In Section 15 of the CCRF,it basically states that everyone should be treated equally,without discrimination,especially without discrimination based on country of origin/study,gender,age,etc.To date,the IMG has suffered severe discrimination by the medical establishment.Case in point:Once the standards set by the authorities (eg.the QE of the Medical Council of Canada[MCC]) have been met,then everyone should be considered to be at par.So far,this is not so for IMGs.Many have passed the relevant exams and exceeded the minimum requirements,but have still been arbitrarily denied equal opportunities to enter Residency training,and eventually practise their chosen profession,even those who are indigenious,and who have never signed waivers from Citizenship and Immigration,{CIC},for example.And this situation exists even in light of the severe doctor shortages in many rural areas of the country.The sites linked to this page,deliberately trimmed,are intended to motivate the reader into taking an active role in shaping her/his own destiny.Attend at our free medical lectures/meetings to get the inside details about the strong undercurrents flowing against the IMG,and the latest opportunities.
x RADICAL INTEGRITY means holding anyone up for accountability of any wrongdoing even if the act was committed by a member of your own religion,race,staff,gender,circle of family/friends,etc x
Around this time also,the Canadian Intern Matching Service (CIMS,now called CaRMS) introduced a new set of rough rules.Qualified IMGs were not permitted to apply for residencies in Ontario,Manitoba,the Atlantic provinces,etc.As well,CaRMS began an even worse two-tier system of matching-Iterations 1 and II-whereby all national medical school graduates (and no IMGs) are matched in the Iteration 1 in the first round.In the second round,all those Canadian grads who still remain unmatched,are then given first chance at any vacancy in the Iteration 2.Lastly,the IMG will be matched for the left-over positions,if any [note:IMGs pay more {approx.$178.00} than the Canadian grads for the matching application].Statistics indicate that of all the IMGs who apply for matching,only about 1 % do actually get a position[author's note:In their statistic,CaRMS have been incorrectly counting graduates of the OIMGP as IMGs]...
xxx Justice being taken away,what are provinces and countries,but great robberies and bullies...any unjust policy/regulation/law is no solution/resolution/validation at all xxx
MORE EXCERPTS from GPMEN:...In light of physician shortages in certain communities,this writer,as a pioneer in advocating on behalf of IMGs,has been meeting and corresponding with Ministry officials and other authorities since 1991,to propose the following:That IMGs are very willing to sign contracts to work for 2-5 years in the underserviced areas, if,and only if,these IMGs are first sponsored for Residency positions,and given a full,as opposed to restricted/temporary,license upon successful completion of said Residency.
Details of this Underservice Proposal (USP) were submitted to MOH policy advisors since 1991,to the NDP,the Liberals,the PCs,to the Mesdames.E.Mahood,C.Abrahams,J.Bertram,E.Witmer,etc;and to the Misters M.Harris,J.Wilson,T.Azmi,C.A.Bigenwald,J.Keystone,Aberman,R.Wigle,the Ont.IMG Program staff,the CPSO Registrar (Dixon),the OMA President,among others.In vituperative response,the authorities have opened up new programs for Midwives and more recently Nurse Practitioners,which seems to take away potential opportunities for/from the IMG.....
...Now what happened to this author's proposal (USP),which as you may recall,was intended to be applied for the placement of IMGs?The answer is even more bothersome,as they plagiarized this proposal,and applied it to the benefit of the already pampered national medical graduates,instead of the unemployed IMGs.The MOH will further enhance opportunities for the local Ontario medical graduates by having their training fully paid for by the gov't.,with the stipulation that they put into some years of service in rural areas,after completion of Residency.Will it work? It has not in the past,why should it be expected to work now?Remember the candle-light vigil exercised by the local medical students and PAIRO members a few years ago?The fact that this writer got no credit for his proposal, while it is truly amazing,comes as no surprise. Life went on in the usual way for those concerned-they continue to orbit a different planet,blissful and oblivious...
xxxxxxx RADICAL HONESTY means never having to intentionally deceive/lie xxxxxxx
MORE EXCERPTS:...IMPENDING ANNOUNCEMENT AS IT IMPINGES ON THE IMG: For years,this writer have been proposing that international doctors be sponsored for training positions so that IMGs can be part of the answer to the physician distribution problem in Ontario and the rest of Canada.And for years the authorities have been saying that there were no shortages;that,in fact,there were too many doctors.Now,all of a sudden,after spending a tremendous sum to hire fact-finders and expert panels,etc.these very same authorities have conceded that this writer's predictions, which were cried out so loudly all along [since 1990] were/are indeed true.Consequently,the Ontario government is perched to make highly-secretive moves this Fall (after the Federal billions pour in,of course)about,inter alia,addressing physician distribution problems.
The Hon.Mrs.Witmer will announce a series of plans-to open another medical school in Northern Ontario;to attract prodigal doctors who previously sought greener pastures in the US;;to recruit specialist doctors from abroad to fill possible rural vacancies;and about opening a new Ontario office-World Education Services (WES)-presently based in New York,to evaluate (cost?) the credentials of these specialist IMGs.After the assesment and ensuing recommendation,the CPSO will conduct refresher/upgrading courses for up to 6-months for these specialist IMGs.Subsequently,these new international doctors will be given a restricted/partial license before being allowed to sign contracts to work in one or more of the 100 designated underserviced communities in Ontario.This writer is concerned that the WES will only bureaucratize and complicate an already complex screening process which is faced by the IMG.Will it be another appalling conspiracy by the entrenched powers that be,to undermine the solution to the rural physician supply/IMG plight?We have already passed through the Medical Council of Canada's investigatory screening process when we took the Council's exams.(The MCC usually send copies of our certificates to our home medical schools for verification,among other checks, etc).Therefore,we urge this body to,first and foremost, give due consideration to unemployed international medical doctors already domiciled here and who have already passed the Qualifying Exam of the Medical Council of Canada,the very same exam used to screen medical graduates from national schools.What damage will the Ministry now do to all those IMGs,already homed and working/breeding here,who have spent years of their life and all their money to pass the EE/QE exams of the Canadian Medical Council,and who have been patriotically and patiently waiting for local positions to open up,if they are now overlooked?Will the Minister have it in her heart to tell these dedicated Canadians (whose only crime is that they studied medicine abroad) that,"sorry we don't need you; we find you now to be absolete as you have either graduated and/or passed the Medical Council Exams too long ago,etc;nothwithstanding,we have to nevertheless,recruit still more IMGs from abroad"..This writer humbly reminds the Authorities yet again,that a bird in hand is worth nine in the bush...Why can't we be sponsored for Residency/required specialty training and fill whatever rural positions exist?
What purpose will the WES serve that cannot be done by the established and highly-respected MCC already in place?With another bureaucratic machine comes another vehicle for more red tape,political euphemisms,nuanced deception,etc which will further comouflage political nepotism,favouritism and the like.Will the introduction of the WES further corrupt the forces at work against the IMG and further frustrate the balance between merit,and effort versus reward and success and hence,circumvent/shortcircuit fairness and justice?
A Case in point is the Ont.IMG Program.It was initiated by the SFC/JVS/M'Tree group in 1987 (After Jamorski et al sued the MOH).Subsequent years of operation of the OIMGP have seen the admission for Pre-Residency training of favoured candidates/relatives/friends/etc derived chiefly from this SFC/JVS/M'TREE group.These favoured candidates even received pointed "review" lectures,given in secret,by "tutors" (who formed the originating frontrunner/forerunner of the later grant-rich projects,such as Possibility Company,later to becomeTrple S) about questions which will appear in upcoming exams,all under the noses/auspices of the Co-ordinator/Directors of the Ont. IMG Program.And some years ago,on or around '94/'95,the Trple S group even paid the simulated patients (SPs) used by the OIMGP to get exam information before the day the actual exam was held.{Later,in 1997,this author saw a man and a woman making copies of the OSCE exam videos at the Audiovisual Centre,U of T's Sigmund Samuel library}.Consequently,a list of those admitted for pre-Residency in the OIMGP,will show that the 24 who got admitted into the OIMGP,as well as others admitted for research/graduate positions,and those given educational/restricted licences,etc.,have an originating background from the same country/region of origin as Ratn O'vidar,the Exec.Dir. (for some 10 years) of the SFC/M'Tree group.All the Directors (eg.L.Cuttress,J.Ross,Cohen) of the OIMGP,who turned a blind eye and condoned wrongdoings at the selection process,etc.,were either hired by/deeply connected to this SFC/JVS group.These Directors [of the OIMGP]even had the audacity to unethically use our OIMGP test scores for research from '86 onwards, without our knowledge,much less consent.
And when one points out afore-mentioned discrepancies and irregularities in the selection process,one gets ostracized and blacklisted by not only the OIMGP,but by COFM,the CPSO,and the establishment in general.Nothing was done about the group that paid the SPs to cheat in the OIMGP exams,they all continued into licensure programs at Ontario medical schools.Nothing was done about the other complaints,either.Everything was swept under the carpet.The names of successful candidates are kept as classified info.The Review findings of the Ont. IMG Program still remain undisclosed,even though this writer has made several futile requests to the MOH,the OIMGP,and Ron Wigle himself,for a copy of same.
x The only purpose for which power may be forced on another,is to prevent harm to self or to society x
MORE EXCERPTS..To date,this writer have seen many copy-cat associations,come and go.Their interest to "help" the IMG suddenly begins with the granting of funds (taxpayer's),but quickly fades when the funding stops.Then the cycle repeats when the original bird changes its feather by using another name and apply another time,for more funding. [Because Possibility Project/Company [now Trple S] took fees from medical student's circa 1996/97,without giving the lectures,this writer was misidentified as their Leader and unjustifiably berated by the mistaken U of T's Prof.Agur,to whom the victims complained].These grant-concious groups-the early forerunners-under the guise of access projects,eg.Fair Competition,Full Recognition (Heather Butlr),Possibility Co./Project,FMGA (Muhammed S.Jaffr.[S.A.S.],Scmit,now Omr {both from Windsor},FMDA (now AIPSO),etc all have a common ancestor and are different branches of the same tree-the root of which is centered at SFC/JVS/M'TREE.These are not doctors,so why are they running interference for us?Why don't they stick to their own occupation? If they want to control doctors,the SFC/JVS/M'TREE should go to the OMA,the CPSO,the CMA,etc.As doctors,we do not interfere in the business of the Teachers Association,or the Nurses Assoc.,the Journalist Associations,or even the Funding Industry.So,why do they use International doctors as bait to get taxpayer's funding etc,and subsequently gouge/bleed these doctors for thousands of dollars for Prep.,ESL,computer,and other courses.These predators,more than anyone else,have been instrumental in the formation of the OIMGP,(which by the way,even when it was just a twinkle in R. Cohen's eyes, was never thought by us,to be any sort of a panacea]and the corresponding restriction of IMGs to only 24 positions since 1987.
Not the least damaging aspect of this group and its affiliates/branches is this:In their profit-making ventures,these grant-seeking groups are tipping the scale of the balance,whereby bright, highly humanistic but poor IMGs who cannot afford the Queen's ransom in dollars for these Prep courses, are cast aside,discarded by the highly competitive screening process for the 24 (now 36) OIMGP positions,for example.In their place,we see only the wealthy,[who has been financed for such costly courses],and favoured candidates,being planted.
In an enlightened society,everyone should have equal opportunity.There must be equal access to Prep courses by tutors who are/have been with,the Ont.IMG Program (if any should be allowed at all!),and the like,for all,not just a chosen few(via CSL,etc).To give a small subgroup undue advantage is tantamount to condoning Olympic athletes who can only win medals by taking steroids!These self-acclaimed gatekeeper [to access to the trades/professions] groups have only added to the tension/pressure forced upon the IMG due to the worsening overcrowding/unemployment situation for IMGs.It is simply not in these groups' financial interest to have the IMG situation stabilized;to have the physician distribution problem solved,and to avail every citizen,especially those in rural areas, full access to adequate health care.They have a stake in having a situation where a glut [of IMGs] exists.It's their plan (with help from CIC) to have even more foreign [IMG] clients attracted here,from whom they can manipulate/capitalize/generate/derive/absorb a constant source of funding.They are not,for their own financial reasons,striving to stabilize the physician situation.Their strategy is to recklessly entice (via web sites,etc) ever more doctors(who are desperately needed by their home countries) from abroad,to increase unemployment/competition chaos,and in so doing,they advance only their empire/goals-ie open up more funding opportunities,to generate more grants.
Over the years,many of these non-medical 'friends' have either themselves attended/or sent their pigeons to our lectures or meetings,and have requested our newsletters, to get inside info,then tried to use same for their own gain,and against us.
xxx It is quite a relief to write/speak openly,to embrace that which is good,and to detest the bad xxx
MORE EXCERPTS...A most exasperating aspect of these groups is that you pitch your ideas to them,they refuse to accept these ideas,and show you the door.Then they plagiarize these very same ideas,present it for,and receive funding,all the while pretending that you don't exist anymore.In one instance,a founding member of the this group went so far as to collaborate in the manufacture and fabrication of false and misleading evidence against this writer,behind his back.This is not exactly an uncommon situation with SFC/JVS/M'TREE affiliates.They self-profess to be everything to everybody,as long as opportunities for funding exist.They also posture that they represent the Midwives,the Nurse Practitioners,Acupuncturists, and many,many others.As well,they purport to represent IMGs.But,when pressed who will they fight for-NPs,Midwives or IMGs?These are mutually exclusive entities.More positions for NPs,etc.,mean less for IMGs!
Should these grant-concious groups parasite off IMGs,who they need for ESL/costly Prep. courses (at their affiliate organizations such as Caplan and Trple S)? Why are they trying to make a living off one of the most vulnerable of society's cohorts?If they truly want to help the unemployed doctor,they can offer/arrange for free Prep courses,same as this writer has been conducting for poor IMGs (who can't afford commercial courses) since 1990.This writer have helped thousands of IMGs pass their screening and licensure examinations-both Canadian (EE/QE1/QE2/OSCE) and American (USMLE/CSA).The best interests of all IMGs will be best served if only sincere doctors advocate for the IMG.No non-medical activist and the like knows what the IMG is personally put through by the system,and therefore,such person will not have our best interest in mind,not like one of our very own colleagues will,anyway.Only then can we become a part of the consensus on the solutions to the egregiously unfair issues plaguing the IMG.Where were these non-doctors when there was no funding?Where will they be when the funding runs out?
...Our association enjoys no funding,and,as such,is free from interference-political and otherwise.It was the first,and original,body to fight to open up the Underservice Program,and for more positions for IMGs;also to have the 4X-limits and the req'ment for references/marital status/SIN,the no appeal mechanism,the witholding,of IMG test papers,etc.,by the Ont. IMG Program,removed;and,to have the fees for the EE lowered to the same or less than that set for the QE 1;to win the attention of the authorities on the plight of the IMG,and so on.On or around 1996,this writer was instrumental in having a review of the OIMGP by the MOH (Ron Wigle),the results of which are kept hidden even today.After letters and phone calls went ignored,a moral victory was won in court by this writer,after which the OIMGP,in 3/99 removed the limits to sit the MCQ.As well,the number of positions offered by the OIMGP increased from 24 to 36/year.And were it not for opposition from the SFC/JVS/M'TREE groups,this writer would have achieved much more.These 'friends' should not,it is submitted,pimp off the naive International Medical Doctor.
xxx It is the individual's right/obligation to resist any action that he cannot morally/ethically support xxx
Chap.1....G. PATIENT INTERVIEW TIPS:(a).Summarize the patient encounter.(b).formulate a problem list and discuss same with the patient.(c).check with the patient ,as per any misunderstanding or questions.(d).answer all queries,reassure patient.(e).end the visit with a handshake and a smile.
...CASE 15.A 64 year old man comes to your medical office presenting with a lack of energy,and a general loss of interest in life since early retirement some months ago....
In the next 8 minutes,conduct a focal and relevant history,then answer the examiner's questions.
Questions (See Answers at pp. 46-47)...
What are the risk factors for the patient's diagnosis?..
Explain the difference between cyclothymia and dysthymia...
Elaborate on the clinical picture of an adolescent with this disorder...
What are 5 major side-effects of anti-psychotics?
...Case 8. A. This 63 year old caucasian lady presents with violaceous papules on the forearm,and around the ankles.When asked,she does not recall itching.She stated that she does not enjoy eating of late....
In the next 15 minutes,take a history and explain how you will conduct a focused exam on this patient....
B. Post-Encounter Probe:
In the next 7 minutes,answer the following questions...
What is your differential diagnosis?...How will you manage this patient?....
If this patient was experiencing bleeding episodes,what relevant investigations will you consider?...
(The 40 cases allows reader & author to interact)...
Chap.1...MAT:This is Atrial arrhythmia with varying P wave morphology,and variable PP and PR intervals.The rate is usually more than 100/min.If the rate is less,then it is called a WANDERING PACEMAKER-due to discharges from different foci within the atria.(see diagrams)...
CRITERIA FOR AV BLOCK:There is delayed conduction ie.the PR interval is more than 0.2 seconds.All atrial impulses are conducted.There must be no dropped or absent beat....
(Besides the illustrative theory,this book has 34 EKG strip questions with explanations).
PART 1:PSYCHOSOCIAL,CULTURAL & ENVIRONMENTAL INFLUENCES ON BEHAVIOR,HEALTH & DISEASE PROCESSES:
SECTION 1.5.1.MOTOR SKILLS DEVELOPMENT
...Fertilization of the ovum by a sperm at the ampullaristhmic junction,results in the formation of a diploid zygote.After a series of divisions,a morula/conceptus is formed.It develops a cavity to form a blastocyst,before entering the uterus,4 days after fertilization.This forms an inner cell mass which becomes the embryo.The blastocyst also forms a peripheral layer which will become the placenta.Implantation occurs by day 7 (see Chart on Milestones)
SECTION 1.5.2.PSYCHOLOGIC AND SOCIAL FACTORS:...
ANNA FREUD,MARGARET MAHLER,and others believe that incomplete or maladaptive early development (see Table 1),may result in disorders of personality,and subsequent difficulty in forming trusting,stable relationships in later life..
HOMES and RAHE listed 43 stressors in their Life Readjustment Rating Scale:The number one stressor is death of a spouse (100 points),followed by divorce (73 points),marital separation (65),jail term (63),death of a close family member (63),personal illness or accident (53),marriage (50),getting fired (47).If >200 points accumulate,the individual adapts by developing psychosomatic illnesses.
DEFENCE MECHANISMS:
Regression is seen in the obstreperous type,who,during bouts of physical illness,goes back to an earlier stage of development....while...Repression is the involuntary exclusion of a conflicting or painful or anxious thought,impulse,or memory from awareness...
PART 2: QUANTITATIVE METHODS:
POWER,P[of a test/study]is the probability of rejecting a NULL HYPOTHESIS (supra) when it is,in fact,false.Usually,80% is acceptable.Use Formula,P=(1-beta).See illustrations & diagrams.
PART 3: PSYCHOPATHOLOGY:
...Munchausen-by-proxy syndrome is the creation or simulation of injury or illness in a child,by the caretaker,so that the caretaker (mother usually) can maintain a relationship with/attention from the caregiver.
CHARACTERISTICS OF ABUSE VICTIMS:
They [VICTIMS] :(a).Are passive in their relationships.(b).lack trust.(c).cannot deal with anger,and keeps it in longer.(d).dissociate affect from experiences.(e).often suffer from post traumatic stress.(f).often present with somatization symptoms (see questions and answers).....
PART 1:GENERAL PRINCIPLES,GROWTH and DEVELOPMENT:
CHAPTER 1.PRENATAL PERIOD-...The intra-uterine period from conception to the end of pregnancy consists of the Embryonic Period (8-9 weeks),and the Fetal Being from 9 to 40 weeks.At 8 weeks,the fetus weighs 1 gm,and is 2.5 cm long.At 12 weeks,it is 14 gm by weight,and 7.5 cm by length.At 28 weeks,it weighs 1000 gm and is 35 cm long.At 40 weeks,its weight averages 3400 gm,while its length averages 50 cm....(see APGAR and Feeding charts)
WELL BABY,WELL CHILD:On the first day,screen the newborn for PKU,and hypothyroidism...The GFR at birth is 20-30 ml/min.It doubles by 2 weeks,reaching adult levels of 120 ml/min. by age 2 years...Serum Cr,in the first 5 days of life,reflects mom's Cr level,and not the infant's renal function (see Immunization Table/Schedule)....
PART 2:MEDICAL ETHICS and JURISPRUDENCE:
....CRITERIA used to diagnose DEATH:(a).Lack of response to internal need/external stimuli.(b).Absence of movement or breathing for a least one hour.(c).Absence of elicitable reflexes.(d).Flat or isoelectric EEGs (confirmatory,not absolute). (e).Negative Flow Shown on Blood Scan of Brain (also,confirmatory).(f).Repitition of the exam after 24 hours,yield similar results....
PART 3:APPLIED BIOSTATISTICS and CLINICAL EPIDEMIOLOGY:
The CHI-SQUARE test is used to test differences between proportions giving the liklihood of events,in terms of p-value.(see p.38).It is also used to test an association between nominal factors eg.frequencies observed vs. those expected,for certain events...
ANOVA compares mean values from 3 or more groups...For F-test,see Questions
The t-test (called a Z-test if the sample size is more than 30) is used for differences between 2 sample means,mostly for continuous data...(see Illustrations,Questions,and Answers):...
PART 4:EPIDEMIOLOGY OF HEALTH AND DISEASE:
LEADING CAUSES OF DEATH IN INFANTS-congenital anomalies,followed by RDS,and SIDS,short gestation/low birth weight...
PREVENTION-3 TYPES:
(a).Primary Prevention-reduces exposure or alters susceptibility to some factors or vectors or reservoirs..eg.immunization,driver's Ed.,speed limits,road bumps,inspections...
(b).Secondary Prevention-involve early detection,eg.screening for cancer,using seat belts,etc.
(c).Tertiary Prevention-the reduction of disability from disease and the restoration of normal function,eg.medical treatment,rehabilitation,First Aid Rx/Ambulance.etc...
A PATIENT'S PERSPECTIVE:The medical professional needs to be more of a humanist,and less of a technician (ie. more kindness,and less smart Alecs),especially in this highly technological age when health information can be quickly accessed at the stroke of a key.Medicine should not be made into a cold competition (MCQs),but a warm collaboration (PBL) guided by teamwork,aimed towards the good health of the unsuspecting patient.Healing(patient-centred,including talk therapy,etc) must be concentric,involving the body,mind,and spirit/soul of the patient.To concentrate on just the physical ailments at the neglect of the mental/emotional/psychological and social state of anyone,is to reduce oneself to being a mere body mechanic.This violates the principles of therapeutic privilege (doctor-patient relationship) and,as well,it deep-sixes the sentiments of the Hippocratic oath.Doctors must always strive to keep the big picture in perspective when facilitating their patients,and address all aspects during a patient visit,even those that the patient may not have the knowledge,foresight,or presence of mind,to verbalize...
FOOD FOR THOUGHT: What is Voluntary Simplicity (VS)? Compare Relative VS with Absolute VS?
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