Tracking the Assessment, Certification and Licensing of International Medical
Graduates in Canada
Steve Slade, VP Research and Analysis
Tamara Brown, Project Manager
Canadian Post-MD Education Registry
Association of Faculties of Medicine of Canada

The History Behind the IMG Database

Primary Drivers of FQR for Physicians
• Increased immigration of medical graduates to Canada
• Balancing our need for physicians with public safety
• Growing emphasis on foreign credential recognition and standardization
• Ethical recruitment and treatment of IMGs

Data in an Evolving Context
Number of IMGs in the Active Physician Workforce, Canada, 1994-2008
9500
9000
8500
8000
7500
7000
6500
6000
5500
5000
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
IMGs from countries with higher doc:pop ratio than Canada
IMGs from countries with lower doc:pop ratio than Canada
Source: Physician counts : Canadian Medical Association Masterfile as of January 1 of each year.
Doc:Pop ratios : Organization for Economic Cooperation and Development and WHO

History of the National IMG Database
2004
2005-2009
Canadian Task Force on the Licensure of
International Medical Graduates
Phase 1: Foundational Activities
2010-2013
Phase 2: Development of an Analytical
Agenda and Increasing Project Visibility

Phase 1: Building Partnerships
• Medical Council of Canada (MCC)
• 7 IMG assessment centres
• 17 Faculties of Medicine
• The College of Family Physicians of
Canada (CFPC)
• The Royal College of Physicians and
Surgeons of Canada (RCPSC)
• Collège des médecins du Québec (CMQ)
• 9 regulatory authorities

Phase 2: Outcomes and Indicators
For Example…
Outcome: Transparent, appropriate and expeditious pathways to practice
• Indicator: numbers traversing various pathways
• Indicator: average time between milestone events
Outcome: Increased standardization across jurisdictions
• Indicator: frequency of milestone events across jurisdictions
• Indicator: frequency of migration across jurisdictions

Effective Indicators for Evaluating Progress towards Outcomes
Four critical indicators along the path to licensure:
• Success on Medical Council of Canada (MCC) Exams
MCCQEE MCCQEI MCCQEII
• Entry into postgraduate training (residency)
• Certification with the CFPC, CMQ, or RCPSC
• Licensure with a Canadian Regulatory Authority

Number of IMGs who passed MCC
Examinations, 2005-2010
16000
14000
12000
10000
8000
6000
4000
2000
0
3462
2135
10280
5762
1521
3693
MCCEE MCCQEI MCCQEII
Medical Council of Canada (MCC) Exams
Canadian Citizens
Non-Canadian Citizens

Data in an Evolving Context
Increased Number of First Year Post-MD Trainees
Number of PGY1 Post-MD Trainees by Place of MD Graduation, Canada, 2000-01 to 2010-11
3000
2500
2000
1500
1000
500
77
1471
138
1436
197
1447
185
1579
289
1640
259
1799
360
1894
404
1976
416
2088
467
2273
426
2419
0
2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11
MD Outside Canada (up 453%) MD in Canada (up 64%)
Source: CAPER, AFMC, 2010. Note: Excludes visa trainees.

Following a Cohort of Canadian Citizen IMGs
ASSESSEMENT
114
1491
461
322
144
41
MCCEE
MCCQEI & MCCQEII
PGME
CFPC/RCPSC/CMQ
LICENSURE

2008-2010
EE
1147
QEI
1530
CERTIFICATION WITH
RCPSC/CFPC/CMQ
2522
QEII
1245
Licensed
829
PGME
1681

2008-2010
EE
1647
QEI
1256
LICENSED
2604
Certified
633
PGME
377
QEII
763

Data Gaps
• Country where MCCEE is written
(many write the EE abroad)
• When was citizenship gained
• Pre-medical experiences/education
• MD program experiences
 Clerkship component?
 Clinical elective in Canada?

Knowledge Gaps – Plans for Future Analysis
PREDICTORS OF
SUCCESS
PREDICTORS OF
RETENTION
CROSS-
JURISDICTIONAL
ANALYSIS
ALTERNATIVES
FOR
UNSUCCESSFUL
IMGs
PATHWAYS AND
PROCESSES

Thank you.
The IMGs in Canada Project Team:
Steve Slade, VP, Research and Analysis CAPER-ORIS
Tamara Brown, Project Manager, tbrown@afmc.ca
Linda Bourgeois, Research Associate, lbourgeois@afmc.ca
This project is funded by the Government of Canada's Foreign Credential
Recognition Program.