Overview of PACE Assessment Program
PACE Assessment Program
The Physician Assessment Centre of Excellence (PACE) is a dedicated assessment centre and medical clinic designed to evaluate internationally trained physicians (ITPs) in office-based primary care. PACE serves as a pathway to independent licensure in Nova Scotia by ensuring Candidates demonstrate the knowledge, skills, and judgment required to practice safely and ethically in Nova Scotia.
The Assessment Program was developed in partnership with the Medical Council of Canada (MCC) and aligns with the National Assessment Collaboration for Practice Ready Assessment (NAC PRA) Family Medicine Standards.
Unique Aspects of PACE
Traditionally, family physicians trained outside of Canada had limited pathways to licensure. The College of Family Physicians of Canada recognizes training from only four countries: Ireland, the United Kingdom, Australia, and the United States.
The only other pathway is through a Practice Ready Assessment (PRA), of which PACE is a unique, centralized model with its own medical clinic and dedicated Assessors.
The PACE Assessment Program occurs in an authentic professional environment using a workplace-based assessment (WBA) model — a method for evaluating what physicians do in daily practice.
PACE is not a point in time examination, and Candidates are never required to complete a point in time examination. Candidates are assessed while providing care to patients under the supervision of fully licenced family physician Assessors.
Key Features of PACE
- Centralized assessment with a dedicated clinic
- Trained Assessors working collaboratively
- Candidates provide direct patient care while being assessed
- Use of audiovisual equipment for assessment of ITPs
- A community of practice for both Candidates and Assessors
- Immediate impact on patient care by serving new patients
Program Expectations
PACE Candidates are expected to have the required training, knowledge, skills and currency to practice as an independent primary care physician in Nova Scotia. The Assessment Program provides the opportunity for them to demonstrate their competence in a safe, well supported environment.
PACE is not a training centre; it is expected that Candidates have the medical knowledge, skills and experience to see patients on their own, while under the supervision of an Assessor (who serves as the most responsible physician).
The assessment is designed to replicate what a Candidate’s practice would look like in the real world; they will have access to the tools and resources that they would use in independent practice and the expectation is that they will deepen their understanding of the Nova Scotia healthcare system throughout the assessment period.
Pre-Arrival Resources
Candidates will receive a digital pre-arrival resource package to help them prepare for the assessment and begin familiarizing themselves with the context for healthcare in Nova Scotia.
Welcome Collaborative
Prior to beginning the Assessment Program, Candidates must attend the Welcome Collaborative; an orientation program offered by The College of Physicians and Surgeons Nova Scotia.
The Welcome Collaborative helps new-to-Canada physicians understand the healthcare system in Nova Scotia and set them up for success in long-term practice. During the Welcome Collaborative, several partner organizations will share insights related to the practice of medicine in Nova Scotia.
PACE Candidates will participate in the in-person or virtual Welcome Collaborative prior to starting their assessment.
Onboarding for Assessment Program and Clinic
Prior to providing patient care, Candidates are onboarded to the Assessment Program and PACE Clinic through an introduction to staff, policies, and procedures. Onboarding includes training on the electronic medical record (MedAccess) utilized at PACE and familiarization with the assessment tools and platform (Risr Advance).
The onboarding phase is designed to set PACE Candidates up for success so that they can focus on practising medicine and providing excellent care to patients.
Candidate Community of Practice
Candidates are co-located in the PACE clinic, allowing for a community of peers who collaborate and share their experiences transitioning to the Nova Scotia health care context. Candidates will start at various points throughout the year (PACE assessment is competency based rather than time based); connecting and collaborating with various peers throughout the Assessment Program.
Patient Expectations
PACE Clinic patients are aware of the dual purpose of the program: to provide medical care and to assess ITPs. Patients are aware that all care is provided by the ITPs, and that audiovisual equipment is utilized for assessment purposes.
The Assessment Process
PACE employs a competency-based approach to assessment, allowing for rolling entry into the program and individualized assessment durations. The assessment typically takes approximately 12 weeks on average, with a maximum duration of 20 weeks.
While all patient care is overseen by Assessors, it is expected that Candidates can see patients independently and do not require constant real-time supervision. Only a small portion of patient encounters are directly observed each day, while all care is reviewed in the patient record by the Assessor. If a Candidate requires constant real-time supervision, this is not the appropriate Assessment Program for them.
The Assessors do not provide training, though they will direct Candidates to relevant resources in Nova Scotia and answer any care or resource questions. Candidates are expected to create and manage a personal learning plan for addressing knowledge or skill gaps identified in assessment.
Physician Assessors have two roles in the Clinic:
- Assessor: To observe and rate care provided for patient encounters and provide feedback.
- Most Responsible Physician: To ensure safe patient care.
The Assessors typically observe patient encounters via audiovisual equipment installed in each treatment room; allowing the Candidate to establish a rapport with patients that more authentically replicates independent practice (rather than the Assessor being physically present in the treatment room during care). However, Assessors may be present in the treatment room.
Each day, at least one Assessor will directly observe some of the Candidates’ patient encounters, documenting their observations and providing ratings on various aspects of the care provided. The assessment reviews several domains of competence and key clinical tasks, which Candidates receive in real-time assessment reports throughout the day in the assessment portal.
In the role of the Most Responsible Physician, Assessors will review the medical records for patients whose encounters were not directly observed to ensure safe patient care. The Assessor must be comfortable with the care provided as long as they are the Most Responsible Physician.
While Assessors are unable to view one another’s assessment reports, the Candidate and Program have full visibility on the Candidates progress and the feedback Candidates have offered in response.
Assessment reports are reviewed regularly to determine the duration of an assessment. When PACE determines sufficient assessment has taken place to make a decision regarding readiness to practice independently, Candidates will be referred to the Competence Committee (additional details included below).
In support of excellent patient care, PACE Candidates begin their assessment with longer patient encounters, increasing their daily volume and reducing encounter times throughout the duration of the assessment.
Assessment Ratings
PACE uses an entrustability scale for rating patient encounters. Entrustment refers to the act of assigning responsibility or putting something into someone’s care or protection. In the context of clinical assessments, entrustment involves evaluating a Candidate’s readiness for independent practice based on their ability to perform tasks safely and competently.
The entrustability scale is a behaviorally anchored ordinal scale used in competency-based clinical assessments to evaluate a Candidate’s readiness for independent practice. The scale helps Assessors make judgments based on narrative descriptors that reflect real-world clinical decisions, focusing on a Candidate’s progression to demonstrate readiness to practice independently in Nova Scotia.
This scale is also used to provide ongoing feedback and assess progress over the assessment period, ensuring that Candidates are well-equipped to integrate into the healthcare system and provide high-quality care.
Candidates are evaluated using an entrustment scale, ranging from “Not Entrustable” to “Fully Entrustable.” Progress is expected over the assessment period, with ongoing feedback.
The Entrustability scale is as follows:
- Not Entrustable (Unsafe): Requires direct supervision; performance is unsafe and cannot be assessed remotely via real-time remote monitoring.
- Heavily Supervised: Needs constant guidance and oversight; performance is not consistently safe or reliable to allow for real-time remote monitoring, as interventions are required
- Lightly Supervised: Can perform tasks with some guidance; performance is observable remotely but requires occasional prompts or clarification to ensure safety.
- Independent: Performs tasks independently with minimal oversight; real-time remote monitoring is appropriate with post-clinical encounter feedback.
- Fully Entrustable: Performs tasks independently and safely; consistently competent and can manage situations without supervision.
Results of the Assessment and Termination
PACE will terminate the Candidate’s participation in the Assessment Program upon being satisfied there is sufficient assessment evidence to support PACE’s recommendation that the Candidate should be licenced for medical practice in Nova Scotia.
The Candidate will be referred to the Competence Committee. The Committee will review all of the assessment information and make a recommendation to The College.
For each candidate who has completed an assessment, the Committee shall send a recommendation letter to The College, indicating that the candidate is:
- ready to practice independently with supervision;
- ready to practice independently without supervision;
- ready to practice under supervision indefinitely; or
- not ready to practice independently.
PACE will also terminate the Candidate’s participation in the Assessment Program upon being satisfied there is sufficient assessment evidence to support its determination that:
- the Candidate does not possess or cannot reasonably be expected to possess the necessary competencies for independent medical licensure without remediation or retraining;
- the Candidate has failed to make appropriate progress during the Assessment Program or has failed to achieve a satisfactory competency assessment by the end of the assessment period, or both; or
- any other event, matter or thing indicates that the Candidate is unlikely to pass the competency assessment without retraining or remediation.
A Candidate whose participation is terminated for any of these reasons is considered to have failed the assessment.
PACE may immediately terminate the Candidate’s participation in the Assessment Program at any time, if any one or more of the following occur or exist, as determined by PACE in PACE’s sole and absolute discretion:
- the Candidate’s practice or conduct indicates patient safety concerns or concerns for the safety of others;
- the Candidate demonstrates unprofessional conduct, including behaviors such as but not limited to harassment, bullying, or sexual misconduct;
- the Candidate violates the Canadian Medical Association Code of Ethics and Professionalism;
- information submitted as part of the Candidate’s application is determined to be inaccurate, incomplete, or falsified;
- the Candidate has failed to comply with or maintain in full effect any of the requirements of their Agreement with PACE
- the Candidate breaches any term of their Agreement with PACE.
A Candidate whose participation is terminated for any of the above reasons is considered to have failed the Assessment. A candidate may make a request in writing that the Competence Committee review a decision by the CEO to terminate the candidate’s assessment before it is complete.
A candidate may make a request in writing that the Committee review a decision by the CEO to terminate the candidate’s assessment before it is complete. The request shall identify the grounds for the requested review and include any information that the candidate wishes the Committee to consider.
The Competence Committee may confirm the decision or reverse the CEO’s decision to terminate the Candidate’s participation in the assessment program prior to completion.
Post-Assessment Process
The Competence Committee provides the recommendation and all relevant documentation to the College, which makes the licensing decision. The recommendations of PACE are not binding on the College, which must review the application against the criteria for licensure set out in the Medical Act and its regulations. Nova Scotia Health assists in placing successful Candidates in a primary care practice once granted a licence. A three-year return of service agreement is required for Candidates.
For clarity, decisions on registration, licensing and placement in a primary care practice are not made by PACE. PACE makes recommendations on readiness for independent practice upon termination of the assessment; The College makes decisions on licensure; and Nova Scotia Health makes decisions on placement in a primary care practice.
Once successful in the PACE Assessment Program, the Candidate applies to The College for a licence enabling them to practice outside of the Assessment Program. If the Candidate meets the licensure criteria, The College may issue one of three types of licence: a Defined Licence, a Restricted Licence for independent practice, or a Clinical Assistant licence for practice requiring permanent supervision.
Impact and Future Vision
PACE is an innovative initiative designed to enhance patient care and address physician shortages in Nova Scotia. By providing a structured, competency-based pathway to licensure, PACE ensures that internationally trained physicians who successfully complete the assessment are well-equipped to integrate into the healthcare system and provide high-quality care to Nova Scotians.
Resources
Eligibility and Selection Process for PACE