The New Areas of Focused Competence (AFC) Accreditation System

Why is there a new AFC accreditation system?

The Royal College embarked on AFC accreditation reform in response to significant feedback from the AFC community. Based on stakeholder input received during the initial years of the AFC category, the college agreed in principle with efforts to align the AFC accreditation system with key components of CanERA (Canadian Excellence in Residency Accreditation), the new conjoint system of accreditation for residency education. Recommendations from the comprehensive evaluation of the AFC category in 2018 and national consultations in 2019 validated the changes underway and informed the development of the new system.

AFC stakeholders highlighted the need to:

  • Digitize the AFC accreditation process;
  • Increase training, tools, and supports relating to accreditation; and
  • Streamline the accreditation standards and their related evidence requirements in order to clarify expectations and better reflect the unique nature of AFC programs.

Based on this feedback, the new AFC accreditation system includes new general standards of accreditation, new processes/polices, and use of the Canadian digital accreditation management system, known as CanAMS.

When does the new accreditation system take effect?

The new AFC accreditation system applies to all accreditation activities beginning as of July 1, 2021.

As accreditation reviews are based on the standards and processes in place 12 months in advance, the new general and discipline-specific standards of accreditation have been available on the Royal College website as of July 2020. Accredited AFC programs are being provided with access to their program profile instruments in CanAMS as they become available and at least 12 months prior to their next accreditation activity. These program profile instruments replace the pre-survey questionnaires (PSQ) that were used previously.

Looking for the standards of accreditation for your discipline? Find them on our Information by Discipline page.

What is CanAMS?

CanAMS is the new digital accreditation management system developed as one of the ten key components of the CanERA system (Canadian Excellence in Residency Education). It is used to support all accreditation activities for the postgraduate office, AFC programs, and residency programs. Over time, this digitized system will significantly decrease the amount of work leading up to an accreditation review and other continuous improvement activities by helping keep program information up-to-date on an ongoing basis.

Within CanAMS, AFC program profile instruments are organized by domain, based on the organization of the new standards. Program profile instruments will replace the pre-survey questionnaires (PSQ) in the current process. Prototype testing of the new AFC accreditation system will provide an opportunity to evaluate and further improve the CanAMS program profiles.

What has changed in the review process?

What stays the same? What is different?

General Standards of Accreditation

A single, national set of standards applicable to all AFC programs in all disciplines

The standards have been revised and are in a new format that aims to make expectations clearer (i.e., organized according to domains, standards, elements, requirements and indicators)

Expectations felt to be inappropriate for the nature of AFC programs were removed

Discipline-Specific Standards of Accreditation

A single, national set of standards for each discipline

Expectations set out in the standards remain the same (unless changes were made by an individual discipline independent of the transition to the new system)

The discipline-specific standards are in a new format that aligns with the new general standards (i.e., organized according to domains, standards, elements, requirements and indicators)

Submission of evidence

All programs are required to submit information prior to an accreditation review

Information is submitted using CanAMS, the new digital accreditation system, rather than the “pre-survey questionnaire”

Information is submitted through two instruments: (1) the program profile instrument; and (2) the area(s) for improvement (AFI) instrument

The program profile instrument is organized by domain, based on the standards. The AFI instrument is pre-populated with the “weaknesses” identified at the time of the last review, mapped to the new requirements

Royal College AFC discipline committee input into the accreditation process

AFC discipline committees provide input pre- and post- review

AFC programs receive the input provided prior to the review

Prior to the review, AFC programs are required to give a written response to input provided by the AFC discipline committee. This takes place close to the date of the review with roughly one week for programs to respond to the input from the relevant AFC committee

Accreditation Review (onsite)

Surveyors meet with a range of AFC stakeholders and review information that cannot be provided in CanAMS due to privacy considerations (i.e., trainee files and AFC program and sub-committee meeting minutes)

There are two surveyors assigned to review each program

Accreditation Decision

The surveyors put forward a recommended accreditation decision and follow-up for consideration by the AFC Accreditation Committee

The recommended accreditation status and follow-up is shared soon after the accreditation review, with the understanding that the status and associated follow-up is considered final only when the decision is made by the AFC Accreditation committee

There are new accreditation statuses and follow-ups (e.g., Accredited Program with follow-up by Regular Accreditation Review, Action Plans Outcome Report, and External Review, etc.), including improved definitions

There are new principles that are used to guide decision-making

A preliminary overview of the ratings associated with each requirement is shared soon after the accreditation review; however, the ratings are considered final only after the decision is made by the AFC Accreditation Committee

Accreditation Report

An accreditation report detailing the findings of the surveyors is provided

The final accreditation review report includes the recommended and final accreditation status and follow-up, a rating for each requirement, identification of any leading practices and/or innovations, and narrative findings

What expectations do programs need to meet?

Accreditation reviews are based on the standards and processes in place 12 months in advance. As such, the new general and discipline-specific standards for AFC accreditation are available on the Royal College website as of July 2020 and came into effect in July 2021. While expectations in the new general standards of accreditation have been revised to reflect the unique nature of AFCs, changes to the discipline-specific standards focused solely on re-articulating existing expectations in a format that aligns with the new general standards.

Looking for the standards of accreditation for your discipline? Find them on our Information by Discipline page.

The general and discipline-specific standards for AFC programs have been formatted with a new Standards Organization Framework (i.e., organized according to domains, standards, elements, requirements, and indicators). For the purposes of an accreditation review, a program will focus on the requirements and their associated indicators. As part of the accreditation review process, surveyors will assign a rating to each requirement. A requirement can be rated as:

  • Meets – all indicators are met, with the exception of any indicators labelled exemplary.
  • AFI-RR – one or more indicator(s) is not met, generating an area for improvement for follow-up at the next regular review in approximately eight years.
  • AFI-2Y – one or more indicator(s) is not met, generating an area for improvement for follow-up in two years by Action Plan Outcomes Report (APOR) or External Review. An AFI-2Y requires an overarching accreditation decision of follow-up other than by regular accreditation review.

What if a program has areas for improvement?

While AFC programs should strive to meet the expectations set out in the standards, areas for improvement (AFIs) are intended to help identify and measure a program’s continuous improvement efforts. Rating at the requirement level aim to be more specific and to help inform the ongoing continuous improvement efforts of AFC programs between accreditation reviews. As such, a program may have requirements rated as AFIs that do not require follow-up (by the Royal College) until the next regular accreditation review. It will depend, however, on the nature of the AFI identified. Some may require follow-up prior to the next regular accreditation review, either by submission of an Action Plan Outcomes Report or by external review.

How does the transition impact new program applications?

As of July 1, 2021, all new program applications will be evaluated based on the new system of accreditation, including the new standards and use of CanAMS.

For individuals interested in initiating their application in the new system, applications based on the new accreditation standards are available in CanAMS. To receive access to CanAMS and the associated application instrument, the postgraduate office must be informed of the intent to apply. The postgraduate office will then inform the Royal College.

The deadlines for PGME offices to submit an application to the Royal College are as follows:

Deadline for submission to the Royal College Reviewed by the Areas of Focused Competence Accreditation Committee (AFC-AC)

June 30, 2021

(final deadline to submit traditional application)

Fall 2021

October 15, 2021

Winter 2022

January 31, 2022

Spring 2022

May 31, 2022

Fall 2022

What are the new accreditation statuses and follow-ups?

Accreditation Status Follow-up Definition

Accredited Program

Next Regular Accreditation Review 1

The AFC program has demonstrated acceptable compliance with the standards

Timelines for follow-up align with the next regular review established in the accreditation cycle, with expectations of ongoing CQI throughout the cycle

Action Plan Outcomes Report (APOR)

(replaces the category of Mandated Internal Review)

There is one (or more) significant area(s) for improvement impacting the overall quality of the program, which requires follow-up prior to the next regular accreditation review and can be evaluated via submission of evidence from the program

The process to address the area(s) for improvement is at the discretion of the institution; however, evidence submitted via an APOR must be sufficient to demonstrate compliance with the associated requirement(s) and be limited to information related to the identified area(s) for improvement

Follow-up will align with the predictable two-year timeline established in the accreditation cycle

External Review

There is one (or more) significant area(s) for improvement impacting the overall quality of the program, which requires follow-up prior to the next regular accreditation review and can be best evaluated by external peer reviewers. Factors that may suggest the need for follow-up by external review include, but are not limited to:

  • Persistence of the area(s) for improvement (i.e., the area(s) for improvement was(were) also identified at a previous accreditation review(s))
  • Nature of the area(s) for improvement (i.e., the issues are best evaluated onsite by a reviewer from outside of the university, and, in some instances, from the same discipline), and/or
  • Concerns with the program’s and/or institution’s oversight of continuous quality improvement of the AFC program

Follow-up will align with the predictable two-year timeline established in the accreditation cycle

1 A follow-up of next regular accreditation review does not imply that an AFC program can go eight years without interacting with the accreditation system; notably, standards detail expectations of continuous improvement efforts between accreditation reviews, AFC programs receive information based on integrated data sources throughout the cycle that may require action, and trainee programs are expected to address any AFI identified at the time of the regular accreditation review.

What are the guiding principles for decision-making in accreditation?

  1. A goal of the AFC accreditation system is to increase emphasis on continuous quality improvement (CQI). AFC programs, with the support of their institution, should be entrusted to drive the continuous improvement of their program.
  2. Consideration should be given to AFC programs to allow for iterative implementation of new expectations detailed in the General Standards of Accreditation for Areas of Focused Competence Programs; however, imperatives from the current system still apply:
    • There are expectations that existed previously and remain the same (i.e., a program is still a program);
    • There are requirements that in and of themselves can impact an accreditation decision and follow-up (e.g., harassment and intimidation).
  3. Consideration should be given to the following:
    • The persistence of the AFI identified;
    • The impact of the AFI on the learning environment and the integrity of the program;
    • The strength of the institution’s internal review process; and
    • The AFC program’s demonstrated quality improvement efforts (e.g., the AFI been identified by the AFC program, and appropriate efforts to address them are under way).

What support is available for transitioning to the new accreditation system?

  • Postgraduate offices – The Royal College is in regular contact with postgraduate offices. As such, the postgraduate office will connect directly with the Royal College in order to obtain a response to any questions arising.
  • Pre-accreditation review visit – The pre-accreditation review visit provides an opportunity to ask Royal College staff questions regarding an upcoming accreditation review.
  • University Personnel Online Training Module (www.canera.ca) – This online module includes information such as how to log on to CanAMS, navigate within the system, upload documents, etc.
  • Targeted online resources and webinars – The Royal College will continue to develop additional support for key groups including AFC committees and subcommittees.