Framework for the Conduct of an 8-week Practice-Ready Assessment

Preamble

Once a physician has been deemed eligible for licensure, there are times when a physician must demonstrate practice readiness to act as the most responsible physician in their intended scope of practice.

This framework has been developed to ensure physicians demonstrate readiness to practice safely and ethically within their intended scope of practice.

The Registrar or the Registration Committee may determine the need for a practice assessment based on various factors, such as when a physician is:

• Newly starting practice in the province, on the Practice Eligibility Route (PER) – Royal College; or the physician is
• Returning to practice after having been off for a period between 3 to 5 years.

There may be other scenarios, whereby the College requires further reassurance that a physician has demonstrated competence in performing as the Most Responsible Physician.

Purpose

This framework describes the components of an 8-week practice ready assessment. Successful completion of this assessment will advance the physician to practice as the Most Responsible Physician within their intended scope of practice.   

Scope

This framework applies to 8-week practice ready assessments required for physicians, as directed by either the Deputy Registrar or the Registration Committee.

Governing Policy                                                               

Capacity, Competence and Character for Safe and Ethical Practice.¹

Note: another licence type may may be issued at the discretion of the Registrar

Scope and Standards

The standards against which the candidate physician is being assessed will be determined in advance in collaboration between the College, Nova Scotia Health and when necessary, the relevant Dalhousie University Department of Medicine.

The scope of the PRA will include, at a minimum, those skills and competencies necessary for safe practise in the proposed workplace position. In usual circumstances, this will include the full breadth of the specialty.

The scope of the assessment must be agreed upon in advance of the assessment. The 8-week PRA will be conducted in a place and manner that satisfies the College of a valid and unbiased practice-ready decision.

The general standard applied will be that of a specialist physician, acceptably competent for entry into independent practice in Canada. 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 8-week Over Time Assessment

The core model of this PRA will be a clinical assessment ‘over-time’ of practice-readiness.

The approach to assessment acknowledges that the candidate requires orientation to their new practice environment, as well as to the relevant cultural competencies and/or the structure and functioning of the Canadian health care system. Otherwise, the focus and expectation of the assessment is to determine whether the physician under assessments demonstrates readiness for practice in Canada. The assessment will include multiple observations, made by one or more physician assessors / supervisors in a variety of relevant practice settings.

The assessment will be a minimum of 8 weeks duration. A longer assessment may be required in some circumstances. There will be a mechanism to terminate the assessment early, should the candidate clearly not be ready for independent practice.

Aligning Scope of Practice – Competence and Currency

To structure the practice assessment requirements, the PRA will include a process to validate both the candidate’s understanding of their intended workplace scope of practice against the expectations of the hiring Department Head or Department Lead. In addition, approval of the assessor/supervisor will require that they are current in the scope of practice of the physician’s intended scope. The PRA will be structured to ensure a sampling of assessment activities across the breadth of the validated scope of practice.

Assessment Structure

The assessment will consist of one-to-one supervision with a College-approved assessor/supervisor³ over the 8-week period. 

• Weeks 1 – 2
  • Introduction/Orientation period – 2 weeks of orientation to the department’s care delivery and hospital work environment, including services and sites, workflow, policies and protocols, equipment and information systems.

• Weeks 3- 6
  • Coaching period – 4 weeks of primarily clinical experience with a 1:1 supervision for coaching toward independent practice in the new environment. Subspecialty rooms/experience to be varied depending on the planned practice location for the physician’s licence period. The focus of this aspect of the assessment is assessment for learning.
• Weeks 7 – 8
  • Assessment period – 2 weeks of continued clinical experience with a focus on assessment for suitability for the physician’s planned practice location – continued ongoing coaching during this time. However, the main focus of the final two weeks is assessment of learning.

Assessment Component

During the introduction period, the physician under assessment will be required to complete “Case Discussion” worksheets, that will be reviewed by the assessor/supervisor. As comfort with their practice environment and equipment increases some coaching can begin. The development of a checklist of items to review, to ensure appropriate orientation to the space is encouraged. The assessor/supervisor will provide documented feedback, to be reviewed by the physician, with the requirement to state goals towards practice improvement. This initial phase of the assessment is considered assessment for learning.  

During the coaching period, there will be regular assessment and feedback completed using a combination of daily assessment activities such as direct observation of practice, patient record review and colleague interviewing.  

During the assessment period, the required assessments will be completed utilizing assessment activities such as direct observation, colleague interviews and patient record review. The assessor/supervisor will ensure that a breadth of patient encounters and procedures are assessed to ensure representation of the scope of practice assessed.

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/Supervisors

There will be a lead assessor/supervisor, who must full the criteria for “Approval of Supervisors for College-directed Supervision”².  Additional assessors/supervisors must also fulfill these criteria.

All assessors will contribute to the over-time assessment and to the practice-ready decision. In their capacity as assessors, they will be considered agents of the College and subject to specific limitations and protections.

The lead assessor will be responsible for:

• Identifying appropriate assessment opportunities and methods
• Collecting and collating assessment documents / instruments
• Leading the team in making the practice-ready decision
• Making a practice-ready recommendation to the College

Practice-Ready Recommendation

The Registrar of the College will review the assessment report and recommendations from the Lead Assessor to determine one of the following:

1. The physician has demonstrated the competencies necessary for Defined licensure with or without conditions and restrictions on the licence.
2. The physician has demonstrated the competencies necessary for a different form of licensure.
3. The physician has not demonstrated competencies for any form of licensure.
4. The Registrar is not prepared to make a licensing decision and will refer the physician to the Registration Committee for adjudication.

Licensure Determination

The decision regarding ongoing licensure status will rest with the Registrar as per policy¹.  This may include a referral to the Registration Committee.

Withdrawal from the Assessment

The PRA candidate has up to 3 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.¹

Resources

1. Capacity, Competence and Character for Safe and Ethical Practice
2. Approval of Supervisors for College-directed Supervision