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

Preamble 

The Registrar of the College has the discretion to authorize a Comprehensive Clinical Assessment of Practice (CCAP) for the purpose of ongoing licensure in Nova Scotia in accordance with policy. ¹

Governing Policy: Comprehensive Clinical Assessment of Practice: Criteria and Outcomes 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.

General Principles

A CCAP may be authorized by the Registrar to a physician with either a Defined or Restricted licence, in accordance with the policy.¹

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 Registrar will consider 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.  Failure to participate may result in loss of or restrictions on licensure, as directed by the Registrar or 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 Registrar. 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.

The exact duration of the CCAP will vary according to the scope of practice and will range from no fewer than three and no more than five days. Assessment activities may be distributed over several weeks, if necessary.

Assessment Team

A minimum of two assessors will participate in the assessment and contribute to any recommendations arising.  Single assessors may perform individual elements of the assessment.

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 oriented and trained in assessment methods and processes 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.

Assessors will be retained by and compensated through the College. In no circumstances will assessors be directly retained or compensated by the assessed physician.

Assessment Elements

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

1. For physicians on a Defined licence, a letter from their Sponsor, supporting the assessment. For physicians on a Restricted licence a letter from their Department Head supporting the assessment.
2. A list of potential colleagues for interview, identified by the Clinical Department Head
3. Physician Scope of Practice Document
4. Physician practice / contact information (all sites)
5. Discipline-specific Objectives of Training Document (RCPSC or CFPC)
6. 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 specialty-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 (see fee schedule), 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 forfeited 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.

Outcomes

The Assessment Team will provide a report to the Registrar, advising one of the following:

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.

When making a decision regarding further licensure, the Registrar will consider the results of the CCAP along with any other relevant information including, but not limited to supervision reports and open complaints status with the College.

The decisions available to the Registrar include:

1. Full licensure; or
2. Restricted licensure, including specific conditions and/or restrictions regarding scope of practice and any other conditions and/or restrictions the Registrar deems necessary to support safe and effective practice ; or
3. For those on a Defined licence immediately prior to the CCAP, continued Defined licensure to the end date outlined in the Licensing Agreement; or
4. Referral to the Registration Committee, if there are concerns of capacity, competence, and/or character to safely and ethically practise medicine.

Resources

1. Comprehensive Clinical Assessment of Practice: Criteria and Outcomes