On September 29, as part of the Medical Council of Canada (MCC) 2022 Annual Meeting, the Council invited more than forty health care leaders and stakeholders to contemplate six questions on the state of health care in Canada. Held in Ottawa, located on the Territory of Anishinaabe Algonquin Nation, these discussions examined a range of topics on the health care landscape in Canada, including physician burnout and emerging competencies required of physicians. During these sessions, co-facilitated by MCC Council members and Executive team, three primary themes that are related to the work of MCC emerged:
The feedback gathered will be used by the Council to inform MCC’s strategic direction. This article offers a high-level overview of the discussions of these themes and the existing links with ongoing MCC projects. This article also identifies areas for further consideration and future projects. A detailed summary of the questions and discussions were captured by members of the MCC staff acting as notetakers and is now available for review.
Curricula and assessments for physicians in Canada currently focus more on medical expertise because of the practicality of assessing knowledge over behavioural skills. There is a continued need for the assessment of nonmedical expert skills, such as resiliency, adaptability, continuous learning, virtual care, and team-based care. Moreover, support and assessment need to continue post-certification and into practice.
Cultural safety and humility need to be core competencies across the continuum of a learner’s medical education. These areas need to be considered and treated as a core subject with assessment built across all scenarios, as opposed to assessment in scenarios with it as primary topic. To help achieve this, it should be essential for learners, IMGs, faculty, and practising physicians to have a fundamental understanding of Canada’s history with Indigenous Peoples as a starting point for continued learning.
Discussions about the need for alternative routes to full licensure for IMGs have grown in the context of physician shortages. These routes need to maintain the high standards of patient care already in Canada. With additional support and expansion, there are existing pathways that could help meet current needs. In addition, there is a need for IMG practice routes to be standardized and resourced to create a national programmatic approach.
The challenges and solutions facing health care in Canada are complex and involve multiple stakeholders. Recognizing there is more work to be done, the MCC’s strategic efforts in the past year align with some of the needs highlighted at the Annual Meeting.
Developed to assist exam candidates to better understand the Canadian context, MCC orientation modules are part of a free self-education program on physciansapply.ca. Recent and planned updates to existing and new modules are focused on emerging competencies as well as cultural safety. For example, in June 2022, the MCC announced its new compassionate virtual care orientation module, which delves into the provision of compassionate care through the expanded use of digital health technologies and virtual contexts in Canadian health care. In addition, through a recent government grant, the MCC is working to enhance the modules with new educational materials related to the social and structural determinants of health and providing anti-oppressive health care.
The MCC 360 program offers physicians in-practice feedback on their communication, collaboration, and professional CanMEDS skills using feedback from patients, colleagues, and co-workers. Working with partner organizations, the MCC has been working to incorporate group practice and cultural safety questions and explore the use of MCC 360 in training and residency programs.
The MCC continues to work alongside Black and Indigenous leaders in health care. This work includes ongoing review of our examinations and preparatory products for inaccurate or stigmatizing content. The MCC is also a proud partner of the National Consortium on Indigenous Medical Education (NCIME), created in 2021. Funded by the Government of Canada, NCIME provides leadership and support to partners as they fulfil their collective responsibilities to respond to the United Nations Declaration on the Rights of Indigenous Peoples, the Truth and Reconciliation Commission of Canada’s Calls to Action, and the National Inquiry into Missing and Murdered Indigenous Women and Girls Calls for Justice. The MCC recognizes that there is more work that must be done on this front, including in our assessments, to support change.
Practice-Ready Assessment (PRA) is an alternative route to licensure of IMGs. Currently, seven provinces in Canada offer a PRA program through the National Assessment Collaboration (NAC) framework, which is overseen by the MCC. PRA programs have become a prominent topic in the context of the physician shortage. The MCC is participating in discussions with government and regulators on a broad set of topics, including considerations around the expanded use of the NAC PRA program.
The MCC continues to consult with stakeholders and examine the needs and current environment in the context of assessments. As part of this, the MCC regularly adds Objectives and updates its examination content. In March 2022, the MCC published Clinical informatics and Health and the climate crisis as Examination Objectives.
The MCC is grateful for the engagement and candor of those who participated in the discussions at the 2022 Annual Meeting. We acknowledge the importance of working together to address the changes and challenges faced by the health care sector. We will continue our work to ensure the highest level of medical care is available to patients in Canada.
The next MCC Annual Meeting will take place September 27 and 28, 2023.