Replacing high-stakes summative examinations with graduated medical licensure in Canada

KEY POINTS

• Disruptions to medical licensing exams in Canada during the COVID-19 pandemic have raised an opportunity for reexamination of processes for licensure.
• No evidence supports the effectiveness of current licensure exams in ensuring patient safety; the current process causes undue stress and directs valuable and limited resources toward passing an exam, potentially detracting from the more meaningful goal of preparing for independent practice.
• Best practices in medical and continuing education support the use of competency-based assessments, guided by robust programmatic assessment models, to judge fitness to practise, followed by life-long self-directed learning.
• Credentialing and licensing authorities should advocate for the resources required to replace current high-stakes summative assessments with graduated licensure and to develop quantifiable, nationally synergized, specialty-specific practice standards that support both the oversight of graduated licensure and maintenance of competence.