Pre-Entry Assessment Program (PEAP) Guidelines

Overview

The Pre-Entry Assessment Program (PEAP), required by the College of Physicians and Surgeons of Ontario (CPSO), ensures International Medical Graduates (IMGs) are qualified for residency or clinical fellowship training. Completing the PEAP is necessary for obtaining an unrestricted medical education certificate of registration (educational license) from the CPSO.

Applicability

The PEAP is mandatory for IMGs who:

Begin a clinical fellowship in Ontario after receiving a specialty certification outside Canada or the U.S.
Enter residency training and:
- Are not Canadian citizens, or;
- Do not have Canadian Permanent Resident status and;
- Are funded by an acceptable sponsoring agency from one of the following countries: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, or the United Arab Emirates.
Are residents currently enrolled in a postgraduate program outside Canada or the U.S. for short term elective training at the University of Toronto.

*For complete information on elective PEAPs, please refer to ‘PEAP Guidelines for Electives’

Definition

The PEAP is an assessment process that evaluates IMGs to determine whether they can function at the appointed level of training. The PEAP period must be a minimum of four weeks and a maximum of twelve weeks. PGME recommends utilizing the full twelve weeks for the assessment. The PEAP assessment is to take place in a supervised clinical multidisciplinary environment where there is patient input on an ongoing basis. The assessors/supervisors are responsible for ensuring that learners are:

Mentally competent to practice medicine;
Able to practice with decency, integrity, and honesty in accordance with the law;
Possessing sufficient knowledge, skill, and judgment for postgraduate medical training as authorized by the educational license; and
Able to communicate effectively and display an appropriate professional attitude.

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

Note: Enrolment in the PEAP can begin only after the CPSO has issued a Certificate of Registration and the learner has registered with Postgraduate Medical Education (PGME) for the PEAP period. It is an offence under the Regulated Health Professions Act for a person to practice medicine in Ontario until they are registered and authorized by the CPSO. It is the learner’s responsibility to ensure they have completed all registration requirements on POWER before beginning their training.

Process

PGME issues a Letter of Appointment (LOA) for (a) the PEAP and, (b) the remainder of the training session within the current academic year, conditional upon the successful completion of the PEAP.
The CPSO issues a Certificate of Registration once all registration requirements of licensure are met.
The learner registers with PGME and POWER generates a Confirmation of Registration.
It is expected that the program assesses the learner at the initial (4th week) and mid-point (8th week), providing the learner with formative and transparent feedback at minimum. If the PEAP is shorter than 12 weeks, evaluations should be adjusted to ensure the learner receives feedback throughout the duration of the program.
The assessor/supervisor and Program/Fellowship Director then completes and signs the Final PEAP Assessment Form, which is submitted to PGME for the Associate Dean’s approval.
PGME records the completion of the PEAP requirements in accordance with CPSO and updates the learner’s POWER record to reflect the transition from PEAP to regular training. An updated Confirmation of Registration will then be accessible in POWER.

Assessments

It is recommended that formal evaluations be conducted at the four, eight, and twelve-week marks at minimum, with formative and transparent feedback provided both verbally and in writing. If the PEAP is shorter than 12 weeks, evaluations should be adjusted accordingly to ensure the learner receives feedback at regular intervals throughout the program. Assessment forms should be used to document this feedback. Learners should have the opportunity to demonstrate their skills throughout the PEAP period and receive constructive feedback on their strengths, areas for improvement, and any weaknesses.
To successfully complete the PEAP, the learner’s Final Assessment Form must receive a "yes" response to all key questions regarding observed competencies.
Please note, the PEAP is not a remedial period and cannot be extended due to concerns about poor performance. The PEAP may be extended by up to four weeks in the event of an unexpected absence of the learner or supervisor. Requests for extensions must be made in writing. Please contact your departmental administrator.

Learners in a Residency PEAP

The Residency PEAP evaluates the resident’s clinical skills, knowledge, and judgment in the relevant discipline, as well as basic competencies in internal medicine, obstetrics & gynecology, pediatrics, psychiatry, and general surgery, ensuring they are appropriate for practice in the chosen discipline. If successful, the PEAP period will be recorded as part of the residency training program.

Learners in a Clinical Fellowship PEAP

The Clinical Fellowship PEAP assesses the fellow’s general knowledge and competency in their certified specialty and ensures they are suitable for practice in the clinical fellowship discipline. If successful, the PEAP counts towards the clinical fellowship’s educational goal and objectives.

An Unsuccessful PEAP

A learner has not successfully completed the PEAP if the Final Assessment Form does not contain a “yes” response to all yes/no questions following the cumulative summary of observed assessments. If a learner fails to meet expectations in any of the five areas of observed assessment:

Clinical skills
Technical skills
Knowledge and judgment
Communication skills
Professional attitudes

They may still pass the PEAP if the Final Assessment Form includes appropriate explanatory comments. However, according to CPSO regulations, a learner who does not successfully complete the PEAP cannot enroll in another PEAP in the same discipline in Ontario.