Zeng Andy G X, Brenna Connor T A, Ndoja Silvio
University of Toronto, Ontario, Canada.
University of Western Ontario, Ontario, Canada.
Can Med Educ J. 2020 Jul 15;11(3):e31-e42. doi: 10.36834/cmej.69289. eCollection 2020 Jul.
The number of unmatched Canadian Medical Graduates (CMGs) has risen dramatically over the last decade. To identify long-term solutions to this problem, an understanding of the factors contributing to these rising unmatched rates is critical.
Using match and electives data from 2009-2019, we employed machine learning algorithms to identify three clusters of disciplines with distinct trends in match and electives behaviours. We assessed the relationships between unmatched rates, competitiveness, rates of parallel planning, and program selection practices at a discipline level.
Across Canada, growth in CMGs has outpaced growth in residency seats, narrowing the seat-to-applicant ratio. Yet not all disciplines have been affected equally: a subset of surgical disciplines experienced a consistent decline in residency seats over time. Applicants to these disciplines are also at disproportionate risk of becoming unmatched, and this is associated with lower rates of parallel planning as quantified through clinical electives and match applications. This, in turn, is associated with the program selection practices of these disciplines.
Long-term solutions to the unmatched CMG crisis require more nuance than indiscriminately increasing residency seats and should consider cluster specific match ratios as well as regulations around clinical electives and program selection practices.
在过去十年中，未匹配的加拿大医学毕业生（CMG）数量急剧上升。为了确定解决这一问题的长期方案，了解导致这些未匹配率上升的因素至关重要。
利用2009 - 2019年的匹配和选修数据，我们采用机器学习算法来识别在匹配和选修行为方面具有不同趋势的三类学科。我们在学科层面评估了未匹配率、竞争力、并行规划率和项目选择实践之间的关系。
在加拿大全国范围内，CMG的增长速度超过了住院医师职位的增长速度，缩小了职位与申请人的比例。然而，并非所有学科都受到了同等程度的影响：一部分外科专业随着时间的推移住院医师职位持续减少。申请这些专业的人未匹配的风险也不成比例地高，这与通过临床选修和匹配申请量化的较低并行规划率有关。反过来，这又与这些专业的项目选择实践有关。
解决未匹配的CMG危机的长期方案需要比不加区分地增加住院医师职位更细致入微，应考虑特定集群的匹配率以及围绕临床选修和项目选择实践的规定。
