The College is made up of individuals who have a doctoral degree and training in medical genetics. Those who are Fellows of the College have (since the early 1980s) been admitted by examination. Honorary Fellows have been invited to join the membership in recognition of outstanding contribution to the field, but do not use the designation FCCMG (Fellow of the Canadian College of Medical Geneticists). Other members (non-fellows) of the College include Fellows-in-training (who are in CCMG-accredited training programs and who wish to be active in the College during this period) and Associate Affiliates, who have applied and been recommended for membership.
The College is somewhat unusual for a medical specialty in that it includes professionals with Ph.D. degrees as well as those with medical degrees. Clinicians may be admitted to the College upon successful completion of a CCMG clinical training program and examination, or upon becoming Fellows of the Royal College of Physicians and Surgeons of Canada (RCPSC) in Medical Genetics (without further examination). Laboratory scientists are admitted after training and successful examination in one or more of 3 specialties: Biochemical Genetics, Molecular Genetics, or Cytogenetics. Some Fellows have entered the College in the specialty of Medical Genetics (Ph.D.s with other specialized training) but this category is rarely used.
2. I am interested in a career in medical genetics. What choices do I have? What education do I need? Which careers can the CCMG help prepare me for?
Careers in medical genetics generally fall into the areas of research or medical service. (See FAQ 3 for more about research vs. service.) Many people do some of each as part of a comprehensive career. They may work in universities, hospitals, government departments, or commercial companies. Most jobs in this field have a minimum requirement of a university undergraduate degree, and many require additional degrees or training.
Genetics or Genomics Research
Medical genetics/genomics research can take many forms.
- Laboratory research
- Clinical (patient-oriented) research
- Policy, ethics, health services research
In each of these areas, the research director usually has a doctoral degree, which in Canadian training means a Ph.D. or an M.D. (or both). The hands-on work is generally done by people in training (undergraduate and graduate students and post-doctoral fellows) and by laboratory technicians, research assistants, or other allied health professionals (such as nurses or counsellors). Technicians and research assistants usually have a B.Sc. or M.Sc. degree in a relevant area and otherwise gain on-the-job research training.
The delivery of genetics health care to the public is usually based in hospitals. Occasionally, commercial laboratories or stand-alone clinics may play a role.
A. Clinical Genetics Service
Physician Geneticist (also called Clinical Geneticist and/or Clinical Biochemical Geneticist/Physician): These clinicians receive specialist training in Genetics after their medical degree through one or more of: the CCMG, Collège des médecins du Québec (CMQ http://www.cmq.org), or Royal College of Physicians and Surgeons of Canada (RCPSC http://royalcollege.ca) (see FAQ 4 for more information).
Nurse: These professionals have a university nursing degree and receive on-the-job training for their specialized role in genetics clinics.
Genetic Counsellor: Training to be a genetic counsellor is through an M.Sc. degree, offered at several Canadian Universities with certification by the Canadian Association of Genetic Counsellors (http://www.cagc-accg.ca)
B. Laboratory Genetics Service
- Laboratory Geneticist: These scientists function as directors or assistant directors for laboratories that undertake genetic testing on patient samples. They have a doctoral degree (either Ph.D., M.D. or equivalent), with additional postdoctoral training. The CCMG oversees two-year postdoctoral training programs in cytogenetics and molecular genetics, and a three-year program in biochemical genetics. Other laboratory specialties, such as molecular pathology are related, but not currently offered through the CCMG. (See FAQ 6 for more details.)
- Genetics Technologist: Some Canadian provinces require all laboratory personnel in medical laboratories to be certified as medical laboratory technologists. Postgraduate training for genetics (molecular and cytogenetics) technologists is offered through two Canadian institutes: the Michener Institute in Toronto (http://www.michener.ca) and the British Columbia Institute of Technology in Vancouver (http://www.bcit.ca). For biochemical genetics technologists there are no specific training programs, but individuals usually enter the field through a general medical laboratory technologist program (widely available). The examination and certification for technologists is through the Canadian Society for Medical Laboratory Science (CSMLS) (http://www.csmls.org).
With rapidly changing technologies, these career paths are likely to take complimentary new directions. Most notable is the development of genome-wide arrays and whole-genome sequencing which are rapidly becoming methods of choice for laboratory analysis. These are bringing together molecular and cytogenetics so that these laboratory disciplines will soon become one. We also anticipate a major role for individuals with skills and training in the interpretation of data from these new technologies, who will likely have a liaison role between the service laboratory and the genomics clinic. For individuals considering training in this area, no specific programs are yet in place, but mentors could probably advise as to how to anticipate this type of career role.
In summary, the CCMG is directly involved in the training of physicians (MDs) in Clinical Genetics and Clinical Biochemical Genetics, and laboratory scientists in Molecular Genetics, Laboratory Biochemical Genetics and/or Cytogenetics. As an overseer of medical genetics services in Canada, the CCMG also liaises with the bodies responsible for training and certifying the other health professionals, particularly, counsellors and technologists. The CCMG accredits Canadian centres for the provision of medical genetics services as well as for the training of M.D.s and Ph.D.s in their respective specialties.
Genetics is a medical specialty that provides diagnostic, counselling and therapeutic services to individuals and families dealing with genetic conditions. Genetics patient care providers include physicians, nurses, dieticians and genetics counsellors. These providers rely on genetics service laboratory directors and laboratory technologists to conduct genetic tests on patient samples specifically for the sake of patient care. All of these individuals usually work in a hospital setting.
Many genetics service providers also have university affiliations and are involved in research designed to further our understanding of genetic diseases and improve our ability to help patients. Much of the research that supports our understanding of medical genetics and its application to health care is done in an academic environment by researchers who are not directly involved in patient care, but who often collaborate with their clinical service colleagues,
Funding for the two pursuits is clearly separate, however.
The CCMG supports research in the realm of medical genetics, but its primary function is to train and certify individuals and accredit centres for the delivery of clinical and laboratory genetics services within Canada’s health care system.
4. I am a medical student / physician with an interest in medical genetics as a specialty. What are the Canadian training routes to become a physician specialist in Medical Genetics?
There are three routes to clinical training, which allow fellowship in the CCMG and use of the FCCMG designation. These are designed to produce a clinician who interacts with patients in an academic environment. Most of these doctors also conduct research, teach medical students, residents and fellows and have administrative responsibilities.
Royal College of Physicians and Surgeons of Canada (RCPSC) or Collège des médecins du Québec (CMQ)specialist training in Medical Genetics Both Colleges have a five-year training program with direct entry after medical school that is designed to produce an undifferentiated specialist in Medical Genetics. RCPSC or CMQ training programs are available at a variety of centres accredited by these Colleges (RCPSC - http://royalcollege.ca; CMQ - http://www.cmq.org). Upon successful completion, individuals in good standing are entitled to the FRCPC or CSPQ designation and, without further examination, may also apply for fellowship in the CCMG.
CCMG Fellowship Training in Clinical Genetics The CCMG offers a three-year fellowship training program at CCMG-accredited centres for MDs with at least three years postdoctoral training in a RCPSC-accredited residency program (and/or a CMQ- accredited residency program). This route is designed for an MD who has already completed a primary specialty through the RCPSC or CMQ (e.g. Pediatrics, Obstetrics or Internal Medicine) and who wants to obtain expertise in Medical Genetics. In some circumstances, the last year of the primary specialty program can overlap with the first year of the CCMG fellowship training. Success in the full examination process is required for fellowship in the CCMG.
CCMG Fellowship Training in Biochemical Genetics (Metabolics): Clinical or Laboratory Focus The CCMG offers a three-year fellowship training program at CCMG-accredited centres for MDs with at least three years postdoctoral training in a RCPSC accredited residency program (and/or a CMQ-accredited residency program).
This route is designed for an MD who has already completed a primary specialty through the RCPSC or CMQ (e.g. Pediatrics or Medical Biochemistry) and who wants to obtain specific expertise in the diagnosis and treatment of inborn errors of metabolism (metabolics). This fellowship can be tailored to produce an MD whose primary focus is the treatment of patients or an MD whose primary focus is the management of a laboratory providing metabolic tests for the purpose of patient care. Individuals with this fellowship will be qualified to serve either or both of these functions. In some circumstances, the last year of the primary specialty program can overlap with the first year of the CCMG fellowship training. Success in the full examination process is required for fellowship in the CCMG. (See Training Guidelines – Clinical Genetics for more details for more details).
5. What are the differences (and pros and cons) of the Fellowship and Residency routes for training physician specialists in Clinical Genetics?
Individuals trained in any of the paths described in FAQ 4 are qualified to provide genetics service delivery.
The RCPSC and CMQ programs in Medical Genetics are 5-year programs that include training in paediatrics, internal medicine and maternal-fetal medicine during the first two years, followed by three years of genetics. Upon successful completion of the training program and related examination, these individuals earn the designation FRCPC or CSPQ. They may then apply for a position as staff Geneticist in a hospital. In general, a Geneticist with the FRCPC or CSPQ designation will work in the context of a Department or Division of Medical Genetics and will not see non-genetics patients. Some of these individuals chose to pursue further training in subspecialties of medical genetics (such as neurogenetics, cancer genetics or metabolic genetics), or laboratory training to enhance their skill set and practice opportunities.
The CCMG programs in Clinical Genetics or Biochemical Genetics are three-year sub-specialty programs for individuals who have completed RCPSC or CMQ training in a primary specialty (usually a related discipline) and wish to sub-specialize in genetics. Upon completion of the fellowship and examination, the individual earns the designation FCCMG.
The clinician with a fellowship in genetics may work primarily as a Geneticist in the same setting as an FRCPC in Genetics, or may see patients in both their primary specialty and genetics. For example, a Pediatrician / CCMG Fellow may be hired to cover pediatrics wards and/or share pediatrics call in addition to seeing clinical genetics or metabolics patients. The RCPSC or CMQ Medical Geneticist would not be qualified to do this.
Both tracks lead to a fully trained Geneticist. The RCPSC or CMQ programs are well suited for individuals who are sure about their decision to specialize in genetics from the moment they finish medical school and who do not want to practice in other disciplines. The CCMG route is ideal for individuals who want double certification (in another specialty and genetics) or for those who discover their interest in genetics during their initial residency training.
The FRCPC or CSPQ designations indicate specialist competency in Medical Genetics and they allow physicians to bill as primary specialists in Genetics. They do not have specialist level competency in another discipline. MDs who successfully complete either of these programs are eligible for fellowship in the CCMG, in which case, they are entitled to use the FCCMG designation in addition to FRCPC or CSPQ.
Recently, Ontario added to the fee schedule a billing code specifically for physicians who are FCCMG, comparable to those used by FRCPCs. Otherwise, these clinicians generally bill through their primary FRCPC or CSPQ specialty designation.
6. I am a science student / scientist with an interest in laboratory genetics. What are the different medical laboratory specialties in genetics? Which ones does the CCMG offer training for?
There are three medical laboratory specialties that the CCMG offers training for:
The clinical practice of human biochemical genetics relates to investigation, interpretation and laboratory monitoring of inherited disorders of metabolism. This is the oldest of the laboratory disciplines in genetics (over 100 years), and is becoming increasingly prominent with the expansion of newborn screening programs in most provinces. It differs from the other laboratory specialties in having a focus on patient management and monitoring, as well as the diagnostic aspect. The biochemical genetics training programme serves both scientists (PhD or MD) who want to direct a biochemical genetics lab and also MDs who want to specialise in diagnosis, management and treatment of patients with inherited metabolic disorders.
The clinical practice of molecular genetics involves the identification and interpretation of variations in small molecules (usually DNA, but sometimes also RNA or proteins) that are associated with human genetic conditions. This laboratory discipline is the newest (approximately 25 years), and started with the ability to test DNA markers linked to disease genes. The human genome project created a huge expansion in this field, and the technology and potential applications are always changing. The focus is primarily on diagnosis and predictive interpretation of DNA findings. Although the emphasis is on inherited genetic disorders, there is considerable overlap with molecular pathology.
The clinical practice of human cytogenetics involves the recognition and interpretation of chromosomal abnormalities. It started over 50 years ago, with the ability to recognize extra or missing whole chromosomes to account for conditions such as Down Syndrome or Turner Syndrome. Now, technology allows the recognition of very subtle changes, including rearrangements, and the interpretive aspect of this laboratory discipline is increasingly challenging. Clinical cytogeneticists are also required to have knowledge of the common translocations and other chromosomal changes in somatic cancers.
There is in fact a great deal of overlap among these specialties. The diagnosis of a metabolic condition may, for example, involve both biochemical and DNA tests. Cytogeneticists use tools derived from molecular laboratories, and enhanced resolution is starting to blur the line between these disciplines, particularly as microarray and sequencing technologies are becoming front-line tools. As a result, a number of laboratory scientists choose to become specialized in two areas.
In all cases, the CCMG post-doctoral training is for individuals who already have a Ph.D. (or M.D.) in a related field, and prepares them for a role as a Laboratory Director. For other career paths, see FAQ 2. See also Training.
If you complete a laboratory-based postdoctoral CCMG training program, you are qualified to direct a clinical genetics laboratory in your area of specialization*. Such individuals are also qualified to act as consultants to other professionals in the health care field in areas related to their area of expertise, to participate in the training of future physicians, scientists, CCMG fellows-in-training and residents in RCSPC training programs, and to conduct research in the field of genetics and other related areas.
*Note: As healthcare is a provincially directed service, please consult with the local provincial governing body for more specific guidelines regarding directorship of a clinical laboratory unit.
Refer to the “Training” section of the CCMG Website.
- The “Guidelines” provide information about each of the specialised training programs offered by the CCMG (Clinical Genetics, Clinical and Laboratory Biochemical Genetics, Molecular Genetics and Cytogenetics), including information on the curriculum, timeframe and educational prerequisites for each program.
- Review the list of “Training Sites” to see which Canadian centres are offering training in the specialty(ies) of interest to you. Contact information is provided for each centre. You may contact any one or several of these centres directly to make further enquiries about training. Each centre has its own application process and makes its own decisions on whether to accept an individual for training. After acceptance of a trainee, the centre will then register him/her with the College. The CCMG does not operate a centralised admissions scheme.
- Linda Stevens Memorial Fund See Training > Funding Opportunities. This fund is operated by the CCMG.
- Ministry of Health and Long Term Care – Province of Ontario – Laboratory Genetics Fellowships The Ministry of Health (MOH) competition is primarily for individuals with a PhD, who wish to undertake postdoctoral training to develop expertise in the clinical (service) laboratory aspects of Cytogenetics, Molecular Genetics, or Biochemical Genetics. The purpose of the fellowship is to provide funds for the candidate to undertake postdoctoral training in Laboratory Genetics in an Ontario Centre accredited for training in the applicant's field of interest by the Canadian College of Medical Geneticists (CCMG). The training program will enable the applicant to meet the requirements of the College so as to be eligible to write the Fellowship examinations conducted by the College. The fellowship stipend is for a maximum of two years of support. Funding will commence the following year, on July 1. Individuals who only require one year of funding in order to fulfil the credentialing requirements of CCMG may also apply. A recipient will be eligible for more than two years of support only by re-entering the competition as a new applicant. Local CCMG Training centres will have additional information and application forms.
- Applications for this Ontario Fellowship must go via an accredited CCMG Training Centre.
- Some centres may be able to make training funds available on a case-by-case basis.
- Provincial Ministries of Health provide funds to support clinical trainees from their own provinces in designated programs. Further information is available from the Training Centres