Doctors argue delaying resident exams will cause ‘serious harms’ amid COVID-19

More than 2,000 doctors from across Canada have signed a letter that says deferring exams for medical residents will “cause real and serious harms” to the country’s healthcare system as it battles COVID-19.

About 2,000 residents from around the country were prepared to take their oral and written certification exams through the Royal College of Physicians and Surgeons of Canada this month when they found out those tests were deferred because of the new coronavirus, according to Dr. John David Neary.

Now Neary, a general internist in Hamilton, has penned a formal request to the college, calling for a one-time process whereby residents are either certified based on assessments of their training or through exams to be delivered in an alternative format such as an online test.

“In this extraordinary, unexpected circumstance and public health emergency … the college [should] adapt the examination process to the circumstances we’re in and find a way to examine these candidates in a streamlined fashion,” Neary explained.

“Deferring the examinations … will cause real and serious harms to examination candidates and to the health care system in a time of crisis,” his letter adds.

The current plan, according to the college’s website, is for the exams to be put off until September at the earliest.

In the meantime, graduating residents, who have already earned a medical degree and are working in teaching hospitals, will be able to seek a temporary licence from a province as long as they understand they must take the certification exam as soon as possible.

Dr. John David Neary says an online exam could replace the traditional written and oral certification exams for residents. (Submitted by John David Neary)

But restricted licences won’t cut it, said Neary.

“Those provisional licences will put restrictions on how those newly-graduated residents can practise during a public health emergency when they, as young, healthy energetic doctors, are most needed at the front lines.”

The cohort of residents waiting for certification includes specialists in emergency medicine, anesthesia, general internal medicine and other skill sets Canada will want on the front lines during a pandemic, he added. 

The other problem Neary points to is that exam hanging over their heads will “hamstring” residents’ ability to work.

Many of them will have spent the past nine months painstakingly preparing for the exams and putting them off for four more months will mean spending hours studying instead of working in hospitals.

For those reasons, the doctor feels a one-time exception must be made so an exam can somehow be administered this spring.

“I think a written exam is feasible and I think a written exam on its own would not be meaningfully different in this context from the traditional written plus oral exam.”

The Royal College plays a central role in the complicated system of medical education and licensing in Canada. It’s charged with carrying out specialty certification exams residents need to pass before seeking a licence from provincial regulators to practise without supervision.

College ‘not ready’ for online exam

A spokesperson for the college said it realizes people plan their life around the exams and described the postponement as a difficult decision.

“We recognize how devastating this news can be,” wrote Melissa Nisbett in an email to CBC. She said the decision was based on following public health guidelines around social distancing as well as acknowledging the role residents are playing in the pandemic.

The provinces look to the college as the “national standard in specialty medical education,” said Nisbett, meaning it has a duty to certify the competence of specialists and surgeons.

The Royal College of Physicians and Surgeons of Canada says it’s not prepared to offer online exams this spring. (Google Maps)

“The complexities of customizing a platform to meet the needs of 68 disciplines in a bilingual format takes time, and won’t be complete by spring,” she wrote in response to a question asking why an online exam isn’t possible.

“Another consideration is that computer-based exams still need to be completed in a secure facility, which would be subject to social distancing restrictions just like written exams.”

A six-page FAQ document on the college’s website, which was last updated Wednesday, offers more details on the decision to delay.

“The Royal College is working toward administering computer-based exams in the next few years but we are not ready now,” it reads, adding it’s also exploring alternative formats including video-conferences, but states “clinical exams are not “well-suited to a video format.”

‘We don’t want to put up barriers in a time of crisis’

Neary’s letter had been signed by more than 2,000 other doctors as of 5:30 p.m. Wednesday — something he says indicates to how badly the residents are needed.

“Existing doctors might not want to open the floodgates to a whole bunch of new certified doctors too easily if they were looking out for themselves,” he said. “They’re saying, ‘We need these new colleagues. We don’t want to put up barriers in a time of crisis.'”

Neary noted many of the exams have a pass rate of over 90 per cent, meaning the vast majority of residents would pass anyway. He also pointed to other countries such as Italy, Spain and the U.K. where officials are considering graduating medical students early to fight COVID-19 — developments Nisbett said the college is continuing to monitor.

The doctor said he’s had some preliminary discussions with the college and seen some “encouraging signs,” but said the doctors who signed the letter are willing to push for a meeting if necessary.

Finding a way to certify the residents won’t make the college an outlier, it will just help it get ahead of the inevitable, said Neary.

“When you look at what’s going on in the world the past few weeks, anyone who has taken decisive action early has tended to look better than people who waited for the storm to come.”

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