Perfecting PRA

Practice-Ready Assessment (PRA) programs play an important role in ensuring that internationally trained physicians who have gone through the process are competent to practise in Canada. Physicians completing a PRA are directly observed and assessed in a workplace setting over a 12-week period by trained assessors. Upon successful completion, PRA participants must apply for a provisional license and fulfill a return of service in a region of need within the same province.

More than physician assessments

PRA programs acknowledge the importance of the process and its impact on the Canadian medical system down the road.

“These programs allow for the assessment of International Medical Graduates (IMGs) in a clinical setting in the particular province,” explains Ms. Fleur-Ange Lefebvre, Executive Director and CEO of the Federation of Medical Regulatory Authorities of Canada (FMRAC). “It is important that these physicians undergo a period of in-practice observation here in Canada before they can be considered for a license. Medicine is a high stakes profession and the Medical Regulatory Authorities (MRAs) must be able to rely on a defensible and comprehensive process as they exercise their duty to protect the public and patients.”

As such, the need for a pan-Canadian model with common standards, tools and materials to be used by PRA programs was crucial. Many partners such as MRAs, assessment programs and the Medical Council of Canada (MCC) collaborated to develop assessment strategies that are consistent and comparable across Canada.

“Chapter Seven (Labour Mobility) of the Canada Free Trade Agreement (formerly the Agreement on Internal Trade) mandates that most physicians who are licensed in one jurisdiction be eligible for licensure in another Canadian province or territory without undergoing further testing,” adds Ms. Lefebvre. “Thus, it is important for the various PRA programs to follow the same standards and rigour; this is the best way to ensure that all jurisdictions can trust each other’s assessment process.”

A process to ensure comparability

How can we ensure that the assessment process across jurisdictions remains valid? In response to that question, a program evaluation process was developed.

The main objectives are to provide a continuous quality improvement framework for PRA programs, monitor and measure ongoing comparability between the PRA programs and inform continuous improvement in pan-Canadian PRA activities and efforts.”

Dr. Marguerite Roy,
Medical Education Researcher, MCC

In addition, the process measures how programs are meeting the PRA standards for Family Medicine, Internal Medicine and Psychiatry.

The process was piloted in 2017 and has since been launched. Dr. Roy adds that “the process provides MRAs with confidence and it is an opportunity for programs to learn from each other and share best practices.”

The program evaluation process involves participants at different levels. PRA programs, assessors and candidates are invited to fill out a survey designed to capture specific feedback. The data is collected once a year and amalgamated to create three types of reports: program reports, national reports and de-identified national reports. “Programs really appreciate this process,” says Dr. Roy. “They find it useful to reflect on the year and discuss with other programs on how to improve.”

The future pan-Canadian model

“FMRAC expects that the programs continue to reflect the intended practice setting and scope of practice for each IMG who undergoes the assessment. We also expect that all PRAs adhere to the agreed upon standards,” affirms Ms. Lefebvre. Organizations involved in developing and improving the pan-Canadian model for PRA can now use the program evaluation process to keep building on the success of the initiative.