Guideline for Re-Entry into Practice Assessments - Registration Policies College of Physicians & Surgeons of Nova Scotia

Preamble

Physicians must report to the College when they:

wish to re-enter practice and have not been engaged in practice for at least 450 hours over the last three years^1,2; and/or
are contemplating a significant or abrupt change in their scope of practice or wish to return to a scope of practice in which they have not practised in the last three years.¹

Governing Policy

Re-entry into Practice and/or Change in Clinical Scope of Practice1

Scope

These guidelines outline the scope and standards that direct the development and implementation of an assessment for the purpose of re-entry to practice for physicians in Nova Scotia.

Guidelines

The re-entry into practice assessment is conducted under the Framework for the Conduct of an 8-week Practice-Ready Assessment.³ For the purpose of this document, the terms Supervisor and Assessor are used interchangeably.

Physicians seeking an assessment for re-entry to practice must complete and submit the appropriate application form to the College’s Registration Department (registration@cpsns.ns.ca). Applications will be considered only from physicians who:

Upon successful completion of the assessment, will be eligible for a Full licence or Restricted licence in Nova Scotia.
When relevant, provide evidence in the form of a written statement from either Nova Scotia Health or Isaak Walton Killam (IWK) Health Centre that they will be credentialed upon successful completion of the assessment.
Have a proposed scope of practice for which assessment capacity exists in Nova Scotia.

Approval and Costs

Approval to enter a re-entry to practice assessment will be contingent upon:

Agreement between the College and physician on an acceptable scope of practice and assessment;
Identification of an assessment site and supervisor(s) acceptable to the College⁴;
Privileging by the relevant health authority and zone;
Evidence of medical malpractice insurance (CMPA or equivalent); and
Payment of costs as outlined below.

In most circumstances, the requesting physician will be responsible for paying all costs of the assessment, including but not limited to:

Application and licensure fees
Malpractice insurance
Site licence fees for Electronic Medical Records, if applicable
CPSNS Assessment Administration Fee⁵, payable in advance of the assessment
Supervisor/Assessor fees⁵

Agreement on the part of a Supervisor (or team of Supervisors) to conduct a re-entry to practice assessment entails a major commitment in terms of time and responsibility. For most Supervisors, the assessment will lie outside their usual duties and therefore increase workload and/or reduce clinical income. It is the College’s position that compensation of a Supervisor is fair and justified for the purpose of ensuring comprehensive oversight and reporting.

In most cases, supervisory fees will be paid by the physician undergoing the assessment, to the College, who will then be responsible for remunerating the Supervisor(s). The agreement to provide supervision is made only between the College and the Supervising physician(s). No direct financial obligation or relationship may exist between the Supervisor(s) and the assessed physician.

Scope of Assessment

The scope of the re-entry to practice assessment will be determined by either the Registrar or the Registration Committee in consultation with the College’s Physician Performance Department and from information provided by the physician candidate and physicians of the same specialty, taking into account the following:

The physician’s intended and reasonably anticipated future scope of practice
The needs of the community to be served
Available resources for assessment (expertise, time, opportunity)
Placing the fewest possible explicit conditions on the physician’s licence, recognizing that change-in-scope of practice provisions are always relevant

Specific major exclusions of scope will in most cases be specified in advance of the assessment and will constitute either implicit or explicit restrictions on the physician’s subsequent scope of practice.

In some circumstances, additional explicit exclusions to the physician’s scope of practice may be made as a result of the assessment, for example:

If there were insufficient opportunities during the assessment to make a judgement of competence within a well-defined and limited aspect of overall practice.
If the physician failed to demonstrate competence within a well-defined and limited aspect of overall practice

Selection of Supervisor(s)

Assessments are more likely to be valid and reliable when conducted by multiple experienced supervisors who have a clear understanding of the expected standard. Furthermore, an adequate number and variety of assessment opportunities is essential to reaching a defensible conclusion regarding competence to re-enter practice.

Approval of supervisor(s) and practice location will ordinarily be made in accordance with the College’s policy on the Approval of Assessors and Supervisors for College-directed Assessments4. Several additional factors will be considered, including:

The availability of experienced and available clinical supervisor(s). Preference will usually be given to locations with more than one supervisor
The availability of a suitable number and variety of clinical experiences within the anticipated scope of practice.
The ability of the supervisor(s) to provide an unbiased assessment of competence (i.e., absent conflict of interest)
Geographic location acceptable to the assessed physician and the College
Reasonable cost

It is the responsibility of the physician requesting the assessment to secure a willing practice location to engage in the re-entry to practice assessment. The College will participate in providing supervisors with orientation, training and the relevant assessment tools and reporting structure. In general, it is not possible to guarantee the availability of an appropriate assessment within the province of Nova Scotia.

Responsibilities of the Supervisor(s)

The re-entry to practice assessment is conducted under the provisions for the Framework for the Conduct of an 8-week Practice Ready Assessment.³

Supervisor(s) must be familiar with and adhere to the Basis of Immediate Reporting to the College section of the Guidelines for College-Directed Supervision.⁶

Supervisor(s) will, in most cases, will be the Most Responsible Physician (MRP).

As such, the Supervisor takes responsibility for appropriate oversight of all activities, including but not limited to clinical assessments, investigation, diagnosis, management, and documentation. The Supervisor(s) is given discretion to determine the circumstances under which direct (i.e., observation / assistance) versus indirect (review and discussion) oversight are used. Typically, this will be determined by the clinical context and the assessed physician’s demonstrated abilities.

Specific additional requirements will be laid out in the detailed Supervision Plan, including:

The clinical context(s) in which supervision / assessment will take place.
The range of skills, knowledge and attitudes that are to be assessed.
The nature and approximate frequency of assessment activities.
The nature and frequency of reports to the College.

Responsibilities of the Assessed Physician

The general responsibilities and obligations of the physician under assessment are laid out in the College’s policy “Responsibilities of Supervisors and Physicians Under Supervision”.7 With respect the re-entry to practice assessment, key areas are highlighted here.

Secure a willing practice location to engage in the re-entry to practice assessment
Present a willing supervisor, approved by the College to engage in the assessment
Pay all fees related to the assessment, unless other funding agency is secured
Should performance concerns be identified during the course of the assessment, acknowledges and provides a plan for practice improvement

Nature of Assessment

Although the primary purpose of the re-entry to-practice assessment is for the physician to demonstrate competence in their intended scope, it is assumed that there will be some element of re-training, particularly in circumstances where the physician has been absent from practice for an extended period.

In all circumstances, there will be an expectation that the practitioner undertake comprehensive professional development activities, both in advance of and in conjunction with the re-entry assessment.
Unless otherwise specified, the re-training responsibilities of the clinical supervisor(s) will be limited to: provision of feedback for improvement based on the participation in real or simulated clinical activities;
clinical teaching around real or simulated cases; and
guidance regarding professional development resources and activities.

A determination of suitability for independent practice is only valid and reliable when supported by a sufficient number and variety of documented discrete assessments. Selection of assessment opportunities and methods must be guided by the supervision plan and intended scope of practice. As the assessment proceeds, the supervisor(s) must adapt their plan to ensure that all essential competencies have been assessed.

In most cases, assessment will be conducted through direct or indirect observation in the clinical environment. Direct observation is self-explanatory. Indirect observation may include the review and discussion of clinical cases or records. Documentation of direct and indirect assessments will in most cases be done using:

Field notes
Direct Observation Tools (Clinical encounters or procedural)

Feedback may be obtained from physician colleagues or other medical personnel and documented using:

Structured forms such as the “Medical Colleague Interview” tool
Field notes

Where capacity exists, (i.e., in an established teaching center), additional methods of assessment, such as simulation or semi-structured oral examinations, may be used.

In the context of a limited clinical assessment, it is impossible to ensure that the full range of foreseeable clinical conditions will be encountered and assessed. Instead, experiences will be chosen for the purpose of providing a representative sample of clinical encounters, from which a determination of competence may be reasonably made.

Where circumstances and resources allow, non-clinical methods of assessment (e.g., technical simulation, simulated patient encounters, oral scenarios etc.) may be employed to extend the scope of assessment or address essential but uncommonly encountered clinical scenarios.

Duration of Assessment

Re-entry to practice assessments will typically be of 8-weeks duration.³ However, in determining the exact duration of any assessment, the following factors will be considered:

Length of absence from clinical care
Nature and scope of any interval practice
Length and nature of practice prior to absence
Intended scope of practice
Demonstrated competence during the assessment

The planned and ultimate duration of any assessment will be determined by the Registrar or the Registration Committee.

If, after an assessment period of at least four weeks, the Supervisor(s) are of the firm opinion that formal retraining is required to ensure a physician’s clinical competence, the assessment may be discontinued with the College’s agreement and the physician will be advised to seek additional training.

Assessment Standard

In general, the standard of performance applied in a Reentry to Practice Assessment will be that of a competent physician, ready to enter practice. In this respect, a competent final year post-graduate trainee, ready to enter independent practice, is the most useful frame of reference.

The specific objectives and standards of performance applied will be those of the respective certifying college (CFPC or RCPSC)^8.9.

Physicians are additionally expected to meet the professional standards of the College.

Reporting

The nature and frequency of reporting will be laid out in the Assessment Plan. Ordinarily, a performance summary accompanied by supporting documents (i.e., field notes) will be required at least once per month.

Outcome

At the end of the assessment period, the supervising physician(s) will be required to make one of the following recommendations to the College:

That the physician has demonstrated competence in the full scope of practice for which the assessment was conducted; or
That the physician has demonstrated competence in the scope of practice for which the assessment was conducted with the following exceptions: <conditions listed>;
That the physician has not yet demonstrated competence in the full scope of practice for which the assessment was conducted and requires either further training or further assessment in the following areas (listed).

The decision regarding licensure will rest with the Registrar. This may include referral to the Registration Committee.

If it is determined that further training or assessment is required, responsibility will rest with the assessed physician to obtain and fund such opportunities.

Resources

Applicable Legislation: Medical Practitioners Regulations pursuant to the Medical Act – Sections 16(1)

Approved by: Assessment Committee and Council

Approval date: April 11, 2025 & May 23, 2025

Review date: April 2027