The Med i ca l Counc i l o f Canada

news le t te r

The ECHO highlights, at a glance, an assortment of MCC activities and milestones, revealing the range of developments, and progress made over the past months.Happy reading!

Dr. Ian Bowmer

MCC on the move

Changes ahead: the MCC Blueprint

Limiting exam attempts

Exam resources

Dr. Karen Mann

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c l i c k i n t e r a c t i v e i c o n s [ d o ub l e t a p i f o n a mob i l e d e v i c e ]

c l i c k p a g e t o z o o m

c l i c k s i d e a r r o w s O R s w i p e p a g e t o a d v a n c e o r r e t u r n

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These were challenges that Dr. Bowmer was ready for. He had been Dean of Medicine at Memorial University of Newfoundland from 1996 to 2003 and had consulted for Health Canada in 2004-2005, when the federal department was putting $41 billion into the health-care system for “transformational change.” He was also a former member of Council and had served as President in 1991.

When Dr. Bowmer stepped in, the Council had recently undergone a governance review, creating a more active Executive Board (currently eight members) with additional responsibilities that can be enacted between the annual meetings of the full Council (currently 51 members). The Council’s

The biggest changes have been the new roles MCC has undertaken and the growth in our people.

The MCC has grown from a staff of 75 to close to 200, while adopting a new role in applications and documents and reaffirming its core competence in assessment.

Dr. Ian Bowmer Executive Director, MCC

A DECADE OF NEW D IRECT IONS AND GROWTH

FEATURE

2006 2016

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a hectic but exciting decade since Dr. Ian Bowmer took the helm as Executive Director of the MCC in January 2007. “The only thing that has been consistent has been change,” said Dr. Bowmer. And it is clear that Dr. Bowmer thrives on change, from his enthusiastic discussion of the myriad developments on his watch.

IT HAS BEEN

makeup, which includes all provincial and territorial regulatory authorities, plus representatives of universities with medical schools is “unique in the world,” said Dr. Bowmer. “Medical schools sit down with the regulatory authorities to determine the pan-Canadian assessment standards.” The review reaffirmed the need for the large Council, but identified the need for the Executive Board to have more responsibility to enable more timely decision-making.

Dr. Bowmer has found that the current structure works well. “We’ve been lucky to have very engaged Executive Board members. That’s made a huge difference, and it has really allowed strategic change.”

The digital repository for physician credentials is one of the prominent achievements. Originally established as a separate corporation, the repository was eventually incorporated in the MCC. With the repository in place, “it became obvious we had all the elements to develop a single web-based application for medical registration,” eventually launched as physiciansapply.ca. Dr. Bowmer and the senior team were instrumental in finding government funding for the project as “it aligned with the federal government’s objective that there should be a clearer pathway for immigrant physicians who want to enter practice in Canada,” said Dr. Bowmer.

International computer-based exams were expanded during Dr. Bowmer’s tenure. The MCC had had computer-based testing for a long time, delivered through Canadian faculties of medicine computer labs. But the international exams were still given using pencil and paper at Canadian embassies around the world. The project was underway when Dr. Bowmer came on board, and in 2008 the computer-based MCCEE was launched around the world.

Dr. Bowmer points to the Assessment Review Task Force (ARTF) as a strategic planning milestone. The ARFT met with regulatory authorities, medical schools and many other stakeholders across the country to determine MCC’s future directions. Its work from 2008 to 2011 marked a “sea change” and determined MCC’s

• Repository launch for physician documents

• Web-based application for medical registration (physiciansapply.ca)

• Computer-based international examinations

• National Assessment Collaboration

• Assessment Review Task Force (ARTF)

• Blueprint project to review how MCC exams reflect today’s medical reality and to relaunch the MCCQE Part I and Part II

• MCC’s new home

HIGHL IGHTS of MCC’s

accomplishments in the last 10 years

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A standard setting exercise to take place in November 2016 may result in a change in the pass score for the Medical Council of Canada Evaluating Examination (MCCEE). The MCCEE assesses basic medical knowledge for international medical graduates wishing to enter postgraduate training in Canada. A standard setting exercise is held every three to five years to ensure that the standard and the pass

score remain appropriate, reflecting the current standard for supervised practice in Canada. During the exercise, a panel of physicians from across Canada review recent exam questions and recommend a pass score that reflects an acceptable level of performance. The recommended pass score will be submitted to the MCC Evaluating Examination Composite Committee for approval. The current pass score is 250 on a scale ranging from 50 to 500. The updated pass score will be announced in April 2017.

Candidates planning to sit the May 2017 exam should checkMCC.CA at that time for

more information.

BITS&BYTESDr. Bowmer said he and the MCC could not have achieved any of these objectives alone. “MCC relies on a collaboration with all our partners,” with input from other medical organizations and individual physicians around the country. He said collaboration has also been key in the project to build MCC’s new home. Not only does the architectural design promote this but MCC staff have participated at every stage of the building process. “If there’s one thing I’m proud of in the past 10 years it is that we’ve created a truly collaborative environment inside and outside the organization.”

focus for the subsequent five years. One of the ARTF’s recommendations led to a national practice review and an entirely new Blueprint for the Qualifying Examinations (see Changes ahead!). “The existing blueprint was very much focused on the medical expert, whereas it became obvious that additional critical core competencies that had to be evaluated were communication, health advocacy, illness prevention, physician management and professional activities of the physician.”

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EE to be updated as of May 2017

MCC

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Click for more photos

of the NEW BUILDING

ChrysalisPROJECT

December 2, 2016 marked an exciting moment in MCC’s continuing legacy, as the organization completed its move into its new home at 1021 Thomas Spratt Place in Ottawa. But the new building is much more than a change of address.

Light-filled, open-concept offices will be a beacon for collaboration among functional teams. A healing garden in front of the building will allow quiet contemplation and automated energy-saving features will help the environment.

The building’s opening is the culmination of a three-year project that started in 2013 with the purchase of land near the MCC’s former location. As MCC had grown over the years, expanding the expertise it offered and managing increasing rosters of applicants and candidates, its staff complement and test committees had grown as well. It had outgrown its former premises and was occupying three sites (including two across the street from the original building), which sometimes made communication and collaboration more difficult.

UPDA

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MCC ON THE MOVE!

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diminishing or turning off when natural light is all that’s needed. Hot water is pumped through the building’s heating system, to minimize energy use for heating water. Radiant heat is built into the floor on the ground level. A “green committee” is being planned to help ensure that day-to-day activities take the environment into account.

The building is also an investment for MCC’s many and varied stakeholders. A welcoming reception area, fully equipped workstations for visitors, more visitor parking — these are just some of the conveniences for visitors. Expanded meeting and collaboration workspaces are designed to ignite discussion and spark ideas among the more than 200 physicians involved in the MCC’s test committee work.

As MCC settles into its new home, it would like to extend an invitation to all stakeholders to drop in and view the new building when they are in Ottawa.

important aspects of the project, said Ms. Wolodarski. They also took care of elements central to working life, such as appliances and dishes for the lunch rooms. Employees were invited to compete to name the building project (Chrysalis), and to choose naming themes for the rooms in the new building. As a result, each floor has a naming theme that combines Canadian heritage with medicine, such as names of famous Canadians in medicine or names of Canadian healing plants such as bergamot and juniper.

Technology is also on display, especially in ways that help the environment. Lighting adjusts automatically to sunlight levels,

The new building brings together the staff members under one roof, with room for meetings and future growth. The architectural design “will definitely contribute to communication and to working as one team,” said Margaret Wolodarski, MCC’s Manager of Corporate Services. “It provides a state-of-the-art workspace for our employees,” including an open-area environment with low dividers as well as more traditional closed rooms and rooms for meetings and quiet work. Ms. Wolodarski said the design and positioning of the building maximize the flow of light throughout the day. Employee offices are in a south wing, “so the sun is hitting that part of the building all day long.” Sun also fills a central atrium and staircase.

As a top-ranked employer in the region, MCC has demonstrated how it values its employees as part of the building transition. A “Change Champions Team” of employees representing all departments of MCC had input into decision-making for

The decision was made to buy land for a purpose-built structure. “The concept of a purpose-designed building received the full endorsement of our Executive Board,” said Dr. Ian Bowmer, MCC’s Executive Director, “especially since it was realized that we would have spent about as much money renovating other buildings in the area.” Dr. Bowmer and Karen Meades, MCC’s Chief Financial Officer, were the project sponsors, working closely with the Executive Board to make it a reality.

MCC’s new home embodies its continued promise and dedication to innovation, collaboration and physician excellence in Canada.

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Other changes affecting MCC’s examination program include:• Changes to exam structure,

including exam sequencing, requirements and content

• Rating changes and new standards

• Changes to how exams can be challenged and to the eligibility requirements

• Increased complexity in some of the competencies to be assessed

• Increased frequency, international access and a new vendor delivery model for the MCCQE Part I starting in 2019

MCC is hard at work preparing the examinations and informing examiners and candidates about the changes to come.

I n e n g i n e e r i n g, blueprints provide guidance for construction of a solid structure. Similar to its engineering counterparts, MCC’s Blueprint for changes to the qualifying examinations for physicians, currently under development, will lead to up-to-date, durable examinations, to be unveiled in 2018. Approved by the Council in 2014, the Blueprint will change the qualifying examinations substantially, to reflect the reality of medical practice and the health care needs of society.

Changes to the MCC Qualifying Examination (MCCQE) Part I, for entry into supervised clinical practice, are coming in the spring of 2018, and changes to the MCCQE Part II for entry into independent clinical practice, in the fall of 2018.

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For more information, visit mccevolution.ca

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2018: the Blueprint becomes reality

The videos highlight MCC’s Blueprint, which “in and of itself is a change in the way we’ve been doing things for a long time,” emphasized Dr. Touchie. It also shows the format of the new exams, so that candidates are familiar with them before entering an examination room. As one example, Dr. Touchie mentioned that in the MCCQE Part II, the objective structured clinical exam stations will be longer, more closely reflecting the time most patients spend with a physician at an appointment. “That allows us to test things we weren’t able to test previously.”

To help candidates and other stakeholders understand the changes, MCC launched a new website mccevolution.ca at the beginning of November 2016. “We explain what our new blueprint is, how it links to our objectives, and changes that it will entail,” explained Dr. Claire Touchie, MCC’s Chief Medical Education Advisor. She said the impetus for the website was to reach medical students and residents, especially international medical graduates, whenever they are interested and wherever they may be.

Dr. Touchie is also the voice of the exam changes, which she explains in several videos on the site. “But the videos are very graphically engaging,” she said, “It’s not just watching a person talk.”

Dr. Claire TouchieChief Medical Education AdvisorMCC

The Blueprint is a change in the way we’ve

been doing things for a long time.

Website prepares

candidates for impending

changes to MCC exams

Assessment is evolving to incorporate MCC’s Blueprint. For physicians targeting exams in 2018 and beyond, it’s never too early to understand what this evolution will mean for the content and format of all exams — the National Assessment Collaboration (NAC) Examination, the Medical Council of Canada Evaluating Examination (MCCEE), the MCCQE Part I and Part II.

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In addition to changes in content and format, there are changes coming to the frequency and location of exams, which the website explains as well. From a schedule of twice a year, starting in 2019, the MCCQE Part I will be offered up to five times a year in Canada and internationally. Dr. Touchie said the new scheduling and international administration will offer many advantages to accommodate candidates’ varying situations.

The new website will be promoted via progress updates to medical faculties, on the MCC website and through social media.

After having fully adopted the latest psychiatric terminology, MCC exams will phase out equivalent older terms in 2017 and 2018. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the American Psychiatric

For more information about MCC’s transition to DSM-5, visit MCC.CA

BITS&BYTESMCC

EXAMS PHASING OUT

PREVIOUS PSYCHIATRIC

TERMS

Association’s text for psychiatric diagnosis and classification, was published in May 2013.

Over the last three years, the MCC has worked with its test committees to review the classification changes in DSM-5 and update the language in its exam content from the previous edition, DSM-IV-TR.

Currently, any MCCEE or MCCQE Part I questions or items use DSM-5 terms with the DSM-IV-TR equivalent term in brackets, such as “autism spectrum disorder (autistic disorder).” This will change in 2017 to include only the DSM-5 language. For the NAC Examination and MCCQE Part II, candidates can currently use either DSM-5 or DSM-IV-TR wording, but should use only DSM-5 terms as of January 2018.

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BITS&BYTES

L’ÉTABLISSEMENTrépond à l’ECFMG

As an organization dedicated to evidence-based assessment of physicians’ clinical competence, the MCC supports research in clinical assessment through grants for research projects.

This grant program is primarily intended for junior or other investigators starting out in the assessment field as well as graduate students in the area of assessment of clinical competence or performance conducting research toward a thesis or postdoctoral program. Preference will be given to proposals on the themes of:

• Outcomes measurement along the continuum

• Improving feedback from assessment results

• Measuring critical and emerging competencies in medicine

For more information about which projects

and expenses are eligible, how to apply,

and how applications are adjudicated,

GRANT COMPETITION FOR RESEARCH IN CLINICAL ASSESSMENT

DEADLINE IS FEB. 1, 2017

MCC.CAvisit our website

or email us at grants@mcc.ca

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This is one of several reasons the Committee has decided to limit the number of exam attempts permitted, beginning in January 2018. “If we keep taking money from people” who pay their fees to retake exams, despite a very low chance of passing, “are we being unfair?” asked Dr. Kvern. The Committee has stated that it is concerned “that the current policy of unlimited attempts creates false hope for candidates who repeatedly fail the examination. … All available data strongly show that passing the examination after a fourth attempt is extremely unlikely.”

According to the decision, approved by MCC’s Council in September 2016, candidates may register and take the MCCQE Part I and Part II a maximum of four times each. Between the third and fourth attempt, the candidate will have to wait one year. Dr. Kvern said the idea of the waiting period “is designed for extra learning.” He said there is no formal requirement to take remedial education during that year, but candidates who had already

made three attempts would be wise to brush up on their medical knowledge and skills before a final attempt.

To ensure limits do not unfairly block a potentially good physician, the committee brought in additional measures. Exam attempts before 2018 do not count toward the total limit; the count starts in 2018. After four attempts, candidates can appeal to the CEC for special permission to make a fifth attempt. Dr. Kvern said this would be in case of “exceptional personal circumstances.” As well, if a candidate has to leave an exam, for example, due to illness, and is granted a status called “no standing” this does not count as an attempt. However, failing or a status of "denied standing” are considered attempts.

In deciding to limit the number of attempts, the Committee looked at many considerations, said Dr. Kvern. If candidates take exams several times, they may improve because they remember questions seen on earlier exams. This means that some

Chances of passing the MCCQE Part I or Part II after the third attempt “decline precipitously,” said

yet a significant number of candidates have taken one of these exams more than 10 times and a few up to 20 times

— without success.

Dr. Brent Kvern Chair of the Central Examination Committee (CEC)

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SPOT

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L imit placed on number of t imes candidates can attempt exams

IMPROVED FINANCIAL AND

CORPORATE SERVICES BENEFIT

MCC STAFF AND STAKEHOLDERS

BITS&BYTES

"AS MCC IS REVITALIZING, SO TOO ARE ITS FINANCIAL AND CORPORATE SERVICES, TO PROVIDE IMPROVED SERVICES TO THE GROWING ORGANIZATION."Ms. Meades said the efforts will have payoffs to the Council and its stakeholders — some that staff and stakeholders will see and some that will work “behind the scenes” to make MCC more efficient and secure. The emphasis is on:

"IT’S MORE SECURE THAN PAYMENT VIA CHEQUE AND MUCH QUICKER."

As an example, payments of honoraria and invoices can now be made through electronic funds transfer.

"WHAT SKILLS AND ABILITIES, SYSTEMS AND PROCESSES ARE NEEDED TO SAFEGUARD THE ASSETS OF THE ORGANIZATION."

Other systems and services are also migrating to electronic platforms from manual processes. MCC staff now use an electronic expense claims form when they travel, and their data are captured for analysis. This will allow MCC to better understand spending on hotels, flights and restaurants, as well as to negotiate prices with hotels frequently visited. The system allows travellers to report on travel “on the fly,” uploading travel receipts via an app, in a secure, convenient and paperless way. This system is only used by MCC staff at this time, but will be rolled out to external stakeholders in the future.

KAREN MEADES:

candidates might pass their next attempt by looking up answers to likely questions in advance. “We are making sure people pass the exam for reasons of their ability and not by remembering questions.” Examination security is also important. It is possible some of the very frequent test-takers may be collecting questions and sharing them with others, despite the multiple warnings and the requirement of agreeing to the confidentiality of the exam content.

As well, the Committee looked at similar high-stakes exams in other professions such as dentistry and law, and found that these generally have limits on the number of attempts. Dr. Kvern described the decision as “very fair,” striking a balance between ensuring public safety and allowing competent candidates to join the profession.

CFO, Director of Finances and Corporate Services, MCC

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2016

#MCC

agm

@GuimondEric

Thrilled to be at #MCCagm! Thanks @MedCouncilCan for the invitation!

@MedCouncilCan

We would like to officially welcome our new Council members. #MCCagm

@MedCouncilCan

Dr. Heidi Oetter from @cpsbc_ca is now presenting a Finance Committee report to Council. #MCCagm

@ARJalali

Stimulating discussion on @AFMC_e EPAs and Future of #MedEd in Canada #MCCagm

@MedCouncilCan

Congratulations Dr. Jeffrey Turnbull, recipient of the 2016 Dr. Louis Levasseur Award! #MCCagm

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S E L E C T E D

MCC ' 16 T w e e t s

BE P

REPA

RED!

C a n d i d a t e s and physician examiners have asked for more direction to be well-oriented and to better understand expectations before they participate in exams. The MCC has responded with several recent initiatives that will assist candidates and physician examiners to handle exams with confidence.

A new video about the clinical decision-making portion of the

MCCQE Part I helps candidates understand how the exam works and dispels some misconceptions along the way, said Tanya Rivard, the Senior Test Development Officer responsible for content in this part of the exam.

She said candidates have asked for a better understanding of what is required. “It’s not a straightforward multiple-choice question exam — it’s more complex,” explained Ms. Rivard.

The video explains the exam and shows examples of questions and how to answer such questions. Ms. Rivard said it also clears up some “confusion and misinformation.” For example, some candidates indicated in feedback that they were under the impression that incorrect answers result in negative marks, which is not the case.

"Approaching the exam involves not only good clinical judgment, but also 'examinship' — reading the exam instructions, preparing for the exam and understanding how it is scored," said Ms. Rivard. For instance, candidates need to understand that the clinical decision-making portion is looking for candidates to provide the best answer or answers to a question for which many responses may be technically correct.

“We’re not trying to confuse anyone,” said Ms. Rivard. “We’re asking a question, and we are looking for a straightforward response, to the best of the candidate’s knowledge.”

MCC adds resources to help candidates and physician examiners prepare for exams

Video highlights

clinical decision-making in

MCCQE Part I

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• protocol for interacting with the SPs and physician examiners

• common mistakes candidates make• how to recover from a bad start• what to expect at the exam centre,

and what may differ from one location to another

• how to move from one station to the next

• the importance of maintaining confidentiality

• how to report problems with the exam• what to expect once the exam is

completed

role of the standardized patient (SP) and the physician examiner, what happens in a typical OSCE station, which equipment is available, and so on. The format will be predominantly short video segments, explained Ms. Fotheringham, with transcripts to help those who speak English or French as a foreign language. She said the material will include the following:• the purpose and format of a typical

OSCE• strategies and skills to navigate an

OSCE• how exam staff can assist

candidates on exam day

An online suite of orientation material planned for launch late in 2017 will help candidates approach objective structured clinical exams (OSCEs), the format upon which the MCCQE Part II and the NAC Examination are based.

“We want to ensure that candidates are being assessed on their clinical skills and knowledge, not their ability to navigate an OSCE,” explained Alexa Fotheringham, the manager for the NAC Examination.

The online orientation material will walk candidates through an OSCE to understand overall exam logistics, the

Online orientation

before an OSCE

… for candidates

… and for physician

examiners

Look for Candidate Online OSCE Orientation — coming to MCC.CA next year.

Changes are coming for both MCC-administered OSCEs. The MCCQE Part II will undergo changes in 2018, when the Blueprint for MCC’s qualifying exams becomes reality (see Changes ahead!). The content of the NAC Examination is also undergoing changes and will be enhanced starting in 2019. As a result, orientation for physician examiners will change as well, said Nathalie Woodstock, Manager of the MCCQE Part II. Currently, mandatory

orientation involves a learning module that includes a scoring exercise, in which two videos of simulated candidate and simulated patient encounters are observed and scored. The in-person orientation the morning of the exam includes a third scoring exercise, in which a video of a simulated candidate and a simulated patient encounter is observed, scored and discussed with the deputy registrar or chief examiner.

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To update current orientation tools, the MCC is gathering and analyzing data, including feedback from physician examiners and site staff. “We are also doing an assessor-training literature review to make sure we’re keeping up with best practices,” said Ms. Woodstock.

“We plan to identify learning objectives, and determine whether our existing orientation meets the objectives.” This will help

determine what needs to be improved or added. “Orientation content is expected to be more complex than it currently is,” said Ms. Woodstock, and more comprehensive resources are planned.

In addition to a wealth of information on application services for physicians, the physiciansapply.ca website provides a self-education program on

physiciansapply.ca

offers a self-study

program

each case links to MCC Objectives, upon which all exams are based. And the program is particularly helpful for international medical graduates, who may be less familiar with Canadian culture.

A new self-education module on ethical, legal and organizational aspects of medicine in Canada is planned for 2017. A segment of this program will deal with physician assessment of patients’ fitness to drive — an important legal aspect of practice.

communication and cultural competence

This program was launched in September 2015 with five modules that include videos, self-reflection questions, knowledge checks and follow-up resources. A sixth module involving care of the elderly was added in June 2016. The program is useful for candidates for all MCC exams, as

The new orientation is scheduled to be launched ahead of the new MCCQE Part II in October 2018 and ahead of the enhanced NAC Examination in 2019.

Delivery of the content will continue to use various modalities and will involve several presentations and videos. The MCC will continue to monitor users to ensure that all physician examiners complete the online orientation and receive feedback.

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BITS&BYTESThe application portal project was funded by:

· Employment and Social Development Canada

· the Federation of Medical Regulatory Authorities of Canada and its members

· Medical Council of Canada

BRITISH COLUMBIA became the sixth medical regulatory authority to integrate physiciansapply.ca into its application process on Sept. 6, 2016. It joins Alberta, Nova Scotia, Quebec, Saskatchewan and Newfoundland in accepting applications through the portal, which is planned to eventually cover medical regulatory authorities across the country. Application for medical registration in BC through physiciansapply.ca is open to all new candidates for independent registration, including Canadian medical residents, and practising physicians relocating to BC from other parts of Canada and from outside of Canada.

physiciansapply.ca is a centralized system for exam registration that receives, reviews, verifies and stores credentials and documents of candidates from across Canada and around the world. The portal makes it easy for medical regulatory authorities to process potential new physicians, and helps candidates apply for exams, view results, submit credentials and documents, have these verified and translated and then shared with organizations registered with the MCC. The portal is easy to use and secure.

BC JOINS PORTAL FOR APPLICATION FOR MEDICAL REGISTRATION

The Medical Council of Canada (MCC) would like to recognize the late Dr. Karen Mann for her support of the organization.

Dr. Mann was a valued contributor to the MCC, where she co-chaired, and subsequently chaired the Objectives Committee for a number of years. She was also a member of the MCC Blueprint Governance Committee.

Her kindness and thoughtfulness will be sorely missed by all of her friends at the MCC.

REMEMBERING DR. KAREN MANN

1942

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ECHO | DEC. 2016

1021 THOMAS SPRATT PLACE, OTTAWA, ON CANADA K1G 5L5613-521-6012 | MCC.CA

For an alternate accessible format ‒ please contact the MCC at 613-521-6012

or by email at communicat ions@mcc .ca