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.