Specialty Committee Chairs’ Update – May and June 2021

Mid-year Specialty Committee Chairs’ Update Webinar

The mid-year update call took place on May 31, 2021. A topic of discussion was the future of meetings at the Royal College. There is no firm date set yet for the possibility of a return to in-person meetings. The Royal College is monitoring public health guidelines, but the Specialties Unit is currently planning for a potential return to in-person meetings in early 2022. As we continue on virtually for now, the Royal College is in the process of assessing technology available in each meeting space, and upgrading where necessary to enhance our capacity to support high-quality hybrid meetings.

The Royal College has established a working group that will be tasked with developing a guidance policy that will be referenced to determine whether a specific meeting should be virtual, in-person, or hybrid. Once that guidance document is ready we will share it with committee chairs for review. During the call, committee chairs in attendance provided feedback on the factors that will need to be considered in determining meeting format:

• Travel/public health restrictions
• Meeting content - with a preference to discuss difficult issues in-person.
• Meeting length and amount of content to be covered.
• Member engagement and networking.
• Considerations of cost and carbon footprint of travel.
• Intent of the meeting – educational/informational/document development/’working meeting’.
• Equity, with a focus on whether all Members are able to attend and participate (e.g. travel, time of day, audio/video quality)

We asked about the possibility of continuing with virtual meetings only and not returning to in-person meetings. The majority of respondents indicated they did not favour that option and would strongly oppose the lack of in-person or hybrid options. There was some feedback about the value of enhancing our virtual meeting platform options and the tools available for virtual work between meetings.

The Specialties Unit is working to determine how to best-support hybrid meetings in the future given that the expectations will have changed from the way the hybrid meetings operated before. Previously all committee meetings (with the exception of Competence by Design (CBD) workshops) allowed members to dial in remotely and follow along with the administrator screen sharing. We collected feedback on the call about the kinds of support that committee chairs felt was needed for hybrid meetings, and the input will be incorporated into our planning. We will provide an update at the Specialty Committee Chairs’ Workshop in November; which will again be offered virtually.

CBD workshops will not be hybrid meetings in the future – the staffing levels required to support a fully-virtual CBD workshop are immense. The workshops will return to in-person sessions when that is possible.

If you have ideas or questions about virtual/hybrid/in-person meetings please send them to specialtycommittees@royalcollge.ca.

Thank you

The following committee chairs will be ending their terms as of June 30, 2021. Thank you to all of you for all of your time, energy, enthusiasm and contributions to your disciplines over your years of committee leadership.

• David Salisbury, MD, FRCPC, chair, Area of Focused Competence Committee in Aerospace Medicine
• Brian Clarke, MD, FRCPC, chair, Area of Focused Competence Subcommittee in Advanced Heart Failure and Cardiac Transplantation
• Sheri Findlay, MD/CM, FRCPC, chair, Specialty Committee in Adolescent Medicine
• Hélène Pellerin, MD, FRCPC, chair, Specialty Committee in Anesthesiology
• Alain Gagnon, MD, FRCSC, chair, Specialty Committee in Maternal-Fetal Medicine
• Harish Amin, MD, FRCPC, chair, Specialty Committee in Neonatal-Perinatal Medicine
• Maury Pinsk, MD, FRCPC, chair, Specialty Committee in Nephrology
• Brian Murray, MD, FRCPC, chair, Specialty Committee in Neurology
• William Morrish, MD/CM, FRCPC, chair, Specialty Committee in Neuroradiology
• Vivek Mehta, MD, FRCSC, chair, Specialty Committee in Neurosurgery
• Wayne Matthews, MD, FRCSC, chair, Specialty Committee in Otolaryngology – Head and Neck Surgery
• Lucia Carpineta, MD, FRCPC, chair, Specialty Committee in Pediatric Radiology
• Jennifer Yao, MD, FRCPC, chair, Specialty Committee in Physical Medicine and Rehabilitation
• Douglas Ross, MD, FRCSC, chair, Specialty Committee in Plastic Surgery

Thank you!

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Committee on Specialties

At the spring 2021 Committee on Specialties (COS) meeting, which took place virtually on April 15-16, 2021, the following outcomes were determined:

Recognition of disciplines: Areas of Focused Competence (AFCs)

The COS considered and approved the following application for recognition as an AFC discipline:

• Spine surgery (Part I)

The next deadline for interested AFC applicants to apply for Part I review is September 1, 2021, for consideration during the fall 2021 meeting. We strongly encourage applicants to submit draft documents well in advance to cos@royalcollege.ca, so that our office and senior clinician staff can review them and provide guidance, as needed.

Dispute Adjudication

In cases where disputes arise between discipline recognition applicants and existing disciplines regarding overlaps in scope of practice and standards of training, the COS will act as the adjudicating body to resolve the issue. Their recommendation is subsequently considered by the Committee on Specialty Education (CSE), for final decision.

The COS considered a request for adjudication, submitted by applicants pursuing recognition for neuromusculoskeletal point of care ultrasound. Ultimately, the COS and CSE determined that the application to recognize neuromusculoskeletal point of care ultrasound could not proceed though the recognition process, without formal support from the Specialty Committee in Diagnostic Radiology.

Discipline reviews

Eight discipline reviews were conducted during the spring 2021 meeting, consisting of six regular reviews and two monitoring reports:

• Anesthesiology
• Nephrology
• Geriatric Medicine
• Medical Genetics and Genomics
• Pain Medicine
• Solid Organ Transplantation
• Neurosurgery
• Gynecologic Oncology

The next COS meeting will be held virtually on November 4 and 5, 2021

Accreditation Update

Regular Accreditation Reviews

The regular accreditation review of the University of Toronto, which was conducted virtually in late 2020 and for which specialty committee post-review input was collected in the spring, was considered at the Residency Accreditation Committee (Res-AC) meeting in May 2021. The final accreditation decisions for University of Toronto and its programs have been rendered.

The regular accreditation review of the Université de Montréal was conducted virtually in March 2021 and the post-accreditation review input will be sought from specialty committees in late summer. This input will be considered at the Res-AC meeting in October 2021. The next regular accreditation review will be the Northern Ontario School of Medicine, also to be conducted virtually, in fall of 2021.

Impact of COVID-19

The Canadian Residency Accreditation Consortium (CanRAC) continues to meet frequently to adapt to the impact of COVID-19 on accreditation activities. Following a successful pilot test of the remote delivery of external reviews, the regular accreditation reviews of the University of Toronto and the Université de Montréal and their residency programs have been conducted virtually. This was a major collaborative effort between the Royal College, the College of Family Physicians of Canada, the Collège des medicines du Québec, as well as the universities and their stakeholders and the many volunteers who participated as accreditation surveyors and specialty committee members.

CanRAC is conducting a thorough evaluation and will use those results, along with observations and direct feedback from staff and stakeholders, to continue to improve the remote delivery of accreditation and to monitor when accreditation activities may return to an in-person delivery.

Canadian Excellence in Residency Accreditation (CanERA)

To support the ongoing transition to CanERA, an interactive online training module specific to specialty committee members is available at www.canera.ca under the Training, Tools and Support tab. Efforts are also underway to develop and pilot additional training to support specialty committee members.

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

Area of Focused Competence Accreditation

A pilot test of the new accreditation system for AFC programs was implemented during the regular review of programs at the University of Toronto and the Université de Montréal. Feedback from this test is informing further development of resources ahead of the full launch of the new standards and processes on July 1, 2021. 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.

CanAMS access for accredited AFC programs

As we approach the full launch on July 1, 2021, the Royal College will begin deploying CanAMS, the new digital accreditation management system, for all remaining AFC programs. The Educational Standards Unit (ESU) will be reaching out to AFC program directors and administrators with information about CanAMS accounts, timing, and additional instructions. In the meantime, please refer to our website or the FAQ for further guidance.

New Program Applications

Beginning in May, the Royal College will be providing access to the new application instruments in CanAMS, by request, for AFC program applicants who wish to start working on applications in the new system. These applications can only be submitted on or after July 1, 2021. The final deadline for “old world” applications is June 30, 2021.

Applications will be reviewed by the Areas of Focused Competence – Accreditation Committee (AFC-AC) according to the table below:

	Application Submission Deadline	AFC-AC Review Date
“Old world” application	June 30, 2021	Fall 2021
“New World” applications	October 15, 2021	Winter 2022
	January 31, 2022	Spring 2022
	May 31, 2022	Fall 2022

AFC Programs

To date, 47 applications for accreditation of an AFC program have been approved by the AFC-AC. These programs are in the following disciplines:

• Acute Care Point of Care Ultrasonography (2),
• Addiction Medicine (2),
• Adult Cardiac Electrophysiology (6),
• Adult Echocardiography (5),
• Adult Hepatology (3),
• Adult Interventional Cardiology (8),
• Adult Thrombosis Medicine (3),
• Adult and Young Adult Oncology (1),
• Brachytherapy (1),
• Child Maltreatment Pediatrics (2),
• Clinician Educator (2),
• Cytopathology (4),
• Hyperbaric Medicine (1),
• Pediatric Urology (1),
• Sleep Disorder Medicine (1),
• Solid Organ Transplantation (4), and
• Trauma General Surgery (1)

In addition, there are 3 accredited AFC (diploma) programs in Transfusion Medicine that transitioned from an Accreditation without Certification (AWC) program in 2012. Thus, in total, there are 50 accredited AFC programs.

International Residency Accreditation

There are currently seven 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 ten international program applications in six disciplines have been submitted. The current status is:

• Three New Accredited Programs (Anatomical Pathology (1), Internal Medicine (2))
• Three programs with Accreditation in Progress in status (Surgical Foundations (1), Pediatrics (2))
• One program with Deferred status (i.e., additional information is required within one year before proceeding to an onsite review) (Emergency Medicine)

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 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.

Competence Committee Chairs Forum

Competence committees play a vital role in supporting resident learning for programs that have implemented Competence by Design (CBD). CBD program evaluation data illustrates the desire for collaboration nationally to share common challenges.

In recognition of the important role that competence committees play in postgraduate medical education, the Royal College is hosting a series of free 90-minute virtual events to foster online learning and connection for competence committee chairs. Each virtual session includes a presentation on trending topics and moderated breakout room discussions targeted at level/need. These events are designed to answer questions, identify common challenges, and share ideas.

The next virtual session will be held on Wednesday, September 22, 2021 from 1100 to 1230 eastern daylight time. For more information, please contact canmeds@royalcollege.ca

Area of Focused Competence Program Evaluation and Reform of the Discipline Category

Since the completion of the program evaluation of the AFC category in late 2018, we have been working to implement the four recommendations approved by the CSE. Now into our second year of reform, we have made significant progress on operationalizing the enabling actions, with many of them already complete or close to completion. We encourage you to visit the SCC Update archives for detailed information about our work on each recommendation as we’ve chosen to provide an abbreviated update for the summer edition of the SCC Update. We will report fully on each outstanding enabling action in September. The following reports progress since April this year:

The in-training route

The new model for the in-training route marked an end to external assessment of portfolios and the phasing out of the digital assessment platform, eDiploma.

• Based on feedback received from stakeholders when the new model was launched, we are considering whether to permit former trainees from accredited programs to come forward for the credential through their training program. Feedback received from AFC directors and chairs during the informal consultation this spring indicated there would be interest and value in pursing this change. As such, a revision to the in-training policy will be shared with the CSE on June 10 for decision. If approved, the change will be operationalized for July 1, 2021, and be in effect until July 1, 2023. More information will be provided to stakeholders following the decision by CSE.
• The development of a shuttering plan for eDiploma has been delayed slightly but will resume in late-June. No new users are permitted to enrol in the platform and the vast majority of those already enrolled no longer use it, having completed training in the new model of assessment. The shuttering plan will however take into consideration those programs who requested continued access to eDiploma for current trainees when the new model was launched. We wish to assure stakeholders that the shuttering plan will include a significant phase-out period, providing ample time for users to extract files from the platform. We will be reaching out to you for feedback on the shuttering plan prior to finalization and implementation.

Last month we created a new in-training route web page, which provides key information for Trainees seeking the AFC credential through an accredited program. We invite you to direct any Trainees to the page and welcome your feedback on the content.

Additional information about the new model of assessment for the in-training route as well as supports for accredited programs and trainees are available on the AFC Committee Resource site.

The practice eligibility route for AFCs

The new model of assessment for the practice route (PER-AFC) was launched in July 2020. As of mid-May, more than three quarters of the 23 disciplines in the first cohort of disciplines to begin development have submitted documents for review by the Credentials Unit. Of these disciplines, four opened their new routes this spring, and another three-to-four are expected to open by the end of June. Based on the current rate of development, we anticipate that a majority of disciplines in the first cohort will have new routes before the end of 2021. The Credentials Unit will continue to review submitted documents in the coming months and will be contacting chairs of these disciplines to coordinate. Disciplines in the working group phase make up the second cohort, and will be on-boarded to the new practice route following dissemination of their national standards and the transition to becoming a new, full AFC Committee.

We are also pleased to share with you that the web page for PER-AFC has been updated and includes information for specialists wanting to apply for the credential through the route. We welcome your feedback on this new practice eligibility route page and any suggestions for improvement.

Accreditation reform

As previously reported, the revised general standards of accreditation will apply to all AFC programs after July 1, 2021, and are available on the New Areas of Focused Competence (AFC) Accreditation System web page (see the section titled “What expectations do programs need to meet?”).

All AFC disciplines have now had their existing discipline-specific AFC Standards of Accreditation (AFC-SA) converted into the new format and are available on our Information by Discipline page.

With regards to applications for new accredited programs, prospective applicants are advised to consult with their postgraduate medical education (PGME) offices. PGME offices will coordinate timelines with the Educational Standards Unit if an application is being developed. As of July 1, 2021, with the launch of CanAMS, the new digital accreditation management system, applications for new programs will be submitted through the platform. ESU is available to answer questions from PGME offices about this new process and will provide training to any AFC committee who require access to make a recommendation on a new application or the regular review of a site.

An AFC campaign and communications plan

The new AFC campaign that seeks to increase the profile and value of the credential among stakeholders soft launched at the end of April. Working with Ken LeDez, MD, FRCPC, chair of the AFC Committee in Hyperbaric Medicine, an article on how AFCs build strong standards for emerging disciplines was published in both Touchpoint and Dialogue. We are pleased to report the article was read by nearly 2500 Fellows. Other articles in the series are planned for early July and September and we are optimistic about the expected reach for this content.

The new resource kit for AFC committees on promoting the AFC credential is in developed but has been delayed. Work will resume on this product in late June and will be made available as soon as is possible. We also anticipate that the new AFC landing page, a one stop shop for all AFC content, will go live in early summer.

Supports

Changes to simplify and streamline the discipline recognition and national consultation processes are underway. Several initiatives, including a new application form for AFCs, began being piloted in spring 2020 with the intention of managing and monitoring their impact through fall 2021 in order to allow a diverse group of applicants the opportunity to provide feedback.

Our work continues to identify opportunities to build expertise and capacity among stakeholders, with the current focus being how to ensure stakeholders remain informed and are a part of the proposed changes. And as we continue to explore new ways to connect with you, we welcome any ideas you’d like share or suggestions to help us improve. Let us know how we are doing or what’s on your mind by contacting the AFC program manager, Linda Rumleski.