From the outset of the pandemic over a year ago, RDoC has been in the trenches fighting on behalf of our members. We have worked around the clock with our PHO partners to ensure that residents’ interests and needs are not overlooked.
We have had many, many successes, but we have not won every battle and the recent decision of the Royal College of Physicians and Surgeons to push forward with the oral exams, has resulted in a wave of disappointment and frustration across the country.
During the pandemic, RDoC has held fast to two guiding principles related to examinations. First – we believe that the safety of the candidate is paramount. Second – we believe that no one’s ability to enter practice should be impeded due to the pandemic. In March 2020, we witnessed the devastating impact on our members when the Royal College, the College of Family Physicians of Canada and the Medical Council of Canada postponed exams. As a result, we added a third principle – that every attempt be made to ensure that exams not be postponed, as long as our first two principles could be met.
Over the past several weeks we brought all of the concerns that many of you raised, while studying for your exams, about the wisdom of preceding with the oral exams in the face of an overwhelming third wave of the pandemic. Thank you to everyone who emailed us or spoke with your RDoC or PHO representatives. We had numerous discussions with senior Royal College officials to ensure that they had a good understanding of: the increasing service demands on our members; the sustained emotional toll of having worked on the front line battling the pandemic over the past year; the seeming unfairness of the cancellation of last year’s orals; the perceived unfairness of cancelling the core internal medicine orals; safety concerns with conducting exams in hotels; the moral challenges of pre-exam quarantining to prevent exposure to COVID, in the face of increased workload on colleagues – to name just a few. We made sure that the Royal College was aware of circulating petitions as well as understanding what was happening on social media. We partnered with our PHOs, many of whom worked to ensure that their PG Deans were supportive of cancelling the orals. We also know that many Program Directors worked to ensure that the Royal College was aware that there was a growing desire to cancel the orals. In all of our conversations and advocacy work with the Royal College we made it clear that postponing the oral exams to later in the year was not, in our opinion, a viable option.
We’ve learned that the Royal College involved many different people in deciding whether or not to cancel the oral exams. Every specialty has both a specialty committee and a specialty exam board and the Royal College reached out to the Chairs of these committees to ask them to review the need for the oral exam as well as to assess whether or not examiners were still available. As many of you may know, it was a shortage of examiners that resulted in the cancellation of the core internal medicine oral exams. The input of the Chairs was also reviewed by the Royal College Committee on Examinations and all of this information was provided to the Royal College Council who held an emergency meeting on April 23rd. We have been assured that all of the advocacy work was also considered. The Royal College Council ultimately decided to move forward with the oral exams because they believe that the exams can still be administered safely and meet the current public health guidelines and because the exam boards confirmed that there were enough examiners available.
In our advocacy work we emphasized that these are extraordinary times and even though the burden of the pandemic has not been borne equally across the country or equally amongst specialty groups, residents have been on the front line often putting themselves at risk caring for their patients and the public writ large. We emphasized that many are tired and frustrated and may not be at their best to challenge the exam. We expressed our concern that in some situations, if a resident were to choose not to sit the oral, that they shouldn’t be penalized. Historically, if a candidate fails to show up for an oral exam in a given exam sitting, they are registered as having made an attempt and they are required to sit both the written and the oral at the next sitting. If there is any consolation in the recent decision of the Royal College Council, it is that should a resident choose not to sit the upcoming oral exam, their attempt will be deferred and if they have passed the written, they will not need to sit the written exam again. For residents who choose to defer, we are working with the Royal College to ensure that the Medical Regulatory Authorities provide a low-supervision COVID-19 license so that the ability to transition to practice is minimally impacted. We have not had final confirmation from the regulatory authorities, but I am confident that with the joint advocacy of the Royal College and RDoC that we will be able to secure this.
RDoC is continuing to monitor any changes in public health recommendations that might impact the ability of candidates to sit the exam. We know that in some jurisdictions across the country, non-essential travel has been limited. I can assure everyone that as of today, all jurisdictions have confirmed that sitting the exam is either considered essential or a component of your need to be able to work. In specific settings, we are working with our PHO counterparts to ensure candidates have letters from their University or Program Director that confirms their travel is essential.
I can’t emphasize enough how much we empathize with everything that exam candidates are going through. A number of our Board and Executive members are sitting their exams this year and even those who aren’t, have worked just as hard to support our advocacy efforts.
For those who are working hard to make change and advocate on our members’ behalf, it can be challenging to see all of the misinformation that is distributed on social media. Much of what is distributed may be well intentioned, but some of it only serves to increase anxiety, frustration and a sense of powerlessness – emotions that are anything but helpful to anyone preparing for their exams.
We will continue to be vigilant and will not stop advocating on your behalf. We are constantly monitoring public health guidelines and will continue to be in frequent conversation with the Royal College about examiner availability, candidate safety as well as any other factors that might impact the exam. RDoC made a commitment to all of our members at the outset of the pandemic that we would only communicate information that we know to be true and that we would only do so when we felt it to be helpful. Just because you may not be hearing from us does not mean we aren’t putting our full effort behind representing your interests. And even though this has been a setback in our advocacy efforts, we remain undaunted.
Esther Kim, MD