ABSTRACT
One of the routes for entry into practice for international medical graduates (IMGs) in Canada entails completing some form of an in-practice assessment program. The latter route is referred to as practice ready assessment and is the focus of the present investigation.
A pan-Canadian practice ready assessment process is currently being designed to evaluate IMGs' practice readiness. The selection of candidates who will not only have the highest likelihood of successfully completing the practice-ready assessment program but who will also attain specialty certification is of paramount importance. Our study focused on assessing how well practice-ready assessment candidates' performance on Medical Council of Canada (MCC) examinations and four demographic variables could predict both their score and pass fail status on the College of Family Physicians' (CFPC) certification examination.
Data from 132 practice-ready assessment candidates were analyzed and indicate that MCC Qualifying Examination Part 1 scores, gender and age were significant predictors of both pass/fail status (p<0.05) as well as scores (p<0.01) on the short-answer management problems component of the family medicine certification examination.
This study provides initial validity evidence for using the MCCQE Part I as a selection tool for practice-ready assessment. Practice-ready assessment programs across Canada might consider adopting the set of standardized predictors examined in this investigation, in addition to other measures, in an effort to better promote a pan-Canadian model.
Introduction
Canada, like Australia, the UK and the United States, relies on an important cadre of internationally trained physicians to better serve the health care needs of a growing and culturally diverse population, especially in under-serviced areas.1–4 Data from the 2014 Canadian Medical Association Masterfile indicates that 23.2% of the approximately 75,000 practicing physicians in Canada were trained abroad, with the largest number of international medical graduates (IMGs) concentrated in Saskatchewan (54.0%) and Newfoundland and Labrador (40.6%).5
Since the report of the IMG Task Force in 2004, it has been recognized that Canada has a fragmented approach to assessing and integrating IMGs.6 This is further compounded by the fact that many listed medical schools around the world have curricula and/or monitoring processes that are unknown to medical regulators in Canada. Consequently, the latter regulators rely on Canadian assessment processes to provide sufficient information about a candidate to determine their readiness to enter clinical practice in Canada. There is consensus that point-in-time assessments of medical knowledge and clinical skills are not sufficient to permit direct entry into practice and that those prospective medical practitioners should be objectively observed in a realistic clinical environment.
Pathways to Licensure in Canada for International Medical Graduates
Currently, IMGs can avail themselves of three general routes for entry into practice in Canada. All of these pathways are based on a screen of their credentials and include: (1) obtaining licensure directly through a determination that their credentials are equivalent to Canadian standards (i.e., IMG specialty certification credentials are accredited by the College of Family Physicians of Canada — CFPC) — or the Royal College of Physicians and Surgeons of Canada; (2) completing Canadian postgraduate training based on the determination that the IMG does not possess sufficient postgraduate training and; (3) entering some form of in-practice assessment program for IMGs, as he or she has completed acceptable postgraduate training and/or has been a practicing physician outside of Canada. The latter route is referred to as practice ready assessment and is the focus of the present investigation.
Practice-ready Assessment in Canada
In Canada, practice-ready assessment is used to determine whether an IMG has the requisite competencies to enter medical practice. “Practice ready” is an indication to a medical regulator that an IMG is qualified to enter medical practice in the capacity of a most responsible physician under a provisional medical license, with the clear proviso that supervision and summative assessments constitute a significant component to meet the final requirements for full medical licensure.
In 2013, approximately 300 IMG physicians were assessed through existing practice-ready assessment programs which are currently offered in family medicine and/or other specialties across seven jurisdictions. The tools used in practice-ready assessment include both a point-in-time assessment, such as the Medical Council of Canada's Evaluating Examination (MCCEE), and a series of over-time workplace-based assessments, such as multisource feedback, chart review, mini-clinical evaluation exercise, field notes and direct observation of procedural skills, in an effort to determine whether an IMG is qualified to enter medical practice as a most responsible physician with a provisional medical license.
WHILE THESE PRACTICE-READY ASSESSMENT PROGRAMS WERE DEVELOPED RELATIVELY INDEPENDENTLY ACROSS JURISDICTIONS, THERE ARE ENOUGH COMMONALITIES AMONGST THE PROCESSES TO FORM A BASIS FOR A PAN-CANADIAN MODEL .
While these practice-ready assessment programs were developed relatively independently across jurisdictions, there are enough commonalities amongst the processes to form a basis for a pan-Canadian model. In fact, pan-Canadian practice-ready assessment is seen as a natural evolution of the processes that have been created in each jurisdiction to meet health human resource needs. The future practice-ready assessment model must be fair, transparent, sustainable, consistent and comparable across the country. Furthermore, the public should expect to receive the same standard of care regardless of where the IMG might have completed their practice-ready assessment.
Practice-ready Assessment Experiences throughout the World
Other practice-ready assessment programs have reported somewhat mixed results with regard to the IMG's readiness to enter the workforce. However, these differences could be explained by divergences in program structures and a failure to recognize the array of challenges faced by IMGs. The Collège des Médecins du Québec, the regulatory authority in that Canadian province, conducted a retrospective study which compared IMG and Canadian Medical Graduate pass rates on both their provincial certification examination as well as the one offered nationally by the CFPC.7 Regardless of the examination, pass rates were significantly lower for IMGs, despite residency program orientation and support for those candidates.7 Similarly, a study conducted in Israel, aimed at evaluating predictors of practice-ready assessment program success for IMGs educated in the former Soviet Union, reported that the latter physicians were significantly lagging behind Israeli trained doctors in a number of competencies, including medical knowledge, research capability, diagnostic skills and doctor-patient relationship.8
On the other hand, a workplace-based practice-ready assessment program aimed at integrating IMGs into Australian medical practice has been successfully piloted and implemented over the past few years.9 Two pathways for registering as practicing physicians in that country are available to IMGs. The more traditional route entails passing both a multiple-choice examination and an objective structured clinical skills examination (OSCE), both administered by the Australian Medical Council. However, an alternative workplace-based pathway, which is founded on a six-month assessment process in a clinical setting and includes mini-clinical evaluation exercises, case-based discussions, multisource feedback as well as in-training assessments, is also available.9 A preliminary study indicated that all participating IMGs successfully completed the program based on a number of pre-determined criteria.9 Though the cost of the latter program for an individual candidate is high (about AUD $16,000), the program has been successful in producing a large number of physicians deemed competent for entry into the Australian medical workforce.10 A pilot program conducted with IMGs in the area of pain management and palliative medicine in the United States similarly concluded that a 4-week course composed of both an educational component and weekly assessments positively impacted levels of concern, knowledge and self-assessed competence with a cohort of 21 IMGs.11 A follow-up study conducted in Québec by MacLellan et al. concluded that IMGs who completed a clerkship pathway, i.e., who completed the final two years of the MD degree in Québec prior to undertaking their postgraduate training, performed as well as Canadian Medical Graduates on the certification examination in Family Medicine.12 The authors surmise that the clinical exposure gained by IMGs as a result of adding two years' worth of undergraduate medical education prior to residency allowed these candidates to “learn and consolidate clinical medical skills in the appropriate structured environment” (p. 667).
The disparity in the results reported by some of these IMG practice-ready efforts underscores a number of key issues which are critical to the success of any such program. First, the importance of acculturating the IMG to both their new medical and social milieus cannot be understated.13 Wong and Lohfeld3 identified the themes of loss, disorientation and adaptation as those typically experienced by IMGs as they transition to medical practice in Canada. In fact, several IMG practice-ready assessment programs have strongly underscored the need for mentorship to ensure that the candidate can successfully integrate not only in Canadian medical practice but also the community at large.14–16
...SEVERAL IMG PRACTICE-READY ASSESSMENT PROGRAMS HAVE STRONGLY UNDERSCORED THE NEED FOR MENTORSHIP TO ENSURE THAT THE CANDIDATE CAN SUCCESSFULLY INTEGRATE NOT ONLY IN CANADIAN MEDICAL PRACTICE BUT ALSO THE COMMUNITY AT LARGE.
A second critical factor to increase the likelihood of success of any practice-ready assessment program for IMGs is a strong screening process to ensure the selection of those candidates who are most apt to effectively complete practice-ready assessment as well as function as a most responsible physician in the community. Findings from several studies indicate that success on specialty board written examinations for those IMG candidates who have completed a practice-ready assessment-like process is highest for those programs that implemented strong selection criteria.7,8,17 In fact, past studies suggest that supplementary teaching hours as well as orientation, while helpful, cannot make up for serious lags in both affective and cognitive domains for those programs that implement little to no screening.7,8
Purpose
The purpose of the present study was to assess the usefulness of Medical Council of Canada (MCC) examination scores as well as a number of educational/socio-demographic variables in predicting both scores and pass/fail standing on each component of the CFPC's Family Medicine certification examination by performing a retrospective analysis on a sample of IMGs who had successfully completed a practice-ready assessment program in Canada. Additionally, we modeled time to passing each component of the CFPC examination as a function of the same predictors using a survival data analysis model. The outcomes of this study could provide valuable evidence to guide the selection of appropriate screening tools for all practice-ready assessment programs to ultimately ensure that candidates' likelihood of success, both in practice-ready assessment and as most responsible physicians, is maximized.
Method
Sample
Our data set included a sample of 132 candidates who had successfully completed a practice-ready assessment program between 2007 and 2011 and attempted the CFPC's certification examination in Family Medicine by the end of 2012. Unique identification numbers were sent to the Canadian Post-M.D. Education Registry, who subsequently provided us with aggregate-level, de-identified data for our sample of 132 practice-ready assessment candidates. The latter organization was established in 1986 through the cooperation of a number of Canadian organizations (including the MCC and the CFPC) and collects data for all residents and fellows from all 17 Canadian Faculties of Medicine. The practice-ready assessment programs, the MCC and CFPC provided the Canadian Post-M.D. Education Registry with data for these 132 candidates in an anonymous fashion. They then merged and de-identified the data across all sources. This study was approved by the Ottawa Hospital Research Ethics Board.
Our sample included 81 male practice-ready assessment candidates (61.4%) and 51 (38.6%) female candidates. Forty-five candidates (34.1%) reported completing their MD degree in English whereas 87 candidates (65.9%) reported a language other than English. The mean age of candidates at entry into practice-ready assessment was 40.86 years with a standard deviation equal to 6.66 years. Finally, the mean number of years from obtaining the MD degree to entering a practice-ready assessment program was equal to 16.15 years with a standard deviation of 6.49 years. The demographic makeup of our sample strongly resembles similar IMG cohorts who have completed postgraduate medical education in Canada.18
THE DEMOGRAPHIC MAKEUP OF OUR SAMPLE STRONGLY RESEMBLES SIMILAR IMG COHORTS WHO HAVE COMPLETED POSTGRADUATE MEDICAL EDUCATION IN CANADA.
Variables
The independent variables or predictors in our statistical models included: (1) the most recent score on the MCCEE; (2) the most recent score on the Medical Council of Canada's Qualifying Examination Part I (MCCQE Part I); (3) gender; (4) age in years of the candidate at the start of the practice-ready assessment process; (5) years since obtaining the MD degree at the start of the practice-ready assessment process and; (6) language in which the MD degree was completed, i.e., English or Other. The outcomes or dependent variables in our models included: (1) the most recent score on the CFPC's simulated office orals component of the certification examination in Family Medicine; (2) the most recent score on the short-answer management problems component of the Family Medicine certification examination; (3) pass/fail status on the most recent simulated office orals attempt and; (4) pass/fail status on the most recent short-answer management problems attempt.
The MCCEE is a four-hour, computer-based examination offered in both English and French at more than 500 centers in 80 countries worldwide. IMGs must take the MCCEE as a prerequisite for eligibility to the Medical Council of Canada Qualifying Examinations. The MCCEE is composed of 180 single-best answer multiple-choice questions and is a general assessment of the candidate's basic medical knowledge in the principal disciplines of medicine. The MCCQE Part I is a one-day, computer-based test that assesses the competence of candidates who have obtained their medical degree for entry into supervised clinical practice in postgraduate training programs. It is one of the requirements for enrollment into the Canadian Medical Registry as a licentiate of the Medical Council of Canada. The MCCQE Part I is administered in two multi-week windows at over a dozen dedicated secure sites across Canada. The first part of the MCCQE Part I is composed of 196 single-best answer computer-delivered multiple-choice questions (3.5 hours) whereas the second part includes about 60 clinical decision-making cases (4.0 hours).
The CFPC's certification examination in Family Medicine includes five simulated office orals which assess both the definition and management of health problems in a patient-centered approach. A physician examiner acts both as patient and examiner in the simulated office orals component. The exam also includes 30–40 short-answer management problems which measure a candidate's problem solving skills and knowledge in the context of a clinical situation.
Analyses
Separate logistic regression analyses were run to predict pass/fail status on the CFPC simulated office orals and short-answer management problems components as a function of the practice-ready assessment candidate's most recent MCCEE and MCCQE Part 1 scores, gender, age in years at the start of the practice-ready assessment process, years since obtaining the MD degree at the start of the practice-ready assessment process and language in which the MD degree was completed. Similarly, two separate multiple linear regression models were fit to our practice-ready assessment dataset to predict the score on each of the CFPC certification examination component as a function of the same predictors.
One novel analytic technique employed in the present research entailed modeling whether the number of attempts required for passing each component of the CFPC certification examination was a significant predictor of pass/fail stratus. More specifically, given the discrete nature of the outcome variable (candidates only have two opportunities per year to attempt the CFPC certification examination as it was only administered twice a year), we applied a logit-linear survival model to assess whether the number of attempts needed to pass each component significantly accounted for pass/fail status on each of the Family Medicine certification examination components in addition to our other predictors.
Results
Predicting the Odds of Passing Each CFPC Exam Component
Table 1 provides the results from the final logistic regression models for predicting pass/fail status on the short-answer management problems component of the CFPC certification examination. Results of the logistic regression analyses for predicting pass/fail status on the simulated office orals component are not provided as none of the independent variables significantly predicted the odds of passing this section of the CFPC certification examination.
Final Logistic Regression Results: Predicting Short-answer Management Problems Pass/Fail Status as a Function of Gender, Most Recent MCCQE Part 1 score and Age at Start of Practice-ready Assessment
The model obtained with the short-answer management problems component significantly accounted for pass/fail status, L2(3)= 24.03, p<0.0001. Specifically, gender, the most recent MCCQE Part 1 score and age at entry into practice-ready assessment were significantly associated with the odds of passing this component. The odds of passing the short-answer management problems component for male practice-ready assessment candidates was 0.194 times what it was for corresponding female candidates. With each increase of one point on the MCCQE Part I (scores range from 50–950), the odds of passing the short-answer management problems component increased by 1.020. Finally, the odds of passing the CFPC short-answer management problems component decreased by 0.917 with each increase of one year in age of the practice-ready assessment candidate.
WITH EACH INCREASE OF ONE POINT ON THE MCCQE PART I (SCORES RANGE FROM 50–950), THE ODDS OF PASSING THE SHORT ANSWER MANAGEMENT PROBLEMS COMPONENT INCREASED BY 1.020.
Predicting Scores on Each CFPC Exam Component
Table 2 provides the results from the final multiple linear regression models that were fit to our practice-ready assessment data set to separately predict scores on the simulated office orals and short-answer management problems components of the CFPC certification examination. As was the case with the logistic regression analysis, the model that was run for the simulated office orals component, while statistically significant, was very weak and accounted for only 6% of the variance in simulated office orals scores, (F(3,128)=9.08; p<0.01). On average, female candidates outperformed their male counterparts by about 3.3% (N.B.: Both the simulated office orals and short-answer management problems scores in this study were reported on a percent-correct scale).
Final Multiple Regression Results: Predicting Simulated Office Orals and Short-answer Management Problems Scores as a Function of Gender, Most Recent MCCQE Part 1 score and Age at Start of Practice-ready Assessment
Findings obtained for the short-answer management problems component mirror results reported in the previous logistic regression analysis. This regression model accounted for a significant proportion (38%) of short-answer management problems score variance; F(3,128)=27.91; p<0.0001. Female practice-ready assessment candidates outperformed male candidates by about 2.57%; an increase of one point in MCCQE Part 1 score was associated with an increase of 0.04% on the short-answer management problems component and finally; short-answer management problems scores decreased by 0.17% with each increase of one year in age of the practice-ready assessment candidate.
...WITH REGARD TO THE SHORT-ANSWER MANAGEMENT PROBLEMS COMPONENT, ONLY GENDER AND THE MOST RECENT MCCQE PART 1 SCORE SIGNIFICANTLY PREDICTED PASS/FAIL STATUS.
Predicting Number of Attempts Needed to Pass Each CFPC Exam Component
Table 3 provides the results of logit-linear survival models that were separately estimated for each CFPC exam component to assess whether the number of attempts was associated with passing or failing each section of the exam, in addition to the other predictors in the model. With respect to the simulated office orals component, both gender and the number of attempts significantly predicted pass/fail status, L2(7)=37.90, p<0.0001. As previously reported, female candidates were significantly more likely to pass the short-answer management problems component than their male counterparts. Also, for first-time repeating candidates, the odds of passing the simulated office orals component on the 2nd attempt was 3.3 times higher than on the initial attempt.
Final Survival Model Results:
Predicting Simulated Office Orals and Short-answer Management Problems Pass/Fail Status as a Function of Gender, Most Recent MCCQE Part 1 score, Age at Start of Practice-ready Assessment and Number of Attempts
Finally, with regard to the short-answer management problems component, only gender and the most recent MCCQE Part 1 score significantly predicted pass/fail status; L2(4)=37.55, p<0.0001. Unlike the simulated office orals component, repeating the short-answer management problems section does not significantly increasing the odds of passing on subsequent attempts. Male practice-ready assessment candidates were 0.360 times as likely to pass the short-answer management problems component as their female counterparts; the odds of passing the short-answer management problems section improved by 1.018 with each increase of one score point on the MCCQE Part I exam.
PHYSICIANS TRAINED ABROAD HAVE PLAYED, AND WILL CONTINUE TO PLAY, A CRITICAL ROLE IN THE CANADIAN MEDICAL LANDSCAPE BY MEETING THE HEALTH CARE NEEDS OF A SIGNIFICANT PROPORTION OF THE POPULACE.
Discussion
Physicians trained abroad have played, and will continue to play, a critical role in the Canadian medical landscape by meeting the health care needs of a significant proportion of the populace. Due to the diversity of IMGs, it is critical that fair, transparent, sustainable and consistent assessment practices be put in place across the country. A patient should expect comparable quality of care from a provisionally-licensed physician who has gone through practice-ready assessment as they would expect to receive from a fully-licensed physician, irrespective of the province or territory.
The present study was aimed at providing evidence to support and inform a critical phase of the practice-ready assessment process to all programs, that is screening, in the hopes of better informing a pan-Canadian strategy that will ultimately be beneficial to IMGs, medical regulators and the Canadian public in the most cost-effective manner. Admitting candidates who have a high likelihood of not only completing the practice-ready assessment program but functioning as a fully licensed and certified physician in the community is a prime consideration for all jurisdictions.
Given the emphasis on primary care needs, our investigation focused on the extent to which a set of standardized examination and socio-demographic variables was helpful in predicting performance on a national family medicine certification examination for a sample of practice-ready assessment candidates. The use of standardized examination scores as predictors in our study seemed warranted in light of past research which showed that performance on licensing and certification exams was significantly related to a number of indices of preventive care as well as acute and chronic disease management in a primary setting, four to seven years into practice.19
A PATIENT SHOULD EXPECT COMPARABLE QUALITY OF CARE FROM A PROVISIONALLY-LICENSED PHYSICIAN WHO HAS GONE THROUGH PRACTICE-READY ASSESSMENT AS THEY WOULD EXPECT TO RECEIVE FROM A FULLY-LICENSED PHYSICIAN.
Our findings demonstrated little to no relationship between our predictors and scores on the performance component of the family medicine certification exam (the simulated office orals component). These results were not entirely unpredictable given that the MCCEE and MCCQE Part I examinations tap heavily into cognitive abilities as opposed to communication and other important affective competencies. Findings suggest that an OSCE might be a better predictor of performance on the simulated office orals component given the similarities in targeted domains. An investigation aimed at assessing whether performance on the National Assessment Collaboration Examination (an OSCE designed for IMGs seeking entry into post-graduate training in Canada) can further inform the practice-ready assessment process was recently completed.
...OUR FINDINGS SUGGEST THAT A NUMBER OF COMMON VARIABLES CAN SIGNIFICANTLY PREDICT PERFORMANCE ON A PROBLEM-SOLVING-IN-CLINICAL-CONTEXT COMPONENT OF THE FAMILY MEDICINE CERTIFICATION EXAMINATION IN CANADA.
However, our findings suggest that a number of common variables can significantly predict performance on a problem-solving-in-clinical-context component of the family medicine certification examination in Canada. Younger, female practice-ready assessment candidates who do well on the MCCQE Part I exam tend to score significantly higher on the short-answer management problems component of the CFPC certification exam than their older, male counterparts with lower scores on the MCCQE Part I exam. These results mirror those reported with other IMG cohorts in Canada and the United States.18,20
Of particular importance is the strong relationship that existed between the most recent score on the MCCQE Part I and performance on the short-answer management problems component of the family medicine certification examination. While the MCCEE was a not significant predictor of the latter outcome, it is important to underscore that practice-ready assessment candidates are currently admitted on the basis of performance on that predictor. Consequently, a restriction of range effect noted for MCCEE scores in all likelihood accounted for its weak predictive power in our models. This does not, in any fashion, discredit the current use of the latter exam as part of the practice-ready assessment screening toolkit.
From a practical standpoint, our findings suggest that all Canadian practice-ready assessment programs should consider adopting the MCCQE Part I as a valuable, additional screening measure in their toolkit. Results from the short-answer management problems logistic regression model, for example, show that the odds that a practice-ready assessment candidate passes the CFPC short-answer management problems component increases by 2% for each increase of one point on the MCCQE Part 1 score. Similarly, an increase of one point on the MCCQE Part I results in a 0.04% short-answer management problems score increase.
To illustrate, consider two thirty-year-old male candidates applying for a practice-ready assessment Canadian program, with respective MCCQE Part 1 scores of 290 and 490 (the pass mark is 390). The odds of passing the practice-ready assessment program are respectively equal to 0.20 and 0.90 for each applicant. Similarly, their short-answer management problems scores would be respectively predicted as 60.7% and 68.7% which constitutes more than a full SD difference. Given the high cost and competiveness associated with the practice-ready assessment route, we feel that the latter information, used judiciously and concurrently with other markers, could significantly contribute to the establishment of a defensible and cost-effective pan-Canadian practice-ready assessment process and ultimately ensure patient safety.
Modeling the number of attempts required to pass each component of the Family Medicine certification exam is a unique contribution of this research. One can imagine comparing the following two candidates who both successfully completed the CFPC components: candidate A passed on their first attempt whereas it took four attempts for candidate B to meet the pass/fail standard. The latter information might be critical to consider in a highly competitive decision-making process. Our findings suggest that repeating the CFPC certification examination is beneficial solely for the simulated office orals component. One might conjecture that given the unique nature of the simulated office orals, a greater level of familiarity towards what might constitute a novel testing modality for the practice-ready assessment IMG and increased preparation on the part of the candidate on their second attempt significantly improves performance. However, retaking the short-answer management problems component of the exam did not lead to similar increases for the cohort under study.
MODELING THE NUMBER OF ATTEMPTS REQUIRED TO PASS EACH COMPONENT OF THE FAMILY MEDICINE CERTIFICATION EXAM IS A UNIQUE CONTRIBUTION OF THIS RESEARCH.
Though encouraging, our results need to be interpreted in light of a number of caveats. First, our findings are based on a modest practice-ready assessment sample. Therefore, future studies should aim to corroborate or refute the results reported in this paper. Second, our analyses were conducted separately for each component of the CFPC certification examination. In reality, the standard is conjunctive in nature, i.e., candidates need to successfully pass both the clinical (simulated office orals) and short-answer management problems components, in addition to completing an accredited family medicine residency. However, given the unique formative and diagnostic nature of practice-ready assessment, we felt it more congruent to the overall philosophy of the process to adopt a similar tailored emphasis by focusing on the usefulness of our models in predicting each distinct set of competencies (i.e., simulated office orals and short-answer management problems).
...OUR FINDINGS PROVIDE SOLID INITIAL EMPIRICAL EVIDENCE TO FURTHER THE DEVELOPMENT OF A PAN-CANADIAN PRACTICE-READY ASSESSMENT STRATEGY, MOST NOTABLY AT THE INTAKE PHASE .
Despite these limitations, we feel that our findings provide solid initial empirical evidence to further the development of a pan-Canadian practice-ready assessment strategy, most notably at the intake phase. Our future efforts will be centered on validating the use of a comparable toolkit of workplace-based assessments, which are at the heart of the practice-ready assessment process, in an effort to provide standards that can be considered by all programs across the country. This greater level of standardization at all phases of practice-ready assessment will ultimately contribute to a fair, comparable and equitable process for candidates, medical regulators and members of the public.
Acknowledgments
The authors wish to thank the following individuals for their support in completing this research: Dr. Claire Touchie for her valuable assistance in obtaining ethics approval for this research investigation; Mr. Stephen Slade, Vice President, Data and Analysis, Director of CAPER, for his assistance in creating the data set that was used in this study; and Dr. Paul Rainsberry for his support in obtaining CFPC examination data.
About the Authors
↵André F. De Champlain, PhD, is Acting Director, Research and Development, at the Medical Council of Canada.
↵Cindy Streefkerk is Project Consultant, Medical Council of Canada.
↵Marguerite Roy, PhD, is Medical Education Researcher, Research and Development, at the Medical Council of Canada.
↵Fang Tian, PhD, is Research Psychometrician, Research and Development, Medical Council of Canada.
↵Sirius Qin, MS, is Research Analyst, Research and Development, at the Medical Council of Canada.
↵Carlos Brailovsky, MD, MA Ed, MCFPC, is Emeritus Professor, Laval University, College of Family Physicians of Canada.
- Copyright 2014 Federation of State Medical Boards. All Rights Reserved.
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