A couple of issues back we ran an article entitled "Trying...
and trying... to get my CCFP" (Vol 2, No 1), which
related the story of Ontario physician Dr Barbara Watts'
struggle to find out why, after 20 years of practise,
she'd been failed on the CCFP orals. The article clearly
struck a chord with readers; we were inundated with letters
and phone calls from other doctors frustrated with the
user-unfriendly certification process.
The general feeling seems to be
that the CCFP exam doesn't sufficiently take into account
a physician's experience or education. We decided to
try to find out why the Canadian College of Family Physicians
(CFPC), which administers the exam, seems to be so out
of step with its membership — and what they're
doing about it.
A major gripe among the practice-eligible
is the fact that courses on one of the CCFP's key requirements
— patient-centred clinical method — are hard
to find, costly and on the other side of the country
for many of you (a busy rural GP from northern BC who
contacted us took little comfort from news that the
only patient-centred clinical method course is held
in Toronto). Considering we're in the midst of a FP
shortage crisis and those we have are stretched to the
limit, it seems nothing short of scandalous that doctors
are expected to search out and then travel long distances
for the elusive basic resources they need to pass this
test.
THERE
IS ANOTHER WAY
Many of you will be interested to learn that Australia's
version of the CFPC has managed to find an examination
process to please its members. In 2000 the Royal Australian
College of General Practitioners (RACGP) established
the Practice Based Assessment (PBA) as an alternative
to the standard College exams with practice-eligible
physicians in mind.
What docs down under like about
PBA is that most of the assessments are conducted on
their own turf, instead of in a simulated clinical setting
like the CCFP. With PBA, the doctor submits a professional
portfolio which includes a practice profile, peer ratings
and a current CPR certificate. PBA also includes an
oral viva (a videotaped oral exam); a clinical visit,
during which the examiner observes the doctor in consultations
with their real patients (rather than actors); and assessment
of 35 hours of videotaped consultations.
Like the CFPC's, the RACGP's certification
process places a lot of emphasis on patient-centred
clinical method, but with one big difference. "The RACGP
recognizes that within our general practice system in
Australia, there are some doctors who have been working
in the field of medicine for some years with no previous
requirement for assessment," explains Dr Morton Rawlin,
director of educational services with the RACGP. He
adds that, "Some doctors don't perform well in traditional
exams, but function very well in a clinical setting."
OUT
OF TOUCH?
If Dr Watts' case and your feedback are any indication,
the CFPC isn't quite as attuned to the needs of physicians
as the RACGP. We took your grievances to the CFPC's
director of education, Paul Rainsberry, PhD. "It's a
challenge," he admits, "and we are working to put more
resources on our website and are encouraging our local
chapters to offer workshops." But in Dr Rainsberry's
opinion accusations that the CFPC is out of touch with
older doctors are unfounded — he insists the CFPC
has an incredibly flexible practice-eligible route.
"The opportunity is there for people and we aren't trying
to close any doors," he says.
Many practising physicians disagree
— and say they share Dr Watts' views. "They were
pleasant and polite," Dr Watts recalls, "but not the
least bit accommodating." She came away from her CCFP
experience feeling that she'd been set up.
On the topic of educational resources
in doctor-patient communication, which are limited to
Toronto, Dr Rainsberry points doctors in the direction
of two possible training grounds. The first, a 'choose-your-own-adventure'
style CME from McMaster, whereby groups of FPs get together
to discuss a range of topics including, in theory, patient-centred
clinical method, using teaching material provided by
the university. The other is a seminar based on the
theory of Hungarian-born physician-psychoanalyst Dr
Michael Balint, dealing with doctor-patient communication.
But Dr Rainsberry admits these seminars are rarely offered
in Canada.
For more on the Australian system,
visit www.racgp.org.au
(information about PBA under the Fellowship menu).
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