In 2018 the Royal College completed a collaborative program evaluation of the Areas of Focused Competence (AFCs). The findings of the program evaluation led to four recommendations which were endorsed by the Royal College’s Committee on Specialty Education in 2018. These recommendations, as well as associated details regarding status to date, are as follows:
Implementation of this recommendation is anticipated to be divided into two lines of work, as follows:
In alignment with the AFC program evaluation’s recommendation to refine and simplify accreditation policy and processes, at their November 2018 meeting, the AFC-AC gave detailed consideration to proposed directions for the ongoing development and implementation of a new system of AFC accreditation. It is anticipated that the April 2019 meeting of the AFC-AC will focus discussion on specific aspects of the new system of AFC accreditation (new program-level accreditation standards, as well as proposed changes to the accreditation process, including digitization and enhanced mechanisms for incorporation of AFC trainee feedback), with an aim to enable consultation with AFC stakeholders on the proposed directions for AFC accreditation reform in May-June 2019.
There are several emergent directions associated with this recommendation, related to principally to membership within the categories, naming conventions for designations, and promotions and increased education. To date, progress has been made to address inequities related to the naming conventions used to refer to the designation of Diplomates. Up until recently, guidelines stipulated that those Diplomates who were not Royal College Fellows were referred to as “Diplomate Affiliates.” However, going forward, all eligible Diplomates, regardless of their Fellowship status with the Royal College, will be granted the opportunity to use the term “Diplomate.” Development of the other directions is presently underway.
Associated with this recommendation, Royal College staff will examine aspects of the current processes for AFC diplomas in order to streamline, clarify, and provide further guidance. Consideration will be given to the National Consultations for AFC-diplomas as a component of this recommendation.
To date, the results of the evaluation and the four recommendations have been shared in a variety of forums including the specialty committee chairs’ workshop in November 2018 and most AFC committee and subcommittee meetings that have taken place since the evaluation was completed. If your committee has not met during this time and you would like a copy of the summary results, please contact your administrator.
As the Royal College moves through the implementation process, updates will be a regular feature in this newsletter. Implementation timelines are currently being developed, recognizing that some changes will be easier to address than others. If your committee is contemplating undertaking significant work (e.g. proposing a new AFC, submitting an application, creating a PER, etc.) please check in with your administrator before undertaking that work so that we can verify whether a new process is in development. We can also help when a decision on that process change is anticipated. Our goal is to ensure efficiency in any work your committee is doing, and help you take advantage of some of the forthcoming changes.
The Western University regular accreditation review is scheduled November 24 to 29, 2019. The specialty committee pre-accreditation review input is planned for early fall 2019.
Recent and Upcoming CanERA-related Activities
CanRAC (the Canadian Residency Accreditation Consortium) continues collaborative efforts emphasizing ongoing development and evaluation of CanERA, as well as the broad release of CanAMS.
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, covering various aspects of a specialty committee member’s role in the accreditation process. Training specific to the pre-accreditation review specialty committee input process was delivered by webinar and an interactive online training module in September 2018. In late March 2019, a webinar detailed the specialty committee’s role in providing post-accreditation review input.
While all voting members of specialty committees were invited to attend the webinars, this training was developed specifically for Dalhousie University and McGill University (Prototype 3 reviews) based on the CanAMS functionality available at that time. CanAMS functionality will evolve as will the associated training.
The link to the webinar and online training has been provided to all voting members via email. The online training module is also available at www.canera.ca under the training, tools and supports tab.
We encourage specialty committee members to regularly visit the CanERA website, which has the latest CanERA news and information. The website includes the new general standards, frequently asked questions (e.g., Competence by Design in the context of accreditation), and other CanERA-specific information.
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) and 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. Thus, in total, there are 35 AFC (diploma) 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 eight international program applications in five disciplines have been submitted. Of the eight applications that have been reviewed, five are proceeding to an onsite accreditation review which is the next step of the international program application process; 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. One took place in January and the preliminary accreditation review report was released to the specialty committee in mid-March for review and input; the other two (at the same institution) are scheduled for late June, the preliminary accreditation review reports of which are anticipated to be provided to the specialty committees by end-August for review and input. In addition, responses to deferred decisions from reviews of applications in 2018 will be forthcoming in mid – late 2019 for review by the relevant specialty committee. Approximately three new program applications (Emergency Medicine, Nuclear Medicine and Pediatrics) are expected in 2019.
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.
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More details will be provided to all Specialty Committee Chairs in the coming weeks. If you have topics you would like to see on the agenda for discussion, please forward those to Chris Farley Ratcliffe at SpecialtyCommittees@RoyalCollege.ca.
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. (email@example.com).
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 firstname.lastname@example.org.
We are beginning the process of planning the 2019 Specialty Committee Chairs Workshop and we look forward to seeing you there.
We also have an opportunity for you to participate in shaping the workshop and agenda. Every year we establish a planning committee to ensure that the workshop responds to your needs as chairs. If you are interested in participating in the planning committee or have questions about this opportunity, please email Chris Farley Ratcliffe, manager, Specialty Support (email@example.com).
Lucinda Whitman, MD, FRCPC, was the first to take on the inaugural challenge.
Transfusion Medicine was originally recognized as an Accreditation without Certification (AWC) discipline. This was in response to the 1997 Krever report of the Commission of Inquiry on the Blood System in Canada, which aimed to improve the education of transfusion professionals in Canada. Dr. Whitman submitted an application to transition the discipline to an AFC-diploma on the basis that a competency-based AFC would provide flexibility in training for individuals entering from different specialty or subspecialty disciplines.
Over the next three years, Dr. Whitman served as chair of the working group tasked with defining the discipline and developing standards, and then as chair of the AFC Committee in Transfusion Medicine, which continues to oversee the implementation and maintenance of the national standards.
Others followed in Dr. Whitman’s footsteps. Early volunteers included Dr. Peter G. Guerra and Dr. Martin Green, who brought forward Adult Cardiac Electrophysiology; Dr. James Tam and Dr. Ian Burwash for Adult Echocardiography; and Dr. Donald Palisaitis for Adult Interventional Cardiology. Contributing to the success of these initial applications was Dr. Cathy Kells of the Canadian Cardiovascular Society (CCS) who played a key role in working with these applicants to align and coordinate the Cardiology-related applications.
Setting national standards in new categories
In 2011, the Royal College established the Areas of Focused Competence (AFC) diploma category to recognize disciplines that meet a legitimate societal need but do not meet the criteria of a specialty or subspecialty. AFC-diplomas are intended to provide national standards for training and patient care in these areas.
Scores of volunteers have been key to the implementation of this new category since the Royal College’s Committee on Specialties (COS) received its first AFC diploma application eight years ago.
Volunteers support critical activities associated with AFC-diplomas including
Paving a path for more robust standards
To date, COS has recognised 24 AFC diplomas. Largely thanks to the efforts of Royal College volunteers, 18 of those disciplines are “live” with approved standards now maintained by the AFC committees and subcommittees. The remaining six are at the working group phase. Across the disciplines, there are 35 accredited training programs and AFC directors across the country. Since AFC diploma recognition began, the Royal College estimates that well over 1,000 passionate, dedicated and committed volunteers have contributed to the AFC program. These volunteers have served as appointed members of discipline-specific committees or other Royal College committees such as the Specialty Standards Review Committee, the AFC-Accreditation Committee and COS. Many others have volunteered for individual roles such as accreditation surveyors or serve as one of the 107 volunteer portfolio assessors available to assess candidate portfolios arriving through the trainee or practice eligibility route (PER-AFC).
The Royal College recognizes the leadership and expertise of the many volunteers who, through their participation in the AFC program, have paved a path for more robust national standards and better quality of care for many Canadians.