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Pan-Canadian Practice Ready Assessment for IMG Physicians:
A competency-based assessment for provisional
licensure in family medicine
Cindy Streefkerk, Dan Faulkner, Lauren Copp, Sydney Smee, PhD, André De Champlain, PhD, Timothy Allen, MD
Ottawa Conference
27 April 2014 - Ottawa
Disclosure Statement
I have no actual or potential conflict of interest in relation to this
presentation.
© NAC / MCC 2014
1. Background
2. Practice-Ready Assessment as a
process
3. Family Medicine PRA standards
3
Overview
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25 per cent of practising physicians in
Canada are International Medical
Graduates (IMGs)
Rural and remote areas are the most
underserviced
13 jurisdictions govern licensure
4
Background
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Ensure public protection
Credentials and experience are often
“unknowns”
No equivalent processes across
jurisdictions
• Complex pathways
Limited capacity to integrate IMGs
5
IMG Physician Situation & Challenges
© NAC / MCC 2014
1. Entry into Canadian Residency
2. Entry into Practice through
provisional licensure
a) Direct – credentials only
b) Practice-ready Assessment
6
IMG Physician Routes to Practice
Today: Current Processes for Entry-to-Practice
© NAC / MCC 2014
8 * M i l l e r ’ s pyramid o f competence
Miller’s Pyramid & PRA – Assessing Clinical Competence
NAC PRA Type
In Practice Assessment Over-Time
Assessment
Selection (Interactions with trained patients and
assessors - OSCE)
Point-in-
Time
Assessment
Selection (Therapeutics, CDM, short-answer)
Screening (MCQ – MCCEE)
SHOWS HOW
DOES
KNOWS HOW
KNOWS
© NAC / MCC 2014
Medical Regulatory Authorities (9) and
Federation of Medical Regulatory
Authorities
PRA Programs (8)
Certifying College – College of Family
Physicians of Canada
Provincial Funders (8-9)
Federal Government (Health Canada as
a project funder) 9
Stakeholders – In Collaboration
© NAC / MCC 2014
Standards as a starting point
• Precluded judgment of what was currently happening
• Set a common goal and expectations of each other’s
processes
• Focused on “what” not “how”
Ultimately, to trust in each others rigour for
provisional licensure purposes
10
Approach to pan-Canadian PRA
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Baseline of current practices and
processes
Reviewed and synthesized possible
processes and tools into standards
Integrated existing practices into the
common standards, with a view to
improve
11
An AIterative Process
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Follow a sampling framework
Sample as many observations as possible
More assessors are always better
Target assessment tools to competencies of
interest
Provide ongoing, structured feedback to
candidates
12
Results – Over-Time Assessment Process
13
Results: What a Family Physician Does Sentinel habits define essential, priority skills that are comprehensive and easily recognizable in busy
clinical settings
1: Incorporates the patient’s experience and context into problem identification and management
5: Uses generic key features when performing a procedure
2: Generates relevant hypotheses resulting in a safe and prioritized differential diagnosis
6: Demonstrates respect and/or responsibility
3: Manages patients using available best practices
7: Verbal or written communication is clear and timely
4: Selects and attends to the appropriate focus and priority in a situation
8: Seeks out and responds appropriately to feedback
14
Results: Who they see
Clinical domains define the various populations and activities that physicians encounter in clinical
settings
1: Behavioural medicine/mental health 5: Care of the vulnerable and underserviced
2: Care of adults 6: Maternity/newborn care
3: Care of children and adolescents 7: Palliative care
4: Care of the elderly 8: Procedural skills
© NAC / MCC 2014
Assessment occurs in a practice
environment (community-based)
• Rich in patient care opportunities
Allow candidates time to acclimatize
Allow adequate time to assess response
to feedback
Should not take longer than 12 weeks to
determine practice-readiness for
provisional licensure
15
Results: Assessment place & time
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Experienced, competent family
physicians
Hold a licence to practise medicine &
be in good standing
At least three years of practice in
Canada
Receive
• Ongoing support & feedback
• Training & orientation
16
Results: Who is the Assessor
17
Results: Over-Time Assessment Toolkit Multi-Source Data
Chart-Based Components
Continuous Clinical Assessment
DEF
INED
Focus is on communicator, collaborator & professional roles
• Chart stimulated recall • Chart audits • Case-based discussions
• Mini-CEX • DOPS • CBAS • Field notes
STA
ND
AR
D
• 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
GU
IDEL
INE
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
© NAC / MCC 2014
Future standards as a first step
• In a complex environment – varying processes
• With multiple stakeholders with a perspective
• Opportunity to bring subject matter expertise to the
table
To ultimately ensure
• Jurisdictions trust each others rigour
• Candidates have a fair/consistent process
18
Summary
