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Hi all,

Family med resident here, I received news yesterday that I passed the CCFP exams from this past April. I then received news today that I failed the LMCC2 exam written in May. More concerning however is that it was my second attempt at the LMCC2 exam (unable to pass in October 2018 as well). Furthermore, my score somehow dropped lower than the first attempt despite a modified approach, and an overall feeling that my performance was significantly improved the second time around.

I know this isn't the first "I can't believe I failed the LMCC" thread, but in light of recent changes to the LMCC format/assessment which were implemented in October 2018.. " the MCC made substantial revisions to the MCCQE II in 2018 with the implementation of a new examination blueprint".. I was wondering if anybody else is struggling to make sense of their results from this exam?

The scoring scale previously ranged from 50 to 950 with a mean of 500 and a standard deviation of 100. Since October 2018, scores range from 50 to 250 with a mean of 150 and standard deviation of 20. I realize that these are equivalent/proportional but now that the pass score is set at 138, doesn't that indicate that ~16% (one standard deviation from mean 150-20=130) of test-takers scored below 130? Beyond that, anyone who scored 131-137 would fail as well.. which would bring to the total fail rate to almost 20%? If this logic is correct, isn't the fail rate much higher compared to previous iterations of the exam before October 2018?

Regardless, I'm now even more unclear as to what I'm doing wrong than I was after the first attempt. The "supplementary information" document that follows the pass/fail notification doesn't get sent for another two weeks, however it's very generalized and provides no specific or detailed feedback. I simply don't understand. Two years of a family med residency without any concerns from preceptors, successful completion of the CCFP exams. I even reviewed each of the stations with a colleague who passed the exam comfortably and we can't identify any significant differences that would account for such profoundly different exam scores.

Any comments or insight would be greatly appreciated.

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Just echoing what others have said, congrats on passing the CCFP! and don’t let this exam question your clinical abilities. I wrote the last sitting too, I passed but came out of it thinking that it w

I disagree. The best way is to get the "previous sample" questions that are passed down year to year and practice those. 

On the topic of possible site/examiner variation.. as per the MCC website, "objectivity of scoring is achieved using standardized guidelines for exam administration, the training of examiners and of S

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Hey I am sorry to hear about your LMCC2 failure. Hearing that you pass CFPC exam on the first try is reassuring. I don't think that LMCC2 failure would warrant you to worry about your medical knowledge or raise any clinical concerns.

LMCC2 performance does not reflect real life scenarios, even for family medicine  residents. 

I personally find LMCC2 with OSCE format to be more challenging than SOOs,  because it involves doing history, physical exam, diagnosis and management in 14 & 6 minutes. The recent change in format focusses more on soft skills of ethics and communication, which could be quite subjective. 

I am not sure about the 20% failure rate?? I am surprised that they raised the score from 134 to 138, given that a lot of people had failed last year. The failure rates are definitely higher since MCC changed the format starting in October 2018. 

Moving forward, the main thing is to figure out what you want to do until you rewrite the exam in October, practice vs focusing on studying for LMCC2 ?

I know that in New Brunswick, Manitoba and Saskatchewan, they let you practice independently with LMCC2 or CFPC alone; it might help you financially until you can write LMCC2.  In Ontario and in Quebec, you have to pass both exams to independently practice.

I would ask for a score recheck in your case for a even slight chance. In the meanwhile, register promptly for October 2019 exam as spaces are limited. 

I think that you will have to wait 1 year between the 3rd and 4th attempt; study well and prepare in abundance!  I have faith that you will do well on this attempt! Third time is the charm (sorry at my bad sense of humour of cheering you up). 

I would be happy to help you prepare and offer you advice. I got a good score even though I felt like crap walking out the door. 

I just want to congratulate you on CFPC success! Well done! I understand the feeling of failing and feeling terrible, you are not alone! Please PM me, would be happy to offer more in-depth advice in order to prepare for the exam :) 

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As a senior family medicine resident, you are theoretically the most prepared person for this exam, however, even FM residents can and do mess this up, so you're not alone. I personally struggled with QE2 back in residency and had to repeat it, but did much better on the retake. If you haven't read through all the pages on the MCC site pertaining to QE2, then I suggest you do so, to get a better idea of the grading and level of detail they expect you to know. Congrats on CCFP. 

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Just echoing what others have said, congrats on passing the CCFP! and don’t let this exam question your clinical abilities. I wrote the last sitting too, I passed but came out of it thinking that it was crap shoot and wouldn’t have been too surprised if I didn’t pass. I was told (but don’t know first hand) that the failure rate for the October sitting was ~20-25% so this doesn’t sounds too far off.

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To those preparing for LMCC2 , I would highly recommend the following resources;

1) Qbanks, subscribe at least 3 months prior to the exam; it's worth the money

2) OSCE and Clinical Skills Handbook by Katrina F. Hurley

3) Clinical skills review: Scenarios Based on Standardized patients- 2013 by Zu-Hua Gao; very good OSCE stations

4) Bird of Alberta by University of Alberta Medical Students- free of charge; PM me if you need the PDF

5) Practise a lot with your friends, and try to practise with different people for honest feedback. 

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15 minutes ago, LittleDaisy said:

To those preparing for LMCC2 , I would highly recommend the following resources;

1) Qbanks, subscribe at least 3 months prior to the exam; it's worth the money

2) OSCE and Clinical Skills Handbook by Katrina F. Hurley

3) Clinical skills review: Scenarios Based on Standardized patients- 2013 by Zu-Hua Gao; very good OSCE stations

4) Bird of Alberta by University of Alberta Medical Students- free of charge; PM me if you need the PDF

5) Practise a lot with your friends, and try to practise with different people for honest feedback. 

I disagree. The best way is to get the "previous sample" questions that are passed down year to year and practice those. 

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1 minute ago, thestar10 said:

I disagree. The best way is to get the "previous sample" questions that are passed down year to year and practice those. 

Hey they changed the format so much, it's impossible to prepare nowadays. I think that they know somehow that people share past stations especially the ones centered on medical expertise and diagnosis. 

They might repeat some stations; but again it's soft skills on ethics and communications :P 

MCC could be very arbitrary and decide to raise the passing scores and fail more people for no reason starting October 2018, it's  unfortunate for those who are affected!

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12 hours ago, 098123 said:

Two years of a family med residency without any concerns from preceptors, successful completion of the CCFP exams. I even reviewed each of the stations with a colleague who passed the exam comfortably and we can't identify any significant differences that would account for such profoundly different exam scores.

If this is true, I will definitely ask for for scores to be re-checked. 

If they confirm, after a re-check, that you still fail, I would focus more on soft skills like empathy, ethics and communication.

It is also essential to identify red flag/safety issues, and failure to do so can jeopardize your score (i.e. sending someone home with cardiac chest pain without urgent cardiac consult, failure to remind someone with potential dx of HIV to avoid sexual intercourse, failure to remind someone with possible seizure d/o to avoid driving, sending home a pregnant patient who presented with headache, and HTN w/o further workup or OBS consult etc). Sounds common sense, but you won't believe how many candidates actually fail to recognize these.

LMCC2 is essentially a family medicine exam. No other specialty will better prepare you for it, and it is very, very unusual for family medicine residents to fail twice, even with the now higher passing mark.  When I was studying for it, my Pathology friends were envious of the advantages I've got over them (they had neither done a neuro exam nor taken a psych hx in >2 years).

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2 hours ago, hamham said:

If this is true, I will definitely ask for for scores to be re-checked. 

If they confirm, after a re-check, that you still fail, I would focus more on soft skills like empathy, ethics and communication.

It is also essential to identify red flag/safety issues, and failure to do so can jeopardize your score (i.e. sending someone home with cardiac chest pain without urgent cardiac consult, failure to remind someone with potential dx of HIV to avoid sexual intercourse, failure to remind someone with possible seizure d/o to avoid driving, sending home a pregnant patient who presented with headache, and HTN w/o further workup or OBS consult etc). Sounds common sense, but you won't believe how many candidates actually fail to recognize these.

LMCC2 is essentially a family medicine exam. No other specialty will better prepare you for it, and it is very, very unusual for family medicine residents to fail twice, even with the now higher passing mark.  When I was studying for it, my Pathology friends were envious of the advantages I've got over them (they had neither done a neuro exam nor taken a psych hx in >2 years).

I would just remind you to be mindful to say  "it's rare for family medicine residents to fail twice" , for OP's sakes as failure of LMCC2 carries huge consequences for independent practice license and automatically delay you for 7 months (the results come out either in January or June).

For FRCPC specialty residents; they can take it through PGY1-PGY5.  For Family Medicine residents, it's only 1-2 shots to make sure that you graduate on time. 

I would caution everyone in FM (especially the PGY2s) to register for the LMCC2 exam early in October, as registering in Spring would carry a risk of redoing it and getting your license delayed, just my two cents.  Especially the MCC decides to raise the passing scores and inherently fails more people (not sure if the 20%-25% failure rate is confirmed, but more people have failed since they changed the exam format in October 2018). 

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1 hour ago, LittleDaisy said:

I would just remind you to be mindful to say  "it's rare for family medicine residents to fail twice" , for OP's sakes as failure of LMCC2 carries huge consequences for independent practice license and automatically delay you for 7 months (the results come out either in January or June).

For FRCPC specialty residents; they can take it through PGY1-PGY5.  For Family Medicine residents, it's only 1-2 shots to make sure that you graduate on time. 

I would caution everyone in FM (especially the PGY2s) to register for the LMCC2 exam early in October, as registering in Spring would carry a risk of redoing it and getting your license delayed, just my two cents.  Especially the MCC decides to raise the passing scores and inherently fails more people (not sure if the 20%-25% failure rate is confirmed, but more people have failed since they changed the exam format in October 2018). 

Just stating a fact that family medicine residents have an advantage over other specialties when it comes to LMCC2. If OP is offended, I apologize. 

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2 minutes ago, hamham said:

Just stating a fact that family medicine residents have an advantage over other specialties when it comes to LMCC2. If OP is offended, I apologize. 

No worries. I apologize as well if I was too sensitive. But the exam is also higher stake for FM residents, as our residency is short and we can only take the exam once or maximum twice during residency to ensure that we graduate on time. 

I don't know why MCC decides to increase the passing score, it seems to delay more residents to be able to practice independently. 

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16 minutes ago, abc123def456 said:

Question - has anyone else heard of site variation? I've heard in the past people were going out of their way to take the exam in Quebec since the examiners there were nicer. Has anyone heard anything for Ontario (Toronto vs Hamilton vs Kingston etc?)?

I was told there is a standardized marking scheme for each station, and examiners cannot simply give you a pass b/c they are "nicer".

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On the topic of possible site/examiner variation.. as per the MCC website, "objectivity of scoring is achieved using standardized guidelines for exam administration, the training of examiners and of SPs, and the use of predetermined scoring instruments for OSCE stations."

So the claim is that objectivity is achieved?

The sample rubrics posted on the MCC website show a standardized checklist for examiners, as well as an "interaction rating scale" where they're asked to score our interviewing skills or physical exam skills as "inadequate, marginal, adequate, or superior". https://mcc.ca/examinations/mccqe-part-ii/clinical-stations/case-1-14-minute-station-ken-scott/

This interaction rating scale inherently carries with it a great deal of subjectivity. Further to that, the "standardized checklists" afford the examiner the option of selecting "attempted only" or "completed satisfactorily" for each bullet point. I'm not sure how you can "attempt to ask about fever or weight loss" .. but not satisfactorily ask about fever or weight loss? This would only make sense for physical exam techniques.

Another point worth mentioning is that the examiner checklists assume that the examiner is listening attentively for the entirety of the 14 minute station. Then for the 7 more stations they have to sit through, totalling almost 120 minutes of attentive listening. If a question is asked, but possibly missed by the examiner.. there is no way to know. High stakes exams like the CCFP SOO stations are recorded on video so that exam results can be re-evaluated when significant discrepancies occur.

There is no option for re-evaluation of scores on the LMCC2. You get a pass/fail score, and then a generalized breakdown of your performance with no tailored feedback or insight into specific adjustments that can be made. If you want your score re-checked, it's another $250 yet they say on the website that a re-check does not include a re-evaluation. So essentially whatever the examiner marks on the checklist is set in concrete and a re-check just makes sure that scores were entered into the computer properly.

Perfect! 

 
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5 hours ago, 098123 said:

On the topic of possible site/examiner variation.. as per the MCC website, "objectivity of scoring is achieved using standardized guidelines for exam administration, the training of examiners and of SPs, and the use of predetermined scoring instruments for OSCE stations."

So the claim is that objectivity is achieved?

The sample rubrics posted on the MCC website show a standardized checklist for examiners, as well as an "interaction rating scale" where they're asked to score our interviewing skills or physical exam skills as "inadequate, marginal, adequate, or superior". https://mcc.ca/examinations/mccqe-part-ii/clinical-stations/case-1-14-minute-station-ken-scott/

This interaction rating scale inherently carries with it a great deal of subjectivity. Further to that, the "standardized checklists" afford the examiner the option of selecting "attempted only" or "completed satisfactorily" for each bullet point. I'm not sure how you can "attempt to ask about fever or weight loss" .. but not satisfactorily ask about fever or weight loss? This would only make sense for physical exam techniques.

Another point worth mentioning is that the examiner checklists assume that the examiner is listening attentively for the entirety of the 14 minute station. Then for the 7 more stations they have to sit through, totalling almost 120 minutes of attentive listening. If a question is asked, but possibly missed by the examiner.. there is no way to know. High stakes exams like the CCFP SOO stations are recorded on video so that exam results can be re-evaluated when significant discrepancies occur.

There is no option for re-evaluation of scores on the LMCC2. You get a pass/fail score, and then a generalized breakdown of your performance with no tailored feedback or insight into specific adjustments that can be made. If you want your score re-checked, it's another $250 yet they say on the website that a re-check does not include a re-evaluation. So essentially whatever the examiner marks on the checklist is set in concrete and a re-check just makes sure that scores were entered into the computer properly.

Perfect! 

 

Pretty much. It's a horrible, brutal reality. You also have nothing to prove that you truly did fail. They tell you that's your score and end of story. 

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Sorry to hear OP! Failing an exam always feels like a huge punch to the gut. As others have said, the LMCC2 is hardly a reflection of your clinical skills.

I will say regarding site:site variation, friends of mine who wrote at some sites like Toronto found it a very stressful day, sometimes with very strict rules and while no one mentioned examiners, they did find even the support staff quite stress inducing. Could have been day to day obviously.

I wrote on the east coast and found the day quite relaxed. Certainly plays into how I do on the days when all the support staff were very friendly and tried hard to keep the day as low stress for us as possible. I don't know how this crossed if any to examined behaviour, but at least registration and etc didn't jack up my heart rate before anything else started.

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On 6/18/2019 at 7:28 PM, LittleDaisy said:

Hey I am sorry to hear about your LMCC2 failure. Hearing that you pass CFPC exam on the first try is reassuring. I don't think that LMCC2 failure would warrant you to worry about your medical knowledge or raise any clinical concerns.

LMCC2 performance does not reflect real life scenarios, even for family medicine  residents. 

I personally find LMCC2 with OSCE format to be more challenging than SOOs,  because it involves doing history, physical exam, diagnosis and management in 14 & 6 minutes. The recent change in format focusses more on soft skills of ethics and communication, which could be quite subjective. 

I am not sure about the 20% failure rate?? I am surprised that they raised the score from 134 to 138, given that a lot of people had failed last year. The failure rates are definitely higher since MCC changed the format starting in October 2018. 

Moving forward, the main thing is to figure out what you want to do until you rewrite the exam in October, practice vs focusing on studying for LMCC2 ?

I know that in New Brunswick, Manitoba and Saskatchewan, they let you practice independently with LMCC2 or CFPC alone; it might help you financially until you can write LMCC2.  In Ontario and in Quebec, you have to pass both exams to independently practice.

I would ask for a score recheck in your case for a even slight chance. In the meanwhile, register promptly for October 2019 exam as spaces are limited. 

I think that you will have to wait 1 year between the 3rd and 4th attempt; study well and prepare in abundance!  I have faith that you will do well on this attempt! Third time is the charm (sorry at my bad sense of humour of cheering you up). 

I would be happy to help you prepare and offer you advice. I got a good score even though I felt like crap walking out the door. 

I just want to congratulate you on CFPC success! Well done! I understand the feeling of failing and feeling terrible, you are not alone! Please PM me, would be happy to offer more in-depth advice in order to prepare for the exam :) 

I'm curious when the pass score was changed from 134 to 138? Given the standard deviation they've set relative to the mean, that is a significant portion of people who would've failed in comparison. 

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11 hours ago, LittleDaisy said:

I don't know why MCC decides to increase the passing score, it seems to delay more residents to be able to practice independently

Failing more candidates helps to justify the existence of the exam itself, because exams with historically high pass rates (like the QE2) often aren't taken seriously. Many have questioned why QE2 is even needed at all. It's been criticized as a relic of the general practitioner era, and that it doesn't make any appreciable difference to patient care or safety beyond normal residency training. Changing the exam and its grading could be a way, at least in part, to ward off those criticisms. Also, the more people who need to retake, the more money in test fees is generated. That being said, there are issues with raising the passing score, because these are supposedly exams to assess minimal competency, and not achievement. The vagueness and lack of utility of the feedback sheet is something they might get dinged for too, because it's a recurrent complaint among examinees that never really seems to get addressed.

No one is certain what the exact motivations of the MCC are, but I would wager these are some of them.

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19 hours ago, abc123def456 said:

Question - has anyone else heard of site variation? I've heard in the past people were going out of their way to take the exam in Quebec since the examiners there were nicer. Has anyone heard anything for Ontario (Toronto vs Hamilton vs Kingston etc?)?

I am not sure that you should go to Quebec for LMCC2. I would stay in your home city to avoid the long travelling distance and the stress of navigating. I find doing LMCC2 in Toronto wasn't too bad, there is always the advantage that you are familiar with the location (hospital, for ex), and sometimes you even run into staff whom you have worked with. During my exam day, I asked around to make sure that I didn't have examiners who have worked with me as I felt that it might be unfair to other candidates or my staff might be biased, but it didn't end up happening. But it definitely could happen to some people. 

The actors were very standardized, I felt that they might be more helpful if you have established a therapeutic relationship with them. What helps is that the examiner is always with the same actor, they could report major discrepancies if the actor/actress was too off from baseline. 

A lot of examiners are academic family physicians, the chance of running into someone you know or worked with might increase fairly if you are in a medium or smaller sized city. Hence, why people say examiners are nicer in the east coast? Per MCC, unless you have personal or familial ties to the examiners, it's not a conflict of interest if you have worked with them before.

At the end, it's just a standardized exam that we will have to get through. I know that MCC has been criticized a lot for keeping LMCC2 as a licensing requirement since FM becomes its own specialty, but I am not sure that they will remove LMCC2 in the near future.  If anything, they have moved from a lot of medical expertise stations to more ethical and communication soft skills stations to avoid biases for residents in FRCPC specialties. 

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I just got my score back and I passed, and I'm in a subspecialty as far away from FM as possible. 

I just want to say that this exam is arbitrary, with no evidence clinically on why they decided to raise the passing score in 2018. 

I urge everyone to rethink this exam: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4830377/ 

If family medicine is a specialty, then what is the point of having a general practitioner exam? 

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10 hours ago, carbene said:

Is there not an "appeal" option to be considered for a re-evaluation of the score?

If you're willing to contribute another $250 to the MCC (in addition to the $2500 it costs to re-write), then they will do a score "re-check", but it's clearly stated on the MCC website that this doesn't include a "re-evaluation". So essentially they check to make sure scores were entered into the computer, to the correct profile, and make sure there weren't any ink errors/smudges or tears in scantron sheets.

This current system assumes that whatever the examiner marked on the bubble sheet is 100% accurate and objective, and it becomes 100% concrete. Since none of the stations are recorded with video or audio (unlike other high stakes/high cost certification exams), there's no option for "re-evaluation" and essentially nothing to hold examiners accountable for what gets marked on the bubble sheets. Beyond this.. without an option for re-evaluation, anyone who fails is essentially kept in the dark with respect to how they can improve or make adjustments going forward.

One of the most difficult things to accept about this exam, in addition to everything that's been mentioned above, is the de-humanized "support" that is provided when reaching out to the MCC for guidance. I've heard of two separate candidates now who've failed by 1 point. One of these individuals called the MCC to explore options for re-evaluation or further feedback. They described the conversation as robotic, as if the individual was reading off a script, and that any further action would cost more money (big surprise).

Getting back to the big picture.. many parts of the country are desperate for family doctors and several thousands of people don't have a primary care physician. In my case, I'm now fully certified by the CCFP based on completion of residency and CCFP exams, however the MCC will delay my ability to practice for 7+ months, factoring in the time it takes to get results. Even if I had failed by just one point as others have, my situation would be exactly the same. One point on a 2 hour exam would overshadow 10+ years of post-secondary training. 

Somehow an exam that used to screen for minimal competency has become an exam with a fail rate in the neighbourhood of 20%. An exam that used to pose very little challenge for residents in generalized fields of medicine is now seeing more and more family medicine residents fail. Something isn't right...

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The thing I find hardest to swallow is that this exam supposedly exists as a public "safety" measure. Where is any evidence this exam somehow protects patients in any capacity? It is a profoundly subjective exam that (like most OSCEs) does not reflect how medicine is actually practised. It's a total cash grab. I hope future MDs won't have to deal with it....

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On 6/18/2019 at 7:28 PM, LittleDaisy said:

I know that in New Brunswick, Manitoba and Saskatchewan, they let you practice independently with LMCC2 or CFPC alone; it might help you financially until you can write LMCC2.  In Ontario and in Quebec, you have to pass both exams to independently practice.

A quick search of each province found that AB, SK, MB, ON, QC, PEI, NWT, YT, NU will require one to be a licenciate of the MCC to get a license for independent practice (non-provisional). I presume that means you need to have passed MCCQE1 and 2. It seems SK allows provisional registration (requires supervision until you pass the MCCQE2) for non-LMCCs, as does MB.

So that leaves BC (allows CCFPs but not FRCPSCs to substitute USMLEs for LMCC), NB (doesn't mention LMCC at all for regular licenses in their regulations), NS (USMLEs may be an allowable substitution for the LMCC?), NL (doesn't mention LMCC as a requirement for regular licenses in their regulations?) as provinces that allow one to get a full license without completing both MCCQEs. So I guess if you wanted to start working in one specific province right away, one could go to one of those provinces, get a full license, and then get a full license in your desired province (except Nunavut) under the Canadian Free Trade Agreement on the basis of your first license.

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