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Framework for the Conduct of a Comprehensive Clinical Assessment of Practice (CCAP)

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Preamble 

The Registration Committee of the College has the discretion to authorize a Comprehensive Clinical Assessment of Practice (CCAP) for the purpose of ongoing licensure in Nova Scotia. Specifically, a physician holding a Defined licence may be eligible to undergo a CCAP as a route to a Restricted licence.

Governing Policy

Comprehensive Clinical Assessment of Practice: Criteria and Outcomes for a Physician on a Defined licence.1   

Purpose 

The framework for the Conduct of a Comprehensive Clinical Assessment of Practice provides guidance for the planning and conduct of such an assessment and outlines the necessary supporting activities and a procedure for determining success or failure. Physicians not already licensed in Nova Scotia and otherwise ineligible may gain conditional licensure on the basis of a successful Practice Ready Assessment.2

General Principles

A CCAP may be authorized at the discretion of the College Registration Committee to a physician with a Defined licence.

The CCAP may only be performed for a physician who is currently in practice, as the Most-Responsible Physician (MRP), in Nova Scotia.

In authorizing a CCAP, the Registration Committee will take into account the availability of resources, including qualified assessors, to conduct the assessment.

The CCAP, including administrative oversight, will be conducted at the assessed physician’s expense (see Costs).

Participation in a CCAP is voluntary for the assessed physician, however, failure to participate may result in loss of or restrictions on licensure, as directed by the Registration Committee.

The CCAP will be conducted primarily in the assessed physician’s own practice. Assessors will use additional tools and resources, as appropriate, to meet all core requirements of the assessment.

The assessment will include a representative sample of the assessed physician’s actual scope of practice, sufficient to inform a decision by the Registration Committee. In addition, the assessment may include elements beyond the physician’s typical scope of practice, but within the reasonably expected scope of a specialist in that discipline (i.e. foreseeable emergency situations or procedures).

The standard applied to all aspects of the assessment will be that of an acceptably competent specialist (Family Medicine and other specialties), providing care that is safe and meets current Canadian standards for the discipline. Specialty-specific standards will be determined by the expert assessors and communicated to the College and assessed physician in advance.

Elements of the CCAP are not considered compensatory i.e., excellence in one core aspect of practice will not compensate for lack of demonstrated competence in another.

Assessors will be physicians who practice in the same discipline as the assessed physician and who have a similar or overlapping scope of clinical practice. It is not necessary that assessors work in the same practice environment as the assessed physician (i.e., rural vs urban, tertiary vs regional center). Assessors will be retained and oriented to the assessment process by the College.

Assessors must be free of any reasonable conflict of interest and, most importantly, be capable of preparing an unbiased assessment report for the College.

  1. That the physician consistently performs at the level of a safe and acceptably competent Canadian specialist in ALL aspects of the CCAP; or

  2. That the physician performs at the level of a safe and acceptably competent Canadian specialist in some aspects of the CCAP, with the following EXCEPTIONS: (list).

  3. Does not perform at the level of a safe and acceptably competent Canadian specialist. Assessors will make no specific recommendation regarding licensure or conditions.

The Registration Committee will consider the results of the CCAP along with other relevant information (e.g. supervision reports, examination results) when making a decision on further licensure.

Decisions may include:

  1. Restricted licence, including specific conditions and/or restrictions regarding scope of practice or professional development; or
  2. No further licence for independent practice after expiration date of the physician’s current Licensing Agreement; or
  3. When there is further eligibility from the RCPSC or the CFPC, continue on a Defined licence

Assessment Elements

In advance of the CCAP, the following documents will be collected:

  1. Letter of Support (Sponsor)
  2. Letter of Support (Clinical Department Head – if different than Sponsor)
  3. A list of potential colleagues for interview, identified by the Clinical Department Head.
  4. Physician Scope of Practice Document
  5. Physician practice / contact information (all sites)
  6. Discipline-specific Objectives of Training Document (RCPSC or CFPC)
  7. Continued Professional Development (CPD) Report – RCPSC or CFPC (up to 5 years)

The above documents will be used by the College, in collaboration with the Assessment Team, to develop the following:

  1. Assessment Plan
  2. Financial Documents

The CCAP will be comprised of the following:

Core Elements:

  1. Direct Observation of Clinical Care (excepting non-clinical disciplines) – Minimum 10 cases.
  2. Direct Observation of Medical Procedures (for procedural specialties) – As required.
  3. Structured Record Review, including audit against key speciality-specific standards and clinical practice guidelines – Minimum 30 Cases
  4. Record-based discussion of Clinical Care – Minimum 10 cases
  5. Review of CPD history – up to 5 years
  6. Structured interviews with clinical colleagues – minimum 6 individuals

In addition, the CCAP may include the following:

Optional Elements:

  1. Simulation (key procedures, team-based care, crisis-resource management)
  2. Structured Case Review (including imaging, laboratory or other investigations) – cases provided by assessors
  3. Review of key outcomes and metrics – as deemed relevant

Costs

Assessors will be compensated at the standard College rate (currently $150 per hour), reviewed and set by College Council from time to time.

On application, the candidate will pay the CPSNS Administrative Assessment Fee of $1,500 to the College, necessary to support the recruitment of assessors, assessor consultation and development of an assessment plan.

  • If the College is unsuccessful in recruiting suitable assessors, the fee will be refunded minus expenditures to date.
  • If the physician elects not to proceed with a developed plan, the fee is forfeit in its entirety.

Once an assessment has started, this fee is not refundable.

The following activities related to the CCAP will be remunerated:

  • Initial consultation and development of the assessment plan.
  • Conduct of all Core and Optional elements under the plan.
  • Report preparation
  • Related meetings
  • Travel and expenses in accordance with College policy

The College will charge appropriate administrative fees reflecting the costs of:

  • Recruitment, consultation with and orientation of physician assessors
  • Development of the assessment plan and related documents
  • Compilation of assessment tools and documents, relevant to consideration by the Registration Committee.

Resources

  1. Comprehensive Clinical Assessment of Practice: Criteria and Outcomes for Physicians on a Defined licence 
  1. Pathway to Licensure for International Medical Graduates via a Practice Ready Assessment: Specialists and SEAP Status Affiliates (with a primary specialty of Internal Medicine) | Registration Policies College of Physicians & Surgeons of Nova Scotia 

Document History

Applicable Legislation: Regulations 15 (3a)

Approved by: Assessment Committee, Council

Approval date: September 10, 2021 & October 15, 2021

Review date: April 2023