Medical School -- Schedules & Exams

Back at the beginning of medical school, I had little concept of how the next four years would unfold. When would we start hospital rotations? Would we still have lectures during those years? What exams would we have to write? When would we start travelling to other cities for electives?

The answers to these questions will vary a bit by medical school, but based on my experience at UBC, I hope this post will provide some idea of what to expect at a typical Canadian four-year medical school.

First & Second Years: Lectures at the University

The first two years are spent at the university, with lectures/tutorials from Monday through Friday, from 8 am to 4 or 5 pm. There's a break every day between 12 - 1 pm for lunch; often meetings are scheduled during this time (occasionally with free lunches!). Most weeks you spend one afternoon at a family practice and a second afternoon learning clinical skills in small group sessions at the hospital; lunch hour on these days is used for commuting. Generally there are also one or two half days off for "self-directed learning" (i.e. studying or shadowing time).

a typical week in second year

In terms of the lectures, topics are taught in blocks, averaging five weeks in length. The academic year starts in the last week of August, with four blocks between August and December, followed by Christmas break, then another four blocks between January and May.

first- and second-year blocks (with longitudinal courses in green along the bottom)

Exams are held twice a year, in mid-December and in the last week of May. Each exam period tests material that was taught over the preceding four/five months. For example, below is the May exam schedule for the second-year students, covering the four blocks that they covered between January and May: Integument (INT), Brain & Behaviour (BB), Reproduction (REP), and Nutrition, Growth, & Development (NGD). There are additional exams for longitudinal courses: Doctor, Patient, & Society (DPAS), Clinical Skills (INDE), Family Practice (FMPR), Pathology, Anatomy (Lab), and Histology (Lab). There is also an OSCE.

second-year May exam timetable

Written exams generally clump two blocks together -- for example, GI block and MSK block may be tested together. Such an exam usually consists of just over 100 multiple choice questions (approximately 10 questions per week) and you are given 3.5 hours to write it, filling in bubbles on a Scantron sheet.

To pass an exam, you must get 60% overall, with 50% on each individual week. If you fail a week, you are required to rewrite the exam for the block that contains that week. Although grades are formally released four to six weeks after the exam period, students are given answer keys to mark their own exams on the final day of the exam period, so that they can determine whether or not they passed (and theoretically so that they can review and learn from their errors or dispute any questions that they found issue with).

On your final transcript (which is used for residency applications), grades show up only as pass (P) -- no one will ever see your percentage grade! When I went through UBC they had an honours (H) designation for the top 10% of the class -- this has since been done away with.

my first- and second-year transcript that I included in my CaRMS residency applications -- see, no % grades!!

Third Year: Clerkship at the Hospital

Third year is spent doing clinical rotations in hospitals and clinics around the city. No (or very minimal) out-of-town travelling is required. Schedules vary greatly depending on what rotation you are on.

sample third-year rotation schedule

Some rotations (internal medicine, pediatrics, obs/gyne) require you to do 24-hour in-hospital call shifts (you get the next day off post-call). Other rotations (surgery, psychiatry) have call shifts ending at 11 pm (you don't get a post-call day off). In third year you receive a small stipend (around $120 per week)...which at least covers your parking. With regard lectures, you have one "academic half day" afternoon a week, when you attend lectures at the hospital.

At the end of each rotation you write an exam. These exams are more comprehensive for the large blocks (internal medicine, surgery, pediatrics, obs/gyne, psychiatry), often involving a written exam and an OSCE. UBC had us write an NBME multiple-choice exam as the written exam for each of these five blocks; other medical schools may create their own exams instead of having students write the NBMEs. Again, all exams written in third year are graded on a pass/fail basis.

my third-year transcript that I included in my CaRMS residency application -- again, no % grades!

Fourth Year: Travelling for Electives / CaRMS

Halfway through third year you start organizing your fourth-year schedule. Unlike third year, which is standardized with all students completing the same rotations, fourth year looks different for everyone. Students schedule their own electives, with a focus on the specialities in which they are most interested. Logistically, in-province elective selection is done by students ranking their choice of UBC electives (i.e. electives anywhere in British Columbia) on an online system, which runs an algorithm to match students to electives. You don't usually get the exact electives you want, but after a bit of shuffling and trading, most people are happy enough with the schedule they end up with.

fourth-year schedule -- note that 4-week elective blocks can be broken into two 2-week elective blocks

Particularly if you are applying to a competitive specialty, you will want to replace some of your UBC electives with out-of-province electives at the schools to which you are planning to apply for residency. These are opportunities to check out other schools, show your face so that you'll hopefully be recognized when you return for an interview, and collect reference letters.

Out-of-province electives are a lot of fun -- but applying for them, not so much. Applying usually involves mailing in an application form and immunization records form, usually with an application fee of around $100, and then waiting some weeks...often to find out that all elective spots have been filled and no, you will not be getting that $100 back. There's also the hassle and expense of booking travel and accommodation for electives.

You need to be somewhat strategic in selecting electives, as UBC (at least when I went through) only allows four two-week electives, which generally means you can only visit four other schools. UBC also doesn't allow you to do all of your electives in one specialty -- you must do a balance of medical, surgical, and primary care electives, as per these guidelines:

As much as you need to use fourth-year electives to gain exposure to your chosen specialty, you need to be careful not to close doors on potential back-up specialties. For example, if you are vying for radiology, but are planning to back up with family practice, you should probably do one or two family practice electives, as when interview time comes along, the family practice programs will see right through an application that shows two months of back-to-back radiology electives and no family practice.

Elective frustrations aside, fourth year is probably the best year of medical school. Aside from completing your CaRMS application, there's little work to be done outside of the clinical day, which leaves you with plenty of time to enjoy the places you're visiting on electives. In terms of exams, you only write two in fourth year: a two-day OSCE (which took place in November during my year) and the one-day LMCC MCCQE Part 1 (the online multiple-choice/fill-in-the-blank licensing exam that all fourth-year medical students must pass in order to graduate; it costs $950; we wrote it in mid-May).

Despite the LMCC looming in the distance throughout all of med school as the Big Scary Final Licensing Exam, it's funny how small of a deal it becomes when you finally reach it. Most of my classmates studied less intensely than they did for any of the first-, second-, or third-year exams. I studied intensely for around two weeks and really wasn't too stressed about it -- by the time May rolled around I had already been accepted by a residency program (Match Day was in March) and I knew that so long as I passed, my LMCC score didn't matter.

Canadian vs. American Medical Exams

In general, I think exams are less stressful for Canadian medical students than they are for our American counterparts, as we have no equivalent of the USMLE Step 1, so exam scores (so long as we pass) carry no weight in our residency applications. The LMCC MCCQE Part 1 is roughly equivalent to the USMLE Step 2 CK and the LMCC MCCQE Part 2 (a two-day OSCE which we do in second-year residency) is similar to the USMLE Step 2 CS. There is no Canadian equivalent of the USMLE Step 3. Although Canadian medical students are not required to write the USMLEs, some do choose to, to keep doors open for potentially working in the US after residency.

Hopefully this is somewhat helpful for people wondering how Canadian medical school is structured! Feel free to comment or email if you have any questions!