CFPC examinations and COVID-19: Pivoting in extraordinary times

Francine Lemire; Nancy Fowler; Brent Kvern

Dear Colleagues,

One of the early decisions the CFPC had to make in the COVID-19 pandemic was to determine whether and, if so, how CFPC’s Certification Examination in Family Medicine and Examination of Added Competence in Emergency Medicine were to be delivered. The CFPC wanted to uphold its standards and maintain the value and reputation of the credentials we confer on those who have met the requirements. In doing so, the CFPC also considered the effect of its decisions on its members. This work included discussion and collaboration with other standard-setting bodies such as the Royal College, the Medical Council of Canada (MCC), and the Federation of Medical Regulatory Authorities of Canada (FMRAC).

Three things became clear: First, the fairest decision would have been to postpone all examinations until 2021; ultimately, this is the only way of treating everyone the same. This option, if selected, would affect the licensure and registration of residency-eligible candidates, who form 85% of the Certification Examination in Family Medicine and 60% of the Examination of Added Competence in Emergency Medicine cohorts annually. Second, we had a reasonable probability of being able to administer the computer-based part of our examinations in fall 2020; the vendor we work with could administer these components country-wide. Third, owing to public health recommendations, travel restrictions, risk of contagion, and the number of staff and examiners, we needed to postpone the spring sitting of the Certification examination to fall 2020. In addition, it was impossible to administer the oral component of either of our examinations in fall 2020.

The Board of Examinations and Certification (BEC) is tasked with making policy decisions regarding the administration of CFPC’s examinations. The BEC defined a set of principles to guide our final decisions: running examinations in this extraordinary year is extremely important; what we do must be feasible and safe; CFPC’s examination decisions are to be made this year with as close to the same standards and confidence as in any other year; this is solely a pandemic response and not a time to address other potential changes to the examination process; and we should minimize the negative effect on members and examination candidates as much as possible, prioritizing those entering practice or needing licensure.

The BEC considered all options for and consequences of conducting the examinations for first-time and repeat examination takers. The CFPC psychometrician conducted an analysis indicating a very high degree of correlation between a passing score on the written and oral examinations for first-time takers. The same correlation did not exist for repeat candidates. Informed by this analysis and the principles listed above, we determined that it would be reasonable, as an exception during pandemic emergency measures, to make certification decisions based on a written-only fall examination. Only first-time candidates and specified repeat takers who need to repeat only the computer-based portions will be eligible.

Oral components of CFPC examinations remain integral aspects that test essential skills and competencies, and thus will continue in future examinations. Anyone who fails this year’s examination must take both components at their next attempt. Pressing pause on oral examinations for one year is valid only for first-time candidates and is supported by the performance statistics. Our confidence in using only a written component test in 2020 to accurately assess candidates who have previously failed is low, and this, in turn, would negatively affect CFPC certification standards.

The CFPC, through the BEC, has determined that those who have previously been unsuccessful on an examination will be held to the prepandemic requirements in place at the time they were unsuccessful in order to be eligible for certification.

We want you to know a thorough process was used, resulting in a difficult but seriously considered decision to ensure our examinations continue to reflect a high standard of certification as part of our responsibility to the people of Canada. We sought to limit changes to the examinations to what was absolutely necessary in response to pandemic limitations.

Although the fall 2020 administration of our examinations is our immediate priority, we are also dedicating attention to the 2021 administration. Other longer-term planning includes further strengthening our examinations’ quality improvement and validity aspects, and creating more efficient lines of communication between the BEC and the CFPC board.

Several years ago, FMRAC determined that certification by either the CFPC or the Royal College, in addition to a medical degree and a passing score on the Licentiate of the MCC parts 1 and 2, was required to obtain an unrestricted licence to practise in most provincial and territorial jurisdictions. This was a purposeful evolution derived, in part, from upholding high certification standards, maintaining certification requirements, and sustaining appropriate relationships with licensing authorities, which are accountable to the public. Upholding high standards of certification and maintenance of certification, along with the CFPC’s role in accreditation of family medicine residency programs and continuing professional development, are important ways of validating what family doctors do and of promoting the role of family practice in a robust health care system.