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Registration Practices Assessment Report
COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO
2016–2018 Assessment Cycle (Cycle 3)


AVAILABILITY OF REPORT

The Office of the Fairness Commissioner (OFC) provides this report to the regulatory body and posts the full report on its website, www.fairnesscommissioner.ca. In the interests of transparency and accountability, the OFC encourages the regulatory body to provide it to its staff, council members, other interested parties and the public.



Introduction

Assessment is one of the Fairness Commissioner's mandated roles under the Fair Access to Regulated Professions and Compulsory Trades Act, 2006 (FARPACTA) and the Regulated Health Professions Act, 1991 (RHPA) – collectively known as fair access legislation.

Assessment Cycle

One of the primary ways the OFC holds regulators accountable for continuous improvement is through the assessment of registration practices using a three-year assessment cycle.

Assessment cycles alternate between full assessments and targeted assessments:

  • Full assessments address all specific and general duties described in the fair-access legislation.
  • Targeted assessments focus on the areas where the OFC made recommendations in the previous full assessment.

Focus of this Assessment and Report

The 2016-2018 assessment of the College of Physicians and Surgeons of Ontario is a full assessment.

The OFC’s detailed report captures the results of the full assessment. However, practices related to provision of information are excluded for regulators who have previously been assessed. For those regulators, these practices have been removed from the report.[1] The assessment summary provides the following key information from the detailed report:

  • duties that were assessed
  • an overview of assessment outcomes for specific duty practices
  • an overview of comments related to the general duty
  • commendable practices
  • recommendations

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Assessment Summary


Specific Duties

Specific duties assessed

The regulator has been assessed in all of the specific duties.

Comments

The regulatory body has demonstrated all of the practices in the following specific-duty areas:

  • Information for applicants,
  • Timely Decisions, responses and reasons
  • Internal Review or Appeal processes,
  • Information to applicants on Appeal Rights,
  • Documentation of Qualifications,
  • Internal Training for College’s staff and,
  • Access to applicants records

General Duty

Assessment method

The regulator selected the following method for the assessment of the general duty:

a. OFC practice-based assessment (following the practices in the Assessment Guide) Checked
b. Regulator practice-based self-assessment (following the practices in the Assessment Guide) Unchecked
c. Regulator systems-based self-assessment (in which it explains systemically and holistically how it meets the general duty) Unchecked

Principles assessed

The regulator has been assessed on all of the general duty principles: transparency, objectivity, impartiality and fairness.

Commendable Practices

A commendable practice is a program, activity or strategy that goes beyond the minimum standards set by the OFC assessment guides, considering the regulatory body’s resources and profession-specific context. Commendable practices may or may not have potential for transferability to another regulatory body.

The OFC has not immediately identified any commendable practices during this assessment report.

Opportunities for Improvement

The regulator can improve in the following areas:

Specific Duty

Assessment of Qualifications

  1. Enhance existing service provider agreements, policies and procedures to hold third-party assessors and providers accountable for ensuring that assessments are transparent, objective, impartial and fair.

General Duty

Fairness

  1. Continue to collaborate with Health Force Ontario (HFO), Ministry of Health and Long term Care (MOHLTC) and other stakeholders to identify further actions for improving access to the profession and managing expectations regarding International Medical Graduates (IMGs) becoming fully licensed in Ontario.

Recommendations

Encourage the Ministry of Health and Long-Term Care to work with other relevant stakeholders to develop capacity to provide additional practice-ready assessment and training positions for family and specialty medicine. †

†  Recommendations marked with a dagger symbol have been carried forward all or in part from the previous assessment. However, they are not accounted for as a new recommendation.

Assessment History

In the previous assessment, the OFC identified eight recommendations for the regulator.

Seven of those recommendations have been implemented and one has been carried forward into this report.

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Detailed Report[2]


Specific Duty

1. Specific Duty — Information for Applicants

RHPA, Schedule 2, s. 22.3

1. The regulator describes requirements for registration on its website. [Transparency]

Assessment Outcome

Demonstrated

2. The regulator describes all the steps in the registration process on its website, including any processes for assessing qualifications. [Transparency]

Assessment Outcome

Demonstrated

3. The regulator provides information on its website about how long the registration process usually takes, including the time required for assessing qualifications. [Transparency]

Assessment Outcome

Demonstrated

4. The regulator publishes a fee scale on its website, showing all registration fees that are under the regulator's control, including the fees required for assessing qualifications. [Transparency]

Assessment Outcome

Demonstrated

5. The regulator ensures that the information required by practices 1-4 in this section is clear, accurate, complete and easy to find. [Transparency]

Assessment Outcome

Demonstrated

2. Specific Duty — Timely Decisions, Responses and Reasons

RHPA, Schedule 2, s.20 (1)

1. If a regulator rejects an application, it gives written reasons to the applicant. [Fairness, Transparency]

Assessment Outcome

Demonstrated

2. The regulator makes registration decisions, and gives written decisions and reasons to applicants, without undue delay*. [Fairness]

Assessment Outcome

Demonstrated

3. The regulator responds to applicants’ inquiries or requests without undue delay*. [Fairness]

Assessment Outcome

Demonstrated

4. The regulator provides internal reviews of decisions, or appeals from decisions, without undue delay*. [Fairness]

Assessment Outcome

Demonstrated

5. The regulator makes decisions about internal reviews and appeals, and gives written decisions and reasons to applicants, without undue delay*. [Fairness]

Assessment Outcome

Demonstrated

3. Specific Duty — Internal Review or Appeal

RHPA, Schedule 2, s. 15, s. 17, s. 19, s. 22.3

1. The regulator provides applicants with an internal review of, or appeal from, registration decisions. [Fairness]

Assessment Outcome

Demonstrated

2. The regulator implements rules and procedures that prevent anyone who acted as a decision-maker in a registration decision from acting as a decision-maker in an internal review or appeal of that same registration decision. [Impartiality]

Assessment Outcome

Demonstrated

3. The regulator provides information on its website that informs applicants about opportunities for an internal review or appeal. [Transparency]

Assessment Outcome

Demonstrated

4. The regulator provides information on its website about any limits or conditions on an internal review or appeal*. [Transparency]

Assessment Outcome

Demonstrated

4. Specific Duty — Information on Appeal Rights

RHPA, Schedule 2, s. 20, s. 21, s. 22

1. On its website, the regulator informs applicants of their right to request further review of, or appeal from, the review or appeal decision. [Transparency]

Assessment Outcome

Demonstrated

5. Specific Duty — Documentation of Qualifications

RHPA, Schedule 2, s. 22.4(1)

1. The regulator provides information on its website about the documents that must accompany an application to demonstrate qualifications. [Transparency]

Assessment Outcome

Demonstrated

6. Specific Duty — Assessment of Qualifications

RHPA, Schedule 2, s. 22.4(2)

1. On its website, the regulator informs applicants about the process, criteria, and policies for the assessment of qualifications. [Transparency]

Assessment Outcome

Demonstrated

2. The regulator communicates the results of qualifications assessment to each applicant in writing. [Transparency]

Assessment Outcome

Demonstrated

3. The regulator gives its assessors access to assessment criteria, policies and procedures. [Transparency]

Assessment Outcome

Demonstrated

4. The regulator shows that its tests and exams measure what they intend to measure*. [Objectivity]

Assessment Outcome

Demonstrated

5. The regulator states its assessment criteria in ways that enable assessors to interpret them consistently. [Objectivity]

Assessment Outcome

Demonstrated

6. The regulator ensures that the information about educational programs that is used to develop or update assessment criteria is kept current and accurate. [Objectivity]

Assessment Outcome

Demonstrated

7. The regulator links its assessment methods to the requirements/standards for entry to the profession or trade. [Objectivity]

Assessment Outcome

Demonstrated

8. The regulator requires that assessors consistently apply qualifications assessment criteria, policies and procedures to all applicants. [Objectivity]

Assessment Outcome

Demonstrated

9. The regulator uses only qualified assessors to conduct the assessments. [Objectivity]

Assessment Outcome

Demonstrated

10. The regulator monitors the consistency and accuracy of decisions, and takes corrective actions as necessary, to safeguard the objectivity of its assessment decisions. [Objectivity]

Assessment Outcome

Demonstrated

11. The regulator prohibits discrimination and informs assessors about the need to avoid bias in the assessment. [Impartiality]

Assessment Outcome

Demonstrated

12. The regulator implements procedures to safeguard the impartiality of its assessment methods and procedures. [Impartiality]

Assessment Outcome

Demonstrated

13. The regulator gives applicants an opportunity to appeal the results of a qualifications assessment or to have the results reviewed. [Fairness]

Assessment Outcome

Demonstrated

14. The regulator assesses qualifications, communicates results to applicants, and provides written reasons for unsuccessful applicants, without undue delay. [Fairness]

Assessment Outcome

Demonstrated

15. Regulators that rely on third-party assessments establish policies and procedures to hold third-party assessors accountable for ensuring that assessments are transparent, objective, impartial and fair. [Transparency, Objectivity, Impartiality, Fairness]

Assessment Outcome

Partially Demonstrated

Recommendations

Enhance existing service provider agreements, policies and procedures to hold third-party assessors and providers accountable for ensuring that assessments are transparent, objective, impartial and fair.

OFC Comments

CPSO informs the OFC that assessors presently sign an Assessor Statement of Commitment, referencing the College Code of Conduct, which reflects the need for procedural fairness, but this will be more clearly identified as part of their commitment. While new assessors are trained on ensuring fairness in their assessment work, this will be expanded on online under expectations for potential and existing assessors, as well as being referenced more in handbooks and/or other supporting assessment documents.

7. Specific Duty — Training

RHPA, Schedule 2, s. 22.4(3)

1. The regulator provides training for staff and volunteers who assess qualifications or make registration, internal review or appeal decisions. [Objectivity, Impartiality, Fairness]

Assessment Outcome

Demonstrated

2. The regulator addresses topics of objectivity and impartiality in the training it provides to assessors and decision-makers. [Objectivity, Impartiality]

Assessment Outcome

Demonstrated

3. The regulator identifies when new and incumbent staff and volunteers require training and provides the training accordingly. [Objectivity, Impartiality, Fairness]

Assessment Outcome

Demonstrated

8. Specific Duty — Access to Records

RHPA, Schedule 2, s. 16

1. The regulator provides each applicant with access to his or her application records. [Fairness]

Assessment Outcome

Demonstrated

2. If there is a fee for making records available, the regulator gives applicants an estimate of this fee. [Transparency]

Assessment Outcome

Demonstrated

3. If there is a fee for making records available, the regulator review the fee to ensure that it does not exceed the amount of reasonable cost recovery. [Fairness]

Assessment Outcome

Demonstrated

General Duty

RHPA, Schedule 2, S.22.2

Transparency

  • Maintaining openness
  • Providing access to, monitoring, and updating registration information
  • Communicating clearly with applicants about their status
Assessment Outcome

Legislation: RHPA, Schedule 2, S.22.2 The College has a duty to provide registration practices that are transparent, objective, impartial and fair.

Transparency

A process is transparent if it is conducted in such a way that it is easy to see what actions are being taken to complete the process, why these actions are taken, and what results from these actions. In the regulatory context, transparency of the registration process encompasses the following:

  • Openness: having measures and structures in place that make it easy to see how the registration process operates
  • Access: making registration information easily available
  • Clarity: ensuring that information used to communicate about registration is complete, accurate and easy to understand

The College of Physicians and Surgeons of Ontario has implemented measures to achieve transparency in its registration decisions. The College has taken steps to help ensure openness, access and clarity in their registration practices. For example, the College has:

  • Council meetings which are open to the public
  • Published on the College website are roles and responsibilities of various committees
  • Public members are appointed to the Registration Committee
  • Published on the College website are Council updates and College News letters
  • The College includes public input on decisions about significant registration changes
  • Published on the college website are steps in the registration process that applicants can start and/or complete while still outside of Canada.

The OFC supports the initiatives and measures of the College which have been taken to help ensure transparency in its registration practices.

Suggestions for Continuous Improvement

The information about “service en français” should be easier to find on The College website. Currently this information is not easily found on the main menu structure. While it appears on the registration page, it follows a long paragraph in English. Searching “français” does not yield any results.

The College informs the OFC that they will be moving text regarding information for “service en français” and make it searchable. The OFC will continue to monitor these developments.

Objectivity

  • Designing criteria and procedures that are reliable and valid
  • Monitoring and following up threats to validity and reliability
Assessment Outcome

Legislation: RHPA, Schedule 2, S.22.2 The College has a duty to provide registration practices that are transparent, objective, impartial and fair.

Objectivity

A process or decision is objective if it is based on formal systems, such as criteria, tools, and procedures that have been repeatedly tested during their development, administration and review and have been found to be valid and reliable. In the regulatory context, objectivity of systems encompasses the following:

  • Reliability: ensuring that the criteria, training, tools and procedures deliver consistent decision outcomes regardless of who makes the decision, when the decision is made, and in whatever context the decision is made
  • Validity: ensuring that the criteria, training, tools and procedures measure what they intend to

The College of Physicians and Surgeons of Ontario has implemented measures to achieve objectivity in its registration practices. The College has demonstrated that the registration conditions and requirements are defined in policies and procedures. These requirements are objective and have measurable criteria. For example, the College has:

  • Information and tools for assessors and decision-makers to access when making registration decisions with regards to conduct.
  • A policy and procedure to help ensure that decision-makers consistently apply registration requirements.
  • A policy, procedure and review process for decision makers to take into account previous decisions made in similar cases.
  • Guidelines, internal reports and records are kept describing actions taken to monitor consistency and accuracy in decision-making and outcomes of those actions.
  • Seminars, training courses and meetings are conducted with assessors, decision-makers and staff

The College informs the OFC that in order to help ensure objective decision making; a three step verification process is incorporated. In which, a supervisor, manager and system generated quality control check helps validate and keep consistent the decision making of the credentials and registration committee staff. Additionally, The College is adding SharePoint by the end of Q1 2019 which will send automatic notification of shared policy changes. These measures are to help ensure that decision-makers are continuously provided with the most up-to-date information and access to information and tools that are needed in reaching registration decisions.

The OFC supports the initiatives of The College to help ensure Objectivity in the registration process.

Impartiality

  • Identifying bias, monitoring, and taking corrective action
  • Implementing strategies
Assessment Outcome

Legislation: RHPA, Schedule 2, S.22.2 The College has a duty to provide registration practices that are transparent, objective, impartial and fair.

Impartiality

A process or decision is impartial if the position from which it is undertaken is neutral. Neutrality occurs when actions or behaviours that may result in subjective assessments or decisions are mitigated. Impartiality may be achieved by ensuring that all sources of bias are identified and that steps are taken to address those biases. In the regulatory context, impartiality encompasses the following:

  • Identification: having systems to identify potential sources of bias in the assessment or decision-making process (for example, sources of conflict of interest, preconceived notions, and lack of understanding of issues related to diversity).
  • Strategies: having systems to address bias and enable neutrality during the assessment and decision making process (for example, training policies that address conflict of interest, procedures to follow if bias is identified, and using group deliberation and consensus strategies to come to decisions

The College of Physicians and Surgeons of Ontario has implemented measures to achieve impartiality in its registration decisions. The College has taken steps to help its decision-makers identify sources of potential bias and strategies to avoid and mitigate situations of bias from its registration processes. For example, the College has:

  • A conflict of interest policy and formal procedures that require staff, committee and council members to declare any potential conflicts of interest; which is undertaken during policy meetings.
  • The College has in place a Code of Conduct which outlines the general expectations for professional standards and conduct for Council members, Committee members, employees and assessors;

While the OFC views these initiatives by the College as steps forward. The process for ensuring impartiality in registration decisions should start with identifying all sources of potential bias in registration decisions. Once potential sources for conflict of interest and any other sources of impartiality have been identified, steps should be taken to minimize those possibilities. The College informs the OFC that diversity and discrimination training are provided to staff at regular intervals.

Fairness

  • Ensuring substantive fairness
  • Ensuring procedural fairness
  • Ensuring relational fairness
Assessment Outcome

Legislation: RHPA, Schedule 2, S.22.2 The College has a duty to provide registration practices that are transparent, objective, impartial and fair.

Fairness

A process or decision is considered fair in the regulatory context when all of the following are demonstrated:

  • Substantive fairness: ensuring fairness of the decision itself. The decision itself must be fair and to be fair it must meet pre-determined and defensible criteria. The decision must be reasonable and the reasoning behind the decision must be understandable to the people affected.
  • Procedural fairness: ensuring fairness of the decision-making process. There is a structure in place to ensure that fairness is embedded in the steps to be followed before, during and after decisions are made. The structure ensures that the process is timely and that individuals have equal opportunity to participate in the registration process and demonstrate their ability to practice.
  • Relational fairness: ensuring people are treated fairly during the decision making process and by considering and addressing their perception about the process and decision.

The College of Physicians and Surgeons of Ontario has implemented measures to help ensure fairness in the registration process. The College has taken steps to demonstrated:

  • A consultation process is engaged which solicits feedback from applicants, the public and stakeholders on both new and revised policies. Feedback is considered in assessing new and old policy and informs policy and procedure development
  • A policy and procedure exists to review registration requirements and are linked to specific competencies.
  • A policy and procedure exists to review and help ensure that registration requirements are relevant and necessary.

While the OFC views the practices of the CPSO as positive steps forward, the OFC continues to express concern around the residency requirement with physician licensure. CPSO’s regulation requires a minimum of one year of practice or residency training in Canada for Independent Licensure. A Canadian experience requirement means that applicants must undergo one year of residency training in Canada in order to be deemed eligible to apply for a licence to practise in the profession. The requirement may present a barrier for domestic graduates and internationally educated professionals applying for a licence to practice in the profession. The OFC continues to support the Ontario Human Rights Commission (OHRC) policy on removing the “Canadian experience” barrier as it is well aligned with the principle of fairness. The OFC is committed to advocating for alternatives to Canadian experience requirements. The OFC expects that regulators explore and implement acceptable alternatives for applicants to develop or demonstrate the competencies associated with existing Canadian experience requirements.

The CPSO informs the OFC the Canadian Resident Matching Service CaRM’s symposium continues to occur bi-annually to provide guidance to physicians seeking guidance in Ontario. The CPSO continues to direct Physicians to Health Force Ontario (HFO) for career support and guidance. Alternatives to residency requirements in Ontario were previously run by APIMG Ontario and now Touchstone with the PRA initiative.

There is currently no confirmed launch date for the Practice Ready Assessment, which remains with the MOH to launch.

The CPSO has representatives on the Operations Working Group, a committee that oversees the operations and coordination of the Practice Ready Assessment program. The CPSO provides oversight of the licensing and registration aspects of the Practice Ready Assessment program.

The OFC is committed to working with CPSO and stakeholders on the residency issue and makes the following recommendation below.

Recommendations

Continue to collaborate with Health Force Ontario (HFO), Ministry of Health and Long term Care (MOHLTC) and other stakeholders to identify further actions for improving access to the profession and managing expectations regarding International Medical Graduates (IMGs) becoming fully licensed in Ontario.

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Background


Assessment Methods

Assessments are based on the Registration Practices Assessment Guide: For Regulated Professions and Health Regulatory Colleges. The guide presents registration practices relating to the specific duties and general duty in the fair access legislation.

A regulatory body’s practices can be measured against the fair access legislation’s specific duties in a straightforward way. However, the general duty is broad, and the principles it mentions (transparency, objectivity, impartiality and fairness) are not defined in the legislation.

As a result, the specific-duty and general-duty obligations are assessed differently (see the Strategy for Continuous Improvement).

Specific Duties

The OFC can clearly determine whether a regulatory body demonstrates the specific-duty practices in the assessment guide. Therefore, for each specific-duty practice, the OFC provides one of the following assessment outcomes:

  • Demonstrated – all required elements of the practice are present or addressed
  • Partially Demonstrated – some but not all required elements are present or addressed
  • Not Demonstrated – none of the required elements are present or addressed
  • Not Applicable – this practice does not apply to the CPSO’s registration practices

General Duty

Because there are many ways that a regulatory body can demonstrate that its practices, overall, are meeting the principles of the general duty, the OFC makes assessment comments for the general duty, rather than identifying assessment outcomes. For the same reason, assessment comments are made by principle, rather than by practice.

For information about the OFC's interpretations of the general-duty principles and the practices that the OFC uses as a guideline for assessment, see the OFC's website.

Commendable Practices and Recommendations

Where applicable, the OFC identifies commendable practices or recommendations for improvement related to the specific duties and general duty.

Sources

Assessment outcomes, comments, and commendable practices and recommendations are based on information provided by the regulatory body. The OFC relies on the accuracy of this information to produce the assessment report. The OFC compiles registration information from sources such as the following:

  • Fair Registration Practices Reports, audits, Entry-to-Practice Review Reports, annual meetings
  • the regulatory body's:
    • website
    • policies, procedures, guidelines and related documentation templates for communication with applicants
    • regulations and bylaws
    • internal auditing and reporting mechanisms
    • third-party agreements and related monitoring or reporting documentation
    • qualifications assessments and related documentation
  • targeted questions/requests for evidence that the regulatory body demonstrates a practice or principle

For more information about the assessment cycle, assessment process, and legislative obligations, see the Strategy for Continuous Improvement.

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References

  1. ^ These includes: all practices from Information for Applicants, practice 3 from Internal Review and Appeals, practice 1 from Information on Appeal Rights, practice 1 from Documentation of Qualifications, practice 1 from Assessment of Qualifications, practice 2 from Access to Records, and practices 4-11 from Transparency of the Registration Practices Assessment Guide.
  2. ^ Please note: Suggestions for continuous improvement appear only in the detailed report. Suggestions for improvement are not intended to be recommendations for action to demonstrate a practice, but are made solely to provide suggestions for areas that a regulatory body may consider improving in the future.

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