Replacing high-stakes summative examinations with graduated medical licensure in Canada.

Competing Interests: Competing interests: Brent Thoma reports honoraria and travel support from the Royal College of Physicians and Surgeons of Canada. Sandra Monteiro reports grants and travel support from McMaster University, and consulting fees from Touchstone Institute and Aquifer. Heather Water reports honoraria, salary support and travel support from McMaster University, honoraria from the Foundation for Medical Practice Education. Teresa Chan has received research grants, honoraria, salary support and support for attending meetings from McMaster University, the Royal College of Physicians and Surgeons of Canada, the Government of Ontario and Physician Services Incorporated, University of British Columbia, Northern Ontario School of Medicine, International Association of Medical Science Educators, Catholic University of Korea START Center for Medical Simulation, Texas Children’s Hospital, Baylor College of Medicine, Taipei Veterans General Hospital, Harvard Medical School and the University of Northern British Columbia, Academic Life in Emergency Medicine Limited Liability Company and the Canadian Association of Emergency Physicians. She also reports sitting on the board of the Canadian Institute for Translation of Knowledge and Education. No other competing interests were declared.