Replacing high-stakes summative examinations with graduated medical licensure in Canada

Brent Thoma; Sandra Monteiro; Alim Pardhan; Heather Waters; Teresa Chan

doi:10.1503/cmaj.211816

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RE: Do we need the Royal College Exam?
Jamal Yazdi [MD, MPH]

Posted on: 09 March 2022
RE: Replacing high-stakes summative examinations with graduated medical licensure in Canada
Genevieve M Casey [MSc MBBS FRCPC]

Posted on: 08 February 2022
RE: Competence by desire
barry I campbell [md]

Posted on: 07 February 2022

Posted on: (9 March 2022)
Page navigation anchor for RE: Do we need the Royal College Exam?
RE: Do we need the Royal College Exam?
Jamal Yazdi [MD, MPH], Resident, Public Health and Preventive Medicine PGY3, University of Ottawa
Medical Council of Canada stopped Qualifying Exam II a few months ago. Now those who have successfully finished one year of postgraduate clinical training are eligible to receive the Licentiate of the Medical Council of Canada (LMCC).

Every year final-year residents from universities across Canada write the Royal College exam. The pass rate is high, roughly 95% for fully Canadian trained applicants. The pass rate could be lower for International Medical Graduates (IMGs).

The residency programs across Canada regularly undergo accreditation to guarantee that the standard level of training is maintained.
Each year every applicant pays thousands of dollars to write the exam. The Royal College also needs to put much effort to create a safe environment for and a standard assessment of the applicants.

Do we still need to continue the royal college exam?

High pass rates, regular accreditation of the residency programs, excessive use of resources by both the residents and the Royal College may be reasons to give a second thought to holding the Royal College exam.

Royal College will still be responsible for many of its current activities, such as maintaining certificates.'

Jamal Yazdi MD,MPH

Public Health and Preventive Medicine, PGY3

uOttawa
Competing Interests: None declared.
References
Brent Thoma, Sandra Monteiro, Alim Pardhan, et al. Replacing high-stakes summative examinations with graduated medical licensure in Canada. CMAJ 2022;194:E168-E170.
Posted on: (8 February 2022)
Page navigation anchor for RE: Replacing high-stakes summative examinations with graduated medical licensure in Canada
RE: Replacing high-stakes summative examinations with graduated medical licensure in Canada
Genevieve M Casey [MSc MBBS FRCPC], Geriatrician, University of Ottawa/The Ottawa Hospital
Just to add to the authors paragraph on 'unintended consequences', I believe the 'once a year full stakes examination' is prejudicial towards any candidate considering parental leave, on parental leave or experiencing a medical crisis. It would be interesting to survey Royal College members post exam to see how many had delayed earnings, delayed career start, missed job opportunities due to having to delay their exam by a full year due to one of the above (this may also contribute to the well described gender pay gap...). Candidates who choose not to delay their exam due to one of the above, experience excessive stress trying to complete this high-stakes exam, whilst sick or with newborn or very pregnant in addition to the stresses well described by the authors in their article.
If the exam has to stay, to be more equitable and take into account the variety of life experiences candidates experience, at a minimum they should offer more than one date per year.
Competing Interests: None declared.
References
Brent Thoma, Sandra Monteiro, Alim Pardhan, et al. Replacing high-stakes summative examinations with graduated medical licensure in Canada. CMAJ 2022;194:E168-E170.
Posted on: (7 February 2022)
Page navigation anchor for RE: Competence by desire
RE: Competence by desire
barry I campbell [md], psychiatrist, Winnipeg Regional Health Authority
I read this article looking for some objective evidence that the summative exams have led to incompetent physicians or that graduated assessments have led to more competent physicians.
I did not see anything that was objective only adjectives and adverbs building a case for what is clearly a biased opinion.
I would think the answer is that our current training process produces competent physicians and either method of evaluation leads to a rise in motivation to learn. Which process is more costly needs to be reviewed as if the result is the same cost should be a factor. In my limited experience the myriad assessments that are required for determining minutia of competencies must be more costly several fold.
There are risks in competence based assessments particularly in programs where relationships with trainee and assessor influences objectivity or there is a need for that particular trainee to work at that site. This lack of objective overview may diminish the public's faith in a system of cronyism.
Change for the sake of change needs to be resisted unless it can be proven to have better outcomes and/or lower costs and is able to be implemented without bias and nepotism.
Competing Interests: None declared.
References
Brent Thoma, Sandra Monteiro, Alim Pardhan, et al. Replacing high-stakes summative examinations with graduated medical licensure in Canada. CMAJ 2022;194:E168-E170.