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January 4th 2014

VOLUME 11 ISSUE 2

Special collaboration!!

“Will you come back to Work here?” By Valérie Desrosiers (p.15)

Q E M F o f In In this issue: Intro from the president

2

IFMSA Review

3

Engagement

5

Spa Agreement, Via Rail and everything that can reduce our students’ stress

7

Prohibited Practices during Interviews for Residency: a Quick Overview

11

Well-being Day

13

“Will you come back to work 15 here?”


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Intro from the president Dear fellow students and future colleagues, As you probably already know, medical studies rarely go hand in hand with relaxation and are too often associated with stress, work overload and exhaustment. For this reason, we have conducted in 2011 a survey on the well-being of externs and then produced a well-being charter. In this context, the third edition of Externs Well-being Day will take place in Quebec next February 21st! Madeleine Plaisance, our Delegate for Academic Affairs, will present feedback on the charter, as well as a sneak preview of the event’s details. You will also have the possibility to read on the services that we offer and that can reduce your stress. We have also found some tips and tricks that will help you prepare for the imminent CaRMS interviews. On a lighter note and as we are already looking

forward to spring, you will be able to read about the top 10 sugar shacks! The FMEQ is dedicated to serving students and we work hard so that medical students can continue their studies while at the same time maintaining a balanced lifestyle. I therefore wish you a good reading of this issue of Info-FMEQ and, above all… take the time to relax! If you have any questions or comments, don’t hesitate to write to us, we are here at your service. Good reading!

Valérie Martel President


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IFMSA-Québec Review This beginning of a new year is not only a sign of renewal, but also the beginning of a winter session that promises to be full of events and activities for all the members of the Fédération médicale étudiante du Québec. IFMSA-Québec, its international branch that aims to improve health here and elsewhere, proposes several continuous activities. They will touch you, mobilize you, teach you about the health issues of the 21st century. Training in Leadership and World Health, from February 7 to February 9 2014 The “Training New Trainers” (TNT) activity of IFMSA-Québec is a week-end of high quality training by and for medicine students. Proud of its success last year in Saguenay, we make a comeback this year in Trois-Rivières, from February 7 to February 9 2014. These workshops are given by experienced students, with the participation of an international expert. You will also have the chance this year to choose between two sections, presented simultaneously: the first is about leadership and communication, and the second one pertains to advocacy and world health. It is a great

opportunity for you to develop your skills in leadership, team management and public health: tools that will be very helpful to you as a doctor! You have until February 19 to register. The costs for participation will be approximately $ 40-50, including accommodation, transport and meals. You can go on our website for more information at www.ifmsa.qc.ca. World Health Organization Simulation, March 28-30 2014 The “Montreal World Health Organization Simulation”, also called MonWHO, is an IFMSA-Québec project that offers participants the chance to take part in a three days simulation of a WHO General Assembly. The event will take place in Montreal from March 28 to March 30 2014. The chosen theme is healthcare access, with special attention given to inequalities. The event’s mission is to give students a chance to familiarize themselves with world health politics, to understand better the role of the WHO and to expose students to health social determinants in a context of globalization. For more information: www.monwho.org


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World Health Symposium, April 26-27 2014 The World Health Symposium is already at its sixth edition. This year, the event will take place on April 26 and 27 at Université de Montréal. The team has been working hard since last September to offer you a quality event that gathers different players from the health community and from various sectors, to discuss, debate and talk about industrialization in healthcare. You will have the possibility to register in the next few weeks. If you have any questions, please write to csm@ifmsa.qc.ca.

International Summer Internships – To Come IFMSA-Québec will soon offer you a newsletter dedicated to summer internships in medicine and healthcare throughout the world. Most of them are summer schools (in various formats) in Europe and Asia. If you don’t want to miss the newsletter, you can go on our Facebook page and subscribe to it directly.

Finally, our spring congress will take place on May 10 and 11 2014 in Montreal (the exact location is still to be determined). This represents a beautiful opportunity to familiarize yourself with the activities of IMFSAQuébec and even run for one of the leadership positions. If you have questions or comments, don’t hesitate to write directly to me at president@ifmsa.qc.ca or at international@fmeq.ca. I will be happy to answer.

Claudel Pétrin-Desrosiers

IFMSA President Delegate for International Affairs


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Engagement Hello everyone, First of all, I would like to take this opportunity to wish you and your academic delegation good luck for the 2014 MedGames. I also wish to congratulate the organizing committee for its exceptional work.

Along these same lines, I would like to continue with some thoughts about an issue that is very important to me: student engagement. Most people will say that studying medicine already takes too much of our time and that once family, friends and other interests are taken into consideration, there’s not much time left for engagement. As for me, involvement is an integral part of my daily life; it allows me to unwind and to enjoy my experience as a university student to its fullest. Well, that’s my passion; what’s yours? You know, the one that you have probably been neglecting during the last months? If it’s not the case, I congratulate you, and you should continue on the same

path. But if you recognize yourself as having neglected your passion, there’s no better moment than the New Year to take a good old resolution. So, make more space in your schedule for a cause or activity that you are very interested in and you will be much the better for it.

That’s why I think it’s important to get involved now and not to wait for the end of your residency. Whether you are a students associations veteran or a weekend volunteer, that’s not what counts. The main goal is to find a domain to which you wish to contribute and that you want to make progress, while at the same time enjoying yourself.

I wish everyone a happy 2014!

Christian Campagna Délégué aux affaires politiques


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Spa Agreement, Via Rail and everything that can reduce students’ stress For most of us, the end of December and post-exams period go hand in hand with relaxation, holiday season and time spent with our loved ones. But…How have you managed to relax this year? Do you know the best places where you can relieve your stress without even leaving Quebec? This article is meant to be a small sparelaxation guide that will give you tools to “recharge” for this beginning of semester. Moreover, we think that our graduates who are going through the CaRMS process might enjoy a welldeserved day of relaxation.

Quebec Spa Repertories Website: http:// www.spa.reaseauinfoquebec.qc.ca The Info-Quebec network offers spa fans an Internet site that allows them to find spas located in their region. By choosing a location, the consumer can compare the different characteristics of the spas, such as the type of spa/ sauna, the prices, and the possibility of accommodation. After visiting a spa, you can vote or submit a comment to allow a new client to take a free and informed decision. This site

also includes a news section where you can read about current promotions. It is true that the site’s design leaves something to be desired, but you are free to take the name of the spa that interests you most and to view the different packages on its official site!

In the Montreal region Five spas are compared for this region. However, offers around this metropolis are easily available for those who like to lose precious minutes looking on sites such as groupon/dealfind/ jumboya/tuango. Your federation has signed an agreement with Ström Spa. Here are the details: 

15% discount on the entry to thermal experience on current prices.

15% discount on all the massages and treatments on current prices.

15% discount on Nights Under the Stars and Cozy Thursdays.

10% discount on gift certificates.


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1 free entry to the thermal experience valid from Monday to Thursday and every night after 6 PM (except on holidays and during the high season) -, each month per 10 visits to the thermal experience. The student members of the FMEQ have to present their valid student card from one of the 4 faculties of medicine members of the FMEQ (either Université de Montréal, McGill University, Université Laval or Université de Sherbrooke).

Going towards (Estrie)

Sherbrooke

This beautiful region offers numerous relaxation spots. Indeed, the site describes 6 well-known spas. These can often be found near a river or an accommodation. Amongst these, the Spa Nordic is the most well-known.

National Capital Region (City of Quebec) Five spas are mentioned for the region of Quebec. Amongst these, we would like to remind you of the

SkySpa, partners.

one

of

our

recent

Here is the current agreement. By the way, this discount is also available at the SkySpa in the region of Montreal. 

15% discount on all SERVICES at all times on the regular fee of the SKYSPA of Quebec and of the Quartier DIX30.

The offer does not apply to food and certificates of monetary value.

The student members of the FMEQ have to present their valid student card from one of the 4 faculties of medicine members of the FMEQ (either Université de Montréal, McGill University, Université Laval or Université de Sherbrooke), as well as a piece of identification.

So, have a nice and relaxing time everyone!

Ana-Maria Copaescu Delegate for Services and Partners


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Prohibited Practices during Interviews for Residency: a Quick Overview The selection of candidates for residency cannot exclude a form of subjectivity. However, a part of the latter can be eliminated by avoiding some kinds of discrimination that are not acceptable. Indeed, it seems that questions from the interview for the matching in residency target aspects that shouldn’t be questioned. There might also be a sort of discrimination based on the university the candidate attends. In its guidelines for interview questions, CaRMS (the Canadian resident matching service) clearly indicates that questions relating to family, religion, marital status, age and finances are prohibited. Indeed, to not be discriminated on these points is a constitutional right. The equivalent of CaRMS in the United State, the NRMP (National Resident Matching Program), stipulates similar standards concerning these questions. However, despite the NRMP standards, alarming data exists in the United States on the prevalence of questions judged to be illegal. We didn’t find data recording the phenomenon in Canada, but given the similarity of the selection process and of medical practices between the two countries, we should expect seeing similar practices here. A 2013 study concerning a survey from 2006-2007 of 7,028 new residents from five chosen medical specialties teaches us that 64.8% of applicants have been asked at least one “illegal question” (Hern et al.,

2013). Another document from 2009 on matching in emergency medicine shows that 30% of applicants think they have been asked this kind of questions. We also learn that in 8% of cases the candidate has been asked about his intentions concerning the ranking of the programs for which he has applied (Thurman et al., 2009). One last survey from 2010 of 63 students shows that 90% applicants were asked illegal questions (Santen et al., 2010). In most cases, for all these surveys, the most frequent questions were those concerning marital status and having or planning to have children. Moreover, two documents quoting these surveys have associated the fact, for an applicant, to be asked an illegal question, to an inferior ranking of the programs. It seems it would be in the interest of residency programs to avoid these questions to increase their chances of recruiting the candidates they would most like to retain. Let us remember that it is legitimate for a residency program to enquire about the capacity of future residents to assume their obligations when on duty. However, the right way to do this is by asking, during interview, if the candidate is really able to meet these obligations and to justify if need be. Asking if a candidate has children and then concluding that he would be unable to assume his obligations when on duty should be prohibited because it is discriminatory.


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Furthermore, it is sometimes c o n v e ye d t h a t d e s p it e a transparent selection process, c a n d id a tes f ro m a g iv e n university have more chances to be selected for residency at this same university than other candidates. It seems that this belief is partially true. Indeed, a study conducted at the University of Calgary for the internal medicine program proves that, in the evaluation of the files of candidates, residents gave, on average, a better score to candidates from this university than to others, while the bosses didn’t (Bass et al., 2013). In conclusion, we notice that admission processes to residency programs are certainly imperfect but also that some of them use discriminatory practices. We should make sure that, at the basis, no question is illegal, and also to study the phenomenon in Canada to know if the same issues are really encountered as in the United States.

Alex Halme Secretary General

References Hern HG et al. Acad Med. 2013 Aug; 88 (8): 11 16-21. Thurman RJ et al. Acad Emerg Med. 2009 Jun; 16(6):550-7 Santen SA et al. J Grad Med Educ. 2010 Sep; 2(3):336-40 Bass A et al. Med Teach. 2013 Sep; 35 (9): 747-51.


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Well-being Day The FMEQ is very happy to offer its members a new edition of the Externs’ Well-Being Day. A wellbeing survey was conducted in 2011 and it showed that Quebec externs live with multi-factorial stress. In response to this survey, the FMEQ had decided to organize in 2012 a special day with several conferences on how to better manage stress. Next February 21 will take place the 3rd edition of the Externs’ Well-Being Day. With a more playful theme this year, the event invites all Quebec externs to gather in the city of Quebec for a well-deserved day of rest from their clerkship. There will be a special guest whose only mission will be to make you

laugh. In the afternoon, workshops will be given: from tai chi to tea workshops, there is something for every taste. Transport will be organized for Montreal, Sherbrooke and TroisRivières and lunch will be served. Because the FMEQ offers everything for the ridiculously low price of $ 0, there is no reason for you not to register!

Madeleine Plaisance Delegate for Academic Affairs


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“Are you going to come back to work here?” - By Émilie Desrosiers, resident in general surgery I hear this question every time I go back to my hometown, St-Jean-Port -Joli. When I stop by to visit family, when I go to the Casse-Croute 204 where I used to work, when I run into childhood friends who came back to that region, when I’m at the grocery store, when I participate in a cultural activity, when I go to bring my income tax return papers to Jean-Pierre… My home (because my real home will always be there), is a closely-knit community in summer and winter, whether things are good or bad. Rumors spread fast and everyone there remembers me, the daughter of Réjean and Geneviève, the one who has worked for 8 years at the playground, the one who has babysat an entire generation of children, the one who sang in choirs, who went away to study medicine, the one whose relatives look at her with great pride. Even if my strongest desire would be to go back and practice in my hometown, I have always answered to this question with a pious lie. The answer is often something along the lines of “It would be really nice, but I have to consult my spouse”. They are not really lies, but they aren’t even half-truths…

The truth is that medical practice is regulated by the rigid frameworks that are PREMs (Plans régionaux

d’effectifs médicaux). To simplify everything, PREMs determine the number of positions for each specialty for a given region and then it is divided per hospital. Numerous variables are taken into consideration when the positions are distributed: the needs of the population, accessibility to technical platforms, hospital capacity, presence of associated specialized teams, the will of the teams in place… These PREMs are generally decided following five-year plans and, for the moment, the actual plan stops at 2015. So, every 5 years, a bunch of committees sit together in a large committee and establish what will be the face of specialty medicine in Quebec for the 5 upcoming years. Of course, all of this is done respecting budgetary envelopes, anticipated departures, needs of the population… and electoral promises!

It is a little difficult to imagine how these calculations on 5 years can take into account all the variables. For example, following the market crash in 2008, numerous doctors postponed retirement because their savings had melted with the crash. Also, some work “part time” but have a full time job * (academic


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work, pre-retirement, maternity leave, or simply the desire to work less in order to keep a better quality of life). We don’t aim to judge the individual choices of these doctors, but we should be aware that all of this has an impact on the capacity of an environment to recruit, because even if a doctor chooses to work at 30%, he occupies 100% on paper. There are also virtual PREMs. Residents have been asking for a long time that these be detected systematically and at an early stage. These virtual PREMs are positions on paper that, for different reasons, aren’t filled (the team in place doesn’t really want to recruit, it lacks technical platforms for interventional and surgery specialties, there aren’t real needs, they’re waiting for the ideal candidate, who finally goes elsewhere…). More than a year ago, I was with my spouse at the Journée Carrière Québec 2012. We toured the regions. He is a resident in cardiology (native of region 01) and I (native of region 12) am a resident in general surgery, and we will finish in 2015. We have started by leafing through the

booklet offered at our arrival, which defined positions by region for all specialties. The advantage of cardiology and of surgery is that these two specialties are next to one another in the alphabetical list. 4 regions offer positions in the same CSSS. After further verification, here is the summary of our findings: Region 04 offers a position in cardiology for 2015, but not really a position in general surgery (they are looking for somebody doing specialty surgery), Region 06 offers a position in the form of anticipated recruitment (overlapping pre-retirement) in cardiology, but there isn’t really a PREM in surgery (even if it is announced), Region 07 offers 2 positions in cardiology in 2013 (which are probably filled or are being filled… positions that were liberated for cases of force majeure, I will spare you the details) and 1 position in surgery for 2012 (possibly filled) and this position is not in the same CSSS (40 km of distance and the necessity to work in 2 hospitals), Region 15 offers 2 PREMs in cardiology, in 2012 and 2014, and has urgent needs, but the


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“Are you going to come back to work here?” - (Continued)

position in general surgery doesn’t have to be filled that rapidly. So we were a little discouraged when we sat on the grass to listen to our new Minister of Health, Dr Réjean Hébert, talk about our future. He said the following words: “I promise all Quebec residents that they will have a position at the end of their residency, a position that meets their expectations.” This sentence imprinted itself in my memory. Are my expectations really too high for me to find a match? Am I unrealistic and capricious to try to find work in the same region as my spouse after these 11 years of university studies? After thinking thoroughly, I am convinced that the most unreasonable is the ministry, not me! But I have read worse recently. Following an editorial of the Royal College of Physicians and Surgeons of Canada, that denounced the decline of recruitment opportunities at the national level, a respondent declared that if doctors didn’t find work here, Canada could become an “exporter of brains” by forming here doctors that will go work elsewhere… what is their problem! After having put so many efforts and investments into training us, do you think citizens would be happy to

see all this expertise leave, while at the same time we keep talking of “doctor shortage”? Do you really think that doubling the cohorts of students in medicine during the last 15 years aimed to export our graduates? Then, we have reached a breaking point. The next five-year plan will be on the menu soon enough. I know several colleagues who exiled themselves to practice elsewhere, I know people who reviewed their choices of career because of a lack of places to practice, I know places that recruit foreign doctors rather than doctors trained here, I know residents that are a couple and have to make extreme efforts to be able to think of living together in the medium and long term. This whole process is extremely stressful for all of us, even more because, we have to admit it, we are directly competing with our colleagues. It is not a free market, these are not positions that meet our expectations and those who aspire to excellence and performance end up leaving behind their roots, heartbroken, to do what they love to do: taking care of people. The real answer to the naive question of the inhabitants of PortJoli is a lot more complex than what


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I might have expected. I would like to send it to our Minister of Health. What is his opinion on the question? I would like to hear him explain what my expectations should be or how I should conciliate my spouse’s profession with mine in order to be able to work in the same region. I would like him to explain to me what use will be my beautiful diploma without a place of practice. I would like him to tell me how he sees the practice of specialty medicine in Quebec in 10, 15 or 20 years. I would like him to take with me the steps for obtaining a PREM in today’s Quebec, and to see the obstacles spring up, and the prospects for our futures lacking long term vision. I would like him to explain to me why a resident that aspires to an academic career and starts a master in education will never be able to use these skills. I would like him to help me find the words when people ask me if I will go back to work in my hometown…

And I would also like to hear you, dear colleagues, on this delicate and sometimes taboo subject.

So, if Santa asks me what I want this year, I will ask for a position that meets my expectations, because I have been very nice!

Valérie Desrosiers Resident in General Surgery Special Collaboration Published first on meduleducation.blogspot.ca


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