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VOLUME 11 ISSUE 3

May 3rd 2014

In this issue: Introduction

2

CaRMS

4

Pass-Fail

8

Choosing wisely

12

Support services

14


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Introduction Dear colleagues, It already is the month of May and with it comes the end of another school year, weather is slowly getting a little warmer and it is starting to feel like summer vacation are coming. It is also, for many of us, the last exam session before clerkship! For the FMEQ, it is in the month of May that is held our annual congress where representatives from all local associations, Laval, McGill, Montreal and Sherbrooke, meet to review the past year, discuss the federation’s orientation for the year 20142015 and vote for next year’s officers, both on the executive and director’s boards. In 2013-2014, the FMEQ has, in short and among other projects, reviewed its partnership structure with IFMSA, consolidated a solid and durable relationship with CFMS, carried the voice of Quebec’s medical

students on various commitees, at the university and at the government level, obtained many new services, organised the Clerk’s Wellness day and the FMEQ Party… In short, it was a busy year! This year’s third edition of the Info-FMEQ will present an article on the topic of CaRMS, a graphic review of the pass or fail system of evaluation, an overview of the Choosing Wisely campaign and a presentation of the differents help ressources avaiable for medical students. Happy reading!


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CaRMS

5 letters that will change your future Foreword The medical education pathway is divided into two large steps. First, comes preclinical which includes the fundamentals and theoretical portions of the curriculum (2 to 3 years) and clerkship or clinical rounds (1 ½ to 2 years). After successful completion of clerkship, students obtain their doctorate in medicine, or MD. To be allowed to practice medicine, the new MD needs to complete a postdoctoral degree through a residency program, in his or her university of origin, or in any other, in a specialty of his or her choice (including family medicine). A new process of admission and selection is therfore necessary.

Description The Canadian Residency Matching Service (CaRMS) is a not-for-profit service offered by the Association of Faculties of Medicine of Canada (AFMC) that works in tight partnership with Canadian post-doctorate medical education programs and medical students in order to provide the best possible match in residency. It takes into account both the individual choices of applying medical students and the preferences of the different programs. Although first installed in Anglophone faculties of medicine across Canada more than 40 years ago, the CaRMS has been

in used in QuĂŠbec also for only 9 years. The service thus allows students to apply for matching all across Canada.

How does it work? The CaRMS is an entirely computerized system that allows student to build their application file almost entirely online. After examination of application files by the directors of residency programs, students whom candidacies have been retained will be offered an interview with the admission committee of the concerned residency program. After the national interview timeframe, students must rank the programs they are interested in, in order of preference. It is possible not to rank a program, even after having been interviewed. After ranking, the system then proceeds to the final match, using an algorithm which takes into account the ranking of candidates and of residency programs. It should be noted that the CaRMS has a contractual value and that a student who has matched to a given program is bound to work as a resident for this program for at least a year. If at the end of the matching process, a student is left unmatched, he can apply at the CaRMS second iteration. The process is repeated, but it is possible to apply to one of the remaining spots.


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Building you CaRMS application file The application file is built according to requirements from residency programs (www.carms.ca). It includes: Dean’s letter The document differ among universities, but it usually provides details of your academic course.

during clerkship or by any significant person. The question that should be asked is «Who is best placed and who will have the most influence to promote my application in this given program and this given university?». It is possible for someone to write you more than one letter of recommendation for different universities or different programs.

Academic file

Letter of support

Directly sent to CaRMS by the candidate’s faculty.

They are required by some residency programs. They are less personnal than letters of recommendation. The supporter has to fill a specific document that confirms the adequacy of the applicant. The supporter can be the same person who wrote a letter of recommendation.

Candidate’s photography Think professionalism

Curriculum vitae

Personal letter Criteria differ among different universities and residency programs

Letters of recommendation (usually two to three) Letters of recommendation can be written by an attending physician

It should be noted that the applicant should not see the letter of recommendation or the letter of support. Therefore, the applicant should provide a pre-stamped envelope to the person writing his letter. The use of registered mail can be anxiolytic for students who can thus obtain confirmation of the delivery of their letters to CaRMS.

(continued on page 6)


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CaRMS (continued) Translation if required is possible through CaRMS, at the expense of the applicant.

Important dates 2014-2015 Will be online at https:// www.carms.ca/en/first-iterationtimetable

Demystifying CaRMS It is absolutely necessary to have done a rotation in the discipline in which I am trying to match. False: solid CaRMS file, personal letter and interview that explain the interest of the student can be enough. It is absolutely necessary to have done a rotation in the university in which I am trying to match. False: it is not required to be already known by the program. Just look at the residents around you! There is a single interview for family medicine in the three French faculties. True: Applicants pass a single interview with officials from two out of the three faculties, chosen randomly. The rating given by the evaluators is independent and the report is sent to the Family Medicine Units (UMFs) chosen by the applicant.

It is possible to apply for match as a couple. True: a specific algorithm exists that gives priority to the program’s site.

The FMEQ’s mission CaRMS’ complaint bureau: Use the FMEQ’s website (www.fmeq.ca) or write directly to the delegate for academic affairs (pedagogique@fmeq.ca)

Seat at the CaRMS’ Board Since 2013, the FMEQ has representation in the CaRMS’ Board of Directors. At the time, I am sitting at the Board until next year. This way, we have a direct link with CaRMS that allows us to represent you and report you complaints or suggestions.

For more info www.carms.ca www.fmeq.ca

Valérie Martel President


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Choosing wisely Launched on April 2 of this year, Choosing Wisely is an awareness campaign on the subjects of over -diagnosis and over-treatment. This campaign is inspired by an initiative of the same name in the U.S., led by the American Board of Internal Medicine. Its goal is to educate both physicians and patients about the pitfalls of over-diagnosis. The movement has its roots in Ontario, led among others by its founder Dr Wendy Levinson of the University of Toronto with the help of the CMA, but it continues to spread all across the country. No wonder, considering the relevance of this subject! nd

Issues With the great increase both in technical advancement and in availability of many diagnostic tools, imaging or laboratory, and treatment options, surgical or pharmacological, it is easy to fall in the over-diagnostic/overtreatment trap. In the case of diagnostic testing, it is straightforward to understand the unnecessary costs added to the healthcare system or the dangers of exposing someone to

radiations. It is also very important to consider the dangers of the escalade of often invasive interventions (eg: biopsies‌) and the stress caused by a non-indicated test or by a false-positive result. Unfortunately, many tests are being used in clinical situations in which they are not indicated. Furthermore, some patients expect to receive tests that are not proven to be beneficial.

Means Choosing Wisely seeks to educate both doctors and patients, in order to promote healthy dialogue and good care relationship. For physicians, and students, the campaign has collaborated with 8 medical associations to construct lists of 5-6 diagnostic tests or treatments that are often used in clinical situations in which they have no proven benefits. These associations and societies are those of family medicine, internal medicine, orthopeadics, rheumatology, geriatrics, radiology, general surgery and cardiology. As an example, the


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Canadian Family Medicine College recommends not to systematically perform routine laboratory chek-up on all healthy patients and the Canadian Association of General Surgery recommends not to treat inguinal hernia that are only mildly symptomatic. Of course, each patient is different and the decision to intervene needs to take into account his or her specific context and after a proper discussion of risks and benefits. These recommandations are all based on current medical litterature and can be found on the Choosing Wisely website.

are indicated in specific conditions. For example, in what situation is imaging indicated in the case of headaches? In short Choosing wisely is an awareness campaign that takes action on an important issue of our modern healthcare system. Develop your CanMEDS manager skill and go take a look at http:// www.choosingwiselycanada.or g/!

Michaël Tibout Délégué aux affaires internes

Most patients have not atteneded public health classes and it is sometimes difficult to understand the negative effects of diagnostic testing. In order to help them to understand the issue and to promote patient-physician dialogue, Choosing Wisely have put up several guides on the general issue of overdiagnosis and on what tests


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Support services Services psychologiques

PAMQ The Quebec Physician’s Health Program is a non-profit organisation whose mission is to provide help to physicians, residents and students who are having personal or health problems. http://www.pamq.org/index.asp? LANG=EN&section=1

McGill The Faculty of Medicine and its Student Affairs Office are offering counselling services specifically for undergraduate medical students. Furthermore, the university are providing counselling, mental health and spiritual support. Finally, the Students and Residents’ Affairs website is offering different resources regarding student’s wellness. http://www.mcgill.ca/ugme/student -affairs/counselling http://www.mcgill.ca/medwell/ yourwellness

Laval Laval’s faculty of medicine is sponsoring the Réseau d’aide en

médecine, which features medical students at the clinical and preclinical level whoe are providing direct individual help and are organizing activities and conferences. The Direction des affaires étudiantes is also providing different services to medical students. Finally, the university provides to all its students resources, psychological and others, through its Student help center. https://www.aide.ulaval.ca/cms/ site/aide http://www.fmed.ulaval.ca/site_fac/ services/direction-des-affairesetudiantes/conciliation/medecine/

Montréal The AÉÉMUM, Montreal’s medical student’s association, supports the Réseau d’entraide des étudiants en medicine. The network features medical students and provides confidential help in the event of difficulties whether it is listening or redirecting towards the appropriate services. They also organize conferences on different subjects. Moreover, U of M’s Faculty of Medicine has put in place the Bureau d’aide aux étudiants et aux residents for students who are experiencing psychological, financial, personal or academic difficulties. The university itself is


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also providing, through the Services d’aide aux étudiants, a health and psychological consultation clinic available to all its students. reseauUdeM@gmail.com http://www.cscp.umontreal.ca/ http://med.umontreal.ca/lacommunaute/les-etudiants/bureaudaide-aux-etudiants-et-residentsbaer/

AGÉÉMUS, Sherbrooke’s medical students’ society, is working towards making these services available on the campus of health science. www.usherbrooke.ca/medecine/ faculte/vie-etudiante/besoin-daide/ www.usherbrooke.ca/etudiants/ services-a-la-vie-etudiante/ psychologie/

Michaël Tibout Sherbrooke In addition to the services offered by the university to all its students, the Faculté de médecine et des sciences de la santé has put in place the adjoints à la vie étudiante, loosely translatable to student affairs assistants. Most of them are teachers at the faculty and their role is to support students all along throughout the process of medical education. They are available for confidential consultation for many different reasons, including academic or personal difficulties. The university of Sherbrooke, like most universities, also provides access to mental health services on the university’s main campus. The school of medicine being located outside of the main campus, the

Délégué aux affaires internes


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