International medical graduates (IMGs) are an integral part of the physician workforce in Canada, and this is particularly true in Saskatchewan where half of the practising physicians are internationally trained. Approximately 75% of the physicians starting rural practice each year in the province come through the Saskatchewan International Physician Practice Assessment (SIPPA) program, an accelerated route where IMGs complete a 12-week clinical assessment to ensure they have the appropriate clinical skills and knowledge to work effectively and safely in the Canadian context.
Having successfully assessed 507 physicians since its inception in 2011, the SIPPA program is valued by the provincial government for the key role its graduates play in improving access to care across rural Saskatchewan. Over the last two years, SIPPA received funding from the Ministry of Health to initiate important changes: in 2022, the program was able to expand its yearly capacity from 36 to 45 participants, followed in early 2023 by the launch of a program to support SIPPA participants after their clinical assessment until they reach full licensure.
Investing in better care for patients
As physicians coming through SIPPA will be welcomed and working in rural and regional communities across Saskatchewan, the program has been focusing on improving the educational support available to them during the orientation and the assessment period, and on providing more resources specifically geared towards rural practice. Dr. Jon Witt, SIPPA medical director, explains that the team reviewed the assessment’s outcomes over the last two years to look for strengths and gaps related to emergency care, and identified courses that SIPPA participants would benefit from. Thanks to funding obtained from the Committee on Rural and Regional Practice which lives with the Saskatchewan Medical Association, the program started offering new courses in Advanced Trauma Life Support and Pediatric Advanced Life Support, as well as an approved airway course.
Dr. Witt is confident that those increased resources will help SIPPA participants strengthen their skills and handle emergency situations more confidently: “There’s a fairly significant resource investment, recognizing that the physicians coming through SIPPA are placed in rural communities where there’s the expectation that they’ll be on call in the emergency department, and ensuring they have the knowledge, skills and training to respond to those emergencies in a competent manner.” He stresses that “there is an understanding across the province of the support these physicians need”, adding that some organizations are now offering dedicated training to SIPPA participants.
The importance of assessors
As the number of IMGs enrolled in the program is steadily rising, the main challenge for SIPPA and other Practice-Ready Assessment (PRA) programs across the country remains the recruitment of physician assessors. Dr. Witt is grateful for the commitment of SIPPA assessors who support the increased capacity and take on the extra work while managing the workload of their own practice: “They recognize the need for participants to have a robust assessment, and they understand that we have to do this as a team province-wide to support the needs of rural communities.”
There has been robust support for internationally trained physicians, to ensure that they have the knowledge, skills and suitability to be safe and work effectively with the health care teams and deliver high quality patient care.
— Dr. Jon Witt
Expanding support beyond the assessment
To better support physicians when they begin working in their community, SIPPA launched in January 2023 a comprehensive post-assessment program. “Prior to this launch, supervision of physicians after their assessment was performed through the College of Physicians and Surgeons of Saskatchewan”, explains Dr. Witt. “SIPPA proposed this program to follow physicians on their post-PRA journey until they reach full licensure”. He points out that this is “an expansion of the SIPPA program’s continuum, as the physicians don’t finish the 12 weeks fully formed and ready to go. There’s still learning, and support and coaching are still happening.”
As SIPPA is now responsible for all elements of supervision, they expanded the process from the College of Physicians and Surgeons of Saskatchewan (CPSS) into the different clinical environments where physicians could be practising, such as emergency rooms and hospital inpatient care. For example, the program recently started offering clinical chart audits in the ER, and it will carry on with hospitalist and long-term care chart audits in the coming months.
A curriculum incorporating educational milestones from the CPSS as well as feedback from past participants, family medicine leads and Chiefs of Staff was also developed to address knowledge and skills gaps identified during the transition into Canadian practice. Dr. Witt specifies that in the first year post-assessment, physicians are actively engaged in a continuing education program as they participate in simulations and attend weekly sessions on a variety of clinical topics. He adds that some sessions also cover patient and team communication, as well as personal wellness.
Gearing up for success
A major component of the post-assessment program is to support physicians on their path to certification, since obtaining a full license requires passing the certification exam. Dr. Witt explains that SIPPA has been working with the College of Family Physicians of Canada (CFPC) to help physicians create personal learning plans and to meet with them periodically to review how they are evolving and where they are having challenges. Those who are progressing well in the first year will be able to transition to preparation for the CFPC examination and to a more targeted curriculum during the second year.
Another initiative in the works, says Dr. Witt, is the development of a feedback program that local clinical leaders would use to regularly assess the performance of SIPPA graduates, with the view to have “an early awareness of any concerns.” The physicians will also undergo the MCC 360 comprehensive review towards the end of the first year of practice in their community.
Only a few months into its launch, the post-assessment program has been well received by SIPPA graduates who feel supported and better equipped for handling situations they may encounter in their daily practice. Dr. Witt adds that “clinical leaders are also very happy with the program and the fact that there’s that connection and continuity.” Once fully operational, SIPPA will have up to 150 physicians at various stages in the program.
In Dr. Witt’s view, expanding the SIPPA program’s continuum is a step in the right direction to improve quality of care, wellness and long-term retention of physicians in rural communities: “Physicians who don’t feel overwhelmed and who are well supported with a community of peers, coaches and mentors around them will feel more competent in their practice and will be comfortable remaining in rural practice.” As retention of physicians is often cited by SIPPA and other PRA programs as one of their biggest challenges, the new post-assessment program charts a path forward in helping physicians stay in their community.