JERRY TENENBAUM MD FRCPC University of Toronto Web site: ONTARIO INTERNATIONAL MEDICAL GRADUATE PROGRAM (OIMGP)

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

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

OIMGP (3) Trainee numbers trainees trainees trainees (some variability when CARMS positions are not filled in Ontario)

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 y/o

OIMGP (5) Applicants ONTARIO IMG APPLICANTS anticipate numbers to be >400 in subsequent years (384 alumni to )

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

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)

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)

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

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

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

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

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)

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

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

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

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

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

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

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

OIMGP ORIENTATION Structure 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

OIMGP ORIENTATION Clinical Skills History Taking & Physical Exam’n Diagnosis Management Plans Use of Laboratory & Imaging Writing Orders Charting Use of evidence-based medicine

OIMGP ORIENTATION Case Presentation Skills How patients should be presented to team Morning Report Bedside Rounds Grand Rounds

OIMGP ORIENTATION Professionalism Responsibility Punctuality Leadership Organizational skills Interactive skills (paramedical personnel) Team skills Attitudes

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

OIMGP ORIENTATION Bioethics End-of-life decisions (DNR) Giving bad news Family encounter issues Counseling patients Living wills Many other issues

OIMGP ORIENTATION Survival (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

OIMGP ORIENTATION The 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

OIMGP ORIENTATION The Process Presentations to all 50 trainees Break-out or small groups at times Facilitation and interaction Problem-based case presentations Homework

OIMGP ORIENTATION Conclusion 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.