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What’s in a name?

By: Sandra Banner, Executive Director and CEO | December 10, 2014 

Recently, I attended a meeting at which I provided an informal update on the status of the 2015 R-1 Main Residency Match (R-1 match). During my update, I was questioned about CaRMS’ use of the term “CSA”, or Canadian studying abroad. More specifically, it was suggested that CaRMS cease using the term CSA because it is an “invented term” and somehow opens the door to accusations of discrimination.

CSAs are Canadian citizens who left Canada to pursue their medical education outside of Canada or the United States. When it comes to the match, CSAs are included in the cohort of international medical graduates (IMGs).

While the origins of the term can be disputed, the term is widely used by organizations including: the Association of Faculties of Medicine of Canada (AFMC), the Canadian Federation of Medical Students (CFMS) and the Canadian Physician Education Registry (CAPER) to name a few. The term is also used by the provincial ministries of health, as demonstrated by the landmark report by Thomson and Cohl titled “IMG Selection: Independent Review of Access to Postgraduate Programs by International Medical Graduates in Ontario.” The term CSA can also be found on a multitude of online discussion forums, typically frequented by applicants.

Regardless of the origins of the term, its systemic use indicates that, while somewhat uncomfortable for some, the term has both analytic and descriptive value and refers to a very real subset of the IMG applicant community. More importantly, the term CSA refers to a discernible group to which we have given a label for analytic and reporting purposes.

It must be acknowledged that simply identifying, naming and conducting analysis based on a subset of IMG applicants is in no way the basis of any practical discrimination. Whether or not discrimination against any given group exists is completely separate from naming or conducting analyses. Discrimination can just as easily exist against an unnamed and unstudied group, just as a lack of discrimination can exist against any number of named and identified groups. The two issues are completely separate.

If there is indeed discrimination against immigrant IMGs (vis-à-vis CSAs) within the larger IMG cohort, removing the term CSA, or the category of analysis, would do nothing more than obscure that fact. It would not eliminate the discrimination, it would simply hide it.

Putting these philosophical considerations aside, why doesn’t CaRMS simply do away with the term and category if there are those who would prefer us to do so? Quite simply, because we have an obligation to provide meaningful and transparent data pertaining to the matches we administer.

No matter how you slice it, the fact remains that in general, eligible students participating in our matches fall into one of two major groups: Canadian medical graduates (CMGs) or IMGs. CMGs are those students who have graduated, or will graduate, from a medical school in Canada. IMGs are those applicants who have graduated, or will graduate, from a medical school outside of Canada or the United States. These terms do not refer to citizenship or place of birth, but simply to where undergraduate medical education was obtained.

Unfortunately, simply providing match statistics broken down by these two broad definitions would be only telling half the story.

A demographic analysis of R-1 match trends over the past 15 years reveals two very different and clearly defined cohorts of IMGs: CSAs and immigrant IMGs. From a profile perspective, there is no typical CSA or immigrant IMG. Both have studied medicine in educational systems that have differing curriculums, resources and patient populations. Occasionally, immigrant IMGs and CSAs have graduated from the same schools.

That being said, all CSAs have one thing in common, they are all citizens or permanent residents of Canada who chose to study medicine abroad. This commonality provides a clear distinction between CSAs and other international physicians who graduated abroad prior to coming to Canada to practice medicine and becoming citizens or permanent residents.

The fact remains that within the larger IMG pool, CSAs are roughly three times more likely to be matched than their immigrant IMG counterparts.  Reporting on this fact is not the cause of this fact.

What do you think of the term CSA? Should it continue to be used as a demographic cohort in future statistical reporting? Contact us at LetUsKnow@carms.ca.