Download - 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
1. Background & context
2. Accomplishments
• Family Medicine Standards for a
competency-based assessment
process
3. Next Steps
• Other Specialties
• Sustainability
Overview
2
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)
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
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
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
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….
FAMILY MEDICINE STANDARDS NAC PRA - Accomplishments
8
http://mcc.ca/wp-content/uploads/Reports-NAC-PRA-family-medicine-standards.pdf
• 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
• 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
• 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
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
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
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
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
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
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 PRA Family Medicine Standards
Over-Time Assessment Environment Standards
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
PSYCHIATRY & INTERNAL MEDICINE NAC PRA – Other Specialties
19
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
SUSTAINABILITY NAC PRA
21
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
COMING UP / NEXT STEPS NAC PRA
23
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
• 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
Thank you!
Questions, comments, concerns?
Dan Faulkner - [email protected]
Cindy Streefkerk - [email protected]