Some will say this is highly innovative. Some will say, it’s re-inventing the wheel from the 50’s and 60’s. And some would say, we are just copying what is currently being done in Europe and Asia. Be that as it may, this week we launch an official new educational initiative at Queen’s to look for and accept ten exceptional high school students from across Canada, who wish to pursue a career in medicine. These students, who will come from a pool of nominees for a Queen’s Chancellor Scholarship, once accepted, will do two years in undergraduate studies in the arts, sciences, or computing, prior to taking up a spot in medical school two years later. In addition to their degree-related curriculum, QuARMS students will be exposed to learning experiences that are closely aligned with the core competencies for physicians. These experiential learning opportunities will hone the students’ skills in advocacy, communication, collaboration, and professionalism.
This new educational initiative is consistent with a major pillar of our strategic plan. That pillar indicates we will focus on new models of training and practice. It currently takes 12-16 years to develop a specialist in Canada. Many have argued that this grueling training program is too long, and we can develop a more streamlined approach. One way to do this, of course, is to start the process earlier. Currently the average time spent in undergraduate/graduate education prior to medical school is about 5 years. Not that shaving off 3 years is best for all prospective doctors, but for a subset, it may well be appropriate.
Queen’s will be the first school in the country to develop this kind of educational strategy. It has been the product hard work of many people, but especially, our current and former Associate Deans of Life Sciences and Biochemistry Michael Kawaja and Ken Rose, our Interim Registrar Teresa Alm, our Associate Dean Undergraduate Tony Sanfilippo, the Associate Dean (Studies) Arts and Science Hugh Horton, and our Director of Admissions, Hugh MacDonald.
I know that there will be a lot of questions, and even though “my door is always open” we have tried to develop materials on the Queen’s web site to address most inquiries.1,2
Nonetheless, if you have comments on this program, respond to the blog, or better yet, please drop by the Macklem House, my door is always open.
Richard
* QuARMS is an acronym for Queen’s University Accelerated Route to Medical School
1. http://www.queensu.ca/admission/programs/quarms/quarmsinbrief.html
2. http://www.queensu.ca/admission/programs/quarms/faq/program.html
Good Afternoon Richard,
I am writing in response to the article in the Globe and Mail on “Looking for 10 talented high school students”. What a great article and an excellent way to enroll some of Canada’s finest future doctors into Queens. My son, Spencer who is 16 yrs old and enrolled in Grade 11 has always had the vision of going into medicine. He has excelled in Elementary, Junior High and thus far in Senior High. His grade average in Grade 10 was 96. I am wondering if this program will be available when he finishes Grade 12. I have been told by many people that is extremely difficult in get into a medical program, therefore many students pursue other careers or go outside Canada to reach their goals. The next two years of Spencer’s high school education will go quickly, so my husband and I are actively pursueing all avenues to help him reach his goal.
Thanking you in advance for a response to my message,
Kathy MacDonald
902-755-5456
Dear Ms. MacDonald,
Our assumption is that this new initiative will meet with success, and therefore we are planning to do this every year. If you visit our websites (ex. http://www.queensu.ca/admission/programs/quarms/faq/selection.html) there are more details about the process. Importantly, we will be drawing from a pool of Queen’s Chancellor Scholarship nominees. Best of luck.
Richard
I had the opportunity to participate in one of the last two year pre-meds groups at Queen’s (before entering Meds 74) and as a result I had completed residency and fellowship training by age 30. The time consuming practice of getting degree after degree as medical school applicants try to outlast the competition has always seemed counter productive to me. Now when I see some mature students start residency as old as 40 years of age ( hence 45 years of age at completion of residency or 47 or 48 at completion of fellowship) I wonder whether we are getting full value from the expensive medical training they receive. While an accelerated stream such as that re-instituted at Queen’s is sure to be a frustration to those who have gone the longer route I see it as a step forward. The challenge will be to devise a system of acceptance that is fair and selects for those qualities considered desirable in medical practice – not so easy!!!
Thanks Bob,
Important comments coming from an outstanding academic!
I agree, we will need to select carefully to incorporate both academic excellence and non-academic qualities.
Richard
Dear Dr. Reznick
Congratulations on taking a step to shortening the course for educating physicians. Taking 10 extremely bright high school students as a start guarantees its success.
I came to Queen’s Faculty of Medicine in the fall of ’47 straight from high school. The course was six years long and I graduated in 1953. A majority of my classmates were veterans of WW 2. All of them were older than high school graduates — I think the oldest was 39 years of age with a wife and three children. He had been out of school for 20 years at least and qualified because he went to rehab school in 1946 after being demobilized.
The veterans were financed by a government grant of $60 per month as long as they maintained at least 70% in all their subjects. Almost all of them did.
The high school graduates were 18 and 19 years of age.
One of my strongest memories of those six years is the intense focus and hard work of the veterans. It inevitablyrubbed off on the rest of us. My thanks to them.
When Dr. John Evans became the founding Dean of the McMaster Medical School he established a host of innovations. One of them was to make the medical course an 11-month-a-year course for three years, This 33-month instruction contrasted at the time with the four-year, eight-month-a-year courses elsewhere. I seem to recall that the McMaster graduates turned out to be not less than eqivalent to the graduates of the four-year schools.
Keep innovating.
Boyd Upper, Meds “53.
Dear Dr. Upper,
Thanks for your reflections and perspective. You are quite right about Mac (and Calgary). The three your course produces equivalent outcomes.
Your story about the challenges for our veterans should remind us all of the ongoing need for Canadians and our government to support our current returning troops.
Richard
Richard
This partial return to the past brings fond memories of my entry to Queens Meds in 1954, directly from high school. The classes were smaller in those days and a close warm comradeship developed amongst us that remains to this day. Of equal or more importance was the continuing and longer-term relationship with our medical teachers that started early with such things as lectures for the St John’s Ambulance course and continued through our internships for those who stayed for a while after graduation, and beyond.
Now-a-days when students have to make earlier choices of their career pathways, a similar mentoring relationship with the medical and basic science teachers is perhaps even more important. Hopefully the alignment with core competencies for physicians will be particularly fostered to allow those supportive and directing influences to have a personal as well as practical value, that carries on thereafter. I would also hope that for these particular students, as well as for the others, that within the career choices will be that of the Clinician Scientist as well, a category that is fast being considered a “dying breed”. As for those of us in the past, the extra time for training will be much easier to deal with.
I see the changes proposed as a welcome direction for many of the reasons expressed by others. Congratulations to you and your colleagues.
Nick
Dear Nick,
Thanks for your insightful comments. I agree, that we will orient the adjunctive experiences towards support for these students, career guidance and mentoring. And absolutely, we won’t forget to encourage the science aspect of our mission.
Richard
Dear Dr Reznick:
This is an excellent innovative project..congratulations. I would love to see a duplicate program for older adults who have several years of work/life experience behind them.
Neil,
Thanks for your comments and it is indeed something we should consider. That having been said, we do have a history of accepting older students to our medical school class already.
Richard
I agree that pursuing options for streamlining this extremely long training process is a great idea. Having worked as an academic advisor, I know that many students have a change of heart with regard to their academic and career goals once they get their feet wet in the university environment. Whether it’s exposure to new classes and ideas or simply reaching new stages of intellectual, psychological and emotional maturity, often paths that seemed like the Only One can become less certain within the first few semesters of university study. Some students may require some degree of flexibility to change programs should they arrive at a well-informed point of realization that they need to rethink their direction.
Also, on a somewhat related note, these students will be under a great deal more academic pressure than their peers in a “standard” undergraduate degree program. I hope that consideration of the students’ mental and emotional health will be well considered in the selection process and well monitored and supported through the program.
All the best to everyone involved in this great initiative!
Dear Kathryn,
You make two excellent points. The figures in Canada for physicians who would have liked to have chosen a different specialty is about 10%. So we must be mindful of not forcing premature career choice. I also agree, we will need to focus attention on these students emotional well-being.
Richard
Dear Dr. Resnick. I say make room for more people as soon as you can, At a gathering on my ninetieth birthday my message to the visitors was to get their . grandchildren to learn as much as they can before they turn 20. I began my first year at Queen’s the year I turned 18. With the pressure of War, I graduated 8 months into my 22nd year. I have never regretted it and I have not been a burden on the C.M.P.A.. It should not be necessary to have 15 years training before we are considered safe to practice, but the individual must also be devoted to his or her calling.
Murray M. Fraser MD;CM.,FRCSC(General Surgery & General Paediatric Surgery)
Dear Dr. Fraser,
Thanks for your endorsement of our initiative. We are looking forward to our emerging experience, and after a year or two get a sense what’s next.
Richard
Dear Dr. Resnick,
I took advantage of the 6-year course at Queen’s ( from senior matric in Ontario) in 1947 after 2 years at UBC, before UBC had a medical school – and no sight of one at that time, although they did start one in 1950. I was a member of Med’s 53 with Boyd Upper – only the 5th class (I think) that had admitted women – there were 60 men and 6 women – 2 of whom had been nurses in the services. The first year was strictly pre-med
and I had had some of it before at UBC, but it got us oriented to the university and ready and eager to get into medical subjects in 2nd year. So in the end, I had only my degree from Queen’s, which at that time was MD,CM. I took the same time – 8 years – as it takes many people now if they have to do a 4-year undergraduate course, and I think you’ll find that your proposed students will do very well, and more power to you for being willing to give it a try.
Dear Dr. Radcliffe
Thanks so much for sharing your personal experience, and for your words of encouragement. Hope to see you back at Queen’s soon.
Richard
What a great initiative! One of my major concerns about our current health professions training programs is the credential creep that is occurring across all fields. The Lancet Commissions report on health professions education (doi:10.1016/S0140-6736(10)61854-5) comments on this concern at a global level. The long training programs come at a cost: our students incur higher debts, our trainees (especially our female trainees) delay starting families and society doesn’t get as long a return on their investment as physicians and other health professionals have fewer potential years to give back.
How wonderful to hear that Queen’s is looking at options to reduce the length of training. I happen to be one of those people who was lucky enough to be accepted to medical school after two years of undergrad. I was barely 23 when I graduated from medical school at Queen’s in 1991. While that was definitely on the young side, it seems to have worked out okay so far.
I look forward to hearing about the accomplishments of all of the Queen’s grads in the years to come–no matter what path they choose to get there.
Richard,
I couldn’t agree more with Nick Diamant’s comments above. I too, went “down to Queen’s” in the 50′s, knowing that I was already enrolled in the Faculty of Medicine and would be proudly wearing the iconic blue leather jacket from the get go.I say, bring back the Premeds program, which was an intense Art’s/Science combo, as the first two years, to be followed by four years of clinical studies.
Those in my year, Meds’63, who wished an undergraduate degree concurrently simply worked their asses off in the summer months registering for additional credits through Queen’s Summer School to complete their degree requirements for a BA or BSc, usually holding down a job or two to meet tuition at the same time. For the most part, my 56 classmates were straight out of high school…mind you we had passed Grade XIII matriculation and so had, what could be considered, an extra year of Secondary Education.Some, however, would believe that those five years are now compressed into four so the starting point ought to be the same for new high school graduates.
Why not reinvent the wheel? It rolled along quite nicely then, thank you, because it was round; so why wouldn’t it roll along smoothly now? Call it what you will, but you can be sure that a six year program designed along these lines would be a winner and bring talent in to the medical pool earlier. As a corollary, there would then be postgraduates from specialty programs entering the workforce earlier and, therefore, for longer active service lifetimes.
Our class exemplified the value of being together for a full six years in the cohesiveness fostered, the mutual respect engendered, the lifetime friendships established, and the longterm relationships with Faculty formed. In time, this class produced more professorships and fellowships than you could shake a stick at and contributed immensely to advancing the educational and research process in Canadian Medicine over the years. Two members have received The Order of Canada, another was a Rhodes scholar who became a neurosurgeon, and many others have distinguished themselves…so, given that practically all “came down to Queen’s” wet behind the ears, direct from High School, let it be seen that this type of program was and can be wildly successful. Cha Gheil!
While we are on the subject of rejigging the competency base for medical school admissions, we should also pay attention to how to manage the new graduates. I strongly favour resurrecting the time honored rotating junior internship following which, having had a scent of the real world, rational decisions could be made in selecting further postdoctoral studies or specialty training. I find the current trend of being forced to make a decision too early in one’s career as to specializaton has led to some dissatisfaction with career choice. So, why not a rethink of this process?In addition, there certainly would be a better understanding of the work done in the trenches if, after internship, a year or two in general practice were considered before deciding upon and entering surgical or medical residency.
Richard, I do applaud your enlightened approach but would encourage you to take the thinking one step further. If 10 high school selectees, why not 60? Or for that matter, the entire current first year medical school enrolment? The phase-in might be a logistical problem at first but could, on an integrated basis, be possible over a two year time frame. You are on to something big here! And it could even be bigger!! Good luck!!!
Garry
(Garry L Willard MD FRCSC FRCSEdin FACS FICS)
Gary,
Thanks for Sharing your experiences and for your words of encouragement. With respect to not forcing career decision making too quickly, I would provide a counterpoint, that we don’t ever offer a robust career sampling program. What would happen if the first 6 months of school were directed strictly to career choice, and then, once declared, we oriented education towards that choice. We do know the data. Only 10% of Canadian
docs are unhappy with their choice. That’s a pretty good batting average.
Thanks again for your comments
Richard
Dear Dr. Reznick:
Like Dr. Andrea Townson (above), I entered Queen’s Medicine (’87) after two years of undergraduate work, as did a fairly sizeable proportion of my class. Our class was also graced with a number of older students with degrees in a variety of fields. While I imagine some of the more mature students may have found the ‘young-uns’ comparatively wet behind the ears in terms of life experience, I suspect we all caught up eventually, and I had completed my family medicine residency by age 26, which allowed more flexibility in terms of family and other life choices (as well as the time to have a general practice for some years, and yet still return to complete specialty training before I turned 40).
However, I was grateful not to be enrolled in a defined ‘pre-med’ program in those first two undergraduate years. At that time, we needed only to complete certain prerequisite courses and take the MCAT. This allowed me the freedom to study psychology and intellectual history alongside my basic sciences, and I have to say that the history courses were among the most formative in my education and in the development of critical thinking skills.
I am not sure when or why the option to enter medicine after 2 years undergraduate work ended, but the current proposal for a ‘new’ 6-year program seems to be a (less flexible) variation on a route that was available to us not that long ago. Had I been given that choice when I was an undergraduate, I’m not sure that I would have chosen pre-med if it restricted me from obtaining a base in a broader range of courses. Presumably it allows for more focussed study on medical topics at an earlier stage, but I wonder if there are clear and proven reasons not to return to the more flexible options available in my day. Have there been any outcome studies assessing the competence (and satisfaction) of doctors with various types & durations of pre-medical undergraduate experience?
Beverly J. Goodwin (Meds ’87)
Dear Beverly,
It’s our plan to allow successful applicants to have great flexibility in their first two years. We agree with you hat it would be a mistake to restrict their courses to biomedical subjects. So in essence, we will be trying to emulate a trajectory vey similar to the one you had.
Richard
I congratulate you on your initiative to accept 10 bright high school students into Medicine. I also wonder whether the initiative might even be richer if focused on selecting high school children from less privileged backgrounds…and perhaps from rural communities. I am sure there are many brilliant promising students in our less populated communities who cannot fathom a career in Medicine with our current approach of endless years of study (and tuition fees!) before even being accepted! These student will be more likely to serve communities in great need at the end of the day.
Thanks Willa, and yes indeed, we have had extensive discussions on achieving just that, a “socially equitable” admissions process that proactively addresses the issues you raised.
Richard
I was really impressed to hear about the new Strategic Plan at our Board meeting recently at HDH, and further, about this new initiative for bright students aspiring to become physicians. I encourage a very robust effort to surround these younger students with support to facilitate the transition from home/high school to university and the rigours of academia. Having worked in a management position within student affairs at another Ontario university in the mid-1990s when OACs went by the wayside and age of enrolment began to drop, I recall that many of our bright, first year 17 year old students really struggled with university life away from home at a young age (i.e. living away from families, meeting new people, balancing budgets, forming new relationships, maintaining good mental health, etc.). While this was not uncommon with older first year students as well, it seemed always to be compounded among those who were on the younger end of the spectrum and those who were particularly academically proficient. I would be very interested in supporting the new Queen’s program personally through mentorship, “family away from home” type initiatives, etc. if there is a role for community members to play. Putting strong supports in place beyond the academic environment should further enhance the students’ success in this exciting new Queen’s Medical School initiative, and might also provide welcome relief to anxious parents back at home too.
Elizabeth,
Thanks so much for your comments, and what a terrific idea. You are quite right, these students ( and likely many others) would benefit from what you suggest. I will discuss this idea with our team.
Much appreciated
Richard
Dr. Reznick,
I am very interested, as a faculty member and residency program director, to see how these talented students fare in this innovative program.
I am curious, however, as to whether this initiative, which involves experimentation on human subjects, has been given approval by the Health Sciences Research Ethics Board and how you feel the issue of informed consent from these students has been addressed…
Best of luck!
Dear David,
Thanks for your comments. We have not considered this an experiment, but rather a modification of our entry criteria. As well, there is precedent in Europe, UK, Asia and to a certain extent Quebec.
Richard
Hi Richard,
I was reading your blog, and I think this is a fantastic opportunity!! About time Canada starts to step up it’s game in the educational system as compared to those in Europe. I agree that it is an extremely long process to become a doctor and it’s wonderful to see amazing changes happening so close to home! I just graduated this year and am now in my first year of university. Only have I dreamed of a program such as this to apply to! It is straining to think of doing 4 years of undergrad, then apply to medical school in Canada with the competitive edge it already has, as well as residency and specialization. All those years really do add up, and the costs are increasing, which usually leads to huge loans and debt. I was wondering if you plan to accept those who are already in university to your program, as I am still in my first few months of first year and in Hamilton, Ontario at McMaster University.
Once again, an amazing idea and truly wonderful to know that you are doing a great deal in the educational system by making a much needed change. Other universities should take note and apply this to their schools as well.
Best of luck and wish you all the success!
- Kaitlyn
dear Kaitlyn,
Presently we are not accepting applications form year 1 undergrad students. Perhaps in the future, but, of course, that doesn’t help with you. Best of luck with future applications.
Richard
Dean Resnick
i too echo the sentiments of others above, and was one of the lucky ones to enter Queens at age 17, complete 6 years of medicine, and then devote more time to my post-graduate surgical training.
For those inclined, I feel that more time should be spent in complex fellowship training in surgery, rather than undergraduate training.
thanks for taking this initiative.
Don Johnson Meds 66.
Don, thanks for your endorsement of the “old” new pathway. We will keep our readership informed as to our progress.
Richard
Hello Dean Riznick,
I am currently a Manitoban high school student who has applied for this amazing opportunity! However I have a couple questions that I could not find the answers to in your FAQ section.
1. After the completion of 2 years in the bachelor program, will the QuARMs student receive a bachelor’s degree?
2. Also after completion of 2 years in the bachelor program, will the QuARMs student be required to write the MCAT?
Thanks for your time,
Ian Veloso
Dear Ian,
The best person to contact is Professor Michael Kawaja, who can answer your questions.
kawajam@queensu.ca
Richard