Meritocracy, Social Accountability and How to Select Canada’s Physicians

In Canada, where much of the population continues to be underserved by the medical profession, looking to characteristics of students admitted to medical school has been increasingly seen as part of the solution by some. In this post, Bolu Ogunyemi and Fola Oguynemi discuss divergent points of views on philosophy underpinning the criteria for medical admissions in Canada and discuss some practical approaches to allow all Canadian patients to receive adequate healthcare.

The field of medicine is one of the most sought after professions in this country, with admission rates around 26 – 28% of domestic applicants in a given year gaining acceptance to a Canadian medical school. Factors included in admissions decisions for medical schools include a combination of grade point average (GPA), Medical School Admissions Test (MCAT) score, extracurricular involvement, autobiographical sketch, and reference letters and interview. Many Canadian medical schools have official quotas based on applicants’ home province, area within a given province and/ or size of hometown. Competition is especially high for international applicants, for which many medical schools reserve only a handful of entry positions.

Given such a low admissions rate, there are far fewer positions than qualified applicants. How, then, should we choose those who are admitted to medical school?

One group of individuals believes that the opportunity to study medicine in Canada should be given to those who have demonstrated academic ability and display evidence of a track record of dedication. This includes MCAT score, GPA and scholarships, awards and bursaries and extra-curricular activities. In an article published in the Montréal Gazette in August 2013, Montréal-based family physician Dr Barry Slapcoff states ”the admissions process should be blind to any quality except excellence.” Those in this camp believe that students who excel in academics and other fields, regardless of demographics, will be most likely to become physicians who possess the diligence, innovation, and intelligence to propel the profession forward. Many students display their dedication by earning extremely high grade point averages and prove unsuccessful in gaining entry into medicine.

Clearly, a plethora of factors beyond academic achievement has been recognized by those in the admissions process for several years. These people are hesitant to incorporate immutable factors such as an applicant’s ethnicity (visible minority or aboriginal status) into admissions decisions. Diversity should not trump excellence and merit. Instead, the medical school admission process should function as part of a meritocracy. Approximately 85% of Canadian Universities are large, publicly-funded, non-profit institutions, while the remaining private post-secondary institutions have considerably smaller enrollment.

A divergent point of view is that the fundamental goal of training physicians in Canada is to effectively deliver quality healthcare and improve the health of Canadians who need it the most. It has been well-documented that Canadians living in rural and remote communities are least likely to receive adequate medical care. Putting this together, it makes senses to select physicians that are most likely to practice in these settings. The approximately 30% of Canadians living in rural areas suffer from higher rates of injury and premature death than their urban counterparts and have higher rates of cardiovascular and respiratory illnesses. Medical school candidates from rural backgrounds are more likely to be prepared for both nonclinical and cultural aspects of rural practice.

The FMEC report continues on to posit “little progress has been made in attracting applicants from First Nations, Inuit, and Métis communities and rural areas. Other socio-cultural and economic groups are also underrepresented.” Many Canadian medical schools have formal quotas reserved for qualified Inuit and First Nations applicants. Further, the Schulich School of Medicine and Dentistry at Western University has explicitly-stated lower academic requirements for applicants from rural and underserved regions. Many subscribers to this second school of thought may find viewing through this holistic lens appropriate.

Regardless of whichever persuasion one fancies, it is clear that there is a physician shortage throughout Canada and especially in rural and remote regions. It has been documented that exposure to rural practice settings during medical schools will increase likelihood that students will be comfortable to work in these settings.

As proportionally fewer applicants come from rural and aboriginal backgrounds, one way to provide for a diverse pool of qualified applicants is to continue to support measures to increase the proportion of applicants from these areas that consider medicine as a career without necessarily factoring in the backgrounds of these applicants into the selection process.

A second way to move forward harmoniously is by increasing exposure to medical practice with rural and aboriginal populations among medical students. Many medical schools have adopted elements of their curriculum to highlight rural medical practice including mandatory rotations in rural settings but there is considerable room for improvement.

Though a divide exists as to whether or not to consider demographic factors into admissions decisions, we believe that community-based, grassroots measures aimed at recruiting applicants under-represented among physicians and increasing exposure to students after they have began medical training are worthwhile practices.

Experience in the medical humanities proves invaluable for all clinicians. This has been recognized in Canada and there has been an increasing emphasis on formal medical humanities training at Canadian medical schools. As well, the revised Medical School Admissions Test, MCAT2015, has an entirely new section: Psychological, Social, and Biological Foundations of Behavior. Its purpose is to test applicants’ “knowledge and use of the concepts in psychology, sociology, biology, research methods, and statistics that provide a solid foundation for learning in medical school about the behavioral and socio-cultural determinants of health and health outcomes.” The official site of the standardized admission test goes on to state than “understanding the behavioral and socio-cultural determinants of health is important to the study of medicine.”

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Boluwaji Ogunyemi is a resident physician in the Department of Dermatology and Skin Science at the University of British Columbia, Vancouver, BC.

Folabomi Oguynemi is a graduate student at the Normal Paterson School of International Affairs at Carleton University, Ottawa, ON.

 

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