Medical Council of Canada

1. 95th Anniversary 1912 ~ 2007 Medical Council of Canada Recruiting for Success Canadian Association of Staff Physician Recruiters February 20, 2007

2. Code of Conduct for CASPR • To accurately and completely represent practice opportunities and communities to physician candidates. • To provide all of the pertinent information necessary to make an informed decision to both candidates and health care entities and communities. • To accurately and completely represent the candidates, their professional preparation, background, interests and expectations to the health care entity and the community.

3. Overview • Immigration changes and their impact on recruitment • The tradition of international medical graduates in Canada • Recent changes in Canadian Medical Education • Towards open and transparent assessment, licensure and certification • Challenges

4. UN estimate of net migration required to keep tax rate constant (106) (migrants – permanent & temporary)

5. Predictions from: Sharing the SpoilsTaxing International Human Capital Flows MA Desai, Kapur, D and McHale, J. NBER-NCAER Conference on Economic Reforms Dec. 2000 • Greater magnitude of immigration to ease the fiscal pressures of aging societies. • Increasingly selective about whom they seek and admit • Encouraging temporary immigration

6. Physician Movement – the change in physicians moving abroad

7. Where are the Physicians in Canada - 2004

9. 95th Anniversary 1912 ~ 2007 Medical Council of Canada International Medical Gradates contribution to Canadian Health Care

10. Canadian Post-M.D. Training Programsas a reflection of the country of origin for IMGGeographic Region or Country Where M.D. was Earned 1989 1994 1999 2004 Africa Europe Americas Oceania Asia Data Source: Canadian Post-M.D. Education Registry (CAPER)

11. Percentage of IMG Physicians15 year period

12. International Medical Graduatesin Canada http://secure.cihi.ca/cihiweb/products/Geographic_Distribution_of_Physicians_FINAL_e.pdf

13. International Medical Graduatesin Canada MIZ - metropolitan influence zone

14. Regulatory authority reporting source of MD degreeDeveloped vs. Developing Country

15. International Medical Graduate License type by province

16. Movement of Physicians in CanadaIMG compared to CMG (2005)

17. 95th Anniversary 1912 ~ 2007 Medical Council of Canada Changes in Canadian Medical Education

18. Changes in Canadian Enrolment

19. CAPER data showing first year residents

20. Ministry funded IMG residencies Source: CAPER Annual Census of Post-MD Trainees, 2005-2006

21. Canadian Citizens/Permanent Residents inCanadian Post-M.D. Training Programs Data Source: Canadian Post-M.D. Education Registry (CAPER)

22. Rank levels of graduates of Canadian Medical Schools compared to International Schools (IMG)

23. 95th Anniversary 1912 ~ 2007 Medical Council of Canada Towards open & transparent assessment, licensure and certification

24. Common Elements for Licensure • Verified documents showing graduation from an approved medical school • Medical Council Evaluating Exam • Medical Council Qualification exam Part I • Evidence of at least 12 months of postgraduate clinical education • Medical Council Qualifying exam Part II • Certification in CFPC or RCPSC

25. MCC -Historical and Projected Registration Volumes50.8% growth in projected volume between 2004 and 2009 18.5% Projected growth 2004-2006 ) 6% 24.4% Actual growth 2004 projection – 2006 actual ) over predictions 15,286 14,106 Actual 12,616 13,167 Actual 12,199 Actual 10,874 12,013 10,951 10,137 3,338 3,265 2,976 5,077 4,638 4,127 4,201 4,296 3,771

26. 95th Anniversary 1912 ~ 2007 Medical Council of Canada Predicting Success

27. MCCEE and MCCQE Part I

28. MCCQE Part I: Discipline Scores by Candidate Group

29. MCCEE and MCCQE Part II

30. IMGs Attempting Each MCC Exam and Number Passing

31. Assessment programs Outcomes 2005OPPORTUNITY LIMITED

32. 95th Anniversary 1912 ~ 2007 Medical Council of Canada Current Work- MCC

33. MCC PROJECTS - Highlights • Physician Credential Registry of Canada: • National Credentials Verification Center • Start-up July 3, 2007 • MCC – EE candidates • MRAs – NS + up to 20% of MRAs, + ? CFPC • Work with CAIR re: Canadians starting in 2008 • On-line MCCEE with AMC: • New Cut Scores in 2007 • New access in 2008 • C2LEO Objectives: available on MCC Web-site: • To include professionalism assessment • IMGs: - National Assessment Collaboration

34. NAC Assessment - common metrics • Centralized Banks - psychometrics • QA - MCC Clinical Period Regional orientation Assessment Modules Mini – CEX Case Based Discussion Demonstration of Procedures Refined 360 processes • Focused OSCE • History taking skills • Physical exam skills • Integration into Diff Dx • First steps in management • Communication and team participation • Therapeutics MCCEE -> MCCQE -1

35. NACZONES OF COMPETENCY • Common scoring • Common blueprints • Recognized standards ZONEOF COMPETENCIES FOR FULL OR PARTIAL LICENSURE ZONE OF COMPETENCIES FOR POSTGRADUATE TRAINING CLINICAL PERIOD FOCUSED OSCE MCCEE + MCCQE - 1 Alternate Career

36. Challenges as we go forward • Professionalism (meeting society’s needs) • Manage expectations of the IMG • Improve transparency for Licensure • Improve integration into the health system • Continue capacity building: • Assessment • Clinical placement • Postgraduate experience

37. 95th Anniversary 1912 ~ 2007 Thank You

38. Regular ministry funded trainees: comparison with the total # post MD trainees

39. ACGME CompetenciesSUGGESTED BEST METHODS FOR EVALUATION

40. MCC Planning Activities New approaches to assessment in light of IMG developments and the implications of harmonization • hybrid models, modules, etc • MCC assisting assessment, providing training, provide quality assurance • Measurement of professional behaviors

41. Features of the NAC Assessment • Common metrics • Common standards for each individual exit point • Entry into full practice acceptable for each provincial regulatory authority • Entry into restricted practice to be determined by individual regulatory authorities • Entry into postgraduate education programs, either truncated or full residency • Opportunities for alternate basic education or career will vary from province to province

42. Features of the NAC Assessment • Common Banks • MCCQE part I managed and sustained through MCC • IMG OSCE item bank maintained by MCC with scoring and standard setting accomplished centrally through a consultative process • Clinical Assessment Modules developed through MCC, with scoring and standard setting accomplished centrally through a consultative process

43. Features of the NAC Assessment • Delivery Managed Collaboratively between MCC and a Region or Provincial Authority • Examinations or modules provided by MCC as banker • Psychometrics and Bank maintenance provided by MCC as service • Education and training for delivery sites available through MCC as a service • Quality Assurance monitoring by MCC as a requirement for acceptability across the country • Regional or Provincial delivery with support as required from MCC

44. Discussion …. Thank You!