Doctors Without Residency by Tetchena Bellange, National Film Board of Canada
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There is this mentality in this country among the medical profession, and most likely in the United States from my experience, that doctors who studied medicine abroad are not as good as Canadian/US educated doctors – that they are lacking the essential skills of patient communication, problem solving, cultural understanding, and clinical skills to be able to safely practice the art of medicine in North America. There is this rumor that the cultural differences are just too great to overcome and the medical training too difficult and costly for a foreign doctor to learn. There is this opinion that there are not enough resources to pay for the extra training that foreign doctors require to be able to meet the high standards of medical care. It always comes down to this rationalization. Of course, anyone with an understanding of medicine, anyone who has worked as a doctor abroad, any foreign doctor that has passed any of the Canadian or American licensing exams, and especially the IMGs already working in Canada or the United States know that this rationalization is not only unfounded, but is in fact a distortion of the truth.
Beyond the language barrier, a barrier that is present in any country and one which can be overcome by simply learning the language, there is no reason why a foreign educated doctor that has passed the required medical licensing exams cannot enter and successfully complete any residency program, effectively practice in Canada, and meet all the required standards. Today’s medical schools of course do not focus only on an isolated group of diseases, but have a holistic approach to medicine. Has anyone ever seen an internal medicine textbook that just covers malaria, or HIV, but that has forgotten to cover heart disease or oncology? Czech medical textbooks, for example, cover every topic in medicine and Czech medical schools examine in all areas of medicine during state examinations. If one prefers to use American or British textbooks from which to learn, this is also a viable option because most of these books also cover the expected fields of medicine. Some books are better than others, there are also specialized books, but doctors and recognized medical institutions generally choose the best sources, and tend to work towards the best curriculum. As medical students and graduates, we study from many sources because the amount of knowledge is so large and is growing. The more one reads, the more one knows. Medicine is the science of human disease, and it has to cover all of human disease because all of human disease is what is encountered during medical practice. How is it possible for internationally recognized medical schools and the doctors who graduate from them to be criticized and to have to defend their knowledge and titles, even when these international medical graduates pass all the licensing exams that North American students must pass to be granted the title of MD. The title “Doctor of Medicine” means exactly that, it does not stand for “Doctor of Malaria”. Where does this animosity come from?
With today’s information technology, with so many medical resources being published and online preparation courses available (e.g. Toronto Notes, CanadaQBank, USMLEWorld), and so many exams being legitimately open to IMGs (e.g. MCCEE, MCCQE Part 1 and 2, NAC examination, USMLE Steps 1, 2CK, 2CS, 3), it is difficult to understand why North American standards of medicine cannot be effectively learned and mastered. The atmosphere to learn medicine has never been brighter thanks to advancements in online learning. Medical knowledge is not unique to every country – the science of medicine is the same everywhere. What really matters is access to quality information and funding for hands-on training, and of course funding for the delivery of health care. Hands-on training is learned during residency. No medical graduate, not even from Canada, is able to safely practice medicine without first undergoing residency training. If one has access to residency, then one can practice medicine safely and effectively. Excluding doctors who have passed the required licensing examinations from residency is completely unfounded.
Also, doctors, hospitals, and research institutions collaborate at international levels to help solve complex medical issues worldwide such as cancer, heart disease, infectious diseases, and major determinants of health such as economic inequality, poverty, and social injustice. Important medical research is being accomplished around the world. Canada is in no way an isolated medical community that does not need the cooperation of other international medical professionals. Medical problems are challenging and require an international effort for humanity to have a chance at finding solutions. Look at all the international research that is being published every year from so many countries around the world. Evidence-based medicine is founded on international efforts and research, not only on Canadian research. The practice of modern medicine and health care in Canada is based on evidence-based medicine from around the world. Thousands of doctors, scientists, and researchers have contributed internationally. I can give countless number of examples throughout history of international contributions to science and medicine – solid organ and bone marrow transplantation, cardiac pacing, minimally invasive surgery, surgery and anesthesiology, vascular catheterization procedures, medical imaging technology, the development of antibiotics, pharmaceuticals, chemotherapeutic agents, PCR, genetic engineering, the prospects of gene therapy, the genetic principles of heredity and disease, the structure of DNA, the human genome project, tissue engineering and stem cell technology all owe their existence to international collaboration and contributions.
To say that foreign educated doctors are not skilled or capable enough to practice medicine in North America is an insult to the international community. It is arrogant, unfounded, and can in fact be viewed as discrimination. The World Health Organization (WHO) is recognized internationally as a legitimate body guiding the principles and practice of medicine worldwide. It is also composed of doctors from all around the world. Some of the greatest scientists, minds, and human beings the world has ever known have been foreigners. Canada is considered a multicultural country – immigrants have always played an important role in her development and evolution. As a former colonial nation, everyone was at one point a foreigner to Canada, with the exception of the native peoples of Canada who really are the true native Canadians. I think one should look at the facts before one openly presents ignorant statements to the public.
The Canadian medical establishment needs to seriously review their approach and demeanor toward foreign educated doctors. What type of example worldwide does Canada want to set, in what light does Canada want to be viewed on the international podium, what fundamental human rights does Canada embrace and protect for its citizens and residents. The leaders of the medical establishment have a responsibility to be accurate and truthful, not only to foreign educated doctors, but also to the Canadian public whom they serve. Above all, they have a responsibility to respect and uphold human rights, and the principles upon which Canada was founded.
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