WHAT HAPPENED NEXT: CCFP CONTROVERSY

A doctor-centred approach to CCFP

College exam gets a rethink to better accommodate practice-eligible MDs

By Sam Solomon

For practice-eligible physicians who want to become Certificants of the College of Family Physicians (CCFP), it sometimes feels like the odds are stacked against them just because of their age. Now the College has let us know they’re overhauling the exam process to level the field for older docs.

AGIST EXAM?
NRM readers have repeatedly told us the test is unfair to older physicians (see our past CCF P articles on our website). They say MD s who qualified before 1992 (when family medicine residencies became the standard) didn’t get training in one of its key tenets — patient-centred care — in medical school. And now, even if they want to learn the method, it’s hard to find courses to help them prepare for the exam. (For a listing of what’s available now, see “CCFP exam prep courses,” left.)

But Paul Rainsberry, director of the CFPC education committee, takes umbrage at the suggestion that there’s not enough CCFP exam prep training available for these docs. “There’s been this impression that we have this sort of detailed, secret approach that we only teach the residents, but that’s misleading. What is taught to the residents is available on our website and through the literature and through workshops at the University of Toronto, for example,” he says. “It’s not rocket science or anything,” he adds, referring to the patient-centred care method, “but it is a sophisticated, well-accepted way of dealing with patient problems.”

Canadian-trained practice- eligible physicians tend to struggle most with the written portion of the exam, says Dr Jean Rawling, who recently took over the job of running the University of Calgary’s CCFP exam prep course. For older doctors, the length of time since they got their medical degrees can be a source of anxiety about sitting a clinical exam.

FAILING GRADES
Despite several vocal physicians’ complaints, says Mr Rainsberry, the notion that CCFP exam failures are endemic among practiceeligible Canadian doctors is a fallacy.

Mr Rainsberry refuses to divulge the College’s statistics on CCFP pass-fail rates for practice-eligible Canadian physicians, saying he’s “not sure they’re helpful” and “would be easily misunderstood.” The small number of practice-eligible applicants — just nine nationwide this year — means the pass-fail rate varies greatly from year to year. By contrast 81 IMGs sat the exam last year. He says residency-eligible candidates have a failure rate of “under 10%” and that practice-eligible candidates do “a little worse” on average, but that most doctors who want the CCFP designation are able to pass the exam by sitting it again.

EXAM REFORM
But the low number of Canadian-trained practiceeligible physicians taking the exam has long been recognized as a problem for the CFPC. Mr Rainsberry’s education committee is now in the process of a major review, in the interest of attracting more physicians to apply.

No reforms have been finalized yet, but Mr Rainsberry says one possibility the committee is considering is the Australian model, which provides an alternate route to certification for practiceeligible candidates called the Practice Based Assessment, which eliminates the written element of the exam. “We’re looking at bringing people into the College in a less intimidating way for older physicians,” says Mr Rainsberry.

The committee’s reforms will not reduce the price of the exam or the preparatory work. The changes, some of which will be announced this fall and others early next spring, says Mr Rainsberry, mean that the new CCFP exam “may not necessarily be the same exam.”