A Research Program in Medical Education in Canada

The current interest in medical education and the proposed expansion of medical education facilities have stimulated the development of a research program by the secretariat of the Association of Canadian Medical Colleges. The projects planned and now in progress include: (1) studies of the cost of medical education in Canadian teaching hospitals and medical schools; (2) a study of the basic medical science departments in Canada with special reference to the occupational careers of scientists who have received M.Sc. and Ph.D. degrees in those departments; (3) establishment of a student registry to facilitate prospective studies of Canadian medical students; (4) a survey of the residents in training in Canadian hospitals to obtain their evaluation of their training experience.     

Polysomnography: addressing the need for standards.

The field of sleep disorders medicine is facing enormous challenges as it strives to gain recognition from the medical profession, the public and government. One of these challenges is to ensure that limited resources for diagnosis are used wisely. The authors argue that the standards for polysomnography developed by the Canadian Sleep Society and the Canadian Thoracic Society (see pages 1673 to 1678 of this issue) will go a long way toward ensuring that this expensive resource is used prudently. In the mean-time, more research is needed to determine valid measures of the impact of sleep disorders and to establish the reliability of different diagnostic methods.     

Dentistry in medical education: results of a comprehensive survey

A survey of all U.S. and Canadian medical schools was undertaken to assess the current extent and nature of instruction in dental topics for medical students. The perceived importance of including such instruction in the undergraduate medical curriculum was ascertained, and barriers to teaching dental topics to medical students were identified.     

That Delilah, Shampoo

Particularly since World War II physical medicine and rehabilitation have assumed a growing importance. The efforts of the Canadian Association of Physical Medicine and Rehabilitation, following a survey of Canadian universities, to increase the theoretical and practical teaching of physiatrics are emphasized. It is considered important that the teaching of physical medicine and rehabilitation should be carried out concurrently with other medical and surgical teaching programs. Paramedical and auxiliary rehabilitation personnel should participate in the teaching program. The number of hours devoted to physiatrics should be increased, and the medical student should be permitted to choose physical medicine and rehabilitation as a part of his internship program.     

Attitudes of healthcare professionals and the public towards the sale of kidneys for transplantation.

We conducted a survey of attitudes towards the sale of kidneys for transplantation within and without the medical community. Half of those polled received a case of a young man in India whose only chance for survival was to purchase a kidney, the other half a case of a Canadian man who was suffering side-effects from dialysis and had been on the transplant waiting list for three years. We found the percentage of responses allowing the patients to purchase a kidney was similar for the two cases (40 per cent in the Canadian case and 49 per cent in the Indian case). The medical groups had much lower rates of approval of this practice than the public. In all groups those allowing the practice showed similar concerns about regulation. This survey indicates public opinion to be contrary to public policy.     

A survey of resuscitation training in Canadian undergraduate medical programs.

OBJECTIVES: To establish a national profile of undergraduate training in resuscitation at Canadian medical schools, to compare the resuscitation training programs of the schools and to determine the cost of teaching seven resuscitation courses. DESIGN: Mail survey in 1989 and follow-up telephone interviews in 1991 to update and verify the information. SUBJECTS: The undergraduate deans of the 16 Canadian medical schools. INTERVENTION: The mail survey asked five questions: (a) Is completion of a standard first aid or cardiopulmonary resuscitation (CPR) course a requirement for admission to medical school? (b) Are these courses and those in basic and advanced cardiac, trauma and neurologic life support for children and adults provided to undergraduate students? (c) During which undergraduate year are these courses offered? (d) Is their successful completion required for graduation? and (e) Who funds the training courses? RESULTS: The medical schools placed emphasis on the seven courses differently. More than half the schools required the completion of courses before admission or taught some courses but did not require the completion of the courses for graduation. On average, fewer than three of the seven courses were taught, and the completion of fewer than two was required for graduation. About half of the courses were funded by the universities. The annual projected maximum cost of teaching the seven courses was $1790 per medical student. CONCLUSION: The seven resuscitation courses have not been fully implemented at the undergraduate level in Canadian medical schools.     

Guidelines on the use of blood glucose meters and nonmeter blood glucose reagent strips in hospitals. Committee on Monitoring Devices, Canadian Association of Pathologists.

A cross-sectional survey of Canadian hospitals carried out in 1984 revealed a large diversity of practices in the use of blood glucose meters and nonmeter blood glucose reagent strips and of providers of this service. Most hospitals lacked guidelines and acceptable delegation of quality control. The results prompted the Committee on Monitoring Devices of the Canadian Association of Pathologists, composed of representatives of the medical profession, professional organizations, industry and an accrediting organization, to develop guidelines on the use of blood glucose monitoring devices in hospitals.     

Status of nutrition education in Canadian dental and medical schools

To investigate the present status of nutrition education for dentists and physicians in Canada, we conducted a survey of the nutrition education programs in 10 Canadian dental and 16 medical schools in the academic year 1982-83. Seven of the dental schools and seven of the medical schools had a separate course in nutrition. The average duration of these courses was 22 hours for the dental schools and 26 hours for the medical schools. Nutrition education was integrated with another discipline in 4 of the dental schools and 11 of the medical schools. The average duration of this type of instruction was 14 hours for the dental schools and 18 hours for the medical schools. Six of the dental schools and eight of the medical schools employed a nutritionist/dietitian to provide instruction in nutrition. We recommend that courses in basic and applied clinical nutrition be incorporated throughout the curricula of Canadian dental and medical schools, and that personnel trained in clinical nutrition be employed to provide instruction in this area.     

Standards for polysomnography in Canada. The Standards Committees of the Canadian Sleep Society and the Canadian Thoracic Society.

OBJECTIVE: To develop standards for polysomnography in Canada in order to assist in the uniform provision of diagnostic and therapeutic services related to sleep disorders. OPTIONS: Uniform testing versus no current Canadian standards. OUTCOMES: Uniform delivery of health care; reduction in number of repeat studies and their attendant costs. EVIDENCE: Availability of diagnostic laboratories and services, and survey responses (written and oral) from directors of sleep laboratories; the American Thoracic Society statement on indications and standards for cardiopulmonary sleep studies was used as a template. VALUES: Acceptable standards of practice were based on consensus opinion of the standards committees of the Canadian Sleep Society and the Canadian Thoracic Society. The committees comprised specialists in neurology, psychiatry, psychology, respirology and polysomnographic technology; family practitioners and otolaryngologists were also consulted. BENEFITS, HARMS, COSTS: Improved level of care and reduction in duplicate or unnecessary testing; establishment, with available resources, of diagnostic sleep laboratories by appropriately qualified physicians in areas where polysomnography is unavailable. RECOMMENDATIONS: Health care practitioners involved in the diagnosis and treatment of sleep disorders should possess a minimum amount of training (both clinical and research) in sleep disorders medicine. The variables recorded and findings entered in a patient's report must be relevant to the sleep disorder under investigation. The recording equipment must provide reliable, accurate and reproducible data and lend itself to appropriate calibration and quality-control procedures. Facilities for sleep studies must meet patient care safety standards, with provisions for emergency or resuscitative measures when necessary; all personnel must be trained in basic cardiopulmonary resuscitation. VALIDATION: No previous standards concerning polysomnography in Canada exist. The recommended standards were reviewed by all members of the Canadian Sleep Society and a revised document was approved by the Standards Committee of the Canadian Sleep Society and by the Standards and Executive committees of the Canadian Thoracic Society. SPONSORS: These standards are endorsed by the Canadian Sleep Society and the Canadian Thoracic Society. The cost of preparing this statement was borne by the individual members of the standards committees; no external funding was provided.     

Canadian pediatricians: demographic characteristics, perceptions of training, and continuing medical education.

A nationwide survey of Canadian pediatricians was undertaken to answer questions about demographic and practice characteristics, perceptions of the quantity and quality of residency training in relation to the realities of practice, and the patterns of use and the value of continuing medical education. The findings included a lower average age of pediatricians from that determined 10 years earlier, a higher proportion of women practising pediatrics, and higher proportions of pediatricians entering practice in smaller communities, doing geographic full-time university work and doing mainly consulting work. Pediatrics is still perceived as an attractive discipline, but there is dissatisfaction with the quantity and quality of training in adolescent medicine, ophthalmology, dermatology, psychosocial pediatrics and orthopedics. The changing patterns of continuing medical education among the most recent certificants suggest a need for journals and professional societies to assess how they can better meet the needs of Canadian pediatricians in this area.     

A survey of postgraduate training for family practice

The results of a survey of Canadian primary care physicians for the Canadian Medical Association (CMA's) Task Force on Education for the Provision of Primary Care Services are reported. Recent Canadian medical school graduates in primary care practice reported that the three major training routes (rotating and mixed internships and family medicine residencies) each prepared them differently for practice. The graduates of 2-year family medicine residencies were more satisfied with their preparation than were the graduates of the other major training routes. A 2- or 3-year family medicine residency was preferred by 50% of the respondents, although only 33% of them had actually taken one of these routes. There was considerable agreement in the respondents' assessments of the types of postgraduate education needed for primary care practice. The results of this survey were consistent with the recommendations in the final report of the CMA's task force.     

Rating authors' contributions to collaborative research: the PICNIC survey of university departments of pediatrics. Pediatric Investigators' Collaborative Network on Infections in Canada.

OBJECTIVES: To determine how department chairs in pediatrics rate involvement in medical research and to determine whether faculty deans' offices have written criteria for evaluating research activity when assessing candidates for promotion or tenure. DESIGN: Cross-sectional mailed survey and telephone survey. SETTING: Canadian faculties of medicine. PARTICIPANTS: Chairs of the 16 Canadian university departments of pediatrics and deans' offices of the 16 university medical faculties. MAIN OUTCOME MEASURE: Weight assigned by department chairs to contributions to published research according to author's research role and position in list of authors and the method of listing authors. RESULTS: Fifteen of 16 chairs responded. Twelve submitted a completed survey, two described their institutions' policies and one responded that the institution had no policy. Eleven reported that faculty members were permitted or requested to indicate research roles on curricula vitae. There was a consensus that all or principal investigators should be listed as authors and that citing the research group as collective author was insufficient. The contribution of first authors was rated highest for articles in which all or principal investigators were listed. The contribution of joint-principal investigators listed as first author was also given a high rating. In the case of collective authorship, the greatest contribution was credited to the principal investigator of the group. Participation of primary investigators in multicentre research was rated as having higher value than participation in single-centre research by seven respondents and as having equal value by four. Only one dean's office had explicit written criteria for evaluating authorship. CONCLUSIONS: Most departments of pediatrics and medical faculty dean's offices in Canadian universities have no criteria for assessing the type of contribution made to published research. In view of the trend to use multicentre settings for clinical trials, guidelines for weighting investigators' contributions are needed.     

Canadian-trained Physicians in United States Internships and Residencies: “Operation Retrieval” and Report of Statistics, 1966-1968

In response to a shortage of medical teachers and scientists, A.C.M.C. began “Operation Retrieval” in 1967 in an effort to contact and to survey graduates of Canadian medical schools who are interns and residents in the United States. This paper describes the publications produced for these graduates, and the concerns of graduates as discovered by on-site visits to Los Angeles, Boston and New York. These concerns centre around difficulties in communication with Canada. This paper also gives a statistical report on the numbers of graduates who are interns and residents in the United States, and the locations, fields of specialization and years of graduation of residents. The decreasing numbers are believed to reflect improving Canadian facilities as well as difficulties associated with the American military draft.     

Fear of ostracism still silences some gay MDs, students.

"Coming out" remains a very major decision for a gay or lesbian medical student. Canadian students interviewed for this article say they have feared being ostracized by their peers or encountering bias among older faculty members. A recent survey by the US-based Gay and Lesbian Medical Association found that 59% of gay and lesbian physician and medical student respondents have experienced job-related discrimination because of their sexuality. However, other gay/lesbian physicians and students are finding that their coming out is being greeted with tolerance, acceptance and understanding.     

Preventing alcohol problems: survey of Canadian medical schools.

In preparation for a national conference on medical education in the prevention of alcohol problems, a survey of conference participants was conducted. Participants were undergraduate and postgraduate representatives from each Canadian medical school and representatives from 11 provincial and territorial alcohol and other drug agencies. There was agreement that physicians and medical schools have important roles in prevention and treatment of alcohol problems, with "traditional" medical roles seen as the most important. Current training is variable and was seen as inadequate, with more time devoted to treatment than prevention. To correct this situation, renewed priorities and faculty leadership are needed. Respondents felt that there should be uniform standards for assessing undergraduate students' skills in dealing with alcohol problems. Provincial alcohol and other drug agencies are underused in medical education in the prevention and treatment of alcohol problems.     

CMA membership survey: opinions on issues facing the medical profession

A sample survey of Canadian Medical Association (CMA) members, conducted in early summer 1985 and designed to provide information to help guide the association's activities and policies, shows that most Canadian physicians support involvement in political activities both by CMA and by indivudual physicians. A majority wishes to maintain the concept of extra/balance billing, to pursue the position that the health care system is underfunded and favours medicare premiums and hospital user fees as the preferred methods for increasing revenue.

Most respondents believe that the number of doctors in Canada is about right but would prefer any reduction to be achieved by cutting medical school admissions or reducing postgraduate training positions open to graduates of foreign medical schools.

Most of those members who know of CMA policies on a number of health care issues agree with them and also find them useful, but a significant proportion are not aware of their content.

There is support for compulsory payment of dues by all licensed physicians to both their provincial medical association and CMA. A majority would like more information on pharmaceutical products and additional membership surveys.

     

Serum cholesterol and triglyceride measurements in Canadian physicians.

In a study of serum cholesterol and triglyceride concentrations in male physicians, blood was drawn after fasting from 2071 registrants at 17 Canadian medical meetings from 1968 to 1973. Eight regional medical laboratories participated in the study. About two thirds of the samples were analysed in one of two laboratories to diminish method variations. When chylomicronemia, hyperglycemia or extremely high triglyceride values were detected, suggesting nonfasting, the data were discarded. The mean serum cholesterol value for the total study population was 233.9 plus or minus 1.22 mg/dl and the mean serum triglyceride value, 150.5 plus or minus 2.48 mg/dl. The mean values and the prevalence of elevated values (cholesterol larger than or equal to 250 mg/dl; triglyceride larger than or equal to 150 mg/dl) were related to age. Of the total study population 34.7% had elevated cholesterol values and 36.2% had elevated triglyceride values; only the cholesterol value was elevated in 17.5%, only the triglyceride value in 19.6% and both values were elevated in 16.8%. Although this was not a random sampling of Canadian physicians or of Canadian men, our findings of elevated serum lipid values were similar to those in French Canadian civic workers, American executives and Scandinavians, and somewhat higher than those in the Albany, New York and Framingham populations, but distinctly higher than those reported by a recent Nutrition Canada survey.     

On-campus physicians witnessing changes in medical problems faced by university students.

Most Canadian universities offer on-campus health services for their students. Ten years ago minor health problems such as infections, cuts and bruises were the common causes of visits to student health centres, but today medical staff report that students are seeking help for more serious problems such as sexually transmitted diseases, stress, sports injuries, eating disorders and asthma and allergies. Many are also seeking psychiatric counselling.     

Projections of Graduates from Canadian Medical Schools, 1970-81

This paper sets forth the projections made by the various Canadian medical schools of first-year undergraduate enrolment through 1977-78. Non-Canadian enrolment and student attrition are discussed and some assumptions are made concerning their levels up to 1981. In conclusion, a set of projections on Canadian and landed immigrant graduates from Canadian medical schools during the period 1970-1981 is offered. The national projections are broken down by medical school and province.

The results of this paper indicate that Canadian medical schools will graduate 1019 Canadians and landed immigrants in 1970, 1052 in 1971, 1064 in 1972, 1113 in 1973, 1250 in 1974, 1342 in 1975, 1377 in 1976 and 1480 in 1981.