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.
Useless exam when you taking NAC-OSCE what you checking there? What was missing to have another $3000 exam? Now compare the licensing exams of major countries, in the UK you give Plab 1 and Plab 2 and you can be registered, in the USA you give step 1,2,3 all are different exams, in Australia, you need to give AMC 1 and 2, and now come to Canada MCCEE (thankfully no more), MCCQE1, NAC-OSCE, MCCQE2, and after all of these exams you will hardly get any position, great, and interestingly no major country exempt you from their exams if you pass all Canadian exams
It is no longer irrelevant for a number of reasons which were previously captured in the article written by Dr. Benusic (http://cmajblogs.com/should-the-mccqe-ii-exams-go-forward/) as well as by Dr. Lougheed (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4830377/).
I would like further information re: the IAMRA poster 2018 you referred to as I could not help but thinking the data presented on the poster does not show the full story – confounders, stratifying the group (CMG vs. IMG) and etc. If this was done 2 years ago, is there a plan to get this published in a peer reviewed journal? After all, this appears to be the cornerstone of your argument and I would rather see the paper than a poster with cherry picked data/incomplete conclusion.
Broken system, lack of clarity , vague, money seeking method !
MCC sends our docs. for source verification to the US ,
why wont MCC follow the structure of ECFMG , it is more clear and accessible !
i guess the Canadian Medical System is simply poorly constructed.
No enough funds , mafias restricting to themselves specialties with higher income and inability to have a decent track for IMGs.
so simply they made QE2 an unethical exam !!! which looks for you knowledge in ethics and communication .
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.
Do international medical graduates need to take the MCCQE Part I to apply for a residency program through the Canadian Resident Matching Service (CaRMS)?
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.
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….
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.
Thank you. I endorse the practice that you have espoused for the MCC!