The National IMG Database Report - CAPER

2012

The National IMG Database Report

Rapport de la base de donnes nationale sur les DIM

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Cover_Layout 1 12-12-07 2:30 PM Page 1

CAPER would like to acknowledge the contribution of its funder and data providers and thank them for their continued support.

CAPER souhaite souligner la contribution de son bailleur de fonds et de ses fournisseurs de donnes et les remercier de leur collaboration soutenue.

Canada

Health Canada

Government of Canada's Foreign Credential Recognition Program (FCR)

Association of Faculties of Medicine of Canada (AFMC)

Canadian Medical Association (CMA)

Medical Council of Canada (MCC)

College of Family Physicians of Canada (CFPC)

Royal College of Physicians and Surgeons of Canada (RCPSC)

Newfoundland and Labrador

Clinical Skills Assessment and Training Program (CSAT)

College of Physicians and Surgeons of Newfoundland and Labrador (CPSNL)

Nova Scotia Clinician Assessment for Practice Program (CAPP)

College of Physicians and Surgeons of Nova Scotia (CPSNS)

New Brunswick College of Physicians and Surgeons of

New Brunswick (CPSNB)

Qubec Collge des mdecins du Qubec (CMQ)

Ontario

College of Physicians and Surgeons of Ontario (CPSO)

The Centre for the Evaluation of Health ProfessionalsEducated Abroad (CEHPEA)

Manitoba Medical Licensure Program for International Medical

Graduates (MLPIMG)

International Medical Graduates Assessment for Conditional Licensure (IMGACL)

Clinicians Assessment and Professional Enhancement (CAPE)

Office of Continuing Medical Education at the University of Manitoba

College of Physicians and Surgeons of Manitoba (CPSM)

Alberta Alberta International Medical Graduate

Program (AIMGP)

College of Physicians and Surgeons of Alberta (CPSA)

Saskatchewan Division of Continuing Professional Learning (CPL)

Unit of the College of Medicine at the University of Saskatchewan

College of Physicians and Surgeons of Saskatchewan (CPSS)

British Columbia

British Columbia IMG Program (IMG-BC)

College of Physicians and Surgeons of British Columbia (CPSBC)

Yukon

Yukon Medical Council (YMC)

This project is funded by the Government of Canada's Foreign Credential Recognition Program. The opinions and interpretations inthis publication are those of the author and do not necessarily reflect those of the Government of Canada.

Ce projet est financ par le Gouvernement du Canada par lentremise du Programme de reconnaissance des titres de comptencestrangers. Les opinions et les interprtations figurant dans la prsente publication sont celles de lauteur et ne reprsentent pas ncessairement celles du gouvernement du Canada.

Cover_Layout 1 12-12-07 2:30 PM Page 2

Canadian Post-M.D. Education Registry

Systme informatis sur les stagiaires post-M.D.en formation clinique

2012The National IMG Database Report

Rapport de la base de donnes nationale sur les DIM

The Association of Faculties of Medicine of CanadaLAssociation des facults de mdecine du Canada

265 avenue Carling Avenue, Suite/pice 800Ottawa ON Canada

K1S 2E1

Telephone/Tlphone: 613-730-1204Facsimile/Tlcopie: 613-730-1196

E-mail/Courriel: [email protected] Site/Site Web: www.caper.ca

Acknowledgements

It is a pleasure to present the 2012 edition of theNational IMG Database Report.

This report is made possible through data inputs froman array of organizations that engage with InternationalMedical Graduates (IMGs) in Canada. Canadas IMG assessment centres contribute data to the National IMGDatabase. Data is provided by all national medical examination and certification bodies, including theCollge des mdecins du Qubec, the College of FamilyPhysicians of Canada, the Medical Council of Canadaand the Royal College of Physicians and Surgeons ofCanada. The Canadian Post-M.D. Education Registry(CAPER) provides a complete picture of IMG entry to, and progression through, the postgraduate medicaleducation system. Finally, medical regulatory authori-ties throughout Canada provide invaluable data aboutIMGs who achieve licensure status within their jurisdictions.

Enormous thanks is given to all of these data providerorganizations. Their time and effort make the NationalIMG Database Report possible.

We are also very grateful to Human Resources and SkillsDevelopment Canada (HRSDC) for their continuedsupport of the IMGs in Canada project. HRSDC funding has helped build the National IMG Databasesince 2005.

Finally, we would like to thank the members ofCAPERs Policy and Executive Committees. Their earlyinput helped establish the National IMG Database and their continued guidance ensures that it remains avaluable information resource today.

Sincerely,

The IMGs in Canada Project Team:

Steve Slade, Vice President, Research and Analysis CAPER-ORIS

Catherine Moffatt, Project ManagerLinda Bourgeois, Research Associate

RemerciementsNous sommes heureux de prsenter ldition de 2012 duRapport de la Base de donnes nationale sur les DIM.

Ce rapport est rendu possible grce la panoplie dorgani-sations qui ont bien voulu partager leurs donnes relativesaux Diplms internationaux en mdecine (DIM) auCanada. Les centres dvaluation des DIM du Canada fournissent des donnes pour la Base de donnes nationalesur les DIM. Les donnes nous parviennent de tous les organismes nationaux dexamen et de certification de lamdecine, y compris le Collge des mdecins du Qubec,le Collge des mdecins de famille du Canada, le Conseilmdical du Canada et le Collge royal des mdecins etchirurgiens du Canada. Le Systme informatis sur les stagiaires post-M.D. en formation clinique (CAPER) offreune vue densemble du cheminement dun DIM, partir delinscription jusqu la formation mdicale postdoctorale.Les organismes de rglementation mdicale lchelle duCanada fournissent aussi des donnes inestimables au sujetdes DIM qui obtiennent leur permis dexercer dans leurressort territorial.

Nous remercions normment toutes ces organisations quiont bien voulu partager leurs donnes. Cest grce ellesque le Rapport de la Base de donnes nationale sur les DIMest rendu possible.

Nous sommes galement trs reconnaissants de la collabo-ration soutenue du projet portant sur les DIM au Canada de la part du ministre des Ressources humaines et duDveloppement des comptences (RHDCC). Le finance-ment de RHDCC a aid peupler la Base de donnesnationale sur les DIM depuis 2005.

En dernier lieu, nous souhaitons remercier les membres ducomit des politiques et du comit excutif de CAPER. Leurentre de donnes diligente a servi de fondement pour laBase de donnes nationale sur les DIM et leur orientationsoutenue veille ce quelle demeure une ressource dinfor-mation trs utile.

Sincres salutations,

Lquipe du projet portant sur les DIM au Canada,

Steve Slade, vice-prsident, Recherche et analyse CAPER-ORI

Catherine Moffatt, gestionnaire de projetLinda Bourgeois, associe en recherche

IThe National IMG Database Report

Table of ContentsTable des matires

Background and Introduction VIII

Index of Abbreviations XVII

The Reporting Process XIX

How to Access the IMG Data Tables XX

Definitions XXI

A. Faculties of Medicine of Canada 1

Legal Status (2005 2010) 3

Province and Faculty(Excluding Visa Trainees) 3

Residents/Fellows (Excluding Visa Trainees) 4

Country where M.D. Earned(Excluding Visa Trainees) 7

Field of Post M.D. Training (Excluding Fellows and Visa Trainees) 10

Years Since M.D. Earned (Excluding Visa Trainees) 11

Metrics of Age (Excluding Visa Trainees) 11

Training Province (Excluding Visa Trainees) 12

B. Assessment Centres 13

Newfoundland and Labrador Clinical Skills Assessment and Training Program (CSAT) 15

IMGs (Completed CSAT) 16

IMGs (Referred for a Defined License) 16

Country where M.D. Earned 17

Gender 17

Years Since M.D. Earned 18

Nova Scotia Clinician Assessment for Practice Program (CAPP) 19

IMGs (Completed Part A) 20

IMGs (Referred for a Defined License) 20

Country where M.D. Earned (Part A) 21

Country where M.D. Earned (Defined License) 22

Gender (Part A) 22

Years Since M.D. Earned (Part A) 23

Contexte et introduction

Index des abrviations

La collecte de donnes

Utilisation du rapport de la banque de donnes sur les DIM

Dfinitions

Facults de mdicine du Canada

Statut lgal (2005-2010)

Province et facult de mdecine(excluant les stagiaires avec permis de travail)

Rsidents/moniteurs cliniques(excluant les stagiaires avec permis de travail)

Pays de luniversit ayant dcern le doctorat en mdecine(excluant les stagiaires avec permis de travail)

Domaine de formation post-M.D. (excluant les moniteurs cliniques et stagiaires avec permis de travail)

Annes depuis lobtention du doctorat en mdecine(excluant les stagiaires avec permis de travail)

ge(excluant les stagiaires avec permis de travail)

Province de formation(excluant les stagiaires avec permis de travail)

Centres dvaluation

Terre-Neuve-et-LabradorClinical Skills Assessment and

Training Program (CSAT)

DIM (CSAT complt)

DIM (recommands pour un permis dfini)

Pays de luniversit ayant dcern le doctorat en mdecine

Sexe

Annes depuis lobtention du doctorat en mdecine

Nouvelle-cosse Clinician Assessment

for Practice Program (CAPP)

DIM (partie A complte)

DIM (recommands pour un permis dfini)

Pays de luniversit ayant dcern le doctorat en mdecine (partie A)

Pays de luniversit ayant dcern le doctorat en mdecine (permis dfini)

Sexe (partie A)

Annes depuis lobtention du doctorat en mdecine (partie A)

II The National IMG Database Report

OntarioThe Centre for the Evaluation of Health Professionals Educated Abroad (CEHPEA) 25

IMGs (CEHPEA Assessment) 27

Method of Application 27

Examinations Completed 27

Country where M.D. Earned (CE1) 28

Country where M.D. Earned (CE2) 31

Country where M.D. Earned (SWE) 32

Gender (CE1, CE2 & SWE) 33

Years Since M.D. Earned (CE1, CE2 & SWE) 34

ManitobaManitoba Medical Licensure Program for International Medical Graduates (MLPIMG)International Medical Graduates Assessment for Conditional Licensure (IMGACL)Non-Registered Specialist Assessment Program (NRSAP) 35

IMGs (Completed 3-Day CAPE by Province of Referral) 37

IMGs (Participated in the IMGACL, MLPIMG and NRSAP Assessment Programs) 37

Country where M.D. Earned(Participated in the IMGACL, MLPIMG and NRSAP Assessment Programs) 38

Gender (Participated in the IMGACL, MLPIMG and NRSAP Assessment Programs) 39

Years Since M.D. Earned(Participated in the IMGACL, MLPIMG and NRSAP Assessment Programs) 39

SaskatchewanDivision of Continuing Professional Learning (CPL)College of Medicine Extended Refresher Course Process for International Medical Graduates 41

IMGs(Completed CAPE and Referred to CPL) 42


Gender 43


Deemed Practice Ready 43

Offered Training by CPL 44

Offered Mentorship by CPL 44

Offered Home Study by CPL 44

OntarioCentre pour les professionnels de la

sant forms l'tranger (CPSFE)

DIM (valuation du CEHPEA complte)

Mthode dapplication

valuation complte

Pays de luniversit ayant dcern le doctorat en mdecine (EC1)

Pays de luniversit ayant dcern le doctorat en mdecine (EC2)

Pays de luniversit ayant dcern le doctorat en mdecine (EES)

Sexe (EC1, EC2 & EES)

Annes depuis lobtention du doctorat en mdecine (EC1, EC2 & EES)

ManitobaManitoba Medical Licensure Program for

International Medical Graduates (MLPIMG)International Medical Graduates Assessment

for Conditional Licensure (IMGACL)Non-Registered Specialist Assessment

Program (NRSAP)

DIM (valuation CAPE de trois jours complte

par province de recommandation)

DIM (participation aux programmes dvaluation

IMGACL, MLPIMG et NRSAP)

Pays de luniversit ayant dcern le doctorat en mdecine (participation aux programmes dvaluation


Sexe (participation aux programmes dvaluation


Annes depuis lobtention du doctorat en mdecine (participation aux programmes dvaluation


SaskatchewanDivision of Continuing Professional Learning (CPL)

College of Medicine Extended Refresher Course Process for

International Medical Graduates

DIM(valuation CAPE complte et recommandation au CPL)


Sexe


Dclar prt exercer

Formation offerte par le CPL

Mentorat offert par le CPL

tudes domicile offertes par le CPL

IIIThe National IMG Database Report

AlbertaInternational Medical Graduate Program (AIMGP) 45

IMGs (Submitted Complete Application) 46

IMGs (Completed OSCE) 46

IMGs (Entered the Externship Phase) 46

Country where M.D. Earned(Completed OSCE) 47

Country where M.D. Earned(Offered Residency Training) 48

Gender (Completed OSCE) 49

Gender (Offered Residency Training) 49

Years Since M.D. Earned(Completed OSCE) 50

Years Since M.D. Earned (Offered Residency Training) 50

British ColumbiaInternational Medical Graduate Program of British Columbia (IMG-BC) 51

IMGs (Completed Clinical Exam / OSCE) 52

IMGs (Completed 13-Week Clinical Assessment) 52


Gender 54


C. Medical Council of Canada (MCC) 55

IMGS Who Passed MCCEE / MCCQEI / MCCQEII 56

Citizenship (Passed MCCEE / MCCQEI / MCCQEII) 57

Country Where M.D. Earned (Passed MCCEE) 58

Country Where M.D. Earned (Passed MCCQEI) 61

Country Where M.D. Earned (Passed MCCQEII 64

Gender (Passed MCCEE / MCCQEI / MCCQEII) 67

Years Since M.D. Earned (Passed MCCEE / MCCQEI / MCCQEII) 68

AlbertaInternational Medical Graduate Program (AIMGP)

DIM (Soumis demande complte)

DIM ayant particip l'examen de comptences cliniques

DIM participant lexternat

Pays de luniversit ayant dcern le doctorat en mdecine(ECOS complt)

Pays de luniversit ayant dcern le doctorat en mdecine(avec offre de formation post-M.D.)

Sexe (ECOS complt)

Sexe (avec offre de formation post-M.D.)

Annes depuis lobtention du doctorat en mdecine(ECOS complt)

Annes depuis lobtention du doctorat en mdecine (avec offre de formation post-M.D.)

Colombie-BritanniqueInternational Medical Graduate Program

of British Columbia (IMG-BC)

DIM (examen clinique complt/OSCE)

DIM (valuation clinique de 13 semaines acheve)


Sexe


Conseil mdical du Canada (CMC)

DIM ayant russi lexamen dvaluation / lexamen daptitude partie I / lexamen daptitude partie II

du Conseil mdical du Canada

Citoyennet (examen dvaluation du Conseil mdical du Canada russi / examen daptitude partie I du Conseil

mdical du Canada russi / examen daptitude partie II du Conseil mdical du Canada russi)

Pays de luniversit ayant dcern le doctorat en mdecine (examen dvaluation du Conseil

mdical du Canada russi)

Pays de luniversit ayant dcern le doctorat en mdecine (examen daptitude partie I du Conseil


Pays de luniversit ayant dcern le doctorat en mdecine (examen daptitude partie II du Conseil


Sexe (examen dvaluation du Conseil mdical du Canada russi / examen daptitude partie I

du Conseil mdical du Canada russi / examen daptitude partie II du Conseil mdical du Canada russi)

Annes depuis lobtention du doctorat en mdecine (examen dvaluation du Conseil mdical du Canada russi /

examen daptitude partie I du Conseil mdical du Canada russi / examen daptitude partie II du Conseil


IV The National IMG Database Report

D. Collge des mdecins du Qubec (CMQ) 69

IMGs Granted Permit 72

IMGs Granted Regular Permit 72

IMGs Granted Restrictive Professor / Non-Professor Permit 72

Country Where M.D. Earned (Regular Permit) 73

Country Where M.D. Earned (Restrictive Professor / Non-Professor Permit) 74

Medical Specialties (Regular Permit) 75

Gender (Regular Permit) 75

Gender (Restrictive Professor / Non-Professor Permit) 76

Years Since M.D. Earned (Regular Permit) 76

Years Since M.D. Earned (Restrictive Professor / Non-Professor Permit) 76

E. College of Family Physicians of Canada (CFPC) 77

IMGs Certified 78


Gender 82


Metrics of Years Since M.D. Earned 83

Metrics of Age 83

Some Post M.D. Training in Canada 84

Some Post M.D. Training in Canada and/or the U.S. 84

Eligibility Route 84

F. Royal College of Physicians and Surgeons of Canada (RCPSC) 85

IMGs Certified 86


Medical Specialties 89


Metrics of Years Since M.D. Earned 90

Some Post-M.D. Training in Canada 91

Some Post-M.D. Training in Canada and/or the U.S. 91

Assessment Route 91

Collge des mdecins du Qubec (CMQ)

DIM avec permis

DIM avec permis rguliers

DIM avec permis restrictif

Pays de luniversit ayant dcern le doctorat en mdecine (permis rguliers)

Pays de luniversit ayant dcern le doctorat en mdecine(permis restrictif)

Spcialits mdicales (permis rguliers)

Sexe (permis rguliers)

Sexe (permis restrictif)

Annes depuis lobtention du doctorat en mdecine (permis rguliers)

Annes depuis lobtention du doctorat en mdecine (permis restrictif)

Collge des mdecins defamille du Canada (CMFC)

DIM certifis


Sexe


Paramtres des annes depuis lobtention du doctorat en mdecine

Paramtres de l'ge

Formation post-M.D. au Canada

Formation post-M.D. au Canada et/ou aux tats-Unis

Voie d'admissibilit

Collge royal des mdecins et chirurgiensdu Canada (CRMCC)

DIM certifis


Spcialits mdicales


Paramtres des annes depuis lobtention du doctorat en mdecine

Formation post-M.D. au Canada

Formation post-M.D. au Canada et/ou aux tats-Unis

Voie d'valuation

VThe National IMG Database Report

G. Regulatory Authorities 93

College of Physicians and Surgeons of Newfoundland and Labrador 97

Licensed by CPSNL 97

Certification Status by License Type 98

Country where M.D. Earned (Full Licenses) 99

Country where M.D. Earned (All Other Categories of Licenses) 100



College of Physicians and Surgeons of Nova Scotia 103

Licensed by CPSNS 103




Gender (Full Licenses) 106

Gender (All Other Categories of Licenses) 106



College of Physicians and Surgeons of New Brunswick 109

Licensed by CPSNB 109








College of Physicians and Surgeons of Ontario 117

Licensed for First Time by CPSO 117








Organismes de rglementation

College of Physicians and Surgeons of Newfoundland and Labrador

Permis par CPSNL

tat de la certification selon le type de permis

Pays de luniversit ayant dcern le doctorat en mdecine(permis rguliers)

Pays de luniversit ayant dcern le doctorat en mdecine (toutes autres catgories de permis)

Spcialits mdicales


College of Physicians and Surgeons of Nova Scotia

Permis par CPSNS



Pays de luniversit ayant dcern le doctorat en mdecine(toutes autres catgories de permis)


Sexe (toutes autres catgories de permis)

Spcialits mdicales


Collge des mdecins et chirurgiens du Nouveau-Brunswick

Permis par CPSNB






Spcialits mdicales


College of Physicians and Surgeons of Ontario

Permis obtenu pour la premire fois auprs du CPSO






Spcialits mdicales


VI The National IMG Database Report

College of Physicians and Surgeons of Manitoba 127

Licensed by CPSM 127






College of Physicians and Surgeons of Saskatchewan 133

Licensed by CPSS 133








College of Physicians and Surgeons of Alberta 141

Licensed by CPSA 141








College of Physicians and Surgeons of Manitoba

Permis par CPSM




Spcialits mdicales


College of Physicians and Surgeons of Saskatchewan

Permis par CPSS






Spcialits mdicales


College of Physicians and Surgeons of Alberta

Permis par CPSA




Spcialits mdicales


Spcialits mdicales


VIIThe National IMG Database Report

College of Physicians and Surgeons of British Columbia 149

Licensed by CPSBC 149








Yukon Medical Council 157

Licensed by YMC 157





Appendix A 160

College of Physicians and Surgeons of British Columbia

Permis par CPSBC






Spcialits mdicales


Conseil mdical du Yukon

Permis par YMC



Spcialits mdicales


Annexe A

VIII The National IMG Database Report

The National IMG Database Report

Rapport de la base de donnes nationale sur les diplms internationaux en mdecine (DIM)

BACKGROUND AND INTRODUCTION

International Medical Graduates (IMGs) play a long-standing role in providing care to Canadians. In2010, 16,728 IMGs were licensed to practise inCanada.1 This represents 24.0% of the 69,699 activephysicians in that year. The proportion of IMGs inthe physician workforce varies significantly acrossjurisdictions, ranging from 11.0% in Quebec to47.1% in Saskatchewan.

The contribution and role of IMGs have surfaced innumerous systematic evaluations of the Canadianhealth care system. The 2002 Kirby Senate Committeereport on the state of the health care system inCanada emphasized the need for a national strategyto enhance the integration of International MedicalGraduates.2 Soon after, the Romanow Commissionreport Building on Values: The Future of Health Carein Canada3 called for a coordinated Human HealthResources (HHR) planning strategy and considerationof the processes IMGs undertake to enter into thephysician workforce. Aligned with the call for collaborative HHR planning, the 2003 First MinistersAccord on Health Care Renewal4 supported evidence-based initiatives in order to develop an informationbase to facilitate the integration of IMGs and increasethe recruitment and retention of the health workforce.5

The creation of the Canadian Task Force on Licensureof IMGs in 2002 was a key step in addressing theissues faced by IMGs in Canada. Recognizing theirimportance in Canadas health care delivery system,the Taskforce made six recommendations to addressIMG barriers to licensure and practice.6 They were:

(1) Increase the capacity to assess and prepare IMGsfor licensure.

(2) Work toward standardization of licensurerequirements.

CONTEXTE ET INTRODUCTION

Les diplms internationaux en mdecine (DIM) jouentun rle de longue date dans la prestation de soins auxCanadiens. En 2010, 16 728 DIM ont reu lautorisationdexercer au Canada.1 Cela reprsente 24,0 % des 69 699mdecins en pratique active pendant lanne en question.Les DIM comptant parmi les mdecins en pratique activevarient considrablement selon le ressort territorial, leQubec en compte 11,0 % alors quen Saskatchewan, ilsreprsentent 47,1 %.

La contribution et le rle des DIM ont fait lobjet deplusieurs valuations systmatiques du systme de soinsde sant canadien. Le rapport Kirby de 2002 du Comitsnatorial sur ltat du systme de sant canadien a mislaccent sur le besoin dune stratgie nationale visant amliorer lintgration des diplms internationaux enmdecine.2 Peu de temps aprs, le rapport de laCommission Romanow intitul Guid par nos valeurs :Lavenir des soins de sant au Canada3 a recommand uneapproche coordonne de la planification stratgique desressources humaines en sant (RHS) et un examen desprocessus entrepris par les DIM avant de pouvoir faire par-tie de la main-duvre des mdecins. Dans la mmeoptique de planification cooprative des RHS, lAccord de2003 des premiers mi nistres sur le renouvellement dessoins de sant4 a appuy des initiatives factuelles pourllaboration de donnes qui favorisent lintgration desDIM et augmentent le recrutement et la conservation desprofessionnels de la sant.5

La cration du Groupe de travail canadien sur laccrdita-tion des mdecins forms ltranger en 2002 a permisde franchir une tape cl du processus de rsolution desproblmes auxquels font face les DIM au Canada.Reconnaissant leur importance au sein du systme deprestation de soins de sant au Canada, le Groupe de travail a formul six recommandations visant limiter lesobstacles des DIM quant laccrditation et la pratique.6

Les recommandations taient les suivantes :

(1) accrotre la capacit dvaluer et de prparer les DIM lobtention du permis dexercice;

(2) travailler la normalisation des exigences lies lautorisation dexercer;

IXThe National IMG Database Report

(3) Expand or develop supports/programs to assistIMGs with the licensure process and require-ments in Canada.

(4) Develop orientation programs to support facultyand physicians working with IMGs.

(5) Develop capacity to track and recruit IMGs.

(6) Develop a national research agenda, includingevaluation of the IMG strategy.

Responding to recommendation #5, the CanadianPost-M.D. Education Registry (CAPER)7 began workon the National IMG Database in 2005. The effort has been supported by the Association of Faculties of Medicine of Canada (AFMC)8 and the ForeignCredentials Recognition Division of HumanResources and Skills Development Canada(HRSDC).9

Phase I of the National IMG Database project focusedon building a data-sharing partnership among allagencies that IMGs encounter as they progresstowards medical licensure within Canada. The initialproject work also involved defining sector-specificdatasets to support research and statistical reportingon the flow of IMGs. By the end of Phase I, in May2009, IMG assessment centres, national medicalexamination and certification bodies, postgraduatemedical education training programs and medicalregulatory authorities were all contributing annualdata files to the National IMG Database. The firstannual National IMG Database Report was publishedin 2009. The report provided a new and comprehen-sive statistical overview of the number of IMGspassing Canadas assessment, training, examination,certification and licensing processes.

Phase II of the National IMG Database started inNovember 2009 as part of the IMGs in CanadaProject. Database development is again led byCAPER, under the auspices of AFMC and with finan-cial support from HRSDC. The IMGs in CanadaProject will strive to maintain and build upon thefoundational database that was established throughthe Phase I partnership. It will also push towards acollaborative analytical agenda that supports theinformation and dissemination needs of dataproviders, planners, decision-makers and other stakeholders.

(3) tendre les programmes ou les laborer en vuedaider les DIM en ce qui concerne les processusdautorisation dexercer au Canada et les exigencesqui y sont lies;

(4) laborer des programmes dorientation afin dap-puyer les professeurs et les mdecins qui travaillentavec les DIM;

(5) renforcer la capacit de suivre les DIM et denrecruter;

(6) mettre au point un programme national derecherche, y compris une valuation de la stratgierelative aux DIM.

En rponse la cinquime recommandation, le Systmeinformatis sur les stagiaires post-M.D. en formation cli -nique (CAPER)7 a entam la Base de donnes nationalesur les DIM en 2005. Ce projet profite de lappui delAssociation des facults de mdecine du Canada(AFMC)8 et du Bureau dorientation relatif aux titres decomptences trangers du ministre des Ressourceshumaines et du Dveloppement des comptences duCanada (RHDCC).9

La premire phase du projet portant sur la Base de donnes nationale sur les DIM a veill la cration dunpartenariat dchange de donnes parmi lensemble desorganismes qui entretiennent des rapports avec les DIMpendant leur cheminement vers laccrditation enmdecine au Canada. Dans le cadre de leffort initial duprojet, on a galement dfini des ensembles de donnespropres aux secteurs dans le but dappuyer la recherche etla reprsentation statistique du parcours des DIM. la finde la premire phase, en mai 2009, les centres dvaluationdes DIM, les organismes nationaux dexamen et de certi-fication de la mdecine, les programmes de formationdenseignement mdical postdoctoral et les organismes derglementation figuraient tous parmi les fournisseurs dedonnes annuelles de la Base de donnes nationale sur lesDIM. Le premier rapport annuel de la Base de donnesnationale sur les DIM est paru en 2009. Grce au rapport,on avait accs pour la premire fois un aperu statistiqueexhaustif du nombre de DIM qui participaient aux proces-sus dvaluation, de formation, dexamen, de certificationet daccrditation lchelle du Canada.

La deuxime phase de la Base de donnes nationale surles DIM a vu le jour en novembre 2009 dans le cadre du Projet portant sur les DIM au Canada . CAPER est tou-jours responsable du dveloppement de la base dedonnes, sous les auspices de lAFMC et avec lappui

X The National IMG Database Report

The analysis, evaluation and decision-support goalsof the IMGs in Canada Project are most timely. Thereare currently more than 60 different combinations ofqualifications that entitle individuals to be licensedas physicians in various Canadian jurisdictions.10 Notsurprisingly, developments like Chapter 7 of theAgreement on Internal Trade (AIT)11 and the Pan-Canadian Framework for the Assessment andRecognition of Foreign Qualification12 are drivingchange within the regulatory environment. For exam-ple, the Federation of Medical Regulatory Authoritiesof Canada (FMRAC) and the Medical Council ofCanada (MCC) are developing a national process ofApplication for Medical Registration in Canada. TheMCC has also partnered with Canadas IMG assess-ment centres and other stakeholder organizations onthe National Assessment Collaboration (NAC),13

which will bring greater standardization to IMGassessment for entry to postgraduate medical educa-tion. In addition to national projects, the regulatoryenvironment has been incrementally transformed byprovincial initiatives such as the Qubec-FranceMutual Recognition Arrangement14 and Ontariossimplified Registration for Qualified InternationalMedical Doctors.15

It is clear that there is a rapidly changing environ-ment of policies and initiatives that affect IMGs. It iscritically important that we evaluate whether thesechanges are creating a more navigable system forIMGs, while simultaneously improving access to highquality physician care. This report, based on theNational IMG Database, marks an important mile-stone in measuring system performance at present.Future studies of the IMGs in Canada Project will tellus if system changes benefit IMGs and the patientswho require their care.

financier de RHDCC. Le Projet portant sur les DIM auCanada veillera entretenir et difier le fondement de labase de donnes mise sur pied grce au partenariat de lapremire phase. Nous miserons galement sur un pro-gramme collaboratif et analytique appuyant les besoins enmatire de renseignements des fournisseurs de donnes,des planificateurs, des dcideurs et des autres intervenants.

Les objectifs en matire danalyse, dvaluation et daide la prise de dcisions du Projet portant sur les DIM auCanada sont des plus opportuns. Il existe actuellementplus de 60 combinaisons diffrentes de qualifications quiautorisent la pratique mdicale dans les ressorts territoriaux du Canada.10 Il nest pas surprenant que des percescomme le chapitre 7 de lAccord sur le commerce intrieur(AIT)11 et le Cadre pancanadien dvaluation et de recon-naissance des qualifications professionnelles acquises ltranger12 encouragent le changement quant la rgle-mentation. Par exemple, la Fdration des ordres desmdecins du Canada (FOMC) et le Conseil mdical duCanada (CMC) veillent la mise en uvre dun processusnational de demande dinscription mdicale au Canada.Le CMC sest aussi joint aux centres dvaluation des DIMdu Canada et dautres groupes dintervenants dans le cadre de la Collaboration nationale en matire dvalu-ation (CNE),13 grce laquelle lvaluation des DIM pourladmission lenseignement mdical postdoctoral serasous-tendue de normes plus rigoureuses. En plus des projets nationaux, le milieu de la rglementation connatdes transformations progressives qui dcoulent des initiatives provinciales comme lAccord de reconnaissancemutuelle entre le Qubec et la France14 et la nouvelleinscription simplifie de lOntario lintention desmdecins internationaux qualifis.15

En toute vidence, les politiques et les initiatives quitouchent aux DIM changent rapidement. Il est essentielde sassurer que ces changements donnent lieu un sys-tme plus navigable pour les DIM tout en amliorantlaccs des soins mdicaux de qualit suprieure. Ce rapport de la Base de donnes nationale sur les DIM estune tape cl dans la mesure actuelle du rendement denotre systme. Les tudes ultrieures du Projet portant surles DIM au Canada dtermineront si les changements ausystme sont bnfiques aux DIM et aux patients qui profitent de leurs soins.

XIThe National IMG Database Report

NATIONAL IMG DATABASE

Contributing Data Providers

Building on the Canadian Post-M.D. EducationRegistrys (CAPER) existing network, the IMGDatabase reflects a collaborative design and a consul-tative methodology. Data providers include the 17Faculties of medicine,16 the Medical Council ofCanada (MCC),17 the College of Family Physicians ofCanada (CFPC),18 the Royal College of Physicians andSurgeons of Canada (RCPSC),19 Collge des mdecinsdu Qubec (CMQ),20 9 provincial and territorial regulatory authorities,21 and 7 IMG assessment andtraining centres.22 Each data contributor adds aunique and critical component to the database.Together, their contributions support decision-makers, researchers and analysts within governmentsas well as professional and academic organizations.As the National IMG Database continues to evolve, itis becoming a valued resource for informed healthcare policy development.

A. Faculties of Medicine of Canada

The 17 Faculties of medicine provide postgraduatetraining to IMGs who enter through the CanadianResident Matching Service (CaRMS)23 or who havesuccessfully completed certain assessment programs,such as the Alberta IMG program. In some instances,faculties may also provide remediation to IMGs whohave been referred by assessment centres or medicalregulatory authorities.

B. Assessment Centres

The provinces of Newfoundland and Labrador, NovaScotia, Ontario, Manitoba, Saskatchewan, Alberta andBritish Columbia have established assessment centresto evaluate the credentials, skills and training ofIMGs. Some assessment centres offer programs thatinclude a training component. Depending on themandate of the specific assessment centre, IMGs maybe referred directly for licensure, to post-M.D. train-ing or to various forms of remediation. IMGs mayelect to cease the assessment process at any stage.

BASE DE DONNES NATIONALE SUR LES DIM

Fournisseurs actifs de donnes

En se fondant sur le rseau existant du Systme informa-tis sur les stagiaires post-M.D. en formation clinique(CAPER), la Base de donnes sur les DIM fait preuve dunesprit de collaboration et dune approche de consultation.Les fournisseurs de donnes comprennent les 17 facultsde mdecine,16 le Conseil mdical du Canada (CMC),17

le Collge des mdecins de famille du Canada (CMFC),18

le Collge royal des mdecins et chirurgiens du Canada(CRMCC),19 le Collge des mdecins du Qubec (CMQ),20

les 9 organismes de rglementation provinciaux et terri-toriaux,21 et les 7 centres dvaluation et de formation desDIM.22 Chaque fournisseur de donnes apporte unetouche unique et essentielle la base de donnes.Ensemble, ces contributions ont appuy les dcideurs, leschercheurs et les analystes au sein du gouvernement etdes organisations professionnelles et acadmiques. Au furet mesure que la Base de donnes nationale sur les DIMvolue, elle devient une ressource rpute quant lla -boration de politiques claires en matire de soins de sant.

A. Facults canadiennes de mdecine

Les 17 facults de mdecine offre une formation postdoc-torale aux DIM qui sinscrivent par lentremise du Servicecanadien de jumelage des rsidents (SCJR)23 ou qui russissent certains programmes dvaluation, comme le programme DIM de lAlberta. Dans certains cas, les facults offrent aussi un enseignement correctif aux DIMqui sont rfrs par les centres dvaluation ou les orga -nis mes de rglementation mdicale.

B. Centres dvaluation

Les provinces de Terre-Neuve-et-Labrador, de la Nouvelle-cosse, de lOntario, du Manitoba, de la Saskatchewan,de lAlberta et de la Colombie-Britannique ont mis enplace des centres dvaluation des titres, des comptenceset de la formation des DIM. Certains centres dvaluationoffrent des programmes comprenant un volet de forma-tion. Selon le mandat de chaque centre dva luation,les DIM peuvent tre orients directement vers lautorisa-tion dexercer, la formation postdoctorale ou divers typesdenseignement correctif. Les DIM peuvent se retirer duprocessus dvaluation tout moment.

XII The National IMG Database Report

C. Medical Council of Canada (MCC)

The MCC develops and administers examinations toevaluate the competency of physicians. The MCCQualifying Examination Part I (MCCQEI) assesses theknowledge, clinical skills and attitudes of those whohave obtained their medical degree for entry intosupervised clinical practice in postgraduate trainingprograms. The Qualifying Examination Part II (MCCQEII) assesses knowledge, skills and attitudesessential for medical licensure, prior to entry intoindependent clinical practice. The MCC EvaluatingExamination (MCCEE) is administered toInternational Medical Graduates as a prerequisite for eligibility to challenge the MCCs QualifyingExaminations. Successful completion of the MCCQualifying Examinations leads to the designation asLicentiate of the Medical Council of Canada (LMCC),which is generally a precondition to medical licen-sure in many Canadian jurisdictions.

D. Collge des mdecins du Qubec (CMQ)

The CMQ plays a multifaceted role in the manage-ment of physicians for the province of Quebec. As an assessment centre it conducts evaluations. As aregulatory authority it awards practice licenses. As acertification body it attests to the achievement ofmedical competencies.

E. College of Family Physicians of Canada (CFPC)

The CFPC evaluates and accredits the family medi-cine and enhanced skills residency training programsfor the 17 Canadian Faculties of medicine. The CFPCmaintains standards of excellence for family medicinetraining at the undergraduate and postgraduate levels. In general, certification by the CFPC is recog-nized as a portable credential that facilitates licensurein all Canadian jurisdictions.

C. Conseil mdical du Canada (CMC)

Le CMC labore et rgit les examens dvaluation des com-ptences des mdecins. Lexamen daptitude du CMC,partie I (EACMCI) value le savoir, les comptences cli -ni ques et les attitudes des personnes diplmes enmdecine qui demandent tre admis des programmesde formation clinique postdoctorale sous supervision.Lexamen daptitude du CMC, partie II (EACMCII) valuele savoir, les comptences cliniques et les attitudes jugesessentielles pour la dlivrance dun permis dexercice de lamdecine au Canada et ce, avant leur entre en pratiqueclinique indpendante. Lexamen dvaluation du CMC(EECMC) est destin aux diplms internationaux enmdecine comme condition pralable ladmissibilit auxexamens daptitude du CMC. Une personne qui russitaux examens daptitude du CMC est licencie du Conseilmdical du Canada (LCMC). Ce titre est habituellementune condition pralable ladmissibilit au permis dexercice de la mdecine dans plusieurs ressorts canadiens.

D. Collge des mdecins du Qubec (CMQ)

Le CMQ joue un rle diversifi dans ladministration des mdecins dans la province du Qubec. En tant quecentre dvaluation, il mne des valuations. En tant quor-ganisme de rglementation, il octroie des autorisationsdexercer. En tant quorganisme de certification, il confirme la russite de comptences mdicales.

E. Collge des mdecins de famille du Canada (CMFC)

Le CMFC est responsable de lvaluation et de laccrdita-tion des mdecins de famille ainsi que des programmesde formation des rsidents de comptences avances danschacune des 17 facults de mdecine au Canada. LeCMFC encourage lexcellence de la formation de lamdecine familiale de premier cycle et de niveau post-doctoral. En gnral, la certification par le CMFC estreconnue en tant que titres de comptences transfrablesqui simplifient lautorisation dexercer dans tous lesressorts du Canada.

XIIIThe National IMG Database Report

F. Royal College of Physicians and Surgeons of Canada (RCPSC)

The RCPSC determines the standards for educationin medical, surgical and laboratory medicine special-ties. It evaluates and accredits residency programs forthe 17 Canadian Faculties of medicine. In general, acertification by the RCPSC is recognized as a portablecredential that facilitates licensure in all Canadianjurisdictions.

G. Regulatory Authorities

Among the responsibilities of the provincial/territor-ial regulatory authorities are the licensing ofphysicians and monitoring of medical practice tosafeguard the publics interest.

PURPOSE AND OBJECTIVES

The goal of the National IMG Database is to compilelongitudinal data that measures the flow ofInternational Medical Graduates as they acquire cre-dentials and eventually contribute to the Canadianphysician workforce.

The following three objectives will shape projectactivities through to 2013:

1. Continue to gather data that will support thedevelopment of policy regulation and legislationrelating to IMGs in Canada.

2. Develop and implement a collaborative analysisagenda that facilitates and supports meaningfulknowledge transfer activities.

3. Develop a sustainable business model for theNational IMG Database.

F. Collge royal des mdecins et chirurgiens du Canada (CRMCC)

Le CRMCC identifie les normes ducatives des spcialitsen mdecine, en chirurgie et en laboratoire. Il est respon-sable de lvaluation et de laccrditation des programmesde rsidence dans chacune des 17 facults de mdecineau Canada. En gnral, la certification par le CRMCC estreconnue en tant que titres de comptences transfrablesqui simplifient lautorisation dexercer dans tous lesressorts du Canada.

G. Organismes de rglementation mdicale

Les organismes provinciaux et territoriaux de rglementa-tion sont, entre autres, responsables dautoriser lexercicedes mdecins et de surveiller la pratique mdicale dans lebut de protger lintrt du grand public.

BUT ET OBJECTIFS

Le but de la Base de donnes nationale sur les DIM est decompiler des donnes longitudinales qui tiennent comptedu parcours des diplms internationaux en mdecine aufur et mesure quils obtiennent leurs titres de comp-tences pour faire un jour partie de la main-duvrecanadienne de mdecins.

Les trois objectifs suivants sous-tendront les activits duprojet dici 2013 :

1. continuer recueillir des donnes qui appuierontllaboration de politiques, de rglements et delois en matire de DIM au Canada;

2. laborer et mettre en uvre un plan analytiquecollaboratif favorisant des activits de transfertdes connaissances significatives;

3. laborer un modle oprationnel durable pour laBase de donnes nationale sur les DIM.

XIV The National IMG Database Report

Challenges

Processes and Terminology

Regulatory authorities and assessment centres employdifferent processes to achieve goals related to the eval-uation, training, remediation and licensing of IMGs.Likewise, the terms used to describe these activitiesand outcomes are not standardized. This generatesdifficulties in establishing equivalencies amongdatasets from different sources. In the report, this limitation prevents the pooling of certain data ele-ments and affects the capacity to present generalfindings. For this reason, explanatory notes precedeeach section of this report, which is organized accord-ing to data provider categories.

PRIVACY AND ACCESS TO PERSONAL INFORMATION

CAPER is committed to the highest standards of privacy and protection of personal information. Toreview the principles that guide CAPERs manage-ment of data, please consult our Privacy Policy atwww.caper.ca.

Dfis

Processus et terminologie

Les organismes de rglementation et les centres dvalua-tion ont recours divers processus pour concrtiser lesbuts relatifs lvaluation, la formation, lenseignementcorrectif et lautorisation dexercer des DIM. De mme,les expressions quon utilise pour dcrire ces activits etces rsultats ne sont pas normalises. Par consquent, il estdifficile didentifier des quivalences parmi les ensemblesde donnes provenant de sources diffrentes. Il est ainsiimpossible de rassembler certains lments de donnes,ce qui nuit la prsentation de rsultats globaux. Cestpourquoi des notes explicatives figurent au dbut dechaque section de ce rapport, lequel est divis selon lescatgories de fournisseurs de donnes.

RESPECT DE LA VIE PRIVE ETACCS AUX RENSEIGNEMENTS PERSONNELSCAPER se conforme des normes suprieures en matirede respect de la vie prive et de protection des rensei -gnements personnels. Pour connatre les principesdirecteurs de CAPER en matire de gestion des donnes,veuillez consulter notre Politique de confidentialit auwww.caper.ca.

XVThe National IMG Database Report

NOTES1. Canadian Institute for Health Information. (2010). Supply, Distribution and Migration of Canadian Physicians, 2008. Ottawa: CIHI.

Available at: https://secure.cihi.ca/free_products/SMDB_2009_EN.pdf

2. The final report of the Kirby Senate Committee is available at http://www.parl.gc.ca/Content/SEN/Committee/372/soci/rep/repoct02vol6-e.htm

3. The final report of the Romanow Commission is available at http://publications.gc.ca/collections/Collection/CP32-85-2002E.pdf

4. Health Canada. (2003). Accord on Health Care Renewal. Available at http://www.hc-sc.gc.ca/hcs-sss/delivery-prestation/fptcollab/2003accord/index-eng.php

5. Health Canada. (2004). The 2003 Accord on Health Care Renewal: A Progress Report. Available at http://www.hc-sc.gc.ca/hcs-sss/delivery-prestation/fptcollab/2004-fmm-rpm/fs-if_01-eng.php

6. Federal/Provincial/Territorial Advisory Committee on Health Delivery and Human Resources. (2004). Report of the Canadian Task Forceon Licensure of International Medical Graduates. More information is available at http://www.hc-sc.gc.ca/hcs-sss/pubs/hhrhs/2007-ar-ra/initiative_int-eng.php

7. For information about the Canadian Post-M.D. Education Registry (CAPER), see www.caper.ca

8. For information about the Association of Faculties of Medicine (AFMC), see www.afmc.ca.

9. For information on the Foreign Credential Recognition Program, see http://www.hrsdc.gc.ca/eng/workplaceskills/credential_recognition/index.shtml

10. For more information on the FMRAC Agreement on National Standards, see http://www.cpso.on.ca/registration/default.aspx?id=3886

11. For more information on Labour Mobility, see http://www.hrsdc.gc.ca/eng/workplaceskills/labour_mobility/index.shtml

12. For more information on the Pan-Canadian Framework, see http://www.hrsdc.gc.ca/eng/workplaceskills/publications/fcr/pcf_folder/section_2_01.shtml

13. For more information on the National Assessment Collaboration, see http://www.mcc.ca/en/research/national_assessment_collaboration.shtml

14. For more information on the Qubec-France Understanding on the Mutual Recognition of professional Qualifications, seehttp://www.mrifce.gouv.qc.ca/en/grands-dossiers/reconnaissance-qualifications/entente-quebec-france

15. Report on Removing Barriers for International Medical Doctors. (2008). Available at http://www.health.gov.on.ca/en/common/ministry/publications/reports/removing_barriers/removing_barriers.pdf

16. Representing every Canadian faculty of medicine, the 17 Faculties of medicine (from east to west) are members of the Association of Facultiesof Medicine (AFMC). For more information, see www.afmc.ca/faculties-e.php

Memorial University of Newfoundland McMaster University Dalhousie University University of Western Ontario Universit Laval Northern Ontario School of Medicine Universit de Sherbrooke University of Manitoba Universit de Montral University of Saskatchewan McGill University University of Alberta University of Ottawa University of Calgary Queens University University of British Columbia University of Toronto

17. For information about the Medical Council of Canada (MCC), see www.mcc.ca

18. For information about the College of Family Physicians of Canada (CFPC), see www.cfpc.ca

19. For information about the Royal College of Physicians and Surgeons of Canada (RCPSC), see http://www.royalcollege.ca/portal/page/portal/rc/public

20. For information about the Collge des mdecins du Qubec (CMQ), see www.cmq.org

21. The following 9 provincial/territorial regulatory authorities submitted data. For links, see http://www.royalcollege.ca/portal/page/portal/rc/resources/provincialmra

College of Physicians and Surgeons of Newfoundland & Labrador (CPSNL) www.cpsnl.caCollege of physicians and Surgeons of Nova Scotia (CPSNS) www.cpsns.caCollege of Physicians and Surgeons of New Brunswick (CPSNB) www.cpsnb.orgCollege of Physicians and Surgeons of Ontario (CPSO) www.cpso.on.caCollege of Physicians and Surgeons of Manitoba (CPSM) www.cpsm.mb.caCollege of Physicians and Surgeons of Saskatchewan (CPSS) www.quadrant.netCollege of Physicians and Surgeons of Alberta (CPSA) www.cpsa.ab.caCollege of Physicians and Surgeons of British Columbia (CPSBC) www.cpsbc.caYukon Medical Council (YMC) www.yukonmedicalcouncil.ca

XVI The National IMG Database Report

22. The following 7 assessment and training centres submitted data. For links, see http://www.mcc.ca/en/NAC/related_programs_IMGs.shtml

CSAT: Clinical Skills Assessment and Training Program (Newfoundland and Labrador)www.cpsnl.ca/default.asp?com=Pages&id=111&m=365

CAPP: Clinician Assessment for Practice Program (Nova Scotia)www.capprogram.ca

CEHPEA: The Centre for the Evaluation of Health Professionals Educated Abroad (Ontario)www.cehpea.ca

CAPE: Clinicians Assessment and Professional Enhancement (Manitoba)umanitoba.ca/faculties/medicine/education/continuing_med_ed/clinical_assessment.html.

CPL: Division of Continuing Professional Learning (Sakatchewan)College of Medicine at the University of SaskatchewanExtended Refresher Course Process for International Medical Graduateswww.usask.ca

AIMGP: Alberta International Medical Graduate Program (Alberta)www.aimg.ca

IMG-BC: International Medical Graduates of British Columbia (British Columbia)www.imgbc.med.ubc.ca

23. For information about the Canadian Resident Matching Service (CaRMS), see http://www.carms.ca/

Index of AbbreviationsIndex des abrviations

XVIIThe National IMG Database Report

ACHDHR http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/committee-comite-hdhr-ssrh/index-eng.phpAdvisory Committee on Health Deliveryand Human Resources

AFMC www.afmc.caThe Association of Faculties of Medicineof CanadaLAssociation des facults de mdecine duCanada

AIMGP www.aimg.caAlberta International Medical Graduate Program

AMC www.cma.caAssociation mdicale canadienne

CACMS http://www.afmc.ca/accreditation-cacms-e.phpCommittee on Accreditation of CanadianMedical Schools

CAMFC http://www.afmc.ca/accreditation-cacms-f.phpComit dagrment des facults demdecine du Canada

CAPE http://umanitoba.ca/faculties/medicine/education/cpd/assessment/cape.htmlClinician Assessment and ProfessionalEnhancement Program [Manitoba]

CAPER www.caper.caCanadian Post-M.D. Education RegistrySystme informatis sur les stagiaires post-M.D. en formation clinique

CAPP www.capprogram.caClinician Assessment for Practice Program[Nova Scotia]

CaRMS www.carms.caCanadian Resident Matching Service

CCPSSRH http://www.hc-sc.gc.ca/hcs-sss/hhr-rhs/committee-comite-hdhr-ssrh/index-fra.phpComit consultatif fdral provincial territorial sur la prestation des soins desant et les ressources humaines

CEHPEA www.cehpea.caThe Centre for the Evaluation of HealthProfessionals Educated Abroad

CFPC www.cfpc.caThe College of Family Physicians of Canada

CIHI www.cihi.caThe Canadian Institute for Health Information

CLEM http://www.lcme.org/Comit de liaison sur lducation mdicale

CMA www.cma.caCanadian Medical Association

CMC www.mcc.caLe Conseil mdical du Canada

CMCNB www.cpsnb.orgCollge des mdecins et chirurgiens du Nouveau-Brunswick

CMF http://www.cma.ca/canadianmedicalforumCanadian Medical Forum

CMFC www.cfpc.caLe Collge des mdecins de famille du Canada

CMQ www.cmq.orgCollge des mdecins du Qubec

CPL http://www.usask.ca/cme/Division of Continuing ProfessionalLearning (CPL)College of Medicine at the University of Saskatchewan Extended Refresher Course Process for International Medical Graduates

CPSA www.cpsa.ab.caThe College of Physicians and Surgeons ofAlberta

CPSBC www.cpsbc.caThe College of Physicians and Surgeons ofBritish Columbia

XVIII The National IMG Database Report

CPSM www.cpsm.mb.caThe College of Physicians and Surgeons ofManitoba

CPSNB www.cpsnb.orgThe College of Physicians and Surgeons ofNew Brunswick

CPSNL www.cpsnl.caThe College of Physicians and Surgeons ofNewfoundland and Labrador

CPSNS www.cpsns.ns.caThe College of Physicians and Surgeons ofNova Scotia

CPSO www.cpso.on.caThe College of Physicians and Surgeons ofOntario

CPSS www.quadrant.net/cpssThe College of Physicians and Surgeons ofSaskatchewan

CRMCC http://www.royalcollege.ca/Le Collge royal des mdecins etchirurgiens du Canada

CSAT www.cpsnl.ca/default.asp?com=Pages&id=111&m=365Clinical Skills Assessment and TrainingProgram [Newfoundland & Labrador]

FCR http://www.hrsdc.gc.ca/eng/workplaceskills/credential_recognition/index.shtmlGovernment of Canadas ForeignCredential Recognition Program

FMC http://www.cma.ca/forum-medical-canadienForum mdical canadien

HRSDC www.hrsdc.gc.caHuman Resources and Skills DevelopmentCanada

ICIS www.cihi.caInstitut canadien dinformation sur la sant

IMGACL www.umanitoba.ca/faculties/medicine/education/imgp/familyphysicianassessment.htmlInternational Medical GraduatesAssessment for Conditional Licensure(Manitoba)

IMG-BC www.imgbc.med.ubc.caInternational Medical Graduates of BritishColumbia

LCME www.lcme.orgLiaison Committee on Medical Education

LEACMCIhttp://www.mcc.ca/fr/exams/qe1/Lexamen daptitude du Conseil mdicaldu Canada (Partie I)

LEACMCIIhttp://www.mcc.ca/fr/exams/qe2/Lexamen daptitude du Conseil mdicaldu Canada (Partie II)

LEECMC http://www.mcc.ca/fr/exams/ee/Lexamen dvaluation du Conseil mdical du Canada

MCC www.mcc.caThe Medical Council of Canada

MLPIMG www.gov.mb.ca/health/mlpimg/index.htmlMedical Licensure Program forInternational Medical Graduates[Manitoba]

PRTCE http://www.rhdcc.gc.ca/fra/competence/reconnaissance_titres_competences/index.shtmlprogrammes/prtce/index.shtmlProgramme de reconnaissance des titresde comptences trangers

RCPSC http://www.royalcollege.ca/portal/page/portal/rc/publicThe Royal College of Physicians andSurgeons of Canada

RHDCC http://www.rhdcc.gc.ca/Ressources humaines et Dveloppementdes comptences Canada

SCJR http://www.carms.ca/fre/index.shtmlService canadien de jumelage des rsidents

YMC www.yukonmedicalcouncil.caYukon Medical Council

XIXThe National IMG Database Report

The Reporting ProcessMthode de dclaration

Through data sharing agreements that comply withprivacy legislation, the individual records ofInternational Medical Graduates are provided toCAPER by regulatory authorities, assessment centres and certification bodies. Datasets are submitted on a calendar year basis by April 30th following the end of the report year.

In addition to providing information relevant to theassessment, licensing or certification process, annualsubmissions also include a series of common data elements. These common data elements are essentialin that they provide a basis by which to match theIMGs in the database, and to avoid duplication ofentries. Common data elements submitted by dataproviders include variables such as last name, firstname, gender, date of birth, MD university, MD country, MD year and in some cases MINC number.

Every data submission sent to CAPER is verified formissing items and inconsistencies. Records withdata content above a specific threshold are assignedan in-house unique identifier.

Data providers are consulted prior to the publica-tion of findings derived from their contribution. Theprocess of verification can lead to the resubmissionof data for the current year and/or past years. Wheredata are resubmitted, results may differ from previous years.

Privacy & Protection of Personal Information

AFMC and CAPER have a long-established policy totreat all physician information in a sensitive man-ner to ensure that our collections, uses, disclosures, retention and disposal of physician information arecarried out in accordance with best practices in privacy protection.

The CAPER Privacy Policy is available on our website at www.caper.ca

Les dossiers personnels des diplms internationaux enmdecine sont transmis au Systme informatis sur les sta-giaires post-M.D. en formation clinique (CAPER) par lesorganismes de rglementation, les centres dvalua tion et lesorganismes de certification en vertu dententes de partage dedonnes qui respectent la lgislation relative la protection dela vie prive. Les donnes portent sur lanne civile et sonttransmises le ou avant le 30 avril suivant lanne faisant lobjet du rapport.

En plus de fournir des renseignements pertinents quant lvaluation, au permis dexercice et au processus de certifica-tion, les prsentations annuelles comptent galement deslments de donnes communes. Ces lments de donnescommunes sont essentiels; ils sous-tendent lassociation desDIM dans la base de donnes et empchent le chevauchementde la saisie de donnes. Les lments de donnes communesreus de la part de fournisseurs de donnes comprennent lenom de famille, le prnom, le sexe, la date de naissance, luniversit ayant dcern le doctorat en mdecine, le paysdobtention du doctorat en mdecine, lanne dobtention dudoctorat en mdecine et, dans certains cas, le NIMC.

Chaque groupe de donnes transmis CAPER est vrifi pourdterminer les lments manquants et les incohrences. Un identificateur unique est donn aux dossiers dont les donnes dpassent un seuil dtermin.

Les fournisseurs de donnes sont consults avant la publication des dcouvertes drives de leurs dclarations.En raison du processus du vrification, il se peut que des don-nes de lanne en cours et (ou) des annes antrieures soientprsentes de nouveau. Sil y a lieu, les rsultats des annesantrieures peuvent tre diffrents.

Vie prive et protection des renseignements personnels

LAFMC et CAPER ont une politique en vigueur depuislongtemps qui vise traiter confidentiellement tous les renseignements concernant les mdecins pour assurer que lacollecte, lutilisation, la divulgation, la conservation et llimination des renseignements concernant les mdecins sefassent conformment aux meilleures pratiques en matirede protection de la vie prive.

La politique de confidentialit de CAPER peut tre consultesur notre site Web ladresse www.caper.ca

XX The National IMG Database Report

How to Access the IMG Data TablesUtilisation du Rapport de la banque

de donnes sur les DIM

Tables are grouped by types of data providers:



C. Medical Council of Canada

D. Collge des mdecins du Qubec

E. College of Family Physicians of Canada

F. Royal College of Physicians and Surgeons of Canada


Data items from each data provider may vary depending on the organizations privacy policies withrespect to data sharing.

To request specific tables and/or to recommend tables forfuture reports, please contact CAPER at:

265 Carling Ave, Suite 800Ottawa, ON, CanadaK1S 2E1

Telephone: (613) 730-1204Fax: (613) 730-1196

E-mail: [email protected]

Les tableaux sont regroups selon le genre de fournisseursde donnes :



C. Medical Council of Canada

D. Collge des mdecins du Qubec

E. College of Family Physicians of Canada

F. Royal College of Physicians and Surgeons of Canada


Les lments de donnes de chaque fournisseur peuventvarier en fonction des politiques de confidentialit de chacun traitant du partage de donnes.

Pour demander des tableaux particuliers ou pour suggrerlajout de tableaux dans les rapports futurs, veuillez communiquer avec CAPER ladresse suivante :

265, avenue Carling, bureau 800Ottawa (Ontario) CanadaK1S 2E1

Tlphone : 613-730-1204Tlcopieur : 613-730-1196

Courriel : [email protected]

XXIThe National IMG Database Report

DefinitionsDfinitions

File specifications for the National IMG Databasewere developed in accordance with definitions established by CAPER. Following are CAPERs conventional definitions for data submission and reporting. Further explanatory notes precede eachData Provider section of this report.

Age

Age is calculated by subtracting the year of birth fromthe year in which data on an IMG are reported.

Broad Medical Specialties

Broad medical specialties are groupings for areas of specialization and subspecialization relevant totraining and medical practice. The four broad specialties used in this report are family medicine,medical specialties, laboratory medicine and surgicalspecialties. See the Specialization definition for a listing of subspecialities assigned to each of the broadspecialties.

Fellows

CAPER uses the following definition for the term fellow: a post M.D. trainee who is registered withthe Postgraduate Medical Education Office of a uni-versity faculty of medicine and who, regardless of thesource of funding, is pursuing clinical or researchtraining which will NOT be evaluated by the super-vising faculty for the purpose of Canadian licensureor certification by The College of Family Physicians ofCanada, the Collge des mdecins du Qubec or TheRoyal College of Physicians and Surgeons of Canada.(Trainees with appropriate prerequisite training reg-istered in RCPSC accreditation without certificationprograms are considered residents, not fellows.).

Geographic Region where M.D. Earned

Geographic region where M.D. earned is a groupingscheme for categorizing where IMGs earned their firstprofessional qualification in medicine or M.D. Themodel used in this publication is the United Nations

Les spcifications des fichiers de la base de donnes nationale sur les DIM ont t tablies conformment auxdfinitions de CAPER. Les dfinitions conventionnelles deCAPER pour la transmission et la dclaration de donnesapparaissent plus bas. Des explications supplmentairessont fournies au dbut de chaque section de fournisseursde donnes du prsent rapport.

ge

Lge est calcul en soustrayant lanne de naissance de lanne au cours de laquelle les donnes dun DIM sontdclares.

Spcialits mdicales largies

Les spcialits mdicales largies correspondent desgroupes de spcialisations et de sur-spcialisations perti-nentes en fonction de la formation et de la pratiquemdicale. Les quatre spcialits largies utilises dans leprsent rapport sont : familiale, mdicale, laboratoire etchirurgical. Consultez la dfinition Spcialisation pour uneliste des spcialits et sur-spcialits correspondant aux spcialits largies.

Fellows

CAPER retient la dfinition suivante du terme fellow : unstagiaire post M.D. inscrit auprs du bureau denseignementsuprieur de la facult de mdecine dune universit et qui,sans gard la source de financement, poursuit une forma-tion clinique ou en recherche qui ne sera PAS value parla facult responsable aux fins dun permis dexercice auCanada ou de la certification par le Collge des mdecins defamille du Canada, le Collge des mdecins du Qubec oule Collge royal des mdecins et chirurgiens du Canada. (Lesstagiaires ayant une formation pralable pertinente inscrits laccrditation sans certification du CRMCC sont considrs comme des rsidents, pas comme des fellows.)

Rgion gographique de luniversit ayantdcern le doctorat en mdecine

La rgion gographique de luniversit ayant dcern le doctorat en mdecine est un regroupant permettant de dterminer o les DIM ont obtenu leur premire quali-

XXII The National IMG Database Report

Composition of macro geographical (continental) regions groupings. For a listing of countries by macrogeographical regions see Appendix A. The listingreflects the most current geographical informationavailable.

International Medical Graduate (IMG)

The term International Medical Graduate or IMG,varies in definition and application. As noted in theIntroduction section, for the purposes of this report,IMGs include physicians who obtained their initialmedical degree outside of Canada. Thus, allInternational Medical Graduates including graduatesof U.S. medical schools, are reported as IMGs inNational IMG Database publications. Physicians arenot classified based on the country in which theirsubsequent, post-MD certification is awarded.

Legal Status

Three categories are used:

Canadian Citizen / Permanent Resident

Someone who is a citizen of Canada or has been accepted as a landed immigrant and has the right tolive and work in Canada.

Visa

Someone holding a visa permitting temporaryemployment in Canada as a post M.D. trainee.

Rank

All new M.D. graduates enter directly into either aFamily Medicine or other specialty training programat the R 1 level.

Two years of training at the R 1 and R 2 levels are required for certification in Family Medicine. R 3level training in Family Medicine is provided in theaccredited Family Medicine training programs inCare of the Elderly and Emergency Medicine as wellas in other additional training programs. To meet thetraining requirements of the RCPSC a minimum offour to six years of training is required, depending onthe specific specialty in which certification is sought.

A trainee progresses through the rank levels in thefollowing sequence:

fication professionnelle en mdecine ou en M.D. Le modleutilis dans la prsente publication est la composition de regroupements des rgions macrogographiques (continen-tales) des Nations Unies. Pour une liste des pays par rgionsmacrogographiques, consultez lannexe A. Linscriptionreflte les plus rcents renseignements gographiques tantdisponibles.

Diplms internationaux en mdecine (DIM)

La dfinition et lapplication de lexpression diplms internationaux en mdecine ou DIM varient. Comme il estmentionn dans la section Introduction et aux fins du prsentrapport, les DIM comprennent les mdecins qui ont obtenuleur premier diplme en mdecine lextrieur du Canada.Par consquent, tous les diplms internationaux enmdecine, incluant ceux des coles de mdecine des tats-Unis, sont signals comme des DIM dans les publicationsassocies la base de donnes nationale sur les DIM. On neclasse pas les mdecins selon le pays o ils ont reu leur certification post-M.D. ultrieure.

Statut lgal

Trois catgories sont utilises :

Citoyen canadien ou rsident permanent

Une personne qui est citoyenne du Canada ou un immigrantadmis ayant le droit de vivre et de travailler au Canada.

Visa

Une personne ayant obtenu un visa lui permettant de travailler temporairement au Canada titre de stagiaire post-M.D.

Rang

Tous les nouveaux diplms en mdecine entreprennent unprogramme de formation en mdecine familiale ou dans uneautre spcialit au niveau R 1.

Deux annes de formation aux niveaux R 1 et R 2 sont nces-saires pour obtenir une certification en mdecine familiale. Laformation au niveau R 3 en mdecine familiale est offerte parles programmes de formation en mdecine familiale en Soinsaux personnes ges et en Mdecine durgence ainsi que pardautres programmes de formation. Pour rpondre aux exi-gences de formation du CRMCC, une formation dune dureminimum de quatre six annes est requise, selon la sp-cialit particulire dans laquelle la certification est recherche.

Le stagiaire progresse entre les niveaux selon la squencesuivante :

XXIIIThe National IMG Database Report

R 1 (Family Medicine or other specialty training)R 2R 3R 4R 5R 6R 7

The following details concerning the ranking systemin specific provinces are to be noted:

Maritime Provinces

(Physicians training at Dalhousie University)

Physicians in the first year of a program are ranked atthe R 1 level. Physicians designated from R 2 to R 7by CAPER are listed according to the PGY 2 to PGY7 levels used at Dalhousie University. Any physiciansbeyond the PGY 7 level are ranked according to theappropriate RCPSC training level.

Ontario

The PGY 1 to PGY 7 or higher training levels inOntario are reported as R 1 to R 7 by CAPER.

Specialties

In the Faculties of Medicine section this item refers tothe type of non-specialized training, Family Medicinetraining, or the speciality field in which a trainee isenrolled on November 1st of the report year. Severalsubspecialties have multiple entry points. For exam-ple, anaesthesiology, emergency medicine, internalmedicine, pediatrics and general surgery all have critical care subspecialties. As individuals move fromprimary to subspecialty training, CAPER counts themwithin the subspecialty field that is consistent withtheir prior training.

In sections other than the Faculties of Medicine section, the same logic applies except that the refer-ence to an enrolment date is not applicable.

In all sections, the highest level of specialization orsubspecialisation found in an IMGs record takesprecedence. All data providers submit records usingthe following list of subspecialties:

Rotating Internship Non-Specialized Upgrading Palliative Medicine

R 1 (mdecine familiale ou formation dans une autre sp-cialit)R 2R 3R 4R 5R 6R 7

Veuillez prendre note des renseignements suivants concer-nant le systme de niveau de certaines provinces :

Maritimes

(Mdecins en formation lUniversit Dalhousie)

Les mdecins inscrits la premire anne du programmesont classs au niveau R 1. Les mdecins classs aux niveauxR 2 R 7 par CAPER sont classs selon les niveaux PGY 2 PGY 7 utiliss par lUniversit Dalhousie. Tous les mdecinsau-del du niveau PGY 7 sont classs selon le niveau de for-mation correspondant du CRMCC.

Ontario

Les niveaux PGY 1 PGY 7 ou plus levs en Ontario sontclasss comme R 1 R 7 par CAPER.

Spcialits

Ce terme rfre, dans la section sur les facults de mdecine,au type de formation non spcialise, la mdecine fami lialeou la spcialit dans laquelle un stagiaire est inscrit au 1er novembre de lanne de la dclaration. Plusieurs sur-spcialits ont de nombreux points dentre. Par exem-ple, lanesthsiologie, la mdecine durgence, la mdecine interne, la pdiatrie et la chirurgie gnrale ont des sur-spcialits en soins intensifs. mesure que les person-nes passent dune formation primaire une sur-spcialit,CAPER les place dans la sur-spcialit qui est cohrente avecleur formation antrieure.

Dans les sections autres que les facults de mdecine, lamme logique est utilise sauf que la rfrence une datedinscription ne sapplique pas.

Dans toutes les sections, le plus haut niveau de spcialisationou de sur-spcialisation inscrit dans le dossier dun DIM a prsance. Tous les fournisseurs de donnes soumettentles donnes en utilisant la liste suivante de spcialits et sur-spcialits :

Internat par rotation Perfectionnement non spcialis Mdecine palliative

XXIV The National IMG Database Report

Family Medicine Specialties

Family MedicineFamily Medicine (Rural Stream)Emergency Medicine (CFPC)Care of the Elderly (CFPC)Family Medicine: Anesthesia (CFPC)Enhanced Skills: ObstetricsEnhanced Skills: PsychiatryEnhanced Skills: Sports MedicineEnhanced Skills: Other Fam. Med. Training

Medical Specialties

AnesthesiologyClinical Pharmacology and Toxicology (Anes.)Critical Care (Anes.)Transfusion Medicine (Anes.)

Dermatology

Diagnostic RadiologyNeuroradiologyPediatric Radiology

Emergency Medicine (RCPSC)Critical Care (Emergency Med.)Pediatric Emergency Medicine

Internal MedicineCardiology (Int. Med.)Clinical Immunology and Allergy (Int. Med.)Clinical Pharmacology and Toxicology (Int. Med.)Critical Care (Int. Med)Endocrinology and Metabolism (Int. Med.)Gastroenterology (Int. Med.)Geriatric Medicine (Int. Med.)Hematology (Int. Med.)Infectious Diseases (Int. Med.)Medical Oncology (Int. Med.)Nephrology (Int. Med.)Occupational Medicine (Int. Med.)Respirology (Int. Med.)Rheumatology (Int. Med.)Transfusion Medicine (Int. Med.)

Medical Genetics

Neurology

Neurology (Pediatrics)

Nuclear Medicine

Occupational Medicine

Spcialits en mdecine familiale

Mdecine familialeMdecine familiale (collectivits rurales)Mdecine durgence (CMFC)Soins des personnes ges (CMFC)Mdecine familiale : Anesthsie (CMFC)Comptences avances : ObsttriqueComptences avances : PsychiatrieComptences avances : Mdecine sportiveComptences avances : Autre formation

en mdecine familiale

Spcialits mdicales

AnesthsiologiePharmacologie clinique et toxicologie (anes.)Soins intensifs (anes.)Mdecine transfusionnelle (anes.)

Dermatologie

Radiologie diagnostiqueNeuroradiologieRadiologie pdiatrique

Mdecine durgence (CRMCC)Soins intensifs (md. durgence)Mdecine durgence pdiatrique

Mdecine interneCardiologie (md. interne)Immunologie clinique et allergie (md. interne)Pharmacologie clinique et toxicologie (md. interne)Soins intensifs (md. interne)Endocrinologie et mtabolisme (md. interne)Gastroentrologie (md. interne)Griatrie (md. interne)Hmatologie (md. interne)Maladies infectieuses (md. interne)Oncologie mdicale (md. interne)Nphrologie (md. interne)Mdecine du travail (md. interne)Pneumologie (md. interne)Rhumatologie (md. interne)Mdecine transfusionnelle (md. interne)

Mdecine gntique

Neurologie

Neurologie (pdiatrie)

Mdecine nuclaire

Mdecine du travail

XXVThe National IMG Database Report

PediatricsAdolescent Medicine (Ped.)Cardiology (Ped.)Clinical Immunology and Allergy (Ped.)Clinical Pharmacology and Toxicology (Ped.)Critical Care (Ped.)Endocrinology and Metabolism (Ped.)Gastroenterology (Ped.)Developmental Pediatrics (Ped.)Pediatric Emergency Medicine (Ped.)Hematology/Oncology (Ped.)Infectious Diseases (Ped.)Neonatal-Perinatal Medicine (Ped.)Nephrology (Ped.)Respirology (Ped.)Rheumatology (Ped.)

Physical Medicine and Rehabilitation

PsychiatryClinical Pharmacology and Toxicology (Psych.)

Public Health and Preventive Medicine

Radiation Oncology

Laboratory Medicine Specialties

Laboratory Medicine (Undifferentiated)

Anatomical PathologyForensic Pathology (Ana. Path.)

General PathologyForensic Pathology (Gen. Path.)

Hematological PathologyTransfusion Medicine (Hem. Path.)

Medical Biochemistry

Medical Microbiology

Neuropathology

Surgical Specialties

Cardiac SurgeryThoracic Surgery (Cardiac Surg.)Critical Care (Cardiac Surg.)

General SurgeryColorectal SurgeryCritical Care (General Surgery)General Surgical OncologyPediatric General SurgeryThoracic SurgeryVascular Surgery

PdiatrieMdecine des adolescents (pd.)Cardiologie (pd.)Immunologie clinique et allergie (pd.)Pharmacologie clinique et toxicologie (pd.)Soins intensifs (pd.)Endocrinologie et mtabolisme (pd.)Gastroentrologie (pd.)Pdiatrie dveloppementale (pd.)Mdecine durgence pdiatrique (pd.)Hmatologie/oncologie (pd.)Maladies infectieuses (pd.)Nonatologie et prinatologie (pd.)Nphrologie (pd.)Pneumologie (pd.)Rhumatologie (pd.)

Physiatrie et radaptation

PsychiatriePharmacologie clinique et toxicologie (psychiatrie)

Sant publique et mdecine prventive

Oncoradiologie

Spcialits en mdecine de laboratoire

Mdecine de laboratoire (sans distinction)

Anatomie pathologiqueMdecine lgale (ana. path.)

Pathologie gnraleMdecine lgale (path. gn.)

Pathologie hmatologiqueMdecine transfusionnelle (path. hm.)

Biochimie mdicale

Microbiologie mdicale

Neuropathologie

Spcialits en chirurgie

Chirurgie cardiaqueChirurgie thoracique (ch. cardiaque)Soins intensifs (ch. cardiaque)

Chirurgie gnraleChirurgie colo-rectaleSoins intensifs (ch. gnrale)Oncologie chirurgicale gnraleChirurgie pdiatrique gnraleChirurgie thoraciqueChirurgie vasculaire

XXVI The National IMG Database Report

Neurosurgery

Obstetrics/GynecologyGynecologic OncologyGynecologic Reproductive

Endocrinology/InfertilityMaternal-Fetal Medicine

Ophthalmology

Otolaryngology-Head and Neck Surgery

Orthopedic Surgery

Plastic Surgery

Urology

Other Field of Medicine

Note:

Clinical Pharmacology

Effective November, 2010 the SpecialtyCommittee in Clinical Pharmacology agreed to a change in nomenclature for the entireSpecialty from Clinical Pharmacology toClinical Pharmacology and Toxicology.

Community Medicine

Effective November, 2010 the SpecialtyCommittee in Community Medicine agreed to a change in nomenclature for the entireSpecialty from Community Medicine to PublicHealth and Preventative Medicine.

Training Province

Training provinces are broad categories pooling therecords of IMGs completing postgraduate trainingwith faculties of medicine whose primary address islocated within the same province. For instance, if anIMG trainee is registered with the University ofSherbrooke but his/her training site is in NewBrunswick, the IMG will be assigned to the provinceof Quebec.

Years Since M.D. Earned

Years Since M.D. Earned is calc

The National IMG Database Report - CAPER

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