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Pathway to Licensure for International Medical Graduates via a Practice Ready Assessment: Specialists and SEAP Status Affiliates (with a primary specialty of Internal Medicine)

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Preamble 

A Defined licence is a time-limited licence to practise medicine while supervised as the most responsible physician while working toward a Full or Restricted licence. To qualify for a Defined licence in a specialty, a physician must successfully challenge the Practice Ready Assessment or otherwise be eligible to challenge the certification examination with the Royal College of Physicians and Surgeons of Canada (RCPSC)1.

Purpose 

This policy outlines the eligibility criteria and pathway to Defined licensure for supervised practice as the most responsible physician in a specialty or subspecialty via a Practice Ready Assessment (PRA) for:

  • Medical or Surgical Specialists whose specialty training is equivalent in years of training to Canadian training programs of the respective specialty.
  • Medical subspecialists who have successfully completed a Subspecialist Examination Affiliate Program (SEAP) and have attained SEAP Affiliate Status with the RCPSC. Specifically, the subspecialist’s primary specialty must be in Internal Medicine. 

Scope

This policy applies to physicians who are trained and certified or eligible to be certified in a specialty (other than Family Medicine) or a subspecialty of Internal Medicine in an international jurisdiction that is not immediately acceptable for eligibility to challenge the Royal College of Physicians and Surgeons of Canada certification examination.

Policy

A PRA is a practice-based assessment used to determine whether the physician is ready for supervised practice as the most responsible physician in Nova Scotia.

All PRAs for specialists or subspecialists must be conducted in accordance with this policy and with agreement between the College, the relevant health authority, the Department of Health and Wellness and the Faculty of Medicine at Dalhousie University. A PRA will not be approved in a retrospective manner by the College under any circumstances. PRAs in a specialty other than Family Medicine are conducted by the relevant department within the Faculty of Medicine at Dalhousie University.

Eligibility Criteria 

In addition to the following criteria, candidates must have fewer than two previous unsuccessful attempts in a Canadian practice ready assessment program.

1. Eligibility to Work 

Candidates: 

  • Must be Canadian citizens or legally entitled to live and work in Canada.
  • Must have an offer of employment upon obtaining a Defined licence, in an area of defined need, from either Nova Scotia Health2 or the IWK Health Centre3.
  • Must not be prohibited or restricted from practising medicine through the decision of any adjudicating body or through voluntary agreement or otherwise (other than by conditions or restrictions imposed on a licence by a regulator).

2. Credentials 

All credentials must be source-verified by physiciansapply.ca4. Candidates must have all of the following credentials:

Credential Description 
Medical Degree Medical degree from a school listed in the World Directory of Medical Schools5.
Medical Council of Canada (MCC) Be a Licentiate of the Medical Council of Canada (LMCC)6 or qualify for an Acceptable Alternative to the LMCC7.
Confirmation of Postgraduate TrainingA certificate of completion of training or letter confirming completion of training.
Specialty RecognitionPrimary Specialists must have certification in a specialty that is equivalent to a Primary Specialty as defined by the RCPSC.

SEAP designates must have both:
– Royal College Subspecialist Affiliate status.
– Certification or eligible for certification in a subspecialty that is equivalent to a subspecialty as defined by the RCPSC.

3. English Language Proficiency 

In accordance with Section 39 of the Medical Practitioners Regulations, candidates are required to demonstrate proficiency in the English language, in a manner prescribed by the Registrar.

All physicians must have the ability to effectively communicate with patients, other professionals and the College as described in the College policy on English Language Proficiency8.

4. Postgraduate Training 

All candidates (primary specialists and SEAP designates) must have successfully completed postgraduate training that is substantively equivalent in amount of time as compared to Canadian training programs in the relevant primary specialty and/or subspecialty.

5. Practice Experience 

All candidates must have the following unsupervised, independent practice experience or training in a Royal College subspecialist Fellowship program:

  • Minimum of three years of unsupervised, independent practice as the most responsible physician in the primary specialty or subspecialty* OR for subspecialists, a minimum of 2 years in a Canadian training program, specifically a Royal College Subspecialty Fellowship training program.
  • Candidates must meet the currency of practice requirements in the primary specialty or subspecialty outlined in the College policy Currency of Practice Experience9 in the 3 years immediately before the date of application to the College. For subspecialists, the College may consider a Canadian Royal College Subspecialty fellowship training program for 6 months in the last 3 years in lieu of independent practice.
  • SEAP designates must also have an unsupervised, independent, unrestricted licence to practise in the current or most recent practice location or enrollment in a Royal College Subspecialty Fellowship training program in Canada within the last three years.

All candidates must provide an explanation for any gaps in practice.

*practice experience must be at least 0.5 Full Time Equivalent (FTE) at a minimum of 900 hours annually.

Pathway from a PRA to Supervised Practice as the Most Responsible Physician

To be considered for a PRA, a candidate must be jointly recommended by the relevant health authority and the relevant department in the Faculty of Medicine at Dalhousie University. Together, the health authority and Dalhousie University’s process includes, but is not limited to:

  1. Ensuring the potential candidate’s medical degree is recognized in the World Directory of Medical Schools;
  2. Determining the potential candidate is not otherwise eligible to challenge the certification examination with the RCPSC;
  3. Ensuring the potential candidate’s training is at least the same length as Canadian training in the respective specialty or subspecialty;
  4. Ensuring the potential candidate qualifies for all of the above-listed eligibility criteria; and
  5. Interviewing the chosen potential candidates to review credentials, scope of practice, and practice history. Review the proposed practice site to ensure the competencies and expectations align between the candidate and the expected practice environment.

The cost of the assessment itself, including the College’s administration fee, is the responsibility of the relevant health authority and the Department of Health and Wellness. The licence fee10 for the assessment and for ongoing licensure in Nova Scotia is the responsibility of the candidate.

More details on the PRA are outlined under the College’s Framework for the Conduct of Practice Ready Assessments – Specialists11.

Once the health authority and the relevant department in the Faculty of Medicine at Dalhousie University choose the candidate, the health authority will provide a letter of endorsement to the College representing a commitment to this process and the relevant roles and responsibilities.

Each letter of endorsement must include:

  1. Confirmation there is a need for the relevant specialty or subspecialty in the province and a job offer will be forthcoming upon successful completion of the PRA leading to Defined licensure;
  2. Confirmation of approval from the Department of Health and Wellness;
  3. Confirmation there is funding in place for the PRA (inclusive of remuneration for the Assessors and the candidate, the College’s administrative fee and any other cost identified by the relevant department in the Faculty of Medicine);
  4. Confirmation that the Department of Health and Wellness will issue a return of service agreement if the candidate is successful;
  5. An outline of the proposed Practice Ready Assessment lasting a minimum of 12 weeks in duration.  The proposed PRA must conform to the National Assessment Collaboration (NAC) model. This may require adaptation for the relevant specialty and should include a set of tools and materials; and
  6. Confirmation the candidate appears to meet the eligibility criteria in this policy.

Once candidates have the endorsement of a health authority, they must apply for a Clinical Assessment licence for the duration of the assessment. This licence type is for assessment purposes only and the physician holding this licence is never the most responsible physician.

Once the clinical field assessment has commenced, it will be considered a PRA attempt whether the candidate withdraws or completes the assessment. All PRA attempts are reported to the Medical Council of Canada and will be noted in future applications.

When the assessment is complete, the Clinical Assessment licence ends and the relevant department conducting the PRA provides its licensing recommendation to the College. The physician must wait until a licensing decision has been made by the Registrar of the College and completion of the Defined licence application prior to starting practice. The College will collect all outstanding documentation in support of the application for a Defined licence. Typically, this process takes approximately 4-6 weeks.

All Defined licensees are required to pursue the requirements for long-term licensure, namely a Restricted licence or Full licence.

Notes for Royal College Subspecialist Examination Affiliate Program (SEAP) Designates

For SEAP designates in particular, the purpose of the PRA is to determine whether the physician has the skills and knowledge to cover on-call shifts in the primary specialty of Internal Medicine.  The PRA does not assess the skills of the SEAP designate in the respective subspecialty as the SEAP designation offers assurance of competence in the designated subspecialty.

A successful outcome in the PRA gives SEAP designates a Defined licence for practise in the SEAP subspecialty, as well as the scope of practice within Internal Medicine assessed by the PRA.

A successful outcome also gives the SEAP designate eligibility for the RCPSC certification exam in Internal Medicine.  For candidates who achieve success in the RCPSC Internal Medicine certification exam, the RCPSC will convert the SEAP designation to certification in the subspecialty.

Practice Ready Assessment Recommendations and Outcomes

The Registrar of the College will review the assessment report and recommendations from the relevant department in the Faculty of Medicine at Dalhousie University to determine one of the following:

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

For candidates who have demonstrated the competencies necessary for Defined licensure:

  • The College will provide a letter of recommendation to the RCPSC to endorse the candidate’s eligibility for the certification examination in the primary specialty for specialists and in Internal Medicine for medical subspecialists.
  • Based on the Registrar’s review of the PRA results, the licence may also include additional conditions and/or restrictions. The Registrar may also refer the physician to the Registration Committee if there are any concerns related to the physician’s capacity, competence or character to safely and ethically practise medicine. The College will issue the candidate a Defined licence with supervision, starting at Standard level supervision12.
  • For successful SEAP designates, the Defined licence will be restricted to the subspecialty practice of the SEAP designation and to Internal Medicine in the scope assessed in the PRA.

For candidates who have not demonstrated competencies for any form of licensure, the candidate will be denied licensure.  This must be disclosed to other Medical Regulatory Authorities if asked about a history of being denied licensure. As with any application for licensure, the candidate can request to withdraw their application. In this case, there will be no licensing decision rendered.

Appeal of the Registrar’s Decision

The candidate has the option to appeal the decision of the Registrar through the College’s Registration Committee.

The candidate must notify the Registrar of their intent to appeal the decision within 30 days from the date of the Registrar’s initial decision.

Once the Registrar receives the candidate’s request for an appeal, they will give the Registration Committee all the information required to conduct a thorough and fair review of the candidate’s file, including but not limited to:

  • all of the information reviewed by the Registrar in making their decision; 
  • the decision of the Registrar; and  
  • any supporting documentation provided by the candidate. 

The Registration Committee is comprised of three physicians and at least one representative of the public. All decisions of the Registration Committee can be appealed to the Registration Appeal Committee. 

Appeal of the Registration Committee Decision

The candidate has the option to appeal the decision of the Registration Committee through the College’s Registration Appeal Committee.

The candidate must notify the Registrar of their intent to appeal the decision of the Registration Committee within 30 days from the date of the Committee’s initial decision.

Once the Registrar receives the candidate’s request for an appeal, they will give the Registration Appeal Committee all the information required to conduct a thorough and fair review of the candidate’s file, including but not limited to:

  • all of the information provided to the Registration Committee;
  • the decision of the Registration Committee; and
  • any supporting documentation provided by the candidate.

The Registration Appeal Committee is comprised of three physicians and at least one representative of the public. All decisions of the Registration Appeal Committee are final.

Resources 

  1. Royal College of Physicians and Surgeons of Canada
  2. Nova Scotia Health
  3. IWK Health Centre
  4. physiciansapply.ca
  5. World Directory of Medical Schools
  6. Licentiate of the Medical Council of Canada
  7. Acceptable Alternatives to the LMCC
  8. English Language Proficiency
  9. Currency of Practice Experience
  10. Fee Schedule
  11. Framework for the Conduct of Practice Ready Assessments – Specialists
  12. Supervision Levels for College-Directed Supervision

Applicable Legislation: Medical Practitioners Regulations Sections 14-15, 36-38, 39-45, and 59-63 

Approved by: Registration Policy Committee, Executive Committee  

Approval date: September 22, 2022 & September 29, 2022

Review date: September 2025