Table of Contents
- 2020 Highlights
- 2021 to 2023 membership cycle
- Accreditation Update
- Area of Focused Competence Program Evaluation Update
- ICRE 2021
Thank you for your commitment to your disciplines, your committees and your contributions as a volunteer with the Royal College. It goes without saying that 2020 was a challenging year in all aspects of life.
At the Royal College, like everywhere else, regular operations were disrupted as we adapted to the changing environment and responded to the impacts of COVID-19 on your clinical work and capacity to continue your volunteer contributions. We appreciate the contributions that each of you continued to make depending on your respective circumstances.
It is important to pause and note some of the things we accomplished together this year.
- All specialty committee, advisory committee, and Area of Focused Competence (AFC) Committee/Subcommittee/Working Group meetings were converted to virtual meetings.
- The Specialties Unit supported 359 meetings in 2020, a full 100 more than in 2019.
- Competence by Design (CBD) workshops were converted to a virtual format for the first time in June, and a total of 13 in-person and virtual workshops were completed.
- Eight disciplines launched CBD in 2020 with a further 13 set to launch in 2021 including some disciplines that deferred their planned 2020 launch, and those that completed their CBD standards development in 2020.
- Five AFC working groups completed their standards and transitioned to active (sub)committees.
- 16 AFC (sub)committees began the process of creating the new Practice Eligibility Route (PER-AFC) as a part of the AFC reforms
- We hosted 17 town halls for committee chairs and program directors to help keep you informed on issues and collect your input related to changes for examinations and facilitate discussions related to Covid impacts on training programs.
- The first virtual Specialty Committee Chairs’ workshop took place in November with many positive reviews in no small part due to your engagement throughout the two days.
All committee meetings, CBD workshops, and AFC workshops will continue to be scheduled as virtual meetings through to the end of August 2021. Some of you have asked about scheduling in-person meetings in the fall of 2021. The Royal College has not yet decided about fall meetings. Your administrator can tentatively book in-person meetings for the fall and convert them to virtual if needed.
2021 to 2023 membership cycle
It is that time of year again! If you are on the odd-year membership cycle, the Specialties Unit will be reaching out to chairs over the coming weeks to confirm the voting membership on your committee.
- Watch your inbox for the renewal request.
- Confirm those roles you wish to renew or replace.
- Invitations and appointment letters will be sent out to officially confirm acceptance of roles.
Regular Accreditation Reviews
The University of Toronto’s regular accreditation review occurred in November and December of 2020; the post-accreditation review input is being sought from specialty committees now. This input will be considered at the upcoming Residency Accreditation Committee (Res-AC) meeting in May, when the final accreditation decisions for University of Toronto and its programs will be rendered.
The regular accreditation review of the Université de Montréal is scheduled for March 2021. At a time when the challenges associated with COVID-19 have been particularly difficult in many communities, the work of the specialty committees to provide pre-accreditation review input has been greatly appreciated particularly due the timelines associated with translation.
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 review of the University of Toronto and its residency programs was conducted virtually over the course of two weeks in November and December of 2020. This was a major collaborative effort between the Royal College, the College of Family Physicians of Canada, the University of Toronto and its stakeholders, and the many volunteers who participated as accreditation surveyors and specialty committee members. Other than extending the schedule from one week to two weeks, the review proceeded as planned and all programs were reviewed as scheduled.
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. Planning is underway for the review of Université de Montréal and its programs in March, as well as a number of External Reviews that will be conducted throughout the first half of 2021.
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
To date, 44 applications for accreditation of an AFC program have been approved by the Areas of Focused Competence – Accreditation Committee (AFC-AC). These programs are in the following disciplines:
- Acute Care Point of Care Ultrasonography (2),
- Addiction Medicine (1),
- 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),
- Solid Organ Transplantation (4), and
- Trauma General Surgery (1).
In addition, there are three accredited AFC (diploma) programs in Transfusion Medicine that transitioned from an Accreditation without Certification (AWC) program in 2012. Thus, in total, there are 47 accredited AFC programs.
International Residency 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 ten international program applications in six disciplines have been submitted. The current status is:
- Three New Accredited Programs (Anatomical Pathology (1), Internal Medicine (2))
- Two programs with Accreditation in Progress in status (Pediatrics (2))
- Two programs with Deferred status (i.e., additional information is required within one year before proceeding to an onsite review) (Emergency Medicine, Surgical Foundations)
- One program application under review (Neurology)
The timeline and processing of some applications has been affected by the status of partners’ contracts and/or travel restrictions due to the COVID-19 pandemic, and in some cases the deadlines for follow-up activities have passed. Work is underway to determine how to appropriately conduct some accreditation operations virtually for partners who remain in good standing, in keeping with the principle of equivalency with Canadian standards and processes.
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.
Area of Focused Competence Program Evaluation and Reform of the Discipline Category
Since the last edition of the Specialty Committee Chairs’ Update, our work has continued on a collaborative response to the AFC Program Evaluation. In addition, we have been working remotely and shifting our priorities to respond to the pandemic. We are now one year into the reform of the category and have made significant progress on the enabling actions, with many of them already complete. The following are updates on the four recommendations approved by the Committee on Specialty Education (CSE):
1. Prioritize reforms of the assessment strategy
This recommendation was divided into two lines of work – one for the in-training route and the other for the practice eligibility route (PER-AFC).
1.1 In-training route
In March 2021, it will be one year since the new model of assessment for trainees in accredited AFC programs was launched, marking an end to external assessment of portfolios by Royal College assessors and the phasing out of the digital assessment platform, eDiploma.
We continue to be mindful of the impacts of COVID-19 on faculty, trainees, accredited programs and our health care system. The guidance provided to AFC programs last spring on how to meet the training requirements during the pandemic remains current at this time. Other resources are available on the Impact of COVID-19 on Residency Education website, which includes topics on teaching and learning in a virtual environment.
In early fall, AFC stakeholders were provided with advance notice of a new policy on the versioning of AFC portfolios that was being considered by the Committee on Specialty Education (CSE). The feedback received from the consultation was generally supportive and identified the need to provide consideration for trainees requiring formal leave from training. The revised policy was approved by CSE in December 2020 and stakeholders will receive formal notice of the policy in February 2021.
Resources to support accredited programs and trainees in the new model of assessment remain available online. These resources include the:
- FAQ on implementing the new model of assessment; and
- Step-by-step guide on applying for the AFC credential.
To recap, the highlights of the new model of assessment for the in-training route are:
- National standards will continue to play a central role, with the expectation that all accredited AFC programs will teach and assess trainees using the standards.
- Accreditation activities will be the mechanisms to ensure the standards are being used as intended by the Royal College.
- Accredited programs (AFC director acting on behalf of postgraduate dean) will be relied upon to make a determination of the trainee’s competence in accordance with the national standards.
- Portfolio evidence will no longer be submitted to the Royal College; external assessment by Royal College assessors will cease.
1.2 Practice eligible route for AFCs
Following approval by the CSE, the new model of assessment for the practice route was launched on July 17 and was received with enthusiasm by AFC committees and subcommittees. The team from the Credentials Unit began work immediately, meeting with chairs and committees to introduce the new model and provide support for the development of the documents required for the new application process. At this time, more than half of the 23 disciplines are in the process of customizing their documents in preparation for opening a new practice route. It is expected that a majority of disciplines will have new routes open in 2021.
To recap, the reform of PER-AFC prioritized streamlining the process and introduced a discipline-specific scope of practice for each candidate to complete, moving from a portfolio-based submission to an application process. The candidate’s competencies would then be verified by numerous peers identified by the candidate who could provide input via a discipline-specific multisource feedback (MSF) questionnaire. The candidate’s submission, along with the results of the MSF results, would then be assessed by the AFC committee or, once a baseline for assessment is set by the committee, an individual discipline-specific assessor.
2. Re-launch ongoing efforts to reform the accreditation policy and process
2.1 Streamline General Standards of Accreditation and associated evidence
With the new General Standards and policy manual approved and prototype implementation taking place at the regular review of accredited AFC programs at the University of Toronto (fall 2020) and Université de Montréal (spring 2021), this enabling action is complete. The revised general standards, that will apply to all AFC programs after July 1, 2021, are available on the Royal College website (see the section titled “What expectations do programs need to meet?”).
2.2 Revise discipline-specific AFC Standards of Accreditation
All AFC disciplines have now had their existing discipline-specific AFC Standards of Accreditation (AFC-SA) converted into the new format. Disciplines at sites other than the University of Toronto and the Université de Montréal worked with the Educational Standards Unit (ESU) throughout the early part of 2020 to convert their AFC-SA in preparation for full implementation of the reformed accreditation process in July 2021. This enabling action is now complete. All revised AFC-SA 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 ESU if there is an application being developed. At this time, the current process remains unchanged until full implementation in July 2021. It is anticipated that the digitized accreditation process of CanERA will improve the process, making it easier for applicants and reducing administrative burden by storing and carrying forward submitted evidence to follow-up accreditation activities. The new standards and restructured evidence will also more clearly communicate expectations.
2.3 Digitize the AFC accreditation process
As part of prototype testing at the on-site reviews at the University of Toronto and the Université de Montréal, the digital accreditation management system (CanAMS) will be used for AFC programs. All other accreditation activities (e.g. follow-ups by progress report, external review, etc.) will remain status quo until July 2021. In keeping with the Royal College’s commitment to accredited programs and PGME offices, access to the new standards and digital platform will be provided at least 12 months before accreditation activities.
2.4 Develop new training modules for accreditation
New resources are being developed and will be made available during the prototype testing phases and are expected to be available to AFC Committees and university personnel before the full launch in 2021. In the meantime, an FAQ on the new AFC accreditation system is available online.
We have heard recently that AFC chairs and AFC directors would be interested in additional opportunities to learn more about the system. Options are being developed and we will keep your committees informed of any new offerings.
3. Formulate a plan to increase the visibility of the value of the category
This recommendation was divided into two lines of work – one focused on recognizing the participation of physicians from Family Medicine in the AFC program and the other on developing an “AFC campaign”.
3.1, 3.2 Physicians from Family Medicine
Having ceased using the phrase ‘Diplomate Affiliate’ in spring 2019 and changes made to the website and other publications, this enabling action is now complete. To recap, with this change, all eligible candidates, regardless of their Royal College Fellowship status, will have the opportunity to use the title Diplomate.
In February, the Royal College Council also approved an exemption from the Royal College Maintenance of Certification (MOC) Program for Diplomates from Family Medicine. Previously, physicians from Family Medicine needed to participate in both the Royal College MOC Program (to maintain Diplomate status) as well as CFPC’s MainPro+ (to maintain their CFPC membership). The approved exemption now eliminates the duplication of data entry and fees for Diplomates from Family Medicine. This enabling action is now complete.
3.3 An AFC campaign
A communications plan has been developed and includes tools, tactics and key messages for a campaign intended to increase the profile of the AFC category, AFC programs, and the value of the credential among stakeholders. The launch of the campaign is expected in late winter 2021.
Work is also underway to make AFC content on the Royal College website more accessible and relevant to key stakeholders. The updates to the website require multiple phases of work, with the first and second phase complete. The final phase is expected to be live by mid-February. More information about the new content will be provided in the next SCC Update.
4. Consider how to continue to provide support, and improve upon the support already provided
1. Streamline the application process: National Consultations and interface with specialty committees and AFC committees, subcommittees and working groups
Changes to simplify and streamline the discipline recognition and national consultation processes are underway. Several initiatives were piloted throughout the spring with the intention of managing and monitoring their impact through fall 2020. Piloting will continue through spring and fall 2021 in order to allow a diverse group of applicants the opportunity to provide feedback. To support these initiatives, revisions to the website have been made which aim to increase transparency of the discipline recognition process and to build knowledge and capacity among a broader group of stakeholders. To this end, additional content on the four categories of discipline recognition as well as a detailed overview of the application process are now available. A new page has also been created to provide information to stakeholders about the status and progress of applications for new disciplines throughout the recognition process, as well as decisions regarding applications for changes to existing disciplines.
2. Facilitate a better sense of community while building expertise and capacity among AFC program participants
Building expertise and capacity is an on-going and evolving reform, with the current focus being how to ensure stakeholders remain informed and are a part of the proposed changes. These core principles inform the communications plan and stakeholder engagement strategy, and were reflected in the 2020 Specialty Committee Chairs’ Workshop. We are also exploring new and additional ways to keep you informed. If you have ideas that you’d like to share or suggestions to help us get the information to you, we’d love to hear from you. Please contact the AFC program manager, Linda Rumleski.
Need more information? Have questions about the reform of the AFC program?
- Visit the archives for previous updates
- Visit section D of the AFC Member Resource Site
- Contact the AFC program manager, Linda Rumleski.
Mark your calendars for a virtual International Conference on Residency Education
The International Conference on Residency Education (ICRE) 2021 will be held virtually from October 20 to 22, 2021.
The theme for the 2021 conference: “A New World of Residency Education: Game Changers and Proven Practices” reflects on the great changes and challenges facing the medical education community, and will highlight the game-changing techniques newly discovered as well as the proven practices that continue to be relevant and successful decade-after-decade.
The 2021 program will offer thought-provoking plenaries, engaging workshops and lightning rounds, and pre-conference courses designed to enhance your skills and knowledge in a given area of residency education.
Stay tuned for program and registration announcements coming this spring.
Looking to showcase your research at ICRE 2021?
The call for abstracts is now open. ICRE’s planning committee is looking for abstracts highlighting research in residency education, as well as ‘what works’ innovations in residency teaching and assessment.
The deadline to submit is March 5.
Submission details can be found on the ICRE 2021 calls for submissions webpage.
New Educational Design Course for Residency Program Directors
Starting in Spring 2021, the Royal College will run a ten-week pilot for a new Educational Design Course for aspiring and new residency program directors. This new competency-based course is comprised of both asynchronous self-paced learning modules, as well as several synchronous virtual workshops facilitated by a CanMEDS Clinician Educator. The Educational Design Course is designed to provide participants with skills and tools to manage an existing curriculum and system of assessment, and develop a new curriculum and system of assessment.
More specifically, the course includes:
- A step-wise approach for designing education, including conducting needs assessments, writing learning objectives and choosing appropriate instructional strategies and assessment methods.
- Best practices for curriculum design and curriculum mapping.
- Planning and implementing competence-based medical education (CBME) in your context, including the use of competency frameworks (e.g., CanMEDS).
- Applying the eight core ingredients in building an effective system of assessment, including how to incorporate workplace-based assessment, coaching and feedback, as well as guidelines for collection of both numeric and narrative ratings of performance.
The Royal College is in the process of choosing individuals to participate in the pilot. Our vision is to eventually make this course (and others) available more broadly. For more information, or to recommend pilot participants, please contact us at email@example.com
CBD Webinar Series
The CBD Webinar Series aims to engage a broad audience in CBD and support CBD-related learning. This series focuses on activities/topics that build readiness and address misconceptions/changing attitudes, all of which are meant to foster positive perceptions and experiences around CBD and the Royal College.
Upcoming CBD webinars include:
- February 8 – Teaching and learning in CBD
- March 11 – Curriculum mapping
- April 7 – Resident orientation
- May 27 – Coaching over time
Competence by Design implementation support in a virtual world
In 2020, the Specialties Unit worked to redesign the Competence by Design (CBD) workshops for virtual delivery. The new virtual workshops now include synchronous and asynchronous elements. The synchronous part of the sessions is shorter and focusses primarily on key tasks associated with writing entrustable professional activities (EPAs) and milestones as well as developing the Competencies, Training Experiences and Standards of Accreditation. These changes also mean that some important topics related to CBD implementation are now covered differently by way of an eSupport Program and Implementation Booster Webinar webinars.
- The new CBD Implementation eSupport Program gives program directors access to self-directed learning modules and faculty development resources pushed right to their email. All specialty committee members are automatically added to the CBD eSupport Program email list. You may opt out at any time.
- The newly expanded CBD Implementation Booster Webinar sessions are facilitated by an implementation expert, and are designed to meet folks where they’re at and to help guide their local implementation efforts.
CBD Implementation Booster Webinars occurred in early-February 2021 and targeted program directors at three specific stages:
February 1, 2021 – for disciplines between workshop 1 and 2
February 3, 2021 – for disciplines between workshop 2 and 3
February 9, 2021 – for disciplines between workshop 3 and launch
All webinars were recorded. If you missed a webinar and would like access to the recording, please contact firstname.lastname@example.org.
Support for 2021 Launch Disciplines
Over the coming months we will be offering CBD Pre-Launch Booster Webinars which are designed to provide targeted support for CBD implementation to all disciplines that will be implementing in July 2021. The first CBD Pre-Launch Booster Webinars was held on February 9, 2021. The webinar will run again in April 2021 for anyone who is unable to attend the February session