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