Oral Examinations

As part of the Clinical Assessment Program, each International Medical Graduate (IMG) will undergo a one-day assessment consisting of six case-based oral examinations.

Each of the six oral examinations will assess their role as a medical expert (as defined by CanMEDS), and their expertise in two or more other CanMEDS roles (e.g., communicator, collaborator, professional, scholar). In addition, where possible the orals will also assess an IMG’s receptivity and response to feedback, and the accuracy of their own assessment of their performance on the case. Cases may focus on a single encounter with the patient, but can also include two or more encounters over time, encounters involving the patient’s family members or other health professionals, etc.

The case-based oral will consist of an interaction between an assessor (a clinician who has been trained to conduct the oral) and an IMG candidate. The interaction will last about 30 minutes. The oral will begin by giving the candidate a sheet of paper on top of which is a brief description of the patient and his/her problem (usually a presenting complaint, but could be a diagnosis, depending on what competencies are being tested). The candidate can use the piece of paper to record notes. The assessor will then start by asking the candidate questions, which will vary depending on the case, but which will probe such things as:

  • their initial thoughts on the patient’s problem(s),
  • what the candidate would do in assessing the patient (what information they would elicit in their history, what they would focus on in their physical, what investigations they would order),
  • their differential or leading diagnosis(es)
  • their management plan in the broadest sense (including involvement of other health team members)
  • follow-up

All of these probes assess the candidate’s CanMEDS role as a ‘medical expert’. During this interactive process the assessor will provide the patient data to the candidate — in response to the history questions the candidate would ask, the physical findings the candidate would elicit, the results of the investigations the candidate would order, etc. The assessor will also maintain a record of the candidate’s actions and responses on a checklist sheet.

Most orals will also assess two or more of the other CanMEDS roles (e.g., communicator, collaborator, professional, scholar) in addition to the role ‘medical expert’. For a given case these roles may include being an effective communicator (e.g., delivering bad news), behaving professionally (e.g., maintaining patient confidentiality), effective collaboration (e.g., referring the patient to another member of the health team, and defining what that team member is to do), and so on. To assess some of these roles, there may be a short role play with the candidate (e.g., The examiner will say, ‘Assume I am the patient’s daughter, please explain to me why my mother should receive this treatment’ – such challenges can test both the ‘communicator role’ and ‘professional role’).

Most orals will also assess a candidate’s receptivity and response to feedback on their performance and the accuracy of their own assessment of their performance on the case.

None of the orals are designed to test competencies that are specific to any specialties; rather they assess generic competencies expected of a candidate entering any residency program.

Candidates will receive a feedback report providing a numerical summary of their performance following completion of the second iteration of the CARMS match.