Can we finally change the system?
CMAJ 1997;157:136
Re: What are the facts concerning the number of residency
positions in Canada?, by Dale Dauphinee and Dianne Thurber, Can
Med Assoc J 1997;156:665-7; [full text / résumé] and Little room for error in Canada's
postgraduate training system, by Sandy Robertson, CMAJ
1997;156:682-4 [full text / en bref]
See response by: W.D. Dauphinee, A.D. Thurber
The size and makeup of the postgraduate training system is determined by 3 main factors: the number of training positions, the number of entrants and the training ratio of family physicians to specialists. The number of training positions must respond to the other 2 factors, rather than being the fixed or primary determinant. As Dauphinee and Thurber note, changes in the training (practice) ratio have a significant impact on the number of postgraduate positions required.
The formal education continuum begins with entry into medical school and ends with licensure and entry into practice. It is not productive, or, arguably, morally justified, to deny undergraduates an opportunity to move into the postgraduate component and, eventually, medical practice.
Provincial ministries of health are concerned about the immediate cost of the postgraduate positions they fund and look to further reductions to save money. They will need to provide, at a minimum, financial support for the postgraduate training of graduates of Canadian medical schools if they want to ensure that the medical education continuum is realized for both individuals and society. Some argue against graduates of Canadian schools being guaranteed postgraduate training in Canada; graduates of other professional schools enjoy no such guarantee. This argument denies the reality of the medical education continuum, artificially splits it into the undergraduate and postgraduate phases and overlooks the fact that medical graduates cannot be licensed and enter practice without a prescribed period of postgraduate training, available only through accredited educational programs that are funded mainly by government. Therefore, if governments continue to regulate and fund postgraduate medical education, they must also preserve the integrity of the education continuum and provide sufficient flexibility to permit extra preparation for academic careers, rural and remote practice, remediation and re-entry of practising physicians.
Robert F. Maudsley, MD
Vice-President
Medical and Academic Affairs
IWKGrace Health Centre
Halifax, NS
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