Validation of a large-scale clinical examination for international medical graduates.

OBJECTIVE: To evaluate a new examination process for international medical graduates (IMGs) to ensure that it is able to reliably assign candidates to 1 of 4 competency levels, and to determine if a global rating scale can accurately stratify examinees into 4 levels of learners: clerks, first-year residents, second-year residents, or practice ready. DESIGN: Validation study evaluating a 12-station objective structured clinical examination. SETTING: Ontario. PARTICIPANTS: A total of 846 IMGs, and an additional 63 randomly selected volunteers from 2 groups: third-year clinical clerks (n = 42) and first-year family medicine residents (n = 21). MAIN OUTCOME MEASURES: The accuracy of the stratification of the examinees into learner levels, the impact of the patient-encounter ratings and postencounter oral questions, and between-group differences in total score. RESULTS: Reliability of the patient-encounter scores, postencounter oral question scores, and the total between-group difference scores was 0.93, 0.88, and 0.76, respectively. Third-year clerks scored the lowest, followed by the IMGs. First-year residents scored highest for all 3 scores. Analysis of variance demonstrated significant between-group differences for all 3 scores (P < .05). Postencounter oral question scores differentiated among all 3 groups. CONCLUSION: Clinical examination scores were capable of differentiating among the 3 groups. As a group, the IMGs seemed to be less competent than the first-year family medicine residents and more competent than the third-year clerks. The scores generated by the postencounter oral questions were the most effective in differentiating between the 2 training levels and among the 3 groups of test takers.

Residents' duty hours in the province of Ontario, Canada.

The author explains the history of the Professional Association of Internes and Residents of Ontario (PAIRO), Canada, founded in 1968-69 to represent postgraduate medical trainees in negotiations with the Ontario Hospital Association over issues of trainees' stipends. Over the years, the negotiations evolved to cover a number of other issues, including duty hours, and established the principle that binding arbitration would be used to resolve any disputes between the two parties that could not be resolved through negotiation. At present, PAIRO negotiates a biannual collective agreement with the Ontario Council of Teaching Hospitals (OCOTH), whose features the author describes. The most important provisions of the 2000-2002 PAIRO-OCOTH agreement on the limits of duty hours are described. The author then comments that while such limits have benefited programs and residents, there is concern that the limits decrease the opportunities for trainees to be involved in the care of patients with a wide variety of medical conditions. Also, the duty-hours limits have required some services to use attending physicians or outside health professionals to perform duties previously carried out by trainees, creating problems that the author describes.