Update #6: COVID-19 and Exams

Here is the latest memo distributed to all RDoC members by our provincial partners.

Dear Colleagues,

With the clinical impact of the COVID-19 pandemic becoming more apparent in Canada, I wanted to update you on a number of key issues that we have been hearing about and working on. As always, RDoC is committed to providing you with information that we know to be accurate.

Many of the operational issues around COVID-19 that I highlight in this Update are also being managed at the provincial level by RDBC, PARA, RDoS, PARIM, PARO, MarDocs and PARNL. The Executive Directors and CEOs of all of the resident organizations are meeting very frequently to identify issues, compare notes, share solutions, and coordinate activities.

Personal Protective Equipment
As the pandemic unfolds, we are hearing more and more stories across the country about the different strategies that various hospitals are using to manage their supply of personal protective equipment. We have heard from you that a lack of consistent guidelines between hospitals leads to confusion and anxiety for those of us working on the frontline. For this reason, RDoC joined with the leaders of Canada’s major national medical organizations to sign a letter to all governments calling for the immediate development of guidelines to support best practices in PPE use by healthcare providers, including standardized advice on the reprocessing and reuse of PPE. We also called for the mobilization of Canadian production of PPE in order to protect healthcare providers and limit the spread of the disease.

We are aware that some Universities are proactively taking steps to house residents who are needing to be self-isolated or quarantined, and who are unable to go home. We have asked the Association of Faculties of Medicine of Canada (AFMC) to determine if every University is working on similar plans.

If you are needing to be self-isolated and are having trouble finding accommodations, please contact your provincial housestaff organization.  We are working in partnership with your provincial housestaff organization to ensure that every University has accommodation contingency plans in place. 

Many Universities have either developed or are in the process of developing redeployment plans. We are working with our provincial partners to develop best practices for redeployment.  RDoC and our provincial partners are fiercely advocating our belief that working during a pandemic provides a unique resident training opportunity, and therefore residents should be credited for their work during this time, and that any disruptions to training be minimized wherever possible.

Medical Regulatory Authorities (i.e. “Colleges”)
The Medical Regulatory Authorities (MRAs) are established by provincial and territorial legislation; they operate within the legal framework under which they are governed. The Federation of Medical Regulatory Authorities (FMRAC) has stated: “The medical regulatory authorities require the 2020 graduating cohort of residents to pass the pan-Canadian certification exams” before they are eligible for a full, unrestricted license, but that provisional temporary licenses can be obtained. We have confirmed that every provincial medical regulatory authority, with the exception of the Northwest Territories, has the ability to issue a provisional license to competent exam-eligible candidates. Some MRAs require that an individual with a provisional license must be supervised. MRAs requiring supervision stated that they are working to ensure that this will be low-level supervision. Together, with your provincial housestaff organizations, we are asking them to be explicit about what “low-level supervision” means. The MRAs have also confirmed that once you receive a provisional license you will be designated as the Most Responsible Physician.

All MRAs have indicated that they will require two things for the provisional licenses: proof of completion of training and a letter from either the CFPC or the RCPSC confirming that you are exam eligible. Your provincial housestaff organizations are working with their respective PGME Office to make sure that they submit the required documentation. We have advocated for, and have received confirmation from, the CFPC and the RCPSC that they are putting in place mechanisms to ensure that there is no delay in their provision of any necessary documentation.

We have emphasized that provisional licenses should be intended to minimize any professional and personal impact of not having received certification. They should protect the ability of our members to provide patient care during this pandemic and proceed with their job or fellowship plans. Some MRAs have been able to work out the details faster than others. Each of your provincial housestaff organizations (e.g. RDoC, RDBC, PARA, RDoS, PARIM, PARO MarDocs and PARNL) are actively advocating on this issue. We will continue to advocate that MRAs provide answers to any ongoing questions you may have.

Medical Council of Canada
The MCC have communicated to all candidates through their accounts at physiciansapply.ca that the MCCQE Part II exams scheduled for May 2 and 3, 2020 have been postponed and have committed to providing an updated exam schedule as soon as possible. They have indicated that exam fees will remain in your account.

Currently the MRAs require the MCCQE Part II exam for an independent license. We continue to hear concerns from many residents about the relevance of the MCCQE Part II exam, particularly in the era of CBME, and RDoC will continue the work that we started pre-pandemic to address these concerns.

College of Family Physicians of Canada
On March 13th, the College of Family Physicians of Canada (CFPC) announced that their resident exams were being delayed. RDoC advocated that the exams be rescheduled as soon as possible, and that indefinite postponement without a set exam date was not acceptable. By March 15th the magnitude of the impending COVID-19 pandemic was becoming better understood. The CFPC set out to determine whether or not they could find spring dates for the exams. The CFPC informed us that spring options were no longer viable when their vendor that manages the online short-answer management problem (SAMP) component of the exam shut down as a non-essential service during the pandemic. Given these circumstances, on March 19th, the CFPC made the decision and have confirmed that the SAMP will be held in October 2020. The simulated office oral (SOO) component of the exam is scheduled for October 16 and 18, 2020. Further details on the SAMP dates will be communicated as soon as they are known.

Royal College of Physicians and Surgeons of Canada 
On March 11th, the Royal College contacted us to indicate that public health was expressing increasing concerns about bringing groups of people together and that this might impact the exams. We were provided with limited information at that time, but we immediately wrote to all of you in the first COVID-19 Exam Update to provide you with the principles we knew that the MCC, the CFPC and the RCPSC had agreed to, in the event that the exams needed to be postponed.

Like the CFPC and the MCC, the Royal College announced on March 13th that they were postponing the exams. In a similar fashion to our advocacy work with the CFPC, we immediately began to advocate that the priority should be rescheduling the exams as soon as possible, as we were acutely aware of how ‘exam ready’ many of our members were. On March 14th, we provided another COVID-19 Exam Update laying out the six principles that were guiding RDoC’s advocacy work at the time. Number one on the list was pushing to have the exams rescheduled for as soon as possible, because indefinite postponement was not acceptable. We also advocated for ample notice before new exam dates, creative solutions to deliver the exams, and for contingency plans to be developed that would meet public health requirements, including many innovative solutions brought forth by residents across the country. We have continued to emphasize the negative impact that examination delay has on resident physicians.

In response to advocacy work that the exams be held as soon as possible, the Royal College developed a plan through the weekend of March 13-15 that would see the exams delivered in every city where there is a medical school, in the spring, in order to reduce travel. They also developed plans to deliver the exams in multiple sites within a city, in order to comply with the province-specific public health recommendations on social distancing and group gatherings. This new plan, with new spread out dates in the spring of 2020, was announced on March 17th.

On March 20th, the Royal College announced their new decision to postpone all exams until the fall. In order to meet the needs of all of our members, we advocated for two sittings of the exam – one in the spring of 2020 and one in the fall of 2020, with residents afforded the choice of determining which sitting would best meet their needs. We made sure that the Royal College was aware of the implications of delaying the exams until the fall of 2020, particularly in light of fellowship and career plans.

Since March 20th, we are aware that there has been increasing confusion and anxiety about Royal College examination dates, and questions about whether the exams might still be rescheduled earlier or perhaps waived. Through emails we have received, various online petitions, Facebook groups, and online discussions, we became aware that in addition to the Royal College, various groups, including PG Deans, Program Directors, Chairs of Departments, Specialty Committees and even RDoC, have been blamed for the postponement, the uncertainty, and the lack of clarity. To the extent that we have not been clear in Updates 1 through 5, where we summarized the principles that the examining bodies had agreed to and outlined the principles underlying our ongoing advocacy efforts, please let us correct that now.

We have heard from thousands of residents through a variety of channels, offering possible solutions and sharing the enormous impacts of the exam postponement on your personal lives and professional plans.  This information has been extremely helpful in illustrating to the Royal College the impact of postponing the exams.

As we have advocated for the consideration of multiple solutions, we have also encouraged the Royal College to help us understand how they have made their decisions. To be clear, we have not been engaged in negotiations or consultations, but our readiness to advance your ideas and concerns and advocate for extraordinary solutions has been welcomed by the Royal College.

We have asked the Royal College and CFPC to explore whether it is possible to provide certification to this year’s cohort without examination at all. We have also strongly advocated that if the writtens are absolutely necessary, that this year’s cohort be exempted from the oral component of the exam. Every time a change to the exams was announced, we have pushed for contingency plans to be put in place, due to the uncertainty of COVID-19.

We know the heavy emotional price that this year’s exam eligible candidates are paying. Ongoing studying while transitioning into an attending physician, particularly during a public health crisis, has tremendous impacts on residents’ mental health, relationships, fellowships, careers, families and family planning decisions, and more. We also know that, for many of you, the COVID-19 pandemic is also having a financial impact on your families. For this reason, we are advocating that the Royal College make available the option for your fees to be refunded until a definite date for the exams has been announced.

If you have fellowship plans outside of Canada and are concerned about the implications of not being certified or having an independent license, please email us and let us know the specifics of your situation. We are working to find appropriate channels to advocate on your behalf.

No matter the ultimate decision regarding the exams, if necessary, we will continue to advocate on behalf of this year’s exam candidates after July 1 to ensure you receive certification and a full independent license to practice medicine. You will not be on your own without representation.

Finally, while we understand that no one is responsible for the COVID19 pandemic and believe that no one is happy with the disruption of the exams including Program Directors, PG Deans, and the three national examining bodies, it is RDoC’s position that this year’s cohort of residents should not be the only ones paying the financial price. For that reason, we are also advocating that the cost of this year’s exams be discounted, if not free.

Ongoing work
We are committed to advocating for residents, amplifying voices, and unifying efforts. We have now collated questions that residents have asked of the Royal College, CFPC, and MCC regarding examinations, and we will be requesting that they review and formally address these questions in an FAQ.

As we all work together – as doctors – to meet the health care needs of the COVID-19 pandemic, it is important that RDoC and the provincial housestaff organizations know what is happening on the ground where you are working so that we can ensure that the needs of resident physicians are not overlooked by decision makers. Please be sure to contact your provincial housestaff organization or email covid19@residentdoctors.ca if concerns arise during the pandemic.

RDoC will continue to stand behind our commitment to only provide you with information that we know to be true so that you can trust what you hear from us.

On behalf of the RDoC team,

Emily Stewart, MD
PGY-4 Emergency Medicine
President, Resident Doctors of Canada

For previous updates from RDoC on COVID-19 and exams, please see:

Update #1 on March 11, 2020

Update #2 on March 12, 2020

Update #3 on March 14, 2020

Update #4 on March 18, 2020

Update #5 on March 24, 2020