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Specialty Committee Chairs’ Update

Mises à jour pour présidents des comités de spécialité

Mises à jour pour présidents

des comités de spécialité

Specialty Committee

Chairs’ Update

May-June 2019



Progress Report on Competence by Design (CBD)

Twelve disciplines will launch CBD in July 2019 which will bring the total number of disciplines to launch CBD to 20. All of the national standards documents and Entrustable Professional Activities (EPAs) for these 12 disciplines are available on the Royal College website and have been uploaded into Royal College ePortfolio.

The Royal College continues to support several other disciplines towards the completion of their national standards documents and EPAs following their series of CBD workshops. Of those disciplines:

  • Three disciplines (Neonatal-Perinatal Medicine, Nuclear Medicine, and the adult stream of Cardiology) have complete and approved CBD standards and EPAs. These documents are currently being translated and will be available on the Royal College website in the near future.
  • Two disciplines (the pediatric stream of Cardiology and Physical Medicine and Rehabilitation) will have their specialty-specific documents reviewed by the Office of Specialty Education (OSE) and the Specialty Standards Review Committee (SSRC) in the coming weeks.
  • Nine disciplines (General Surgery, Psychiatry, Respirology, Clinical Immunology and Allergy, Neurology, Plastic Surgery, Pediatric Surgery, Orthopedic Surgery, and Vascular Surgery) are working to finalize their documents following their final workshops and hope to submit them for approval between now and July.

Over the next few weeks, more information will be provided to stakeholders regarding the status of those disciplines including which disciplines aim to launch CBD in 2020. Final confirmation of the specific disciplines launching CBD in 2020 will be provided in the fall of 2019.

With regard to preparations for the launch of CBD as it relates to residency in Pediatrics, there are a number of issues active in the discipline, and work continues to finalize the Pediatrics national standards documents. Considering all aspects, it is not feasible for Pediatrics to launch CBD in 2020. At this time, the launch date for Pediatrics will be pushed back to July 1, 2021. The Specialty Committee in Pediatrics, postgraduate medical education (PGME) deans and competency based medical education (CBME) leads have all been advised. We are working with the specialty committee, Program Directors and CBME Leads to support Pediatrics in the interim, and to maintain momentum for CBD readiness.



Entry Routes Report

In April, the Royal College informed you that a draft report was being disseminated by the Association of Faculties of Medicine of Canada’s (AFMC) Entry Routes Working Group (ERWG). This report calls for a reduction in entry routes and named several Royal College disciplines that they believe could be consolidated into “more general entry routes”. These disciplines were noted in the report without Royal College endorsement, consent, or approval. We appreciate the feedback many of you sent into the Royal College on behalf of your committees.

Since that time, the ERWG report has been discussed at both the Committee on Specialties (COS) during their April meeting and the Committee on Specialty Education during their May meeting. Both committees provided feedback on the report and suggested that more analysis regarding current issues be undertaken.

The Royal College is presently drafting a paper in response to the AFMC’s ERWG report. Our response aims to underline current policies and procedures related to the system of specialties; namely the current governance of that system, of which specialty committees are key players. Once finalized, the Royal College’s response paper will be circulated to key stakeholders, including specialty committee members. We are thankful for the feedback specialty committees sent to us, as the input you provided has confirmed the tone and framing of the Royal College’s response.



Areas of Focused Competence (AFC-diploma) Updates

The Specialties Unit continues to support the growing numbers of AFC-diplomas recognized by the Royal College. As of April 1, 2019, there were 24 recognized AFCs of which:

  • 19 have approved sets of national standards: Competency Training Requirements (CTR), portfolio and Standards of Accreditation;
  • 11 have accredited programs (36 accredited programs in total); and
  • 11 have approved Practice Eligibility Route for AFCs (PER-AFC) standards of which 9 have officially launched their PER-AFC.

A total of 27 candidates have been granted the Diplomate designation.

The following provides an update on the most recently approved AFCs:

  • Hematopoietic Stem Cell Transplantation and Pediatric Urology are in the process of creating their national standards;
  • Addiction Medicine will be launching their newly approved national standards for training and their PER-AFC in the coming weeks; and
  • Acute Care Point of Care Ultrasonography, Patient Safety and Quality Improvement and Prehospital and Transport Medicine have submitted their national standards for review by the Specialty Standards Review Committee (SSRC).


AFC Program Evaluation Update

This spring an internal AFC Program Evaluation Implementation Working Group was launched with the aim of coordinating the development of actions to operationalize the four key recommendations arising from the program evaluation that concluded in late 2018. Bringing together leads from the key units that support the AFC program – Credentials, Membership, Educational Strategy, Innovations, and Development (ESID), Specialties Unit, Communications, and Educational Standards Unit (ESU) – the group’s goal is to address the issues identified and to deliver a more cohesive and consistent AFC program through the reform activities.

The following are the four key recommendations and an update on each:

  1. Prioritize reforms of the assessment strategy for AFC diplomas

    This recommendation has been divided into two lines of work – to revise the assessment philosophy for the trainee in a Royal College-accredited AFC program and to revise the practice eligibility route for physicians (PER-AFC). The teams responsible for these recommendations continue to explore the assessment philosophy and processes for each pathway with a focus on maintaining the high-quality, national standards while streamlining and improving the user experience.

  2. Re-launch ongoing efforts to reform the accreditation policy and process

    The April 2019 meeting of the AFC-Accreditation Committee focused on the development of a proposal for comprehensive changes to the system of AFC accreditation, including draft new General Standards of Accreditation for AFC programs, as well as proposed changes to the accreditation process that include transition to a digital accreditation management system, and enhanced mechanisms for incorporating AFC trainee feedback. Consultation with stakeholders, including members of AFC committees, subcommittees and working groups, will take place this summer.

  3. Consider how to continue to provide support, and improve upon the support currently provided

    The various units are now reviewing some of their current processes to identify areas requiring clarification through communication and guidance compared to those that need to be streamlined and improved for stakeholders. For example, in addition to the AFC accreditation reform, the ESU is looking to develop improved guidelines and supports to help navigate the accreditation process, including tools for programs wishing to submit applications for accreditation of new AFC programs.

In the meantime

The program evaluation results and recommendations continue to be shared with stakeholders and governing committees of the Royal College. Since April, the results have been discussed at meetings of the Committee on Specialties, the AFC-Accrediation Committee and the Committee on Specialty Education.

ESID continues to meet with committees to present the recommendations and to answer questions about the program evaluation. If you would like your committee to receive this presentation, please contact your administrator to arrange. A copy of the results can be shared in advance by email.

We know there is considerable anticipation about when the reform activities will be implemented. We will keep you informed of new developments as they become available. Now more than ever though, during this time of change, if your discipline is considering applying for recognition of a new AFC or knows of an application for accreditation underway, please check with your administrator to verify whether a new process is in development.

Previous reports on the AFC program evaluations results and recommendations are available in the online archives. If you have questions about the program evaluation or require more information, please contact Linda Rumleski, policy analyst, ESID (educationstrategy@royalcollege.ca).



CanMEDS

CBD Innovators

As of July 2019, twenty disciplines will have launched CBD, dozens more are in the midst of preparing to launch, and others are about to begin their CBD journey. At this stage of implementation there is a great deal of lived experience yielding positive results and lessons learned. With the help of CBME leads and PGME deans, CanMEDS will facilitate the widespread sharing of these experiences. This is an important point in the CBD process to make progress visible and share stories of the “bright spots” making headway in order to enable greater adoption.

Based on recommendations from CBD workshop facilitators, the Royal College has identified approximately 50 program directors and faculty who are implementing CBD in innovative ways.

Over the course of the next year, innovator stories will be featured on a newly-built webpage and promoted through various marketing channels. Innovators will receive special recognition from the Royal College (i.e. CBD Innovator title), and their experiences and favourite CBD resources will be shared broadly with the goal of fostering a peer-to-peer experience-sharing network. If the initiative is successful, we hope to continue promoting Innovators over the next several years.

AFC Program Directors

This year the Royal College will pilot a new AFC program directors workshop as a preconference session to the 2019 International Conference on Residency Education (ICRE) on September 26th in Ottawa. This is a faculty development session designed to introduce AFC program directors to their role and their many common challenges and experiences. It will be a full day session held jointly with the New Residency Program Directors Workshop.

The program is based on two needs assessments that were conducted in early 2019. There will be a session on Accreditation and the new C standards and another session on navigating the eDiploma system.

Committee on Specialties (COS)

At the April COS and the May Committee on Specialty Education (CSE) meetings, the applications for recognition of two AFCs were reviewed. Both committees approved the following new AFCs:

  • Adult Congenital Heart Disease
  • Retina

Following those approvals, the Office of Specialty Education (OSE) will be supporting the creation of two working groups which will be tasked with establishing new national standards for their AFCs. As of May 31, 2019, this now brings the total number of recognized AFCs to 26.

At the spring 2019 COS meeting, which took place on April 8-9, 2019, the following outcomes were determined:

Recognition of Disciplines: Part I AFC (Diploma)
  • Targeted neonatal echocardiography: was approved by the COS to proceed to Part II, including a national consultation of stakeholders, pending minor clarifications from the applicant.

The next deadline for interested AFC (Diploma) applicants to apply for Part I review is September 1, 2019, for consideration during the fall 2019 COS meeting.

Recognition of Disciplines: Part I Subspecialty
  • Dermatopathology: the application to recognize dermatopathology was deferred, pending major clarifications from the applicant.
Recognition of Disciplines: Part II AFC (Diploma)
  • Adult congenital heart disease: both the COS and CSE approved the application to recognize adult congenital heart disease as an AFC (Diploma).
  • Retina: both the COS and CSE approved the application to recognize retina as an AFC (Diploma). Minor clarifications will be submitted to the OSE prior to initiating work.
Changes to Recognized Disciplines
  • Pediatrics: the proposal was considered at COS during its spring 2019 meeting. Any updates on the status of the proposal will be sent to the specialty committees after the Royal College’s spring committee cycle.
  • Hematopoietic stem cell transplantation: the COS determined that the request to change the name of the discipline to Hematopoietic Stem Cell Transplantation and Cellular Therapy signified a minor change.
Discipline Reviews

Eleven discipline reviews were conducted during the spring 2019 meeting, consisting of nine regular reviews, one follow-up, and one in-depth review:

  • Anatomical Pathology
  • Cytopathology
  • General Pathology
  • Gynecologic Oncology
  • Gynecologic Reproductive Endocrinology and Infertility
  • Hyperbaric Medicine
  • Maternal-Fetal Medicine
  • Medical Biochemistry
  • Neurology
  • Neurosurgery
  • Obstetrics and Gynecology

The next COS meeting will take place on November 14-15, 2019 in Ottawa.

The following specialty reviews will take place:

Discipline Reviews:
  • Adolescent Medicine
  • Cardiac Surgery
  • Dermatology
  • Developmental Pediatrics
  • General Surgical Oncology
  • Neonatal-Perinatal Medicine
  • Neuropathology
  • Neuroradiology
  • Pediatrics
  • Public Health and Preventative Medicine
  • Child Maltreatment Pediatrics AFC
  • Clinician Educator AFC

The COS plans to review the following Part I and Part II applications:

Part I Subspecialty
  • Dermatopathology
Part I AFC (diploma)
  • TBD
Part II AFC (diploma)
  • Targeted Neonatal Echocardiography clarifications


Residency Accreditation Update

Residency Accreditation Reviews

The onsite portion of the McGill University regular accreditation review (March 2019) is complete; post-review specialty committee input for McGill University will be sought in summer or early fall 2019, which will inform the final accreditation decisions to be made at the October 2019 Residency Accreditation Committee (Res-AC) meeting. The Western University regular accreditation review is scheduled to take place November 24 to 29, 2019. The specialty committee pre-accreditation review input is scheduled for early fall 2019.

Canadian Excellence in Residency Accreditation (CanERA)

Recent and Upcoming CanERA-related Activities

The Canadian Residency Accreditation Consortium (CanRAC) continues collaborative efforts in the ongoing development and evaluation of CanERA, with an emphasis on the final stages of Prototype 3 testing and preparation for full implementation of CanERA July 1, 2019.

What CanERA transition support is available to specialty committee members?

To support the ongoing transition to CanERA, training specific to the pre-accreditation review specialty committee input process was delivered via webinar and an interactive online training module in September 2018. In addition, in late March 2019 a webinar session was held detailing the specialty committee’s role in providing post-accreditation review input, with updates made to the interactive online training module to reflect to post-accreditation review input process.

While all voting members of specialty committees were invited to attend the webinars above, this training was developed specifically for Prototype 3 reviews (i.e., Dalhousie University and McGill University), based on the CanAMS functionality available at that time. CanAMS functionality will evolve as will the associated training. The link to the webinar and the online training module is available at www.canera.ca under the training, tools and supports tab.

Specialty committee members are encouraged to regularly visit the CanERA website (www.canera.ca), as it is up to date with the latest CanERA news and information. The website includes the new general standards, frequently asked questions (e.g., Accreditation in CBD), and other CanERA-specific information that may be of interest.

International Residency Program Accreditation

There are currently eight international accredited institutions in five countries. Residency programs under the jurisdiction of these institutions are eligible to apply for Royal College accreditation, and to date eight international program applications in five disciplines have been submitted. Of the eight applications reviewed, five are proceeding to the next step of the international program application process which is an onsite accreditation review; three have been deferred pending further information/clarification from the program. Given that activities with partners in Saudi Arabia are currently on hold, only three of the five program onsite accreditation reviews have been scheduled. One took place in January and the accreditation review report was released to the specialty committee in mid-March for review and input. The other two reviews (at the same institution) are scheduled for late June and the preliminary accreditation review reports are anticipated to be provided to the specialty committees by mid-August for review and input. In addition, responses to deferred decisions from reviews of applications in 2018 will be forthcoming in mid – late 2019 for review by the relevant specialty committee. Approximately three new program applications (Emergency Medicine, Nuclear Medicine and Pediatrics) are expected in 2019.

The international residency program accreditation application is a two-step process that involves the submission of an application form followed by an onsite review to verify and validate information before a final decision is made on accreditation status. Specialty Committees are asked to review both the application form and the onsite review report to inform a decision of the International (residency) Program Review and Accreditation Committee (IPR-AC) at each step. The process is comparable to the specialty committee review of a Pre-Survey Questionnaire (PSQ) and accreditation review report in the Canadian accreditation system. As applications in additional disciplines are expected, the Educational Standards Unit will work directly with those specialty committees to provide a tailored briefing on the international program accreditation process, and provide support as needed throughout the process.



A Volunteer Success Story - Collaboration at Work

That’s a MATCH!

The sub-specialty of Maternal-Fetal Medicine (MFM) has been matching qualified resident candidates for over fifteen years. As a sub-specialty not covered by the Canadian Resident Matching Service (CARMS) it was important to create a fair system that would provide successful results.

“It is a useful tool that provides better coordination and a more streamlined process for the candidates” says Alain Gagnon, MD, FRCSC, chair of the Specialty Committee in MFM.

To avoid losing candidates who prefer a Canadian program but had a contractually binding offer from a United States based program, this process occurs in the fall, in advance of the deadline for withdrawing from the United States match. Quebec does not participate in this match process due to the later timelines for funding assignment in the province (the number of funded positions is not known until winter prior to the July start.

The process is simple to administer by the chair. Having a second independent person looking at the responses and supporting the match is also possible. The key principle is to assign a candidate based on the candidate’s choice first, and then availability in the program of their choice. There is no second round for the match. Unmatched candidates are given information by their top-ranked program about programs who have unmatched positions and direct contact and arrangements are made on a one-on-one basis.

Maternal Fetal Medicine’s matching system is used by multiple programs around the country. Subspecialties such as Gynecologic Oncology and Gynecologic Reproductive Endocrinology & Infertility (GREI) have recently adopted this matching model with great success. Using the MFM match system has made it easier for the residents with their choices and it benefits the candidates and the institutions. It is gratifying to see a successful process shared with other disciplines. Collaboration at work! If you would like more information about the MFM Match please email us at specialtycommittees@royalcollege.ca



Save-the–Date: SCC Workshop

Specialty Committee Chairs Workshop – November 25-26, 2019

We are planning the 2019 Specialty Committee Chairs Workshop and we look forward to seeing you there.

We also have an opportunity for you to participate in shaping the workshop and agenda. Every year we establish a planning committee to ensure the workshop responds to chairs’ needs. If you are interested in participating in the planning committee or have questions about this opportunity, please email Chris Farley Ratcliffe, manager, Specialty Support (cfarleyratcliffe@royalcollege.ca).



Committee Appointments

The 2019-2021 appointment process is underway. If you are eligible for reappointment this year, please respond to the email you have received to verify whether or not you would like your appointment to be renewed for another term. If you are not continuing as chair, we will be in touch to seek your nominations for new committee chair.

Chairs of committees in the appointment process this year can review the terms of reference, policies and role descriptions in the committee member resource site to assist with succession planning and identifying nominees for vacancies. Please share the above links with people you are encouraging to volunteer on your committee or new appointees to your committee.

If you have any questions about your appointment status or nominations for committee members please send them to specialtycommittees@royalcollege.ca.



Chair and Specialty Committee Members’ Resource

The Specialties Unit home page has the same address and we encourage you to bookmark the appropriate Member Resource site for your committee:

Specialty Committee Member Resources
AFC Subcommittee Member Resources
AFC Committee Member Resources

The resources compiled on the Specialties Unit home page will help members navigate their volunteer role on AFC (diploma) or specialty committees. You’ll find everything you need to know about the functioning of the committee and its ongoing work to maintain its discipline standards. Additionally, information on the activities relating to the Committee on Specialties, accreditation, AFC application process, credentialing, and exams and assessment is housed here.

If you didn’t find something you were looking for on the site, please let us know. (specialtycommittees@royalcollege.ca).



2019 Federal Election Advocacy Strategy

The 2019 Federal Election offers an opportunity to engage with the federal political parties to advance issues of importance to Fellows, the Royal College, and the public. The Royal College will focus its advocacy efforts on four priority areas, which were approved by Council in February, 2019:

  1. Technology
    • Communications technology improves access to and the quality of health care, with particular emphasis on the health of people living in Indigenous, rural and remote communities.
    • Investing in a connected country will facilitate the leveraging of telemedicine, electronic consultations and referrals, as well as supporting the implementation and uptake of Electronic Health Records.
    • Sustained investment in technology – particularly broadband internet – is needed to increase access to high quality, life-saving specialty care, and patient engagement in healthcare.
  2. Pharmacare
    • No person should go without medical treatment because of cost. Experience from other countries suggests that a national pharmacare strategy is a viable, cost-effective, high impact way to improve health.
    • The development and implementation of a national pharmacare strategy requires input from a range of stakeholders, including physicians, surgeons, patients, care partners and decision makers.
  3. Advancing Research Careers
    • Basic, applied and systems-level research are critical to the development and enhancement of health, health care and the health care system. Research is also a strong economic driver, leading to the creation of high-quality jobs and investment in communities.
    • Diversity in research, including increased opportunities for Indigenous people, minority groups, and disadvantaged populations will lead to “more creativity, more innovation, and more meaningful research outcomes” (CIHR 2017).
    • Investment in research must focus on supporting sustainable health research careers, for all career stages.
  4. Advancing Reconciliation
    • The Truth and Reconciliation Commission Calls to Action asks that Canada’s future physicians be educated about Indigenous health issues. In 2017, the Royal College made the decision that Indigenous health will become a mandatory component of postgraduate medical education (PGME).
    • The Royal College is supporting the advancement of Indigenous health; our efforts are led and guided by our Indigenous Health in PGME Committee, Indigenous Health Committee and Indigenous organization partners.
    • The Federal Government will be a vital partner in the implementation of Indigenous Health in PGME – the government may be called upon to offer financial, advisory, program development and other supports.

The Royal College’s advocacy messages will be advanced through three main advocacy activities: engaging Fellows, engaging decision makers, and engaging the public. We are building resources to support Fellows in engaging with elected officials and election candidates, to leverage the knowledge and expertise of our Fellows. We are working hard to build a better, more equitable health system, and invite Fellows to get involved leading up to the 2019 Federal Election. For more information or to get involved, contact Steve Slade, Director, Health Policy & Advocacy at sslade@royalcollege.ca.



Upcoming Meetings and Deadlines 2019

  • Examination Committee – September 10-11
  • ICRE – September 26-28
  • Residency Accreditation Committee (Res-AC) – October 3-4
  • Credentials Committee – October 9
  • Council – October 23-25
  • Committee on Specialties – November 14-15
  • Specialty Committee Chairs’ Workshop – November 25-26, 2019


Early bird registration for ICRE 2019 is now open!

The wait is over! Online registration for the 2019 International Conference on Residency Education is now open.

Join more than 1,500 medical education leaders, clinical educators, program directors, residents and policy makers from around the world in Ottawa, Canada, September 26-28, for the world's largest conference devoted exclusively to advancing residency education.

This year's conference will:

  • explore the theme of Diversity in Residency Education: Training in a World of Differences
  • feature six plenary sessions, 21 learning tracks, 60+ workshops, and more than 200 paper and poster presentations
  • showcase the 5th edition of International Conference on Faculty Development in the Health Professions that brings together international faculty development leaders and educators to share best practices and current research in faculty.

Register for ICRE 2019

The early bird deadline for online registration is August 12, 2019.

We can't wait to see you in Ottawa!