Is it time to rethink the MCCQE Part II?

Taylor LougheedApril 4, 2016 by | 8 comments

This letter was originally published on March 31, 2016 in the Canadian Medical Education Journal, and is reproduced here under the Creative Commons license for further dissemination and discussion. The citation is:

Lougheed, T. (2016). Is it time to rethink the MCCQE Part II?. Canadian Medical Education Journal7(1), e87. Retrieved from http://cmej.ca/cmej/index.php/cmej/article/view/686/pdf

It is also indexed on PubMed: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4830377/


 

Is it time to rethink the MCCQE Part II?

History

Formed in 1912, the Medical Council of Canada (MCC) was given a “legislated mandate to assure patients that their doctors, wherever they are in Canada and whatever their medical specialty, meet the same demanding, consistent standards.”(1) This was a time of variable medical training practices, and the new Licentiate of the Medical Council of Canada (LMCC) designation awarded to candidates who completed the appropriate requirements represented a step towards a more standardized, higher quality, and safer medical system. Prior to 1954, those awarded the LMCC designation, following successful completion of the MCC Qualifying Exam (MCCQE), were typically awarded a provincial license to practice medicine.(2) Following 1954, the LMCC required successful completion of the MCCQE, as well as one year of additional training prior to registration.(2) This ultimately became the basis for the rotating internship year, after which a provincial license would be granted to allow practice as a “General Practitioner” or “GP.” In the 1980s and early 1990s, however, provincial licensing bodies began moving towards requiring a minimum of two years of post-graduate training, and often required certification through one of the national colleges.(3) This was followed by changes to the LMCC and the introduction of the MCCQE Part II – a simulated clinical examination taken after a minimum of one year of postgraduate residency training.(4)

 

Current Situation

The current LMCC comprises two components:

1.MCCQE Part I, is a computerized exam written at the end of medical school. It includes up to 3.5 hours of multiple choice questions, followed by up to 4 hours of short answer questions designed to “assess knowledge, clinical skills and attitudes as outlined by the Medical Council of Canada (MCC) Objectives.”(5) Canadian Medical Graduates (CMGs) who took the MCCQE Part I for the first time between 2012-2014 had a pass rate of 98-99%.(6) The cost to write this exam is currently $1005.(5)

2. MCCQE Part II, contested after at least one year of postgraduate residency training, is a simulated clinical exam designed to “assess the knowledge, skills, and attitudes essential for medical licensure in Canada prior to entry into independent clinical practice.”(7) It was recently expanded to be spread over two days. CMGs who took the MCCQE Part II for the first time between 2012-2014 had a pass rate of 93-96%.(6) The cost to take this exam is currently $2409.(5)

The updated licensing requirements developed in 2011 by the Federation of Medical Regulatory Authorities of Canada (FMRAC) and called the “Canadian Standard” state what is currently required to practice medicine in Canada:

  1. Have a medical degree.
  2. Become a Licentiate of the Medical Council of Canada (complete the MCCQE I and II and its requirements).
  3. Complete a postgraduate training program (residency) and associated certification.

 

Is the MCCQE Part II still relevant?

Is this clinical exam (MCCQE Part II) truly protecting Canadian patients by assuring them “that their doctors, wherever they are in Canada and whatever their medical specialty, meet the same demanding, consistent standards,”(1) or are they an outdated requirement, a historical artifact?

The reality is that those who pass or fail the MCCQE Part II are equally unable to practice without further achieving certification through the College of Family Physicians of Canada, the Royal College of Physicians and Surgeons of Canada, or the Collège des médecins du Québec – each of which have final certifying exam requirements. What then, is the importance of an exam that no longer imparts actual practice certification? Is it important for a future orthopedic surgeon to be able to provide counselling on birth control, or an ophthalmologist to examine a hip injury?

 

Conclusion

The MCCQE Part II was arguably an important part of licensing for independent practice 15-20 years ago, and provided quality assurance to the public. Under the current regulations, it is required that all new physicians (generalists as well as specialists) achieve further certification through one of the national colleges, making it difficult if not impossible to practice as a GP with only a successful MCCQE 2. This being the current reality, it is important to ask what role the MCCQE Part II now plays in the Canadian medical landscape. I humbly suggest: None.

 

Conflict of interest: None noted.

 

References

1. Medical Council of Canada. Our Story [Internet]. Ottawa: Medical Council of Canada; [Cited 2015 Jan 15] Available from: http://mcc.ca/about/story/

2. Bain ST. The president of the Federation of Medical Licensing Authorities of Canada responds. CMAJ. 1992;146(1),10-1.

3. College of Family Physicians of Canada. College History [Internet]. Mississauga: College of Family Physicians of Canada; [Cited 2015 Oct 30]. Available from: http://www.cfpc.ca/CollegeHistory/

4. Williams LS. New MCC qualifying exam causing confusion and anxiety, interns and residents say. CMAJ: Canadian Medical Association Journal. 1992;146(11):2049.

5. Medical Council of Canada. Medical Council of Canada Qualifying Exam Part I [Internet]. Ottawa: Medical Council of Canada; [Cited 2015 Oct 30]. Available from: http://mcc.ca/examinations/mccqe-part-i/

6. Medical Council of Canada. Annual Report 2014-2015 [Internet]. Ottawa: Medical Council of Canada; [Cited 2016 Mar 25]. Available from: http://mcc.ca/wp- content/uploads/ANNUAL-REPORT-2014-2015.pdf

7. Medical Council of Canada. Medical Council of Canada Qualifying Exam Part II [Internet]. Ottawa: Medical Council of Canada; [Cited 2015 Oct 30]. Available from: http://mcc.ca/examinations/mccqe-part-ii/


 

A response to this letter by the Executive Director and CEO of the Medical Council of Canada (MCC), Dr. M. Ian Bowmer, is available here (note: PDF file):http://cmej.ca/cmej/index.php/cmej/article/view/738/pdf

 

Agree? Disagree? Feel free to leave a comment below and consider sharing with your colleagues.

Taylor Lougheed

About the Author

Taylor Lougheed is a physician in Family and Emergency Medicine, and passionate about sustainable public healthcare, quality improvement and patient safety, medical education, and global health.

8 Comments

  1. Chris M

    I agree with your points, Taylor, and thank you for making them. I also read through Dr. Bowmer’s reply, and while I can appreciate that the test results are correlated with physician complaints, I can’t help but think that there are likely at least a few other indicators throughout their residency that could also be used to identify struggling physicians without having to pay an extra $2000. Instead of building new standardized tests and then determining whether they correlate with practice outcomes, why not look at resident evaluations themselves and ask the same question?

    • Taylor Lougheed
      Taylor Lougheed

      Thanks for your comment, Chris. It is a regular CMPA talking point that communication is a major factor in physician complaints and legal action. I too am rather doubtful that we need to have residents pay $2409 to identify who is struggling in this regard, and do not believe this was what the test was originally designed for.

  2. miguel

    Dr Bowmer and the MCC have deftly sidestepped the issue. A test that was implemented for licensure and guarding the public safety has continued to evolve, and is apparently now being touted as a test to assess communication skills. While certainly important, the question remains whether the most appropriate test for this is the part II. Its original intended purpose is outdated with the current college requirements, and the proposed purpose is likely redundant amongst other residency evaluations.
    What remains is a frustrating and much hated cash cow that just won’t go away.

    • Taylor Lougheed
      Taylor Lougheed

      Thanks for commenting, Miguel.
      I agree that there appears to be a frustrating disconnect between the test’s intended purpose, and what the MCC is now hoping to use it for. The next question is even with changes to the test to align it with the new goal of assessing communication, is it necessary beyond the existing evaluations and certification exams?

  3. retiredMD

    Im an old guy and never had to complete the clinical part of the exam. I do remember though that this test was controversial when it was introduced for many of the same reasons you listed. People thought it was useless, expensive and not add anything in the way of ensuring high standards, public safety and whatnot.

  4. Andrew S

    Thank you for putting this out there, Taylor. I hope that this might spark a bit more discussion or action around what role these tests actually serve. Ian’s response unfortunately demonstrates just how far out of touch the MCC is and how much work needs to be done to close the gap.

  5. OrthoGuy

    Spot. On.
    At what point do we reject these outdated professional requirements as a profession? I may struggle to find a job in a few years after my ortho residency, but thank god the MCC kept the public safe by making sure I could council someone on their pregnancy.

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