Royal College of Physicians and Surgeons of Canada

Value to Fellows and Professional Practice

We’re trying to get your attention. Is it working?

We want to know what Fellows value. We spent the year reaching out to try and answer that question. We surveyed our members, engaged in face-to-face meetings, showed up at resident orientation days and even refreshed our website — all part of our efforts to improve our services.

Member Value Survey

More than 4,000 Fellows provided feedback by way of our Member Value Survey — our first full-scope survey of its kind since 2010. Findings will help us develop strategies related to our operational priorities, especially those around the value of membership and support for professional practice.

Regional Advisory Committees (RACs)

The work of the Royal College is supported by five Regional Advisory Committees. They report on issues related to specialist practice in the country. In 2018, they provided advice on gaps and opportunities. They encouraged us to increase awareness and engagement of residents and early-career Fellows, and to improve our value proposition for community-based Fellows.

We held a series of face-to-face town halls (one each in Brandon, Man., Quebec City, Que., Saskatoon, Sask., and Peterborough, Ont.) We asked for feedback on the work and priorities of our Office of Professional Practice and Membership, and on potential future directions for the Maintenance of Certification (MOC) Program. We also discussed Competence by Design.

Resident Orientation days

We operated booths at five orientation days for new residents. We talked one-on-one with future Fellows, and answered their questions about Competence by Design, the MOC Program and the role of the Royal College.

Refreshed website and brand

As part of our rebrand, we launched new website landing pages for Fellows, residents, medical educators, international and volunteers. Content is regularly updated and tailored to each audience’s interests and needs.

2018 Fellowship Affairs Summit

We streamed several presentations from this summit on Facebook Live. Summit participants generated meaningful feedback that will enhance our strategies for member engagement and value, and continuing professional development.

New offerings for credits in Section 3 (Assessment)

The Royal College is committed to supporting physicians’ lifelong learning.

We launched Prescribing Safely Canada to help physicians assess and enhance their skills, and reduce medication errors. After successfully piloting three online self-assessments in late 2017 through spring 2018, we promoted three new modules in late 2018:

  • frail client,
  • antibiotic stewardship, and
  • opioid prescribing.

We also teamed with mdBriefCase Group to bring members a new accredited self-assessment program on opioids.

Also in 2018, we initiated a new Assessment Activity Development Grant. This grant supports Royal College Accredited CPD Provider Organizations in creating/providing more high-quality Section 3 (Assessment) activities. Up to $50,000 in funding was available for 2018-2019.

Fellows-in-practice

Growing up in Ghana, Vincent Agyapong knew he was destined for a career in medicine. “My father was a farmer but he said I must become a doctor!”

A medical degree at the Kwame Nkrumah University of Science and Technology in Kumasi led to a Psychiatry residency in Dublin, followed by a PhD in Global Mental Health and a fellowship in Canada. “Psychiatry is a neglected specialty in most of Africa but I found I liked it. It’s so stigmatized that there’s much work to be done from a public health perspective. I think I can make more of an impact than if I were working in any other discipline.”

Improved access to services led him to introduce new efficiencies

When he moved to Fort McMurray in 2013, three psychiatrists were serving 120,000 people. Waitlists were nine months long. Dr. Agyapong worked with family doctors to build a culture of shared care. “I told them I was not going to hold onto patients. I was going to diagnose, stabilize and then transfer care back to them, making myself available as backup if patients relapse.” Other psychiatrists followed suit and wait times dropped to just four weeks.

Dr. Agyapong also launched an award-winning Text4Mood program that offers daily supportive text messages to people with depression, anxiety and other disorders. The response was overwhelming: within six weeks 5,000 people across Alberta had self-subscribed. Research showed 83% of subscribers reported a positive impact on their mental well-being.

“I signed up one patient in her home, an elderly quadriplegic woman who had become depressed. When I followed up two weeks later, she told me she was so happy and excited for the next text message to come. It was personally very gratifying.”

Increased capacity for psychiatric services in Africa is his next focus

Now a clinical professor in the department of psychiatry at the University of Alberta, Dr. Agyapong is working to improve access to mental health services in developing countries. With support from the coordinator of the Department of Mental Health and Substance Abuse at the World Health Organization, he’s designed a Master’s program that trains doctors, nurses and social workers in global mental health policy, services and development. Psychiatry faculty from Canada, Ghana, the U.S., Ireland, Nigeria and the U.K. are currently training Ghanaian and Nigerian students. “I expect that with time this program will help many countries to produce trained global mental health practitioners that can design, implement and evaluate services where psychiatrists are in short supply.”

Within months of moving to Canada, Dr. Agyapong obtained his Royal College Fellowship. “I made it a priority. It’s very highly respected wherever you go so it means a lot to me.”

His father visited him in Edmonton recently. “He’s very pleased. And I have never been so pleased with the medical profession and the opportunities to help people.”

It’s a new world. We’re preparing for change.

We always say that medicine changes at a rapid pace. At this year’s Royal College-National Specialty Societies (NSS) Specialty Medicine Summit we discussed some of the opportunities to break down barriers to care. One example is eConsult services. A growing body of evidence shows that they improve the timeliness of specialist consultation, reducing referrals and emergency room use.

In November, we hosted a national eConsult/eReferral Forum. It brought together health care providers and patients to identify best practices in eConsult/eReferral, including in the design and delivery of these services. The Royal College’s involvement in this work stems from its partnership in the Connected Medicine Collaborative. Funded by the Canadian Foundation for Healthcare Improvement, this initiative is scaling up and adapting well-established virtual care services in Ontario and British Columbia. At present, projects in six provinces are being supported.

We are also studying some important issues through new task forces:

  • The Task Force on Artificial Intelligence and Emerging Digital Technologies was formed. Its members will formulate recommendations to inform the Royal College’s strategy on the impact of emerging technologies in specialty medical education, and their implications for the ongoing professional development of specialists.
  • The Task Force on Periodic Reaffirmation of Professional Competence is also new. Its members are working to formulate and provide recommendations that will inform the Royal College’s commitment to developing education and assessment strategies that ensure competence post-certification.

We are not preparing for change alone. We are working with partners across the health care system to get a fuller and more nuanced view of what is to come. In 2018 alone, we were witness to many Fellow-led innovations and incredible work led by others in health care. By sharing knowledge and learnings, together we can better prepare for change and the many opportunities that come with it.

Fellows-in-practice

Dr. Ron El-Hawary had no intention of pursuing medicine when he started a mechanical engineering degree in his hometown, Halifax. A summer job in an orthopedics practice piqued his interest. “I could see that a lot of what they do in Orthopedic Surgery is applied engineering but with the bonus of patient interaction.”

After medical school at Dalhousie University, he completed fellowships in Ontario and Texas before returning to Nova Scotia. “My intention was always to get the best training I could, then come back home to work.” Now chief of paediatric orthopaedics at IWK Health Centre, he often sees patients he knows personally. “Or they know my parents, or my brother or sister. It’s a small community and it’s rewarding.”

One of only two pediatric scoliosis surgeons in the Maritimes (the other is his colleague at the IWK, Dr. Ben Orlik) Dr. El-Hawary worked hard to build up his research program. “That was the main challenge. I had to start small and build up the program with grants.”

Improved quality of life is the driver behind his use of pioneering treatments

With a sub-specialty in early onset scoliosis, Dr. El-Hawary uses novel techniques that can dramatically change the lives of children with serious, sometimes life-threatening, conditions. He recalls operating on a young boy with spinal muscular atrophy. “We inserted growing rods so the spine grows as he grows. We used anchors to keep the ribcage from collapsing down. To see the change in his quality of life was really impressive. Without treatment, he’d be bed-ridden and have a significantly shortened life expectancy.”

In 2017, Dr. El-Hawary was the first North American surgeon to perform a fusionless surgical technique called ApiFix. Developed in Israel, the procedure is shorter than fusion surgery, using fewer screws and a single rod with joints and articulations. “The whole construct moves with the patient. We want active teenagers to maintain whatever range of motion they can.”

Dr. El-Hawary has successfully performed the ApiFix surgery on 11 adolescents. He also designs new surgical tools, reviews case studies in Europe and Israel, and is training select Canadian surgeons in the technique.

Education has been a priority during his ten years as an oral examiner for the Royal College, including one year as chair of the Orthopedic Surgery Examination Board. “I was part of an evolution in how exams are conducted. There’s more open discussion now between examiner and candidate, giving us a better glimpse into thought process, surgical maturity and judgment.”

“I love the education, I love the research, I love the clinical side. I try to do it all.”

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