Licensing international medical graduates
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* Rodney Andrew
* Joanna Bates

T.B. MacLachlan comments on the method of selection of the 2 candidates1 and whether this may be perceived as unfair and open to challenge. The initial examinations by the Medical Council of Canada are externally set and validated, and the objective structured clinical examination has demonstrated reliability in psychometric evaluation. During the 6-week clinical evaluation, skills are evaluated by clinical faculty with extensive experience. The director of the international medical graduate (IMG) program remains at arm's length from candidates, grants no interviews and plays no personal role in the evaluation. IMGs who have participated in the process indicate that it is as fair as possible, although senior and experienced IMGs feel that the process is demeaning.

The financial costs are considerable, given that so few residents are produced. The evaluation component could be expanded at relatively low cost to produce more residents, but the largest part of the cost is residents' salaries. Still, the cost of producing a licensable physician from the IMG pool is much lower than the additional cost of 4 years of medical school incurred by Canadian graduates.

We agree that many IMGs arrive here with scant knowledge of the requirements that must be met to enter medical practice. Many of our candidates comment on the extreme hardship involved in acquiring a licence and the considerable barriers to residency training. Many are so daunted that they never do practise medicine here.

Canada's colleges of physicians and surgeons have a crucial role in ensuring that only competent physicians gain the right to practise here. Our experience is that, with appropriate evaluation and residency training, many more IMGs could make a contribution to the health care of Canadians.

## Reference

1.  1. Andrew R, Bates J. Program for licensure for international medical graduates in British Columbia: 7 years' experience. CMAJ 2000;162(6):801-3.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjIvNi84MDEiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTYzLzMvMjYxLjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9)