Factors affecting residency rank-listing: a Maxdiff survey of graduating Canadian medical students.

BACKGROUND: In Canada, graduating medical students consider many factors, including geographic, social, and academic, when ranking residency programs through the Canadian Residency Matching Service (CaRMS). The relative significance of these factors is poorly studied in Canada. It is also unknown how students differentiate between their top program choices. This survey study addresses the influence of various factors on applicant decision making. METHODS: Graduating medical students from all six Ontario medical schools were invited to participate in an online survey available for three weeks prior to the CaRMS match day in 2010. Max-Diff discrete choice scaling, multiple choice, and drop-list style questions were employed. The Max-Diff data was analyzed using a scaled simple count method. Data for how students distinguish between top programs was analyzed as percentages. Comparisons were made between male and female applicants as well as between family medicine and specialist applicants; statistical significance was determined by the Mann-Whitney test. RESULTS: In total, 339 of 819 (41.4%) eligible students responded. The variety of clinical experiences and resident morale were weighed heavily in choosing a residency program; whereas financial incentives and parental leave attitudes had low influence. Major reasons that applicants selected their first choice program over their second choice included the distance to relatives and desirability of the city. Both genders had similar priorities when selecting programs. Family medicine applicants rated the variety of clinical experiences more importantly; whereas specialty applicants emphasized academic factors more. CONCLUSIONS: Graduating medical students consider program characteristics such as the variety of clinical experiences and resident morale heavily in terms of overall priority. However, differentiation between their top two choice programs is often dependent on social/geographic factors. The results of this survey will contribute to a better understanding of the CaRMS decision making process for both junior medical students and residency program directors.

Canada's new medical school: The Northern Ontario School of Medicine: social accountability through distributed community engaged learning.

Like many rural regions around the world, Northern Ontario has a chronic shortage of doctors. Recognizing that medical graduates who have grown up in a rural area are more likely to practice in the rural setting, the Government of Ontario, Canada, decided in 2001 to establish a new medical school in the region with a social accountability mandate to contribute to improving the health of the people and communities of Northern Ontario. The Northern Ontario School of Medicine (NOSM) is a joint initiative of Laurentian University and Lakehead University, which are located 700 miles apart. This paper outlines the development and implementation of NOSM, Canada's first new medical school in more than 30 years. NOSM is a rural distributed community-based medical school which actively seeks to recruit students into its MD program who come from Northern Ontario or from similar northern, rural, remote, Aboriginal, Francophone backgrounds. The holistic, cohesive curriculum for the MD program relies heavily on electronic communications to support distributed community engaged learning. In the classroom and in clinical settings, students explore cases from the perspective of physicians in Northern Ontario. Clinical education takes place in a wide range of community and health service settings, so that the students experience the diversity of communities and cultures in Northern Ontario. NOSM graduates will be skilled physicians ready and able to undertake postgraduate training anywhere, but with a special affinity for and comfort with pursuing postgraduate training and clinical practice in Northern Ontario.

Developing partnerships for distributed community-engaged medical education in northern ontario, Canada.

The Northern Ontario School of Medicine (NOSM) was established as a not-for-profit medical education corporation in November 2002 with a social accountability mandate to provide "undergraduate and post graduate medical education programs that are innovative and responsive to the individual needs of students and to the healthcare needs of the people in Northern Ontario."[1] NOSM is not only the first new medical school in Canada in 30 years; it is also the first medical school established in, for and about the Northern Ontario region; and the first Canadian dual university medical school. In practice, these "firsts" constitute community-engaged medical education programs distributed in 70 communities across Northern Ontario, made possible by partnerships with universities, advisory groups, community organizations, hospitals and clinics. It is through these partnerships that NOSM works to fully achieve its social accountability mandate with a diverse, multilingual population, dispersed over a wide geographic area. Northern Ontario is a mostly rural, densely forested area of 820,000 square kilometers (approximately the size of France and Germany combined) with a population of just over 800,000, including First Nations (Aboriginal), Francophone and Anglophone groups. In general, the largest First Nation populations are located on reserves in the Northwest, while Francophone populations are generally concentrated in the Northeast. In April 2007, the Ministry of Health and Long-Term Care designated 37 Northern Ontario communities (including some larger communities such as North Bay and Thunder Bay) as medically "underserviced" with a total shortage of 132 family physicians.[2] In addition, 14 Northern Ontario communities were designated as underserviced in specialists with a total shortage of 129.[3].