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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
Nova Scotia
     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
                   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
     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
          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
           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
          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
              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
   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
              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
                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
          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
                    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
        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
          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
               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
 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
 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
    The CAPP Pyramid


       Mentorship, 360 Evaluation,
  Does On-site assessment

Shows how   OSCE

                 OSCE Questions,
Knows how        Therapeutics Exam

                      Therapeutics Written
  Knows
                      Exam, MCCQE1
          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
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.
       Progress of CAPP Candidates
        Part A   Part B   Part C   CFPC Certification


2005     98       21       NA             NA
                  (16)


2006                       NA             NA
         30        9
     Candidate Profile (N=128)
• 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%
            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
  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
                 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
              Summary

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

				
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posted:12/8/2011
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