Canada’s home for specialty medicine

In June 1929, a special act of Parliament established the Royal College of Physicians and Surgeons of Canada to oversee postgraduate medical education. At first, the Royal College offered just two specialty qualifications: Fellowship in general medicine and Fellowship in general surgery. Similarly limited were categories of membership: a single one, Fellow.

Today, the Royal College recognizes over 100 specialties, subspecialties, special programs and Areas of Focused Competence (AFC-diplomas). While Fellows still constitute the legal members of the Royal College, our engagement has broadened to include Diplomates, Residents, Medical Students, and many others.

One high standard for certification

From the 1940s to the 1970s, the Royal College conducted examinations at two levels in most specialties: Fellowship, the higher qualification, and Certification, a lesser designation. The dual standard was abolished in 1972 in favour of a single certification, ensuring only the highest standards for specialty medical education.

In 1968, the Royal College established the McLaughlin Examination and Research Centre at the University of Alberta and Laval University to research and develop modern techniques for evaluating specialist physicians. In 1987, the Royal College merged the centre’s two components into a bilingual McLaughlin Centre based in Ottawa.

Beyond examinations

In the latter part of the 20th century, the Royal College expanded its activities and voice, becoming increasingly active in research, public policy and international affairs.

CanMEDS framework, lifelong learning, and Competence by Design (CBD)

In 1996, the Royal College adopted CanMEDS, a medical education framework developed by physicians to define the necessary competencies for all areas of medical practice and provide a comprehensive foundation for medical education and practice in Canada. CanMEDS is a significant achievement and vital resource, respected and used across Canada and abroad. Renewal is key to the CanMEDS Framework’s ongoing success: updated twice already — in 2005 and again in 2015. The Framework will be reviewed again for release in 2025.

In 2000, the Royal College introduced the Maintenance of Certification Program, a lifelong learning program for specialist physicians that supports continuing professional development in specialty practice. The MOC Program continues to evolve to meet the changing needs of specialists, and to incorporate new concepts in competency-based learning and physician practice improvement cycles.

After years of preparation, in 2017 the Royal College launched its transformative Competence by Design (CBD) initiative, working with medical education partners across the country to implement a cutting-edge approach to 21st century specialty training education. CBD is a hybrid Competency-based Medical Education (CBME) model designed to work within the Canadian context, and combines a time-based and an outcomes-based approach to learning. It reviews the design, implementation, assessment and evaluation of each specialty program across Canada’s 17 medical universities, using CanMEDS 2015 as an organizing framework of competencies. Each discipline becomes part of a cohort group where the official CBD transition is planned in waves. Roll-out of CBD-based programs is scheduled for completion in 2025.

A 21st Century Royal College

Computer-based exams (CBex)

The CBex initiative sees the entire exam process move from a paper-based process to a self-serve journey through a computer-based platform. Candidates due to challenge their exams sign-up online, input their information, register through eBooking to take their exam, and receive all correspondence such as appointment letters (confirming where, when their exam will take place) electronically. Marking is in real-time. Specialists who aid in the writing, editing, approval of the exam content, also do this through a fully computer-based platform.

Equity, Diversity & Inclusion (EDI)

The Royal College stands in solidarity with Fellows, residents, patients and other stakeholders who are black, Indigenous Peoples, and people of colour, who experience racism and injustice. It is both our individual and collective responsibility in medicine and society in general to take steps to disrupt and dismantle the systems and behaviours that perpetuate racism and oppression.

In early 2019, building on more than a decade of work in Indigenous health, and in collaboration with Indigenous Leaders and various national organizations whose goals are to represent the interests of racialized Canadians, the Royal College began important conversations about diversity and inclusion. Through listening and learning, reshaping structures and attitudes, and taking decisive and well-informed actions, we can ultimately identify, address, and continually strive to eradicate systemic racism and other barriers present today.

Broadened scope for member services and engagement

The Royal College is best-known for its role in setting of standards for post-graduate medical education and lifelong learning, accreditation, examinations and professional development support. However, in response to feedback from members that they are seeking more value for their Fellowship dues, and are looking to the Royal College for additional services and support, the scope of services offered by the Royal College continues to expand. We strongly believe that supporting our members in their lives outside of medical practice helps enable them to provide excellent patient care. A strategic partnership with RBC, launched in 2021, is an example of ongoing efforts to provide increased value to our members.

Connect with us at history@royalcollege.ca with your history of medicine research questions and/or comments.

Learn about the Royal College Building

Did you know? Fellows are welcome to peruse the Royal College’s extensive library onsite in Ottawa. It is a rich resource of medical information and is yours to discover. (*by appointment only at history@royalcollege.ca)