The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Saturday, November 04, 2006


Every year at about this time, residents in their second year of training all unite in a common purpose-- to pass the LMCC-II. See, the Licensing Medical Council of Canada has devised a sadistic two-step test that we must pass in order to be licensed to practice medicine independently in Canada. The LMCC-I was written just weeks after graduating from medical school. It is the longest, most exhausting multiple-choice exam since the MCAT. For those of us in 'traditional' medical schools, the exam is just a formality. Very few people fail, and no one really feels the need to study-- after all, isn't that what we've been doing for the past four years? For the non-traditional medical schools that don't do much formal teaching and rely mostly on small group learning, this exam is often stressful and weeks, if not months, of time are dedicated to preparation.

For many of us, the LMCC-II is the first time we've done any formal studying since the LMCC-I. The LMCC-II is very different from the LMCC-I in that the formal is along the lines of an OSCE... they're all simulated patient stations. So in each room is a standardized patient (i.e. an actor) and an examiner. Each station is 10 minutes long, although in some of them the scenario stops after 5 minutes then you have 5 minutes to answer written questions on the station. Sound like fun yet?

I can't complain too much, though. Family medicine and emergency medicine residents definitely have the advantage here. All we do is manage 'the undifferentiated patient'. Our life, essentially, is the LMCC-II. Other specialties, on the other hand, aren't so lucky. Pediatrics residents haven't touched an adult since medical school. Psych residents... well, let's just say that 'the physical exam' isn't really part of their repertoire. Anaesthesia? Ninety percent of the time their patients are asleep. These are the specialties that crammed... some of them using valuable vacation time to prepare for this ridiculous waste of time.

Waste of time, you ask? How could an exam that makes sure that doctors graduate with a minimum level of competency be a waste of time? Well, consider the origins of the exam. In the olden days, as I've mentioned in previous posts, the first year of residency was a common 'rotating internship' year. After this first year, doctors in Canada were granted a general practice license allowing them to moonlight in walk-in clinics and hospitals while they did specialized residency training, a huge help in supplementing their income. Sometime about 20 years ago they abolished this rotating internship-- now, we can't practice independently until we pass the exams specific to our specialty. Either through the Canadian Council of Family Practice (for family medicine) or though the Royal College of Physicians and Surgeons (for other specialties)-- the exams we sit at the very end of residency. So the government of Ontario has managed to take away moonlighting, and whenever our union tries to raise the subject of getting it back we're told that we can't fight for better working conditions for residents if we're going to turn around and try to tell them that residents have enough free time to moonlight. Bastards.

So since the LMCC-II no longer certifies us for a general practice license, and we can't practice until we pass our specialty-specific exams anyway, this late October day amounts to nothing more than a $1400 cash grab.

Damn, I hope I passed.

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Anonymous Anonymous said...

Pathology is also another victim of LMCC part 2. PGY1 Internship just stealing good PGY1's from the programs. They say "Listen, you r too good to cut cadavers.."

Well, if you are by chance a pathologist from abroad with decade of experience and canadian residency, you can practice it without LMCC p2 but with Royal College exam, but only on provisional license. Stupid. After being certified as a specialist LMCC part 2 costs look like mandatory charitable donation; the only difference is that they are not tax deductible.

Cash grab for beaurocrats and waste of time.

4:21 PM

Blogger Vitum Medicinus said...

Thanks for this description.

I started hearing that the LMCC is this week for 4th year meds. As a first-year medical student with finals approaching I decided I didn't have enough stress and decided to worry about the LMCC too for a bit (you know, a bit of residual typical keener pre-med mentality.) So I googled "fail lmcc" to see what happens if you fail and found your article pretty quick. It was quite reassuring.

Maybe I should now google "fail first year of medical school." Or maybe I should just get back to studying.

7:03 PM

Anonymous Anonymous said...

Those bums in Ottawa spent so much money starting up the LMCC in the early 90's that it's here to stay (even though everyone agrees that it's a complete waste of time). At least we can feel a little better knowing that our American counterparts also have the just as useless USMLE 3 - another cash cow - and don't get off any easier.

9:15 PM

Anonymous Anonymous said...

If CAIR can do anything for us, it should be to abolish the ridiculous exam.

8:13 PM


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