Specialty Committee Chairs’ Update

September and October 2023

Table of contents

1. Specialty Committee Chairs’ Workshop
2. Committee mandate review
3. Creating collaborative spaces for committees
4. Competence by Design Summits Series update
5. Update on the CanMEDS Project
6. Indigenous Health Foundations Curriculum
7. Accreditation Update

Specialty Committee Chairs’ Workshop   

We’re looking forward to connecting with all of you at the annual Specialty/AFC Committee Chairs’ Workshop on November 13 and 14.  The event this year is virtual.  If you don’t have the event details in your calendar, please reach out to your administrator to let them know.  The agenda is attached to the event invitation and is also available on the SharePoint site we have created for committee chairs. All the workshop resource materials will be posted to this site. 

The focus of the event this year is to hear from you.  We will be consulting with you about your specialty and AFC committees, the evolution of Competence by Design (CBD), the Area of Focused Competence (AFC) operational review and we’ll also be providing guidance on standards revisions related to CBD, CanMEDS and updates driven by your committees.

Committee mandate review

We are reaching out to you to explore your experiences and your reflections on the mandate of the specialty and AFC committees, the enablers and challenges you encounter undertaking your work, and the opportunities you see for 2024and beyond. 

Specialty and AFC committees are critical to the system of specialties and to achieving the important work of the Royal College. We also believe the role of your committee and the need for discipline-specific expertise may have evolved somewhat since the last formal review of the Terms of Reference in 2016.  In addition, as more and more disciplines are recognized, the Royal College must ensure our approach to supporting your important work is appropriate.   As such, we’d like to check in to ensure your committee structure is optimized to meet the evolving needs of the system of specialties and the mandate of the Royal College, all while fostering an unparalleled contributor experience for you and your colleagues as well as supporting staff wellness and morale.

We will be holding a consultation session on the mandate of, and support offered, to specialty and AFC committees at the upcoming Specialty Committee Chairs’ Workshop.  

Alternatively, you are welcome to reach out to your administrator to discuss your feedback one-on-one, and your input will be shared with the team planning the consultation.

The data we compile from the survey will serve as a springboard for our discussions during the workshop. We will be in touch after that session with the outcomes of our work together.

If you have any questions, please contact Chris Farley Ratcliffe, manager, Specialty Support (cfarleyratcliffe@royalcollege.ca), or Lisa Gorman, associate director, Member Experience (ljgorman@royalcollege.ca) 

Creating collaborative spaces for committees

As part of our ongoing effort to facilitate the interactive, collaborative work you and your committees do, we are creating SharePoint pages for each of your committees.  These sites will provide a place to house your committee documents like meeting minutes and materials and will offer collaborative document working spaces and communication tools. 

We want to ensure we are set up for success, so we are doing this as a pilot process.  Initially, one committee will be set up per committee administrator to help us determine the best design for the sites and the staff resources required to set them up.  We will then determine a roll out timeline to set them up for all committees in the coming months. If you are interested in being an early adopter of these new tools, please let your administrator know so we can prioritize your committee in the roll-out schedule.  

Competence by Design Summit Series update

Following the Commitment to Action issued by Royal College leadership in May 2023, the Royal College is in the middle of three national summits over a 12-month collaborative process to reimagine the evolution of CBD and continue towards its goal to enhance residency training across Canada.  

The second summit was held in-person at the Royal College in Ottawa, Ontario September 18 and 19, 2023.  The summit brought together the Royal College’s CBD Steering Group withy system partners for ‘deep dive’ discussions on potential adaptations to CBD, with the goals of:

• Increasing flexibility while maintaining accountability;
• Decreasing the assessment burden for trainees;
• Enhancing ‘in-the-moment’ and longitudinal feedback and coaching; and
• Decreasing performance orientation to create space for desired feedback and coaching opportunities.

In striving toward these goals, participants also considered the resource implications and constraints of the medical education system, the shared, system-wide responsibility for solutions, and the recognition that there will not be a ‘one-size-fits-all’ approach to CBD>=.

The path forward

A detailed consolidation of the second CBD summit will be circulated in November, including potential shared workflows and supports, as a draft ‘Call to Action – Options for Change’ document.  Specialty committee chairs will have the opportunity to provide feedback to inform the co-development of recommendations prior to the third CBD summit, currently being planned for early 2024.  The Royal College is committed to optimizing previous work completed by the specialty committees – not changing the fundamental model – and exploring enhanced supports and resources.  Hear more about this work in a dedicated session during the Specialty Committee Chairs’ Workshop on November 13 and 14, 2023.

Update on the CanMEDS Project 

The intention of the CanMEDS Project is to refresh the CanMEDS framework to broadly define a competent physician throughout a physician’s career with emerging themes relevant for today’s physicians.  A guiding principle of the CanMEDS Project is foster diversity and inclusivity, starting with the recruitment of the CanMEDS Expert Working Groups (EWGs) and engagement with the National Advisory Board and the Steering Committee. 

At this stage of the project, we are hearing that the intention is not manifesting as fully as hoped and planned.  In the spirit of unlearning and relearning, we recognize that the CanMEDS Framework requires more than a refresh.  It will require thinking differently and re-envisioning both our processes and the resultant refreshed CanMEDS Framework.  

What has been done so far?

Over the first half of 2023, the 13 EWGs have considered how the emerging concepts could be integrated into the CanMEDS Framework.  They have produced an interim report in the summer of 2023 and most of the Role EWGS have presented a revised set of key and enabling competencies. Role-specific ePanelists reviewed and commented on the work of the EWGs.

An Open Call

We recently launched an open call for feedback on the CanMEDS competency framework.  Our hope is to hear from a range of diverse voices and provide everyone with the opportunity to provide input into what they feel should be included in the updated framework.  We are coming into this space with an open hand, ready to hear and learn.  As part of the open call, we will be reaching out to all physicians, learners, and those impacted by the CanMEDS framework (other healthcare disciplines, patients, organizations), for feedback. In this open call, we will be asking:

1. Are we on the right track?
2. Is there something we are missing?
3. Can you provide guidance as to where we should be headed?

How can you help?

As specialty committee chairs, we want to hear your thoughts and perspectives.  We encourage you to look at the collated reports and themes from the EWGs and then submit position papers/statements, concerns, questions, feedback, or content that you feel is essential to a CanMEDS re-envisioning.

Action items

1. We would ask that you kindly circulate this request within your spheres of influence.
2. We ask that you respond to the open call request by December 31, 2023.

Your feedback will be analyzed and considered in the creation of the CanMEDS framework.  We will ask for feedback again in a second round of consultations once a draft of the re-envisioned framework is available in mid-2024. 

We are not asking you to give us feedback on the documents, per se. We want you to tell us what is important to you; what will allow you to bring your authentic self to the new CanMEDS framework.

Please share your thoughts with us by responding to the open call, or by email at CanMEDSproject@royalcollege.ca

Indigenous Health Foundations Curriculum

The Office of Indigenous Health (Royal College) and the Indigenous Health Committee (IHC) has released a new ‘ready-to-teach’ postgraduate medical education (PGME) workshop called Indigenous Health Education – Foundations.  The workshop has been developed to address the gaps in knowledge of Indigenous history and an understanding of the impacts of ongoing colonization and colonial systems on the health of Indigenous Peoples in Canada.  It is meant to be an introduction to Indigenous Health and to provide a foundation upon which residents/physicians can build their knowledge and skills in practicing cultural humility and culturally safe care throughout their residency/practice.

The Indigenous Health Foundations workshop helps institutions and programs meet upcoming General Standards of Accreditation standards regarding equity, diversity, and inclusion (EDI).  The workshop is also a step towards fulfilling the Truth and Reconciliation Commission’s Calls to Action, particularly those that focus on ensuring health care providers nurture and demonstrate cultural safety in medical education and practice.

Please visit the Office of Indigenous Health web page to learn more and to download the contents of the workshop, including:

• Facilitator guide
• PowerPoint deck
• Pre-Workshop activities (for participants)
• Indigenous Health vignettes
• Workshop evaluation survey (for participants)
• Workshop evaluation survey (for facilitators)

Please feel free to share this resource widely as it is applicable to all PGME programs.  For more information, contact the Office of Indigenous Health at indigenoushealth@royalcollege.ca.

Accreditation Update

Regular accreditation reviews

The regular accreditation reviews of the l’Université de Sherbrooke and McMaster University were conducted in-person in March and May, respectively. This unusual occurrence of having two back-to-back regular reviews was the result of catching up on timelines that were modified or extended during the peak of the COVID-19 pandemic. We recognize the workload impact of this modified schedule, and sincerely appreciate the significant work of the specialty committees in providing double the amount of pre- and post- accreditation review input along with the continuing volume of external reviews. Post-accreditation review input from the specialty committees was considered at the Residency Accreditation Committee (Res-AC) meeting in October.  

Upcoming regular reviews

The next regular accreditation review will be the University of Saskatchewan at the end of November. Pre-accreditation review input was sought from specialty committees in early October, and post-accreditation review input will be sought in early 2024 for consideration at the Res-AC meeting in May. Subsequent regular reviews are noted in the table below.

University	Review Date	Res-AC Review Date
University of Saskatchewan	November 2023	May 2024
University of Ottawa	May 2024	October 2024
Memorial University of Newfoundland	November 2024	May 2025

Upcoming follow-up reviews

In addition to the regular reviews noted above, special committee input is also an integral part of the evaluation of follow-up external reviews and Action Plan Outcome Reports (APORs). Not all programs require an external review or APOR; such follow-up is decided by the Res-AC based on the recommendation of surveyors and input of specialty committees. Programs may have different “off-cycle” follow up deadlines based on the timing of their last regular review, if the program was inactive and subsequently re-activated, and/or if it is a newly approved program undergoing its first external review. Specific programs undergoing follow-up by external review or APOR are communicated to specialty committee chairs on an ongoing basis as input is sought. As the Royal College is in the midst of transitioning to new technology platforms, the accreditation team continues to look for more efficient ways to communicate upcoming activities and deadlines to specialty committee chairs and administrators.

Anti-Racism Initiatives and Equity, Diversity and Inclusion

As previously shared, priority initiatives related to anti-racism and EDI are well underway in collaboration with accreditation partners at the College of Family Physicians of Canada (CFPC) and the Collège des médecins du Québec (CMQ). Proposed revisions to the general standards of accreditation have been developed, with particular input from two key groups are driving the first wave of changes: the conjoint Accreditation Working Group to address Anti-Black Racism (AWG-ABR), led by Black residents and faculty and chaired by Kannin Osei-Tutu, MSc, MD, CCFP; and the Indigenous Health in Specialty Postgraduate Medical Education Accreditation Expert Working Group (IH-EWG), chaired by Ryan Giroux, MD, FRCPC.

The accreditation committees of the three CanRAC colleges are currently reviewing the draft changes and will have the opportunity to vote on the revision this fall. Based on discussion at the committees and input from many key partners, including the specialty committee chairs at last year’s workshop and the mid-year webinar, the revisions will focus primarily at the institution level (i.e., via revisions to the General Standards of Accreditation for Institutions with Residency Programs) with limited changes to the program standards at this time. If approved, the next steps would be to continue to refine and broaden the approach to anti-racism, anti-oppression, and anti-discrimination to include other equity-deserving groups, and to bring appropriate changes to the General Standards of Accreditation for Residency Programs through further consultation.

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 (AFC) accreditation

Please update your bookmarks! Recent updates to the Royal College website may have broken your links and bookmarks. Here is where you can find:

• An FAQ regarding accreditation of AFC programs  
• A link to the general standards of accreditation for AFCs 
• Discipline-specific standards of accreditation for each AFC are available through the Information by Discipline page

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
October 15	Winter/Spring meeting (typically in March)
January 31	Spring/Summer meeting (typically in June)
May 31	Fall meeting (typically in November)

AFC programs

There are currently 75 accredited AFC (diploma) programs that have been approved by the Areas of Focused Competence – Accreditation Committee (AFC-AC) in 22 disciplines:

• Acute Care Point of Care Ultrasonography (5),
• Addiction Medicine (3),
• Adolescent and Young Adult Oncology (1),
• Adult Cardiac Electrophysiology (6),
• Adult Congenital Heart Disease (1),
• Adult Echocardiography (7),
• Adult Hepatology (3),
• Adult Interventional Cardiology (10),
• Adult Thrombosis Medicine (3),
• Advanced Heart Failure Cardiac Transplantation (1),
• Brachytherapy (3),
• Child Maltreatment Pediatrics (2),
• Clinician Educator (2),
• Cytopathology (4),
• Hyperbaric Medicine (1),
• Neonatal Hemodynamics and Targeted Neonatal Echocardiography (1),
• Pediatric and Perinatal Pathology (1),
• Pediatric Urology (1),
• Prehospital and Transport Medicine (2),
• Retina (2),
• Sleep Disorder Medicine (5),
• Solid Organ Transplantation (6), 
• Transfusion Medicine (3), and
• Trauma General Surgery (2).

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. To date there are six accredited international programs:

• Anatomical Pathology (now Diagnostic and Molecular Pathology)
• Internal Medicine 
• Neurology (adult)
• Pediatrics
• Psychiatry
• Surgical Foundations

International residency program accreditation application process

Additionally, a total of 42 program applications are underway in various stages at these institutions.

The international residency program accreditation application process has been designed to align to the application process for residency programs in the Canadian accreditation system. For specialty committees reviewing international residency programs, 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.