=2046

Australia University of Melbourne http://www.mdhs.unimelb.edu.au/

Australia Flinders University of South Australia http://www.flinders.edu.au/medicine/

Australia University of Sydney http://sydney.edu.au/medicine/

Australia Bond University http://www.bond.edu.au/faculties-colleges/faculty-of-health-sciences-and-medicine/index.htm

Australia University of Wollongong http://www.uow.edu.au/gsm/index.html

Australia Deakin University http://www.deakin.edu.au/hmnbs/medicine/

Australia James Cook University http://www-public.jcu.edu.au/courses/health/medicine/index.htm

Australia University of Newcastle http://www.newcastle.edu.au/school/medicine-public-health/

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*



Medical School Year YearUniversity International Founded Program Began

University of New South Wales 1949 1951Australian National University 1946 unknownMonash University 1958 unknownUniversity of Adelaide 1874 unknownUniversity of Notre Dame 1989 unknownUniversity of Western Sydney 1989 unknownUniversity of Western Australia 1911 unknownUniversity of Tasmania 1890 unknownUniversity of Queensland 1909 unknownUniversity of Melbourne 1853 unknownFlinders University of South Australia 1966 unknownUniversity of Sydney 1850 unknownBond University 1987 unknownUniversity of Wollongong 1951 2007Deakin University 1974 unknownJames Cook University 1970 unknownUniversity of Newcastle 1965 1951

* Unknown denotes locations where CSAs are known to study but no numbers were provided. An overall estimate was given for the region.

Overall, 17 medical schools were identified in Australia educating an estimated 550 Canadian students.

Australian medical schools currently educating Canadianswere typically founded long before the boom of internationalmedical education.



Medical School Programs Admissions Fielded Admission RequirementsAvailable Through

University of New South Wales

Australian National University

Monash University

University of Adelaide

University of NotreDame

Six year MBBS

Four yearMBBS

Four yearMBBS andFive yearMBBS

Six year

Four year

School - online application

School – mail in application or AustralianCouncil for EducationalResearch (ACER)

Victorian Tertiary Admissions Centre,Oztrekk, or school – online application.

School - application tobe mailed to universityor Australearn

ACER

As a minimum, undergraduate applicants will need to have aqualification considered to be equivalent to year 12 (completionof 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 completedone year or more of tertiary studies at undergraduate level bythe end of 2010 will be assessed on the basis of both their highschool results and their tertiary results. These will be combined in the ratio of 50:50. They will be required to attain an academicrank 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.

Bachelor’s degree in any discipline, GPA, Graduate AustralianMedical Schools Admission Test (GAMSAT) or Medical CollegeAdmissions 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.

Four year MBBS: completed three-year undergraduate degree orequivalent qualification (degree does not have to be medically orscientifically 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 Eng-lish 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 inone of the following tests of English language: IELTS score of 7.0with no individual band score less than 6.5. TOEFL minimum testscore of either; in the written TOEFL, 600 with a Test of WrittenEnglish (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. InternationalStudent Admissions Test (ISAT).

Provincial high school diploma (i.e. OSSD formerly known asCanadian Grade 13), International TER score of 90, and IELTSTotal 6.5.

GAMSAT, GPA minimum of 5.0 over three years of study, bachelor’s degree, interview, and personal statement.





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

Five year

Six year

Five year

Four year

Four year

Four year

Four year

Five year

Four year

Four year

Six year

Five year

UAC International

School - form to be mailed to university, or UWA overseas representative

School - forms to be mailed to university

School - forms to be mailed to university

GMAC Online Admission Systemor direct to International Admissionsat the University of Melbourne.

School – online application

Australian Council for EducationalResearch (ACER) or Australearn


Australearn


QTAC

Directly to school

Ontario Secondary School Diploma (Canada OSSD) - scorebased on Secondary School Diploma including six UniversityPreparation Courses with minimum 65% average. Achieve ascholastic performance in the final year of secondary schoolequivalent to a New South Wales University Admission Index of95 (International Baccalaureate 34) or higher.

For those who have completed a three year or longer bachelor’sdegree, the GPA in the degree must be at least 5.5 on the 7point scale.

Have completed IELTS or equivalent examination (AcademicModule) and achieve a minimum score of 6.5 in each of the fourcomponents, and an overall score of at least 7.0.

Minimum International Baccalaureate of 37, and ISAT.

Chemistry at Australian year 12 level or equivalent, mathematicsat Australian year 12 level or equivalent, Ontario SecondarySchool Diploma – average 89, and ISAT score.

Minimum bachelor’s degree, minimum GPA 0f 5.0 out 7.0 scaleor 2.8 out of 4 scale, and GAMSAT or MCAT, UMAT, ISAT.

Bachelor's degree, second year university courses in anatomy,physiology, and biochemistry, GAMSAT or MCAT, GPA, and interview.

Bachelor's degree, and GAMSAT or MCAT.

Bachelor's degree, GAMSAT, and interview.

GPA 5.0 out of 7 scale or 2.8 out of 4 scale, and GAMSAT or MCAT.

Bachelor’s degree, GPA 5.0/7 or 2.8/4, GAMSAT or MCAT, portfolio, and interview.

IELTS score of 7.0 or undergraduate degree in English, MCAT8/8/M/8 or GAMSAT score of 50, bachelor’s degree, and GPA 5.0/7.

A minimum score of 63% or better in the Ontario Secondary SchoolDiploma based on the average of the best six OSSD or OAC subjects. Courses in mathematics and chemistry.

Year 12 studies or higher education qualifications or overseas qualifica-tions considered equivalent to Australian qualifications, and UMAT.

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.




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, MFAC1524Health Maintenance B, MFAC1525 Ageing & End-ings A, MFAC1526 Ageing & Endings B, MFAC1527Society & Health, MFAC1511 Phase 1 Portfolio Ex-amination, 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 Maintenance3, MFAC2504 Ageing and Endings 3, MFAC2511Phase 2 Portfolio Examination, MFAC2512 Phase 2Integrated Clinical Examination, MFAC4501 Independent Learning Project 1, MFAC4502Independent Learning Project 2, and MFAC4503Independent Learning Project 3.

Two years: DNA to Death, Cardiorespiratory, Renal, Endocrine & Reproductive Health, Cardiorespiratory, Renal, Endocrine & ReproductiveHealth, Musculoskeletal, Neurosciences, HumanDisease & 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 studyintegrated medicine and surgery, which will betaught together with a series of problem basedand case-based learning sessions.

Five year MBBS (two years): the first two years,blocks of systems-based sub-units will be presentedwith a mix of basic medical science content, patient-based presentations and discussions in smallgroups. These sub-units are set in appropriate clinical contexts, largely through the use of patient-oriented learning. Topics include: Cardiovascular,Endocrinology, Gastrointestinal, Genomics, HumanBehaviour, Human Development and Growth, Im-munology 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, MFAC3508Emergency/Selective, MFAC3509 Selective, MFAC3510PRINT, 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’sand Children’s Health, General Practice and PsychologicalMedicine. The final year of the course will be structured as aseries of electives where students will choose to completetheir degree by gaining wider experience in chosen disciplinesand specific areas of interest through a range of metropolitan,rural and overseas settings.

Five year MBBS (Three years): In third year, students will studyintegrated medicine and surgery which will be taught togetherwith a series of problem-based and core-based learningsessions. The fourth year will be largely taken up with thecore clinical rotations of Women’s and Children's Health andGeneral Practice and Psychological Medicine. The fifth year of the course is focused on facilitating the transition of studentsinto the medical workplace as trainee interns and will be struc-tured as a series of clinical rotations. Students will consolidateand 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, experienceand skills within these three streams as they undertake placements within the teaching hospitals and in the broadermedical community.





University ofNotre Dame

University ofWestern Sydney

University ofWestern Australia

University of Tasmania

University ofQueensland

University of Melbourne

Flinders Universityof South Australia

University of Sydney

Bond University

Two years: Communication and Clinical Skills, basicClinical Sciences, Population and PreventativeHealth, 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, andcommunity 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 ofHealth 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, Pharmacol-ogy, 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 generalpractices, both urban and rural. In the penultimate year, 25 per cent of students spend the year at one of the ten ruralclinical sites located throughout the state. The teaching isstructured around blocks of General Medicine, Surgery, Obstetrics and Gynecology, Pediatrics, Psychiatry, GeneralPractice and Emergency Medicine. Specialty clinical areas arealso covered. In the final year this block (elective) may be takenin an overseas centre.

Three years : the third year consolidates Fundamentals of Clinical Science and lays the foundations for clinical practice asstudents begin to apply their learning in the clinical setting. Infourth year, students will rotate through areas such as Medi-cine, Intensive Care, Obstetrics & Gynecology, PsychiatricMedicine, General Practice, Emergency Medicine, and Pedi-atrics & Child Health. The fifth year focuses on consolidatinglearning in preparation for hospital practice through a series ofclinical placements, such as Medicine, Surgery & EmergencyMedicine 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, studentswill be located in hospital and community clinical settings.In year four, there is also an elective term where studentscan spend time at any approved hospital post in Australia or overseas.





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 MedicalStudies, Integrated Human System Pathophysiology,Independent Study, Introduction to Clinical Healthcare, and Integrated Pathology & ClinicalMedicine.

Students enroll in six courses in year one, fourcourses in years two, four and five, and threecourses 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 concludeswith two electives, a pre-internship hospital rotation and afurther ambulatory rotation, and an elective that can betaken in Australia or overseas.

Two years: integrated clinical practice and advancedclinical medicine.

Clinical exposure begins in the first year and continuesthroughout the program.


Medical School Accreditation and Approvals

University of New South Wales Australian Medical Council (AMC)Australian National University Australian Medical Council (AMC)Monash University Australian Medical Council (AMC)University of Adelaide Australian Medical Council (AMC)University of Notre Dame Australian Medical Council (AMC)University of Western Sydney Australian Medical Council (AMC)University of Western Australia Australian Medical Council (AMC)University of Tasmania Australian Medical Council (AMC)University of Queensland Australian Medical Council (AMC)University of Melbourne Australian Medical Council (AMC)Flinders University of Australian Medical Council (AMC)South AustraliaUniversity of Sydney Australian Medical Council (AMC)Bond University Australian Medical Council (AMC)University of Wollongong Australian Medical Council (AMC)Deakin University Australian Medical Council (AMC)James Cook University Australian Medical Council (AMC)University of Newcastle Australian Medical Council (AMC)


Medical School Total Tuition Average Yearly ($CAD) Tuition ($CAD)

University of New South Wales $131,538 $21,923Australian National University $193,824 $ 48,456Monash University $213,952* $53,488University of Adelaide $270,078 $45,013University of Notre Dame $110,104 $27,526University of Western Sydney $188,340 $37,668University of Western Australia $259,908 $43,318University of Tasmania $188,340 $37,668University of Queensland $218,284 $54,571University of Melbourne $226,008 $56,502Flinders University of South Australia $163,104 $40,776University of Sydney $212,448 $53,112Bond University $331,850 $66,370University of Wollongong $75,576 $18,894Deakin University $187,556 $46,889James Cook University $203,406 $33,901University of Newcastle $168,000 $33,600

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 withclerkship rotations done in Australian hospitals, with the possibility of electives in North American hospitals. Core clerkships are typicallydone in Medicine, Surgery and Anesthesia, Pediatrics and Child Health, Obstetrics and Gynecology, General Practice, and Psychiatry.

All Australian medical schools are accredited by the AustralianMedical Council (AMC).

* 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).




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

Western Sydney and also possibly rural NSW.

University of Western Australia Australia Unknown

University of Tasmania Australia Unknown

University of Queensland Australia Unknown

University of Melbourne Australia Unknown

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 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.

IRELAND

TABLE 30 IRISH MEDICAL SCHOOL DATA WEBSITE SOURCES


Ireland Trinity College Dublin http://www.medicine.tcd.ie/Ireland University College Dublin http://www.ucd.ie/medicine/index.htmlIreland Royal College of Surgeons Ireland (RCSI) www.rcsi.ieIreland University College Cork http://www.ucc.ie/en/CollegesandDepartments/MedicineandHealth/Ireland University of Limerick http://www2.ul.ie/web/WWW/Faculties/Education_%26_Health_

Sciences/Departments/Graduate_Medical_School/Ireland National University of Ireland, Galway http://www.nuigalway.ie/medicine/

TABLE 31 NUMBER OF CSAS STUDYING MEDICINE IN IRELAND

Location Medical School Estimation of CSAs

Ireland Trinity College Dublin ~ 70Ireland University College Dublin ~ 90Ireland Royal College of Surgeons Ireland (RCSI) ~ 200Ireland University College Cork ~ 70Ireland University of Limerick ~ 50Ireland National University of Ireland, Galway ~ 20Ireland Additional Admissions in Sept 2010 ~ 150




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.

Six year: high school transcript, 85% overall average, must have courses in biology, chemistry, physics, and math.

University College Cork Four year and five year Atlantic Bridge Program Unknown

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.

With the exception of one medical school, all schools in Ireland have been offering medical education to international students for over 30 years.



Trinity College Dublin 1592 1953University College Dublin 1854 1945/2008Royal College of Surgeons Ireland (RCSI) 1784 1978/2006University College Cork 1845 1953/2008University of Limerick 1989 2007Ireland National University of Ireland, Galway 1845 1953


Irish medical schools also divide studies into basic sciences and clinicals. Both stages of the curriculum are taught in Ireland.



Trinity CollegeDublin

University CollegeDublin

Royal College ofSurgeons Ireland(RCSI)

University College Cork

University of Limerick

National University of Ireland, Galway

Three years: Human Development and Behavioural Science, Evolution andLife, 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, Physiologyand Biochemistry of Healthy Cells, Tissues and Organ Systems, PatientCare in Community and Hospital Settings, Pathology, Microbiology andPharmacology, 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 BasedHealth, 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 andMetabolic 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, ChildHealth (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, Neu-rology/Neurosurgery, Vision & Ophthalmology, Psychiatry, and Psychology.

Human Biology, Anatomy, Physiology, Biochemistry, Pharmacology) andcognitive 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 Gynecol-ogy, Pediatrics and Psychiatry, andGeneral Practice and CommunityMedicine.

Two years: rotations in Medicineand Surgery, Medicine and Surgeryof Childhood, Obstetrics, Neonatalmedicine, 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 andGynecology, Pediatrics, Psychiatry,Radiology, General Practice, theSubspecialties, the Clinical Laboratory Departments and theSpecialist Diagnostic Units.




Trinity College Dublin Irish Medical CouncilUniversity College Dublin Irish Medical CouncilRoyal College of Surgeons Irish Medical CouncilIreland (RCSI)University College Cork Irish Medical CouncilUniversity of Limerick Irish Medical CouncilNational University of Irish Medical CouncilIreland, Galway


Medical School Total Tuition Average Yearly ($CAD) Tuition ($CAD)

Trinity College Dublin $209,045 $41,809University College Dublin $189,356* $ 47,339Royal College of Surgeons $252,204* $63,051Ireland (RCSI)University College Cork $211,476* $52,869University of Limerick $207,700 $51,925National University of $209,045** $41,809Ireland, 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 studymedicine internationally.



Trinity College Dublin

University College Dublin

Royal College of Surgeons Ireland(RCSI)

University College Cork

Ireland

Ireland, US, Malaysia

Ireland

Ireland

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 forsick 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 (DúnLaoghaire), Mount Carmel (Dublin).

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 LourdesHospital (Co. Louth).

Bon Secours Hospital, Cork University Hospital, Cork University Maternity Hospital,Mercy University Hospital, South Infirmary - Victoria University Hospital, St. Finbarr'sHospital, St. Mary's Orthopaedic Hospital, St. Patrick's/Marymount (Cork), Mid-WesternRegional 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).





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 (Castle-bar), Portiuncula Hospital (Ballinasloe), Roscommon County Hospital (Roscommon), SilgoGeneral 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 inNorth America and Malaysia.


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.

POLAND

TABLE 38 POLISH MEDICAL SCHOOL DATA WEBSITE SOURCES


Poland Medical University of Silesia www.slam.katowice.plPoland Jagiellonian University Medical College www.medschool.cm-uj.krakow.plPoland Poznan University of Medical Sciences http://ump.edu.pl/eng/Poland Medical University of Bialystok http://ed.umb.edu.plPoland Medical University of Lodz www.umed.lodz.pl/eng/Poland Pomeranian Medical University www.pum.edu.plPoland Medical University of Warsaw www.wum.edu.pl/english/Poland Wroclaw Medical University http://www.am.wroc.pl/en/content/view/19/20/Poland Medical University of Lublin http://www.umlub.pl/departments_and_courses_id_3927.htmlPoland Medical University of Gda!sk www.mug.edu.pl

TABLE 39 NUMBER OF CSAS STUDYING MEDICINE IN POLAND


Poland Medical University of Silesia ~ 30Poland Jagiellonian University Medical College ~ 90Poland Poznan University of Medical Sciences ~ 90Poland 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 Gda!sk Unknown*



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 2004.



Medical University of Silesia 1948 1996Jagiellonian University Medical College 1364 1994Poznan University of Medical Sciences 1950 1992Medical University of Bialystok 1950 2004Medical University of Lodz 1945 2003Pomeranian Medical University 1948 1996Medical University of Warsaw 1816 1993Wroclaw Medical University 1945 2003Medical University of Lublin 1950 2001



Medical University Four year Hope Medical Four year: bachelor’s degreeof 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 Collegesix 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 Unknownof Lodz

Pomeranian Medical Six year Hope Medical UnknownUniversity 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.





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 whichoffer four year programs.


Medical School Basic Science Curriculum Clinical Curriculum – includes Core Clinicals and Electives

Medical Universityof Silesia

Jagiellonian University MedicalCollege

Poznan University of Medical Sciences

Medical Universityof 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, Neuro-sciences, Medical Genetics, Immunology, MedicalEthics, Intro to Clinical Sciences, Cell Biology, MedicalPolish, Behavioral Sciences, Pathomorphology, Pathophysiology, Pharmacology, and Intro to Surgery.

Gross Anatomy, Histology and Cell Biology, Biochemistry,Human Physiology, Biophysics, Neuroscience, Microbiol-ogy, Embryology, Law and Ethics, Medical Sociology,Pathology, Polish, Pathophysiology, Pharmacology, Public Health and Epidemiology, Immunology, Biostatis-tics, Behavioral Science, First Aid, Clinical Diagnosis, andInternal Medicine.

Histology, Biophysics, First Aid/Nursing, Anatomy, Medical Polish, Physical Education, History of Medicine,Medical Psychology, Biochemistry, Sociology, Physiol-ogy, 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, andForensic 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, MedicalPolish, Infectious Diseases, Neurology, Radiology,Forensic Medicine, Oncology, Palliative Care, TropicalDiseases, 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.




Medical School Basic Science Curriculum Clinical Curriculum – includes Core Clinicals and Electives

Medical Universityof Lodz

Pomeranian Medical University

Medical Universityof Warsaw

Wroclaw MedicalUniversity

Medical Universityof Lublin

Normal Anatomy, Chemistry, Biology, Bioorganic Chemistry, Biophysics, Physiology Pathomorphology,Pharmacology, Pathophysiology, Microbiology, Immunology, and Medical Psychology.

Medical Biology, Medical Chemistry, Propedeutics of Med-icine, Anatomy, First Aid with Elements of Nursing , Latinwith Medical Terminology, Physical Education, Biophysics,Histology & Cytophysiology with Embryology, ComputerScience and Medical Statistics, Sociology, Physiology, Biochemistry, History of Medicine, Psychology, Immunol-ogy, Medical Microbiology, Pathophysiology, Epidemiol-ogy, 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, Hygieneand Epidemiology, Surgery, Internal Medicine, and Medical Psychology.

Medical Chemistry (Inorganic And Organic), Biophysics,Biology, Anatomy, Histology, Embryology, Genetics, Immunology, Cytophysiology, Biochemistry, ComputingTechniques, Physiology, Latin, Physical Education, FirstAid and Resuscitation, and Polish.

Introduction to Biophysics, General Chemistry, Generaland 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, Pathophysiol-ogy, Pharmacology, Genetics, Immunology, Clinical Biochemistry, Neuroanatomy, Neuropharmacology, Physical Diagnosis, and Introduction to Psychiatry.

Internal Medicine, Pediatrics, Surgery, Neurology,Dermatology and Venerology, Endocrinology, andInfectious Diseases.

Internal Medicine, OB/GYN, Neurology, GeneralSurgery, Pediatrics, Pediatric Surgery, Gerontology,Oncology, Family Medicine, Orthopedics, andOphthalmology.

Diabetology, Internal medicine, Cardiology, Pulmunol-ogy, Gastroenterology, Surgery, Oncological Surgery,Thoracic Surgery, Vascular Surgery, Urology, Orthope-dics and Traumatology, Obstetrics and Gynecology,Pediatrics, Nuclear Medicine, Endocrinology, InfectiousDiseases, Nephrology, Rheumatology, Hematology, Oncology, Dermatology and Venerology, Anesthesiol-ogy 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, Microbiol-ogy , Internal Medicine, General Surgery, Pediatrics,Gynecology And Obstetrics, Neurology, Dermatology,Psychiatry, Ophthalmology, Radiology, Otorhinolaryn-gology, Urology, Pulmonology, Rheumatology, Foren-sic 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 includesstandard courses such as anatomy and physiology; however it also includes Polish language classes. The clinical rotations are done inPoland, with the option of North American electives. During clinical rotations students are assisted by a Polish translator.


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.

While a portion of all clerkships are done in Poland, students also have the opportunity to do rotations in US hospitals.



Medical University of Silesia ACPUMS & The Polish State Accreditation CommitteeJagiellonian University Medical College ACPUMS & The Polish State Accreditation Committee, US Department of Education and

Medical Board of CaliforniaPoznan University of Medical Sciences ACPUMS & The Polish State Accreditation Committee, The Medical Board of CaliforniaMedical University of Bialystok ACPUMS & The Polish State Accreditation CommitteeMedical University of Lodz ACPUMS & The Polish State Accreditation CommitteePomeranian Medical University ACPUMS & The Polish State Accreditation CommitteeMedical University of Warsaw ACPUMS & The Polish State Accreditation CommitteeWroclaw Medical University ACPUMS & The Polish State Accreditation CommitteeMedical University of Lublin ACPUMS & The Polish State Accreditation Committee

* School has more than one program. Total tuition was calculated using four years.

The cost of medical education for international students in Poland is substantially less than other international locations; in somecases the entire education in Poland equals one year’s tuition in some of the more expensive countries.


Medical School Total Tuition ($CAD) Average Yearly Tuition ($CAD)

Medical University of Silesia $61,500* $15,375Jagiellonian University Medical College $63,120* $15,780Poznan University of Medical Sciences $51,644* $12,911Medical University of Bialystok $51,252* $12,813Medical University of Lodz $89,016 $14,836Pomeranian Medical University Unknown UnknownMedical University of Warsaw $61,480* $15,370Wroclaw Medical University $73,500 $12,250Medical University of Lublin Unknown Unknown



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 UnknownMedical University of Bialystok Poland UnknownMedical University of Lodz Poland Seven teaching hospitals in Poland.Pomeranian Medical University Poland UnknownMedical University of Warsaw Poland Five affiliated teaching hospitals in

Warsaw and 16 affiliated hospitals.Wroclaw Medical University Poland UnknownMedical University of Lublin Poland Unknown


Information was not available on when medical schools in the UK began accepting international students.



Barts and The London School of Medicine and Dentistry 1785 UnknownUniversity of Leicester 1921 UnknownUniversity of Cambridge 1209 UnknownUniversity of Edinburgh 1583/1726 UnknownUniversity of Aberdeen 1495/1497 UnknownWarwick Medical School 2000 UnknownUniversity of Leeds 1904 >100 YrsUniversity of Nottingham 1948 UnknownUniversity of Birmingham 1900 UnknownImperial College London 1907 UnknownUniversity of Manchester 2004 UnknownUniversity of Glasgow 1451 UnknownMedical University of Lublin Unknown Unknown

UNITED KINGDOM (UK)

TABLE 46 UK MEDICAL SCHOOL DATA WEBSITE SOURCES

Medical School Website

Barts and The London School of Medicine and Dentistry www.smd.qmul.ac.ukUniversity of Leicester http://www.le.ac.uk/sm/le/University of Cambridge http://www.medschl.cam.ac.uk/University of Edinburgh http://www.ed.ac.uk/schools-departments/medicine-vet-medicineUniversity of Aberdeen http://www.abdn.ac.uk/ims/Warwick Medical School www2.warwick.ac.uk/fac/med/University of Leeds http://www.leeds.ac.uk/info/20029/faculties/191/faculty_of_medicine_and_healthUniversity of Nottingham http://www.nottingham.ac.uk/mhs/index.aspxUniversity of Birmingham http://www.medicine.bham.ac.uk/Imperial College London http://www1.imperial.ac.uk/medicine/University of Manchester http://www.medicine.manchester.ac.uk/University of Glasgow http://www.gla.ac.uk/schools/medicine/

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.




Barts and The LondonSchool 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

Five year andfour year

Five year

Five year

Five year

Five year

Four year

Five year

Four year andfive year

Five year

Four year andsix year

UCAS

UCAS

UCAS

UCAS

UCAS, the associatedean, along with ateam of membersof staff, is responsi-ble for managing thewhole of the annualadmissions cycle.

UCAS

UCAS

UCAS

UCAS

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 leastequivalent 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 biologyand achieve BB grades at the time of application.

International Baccalaureate: Pass Diploma with 36 points includingchemistry and biology at higher level. Grade six required in all subjects.Other national and international qualifications welcomed. Mature students welcomed: alternative qualifications considered.

Passes in three of the following: biology/human biology, chemistry,physics, or mathematics. One of the subjects must be chemistry and atleast one pass must be at A level.

Unknown

UKCAT

Check with medical admissions office if in doubt about suitability of asubject. A typical offer will be conditional upon achieving the minimumrequirements for GCE* / SQA / IB / EB applicants or a minimum of thepredicted grades. There may be an English requirement.

UCAS, UK Clinical Aptitude Test(UKCAT)

A Level qualification or equivalent. Minimum requirements are: 6.0overall 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 thepaper-based version), with 4.0 on the essay rating (4.0 on the Test ofWritten English associated with the paper-based version); 83 on TOEFLiBT (internet-based), with minimum scores of 18 in listening, 20 in reading, 20 in speaking and 21 in writing.

Four year: bachelor's degree.Five year: UKAT, Advanced Diploma, International Baccalaureate 36.

Five year: International Baccalaureate Diploma: minimum 36 points including HL chemistry and HL biology.

Four year: honours degree or a PhD in a biological subject, and UKCAT.

Six year: International Baccalaureate 38 points in total with a minimumof six points in each of chemistry and biology, and Biomedical Admissions Test (BMAT).





University of Manchester

University of Glasgow

Five year andsix year

Four year andfive year

UCAS

UCAS - There areonly 18 places forcandidates fromnon-EU countries

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.

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.




Barts and TheLondon School ofMedicine andDentistry

University ofLeicester



Fundamentals of Medicine, Systems in Health, Cardiorespiratory, Metabolism, Locomotor (Musculoskeletal), Brain and Behaviour (neuroscience,psychology, psychiatry), Human Development (embryology, reproductive medicine, child health), andSystems in Disease.

Laying the Foundations, Clinical Skills, Medical Sciences,Social and Behavioural Medicine, Learning How toLearn, Learning to Integrate, and Rational Practice.

Three years: Functional Architecture of the Body Physio-logical Systems; Molecules in Medical Science, Preparingfor Patients, Biology of Disease, The Mechanisms of DrugAction, Neurobiology and Human Behaviour Human Reproduction, Biological and Biomedical Sciences includ-ing 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 aspectsof clinical practice).

Integrated Clinical Studies, Systems (specialties),Preparation for Clinical Practice.

Developing Your Skills, The Learning Environment,Elective, Preparing for Postgraduate Training, andTesting Your Skills: Assessment.

Three years:Stage 1 – Clinical MethodStage 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 revisitedand developed. Students undertake an eight-weekelective in year five. Most split this into two fourweek blocks.





Warwick MedicalSchool

University ofLeeds

Two years: Science for Medicine (The Principles and Vocabulary of Biochemistry, Physiology, Anatomy, Geneticsand other Biomedical Sciences). Integrated teaching ofbody systems (Systems II) that began with the Respiratoryand Cardiovascular Systems in year one, Systems Teachingin Relation to Disease, and Medical Humanities.

One and a half years: Attending lectures with your fellowstudents, work in small learning groups, guided, as appropriate, by clinicians or members of Warwick's academic staff. These groups contain students of differentages, background and experience, and this method ofworking enables everyone to bring their own skills andknowledge to the group so that students also learn fromone another.

Three years: preparing for clinical practice.

Three years: Clinical Effectiveness, an apprentice-ship year in which the student is a junior memberof the healthcare team and develops the generic,professional skills required in the delivery of health-care by the multi-professional team. There are foureight-week blocks which run simultaneouslythrough the year: Medicine, Surgery, CommunityHealth (Psychiatry or General Practice), ClinicalElective, and Professional Practice Block.

Following the four eight-week blocks describedabove, this phase is completed before the finalexams with a Professional Practice Block. The eightkey themes are:

Core Knowledge and Skills (with emphasis on non-technical skills); Clinical Ethics and Law; End of Life;Prescribing; Handover and Communication; Dealingwith Stress and Conflict; Professional Development(including careers), and WHO Patient Safety.

Two and a half years: clinical attachments in acutehospital settings in Coventry, Nuneaton, Redditch,Rugby and Warwick. Experiences are also providedin primary and community care placements rangingfrom GP practices to outreach projects in the Coventry,Rugby, Leamington, Warwick and Alcester areas.

Elective: students devise and undertake a medicalproject in a setting of their choice. The elective canbe anywhere in the world, subject to suitablearrangements.

Personal Development Plan: Throughout their timeat Warwick Medical School, students will be asked to keep a Personal Development Plan (PDP). This isan opportunity for self-reflection - to think not onlyabout 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 otherprofessionals, medicine in the community, ethics and law, information technology handling and management.







Imperial CollegeLondon



Structure, Function and Pharmacology of ExcitableTissues, Molecular Basis of Medicine, Public HealthEpidemiology, Behavioural Sciences, Human Development and Tissue Differentiation, Early Clinicaland Professional Development, Clinical Communica-tion Skills, Clinical Laboratory Sciences, Cardiovascularand Respiratory Systems, Hematology, Renal and Endocrine Systems, Human Development Structureand Function, Alimentary System and Nutrition, General and Biochemical Pharmacology, Functionaland Behavioural Neuroscience, Using Epidemiology in Practice, up to two optional modules Research Methods, Honours Year Project, Infection, plus twotaught modules.

This involves case based learning following a structuresimilar to that used in the long established Maastrichtproblem-based learning course. Students will work onthe cases as part of a group of about eight studentswith a tutor for each group. Each student will cover allaspects of the cases. The problems are grouped intofour to six-week themed blocks covering basic sci-ence, Anatomy (including Prosection), Ethics, Medi-cine in Society, and Behavioural Science with all theseaspects integrated into each of the cases studied.Over the year students will be working with differentgroups of students and with different tutors to preparethem for the way group working operates within thehealth service.

Cellular and Molecular Science, Regional and SystemsAnatomy, Systematic Physiology, Pharmacology andGeneral Pathology, Introduction to Clinical Practice: Medical and Surgical Takes (receiving unselectedemergency admissions), GP Teaching (basic clinicalskills/methods in general practice), Patient Clerking,Consultant Teaching, and other teaching (outpatientclinic teaching, theatre sessions, endoscopy sessions,and anaesthetic sessions).

Unknown

Unknown

Clinical Practice (Medicine and Surgery), CommunityFollow-up, and Therapeutics Obstetrics and Gyne-cology, Child Health, Healthcare of the Elderly, Psychiatry, Ophthalmology, Otorhinolaryngology('Ear, nose and throat'), Dermatology, Special StudyModule Medicine, Surgery, Musculoskeletal Disor-ders 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, TeachingSkills Emergency Medicine, General Practice StudentAssistantship, Cardiology, Neurology, Ears, Nose andThroat, 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.


* 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.

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.

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



Barts and The London School of Medicine and Dentistry The General Medical Council, UKUniversity of Leicester The General Medical Council, UKUniversity of Cambridge The General Medical Council, UKUniversity of Edinburgh The General Medical Council, UKUniversity of Aberdeen The General Medical Council, UKWarwick Medical School The General Medical Council, UKUniversity of Leeds The General Medical Council, UKUniversity of Nottingham The General Medical Council, UKUniversity of Birmingham The General Medical Council, UKImperial College London The General Medical Council, UKUniversity of Manchester The General Medical Council, UKUniversity of Glasgow The General Medical Council, UK

All of the medical schools in the UK are accredited by the General Medical Council, UK.




Barts and The London School ofMedicine and Dentistry

University of Leicester




Warwick Medical School

University of Leeds



Imperial College London



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 otherhospitals 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 studentsundertake 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 Huddersfieldhospitals to the west, Pinderfields (Wakefield), Dewsbury and Pontefracthospitals just to the south of Leeds and Harrogate hospital, north ofLeeds. General practices across West Yorkshire and beyond provide avariety of placements.

Nottinghamshire, Derbyshire and Lincolnshire.

Unknown

Unknown

Central Manchester, University Hospitals NHS Foundation Trust, Lancashire Teaching Hospitals NHS Foundation Trust, Salford RoyalNHS Foundation Trust, University Hospital of South Manchester NHSFoundation Trust

Unknown

Clerkship rotations are done at affiliated hospitals in the UK and Europe.



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 54 NUMBER OF CSAS STUDYING MEDICINE IN EUROPE/MIDDLE EAST


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 ~ 50Israel Sackler School of Medicine ~ 20Israel Ben-Gurion University of the Negev Unknown*Israel Technion Israel Institute of Technology 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.



Kaunas University of Medicine 1919 UnknownUniversity of Medicine and Pharmacy Iuliu Hatieganu 1919 UnknownUniversity of Cairo 1837 UnknownIslamic Azad University 1361 UnknownRCSI Bahrain 2004 2004Sackler School of Medicine 1964 1976Ben-Gurion University of the Negev 1969 UnknownTechnion Israel Institute of Technology 1924 Unknown

EUROPE/MIDDLE EAST

TABLE 53 EUROPE/MIDDLE EAST MEDICAL SCHOOL DATA WEBSITE SOURCES


Lithuania Kaunas University of Medicine http://naujas.kmu.ltRomania University of Medicine and Pharmacy Iuliu Hatieganu www.umfcluj.roEgypt University of Cairo http://cuportal.cu.edu.egIran Islamic Azad University www.iau.ac.irBahrain RCSI Bahrain www.rcsi-mub.comIsrael Sackler School of Medicine http://medicine.tau.ac.ilIsrael Ben-Gurion University of the Negev http://cmsprod.bgu.ac.il/eng/fohsIsrael Technion Israel Institute of Technology http://md.technion.ac.il/




Kaunas University Six year Unknown In-person interview required, physical exam/health records, transcriptof Medicine and written application.

University of Medicine Six year University based Unknownand Pharmacy Iuliu Hatieganu

University of Cairo Six year Unknown Unknown

Islamic Azad University n/a International Affairs Unknownof 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 theNew 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 Unknownof Technology

The majority of schools offer one medical program, however RCSI Bahrain offers two different streams. Admission is primarily basedon high school transcripts, a bachelor’s degree and MCAT scores.


Medical School Clerkship Locations Clinical Curriculum – includes Core Clinicals and Electives

Kaunas University ofMedicine

Two years: theoretical disciplines onmedicine such as Human Anatomy, Histology-Embryology, Physiology, bothchemistry, physics, foreign languages,and philosophy are subjects of first andsecond year studies.

Three years: clinical medicine subjects begin during thirdyear 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 undergraduatestudies the program contains disciplines such as Pediatrics,Emergency Medicine, Social Medicine, Public Health, Family Medicine, and others.




Medical School Clerkship Locations Clinical Curriculum – includes Core Clinicals and Electives

University of Medicineand Pharmacy Iuliu Hatieganu

University of Cairo

Islamic Azad University

RCSI Bahrain

Sackler School of Medicine

Ben-Gurion University ofthe Negev

Technion Israel Instituteof Technology

Unknown

Two years: first year Anatomy, first yearMedical Physiology, first year MedicalBiochemistry and Molecular Biology, firstyear Histology, second year Anatomy,second year Medical Physiology, secondyear Medical Biochemistry and MolecularBiology, second year Histology, Computer; Psychology and Behavioral Sciences, Microbiology and Immunology,third year Community Medicine& PublicHealth; Medical Parasitology; ClinicalPharmacology, Pathology, Ear, Nose andthroat (E.N.T.), Ophthalmology, ForensicMedicine and Clinical Toxicology.

Unknown

Neuromuscular, Biomedicine, Haemo-topoietic and Immune Systems, Health Behavior and Society, Clinical Competen-cies, 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, andMedicine.

Unknown

Unknown

The curriculum is broken up into basic sciences and clinical rotations as is the case with all other international medical schools.


Accreditation is varied and dependent on the location of the medical school.


Medical School Accreditation and Approvals (Domestic and International)Kaunas University of Medicine UnknownUniversity of Medicine and Pharmacy Iuliu Hatieganu UnknownUniversity of Cairo UnknownIslamic Azad University UnknownRCSI Bahrain GCC Medical Schools Deans’ CommitteeSackler School of Medicine Council for Higher Education, New York State Education Department, State of IsraelBen-Gurion University of the Negev Council for Higher EducationTechnion Israel Institute of Technology Council for Higher Education

* 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 RCSIBahrain was similar to rates found in Ireland.


Medical School Total Tuition ($CAD) Average Yearly Tuition ($CAD)Kaunas University of Medicine Unknown UnknownUniversity of Medicine and Pharmacy Iuliu Hatieganu $42,036 $ 7,006University of Cairo Unknown UnknownIslamic Azad University Unknown UnknownRCSI Bahrain $191,225 $38,245* Sackler School of Medicine $ 114,576 $28,644 Ben-Gurion University of the Negev $ 60,468 $15,117Technion Israel Institute of Technology Unknown $ 23,339

Clinical rotations are typically done within the country of medical education, although a couple of schools do state that internationaland US locations are available for a portion of the clinical rotations.



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


INTERNATIONAL MEDICAL SCHOOL DATA - MEDICAL SCHOOL SURVEY RESULTSThe 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 3Australia Flinders University of South Australia 1Australia University of Sydney 2Australia University of Queensland 1Australia University of Wollongong 1Australia James Cook University 1Bahrain RCSI Bahrain 1Ireland University of Limerick 1Ireland Royal College of Surgeons in Ireland 1Ireland Trinity College, University of Dublin 1Ireland University College Cork 1Ireland University College Dublin 1Israel Sackler School of Medicine 1Poland Jagiellonian University Medical College 1Poland Medical University of Silesia, School of Medicine in Katowice 1Poland Poznan University of Medical Sciences Center for Medical Education 1Czech 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 demonstratesthat 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 20 100%

Medical school deans and professors were the two most likely to answer the medical school survey.


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:

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 29 100%

* Respondents were able to choose more than one answer.

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 inthe 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 thatopportunity.”

• “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.

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).

Factors that influence international student training capacity by medical school region:


TABLE 64 INTENTION TO CHANGE THE SIZE OF INTERNATIONAL MEDICAL TRAINING PROGRAMS

n %Yes 8 50%No 8 50%Total 16 100%

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.

TABLE 65 EXPECTED CHANGES IN LEGISLATION THAT WILL IMPACT INTERNATIONAL MEDICAL TRAINING PROGRAMS

n %Yes 5 31%No 11 69%Total 16 100%

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.

Ireland• Reduce size (n = 2)

Poland• Expand program (n = 1).• No change (n = 2).

Caribbean• Expand program (n = 2).• Reduce size (n = 1).

Australia• No change (n = 3).• Expand program (n = 2).

Middle East• No change (n = 2).

Czech Republic• No change (n = 1).

Intention to change the size of the 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 priorityfor residency positions.

- Program is currently provisional going to full accreditation in 2011.

Middle East• No expected changes in legislation (n = 2)

Czech Republic • No expected changes in legislation (n = 1)

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

Medical School Medical Degree Example of Admission RequirementsRegion 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.

TABLE 67 ADDITIONAL ADMISSION PROCEDURES BY REGION OF MEDICAL SCHOOL

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)

Medical School Region Admission Procedures

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)

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.

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 internationaland domestic students.


TABLE 68 DO ADMISSIONS CRITERIA DIFFER FOR INTERNATIONAL STUDENTS VERSUS NATIONAL STUDENTS?

n %Yes* 9 45.0%No** 4 20.0%N/A 7 35.0%Total 20 100%

* 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).

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 initialscreening with high school grades and a psychometric exam score.They have at least four methods of assessment including personalinterview, group simulation, and individual simulation with SP's.”

Admission differences reported by region of medical school were:

TABLE 69 ADMISSIONS COMMITTEE REPRESENTATIVES

n %Medical School Faculty 14 56%Deans of Medical School 4 16%Other 7 28%

TABLE 70 AVERAGE YEARLY TUITION

Medical School Region Avg. Yearly Tuition ($CAD)

Ireland $49,800Poland $14,191Caribbean $25,608Australia $42,334Middle East $26,336

While 72% of the representatives on the admissions committees were cited as medical school faculty and/or deans, others includedrecruitment agencies such as The Atlantic Bridge Program for Ireland medical school admissions, and Hope Medical Institute forsome Polish medical school admissions. Additionally, there were physician recruiters located in North America.

Admissions committee

TUITION

When asked whether or not tuition costs differed for international students versus domestic students, 60% of the medical schools surveyedanswered yes. The most commonly cited reason was financial gain, as a majority of the medical schools surveyed were located in countrieswere domestic medical students do not pay tuition, or pay a small amount and the remainder is subsidized by the government.


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 : www.oecd.org/publishing

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 2009.

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 2006:1-20.

4 Collier R. Medical school admission targets urged for rural and low-income Canadians. CMAJ 2010; 182(8): 327-328.

5 The Association of Faculties of Medicine of Canada. Canadian Medical Education Statistics 2009. Volume 31. Available at: http://www.afmc.ca/pdf/cmes/CMES2009.pdf. Accessed August 2010.

6 CaRMS 2010 Canadian Medical Graduate Cohort Data. Accessed June-August 2010.

7 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: 577-586.

8 Clark C. Increasing US Medical School Spots Won’t Increase Physician Supply. Health Leaders Media 2010. Accessed August 2010. Available at: http://www.healthleadersmedia.com/content/PHY-250808/Increasing-US-Medical%20School


Medical School Region Age

24 and under 25 - 29 30 - 34 35 - 44 45 and over Total

n % n % n % n % n % n %

Western Europe 100 36.8% 148 54.4% 22 8.1% 1 0.4% 1 0.4% 272 100%

Eastern Europe 24 30.4% 47 59.5% 7 8.9% 1 1.3% 79 100%

Caribbean 218 43.5% 234 46.7% 38 7.6% 9 1.8% 2 0.4% 501 100%

Australia 21 10.2% 149 72.3% 27 13.1% 9 4.4% 206 100%

Middle East 9 39.1% 14 60.9% 23 100%

AGE BY MEDICAL SCHOOL REGION

a) Chi-square test:Is there a relationship between age groups across medical schoolregions? Yes. A chi-square test of independence was done to seewhether age groups are related to medical school region. The results of the test were significant,X2 (20, n = 1082) = 96.07, p < .001. These results indicate that there are age differencesacross 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 ageacross medical school regions.

b) Significant differences in proportions:A z-test for proportions was done to test for significant differences inage 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 versusPoland, Australia versus Caribbean, and Australia versus Middle East.With the number of comparisons, a Bonferonni correction was ap-plied to control for Type 1 error. For testing significant differences, allp values must be less than 0.0125 (.05/4) to be considered significant.

For the ’24 and under’ age group, there were significant differencesbetween Australia and all other regions: Ireland (z = 6.51, p < .001),Poland (z = 4.003, p < .001), Caribbean (z = 8.423, p < .001), MiddleEast (z = 3.576, p < .001). Australia had a significantly smaller propor-tion of the youngest CSAs (10.2%) compared to other medical schoolregions for the 24 and under age group.

APPENDIX – ANALYSIS RESULTS

Group Age (Years)

20 - 25 26 - 30 31 - 40 41 - 50 Total

n % n % n % n % n %

CSA 115 10.6% 799 73.9% 160 14.8% 7 0.6% 1081 100.0%

CMG 826 45.3% 845 46.4% 140 7.7% 11 0.6% 1822 100.0%

Total 1361 1312 214 17 2904

AGE – 2010 CSAS VERSUS CMGs

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, X2

(3, n = 2903) = 376.09, p < .001. These results indicate that thereis 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 differ-ences a total of three comparisons were made in the following agegroups: 20-25 years, 26-30 years, and 31-40 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) tobe considered significant.

There were significant differences in all comparisons. There is a significant difference between CSAs and CMGs in the 20 – 25 age group (z = 19.264, p < .001). There is a significant differencebetween CSAs and CMGs in the 26 – 30 age group (z = 14.43, p < .001). There is a significant difference between CSAs and CMGsin the 31 - 40 age group (z = 6.029, p < .001).


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 whethergender is related to being a CSA or CMG. The results of the testwere significant, X2 (1, n = 2880) = 31.31, p < .001. These resultsindicate that there are gender differences by group.

b) Significant differences in proportions:A z-test for proportions was done to test for significant differencesin 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 differ-ences in proportion between females between the CSA and theCMG group. A Bonferonni correction was applied to control forType 1 error. For testing significant differences, all p values must be less than 0.025 (.05/2) to be considered significant.

There were significant differences in the proportion of males betweenCSAs 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).

Group Gender

Male Female Total

n % n % n %

CSA 568 52.5% 514 47.5% 1082 100.0%

CMG 751 41.8% 1047 58.2% 1798 100.0%

Total 1319 1561 2880

GENDER – 2010 CSAS VERSUS CMGs

Medical School GenderRegion Male Female Total

n % n % n %

Ireland 117 43.0% 155 57.0% 272 100%

Poland 43 54.4% 36 45.6% 79 100%

Caribbean 282 56.3% 219 43.7% 501 100%

Australia 114 55.3% 92 44.7% 206 100%

Middle East 12 52.2% 11 47.8% 23 100%

GENDER BY MEDICAL SCHOOL REGION

a) Chi-square test:Is there a relationship between the number of males and femalesacross medical school regions? Yes. A chi-square test of independ-ence was done to whether there is a relationship between gendersacross medical school regions. The results of the test were significant,X2 (4, n = 1081) = 13.48, p < .05. These results indicate that there aregender differences across medical school regions. To provide morespecific information about these gender differences across regions, az-test for two proportions was conducted..

b) Significant differences in proportions:A z-test for proportions was done to test for significant differencesin 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. Fortesting 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 propor-tion of males to females in Ireland (z = 3.566, p < .001). In Irelandthere are more females than males (30.2% versus 20.6%). Therewere no significant differences between males and females acrossthe other medical school regions.


a) Chi-square test:Is there a relationship between marital status and group (CSA orCMG)? Yes. A chi-square test of independence was done to seewhether marital status is related to being a CSA or CMG. The results of the test were significant, X2 (1, n = 2892) = 147.85, 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 differencesin marital status across the CSA or CMG group. To test for significant differences between CSAs and CMGS a total of twocomparisons were made across the marital status groups:

‘Single/Divorced/Separated/Widowed’ status of CSAs versusCMGs, and ‘Married/Living with partner’ status of CSAs versusCMGs. A Bonferonni correction was applied to control for Type 1error. For testing significant differences, all p values must be lessthan 0.025 (.05/2) to be considered significant.

For the ‘Single/Divorced/Separated/Widowed’ group there weresignificant 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).

Group Marital Status

Single/Divorced/Separated/Widower Married/Living with partner Total

n % n % n %

CSA 899 83.1% 183 16.9% 1082 100%

CMG 1115 61.6% 695 38.4% 1810 100%

Total 2014 878 2892

MARITAL STATUS – 2010 CSAS VERSUS CMGs

Marital Status

Region of Medical School Single Married/Living with a partner Separated/Divorced Total

n % n % n % n %

Ireland 233 85.7% 39 14.3% 0 0 272 100.0%

Poland 65 82.3% 14 17.7% 0 0 79 100.0%

Caribbean 426 85.0% 70 14.0% 5 1.0% 501 100.0%

Australia 146 70.9% 58 28.2% 2 1.0% 206 100.0%

Middle East 21 91.3% 2 8.7% 0 0 23 100.0%

MARITAL STATUS BY MEDICAL SCHOOL REGION

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 seewhether marital status is related to medical school region. The resultsof the test were significant, X2 (8, n = 1081) = 27.97, p < .001. Theseresults indicate that there are marital status differences across medicalschool regions.

b) Significant differences in proportions:A z-test for proportions was done to test for significant differences inmarital status across medical school regions in the married/living witha partner category. To test for significant differences a total of fourcomparisons were made: Australia versus Ireland, Australia versusPoland, 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 0.0125 (.05/4) to be considered significant.

For the ‘Married/Living with a partner’ group, there were significantdifferences between the Australia and Ireland (z = 3.606, p < .001).There were also significant differences between Australia and theCaribbean (z = 4.345, p < .001) for the proportion of CSAs in the‘Married/Living with a partner’ category. Australia has a larger groupof CSAs that are married or living with a partner than CSAs in Irelandand the Caribbean. There were no significant differences betweenAustralia and Poland or Australia and the Middle East in the marriedor living with a partner category.


Medical School Parent(s) Medical DoctorRegion Yes No Total

n % n % n %

Ireland 87 31.64% 185 68.36% 272 100%

Poland 18 22.78% 61 77.22% 79 100%

Caribbean 79 15.77% 422 84.23% 501 100%

Australia 39 18.93% 167 81.07% 206 100%

Middle East 4 17.39% 19 82.61% 23 100%

Total 227 857 1081

CSAs WITH PARENTS WHO ARE PHYSICIANS BY REGION

a) Chi-square test:Is there a relationship between having a parent or both parents amedical doctor and medical school region? Yes. A chi-square testof independence was done to see whether parent(s) is a medicaldoctor is related to medical school region. The results of the testwere significant, X2 (4, n = 1081) = 28.91, p < .001. These resultsindicate that there are differences whether a parent(s) is a medicaldoctor or not across medical school regions.

b) Significant differences in proportions:A z-test for proportions was done to test for significant differencesacross medical school regions. Looking over the graph, CSAs fromIreland seem to have a higher proportion of having a parent or par-ents 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 versusAustralia, and Ireland versus Middle East. With the number of comparisons, a Bonferonni correction was applied to control for Type1 error. For testing significant differences, all p values must be lessthan 0.0125 (.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 med-ical school regions, there were significant differences between Irelandand the Caribbean (z = 5.153, p < .001) and Ireland and Australia (z =3.105, p < .01). There were no significant differences between Irelandand Poland or Ireland and the Middle East for whether CSAs inIreland had a larger proportion of parent(s) as a medical doctor. CSAsin Ireland had a significantly higher proportion of a parent or parentsas a medical doctor than CSAs in the Caribbean or Australia.

Medical School Post-secondary Education in CanadaRegion Yes No Total

n % n % n %

Ireland 219 80.5% 53 19.5% 272 100%

Poland 66 83.5% 13 16.5% 79 100%

Caribbean 470 93.8% 31 6.2% 501 100%

Australia 202 98.1% 4 1.9% 206 100%

Middle East 20 87.0% 3 13.0% 23 100%

POST-SECONDARY EDUCATION IN CANADA BY MEDICAL SCHOOL REGION

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 ofthe test were significant, X2 (4, n = 1081) = 55.76, p < .001. These results indicate that having a post-secondary education in Canadavaries across medical school regions.

b) Significant differences in proportions:A z-test for proportions was done to test for significant differencesacross medical school regions. To test for significant differences a totalof four comparisons were made: Ireland versus Poland, Ireland versusCaribbean, Ireland versus Australia, and Ireland versus Middle East.

With the number of comparisons, a Bonferonni correction was appliedto control for Type 1 error. For testing significant differences, all pvalues must be less than 0.0125 (.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 com-pared to CSAs in other medical school regions, we found that therewere significant differences between Ireland and the Caribbean (z =5.553, p < .001) and Ireland and Australia (z = 5.721, p < .001). Therewere no significant differences between Ireland and Poland or Irelandand the Middle East in the number of CSAs having a post-secondaryeducation in Canada. CSAs in Ireland had a significantly lower proportion of having a post-secondary education in Canada thanCSAs in the Caribbean or Australia.


Highest Level of Education Ireland Poland Caribbean Australia Middle East

n % n % n % n % n %

High school 43 15.8% 10 12.7% 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) 21 7.7% 11 13.9% 12 2.4% 2 1.0% 5 20.8%

Bachelor’s degree 167 61.4% 54 68.4% 397 79.2% 166 80.6% 13 54.2%

Master’s degree 37 13.6% 4 5.1% 67 13.4% 30 14.6% 4 16.7%

Ph.D. or equivalent 3 1.1% 10 2.0% 3 1.5% 1 4.2%

Other 7 1.4%

Total 272 79 501 206 24

HIGHEST LEVEL OF EDUCATION BY MEDICAL SCHOOL REGION

a) Chi-square test:Is there a relationship between CSAs highest level of post-secondaryeducation in Canada and medical school region? Yes. A chi-squaretest 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, X2 (24, n = 1081) = 142.05, p < .001. These results indicate that the highest level of post-secondary education of CSAs varies across medical school regions.

b) Significant differences in proportions:Of interest is the comparison of bachelor degrees across medicalschool regions. A z-test for proportions was done to test for significantdifferences across medical school regions. To test for significant differ-ences 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 compar-isons, a Bonferonni correction was applied to control for Type 1error. For testing significant differences, all p values must be lessthan 0.0125 (.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 othermedical school regions, we found that there were significant differencesbetween Australia and Ireland (z = 4.417, p < .001) and Australia andPoland (z = 2.688, p < .01). There were no significant differences in theproportion of CSAs having a bachelor’s degree between Australia andthe Carribean or Australia and the Middle East. CSAs in Australia had asignificantly higher proportion education than CSAs in Europe.

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 64 5.9% 4 0.4% 30 2.8% 21 1.9% 797 73.7% 142 13.1% 17 1.6% 7 0.6% 1082 100%

CMG 15 0.8% 264 14.5% 68 3.7% 129 7.1% 1109 60.9% 179 9.8% 52 2.9% 5 0.3% 1821 100%

Total 79 268 98 150 1906 321 69 12 2903

CMA AND CMG COMPARISON – HIGHEST LEVEL OF EDUCATION PRIOR TO ATTENDING MEDICAL SCHOOL

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 tosee whether the highest level of education prior to attending medicalschool is related to being a CSA or CMG. The results of the test weresignificant, X2 (7, n = 2903) = 278.47, p < .001. These results indicatethat there is a relationship between being a CMG or CSA and thehighest level of education prior to medical school.

b) Significant differences in proportions:The z-test for proportions was done to test for significant differencesin highest level of education prior to medical school across the CSAor 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 controlfor Type 1 error. For testing significant differences, all p values mustbe less than 0.01 (.05/5) to be considered significant.

There were significant differences across four of the five compar-isons. 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 andCMGs for Ph.D. or equivalent (z = 2.08, p = .04).


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) equivalentBefore Going Abroad

n % n % n % n % n % n % n % n

Did not apply 61 95.3% 2 50.0% 43 84.3% 166 20.8% 12 8.5% 1 5.9% 4 57.1% 289

Applied once 2 3.1% 2 50.0% 6 11.8% 357 44.8% 27 19.0% 4 23.5% 2 28.6% 400

Applied 2x or more 1 1.6% 0 0.0% 2 3.9% 274 34.4% 103 72.5% 12 70.6% 1 14.3% 393

Total 64 100% 4 100% 51 100% 797 100% 142 100% 17 100% 7 100% 1082

APPLICATION TO CANADIAN MEDICAL SCHOOLS BY HIGHEST LEVEL OF EDUCATION PRIOR TO ATTENDING MEDICAL SCHOOL

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 educa-tion prior to attending medical school is related to the number oftimes a CSA applied to a Canadian medical school before goingabroad. The results of the test were significant, X2 (12, n = 1082) =361.51, p < .001. These results indicate that there is a relationship between the number of times a CSA applied to a Canadian medicalschool 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 differencesin highest level of education prior to medical school for the CSAgroup that did not apply to any Canadian medical school. To test for

significant differences in this group a total of two comparisons weremade: Bachelor’s degree versus high school, and bachelor’s degreeversus Master’s degree. A Bonferonni correction was applied to control for Type 1 error. For testing significant differences, all p valuesmust be less than 0.025 (.05/2) to be considered significant.

There were significant differences across both comparisons. ForCSA that did not apply to a Canadian medical school, there is a significant difference between those with a bachelor’s degree andthose with a high school degree (z = 12.86, p < .001). There is also a significant difference between those with a bachelor’s degree andthose with a master’s degree (z = 3.35, p < .001). In the ‘Did notapply’ category, there were more CSAs with a high school degreethan those with a bachelor’s degree, and there were less CSAs witha master’s degree than bachelor’s degree.

Number of Times Applied

Medical School Region Did not apply Applied once Applied 2x or more Total

n % n % n % n %

Ireland 79 29.0% 89 32.7% 104 38.2% 272 100%

Poland 43 54.4% 23 29.1% 13 16.5% 79 100%

Caribbean 118 23.5% 216 43.1% 167 33.3% 501 100%

Australia 40 19.4% 65 31.6% 101 49.0% 206 100%

Middle East 8 34.8% 7 30.0% 8 35.0% 23 100%

Total 288 400 393 1081

APPLICATION TO CANADIAN MEDICAL SCHOOLS BY REGION OF MEDICAL SCHOOL

a) Chi-square test:Is there a relationship between the number of times a CSA appliedto 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 tomedical school region. The results of the test were significant, X2

(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 significantdifferences a total of eight comparisons were made. In the ‘Didnot apply’ category we compared Poland to the other regions(Ireland, Caribbean, Australia, and Middle East). In the ‘Applied2x 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 tocontrol for Type 1 error. For testing significant differences, all pvalues must be less than 0.006 (.05/8) to be considered significant.

For the ‘Did not apply’ category, there were significant differencesbetween 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 betweenPoland and the Middle East for the ‘Did not apply’ category (z = 1.422, p = .155). For the ‘Applied 2x or more’ category, therewere significant differences between Australia and Poland (z =5.677, p < .001). There were no significant differences betweenAustralia and Ireland (z = 2.302, p = .021), Australia and theCaribbean (z = 1.098, p = .272), and Australia and the MiddleEast (z = 1.446, p = .148).


Difficulty in Arranging a Clerkship Rotation in Canada

Medical School Region Easy Okay Difficult Total

n % n % n % n %

Ireland 18 26.9% 19 28.4% 30 44.8% 67 100%

Poland 3 25.0% 4 33.3% 5 41.7% 12 100%

Caribbean 0 0.0% 7 17.5% 33 82.5% 40 100%

Australia 10 21.3% 14 29.8% 23 48.9% 47 100%

Total 31 44 91 166

DIFFICULTY IN ARRANGING A CLERKSHIP ROTATION IN CANADA BY MEDICAL SCHOOL REGION

a) Chi-square test:Is there a relationship between levels of difficulty in arranging aclerkship rotation in Canada across medical school regions? Yes.A chi-square test of independence was done to see if there is arelationship between level of difficulty and medical school region.The results of the test were significant, X2 (6, n = 166) = 19.52, p < .05. These results indicate that levels of difficulty in arranginga clerkship rotation is related to medical school regions.

b) Significant differences in proportions:Of interest is whether there are significant differences acrossmedical school regions for the “Difficult’ category. A z-test forproportions was done to test for significant differences betweenthe proportions. A total of three comparisons were made:

Caribbean to Australia, Caribbean to Ireland, and Caribbean toPoland. With the number of comparisons, a Bonferonni correctionwas applied to control for Type 1 error. For testing significant differences, all p values must be less than 0.0166 (.05/3) to beconsidered significant.

For the ‘Difficult’ category there is a statistically significant difference across all regions. CSAs from the Caribbean found itmore difficult to arrange clerkship positions than CSAs in: Australia (z = 3.033, p < .01), Ireland (z = 3.633, p < .001), andPoland (z = 2.426, p = .0153).

Satisfaction with Medical Degree Program

Medical School Region Satisfied Neutral Dissatisfied Total

n % n % n % n %

Ireland 254 93.4% 12 4.4% 6 2.2% 272 100%

Poland 73 92.4% 5 6.3% 1 1.3% 79 100%

Caribbean 469 93.6% 22 4.4% 10 2.0% 501 100%

Australia 177 85.9% 18 8.7% 11 5.3% 206 100%

Middle East 20 87.0% 3 13.0% 0 0.0% 23 100%

Total 993 60 28 1081

SATISFACTION WITH MEDICAL DEGREE PROGRAM BY MEDICAL SCHOOL REGION

a) Chi-square test:Is there a relationship between levels of satisfaction with medicaldegree program and region of medical school? Yes. A chi-squaretest of independence was done to see if satisfaction is related toregion of medical school. The results of the test were significant,X2 (8, n = 1081) = 17.10, p < .05. These results indicate that thereis a relationship between region of medical school and levels ofsatisfaction 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 MiddleEast. A Bonferonni correction was applied to control for Type 1error. For testing significant differences, all p values must be lessthan 0.0125 (.05/4) to be considered significant.

There were significant differences across two regions. CSAs inAustralia are significantly less satisfied than CSAs inIreland (z = 2.56, p = .0106), and CSAs in Australia are significantly lesssatisfied than CSAs in the Caribbean (z = 3.16, p < .01). Therewere no significant differences in satisfaction between Australiaand Poland (z = 1.29, p = .196) and between Australia and theMiddle East (z = -0.18, p = .857).


Popular Funding Types

Medical School Family Bank Loan Government Personal International Bank Loan Other TotalRegion Savings in Canada Grants Savings Scholarships Elsewhere

n % n % n % n % n % n % n % n %

Ireland 229 38.4% 171 28.7% 75 12.6% 81 13.6% 5 0.8% 19 3.2% 16 2.7% 596 100%

Poland 53 33.3% 45 28.3% 24 15.1% 29 18.2% 2 1.3% 4 2.5% 2 1.3% 159 100%

Caribbean 315 26.9% 375 32.0% 202 17.2% 134 11.4% 67 5.7% 37 3.2% 42 3.6% 1172 100%

Australia 142 27.8% 146 28.6% 102 20.0% 88 17.3% 9 1.8% 9 1.8% 14 2.7% 510 100%

Middle East 21 45.7% 11 23.9% 4 8.7% 6 13.0% 1 2.2% 2 4.3% 1 2.2% 46 100%

POPULAR FUNDING TYPE BY MEDICAL SCHOOL REGION

a) Chi-square test:Is there a relationship between popular funding types and med-ical school regions? Yes. A chi-square test of independence wasdone to see if there is a relationship between the types of fund-ing that CSAs used towards their medical education and medicalschool region. The results of the test were significant, X2 (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 overa majority of medical school regions, the z-test for proportionswas done to test for significant differences. To test for significantdifferences 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 versusthe Middle East. A Bonferonni correction was applied to controlfor Type 1 error. For testing significant differences, all p valuesmust be less than 0.0125 (.05/4) to be considered significant.

There were significant differences across two of the four compar-isons. Ireland was significantly different from the Caribbean in theuse 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 Caribbeanand Australia, family savings was more popular in Ireland than theCaribbean and Australia. Ireland was not significantly differentfrom Poland (z = 1.087, p = 0.277). Ireland was not significantlydifferent from the Middle East (z = 0.812, p = 0.417).

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% 53 19.5% 120 44.1% 95 34.9% 272 100%

Poland 34 43.0% 28 35.4% 13 16.5% 4 5.1% 79 100%

Caribbean 89 17.8% 119 23.8% 113 22.6% 126 25.1% 54 10.8% 501 100%

Australia 2 1.0% 14 6.8% 55 26.7% 87 42.2% 48 23.3% 206 100%

Middle East 1 4.3% 4 17.4% 12 52.2% 5 21.7% 1 4.3% 23 100%

Total 126 169 246 342 198 1081

SATISFACTION WITH COST OF MEDICAL EDUCATION BY MEDICAL SCHOOL REGION

a) Chi-square test:Is there a relationship between satisfaction with the cost of med-ical education to medical school region? Yes. A chi-square test ofindependence was done to see if there is a relationship betweenlevel of satisfaction and medical school region. The results of thetest were significant, X2 (16, n = 1081) = 356.67, p < .001. Theseresults indicate that levels of satisfaction with the cost of medicaleducation are related to medical school regions. To provide morespecific information about these differences, a z-test of propor-tions was conducted.

b) Significant differences in proportions:Of interest is whether there are significant differences acrossmedical school regions for the “Dissatisfied’ category. A z-test for

proportions was done to test for significant differences betweenthe proportions. A total of four comparisons were made:Caribbean to Australia, Caribbean to Ireland, Caribbean toPoland, and Caribbean to Middle East. With the number of comparisons, a Bonferonni correction was applied to control forType 1 error. For testing significant differences, all p values mustbe less than 0.0125 (.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 andPoland (z = 3.835, p < .001). CSAs in the Caribbean were not significantly different in their levels of dissatisfaction with CSAsfrom Australia and the Middle East.


Satisfaction with Satisfaction with Cost of Medical EducationMedical Program

Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied Total

n % n % n % n % n % n %

IVery satisfied 79 18.0% 62 14.2% 120 27.4% 118 26.9% 59 13.5% 438 100%

Satisfied 46 8.3% 97 17.4% 111 20.0% 193 34.7% 109 19.6% 556 100%

Neutral 2 3.3% 7 11.7% 13 21.7% 24 40.0% 14 23.3% 60 100%

Dissatisfied 2 9.5% 2 9.5% 5 23.8% 12 57.1% 21 100%

Very dissatisfied 1 14.3% 2 28.6% 4 57.1% 7 100%

Total 127 169 246 342 198 1082

SATISFACTION WITH MEDICAL PROGRAM BY SATISFACTION BY COST OF MEDICAL EDUCATION

a) Chi-square test:Is there a relationship between a CSAs satisfaction with their medicalprogram and satisfaction with the cost of medical education? Yes. Achi-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, X2 (16, n = 1082) = 76.07, p < .001. These results indicate that satisfaction with their medicalprogram and levels of satisfaction with the cost of medical educationare related. The results indicate that higher levels of dissatisfactionwith 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 CSAsthat were very dissatisfied with their medical program and CSAs thatwere very satisfied with their medical program under the group of CSAsthat 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 CSAsthat were very satisfied with their medical program and CSAs thatwere very dissatisfied with their medical program (z = 2.742, p < .05).CSAs that were very dissatisfied with the cost of their education werealso very dissatisfied with their medical program.

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 ofthe test were significant, X2 (5, n = 1082) = 33.25, p < .001. These results indicate that year of graduation is related to intention to returnto Canada for postgraduate training. To provide more specific informa-tion 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 returnto Canada we compared 2010 versus 2011, 2010 versus 2014. Comparisons to 2015 were not done due to the small number of CSAsgraduating in that year. For CSAs intending not to return to Canada welooked at the significant difference between 2010 and 2014. With thenumber of comparisons, a Bonferonni correction was applied to control

for Type 1 error. For testing significant differences, all p valuesmust be less than 0.017 (.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 in2010 and 2014 (z = 4.419, p < .001). The closer CSAs are to graduatingthe less likely they plan on returning to Canada for postgraduate training.There is no difference between the proportion of CSAs graduating in 2010and 2011 in their intention to return to Canada.

For CSAs intending to not to return to Canada to pursue postgraduatetraining, there is a statistically significant difference between CSAsgraduating in 2010 and 2014 (z = 4.419, p < .001). Again, the closerCSAs are to graduating the less likely they plan on returning to Canadafor postgraduate training.

Year of Graduation Intention to Return to Canada for Training

Yes No Total

n % n % n %

2010 98 77.8% 28 22.2% 126 100%

2011 146 87.4% 21 12.6% 167 100%

2012 281 92.7% 22 7.3% 303 100%

2013 317 91.6% 29 8.4% 346 100%

2014 125 96.9% 4 3.1% 129 100%

2015 9 90.0% 1 10.0% 10 100%

Total 976 105 1081

YEAR OF GRADUATION BY INTENTION TO RETURN TO CANADA TO PURSUE POSTGRADUATE MEDICAL TRAINING


Is there a relationship between intention to return to Canada topursue postgraduate training and medical school region? Yes. A chi-square test of independence was done to see if there is arelationship between intention to return and medical school

region. The results of the test were significant, X2 (4, n = 1081) =10.73, p < .001. These results indicate that CSAs across all regionsplan on returning to Canada for their postgraduate training.

Medical School Intention to Return to Canada for TrainingRegion Yes No Total

n % n % n %

Ireland 255 93.8% 17 6.3% 272 100%

Poland 65 82.3% 14 17.7% 79 100%

Caribbean 454 90.6% 47 9.4% 501 100%

Australia 182 88.3% 24 11.7% 206 100%

Middle East 20 87.0% 3 13.0% 23 100%

Total 976 105 1081

REGION OF MEDICAL SCHOOL BY INTENTION TO RETURN TO CANADA TO PURSUE POSTGRADUATE MEDICAL TRAINING

Documents

Carms 2010 Csa Report