Pathway to Licensure for International Medical Graduates via a Practice Ready Assessment – Family Medicine

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 Family Medicine, a physician must successfully challenge the Practice Ready Assessment in Family Medicine or otherwise be eligible to challenge the certification examination with the College of Family Physicians of Canada¹.

Purpose 

This policy outlines the eligibility criteria and pathway to Defined licensure for supervised practice as the most responsible physician in Family Medicine via a Practice Ready Assessment (PRA). 

Scope

This policy applies to physicians who are trained and certified in Family Medicine or General Practice in an international jurisdiction that is not recognized by the College of Family Physicians of Canada (CFPC).

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 Family Medicine must be conducted in accordance with this policy and with agreement between the College, the Nova Scotia Practice Ready Assessment Program², and Nova Scotia Health³ or the IWK Health Centre⁴.  A PRA will not be approved in a retrospective manner by the College under any circumstances. PRAs in Family Medicine are conducted by the Nova Scotia Practice Ready Assessment Program – Family Medicine (NSPRAP).

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 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.ca⁵. Candidates must have all of the following credentials:

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 Proficiency⁹.

4. Postgraduate Training

Candidates must have successfully completed a postgraduate training or internship program leading to certification, recognition and practise in Family Medicine or General Practice in their training jurisdiction.

The program must include 24 months of training in Family Medicine or General Practice, with a minimum of 8 weeks of postgraduate training successfully completed in the following rotations:

1. Family Medicine/ General Practice
2. Internal Medicine
3. Surgery
4. Pediatrics
5. Psychiatry*
6. Obstetrics/ Gynecology*
7. Emergency Medicine**

* At the discretion of the Registrar, candidates for practice ready assessment in Family Medicine, may be excused the requirement for 8 weeks of postgraduate training in Psychiatry and/or Obstetrics/Gynecology, provided they have the equivalent amount of extra training in Family Medicine.

**  The College will consider Emergency Medicine rotations as part of the 24 months of postgraduate training required.

5. Practice Experience

Candidates must have the following independent practice experience:

• At least 24 months of unsupervised, independent practice as the most responsible physician in Family Medicine or General Practice* following completion of 24 months total of postgraduate training or internship in Family Medicine.
• A Practice Ready Assessment qualifies as an assessment satisfactory to the Registrar as it relates to the candidate’s currency of practice experience. Candidate’s must meet the currency of practice requirements in Family Medicine outlined in the College policy Currency of Practice Experience¹⁰.
  
  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

The College will refer eligible candidates to the NSPRAP for review. The NSPRAP makes the final decision to accept a candidate into the program. The cost of the assessment itself is the responsibility of the NSPRAP. The licence fee¹¹ for the assessment and for ongoing licensure in Nova Scotia is the responsibility of the candidate. 

For more information, please refer to the College webpage for Practice Ready Assessments for International Medical Graduates¹².

Once selected by the program, the physician 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 NSPRAP 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.

PRA Recommendations & Outcomes 

The Registrar of the College will review the reports from the Recommendations Committee of the NSPRAP 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 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:

• Based on the Registrar’s review of the PRA results, the licence may include additional conditions and/or restrictions beyond those typically applied to a Defined licence. 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 supervision¹³.
• For physicians issued a Defined licence prior to September 1, 2022, following their original licensing pathway: Within one year of their Defined licence being issued, the candidate will be required to apply to the CFPC for their eligibility to challenge the certification examination. The candidate must provide confirmation of the application to the College. 

For candidates who have not demonstrated competencies necessary 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 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 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. College of Family Physicians of Canada (CFPC)
2. Nova Scotia Practice Ready Assessment Program in Family Medicine
3. Nova Scotia Health
4. IWK Health Centre
5. physiciansapply.ca
6. World Directory of Medical Schools
7. Licentiate of the Medical Council of Canada
8. Acceptable Alternatives to the LMCC
9. English Language Proficiency
10. Currency of Practice Experience
11. Fee Schedule
12. Practice Ready Assessment for International Medical Graduates
13. Supervision Levels for College-Directed Supervision