Validation of a large-scale clinical examination for international medical graduates.

Objective: To evaluate a new examination process for international medical graduates (IMGs) to ensure that it is able to reliably assign candidates to 1 of 4 competency levels, and to determine if a global rating scale can accurately stratify examinees into 4 levels of learners: clerks, first-year residents, second-year residents, or practice ready.

Design: Validation study evaluating a 12-station objective structured clinical examination.

Setting: Ontario.

Residents' duty hours in the province of Ontario, Canada.

The author explains the history of the Professional Association of Internes and Residents of Ontario (PAIRO), Canada, founded in 1968-69 to represent postgraduate medical trainees in negotiations with the Ontario Hospital Association over issues of trainees' stipends. Over the years, the negotiations evolved to cover a number of other issues, including duty hours, and established the principle that binding arbitration would be used to resolve any disputes between the two parties that could not be resolved through negotiation. At present, PAIRO negotiates a biannual collective agreement with the Ontario Council of Teaching Hospitals (OCOTH), whose features the author describes.