Policies for Certification in a Competence by Design Model of Residency Training

October 2022
These regulations supersede previously published editions.
The Royal College reserves the right to change these regulations at any time, without prior
notification.

TABLE OF CONTENTS
SECTION I – GENERAL INFORMATION
1.1 Introduction ...................................................................................................................... 4
1.2 Contact information ........................................................................................................ 4
1.3 Acronyms .......................................................................................................................... 5
1.4 Definitions, terms, and quick reference........................................................................ 5
1.5 Privacy .............................................................................................................................. 9

SECTION II – EXAMINTION ELIGIBILITY REQUIREMENTS

General information ..................................................................................................................... 10
2.1 Requirements for examination eligibility...................................................................... 10
2.2 Satisfactory moral, ethical and professional standing ................................................ 10
2.3 Satisfactory completion on postgraduate medical education ................................... 11

SECTION III – POSTGRADUATE MEDICAL EDUCATION IN A CBD DISCPLINE

3.1 Residency Training Requirements ................................................................................. 12
3.2 Policy on Training Requirements ................................................................................... 12

SECTION IV – ROYAL COLLEGE RULINGS ON EXAMINATION ELIGIBILITY

General Information ……………………………………………………………………………………………………….. 14
4.1 Examination Eligibility Ruling ......................................................................................... 14
4.2 Conditions pertaining to Rulings ................................................................................... 14
4.3 Examination Eligibility ..................................................................................................... 14
4.4 Deferral of examination eligibility ................................................................................. 15
4.5 Reconsideration of a ruling on examination eligibility................................................ 15
4.6 Appeal of a Decision on a Royal College Ruling ........................................................... 16
4.7 Withdrawal of Examination Eligibility ................................................................................. 16

SECTION V – ROYAL COLLEGE EXAMINATIONS

General information ..................................................................................................................... 17
5.1 Surgical Foundations Examination ................................................................................ 17
5.2 Examination Registration................................................................................................ 17
5.3 Payment of Examination fees ........................................................................................ 17
5.4 Deadline for Examination Registration ......................................................................... 17
5.5 Examination Dates........................................................................................................... 17
5.6 Examination Sites ............................................................................................................ 17
5.7 Examination Format ........................................................................................................ 18
5.8 Withdrawals from Examinations.................................................................................... 18
5.9 Frequency of Examinations ............................................................................................ 18
5.10 Language of Examinations ............................................................................................. 18
5.11 Access to Examinations................................................................................................... 18
5.12 Rules & Procedures applicable to the delivery of examinations ............................... 19
5.13 Conflicts ............................................................................................................................ 19
5.14 Candidates requiring an Examination Accommodation ............................................. 19
5.15 Examination Rules and Procedures .............................................................................. 20
5.16 Decision of Royal College Examination Boards ........................................................... 20
5.17 Exam Results/posting of marks ..................................................................................... 21
5.18 Expiration of Exam Results ............................................................................................. 21
5.19 Formal Review of Examinations ..................................................................................... 21

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 SECTION I – GENERAL INFORMATION

The Royal College is the national professional association that oversees the assessment of medical specialists in
Canada. In its mandate articulated by a Royal Charter in 1929, the Royal College was given a key role in the oversight
of the system of specialty medicine in Canada. The Royal College verifies that a physician has met all the
requirements necessary for Royal College certification. To become eligible for examination — physicians must meet
an array of credentialing requirements set by Royal College Council and Royal College Committees including a
designated specialty committee of the Royal College. With significant assistance from volunteer Fellows, the Royal
College produces and administers the national certification exams.

1.1 Introduction
The Royal College Policies for Certification in a Competence by Design Model of Residency Training is a detailed
policies and procedures manual that outlines the process leading to certification by the Royal College for
competency-based training programs. Candidates from time-based training programs may refer to the
Royal College Policies and Procedures for Certification and Fellowship. The guide is divided into sections for
easy reference and clearly outlines each step in the certification process.

The following represents the basic steps to achieving Royal College certification:
• The applicant has obtained a medical qualification acceptable to the Royal College.
• The applicant has trained in an accredited Royal College competency-based training program.
• The applicant has satisfactorily completed the specialty specific objectives of training, specialty
training requirements, or required training experiences.
• The applicant has successfully completed all examination requirements.

Competency by Design (CBD)

The CBD initiative is based on a competency-based model of education and assessment. The Royal College
and its partners are bringing the best of this learning to the development of CBD to achieve the ultimate end
goal: improving patient care through an explicit focus on the outcomes desired of our trainees and practicing
physicians and surgeons.

In the Competence by Design model, learners will progress through their residency education program and
stages of training by demonstrating competence on Entrustable Professional Activities (EPA) and related
milestones within their current stage of training. Promotion decisions are based on observations made of the
learner as successful completion of EPAs and other observations and feedback on the candidate. An electronic
portfolio that captures resident information and observations of competence is required to document
resident progression. In addition to successful completion of stages of training, and an electronic portfolio,
successful completion of specialty specific examinations remains necessary for Royal College certification.

All Royal College accredited specialty and sub-specialty training programs have already or are in the process
of transitioning to a CBD model of training. This policy is applicable to candidates training in a CBD program.

1.2 Contact Information

For further information, to request an application for assessment of training for examination eligibility, or to
obtain objectives of training, specialty training requirements and/or required training experiences, please
contact the Office of Standards and Assessment at:

The Royal College of Physicians and Surgeons of Canada

Office of Standards and Assessment - Credentials Unit
774 Echo Drive

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 Ottawa, ON
K1S 5N8
Canada

Telephone: (613) 730-8191

Toll Free: 1 (800) 267-2320
Extension: 7750
Fax: (613) 730-3707
E-mail: [email protected]
Website: www.royalcollege.ca

Please note: Applicants are responsible for ensuring that the Royal College always is provided with any
updated contact information each time there is a change.

1.3 Acronyms
Common acronyms include:

ACGME - Accreditation Council for Graduate Medical Education (in the United States)
CACMS - Committee on Accreditation of Canadian Medical Schools
CanMEDS - Canadian Medical Education Directions for Specialists
CBME - Competency-based medical education
CCT - Confirmation of completion of training
CBD - Competence By Design
CFPC - College of Family Physicians of Canada
EPA - Entrustable Professional Activities
FAIMER - Foundation for Advancement of International Medical Education and Research
FRCPC - Fellow of the Royal College of Physicians of Canada
FRCSC - Fellow of the Royal College of Surgeons of Canada
IMG - International Medical Graduate
LCME - Liaison Committee on Medical Education
MCC - Medical Council of Canada
MCCEE - Medical Council of Canada Evaluating Examination
MD - Doctor of Medicine
USMLE - United States Medical Licensing Examinations
WHO - World Health Organization

1.4 Definitions, Terms and Quick Reference

Postgraduate medical education, training and residency training are used interchangeably throughout this
guide.

1.4.1 Assessment of Training for Eligibility to Access the Royal College Certification Examination
All applicants must have their residency training assessed by the Royal College to ensure that the
specialty specific training requirements have been met in a program that is recognized and approved
by the Royal College. Applicants seeking credit towards examination eligibility for training in a
postgraduate medical education system outside of accredited Royal College/ACGME approved
programs should refer to Section VII “International Training” of the Policies and Procedures for
Certification and Fellowship for additional information regarding the application process.

1.4.2 Assessment Committee

The Assessment Committee is a Royal College committee responsible for the governance of

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 assessment matters relevant to Royal College credentialing and examination policy and
requirements.

1.4.3 Clinical Supervisor

The clinical supervisor appointed by the Residency program director oversees the trainee for a
specific milestone or milestones during their residency. They approve the documented evidence for
the milestones that they supervised.

1.4.4 Competence
Competence is the array of abilities across multiple domains or aspects of physician performance.
Competence is both conditional on, and constrained by, each physician’s practice context, is
dynamic and continually changes over time.

1.4.5 Competence by Design (CBD)

Competence by Design (CBD) is the Royal College competence-based medical education
(CBME) approach to residency training and specialty practice in Canada, which focuses on
outcomes that are based on a framework of competence.

1.4.6 Competence Committee (CC)

A Competence Committee (CC) is a university committee responsible for assessing the progress of
trainees in achieving the specialty-specific requirements of a program. These requirements are
established for each stage of training. Each University’s residency program committee commissions
the creation of a CC with designated members who will regularly review and synthesize the various
assessment information in each trainee’s portfolio.

1.4.7 Discipline-Specific Examination Boards

Royal College Exam Boards act on behalf of the Royal College in matters relating to the content,
format, evaluation of candidates and marking of the examination. The discipline-specific
examination board is supported by Royal College staff in the production and delivery of the
examination. Planning of logistics and psychometric analysis is the responsibility of The McLaughlin
Centre for Evaluation (TMCE), Office of Standards and Assessment. The Board must ensure that the
examination effectively tests the Royal College objectives of training for the discipline.

1.4.8 Entrustable Professional Activity (EPA)

EPAs are “units of professional practice”, that are built of tasks and abilities. Once sufficient
competence is achieved, these tasks are “entrusted to the unsupervised execution by a
trainee”. EPAs can be completed independently and are to be observed and measured (in both
process and outcomes) for use in entrustment decisions (ten Cate, 2013).
• Typically, each EPA integrates multiple milestones
• EPAs are a measure of assessment defined by the Royal College and assessed by the
universities.

1.4.9 Exam Candidate

A resident who has received exam eligibility from the Royal College is a candidate for the examination.
They remain a candidate if they retain examination eligibility or until they successfully complete all
the examination components.

1.4.10 Examination Format

Each Royal College Examination Board determines the construct of their discipline’s examination
and uses these components to examine candidates based on an examination blueprint. Specialty
specific examination format documents outline the exam components that will be administered for
an examination cycle. These components may change from time to time and candidates should refer
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 to the specialty specific examination format found on the Royal College website.

1.4.11 Examination Eligibility Ruling

A ruling is a decision made by the Royal College Credentials Unit only on examination eligibility.
Once the resident’s program has decided the resident is ready to receive exam eligibility, the
program will notify the Royal College Credentials Unit who will confer exam eligibility to the
resident in the form of a ruling letter. This letter will outline the candidate’s examination
eligibility. The Royal College reserves the authority to withdraw examination eligibility. Please
refer to the conditions on rulings outlined in section IV “Royal College Rulings on Examination
Eligibility”.

1.4.12 Examiner
Examiners are members of the Royal College discipline-specific examination board. Examiners
have many roles in the development and delivery of exams. These roles include development
of written and applied exam questions and evaluation of the candidate’s performance.

1.4.13 Licensure
The Royal College does not grant licenses to practice medicine. Applicants who intend to obtain
a license to practice in one of the provinces or territories of Canada must hold registration with
the provincial/territorial regulatory authority. Applicants should contact the
provincial/territorial medical regulatory authority directly for more information. Links to the
regulatory authorities can be found on the Royal College website.

1.4.14 Milestone
A milestone is the expected ability of a health care professional at a stage of expertise. CanMEDS
milestones illustrate the expected progression of competence from novice to mastery associated
with each enabling CanMEDS competency. Each milestone is an observable marker of a person’s
ability along a developmental continuum. In the context of CBD, milestones are used for planning,
teaching, and assessment.
• Milestones are observable and can therefore be linked with feedback
• Milestones are the organizational framework for the curriculum; and,
• EPAs are made up of milestones. Milestones are more detailed and are clear
descriptions with explicit statements.

1.4.15 Observer
The observer supports learning in residency, contributes to the narrative and reviews evidence.
Observations made by the observer are noted in the learner’s portfolio. Observers may include
preceptors, nursing staff, and senior residents who have already achieved the EPA that is being
observed.

1.4.16 Postgraduate Dean

Part of the role of the university Postgraduate Dean is to attest that the trainee has acquired all
the competencies.

1.4.17 Program Director

The university Program Director guides learning, meets with learners regularly, and
reviews/monitors a learner’s progress. The Program Director attests that the trainee has acquired
all the competencies required to progress through their learning plan.

1.4.18 Resident
The Royal College classifies postgraduate clinical trainees in accredited Royal College approved
programs as residents if they meet all the following criteria:

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 • The applicant is registered with the office of postgraduate medical education of a medical
school in Canada. The applicant is admitted to and enrolled in an accredited Royal College
residency program, the content of which is defined, supervised, and assessed by the
residency Program Director and the Residency Program Committee, informed by a
Competence Committee, and
• The applicant's postgraduate clinical training is in a discipline recognized by the Royal
College.

1.4.19 Royal College Mainport ePortfolio

The Royal College Mainport ePortfolio provides evidence of a physician’s development and
maintenance of competence from residency until retirement. It tracks the learner’s progress as they
meet milestones and develop competencies, and it identifies assessment strategies to evaluate the
performance of Royal College Entrustable Professional Activities (RC EPAs). The Royal College will
be phasing out Mainport ePortfolio effective June 30, 2025.

1.4.20 Stages of Training – (Competence Continuum)

The CBD Competence Continuum is a series of integrated stages, which begin upon entry into a
discipline specific residency training program. Residents will transition through the stages of training
upon attestation by the Program Director, and Postgraduate Dean, in consultation with the
Competence Committee and Residency Program Committee.
• Transition to discipline
This stage emphasizes the orientation and assessment of new trainees arriving from
different medical schools and programs.
• Foundations of discipline
This stage covers broad-based competencies that every trainee must acquire before moving on to
more advanced discipline specific competencies.
• Core of discipline
This stage covers the core competencies that make up most of the discipline.
• Royal College examination
Residents will appear for the written and/or applied component of the Royal College examination
during the core of discipline stage and the transition to practice stage.
• Transition to practice
In this stage, the senior trainee should demonstrate readiness to make the transition to
independent practice.

1.4.21 Training Experiences

A training experience replaces the ‘rotation’ in the traditional residency education model. Training
experiences include both mandatory and recommended training activities, which support a
resident’s acquisition of competence. These activities can include clinical care such as inpatient
care, ambulatory clinics, performing technical procedures; or extra-clinical activities (e.g.,
simulation exercises, scholarly projects, journal clubs, etc.).

1.4.22 Written-before-Applied
Written-before-Applied is an exam format requiring candidates to complete the written
component of the exam with a passing grade before being invited to take the applied (oral, OSCE,
practical) component of the exam. This format will be applied to all candidates in programs that
have moved to a Competence-by-Design training model. In years where candidates from both CBD
and traditional time-based training programs have their exams at the same time, a Written-before-
Applied format will apply to all candidates.

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1.5 Privacy
All documents and information obtained by the Royal College during the certification and fellowship process
will be kept confidential, except as required or permitted by law. Candidates are requested to provide copies
and NOT original documents. All personal information is managed in accordance with the Royal College
Privacy Policy. Please refer to the Privacy Policy on the Royal College website for an explanation of how
personal information is managed.

Under the Royal College Privacy Policy, individuals have the right to view information stored in their personal
files. To access your personal information, forward a written request to the Royal College Privacy Officer at
[email protected]. In some instances, information will be redacted from the documents before access
is granted.

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SECTION II – EXAMINATION ELIGIBILITY REQUIREMENTS

General Information
The Royal College will assess whether an applicant’s training and credentials meet the eligibility requirements for
admission to the examinations for their specialty or subspecialty area. These eligibility criteria are:

2.1 Requirements for examination eligibility

The following represents the basic requirements for eligibility for the Royal College certification.
Each step in the process is outlined in more detail in applicable section of these policies and
procedures:
2.1.1 The candidate must maintain enrollment in an accredited Royal College residency program in a CBD
discipline.
2.1.2 The candidate must complete all training requirements, including demonstration of competence in
the required Entrustable Professional Activities (EPAs) prescribed by the discipline, as evidenced by
the attestation of the applicant’s Postgraduate Dean and Residency Program Director, in
consultation with a Competence Committee.
2.1.3 The candidate must be deemed exam eligible by the Royal College, as evidenced by a Royal College
ruling letter for exam eligibility.
2.1.4 The candidate must complete all Royal College exam components before being invited to become
certified and be invited to become a member of the Royal College.

2.2 Demonstration of Satisfactory Moral, Ethical and Professional Standing

2.2.1 Candidates must demonstrate satisfactory moral, ethical and professional standing in clinical
and/or research activities. This requires that the candidate appropriately relates to patients,
students, colleagues, and other health care professionals with respect to gender, ethnicity and
cultural, religious, and personal values.
2.2.2 If, at any time prior to certification, the Royal College receives information pertaining to a restriction
of a medical license, a criminal conviction or charge and/or other relevant information which puts
into issue a candidate’s satisfactory moral, ethical and/or professional standing, the matter will be
investigated and reviewed by the Executive Director, Office of Standards and Assessment, or a
delegate.
2.2.3 Upon completion of the investigation and review, the Executive Director, Standards and
Assessment, or their delegate has the following options for decision:
• deny eligibility,
• suspend a candidate’s eligibility (with or without conditions for re-instatement of eligibility); or,
• revoke a candidate’s eligibility.
Prior to denying, suspending, or revoking a candidate’s eligibility, the Executive Director, Standards
and Assessment, or their delegate shall disclose to the candidate the nature of the information
received and allow the candidate an opportunity to provide relevant information and make
submissions as to their satisfactory moral, ethical and/or professional standing.
2.2.4 The candidate may appeal against the decision of the Executive Director, Standards and
Assessment, or their delegate pursuant to the procedure in section 4.6 of this Policy.

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2.3 Satisfactory Completion of Postgraduate Medical Education
Eligibility for the examinations leading to Royal College certification requires satisfactory completion of all
requirements of postgraduate medical education as defined in the specialty specific objectives of training,
specialty training requirements and/or required training experiences, in a program that is recognized and
approved by the Royal College.

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SECTION III – POSTGRADUATE MEDICAL EDUCATION IN A CBD DISCIPLINE

3.1 Residency Training Requirements

3.1.1 Residency training requirements are subject to change. Normally, when amendments are made, an
appropriate period is allowed to protect the interest of the resident who has already embarked on
a program recognized by the Royal College. However, should a resident interrupt training, no
assurance can be given that all training taken prior to the interruption will still be acceptable, even
though previously recognized by the Royal College.

3.1.2 By the end of training, the resident must have achieved all training requirements, including
demonstration of competence in the required Royal College Entrustable Professional Activities
(EPAs) prescribed by the discipline. Their achievement of these requirements must be attested to
by the resident’s Postgraduate Dean and Residency Program Director, in consultation with a
Competence Committee.

3.1.3 The Royal College does not set requirements for training that must be completed before being
eligible for the exam. The trainee may challenge the exam at any point in their training – certification
will not be conferred until their training is complete.

3.1.4 Residency Programs will communicate resident exam readiness, and completion of training to the
Royal College in two stages, as a condition of the resident being granted and maintaining eligibility
to their discipline-specific examination, and ultimately, certification. Documents must be
submitted by the Royal College discipline specific deadline:

3.1.4.1 Notification of Exam Eligibility: The Royal College Credentials Unit requires notification from
the resident’s program that the resident is ready to receive exam eligibility. This notification
is given to the Credentials Unit by submission of a document attesting that the program
believes the resident is ready to be ruled eligible for the exam. Ruling letters conferring
exam eligibility are sent to the resident after this attestation has been received. Pursuant
to the procedure in Section 4.7, the program reserves the ability to withdraw a trainee’s
exam eligibility at any point prior to the examination by notifying the Credentials Unit at
the Royal College.
3.1.4.2 Eligibility for Certification: A notification must be sent from the program to the Royal
College Credentials Unit, signed by the post-graduate Dean confirming the date of the
resident’s completion of training. Upon receipt of this confirmation, alongside
acknowledgement that the resident has successfully completed their specialty and
subspecialty examination, the Royal College will contact the resident about certification and
an invitation to become a Fellow of the Royal College.

3.2 Policy on Training Requirements

In evaluating completion of training requirements, the Post-Graduate Dean, the Program Director, and the
Competence Committee, as applicable, may apply the following policies:

3.2.1 Accelerated Achievement of EPAs:

It is understood by the Royal College that residents may have training or clinical experiences prior
to entering a CBD residency program. The Competence Committee should use evidence from those
previous clinical experiences to recommend achievement of an EPA to the Program Director and
competence committee. In such circumstances, the previous clinical experiences must be

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 documented by the competence committee as justification as to why they represent a valid
substitute for clinical observations and workplace-based assessments.

3.2.2 Version of EPAs:

The discipline-specific training requirements under which residents are assessed will evolve over
time. To ensure that residents are assessed on current standards, the Royal College requires that
the most current training requirements (EPAs) are applied to the resident when the resident is
promoted to their next stage of training. Their current stage of training, as well as any completed
stage of training, will not be affected.

3.2.3 Modifications to Residency Training:

It is understood by the Royal College that residents may require leaves of absence from training.
The circumstances that would qualify residents for leaves of absence are determined by the
university. Following leave, trainees must be reassessed on their performance on their most
recent stages of training, which allows the Program Director and Postgraduate Dean to determine
if any adjustments to the training program are required.

3.2.4 Transferability of EPAs between Universities:

Required EPAs are the same for the specific discipline regardless of the university. If a resident
transfers to another university for training, it is the responsibility of the Program Director and
Postgraduate Dean of the former institution to identify to the Program Director and Postgraduate
Dean of the accepting institution which EPAs and milestones have been achieved by the resident
to date. It is the responsibility of the accepting Program Director and Postgraduate Dean to approve
the achievement of any EPAs and milestones.

3.2.5 Transferring from CBD to Non-CBD program:

In the event a trainee transfers from a specialty using a Competence-by-Design model of training
to a specialty that does not utilize a CBD model, the program director will work alongside the
trainee to assess the resident’s knowledge and create a plan for transitioning the trainee into a
traditional time-based residency program. The Royal College does not need to be informed of
transfers between programs but must be informed if the resident is expected to take the
examination. The receiving program will make the decision about the resident regarding
completion of training and exam readiness.

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SECTION IV – ROYAL COLLEGE RULINGS ON EXAMINATION ELIGIBILITY

General Information
The attestation to the satisfactory completion of specialty or subspecialty residency training (e.g., CCT) does not
alone ensure admission to the examinations leading to Royal College certification.

Important Note: As training programs in Canada transition to a Competence-by-Design (CBD) model, exam
components will be de-coupled (the written and applied components will become independent components) and
success at the written will be a requirement to continue to the subsequent component.

The specialties that have a written-before-applied exam format can be identified in the exam format documents
on the Royal College website. This includes any CBD cohort presenting for the examination.

4.1 Examination Eligibility Ruling

4.1.1 Upon receipt of a “Notification of Exam Eligibility” document from the resident’s program, the
Royal College Credentials Unit will issue a “ruling letter” to the candidate. Receiving a Royal
College “ruling letter” does not mean certification has been granted, rather, it is a step in the
process of becoming certified.

4.2 Conditions Pertaining to Rulings

4.2.1 A ruling of eligibility for any Royal College examination is valid for five (5) years, subject to the time
limitation set out in 4.3.1.
4.2.2 Candidates writing decoupled exams will be required to successfully complete one exam
component before being invited to a subsequent exam component (e.g., written, or applied).
Note: If a candidate is successful on the written component of the examination, but unsuccessful
on the applied component, they will not be required to repeat the written component in
subsequent years, subject to the time limitation set out in section 4.3.1.
4.2.3 Candidates writing comprehensive exams will be required to successfully complete both exam
components in one year. Those that are unsuccessful will be required to re-take both components
at the subsequent attempt.
4.2.4 Certification in an applicable primary specialty is required before exam eligibility will be granted
towards a sub-specialty examination.
4.2.5 The program reserves the ability to withdraw a trainee’s exam eligibility at any point prior to the
examination by notifying the Credentials Unit at the Royal College.

4.3 Examination Eligibility

4.3.1 Candidates must complete all required examination components for their specialty within five (5)
years of being granted eligibility. A maximum of four (4) attempts are permitted on a single exam
component. Note: If a candidate should use all four (4) years of eligibility to pass their written
examination component, their maximum eligibility for the applied component will be limited to
the remainder of the five (5) years of examination eligibility set out in 4.3.1.
4.3.2 A candidate will be granted no further eligibility on the occurrence of either of the following:
• the candidate has exhausted four (4) years of eligibility on a single exam component (written
or applied) without successful completion.
• the candidate has not completed all examination components within five (5) years of their
initial grant of eligibility.
4.3.3 Candidates who have exhausted their eligibility under section 4.3.2 may only re-apply for
examination eligibility upon completion of additional accredited residency training and

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 submitting a request for a reconsideration of a ruling on exam eligibility pursuant to the
reconsideration of a ruling process set out in section 4.5.
4.3.4 Exam eligibility is granted notwithstanding the route to certification. Exam eligibility is not
renewed upon submission of an application through another route to certification.

4.4 Deferral of examination eligibility

4.4.1 In the event a candidate cannot attend or unexpectedly misses an examination due to a serious
accident, illness or other impediment, the Royal College will consider a deferral of examination
eligibility for one (1) additional year of eligibility. Note: Deferrals will only be granted in
exceptional situations. Deferrals will generally not be granted for missed flights and other travel
delays, minor illness, lack of preparedness or scheduling conflicts.
4.4.2 Candidates who know in advance of the examination that it will be missed should contact the
Royal College to request a deferral as early as possible.
4.4.3 Candidates who miss an examination unexpectedly must submit a request for deferral within five
(5) business days of the missed examination date.
4.4.4 All requests for deferral must include the following documentation:
(i) A written request for deferral and a detailed description of the circumstances leading to the
request, signed by the candidate.
(ii) In the case of serious accident or illness, an original letter, on office letterhead, from the
candidate’s qualified treating professional identifying and confirming the accident or illness,
together with verification that the accident or illness is or was serious enough to warrant
missing the examination; and,
(iii) In the case of any other impediment, appropriate documentation, from a source with direct
involvement or knowledge of the circumstances in question.

Note: The Royal College may request additional information and/or confirmation, as it considers
necessary on a case-by-case basis.
4.4.5 The final decision regarding a request for deferral lies with the Executive Director, Standards and
Assessment, or a delegate, and is not subject to reconsideration or appeal.

4.5 Reconsideration of a Ruling on Examination Eligibility

4.5.1 A reconsideration of a ruling on examination eligibility may be initiated at the request of an
applicant or by the Executive Director, Standards and Assessment of the Royal College, or a
delegate, if substantive new information about an applicant’s credentials or training is received or
if there was an error in the administration of policy in an applicant’s assessment of training. New
information may be received from the applicant or any other knowledgeable source and should
be sent to the attention of the Executive Director, Standards and Assessment.
4.5.2 Requests for reconsideration of a ruling will be considered by the Executive Director, Standards
and Assessment or a delegate.
4.5.3 If a reconsideration of a ruling is initiated by the Executive Director, Standards and Assessment, or
a delegate, the Executive Director or a delegate shall disclose to the applicant the nature of the
information received and allow the applicant an opportunity to provide relevant information and
make submissions.
4.5.4 The Executive Director, Standards and Assessment or a delegate shall issue a written decision
either confirming or amending the original ruling with respect to examination eligibility and
provide a copy of the decision to the applicant.
4.5.5 The applicant may appeal against the decision of the Executive Director, Standards and Assessment
or a delegate following the procedure set out in section 4.6 of this Policy.

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 4.6 Appeal of a Decision on a Royal College Ruling
4.6.1 An applicant who wishes to appeal a decision made under sections 2.2 or 4.5 of this policy must
notify the Executive Director, Standards and Assessment of the Royal College within thirty (30)
working days of the date of the decision with a written statement of the reasons for the request.
The appeal request must be submitted with a non-refundable administrative fee (see Royal
College website for current fees).
4.6.2 The appeal of the decision will be conducted by a panel of three (3) members of the Royal College
Assessment Committee designated by the Executive Director, Standards and Assessment or a
delegate.
4.6.3 If a conflict of interest exists or any other impediment such that a panel of three (3) members
selected from the Royal College Assessment Committee is unfeasible in the circumstances, the
Executive Director, Standards and Assessment or a delegate shall appoint appeal panel members
from outside of the Royal College Assessment Committee.
4.6.4 Appeals shall be conducted by way of a written hearing. In extraordinary circumstances, the
Executive Director, Standards and Assessment or a delegate may, in their sole discretion, direct
that the appeal be conducted by way of an oral hearing, in whole or in part, instead of a written
hearing. The decision of the Executive Director, Standards and Assessment or a delegate in this
regard is final and not subject to review or appeal.
4.6.5 Prior to the date of the oral hearing or the date for deliberations in the case of a written hearing,
the Executive Director, Standards and Assessment or a delegate shall provide to each member of
the appeal panel all materials, documents and evidence submitted by the parties as well as any
other relevant information to the matters at issue.
4.6.6 Within thirty (30) days of its deliberations, the Chair of the Panel shall issue in writing the panel’s
decision and any other relevant information or recommendation to the Office of the Executive
Director, Standards and Assessment.
4.6.7 The appeal panel may confirm or amend, in whole or in part, the decision of the Executive Director,
Standards and Assessment or a delegate made under sections 2.2 or 4.6 of this Policy.
4.6.8 There is no provision for further appeal to the Royal College of the decision of the appeal panel,
which is considered final.

4.7 Withdrawal of Examination Eligibility

4.7.1 The Royal College retains the authority to withdraw acceptance of an applicant’s credentials or
withdraw permission to access the examinations leading to Royal College certification on the
recommendation of an Examination Board, the Royal College Credentials Unit, or the applicant’s
program director.
4.7.2 The Royal College may require that the applicant satisfy specific requirements as a condition of
accessing the examination leading to Royal College certification.
4.7.3 Withdrawal of a satisfactory CCT form, or questionnaire attestation will result in withdrawal of
examination eligibility.
4.7.4 Candidates who have had their examination eligibility withdrawn under section 4.7.1 may only re-
apply for examination eligibility upon substantive changes in their application pursuant to the
reconsideration of a ruling process set out in section 4.5 of this Policy.

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SECTION V – ROYAL COLLEGE EXAMINATIONS

General Information
In the context of a candidate preparing for the Royal College examination, the Royal College does not provide or
endorse any preparatory courses, syllabi, reading lists, or ghost banks. The candidate should seek the advice of the
program director for examination preparation.

5.1 Surgical Foundations Examination

5.1.1 In the surgical specialties of Cardiac Surgery, General Surgery, Neurosurgery, Obstetrics and
Gynecology, Orthopedic Surgery, Otolaryngology, Plastic Surgery, Urology and Vascular Surgery,
candidates must successfully complete the Surgical Foundations examination to attain eligibility
for any examination in the relevant surgical specialty.
5.1.2 The Surgical Foundations examination is held annually in the fall and examination dates are set
on a yearly basis. A ruling for the Surgical Foundations examination is valid for five (5) years as
noted under section 4.2.1. For more information about the registration deadline, examination
dates, sites, and format for the Surgical Foundations examination, please refer to the Royal
College website.

5.2 Examination Registration

5.2.1 Residents who intend to register for the examination leading to Royal College certification must
have received from the Royal College an official ruling letter confirming their eligibility for the
examination.
5.2.2 Candidates must register for the examinations by the deadlines published on the Royal College
website. Candidates must obtain confirmation of receipt of their registration from the Royal
College to ensure that the Royal College has received their registration.
5.2.3 Residents who are ruled eligible for the next examination session will receive information about
the examination with their official ruling letter.

5.3 Payment of Examination fees

Examination fees must be paid in full and are due by the posted deadline.

5.3.1 Examination fees will be published on the Royal College website prior to the examination
registration deadline. Candidates need to refer to the published fees prior to submitting their
registration for the exams.
5.3.2 Non-payment of fees by the deadline may result in the candidate’s registration for the
examination to be declined.
5.3.3 Examination fees are reviewed annually by the Royal College and are subject to change. To obtain
an Examination Fee Schedule please refer to the Royal College website.

5.4 Deadline for Examination Registration

All applications must be received before 11:59pm EST (Ottawa time) on the date of the relevant deadline.
Please refer to the Royal College website to see the current deadlines for the spring and fall examinations.

5.5 Examination Dates

Examination dates are subject to change without notice. Please refer to the Royal College website to
obtain the official examination dates.

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5.6 Examination Sites
Examinations, including the Surgical Foundations examination, may be held in various centres across
Canada. Information on the ___location of the exam venues is available on the Royal College website.

5.7 Examination Format

5.7.1 The Royal College examination incorporates combined written and applied components that
may include one or more short answer questions (SAQ) and/or multiple-choice questions (MCQ),
oral, Objective Structured Clinical Examination (OSCE), clinical, practical, or other examination
components.
5.7.2 As disciplines transition to a CBD training model, there may be an occurrence of candidates from
both the traditional and CBD programs writing exams in the same exam season. In this case, the
written-before-applied format that applies to CBD candidates will also be applied to traditional
candidates. Note: A written-before-applied format requires candidates to pass the written
component of the exam before they are invited to take the applied (oral, OSCE, practical) exam.
5.7.3 Information about the examination format of each specialty and subspecialty is available on the
Royal College website.
5.7.4 Candidates are notified as soon as possible of changes in the examination format or timing
approved by the Royal College Examination Committee.

5.8 Withdrawals from Examinations

5.8.1 Notification of withdrawal must be received by the Royal College at [email protected]
at least twenty (20) business days before the first component of the examination. Upon receipt,
50% of the examination fees will be refunded. Notification of withdrawal less than twenty (20)
days before the examination will result in no refund of the fees.
5.8.2 All candidates who withdraw from the examination, or do not appear at the examination, will have
been considered to have used one year of eligibility, unless granted a deferral pursuant to section
4.4.

5.9 Frequency of Examinations

5.9.1 The Royal College will offer discipline specific examinations on a yearly basis as directed by the
Assessment Committee.
5.9.2 Where specialties have more than one examination component, each component will be offered
once during an examination year. For example, if a discipline has a written exam component and
an applied exam component, each component will be offered only once during an exam year.

5.10 Language of Examinations

5.10.1 The Royal College examinations are offered in both English and French.
5.10.2 Standard medical terminology is used in both English and French examinations. All candidates
must anticipate that the examination text will be presented in Standard Medical Terminology.
“Standard Medical Terminology” means language used to describe medical textbooks, lexicons,
dictionaries, and journals; it may be specific to a medical specialty.
5.10.3 Candidates must declare at the time of examination registration whether they wish to be
examined in English or French for each component of the exam. The candidate must consistently
respond to questions on the exam component using the declared language.
5.10.4 Candidates whose first language is not English, or French should ensure that they have reasonable
fluency, written and oral, in either English or French.

5.11 Access to Examinations

Access to the examinations will be granted to candidates that have registered and have received
confirmation of their examination registration. Candidates are also required to show a government
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 issued photo identification at the time of the examination.

5.12 All Royal College examinations are conducted in accordance with the Rules & Procedures applicable to
the Delivery of Royal College Examinations. Please refer to the policy on the Royal College website.

5.13 Conflicts
The Royal College tries to ensure that potential examiner and candidate conflicts are minimized. A
conflict that could exist may include:
• a past candidate/faculty teaching relationship.
• a past work-based candidate/examiner relationship.
• past candidate/ examiner encounters in other exams; and
• all other relationship encounters that could present a bias at an examination.

If a candidate identifies a conflict, they are obligated to bring the conflict to the attention of the examination
invigilator who will them bring it to the attention of the Chair of the Discipline-Specific Examination Board
who will identify a substitute member of the same Discipline-Specific Examination Board to take over the
examiner duties.

The Royal College cannot guarantee that a candidate will have new examiners when re-writing or taking
multiple examinations. Candidates may not request substitute examiners unless there is a legitimate
conflict.

If you anticipate a conflict of interest with an examiner, please report it to the Royal College Credentials
Unit at [email protected] before the exam.

5.14 Candidates requiring an Examination Accommodation

5.14.1 The Royal College will attempt to accommodate candidates with specific requirements for the
examination provided that the validity of the examination is maintained, and the accommodation
does not cause undue hardship or unreasonable expense for the Royal College.
5.14.2 Requests for examination accommodation must be submitted to the Royal College at the time of
registering for the examination through the online e-booking system. Requests must include the
following documentation:
• A signed letter from the candidate with a description of the need for accommodation and its
severity, along with a description of the required accommodation.
• If the candidate has previously been provided accommodations by their university or other
medical education programs, the candidate should provide documentation of the
accommodations provided.
• Supporting documentation from a qualified treating professional confirming the need for
accommodation, its severity, the candidates’ functional limitations, and specific
recommendations for the accommodation. All supporting documentation must be provided
on office letterhead, from the candidate’s fully licensed practicing physician, clinical
psychologist, or other appropriate licensed healthcare provider (the practitioner cannot be a
relative or spouse of the candidate).
• If the supporting documentation specified above is more than two (2) years old, the
candidate must provide up-dated documentation from a qualified treating professional
confirming that the original documentation and functional limitations outlined therein are
still valid.

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 Note: The Royal College may request additional information, as it considers necessary, on
a case-by-case basis.
5.14.3 In the event that the need for an examination accommodation arises after the application for
examination is submitted, the candidate must inform the Program Manager, Assessment at
[email protected] and submit the documentation described in section 5.14.2
as soon as possible. In some circumstances, it may not be possible to arrange the examination
accommodation requested too close to the examination date.
5.14.4 The final decision regarding an accommodation request lies with the Director, Assessment and
Certification, or a delegate.
5.14.5 Prior to taking the Royal College examination, the candidate and the Royal College must confirm
arrangements and accommodations in writing.
5.14.6 Candidates requesting exam scheduling accommodations in relation to religious observances
may do so using the exam accommodations process.

5.15 Examination Rules and Procedures

All examination candidates are required to conduct themselves in a professional and ethical manner
and in compliance with the Rules & Procedures applicable to the Delivery of Royal College Examinations.

5.16 Decisions of Royal College Examination Boards

5.16.1 The Royal College Examination Boards are empowered by the Royal College Examination
Committee and by the Council of the Royal College to make final decisions on the examinations
of all candidates, following procedures approved by the Royal College Examination Committee
and Council of the Royal College.
5.16.2 Unsuccessful candidates will receive a summary of their performance from the Exam Board Chair.
The intent of this report is to indicate where the performance did not meet the standards set by
the examination board. The report will provide very general comments and will not include details
on the specific questions. Candidates are not permitted access to their exam content, and they
are not allowed to review their exams.

5.17 Exam Results/posting of marks

Candidate results are posted on a secure, confidential server and can only be accessed through the Royal
College website using a unique identifier. If a candidate does not want their results posted on the website,
they must inform the Credentials Unit as soon as possible, including up to the day before their examination
by email at [email protected]. Examination results go through a rigorous data verification
process to ensure that posted results have been audited and verified as complete and accurate.

5.18 Expiration of Exam Results

Candidates who successfully complete all exam components in their specialty will receive a letter from the
Credentials Unit acknowledging the candidate’s successful result. Additionally, this letter will contain an
invitation to become certified by the Royal College pending any further requirements (e.g., completing
training). This results letter will be valid for five (5) years. If the outstanding requirements outlined in the
letter have not been met and certification has not been achieved within five (5) years, the candidate will be
required to re-take all examination components in their specialty and complete all outstanding
requirements to re-qualify for certification.

5.19 Formal Review of Examinations

Formal reviews of exams are conducted based on alleged significant procedural irregularities in the
assessment process, not because of alleged errors in content. Please refer to Policy on Formal Review of
Examinations on the Royal College website for detailed information about policy and process.

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6. Policy record

Approved by: Assessment Committee, Committee on Specialty Education

Original approval date: May 2017
Approval path: Assessment Committee, Committee on Specialty Education
Effective date: May 2017
Revised approval date: October 2022
Date of next review: October 2025
Royal College Office: TMCE, Assessment
Version status: Approved
Keywords: Competence by Design, resident, training, exam eligibility, entrustable
professional activity, examination format, written-before-applied, training
experiences, deferral, appeal, exam accommodation
Information security Public
classification

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