Overview of PACE Assessment Program
The Physician Assessment Centre of Excellence (PACE) is a dedicated assessment centre 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 that candidates demonstrate the knowledge, abilities, and judgment required to practice safely and ethically.
Prior to beginning the assessment program at PACE, candidates must attend and complete the Welcome Collaborative, an orientation program. PACE functions as an assessment centre and a medical clinic. Candidates are assessed while providing care to PACE Clinic patients under the supervision of fully licensed family physician assessors. The 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.
Orientation Program: The Welcome Collaborative
The Welcome Collaborative is the initial orientation program for internationally trained physicians. Currently, it is a four-day in-person orientation held at the College of Physicians and Surgeons of Nova Scotia. The goal is to help new-to-Canada physicians understand the healthcare system in Nova Scotia and set them up for success in long-term practice.
The vision for the Welcome Collaborative includes a longitudinal component to maintain physician connections and provide continuing professional development, a vital part of a physician’s career.
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.
Key Features of PACE
- Centralized assessment with a dedicated clinic.
- Trained assessors working collaboratively.
- Candidates provide direct patient care while being assessed.
- A community of practice for both candidates and assessors.
- Immediate impact on patient care by serving new patients.
The Assessment Process
PACE employs a competency-based approach, allowing for rolling entry into the program and individualized assessment durations. The assessment typically takes approximately 12 weeks, with a maximum duration of 20 weeks.
The Assessment reviews several domains of competence and key clinical tasks. The assessors directly observe patient encounters every day, provide feedback and complete various assessment reports.
Assessment Ratings
Candidates are evaluated using an entrustment scale, ranging from “Not Entrustable” to “Fully Entrustable.” Progress is expected over the assessment period, with ongoing feedback.
- 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.
Prior to participating in the Assessment, the candidate must apply for and be granted a Clinical Assessment licence by the College. While holding a Clinical Assessment licence, candidates are not the most responsible physicians (MRP) and must be continuously assessed and subject to the forms of supervision outlined above. They cannot bill Medavie Blue Cross for their services but will receive a stipend from the Assessment Program throughout the assessment period.
Application and Licensing Process
Space is limited in the Assessment Program. The College will only make determinations of eligibility when spaces are anticipated to be available.
The College of Physicians and Surgeons of Nova Scotia (the College) determines initial eligibility for participation in the PACE Assessment Program and eligibility for a Clinical Assessment Licence. Nova Scotia Health makes the final decision on selection of eligible candidates for the Program. Details of these processes are set out in the Eligibility and Selection Policy.
Prior to beginning the PACE Assessment Program, the candidate must sign a contract with PACE, a letter of offer from Nova Scotia Health, and a Return of Service Agreement from the Nova Scotia Department of Health and Wellness. The candidate must also hold medical liability protection coverage with the Canadian Medical Protective Association.
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 licensed for medical practice in Nova Scotia.
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 the above 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.
Decisions to remove a candidate from the Program are made by PACE’s Competence Committee.
At the end of the Assessment Period a final assessment is conducted by the Competence Committee and a recommendation is made to the College as set out in the Post-Assessment Process.
Post-Assessment Process
If a candidate has not been earlier removed from the Program, upon completion of the assessment, a Competence Committee (comprised of the Lead Assessor, another assessor selected by the CEO of PACE, and the CEO of PACE) reviews all Assessment Reports and makes one of the following recommendations to the College:
- Recommend the candidate be considered for independent licensure by the CPSNS within a defined scope of practice, with supervision (Defined licensure), where the candidate has mostly demonstrated habitual and judicious use of clinical and professional competencies and Domains of Competence and Key Tasks described by the Medical Council of Canada. The candidate still requires some oversight as they work independently.
- Recommend the candidate be considered for independent licensure by the CPSNS within a defined scope of practice without supervision (Restricted licensure), where the candidate has fully demonstrated habitual and judicious use of clinical and professional competencies and Domains of Competence and Key Tasks described by the Medical Council of Canada.
- Recommend the candidate not be considered for independent licensure by the CPSNS, where the candidate has not demonstrated the habitual and judicious use of clinical and professional competencies and Domains of Competence and Key Tasks described by the Medical Council of Canada or where, in the view of the Competence Committee, the candidate will not be able to attain these competencies without remediation or retraining.
- Recommend the candidate be considered for licensure as a Clinical Assistant by the CPSNS, where the candidate has demonstrated limited use of clinical and professional competencies and Domains of Competence and Key Tasks described by the Medical Council of Canada and where, in the view of the Competence Committee, the candidate could provide safe, ethical care as a Clinical Assistant/Associate Physician.
PACE then provides the recommendation and all relevant documentation to the College, which makes the licensing decision. The recommendations of PACE are not binding on CPSNS, 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 primary care roles 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 licensure upon completion 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.
If issued a Defined licence, the physician will practice as the Most Responsible Physician while under supervision. Please refer to the Defined licence policy and the Pathway to long-term licensure via Defined licence (linked below). Success under supervision in the first six (6) months will lead to long-term Restricted licensure without further supervision requirements.
The holder of a Restricted licence practises as the Most Responsible Physician. A Restricted licence will not require a sponsor or a supervisor. The physician will be restricted to a specified scope of practice, most likely office-based primary care, and may have additional conditions or restrictions on their licence as determined by their assessment, training, and practice experience. A Restricted licence is a long-term licence that is renewed annually.
A Clinical Assistant licence holder must have a position within a Physician Extender Program. With a Clinical Assistant licence, the physician is never the Most Responsible Physician and must be under supervision at all times. The relevant College policies may be found below.
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