Specialty Committee Chairs’ Update

May and June 2022

Thank you to outgoing chairs

The Royal College and the Specialties Unit would like to thank the outgoing chairs of the specialty committees and AFC sub-/committees.  Leading volunteers is challenging, but the past two years have been especially challenging for every discipline, and we truly appreciate how every single volunteer that we work with continued to keep education a top priority among so many competing priorities.  Continued communications and effective leadership from the chairs played a critical role to ensuring committees continued to come together to complete time-sensitive work and share best practices and ideas to ensure that the impact to residency education was monitored and upheld the highest standards.  Canadian residency programs truly are world class, and we would like to thank you all for your steadfast leadership:

• Andrew Healey, MD, FRCPC, Acute Care Point of Care Ultrasonography
• Bradley Booth, MD, FRCPC, Forensic Psychiatry
• Cheryl Main, MD, FRCPC, Infectious Diseases
• George Dresser, MD, FRCPC, Clinical Pharmacology and Toxicology
• Ian Beauprie, MD, FRCPC, Pain Medicine
• Irene Sadek, MBBCh, FRCPC, Hematological Pathology
• Jacqueline Parai, MD, FRCPC, Forensic Pathology
• Justin Weinkauf, MD, FRCPC, Solid Organ Transplantation
• Lilian Gien, MD, FRCSC, Gynecologic Oncology
• Mark Bosma, MD, FRCPC, Geriatric Psychiatry
• Mary Wells, MD, FRCSC, General Surgery
• Najma Ahmed, MDCM, FRCSC, Trauma General Surgery
• Renda Bouzayen, MD, FRCSC, Gynecological Reproductive Endocrinology and Infertility

Even-year cycle appointments update

The specialty committees and Area of Focused Competence (AFC) sub-/committees that are on the even-year appointment cycle will start the new cycle on July 1, 2021.  Committee chairs have had the opportunity to review the voting membership for the upcoming cycle, and the majority of returning and new members are in place.  Please work with your specialty committee administrator to ensure that the vacancies are addressed before July 31, 2022.  It is important to have a full roster of engaged members who contribute expertise and experience for critical projects and tasks that affect your discipline.

Specialty Committee Chairs’ Workshop Update

The 2022 Specialty Committee Chairs Workshop will take place November 14 and 15, 2022.  A save-the-date has been delivered to your inboxes to hold the time in your calendars.  We have not confirmed whether the workshop will be in-person or a virtual event.  The Specialties Unit is working with our hotel partners in Ottawa, Ontario to obtain quotes for meeting and hotel room space, as well as quotes on the technology that will be available to allow for a truly hybrid event; all of which must fit within a reduced budget. Once we have the information, we need to make a decision, we will reach out to chairs and chair-elects over the spring and summer. Thank you all for your input into the needs assessment to help us identify the topics you want to learn more about during the 2022 workshop.

CanMEDS entrustable professional activity audit

The Royal College has undertaken a CanMEDS entrustable professional activity (EPA) audit over the past year.  The goal of this audit is to understand how the Intrinsic CanMEDS Roles are featured within a given disciplines’ newly developed EPAs.  In doing so, we hope to prompt specialty committee discussions about the design as well as methods of teaching and learning these Roles. This data may inform further refinements in the specialty education design to support the teaching and assessment of all CanMEDS competencies.

To-date, eight discipline reports have been generated that illustrates the spread of CanMEDS Roles represented by the collective milestones within a discipline’s set of EPAs.  The project aims to provide a high-level overview of the Roles, something that is not so easily seen when the EPAs are viewed in isolation.  A meeting was held with the specialty committee chairs for the eight disciplines in May 2022 and confirmed that the data generated was valuable and could provide further insight on how EPAs are developed and revised throughout the Competence by Design (CBD) curriculum development process.

For more information, or to request a report for your specialty, please contact us at canmeds@royalcollege.ca

Competence committee chairs’ forum at the International Conference on Residency Education

We encourage specialty committee chairs and program directors to spread the word about a full day of interactive and helpful sessions for competence committee chairs.  Topics range from the basics of setting up and running a competence committee, to longer-term considerations like maintaining engagement, ensuring professional development for committee members, continuous quality improvement (CQI), and other topics.

Targeted at the vital role of competence committee chairs, participants will work through typical scenarios and develop the skills to lead and support the work of a competence committee and discuss common challenges and strategies to manage those challenges.  The day is designed to encourage the sharing of resources and best practices and networking with your colleagues.

Space is limited so please share this information with your competence committee chairs as soon as possible.

You can register for this free workshop by clicking the following link: https://royalcollege.CCChairsForumICRE2022

Note – if you have already registered for ICRE and wish to join the forum please reach out to Megan McComb via canmeds@royalcollege.ca

New physician wellness report and recommendations

Now more than ever, physicians are at high risk of experiencing adverse effects on their health and well-being, including burnout.  Physician health and wellness was emphasized as a key competency in the 2015 CanMEDS Physician Competency Framework, and since then Leslie Flynn, MD, FRCPC, has taken this work further by leading a task force and advisory group into a deeper dive of physician wellness, in particular the physician wellness competencies within the Professional Role.  The work included:

• an environmental scan of wellness programming at Canadian medical schools for learners and faculty as well as existing wellness resources available through provincial and national physician organizations;
• a scoping literature review of evidence-based practices in physician health published between 2010 and 2018;
• regular meetings of both groups to ensure we were on track;
• repeated surveys with stakeholders;
• the presentation of the work at multiple national and international medical conferences;
• the development of a template to categorize information about existing and aspirational physician health practices in Canada; and
• a 2021 review of recommendations to include examples relevant to the COVID-19 pandemic and its challenges.

All of that work culminated in a report that includes a set of five guiding principles and fifteen recommendations with several examples of programming.  This work will be published in July so stay tuned to the Royal College’s social media and website.

For more information, contact us at canmeds@royalcollege.ca

Update from the Translation Unit

The translation team is proud to support excellence in translation for all CBD and specialties/AFC documents.  In 2021, the Translation Unit translated a total of eight new CBD suites, three new AFC suites, eight CBD suite revisions, and one AFC suite revision.  This effort that is not possible without the guidance and collaboration of French medical reviewers.

We look forward to continuing partnerships with expert Francophone members of the committees supported by the Specialties Unit.  We are available to discuss the review process if your discipline’s suite is currently in development and you are interested in doing the French linguistic medical review.  We welcome all feedback at cbdtranslation@royalcollege.ca

Area of Focused Competence Update

Our work continues to reform the AFC Program following the program evaluation in 2018.  We have made considerable progress with only three of the eleven enabling actions from the Management Action Plan (AFC PE MAP) remaining.  We expect our work on these three projects to be completed by the end of the year, if not sooner.  The following are highlights of some of our recent work to continue to develop and improve the AFC Program.  We encourage you to visit the SCC Update archives for previous updates on AFCs.

Getting to know the Royal College’s AFC Program

As we continue to reform and improve the AFC Program, there is continued interest from various stakeholders, as demonstrated by the growth in key areas.  Some highlights are as follows:

• 34 Royal College recognized AFC disciplines, which includes the recent approval of Spine Surgery, Adult Glomerular Diseases, and Neuromuscular Medicine by the Committee on Specialty Education (CSE).
• 26 AFC discipline-specific national standards, and two additional new suites of standards expected to be disseminated this spring/summer (Neonatal Hemodynamics and Targeted Neonatal Echocardiography and Pediatric and Perinatal Pathology).
• Of the 26 disciplines with ‘live’ standards:
  • 20 disciplines have 1+ accredited PGME training programs with a total of 63 accredited programs in Canada (all AFC disciplines combined)
  • 18 disciplines have open practice routes (PER-AFC) (4 portfolio-based and 14 reformed routes combined);
  • As of mid-May 2022, 189 candidates have achieved eligibility for the AFC credential, with 152 becoming Diplomates (DRCPSC).
  • 17 countries are now home to Royal College Diplomates, including Canad

Reformed practice routes (PER-AFC) continue to open

In early May, Trauma General Surgery opened their new practice route and the first Diplomate from the route has been recognized.

There are now a total of 14 new practice routes for AFC disciplines of which ten disciplines have assessed their first applicants, leading to 26 new Diplomates.  An additional seven disciplines are in the final stages of developing application documents and the routes are expected to open later this year.  The list of AFC disciplines with new practice routes is available on the website, along with instructions on how to apply.   We encourage you to bookmark this page for future reference and sharing with colleagues.  Please contact Tiffany Lynch with any questions about developing the required discipline-specific application documents or how to apply.

Our work to reform the practice route is one of the remaining enabling actions from the MAP and will be complete when the remaining four portfolio-based practice routes for AFCs are closed (and the new routes open (Adult Cardiac Electrophysiology, Transfusion Medicine, Aerospace Medicine, and Adult Hepatology).

Training modules for CanAMS users

Following the launch of CanAMS for AFCs last July, user training is being provided on an as-needed basis to AFC Committees and is based on the receipt of applications for new programs and scheduled accreditation reviews. Additional training resources are being developed this summer and are expected for fall 2022. At that time, this enabling action will be complete and AFC accreditation will be fully operational in its reformed state.

Please refer to the section below for more information about AFC accreditation

New resource kit for AFC stakeholders – Promoting the AFC Credential

Over the past year we have been meeting with AFC committees to discuss how best to increase the visibility of AFC disciplines.  Since then, we’ve compiled your feedback and ideas, and created a kit of resources to assist with this work.  The kit includes a customizable presentation deck that can be used for various audiences, a list of strategies that you are considering or using, and a template recruitment letter to share with potential applicants for the practice route.  At the time of submitting this update for publication, the kit is at translation and is being prepared for distribution.  We will email you the kit directly and it will also be available on the AFC resource page.

Thank you to the chairs and committee members who piloted early versions of the presentation deck at meetings of your national specialty societies, and the feedback you provided.  You have helped us improve this resource. We’ve also noticed that after each presentation there is an increase in the number of requests for information and PER-AFC application packages.  Together we are making AFCs more visible!

Full implementation achieved!

Congratulations to the AFC Committee in Trauma General Surgery for completing the steps to implementation, opening both the in-training and practice eligibility route for the discipline in late spring.

There are currently 26 AFC disciplines whose standards have been disseminated and are considered ‘live’ (available in the Information by Discipline database). Of the 26 AFC disciplines that are live, 16 are fully implemented (or 62%).

Committee on Specialties special review of AFCs

The second cohort of disciplines to undergo a special review was considered by the Committee on Specialties (COS) in April (Acute Care Point of Care Ultrasonography, Aerospace Medicine, Adult Thrombosis Medicine, Advanced Heart Failure and Cardiac Transplantation).

In November 2022, COS will review the last scheduled cohort of disciplines to undergo a special review (Hematopoietic Stem Cell Transplantation and Cellular Therapy).  Shortly thereafter, a final report on the special review will be prepared for COS and will include COS’ findings and decisions, key themes from the consultation with fully implemented disciplines, as well as recommendations to improve implementation processes for stakeholders and operational units.  Stakeholders can expect a briefing on the special review following COS’ consideration of the report.

Questions? Feedback? Let us know!

Our virtual doors are open! Please do not hesitate to contact the AFC program manager, Linda Rumleski, with questions or feedback.

Accreditation Update

Regular Accreditation Reviews

The regular accreditation review of the University of Manitoba took place in a virtual format on March 20 to 25, 2022.

Post-accreditation review input was collected from specialty committees following the Northern Ontario School of Medicine (NOSM) regular review in November 2021.  This input was considered at the Residency Accreditation Committee (Res-AC) meeting in May 2022, to inform the final accreditation decisions for NOSM and its programs.

The Royal College is exploring the possible use of a hybrid/in-person model for the upcoming regular review of the University of Calgary in the fall if public health restrictions allow.  All external reviews continue to be delivered virtually.

Upcoming Regular Accreditation Reviews

University	Review Date	Res-AC Review Date
University of Calgary	September 18-23, 2022	Spring 2023
Université de Sherbrooke	April 2023	Fall 2023
McMaster University	May 2023	Fall 2023

Impact of COVID-19

The Canadian Residency Accreditation Consortium (CanRAC) continues to adapt accreditation activities to optimize operations despite the impact of COVID-19.  So far, regular reviews of the University of Toronto, l’Université de Montréal, NOSM, and the University of Manitoba were successfully conducted virtually.  CanRAC has adopted several modifications to the accreditation process that will continue post-pandemic, including the virtual delivery of some aspects of accreditation (e.g., surveyor training).  As the three Colleges begin to resume some in-person activities in the coming months, CanRAC will identify opportunities for hybrid and/or in-person delivery of accreditation activities in collaboration with volunteers and accreditation stakeholders.

Building on the considerations that were used in the beginning of the pandemic to guide the virtual delivery of accreditation activities, and incorporating discussions with a variety of stakeholders, the Royal College Accreditation Committee (Res-AC) has put together a draft set of principles and guidelines for the virtual delivery of accreditation activities.  These will be brought forward to all the accreditation subcommittees under the purview of the Res-AC and used to inform decisions about future virtual accreditation activities.

Equity, Diversity, and Inclusion (EDI)

The conjoint Accreditation Working Group on Anti-Black Racism (led by Black residents and faculty and chaired by Dr. Kannin Osei-Tutu, MSc, MD, CCFP) and the Indigenous Health in Specialty Postgraduate Medical Education Accreditation Expert Working Group (chaired by Dr. Ryan Giroux, MD, FRCPC) have drafted a set of recommendations for changes to the General Standards of Accreditation for Institutions with Residency Programs.

Members of the Royal College Residency Accreditation Committee (Res-AC), the College of Family Physicians of Canada (CFPC) Residency Accreditation Committee (RAC), and the Collège des médecins du Québec Comité de l’éducation medicale et de l’agrément (CÉMA) had the opportunity to discuss these detailed recommendations at their May 2022 committee meetings. These detailed recommendations will now be brought forward to the conjoint Accreditation Standards Improvement Committee (ASIC) in May 2022 for preliminary discussion on how to integrate and implement the recommendations.

Canadian Excellence in Residency Accreditation (CanERA)

Specialty committee members are encouraged to visit the CanERA website (www.canera.ca), to access the general standards, frequently asked questions (e.g., CBD in the context of accreditation), and other CanERA-specific information that may be of interest.

Revising the specialty committee processes

As a part of the ongoing commitment to continuous improvement and in response to feedback and challenges with the current process, Royal College staff have prioritized work focused on improving the process for gathering specialty and AFC committee input into the accreditation process. The Educational Standards Unit is aiming to pilot some components of the new process in June 2022 and will be reaching out to specialty committee chairs soon with more information and a request for volunteers to participate in consultations and pilot testing.

Update to the General Standards of Accreditation

The Accreditation Standards Improvement Committee (ASIC) has begun meeting to inform the next update to the General Standards of Accreditation for Institutions with Residency Programs and the General Standards of Accreditation for Residency Programs, scheduled for July 1, 2023.  ASIC will be incorporating recommendations from the Accreditation Working Group on Anti-Black Racism, the Indigenous Health in Specialty Postgraduate Medical Education Accreditation Expert Working Group, the Institutional Oversight of Assessment Decision-making Working Group, and the Royal College Physician Wellness Task Force.

Area of Focused Competence (AFC) Accreditation

The new accreditation system for AFC programs was fully launched on July 1, 2021. This includes new standards, processes, and the use of the digital accreditation management system, CanAMS, for all accreditation activities thereby further aligning AFC accreditation with the processes and platform already in place for PGME institutions and residency programs.

An FAQ regarding the changes is available on the Royal College website, including a link to the new general standards of accreditation. The new discipline-specific standards of accreditation for each AFC are available through the Information by Discipline database.

New Program Application Deadlines    

AFC program applications will be reviewed by the AFC-AC according to the table below.

Application Submission Deadline	AFC-AC Review Date
May 31, 2022	Fall 2022
October 15, 2022	Winter 2023
January 31, 2023	Spring 2023

 AFC Programs

There are currently 63 accredited AFC (diploma) programs that have been approved by the Areas of Focused Competence – Accreditation Committee (AFC-AC) in 20 disciplines. These programs are in the following disciplines:

• Acute Care Point of Care Ultrasonography (4),
• Addiction Medicine (3),
• Adult Cardiac Electrophysiology (6),
• Adult Echocardiography (5),
• Adult Hepatology (3),
• Adult Interventional Cardiology (9),
• Adult Thrombosis Medicine (3),
• Adolescent and Young Adult Oncology (1),
• Brachytherapy (3),
• Child Maltreatment Pediatrics (2),
• Clinician Educator (2),
• Cytopathology (4),
• Hyperbaric Medicine (1),
• Pediatric Urology (1),
• Prehospital and Transport Medicine (1),
• Retina (2),
• Sleep Disorder Medicine (3),
• Solid Organ Transplantation (5),
• Transfusion Medicine (3), and
• Trauma General Surgery (2)

International Residency Accreditation

Through the Royal College International (RCI), our more than 20 international partners may apply for consultation, recognition, or accreditation services for their institutions and programs. There are currently six international accredited institutions in five countries. Residency programs under the jurisdiction of these institutions are eligible to apply for Royal College accreditation. There are currently 3 accredited programs, with several additional applications that are still in progress or under review. Aligned with the processes for accreditation in Canada, international partners have been brought on to CanAMS and several institution-level reviews have been conducted with the new system.

International Residency Program Accreditation Application Process

The international residency program accreditation application two-step process 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 program profile instrument 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.