Why the change? The original dates conflicted with a two key Fellow and Royal College activities. Several chairs of the radiology disciplines have not been able to attend the past few years because the workshop occurred contiguous to a major conference. As well, on-site Accreditation Surveys were scheduled during the original workshop dates which would prevent attendance by senior Royal College accreditation staff. With the relocation of the Workshop earlier in November, we will avoid these overlaps.
We look forward to a fuller meeting in many respects in 2020. See you then!
The Royal College of Physicians and Surgeons of Canada and the Canadian Patient Safety Institute are pleased to offer a new ASPIRE Certificate Course in Sherbrooke (French course) from October 21-23, 2020 and in Ottawa (English course) from November 24-27, 2020.
ASPIRE prepares faculty to teach and assess the quality improvement and patient safety competencies integrated throughout the CanMEDS 2015 framework in the context of Competence by Design (CBD). The ultimate goal is to ensure that every resident in Canada develops the necessary competencies to deliver high quality, safe care for patients and their families.
Have you ever asked yourself, “What exactly do I need to do for CBD and when do I need to do it?” If so, you’re not alone. While every program and institution has differing needs, priorities and resources, a small group of clinician educators, program directors, and Competency Based Medical Education (CBME) Leads have created a CBD planner based on what they characterize as “fairly typical” patterns and strategies that enable implementation.
We are pleased to announce that the CBD Implementation Planner is now available on the Royal College website as an interactive resource. Although there will be some variability in timelines and activities, you can now access the typical activities that you should plan for, based on how far you are from your planned launch.
The typical activities are split into three big buckets to help you more easily think about and organize your work: (1) team and resources, (2) structure and (3) capacity building.
Note: Be sure to connect with your local systems and resources early on to ensure that you are implementing CBD according to the policies of your institution and within a timeline that facilitates success.
Implementation Booster Webinars periodically bring together several specialty committees that are at a similar stage of their CBD transition, and have been offered for the past 18 months. These web-based sessions are scheduled between CBD workshops and are meant to “boost” local activities that focus on CBD capacity building.
We are pleased to announce that we are expanding on the Implementation Booster model and will now offer pre-launch boosters to all disciplines approximately 6-8 weeks prior to launch. Watch for your invitation to attend one of these pre-launch boosters where you can discuss common experiences and local successes as well as troubleshooting and resource sharing.
The Royal College is pleased to announce the addition of a new module on program evaluation to the CBD for Program Directors resource, which offers both Section 2 and Section 3 Maintenance of Competence (MOC) credits. The goal of the program evaluation module is to help program directors build a plan to evaluate the impact of their CBD program.
The module introduces the basics of program evaluation, and then offers an in-depth look at each of the elements of the CBME Logic Model, a recommended framework for CBD program evaluation. After completing the module, it’s expected that program directors will have a first draft of a personalized CBD program evaluation plan.
Western University’s regular accreditation review occurred in November 2019; the post-accreditation review input will be sought in winter/spring 2020. The University of British Columbia regular accreditation review is scheduled for March 2020; the associated specialty committee pre-accreditation review input was received and reviewed in early winter 2020.
Recent and Upcoming Activities
July 1, 2019 signalled the transition to the new CanERA model for all Canadian residency institutions and programs, with new standards, processes and policies, and use of the digital accreditation management system (CanAMS). Although the new system has been successfully launched, CanRAC (the Canadian Residency Accreditation Consortium) will continue collaborative efforts with respect to the ongoing development, evaluation, and continuous improvement of the CanERA model.
What CanERA transition support is available to Specialty Committee members?
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.
Recent and Upcoming Activities
Following input from the comprehensive evaluation of the AFC category in 2018, as well as from the national consultations held in summer 2019, efforts have been underway to reform the AFC accreditation system. In alignment with the approach taken to the implementation of CanERA, a prototype test of all aspects of the new system will take place during the regular accreditation review of AFC programs at the University of Toronto and the Université de Montréal (November 2020 and March 2021, respectively). Experience and feedback gathered during prototype testing will be used to introduce further improvements to the new system of accreditation. Full launch of the new AFC accreditation system (i.e., when it will be applicable to all accreditation reviews) is anticipated for July 1, 2021.
Training and support will be provided to AFC discipline-committees to prepare for providing pre- and post- accreditation review input based on the new AFC accreditation system.
Overview of Accredited AFC Programs
To date, there have been 33 applications for accreditation of an AFC program that have been approved by the Areas of Focused Competence – Accreditation Committee (AFC-AC). These applications are in the following disciplines:
In addition, there are four accredited AFC (diploma) programs in Transfusion Medicine that transitioned from an Accreditation without Certification (AWC) program in 2012. Thus, in total, there are 37 AFC accredited programs.
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 10 international program applications in six disciplines have been submitted. The current status is:
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.
Work continues on a collaborative response to the AFC Program Evaluation that concluded in fall 2018. The following are updates on the implementation of the four key recommendations approved by the Committee on Specialty Education:
This recommendation was divided into two lines of work – one for the in-training route and the other for the practice route (PER-AFC).
Following the consultations with AFC Chairs throughout the fall, including some preliminary discussions with postgraduate deans and the Committee on Specialties (COS), a proposed model for in-training assessment was shared with AFC Directors (and AFC Chairs) via a webinar on January 9. Comments provided during the meeting and in the survey results indicated considerable enthusiasm for the changes, along with a desire to see them implemented as soon as possible. Having received approval to proceed with the reforms, implementation began in late January with the impacted stakeholders being advised of the changes through a formal memorandum, along with guidance on implementation, timelines and next steps. These stakeholders include PGME offices, AFC Directors, AFC Chairs and Committees, and Assessors.
To recap the highlights of the reformed model of assessment for the in-training route, it includes the following:
Step 1: Trainee registers with the Credentials Unit and pays the assessment fee.
Step 2: Trainee achieves each milestone of the portfolio, confirmed through the sign-off by the assigned Clinical Supervisor(s).
Step 3: AFC Director signs-off on the completed portfolio, attesting that the trainee achieved the required competencies and is therefore eligible for the designation of Diplomate.
Step 4: Postgraduate medical education (PGME) office signs off on completed portfolio, attesting that the trainee completed the accredited AFC training program as per the national standards and is therefore eligible for the designation of Diplomate. PGME office advises Royal College trainee is eligible for designation of Diplomate.
Step 5: Credentials Unit advises the Trainee that the AFC Director and PGME office has confirmed their eligibility for the designation of Diplomate.
Step 6: Trainee is invited by the Membership Unit to become a Diplomate of the Royal College (DRCPSC).
Step 7: Trainee becomes a Diplomate by paying the category fee, receiving both their Diploma and updated identification card.
Following confirmation from the AFC Director and postgraduate medical education (PGME) office that a trainee is eligible for the designation, the trainee will then be invited by the Royal College to become a Diplomate. If the invitation is accepted, they will be awarded a Diploma. Only those who continue to maintain their status as a Diplomate are eligible to use the designation.
We have just begun the work to create the changes needed and it will take several months, if not longer, to fully implement. We appreciate the time and energy that you, as volunteers and stewards of the discipline, have committed not only to the AFC program, but the consultation process. Your willingness to participate and provide input has been invaluable and we are optimistic that the changes being introduced will improve your experience of the program, while also helping to increase the value and visibility of the category.
Discipline-specific scope of practice
Curriculum vitae (CV)
Narrative of physician’s national/ international reputation in the AFC, if applicable
Names of 8 peers, including Chief of Staff*, to complete a multisource feedback questionnaire (MSF)
*depending on discipline
To recap, the proposed reform of the practice eligibility route (PER-AFC) prioritized streamlining the process and introduced a discipline-specific scope of practice for each candidate to complete. The candidate’s competencies would then be verified by numerous candidate-identified peers who could provide input via a multisource feedback (MSF) questionnaire. The candidate’s submission, along with the results of the MSF results, would then be assessed by one discipline-specific assessor, and sent to a second only in cases when there is uncertainty.
Following the consultations last fall, work has begun to develop an implementation plan, with an anticipated start date in the spring 2020.
Please contact us if you have any questions: Dr. Bhanji, Associate Director, Assessment Strategy, Assessment (email@example.com) and Tiffany Lynch, Program Coordinator, Credentials Unit (firstname.lastname@example.org) are available to answer questions and can meet with you and/or your committee.
The new General Standards and policy manual, which seek to streamline to key markers of program quality, were endorsed by the Accreditation Committee in November, allowing prototype implementation to take place at the on-site surveys at the University of Toronto in fall 2020 and Université de Montréal in spring 2021. The University of Toronto has received the required documents, materials and information from the Royal College to begin preparing for the review.
AFC disciplines with accredited programs at the University of Toronto and the Université de Montréal have had their existing AFC-SA converted into the new format. The remaining disciplines will be contacted in early 2020 to schedule a committee meeting so that ESU can assist with the conversion. Do not hesitate to contact your administrator if you wish to plan a meeting.
With regards to applications for an accredited program, applicants are advised to consult with ESU if you have an application being developed (email@example.com). At this time, the current process remains unchanged until the full implementation of the new standards in July 2021. It is anticipated that the digitized accreditation process of CanERA will improve the process, making it easier for applicants, and that the new standards and restructured evidence will more clearly communicate expectations.
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 full launch of the accreditation reform in July of 2021. In keeping with the Royal College commitment to accredited programs and PGME offices, access to the new standards and digital platform will be provided 12 months before accreditation activities.
New resources will be developed and made available during the prototype testing phases and are expected to be available to committees and university personnel before the full launch in 2021.
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 considered and we will keep your committees informed of any new offerings.
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”.
Physicians from Family Medicine
Having ceased using the phrase ‘Diplomate Affiliate’ in spring 2019, work has begun to update the website and other publications. Following this change, all eligible candidates, regardless of their Royal College Fellowship status, will have the opportunity to use the title Diplomate. This not only includes candidates from Family Medicine but also international medical graduates. To be eligible to become a Diplomate, a candidate must first achieve the discipline’s portfolio through either the in-training or practice route. Diplomates may use the designation DRCPSC if their Diplomate status is maintained annually and they are participating in the MOC program. Currently, physicians from Family Medicine need to participate in both the Royal College MOC Program (to maintain Diplomate status) as well as CFPC’s MainPro+ (to maintain their CFPC membership). To eliminate the duplication of data entry and fees, a proposal is proceeding to Royal College Council for decision in February to allow for exemption of family physicians from the Royal College MOC Program requirement and fees, so long as they remain in good standing with CFPC’s program. Royal College staff will be in contact with relevant AFC Chairs to provide more details following Council’s decision on Feb. 21-22.
An AFC campaign
A communications plan is in development and includes tools, tactics and key messages intended to increase the profile of the AFC category, AFC programs, and the value of the diploma among stakeholders. This work includes making AFC content on the Royal College website more accessible and more relevant to key stakeholder groups. The updates to the website will require multiple phases, with the first phase of work expected to launch by spring.
Work has begun to simplify and streamline the discipline recognition and national consultations processes. Several initiatives are being piloted through until spring 2020 with the intention of managing and monitoring their impact. To support these initiatives, revisions to the website are being made which aim to increase transparency of the discipline recognition process and to build knowledge and capacity among a broader group of stakeholders.
Building expertise and capacity among key stakeholders is an on-going and evolving reform, with the current focus being on how to ensure key stakeholders remain informed and are a part of the proposed changes. These core principles inform the communications plan and stakeholder engagement strategy, and will be supported by additional reforms such as updates to the website. We are currently prioritizing communications to stakeholders who will be immediately impacted by the reforms, which include AFC Chairs and Committees, AFC Directors, Trainees and Assessor pools. We are also exploring new and additional ways to keep you informed.
An internal staff team, the AFC Program Evaluation Implementation Working Group (AFC PE IWG) continues to meet regularly to coordinate the reform activities of the respective operational units, in accordance with the directions and recommendations approved by the Committee on Specialty Education. 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 Linda Rumleski, Program Manager, AFC (firstname.lastname@example.org).