Examinations: 2021 and beyond

Dear Colleagues,

We learned several things from changes implemented to the 2020 CFPC examinations owing to the pandemic.

• Holding the safety of candidates, examiners, and staff as our grounding principle was absolutely correct.

• The difficult decisions we made prevented certain groups who needed to retake the examinations from doing so, and this must be avoided in future.

• In times of crisis, more frequent, regular communications are needed between the CFPC Board of Directors and the Board of Examinations and Certification.

• The timing, content, and tone of communications to candidates, who are also CFPC members, matters, and so do communications to other stakeholders.

These lessons guided CFPC’s approach to planning examinations for 2021. The pandemic is still very much with us, and ensuring safety is still paramount. We want to bring certainty to help members cope with the uncertainty created by the pandemic. In view of this, informed by our psychometric data, and in consultation with the Board of Examinations and Certification and the CFPC Board of Directors, the CFPC will, again, only use the written component of the examination (short-answer management problems) to make Certification in Family Medicine (CCFP) decisions in 2021. Both the written and oral components will be used to make decisions regarding the Certificate of Added Competence in Emergency Medicine (CCFP[EM]) in 2021. The oral component of the emergency medicine (EM) examination will be delivered virtually. The CFPC will offer a simulated office oral (SOO) component as part of the Certification Examination in Family Medicine virtually to the small group of members who have a fail standing from a previous SOO. The reason SOOs are not happening on a large scale is feasibility.

In 2022, it is anticipated that we will revert to the usual written and oral components for both examinations. A final decision will be made in fall 2021 regarding this, with subsequent announcements in time to allow candidates and programs to plan accordingly.

Rural FPs expressed concerns about the practice-eligible route criteria to sit the CCFP(EM) examination. We thank the Society of Rural Physicians of Canada for highlighting this. Our intention was not to exclude rural FPs. The criteria are a core part of the overall assessment for and awarding of a CCFP(EM) and not just a “bar” to write the examination. Our objective is to determine eligibility based on a scope of practice that reflects advanced expertise and leadership in this clinical area, distinct from the competencies of a certified FP involved in EM. A working group has been formed to consider the practice-eligible route criteria from a rural EM view, and we hope to provide further clarification on this in the early spring, before the April 2021 opening of applications for this fall’s EM examination.

The pandemic accelerated our plan to create a modern, adaptable examination. The CFPC board approved funds from the Certification and Assessment Reserve to develop a program assessment review and examination blueprint, with support for an Assessment Objectives Subcommittee. We will explore the feasibility of completing the examination securely, virtually, and easily, thereby reducing travel costs and facilitating examination retakes.

The examination blueprint will also incorporate the Outcomes of Training project and is a necessary quality assurance measure. By being explicit about what we are aiming for in family medicine training, we reinforce the brand of family medicine—one that is socially accountable, legitimizes and strengthens our value in the health care system, can be evaluated, establishes us to continually strive for quality improvement, and commits to the provision of comprehensive care and improved health outcomes.

Our examinations cannot be static; they must evolve just as the profession does. We predict that we will continue to assess clinical knowledge with the short-answer management problems. We will continue to assess competence in the patient-centred clinical method, but the tool we use will be refreshed during the next 3 years. We will further assess judgment and clinical decision making, and consider how to assess emerging competencies such as delivering care virtually, and those related to health equity such as cultural safety and trauma-informed care.

Awarding the CCFP is one of our most important activities. In strengthening the foundation for robust, valid, reliable Certification decisions, the CFPC validates what most members have been working toward, articulates more clearly what FPs can do, and reaffirms the importance of FPs’ contribution to community care.

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