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Pre-entry Assessment Program (PEAP) and!
Assessment Verification Period (AVP)"
December 16, 2014"
Pre-Entry Assessment Program (PEAP): A Requirement of The Medicine Act, 1991 Ø The Medicine Act, 1991 – Ontario Registration Regulations
Ø According to the Regulations, a PGME trainee must be:
§ A graduate of an accredited school (CACMS, LCME)
§ A graduate of a school listed in the WHO World Directory of Medical Schools and successfully complete the Medical Council of Canada Evaluating Examination (MCCEE) and PEAP
or
Who is a candidate for the PEAP? Ø An international medical graduate (IMG) is a
candidate for the PEAP if he or she is registering at the University of Toronto for: § A residency § An elective appointment (only if the IMG is
enrolled in a residency program outside Canada and the U.S.)
§ A clinical fellowship
Ø PEAP enrolment totals for 2013-14 academic session: § 15 residents § 14 elective residents § 404 clinical fellows
PEAP for Clinical Fellows: Before January 2003 Ø Before January 2003 – the CPSO would exempt
international medical graduates from the MCCEE and PEAP requirement if the PG Dean would confirm that:
ü The applicant had completed all requirements for specialist recognition in the jurisdiction where they were practicing immediately prior to the fellowship
ü The organization that recognized the applicant as a specialist did so using standards “substantially similar” to those of the RCPSC and the CFPC
PEAP for Clinical Fellows: Beginning January 2003
Ø Beginning January 2003 – the CPSO agreed that:
ü The PEAP would be mandatory for international medical graduates entering clinical fellowship training, eliminating the need for the PG Dean’s letter
ü Successful completion of the MCCEE and TOEFL/TSE (where applicable) would not be required for the issuance of CPSO certificate of registration for IMGs as clinical fellows
PEAP for Clinical Fellows: Fundamentals § Must be 4 to 12 weeks in duration, but it can be
extended to a total of 16 weeks in special circumstances (e.g. illness or a leave of absence)
§ Is an assessment (of general knowledge and competency appropriate for practice in the discipline, and of language proficiency sufficient for safe and effective medical practice) not a period of remedial training
§ Must end with the submission to the CPSO of a completed Final Assessment Form or notice of the trainee’s withdrawal from the PEAP
§ Should include a detailed interim assessment after the first 2 weeks of the PEAP for internal departmental reference
PEAP for Clinical Fellows: Failure, the Cost of Failure, and Appeals
Ø Failure to meet expectations in areas of PEAP assessment, without explanatory comments, will result in PEAP failure
Ø Failure is final – the CPSO will not allow those who fail the PEAP to enter another PEAP in the same discipline in Ontario
Ø The CPSO will communicate failure in the PEAP to all Ontario medical schools
Ø A failed PEAP is open to appeal on procedural grounds only
Ø Complaints of intimidation and harassment are separate from issues regarding academic or clinical evaluation and there is a process for addressing them
PEAP for Clinical Fellows: Final Assessment Form – Page 1
PEAP for Clinical Fellows: Final Assessment Form – Page 2
PEAP for Clinical Fellows: Final Assessment Form – Page 3
Exemption from the PEAP Requirement Ø With the support of the Program Director and the Vice Dean
PGME, IMGs may be exempted from the PEAP:
§ Residents
– if the applicant has recently completed at least one year of residency training in Canada or the U.S.
– if the applicant is taking residency training in the same discipline as residency already completed in Canada or the U.S.
§ Clinical Fellows – if the applicant has completed one year or more of clinical fellowship in the same discipline in Canada or the U.S.
Ø The Program Director can always require an IMG to complete the PEAP regardless of eligibility for exemption
Assessment Verification Period for IMGs
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The AVP
What it is…. Ø 12 weeks of assessment
Ø “restricted” period
Ø multiple rotations
Ø counts towards PGY1 training (if successful)
Ø high stakes for the resident
Ø required for PGY1 and PGY2 IMG candidates
Ø paid - at PARO rates, with union dues, LTD, benefits
What it is not…. Ø orientation period
Ø remediation period
Ø unsupervised
Ø clerkship elective
Ø an observership
Ø time without feedback until the end of the 12 weeks
Ø unpaid
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Why? Ø Medicine Act requirement
Ø Replaced 9-month clerkship (old IMG program) in 2004
Ø Developed by medical schools and CPSO
Ø Based on Pre-Entry Assessment Program (PEAP) for international (visa) trainees
Ø CPSO issues “PEAP” certificate, not AVP
Ø Began as variable 8-12 weeks but standardized at 12 weeks in 2006
Ø 4 week extension possible without CPSO Registration Committee approval
16
Orientation before AVP
Ø Since 2007, Family Medicine IMGs matched from CARMS have undertaken an orientation period in advance of AVP (5 weeks classroom + 5 weeks clinical)
Ø Since 2009, specialty residents have undertaken the Orientation to Training and Practice in Canada (OTPC) offered by CEHPEA, in advance of AVP.
Ø No payment during PRP or OTPC orientations
Ø Now enrolled in Canadian Primer program from Touchstone Institute (see flexible sessions in handout)
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Assessment Milestones During the AVP
Ø 2 weeks with assessment form submitted to PGME
Ø Mid-point – with assessment form submitted to PGME
Ø 11th week – for completion of FINAL AVP FORM
Ø With a successful AVP, CPSO is notified and status of license changes from AVP to regular postgraduate license.
18
How and What Is Being Assessed?
Ø Clinical skills, knowledge and judgment in the discipline in which the candidate is seeking postgraduate education with reference to:
Ø Rotation-Specific Goals and Objectives
Ø CANMEDs roles
Ø Evaluations/comments from faculty and health care workers
Ø Candidate signs the assessment form at 2-week and mid-point, and final
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Detailed Assessment Form
20
The Final Assessment (AVP) Form
21
Is “Meets Expectations” Required in All Areas?
Submitting the signed AVP form
• Program Director may also be the supervisor • Form should not be signed and dated earlier than 7 days
before the end date
• Submit to PGME at least 3 days before the AVP end date to allow College to process
• Late submission may mean interruption in licensure
AVP CASES
#1 – CRITICAL INCIDENT • AVP candidate on family
medicine has just seen a baby – 18 months
• After the well-baby visit, he is giving you a full report with the mom and child present, Mom questioned the medication dosage – it seemed high to her.
• The supervisor’s review revealed that the adult dosage was prescribed
• What should this
incident trigger in terms of critical steps and documentation?
• Note the critical
incident question on the Detailed Assessment form
#2 - PROCESS
• The AVP resident spent 12 weeks in a surgical AVP.
• Regular daily verbal feedback was given, and not all of it positive.
• Some of the feedback was given in the presence of other learners, but only verbally.
• No AVP specific forms were utilized. • No interim evaluation was given. • At the end of 12 weeks, a failure was
submitted via a poorly written final AVP form.
• The candidate appeared shocked and alleged there was never any feedback given to him.
• What do you think will happen next?
• What will happen if the resident decides to appeal the decision to Fail?
• What lessons can be learned about process from this case?
#3 – EARLY FAILURE • The resident has a moderately poor
2-week evaluation.
• At the end of the first 1- month rotation, the candidate is deemed to have clearly failed the rotation.
• Can the candidate carry on with the
rotation?
• What needs to happen next?
#4 – APPEALS • The resident failed his AVP but is
appealing due to: - lack of initial info about the process - unfair evaluations - inadequate feedback
• The Vice Dean PGME investigated and found sufficient documentation to support the program’s decision.
• Candidate next appealed to the Faculty of Medicine Appeals Committee and lost.
• Candidate went to the final level – the University Board of Appeals.
• How could this sequence
of events be avoided? • How should AVP
residents be informed about the process before the start of their assessment?
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Unsuccessful AVPs
• Candidates can withdraw before the end of the AVP and will be eligible to re-apply to the 1st iteration of CARMS the following year
• CPSO will accept withdrawal for personal reasons only. Those who withdraw must inform the Ontario Ministry of Health (re Return of Service Contract)
• Appeals of failed AVPs follow the Faculty’s procedure – on
the basis that due process was not followed
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Questions You Will Be Asked….
• Will I be assessed by the same standards as other residents?
• How can I be assessed accurately on a service that is outside my program?
• Can I sign my own orders? • Will I be supervised on call? • Can I take a vacation during the AVP? • Who signs my final assessment form – each supervisor of
each rotation? • What happens if I fail? • Why 12 weeks?
