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Specialty Committee Chairs’ Update

Mises à jour pour présidents des comités de spécialité

Mises à jour pour présidents

des comités de spécialité

Specialty Committee

Chairs’ Update

September-October 2020


Return of the Specialty Committee Chairs’ Update

In the spring of 2020 we stopped the regular production of the Specialty Committee Chairs’ Update given the speed at which changes were taking place and the amount of information that was being sent out to you from the Royal College. Now that we have settled into a more regular rhythm and the pace of change has slowed down we are returning to our regular bimonthly updates to ensure that you are all kept informed of activities and changes at the Royal College.

The Specialties Unit will continue to provide updates outside of this schedule to any changes that require more timely information.


Specialty Committee Chairs’ Workshop

As previously announced, the annual Specialty Committee Chairs’ Workshop will be taking place November 16 and 17. It will be a virtual event this year and in recent weeks you will have received the workshop agenda and information that you can use to register for the workshop.

The agenda will include updates on Accreditation, Examinations, tips on how to best fulfill your role as a committee chair, opportunities for discussion on Area of Focused Competence (AFC) reforms, Competence by Design (CBD), Royal College communications, impacts of COVID-19 on training and best practices for running virtual meetings.

The workshop will include opportunities for you to network and learn from one another.

We look forward to seeing you there!

Questions about the workshop or any other topics can be sent to specialtycommittees@royalcollege.ca


Committee on Specialties

At the spring 2019 Committee on Specialties (COS) meeting, which took place virtually on March 26, 2020, the following outcomes were determined:

Recognition of disciplines: Areas of Focused Competence

The COS considered and approved the following applications for recognition as an AFC discipline:

  • Neuro-intervention (Part I)
  • Antimicrobial Stewardship (Part II)
  • Consultation Liaison Psychiatry (Part II)
  • Pediatric and Perinatal Pathology (Part II)

The next deadline for interested AFC applicants to apply for Part I review is February 1, 2021, for consideration during the spring 2021 meeting. We strongly encourage applicants to submit draft documents well in advance to cos@royalcollege.ca, so that our office and senior clinician staff can review them and provide guidance, as needed.

Changes to existing disciplines: modification to discipline entry routes

The COS determined that the removal of Internal Medicine as an entry route to Pediatric Hematology/Oncology represented a minor change, and a public notification of intent toward this change was published by the Royal College on its website, for a period of 60 days. The final decision will be published on the website and circulated in a memorandum to stakeholders.

Discipline reviews

Nine discipline reviews were conducted during the spring 2020 meeting, consisting of eight regular reviews and one monitoring report:

  • Neuroradiology
  • Diagnostic Radiology
  • Adolescent and Young Adult Oncology
  • Medical Oncology
  • Pediatric Radiology
  • Radiation Oncology
  • Interventional Radiology
  • Brachytherapy
  • Public Health and Preventive Medicine

The next COS meeting will be held virtually on November 2 and 3, 2020, and the following discipline reviews will take place:

  • Sleep Disorder Medicine
  • Sport and Exercise Medicine
  • Medical Biochemistry
  • Pediatrics
  • Nuclear Medicine
  • Physical Medicine and Rehabilitation
  • Clinical Immunology and Allergy
  • Respirology
  • Rheumatology

The COS also plans to consider the following applications for the recognition of new disciplines:

Part II AFCs

  • Neuro-intervention

Accreditation Update

Impact of COVID-19

In response to the COVID-19 global pandemic, the Canadian Residency Accreditation Consortium (CanRAC) first met in early April 2020 to discuss the impact on accreditation activities. A memo was issued to postgraduate deans and posted on the Canadian Excellence in Residency Accreditation (CanERA) website English | Français. CanRAC outlined a number of considerations in deciding if and how to proceed with accreditation activities during the pandemic. Some external reviews that were scheduled for spring/summer were rescheduled to the fall, but others were selected (in consultation with all relevant stakeholders) for a pilot test of the remote delivery of accreditation reviews.

Since then, testing and evaluation have been ongoing. Four Royal College virtual external reviews were completed in May and June 2020. Evaluation results indicate that the majority of stakeholders (including surveyors, programs, and postgraduate medical education (PGME) stakeholders) felt that the rigour and integrity of the accreditation process were upheld, and these evaluation results are informing the design and scheduling of remote accreditation activities on an iterative basis. CanRAC leadership and the accreditation staff of all three colleges remain in close consultation with all stakeholders to continuously reassess and define appropriate next steps.

Regular Accreditation Reviews

The University of British Columbia (UBC) regular accreditation review occurred in March 2020, just before the global pandemic was declared; the post-accreditation review was sought from specialty committees in the spring/summer, who delivered extremely valuable input despite multiple competing priorities and delays. This input was considered at the Residency Accreditation Committee (Res-AC) meeting in early October when the final accreditation decisions for UBC programs were rendered.

The University of Toronto’s regular accreditation review remains scheduled for November 2020; however, due to the ongoing global pandemic, the review will be conducted remotely via virtual meetings and extended over two weeks. The associated specialty committee pre-accreditation review input was sought earlier this fall.

Similarly, the regular accreditation review of the Université de Montréal remains scheduled for spring 2021, with planning underway for a remote delivery informed by any lessons learned this fall. Due to the need for translation, specialty committees should expect to provide pre-accreditation review input in mid-January and extensions to deadlines will not be possible; the work of all specialty committees is greatly appreciated in ensuring the timely provision of that input.

Canadian Excellence in Residency Accreditation (CanERA)

Recent and Upcoming Activities

In keeping with the goal of continuous quality improvement, CanRAC continues to evaluate and iterate now that CanERA has been fully deployed nationwide. Updates to the General Standards of Accreditation English | Français were approved and made available to institutions and programs over the summer, with accompanying updates to the evidence collected in the digital Canadian Accreditation Management System (CanAMS). Updated training and additional guidance are in development to support program stakeholders and specialty committees, particularly in areas such curriculum mapping and CanAMS functionality.

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 often, as it is updated with 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 that may be of interest.

Area of Focused Competence (AFC) Accreditation

To date, 38 applications for accreditation of an AFC program that have been approved by the Areas of Focused Competence – Accreditation Committee (AFC-AC). These programs are in the following disciplines:

  • Adult Interventional Cardiology (8),
  • Adult Cardiac Electrophysiology (6),
  • Adult Echocardiography (5),
  • Adult Hepatology (2),
  • Adult Thrombosis Medicine (3),
  • Brachytherapy (1),
  • Child Maltreatment Pediatrics (2),
  • Clinician Educator (1),
  • Cytopathology (4),
  • Solid Organ Transplantation (4),
  • Trauma General Surgery (1), and
  • Hyperbaric Medicine (1).

In addition, there are three accredited AFC (diploma) programs in Transfusion Medicine that transitioned from an Accreditation without Certification (AWC) program in 2012. Thus, in total, there are 41 accredited AFC 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 ten international program applications in six disciplines have been submitted. The current status is:

  • Three new Accredited Programs (Anatomical Pathology (1), Internal Medicine (2)).
  • Three programs with Accreditation in Progress in status (Internal Medicine, Pediatrics), two of which have not proceeded to scheduling as they are at institutions in Saudi Arabia where all activities are currently on hold.
  • Three programs with Deferred status (i.e., additional information is required within one year before proceeding to an onsite review) (Emergency Medicine, Ophthalmology, Surgical Foundations).
  • One program application under review (Pediatrics).

The timeline and processing of some applications may be affected by the status of partners’ contracts and/or travel restrictions due to the COVID-19 pandemic.

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 (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.


Competence Committee Chairs Forum – It takes a village

In recognition of the important role that competence committee chairs play in postgraduate medical education (PGME), the CanMEDS team is organizing a series of free 90-minute virtual events to foster online learning and connection for Canadian competence committee chairs.

The goal is to build, support and strengthen ties in this new and growing community of PGME leaders.  Each virtual session will include a presentation on trending topics and moderated breakout room sessions targeted at level/need. The events are designed to answer questions, identify common challenges and share ideas. 

The first forum, Network of Competence Committee Chairs – It takes a Village, will be held on Thursday, November 26, 2020 from 1100-1230 EST.  Subsequent sessions will be held on February 3 and April 21, 2021. Please share news of this Forum with any of the competence committee chairs in your network.

For more information contact canmeds@royalcollege.ca


New Program Director Workshop

The Office of Specialty Education (OSE) sponsors an annual invitational workshop for new program directors. Designed and run by current and past program directors, the various sessions assist new program directors to better-understand and prepare for their role. Topics in the workshop include: Standards of Accreditation, Create a Curriculum Map, Residents in Academic Difficulty, and more.

As you may know, this popular annual workshop is typically a pre-conference event to the Royal College’s International Conference on Residency Education (ICRE). As a result of COVID-19, we’ve made a number of adjustments including a decision to redesign and offer this important workshop virtually in 2020. The virtual event will be held over two half days on Monday October 26, 2020 and Thursday January 14, 2021 (beginning at 1130 EST).


AFC Program Evaluation and Reform of the Discipline Category

Since the last edition of the SCC Update in February, our work has continued on a collaborative response to the AFC Program Evaluation. In addition, we have been working remotely and shifting our priorities to respond to the pandemic. We are now one year into the reform of the category and have made significant progress on the enabling actions, with many of them already complete. The following are updates on the four recommendations approved by the Committee on Specialty Education (CSE):

1. Prioritize reforms of the assessment strategy

This recommendation was divided into two lines of work – one for the in-training route and the other for the practice eligibility route (PER-AFC).

1.1 In-training route
In early March, the new model of assessment for trainees in accredited AFC programs was launched, marking an end to external assessment of portfolios by Royal College assessors and the phasing out of the digital assessment platform, eDiploma.

Shortly thereafter, our attention turned to responding to COVID-19 and supporting accredited programs and members during the state of emergency. Working with a wide range of stakeholders, new resources were created including a guidance document for AFC programs on how to meet the training requirements during the pandemic. Other resources are available on the Impact of COVID-19 on Residency Education website, which includes topics of teaching and learning in a virtual environment.

In early summer, we reached out to AFC directors to answer questions and provide additional guidance on implementing the new model of assessment and meeting the training requirements during the crisis. Thank you to all the AFC directors that participated in the consultation and the AFC COVID-19 impact survey that followed. Those conversations informed the development of an FAQ on implementing the new model of assessment as well as a step-by-step guide on applying for the AFC credential. We are continuing to prepare our work plan for the survey results and will provide you with more information about this shortly.

To recap, the highlights of the new model of assessment for the in-training route are:

  • National standards will continue to play a central role, with the expectation that all accredited AFC programs will teach and assess trainees using the standards.
  • Accreditation activities will be the mechanisms to ensure the standards are being used as intended by the Royal College.
  • Accredited programs (AFC director acting on behalf of postgraduate dean) will be relied upon to make a determination of the Trainee’s competence in accordance with the national standards.
  • Portfolio evidence will no longer be submitted to the Royal College; external assessment by Royal College assessors will cease.

1.2 Practice eligible route for AFCs
Following approval by the CSE, the new model of assessment for the practice route was launched on July 17 and was received with considerable enthusiasm by AFC committees. The team from the Credentials Unit began work immediately, meeting with chairs and committees to introduce the new model and provide support for the development of the documents required for the new application process. At this time, more than half of the 23 disciplines are in the process of customizing the documents in preparation of opening a new practice route.  It is expected that a majority of disciplines will have new routes open by early 2021.

To recap, the reform of PER-AFC prioritized streamlining the process and introduced a discipline-specific scope of practice for each candidate to complete, moving from a portfolio-based submission to an application process. The candidate’s competencies would then be verified by numerous peers identified by the candidate who could provide input via a discipline-specific multisource feedback (MSF) questionnaire. The candidate’s submission, along with the results of the MSF results, would then be assessed by the AFC committee or, once a baseline for assessment is set by the committee, an individual discipline-specific assessor.

For more information about the new PER-AFC, please contact Farhan Bhanji, MD, FRCPC, associate director, Assessment Strategy, Assessment or Tiffany Lynch, program coordinator, Credentials Unit.

2. Re-launch ongoing efforts to reform the accreditation policy and process

2.1 Streamline General Standards of Accreditation and associated evidence
With the new General Standards and policy manual approved and prototype implementation taking place at the regular review of accredited AFC programs at the University of Toronto (fall 2020) and Université de Montréal (spring 2021), this enabling action is complete. The revised general standards, that will apply to all AFC programs after July 1, 2021, are available on the Royal College website (see the section titled “What expectations do programs need to meet?”).

2.2 Revise discipline-specific AFC Standards of Accreditation
All AFC disciplines have now had their existing discipline-specific AFC Standards of Accreditation (AFC-SA) converted into the new format. Disciplines at sites other than the University of Toronto and the Université de Montréal worked with the Educational Standards Unit (ESU) throughout the early part of 2020 to convert their AFC-SA in preparation for full implementation of the reformed accreditation process in July 2021. This enabling action is now complete. All revised AFC-SA are available on our Information by Discipline page.

With regards to applications for new accredited programs, prospective applicants are advised to consult with their postgraduate medical education (PGME) offices.  PGME offices will coordinate timelines with ESU if there is an application being developed. At this time, the current process remains unchanged until full implementation in July 2021. It is anticipated that the digitized accreditation process of CanERA will improve the process, making it easier for applicants and reducing administrative burden by storing and carrying forward submitted evidence to follow-up accreditation activities. The new standards and restructured evidence will also more clearly communicate expectations.

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 July 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 at least 12 months before accreditation activities.

2.4 Develop new training modules for accreditation
New resources are being developed and will be made available during the prototype testing phases and are expected to be available to AFC Committees and university personnel before the full launch in 2021. In the meantime, an FAQ on the new AFC accreditation system is available online.

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 developed and we will keep your committees informed of any new offerings.

3. Formulate a plan to increase the visibility of the value of the category

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”.

3.1, 3.2 Physicians from Family Medicine
Having ceased using the phrase ‘Diplomate Affiliate’ in spring 2019 and made changes to the website and other publications, this enabling action is now complete. To recap, with this change, all eligible candidates, regardless of their Royal College Fellowship status, will have the opportunity to use the title Diplomate.

In February, the Royal College Council also approved an exemption from the Royal College Maintenance of Certification (MOC) Program for Diplomates from Family Medicine. Previously, physicians from Family Medicine needed to participate in both the Royal College MOC Program (to maintain Diplomate status) as well as CFPC’s MainPro+ (to maintain their CFPC membership). The approved exemption now eliminates the duplication of data entry and fees for Diplomates from Family Medicine. This enabling action is now complete.

3.3 An AFC campaign
A communications plan is in development and includes tools, tactics and key messages for a campaign intended to increase the profile of the AFC category, AFC programs, and the value of the credential among stakeholders. The launch of the campaign is expected before the end of 2020.

Work is also underway to make AFC content on the Royal College website more accessible and relevant to key stakeholders. The updates to the website require multiple phases of work, with the first phase completed in spring 2020 and the second in progress. You will find some of the new content linked to throughout this article.

4. Consider how to continue to provide support, and improve upon the support already provided

1. Streamline the application process: National Consultations and interface with specialty committees and AFC committees, subcommittees and working groups
Changes to simplify and streamline the discipline recognition and national consultations processes are underway. Several initiatives were piloted throughout spring with the intention of managing and monitoring their impact through fall 2020. To support these initiatives, revisions to the website have been made which aim to increase transparency of the discipline recognition process and to build knowledge and capacity among a broader group of stakeholders. To this end, additional content on the four categories of discipline recognition as well as a detailed overview of the application process are now available. A new page has also been created to provide information to stakeholders about the status and progress of applications for new disciplines throughout the recognition process, as well as decisions regarding applications for changes to existing disciplines.  

2. Facilitate a better sense of community while building expertise and capacity among AFC program participants
Building expertise and capacity is an on-going and evolving reform, with the current focus being on how to ensure 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 reflected in the 2020 Specialty Committee Chairs’ Workshop. We are also exploring new and additional ways to keep you informed. 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 the AFC program manager, Linda Rumleski.

*If you would like more information about our work on the enabling actions, please visit the SCC Update Archives for previously published summaries on AFC Program Evaluation reform or the AFC Member Resource Site (section D).