Assessment and Integration of IMG Physicians into Family Practice

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Assessment and Integration of IMG Physicians into
Family Practice
Robert F. Maudsley1, Cameron D. Little1, D. Bruce
Holmes2, 1College of Physicians and Surgeons of
Nova Scotia 2Dalhousie University Faculty of
Medicine
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Nova Scotia
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• Clinician Assessment for Practice Program (CAPP)
• A program of the College of Physicians and
  Surgeons of Nova Scotia (CPSNS)
• A 3 part program assesses IMG physicians,
  resident in Canada, for practice readiness
  without formal Canadian training
• Developed in collaboration with Dalhousie Faculty
  of Medicine and others

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• Why CAPP?
• Significant physician attrition in next 5-10
  years
• Dalhousie Faculty of Medicine unable to meet
  shortfall
• Family physicians needed immediately in Nova
  Scotia

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Special Features of CAPP

• focus is on determining readiness to enter family
  practice without additional formal Canadian
  training
• 12 month mentorship
• measures of performance
• CME component

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CAPP Prerequisites

• must be a Canadian citizen or permanent resident
• graduated abroad
• trained and practised abroad at least 3 years
• out of practice less than 5 years
• no test of English required
• must be referred by a medical regulatory
  authority
• credentials reviewed by referring authority

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The CAPP Process

• Three part program
• A. Initial Assessment
• competence assessment by OSCE Therapeutics exam
• B. mentorship with a family physician-12 months
• Performance assessment
• C. additional three years of defined license,
  until Canadian Family Medicine certification and
  Medical Council of Canada licentiate achieved

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The CAPP Process

• Part A
• 1) Clinical Assessment (OSCE)
• Clinical knowledge
• Diagnostic skills
• Communicating skills
• Doctor-patient relationship
• 2) Therapeutics Assessment (written exam)

Report provided to regulatory authority by CAPP

• Part B
• College considers defined license
• Sponsor identified (DHA)
• Mentorship formalized
• Educational plan developed
• Practice-based assessment by external assessor at
  4-6 months
• Multi-source assessment at 10 months

After one year

• Part C
• All reports and assessments reviewed by College
• Continuation of defined license, conditions and
  further follow-up decided
• Reassessment as necessary
• Educational plan reviewed and new needs identified

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Part A OSCE

• Cases mirror a typical physician workday
• Cases developed by physicians
• Candidates expected to exhibit a whole patient
  approach
• Fourteen 10-minute stations
• Trained examiners-all active family practitioners
• Trained simulated patients
• Not a pass or fail exam
• an assessment of strengths and weaknesses

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Part A2 Therapeutics Exam

• Three-hour written exam
• - clinical vignettes short answer questions
• Developed by a panel of physicians
• Designed to explore candidates knowledge of
  common therapeutic agents
• Domains of pharmacotherapy, adverse drug effects,
  disease prevention and health promotion

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CAPP Report

• Prepared by the Chief Examiner and CAPP Executive
  Director
• A comprehensive narrative report supplied by the
  CAPP to candidate
• Same report provided to referring licensing
  authority
• One factor considered in licensure decision
• Provides feedback and serves as needs assessment
  for Part B

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CAPP Report

• - History taking
• Physical examination
• Diagnosis and management
• Clinical reasoning and decision making
• Public health/Medicolegal, and Safety
• Professional/Ethical Behaviour
• - Communications skills rated by SP and PE
• Spoken English
• Therapeutics exam

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The CAPP Process

• Part A
• 1) Clinical Assessment (OSCE)
• Clinical knowledge
• Diagnostic skills
• Communicating skills
• Doctor-patient relationship
• 2) Therapeutics Assessment (written exam)

Report provided to regulatory authority by CAPP

• Part B
• College considers defined license
• Sponsor identified (DHA)
• Mentorship formalized
• Educational plan developed
• Practice-based assessment by external assessor at
  4-6 months
• Multi-source assessment at 10 months

After one year

• Part C
• All reports and assessments reviewed by College
• Continuation of defined license, conditions and
  further follow-up decided
• Reassessment as necessary
• Educational plan reviewed and new needs identified

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Part B

• Nine District Health Authorities (DHAs) in Nova
  Scotia
• DHAs in collaboration with provincial Dept. of
  Health (DOH) identify family physician needs
• DHA Medical Chief of Staff serves as sponsor
• DHAs and DOH coordinate site visits to designated
  communities.
• Roles of sponsors and mentors described in the
  Provincial Medical Act

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Part B Mentorship

• An established family physician in the community
  is a mentor for 12 months
• Mentor proposed by DHA and approved by CPSNS
• Mentor prepared in a workshop and have mentors
  manual
• Mentorship Coordinator provides ready support

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Part B Mentorship

• Mentors expected to spend 4-5 hours per week
• Mentors are compensated
• Following satisfactory 2-4 week initial phase of
  practice, Mentor, sponsor, and IMG physician
  enter into formal agreement approved by
  Department of Health
• During the 12 months, mentor provides periodic
  progress reports to physician, sponsor and CAPP

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Part B CME

• Dalhousie faculty member serves as CME advisor
• Initial meeting of CAPP physician with CME
  advisor
• Advisor has Report, past training and experience,
  and procedural skills checklist
• Initial CME plan developed and shared with mentor
• Follow-up re implementation of plan
• Emphasis on reflective practice

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Part B Performance Assessment

• At 4-6 months, an external assessor visits the
  practice and provides a detailed report to
  physician, mentor, sponsor and CAPP
• CAPP follows-up with areas of concern
• Assessor is active family physician
• Protocol includes chart review and stimulated
  chart recall
• CME plan may be modified

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Part B Performance Assessment

• At 10 months, multi-source feedback
  questionnaires are used seeking views of
  patients, physicians, and other health
  professionals, as well as a self-appraisal
• Questionnaires have been validated
• Results sent to physician, mentor, sponsor and
  CAPP

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The CAPP Pyramid
Mentorship, 360 Evaluation, On-site
assessment
Does
Shows how
OSCE
OSCE Questions, Therapeutics Exam
Knows how
Therapeutics Written Exam, MCCQE1
Knows
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The CAPP Process

• Part A
• 1) Clinical Assessment (OSCE)
• Clinical knowledge
• Diagnostic skills
• Communicating skills
• Doctor-patient relationship
• 2) Therapeutics Assessment (written exam)

Report provided to regulatory authority by CAPP

• Part B
• College considers defined license
• Sponsor identified (DHA)
• Mentorship formalized
• Educational plan developed
• Practice-based assessment by external assessor at
  4-6 months
• Multi-source assessment at 10 months

After one year

• Part C
• All reports and assessments reviewed by College
• Continuation of defined license, conditions and
  further follow-up decided
• Reassessment as necessary
• Educational plan reviewed and new needs identified

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Part C Continuing Practice and Learning

• At 12 months all reports reviewed by CPSNS
• Continuation of defined licence (with any
  conditions)
• Need for continuation of formal mentorship
  determined
• Sponsorship continues
• In next 3 years must successfully achieve
  certification of the College of Family Physicians
  of Canada and Medical Council of Canada
  licentiate.

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Progress of CAPP Candidates
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Candidate Profile (N128)

• Gender
• male - 45 female - 55
• Countries of Graduation 25
• South Asia 52
• Middle East 23
• Eastern Europe/Russia 10
• Years of Graduation
• 1970-1980 16
• 1981-1990-46
• 1991-2000-35

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CAPP Funding

• CAPP developed by support of CPSNS
• Part A candidate fee 5500 CDN
• Part B supported by Dept. of Health
• (mentors, CME, on-site assessment, MSF
  assessment)
• CAPP physicians receive a salary for first 12
  months
• 3 full-time, 2 part-time CAPP staff

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Modifications to the Program (2006)

• Orientation Program to begin Part B
• - 5 day, 10 module program
• CME protocol to better engage mentor in the
  process
• More emphasis on clinical reasoning and clinical
  decision making in the OSCE

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Summary

• CPSNS through its CAPP has implemented a program
  to
• - assess the practice readiness of IMG family
  physicians.
• - attract and retain IMGs for practice in Nova
  Scotia
• - prepare IMGs to be successful family
  physicians and achieve certification of the
  College of Family Physicians of Canada

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Summary

• Next cohort scheduled for June 2007
• CAPP model can be extended to specialist
  physicians and other health professions, with
  appropriate modifications and resources

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www.capprogram.ca