Pathway to conditional licensure for internationally trained physicians via a practice ready assessment: specialties other than family medicine

Preamble

The criteria for registration on the Conditional Register are laid out in section 39 of the Medical Act Regulations.¹ Specialist physicians not in family medicine (“specialists”) who are not eligible for a Full licence² may be eligible for licensure on the Conditional Register.

Successful completion of a Practice Ready Assessment (PRA) supports eligibility towards Conditional licensure. Physicians registered on the Conditional Register are permitted to practise medicine in accordance with the conditions and restrictions outlined in their licensing agreement with the College of Physicians and Surgeons of Nova Scotia (the College).

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. As a guideline, this equates to a minimum of 75% at other location(s) and a maximum of 25% at the intended site of practice.

More information related to the PRA is available under the College’s Guidelines for Practice Ready Assessments – Specialists,³ as well as in the Framework for the Conduct of an 8-week Practice Ready Assessment.⁴

Purpose

This policy outlines the College’s eligibility requirements for a physician to complete a PRA in a specialty other than family medicine and the licensing decisions available to the Registrar at the conclusion of the assessment.

Scope

This policy applies to all applicants for a PRA in a specialty other than family medicine who have completed their specialty training in an international jurisdiction who seek to demonstrate practice readiness to qualify for a Defined licence.

Policy

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.

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

During the PRA, the physician candidate is never the Most Responsible Physician (MRP).

All PRAs must be approved by the College in advance. PRAs in a specialty other than Family Medicine are conducted by the appropriate department with the capacity to run the PRA. This includes availability of approved assessors, as well as ensuring there is the appropriate patient exposure to assess the physician for the scope of their anticipated practice.

Once the assessment has commenced, it will be considered a PRA attempt whether the candidate withdraws or completes the assessment.

Eligibility criteria

In addition to the following requirements, candidates are ineligible if they have had two or more unsuccessful attempts in Canadian practice ready assessment programs. They must have secured a job offer with Nova Scotia Health or the IWK Health Centre related to their specialty position, and secured funding from the Department of Health and Wellness connected to a return of service agreement.

All credentials must be source-verified by physiciansapply.ca.⁵ Candidates must meet all of the following requirements:

Licensing decisions following a PRA

The Registrar of the College will make a licensing decision upon consideration of all reports or recommendations, specifically determining whether:

1. The physician has demonstrated the competencies necessary for Defined licensure with supervision, with or without additional conditions and/or restrictions beyond those typically applied to a Defined licence. The physician will be restricted to the scope of practice and location(s) outlined in their return of service agreement with the Department of Health and Wellness.​For successful candidates, the College will provide a letter of recommendation to the relevant Canadian certifying college endorsing the physician’s eligibility for the certification examination. The College will collect all outstanding documentation in support of the application for a Defined licence. Typically, this process takes approximately 4-6 weeks. OR
2. The physician has demonstrated the competencies necessary for a Clinical Assistant licence for practise as an associate physician within an approved associate physician program. A letter of offer for employment as an associate physician in an approved program from Nova Scotia Health or the IWK Health Centre is a requirement for a Clinical Assistant licence. OR
3. The Registrar is not prepared to make a licensing decision based on concerns related to the physician’s capacity, competence, or character to safely and ethically practise medicine. In such cases, the Registrar will refer the physician to the Registration Committee for adjudication. OR
4. In the view of the Registrar, the physician has not demonstrated the competencies necessary for any form of licensure and the application is denied. This denial must be disclosed to other Medical Regulatory Authorities if asked about a history of being denied licensure.

The candidate has the option to withdraw their application for licensure at the conclusion of the assessment. In this case, there will be no licensing decision rendered.

Appealing a licensing decision

All licensing decisions have an appeals process depending on the circumstances. The internal review and appeal processes are laid out in the policy for Appealing a Licensing Decision.⁹

Resources

1. Medical Act Regulations
2. Full Licensure: Requirements and Criteria for Physicians
3. Guideline for Practice Ready Assessments - Specialists
4. Framework for the Conduct of an 8-week Practice Ready Assessment
5. physiciansapply.ca
6. World Directory of Medical Schools
7. Currency of Practice Experience
8. English Language Proficiency
9. Appealing a Licensing Decision