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Areas of Focused Competence diploma discipline

The Royal College offers Areas of Focused Competence (AFC) diplomas, which are a specialized discipline of specialty medicine that address a legitimate societal need. But AFC diplomas do not meet the Royal College criteria for a specialty, foundation program or subspecialty.

AFC diplomas usually represent either supplemental competencies that enhance the practice of physicians in an existing discipline, or a highly specific and narrow scope of practice that does not meet the criteria of a subspecialty. In both scenarios, AFC diplomas are not meant to prepare physicians for practice, but rather to recognize areas of supplemental or advanced training.

Supporting the growth of specialty education with national standards of excellence while ensuring an appropriate blend of generalist and specialist physicians to meet the needs of Canadian society — without harming the existing system — is an ongoing challenge facing postgraduate medical education.

Discipline rationale

The AFC diploma category was developed to create national standards, not to replace specialists’ existing scopes of practice. Akin to current clinical fellowship or post-residency training, the category is intended to:

  • Help establish national standards for training and specialist competence, designed to improve quality of care and patient safety
  • Prevent unnecessary fragmentation of specialty training, care and practice by mitigating the recognition of subspecialties
  • Provide Fellows with additional opportunities to acquire nationally and internationally portable credentials — the Diploma of the Royal College of Physicians and Surgeons of Canada (DRCPSC)
  • Offer universities opportunities to enhance the academic environment

Key features

  • Equivalent to one to two years of additional training, but competency-based, not time-based
  • Typically built upon training in a broader discipline
  • Supported within the existing specialty committee of the primary discipline (unless one does not exist)
  • Assessed through a summative portfolio
  • Accredited according to new “C” standards with the process integrated with that of residency programs
  • Subject to an annual Diplomate dues fee and separate Maintenance of Certificate (MOC) requirements

DRCPSC recognition

Candidates who complete all of the requirements of an approved program and maintain their status as a Diplomate or Diplomate Affiliate of the Royal College receive an added qualification known as Diploma of the Royal College of Physicians and Surgeons of Canada, or DRCPSC.

Members with a DRCPSC are known nationally and internationally as individuals who have sought to advance their knowledge and expertise with additional complementary skills and competencies.

Current status

The Committee on Specialties considers new diploma applications twice a year, at its fall and spring meetings. As of October 2019, the Committee on Specialty Education of the Royal College has approved the following AFC diploma disciplines:

  • Acute Care Point of Care Ultrasonography
  • Addiction Medicine
  • Adolescent and Young Adult (AYA) Oncology
  • Adult Cardiac Electrophysiology
  • Adult Congenital Heart Disease
  • Adult Echocardiography
  • Adult Hepatology
  • Adult Interventional Cardiology
  • Adult Thrombosis Medicine
  • Advanced Heart Failure and Cardiac Transplantation
  • Aerospace Medicine
  • Brachytherapy
  • Child Maltreatment Pediatrics
  • Clinician Educator
  • Cytopathology
  • Hematopoietic Stem Cell Transplantation and Cellular Therapy
  • Hyperbaric Medicine
  • Patient Safety and Quality Improvement
  • Pediatric Urology
  • Prehospital and Transport Medicine
  • Retina
  • Sleep Disorder Medicine
  • Solid Organ Transplantation
  • Sport and Exercise Medicine
  • Transfusion Medicine
  • Trauma General Surgery