More than 2,500 Canadian staff specialist physicians have asked the Royal College of Physicians and Surgeons of Canada to fast-track the certification of final-year medical residents — many now working on pandemic front lines — or certify them en masse as an emergency measure during the COVID-19 crisis.

Last month, the college postponed scheduled spring certification exams until September — at the earliest — because of infection concerns. Most graduating medical residents planned to begin their independent professional lives as certified doctors (who are then licensed to practise in their province of choice) in July.

In a letter sent this week to Royal College CEO, Dr. Susan Moffatt-Bruce, the staff physicians say if the college cannot provide a simplified exam process to graduate 2,600 young specialists into the health-care system by June, then the college should issue emergency certifications — akin to a battlefield promotion — as other countries have during the pandemic that is overwhelming hospitals and staff. On Wednesday, Ontario premier Doug Ford warned the public that “a surge is coming” in the next three weeks.

Moffatt-Bruce said in an interview that finding solutions “has been a 24/7 priority for the Royal College” and that delivering examination papers — yes, the exams are paper-based, followed by oral testing — to residents in 29 different specialities during a pandemic carries serious safety considerations. She said a colleague’s suggestion that empty NHL arenas could possibly house student exams to achieve proper physical distancing “is not a crazy idea.”

Moffat-Bruce also said the college has a duty to maintain public trust in a 90-year-old Canadian institution that certifies highly trained doctors for life through a vigorous examination process.

For now, though, exams remain scheduled for September. This delay — not the taking of an exam — is what 2,577 staff specialist physicians oppose in the letter written by Hamilton general internist Dr. John David Neary.

“Deferring the examinations...in order to maintain traditional examination processes will cause serious harms to examination candidates and to the health-care system in a time of crisis” because “residents will not be able to work near normal efficiency when they are focused on examinations at unpredictable dates,” Neary states in the letter.

“Regulators in worse-affected countries have taken radical action,” Neary continues.

“Italy, Spain and Great Britain have licensed graduating medical students en masse. Many provinces are returning retired nurses to work without formal skills assessment and fast tracking licenses for retired physicians,” the letter continued. “Residents who are completing Royal College accredited programs have the skills and knowledge necessary to practise in their respective specialties.”

Neary made a request to the college for a “special meeting of the members,” citing a college by-law as the authority to do so, to discuss resolutions he and his colleagues have put forward. The Royal College is governed by a council.

Their first suggestion is for the college to create “an alternative one-time path to certification” for those who had been scheduled to sit the spring exams. The letter suggests the one-time process consist of an assessment of resident in-training evaluations (possibly in the form of a summary prepared by the residents’ program directors) and “with or without a written examination delivered electronically in a massively distributed fashion (i.e. on the candidates’ own computers) with appropriate (monitoring) prior to June 30, 2020.”

If that can’t occur, the second solution asks that “all candidates who had registered for the spring examinations shall be formally certified in the specialities to which they had registered for examinations as if they had passed those examinations (i.e. with no subsequent requirement for make-up examinations).”

The average pass rate for graduating medical residents is above 85 per cent, according to Moffatt-Bruce, describing that success rate as “high.”

The physician group agrees with the college that holding traditional oral exams this spring is not feasible, according to the letter.

Residents say the exam delay is worrisome, even as they put their own health at risk working side-by-side with fully licensed doctors at hospitals and clinics.

“We’re doing shifts right now as residents — we’re on the front lines,” said Dr. Blair Bigham, an emergency medicine resident for five years in McMaster University’s hospital system.

“But this exam uncertainty has stressed us out beyond belief, in addition to the stress of having to work in a pandemic,” continued the 34-year-old former paramedic, who has three confirmed job offers awaiting him this summer.

“Things are changing daily and we’re fully expecting to have an overwhelmed system where people are dying around us who shouldn’t be dying, so we need to be ready to go, 100 per cent.”

Other residents say not earning the Royal College certification — mandatory before one can apply for a licence to practise from a provincial medical regulatory authority, like the College of Physicians and Surgeons of Ontario — may jeopardize fellowship training in countries that require certification. Fellowships can offer further sub-specialization training in specific medical fields.

Moffatt-Bruce said she empathizes with the residents and their anxiety.

“None of this is precedented. None of this is what we wanted (and) we are trying to make things as safe as possible,” she said.

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“What I think would be even more difficult is if we were to administer (exams) right in the middle of a pandemic and the residents fell sick or they’re still working in the middle of a pandemic and unable to study and take care of patients. I would feel, and this is what a lot of educators are saying, that it would add additional stress.”

The Royal College has a dedicated Crisis Management Team that meets virtually twice daily to monitor COVID-19 impacts on its residents.

When asked about seeing Neary’s letter pop up on her computer screen, Moffatt-Bruce became a bit emotional.

“It’s a tough one for sure,” she said.

“Everybody’s entitled to their very, very good opinions and I think everybody’s going from a place to try and do the right thing, no doubt about it,” she continued, after a pause.

“It’s important. These are our residents. These are our future doctors.”

She also said no one working with the college, including university medical school deans and provincial medical regulatory authorities, have given up on any idea or opportunity.

“We’ve tried to embrace every one of them,” she said, noting a whiteboard on a college wall is crammed with scenarios from “A to Z.”

The Royal College CEO said she’s also concerned that post-pandemic Canada will require intense health care supports.

“I think what’s going to happen after the pandemic is going to be even more formidable,” Moffatt-Bruce said.

“We don’t know what that’s going to look like and (that’s) why we’re trying to get these exams done in a safe time period.”

Moffatt-Bruce said it’s a balancing act to help residents while not compromising certification standards.

“What I think is unique about the Royal College certification...(for a medical) specialist, is that certification is for life,” she said.

“It’s a little bit different than other countries where you have to do examinations every so often to recertify,” she continued.

“So the public puts their trust in us, not only to train them really well — because they are really well trained — but also to examine them so their certification is validated and that it stands for a lifetime.”

In the interim, graduating medical residents have been given an opportunity to apply for provisional (temporary) licensing to work legally after July 1, 2020. That licence comes with some conditions, including that Royal College certification exams must be taken at the earliest opportunity. The provisional licensure is not the same as certification, which is required for some work opportunities, like fellowships in other countries.

Some residents feel there are drawbacks with provisional licensing. For instance, those starting their own practice are responsible for finding a physician to supervise them, which may prove difficult during a pandemic. Not everyone feels the temporary license is worthwhile; the Star was told by some residents that they may not work at all this summer in order to fully prepare for exams.

Neary said he has not yet heard if a special meeting will be called but said the college confirmed his letter had been received.