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There was no difference among the groups in passing the Qualifying Examination Part II or obtaining a specialty designation. Interpretation: Canadians who studied abroad were more likely than other international medical graduates to obtain a postgraduate position; there were no differences among the groups in realizing milestones once in a postgraduate program. These findings support policies that do not distinguish postgraduate applicants by citizenship or permanent residency status before medical school.
International medical graduates are physicians who, regardless of citizenship, graduated from medical school outside of Canada. To obtain full licensure, international medical graduates must have their educational credentials verified and pass language proficiency tests and 3 Medical Council of Canada examinations Evaluating Examination, Qualifying Examination Part I and Qualifying Examination Part II. Obtaining a residency position is the greatest obstacle to full licensure because there are more applicants than positions available to international medical graduates.
We hypothesized that Canadians who studied abroad would be more successful in realizing these milestones than other international medical graduates.
Education Registry's National IMG Database, which includes data from agencies involved in the training, assessment, certification and licensing of physicians.
The database is the most complete and comprehensive data set on international medical graduates in Canada, with data from to funding to maintain the original database beyond this period was not available.
We included both residency and fellowship training because fellowship additional years of training that normally follow residency qualifies as recognized clinical experience that enables international medical graduates to write the Qualifying Examination Part II and specialty examinations.
The database includes the year in which an international medical graduate passed the Qualifying Examination Part II and the year in which he or she was awarded a specialty designation; it does not include whether a graduate wrote or failed the examination.
In our analyses, we assumed that all international medical graduates would attempt to obtain full licensure i.
We defined Canadians who studied abroad as international medical graduates who were Canadian citizens or permanent residents before entering medical school. We identified Canadian citizens and residents based on birth place and legal status in Canada reported by multiple agencies to the National IMG Database.
Preliminary analyses, corroborated by consultations with medical educators, suggested that physicians who graduated from medical schools in Western United Kingdom, Ireland, Western Europe, New Zealand or Australia or Caribbean countries may have different outcomes than physicians who graduated from non-Western, non-Caribbean medical schools.
Sample Because the National IMG Database covers a 7-year period and few international medical graduates would have been able to complete all the steps from Medical Council of Canada Evaluating Examination to specialty examination needed for full licensure during that time, we examined 2 separate cohorts in the study.
For the outcome "obtained postgraduate position," physicians had to have passed the Qualifying Examination Part I between and ; this time cut-off allowed physicians at least 1 year to obtain a postgraduate position. For the outcomes "passed Medical Council of Canada Qualifying Examination Part II" and "obtained specialty designation," physicians had to have first entered a family medicine postgraduate program between and , or have first entered a specialty postgraduate program in or Arguing otherwise constitutes a well-known inferential fallacy known as transposition of the conditional see for example Paulos 9 , which in this case takes the form of wrongly assuming the unknown probability of a medical advance taking place given the use of animals is equivalent to the very high probability that animals were used given a medical advance has taken place.
This can be made precise and quantitative via the familiar concepts of sensitivity i. All animal models possess both sensitivity and specificity values, and thus lead to values for the evidential weight provided by each such model. As such, they provide the quantitative underpinning for statements about the value of animal models to medical progress. Or, rather, they would if they existed. As has been pointed out repeatedly by authors for several decades, there is a striking paucity of quantitative comparative data for animal models.
Secondly, it is frequently difficult to establish end-points sufficiently clear-cut to allow categorization as true positives or true negatives. Thirdly, much of the comparative animal-human data is obtained under conditions of commercial confidentiality. These are all serious difficulties for those seeking to show that the value of animal models is supported by quantitative evidence rather than anecdote.
While there may be relatively few quantitative studies of the predictive abilities of animal models, they do exist. The principal source of such studies is in an area where both critics and advocates agree there is a pressing need for the validation of animal models: toxicity testing.
Regrettably, the data provided by these studies is typically incomplete, ambiguous, and subjected to inadequate or incorrect analysis. As a result, the estimates for the evidential weight of animal models that emerge are at best inconclusive, and sometimes wholly misleading.
For example, the largest review of the predictive performance of animal toxicity studies covers drugs specifically associated with adverse events or toxicity in humans in testing by pharmaceutical companies.
Yet without this, it is simply impossible to assess the evidential weight provided by the animal models. In his review of the predictive power of seven animal models for toxic lesions in humans, 17 Hottendorf provides explicit values for both the false positive and false negative rates.
Unfortunately, these are based on incorrect definitions, while other data are stated in a format that precludes calculation of unambiguous values for the LRs see Appendix. The review of comparative anticancer drug toxicity by Schein et al. Once again, however, the values quoted by the authors cannot be used directly, as they are based on incorrect definitions regrettably, this has not prevented the values being cited directly by other authors When calculated correctly see Appendix , the LRs of the animal models examined by Schein et al.
In other words, the data provide no statistically credible evidence that these animal models contribute any predictive value, either separately or in combination. So do animal models have predictive value? The debate over the use of animals in medical experiments has a long and often bitter history.
It is therefore perhaps not surprising that the research community has responded by becoming more assertive in its claims.
As we have seen, despite its now routine use by the scientific community, it is far from clear that this statement has been, or even could be, formally validated. This is not to say that animal models do not provide evidential weight, still less that they have no role in research. There are many examples of research on animals providing insights that have transformed medical science.