Qualifications required to work as resident physicians

IMGs:  Canadians who are international medical graduates must pass the MCCQE1 (Medical Council of Canadian Qualifying Examination Part 1) and NAC OSCE (National Assessment Collaboration Objective Structured Clinical Examination) before being eligible to compete for a job as a resident physician.  Passing these exams determines that the individual has met the national standard of medical knowledge and clinical skills.  Realistically an IMG must excel in these exams to be considered for an interview and to match to a residency position.

CMGs:   Canadians who are graduates of Canadian and American medical schools never have to take the NAC OSCE.  They take the MCCQE1, but only after the competition for residency positions is over.  CMGs are free to work as resident physicians even if they fail the MCCQE1.  The Medical Council of Canada reports that each year between 3% and 5% of graduates of Canadian medical schools fail the MCCQE1. 

Visa Trainees:  Non-Canadians who purchase residency positions from the universities and ministries of health (visa trainees), do not have to take the NAC OSCE in any province.  In some provinces, visa trainees must pass the MCCQE1 to qualify to work as resident physicians, but not in all.  In British Columbia for instance visa trainees do not have to pass any competency examinations to work as resident physicians.

Medical Council of Canada Qualifying Examination Part 1

The Medical Council of Canada describes the MCCQE1 as: “The MCCQE Part I is a one-day, computer-based test that assesses the critical medical knowledge and clinical decision-making ability of a candidate at a level expected of a medical student who is completing their medical degree in Canada.”

National Assessment Collaboration Objective Structured Clinical Examination

This examination is described by the Medical Council of Canada as being designed to “evaluate an IMG’s clinical skill at the level of a Canadian medical graduate entering postgraduate training.”  More specifically it assesses:

a. A candidate’s clinical skills, knowledge, and behaviours at a level of a recent Canadian medical graduate ready to begin postgraduate medical training including history taking, physical examination, ability to identify relevant concerns and symptoms;

b. Problem solving in various facets of medicine including family medicine, pediatrics, psychiatry, and internal medicine (amongst other areas);

c. Characteristics and components necessary for effective clinical practice including for example:

   i. attitude including demonstration of interest and attentiveness;

   ii. demonstration of respect for the patient;

   iii. characteristics and interpersonal skills relevant to putting patient at ease including establishing rapport and patient comfort, obtaining appropriate consents, and presenting with warmth and empathy;

   iv. language fluency;

   v. communication skills;

   vi. investigation skills and ability to elicit and provide relevant information necessary to develop diagnosis and treatment plan including;

       a. history of presenting problem such as onset of symptoms, duration, and other factors relevant to the presentation;

       b. past medical history;

       c. symptoms which may be relevant to presentation and diagnosis;

       d. information about lifestyle that may be relevant; and

       e. management of uncertainty.

   vii. organization and efficiency of interviewing and eliciting information from patient;

   viii. organization and efficiency of providing information to patient including diagnosis, plan, and recommended treatment;

   ix. ability to focus;

   x. ability to elicit and present information logically, purposefully, and accurately;

   xi. problem solving; and

   xii. ethics.