Practice Ready Assessment for IMG Physicians

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Practice Ready Assessment for IMG Physicians

  1. 1. Practice Ready Assessment for IMG Physicians Medical Council of Canada – Annual General Meeting 15-17 September 2013 - Ottawa Dan Faulkner Cindy Streefkerk
  2. 2. 1. Background & context 2. Accomplishments • Family Medicine Standards for a competency-based assessment process 3. Next Steps • Other Specialties • Sustainability Overview 2
  3. 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. 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. 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. 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. 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. 8. FAMILY MEDICINE STANDARDS NAC PRA - Accomplishments 8 http://mcc.ca/wp-content/uploads/Reports-NAC-PRA-family-medicine-standards.pdf
  9. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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
  19. 19. PSYCHIATRY & INTERNAL MEDICINE NAC PRA – Other Specialties 19
  20. 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
  21. 21. SUSTAINABILITY NAC PRA 21
  22. 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
  23. 23. COMING UP / NEXT STEPS NAC PRA 23
  24. 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. 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
  26. 26. Thank you! Questions, comments, concerns? Dan Faulkner - dfaulkner@cpso.on.ca Cindy Streefkerk - cstreefkerk@mcc.ca

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