Five years after taking legal action, a group of foreign-trained doctors has won a significant appeal against the Royal College of Physicians and Surgeons of Canada, highlighting questions about fairness and transparency in the country’s medical certification system.

The Ontario Court of Appeal, in Adewale v. Royal College of Physicians and Surgeons of Canada, 2025 ONCA 738, set aside a lower court ruling that had dismissed claims by the doctors and directed a new trial to examine whether the Royal College breached contractual obligations in grading its 2020 psychiatry qualifying exam.

The appellants, all international medical graduates; argued that they had earned passing scores of at least 70% on the Royal College’s qualifying exam and were entitled to certification for independent psychiatric practice in Canada.

The original trial judge, Justice Jane Ferguson of the Superior Court of Justice, concluded that the court should not intervene in the Royal College’s grading system and upheld the organization’s 6.5% downward adjustment to all 2020 exam scores, which resulted in the appellants’ scores falling below the passing threshold.

The Court of Appeal disagreed, ruling that the lower court had failed to analyze key evidence, including expert testimony, and had not properly assessed the appellants’ claim for breach of contract.

The appellate court emphasized that the question of whether the Royal College acted in good faith and adhered to its contractual obligations must be determined at a new trial, stating that the appellants’ claims were substantial and deserved a reasoned judgment.

Background of the Case

The Royal College, a national not-for-profit corporation that accredits medical specialty programs and certifies physicians in Canada, set the written psychiatry exam in 2020.

Originally scheduled for March 24, the exam was postponed due to COVID-19, with the clinical/oral component waived and replaced by supervisor letters attesting to the candidates’ clinical competence.

Candidates, including the appellants, were informed that a 70% score was required to pass. After completing the exam on August 26, 2020, they were notified they had failed.

Later, it was revealed that their initial raw scores ranged from 70.45% to 75.76%, but the Royal College’s post-exam review raised the “cut score” to 76.5% and applied a uniform 6.5% downward adjustment, resulting in final scores between 63.95% and 69.26%.

The appellants argued that this adjustment was arbitrary and lacked psychometric justification, constituting a breach of the contractual duty of good faith by the Royal College.

They also cited the financial and emotional impacts, noting that each paid $4,415 to take the exam and faced delays in practicing independently in psychiatry.

Court of Appeal Decision

The Court of Appeal highlighted several deficiencies in the lower court’s ruling, including:

Failure to analyze expert evidence regarding the psychometric validity of the 6.5% score adjustment. Lack of reasoning on whether a contract existed and whether the Royal College breached it and reliance on the Royal College’s submissions without adequate independent analysis.

The appeal court stressed that the case involves legally and factually complex issues that cannot be resolved without a full trial. It granted the appeal, overturned the previous judgment, and ordered a new trial, awarding the appellants $35,000 in appellate costs.

Costs for the original trial and the forthcoming trial are to be determined by the trial judge.

Implications

This case raises serious questions about fairness and transparency in Canada’s medical certification system, particularly for international medical graduates.

Experts and advocates have pointed to broader concerns regarding the Royal College’s processes and the systemic challenges faced by foreign-trained physicians seeking to practice independently in Canada.

As the new trial proceeds, the decision is expected to set an important precedent for the rights of international medical graduates and may influence how professional regulatory bodies manage examinations and certification in the future.