Finding Your Way Home:Information on Rotations and

Residency in Ontario

Where Do I Start? – I have NO Where Do I Start? – I have NO connectionsconnections

Talk to everyone you know – try to find a Talk to everyone you know – try to find a shadowing opportunity at a hospital in your area shadowing opportunity at a hospital in your area on every break – this is a great networking on every break – this is a great networking opportunity. opportunity.

Ask your family doctor who the local physician Ask your family doctor who the local physician recruiter is or look this information up on-line. recruiter is or look this information up on-line. They may be affiliated with a particular hospital They may be affiliated with a particular hospital or region. or region.

Send them an e-mail and introduce yourself – ask Send them an e-mail and introduce yourself – ask them what clinical opportunities exist in your them what clinical opportunities exist in your area. area.

Where Do I Start? – I have NO Where Do I Start? – I have NO connectionsconnections

Try to meet people face to face – this is your best Try to meet people face to face – this is your best chance at creating a lasting impression – be chance at creating a lasting impression – be flexible – make it clear you are willing to work in flexible – make it clear you are willing to work in any environmentany environment

If you are from an area that is underserviced sell If you are from an area that is underserviced sell the fact that you want to practice therethe fact that you want to practice there. Talk about . Talk about your roots in the community, your family there, your roots in the community, your family there, anything that ties you to that area.anything that ties you to that area.

Did you go to a university with a medical Did you go to a university with a medical program? Did you do any research there? E-mail program? Did you do any research there? E-mail the clinical department, tell them you are an the clinical department, tell them you are an alumnus and ask about what your options are. alumnus and ask about what your options are.

First ImpressionsFirst Impressions

Be sure to ask about core rotations if this is Be sure to ask about core rotations if this is what your after– it is easier to get elective what your after– it is easier to get elective rotations and most universities have a system rotations and most universities have a system in place to apply. in place to apply.

Remember that you only have 1 chance to Remember that you only have 1 chance to leave an impression – be selective in your leave an impression – be selective in your choice of language – don’t downplay your choice of language – don’t downplay your status as an IMG and don’t oversell yourself. status as an IMG and don’t oversell yourself.

Cores or Electives?Cores or Electives? In Ontario it has been communicated to me and to In Ontario it has been communicated to me and to

the past clinical liaison that residency program the past clinical liaison that residency program directors will give preference to those students directors will give preference to those students who have pursued core clinical work in the who have pursued core clinical work in the province however elective work also gives you a province however elective work also gives you a favourable advantage. favourable advantage.

Obviously the more Canadian clinical work you Obviously the more Canadian clinical work you can secure the better. Keep in mind your electives can secure the better. Keep in mind your electives can be done in regional health units or other can be done in regional health units or other settings that are not university affiliated - this can settings that are not university affiliated - this can cut out a lot of the red tape. cut out a lot of the red tape.

Location, Location, LocationLocation, Location, Location Consider going North or going East. In both of Consider going North or going East. In both of

these areas the so called ‘12 week rule’ is less these areas the so called ‘12 week rule’ is less likely to be upheld and there obviously is a likely to be upheld and there obviously is a greater needgreater need

In Ontario, Look at the LADAU listIn Ontario, Look at the LADAU list – this a list of – this a list of underserviced areas published by the MOHLTC underserviced areas published by the MOHLTC

These spots are where IMGs who secure a These spots are where IMGs who secure a residency match via CaRMS must fulfill their 5 residency match via CaRMS must fulfill their 5 year ROS agreementyear ROS agreement

Location, Location, LocationLocation, Location, Location If you can obtain clinicals in one of these If you can obtain clinicals in one of these

communities and make connections you may have a communities and make connections you may have a better chance of securing residency later – it isn’t as better chance of securing residency later – it isn’t as bad as you think – bad as you think – Windsor, Burlington, Perry Windsor, Burlington, Perry Sound and Barrie are considered underserviced. Sound and Barrie are considered underserviced.

In Southern Ontario you are less likely to secure In Southern Ontario you are less likely to secure rotations but it is not impossible. Consider however rotations but it is not impossible. Consider however that you might only get 1 – try for 12 weeks and that you might only get 1 – try for 12 weeks and consider a rotation that be helpful to you in the consider a rotation that be helpful to you in the future. future.

The CPSO does not care where you do your The CPSO does not care where you do your rotations, only that you have fulfilled Saba’s degree rotations, only that you have fulfilled Saba’s degree requirementsrequirements

If you have a connection…If you have a connection… Great, just don’t take it for granted. Great, just don’t take it for granted. You will likely have to deal with the university affiliated You will likely have to deal with the university affiliated

hospital where the physician in question works and may hospital where the physician in question works and may encounter resistance relating to your status as a 3 year encounter resistance relating to your status as a 3 year student. student.

Some universities only offer rotations to 4Some universities only offer rotations to 4thth year students as year students as a way of preserving cores for their own students. a way of preserving cores for their own students.

Just be persistent and ask your contact to help you if you run Just be persistent and ask your contact to help you if you run into a problem.into a problem.

Prepare your CV (a link to the guidelines is at the back of Prepare your CV (a link to the guidelines is at the back of this document) this document)

Call Sandy and let her know you have a rotation set up. Call Sandy and let her know you have a rotation set up. Make sure the affiliated university has no issue with taking Make sure the affiliated university has no issue with taking you on before you call her. you on before you call her.

Ensure your immunizations are up to date. Ensure your immunizations are up to date.

Timing is EverythingTiming is Everything

You want to start the process You want to start the process no sooner but no sooner but no later than 4no later than 4thth semester semester. Your break . Your break between 3between 3rdrd and 4 and 4thth is a good time to meet with is a good time to meet with any potential contacts. any potential contacts.

When you are telling a doctor or university When you are telling a doctor or university about when you are available for rotations about when you are available for rotations consider the time you will need to write the consider the time you will need to write the step – typically students need 6-8 weeks to step – typically students need 6-8 weeks to prepare. prepare.

Rejected?Rejected?

Be prepared to hear NO a lot before you find a breakBe prepared to hear NO a lot before you find a break.. The good news is many Saba grads have been able to The good news is many Saba grads have been able to

get at least 1 core or elective in Canada, and Ontario get at least 1 core or elective in Canada, and Ontario is slowly becoming more IMG friendly.is slowly becoming more IMG friendly.

Also doing rotations in canada does not limit your Also doing rotations in canada does not limit your ability to go back to the US for residency if you ability to go back to the US for residency if you choose do do so. As long as the hospital you were at choose do do so. As long as the hospital you were at has a residency program then the rotations are has a residency program then the rotations are considered “greenbook”. considered “greenbook”.

WSIBWSIB If you are considering rotations in Northern If you are considering rotations in Northern

Ontario you will be going through NOSM – and Ontario you will be going through NOSM – and they require WSIB coverage. they require WSIB coverage.

There is now a system in place to deal with this There is now a system in place to deal with this complication but it requires you paying for private complication but it requires you paying for private insurance for 1 year. insurance for 1 year.

So even if you get only 1, 12 week rotation, you So even if you get only 1, 12 week rotation, you may be stuck with 9 months of extra insurance may be stuck with 9 months of extra insurance payments. payments.

Fortunately for now, NOSM is the only Canadian Fortunately for now, NOSM is the only Canadian school requesting this type of coverage. school requesting this type of coverage.

Applying for Residency as an Applying for Residency as an IMGIMG

The MCCEE is required for all IMGs The MCCEE is required for all IMGs It is similar to the Step 1 but has a greater It is similar to the Step 1 but has a greater

assumption of basic science info and is more assumption of basic science info and is more clinical in nature – the rep I spoke to at the clinical in nature – the rep I spoke to at the MCC told me it is more of a fusion between MCC told me it is more of a fusion between Step 1 and 2 Step 1 and 2

If You must then apply and sit for the If You must then apply and sit for the MCCQE1MCCQE1

CEHPEACEHPEA As of April 19, 2007 the Center for Evaluation of As of April 19, 2007 the Center for Evaluation of

Health Professionals Educated Abroad or the CEHPEA Health Professionals Educated Abroad or the CEHPEA replaced IMG Ontario replaced IMG Ontario

The CEHPEA evaluates all foreign gradsThe CEHPEA evaluates all foreign grads, in our case , in our case this step will come after you successfully complete this step will come after you successfully complete MCCEE and MCCE1 and are ready to apply for first MCCEE and MCCE1 and are ready to apply for first year of residency - PGY1 year of residency - PGY1

You are now required to complete the CE1 – the You are now required to complete the CE1 – the general comprehensive clinical exam general comprehensive clinical exam

The CPSO website says that preference is given to The CPSO website says that preference is given to candidates to are successful on the CE1 – however in candidates to are successful on the CE1 – however in speaking to the college I was told that those who fail it speaking to the college I was told that those who fail it are not likely to be considered in the matchare not likely to be considered in the match

MCCE2MCCE2 After 12 months of residency you are able to sit for the After 12 months of residency you are able to sit for the

MCC2 and proceed with your second year of residencyMCC2 and proceed with your second year of residency The MOHLC however has some confusing The MOHLC however has some confusing

information that suggests that core clinical work done information that suggests that core clinical work done in Canada will fulfill this 12 month requirement. I in Canada will fulfill this 12 month requirement. I don’t have a clear answer on this yet..don’t have a clear answer on this yet..

You complete your residency and then sit for the Royal You complete your residency and then sit for the Royal College exams – then you can apply for a permanent College exams – then you can apply for a permanent liscence in Canada. liscence in Canada.

Too Complicated?? Consider Too Complicated?? Consider RepatriationRepatriation

In Ontario, IMGs who have 1 or 2 years left in In Ontario, IMGs who have 1 or 2 years left in a residency program can apply for repatriationa residency program can apply for repatriation

Your application goes through one of the 5 Your application goes through one of the 5 Ontario Universities for post-graduate Ontario Universities for post-graduate residency in collaboration with the MOHresidency in collaboration with the MOH

If accepted you will be required to complete a If accepted you will be required to complete a ROS agreement in an under serviced areaROS agreement in an under serviced area

And The Easiest Route??And The Easiest Route?? Complete residency in the USComplete residency in the US Apply as a relocating MDApply as a relocating MD As of April 06 the USMLE is considered equivalent to As of April 06 the USMLE is considered equivalent to

the MCC exams but only in Ontariothe MCC exams but only in Ontario The CEHPEA will likely require you to sit for the CFPC The CEHPEA will likely require you to sit for the CFPC

(family) or RCPS (specialty)(family) or RCPS (specialty) You can apply to both the Canadian and American match You can apply to both the Canadian and American match

in the same year – keep in mind though that the in the same year – keep in mind though that the American match comes up firstAmerican match comes up first

If you match you are removed from CaRMsIf you match you are removed from CaRMs If you don’t match with CaRMs you are looking a year If you don’t match with CaRMs you are looking a year

until you can reapply until you can reapply

CaRMSCaRMS

If you don’t match with CaRMs you are If you don’t match with CaRMs you are looking a year until you can reapply looking a year until you can reapply

Although IMGs and CMGs both apply in the Although IMGs and CMGs both apply in the first round, there are parallel streams with first round, there are parallel streams with designated spots for both designated spots for both

Not all of these spots are filled every year Not all of these spots are filled every year despite the large number of applicantsdespite the large number of applicants

Recent DevelopmentsRecent Developments

With the launch of the CEHPEA it was With the launch of the CEHPEA it was decided that people accepted to FP residencies decided that people accepted to FP residencies will have to complete a pre-residency will have to complete a pre-residency assessment which delays the start of your assessment which delays the start of your residencyresidency

There is currently discussion on implementing There is currently discussion on implementing this for specialty residencies possibly in 2008this for specialty residencies possibly in 2008

Sorry to Exclude Most of the Sorry to Exclude Most of the CountryCountry

In a nutshell, the only province which students can’t In a nutshell, the only province which students can’t match in the first round is Alberta - they also require match in the first round is Alberta - they also require students doing rotations to be in their 4students doing rotations to be in their 4 thth year year

The West in general is tough but if you look at the The West in general is tough but if you look at the IMG Canada website – more resources are now in IMG Canada website – more resources are now in placeplace

In the Atlantic provinces most hospitals are officially In the Atlantic provinces most hospitals are officially or unofficially affiliated with Dal. or unofficially affiliated with Dal.

Dal will stick to the 12 week rule sometimes, so best Dal will stick to the 12 week rule sometimes, so best advice is to set things up yourself especially in NS advice is to set things up yourself especially in NS and NFLD– try the rural health centers.and NFLD– try the rural health centers.

So far the East is the most IMG and Saba friendly So far the East is the most IMG and Saba friendly

For More InformationFor More Information

IMG Canada: http://www.img-canada.ca/en/resources/img_programs.htm

MCC: http://www.mcc.ca/pdf/IMGQEI_e.pdf

CEHPEA: http://www.cehpea.ca/

CARMS: http://www.carms.ca/eng/r1_eligibility_prov_e.shtml

http://www.cpso.on.ca/

Health Force Ontario: Health Force Ontario: http://www.healthforceontario.ca