Production of this report has been made possible through a financial contribution from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada. Project team: Sandra Banner, team leader and site visitor; Ashley McKiver, project manager and researcher; Sara Rattanasithy, data analyst; Josephine Cassie, site visit collaborator; Christel Woodward, survey tool consultant; Rebecca Ford, editor. TABLE OF CONTENTS BACKGROUND.....................................................................................5 Figure 20 –How CSAs learned about medical school abroad......18 Figure 21 – Year of graduation from medical school......................19 EXECUTIVE SUMMARY.......................................................................6 Figure 22 – Year of graduation by medical school region..............19 Figure 23– Satisfaction with medical degree program..................20 SUMMARY OF RESULTS......................................................................7 Figure 24– Satisfaction with medical degree program by medical school region.......................................................................20 RESULTS ................................................................................................8 CLERKSHIPS..........................................................................................21 SAMPLE .................................................................................................8 Figure 25– Difficulty in arranging a clerkship rotation in Table 1 – Breakdown of 2010 sample by region ............................8 Canada by medical school region....................................................21 Table 2 – Medical school of respondents........................................8 Figure 26– Number of clerkship rotations done or confirmed in Canada by medical school region ...............................................21 DEMOGRAPHIC INFORMATION .......................................................9 Comparison of the 2006 pilot CSA study to the 2010 CSA study ..22 Figure 1– Age by medical school region.......................................9 Figure 2– Age: CSA vs. CMG....................................................10 FUNDING...............................................................................................22 Figure 3 – Gender by medical school region..................................10 Table 4 – Most popular funding types for medical school abroad.....22 Figure 4– 2010 and 2006 gender and age comparison 2010 ......11 Figure 27 – Most popular funding types by medical school region...22 Figure 5– Gender comparison: CSA vs. CMG...............................11 Table 5 – Top funding source by region and medical school.........22 MARITAL STATUS .................................................................................12 DEBT.......................................................................................................23 Figure 6 – Marital status by medical school region........................12 Estimated total amount of debt.......................................................23 Figure 7– Marital status by gender ................................................12 Figure 28– Median debt by medical school region.......................23 Figure 8– Marital status: CSA vs. CMG .........................................13 Comparison of the 2010 CSA study to the 2010 Canadian medical graduate cohort................................................................23 CSAs WITH PARENTS AS PHYSICIANS ............................................13 Figure 29 – Satisfaction with cost of medical education................23 Figure 9– CSAs with one or more parents who are physicians.....13 Figure 30 – Satisfaction with cost of medical education Figure 10 – CSAs with parents who are physicians by region .......13 by medical school region..................................................................24 Comparison of the 2010 CSA study to the 2010 Canadian Table 6 – Annual tuition rates...........................................................24 medical graduate cohort................................................................14 POSTGRADUATE PLANS ....................................................................25 PRE-MEDICAL EDUCATION................................................................14 Figure 31 – Intention to return to Canada to pursue Figure 11– Province of residence before moving abroad.............14 postgraduate medical training.........................................................25 Projected number of CSAs by province...........................................14 Figure 32– Intention to stay in Canada to practice medicine Figure 12– Comparing province of residence of survey after Canadian postgraduate training..............................................25 respondents to provincial medical school admission rates Table 7 – Year of graduation from medical school by intention and provincial baseline statistics.......................................................14 to return to Canada to pursue postgraduate medical training.......25 Table 8– Region of medical school by intention to return to CANADIAN POST-SECONDARY EDUCATION.................................15 Canada to pursue postgraduate medical training...........................26 Table 3– Top five reported post-secondary schools attended Comparison of the 2006 pilot CSA study to the by CSAs.............................................................................................15 2010 CSA study...............................................................................26 Figure 13– Post-secondary education in Canada by medical school region.....................................................................................15 FIRST/TOP CHOICES............................................................................26 Figure 14– Highest level of education prior to attending a Table 9 – Intending to return for postgraduate training in Canada: medical school abroad .....................................................................15 first choice locations for postgraduate medical training in Canada.....26 Highest level of education by medical school region......................16 Table 10 – Intending to return to postgraduate training in Canada: Figure 15– Highest level of education prior to attending top choice disciplines for postgraduate medical training in Canada ...27 medical school: CSA vs. CMG..........................................................16 Comparison of the 2006 pilot CSA study to the Figure 16– Number of times CSAs applied to Canadian 2010 CSA study ..................................................................................28 medical schools prior to studying medicine abroad........................16 Table 11– Top five locations for postgraduate medical Figure 17– Number of times CSAs applied to Canadian training in Canada (CSA vs. CMG)..................................................28 medical schools prior to studying medicine abroad by region..........17 Table 12– Top five disciplines for postgraduate medical Comparison of the 2010 CSA study to the 2010 Canadian training in Canada (CSA vs. CMG)...................................................28 medical graduate cohort ...............................................................17 CANADIANS NOT INTENDING TO RETURN TO CANADA STUDYING MEDICINE ABROAD........................................................17 FOR POSTGRADUATE MEDICAL TRAINING....................................29 Figure 18– Motivation to study medicine abroad..........................17 Figure 33 – Perceived barriers to returning to Canada for Figure 19 – Criteria for choosing a medical school abroad............18 postgraduate training ......................................................................29 CaRMS Report: 2010 3 Table 13 – Reasons for not intending to return to Canada Table 50 – Accreditation by medical school...................................66 for postgraduate medical training by region...................................30 Table 51 – Average tuition by medical school ...............................66 Figure 34– Country (if not Canada) where CSAs intend to Table 52– Clerkships by medical school ........................................67 complete their postgraduate medical training ...............................30 Figure 35– Intention to return to Canada to practice medicine EUROPE/MIDDLE EAST ................................................................68 after postgraduate medical training abroad....................................30 Table 53 – Europe/Middle East medical school data Figure 36– Perceived barriers to returning to Canada to website sources................................................................................68 practice medicine after postgraduate medical training abroad .....31 Table 54– Number of CSAs studying medicine in Comparison of the 2006 pilot CSA study to the Europe/Middle East .........................................................................68 2010 CSA study..............................................................................31 Table 55 – General information ......................................................68 Table 56– Admissions by medical school ......................................69 INTERNATIONAL MEDICAL SCHOOL DATA Table 57– Curriculum summary by medical school.......................69 BY MEDICAL SCHOOL........................................................................31 Table 58– Accreditation by medical school....................................71 CARIBBEAN Table 59– Tuition by medical school...............................................71 Table 14 – Caribbean medical school data website sources .........31 Table 60 – Clerkships by medical school........................................71 Table 15– Number of CSAs studying medicine in the Caribbean...32 Table 16– General information.......................................................33 INTERNATIONAL MEDICAL SCHOOL DATA – Table 17 – Admissions by medical school.......................................33 MEDICAL SCHOOL SURVEY RESULTS .............................................72 Table 18 – Curriculum summary by medical school.......................38 Table 19– Accreditation by medical school...................................42 SURVEY RESPONDENTS ..............................................................72 Table 20 – Tuition by medical school ..............................................44 Table 61– Location of survey respondents ....................................72 Table 21– Clerkships by medical school ........................................44 Table 62– Role of survey respondents...........................................72 AUSTRALIA .....................................................................................46 MOTIVATION TO RECRUIT INTERNATIONAL MEDICAL Table 22 – Australian medical school data website sources ..........46 STUDENTS REGIONS OF RECRUITMENT...................................73 Table 23 – Number of CSAs studying medicine in Australia .........46 Table 63 – Factors that influence the number of international Table 24– General information ......................................................46 students trained ...............................................................................73 Table 25– Admissions by medical school ......................................47 Factors that influence the number of international students Table 26– Curriculum summary by medical school.......................49 trained by medical school region .................................................73 Table 27 – Accreditation by medical school...................................51 Table 64– Intention to change the size of international Table 28– Tuition by medical school..............................................51 medical training programs ...............................................................74 Table 29– Clerkships by medical school ........................................52 Intention to change the size of international medical training programs by medical school region.............................................74 IRELAND .........................................................................................52 Table 65– Expected changes in legislation that will impact Table 30 – Irish medical school data website sources.....................52 international medical training programs .........................................74 Table 31 – Number of CSAs studying medicine in Ireland ............52 Expected changes in legislation that will impact international Table 32 – General information.......................................................53 medical training programs by medical school region................74 Table 33– Admissions by medical school ......................................53 Table 34 – Curriculum summary by medical school.......................54 MEDICAL DEGREE PROGRAMS AND ADMISSION Table 35– Accreditation by medical school...................................55 REQUIREMENTS BY MEDICAL SCHOOL REGION ...................75 Table 36– Tuition by medical school ..............................................55 Table 66– Available medical degree programs and admission Table 37– Clerkships by medical school........................................55 requirements by medical school region ..........................................75 Admission procedures ...................................................................75 POLAND...........................................................................................56 Table 67– Additional admission procedures by region of Table 38 – Polish medical school data website sources.................56 medical school .................................................................................75 Table 39 – Number of CSAs studying medicine in Poland............56 Table 68– Do admissions criteria differ for international Table 40 – General information ......................................................57 students versus national students?..................................................76 Table 41– Admissions by medical school ......................................57 Admissions committee ..................................................................76 Table 42– Curriculum summary by medical school.......................58 Table 69– Admissions committee representatives........................76 Table 43 – Accreditation by medical school ...................................60 Table 44– Tuition by medical school..............................................60 TUITION...........................................................................................76 Table 45 – Clerkships by medical school........................................60 Table 70– Average yearly tuition.....................................................76 UNITED KINGDOM (UK) ...............................................................61 POSTGRADUATE TRAINING ........................................................77 Table 46 – UK medical school data website sources ....................61 Table 47– General information ......................................................61 REFERENCES.........................................................................................77 Table 48– Admissions by medical school ......................................62 Table 49 – Curriculum summary by medical school ......................66 APPENDIX – ANALYSIS RESULTS.................................................78 CaRMS Report: 2010 4 BACKGROUND Canada’s doctor to patient ratio is among the lowest of any The Canadian Resident Matching Service (CaRMS) administers industrialized nation.1Despite a 69.0% increase in medical school the match into postgraduate training in Canada. CaRMS was the enrolment,2Canadians continue to perceive a doctor shortage. first Canadian medical organization to identify this growing The applicant pool for medical school remains unchanged in the cohort of CSAs seeking entry into the Canadian healthcare last decade with four qualified applicants for every admitted system. In 2005-2006 Sandra Banner, the Executive Director and medical school student in Canada.2Over the past decade, and CEO of CaRMS, conducted a brief survey of select CSA schools perhaps due to these factors, there has been a recognized and and applicants. This study was based only on informal discussions increasing subset of Canadians who have chosen to pursue among some of the international medical schools identified at a medical education abroad. Although these Canadians appear to point when the medical community estimated that there were be increasing in number and have begun to have a political voice, approximately 400 students studying medicine outside of North little is known about their true numbers, demographics, motiva- America. The results of this survey estimated that there were tion to study abroad, general characteristics or whether they are approximately 1500 Canadian students studying medicine interested in returning to Canada. This study was developed to abroad.3Since 2006, the project team has identified additional provide a description of this potential resource and to help inform international schools and an increasing number of CSAs who the provincial and federal governments for future physician re- were used to form the study population for this report. Where source planning. The definition of a Canadian studying abroad possible, the results in this report are compared to data from the (CSA) recognizes that while these individuals are international 2006 report. medical graduates (IMGs), they are Canadians who left Canada to pursue their dream of medical education abroad. They are CSAs were identified using several data sources including: the citizens born in Canada, or permanent residents. Almost all of CaRMS 2008 and 2009 applicant databases, a list of schools them have done some of their earlier education in Canada, but provided by the Medical Council of Canada (MCC), using data choose to go abroad for medical education. This definition from graduates of international institutions applying for MCC’s separates these individuals from other international physicians evaluating examination (a prerequisite for residency training in (IMGs), who graduate abroad prior to coming to Canada and Canada). Using this methodology, 55 schools outside of North becoming citizens or permanent residents. America were identified as having Canadian students studying at them. Each school was contacted and asked to distribute a letter to their Canadian students. The letter outlined the scope of the study and provided the online student survey link with password. The online student survey was available from August 2009 through to June 2010. Each institution was also asked to com- plete a school survey and if they were willing to host a site visit. CaRMS Report: 2010 5 EXECUTIVE SUMMARY Canadians studying abroad are spread across the globe from to a site visit of the curriculum, to a government-led overall Australia to China to the Netherlands. What they have in common education standard across all of the professional education is their desire to come home to Canada to practice medicine. institutions not specific to medicine. The educational curriculum Canadian students who are unsuccessful in being admitted to a varied across all schools visited, and the clinical component of the Canadian medical school, and make the decision to go abroad to students’ undergraduate medical education did not usually offer a foreign medical school do so largely because they believe there the autonomy and direct patient care of the North American is a shortage of physicians in Canada, and there will be opportuni- medical education model. ties for them to return to Canada to practice medicine. Demographically, the majority of CSAs continue to be male, While provincial health human resource planning regulates admission slightly older, single and with more post-secondary education to medical schools in Canada, and federal citizenship and immigration than their medical student counterparts in Canada. CSAs on regulates the number of immigrants to Canada, there are no average have more debt than CMGs—CSAs have nearly $90,000 regulations that will allow for a prediction of the number of Canadian more debt than students in Canadian medical schools,7though students who will choose to study medicine abroad and return to many cite funding from family savings as a source of support for Canada for postgraduate training and practice. their education. This study found that more CSAs have a medical doctor as a parent than were identified in a study of Canadian The number of CSAs has grown exponentially since 2000. The medical graduates (CMGs).4The majority of CSAs are residents of estimated number has more than doubled since the first survey British Columbia and Ontario where the success rates of in 2006.3As the majority of Canadians are enrolled in programs medical school applicants are the lowest.5 with a duration of four years, the output of these international medical schools could contribute almost 700 graduates per year While some students have entered into their international (equal to the total number of graduates each year in all medical medical school directly from high school, most CSAs have not schools west of Ontario), or nearly 30% of the total Canadian applied to Canadian medical schools as many times as the medical school output. Furthermore, this study indicates that successful student studying in Canada.5This suggests that due more schools are opening enrolment to international students to their age and higher education, CSAs opt to study abroad each year. CSAs are studying medicine in schools all over the because they have decided they would not be successful in world—today approximately 80 schools in almost 30 countries Canada, or would rather not wait several years to be successful are identified as having Canadian students enrolled in medicine. in their Canadian medical school applications. However, most people are only familiar with schools in Ireland, Australia, the Caribbean and most recently, Poland. This study CSAs express frustration in their attempts to arrange Canadian found that every year, new schools are emerging, offering clinical rotations while in their undergraduate years abroad. The international students the opportunity to study medicine. The inability to obtain clinical experiences during their undergraduate majority of these programs target North American students, who education has increased between the survey in 2006 and 2010,3 are prepared to pay the high tuition fees for the opportunity to and may result from the increased domestic enrolment and the become physicians. The medical education they are receiving is perceived lack of capacity to provide these experiences to as diverse as the countries themselves. There is no typical CSA, as anyone other than Canadians studying in Canada. The Caribbean there is no typical immigrant IMG. Both have studied medicine in school respondents reported the most difficulty, while respon- education systems that have differing curriculums, resources and dents from Australia and Ireland continue to report some success, patient populations. Often, immigrant IMGs have graduated from suggesting that a lack of capacity may not be the entire reason the same schools that CSAs are graduating from. for not obtaining clerkship opportunities. In countries where the native language is English, international While most CSAs (over 90%) want to return to Canada for students are integrated into classes with national students. postgraduate training, they report frustration with the perceived Among the non-profit schools that were visited in this study, barriers to pursuing postgraduate education in Canada. These international students were valued for their diverse backgrounds, barriers include: choice of discipline, return of service, and the high unique perspectives, and as a significant revenue source for the competition for positions. While Canada has a ubiquitous shortage medical school. of family physicians, particularly in rural communities, only 21% of CSAs choose a career in family medicine. However, they have very In some countries, international students are taught in English in few, if any, opportunities to complete postgraduate training in the a parallel curriculum to the national students who are taught in country where they are studying medicine. None of the for-profit their native language. International students are given the schools in the Caribbean have postgraduate training opportunities, opportunity to learn the language, but translators are provided and the schools that recruit Canadian students in Ireland, Poland, during their clinical rotations so that they can experience direct other European countries and Australia have little or no postgraduate patient contact in the hospitals and clinics. This is the case for opportunities available for international students. schools offering international medical programs to North Ameri- can students in Poland, the Czech Republic, Romania, Hungary Admission data provided by the schools and the international and Bahrain, just to name just a few. Canadian student organizations led to an estimation of about 3500 Canadian students enrolled in medical schools abroad. Although most schools visited in the study had some sort of national accreditation, it varied considerably from a peer review, CaRMS Report: 2010 6 SUMMARY OF RESULTS Survey results • CSAs with lower reported median debt reported higher • 32 of the 55 schools (58.2%) agreed to distribute the student satisfaction with the cost of their medical education. survey, 20 (36.4%) answered the institutional survey and 16 (29.1%) agreed to site visits. This represents a four times Educational process, choices and perceived barriers to greater response rate than the original survey in 2006.3 postgraduate education • 1082 students completed the online survey (approximately a • A smaller percentage of respondents in this survey reported 30.3% response rate, based on estimated enrolment). success negotiating clinical type clerkship experiences than • Students studying in Irish medical schools had the highest respondents in the 2006 survey.3 response rate (41.8%). • Respondents from Australia and Ireland were more successful • The majority of CSAs (46.3%) were found in Caribbean schools. than the respondents from the Caribbean in arranging Canadian clerkships. Cohort demographics • 90.3% of the respondents reported a desire to return to • Overall there was a higher percentage of male students Canada for a portion of their postgraduate medical (52.5%) enrolled in international medical schools than males education, and 24.8% reported a plan to return to Canada in Canadian medical schools (41.8%).5 after postgraduate training abroad. Only 67.2% of respondents • Irish medical schools were the exception, with 57.0% female in the 2006 survey indicated their intention to return to students, which is similar in composition to Canadian medical Canada for postgraduate training.3 schools which average 58.2% female students.5 • In both the 2006 and 2010 surveys, the further away the • Overall, CSAs are older than students in Canadian medical respondents were from graduation, the more likely they were schools, 73.9% of CSAs are 26-30 years old while only 46.4% to respond that they intended to return to Canada.3 of Canadian medical graduates (CMGs) are the same age.6 • The main barriers cited regarding the return to Canada for • A higher percentage of CSAs are single (83.1%) compared to postgraduate medical training were: students studying medicine in Canada (61.6%).6 - The requirement to provide “return of service” for the • CSAs were more often children of physicians, with 21.0% postgraduate experience. reporting one or more of their parents as medical doctors - The choice of discipline was difficult to obtain. compared to 15.6% of CMGs.4 - The perception that they would have difficulty matching • CSAs whose parents are physicians were more likely to to a program in Canada. attend medical school in Ireland. • The top two career choices of CSAs continue to be Family • The majority of CSAs come from the provinces of British Medicine and Internal Medicine, similar to the 2006 survey.3 Columbia and Ontario. • The top two university choices were the University of Toronto and the University of British Columbia. Entry into medical school • 5.9% of CSAs entered medical school from high school. Limitations • Despite some CSAs entering medical school directly from The following limitations have been identified: high school, more CSAs have advanced degrees than • Respondent bias—as analysis has been done on self- students in Canada, 13.1% of CSAs reported master’s reported data. degrees, while 9.8% of CMGs reported the same level of • The findings are also subject to non-response bias, as well as education.5 low response bias. As an example, it was difficult to compare • CSAs applied to Canadian medical schools an average of the Middle East to all other areas surveyed, as the response 1.76 times while CMGs applied 2.59 times before being rate was much smaller. This made it difficult to project any successful.5 true trends for that area. • 26.7% of CSAs had never applied to a Canadian medical school. • Non-participation—the study was subject to the international • The most frequently reported reason for choosing an medical schools’ willingness to participate. Without the aid international medical school was students felt they would be of the schools, it proved to be very difficult to contact and unable to secure a place in a Canadian school. recruit participation of Canadian students. • The findings are limited by having little access to Cost, debt and satisfaction Canadian students from the Caribbean medical schools, • The average annual tuition cost ranges from $12,250(CAD) in especially those in their clinical years. Poland to $66,369(CAD) in Australia. • Faculty and students likely wanted to present their schools • Site interviews revealed that international students are in the best possible light. important revenue sources for not only the for-profit universities • There was no incentive to complete the surveys. but also the non-profit state universities. In the latter cases, • At the beginning of the study, only 55 of the more than CSAs’ tuition supplements the national medical education costs. 75 schools where Canadians are now known to be studying • The CSA median debt is $160,000(CAD) compared to the medicine abroad were identified, as more schools are 2007 CMG median debt of $71,000(CAD).7 discovered every day. CaRMS Report: 2010 7 RESULTS SAMPLE Statistical analysis In total, 1082 CSAs completed the survey. From these respondents, school to determine if there were notable differences across a summary of demographic information was conducted, followed geographic regions. The Pearson chi-square test of independence by an analysis of pre-medical education, current experience with was used to look for relationships between variables. Further, differ- medical education, and postgraduate plans. The respondents were ences in proportions were tested using the z-test for proportions. also grouped according to the geographic region of their medical A pvalue < 0.05 was regarded as being significant. TABLE 1BREAKDOWN OF 2010 SAMPLE BY REGION * Three respondents listed as attending a medical school in the UK were included in Medical School Survey Estimation of CSAs Enrolled in Medical this group as there were not enough respondents to create a separate group Region Respondents Schools Across all Years of Study for analysis. Ireland* 272 650 ** Two respondents listed as attending a medical school in the Czech Republic and Poland** 79 300 one survey respondent listed as attending Caribbean 501 2000 a medical school in Romania were included Australia 206 550 in this group. ***Middle East group includes respondents Middle East*** 23 70 attending a medical school in Bahrain Totals 1081 3570 and Israel. Note:one respondent was excluded from the regional analysis because they were from an international medical school not contacted for this study, and not within any of the regions contacted. TABLE 2MEDICAL SCHOOL OF RESPONDENTS Medical School Region n % St. George’s University Caribbean 233 21.5% Saba University School of Medicine Caribbean 187 17.3% University of Queensland Australia 114 10.5% Royal College of Surgeons in Ireland Western Europe 104 9.6% University of Sydney Australia 52 4.8% Jagiellonian University Medical College Eastern Europe 50 4.6% Ross University Caribbean 47 4.3% Trinity College, University of Dublin Western Europe 46 4.3% University College Dublin Western Europe 46 4.3% University College Cork Western Europe 32 3.0% University of Limerick Western Europe 30 2.8% Poznan University of Medical Sciences Center Eastern Europe 24 2.2% Flinders University of South Australia Australia 19 1.8% RCSI Bahrain Middle East 12 1.1% Sackler School of Medicine Middle East 11 1.0% University College, Galway Western Europe 11 1.0% American University of the Caribbean School of Medicine Caribbean 10 0.9% Xavier University School of Medicine, Bonaire Caribbean 10 0.9% University of Wollongong Australia 8 0.7% University of Melbourne Australia 7 0.6% James Cook University Australia 6 0.6% Windsor University Caribbean 6 0.6% All Saints University School of Medicine, Dominica Caribbean 3 0.3% Continued on page 9 CaRMS Report: 2010 8 TABLE 2MEDICAL SCHOOL OF RESPONDENTS Medical School Region n % International American University College of Medicine Caribbean 2 0.2% University of Sint Eustatius Caribbean 1 0.1% Spartan Health Sciences University Caribbean 1 0.1% IAU College of Medicine Caribbean 1 0.1% Medical University of Warsaw Eastern Europe 1 0.1% Medical University of Silesia, School of Medicine in Katowice Eastern Europe 1 0.1% St. Georges University Western Europe 1 0.1% University of Manchester Western Europe 1 0.1% University of Nottingham Western Europe 1 0.1% Other 4 0.4% Total 1082 100% * Other includes schools in: Chile, Romania, and the Czech Republic DEMOGRAPHIC INFORMATION Age The average age of CSAs is 26 years old, with a range of 18 years old to 46 years old. AGE BY MEDICAL SCHOOL REGION 80% 24 & under 72.3% 70% 25-29 60.9% 60% 59.5% 30-34 54.4% 35 & over 50% 46.7% 43.5% 40% 39.1% 36.8% 30% 30.4% 20% 13.1% 10.2% 10% 8.1% 8.9% 7.6% 0.7% 1.3% 2.2% 4.4% 0% Ireland Poland Carribean Australia Middle East Figure 1Age by medical school region When examining the age of CSAs in relation to their region of study, it was found that Australia had a significantly older population than any other region. CaRMS Report: 2010 9 Comparison of the 2010 CSA study to the 2010 Canadian medical graduate cohort AGE COMPARISON * Source: CaRMs 2010 CMG Cohort Data 100% 20-25 73.9% 26-30 31-40 50% 45.3% 46.4% 41-50 10.6% 14.8% 7.7% 0.6% 0.6% 0% CSA CMG Figure 2 Age: CSA versus CMG By increasing the age of the CSA respondents to reflect their true age at graduation, they could then be compared to the Canadian medical graduate cohort of 2010. It was found that only 10.6% of CSAs are under 25, compared to 45.3% of CMGs. While 91.7% of CMGs are under 30, twice as many CSAs are older than 30. Overall, the CSA cohort is older than the CMG cohort. Gender Overall, males made up 52.5% of the respondents and females accounted for the remaining 47.5%. GENDER BY MEDICAL SCHOOL REGION 60% 57.0% 54.4% 56.3% 55.3% 52.2% Male 50% 47.8% Female 43.0% 45.6% 43.7% 44.7% 40% 30% 20% 10% 0% Ireland Poland Carribean Australia Middle East Figure 3 Gender by medical school region A higher percentage of men studying abroad than women was found in every region surveyed, with the exception of Ireland, where there were 14.0% more women studying medicine than men. CaRMS Report: 2010 10