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Background & Importance

Many Canadians who attend medical school abroad apply to and often complete residency and/or fellowship training in the United States, including in radiology. Matching to a Canadian residency program as an international medical graduate (IMG) is extremely competitive, particularly in diagnostic radiology where there are only five positions reserved for IMGs. Per the J1 Visa Statement of Need Program at Health Canada, there are currently 61 Canadian citizens and permanent residents actively enrolled in radiology training programs throughout the United States for the 2023-2024 academic year.

All postgraduate training programs pose challenges to residents, however, Canadian citizens training abroad face a unique set of circumstances with often unclear solutions. Every year, countless Canadians pursue medical school training abroad given the increasing competitiveness of Canadian medical schools; several of these Canadians studying abroad may choose to pursue residency training in the United States given the abundance of programs and the perception of a more level playing field. For those wishing to return to Canada for fellowship and/or practice, there are several additional hurdles that must be tackled.

Examinations

Canadians wishing to return to Canada for practice must obtain specialty board certification in Diagnostic Radiology through the Royal College of Physicians and Surgeons of Canada (RCPSC). Unlike the American Board of Radiology (ABR) CORE Examination, the Canadian counterpart remains a two-step process, with both written and oral board components. This examination is typically undertaken in the spring of PGY-5, although the registration process begins nearly 18 months prior.

There are additional province-dependent criteria necessary to obtain a provincial medical license. This may include completing the Medical Council of Canada (MCC) examinations and obtaining the Licentiate of the MCC designation, although this varies by province. In a minority of provinces, including British Columbia, Ontario, and Nova Scotia, the United States Medical Licensing Examinations (USMLE) may be accepted in lieu of the MCC examinations. Barriers to provincial licensure for US-trained physicians are currently evolving and criteria should be verified with the respective provincial authority.

Fellowship Training & Job Market

It is not uncommon for residents of Canadian residency programs to pursue fellowship training in the US. Likewise, many Canadian residents in the US continue their training in an American fellowship program. However, a key obstacle to consider is visa sponsorship. Similar to residency positions, not all fellowship programs and institutions in the US sponsor J1 visas for fellowship. Additionally, for those intending to return to Canada to practice, it may be desirable to obtain fellowship training in Canada to network and acclimatize to the differences in healthcare systems prior to pursuing a staff position. Despite being a geographically large country, Canada has a small and tight-knit radiology community and those hoping to practice in Canada may find it beneficial to get a foot in the door prior to applying to jobs. However, US fellowship programs are overall well-respected in Canada and completing fellowship training in the US will not necessarily preclude one from working as a radiologist in Canada in the future. In my experience, I opted to apply to both Canadian and American fellowship programs and ultimately accepted a position in Canada as I felt it would better prepare me for the nuances of practice in the Canadian healthcare system.

Networking & Conferences

There are numerous opportunities for networking within the Canadian radiology community, both in-person and virtually. The Canadian Association of Radiologists (CAR) holds its Annual Scientific Meeting (ASM) every spring and offers a dedicated Trainee Day at the beginning of the conference. This day boasts focused educational content as well as networking opportunities for residents and fellows at all levels of training. Furthermore, multiple networking events are hosted at the CAR ASM, organized by the CAR itself and by affiliated and non-affiliated organizations. Trainees from across Canada as well as those training outside of Canada are welcome to register and are afforded the same perks of registration.

Canada also boasts a presence at the Radiological Society of North America (RSNA) Annual Scientific Assembly in Chicago. The CAR and other affiliated organizations such as Canadian Radiology Women (CRW) host receptions for their members and guests. From my own experience, both the CAR and CRW are immensely welcoming, and I have both made many strong professional relationships, and strengthened pre-existing friendships at these in-person events.

Getting Involved

There are multiple avenues available to Canadian residents who train abroad to become involved in the Canadian radiology community. The CAR provides membership to residents and fellows training in institutions outside of Canada for a nominal fee of $35 CAD per year. This grants access to the numerous volunteering, advocacy, and educational opportunities offered by the CAR. The CAR has multiple volunteering opportunities through its working groups on a variety of topics ranging from guideline development and accreditation to equity, diversity, and inclusion and planetary health. The CAR is also instrumental in radiology advocacy in Canada, both at the federal and provincial levels, and offers several paths to get involved.

The CAR Resident & Fellow Section (RFS) is an excellent resource for trainees both in Canada and abroad. Effective for the 2023-2024 academic year, the CAR RFS Executive Committee has instituted a new position of International Resident Representative. This position is open to all CAR members at non-Canadian residency training programs and will be held for a one-year term. The International Resident Representative position will provide yet another avenue for Canadians training abroad to collaborate with their peers and contribute to the Canadian radiology community. I have been fortunate to serve as the International Representative for the 2023-2024 academic year, which has further strengthened my ties with the radiology community in Canada. I highly recommend international trainees consider applying for this position to hone their leadership skills and to increase their networking opportunities.

There are several subspecialty affiliate societies offered through the CAR for which membership is included in CAR membership, including the Canadian Society of Abdominal Radiology (CSAR), the Canadian Society of Thoracic Radiology (CSTR), Canadian Society of Pediatric Radiology (CSPR), Canadian Emergency, Trauma and Acute Care Radiology Society (CETARS), and the new Canadian Society of Skeletal Radiology (CSSR). Each of these groups offers additional opportunities for engagement and have a presence at the ASM.

There are additional associations not directly affiliated with the CAR such as the Canadian Association for Interventional Radiology (CAIR) and the Canadian Society of Breast Imaging (CSBI), although there are strong bidirectional ties. CAIR membership is affordable for trainees at $50 CAD per year, while CSBI membership is free. The CAIR and CSBI both host an annual conference as well as offering additional opportunities for advocacy and engagement.

The CRW is a more informal community of Canadian women in radiology with a strong social media presence. The CRW offers many free and affordable webinars throughout the year, including an annual workshop on leadership for women in radiology, co-hosted by Dalhousie University, the Nova Scotia Association of Radiologists, and the Canadian Radiological Foundation. The CRW and its members also arrange in-person meetings, both formally and informally, for networking, mentorship, and community.

From my own experience through involvement with the CSBI and the CRW, both communities are extremely welcoming and supportive of the next generation of radiologists in Canada. I have formed transformative mentorship relationships through these two organizations, which have made me look forward even more to a lifetime of teamwork and camaraderie with a group of exemplary Canadian radiologists.

There are also several provincial radiological societies such as those in British Columbia, Alberta, Ontario, Québec, and Nova Scotia that provide membership to trainees. These societies offer various educational events and are a great resource when looking for jobs and making local connections.

Concluding Thoughts

Finding your place in the closely connected community of Canadian radiologists can initially seem daunting as an outsider; however, I have experienced nothing but genuine kindness, encouragement, and support on my “slow-but-steady” journey back home to Canada. I encourage any Canadian training in the US or abroad to get involved and start networking early, even if you are not yet sure of your future plans for fellowship or practice. In my opinion, the combination of experiences gained from my US residency training and associated activities and my involvement in the Canadian radiology community have been extremely fruitful and are all contributing to the development of a well-rounded perspective in shaping my future as a radiologist.

Resources:

• Royal College of Physicians and Surgeons of Canada - https://www.royalcollege.ca/rcsite/home-e
• Medical Council of Canada - https://www.mcc.ca
• Canadian Association of Radiologists – https://car.ca
• Canadian Association of Interventional Radiology – https://www.cairweb.ca
• Canadian Society of Breast Imaging – https://www.csbi.ca
• Canadian Radiology Women - https://twitter.com/canadaradwomen?lang=en

About Dr. Kaitlin M. Zaki-Metias

• Chief Resident, Diagnostic Radiology, PGY-5, Trinity Health Oakland/Wayne State University
• International Resident Representative, Canadian Association of Radiologists Resident & Fellow Section
• Trainee Representative, Canadian Society of Breast Imaging
• Resident Representative, Canadian Society of Abdominal Radiology
• International Resident Representative, Canadian Radiology Women