As you all know we hosted the annual chairs workshop on November 25 and 26 in Ottawa. It was great to see so many of you there. We had more than 80 chairs, chairs-elect and delegates in attendance. We covered topics including accreditation, Area of Focused Competence (AFC) reforms, Competence by Design (CBD), credentialing, Committee on Specialties (COS) reviews and others. Whether you were able to attend or not, we have saved the presentation decks and related materials and made them accessible to you for your reference here. If you have any questions about any of the topics or the workshop itself, please let us know at firstname.lastname@example.org. We’ll be sending out a save the date for the 2020 workshop early in the new year.
1. Prioritize reforms of the assessment strategy for AFC-diplomas
1.1 Revise the assessment policy for the trainee in a Royal College-accredited program
The proposed reform of assessment for the in-training route will be aligned with the competence-based medical education, while identifying processes and policies appropriate to the diploma category.
The national standards will continue to play a central role, with the expectation that all accredited AFC programs will teach and assess candidates using the standards. Accreditation activities, specifically on-site reviews and two-year touchpoints, would help ensure the national standards are being used as intended by the Royal College.
Local programs (AFC director acting on behalf of postgraduate dean) will make a determination of candidate competence in accordance with the national standards. In this model, there is no submission of evidence to the Royal College and no external assessment of evidence of achievement. The Royal College would award a Diploma according to attestation of the AFC director and postgraduate medical education (PGME) office.
Consultations with AFC chairs took place on Friday, October 25 and Friday, November 1. A session at the Specialty Committee Chairs’ Workshop on November 25 and 25 was an additional opportunity for discussion and feedback about this proposal. Preliminary discussions with postgraduate deans began in early November and December, and will be on-going. The model was also shared with and well received by the Committee on Specialties (COS) and the Committee on Specialty Education (CSE). Planning is underway for a web conference with AFC Directors in the New Year.
Feedback received during the consultations will inform the final model of reform adopted and implemented. As consultations were ongoing at the time this article was submitted, it is not possible to comment on timelines or next steps following December. More information will be available in the next edition of the SCC Update.
1.2 Revise the Practice Eligibility Route (PER) for AFCs
The proposed reform of the practice eligibility route (PER-AFC) prioritizes streamlining the process and introduces 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. As is current practice, candidate submission (scope of practice, curriculum vitae (CV), national and international reputation in the AFC, if applicable to the discipline), and MSF results would then be assessed by one discipline-specific assessor, and sent to a second only in cases when there is uncertainty in the first assessor’s review.
The proposed changes were presented to AFC chairs by web conference on September 6 with an opportunity to provide feedback until September 30. The proposed reform was also part of the consultation at the Specialty Committee Chairs’ Workshop in November. More information will be available in the next edition of the SCC Update.
2. Re-launch ongoing efforts to reform the accreditation policy and process
2.1 Streamline General Standards of Accreditation and associated evidence
Following national consultation with key stakeholders throughout summer 2019, the new General Standards and policy manual (which seek to streamline to key markers of program quality) were endorsed by the overarching Accreditation Committee in November. As a result, prototype implementation will take place at the on-site surveys at the University of Toronto in fall 2020 and Université de Montréal in spring 2021.
2.2 Revise specialty-specific AFC standards of accreditation
Throughout the fall, staff from the Educational Standards Unit (ESU) met with the AFC committees for disciplines with accredited programs at the University of Toronto and the Université de Montréal to convert the existing AFC-SA into the new format. This work is complete. Disciplines not yet converted will be contacted in early 2020 to schedule meetings so that ESU can assist with the conversion.
With regards to applications for an accredited program, the 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 this process, making it easier for applicants, and that the new standards and restructured evidence will more clearly communicate expectations. Applicants are advised to consult with ESU if you have an application being developed (email@example.com).
2.3 Digitize the AFC accreditation process
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 programs and PGME offices, access to the new standards and digital platform will be provided 12 months before accreditation activities.
A plenary session on CanERA and the digitized accreditation process took place on Tuesday, November 26, at the Specialty Committee Chairs’ Workshop.
2.4 Develop new training modules for accreditation
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.
3. Formulate a plan to increase the visibility of the value of the category
3.1 Cease use of the word “affiliate” within the designation
In spring 2019, the Royal College ceased use of the phrase ‘Diplomate Affiliate’. Now, all eligible candidates, regardless of their Fellowship status, will have the opportunity to use the designation Diplomate. This includes not only 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. Diplomates may use the designation DRCPSC if their Diplomate status is maintained annually.
3.2 Create a new affiliate category for Diplomates from Family Medicine
A new category was considered by the Fellowship Affairs Committee (FAC) for decision in December. Pending approval, the proposal will proceed to Royal College Council for decision in February 2020. Royal College staff will be in contact with relevant AFC committees to provide more details on implementation pending approval of the category.
3.3 Develop 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 be completed early in the New Year.
As part of the campaign, updates have been made to the online directory to make available to the public those who have become Diplomates as well as the AFC discipline descriptions.
4. Consider how to continue to provide support, and improve upon the support already provided
4.1 Streamline the application process: National Consultations and interface with specialty committees and AFC committees, subcommittees and working groups
Based on feedback from stakeholders, including AFC applicants and specialty committee chairs, the Royal College is working to simplify and streamline the discipline recognition and national consultation processes. Additionally, the Royal College aims to increase the transparency of the discipline recognition process and will be working to make information more readily available and accessible.
It is anticipated that the next cohort of new disciplines going to national consultation will be able to access the streamlined process.
4.2 Facilitate a better sense of community while building expertise and capacity among AFC program participants
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, such as AFC chairs, 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.
Similarly, to align with these principles, an AFC booth was also added to the tradeshow at the Specialty Committee Chairs’ Workshop, making it possible for both specialty and AFC chairs to ask questions, seek clarification and provide feedback on the proposed reforms.
In terms of additional supports, work is being done to identify and assess the impact of the reforms for each AFC discipline. A discipline-by-discipline impact summary will help AFC chairs better understand what changes will impact their discipline and to assist them with work planning in 2020.
Change in a time of growth
We see continued interest in all aspects of the AFC program, ranging from new applications for discipline recognition and accredited programs through to an increase in the number of candidates becoming Diplomates. We appreciate all those who have supported the AFC program, provided feedback and are advocates for your discipline and the category. We are learning throughout this process and hope to always improve, not only the way we deliver the program but also support you, our vital volunteers.
The Royal College is leading a multi-year program evaluation initiative to evaluate CBD, with several ongoing and concurrent projects, both by the Royal College and other organizations.
Several program evaluation projects have already been completed; most recently the CBD program evaluation operations team completed a Pulse Check, which examined implementation at the program level for the 2017 and 2018 launch disciplines, and a Readiness to Implement Checklist, which examined readiness at the program level for the 2019 launch disciplines. Other program evaluation initiatives have also focused on the institution level, and many organizations across the country are engaging in program evaluation at different levels. For example, the resident organizations have undertaken informative studies at the resident level.
The CBD Pulse Check indicated that many programs are in the process of fully implementing key features of CBD, and that overall their implementation is going neutral to well.
The Readiness to Implement Checklist found that programs have completed, on average, 72% of pre-implementation tasks just prior to their CBD launch. Typically, programs were more likely to have completed administrative tasks, such as identifying competence committee members, than on the ground work, such as preparing faculty to integrate direct observation into their workflow.
Program evaluation projects thus far have highlighted several benefits and successes, as well as challenges and areas to monitor going forward. Recommendations address these challenges.
|Benefits and Successes||Challenges and Areas to Monitor|
Recommendations from the current initiatives have been brought forward to relevant teams. Other projects, such as studying outcomes, are currently in development. Work is also ongoing to engage other organizations and sites doing program evaluation, in order to form a program evaluation community and learn from the many initiatives and insights across the country.
The Exams Unit has completed a review of the roles and responsibilities of all examination board positions in order to increase transparency and better inform expectations.
There are several key functions the specialty committee chair is expected to perform. It is important to note that most of these activities are recognized in the Maintenance of Certification (MOC) () program.
The responsibilities associated with the specialty committee chairs’ role are identified below. We hope this information helps you navigate your responsibilities to the examination board.
Strategic Direction & Leadership
At the November 14-15, 2019 COS meeting, the following outcomes were determined:
Recognition of Disciplines: Areas of Focused Competence (AFCs)
The COS considered the following applications for recognition as AFC disciplines:
The next deadline for interested AFC applicants to apply for Part I review is February 1, 2020, for consideration during the spring 2020 COS meeting. We strongly encourage applicants to submit draft documents well in advance to firstname.lastname@example.org, so that our office and senior clinician staff can review them and provide guidance, as needed.
Recognition of Disciplines: Part I Subspecialty
The COS also considered an application for the recognition of dermatopathology as a subspecialty of Anatomical Pathology and General Pathology.
Eleven discipline reviews were conducted during the fall 2019 meeting, consisting of five regular reviews, three monitoring reports, and one in-depth review:
The next COS meeting will take place on March 26-27, 2020 in Ottawa.
The following discipline reviews will take place:
The COS also plans to review the following applications for discipline recognition:
Part I AFCs
Part II AFCs
Part II Subspecialty
Learn more about CBD and coaching – and earn MOC credits!
As Competence by Design (CBD) rolls out across Canada, residents and faculty tell us there is still a significant need for knowledge and skill development around the concept of coaching. To this end, a small group of educators and physicians have developed a new resource to help fill the gap: “Coaching to Competence” consists of five short interactive online activities that allow you to practice applying the RX-OCR coaching process.
These quick activities are meant to help you develop coaching skills and knowledge through practice, reflection and other learning opportunities.
BONUS: Earn Section 3 MOC credits for each of the five activities!
Access the RX-OCR activities here: /mssites/rxocr/en/story.html
And be sure to bookmark the RX-OCR Toolkit, which includes:
Please feel free to share the information widely within your program.
And let us know if you find these modules helpful - your feedback is always helpful as we continue to refine CBD faculty development resources.
Regular Accreditation Reviews
The final accreditation decisions for McGill University were made at the October 2019 Res-AC meeting, concluding the prototype testing phase of CanERA implementation. The Western University regular accreditation review is scheduled to take place November 2019. The associated specialty/area of focused competence discipline committee pre-accreditation review input was sought early fall 2019; the post-accreditation review input is anticipated to be sought winter 2020. The University of British Columbia regular accreditation review is scheduled to take place March 2020; the associated specialty/area of focused competence committee pre-accreditation review input will be sought in late fall 2019/early winter 2020.
Canadian Excellence in Residency Accreditation (CanERA)
Recent and Upcoming Activities
As of July 1, 2019, all accreditation reviews conducted will be based on the new system of accreditation. The Canadian Residency Accreditation Consortium (CanRAC) will continue collaborative efforts with respect to the ongoing development, evaluation, and continuous improvement of CanERA.
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 regularly visit the CanERA website (www.canera.ca), as it is up to date 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.
Areas of Focused Competence (AFC) Accreditation
Recent and Upcoming Activities
Efforts are underway to prepare for the testing of the new AFC accreditation system during the regular accreditation review of AFC programs at the University of Toronto and Université de Montréal, in November 2020 and March 2021, respectively. In alignment with the approach to testing and implementation of CanERA, prototype testing of all aspects of the new AFC accreditation system will take place, prior to its full implementation where the new system will apply to all accreditation review; full implementation 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 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 (3), Trauma General Surgery (1) and Hyperbaric Medicine (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 37 AFC (diploma) accredited programs.
International Residency 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, 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 ESU 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.
A draft Annual Discipline Status Report covering committee activities from January to December 2019 will be sent to all chairs for validation mid-February. Chairs will have two weeks to review this information and advise their Specialties Unit administrator of corrections. The final status reports will be disseminated to chairs by email in mid-March 2020.