Statement in response to the USMLE announcement

The Medical Council of Canada (MCC) acknowledges the January 26, 2021, announcement by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), co-sponsors of the United States Medical Licensing Examination® (USMLE®), regarding the discontinuation of the Step 2 Clinical Skills examination (Step 2 CS). This announcement has renewed discussions regarding the Medical Council of Canada Qualification Examination (MCCQE) Part II, and we wish to address the questions we are receiving.

Canada is very different from the United States in terms of its health care delivery. Our assessment of physicians’ competencies and the Canadian standard for independent licensure are based on our society, demographics, public health, medicolegal requirements, and cultures. The MCC will continue to respond to the licensing requirements of the provincial Medical Regulatory Authorities (MRA) for both Canadian Medical Graduates (CMGs) as well as International Medical Graduates (IMGs), by administering assessments including the MCCQE Part II, an objective and standardized assessment of core physician skills.

The MCCQE Part II is a clinical exam that assesses competence, knowledge, skills and attitudes essential for entry into independent clinical practice, regardless of specialty. Developed by expert educators and assessors from Canadian faculties of medicine, the exam encompasses two broad categories: dimensions of care across the medical continuum and physician activities, including assessment and diagnosis, management, communication and professional behaviours.

Recent administrations of this exam, in May 2020 and in October 2020, were postponed due to the pandemic guidelines established by health authorities. Regrettably, these postponements impacted several hundred candidates, who are now practising on provisional, temporary or restricted licenses. The MCC is currently in the process of shifting to a virtual and semi-continuous delivery which, as soon as this spring, will result in more frequent opportunities for candidates to take the MCCQE Part II, a decreased need for candidate travel and a reduced risk of cancellation.

The MCC’s vision is to achieve the highest level of medical care in Canada through excellence in assessment of physicians. We continue to look at ways to enhance our assessments and to consider what future requirements to ensure safe health care in Canada will be. In the early days of the pandemic and on frequent occasions since, the MCC has had ongoing discussions with our counterparts in the UK and Australia regarding our respective clinical exams, exchanging lessons learned on these important assessments and their delivery.

The MCC has initiated an Assessment Innovation Task Force, comprised of health care and medical education professionals whose 12-month mandate is to: review the evolving landscape of health care; identify new core physician competencies required in light of the move to virtual and technology enabled care; liaise with partner assessment organizations on appropriate assessment modalities; and provide recommendations to Council.

Relevant research articles:

Cadieux, G., Abrahamowicz, M., Dauphinee, D., & Tamblyn, R. (2011). Are Physicians With Better Clinical Skills on Licensing Examinations Less Likely to Prescribe Antibiotics for Viral Respiratory Infections in Ambulatory Care Settings? Medical Care, 49 (2): 156-165. https://doi.org/10.1097/MLR.0b013e3182028c1a

De Champlain, A. F., Ashworth, N., Kain, N.,  Qin, S.,  Wiebe, D., & Tian, Fang. (2020). Does Pass/Fail on Medical Licensing Exams Predict Future Physician Performance in Practice? A Longitudinal Cohort Study of Alberta Physicians. Journal of Medical Regulation, 106 (4): 17–26. https://doi.org/10.30770/2572-1852-106.4.17

Ecker, D.J., Milan, F.B., Cassese, T., Farnan, J.M., Madigosky, W.S., Massie, F.S. Jr., Mendez, P., Obadia, S., Ovitsh, R.K., Silvestri, R., Uchida, T., & Daniel, M. (2018). Step Up—Not On—The Step 2 Clinical Skills Exam: Directors of Clinical Skills Courses (DOCS) Oppose Ending Step 2 CS. Academic Medicine, 93 (5): 693-698. https://doi.org/10.1097/ACM.0000000000001874

Holmboe, E.S. (2004). Faculty and the Observation of Trainees’ Clinical Skills: Problems and Opportunities. Academic Medicine, 79 (1): 16-22. https://doi.org/10.1097/00001888-200401000-00006

Meguerditchian, AN., Dauphinee, D., Girard, N. Tewodros, E., Riedel, K., Jacques, A., Meterissian, S., Buckeridge, D.L., Abrahamowicz, M., & Tamblyn, R. (2012). Do physician communication skills influence screening mammography utilization? BMC Health Services Research, 12 (219). https://doi.org/10.1186/1472-6963-12-219

Pugh, D., Desjardins, I., & Eva, K. (2018). How do formative objective structured clinical examinations drive learning? Analysis of residents’ perceptions. Medical Teacher, 40 (1): 45-52. https://doi.org/10.1080/0142159X.2017.1388502

Tamblyn, R., Abrahamowicz, M., Dauphinee, D., et al. (2007). Physician Scores on a National Clinical Skills Examination as Predictors of Complaints to Medical Regulatory Authorities. JAMA, 298 (9): 993-1001. https://doi.org/10.1001/jama.298.9.993