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Planification de formations en santé

L’approche expérientielle qui inspire cet ouvrage exige que la pratique précède la théorie, que l’on vive d’abord l’expérience avant de l’analyser et d’en tirer des principes. Ainsi, avant de proposer des stratégies pour la planification et la mise en oeuvre de réforme de programmes de formation médicale, je vais d’abord décrire, dans les cinq prochains chapitres, les expériences que j’ai vécues dans cinq facultés de médecine ayant changé profondément leur curriculum.

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Just What the Doctor Ordered

Just What the Doctor Ordered

The Insider’s Guide to Getting into Medical School in Canada
also available: Paperback
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“I got in!”

These are three of my favourite words, and I am fortunate to hear them quite regularly from the medical-school applicants I work with directly. I wish I could hear them even more than I already do. This is part of what has led me to write this resource: the idea that more students might benefit from the information, perspectives, and strategies that other applicants to medical school have found useful.

I hope this resource gives support and encouragement to your dreams of becoming a physician, and concrete ideas and strategies for success in a challenging process. I hope it will, in some small way, help you be the next one to say: I got in!


If you’re reading this resource, you are likely already aware of how challenging the process of admission to a Canadian medical school can be. If you are like many applicants, you may have already tried applying on your own, without success.

You are not alone. Most medical-school applicants I see have extremely high grade point averages, not to mention extracurricular and community activities galore. They tend to apply to many medical schools, yet receive only one or two interviews—if any. Many of the accomplished students who have sought my help are on their second or third application attempt.

How can this be?

I believe part of the answer lies in numbers. There are ninety-six universities in Canada with a total student population of about 1.8 million. Not every student hopes to become a physician, of course, but take a moment to think about how many students you know in high school or university who are thinking about medical school. When I worked at orientation fairs for incoming students to first-year university, the question I got most from students and parents was: Can you tell me what courses we need to get into medical school?

So, there are potentially lots of interested students. We have limited numbers of medical schools in Canada and limited numbers of spots available at each school. This means that the posted “minimum requirements” from medical schools don’t necessarily reflect the reality of a successful application in Canada.

When I visited a Caribbean medical school several years ago, I spent a week with several premedical advisors from the United States. As the only Canadian advisor, I was startled to hear some of the statistics that my American counterparts told me represented their students: grade point averages in the low 2s (out of 4), and entrance exam scores far lower than any I had seen in my daily work at a Canadian university.

I thought to myself: If the students I worked with had similar statistics, I could understand why they didn’t receive offers of admission. But their statistics were much better—even among students who were applying to Caribbean medical schools because they felt they couldn’t compete with applicants to Canadian medical schools.

The students I have seen in the last twenty years have, by an overwhelming majority, strong academics and good test scores, and contribute enthusiastically, consistently, and broadly in their larger communities. Yet, less than fourteen percent of applicants to medical school received offers in 2015–2016 in Ontario. This percentage appears to be similar across Canada.

In my experience, most medical-school hopefuls—whether they are in high school or university—are used to setting difficult goals and achieving them. The goal of admission to medical school, or the perceived “failure” to achieve it (if you have applied before), can present the biggest challenge you have ever faced. I have seen this challenge erode the confidence of the most stellar students, but I have also seen those students and many others persevere and succeed.


I’d like to tell you a bit about why I think I can help.

Over the last twenty years working as a career advisor at a Canadian university, I have worked with thousands of students, from first-year undergraduates to PhD candidates, in diverse degree programs from fine arts to engineering physics. My work has involved helping undergraduate and graduate students explore career options, consider related degree decisions, strategize about further education, search for jobs, and improve their career-development knowledge and skills.

During this time—in my university job and, since 2007, in my private practice—I have also worked with thousands of students hoping to become physicians. I have an “insider” perspective on the health sector from a wide range of experience. For example, for eight years, I volunteered as a community member on a medical-school admissions committee, where I reviewed applications and interviewed candidates. I was not involved in selecting candidates, and I do not speak for medical schools or their selection criteria (particularly since admissions procedures have evolved since my committee work), but I did screen many candidates and came to recognize qualities that, in my judgement, made some candidates stand out. I have also developed and delivered hundreds of workshops on applying to, and interviewing for, medical school and residency programs, and have spent eighteen years working with final-year medical students and international medical graduates applying to residency programs.

So, I offer you:

  • experience as someone who has read thousands of medical-school applications and coached thousands of students through application strategies and medical-school interviews (in my private practice, I have given personalized coaching to a hundred or so students—all, except one, have succeeded in getting accepted to medical school)
  • knowledge of the processes, terminology, and challenges of medical school and residency programs
  • stories of applicants who have struggled and ultimately succeeded in their goals
  • twenty years of coaching students to medical school and residency placements
  • career-counselling techniques to help you present yourself as an informed and focused applicant, and to develop crucial backup plans

And I offer you the experience of hundreds of thousands of hours working with students just like you.

However, I want you to be skeptical of any secondhand source (and that includes me and a long list of others: medical students, doctors, advisors, guidance counsellors, parents, and helpful books and friends). Only the medical schools themselves, in the year that you plan to apply, have the most current and accurate information or interpretation of a given “rule.” Be wary of people or sources (websites, campus clubs, mentoring groups) that make definitive statements about “rules”: the rules come from processes that continually evolve. Every “expert” (including me) is filtering information through their own lens. We are merely interpreters and not the source. Make sure that you are getting the information that you need and can trust. That means always validate what you hear, read, see, or suspect from the source—in other words, from the people who will take your application money and decide your future in their program.

To be clear: the source is each medical school in the year you plan to apply.

Repeat this to yourself! Chant it whenever you are tempted to take shortcuts and assume that someone else knows what they are talking about.

For example, your question might be, Does my human geography course count as a humanities prerequisite for medical school? The “expert” answer of a secondhand source is always: Blah, blah, blah, blah, blah. They might sound very sure of themselves as they answer your question—but what you should hear, especially with a question that asks them to interpret what a medical school wants, is blah, blah, blah, blah, blah.

You can listen to what the person says, and think of it as possibly true, but always remember it is only one perspective. You need to verify the information directly from the medical school itself. Yes, this means more work for you, but it is really important work to do. Pretend a patient’s life is at stake, because it is: you are the patient in this case.

This resource and other people will help you get information and ideas that can be very useful in your process. You can incorporate some of those views and advice (and mine) into your strategy. But always, always remember that what is true for them, and true for now, might not be true for you or true when you apply.

I wrote this resource less as a “do this, do that” manual and more as a “think about this, think about that” strategy tool. This is my biggest gift to you: a strategy to find your own “insider” perspective, which, in my experience, has produced the most confident and competent applicants in the end.


While my primary client base is university and postgraduate students, I do work with some high school students. I wanted to include them in this book because I believe that starting earlier in the process (without overly stressing our students) can be a helpful way to pace out an application to medical school, review additional career options, and ultimately have a less difficult and more successful application process, if and when the time comes around. This resource has a specific chapter for high school students, but also many additional strategy suggestions throughout.


In my experience, parents and other supporters often play a large and vital part in encouraging medical-school hopefuls, so that’s why I have included a chapter for them in this resource. If you are a parent, or have a parent or supporter who is aware of your medical- school hopes, take a look at chapter 17. I hope it gives parents strategies to help support students embarking on this process, as well as some information about what students might be facing as they do so.

If you are a student with well-meaning parents or supporters, I suggest leaving that chapter lying casually open somewhere, in a place they might trip over it. They want to help you and this might be a good start.

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Pathology Review and Practice Guide



Knowledge is the foundation of excellent pathology practice and excellent outcomes on exams. This book helps build that foundation in a comprehensive yet concise format. It is a solid reference for practicing pathologists, and provides excellent preparation for the US and Canadian pathology exams.


The US and Canadian pathology exams differ in format: the US exam is entirely written and multiple choice; the Canadian exam has a written and an oral component, and the written component is entirely short answer.


For this reason, the exam strategies discussed below cover different formats, and the book itself includes short answer questions and multiple choice questions.




A Structured Study Plan


In addition to reading cases, a structured study plan should include a thorough and systematic reading of Robbins and Cotran Pathologic Basis of Disease and of a surgical pathology textbook (either Sternberg's Diagnostic Surgical Pathology or Rosai and Ackerman's Surgical Pathology). Pay particular attention to definitions, fundamental terms, and concepts. Make lists and tables for comparison and grouping. Focus on subspecialty books during your rotation of that subspecialty. When it is closer to the time of the examination, go over old examination questions and collections of images to help you objectively assess your knowledge and your weaknesses.


Group Study


If there are more than 3 people writing the examination, it can be helpful to get together regularly to go over old examination questions, slides, gross images, and so on. As a group, go over a chapter or a topic in Robbins and Cotran Pathologic Basis of Disease and brainstorm possible questions on the areas you think are important.


Literature Review


Glance over the last 3 years of the American Journal of Surgical Pathology. This should be sufficient to keep you up to date on this field. Advances in Anatomical Pathology has some very good review articles that can help you quickly update your knowledge on specific topics. You also need to be aware of any new tumor classification systems in the most recent editions of World Health Organization publications.


Practice Exams


In the 3 months before the examination, try to systematically gain exposure to all subspecialty experts in your department. Trust yourself and your program. If the resident training committee thinks you are doing well, and you did well on your department exams, you will do fine on the pathology exam.




In Canada, you must bring a microscope to the exam. In the US, you can bring your own microscope, but microscopes are also supplied.


If you bring a microscope, also bring a slide, a back-up light bulb, and a filter. Use the slide to adjust your microscope.


If you have to travel to a different time zone for the exam, consider arriving 2 to 3 days early to avoid jet lag. No matter where the exam is held, give yourself at least a day to become familiar with the examination venue and your route to the venue.


Know your examination schedule well. Get to the site at least 15 minutes early to allow time for preparation, sign-in, going to the washroom, finding your seat, and so on.




The Basics


Before you begin taking the exam, enter all pieces of required information on your answer sheet. If you forget to enter your name and ID number, your results may not be scored. Do not bring personal electronic devices into the examination room. Do not communicate with fellow examinees while the exam is in progress. Do not comment about the wording of questions in your answers.


Strategies for Unknown Lesions


First, try to categorize the lesion as neoplastic or nonneoplastic.


Nonneoplastic lesions can be classified as congenital, inflammatory, or infectious.


Neoplastic lesions can be classified as benign or malignant. Malignant neoplasms can be primary or secondary. Most neoplasms can be further classified into the following 3 subcategories based on cell lineage or origin: epithelial (carcinomas), stromal (sarcomas), and hematopoietic (lymphomas, leukemias).


Strategies for Multiple Choice Questions (US)


- Anticipate the correct response while you read the question. If you see the response that you anticipated, circle it and then check to be sure that none of the other responses is better. If you do not see the response that you expected, use the following strategies to eliminate responses that are probably wrong:
- Responses that use absolute words, such as "always" or "never," are less likely to be correct than ones that use conditional words such as "usually" or "probably."
- "Funny" responses are usually wrong.
- If you can identify more than 1 correct response, "all of the above" is the correct answer. "None of the above" is usually an incorrect response, but be very careful not to be trapped by double negatives.
- The longest response is often the correct one.
- A response that repeats key words that are in the body of the question is likely to be correct.
- If you have no idea of the correct answer, choose response b or c. Response a is least likely to be correct.


- If you cannot answer a question within a minute, skip it and come back to it later.


- Transfer all responses to the answer sheet at the same time, once you have marked all questions on your exam. Make sure that you have filled the appropriate bubbles carefully in pencil.


- Take the time to check your work before you hand in the answer sheet. Trust your instincts and try not to change your original answers.


Strategies for Short Answer Questions (Canada)


- Bring at least 2 pens.


- There are about 30 questions divided by groups and each question has multiple parts. You have 3 hours to answer them. Pace yourself appropriately.


- Glance through the questions and answer the easy ones first.


- Read the entire question before putting down your answer.


- Write legibly. Use bulleted lists and tables.


- Provide the number of answers that are asked for. If you provide 5 answers when 3 are asked for, only the first 3 will be marked.


- Write down the most important answer first. If a disease has multiple histologic features, write down the most common feature first.


- Do not leave any questions unanswered.


Strategies for Examining Slides and Images


- Make sure your microscope works well before the examination starts.


- For the US and Canadian exams, you have about 2 minutes to examine each glass slide, and about 20 seconds to provide your answer and pass the slide to the next candidate.


- Both the US and Canadian exams also include screen-based images for showing virtual slides, and gross pathology, forensic, and other images.


- Pace yourself appropriately:
- The US exam has a 3.5-hour session for examining about 50 glass slides and 25 virtual slides, and a further 1.75-hour session for screen-based images.
- The Canadian exam has a 2-hour session for examining about 50 glass slides, and a 90-minute session for examining 40 to 60 screen-based images.


- Provide 1 answer only to each question unless otherwise specified.


- If you cannot make a satisfactory diagnosis, provide the best answer you can, and move on. Do not leave any questions unanswered.


- Remember "common things are common" and the answer is most likely straightforward. You do not need to rack your brain looking for "rare birds."


- For the Canadian exam, do not write lists of differential diagnoses, and write legibly but quickly.


Strategies for Oral Examinations (Canada)


- Be professional. Dress professionally and act professionally. Look at the examiners with a level of confidence. You have studied hard and prepared yourself well for this day. Accept that you will be a bit nervous, which is expected and appropriate.


- There are 5 to 6 cases to examine in 1 hour. Each case will have 1 or 2 slides with age, gender, and site information. The materials could come from surgical cases, autopsy, or cytology. After reviewing the cases, you will be examined by 2 examiners for 1 hour.


- Make notes while looking at the cases: summarize histologic features, differential diagnoses, and diagnosis; note answers to anticipated questions. Take the notes with you into the examination room. You can also make notes during the oral exam to organize your thoughts.


- The oral examination usually starts with "describe what you see and give a differential diagnosis," followed by "describe how you would work this case up." Do not jump to the diagnosis right away even if you are confident with your diagnosis. Do not be panic when you cannot get a definitive diagnosis. A structured approach with a differential diagnosis is usually what the examiners are looking for.


- Be patient. Wait for the full question to be asked before answering. Think and organize your thoughts before answering. It is fine to ask for clarification or for the question to be repeated if you do not completely understand the question.


- Be honest. When you do not know the answer, say, "I do not know," or "I will look it up," or "I will show it to someone else." Do not guess wildly. Do not ramble wildly. You will be interrupted if you ramble.


- Be independent. Do not expect feedback or comments on how you did during the exam. Do not be misled by inadvertent feedback, or the behavior or attitude of the examiners.


- Take hints from your examiners. If they ask you whether you have anything else on your differential or any other stains you would like to order, it means you are missing something. If they ask whether you are sure, it means you are probably wrong. Do not argue with or question the examiners.




- You have done your best. Do not contact your examiner to see how you did.


- In the US, you receive your results through PATHway from the American Board of Pathology.


- In Canada, the exam board stratifies candidates into pass, borderline, and fail groups. For all borderline candidates, the exam board reads final in-training evaluations reports (FITER) and considers scores on all components to make the pass/fail decision. Exam results are usually available within 1 week.

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