JERRY TENENBAUM MD FRCPC University of Toronto

1. JERRY TENENBAUM MD FRCPCUniversity of Toronto ONTARIO INTERNATIONAL MEDICAL GRADUATE PROGRAM (OIMGP) • Web site: http://www.utoronto.ca/medicine/oimg • E-mail: oimg.information@utoronto.ca

2. ONTARIO INTERNATIONAL MEDICAL GRADUATE PROGRAM (OIMGP)(1) OIMGP - created in 1986 - pilot project - MOH, CPSO, COFM • Became sole route to licensure for IMGs in 1992

3. OIMGP (2)Purposes • To provide an opportunity for IMGs to practice medicine in Ontario. • To increase number of highly skilled physicians in Ontario. • To increase diversity of the physician community to meet needs of an increasingly diverse population

4. OIMGP (3)Trainee numbers • 1986-2000 24 trainees • 2000-2001 36 trainees • 2001-2002 50 trainees • (some variability when CARMS positions are not filled in Ontario)

5. OIMGP (4)Who are they? • ~1000 unlicensed physicians in ON • ~from approximately 80 countries • including Canadian born trained abroad • 27% citizens/ most others landed immigrants • > 2/3 between 30-49 y/o

6. OIMGP (5)Applicants • ONTARIO IMG APPLICANTS • 1998-1999 165 • 1999-2000 266 • 2000-2001 286 • anticipate numbers to be >400 in subsequent years • (384 alumni to 2001-2002)

7. OIMGP (6)Admission Requirements • Citizen or permanent resident • Ontario resident for 12 months • WHO listed medical school (MD/MBBS/MBBCh) • Proficiency in English language • (primary & secondary education English or French) • TOEFL & TSE • MCCEE or MCCQE PT. 1

8. OIMGP (6b)English Requirements • Proof of English fluency required by CPSO for licensure • TOEFL (min. 237) & TSE (min.50) mandatory • Exemption: English is mother tongue (with letter proof from schools attended submitted with application)

9. OIMGP (7)Selection Process • Multiple Choice exam (250 ?s) • clinical knowledge • top 150 may go to OSCE • Objective Structured Clinical Exam (OSCE) (clinical & communication) • 14 stations: MD + SP • Task-specific checklists • Process-oriented global assessment(verbal, non-verbal, empathy, coherence)

10. OIMGP (11)Steps to Ontario Licensure • OIMG candidate applies to residency program • MCCQE Pt. 1 • MCCQE Pt. 2 • Either CCFP or RCPSC examination

11. OIMGP (8)Orientation Period • Orientation (1-2 weeks) • skills (clinical, charting, etc.) • case presentation skills • professionalism • cross-cultural communication • bioethics • functional issues (library, labs..)

12. OIMGP (9)Pre-Residency Program • 36 week training period • Medicine • Surgery • Psychiatry • Obstetrics/Gynecology • Pediatrics • Family Medicine • Emergency Medicine

13. OIMGP (10)Assessment Strategies • Entrance MCQ exam & OSCE • Standard ITER (each rotation) • Professionalism ITER (each rotation) • Exit OSCE

14. OIMGP (12)Some Costs & Figures • $200 application fee (covers MCQ) • $300 OSCE fee • $2000 tuition (for those selected) • (Canada student loans are available for eligible trainees)

15. OIMGP (13)Program Details • 5 medical schools involved • 50 positions =16T/10 UWO/8 Q/ 8 McM/ 8 O • Placement - by lottery • start date (May-June) varies with each school • Minimum 36 weeks training • Evaluation at end of each rotation (ward + examination) • Exit OSCE must be passed to complete OIMG program

16. OIMGP (14)Program Details • OIMG trainees = 4th yr.clin.clerks • Hx, PxEx, Dx, care of patients • orders countersigned by resident supervisor • Staff physician has ultimate responsibility for patients and must supervise OIMG trainees

17. OIMGP (15)Residency Training • Ontario government has certain restrictions regarding residency programs & specialties • Based upon underserviced/needed specialties and areas of province requiring these specialties

18. OIMGP (16)Available Programs • General Internal Medicine • Obstetrics/Gynecology • Psychiatry • Diagnostic Radiology • Family Medicine • Radiation Oncology • General Surgery • Paediatrics • Orthopedic Surgery • Anaesthesia • Laboratory Medicine • Community Medicine

19. OIMGP (17)Summary • AIM: The successful introduction & integration of IMGs to medical practice in Ontario. • Attention to individual issues and problems is vital • Understanding cultural diversity is essential

20. OIMGP ORIENTATION (1)Cast of Characters IMG OFFICE • Director Dr. Jerry Tenenbaum • Admin.Coord. Mary Cunningham • Secretary Stuart McAslan • Receptionist Jennifer Shaw

21. OIMGP ORIENTATIONCast of Characters CLINICAL SKILLS ASSESSMENT UNIT (CSAU) • Director Dr. Lynn Russell • Admin. Suzanne Johnson • Psychometrics Jody McIlroy • Secretary Claire Naudi

22. OIMGP ORIENTATIONStructure • 5-8 day program in April • held centrally in Toronto at Faculty of Medicine • Many invited speakers & facilitators • Aim: To prepare OIMGs for 36 week training program in an Ontario medical school

23. OIMGP ORIENTATIONClinical Skills • History Taking & Physical Exam’n • Diagnosis • Management Plans • Use of Laboratory & Imaging • Writing Orders • Charting • Use of evidence-based medicine

24. OIMGP ORIENTATIONCase Presentation Skills • How patients should be presented to team • Morning Report • Bedside • Rounds • Grand Rounds

25. OIMGP ORIENTATIONProfessionalism • Responsibility • Punctuality • Leadership • Organizational skills • Interactive skills (paramedical personnel) • Team skills • Attitudes

26. OIMGP ORIENTATIONCross-Cultural Issues • Cross-cultural communication (nuances of language etc.) • Interviewing skills • Gender issues • Cultural attitudes • Social issues

27. OIMGP ORIENTATIONBioethics • End-of-life decisions (DNR) • Giving bad news • Family encounter issues • Counseling patients • Living wills • Many other issues

28. OIMGP ORIENTATIONSurvival (Functional) • How to survive in a hospital! • On-call , post-call • Efficient use of laboratory, radiology • Interacting with paramedical personnel • Pharmacy • Library & Computers • Public Health • PAIRO, CMPA, role of Resident/ Staff

29. OIMGP ORIENTATIONThe Cast • IMG & CSAU personnel • IMG residents (other senior residents) • Language Consultant • Bioethicist • Pharmacist • Librarian (computer search expertise) • Social Worker • Educator physicians • CMPA representative • Standardized patients

30. OIMGP ORIENTATIONThe Process • Presentations to all 50 trainees • Break-out or small groups at times • Facilitation and interaction • Problem-based case presentations • Homework

31. OIMGP ORIENTATIONConclusion • ORIENTATION designed to prepare the OIMG trainee for the 36 week period of training with supervision • Help prepare trainee by discussing issues which trainee may face • Anticipate issues which may be culturally challenging.