Pathway to Licensure for International Medical Graduates via a Practice Ready Assessment: Specialists

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 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.

Scope

This policy applies to physicians who are trained and certified or eligible to be certified in a specialty (other than Family Medicine) in an international jurisdiction that is not eligible 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 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:

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 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.⁹

5. Practice Experience

All candidates must have the following unsupervised, independent practice experience:

• Minimum of three years of unsupervised, independent practice as the most responsible physician in the primary specialty*.

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.

6. Currency of Practice

Candidates must meet the currency of practice requirements in the primary specialty outlined in the College policy Currency of Practice Experience¹⁰ in the 3 years immediately before the date of application to the College.

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;
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 fee¹¹ 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 – Specialists¹².

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 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. It may take approximately six months to obtain all of the required documentation for a Clinical Assessment licence.

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.

PRA 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.
• 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 supervision¹³.

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 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. Royal College of Physicians and Surgeons of Canada – Information by Discipline
10. Currency of Practice Experience
11. Fee Schedule
12. Framework for the Conduct of Practice Ready Assessments – Specialists
13. Supervision Levels for College-Directed Supervision