Waive requirement to pass MCC Examinations for UK trained family physicians

Waive requirement to pass MCC Examinations for UK trained family physicians

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Uzma Ahmad started this petition to Medical Council of Canada and

This petition is to formally request the College of Family Physician of Canada (CFPC) and Medical Council of Canada (MCC) to waive the Medical Council of Canada Qualify Examinations Part 1 and Part 2 (MCCQE1 and MCCQE2) for the purpose of granting a full license to practice for general physicians (family physicians) from the United Kingdom (UK). 

The UK has a three-year structured General Practice training which is one year longer than Canadian training. Thus, trainees would have worked longer under strong scrutiny in the UK. RCGP UK training encompasses 18 months of hospital rotation in various relevant specialties and 18 months of placement in the General Practice Surgery (Family Practice Clinic). The hospital rotations can be 4 or 6 months depending on the regions. In each rotation, a trainee has one dedicated clinical supervisor in the hospital rotations and an educational supervisor, who must be a family physician that has overall supervision of the trainee throughout the training. This arrangement enhances thorough in-depth supervision and learning that equates to standard knowledge and practice.
 
For a trainee to graduate, there is a three-layered filtration system. Thus a trainee is required to jump through 3 hoops before qualifying as a  general physician (family physician). These are two examinations and a continuous work-based assessment process. The first examination is Applied Knowledge Test (AKT) which is a computer-based assessment examination that tests the knowledge base behind the independent general practice. This test is the same standard as MCCQE1. The second is the clinical skill assessment (which due to COVID is in the form of recorded assessment), which tests the doctor’s ability to gather information and apply learned understanding of disease processes and patient-centered care appropriately in a standardized context, make evidence-based decisions and communicate effectively with patients and colleagues. It is worth noting that in the second examination, trainees are tested through a wide range of 13 case stations. This exam is of the same standard or even above the MCCQE2. Third is continuous work-based assessments that the trainees have to keep a record of on their portfolios. This is checked 4-6 monthly by their educational supervisors and once a year by an independent panel of specialist doctors. Success in all three components qualifies a trainee to be awarded the certificate of completion of training (CCT) and the MRCGP, which allows for independent practice. This process is accredited in Canada and thus the UK is an approved jurisdiction for Canada.

RCGP graduates are eligible for Certification in the College of Family Physicians (CCFP) without specialist examinations since its a recognized jurisdiction. But RCGP graduates are still required to pass the licensing examinations of MCC. This seems unfair since the candidates would have already demonstrated their capabilities to work in Canada as Family Physicians by passing the specialty examinations in the same approved jurisdiction. Also, worth noting is that UK general physicians (family physicians) are exempted to write Australian and New Zealand's medical councils licensing examinations and get direct accreditation to work independently in these two jurisdictions.

Worthy to note, this practice is not standardized through the different provinces of Canada. Some provinces require pass standing in both MCCQE1 and MCCQE2, some require pass standing in one of the two exams and some do not require pass standing in either. If the passing of these exams determines the quality of care the patients receive then why this quality not maintained throughout Canada? Does this mean that patients in one province are considered superior to receive higher standards of care compared to patients in other provinces?

General Medical Council (GMC) of the United Kingdom (from this year) considers MCC examinations (MCCQE1 and MCCQE2) equal to their licensing examinations (PLAB 1 and PLAB 2). Thus, any doctor with pass standing in MCCQE1 and 2 will be granted licensing with GMC. Why is MCC not granting the same reciprocal recognition to candidates who have passed PLAB1 and PLAB2?

One fact, many overseas Canadian graduates fail to secure residency positions and end up coming to the UK. Most of these come with the aim to return to Canada after their graduation since the UK is approved jurisdiction for Canada compared to their initial county of origin. These doctors go through the same standardized training and pass all the specialty examinations. Most of these specialty examinations are tougher than MCCQE1 and MCCQE2. There is currently a large number of such Canadian overseas doctors routing to go back. The biggest hurdle that they face is the MCC examination requirement. This becomes hard due to full-time commitment to their work, a huge amount of financial sacrifice, and the unavailability of the test especially due to the COVID crisis. On the other hand, Canada is facing the worst shortage of doctors. If MCC examinations are exempted for this doctor, they can return home soon and start reducing the huge difference between the number of patients per doctor. This will also help reduce the wait time to see specialists and increase the availability of Family physicians. This is a win-win situation for all the parties involved.

 

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