ECHO What the creation of the MCC meant for health care in Canada by : Na n c y Ma c Be t h , Vice-President and Member at Large of the Medical Council of Canada Sir Thomas Roddick’s vision over 100 years ago was borne of a desire to develop a qualification in medicine that would be accepted across the country. His eloquent and impassioned statements on the floor of the House of Commons argued that for the sake of the The Medical “peace, order and good government” clause in the British North America Cou ncil Act, we must develop national standards to assess our physicians. The Medical Council of Canada, forged as an Act of Parliament in 1911, of Canada is the result of Roddick’s persistence. We might pause and reflect N e w s l e tter on what that event meant for Canada as we celebrate our 100th anniversary. August 2012 Firstly, it was the beginning of Canada’s treasured value of universal health care. If Canadians were to eventually have access to health care regardless of ability to pay, it had to start with an acceptance of a co-ordinated, pan-Canadian role in health care. And that is exactly Canadians have a right to demand. Our core what Roddick’s Bill did. It took another 70 years to find acceptance for responsibility will always be to improve the the five principles of the Canada Health Act but I would like to think that assessment of physicians. We will also work it was the legislation sheparded by Roddick that first opened the door to maintain a complete record of all physicians to this concept. practising in Canada. We will meet the highest Secondly, federal/provincial tension is inevitable in Canada due to the of research standards in assessment and 1 0 0 y e a r s o f e xc e l l e n c e 2 division of powers giving health-care responsibility to the provinces. since evaluation tends to drive curriculum development, we will continue to influenceUp d a t e o n t h e Ap p l i c a t i o n f o r But, here again, the history of the development of the MCC has medical education curriculum. Me d i c a l Re g i s t r a t i o n 4 proven that we can have national standards as a result of collaboration among the provinces rather than having that standard imposed by the Some may say that a 100-year old organization Bl u e p r i n t p r o j e c t 6 Federal government. Since representatives from all the provincial and is an anachronism and therefore not relevant territorial medical regulatory authorities and all the Canadian faculties Clinical exam harmonization 8 of medicine make up the Council, the collective provincial role is in today’s changing world. In fact, the MCC has struggled, evolved and changed and Pr a c t i c e - re a d y a s s e s s m e n t 10 respected and enhanced. will continue to do so in contributing to the C a n a d i a n C o n f e re n c e o n Finally, from that first exam session in Montreal in 1913 of 71 excellence of our Canadian health-care system. Me d i c a l E d u c a t i o n 11 candidates to the point today where the MCC administers 13,000 exams a year in Canada and in over 80 countries, we have come a That is cause for celebration. Happy anniversary to the Medical Council of Canada. Dr. Ia n B ow m e r h o n o u re d 13 long way. And we have much to do to continue to uphold the standards Nancy MacBeth was Minister of Health of the Province of Alberta from 1988 to 1992.
2 ECHO MCC celebratesMedical C o u n c i l o f C a n a d a 100 years of excellence 100 On b e h a l f o f Dr. Hé l è n e B o i s j o l y, De a n o f t h e Faculty of Medicine of the Un i ve r s i t y o f Mo n t re a l , Dr. R a m s e s Wa s s e f, Chair of the MCC’s Central Ex a m i n a t i o n C o m m i t t e e ( l e f t ) p re s e n t s Dr s . Michael Marrin (centre) and Ia n B ow m e r ( r i g h t ) w i t h a c e r t i f i c a t e i n re c o gnition of the MCC’s 100 years o f s e r v i c e a n d d e vo t i o n t o t h e m e d i c a l p ro f e s sion and also for excellence a n d v i g i l a n c e i n t h e e va l u a t i o n o f p h y s i c i a n s . One-hundred years ago, the 32 members of the newly established Medical Council of Canada (MCC) met for the first time on Parliament Hill in Ottawa. A unique combination of representatives from each of the licensing bodies and each recognized medical school of the day, Council embodied then, as it does today, inter-provincial co-operation as well as collaboration among academic and practising physicians. This historic inaugural assembly was also a testament to the efforts of the Council’s founder, Sir Thomas Roddick, who had strived for nearly two decades to introduce the legal changes needed to create the Council. A century later, the 2012 Council will convene in a special commemorative Annual Meeting that will honour his memory and continue to build on his legacy. This year ’s meeting, which will be held at the new Ottawa Convention 00 Centre, promises to be very special. Its program includes an elegant gala dinner at the Museum of Civilization, complete with entertainment and special guests, and a centennial breakfast on Parliament Hill, the location where the first meeting was held. Executive Secretary to the Board Andrée Fortin-Bélanger, who has been instrumental in planning this event, said she looks forward to the parliamentary breakfast and the gala dinner, where the former MCC presidents will be honoured. “Locating and contacting former MCC presidents as far back at 1975 was a challenge,” she said. “But such an interesting one! Through this process, I also learned tremendously about these extraordinary individuals.”
3 ECHO MCC celebratesMedical C o u n c i l o f C a n a d a 100 years of excellence 100 Dr. C l a i re To u c h i e p resenting at Dalhousie Un i ve r s i t y o n Ju n e 1 4 , 2012, as par t of the M C C ’s c e n t e n n i a l w o rkshop series photo credit | Rox y Pe lham, Administrator, Division of Medical Education, Dalhousie University A series of other special events and activities to celebrate the MCC’s centennial will take place throughout 2012 and in early 2013. The Council will be sponsoring an invitational workshop and reception at each faculty of medicine in Canada. The MCC will bring together guest speakers who are experts in their respective fields to present on topics related to physician assessment. The receptions will provide university faculty and student representatives with a chance to get to know the Council members appointed by their university and provincial regulatory 00 She said that she felt the centennial meeting would not only serve as an opportunity to honour the past, but also a chance to celebrate the organization for what it is today. “This Annual Meeting will show how far we’ve come and how much was achieved in 100 years. This year ’s theme, Excellence through evidence: implementing the recommendations of the Assessment Review Task Force, will also encourage us to look at our plans for the future. authority. The MCC created a corporate video to mark its 100th anniversary. This video, which is available on the MCC’s website and on YouTube, highlights the organization’s history and its role in the Canadian medical community. As part of the centennial celebrations, the MCC had asked Members of Council and vital contributors to submit a Medical assessment is in constant evolution.” brief personal account of what the Council means to them. A different article has been featured on the MCC website every week In addition, in conjunction with the 2012 Annual Meeting, of 2012. the MCC and the Federation of Medical Regulatory Authorities of Canada will host the International Association To enter its second century in style, the MCC has also freshened of Medical Regulatory Authorities (IAMRA) International up its image. After undergoing a branding exercise, the MCC Conference on Medical Regulation, an event that will bring launched on Feb. 9, 2012, a new look and feel complete with a together over 250 delegates and distinguished guests from new logo, which has been applied to its website, applications and over thirty countries. publications.
4 ECHO Update on the Application forMedical C o u n c i l o f C a n a d a Medical Reg istration in Canada The AMRC development team regularly holds “sprint revie ws” to update staff on the latest progress with the project. On July 20, staff were briefed on the application’s centre assignment functionality. Once all medical regulatory authorities (MRAs) sign on to use Human Resources and Skills the new system, physicians will be able to apply through the Development Canada, the Federation portal to multiple MRAs for a licence to practise medicine. of Medical Regulatory Authorities of This will help physicians, and especially international medical Canada (FMRAC) and the Medical graduates, apply to multiple jurisdictions simultaneously. Council of Canada (MCC) are collaborating to develop the Application The system h a s a n e w n a m e ! for Medical Registration in Canada The new portal will be called PhysiciansApply.ca system. The new system, launching in (InscriptionMed.ca in French). The MCC and FMRAC would April 2013, will feature an application like to thank the survey participants who helped select the process that will allow physicians name for the portal. Your feedback has been invaluable. Your to apply for a medical licence. The comments have helped ensure that the selected name is project is funded by the Government appropriate to position the system as a central application of Canada’s Foreign Credential portal for the medical community, both in Canada and on the Recognition Program. international scene.
5 ECHO Update on the Application forMedical C o u n c i l o f C a n a d a Medical Reg istration in Canada Pro j e c t p ro g ress The business requirements for the project system. This means that candidates will use begin an application process through the have almost all been collected. The system PhysiciansApply.ca instead of MCC-Online new system. The application will already is in the midst of its development and testing and PCRC-Online to apply for MCC exams, be pre-populated with existing data in phase. Fifty per cent of the development of view examination results, submit source the candidate’s account. For example, the new system is complete. verification requests, etc. information that was contained in his or her PCRC-Online and/or MCC-Online accounts, The project team has been collaborating In addition to this functionality, the system in addition to the new information and with stakeholders, including the faculties will be designed to allow qualified physicians documents in the PhysiciansApply.ca of medicine and the certifying colleges, to to apply for a medical licence. However, account, will appear as part of the establish processes for the exchange of data MRAs will adopt the new system gradually, application. This will ensure a more and documents to the new system. meaning that most MRAs will start directing seamless process to share information and their applicants to use the system over time documents with the MRAs. The new system has undergone a privacy and not necessarily at the time of the system impact assessment. As a result, the MCC’s launch in April 2013. Applicants will just need to answer some Privacy Officer is working on updating privacy additional questions. The types and number policies and procedures prior to the launch of To learn about the requirements and the of questions will vary depending on the the new system. process to apply for a medical licence in a MRAs selected by the candidate. Once particular jurisdiction, physicians will continue submitted, the application will be directed W h a t t o e x p ect when the system to be encouraged to first visit the MRA’s electronically to the MRA itself to process launches website. Links to these sites are available the application. from the FMRAC website. The new system will launch in April 2013. Stay tuned for more information on the At that time, candidates with MCC and However, once a candidate is directed by the PhysiciansApply.ca portal, including a sneak Physician Credentials Registry of Canada MRA to use the PhysiciansApply.ca portal to peek in the coming months of what the new (PCRC) accounts will be migrated to the new apply for a medical licence, the candidate will system will look like.
6 ECHOMedical C o u n c i l o f C a n a d a Blueprint project The MCC is launching this project to provide assurance that MCC assessments fulfill all the requirements and standards for credentialing examinations. It will also provide a clearly documented and deliberate process to update exam specifications while responding to ongoing developments in the profession. The MCC has struck a Board of Governance to oversee the Blueprint project process. Board of Governance members include: As the Medical Council of Canada (MCC) begins to implement • Dr. Ramses Wassef, the recommendations of the Chair of the Blueprint project Board of Governance Assessment Review Task Force, one and the Central Examination Committee of the first priorities is to undertake • Dr. Trevor Theman, an examination blueprint project. This representing the MCC’s Executive Board and the project will ensure that the critical core Assessment Review Task Force competencies, knowledge, skills and behaviours of a physician entering • Dr. Florin Padeanu, supervised and unsupervised practice representing the MCC’s Clinical Decision Making are being appropriately assessed. Test Committee
7 ECHOMedical C o u n c i l o f C a n a d a Blueprint project • Dr. Nancy Brager, The full project will consist of three The project is currently in the first phase, which representing the MCC’s Central phases that will take place over a includes collecting data from external sources, Examination Committee period of three to five years. piloting some key survey instruments and conducting analyses. The first phase also includes • Dr. Ken Harris, launching a national survey in early 2013 to obtain representing the Royal College of feedback on areas that require assessment. Physicians and Surgeons of Canada Phase 1 – data collection – research and analysis • Dr. Tim Allen, of possible skills and The MCC has approached a group of experts in representing the College of Family competencies required the medical community to take part in a Delphi Physicians of Canada for the MCCQE Part I questionnaire process. The questionnaire was and Part II launched in July and will take place over the • Dr. Anne-Marie MacLellan, summer. The outcome of the questionnaire will be representing the Collège des médecins Phase 2 – development and consensus on overarching competency statements. du Québec transition to new These statements, in turn, will be used to guide the examination blueprint development of the national survey. • Dr. Karen Mann, representing the MCC’s Objectives As a result of the research and consultation Committee Phase 3 – construction and administration of new undertaken throughout the first phase of the • Dr. Sarkis Meterissian, examinations Blueprint project, the MCC will produce draft test representing postgraduate deans specifications for the Medical Council of Canada Qualifying Examination Part I and Part II. The • Dr. Bruce Wright, public will be invited to provide feedback on the representing the MCC’s Research draft test specifications in fall 2013. The MCC’s and Development Committee and Central Examination Committee will approve the undergraduate deans final test specifications at the end of 2013. • Dr. Dipinder Keer, representing the Canadian Association of Internes and Residents • Dr. Fleur-Ange Lefebvre, representing the Federation of Medical Fo r m o r e i n f o r m a t i o n o n t h e Regulatory Authorities of Canada M C C ’s Bl u e p r i n t p r o j e c t , p l e a s e v i s i t w w w. m c c . c a / e n / e x a m s / b l u e p r i n t • Ms. Gwen Haliburton, public member
8 ECHOMedical C o u n c i l o f C a n a d a Clinical exam harmonization by the Medical Council of Canada and the College of Family Physicians of Canada The harmonization p ro j e ct t e a m d u r i n g a r u n - t h ro u g h of the special accommodation p ro c e s s e s i n p re p a r a t i o n f o r the launch of t h e h a r m o n i ze d examination The Medical Council of Canada (MCC) and the College expertise and know-how to develop • All candidates will be required to of Family Physicians of Canada (CFPC) are harmonizing the a harmonized exam that will meet the eligibility requirements Certification Examination in Family Medicine with the Medical streamline the assessment process of both the CFPC and the Council of Canada Qualifying Examination (MCCQE) Part II. for family medicine candidates MCC. As a result, the eligibility The resulting new Certification Examination in Family Medicine while maintaining exam validity and requirements for the new (incorporating SAMPs, SOOs and OSCEs) will be launched in reliability.” Certification Examination in Family spring 2013. Medicine include a pass standing Family medicine candidates who on the MCCQE Part I and source When meeting all other requirements of both organizations, are eligible to take the MCCQE verification of required medical candidates who challenge and pass this exam will be granted Part II are encouraged to forgo this credentials. For more information Certification in Family Medicine (CCFP) from the CFPC and the exam and instead take the new and a complete list of eligibility Licentiate of the Medical Council of Canada (LMCC). Certification Examination in Family requirements, visit: Medicine starting in spring 2013. “This project has been an excellent collaboration between www.cfpc.ca/2013_CCFP the MCC and CFPC,” said Dr. Ian Bowmer, Executive Director Several new policy decisions have of the MCC. “Both organizations have contributed their recently been announced:
9 ECHOMedical C o u n c i l o f C a n a d a Clinical exam harmonization by the Medical Council of Canada and the College of Family Physicians of Canada • Those residency or practice- • Candidates must successfully eligible candidates who passed complete both the written the MCCQE Part II on or before component (SAMPs) and spring 2011 will have the the enhanced clinical skills An initial list of examination sites has been opportunity to sit the traditional component (SOOs and OSCEs) published. This list will be expanded to include Certification exam (current to be awarded their CCFP. If additional sites as they become confirmed. format of SAMPs and SOOs candidates are unsuccessful on Both organizations are meeting regularly only) in the spring and fall of both components, they will be to finalize examination processes including 2013. The CFPC will offer the required to re-sit the full exam. candidate registration, site administration, traditional exam to these groups If candidates are unsuccessful examiner recruitment and scoring. Operational only in 2013. on one of the two exam processes have been documented and the components, they may retake • Both organizations had project team is running exam simulations to that component of the exam at a committed that the fee for the help prepare for the launch of the harmonized reduced fee. Decoupling of the harmonized exam would not examination. exam components only applies to be higher than the combination repeat attempts to pass the new of the two separate 2013 fees Certification exam. for the traditional Certification exam and the MCCQE Part II. • If a candidate is unsuccessful The new exam fee for 2013 has in meeting the standard for Fo r m o r e i n f o r m a t i o n o n t h e n e w been set at $4,600, the agreed- Certification, the MCC’s Central upon threshold. Key elements Examination Committee (CEC) Certification Examination in contributing to the exam fee will review the candidate’s Fa m i l y Me d i c i n e , p l e a s e v i s i t include opening new exam performance on the clinical www.mcc.ca/en/news/Enhanced_examination.shtml sites and offering the exam skills component of the new or as geographically close to the Certification exam. The CEC will candidates as possible. determine if the performance www.cfpc.ca/2013_CCFP meets a pass standard comparable to the one for the MCCQE Part II, and therefore whether to award the LMCC.
10 ECHOMedical C o u n c i l o f C a n a d a Coming soon: a national process for practice-ready assessment The first phase of the project involved cataloguing the various program elements already in place across jurisdictions in Canada. Cindy Streefkerk, a consultant Partners from across the country will develop a working with the Medical Council of Canada, spearheaded pan-Canadian practice-ready assessment process for the development of this environmental scan. international medical graduates (IMGs). “It was a great experience and quite informative,” she Of the new IMGs who are registered for practice every said. “The regional programs understand the value year, approximately 50 per cent of them have pursued in what they each do day-to-day and how it fits in the postgraduate training in Canada. The other half went broader context. There are regional variations in program through a practice-ready route. processes but there’s also a willingness to participate and share across jurisdictions.” The National Assessment Collaboration (NAC) was established to streamline the evaluation process for Now that the environmental scan is complete, the IMGs. The NAC’s ultimate goal is to offer an integrated project will turn to designing and developing the pan- assessment continuum. Canadian PRA. The pan-Canadian process will build on the strengths and best practices of the provincial The NAC’s initial focus was developing a clinical assessments. examination to help determine IMGs’ readiness for entry into residency. This exam, the NAC OSCE, is “I’m looking forward to the design and implementation of a now offered in five different provinces. Last year, over pan-Canadian practice-ready assessment”, Ms. Streefkerk 680 IMGs took the NAC OSCE. said. “We’ll have to look at areas including standards development, quality assurance processes and ensuring Given the successful operational launch of the that a solution is comparable across jurisdictions.” In t e re s t e d i n m o re NAC OSCE, the NAC will now focus its attention information on on developing the pathway for practice-ready The project will be led by the NAC PRA Steering assessment. This route would be available to IMGs Committee, and will report to the governing body of the the pan-Canadian NAC, the National Assessment Central Coordinating p r a c t i c e - re a d y seeking a provisional licence to enter independent practice. Committee. An integral part of the project includes assessment project? consultation and participation of the provincial PRA L e t u s k n ow , a n d w e Several provinces already offer a practice-ready programs. will add you to the assessment (PRA) locally. To enhance transferability PRA design sessions will be held in September, October across provincial boundaries and to reduce distribution list for and November. Research activities and a communications duplication, the NAC will now work with its partners to project updates. plan are being developed to support the project. create a pan-Canadian PRA that will be consistent and comparable across Canadian jurisdictions. The project The Medical Council of Canada will make the has received funding from Health Canada for design environmental scan available on its website over the and development activities. summer months.
11 ECHOMedical C o u n c i l o f C a n a d a Canadian Conference on Medical Education a successful and productive experience for MCC staff M C C s t a f f t o o k t u r n s a d d re s s i n g q u e s t i o n s f ro m p a r t i c i p a n t s a n d p rov i d i n g i n f o r m a t i o n o n t h e M C C and its services at the corporate The 2012 CCME was held b o o t h . Sh ow n h e re a re Il o n a in Banff, Alta., from April 14 Ba r t m a n a n d Dr. Ma r g u e r i t e Roy. to 18, 2012 and centred on the theme Global Health and Medical Education: Beyond Boundaries. The MCC’s Manager A delegation of world-class in Assessment, Dr. Sydney researchers and experts in assessment Smee, represented the Medical ensured the Medical Council of Canada Council on the CCME Program (MCC) was well represented again Committee, helping to develop this year at the Canadian Conference the conference theme and on Medical Education (CCME). The plenary sessions as well as conference is the largest of its kind in reviewing abstract submissions. Canada, attracting on an annual basis over 1,300 participants from across Dr. Smee had the honour of the medical education and assessment chairing a plenary session on communities. global health featuring medical doctor and founder of the This event provided MCC staff with the international humanitarian opportunity not only to showcase their organization War Child, own research projects but, as well, to Dr.Samantha Nutt. “I was draw on the knowledge of some of the very pleased to introduce sharpest minds in the country and bring [Dr.] Samantha Nutt,” said Dr. back best practices and new research Smee. “I admire her activism ideas. The conference was also a great and I enjoyed reading her networking event, allowing MCC staff book ‘Damned Nations’. Her to connect with Medical Council alumni, suggestions have changed how colleagues from sister organizations, I am managing my personal peers and committee members. donations.”
12 ECHOMedical C o u n c i l o f C a n a d a Canadian Conference on Medical Education a successful and productive experience for MCC staff Dr. Syd n ey Smee introducing a p l e n a r y s ession on global health Her presentation, Analytic Methods to Evaluate Item and Test Fairness: A Case study of the Medical Council of Canada Evaluating Examination (MCCEE), was co-authored by MCC Research-psychometrician Dr. Andrea Gotzmann with research conducted in partnership with Dr. Mark Gierl and Hollis Lai at the University of Alberta, a collaboration Dr. Roy qualified as “fabulous!” Although DIF analyses are not new to pencil-and-paper examinations, performing one on a computer-based examination was innovative. To contend with the several forms or versions of the exam, the researchers had to develop new procedures for a practical application of complex statistical models. The analysis found that almost none of the questions in the MCCEE bank were potentially biased based on the variables Dr. Smee also co-presented a workshop Dr. Marguerite Roy, Research examined. “You’d always expect to find flagged items and with Bruce Holmes of Dalhousie University, Analyst, presented cutting- I was surprised to find how few there were,” said Dr. Roy. Dr. Robert Maudsley of the College of edge research on applying a “This is good news that speaks to the quality of our items.” Physicians and Surgeons of Nova Scotia and differential item functioning As for the questions that were flagged by the study, they Alexa Fotheringham, the MCC’s Associate (DIF) analysis to the MCC’s have been sent for review and revision by the expert test Manager, National Assessment Collaboration Evaluating Examination to committees. (NAC). The workshop, entitled Fostering flag potentially biased items Better OSCE Examiners: Participate in (questions). A DIF study As a next step, Dr. Roy said that she would like to see this Examiner Orientation Development, was evaluates exam questions type of analysis continue to be performed as part of the designed to help participants improve the to verify that candidates, at MCC’s regular exam validity quality assurance processes. scoring consistency of physician examiners the same ability level, fare She would also like to explore whether this method could be (PEs) by learning to prepare effective comparably on the item, adapted to assess other types of examinations such as the PE orientation presentations and scoring regardless of gender, language, objective structured clinical examinations (OSCEs) and other guidelines. country of birth or citizenship. performance-based tests.
13 ECHOMedical C o u n c i l o f C a n a d a Dr. Ian Bow mer honoured by the Royal College of Physicians and Surgeons of Canada In recognition of his important HIV research and his role in shaping medical education in Canada, Dr. M. Ian Bowmer, Executive Director and CEO of the Medical Council of Canada (MCC) and Professor Emeritus at Memorial University, has been named 2012 laureate of the James H. Graham Award of Merit. The award is presented each year by the Royal College of Physicians and Surgeons of Canada (RCPSC) to a person whose outstanding achievements reflect the aims and objectives of the RCPSC. “Dr. Bowmer is a true leader in Canadian health care,” said Dr. Andrew Padmos, CEO of the RCPSC. “He has worked diligently to advance patient care, improve training and bring medical institutions together to create lasting change.” Dr. Bowmer is recognized worldwide as a leader in medical education. He has already received several prestigious awards, including the Dr. Louis Levasseur Distinguished Service Award and the Canadian Professors of Medicine Christie Award, for his contributions in this field. In addition to his leadership role with the MCC, he has directed pivotal projects in Canadian medicine, including the Physician Credentials Registry of Canada. “Dr. Bowmer’s thoughtful approach to assessment issues, his enthusiasm, and his spirit of collaboration have contributed substantially to the development of comprehensive strategies for the assessment of physicians entering practice,” said MCC President Dr. Michael Marrin. “More broadly, his vision Dr. M . Ia n B ow m e r, and leadership throughout his career have contributed to Exe c u t i ve Di re c t o r a n d C E O o f t h e Me d i c a l improved medical care in Canada and internationally.” Council of Canada Dr. Bowmer will receive the award this October at the 2012 Royal College Convocation ceremony in Ottawa.