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RHPA - Royal College of Physicians and Surgeons of Canada (RCPSC). Adewale v. Royal College of Physicians and Surgeons of Canada
In Adewale v. Royal College of Physicians and Surgeons of Canada (Ont CA, 2025) the Ontario Court of Appeal allowed a plaintiff's appeal, here brought against "the dismissal of their action for breach of contract" where "they sought a declaration that they each obtained a passing grade of at least 70% on a qualifying exam administered by the Royal College of Physicians and Surgeons of Canada (the “Royal College”) in 2020 and were therefore entitled to be certified for independent psychiatric practice".
Here the court explains the physician qualification role of the Royal College of Physicians and Surgeons of Canada, particularly during the COVID crisis:[6] The Royal College is a national not-for-profit corporation that sets standards for physicians practising in Canada. Among other things, it accredits university programs that train resident physicians for specialty practices and administers exams that residents must pass to be certified as specialists. The provincial colleges that license physicians for specialized practice generally require that applicants obtain a Royal College certification.[1]
[7] Each appellant is an international medical graduate, that is, they obtained a medical degree and completed specialty training in psychiatry in jurisdictions outside of Canada and the United States that are approved by the Royal College. After assessing each appellant’s training and practical experience, the Royal College determined that they were eligible to seek certification for independent psychiatric practice in Canada by taking the College’s qualifying exam.
[8] Candidates for certification have a three-year window, subject to two possible renewals of one year each, to take and pass the Royal College’s qualifying exam before losing their eligibility. In the meantime, they can practice psychiatry (or any other medical specialty for which they are qualified) in Canada within a supervised setting.[2]
[9] Each appellant paid the Royal College $4,415 to take the psychiatry exam offered in 2020. The exam was to consist of two components: a written component, followed by a clinical/oral component a few weeks later.
[10] The 2020 written exam was originally scheduled to take place on March 24, 2020. In the wake of public health measures imposed due to the COVID-19 pandemic, the Royal College cancelled the exam on March 13, 2020.
[11] In April 2020, the Royal College notified the appellants and other candidates that the clinical/oral component of the exam would not be required for their cohort. Instead, candidates had to submit a letter from their respective clinical supervisors attesting that they had the necessary clinical experience, the “knowledge, skills, attitudes and judgment necessary for the independent practice” of psychiatry, and “satisfactory moral and ethical standing”. If accepted, this letter would entitle each appellant to take a written exam, eventually set for August 26, 2020. In an April 9, 2020 email to candidates, the Royal College advised that: “If you pass the written exam you will be immediately certified.”
[12] On its website, the Royal College stated that the pass score for the written psychiatry exam was 70%. In 2020, in a new entry in the Frequently Asked Questions section, it denied that exams would be graded on a bell curve; instead, a post-exam review would ensure that the exam was “criterion-referenced”:Given the current environment, will the Royal College use a bell curve to grade exam results?
No, the Royal College does not use a bell curve to grade exam results. Our exams are criterion-referenced, which includes an in-depth analysis of all examinations after they are written. This is something we do every year, and 2020 will be no different. [13] The term “criterion-referenced” was not explained, other than to state that this would include an “in-depth analysis of all examinations after they are written.” In another section of its website, however, the Royal College provided this further explanation of the post-exam review process:Exam data verification
A thorough process of data verification and quality assurance of exam results is conducted during and after the exams.
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As part of the quality assurance process for all exams a complete psychometric and performance analysis is conducted. During this process, questions that were overly difficult, non-discriminating, or for which new evidence emerged between the time of question writing and exam administration are reviewed. As a result of this review process, some questions may be deleted from the final exam score for all candidates.
Quality assurance of exam questions
A rigorous exam development and quality review process is followed to ensure the validity and quality of the exam questions.
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Following the exam, a psychometric analysis of the questions is conducted and items that do not meet psychometric standards are removed from the exam and the exam is rescored without those items. In addition, any items that have been flagged during the exam administration are reviewed and if these items are deemed to be defective for any reason they are removed from the exam. [14] There was no other information provided to candidates prior to the August 26, 2020 exam, either on the Royal College’s website or in its general communications to all candidates, explaining how the post-exam review process might affect exam scores.
[15] On August 26, 2020, the appellants wrote the exam. Several weeks later, the Royal College told them they had failed it.
[16] The appellants later learned that they had each received an initial score of between 70.45% and 75.76% on the exam before any adjustments were made pursuant to the post-exam quality review process. Three exam questions were removed as a result of the review and the exams were rescored without them. Each appellant had an adjusted score of over 70% as a result.
[17] In addition, however, the Royal College’s post-exam review resulted in the “cut score” for certification being set at 76.5% and all examinees’ scores being adjusted downward by 6.5%. As a result, the appellants’ final grades were between 63.95% and 69.26%.
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