The Saudi-Canadian dispute: hidden racism in medical education

Bader Alamri is an Internal Medicine Resident (R3) at Dalhousie University

 

Since 1978, more than 4,500 Saudi physicians and surgeons have been trained and have provided healthcare in Canada. These individuals have trained and practiced at many university hospitals across Canada over the past forty years, working within a very wide range of specialties—from general residency training to subspecialty fellowships, as well as very specific areas of research and clinical interest [1].

The Royal College of Physicians and Surgeons in Canada (RC) with the Saudi Commission for Health Specialties (SCFHS) to increase and improve the quality of training in Saudi Arabia, which reflects the long-standing relationship between the two parties [2]. In fact, the current SCFHS CEO is himself a Canadian-trained gastroenterologist at the University of British Columbia, and the current CEO of RC is a hematologist who established the first bone marrow transplant program in the Kingdom of Saudi Arabia.

What most don't know is that Saudis in Canada do not compete with Canadians for training positions, as their seats are not funded by the Canadian government. Only internationally funded trainees can apply to them. All costs (including a tuition fee of $100,000/year for each resident, salaries, and allowances) are paid by the sponsoring government (e.g., the Kingdom of Saudi Arabia).

Sadly, on August 3, 2018, a diplomatic dispute between the two governments resulted in a termination of all medical scholarships for Saudi trainees. These trainees have been asked to return to the Kingdom by the end of summer 2018. This decision will have an impact on healthcare in Canada, as approximately 1000 Saudi medical trainees will be leaving the system [3].

Despite the management crises in many university hospitals, great support has been provided to the affected residents—both Saudis and the Canadians who will have to work longer hours to cover the shortage. Some senior medical staff even took action and wrote letters to the leaders of both governments, urging them to find a solution that would allow Saudi trainees to complete their training. Other senior medical staff accepted the decision and started looking for opportunities for their trainees in the United States. Unsurprisingly, most universities and staff rushed to help the affected trainees.

Social media (in particular, Twitter) was filled with supportive comments. But not all tweets were positive. Some comments on were hurtful and seemed ill-informed and racist.

Racism in medical education is very real. In a British study assessing the acceptance rate among applicants to medical schools, candidates from ethnic minorities were disadvantaged [4]. In 2005, Albertan residents reported intimidation or harassment approximately 50% of the time from their staff or nurses; although the focus in that study was on gender differences, ethnicity was the second perceived base of such behaviour against the residents [5]. However, most research on racism in medicine is directed toward physician-patient interactions rather than amongst healthcare providers themselves.

The current diplomatic dispute has revealed the beautiful side of Canadians, including the attitudes of medical staff to people in distress regardless of political conflicts. However, it has also uncovered ignorance and hidden racism in the medical education system, highlighted by the vulnerability of Saudi residents in the current situation. This should raise the question of fairness toward residents from different ethnic minorities, and whether there have been cases of discrimination that were missed in our medical education system. Medical education organizations should be more open and acknowledge the existence of racism among healthcare providers and educators, working to educate and support all members of their programs.

I am sure if this dispute were to be resolved, many Saudi trainees would continue working and learning as diligently and professionally as before—but will they feel as safe and welcomed as before?

 

References

  1. Bureau, S.A.C. Postgraduate Medical Program in Canada. [cited 2018; Available from: .
  2. College, R. International collaboration. [cited 2018; Available from: .
  3. Khan, M.H., N. Abdullah, and M.B. Stanbrook, Withdrawal of Saudi trainees exposes vulnerability of Canadian health care. Canadian Medical Association Journal, 2018.
  4. McManus, I.C., Factors affecting likelihood of applicants being offered a place in medical schools in the United Kingdom in 1996 and 1997: retrospective study. BMJ, 1998. 317(7166): p. 1111-6; discussion 1116-7.
  5. Cohen, J.S. and S. Patten, Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta. BMC Med Educ, 2005. 5: p. 21.