`THIS REALLY DOESN'T MAKE ANY SENSE'
As Canadian hospitals fill up with COVID-19 cases, a licensing body's controversial decision is temporarily pulling hundreds of highly qualified doctors off the front lines — and potentially triggering even more infection, critics charge.
Trainee physicians at the end of their five-year residencies must take their final written and oral exams this spring, or defer the assessments and their careers for a year, the Royal College of Physicians and Surgeons has ruled.
The licensing agency cancelled oral exams for the 2020 crop of graduating residents because of the pandemic.
But it's insisting the assessments go ahead this year, amid even higher numbers of coronavirus cases and hospitalizations.
More than 1,000 residents have signed a petition urging the college to reverse its decision. Held at hotels, the exams not only draw much-needed resources away from COVID-burdened hospitals, but could themselves become “high-risk” hubs of coronavirus spread, they allege.
Many doctors already in practice are echoing their concerns.
“It's absolutely mind-boggling,” said Dr. Andrew Morris, an infectious-disease specialist at Toronto's Mount Sinai Hospital and University of Toronto professor.
“We need to train and evaluate our doctors really well, but we have to have one foot in the real world, and right now the pandemic is raging through most of Canada,” he said.
The exam decision “will have an impact on the residents and their families, (and it) will have an impact on the care patients receive.”
Although the oral exams take only a day or so, many residents are given four days off work to prepare for them and the written tests, and another eight days in the runup to the exams — 16 days away from clinical work, noted Dr. Franco Rizzuti, a public-health medicine resident at the University of Calgary.
“This really doesn't make any sense,” he said. “We're in the highest, peak surge of this pandemic to date.”
Residents and other doctors argue that assessments done throughout the five years of training ensure specialists certified without a final exam would still be fully competent and knowledgeable.
But the Royal College strongly defended its decision Tuesday, noting that it carefully considered all the feedback, even providing a summary of emails and the petition to its governing council. The council and its education committees are made up of practising doctors, it noted.
In the end the body concluded it could safely meet its obligations to the public by delivering the oral exams.
“This was an extremely difficult decision for us to make,” the organization said in a statement. “We needed to consider both our ability to safely deliver exams, while maintaining our public duty to assess and certify the competence of specialist physicians and surgeons.”
The oral exams — written tests have already finished — are being held at hotels across Canada to prevent the need for moving between provinces, with each resident assigned to a separate room, said the agency.
It noted that trainees can defer their exams for a year.
But residents and other doctors maintain that's not a viable option, as it would mean professionals in their 30s and with considerable student debt putting their careers on hold for another 12 months.
Adding to the controversy, the Royal College did cancel the oral exams for internal-medicine residents — which includes infectious-disease specialists — after many physicians who act as examiners said they could not take time off to conduct the testing.
In an email last month, McMaster University's associate dean of postgraduate medical education told residents he had passed on their “very valid” concerns to the Royal College. Trainees have been left “feeling abandoned and questioning the decision-making,” wrote Dr. Parveen Wasi.
After graduating medical school, doctors in Canada must complete practical training — residencies — of two years for family doctors, five for specialists. The College of Family Physicians certifies family doctors at the end of their residencies, while the Royal College accredits specialists, more than 1,000 per year. Provincial colleges of physicians and surgeons then issue licences allowing doctors to practise in their particular jurisdiction.
Written exams are followed by oral tests conducted by experienced physicians.
Dr. Katrina Hui, the University of Toronto psychiatry resident who organized the petition. acknowledged the importance of the final exams. But she said residents are assessed and evaluated throughout their training and must pass the written exams just to be eligible for the oral segment. She pointed to average pass rates for the certification process that range from the mid-90s to 100 per cent for most specialties.
If it cancelled oral exams, the Royal College could also consult the residents' supervisors, and focus attention on any trainee doctors who might not be up to snuff, said Morris.
“If there was any one time to say 'Let's make an exception,' this is it.”
A resident at McMaster University, who asked not to be named to avoid possible negative repercussions, said she's been redeployed from her specialty to work in a COVID-19 hospital ward under stressful conditions.
With her professional responsibilities and a daughter in junior kindergarten, the resident said she could only study for the exams late at night or early in the morning.
“To proceed with an indoor exam at a time like this, when we are not fully vaccinated and all teetering on the brink of collapse, is dangerous.”