Pre-Entry Assessment Program (PEAP)

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Note: Before downloading these forms, please check with your central Department Office for a Department-specific form.

In General

To obtain an unrestricted postgraduate medical education certificate of registration (educational license) from the College of Physicians and Surgeons of Ontario (CPSO), international medical graduates (IMGs) must successfully complete the Pre-Entry Assessment Program (PEAP).

  • Enrolment in the PEAP can begin only after the CPSO has issued a PEAP certificate of licensure and the candidate has registered with PGME for the PEAP.
  • Successful completion of the PEAP is a requirement for full acceptance into residency training for IMGs who enter residency training outside the CaRMS match.
  • Successful completion of the PEAP is also a requirement for IMGs entering clinical fellowship or elective residency training (if the elective IMG’s home residency program is outside Canada and the U.S.).

The PEAP includes an assessment of communication skills but Program Directors have the option of requiring applicants to provide additional evidence of language proficiency, such as the TOEFL iBT test.


The PEAP is an assessment process that evaluates IMGs to determine whether they can function at the appointed level of training. It is normally between four to twelve weeks in duration (two weeks for elective appointments). The assessment is to take place in a supervised clinical, multidisciplinary environment where there is patient input on an ongoing basis. Assessors are to ensure that the candidate is: mentally competent to practice medicine; able to practice with decency, integrity and honesty in accordance with the law; have sufficient knowledge, skill and judgment to engage in postgraduate medical training as authorized by the educational license; can communicate effectively and to display an appropriate professional attitude.


  1. The Postgraduate Office issues a Letter of Appointment (LOA) appointing the trainee to (a) the PEAP period and, (b) the remainder of the academic session conditional on successful completion of the PEAP.
  2. The CPSO issues a PEAP certificate to the candidate for the PEAP period once all the CPSO’s registration requirements have been met (including receipt of a copy of the LOA).
  3. The trainee registers with PGME for the PEAP period and obtains a Confirmation of Registration indicating partial registration.
  4. The department assesses the IMG resident/fellow/elective trainee at the end of the second week (recommended) and at the end of the PEAP. Upon completion of the PEAP, the supervisor and the program director complete and sign the PEAP Final Assessment Form and forward it to PGME for the approval and signature of the Associate Dean. (Note: the Detailed Preliminary Assessment Form is for internal use only and stays in the department).
  5. PGME sends the PEAP Final Assessment Form with the Associate Dean’s signature to the CPSO. If the PEAP is passed, the CPSO converts the trainee’s registration to a Postgraduate Education Certificate. PGME then revises the trainee’s record to reflect the end of the PEAP and the start of the regular training period. The trainee obtains an updated PGME Confirmation of Registration indicating complete registration for the academic period.

Candidates in a Residency PEAP

The Residency PEAP must provide assessment of the candidate’s clinical skills, knowledge and judgment in the discipline in which the candidate is seeking postgraduate education as well as the candidate’s basic skills in internal medicine, obstetrics & gynaecology, paediatrics, psychiatry and general surgery, appropriate for practice in the chosen discipline.

Successful completion of the Residency PEAP determines eligibility to enter residency training and therefore is not recorded as part of the residency training program.

Candidates in an Elective Residency PEAP

International Medical Graduates who are currently enrolled in residency training outside of Canada or the US who wish to come to Ontario to complete an elective rotation must undergo PEAP training.

The criteria for out-of-country resident electives are:

  1. Trainees must have completed a minimum of two years in a specialty or one year in Family Medicine.
  2. The language of patient care during those years must have been in English and/or French.
  3. There must be written educational objectives for the elective period. A letter must accompany requests for electives from the Vice Dean of the applicant’s home institution confirming approval for the elective as well as the level of training and the abilities of the trainee.
  4. An evaluation must be completed at the end of the elective period and sent to the school of origin.

The PEAP assessment of out-of-country residents seeking electives in Ontario must:

  1. Be two weeks in duration.
  2. Be concurrent with the elective rotation
  3. Provide assessment of the candidate’s general knowledge, skills (both technical and communication), judgment and competence in the designated specialty and the designated level of training for which the candidate is pursuing an elective.
  4. Electives for Out of Country Residents Assessment Form

Candidates in a Fellowship PEAP

The Fellowship PEAP must provide assessment of the candidate’s general knowledge and competency in the specialty in which she/he is certified, and appropriate for practice in the discipline in which the candidate is entering fellowship training.

Unless the Program Director indicates otherwise, the PEAP period for Clinical Fellows will not add to the original fellowship appointment. In other words, the PEAP candidate is able to count educational activity during the PEAP towards the fulfillment of the educational goals and objectives of the clinical fellowship.

An Unsuccessful PEAP

The candidate has not successfully completed the PEAP if the Final Assessment Form does not contain a “yes” response to all yes/no questions that follow the cumulative summary observed assessments on page 2 of the form. If the candidate fails to meet expectations in any of the five areas of observed assessment (i.e. clinical skills, technical skills, knowledge and judgment, communication skills, and professional attitudes) it is still possible for the candidate to pass the PEAP if the Final Assessment Form contains appropriate explanatory comments.

According to the CPSO’s regulations, if the PEAP is not completed successfully then enrolment in a subsequent PEAP in Ontario in the same discipline is not permitted.

Last updated: February 11, 2016

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