Update on the AFC (diploma) Category Program Evaluation Results and Recommendations
A program evaluation of the AFC (diploma) category was conducted throughout 2018 by the Office of Specialty Education (OSE). This program evaluation examined the benefits and challenges of the category in terms of the influence of AFCs on national standards, the perceived value of the AFC designation, and the implementation and sustainability of the AFC processes and programs. Over 100 AFC stakeholders contributed feedback to the evaluation.
Benefits focus on the overarching goals of the category
Goals of the category
Stakeholders agree that AFCs are meeting their goals, including:
- Creating national standards in areas of supplemental expertise,
- Enhancing, rather than replacing, specialists’ existing scope of practice, and
- Ensuring specialists have the competencies needed to provide health care services to meet the evolving needs of society.
Value of the category
Stakeholders agree that AFCs are adding value to postgraduate medical education
Helpful activities throughout the AFC process: Royal College support, collaboration with other groups, and easy submission of materials
Many challenges were within the processes and implementation of AFCs, rather than high level goals. Despite these challenges, most stakeholders felt that the AFCs had more benefits than challenges.
Creating national standards
The national standards may be too heavy or rigid in the areas of assessment and accreditation, and could be streamlined
Value of the category
Trainees do not see the value in becoming a diplomate, and often do not submit a portfolio
Sustainability of the category
There may be areas of the category that are not sustainable
Barriers throughout the AFC process included the time required for the process, a lack of clear guidelines, prohibitive fees, a lack of support, the large amount of work involved, and the use of eDiploma
Stakeholder feedback was also received during the program evaluation process, which shed light on some additional stakeholder concerns. For example, there were concerns identified about the accessibility and applicability of the category and subsequent designation for Fellows of the College of Family Physicians of Canada. Proposed solutions for these concerns are currently being addressed internally.
Key recommendations were formulated based on the findings of the evaluation. The main recommendations involve reforming the assessment and accreditation strategies. These reforms will address the rigour and amount of work involved in the assessment and accreditation standards, such that they are scaled to the goals of the AFC-Diploma Category. The next recommendation is to develop a plan to increase the visibility of the value of the category, and the final recommendation is to continue to provide, and improve upon, the support currently provided to stakeholders. These recommendations were adopted by the Committee on Specialty Education in December, 2018, and Royal College staff are formulating action plans to implement them. Updates will be provided as details become available.
If you have questions or require additional information, please contact Lisa Gorman, manager, or Alexandra Skutovich, research coordinator, Educational Strategy, Innovations and Development (ESID) by email (email@example.com).
Competence by Design (CBD) for Program Directors
Program directors have asked for more support, knowledge and tools in several key areas of CBD, including curriculum mapping, coaching and feedback, setting up a competence committee, and engaging faculty. The Royal College is pleased to present Competence by Design for Program Directors, an online resource that includes practical tools and templates to support program directors through the transition. Please visit the Royal College website to see the first two modules, “Lead the Change” and “Set up a Competence Committee” and to learn more about the other modules that are coming soon.
Registration is open! ASPIRE 2019
The ASPIRE (Advancing Safety for Patients in Residency Education) is a national faculty development certificate program dedicated to advancing the teaching and education of patient safety, quality improvement and resource stewardship competencies that have recently been integrated into the updated CanMEDS 2015 framework. The next course will be held in Ottawa on May 28-31, 2019.
This year’s learning objectives are to:
- Learn how to develop a training and assessment program in quality improvement and patient safety within the CanMEDS framework;
- Advance teaching skills for integrating quality improvement and patient safety into residency training;
- Gain skills in leadership and change management; and
- Receive personalized support in developing a patient safety and quality improvement curriculum project.
For more information and to register: ASPIRE website
Residency Accreditation Update
Residency accreditation reviews
The Dalhousie University regular accreditation review took place the week of November 25, 2018. Post-review specialty committee input will be requested in spring 2019, which will inform the final accreditation decisions to be made at the May 2019 Residency Accreditation Committee (Res-AC) meeting. Dalhousie University is the first school reviewed in CanERA, the new system of accreditation, as part of prototype 3 (P3) of the multi-phased implementation of CanERA. P3 is the final phase of testing prior to full implementation of CanERA on July 1, 2019, after which all accreditation reviews will be conducted in the new system.
P3 also includes the McGill University regular accreditation review scheduled to take place the week of March 17, 2019. The pre-review specialty committee input is scheduled for early winter 2019 while the post-review specialty committee input, which will inform the final accreditation decisions to be made at the October 2019 Res-AC meeting, will be requested in summer or early fall 2019.
Canadian Excellence in Residency Accreditation (CanERA)
Recent and upcoming CanERA-related activities
The Canadian Residency Accreditation Consortium (CanRAC) continues collaborative efforts with an emphasis on:
- ongoing development and evaluation of CanERA;
- preparation for the P3 review of McGill University; and
- broad release of CanAMS (the new digital accreditation management system), which is anticipated to be available to all Canadian residency education institutions and programs by Spring 2019.
What CanERA transition support is available to specialty committee members?
To support the ongoing transition to CanERA, a phased approach to training has been developed. The training covers the various aspects of a specialty committee member’s role in the accreditation process.
The initial training was delivered via webinar and an online training module in September 2018. It focused on familiarizing members with the new standards and how to provide pre-accreditation review input (e.g. how to navigate CanAMS). All voting members of specialty committees were invited to attend. This training was developed specifically for P3 and based on the CanAMS functionality available at the time.
Additional training will be made available as CanAMS functionality is enhanced. The link to the webinar and online training has been provided to all voting members via email. These links will be re-sent in advance of the pre-accreditation review activities for McGill University. The online training module is available at www.canera.ca under the training, tools and supports tab.
We will be reaching out to specialty committee members imminently to arrange a second training webinar. This webinar will focus on the post-accreditation review stage of specialty committee input into the accreditation process.
Specialty committee members are also encouraged to regularly visit the CanERA website (www.canera.ca), as it contains the latest CanERA news and information. The website includes the new general standards, frequently asked questions (e.g., that relate to Competence by Design in the context of accreditation), and other CanERA-specific information that may be of interest.
To date, there have been 31 applications for accreditation of an Areas of Focused Competence (AFC-diploma) program that have been approved by the Areas of Focused Competence – Accreditation Committee (AFC-AC). These applications are in the following disciplines:
- Adult Interventional Cardiology (8)
- Adult Cardiac Electrophysiology (5)
- Adult Echocardiography (4)
- Adult Hepatology (2)
- Adult Thrombosis Medicine (3)
- Brachytherapy (1)
- Clinician Educator (1)
- Cytopathology (4)
- Solid Organ Transplantation (2)
- Trauma General Surgery (1)
In addition, there are four accredited AFC (diploma) programs in Transfusion Medicine that transitioned from an Accreditation without Certification (AWC) program in 2012. In total, there are 35 AFC (diploma) accredited programs.
International residency program 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. To date, eight international program applications in five disciplines have been submitted. Of the eight applications that have been reviewed, five are proceeding to the next step of the international program application process which is an onsite accreditation review; three have been deferred pending further information/clarification from the program. Given that activities with partners in Saudi Arabia are currently on hold, only three of the five program onsite accreditation reviews have been scheduled and these will be undertaken in the first half of 2019.
The international residency program accreditation is a two-step process that involves the submission of an application form followed by an onsite review to 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.
Committee on Specialties (COS)
Part I AFC (diploma)
- Adult congenital heart disease was approved by the COS to proceed to Part II, including a national consultation of stakeholders, pending minor clarifications from the applicant.
The next deadline for interested AFC (diploma) applicants to apply for Part I review is September 1, 2019, for consideration during the fall 2019 COS meeting.
Changes to Recognized Disciplines
Pediatrics: the request from the Specialty Committee in Pediatrics proposed that all trainees wishing to be certified by the Royal College in Pediatrics should complete the entire residency program (and all associated milestones and entrustable professional activities (EPAs)) in Pediatrics prior to beginning subspecialty training. The application was approved by the COS to proceed to Part II, including a national consultation of stakeholders, pending additional information and clarifications from the applicants.
The four discipline reviews conducted during the fall 2018 meeting, consisting of three regular reviews and one monitoring report, resulted in two of the disciplines returning to the regular review cycle, one of which has been asked to provide minor follow up, for information only, during the next COS meeting. Two other disciplines were requested to submit interim monitoring reports in fall 2019:
- Forensic Pathology
- Public Health and Preventive Medicine
The next COS meeting is April 8-9, 2019 in Ottawa.
The following specialty reviews will take place:
- Anatomical Pathology
- General Pathology
- Gynecologic Oncology
- Gynecologic Reproductive Endocrinology and Infertility
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Medical Biochemistry
- Hyperbaric Medicine
The COS will also review the following Part I and Part II applications:
Part I AFC (diploma)
- Pediatric and perinatal pathology
- Targeted neonatal echocardiography
Part II AFC (diploma)
- Adult congenital heart disease
Changes to recognized disciplines – name change
- Hematopoietic Stem Cell Transplantation: request to change the discipline’s name to Hematopoietic Stem Cell Transplantation and Cellular Therapy.
Changes to recognized disciplines Part II
- Pediatrics: request to have residents in Pediatrics complete their entire residency program (and all associated milestones and EPAs) in Pediatrics prior to beginning subspecialty training.
Specialty Committee Volunteers in the News
Congratulations to Ross Feldman, MD, FRCPC, a voting member of the Specialty Committee in Clinical Pharmacology and Toxicology, who was awarded the Order of Canada on December 27, 2018. The Governor General’s office cited Dr. Feldman’s “leadership in the prevention and control of hypertension in Canada.” Dr. Feldman was one of 103 Canadians newly named to the Order.
Upcoming Meetings and Deadlines
Credentials Committee – February 28, 2019
Council – February 20-22, 2019
Assessment Committee – March 14, 2019
Committee on Specialties – April 8-9, 2019
Chair and specialty committee members’ resource
Did we lose you in our new website look?
With changes to the Royal College website to reflect our new brand, you may not be able to easily locate some of the resources you depend on as a volunteer.
The Specialties Unit home page has the same address and we encourage you to bookmark the appropriate Member Resource site for your committee:
The resources compiled on the Specialties Unit home page will help members navigate their volunteer role on AFC (diploma) or specialty committees. You’ll find everything you need to know about the functioning of the committee and its ongoing work to maintain its discipline standards. Additionally, information on the activities relating to the Committee on Specialties, accreditation, AFC application process, credentialing, and exams and assessment is housed here.
If you didn’t find something you were looking for on the site, please let us know. (firstname.lastname@example.org).
The 2019-2021 appointment process is underway. If you are eligible for reappointment this year, please respond to the email you have received to verify whether or not you would like your appointment to be renewed for another term. If you are not continuing on as chair, we will be in touch to seek your nominations for new committee chair.
Chairs of committees in the appointment process this year can review the terms of reference, policies and role descriptions in the committee member resource site to assist with succession planning and identifying nominees for vacancies. Please share the above links with people you are encouraging to volunteer on your committee or new appointees to your committee.
If you have any questions about your appointment status or nominations for committee members please send them to email@example.com.