Why the MCC Qualifying Examination Part II still matters

Maureen Topps is the Executive Director and CEO of the Medical Council of Canada.


Nothing matters more in my role than helping Canadian and international medical graduates succeed as they prepare to practice medicine in Canada. But what does success look like and how do we measure it?

Some in the medical community feel that the Medical Council of Canada Qualifying Examination Part II (MCCQE Part II), taken by candidates early in their residency as a condition of licensure, has outlived its purpose given how medical education and licensing is evolving.

While medical education and the assessment of medical students and physicians has evolved substantially since the founding of the MCC and the inclusion of the MCCQE Part II as a prerequisite for the Licentiate of the Medical Council of Canada (LMCC), the need for an objective and standardized assessment of core physician skills has not. Mounting evidence suggests that the exam results might predict elements of professional performance. That’s why the MCC examination continues to evolve - to remain relevant in a fast-changing medical landscape that constantly brings new challenges.

We periodically redesign it, in collaboration with numerous stakeholders, to meet modern trends in medical education and assessment.

The MCC has regularly updated the qualifying exams since they were first developed in the 1990s. The latest update to the MCCQE Part II was launched in 2018, after the Council completed an extensive, multi-year practice analysis led by 12 representative stakeholders, who reviewed our assessment processes in consultation with medical regulatory authorities, medical schools and other groups. The resulting blueprint and updated exams reflect what clinicians in practice and stakeholders now expect of candidates.

The updated MCCQE Part II assesses the knowledge, skills and behaviours that all physicians practising in Canada should be able to demonstrate, regardless of specialty. It encompasses two broad categories: dimensions of care across the medical continuum and physician activities, including assessment/diagnosis, management, communication and professional behaviours.  These competencies aren’t just “nice-to-haves” — they are critical competencies in today’s health-care environment. The complexity of patient needs is increasing while service delivery involves a greater number of players, from other health-care professionals to patients and their family members. Providing high-quality patient care simply isn’t possible without being able to communicate effectively with others.

Medical schools and residencies comprehensively prepare students for independent practice. However, there is no one way to teach, and it’s critical that every physician be able to demonstrate what they have learned at a level expected of the profession and by patients.  As is the case with any professional exam, there is a common standard that must be achieved before a license is granted. The MCCQE Part II is the only independent, objective assessment in Canada that evaluates these foundational skills. The exam can be taken early in a candidate’s residency (PGY1 or PGY2), at a time when candidates have had practical opportunities to refine and demonstrate their skills and they still have time to address feedback on any performance issues identified by the exam. This allows candidates to build a solid foundation of core competencies before adding on discipline-specific knowledge and skills.

Some might ask whether the skills measured in the exam actually help candidates perform better in practice. Previous research showed that lower MCCQE score on communication was associated with more future patient complaints about care given. As the exams have been updated, so have the analyses. Current research led by Dr. André De Champlain, Director of Psychometrics and Assessment Services at the MCC, suggests that this relationship continues. Preliminary results from our team’s analysis of data from the College of Physicians and Surgeons of Alberta found that candidates who failed the MCCQE Part II on their first attempt, on average, prescribed two-plus opioids and two-plus benzodiazepines to 30 per cent more patients than passing candidates. More work is needed to better understand this relationship, but these early results suggest an important link between exam performance and measurable professional outcomes.

MCC examinations were created to ensure that physicians across Canada meet common standards in order to provide safe and effective patient care. When the many current and emerging issues facing the physicians of today and tomorrow are considered, together with the increasing complexity of medical knowledge, we, at the MCC, believe the MCCQE Part II examination is more relevant than ever. It plays a substantial role in making sure that physicians across Canada meet common standards that prepare them to succeed in professional practice. Our medical community—and all Canadians—deserve it.

13 thoughts on “Why the MCC Qualifying Examination Part II still matters

  1. Anonymous

    Looking at the "preliminary results" it would seem that being a Canadian Medical Graduate is both linked with lower complaints as well as lower prediction of prescribing 2+ Opioids & 2+ Benzodiazepines.

    Was a sub-analysis done only using Canadian Medical Gradutes to see if the association with complaints and opioid/benzo prescribing remains for those who fail to pass the MCCQEs on first attempt?

    Surely the dataset would be large enough to make this analysis. This would really answer the question as to the value of the MCCQE Part 1 and 2 for Canadian Medical Graduates.

    1. Andre De Champlain

      Thanks for your comment and questions. The study is currently under review and a full publication with all results and details is expected in the near future. Stay tuned....

      1. Anonymous

        I will infer from your non-answer that the answer is that no sub-analysis was done... or it was done but didn't demonstrate results that support the continued exist of the MCCQE.

  2. Declan Fox

    Not sure how the first paragraph links to the rest of the piece? In any case, are we to believe that medical schools are incapable of assessing the knowledge, skills and attitudes of their students? In other words, what is the justification for the LMCC? Are medical schools really doing such a bad job that a further layer of examination is required to ensure safe practice?
    There is a shade of post hoc propter hoc about this article. The MCC exams were set up quite some time ago and I wonder if there was much evidence to support that initially?
    Finally, to a IMG such as I who qualified from a decent medical school, did UK GP training and came to Canada with certification of satisfactory completion of training as well as MRCGP and a lot of experience, it is an insult to insist on me spending a lot of time and thousands of dollars on exams typically done by young graduates. Is there any evidence that possession of MCCQE 1 and 2 improves my performance? Personally, I consider the MCCQE routine a major impediment to recruitment of IMGs and let's face it folks, Canada is never going to produce enough home-grown doctors to meet its needs.

  3. Do international medical graduates need to take the MCCQE Part I to apply for a residency program through the Canadian Resident Matching Service (CaRMS)?

    1. Marc Elliott

      The stated goal of the MCCQE 2 was (when I looked last) “to ensure fitness for independent practice.” For anyone in radiology, pathology, paediatrics, ophthalmology, or ENT (off the top of my head) the examination is in fact a detriment. As a radiologist, I had to reduce studying for my core speciality until October of my PGY-2 year, so I could spend time on a great many topics that have never again proved at all relevant to my independent practice. My fitness for practice was evaluated repeatedly, and much more effectively, under the aegis of my own programme and the Royal College.

      The increasing complexity of medical knowledge is not an argument for more general examinations, but rather the converse.

      So what do we have? An examination which is largely irrelevant to a broad range of medical specialities, and only partially relevant to others. An examination which costs thousands of dollars, and is an additional source of stress. For me, it was and has been a net negative. I don’t use the term “cash grab” lightly, but that’s the only conclusion I’m left with.

      The days of the general licence are long gone. It’s time we caught up to that reality.

  4. Stephen Beerman

    I read the opinion paper with interest. I have been a Postgraduate Family Medicine Site Director for 12 years. The CFPC competency based education and assessment has matured considerably. The CCFP certification process evaluates knowledge,skills,attitudes and behaviors.

    The MCCQE Part 2 does not add value to the assessment process for Canadian Medical School graduates undertaking Family Medicine Residency Training in Canada. The cost of certification process shuold be reduced.

    A reasonable arguement to maintain the MCCQE Part 2 for Canadian Family Medicine learners, is equity.

  5. Anonymous Anonymous

    I am a Pathologist. Why would I need to know how to prescribe opioids? Its this blanket requirement of passing QE 2 irrespective of the specialty that doesn't make sense.

    I trained in the US. I passed the USMLE and I am board certified by the American Board of Pathology. Now you are asking me to take QE2 which is going to test me on what? How to prescribe opioids?

  6. Anonymous

    This article completely leaves out addressing the elephant in the room. The fact that it is completely redundant to family medicine residents who has CCFP exams which tests the same compentencies unlike historically when MCCQE2 was the only one. This exam is not needed anymore now that family medicine has its own licenscing exams.

  7. Anonymous

    The revenue from this examination, as audited by Deloitte, was $12,539,670 in 2019. The audited cost of administering the exam was $5,668,212 in 2019.
    If one is to believe that the documented cost of administering the exam is accurate, then the net revenue for the MCC of administering this exam is $6,871,458. This is not a trivial profit margin.

    The idea that this increasingly irrelevant exam is funding an organization in Ottawa that I otherwise have zero contact with, hires employees with the enticement of "in-house massages", 35 hour work weeks and all holidays guaranteed to be free of work ( see mcc.ca/careers) is somewhat insulting as a surgical resident who carries a significant debt load and will be on call Christmas eve.

    1. 35 hours a week...of call

      I didn't realize the huge revenue that appears to be made on this exam. I've always been told that these exams are cost neutral "We don't make any money by putting them on." Could someone at the CMAJ reach out to Maureen Topps and ask about this discrepancy? Maybe another article that address some of the comments made would be good?

  8. Broke resident

    The consensus amongst residents is that the exam (part 2) is just a big cash grab. Either redundant or irrelevant depending on your specialty. With the money the organization is making it's obvious they're not going to just dissolve themselves. My guess is the CFPC and Royal College are either too removed from residency or just don't have the energy to deal with this bureaucratic nightmare of an organization. The consequences are real, I know stellar residents whose practice has been delayed over a year for not being able to pass this poorly constructed and tangentially relevant exam.


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