Policy on:

The Practice Eligibility Route

(PER)
1. Objective & Scope
The Practice Eligibility Route is intended to be the primary route to certification for International
Medical Graduates. The purpose of the Practice Eligibility Route is to remove barriers to primary
specialty certification for practicing specialists, both in Canada as well as abroad, who are not
currently Royal College certified and did not complete their training in a Royal College-accredited
residency program or the United States. The PER is intended to provide a route to Royal College
certification for all specialists who meet the established training and experience requirements. It
provides an opportunity for specialists to have their credentials assessed and compared to Royal
College medical graduate standards and, subsequently, the ability to challenge the Royal College
specialty examination.

Successful application to the PER does not guarantee Royal College certification, rather it provides
access to the Royal College examination which must be successfully completed (all components)
in addition to meeting the outlined practice requirements before the candidate is eligible for
certification.

2. Definitions and Acronyms

CCT Confirmation of Completion of Training.

Credentials The Credentials Committee is a decision-making body

Committee comprised of volunteers and Royal College staff tasked with
overseeing credentialing policies and routes to certification.

I nternational A physician who completed post-graduate training in a

Medical Graduate jurisdiction outside of Canada.

PER Practice Eligibility Route: the primary route for certification for
International Medical Graduates.

PGME Post graduate medical education.

Physicians Apply A service used by the Royal College to verify authenticity of
documents.

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 MRA Medical regulatory authority: The MRAs are the provincial and
territorial bodies responsible for granting physicians a license to
practice within their jurisdiction.

MSF Multisource feedback.

Royal College Royal College of Physicians and Surgeons of Canada is the

national professional association that oversees the medical
education of specialists in Canada. In its mandate articulated by
a Royal Charter in 1929, it is entrusted with a key role in the
oversight of the system of specialty medicine in Canada.

Royal College The unit of the Royal College responsible for evaluating and
Credentials Unit processing applications for exam eligibility received from
specialists and trainees.

Specialty Each Royal College specialty has a committee comprised of

Committee Fellows certified in the respective specialty.

STRs Specialty training requirements.

3. Policy
Ov erview of the Procedure for Submission of a PER Application

The Practice Eligibility Route is available to applicants currently practicing in Canada or abroad,
who have training equivalent to Royal College standards. Substantial training equivalence is
required to be eligible for the examination, and 5 years of practice with a minimum of 2 in Canada
are required to become certified. A license to practice in Canada is not required to initiate a PER
application but will be required to complete the process and receive certification (to meet time in
practice in Canada requirements). Applicants currently without a license to practice in Canada may
access the exam component(s) of their discipline’s examination. Success at the examination may
be considered by the MRAs in the licensure application process. The Royal College does not have
the authority to issue licenses to practice in Canada and cannot guarantee that success at an exam
component will lead to being conferred a license by an MRA.

The applicant must ensure they are able to submit all the documents listed in Section 6 for their
application to be evaluated by the Credentials Unit. An application must be submitted along
with the required fee and addressed to the Royal College Credentials Unit. The review of the
applicant’s credentials will result in a determination of whether the applicant’s training is
sufficient to receive Royal College exam eligibility.

An application for the Practice Eligibility Route can be found on the Royal College website.

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3.1 Eligibility Criteria

3.1.1 Medical specialty training completed outside Canada

3.1.2 Time in training substantially equivalent to Royal College training standards

3.2 Credentials Review

The Credentials Unit requires the following as part of the initial assessment of medical training
and practice abroad, as further detailed below:
• Details of the applicant’s training (to be compared with Royal College’s training
standards)
• Source verification of training documents by Physicians Apply

These documents must be compiled and completed alongside the PER application form
found on the Royal College website. The non-refundable application fee must be paid at the
time of submission of the application. This application package is reviewed by the
Credentials Unit and a ruling letter is issued either confirming or denying exam eligibility.

3.2.1 The Royal College requires proof that the applicant has completed training which is
substantially equivalent to the specialty training requirements (STRs) in the respective
specialty and is recognized as a specialist in the jurisdiction of training. The applicant
must provide satisfactory evidence of completion of all postgraduate medical education
(PGME) training requirements of the jurisdiction in which training occurred.

3.3 Royal College Specialty Examinations

3.3.1 Following approval by the Credentials Unit of a successful initial credentials review, the
Royal College will issue a ruling letter granting eligibility to the specialty examination(s).
3.3.2 Candidates may have access to the examination, at any point of the 5 years in practice,
including immediately following completion of training abroad if training is determined
to be substantially equivalent.
3.3.3 Applicants with exam eligibility must register and pay for the examination using the e-
booking system. The exams are on fixed dates and take place annually. Registration
deadlines can be found on the Royal College site. Applicants must appear at the Royal
College examination center in-person to sit the written examination.
3.3.4 Royal College examinations typically consist of multiple components. A typical model
consists of a written examination component followed by an applied component.
Examination formats vary by specialty.
3.3.5 Applicants successful at the written component will receive eligibility towards any
subsequent exam components (if applicable).
3.3.6 Applicants who have met all the PER requirements (including assessment of practice in
Canada) outlined in this policy and have successfully completed all the exam
components in their discipline, are eligible to become certified by the Royal College.
The Credentials Unit will issue this letter when all requirements have been met.

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3.4 Time in Practice in Canada Requirement
The Practice Eligibility Route requires applicants to complete two years of practice in Canada
before becoming eligible for certification. It is the responsibility of the applicant to obtain a
license to practice and to complete a minimum two years of practice in Canada. The Royal
College does not issue licenses. It is at the discretion of the Medical Regulatory Authorities to
grant licenses to practice in Canada. Typically, the applicant will use the letter confirming
success at the examination to apply for a license with an MRA.

3.4.1 The two years in practice may be completed in any jurisdiction in Canada. Each
province and territory have a local medical regulatory authority responsible for issuing
licenses to practice medicine in their jurisdiction. The Royal College of Physicians and
Surgeons of Canada does not grant licenses to practice. These two years must be the
equivalent of two full-time years in practice.
3.4.2 It is the responsibility of the applicant to obtain a license to practice and to meet the
time in practice requirement. During this period of 2 years, the Royal College keeps the
application on file and, pending the completion of two years, the applicant may submit
documents to complete the subsequent stage of the PER process, the assessment of
practice in Canada.
3.4.3 Applicants already in Canada and in practice at the time of PER application may have
already met the minimum time in practice requirement. If the applicant already has a
total of two years of practice in Canada, they may immediately apply for an assessment
of practice.

Note: Practice during a fellowship or postgraduate medical education (PGME) is not

considered independent practice; it is considered a learning experience for the specialty.

3.5 Assessment of Practice

Following demonstration of completion of the required time in practice requirements
(completion of two years of practice in Canada and a minimum of 5 years total practice), the
applicant is required to submit the following documents to have this time in practice
assessed. Approval of an assessment of practice is necessary for certification.

3.5.1 Feedback from a chief of staff (or other relevant supervisor): A supervisor verifies the
applicant’s declared scope of practice and answers a confidential questionnaire about
the quality of the applicant’s practice.
3.5.2 Multisource feedback (MSF) survey: Feedback on the professional competencies relating
to the CanMEDS roles is gathered and then benchmarked against scores from similar
practices. This process allows the applicant to reflect on their performance across the
range of CanMEDS roles and to identify their areas of strength and areas for growth.
3.5.3 A current Certificate of Professional Standing (CPS) is required to prove that the
applicant is a member in good standing with their medical regulatory authority in
Canada.
3.5.4 Scope of practice review: The applicant’s declared scope of practice is reviewed by
members of the respective discipline’s Specialty Committee.

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 Note: If the current practice profile does not meet that of a Royal College specialist, the
applicant will not be able to continue with the PER route. However, the applicant can submit
additional information on their practice for a second review, if appropriate.

3.6 Royal College Certification

Applicants who have met all the PER requirements including: a successful credentials review
verifying training equivalence to Canadian programs and 5 years of practice with a minimum
of 2 in Canada, success at the examination component(s), and a successful assessment of time
in practice in Canada as outlined in this policy the individual will be eligible to become certified
by the Royal College. The Credentials Unit will issue this letter when all requirements have
been met.

4. Roles and Responsibilities

4.1 Applicant
The applicant is responsible for compiling all necessary documents required for a complete
application and providing required information to the Royal College at all stages of the process.
Following a successful credentials review, the applicant will receive eligibility to the Royal College
examination and will be responsible for registering and completing the examination. Further, to
complete the PER process, the applicant must complete two years of practice in Canada and
complete the required assessment of this time in practice. The applicant must work with a
medical regulatory authority (MRA) to receive the necessary licensure to complete this
requirement.

All PER applicants will remain subject to the policies and procedures of the Royal College, as
applicable, including those listed in section 5 of this policy. This includes examination eligibility
and renewal policies.

4.2 Royal College Credentials Unit

The Credentials Unit receives applications and renders decisions on behalf of the Royal College.
The Credentials Unit is responsible for reviewing credentialing documents and determining
equivalency to Canadian training programs. The Credentials Unit issues ruling letters regarding
exam eligibility.

4.3 Medical Regulatory Authority (a Canadian licensing body)

For an applicant to meet the entirety of the PER requirements, the physician will need to
complete a minimum of 2 years of practice in Canada. The applicant will have to apply to an
MRA to receive licensure and the ability to practice in Canada. A list of MRAs can be found here:
https://www.royalcollege.ca/rcsite/resources/provincial-medical-regulatory-licensing-
authorities-e

4.4 Credentials Committee

The Credentials Committee makes decisions regarding the PER policy. Panels made up of
members of the Credentials Committee also hear appeals for reconsiderations of eligibility
rulings.

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4.5 Specialty Committees
The Specialty Committee is responsible for viewing the scope of practice of PER applicants.
Following completion of the requirements for time in practice in Canada, a second scope of
practice review is performed to ensure the practice meets the criteria to be considered a
specialist in the respective discipline.

5. References
Policies and Procedures for Certification and Fellowship: The policies can be found on the Royal
College website at: http://www.royalcollege.ca/rcsite/credentials-exams/exam-eligibility-e.

Policy on Formal Review of Examinations

6. Contact(s)
For information or clarification, please contact:

The Royal College of Physicians and Surgeons of Canada

Office of Specialty Education, Assessment
774 Echo Drive
Ottawa ON K1S 5N8
Telephone (toll-free): 1-800-668-3740
assessmentpolicies@royalcollege.ca

7. Appendices
This policy has no appendices.

8. Policy record
Policy number
Most recent resolution: Resolution No. 2021- 22; C: 2021-06017/18 (revision)
Previous resolution(s): Resolution No. 2011-15; C: 2011-06-22 (revision)
Resolution No. 2010-13; C: 2010-02-22/23 (approval)
Resolution No. 2009-39; C: 2009-09-29 (approval in principle)
Approved by: Council Committee
Approval Date: June 2021
Approval path: Credentials, Assessment, CSE, ECC, Council
Effective date: June 2021
Date of next review: 2023
Royal College Office: OSE
Version status: Original presented for approval
Keywords: policy, credentialing, international medical graduates, IMGs, PER
Information security Public
classification

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