Assessing physicians throughout their education and career

Organizations involved in assessing today’s and tomorrow’s physicians have joined forces to work toward an Assessment continuum for Canada

Dr. Sarita Verma paints a picture of the medical life in Canada — from applying to medical school, through education, residency, practice, and retirement. “Every milestone along the way is handled by a different organization,” she points out. As a white paper released with this article describes, getting from one stage to the next involves various examinations and assessments. But there are gaps during some of those career stages, when physicians may receive little or no feedback, and redundancies in others, when physicians must pass multiple examinations for similar skills.

“How do you ensure physicians maintain their lifelong learning? What is the purpose of going through all these training programs?” asked Dr. Verma, Vice-President, Education for the Association of Faculties of Medicine of Canada (AFMC) and a former postgraduate dean at Queen’s University and the University of Toronto. These questions are being answered by a working group that includes Canada’s medical assessment and standard-setting organizations as well as regulatory authorities.

The group agreed to collaborate in 2014, as several organizations had projects underway that affected assessment. The MCC was preparing its Blueprint project for assessment evolution, the AFMC was leading the Future of Medical Education project, the College of Family Physician was implementing the Triple C Curriculum (insert link), and the Royal College was introducing its Competence by Design initiative. They realized existing assessments were in “silos” that need to be broken down, explained Dr. Claire Touchie, MCC’s Chief Medical Education Officer.

The white paper Assessment Continuum for Canada — Towards a National Assessment Program calls for a coherent national assessment system. “Continuum” refers to both the entire physician life-cycle and the many organizations involved in assessment, said Dr. Touchie.

At a retreat held in April 2016, 25 participants from various organizations talked about what an ideal “world of assessment” would look like. That discussion led to the white paper, which led, in turn, to a “summit” meeting on September 15, 2017. “It was a fantastic day,” said Dr. Touchie, building momentum and leading to several conclusions. First, participants agreed the voice of the patient needs to be brought into discussions. Second, the working group is asking the organizations involved to approve in principle the white paper’s recommendations. And participants concluded that they need to be cautious in building an assessment system. At a time when physicians are facing increasing pressures on many fronts, assessment cannot pose a burden or set up more administrative barriers.

“The very fact that these organizations are getting together to accomplish this is an amazing thing,” explained Dr. Glenn Regehr, Associate Director, Research at the Centre for Health Education Scholarship at the University of British Columbia, and an adviser on the white paper. He said the collaboration is probably unique in the world. Dr. Touchie agreed. “Canada is small enough that we can do this.”

But it’s also a difficult goal to reach, said Dr. Regehr. “I’m challenging the working group to think about how it’s going to play out on the ground on a day-to-day basis.” He said that assessment must provide meaningful data to practitioners “to reflect on and understand their own practice, to focus on their education and continuing education” — all for the ultimate benefit of patients.