Dear Colleagues,

Since 1929, the Royal College has existed to establish and maintain the highest standards in specialty medical education and professional practice. To that end, it’s vital that we continue to develop programs and policies so that all specialists and subspecialists practising in Canada can be assessed against one common standard of competence.

However, over the past decade, various factors have driven the provinces to increasingly meet their specialist physician resource gaps through other means, including internationally-trained physicians. Currently, we estimate that there are 1,500 or more “non-Royal College certified” specialists and subspecialists, licensed by provincial regulators and currently practising in Canada.

Given this reality, we need to assert the importance of our role in defining Canada’s national standard for medical expertise, while also demonstrating our leadership by being more adaptable and innovative. We are taking a three-pronged strategic approach to address this situation by

  • developing programs that close the gap between no Royal College assessment for practising non-certified specialists and subspecialists, and the standard traditional Royal College examination;
  • collaborating with medical regulatory authorities to ensure they are aware of the Royal College’s approved mechanisms for assessment against one national standard; and
  • actively raising public awareness of the importance of Royal College Fellowship and the significance of the FRCPC and FRCSC designations.

Closing the assessment gap – fulfilling our professional responsibility

In February 2010, Royal College Council approved the Practice Eligibility Route (PER) to certification, which is targeted to internationally-trained physicians who are already licensed and practising as specialists in Canada, but who are not certified by the Royal College. PER offers two equally rigorous routes for examining candidates’ competencies in primary specialties:

  • Route A – the traditional Royal College certification exam; and
  • Route B – an in depth practice-based examination/assessment that will cover the candidates’ declared scope of practice, as well as generic competencies for that specialty.

Route A is now open to all specialties, and to date, 15 specialties are in the process of developing their scope-of-practice documents.

I would like to take this opportunity to thank the members of the Psychiatry Specialty Committee, who are partnering with the Royal College to pilot the Route B in-practice examination that will be implemented in 2014. Under the leadership of their Chair, Paul Dagg, MD, FRCPC, this group has made significant contributions of their time and expertise to create a draft practice-based exam and practice review.

For those who may be somewhat skeptical about the rigour of the PER Route B assessment approach, you may be interested to hear directly from our Psychiatry colleague on his experience.

“We have made progress on the PER Route B and are planning for a pilot in early 2015. We believe that we have been able to construct a very robust and rigorous assessment process that is more suitable for psychiatrists who are mid-career, and will assess not only knowledge but those important competencies that are not easily measured through traditional post residency examinations. At the end of the day, we need to know that people are competent to practice as psychiatrists, and so have developed a process that includes comprehensive and normed multisource feedback, and a variety of in-the-moment assessment tools including OSCE’s, chart reviews and case discussions, and an observed consultation.” Dr. Paul Dagg, Chair, Psychiatry Specialty Committee.

On February 21, 2014, Royal College Council also approved a new program that will further close the assessment gap for non-Royal College certified subspecialists practising in Canada.

Announcing the new Subspecialty Examination Affiliate Program (SEAP)

The Subspecialty Examination Affiliate Program (SEAP) will impact the following two groups

  1. Internationally-trained physicians already licensed and practising as subspecialists in Canada, who do not have access to Royal College certification via a primary specialty.
  2. Internationally-trained physicians who are registered with a postgraduate office in an accredited Royal College subspecialty training program , but who are not eligible to meet the prerequisite for subspecialty certification (Royal College certification in a primary specialty), based on the jurisdiction of their primary specialty training (i.e. primary specialty training was completed outside of Canada or the United States).

Those who pass the subspecialty exam will be provided Royal College attestation of their successful completion and offered the option to become a Royal College Subspecialist Affiliate. They will not be eligible to use the Fellowship designation.

SEAP is not open to individuals who are completing training in a Canadian specialty program.

Phased implementation and a focused pilot

We will pilot the new program with a small number of subspecialists from Group #2 (internationally-trained physicians currently registered with a postgraduate office in an accredited Royal College subspecialty training program) in the fall of 2015, and then assess the results before expanding the program to more subspecialties in 2016. The following subspecialties have agreed to participate in the 2015 SEAP pilot

  • Neonatal-Perinatal Medicine
  • Pediatric Emergency Medicine
  • Maternal-Fetal Medicine
  • Neuroradiology
  • Nephrology

In addition, a working group has been formed to assess the needs of non-Royal College certified internationally-trained physicians who are already licensed and practising in Canada (Group #1). Click here for more information on SEAP.

Leadership, innovation and awareness

The Canadian health care system evolves more swiftly with every passing year. While there may be factors that are not in our control, it is our professional responsibility to address the reality of an increasing number of non-Royal College certified specialist and subspecialist physicians licensed and practising in Canada.

For those non-Royal College certified specialists and subspecialists already practising in Canada, the Practice Eligibility Route and Subspecialty Examination Affiliate Program offer approved mechanisms to close the assessment gap.

We believe that these programs, supported by our Value of Fellowship online marketing campaign, make a strong statement to our members and the public that the Royal College is Canada’s national standard for specialist medical expertise.

As always, I look forward to your comments and further engagement.

Warm wishes and kind regards,
Andrew Padmos, MD, FRCPC, FACP
Chief Executive Officer