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Practice Ready Assessment for IMG Physicians Medical Council of Canada Annual General Meeting 15-17 September 2013 - Ottawa Dan Faulkner Cindy Streefkerk

Practice Ready Assessment for IMG Physicians

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Page 1: Practice Ready Assessment for IMG Physicians

Practice Ready Assessment for IMG Physicians

Medical Council of Canada – Annual General Meeting

15-17 September 2013 - Ottawa

Dan Faulkner

Cindy Streefkerk

Page 2: Practice Ready Assessment for IMG Physicians

1. Background & context

2. Accomplishments

• Family Medicine Standards for a

competency-based assessment

process

3. Next Steps

• Other Specialties

• Sustainability

Overview

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Page 3: Practice Ready Assessment for IMG Physicians

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

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Canadian

• LMCC

• Certification

IMG Physician Routes to Practice

Assessments

(Over-time)

Page 4: Practice Ready Assessment for IMG Physicians

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

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Page 5: Practice Ready Assessment for IMG Physicians

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

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Critical Success

Factor:

Our objectives will

be achieved through

consultation &

definition as we go

forward.

Page 6: Practice Ready Assessment for IMG Physicians

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Future:

Pan-Canadian PRA Process An objective assessment that allows for

common, summative evaluation across

different models IMG PGT not in Canada and/or has practised outside of Canada

Page 7: Practice Ready Assessment for IMG Physicians

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

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Over the past year….

Page 8: Practice Ready Assessment for IMG Physicians

FAMILY MEDICINE STANDARDS NAC PRA - Accomplishments

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http://mcc.ca/wp-content/uploads/Reports-NAC-PRA-family-medicine-standards.pdf

Page 9: Practice Ready Assessment for IMG Physicians

• 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

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Page 10: Practice Ready Assessment for IMG Physicians

• 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

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NAC PRA Family Medicine Standards

Initial Screening & Selection

Page 11: Practice Ready Assessment for IMG Physicians

• 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

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NAC PRA Family Medicine Standards

Initial Screening & Selection

Page 12: Practice Ready Assessment for IMG Physicians

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

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Timing of Minimum Eligibility Requirements

NAC PRA Family Medicine Standards

Initial Screening & Selection

Page 13: Practice Ready Assessment for IMG Physicians

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

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Page 14: Practice Ready Assessment for IMG Physicians

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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

Page 15: Practice Ready Assessment for IMG Physicians

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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

Page 16: Practice Ready Assessment for IMG Physicians

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NAC PRA Family Medicine Standards

Over-Time Assessment Standards 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

Page 17: Practice Ready Assessment for IMG Physicians

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

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NAC PRA Family Medicine Standards

Over-Time Assessment Environment Standards

Page 18: Practice Ready Assessment for IMG Physicians

Collaborators

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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

Page 19: Practice Ready Assessment for IMG Physicians

PSYCHIATRY & INTERNAL MEDICINE NAC PRA – Other Specialties

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Page 20: Practice Ready Assessment for IMG Physicians

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

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Linkage & integration

• Competency models

• Practice eligible route – in-practice assessment for Certification

Page 21: Practice Ready Assessment for IMG Physicians

SUSTAINABILITY NAC PRA

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Page 22: Practice Ready Assessment for IMG Physicians

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

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Page 23: Practice Ready Assessment for IMG Physicians

COMING UP / NEXT STEPS NAC PRA

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Page 24: Practice Ready Assessment for IMG Physicians

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

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Page 25: Practice Ready Assessment for IMG Physicians

• 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

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Page 26: Practice Ready Assessment for IMG Physicians

Thank you!

Questions, comments, concerns?

Dan Faulkner - [email protected]

Cindy Streefkerk - [email protected]