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The last-minute cancellation of the MCCEQ II will leave many newly graduated doctors in licensing limbo.

Controversial medical licensing exam cancelled with two days’ notice

The Medical Council of Canada has called off an in-person medical licensing exam amid mounting safety concerns and questions about the exam’s relevance.

The cancellation of the MCC Qualifying Examination Part II, or MCCQE II, comes after 11 of 19 exam sites nixed local sittings to avoid the potential spread of SARS-COV-2. Pressure to postpone the fall sitting increased in recent weeks after at least seven people were potentially exposed to the virus during an internal medicine specialty certification exam in Toronto.

The MCC said it had fully intended to proceed with the MCCQE II on October 24 and 25 at as many sites as possible. But according to the MCC, “due to recommendations by Public Health and late-breaking decisions by some contracted third-party exam sites, primarily in university settings, we are no longer able to administer the MCCQE Part II to a large enough reference group cohort to ensure the exam results are defensible.”

Originally, the MCC anticipated more than 2000 candidates would participate in the fall sitting of the MCCQE II – a key hurdle on the path to full medical licensure. But that number dropped to just 1000 as exam sites pulled out. The MCC said it delayed making the decision to call off the exam for as long as possible “in the best interest of those candidates who wished to proceed.”

Dr. Michelle Cohen, a rural family physician who advocated for the cancellation, said she’s glad the MCC “finally made the rational choice.” However, questions remain about how to deal with the newly graduated doctors who are now stuck in licensing limbo. “Personally, I think all graduates who perform adequately in residency should just be granted full license,” Cohen told CMAJ.

The MCC said it may add extra exam dates in early 2021, although it’s unclear if these will be in-person sittings. According to an earlier statement, the MCC is working on launching a virtual alternative in the next 12 months.

“The MCC determined that we could not rapidly switch to deliver them in an online format, at this time, and still maintain the quality of these assessments,” said MCC communications director, Kathryn Keyes. “We are however looking at delivery options that can be implemented in a timely manner.”

In the meantime, exam candidates can transfer their application to the next sitting or withdraw and get a full refund. According to Resident Doctors of Canada, medical licensing authorities will extend existing provisional licenses for anyone who was unable to sit the MCCQE II this fall.

Some doctors have been practicing under provisional licenses since the spring without completing the MCCQE II, reigniting longstanding questions about the relevance of the exam.

The MCCQE II assesses generalist competencies that every doctor should be able to demonstrate like assessment and diagnosis and professional behaviour. Doctors who passed the test used to be able to practice as general practitioners.

However, critics point out that the same competencies are continuously evaluated throughout medical school and residency. And now, even generalists require additional postgraduate training and certification after completing the exam. “I will always maintain that the Part II is pointless and obsolete,” said Cohen.

A day prior to cancelling the MCCQE II, the MCC issued a statement pushing back on “opportunistic and poorly informed” calls to abolish the exam.

The MCC noted that it has regularly updated the MCCQE II since the 1990s, and “hundreds of candidates taking the exam do not meet the standard competencies.” Between October 2018 and 2019, overall pass rates for Canadian medical school graduates ranged from 88% to 91%.

Some exam candidates reported on Twitter that they received a letter from the MCC warning that now is not the time to reimagine the route to medical licensure in Canada. Critics retorted: if not now, when?

Photo credit: iStock/AnthiaCumming

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