Practice-Ready Assessment (PRA) programs are one of the licensure pathways that are available in various provinces in Canada for ITPs who have already completed post-graduate
training and have independent clinical experience outside of Canada. Ontario is one of the most recent provinces to implement a PRA pathway, named Practice Ready Ontario (PRO) with its
implementation in June 2023. PRA is an efficient way to address physician shortages affecting access to primary care in Canada, especially in rural and remote areas. However, of the total number of respondents that responded to the ITPO PRO Eligibility Survey (n= 208); 22% (n=45) of respondents were planning to apply to the PRO program and 60% (n=126) were not planning to apply due to the eligibility criteria. The major barriers reported were the length of postgraduate training, the specificity of the required rotations, the currency of
practice requirements, the continuity of the 3 years of independent practice requirements and the rigid examination cut-off scores.
This report will show that although ITPs fit the characteristics of the CanMeds roles of family physicians, and although ITPs have vast and diverse clinical experience, the current tools being used to assess practice readiness fall short.
To alleviate the physician shortage in Ontario, we recommend 3 broad categories of
1) Revise the PRO criteria- Our recommendations have benefitted from knowledge
gathering and an understanding of postgraduate training and clinical experience in
various international systems. These criteria will identify a qualified and safe ITP that is
a) Length of Postgraduate training should be 12 or more months.
b) Recency and Continuity of Practice requirements should be widened to include
other forms of experiences such as Clinical Assistants and the number of hours
required should be reduced.
c) Required rotations not met could be remedied by demonstrating additional
training in Family Medicine or independent practice in the areas of deficiency.
d) NAC OSCE Exam- Pass/Fail approach.
2) Safeguard and Support the Practice-Ready ITP- In the case where a practice-ready
ITP may need bolstering in a few areas, programs should exist that supply this focused
training and propel the ITP directly back toward PRA. Important to this section as well is
safeguarding the currency of practice of a practice-ready ITP through a regulated Clinical
Assistant role approved for this purpose.
3) Safeguard and Support the non Practice-Ready ITP- Given the dire need for family
doctors, it must be ensured that ITPs who are not practice-ready, are able to secure a
residency spot to complete training. For this to be successful, the quantity of residency
training spots must be increased and made competitive/open such that ITPs have more
opportunities available to them.