Specialty Committee Chairs’ Update

September and October 2022

Specialty Committee Chairs’ Workshop 2022

The 2022 Specialty Committee Chairs’ Workshop (SCCW) is coming up November 14 and 15, 2022. This hybrid event will be taking place in Ottawa, Ontario at Le Fairmont Château Laurier. The SCCW brings together the chairs and chair-elects of all specialty and Area of Focused Competence (AFC) sub/committees to share expertise across disciplines. For those attending virtually this year, the link will be sent along with the final agenda.

The planning committee for the SCCW are currently finalizing the agenda, and identifying the sessions that will be offered in-person only or as a hybrid option given the technology limitations that will be present in some of the breakout rooms.

  • Plenary topics include:
  • Being a chair 101
  • Competence by Design (CBD) program update
  • Credentials update:
    • Practice Eligibility Route (PER)
    • Practice Eligibility Route for subspecialists (PER-sub)
    • Practice Eligibility Route for AFCs (PER-AFC)
  • Accreditation update
  • Equity, diversity, and inclusion (EDI):
    • Accreditation updates
    • Committee appointments and EDI
  • Advocacy and the role of the committee chair
  • Concurrent sessions include:
  • CBD standards revisions
  • Running effective meetings
  • PER for specialty and subspecialty
  • PER-AFC and assessing candidates
  • Advocacy
  • Issues related to AFC training routes
  • Workplans for committees
  • Preparing for a Committee on Specialties discipline review
  • Other important updates on Royal College priorities:
  • CanMEDS 2025
  • Royal College International (RCI)
  • Indigenous Health

If you don’t have the invitation to the workshop in your calendars, please reach out to your committee administrator for assistance. If you haven’t already sent in your RSVP, please let us know and book your travel as soon as possible. Questions about the workshop can be sent to specialtycommittees@royalcollege.ca.

The importance of land with Elder Albert Dumont

What is a territorial acknowledgement? Why and when should we acknowledge our land? More to the point – how can medical specialists create a truly meaningful territorial acknowledgement? Is there a risk in not doing them well, especially in a virtual world, and will falling short cause more harm?

Tune-in to hear Elder Albert Dumont offer teachings on how the land, the forest, and medicine (Indigenous and conventional) are so connected. He shares insights into why the natural elements of our land come first, always…before human beings. Without water, plants, birds, animals…quite simply humans will not exist. He explores medical specialists’ responsibility as healers to not only take care of patients – but to also preserve, honour, and respect the land.

As Elder Dumont puts it…acknowledging this nourishing land is not complicated – it’s simple and essential to our survival!

You can access this and other episodes of the Specialty Scoop podcast here.

Specialty café podcast

The Royal College hosts a podcast for and by medical students. Each episode focuses on a specific discipline and the medical student hosts interview a specialist and a resident training in the discipline. The podcast is designed to help medical students learn more about different disciplines as they consider their future career options.

Area of Focused Competence update

Since 2019, the Royal College has been operationalizing the Area of Focused Competence Program Evaluation Management Action Plan (MAP), which guides our work to reform and improve the Area of Focused Competence (AFC) program. The MAP included 11 enabling actions. Now, with only three enabling actions remaining, work is expected to be completed by the end of 2022. Stakeholders can expect additional information about the work to close the MAP in the coming months. Below is the list of enabling actions and the status of the remaining three:

1. Revise the assessment policy for trainees in accredited training programsCOMPLETE

2. Revise the Practice Eligibility Route (PER-AFC) for AFCs

The new model of assessment for the PER-AFC was operationalized in 2020, and since then 19 disciplines have opened the new, reformed practice routes. It is anticipated that another three routes will open by the end of 2022, with the remaining eligible disciplines to follow in 2023. 12 of the 19 routes have assessed their first applicants which has led to 45 new Diplomates.

This enabling action will be complete when the remaining three portfolio-based PER-AFCs are closed and the new application-based routes are opened (Aerospace Medicine, Transfusion Medicine, and Adult Hepatology).

3. Streamline the Area of Focused Competence General Standards of Accreditation and associated evidence.COMPLETE
4. Revise the discipline-specific Standards of Accreditation (AFC-SA).COMPLETE
5. Digitize the accreditation process.COMPLETE

6. Develop new training modules for accreditation.

Following the launch of the Canadian Accreditation Management System (CanAMS) for AFCs in July 2021, user training is being provided on an as-needed basis to AFC sub/committees and is based on the receipt for new applications for new programs and schedules accreditation reviews. To-date, training has been provided to 18 AFC sub/committees; 20 in total by the end of 2022. Additional training resources are in development and will be released in late-fall 2022.

The accreditation update, below, has more information about AFC accreditation.

7. Cease use of the ‘affiliate’ moniker with the designation for Diplomates.COMPLETE
8. Create a Maintenance of Certification (MOC) exemption for Diplomates from Family Medicine.COMPLETE
9. Develop and AFC campaign.COMPLETE
10. Streamline the application for recognition process.COMPLETE

11. Facilitate a better sense of community, while building expertise and capacity among AFC program participants.

The creation of a shared virtual space for AFC chairs has been delayed. This project was dependent on the delivery of other, complementary,

Royal College information-sharing technology updates. It is unlikely that this enabling action will be complete by the time the MAP is closed. However, since the start of the reform, the AFC program has supported the principles of this enabling action and embedded them within the communications and stakeholder engagement plans (i.e., guidance documents, resources kit, improved web content, etc.)


For more information about enabling actions already operationalized (and marked complete above), please see the SCC Update archives.

Getting to know the Royal College’s reformed AFC program

The following is a snapshot of the Royal College AFC program pre- and post-reform. The post-reform data was current as of September 22, 2022, at the time this article was submitted.

ActivityPre-reform (2018/19)Post-reform (2022)
Number of AFCs recognized by the Royal College2434
Number of disciplines ‘fully implemented’518
Number of disciplines with approved national standards1828
Number of disciplines with 1+ accredited PGME training programs1120
Overall number of accredited training programs3563
Number of practice routes open12 (portfolio)19 (application)
Number of Diplomates (DRCPSC)21200

Committee on Specialties special review of AFCs

In November 2022, the Committee on Specialties (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. The COS will consider the report at the spring meeting in April 2023. Stakeholders can expect a briefing on the special review following the COS’ consideration of the final report.

New practice routes (PER-AFC) opened

Since the last edition of this publication, five AFC disciplines opened new practice routes: Patient Safety and Quality Improvement, Hematopoietic Stem Cell Transplantation and Cellular Therapy, Acute Care Point-of-Care Ultrasonography, Adult Cardiac Electrophysiology, and Adult Interventional Cardiology.

The list of AFC disciplines with new practice routes is available on the website, along with instructions on how to apply.

We depend on AFC committees to identify potential applicants for the practice route and encourage you to forward or borrow the key messages provided in the new applicant recruitment letter. Please contact Tiffany Lynch with any questions about developing, assessing, or applying for the practice route.

AFC committee support for additional applications for accreditation – new guidance document available!

In September 2022, a new guidance document on supporting additional applications for accreditation was distributed to AFC sub/committee members. This guidance clarifies expectations and processes for committees who identify the need for additional accredited programs to meet societal health needs. This new resource is available on the AFC resource page as part of the Promoting the Credential kit (more information below).

Promoting the Credential Resource Kit available online

In case you missed it, the new Promoting the Credential Resource Kit launched on August 8, 2022, and is available for download from the AFC resource page. We love hearing about the ways you are using the kit’s resources to promote your discipline and continue to compile your feedback and ideas for new resources. You are welcome to use the resources as published, or customize them, or borrow key messages for your specific audience/ purpose. Please contact the AFC program manager if you have questions or need assistance. Together we are making AFCs more visible!

The kit includes the following resources:

New CanMEDS Leader resources

Incorporating the CanMEDS Leader Role competencies into teaching and assessment plans can be a challenge. Ensuring residents experience the realities of managing a busy professional practice to demonstrate leadership skills and abilities during residency training can be daunting for programs to implement. Leader Role experts across Canada have developed a new Royal College resource: a web-based collection of educational materials for medical educators seeking advice while implementing the Leader Role into postgraduate training.

Accessing the materials is easy – follow this link. For more information, contact CanMEDS at canmeds@royalcollege.ca.

Patient Safety Culture module

A new module on patient safety culture has been developed as part of the Advancing Safety for Patients in Residency Education (ASPIRE) program. The goal of this module is to provide an understanding of what it takes to develop a culture of safety in your context, and to consider opportunities for learning around patient safety.

After completing this module, participants will be able to:

  • Apply a just culture framework to address patient safety incidents.
  • Identify opportunities in everyday clinical supervision to incorporate patient safety learning.
  • Demonstrate appropriate role modelling behaviours when patient safety incidents arise.
  • Cultivate a toolkit of strategies to teach about patient safety incidents.

Please visit the ASPIRE website to access the module.

Competence by Design webinar series | Fall 2022 lineup

Since 2017, the CanMEDS and Faculty Development team and content expert leads have presented over 30 CBD webinars on a variety of topics. Upcoming webinars include:

  • CBD orientation for residents | November 23, 2022 from 1330 to 1500 eastern REGISTER HERE
  • Competence committees for residents | December 2022 (date and time to be confirmed)

For more information, contact cbd@royalcollege.ca

CanMEDS 2025 – emerging concepts

In preparation for the upcoming 2025 update to the CanMEDS Physician Competency Framework, a group of more than 50 physicians, researchers, and clinicians have come together under the direction of Brent Thoma, MD, FRCPC to identify emerging concepts in literature related to physician competencies. The group has conducted qualitative knowledge synthesis, which involve a literature scan, title, and abstract review, and thematic analysis to identify emerging concepts. For more on the methodology follow this link.

The team identified major concepts:

  • Adaptive expertise
  • Clinical reasoning
  • Clinical learning environment
  • Complex adaptive systems
  • Data-informed medicine
  • Physician humanism
  • Planetary health
  • Virtual care and telemedicine
  • Anti-racism
  • Equity, diversity and inclusion
  • Social justice

Writing groups were formed to elaborate on each of the key themes and how they can be incorporated into CanMEDS 2025. These articles will be published in the Canadian Medical Education Journal in fall 2022 and provided to anyone working on the CanMEDS 2025 revisions.

Of the eleven underrepresented concepts identified, six will join the existing seven CanMEDS Roles to create 13 Expert Working Groups. If you are interested in learning more about CanMEDS 2025, the emerging concepts project, or the Expert Working Group recruitment, please visit the CanMEDS 2025 website and get in touch by emailing CanMEDS25@royalcollege.ca.

Translation update

The translation team would like to welcome new translators to the CBD portfolio: Marie-Josée Drouin and Julie Lamontagne. The team thanks and recognizes the excellence of the work provided by Geneviève Carrier and Mélanie Boyer on the francophone CBD suites to date. We wish Mélanie and Geneviève the very best in their future endeavours. Our translators’ contributions ensure access to fully-bilingual medical education standards across the country.

The work of the translation team heavily relies on the guidance and collaboration that our French medical reviewers provide. We are grateful to those who accepted this mandate and look forward to collaborating with the reviewers of the upcoming suites. We are available to discuss the review process if your specialty’s suite is currently in development or will be in development next year and you are interested in doing the French medical review. We welcome all feedback and value a culture of continuous process improvement cbdtranslation@royalcollege.ca.

Accreditation update

Regular accreditation reviews

The regular accreditation review of the University of Calgary took place in-person from September 18 to 23, 2022. This is the first in-person regular accreditation review since the declaration of the COVID-19 pandemic in March 2020. The Royal College will be reaching out to specialty committees for post-accreditation review input for these programs in late fall.

Post-accreditation review input was collected from specialty committees following the regular review of the University of Manitoba in March 2022. This input was considered at the Residency Accreditation Committee (Res-AC) meeting in October 2022, for final accreditation decisions for the University of Manitoba and its programs.

Pre-accreditation review input for the upcoming regular review of l’Université de Sherbrooke will be sought in early 2023.

The Royal College is continuing to monitor the situation to evaluate the feasibility of continuing in-person regular reviews. All external reviews continue to be delivered virtually.

Upcoming Regular Accreditation Reviews
UniversityReview DateRes-AC Review Date
Université de SherbrookeMarch 19–24, 2023Fall 2023
McMaster UniversityMay 2023Fall 2023
University of SaskatchewanFall 2023Spring 2024

Impact of COVID-19

After two years of exclusively virtual delivery, the ability to gather and meet in-person for the regular accreditation review of the University of Calgary in September was greatly welcomed by accreditation surveyors as well as university and program stakeholders. Informed by its experience since March 2020, the Royal College conducted some components of the process virtually (e.g., pre-survey sessions with stakeholders and surveyor training) for the Calgary review and will continue to identify opportunities to adopt a hybrid approach going forward.

As we return to in-person delivery of certain activities, the Royal College is carefully considering all factors including planetary health, equity and access, and the stewardship of financial resources. The Royal College corporate Accreditation Committee has drafted a set of principles to help guide decision-making regarding the virtual delivery of accreditation activities in particular. These are being brought forward to the various accreditation committees under the purview of the corporate Accreditation Committee and used to inform decisions about future accreditation activities.

Equity, diversity, and inclusion (EDI)

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 Collège des médecins du Québec (CMQ). Two key groups are driving the first wave of changes: the conjoint Accreditation Working Group on 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. Both the AWG-ABR and IH-EWG have developed comprehensive and transformative recommendations to ensure that the next revision of the General Standards of Accreditation for Institutions with Residency Programs is inclusive of racialized perspectives and addresses anti-Black racism, anti-Indigenous racism, and Indigenous health consciousness.

The recommendations from the AWG-ABR and IH-EWG have been embedded within the penultimate drafts of the General Standards of Accreditation for Institutions with Residency Programs. Drs. Osei-Tutu and Giroux attended the February, May, and September 2022 ASIC meetings to participate in the discussions of the latest iterations. Additionally, the Accreditation Standards Improvement Committee for Family Medicine (ASIC-FM) reviewed and provided input on the integration of the recommendations within the general standards as part of its preparation for revisions to the Standards of Accreditation for Residency Programs in Family Medicine (the “Red Book”).

Members of the accreditation committees of the three Colleges will review these drafts in October 2022 and will ultimately be asked to approve changes to accreditation standards in February 2023. National consultation will occur in the Fall 2022 to allow all accreditation stakeholders to hear and comment on major changes. Throughout the process, there will be opportunities for further input by the working groups and accreditation committees along the way.

Work is also underway to outline the key criteria for safe and effective reporting mechanisms regarding experiences of racism. Institutions do not currently have effective means of reporting race-based harm or trauma and current structures can marginalize, deny, and erase the experiences of Black and Indigenous residents. Furthermore, the scale of anti-Black and anti-Indigenous racism within PGME is unknown. Safe and effective reporting mechanisms are crucial in operationalizing an anti-racism policy and provide the practical means for accreditation to drive change.

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.

Review of specialty committee processes

As a part of the ongoing commitment to continuous improvement and in response to feedback about 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 has begun piloting some of the new components of this mechanism with external reviews this year, with the help of some volunteer committees. Feedback is being sought as each component is piloted and used to inform updates. As this mechanism develops and we continue to pilot test more components, we will reach out for additional volunteers as needed. Thank you to all those who have contributed their feedback so far!

Update to the General Standards of Accreditation

ASIC is nearing completion of the final draft for the next update to the General Standards of Accreditation for Institutions with Residency Programs and the General Standards of Accreditation for Residency Programs.

As noted above, ASIC is particularly focused on incorporating recommendations from the Accreditation Working Group on Anti-Black Racism and the Indigenous Health in Specialty Postgraduate Medical Education Accreditation Expert Working Group, as well as other input from a conjoint Working Group on Assessment Decision-Making and the Royal College Physician Wellness Task Force.

Under the CanRAC governance model, ASIC makes recommendations that are then considered, refined, and endorsed by the accreditation committees of the three Colleges, a process which is currently underway. The draft revisions will be shared for detailed consultation with a broad range of stakeholders, including specialty committee members, in late 2022, with approval to be sought in early 2023 and an anticipated launch date of July 1, 2023.

AFC accreditation

New program application deadlines

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

Application Submission DeadlineAFC-AC Review Date
October 15, 2022Winter 2023
January 31, 2023Spring 2023
May 31, 2023Fall 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 19 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.