ORIGINAL ARTICLE
Seasonal timing of the Royal College examination in general
paediatrics: A survey of residents’ preferences
Herbert Brill MD FRCPC1, Eric I Benchimol MD FRCPC2, David Goldfarb MD FRCPC3
H Brill, EI Benchimol, D Goldfarb. Seasonal timing of the
Royal College examination in general paediatrics: A survey of
residents’ preferences. Paediatr Child Health 2007;12(9):765770.
La saison de l’examen du Collège royal en
pédiatrie générale : Un sondage des préférences
des résidents
BACKGROUND: Currently, the general paediatrics examination
administered by the Royal College of Physicians and Surgeons of
Canada is offered annually in the spring. Controversy exists regarding
its seasonal timing. Assessing the views of residents anticipating the
examination is relevant to examination administrators.
OBJECTIVE: To determine paediatric residents’ opinions regarding
the timing of the general paediatrics examination.
METHODOLOGY: A survey was electronically distributed to all resident members of the Canadian Paediatric Society with an e-mail
reminder after one week. Responses were collected independently,
forwarded to the authors and summarized using descriptive statistics.
Multinomial regression identified predictors of examination preference and estimated prediction value.
RESULTS: One hundred sixty-four of 585 surveys (28%) were
returned. Common preferences included ‘spring of 4th year’ (42%)
and ‘fall of 4th year’ (22%). Respondents intending four years of general paediatrics demonstrated a 55% preference for ‘spring of 4th year’
and 11% for ‘fall of 4th year’, compared with preferences of 29% and
34%, respectively, for respondents intending three years of general
paediatrics followed by subspecialty training (P<0.001). This was confirmed by multinomial regression (OR 2.49; P<0.0001). Increasing
training year was associated with increasing support for examination
in the fall relative to the spring of 4th year (OR 1.37; P=0.019).
CONCLUSIONS: Residents’ preferences for the timing of the examination are varied, with ‘spring of 4th year’ being most preferred.
Residents demonstrated stronger support for ‘fall of 4th year’ with
increasing years of training, and if planning to pursue subspecialty
training after three years of general paediatrics.
HISTORIQUE : L’examen de pédiatrie générale administré par le
Collège royal des médecins et chirurgiens du Canada a lieu tous les ans au
printemps. Il existe une controverse quant à la saison à laquelle il est
donné. C’est pourquoi les administrateurs de l’examen jugent pertinent
d’explorer le point de vue des résidents qui prévoient passer l’examen.
OBJECTIF : Déterminer le point de vue des résidents en pédiatrie au sujet
de la date de l’examen de pédiatrie générale.
MÉTHODOLOGIE : Tous les membres résidents de la Société
canadienne de pédiatrie ont reçu un sondage par courriel, suivi d’un rappel
au bout d’une semaine. On a colligé les réponses de manière indépendante
et on les a transmises aux auteurs qui les ont résumées à l’aide de
statistiques descriptives. Une analyse de régression multinomiale a permis
de repérer les prédicteurs de préférence d’examen et d’évaluer la valeur
prédictive.
RÉSULTATS : On a reçu 164 réponses sur les 585 sondages (28 %). Parmi
les préférences courantes, soulignons « le printemps de la 4e année »
(42 %) et « l’automne de la 4e année » (22 %). Cinquante-cinq pour cent
(55 %) des répondants qui se destinaient à quatre ans d’étude en pédiatrie
générale préféraient « le printemps de la 4e année », et 11 %, « l’automne
de la 4e année », par rapport à 29 % et 34 %, respectivement, des
répondants qui se destinaient à la pédiatrie générale suivie d’une formation
en surspécialité (P<0,001). Ces résultats ont été confirmés par une analyse
de régression multinomiale (RR 2,49; P<0,0001). L’augmentation des
années de formation s’associait à un plus grand soutien de l’examen à
l’automne plutôt qu’au printemps de la 4e année (RR 1,37; P=0,019).
CONCLUSIONS : Les préférences des résidents quant à la date de
l’examen sont variées, mais « le printemps de la 4e année » remporte les
suffrages. Les résidents appuyaient davantage « l’automne de la 4e année »
s’ils avaient terminé plus d’années de formation et s’ils prévoyaient
poursuivre une formation de surspécialité après trois ans de pédiatrie
générale.
Key words: Certification examination; Paediatrics; Postgraduate
medical education; Residency training; Survey; Timing
ertification examinations are the hallmark of
contemporary postgraduate medical and surgical
training. Some countries limit the examination to a written
component, while others include a practical evaluation,
which may include a detailed history and physical examination, or an observed structured clinical examination, composed of multiple stations (1). The objective of certification
C
examinations is to determine whether trainees meet an
acceptable set of standards that correspond to fitness to
practice in a given specialty (2).
In Canada, the Royal College of Physicians and Surgeons
of Canada (RCPSC) and the Collège des Médecins du
Québec administer general paediatrics certification examinations in the 4th and 5th year of training, respectively.
1Division
of Gastroenterology and Nutrition, Department of Paediatrics, Montreal Children’s Hospital, McGill University Health Centre, McGill
University, Montreal, Quebec; 2Division of Gastroenterology, Hepatology, and Nutrition, Department of Paediatrics, The Hospital for Sick
Children, University of Toronto, Toronto; 3Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Eastern Ontario,
University of Ottawa, Ottawa, Ontario
Correspondence: Dr Herbert Brill, Division of Gastroenterology and Nutrition, Department of Paediatrics, McMaster Children’s Hospital,
1200 Mail Street West, Hamilton, Ontario L8S 3Z5. Telephone 905-521-2100 ext 75637, fax 905-521-2655, e-mail herbertbrill@yahoo.ca
Accepted for publication July 25, 2007
Paediatr Child Health Vol 12 No 9 November 2007
©2007 Pulsus Group Inc. All rights reserved
765
Brill et al
1) What is your year of training?
1st year
2nd year
3rd year
4th year
5th year
6th year
>than 6 years
2) What is your planned training path?
a) 4 years General Paediatrics
b) 4 years General Paediatrics followed by 2 year subspecialty fellowship
c) 4 years General Paediatrics followed by 3 year (or more) subspecialty fellowship
d) 3 years General Paediatrics followed by 2 year subspecialty fellowship
e) 3 years General Paediatrics followed by 3 year (or more) subspecialty fellowship
N.B. For the purposes of data analysis, these categories were narrowed to three
choices: ‘4 years General Paediatrics’, ‘4 years General Paediatrics followed by
a subspecialty’ (i.e. combined choices b and c), and ‘3 years General Paediatrics
followed by a subspecialty’ (i.e. combined choices d and e).
3) In considering the timing of the Royal College Exam for General
Paediatrics, your first preference is:
Spring of 3rd year (April - June)
Fall of 4th year (September - November)
Spring of 4th year (April - June)
Summer of 4th year (July- August)
Winter of 4th year (January - March)
Summer after completion of 4th year
4) In considering the timing of the Royal College Exam for General
Paediatrics, your second preference is:
Spring of 3rd year (April - June)
Fall of 4th year (September - November)
Spring of 4th year (April - June)
Summer of 4th year (July- August)
Winter of 4th year (January - March)
Summer after completion of 4th year
5) In considering the timing of the Royal College Exam for General
Paediatrics, your third preference is:
Spring of 3rd year (April - June)
Fall of 4th year (September - November)
Spring of 4th year (April - June)
Summer of 4th year (July- August)
Winter of 4th year (January - March)
Summer after completion of 4th year
Figure 1) Survey sent to resident members of the Canadian Paediatric
Society
Excluding Quebec, Canada’s postgraduate training program
in paediatrics is unique relative to other countries in that
the 4th year of training marks the fulfillment of training
requirements for certification in general paediatrics, regardless of whether trainees continue in a general paediatrics
program or begin the 1st year of a paediatric subspecialty
training program. Approximately one-half of paediatric
trainees plan to complete subspecialty training (S Vohra,
personal communication), with some beginning this training after three years of general paediatrics residency. Thus,
the pool of candidates sitting the certification examinations
are composed of a mix of individuals that include those
completing four years of general paediatrics training and
those finishing the 1st year of subspecialty training.
As a result of this mixed candidate pool, discussion has
ensued in recent years regarding the timing of the annual
RCPSC certification examinations in general paediatrics.
In the past, biannual examinations were held in the fall and
spring allowing candidates in their 4th year of training to
participate in either sitting. In the 2000/2001 academic
year, the RCPSC reduced the available sittings to a single
annual spring examination, occurring in tandem with a
decision to change the practical portion of the examination
to an observed structured clinical examination format from
the traditional format of a detailed history, physical
examination, investigation and treatment plan, and interpretation of results to the patient and the family. With a
single examination offered late in the 4th year of training,
trainees in subspecialty programs may be distracted from
their training while studying for the general paediatrics
766
examination. Thus, the RCPSC Paediatrics Committee
recently considered moving the certification examination
from the spring to the fall of 4th year of training (3).
Certification examinations are a source of considerable
stress to resident trainees (4). In formulating an opinion
regarding the timing of an examination, the examiners
would likely wish to minimize stress to assess residents’
knowledge and skill with maximum accuracy. Thus, the
preferences of resident trainees anticipating the certification examination are relevant to examiners who believe
that minimizing stress improves performance. The purpose
of the present study was to determine Canadian-trained residents’ preferences of seasonal timing for the RCPSC general paediatrics certification examination.
METHODS
Subjects and study protocol
All paediatrics trainees who were provisional members of
the Canadian Paediatric Society (CPS) were invited to
participate in a cross-sectional survey in February 2006.
Five hundred eighty-five provisional members of the CPS
were surveyed, comprised of postgraduate trainees enrolled
in general paediatrics programs across Canada (5), along
with an undetermined number of subspecialty trainees who
have maintained their membership with the CPS. A simple
survey was created to gauge respondents’ preferences with
respect to timing of the RCPSC general paediatrics certification examination (Figure 1). The survey was e-mailed to
all CPS trainee members on January 11, 2006, with an
introductory information page explaining the rationale for
the survey in neutral language. The survey was approved
and translated into French by the CPS administrative services. The French version of the survey and information page
was e-mailed to trainees in French language programs
simultaneously. Subjects were asked to specify their choices
and e-mail their survey directly to the CPS administrative
office. A reminder was e-mailed after one week.
Data collection
Investigators were blinded to the respondents’ individual
survey forms. The CPS administrative employees collected
the returned surveys and entered the responses into a
Microsoft Excel 2000 (Microsoft Corporation, USA)
spreadsheet. The collated spreadsheet was then forwarded
to the investigators for summary and analysis.
Data analysis
Data were summarized using descriptive statistics and
tables. χ2 analysis was used to determine differences among
categorical variables.
Multinomial logistic regression analysis was performed
using the CATMOD procedure in SAS version 9.3.1 (SAS
Institute Inc, USA). Examination choice was defined as the
dependent variable. Year of study (continuous data) and
path of study (nominal categorical data) were defined as
independent and potentially predictive variables. The path
of study was simplified to three categories: ‘four years of
Paediatr Child Health Vol 12 No 9 November 2007
Residents’ choice of paediatrics examination timing
TABLE 1
Summary of examination timing preference according to the year and path of training (n=164)
Characteristic
Spring of
3rd year
Summer of
4th year
Fall of
4th year
Winter of
4th year
Spring of
4th year
Summer after
4th year
Training year, n (%)
1st (n=35)
4 (11)
2 (6)
5 (14)
9 (26)
10 (29)
5 (14)
2nd (n=38)
4 (11)
4 (11)
7 (18)
3 (8)
20 (53)
0 (0)
3rd (n=26)
2 (8)
0 (0)
3 (12)
3 (12)
16 (62)
2 (8)
4th (n=30)
1 (3)
2 (7)
9 (30)
5 (17)
10 (33)
3 (10)
5th (n=16)
0 (0)
0 (0)
3 (19)
3 (19)
9 (56)
1 (6)
6th (n=12)
0 (0)
0 (0)
6 (50)
4 (33)
2 (17)
0 (0)
>6th (n=4)
0 (0)
0 (0)
3 (75)
0 (0)
1 (25)
0 (0)
–
–
–
–
–
–
11 (7)
8 (5)
36 (22)
27 (17)
68 (42)
11 (7)
9 (11)
6 (8)
27 (34)
11 (14)
23 (29)
4 (5)
2 (5)
1 (2)
5 (12)
8 (19)
25 (60)
1 (2)
5 (4)
No response (n=3)
Total (n=161)
Training path, n (%)
Three years of general paediatrics +
subspecialty (n=80)
Four years of general paediatrics +
subspecialty (n=42)
Subspecialty (n=122)
11 (9)
7 (6)
32 (26)
19 (16)
48 (39)
General paediatrics (n=40)
1 (2)
1 (2)
4 (10)
8 (20)
20 (50)
6 (15)
At least four years of general paediatrics (n=82)
3 (4)
2 (2)
9 (11)
16 (20)
45 (55)
7 (9)
general paediatrics only’, ‘three years of general paediatrics
followed by a subspecialty (any length)’ and ‘four years of
general paediatrics followed by a subspecialty (any length)’.
Independent variables were neither correlated (Pearson’s
correlation coefficient = –0.03) nor collinear (proportion of
variation less than 0.65). Interaction between the year of
study and the path of study was initially included in the
model and was found to be nonsignificant (P=0.7226).
Therefore, the interaction term was excluded from the final
model. To allow a more powerful analysis, question 2 (path
of training) was narrowed to three choices: ‘three years of
general paediatrics plus a subspecialty’, ‘four years of general
paediatrics plus a subspecialty’ or ‘general paediatrics only’.
The present timing of the examination (spring of 4th year) was
assigned as the reference value. The reference value for the
path of study was general paediatrics training (four years of
general paediatrics with no subspecialty training). ORs were
calculated by taking the exponent of the regression coefficient.
RESULTS
There were 164 surveys returned with 161 complete
responses, a response rate of 28%. Of these respondents,
129 (80%) were between their 1st and 4th year of training.
Only one 5th-year resident stated a career path of general
paediatrics. Preferred choices are summarized in Table 1.
Residents from all training years and intended training
paths were reasonably represented, with the exception of
five-year general paediatrics residents, of which there was
only one respondent. Overall, residents’ first choice for the
time of the examination was variable, but 42% of
respondents chose the spring of 4th year (the current examination timing) as their first choice, compared with 22% for
the fall of 4th year. Fourth year residents were almost evenly
split between these two choices (33% in favour of spring
Paediatr Child Health Vol 12 No 9 November 2007
examinations versus 30% in favour of fall examinations).
When the respondents were stratified according to whether
residents planned general paediatrics training or subspecialty
training, 50% of residents intending to be general paediatricians preferred the spring of 4th year and 10% preferred the
fall of 4th year. This compared with 39% of residents planning to become paediatric subspecialists preferring spring of
4th year and 26% preferring fall of 4th year (P=0.035).
Stratifying the responses according to whether residents
planned three years of general paediatrics before subspecialization or underwent at least four years of general paediatrics before subspecializing or graduating yielded 29% and
34% support for spring and fall of 4th year, respectively,
among the former group, and 55% and 11% support for
spring and fall of 4th year, respectively, among the latter
group (P<0.0001).
The second and third preferences of respondents were
varied and did not reveal any significant trends (data not
shown).
Multinomial regression model analysis
Overall, the maximum likelihood ANOVA indicated that
both the year of study (P=0.0266) and the path of study
(P=0.0063) influenced examination preference. Regression
analysis results are presented in Table 2. Increasing year of
study was associated with examination choice of ‘fall of 4th
year’ (OR 1.37; P=0.019). This indicates that as the year of
study increased, respondents were more likely to choose the
‘fall of 4th year’ as their examination preference. The year
of study had no statistically significant impact on other
examination preferences. Respondents who indicated their
path of study would be ‘three years general paediatrics plus
a subspecialty’ were significantly more likely to specify their
examination preference as ‘spring of 3rd year’ (OR 2.97;
767
Brill et al
TABLE 2
Results of multinomial logistic regression: Examination
preference of respondents (n=161)
Spring of Summer of Fall of Winter of Summer after
3rd year 4th year 4th year 4th year
4th year
Year of study
–0.4478
–0.2945
0.3177*
0.0502
–0.1671
(0.2679)
(0.2795)
(0.1355)
(0.1417)
(0.2413)
Path of study
3 years of
1.0870*
1.1431*
1.2095**
0.1988
0.2898
general
(0.5063)
(0.5730)
(0.3168)
(0.3128)
(0.5782)
TABLE 3
Results of multinomial logistic regression: Examination
preference of respondents (with path of study
redistributed as a binomial categorical variable) (n=161)
Spring of Summer of Fall of Winter of Summer after
3rd year 4th year 4th year 4th year
4th year
Path of study
3 years of
0.7781*
0.8600*
0.9111**
general
(0.3658)
(0.4297)
(0.2371) (0.2344)
0.1519
0.0408
(0.3399)
paediatrics +
subspecialty
paediatrics
+ subspecialty
4 years of
–0.2983
–0.6644
–0.7208
–0.2215
–1.1342
general
(0.6178)
(0.7780)
(0.4014)
(0.3307)
(0.7214)
paediatrics
Estimates are presented with standard errors in parentheses. Reference category for examination preference (dependent variable) is ‘spring of 4th year’.
Reference category for path of study (independent variable) is ‘four years of
general paediatrics training (with or without subsequent subspecialty training)’. *P<0.05; **P<0.001 (two-tailed tests)
+ subspecialty
Estimates are presented with standard errors in parentheses. Reference category for examination preference (dependent variable) is ‘spring of 4th year’.
Reference category for path of study (independent variable) is ‘general paediatrics only’. Year of study is treated as a continuous variable. *P<0.05;
**P<0.001 (two-tailed tests)
P=0.0318), ‘summer of 4th year’ (OR 3.14; P=0.0461) and
‘fall of 4th year’ (OR 3.35; P<0.0001) compared with
respondents who specified ‘general paediatrics only’ as their
path of study. Respondents who specified their path of study
to be ‘four years general paediatrics plus a specialty’ were
not statistically significantly more likely to prefer any one
examination timing choice compared with respondents
who specified their path of study to be ‘general paediatrics
only’. Respondents intending to undergo three years of
general paediatrics training plus a subspecialty were statistically significantly more likely to indicate a preference for
the examination in spring of 3rd year (OR 2.20; P=0.0312),
summer of 4th year (OR 2.36; P=0.0454) or fall of 4th year
(OR 2.49; P<0.0001).
Respondents indicating a path of study including a
4th year of general paediatrics (with or without intended subsequent subspecialty training) were pooled, changing the variable ‘path of study’ to a binomial categorical variable.
Regression analysis was repeated and results are presented in
Table 3. Respondents intending to undergo three years of
general paediatrics training plus a subspecialty were significantly more likely to indicate a preference for the examination in the spring of 3rd year (OR 2.20; P=0.0312), summer
of 4th year (OR 2.36; P=0.0454) or fall of 4th year (OR
2.49; P<0.0001) compared with those intending to engage
in a 4th year of general paediatrics training. Respondents
intending to undergo only three years of general paediatrics
training were no more or less likely to indicate a preference
for the winter of 4th year (P=0.5171) or the summer after
4th year (P=0.9045) compared with those intending to
engage in a 4th year of training.
DISCUSSION
The present survey demonstrates several insights. First, paediatric residents’ preferred choice for sitting the RCPSC
general paediatrics certification examination is the spring
of 4th year of training. However, as residents progress
768
through training, they are more likely to prefer the
examination in the fall of 4th year (OR 1.37 relative to
trainees at an earlier stage). Moreover, the choice of an
earlier examination (in the spring of 3rd year or the fall of
4th year) seems to be impacted mostly by the respondents
indicating plans to enter subspecialty training after three
years of paediatrics training. To further examine this issue,
respondents indicating a path of study including a 4th year
of general paediatrics were pooled, and multinomial regression analysis was repeated. These results confirm that the
intention to undergo only three years of general paediatrics
training (as opposed to four years of general paediatrics
training) made a respondent more likely to choose an
earlier examination time.
The seasonal setting of a certification examination may
affect performance on the examination itself and on
concurrent subspecialty training. Identifying such an easily
modifiable factor would be advantageous for examination
administrators wishing to improve examination sensitivity.
Few studies have examined the effect of timing on performance in examinations. In particular, there is a paucity of
Canadian studies investigating this issue. A number of studies conducted on American medical students sitting The
National Board of Medical Examiner subject examinations
found an association between timing of a variety of
clerkship rotations and examination performance (6-9).
American general surgery programs have the option of
instituting a remedial year for trainees failing to pass the
written qualifying examinations before allowing a new
attempt, with the result being that all remedial year trainees
eventually enter successful practice (2). To our knowledge,
this is the first study seeking to examine resident trainee
preference for timing of their certification examination.
A number of factors influence examination performance, including conference attendance, amount of study,
confidence and previous performance (10). Rose et al (11)
examined the impact of parental leave during residency
training on the examination process among 100 medical
specialties. The study found that outcomes range from no
discernable impact to delay of the examination by one year,
depending on individual program policies. Shapiro et al
(12) explored the reasons for failure of the subspecialty
Paediatr Child Health Vol 12 No 9 November 2007
Residents’ choice of paediatrics examination timing
examination for child and adolescent psychiatry, and found
that previous performance on the general psychiatry
examination did not predict performance outcome on the
subspecialty test. Rather, failure was primarily due to a lack
of ability in organizing information during the oral examination. Taken together, these studies suggest that examination performance is influenced by a complicated and varied
set of factors that are likely unique to each individual. One
of these might be examination timing, although this factor
has not been previously assessed in a research setting.
In our study, the spring of the 4th year of training was
the preferred examination timing among respondents
intending to complete at least four years of general paediatrics residency. However, as respondents became more senior in their training, they became more likely to prefer a fall
examination compared with trainees at an earlier stage of
training. One explanation for this shift is that confidence
and knowledge increases as residents proceed through training, with an increasing number of trainees in a given cohort
feeling ready to sit the certification examination. However,
the preference for the spring of 4th year remained higher
than the fall of 4th year for all respondents, except those in
their 6th year of training or higher.
The impact of examination timing on subspecialty training is of particular interest to subspecialty educators and subspecialty trainees. The finding that trainees who plan to enter
subspecialty training after three years prefer earlier examination dates supports the view that subspecialty residents feel
distracted by the certification examination and would prefer
to complete the examination earlier and focus on their subspecialty training. However, because respondents in this training path make up less than 50% of respondents, a change in
examination timing is contrary to a majority of respondents’
views. Moreover, a preference for an earlier examination
would need to be correlated with observed comparable performance on certification examinations held at earlier times
to be a viable alternative. In the absence of such data, the
only way to respond to the differing preferences in examination timing would be for the RCPSC to offer two examination
sittings per year by adding a fall sitting to the current schedule. Such a decision would carry financial and recruitment
issues beyond the scope of the present study (13).
It is not known whether the current timing of the RCPSC
examination in general paediatrics contributes to
performance. An indirect measure of this would be to retrospectively compare examination pass rates among wholly
Canadian-trained examinees both before and after the fall
sitting of the RCPSC examination was removed. However,
interpreting such a comparison would be difficult given the
different structure of the present examination. Offering a fall
sitting on an experimental basis would allow the RCPSC to
test the hypothesis that examinees perform better on the
RCPSC examination if they were able to sit the examination at a time compatible with their stated preference.
There are a number of limitations of the present study.
The survey was sent by e-mail and depended on respondents to return the filled survey. Coupled with a response
Paediatr Child Health Vol 12 No 9 November 2007
rate of 28%, there exists a potential for responder bias. It is
uncertain how responder bias would modify the observed
data. Respondents believing in maintaining the status quo or
changing the examination date each have compelling reasons for responding to this survey. Subspecialty trainees at
higher levels of training are less likely to remain members of
the CPS Residents Section and, therefore, may not have
been represented completely in this survey. Additionally, the
survey discusses resident plans and preferences. Residents
stating that they presently plan to undergo subspecialty training may not in fact continue those plans. There are potential
effect modifiers that were not studied. These include, but are
not limited to, sex differences, age differences and training
site differences. The latter is of particular interest and may
represent a confounder because trainees from certain
programs are more likely to undergo subspecialty training.
Additionally, residents at smaller programs may have
different opinions than residents at larger programs. Trainees
who plan to move centres for subspecialty training after
three years may not be as interested in an earlier certification
examination as trainees who remain at the same centre. The
converse may be true for trainees planning to move centres
after four years of training. Finally, respondents are heterogeneous in their experiences, as 5th- and 6th-year residents
have already sat the examination, 4th-year residents were
studying (presumably) at the time of questionnaire administration and 1st-, 2nd- and 3rd-year residents were at various
stages of precontemplation.
CONCLUSION
Individuals who plan to undergo at least four years of
paediatrics training prefer a spring of 4th year certification
examination, while those who plan to undertake subspecialty
fellowships after three years of paediatrics training seem to
prefer an earlier examination date compared with other
trainees. Increasing year of training is also associated with an
increasing support for the examination in the fall of 4th year.
Further study is needed to determine whether timing of the
certification examination impacts on performance, whether
there is a difference in performance between individuals
anticipating careers in general paediatrics versus subspecialties, and what factors contribute to performance. The
impact of certification examination timing on performance
in subspecialty training should also be examined.
ACKNOWLEDGEMENTS: The authors thank the Canadian
Paediatric Society and its office staff for their assistance in
distributing the survey and collecting and entering responses, and
Denis Leduc and Marie Adèle Davis from the Canadian Paediatric
Society for their support and suggestions. At the time of the present study, the Council for Services for Children and Adolescents
financially supported Dr Brill’s fellowship.
REFERENCES
1. Khalili K. Canadian versus US radiology certification examinations:
The 1999 experience. Can Assoc Radiol J 2000;51:8-9.
2. Rehm CG, Rowland PA. The remedial year in the general surgery
board certification process: How effective is it? Curr Surg
2005;62:644-9,649-50.
769
Brill et al
3. RCPSC Pediatric Specialty Committee. Paediatric Resident
Training. CPS Board of Directors Meeting. Ottawa, November 11
to 13, 2005.
4. Perrin K, Prasad S, Robinson G. Survey of the Royal Australasian
College of Physicians examination candidates: preparation and
impact on lifestyle. Intern Med J 2005;35:680-2.
5. Canadian Paediatric Society, Membership Subcommittee. Board of
Directors Meeting. Ottawa, November 11 to 13, 2005.
6. Whalen JP, Moses VK. The effect on grades of the timing and site of
third-year internal medicine clerkships. Acad Med 1990;65:708-9.
7. Hampton HL, Collins BJ, Perry KG Jr, Meydrech EK, Wiser WL,
Morrison JC. Order of rotations in third-year clerkships.
Influence on academic performance. J Reprod Med 1996;41:337-40.
8. Ripkey DR, Case SM, Swanson DB. Prediciting performance on
the NBME surgery subject test and USMLE step 2: The effects of
surgery clerkship timing and length. Acad Med 1997;7:S31-3.
770
9. Reteguiz JA, Crosson J. Clerkship order and performance on family
medicine and internal medicine National Board of Medical
Examiners Exams. Fam Med 2002;34:604-8.
10. Godellas CV, Huang R. Factors affecting performance on the
American Board of Surgery in-training examination. Am J Surg
2001;181:294-6.
11. Rose SH, Burkle CM, Elliott BA, Koenig LF. The impact of
parental leave on extending training and entering the board
certification examination process: A specialty-based comparison.
Mayo Clin Proc 2006;81:1449-53.
12. Shapiro T, Juul D, Scheiber SC. Exploration of failure on the
subspecialty examination for child and adolescent psychiatry.
Am J Psychiatry 1996;153:693-7.
13. Humphrey-Murto S, Wood TJ, Touchie C. Why do physicians
volunteer to be OSCE examiners? Med Teach
2005;27:172-4.
Paediatr Child Health Vol 12 No 9 November 2007
Eric I Benchimol