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Clinical Assistant Program

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Policy

Clinical Assistant Programs must assure uniform standards of qualification and a minimum level of competency for all clinical assistants.

Program goals and objectives include:

  • ensuring a standardized accountability framework for the conduct of the clinical assistants;
  • supporting an employment environment for physicians in Nova Scotia who do not meet the criteria for licensure as independent medical practitioners; and
  • assisting regional and tertiary care hospitals in the provision of patient care.

Program Requirements

  1. There must be a mechanism to ensure that all clinical assistants have appropriate qualifications and have been properly credentialed within the institution. 
    • All clinical assistants must hold a valid Clinical Assistant Licence with the College of Physicians and Surgeons of Nova Scotia.
    • All clinical assistants must have clinical assistant privileges through the Credentials Committee of the Nova Scotia Health Authority or the Isaac Walter Killam Centre.
    • All clinical assistants in adult medicine must have current Advanced Cardiac Life Support (ACLS) certification.
    • All clinical assistants in pediatric medicine must have current Pediatric Advanced Life Support (PALS).
    • All clinical assistants in neonatal medicine must have current Neonatal Resuscitation Program (NRP) certification.
    • All clinical assistants must have CMPA coverage.
  2. There must be a probationary evaluation of all clinical assistant candidates. 
    • All clinical assistant candidates must undergo and satisfactorily complete a probationary period of 12 weeks during which time they will be evaluated with respect to their competence to perform the role of a clinical assistant in the intended clinical discipline.
    • During the probationary period the clinical assistant candidate must be under the supervision of a clinical supervisor who is a staff physician.
    • The evaluation of a clinical assistant candidate during the probationary period must be directed by the clinical assistant program director, who shall report the results of the final evaluation to the Registration department of the College of Physicians and Surgeons of Nova Scotia.
    • The evaluation must include but not be limited to the assessment of:
      1. basic clinical skills;
      2. communication skills;
      3. the ability and willingness to function as a member of a clinical team;
      4. special knowledge and skills applicable to the intended clinical placement;
      5. clinical decision making and the appropriate use of clinical and diagnostic resources;
      6. prescription writing;
      7. clinical documentation; and
      8. procedures required to function effectively (during the initial months of the probationary period) and to be added to as need, or circumstances and demonstrated competence permit.
  3. There must be appropriate supervision of all clinical assistants. 
    • Each clinical assistant must be supervised by a clinical supervisor who is a physician who holds active staff privileges.
    • There must be a clinical assistant program director appointed within each division in which clinical assistants are employed. In the case of a small clinical division, the clinical assistant program director may be shared with another division. The clinical assistant program director is responsible for the following:
      • Assigning clinical assistants to various services or duties within the division;
      • Assigning on-call duties;
      • Obtaining feedback and evaluations from clinical supervisors, co-workers, nursing and allied professional staff;
      • Maintaining a record for each clinical assistant;
      • Supervision, training, certification and recertification in procedures required to perform their role;
      • Acting as a liaison with the College, ensuring completion of evaluations and any reports the College requires on the performance of a clinical assistant;
      • Providing formal and informal feedback to clinical assistants; and
      • Participating in periodic College Accreditation Surveys.
    • There must be evidence that the clinical supervisor reviews the clinical work of the clinical assistant on a daily basis.
    • A clear description of the roles and responsibilities of the clinical assistant must be documented, available to the supervising physician, clinical assistant, clinical assistant program director and department head, and form part of the permanent record of the clinical assistant.
  4. There must be an evaluation process to periodically assess the performance of all clinical assistants. 
    • The clinical assistant program director must evaluate each clinical assistant’s performance on at least a six month basis and provide a written summary of the evaluation to the clinical assistant and to the chief of the department. The clinical assistant program director and clinical supervisor should provide verbal feedback to the clinical assistant on an on-going basis throughout the year.
    • The evaluation must address the defined roles and responsibilities of the clinical assistant.
    • The periodic formal evaluation and the on-going feedback should form the basis for the continuous professional development needs for the clinical assistant.
    • Copies of the formal evaluations and any interim evaluations of note must be maintained in the clinical assistant file and be available for review.
  5. There must be a process to document demonstrated competence for all procedures performed by all clinical assistants.
    • There must be a well-documented process in place to certify the competence of any procedure to be performed by the clinical assistant.
    • The process must include appropriate training, demonstration and maintenance of competence.
  6. There must be opportunities for all clinical assistants to engage in continuous professional development that must be confirmed annually by the clinical assistant program director to the College. 
    • There must be opportunity for the clinical assistant to attend clinical rounds and other educational sessions as their clinical responsibilities permit.
    • Educational resources (e.g. hospital/departmental library) must be available to the clinical assistant.
    • There must be mechanism to monitor and report on each clinical assistant’s participation in continuing professional development.
    • Clinical assistants must participate in continuing professional development at a minimum of 50 hours per year.
  7. There must be periodic satisfaction surveys completed by all clinical assistants. 
    • At least on a yearly basis the institution must conduct a written satisfaction survey by all clinical assistants. The survey must address, but not limited to: supervision, evaluation (formal and informal) certification of procedures, opportunities for continuous professional development, working environment, collegial working relationships with members of his/her clinical team.
    • The surveys must be maintained in a central file for review as necessary.

There must be evidence that significant and/or repetitive concerns expressed by the clinical assistants or the department are addressed in a timely manner with outcomes documented.

Accountability Framework

Required components include:

  1. A detailed job description for clinical assistants within each clinical program;
  2. Clear guidelines for delegation of the performance of procedures, including training leading up to demonstration of competence, as determined by the clinical assistant program director. Any procedure not specified in the clinical assistant’s approved job description will require evidence of training, demonstration and maintenance of competence by the clinical program and approval by the clinical assistant’s program director; and
  3. Evidence of adequate supervision, including the co-signing of hospital orders and prescriptions (as appropriate) as well as documentation of the clinical assistant’s attainment of the various levels of responsibility.

Supervision of Clinical Assistants 

Clinical assistants must be supervised by a clinical supervisor who is a staff physician credentialed by the health authority and/or the facility. Each division in which clinical assistants are employed must designate a clinical assistant program director. The program director is responsible for the following:

  • Assigning clinical assistant to various services or duties within the division;
  • Assigning on-call duties;
  • Obtaining feedback and evaluations from clinical supervisors, co-workers, nursing and allied professional staff;
  • Maintaining a record for each clinical assistant;
  • Supervision, training, certification and recertification in procedures required to perform their role;
  • Liaising with the College, ensuring completion of evaluations and any reports the College requires on the performance of a clinical assistant;
  • Providing formal and informal feedback to clinical assistants; and
  • Participation in periodic College accreditation surveys.

The clinical assistant program director is accountable to the College for the actions of clinical assistants in the course of their employment within the hospital or health authority. The program director may recommend an alternate to perform the duties of program director during absences such as vacations, sabbaticals, etc.

Clinical Supervisors of Clinical Assistants

  • Shall not delegate to a clinical assistant a duty or responsibility for which the clinical assistant is not adequately trained
  • Shall not delegate to a clinical assistant a duty or responsibility the clinical supervisor is not competent to perform himself/herself
  • Shall provide daily onsite direct or indirect supervision
  • Shall not permit a clinical assistant to provide medical services in an area in which the clinical supervisor does not provide services

 

Applicable Legislation

Medical Practitioners Regulations – Sections 49-54

Approved By

Registration Policy Committee

Council

Approval Date

April 25, 2019

May 24, 2019

Review Date

January 2021