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Medical Matters: the impact of COVID-19 on early career licensure
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June Messenger 2021, Medical Matters, Physicians |
Posted June 11, 2021
The past year has been difficult and devastating for many Albertans across all sectors. In this edition of Medical Matters, I want to discuss the pandemic’s impact on medical learners, who have experienced a significant disruption to their educational experience, and what that means with respect to licensing and the protection of the public.
Provincial and Territorial Medical Regulatory Authorities are the only organizations in Canada that have a legal mandate to ensure physicians are competent to practise medicine. We rely on our accredited medical schools to provide the learning environment and we rely on organizations like the College of Family Physicians of Canada (CFPC), The Royal College of Physicians and Surgeons of Canada (RCPSC) and the Medical Council of Canada (MCC) to assess the core competencies required to practise.
The MCC assesses the core competencies every physician should have and the CFPC and the RCPSC assess the competencies specific to those specialties. For regulators, these are important assessments that help us demonstrate to the public that we are confident a physician who holds a licence to practise has the knowledge and ability to do so safely and competently.
It’s fair to say the experience medical students and residents have had over the past 15 months has been different than in the past. There are some cases where residents have had very little opportunity to learn in face-to-face clinical settings, there has been far more virtual learning, and as a result of changes in healthcare delivery and demands brought on by the pandemic there have been different clinical experiences for learners. In addition, we’re now seeing significant changes in how learners are assessed for the core competencies required to practise medicine: the CFPC has removed the requirement for an oral exam and, more recently, the Medical Council of Canada Qualifying Examination (MCCQE) Part II was cancelled.
So, what does this mean for registration and licensure in Alberta? The reality is that we walked into an uncertain space that we are all trying to navigate. The MCC has announced that delivery of the MCCQE Part II is cancelled going forward. The Licentiate of the Medical Council of Canada (LMCC) will be granted based on completing a medical degree from a recognized medical school, having successfully completed the MCCQE Part I, completing at least 12 months of clinical postgraduate training and having the required medical credentials including verification of postgraduate training successfully source verified through the MCC. The CFPC is not doing their oral exam and not all RCPSC specialties will have their oral exams. This means several thousand doctors will be completing their residencies with a very different educational experience and assessment of competence.
On June 8, CPSA held an emergency Council meeting to discuss this issue and decided that despite the dramatically different experience these learners have had, we will still allow them to apply for the General Register based on the certifications granted, specifically the LMCC. This would mean they would all be eligible for an unrestricted licence to practise in Alberta if they meet all of CPSA’s other standard requirements.
Considering CPSA’s mandate is to protect the public, we must now look at whether this decision puts the public at any risk. Over the coming months, CPSA will be looking into ways we can support this unique cohort of doctors and help them start off their careers on the right foot. If someone is struggling, whether they’re in this cohort or otherwise, we want to support them instead of waiting until a complaint comes in or a patient is harmed. However, CPSA can’t do this on our own. This is where the entire profession can help out.
We all need to recognize the past 15 months have been challenging for all of us and the more we can support each other as colleagues in the coming months and years, before problems happen, the better it will be for the profession and the public. If you know someone who is just starting off, don’t be afraid to reach out as a mentor.
These are tough times for everyone, but this is also a time for seeing opportunities in education and assessment. There is no question we will be doing things differently moving forward, but what that looks like is still to be determined. I ask for everyone’s patience as we work through this.
Scott
5 Responses
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Pretending that licensure without the MCC is “putting the public at risk” is a huge insult to the hundreds of MDs who put their time into supervising and teaching learners through residency programs. The idea that any exam, let alone one so outdated and poorly administered as Part II, can determine a residents ability is laughable.
The MCC has been extorting medical learners to line their pockets for far too long. Part 2 was a pointless and antiquated exam long before covid hit and from those of us who have actually written (and passed) the exam in the last decade we have first hand experience at how poorly this exam assesses residents. It is a money grab. Plain and simple.
The idea of supporting each other is great. However, the CPSA was extraordinarily belittling to the hundreds of residents who were expressing concerns about the way the MCC has handled examinations during covid. The most recent example of this that comes to my mind is a widely circulated email from the CPSA registrar. I would have much more confidence in the CPSA if their public messaging matched their actual actions towards their members.
If the CPSA is serious about this being “a time for seeing opportunities in education and assessment” I expect them to push for learners to be placed back into advisory positions within the MCC (a role that was recently taken from them). I’d also expect significantly more onus on the MCC to demonstrate that their exams accomplish what they claim.
While we are at it, we should probably also address the blatant conflicts of interest which arise when college registrars also sit on the board of the MCC.
Good afternoon Dr. Vandermeer,
It’s unfortunate you feel my sentiments are a “huge insult to the hundreds of MDs who put their time into supervising and teaching learners through residency programs.” It was certainly never intended to be so. In fact, I believe they do an incredible job every day.
While it’s fine you feel comfortable being so frank in your public opinions, I implore you to do your due diligence before making false and accusatory claims. You’ve made some aggressive allegations in your comment, and I think it would be best to stick to facts and not accusations.
The reality is that CPSA is the only organization in Alberta accountable for ensuring physicians are competent to practise medicine. Despite the fact that I believe the vast majority of physicians in Alberta are excellent doctors who care deeply about their patients, there are still some physicians who practise in ways that raise concerns. The concept of “failure to fail” in medical training programs has been well documented such that we can’t ignore that reality either.
CPSA has no significant input into the medical school curriculum or into the accreditation standards for medical schools’ undergrad and postgrad programs. We have little, if any, influence on specialty certification exams by the CPFC or the Royal College to ensure competence in those specialties, yet we are the ones held accountable if a physician is not practising safe medicine.
The Medical Council of Canada was established under federal law to ensure all physicians have demonstrated the core competencies every physician must have. The MCC is also the only organization where regulators have any real influence over what is being assessed. Together, the MCC, the CPFC and the Royal College provide reassurance that physicians are competent to practise.
You state above that, “The MCC has been extorting medical learners to line their pockets for far too long.” This is a bold accusation that is simply not grounded in fact. The MCC is a charitable organization by legislation and legally can’t make a profit. Like all organizations, they have an obligation to maintain a restricted financial reserve to address emergent issues, such as the pandemic, but they do not have huge coffers of money sitting around. If you have evidence suggesting otherwise, I advise providing that evidence before making such defamatory statements.
I would also like to address your comment alleging “the blatant conflicts of interest which arise when college registrars also sit on the board of the MCC.” The position I hold on the MCC Council is to ensure MCC assesses what provincial regulators need demonstrated to help ensure a physician’s competency to practise medicine. It is a voluntary position for which I receive no payment and in which I invest many hours because I need the MCC to assure me and my counterparts across Canada that physicians are safe and competent. I have no financial incentive to hold this position or to prop up the MCC, I do not have friends or family that work for MCC, nor do I have family members or friends that would be impacted by the exam in any way. In other words, I have no personal or financial gain from being a member of the MCC governing Council. For these reasons, I can earnestly say I’m free of any real, perceived or potential conflicts of interest.
I’m happy to have a discussion about how CPSA can assure Albertans their physicians are competent to practise medicine and how we need to advance the assessment of medical graduates. However, these discussions must be based on fact and not unsubstantiated accusations.
Though I do agree that the CPSA’s mandate is the protection of the public, I question whether having our learners feel used, abused, bilked, and manipulated through the poor manner in which the MCC handled all of these exam changes and cancellations doesn’t add up to risk to the public over time? Certainly it is well known that physician wellness is an important contributor to safe, competent practice, and I would ask the CPSA to look inward to determine what role it can play in ensuring that paths to licensure both protect the public and also treat our learners as the valued future colleagues that they are.
Hi Heidi, thanks for taking the time to write in and share your thoughts with me. You’re correct that physician wellness plays a part in good, safe medical care, and it’s something that CPSA takes seriously.
Over the past few weeks, we’ve heard from many medical residents in Alberta and met virtually with groups of residents to hear from them directly about their concerns and challenging experiences with the MCC exams. This direct feedback was in addition to the many emails and phone calls CPSA received. We heard loud and clear that resident physicians felt frustrated with how the exam was being administered, the way MCC was communicating with them and by the technical challenges of completing this important exam virtually. This combined with other stressors, such as those presented by living and working in a pandemic, all most likely impacted their wellness. I was happy to see MCC has taken accountability and apologized for this impact.
We brought forward everything we heard during our outreach for discussion at May’s Council meeting, where our Council formally decided to move forward with accepting MCC’s recently updated criteria for granting LMCC as an equivalent to any prior LMCC. A consideration in making this decision was the challenge the exam issues posed for residents.
With our path forward determined, our focus remains on ensuring all Albertans receive safe, competent care from their physicians. The sentiment of physician wellness is important for all physicians—not just those early in their careers. As I shared above, we all must play an important part in mentoring and supporting one another so we can do right by our patients and maintain our own health.
Thank you for your work on the front lines of this pandemic—please take care.
Thank you for this thoughtful reply.