Pan-Canadian Practice Ready Assessment for IMG Physicians:
A competency-based assessment for provisional
licensure in fami...
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
© NAC / MCC 2014
25 per cent of practising physicians in
Canada are International Medical
Graduates (IMGs)
Rural and rem...
© NAC / MCC 2014
Ensure public protection
Credentials and experience are often
“unknowns”
No equivalent processes acros...
© NAC / MCC 2014
1. Entry into Canadian Residency
2. Entry into Practice through
provisional licensure
a) Direct – credent...
Today: Current Processes for Entry-to-Practice
© NAC / MCC 2014 8* Miller’s pyramid of competence
Miller’s Pyramid & PRA – Assessing
Clinical Competence
NAC PRA Type
In ...
© NAC / MCC 2014
Medical Regulatory Authorities (9) and
Federation of Medical Regulatory
Authorities
PRA Programs (8)
C...
© NAC / MCC 2014
Standards as a starting point
• Precluded judgment of what was currently happening
• Set a common goal a...
© NAC / MCC 2014
Baseline of current practices and
processes
Reviewed and synthesized possible
processes and tools into ...
© NAC / MCC 2014
Follow a sampling framework
Sample as many observations as possible
More assessors are always better
...
13
Results: What a Family Physician Does
Sentinel habits define essential, priority skills that
are comprehensive and easi...
14
Results: Who they see
Clinical domains define the various populations and
activities that physicians encounter in clini...
© NAC / MCC 2014
Assessment occurs in a practice
environment (community-based)
• Rich in patient care opportunities
Allo...
© NAC / MCC 2014
Experienced, competent family
physicians
Hold a licence to practise medicine &
be in good standing
At ...
17
Results: Over-Time Assessment Toolkit
Multi-Source Data
Chart-Based
Components
Continuous Clinical
Assessment
DEFINED
F...
© NAC / MCC 2014
Future standards as a first step
• In a complex environment – varying processes
• With multiple stakehol...
Thank you!
Questions, comments, concerns?
Cindy Streefkerk - cstreefkerk@mcc.ca
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NAC PRA update - 2014 Ottawa Conference

Published on: Mar 3, 2016
Published in: Education      Health & Medicine      Technology      
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Transcripts - NAC PRA update - 2014 Ottawa Conference

  • 1. 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
  • 2. Disclosure Statement I have no actual or potential conflict of interest in relation to this presentation. 
  • 3. © NAC / MCC 2014 1. Background 2. Practice-Ready Assessment as a process 3. Family Medicine PRA standards 3 Overview
  • 4. © NAC / MCC 2014 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
  • 5. © NAC / MCC 2014 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
  • 6. © 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
  • 7. Today: Current Processes for Entry-to-Practice
  • 8. © NAC / MCC 2014 8* Miller’s pyramid of 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
  • 9. © 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
  • 10. © 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
  • 11. © NAC / MCC 2014 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
  • 12. © NAC / MCC 2014 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. 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. 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
  • 15. © 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
  • 16. © NAC / MCC 2014 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. 17 Results: Over-Time Assessment Toolkit 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
  • 18. © 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
  • 19. Thank you! Questions, comments, concerns? Cindy Streefkerk - cstreefkerk@mcc.ca

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