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Practice Ready Assessment for IMG Physicians
1. Practice Ready Assessment for IMG Physicians
Medical Council of Canada – Annual General Meeting
15-17 September 2013 - Ottawa
Dan Faulkner
Cindy Streefkerk
2. 1. Background & context
2. Accomplishments
• Family Medicine Standards for a
competency-based assessment
process
3. Next Steps
• Other Specialties
• Sustainability
Overview
2
3. Initial
Screening
(MCCEE/CLBA/
Credentials)
Practice Ready Assessment
Provisional
Licensure
IMG Orientation
Summative
Assessment
Licensure
(Full)
Practice
Eligible Route
for
Certification
Seek Alternative Career Path
Seek Alternative Career Path
Canadian
Residency
Training
Required
Selection Decision
Other Routes
(i.e., Credentials (Accredited
Qualifications), Other Programs)
Clinical
Assessment
(NAC Examination)
Supervised
(Monitored)
Practice
Competencies
Entry-to-
Residency
Entry-to-
Practice
3
Canadian
• LMCC
• Certification
IMG Physician Routes to Practice
Assessments
(Over-time)
4. Practise under Provisional Licensure
NL NS QC ON MB SK AB BC YK
Current to Future State
Supporting Business Model
NAC PRA Common Framework & Process
Practice-Ready Assessment to Provisional Licensure
Jurisdictional PRA Delivery
4
5. NAC PRA Objectives
1. Design & propose a pan-
Canadian process for the
evaluation of a physician’s
readiness for practice
(provisional licence)
2. Develop or adopt standards &
materials for common use
5
Critical Success
Factor:
Our objectives will
be achieved through
consultation &
definition as we go
forward.
6. 6
Future:
Pan-Canadian PRA Process
An objective assessment that allows for
common, summative evaluation across
different modelsIMG PGT not in
Canada and/or has
practised outside of
Canada
7. 1. Focus on family medicine first &
standards development is complete
a. Common area of physician need – rural/remote
b. Collaborate - CFPC alternate route to
certification through observation rather than
examination
c. Majority of PRA are family medicine with BC &
YK planning a family medicine PRA
2. Supported by continued research to
inform decision-making
7
Over the past year….
8. FAMILY MEDICINE STANDARDS
NAC PRA - Accomplishments
8
http://mcc.ca/wp-content/uploads/Reports-NAC-PRA-family-medicine-standards.pdf
9. • Purpose of initial screening & selection:
• Outline acceptable elements required to select
IMG physicians with the highest chance
(likelihood) of success through a PRA process
• Recognition that, for many jurisdictions, it will
be a competitive process (capacity
constraints)
• Clearly articulate requirements & process to
provide consistent communications for IMGs
NAC PRA Family Medicine Standards
Initial Screening & Selection
9
10. • Initial screening & selection includes:
• Common screening:
• Based on initial screening assessment, applicant
credentials & experience
• Criteria acceptable to MRAs for provisional licensure
• Comparable PRA selection:
• Eligibility rules or regulations
• Ranking practices (guidelines)
• Standard application/registration-related policies
for pan-Canadian process
10
NAC PRA Family Medicine Standards
Initial Screening & Selection
11. • Minimum eligibility standards defined:
• To qualify for a PRA process, a physician applicant
must meet the minimum eligibility requirements
for registration in Canada as per FMRAC’s
Agreement on Standards for Medical Registration
in Canada
11
NAC PRA Family Medicine Standards
Initial Screening & Selection
12. Must happen before
assessment is offered:
• Language proficiency
testing
• Currency of practice
• Length of time away from
practice
• Credentials verification
• Medical degree &
postgraduate training
• MCCEE
Can happen after assessment
is offered but before over-
time assessment period
begins:
• Good standing/character
• Fitness to practise
• Orientation
12
Timing of Minimum Eligibility Requirements
NAC PRA Family Medicine Standards
Initial Screening & Selection
13. Miller’s pyramid of competence
NAC PRA Type
Workplace Assessment
Over-Time
Assessment
Selection
(Interactions with trained patients &
assessors - OSCE)
Point-in-Time
Assessment
Selection
(Therapeutics, CDM, short-answer)
Screening
(MCQ – MCCEE)
Miller’s Pyramid & PRA - Clinical Competence
SHOWS
HOW
DOES
KNOWS
HOW
KNOWS
13
14. 14
Competency Framework
Sentinel habits define essential, priority skills that
are comprehensive & easily recognizable in busy
clinical settings
1: Incorporates the patient’s experience
& context into problem identification &
management
5: Uses generic key features when
performing a procedure
2: Generates relevant hypotheses
resulting in a safe & prioritized
differential diagnosis
6: Demonstrates respect and/or
responsibility
3: Manages patients using available best
practices
7: Verbal or written communication is
clear & timely
4: Selects & attends to the appropriate
focus & priority in a situation
8: Seeks out & responds appropriately to
feedback
* Two of the original 10 sentinel habits were excluded as not being relevant within the NAC PRA family medicine context:
• Teaches to relevant & achievable objectives
• Participates with practice/quality management
15. 15
Patient Contexts
Clinical domains define the various populations &
activities that physicians encounter in clinical
settings
1: Behavioural medicine/mental health 5: Care of the vulnerable & underserviced
2: Care of adults 6: Maternity/newborn care
3: Care of children & adolescents 7: Palliative care
4: Care of the elderly 8: Procedural skills
16. 16
NAC PRA Family Medicine Standards
Over-Time Assessment Standards
Multi-Source Data
Chart-Based
Components
Continuous Clinical
Assessment
DEFINED
Focus is on communicator,
collaborator & professional
roles
• Chart stimulated recall
• Chart audits
• Case-based discussions
• Mini-CEX
• DOPS
• CBAS
• Field notes
STANDARD
• Feedback comes from
patients & professional
colleagues
• Feedback is
documented
• Demonstrates ability to
meet regulatory
standards for charting
• Observation of chart-
based assessments are
documented
• Observations cover all
sentinel habits across all
clinical domains
• Observations occur across
time & patient problems
GUIDELINE
Ideally, feedback comes
from:
• Minimum of 15
patients sampled as
broadly as possible
across demographics &
problems
• 5-8 professional
colleagues
(MD & non-MD)
Assessor judgement
determines the number of
charts for review
• More than one clinical setting
may be required to ensure
appropriate sampling
• Ideally,
• If field notes only,
one/day totaling 40-80
• If mini-CEX (or
equivalent), one/week
totaling 8-12
17. Environment:
• Supervision & assessment
occur in a practice
environment (community-
based)
• Commitment of assessor &
practice partners who are
not assessors in their host
environment
• Rich in patient care
opportunities
Time Period
• Allow candidate time to
acclimatize
• Allow adequate time to
assess response to feedback
• Should not take longer than
12 weeks to determine
practice-readiness
17
NAC PRAFamily Medicine Standards
Over-Time Assessment Environment Standards
18. Collaborators
18
Carl Sparrow*
PRA, Newfoundland
Heidi Oetter*
MRA, British Colombia
Gwen MacPherson
PRA/MRA, Nova Scotia
Lynda Campbell
MoH, Nova Scotia
Bill Lowe*
PRA/MRA, Nova Scotia
Laurel Miller*
MoH, Yukon
Debra Sibbald
PRA, Ontario
Jeff Goodyear
MoH, Ontario
Ernest Prégent*
PRA/MRA/CMQ, Quebec
Tim Allen*
CFPC
Penny Davis
PRA, Saskatchewan
Brooke Ballance
MoH, Manitoba
Dan Faulkner*
MRA, Ontario
Ken Harris*
RCPSC
Marilyn Singer
PRA, Manitoba
Ingrid Kirby
MoH, Saskatchewan
Anna Ziomek*
MRA, Manitoba
Fleur-Ange Lefebvre*
FMRAC
Erin Andersen
PRA/MRA, Alberta
Adrienne Hagen-Lyster
MoH, Saskatchewan
Karen Shaw*
MRA, Saskatchewan
Ian Bowmer*
MCC
Rodney Andrew
Program, British
Columbia
Libby Posgate
MoH, British Columbia
Ken Gardener*
PRA/MRA, Alberta
Jack Burak
MRA, British Columbia
Shelley Ross
UofA, Alberta
Liz Hong-Farrell
Health Canada
* NAC PRA Steering Committee members
20. Other Specialties – For Exploration
Preferred other specialty focus
for summer 2013 to March 2014
• Psychiatry
• Internal medicine
Continue collaborative partnership approach to
define competency standards
• Look to Royal College content experts
to participate in developing the
competency framework/ standards
– Selection, competency & assessment
• Consult & involve MRAs, current IMG
PRA programs delivering assessments
for psychiatry & internal medicine &
broader PRA programs, provincial &
territorial (P/T) governments
20
Linkage & integration
• Competency models
• Practice eligible route –
in-practice assessment
for Certification
22. Maintain
PRA programs
continue to meet
Standards
Specialization
opportunities
looking for
efficiencies
Financial Support
based on form,
function & fiscal
realities
Oversight
ensuring the right
balance & focus
Sustainability Challenges
22
24. Other Specialties (Psychiatry & Internal Medicine)
• Design standards with PRA Programs & RCPSC
Family Medicine Development
• Common Candidate Orientation (funding tbd)
• Selection ranking guidelines
• Streamline point-in-time selection assessment tools
• Common assessor training and over-time assessment tools
• Common reporting
Sustainable business model
• Ensuring ongoing pan-Canadian PRA comparability
Ongoing research
• Research agenda & ongoing data collection
• NAC OSCE discrimination study
What is coming up this year
24
25. • Do the Family Medicine PRA standards
resonate with you?
• What have you been hearing about PRA in
your jurisdictions?
• As we move forward with Other Specialties, is
there advice you’d like to share?
Discussion
25
