Guideline for practice-ready assessments – specialties other than family medicine

Preamble

The pathway to Conditional Licensure for internationally trained physicians via a Practice Ready Assessments for Specialists other than Family Medicine¹, is a pathway to licensure for independent practice in Nova Scotia. The following set of guidelines apply to internationally trained physicians whose training, certification or currency² is not recognized by the Royal College of Physicians and Surgeons of Canada (RCPSC)³ or the Collège des Médecins du Québec (CMQ)⁴.

The Practice Ready Assessment (PRA) assists in establishing that the physician’s scope of practice matches the position offered in Nova Scotia and ensures they are ready to begin practice as the most responsible physician on a Defined licence⁵ under supervision.

Governing Policy

The pathway to Conditional Licensure for Internationally Trained Physicians via a Practice Ready Assessment: Specialties Other than Family Medicine.¹

Scope

These  guidelines outline the scope and standards that direct the development and implementation of a Practice Ready Assessment for Specialists other than Family Medicine within Nova Scotia.

Guideline overview

A PRA is a practice-based assessment used to determine whether the physician is ready for supervised practice as the most responsible physician in Nova Scotia. During the PRA, the physician candidate is never the Most Responsible Physician (MRP).

All PRAs for specialists must be conducted in accordance with this guideline and with agreement between the College, the relevant health authority and associate departments, and the Department of Health and Wellness.

A PRA is conducted by College-approved assessors with specialty designation in the same discipline as the physician candidate completing the PRA. The majority of the PRA will be conducted at a site other than the intended site of practice for the physician candidate. This equates to a minimum of 75% at other location(s) and a maximum of 25% at the intended site of practice.

Assessment scope and standards

The standards against which the candidate physician is being assessed will be determined in advance of the assessment and in collaboration between the College and the relevant content experts in the field of practice that the specialist candidate is intending to practice.

The scope of the PRA will include, at a minimum, those skills and competencies necessary for safe practise in the proposed position.

The scope of the assessment must be agreed upon in advance of the assessment. The PRA will be conducted in a place and manner that satisfies the College of a valid and unbiased practice-ready decision.

At the completion of the assessment, the general standard applied will be that of a specialist physician, acceptably competent for entry into practice in Canada as the Most Responsible Physician (MRP). By way of reference, this would be considered equivalent to a competent final-year postgraduate trainee in a Canadian specialty postgraduate training program, ready to enter practice.

The specialty specific RCPSC Objectives of Training document will be the source document from which critical competencies are identified.⁶ When available, competency-based standards including milestones and entrustable professional activities (EPAs) will be used. In addition, the respective core in-training evaluation reports (CITER) and final in-training evaluation reports (FITER) may be utilized for the respective specialty.

The overtime assessment

The core of the PRA will be an over-time clinical assessment of practice-readiness structured around the College’s “Framework for an 8-week Practice Ready Assessment”.⁷ It is acknowledged that the candidate may require some orientation regarding relevant cultural competencies and/or the structure and functioning of the Canadian health care system. Otherwise, the expectation is demonstrated readiness for practice in Canada. The assessment will include multiple observations, made by multiple individuals in a variety of relevant practice settings.

The assessment will be competency-based, and a minimum of 8 weeks duration. A longer assessment may be scheduled if necessary, to properly cover the candidate’s proposed scope of practice.

There will be a mechanism to terminate the assessment early, should the candidate clearly not be ready for independent practice.

Assessment methods/instruments

Assessment methods and documentation will be varied and appropriate to the task, and may include:

• Patient-based case discussion with Assessor/Supervisor using
• Direct observation of clinical encounters and procedures
• Structured record review
• Structured interviews with colleagues, allied health professionals and administrative support staff
• Simulation, where available
• Structured feedback, requiring the physician under assessment to document their intention/actions towards practice improvement

Assessors

There will be a lead assessor, who must fulfill the criteria for “Approval of Supervisors for College-directed Supervision”.⁸ There will be other physician assessors delegated to the assessment team, as determined by the Lead Assessor.

The Lead Assessor will collate the assessment results and make a recommendation to the College as to whether the physician is “practice-ready”. In their capacity as an assessor, they will be considered an Agent of the College and subject to specific limitations and protections.

The Lead Assessor will be responsible for:

• Identifying appropriate assessment opportunities and methods
• Reporting to the College using assessment documents / instruments
• Making a practice-ready recommendation to the College

Practice-ready recommendation

The Lead Assessor will make one of the following recommendations:

1. The physician has demonstrated the competencies necessary  to practice as the Most Responsible Physician in the scope of practice assessed.
2. The physician has demonstrated the competencies necessary to practice as the Most Responsible Physician in the scope of practice assessed, with the exclusion of : <List areas not assessed or areas physician did not demonstrate competence during the course of the assessment>.
3. The physician has not demonstrated the competencies necessary to practice as the Most Responsible Physician in the scope of practice assessed.

The Registrar of the College will review the assessment report and recommendations and will make a licensing decision according to the relevant College policy.¹

Withdrawal from the assessment

The PRA candidate has up to 4 weeks to formally withdraw from the assessment. 

Appeals

The candidate has the option to appeal the decision of the Registration Committee through the College’s Registration Appeal Committee.

Resources

1. Pathway to Conditional Licensure for Internationally Trained Physicians via a Practice Ready Assessment: Specialists other than Family Medicine
2. Currency of Practice Experience
3. Royal College of Physicians and Surgeons of Canada - Eligibility
4. College des Medecins du Quebec (CMQ)
5. Defined licence requirements and conditions for supervised practice as the most responsible physician
6. Royal College of Physicians and Surgeons Objectives of Training by Discipline
7. Framework for the Conduct of an 8-week Practice Ready Assessment
8. Approval of Supervisors and Assessors for College-directed Supervision