Perceptions of bias in the selection of international medical graduate residency applicants in Canada

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DOI:

https://doi.org/10.36834/cmej.73320

Abstract

Background: In Canada, international medical graduates (IMG) consist of immigrant-IMG and previous Canadian citizens/permanent residents who attended medical school abroad (CSA). CSA are more likely to obtain a post-graduate residency position than immigrant-IMG and previous studies have suggested that the residency selection process favours CSA over immigrant-IMG. This study explored potential sources of bias in the residency program selection process.

Methods: We conducted semi-structured interviews with senior administrators of clinical assessment and post-graduate programs across Canada. We asked about perceptions of the background and preparation of CSA and immigrant-IMG, methods applicants use to improve likelihood of obtaining residency positions, and practices that may favour/discourage applicants. Interviews were transcribed and a constant comparative method was employed to identify recurring themes. 

Results: Of a potential 22 administrators, 12 (54.5%) completed interviews. Five key factors that may provide CSA with an advantage were: reputation of the applicant’s medical school, recency of graduation, ability to complete undergraduate clinical placement in Canada, familiarity with Canadian culture, and interview performance. 

Conclusions: Although residency programs prioritize equitable selection, they may be constrained by policies designed to promote efficiencies and mitigate medico-legal risks that inadvertently advantage CSA. Identifying the factors behind these potential biases is needed to promote an equitable selection process.

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References

Banner S, McKiver A, Rattanasithy S, Cassie J, Woodward C, Ford R. Canadian students studying medicine abroad. Ottawa: Canadian Residency Matching Service; 2010 [Available from: https://www.carms.ca/pdfs/2010_CSA_Report/CaRMS_2010_CSA_Report.pdf [Accessed on Aug 18, 2021].

Thomson G, Cohn K. IMG selection: independent review of access to postgraduate programs by international medical graduates in Ontario. Volume 2: analysis and background. Toronto: Ontario Ministry of Health and Long-Term Care and the Council of Ontario Universities; 2011. Available from: http://www.health.gov.on.ca/en/common/ministry/publications/reports/thomson/v2_thomson.pdf. [Accessed on Aug 18, 2021].

Thomson G, Cohn K. IMG selection: independent review of access to postgraduate programs by international medical graduates in Ontario. Volume 1: findings and recommendations [Internet]. Toronto: Ontario Ministry of Health and Long-Term Care and the Council of Ontario Universities; 2011. Available from: http://www.health.gov.on.ca/en/common/ministry/publications/reports/thomson/v1_thomson.pdf. [Accessed on Aug 18, 2021].

Mathews M, Kandar R, Slade S, Yi Y, Beardall S, Bourgeault I. Realization of entry-to-practice milestones of Canadians who studied medicine abroad and other international medical graduates: a retrospective cohort study. CMAJ Open. 2017;5(2):E476-82. https://doi.org/10.9778/cmajo.20160144

Medical Council of Canada. Phasing out the MCCEE. MCC:2022. Available from: https://mcc.ca/news/phasing-out-of-the-mccee/ [Accessed on May 20, 2022].

Medical Council of Canada. Application and eligibility. [Internet]. MCC:2022. Available from: https://mcc.ca/examinations/mccqe-part-i/application-information/ [Accessed on May 20, 2022].

Canadian Residency Matching Service. Eligibility criteria. CaRMs: 2021 [cited 2021 Aug 05]. Available from: https://www.carms.ca/match/r-1-main-residency-match/eligibility-criteria/ [Accessed on Aug 05, 2021].

Andrew RF. How do IMGs compare with Canadian medical school graduates in a family practice residency program? Can Fam Physician. 2010;56:E318-22.

Bates J, Andrew R. Untangling the roots of some IMGs poor academic performance. Acad Med. 2001;76(1):43-6.

Szafran O, Crutcher RA, Banner SR, Watanabe M. Canadian and immigrant international medical graduates. Can Fam Physician. 2005;51:1242-3.

Giacomini M. The SAGE handbook of qualitative methods in health research. Bourgeault I, Dingwall R, De Vries R, editors. London: SAGE Publications Ltd.; 2010.

Berg BL. Qualitative research methods for the social sciences. 2nd ed. Boston: Allyn and Bacon; 1995.

Guest G, MacQueen KM, Namey EE. Applied thematic analysis. Los Angeles: SAGE Publications Ltd.; 2012.

Campbell JL, Quincy C, Osserman J, Pedersen OK. Coding in-depth semistructured interviews: problems of unitization and intercoder reliability and agreement. Sociol Methods Res. 2013;42(3):294-320.

Creswell JW. Research design - qualitative, quantitative and mixed methods approaches. 4th ed. Los Angeles: SAGE Publications Ltd.; 2014.

Rowan M, Huston P. Qualitative research articles: information for authors and peer reviewers. CMAJ. 1997;157:1442-6.

Saarjärvi M, Bratt E-L. When face-to-face interviews are not possible: tips and tricks for video, telephone, online chat, and email interviews in qualitative research. Eur J Cardiovasc.Nurs. 2021;20:392-396.

The Association of Faculties of Medicine. DataPoint! International medical graduates and Canadians studying abroad. Ottawa. 2012 Available from: https://www.afmc.ca/web/sites/default/files/pdf/2012-DATAPOINT_EN.pdf [Accessed on Aug 18, 2021].

Bandiera G, Abrahams C, Ruetalo M, Hanson MD, Nickell L, Spadafora S. Identifying and promoting best practices in residency application and selection on a complex academic health network. Acad Med. 2015;90(12):1594-601. https://doi.org/10.1097/acm.0000000000000954

The Association of Faculties of Medicine. AFMC student portal 2021. Available from: https://www.afmcstudentportal.ca/ [Accessed on Aug 18, 2021].

Bandiera G, Regehr G. Evaluation of a structured application assessment instrument for assessing applications to Canadian postgraduate training programs in emergency medicine. Acad Emerg Med. 2003;10:594-8. https://doi.org/10.1111/j.1553-2712.2003.tb00041.x

Bandiera G, Regehr G. Reliability of a structured interview scoring instrument for a Canadian postgraduate emergency medicine training program. Acad Emerg Med. 2004;11(1):27-32. https://doi.org/10.1197/j.aem.2003.06.011

Grierson LEM, Mercuri M, Brailovsky C, et al. Admission factors associated with international medical graduate certification success: a collaborative retrospective review of post-graduate medical education programs in Ontario. CMAJ Open. 2017;5(4):E785-90. https://doi.org/10.9778/cmajo.20170073

Schabort I, Mercuri M, Grierson LEM. Predicting international medical graduate success on college certification examinations: responding to the Thomson and Cohl judicial report on IMG selection. Can Fam Phys. 2014;60:E478-84.

Mathews M, Kandar R, Slade S, Yi Y, Beardall S, Bourgeault I. Examination outcomes and work locations of international medical graduate family medicine residents in Canada. Can Fam Phys. 2017;63:776-83.

Robinett K, Kareen R, Reavis K, Quezada S. A multi-pronged antiracist approach to optimize equity in medical school admissions [online ahead of print 2021 Jun 26]. Med Educ. https://doi-org.qe2a-proxy.mun.ca/10.1111/medu.14589

Novick G. Is there a bias against telephone interviews in qualitative research? Res Nurs Health. 2008;31(4):391-198.

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Published

2022-09-20

How to Cite

1.
Mathews M, Bourgeault I, Ryan D. Perceptions of bias in the selection of international medical graduate residency applicants in Canada. Can. Med. Ed. J [Internet]. 2022 Sep. 20 [cited 2023 Dec. 5];14(2):16-22. Available from: https://journalhosting.ucalgary.ca/index.php/cmej/article/view/73320

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Original Research