Medical Council of Canada

The Medical Council of Canada Qualifying Examination (MCCQE) Part II has been repeatedly criticized for nearly two decades for its limited relevance, questionable validity, enormous redundancy, and significant financial burden on resident physicians.[1][2][3][4] As such, thousands of physicians and resident physicians from across Canada have been advocating for its elimination as a requirement for full licensure to practice medicine independently in Canada.

The Licentiate of the Medical Council of Canada (LMCC), currently awarded to resident physicians who pass both Parts I and II of the MCCQE and have completed 12 months of postgraduate medical training, was originally established in 1912. Historically, the LMCC played an important role in medical licensing, as those who were awarded this designation were provided with a provincial license to practice medicine independently as a general practitioner (GP). However, since the early 1990s, when provincial licensing bodies began requiring certification through the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada before permitting physicians to practice independently, possession of the LMCC has become utterly obsolete in serving its original purpose for today’s physicians.

According to Dr. Maureen Topps, Executive Director and CEO of the Medical Council of Canada (MCC), “MCC examinations were created to ensure that physicians across Canada meet common standards in order to provide safe and effective patient care.”[16] This is an important objective, and the MCC’s efforts to standardize Canadian medical education in the early 20th century played a key role in the development of the consistently high quality of education provided by Canadian medical schools today. However, the MCC examinations are no longer the only tool available to evaluate medical learners. Canadian medical schools now universally utilize comprehensive written and clinical exams to test students prior to graduation. In addition, residency programs across Canada are transitioning towards a Competency-Based Medical Education (CBME) curriculum, based on a philosophy of longitudinal continuous assessment; years’ worth of regular assessments over the course of a resident physician’s training would arguably provide both a greater amount of and more accurate information about a resident physician’s clinical performance than a one-time examination like the MCCQE Part II. Even prior to the implementation of CBME, it has been demonstrated that rotation evaluation reports and residency program director ratings are “significant predictors of pass-fail performance on the MCCQE Part II.”[17] Finally, resident physicians must pass rigorous written and clinical examinations organized by the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada prior to being authorized to practice medicine independently in their chosen specialties. It is evident that the MCCQE Part II is a vestige of an earlier, less evolved medical education system, and it is now widely regarded as an outdated artifact.[3] Given that the MCCQE Part II no longer confers resident physicians the ability to practice independently during residency, nor is it used by residency programs to evaluate the readiness of resident physicians to progress to their next postgraduate year, the exam no longer has any objective utility.

The exorbitant, ever-increasing costs of the MCCQE Part II place a significant and unacceptable financial burden on resident physicians across Canada. The May 2020 exam cost each applicant $2,980 ($2,780 exam fee with an additional $200 account fee).[15] According to publicly available financial information on the MCC website, the organization was audited by Deloitte in 2019. These data reveal that the MCC’s net revenue directly related to the MCCQE Part II that year was $6,871,458 (gross revenue $12,539,670; expenses $5,668,212).[18] This significant profit margin is contrasts starkly with the average debt of $164,000 of Canadian medical graduates,[19] who will be plunged further into debt to pay for this exam. Resident physicians work an average of 70 hours per week, and up to over 100 hours per week, providing essential medical care to patients across Canada, for a modest salary out of proportion with our level of education and responsibility.[20] Many are still pondering why Canada's resident physicians are shouldering the costs of an exam that continues to exist mainly as a means to generate substantial revenues for the MCC.

The impact of the MCCQE Part II on resident physicians’ mental health cannot be disregarded. Under normal circumstances, this exam is a source of considerable stress and anxiety. Resident physicians fear the financial repercussions of failing and having to repeat the exam, and accordingly sacrifice months of our limited free time to prepare for it, often utilizing our vacation time to do so. In the context of the COVID-19 pandemic, resident physicians experience an unprecedented amount of work-related stress, being afraid of being exposed to the virus at work and infecting loved ones, colleagues, and patients. This stress and anxiety will likely remain present for the foreseeable future. These conditions are unquestionably incompatible with studying for a complex exam that is in and of itself a source of stress, is largely irrelevant to our careers, and poses a serious financial burden in the midst of an unprecedented global economic crisis.

While the MCC initially postponed in-person examinations taking place during the first wave of the COVID-19 pandemic, leaving graduating physicians with provisional licenses, administrators decided to proceed with future upcoming examinations during the pandemic's second wave in October 2020 and beyond.[21][22][23] The MCCQE Part II examination is to be held in-person only, with no online alternative offered, an arrangement which stands in stark contrast to the format of national OSCEs administered by the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada, the other Canadian certifying bodies. Although basic respiratory etiquette was made mandatory during the examination,[22] the MCC specified that it could not ensure the safety of all participants as physical distancing may not be possible in examination rooms.[23] The MCC disregarded participants' concern for the risk of COVID-19 transmission during the examination and the implications for their communities.[24] Following contact by resident physicians concerned by the significant public health risk posed by the upcoming MCCQE Part II examinations, local public health departments ordered site closures in several locations, including Kingston, Montreal, Toronto, and Quebec City.[21][22] It was discovered that the MCC had registered participants requiring international and inter-provincial travel. Nearly a third of 90 candidates scheduled at the cancelled Kingston examination site originated not only from hot spots in Ontario but from the United States as well.[21][22] Multiple Canadians studying medicine abroad were also forced to return to Canada amidst the COVID-19 pandemic in order to attend an in-person examination administered by the MCC.[25] Public health and preventive medicine physicians indicate that the MCC's decisions are the least effective means of preventing exposures.[23] In order to maximize prevention, examinations should be substituted or eliminated entirely.[23] The MCC's lack of proactivity in planning a sound format for examinations to take place safely is strongly criticized.[23]

Less than 48 hours ahead of exam time, the MCC cancelled the October 2020 MCCQE Part 2 across Canada. Secured communications were later sent to all those already registered for the upcoming February 2021 MCCQE Part 2, informing them that the examination was cancelled.[26] With an ever-growing backlog of competent physicians, having passed their specialty examinations with the College of Family Physicians of Canada or the Royal College of Physicians and Surgeons of Canada, the MCC decided to fully refund candidates who withdrew their application to the MCCQE Part 2.[26] This is in stark contrast with the MCC's usual significant "non-refundable" administrative fee, which was announced at $1,390 for the 2020 examinations.[15] It was later announced that the preregistration period for the May 2021 MCCQE Part 2 was postponed to a later date to allow even more time for the MCC to organize virtual OSCEs.[26]

In order to deliver the MCCQE Part I, the MCC developed a remotely proctored version of the examination, allowing medical graduates to complete the examination in a safe location while being remotely supervised. [27][28] The MCC has even issued a statement acknowledging the "unacceptable" experience candidates were required to endure, while blaming the Prometric testing firm for the shortcomings.[27][28] The Canadian Federation of Medical Students heard over 180 student complaints regarding MCCQE Part 1 examination difficulties.[29] These included difficulties booking the online examination, frequent unexplained disconnections on the day of the examination, no remote proctor seemingly present, and having to conduct one's own security check to show one was not cheating.[29]