University of Toronto

Pre-Survey Meeting withDepartment / Clinical Chairs

Date: September 21, 2012

Time: 10:45 a.m. to 12:15 p.m.

Room: Queen’s Park BallroomPark Hyatt Hotel

Objectives of the Meeting

To review the:• Accreditation Process• New Categories of Accreditation• Standards of Accreditation• Pilot Accreditation Process• Role of the:

– Program director

– Department / division chairs

– Residents

– Program administrators

• Is a process to:– Improve the quality of postgraduate medical

education– Provide a means of objective assessment of

residency programs for the purpose of Royal College accreditation

– Assist program directors in reviewing conduct of their program

•Based on Standards

Accreditation

•Based on General and Specific Standards

•Based on Competency Framework•On-site regular surveys•Peer-review• Input from specialists•Categories of Accreditation

The Accreditation Process

The University of Toronto is one of three universities participating in a pilot accreditation process!

• Details for the pilot process will be discussed later in presentation

Pilot Accreditation Process

Internal Reviews

1

2

34

5

6

Monitoring

Six Year Survey Cycle

Process for Pre-Survey Questionnaires

Royal CollegeComments

Questionnaires

University

Specialty Committee

Questionnaires

Questionnaires &Comments

Program Director

Comments

Surveyor

•Prescribe requirements for specialty education

– Program standards– Objectives of training– Specialty training requirements– Examination processes– FITER

• Evaluates program resources, structure and content for each accreditation review

•Recommends a category of accreditation to the Accreditation Committee

Role of the Specialty Committee

•Voting Members (chair + 5)– Canada-wide representation

•Ex-Officio Members– Chairs of exam boards– National Specialty Society (NSS)

•Corresponding Members– ALL program directors

Composition of a Specialty Committee

• Chair - Dr. Kamal Rungta– Responsible for general conduct of survey

• Deputy chair – Dr. Anurag Saxena– Visits teaching sites / hospitals

• Surveyors • Resident representatives – CAIR

• Regulatory authorities representative – FMRAC

•Teaching hospital representative – ACAHO

The Survey Team

•Revised questionnaire (PSQ) and appendices– Completed by program

•Program-specific Standards (OTR/STR/SSA)

•Report of last regular survey– Reports of mandated Royal College reviews since last

regular survey, if applicable

•Specialty Committee comments– Also sent to PGD / PD prior to visit

•Exam results for last six years

Information Given to Surveyors

•Document review (30 min)

• Residency Program Committee minutes• Resident assessment files

•Meetings with:• Program director (75 min)

• Department chair (30 min)

• Residents (per group of 20 - 60 min)

• Teaching staff (60 min)

• Residency Program Committee (60 min)

The Survey Schedule

•Program director• Overall view of program• Address each Standard• Time & support

•Department chair• Support for program• Concerns regarding program• Resources available to program• Research environment

•Teaching faculty• Involvement with residents• Communication with program director

Meeting Overview

•Topics to discuss with residents– Objectives– Educational experiences– Service /education balance– Increasing professional responsibility– Academic program / protected time– Supervision– Assessments of resident performance– Evaluation of program / assessment of faculty– Career counseling– Educational environment– Safety

Meeting with ALL Residents

•Survey team discussion– Evening following review

•Feedback to program director– Exit meeting with surveyor

•Morning after review– 07:30 – 07:45 at the Park Hyatt Hotel

– Survey team recommendation• Category of accreditation

• Strengths & challenges

The Recommendation

New terminology • Revised and approved by the Royal College,

CFPC and CMQ in June 2012.

Categories of Accreditation

Accredited program• Follow-up:

– Next regular survey – Progress report within 12-18 months (Accreditation

Committee)– Internal review within 24 months– External review within 24 months

Accredited program on notice of intent to withdraw accreditation

• Follow-up:– External review conducted within 24 months

Categories of Accreditation

• Accredited program with follow-up at next regular survey

– Program demonstrates acceptable compliance with standards.

Categories of Accreditation Definitions

• Accredited program with follow-up by College-mandated internal review

– Major issues identified in more than one Standard

– Internal review of program required and conducted by University

– Internal review due within 24 months

Categories of Accreditation Definitions

• Accredited program with follow-up by external review

– Major issues identified in more than one Standard AND concerns -• are specialty-specific and best evaluated by a

reviewer from the discipline, OR• have been persistent, OR• are strongly influenced by non-educational issues

and can best be evaluated by a reviewer from outside the University

– External review conducted within 24 months– College appoints a 2-3 member review team – Same format as regular survey

Categories of Accreditation Definitions

• Accredited program on notice of intent to withdraw accreditation

– Major and/or continuing non-compliance with one or more Standards which calls into question the educational environment and/or integrity of the program

– External review conducted by 3 people (2 specialists + 1 resident) within 24 months

– At the time of the review, the program will be required to show why accreditation should not be withdrawn.

Categories of Accreditation Definitions

SURVEY TEAM

ROYAL COLLEGESPECIALTY

COMMITTEE

ACCREDITATION COMMITTEE

Rep

ort

sR

ep

ort

s &

R

esp

on

ses

Recom

mendation

Reports

Responses

After the Survey

Report &Response UNIVERSI

TY

• Chair + 16 members• Ex-officio voting members (6)

– Collège des médecins du Québec (1)

– Medical Schools (2)

– Resident Associations (2)

– Regulatory Authorities (1)

•Observers (9)– Collège des médecins du Québec (1)

– Resident Associations (2)

– College of Family Physicians of Canada (1)

– Regulatory Authorities (1)

– Teaching Hospitals (1)

– Resident Matching Service (1)

– Accreditation Council for Graduate Medical Education (2)

The Accreditation Committee

•All pre-survey documentation available to surveyor

•Survey report

•Program response

•Specialty Committee recommendation

•History of the program

Information Available to the Accreditation Committee

•Decisions

– Accreditation Committee meeting

• October 2013

• Dean & postgraduate dean attend

– Sent to• University• Specialty Committee

•Appeal process is available

The Accreditation Committee

“A” Standards• Apply to University, specifically the PGME office

“B” Standards• Apply to EACH residency program• Updated January 2011

General Standards of Accreditation

Standards for University & Education SitesA1 University Structure

A2 Sites for Postgraduate Medical Education

A3 Liaison between University and Participating Institutions

“A” Standards

Standards for EACH residency programB1 Administrative Structure

B2 Goals & Objectives

B3 Structure and Organization of theProgram

B4 Resources

B5 Clinical, Academic & Scholarly Content of the Program

B6 Assessment of Resident Performance

“B” Standards

There must be an appropriate administrative structurefor each residency program.

• Qualifications of, and support for program director• Membership = resident(s) + faculty

• Responsibilities• Operation of program• Program & resident evaluations• Appeal process• Selection of candidates• Process for teaching & evaluating competencies• Research

B1 – Administrative Structure

•Program director autocratic•Residency Program Committee

dysfunctional– Unclear Terms of Reference (membership,

tasks and responsibilities)• Agenda and minutes poorly structured• Poor attendance

– Department chair unduly influential– RPC is conducted as part of a Dept/Div

meeting

•No resident voice

B1 – Administrative Structure“Pitfalls”

There must be a clearly worded statement outlining the Goals & Objectives of the residency program.

• Rotation-specific• Address all CanMEDS Roles• Functional / used in:• Planning• Resident evaluation

• Distributed to residents & faculty

B2 – Goals and Objectives

B2 – Goals & Objectives“Pitfalls”

•Missing CanMEDS roles in overall structure

– Okay to have rotations in which all CanMEDS roles may not apply (research, certain electives)

•Goals and objectives not used by faculty/residents

•Goals and objectives dysfunctional – does not inform evaluation

•Goals and objectives not reviewed regularly

There must be an organized program of rotations and other educational experiences to cover the educational

requirements of the specialty.

• Increasing professional responsibility• Senior residency• Service responsibilities, service /

education balance• Resident supervision• Clearly defined role of each site /

rotation• Educational environment

B3 – Structure & Organization

•Graded responsibility absent•Service/education imbalance

– Service provision by residents should have a defined educational component including evaluation

•Educational environment poor

B3 – Structure & Organization “Pitfalls”

There must be sufficient resources –Specialty-specific components as identified by

the Specialty Committee.

• Number of teaching faculty• Number of variety of patients and

operative procedures• Technical resources• Resident complement• Ambulatory/ emergency /community

resources/experiences

B4 - Resources

• Insufficient faculty for teaching/ supervision

• Insufficient clinical/technical resources• Infrastructure inadequate

B4 – Resources “Pitfalls”

The clinical, academic and scholarly content of the program must prepare residents to fulfill all Roles of the specialist.

• Educational program• Curriculum / structure

- Content specific areas defined by Specialty Committee

• CanMEDS Roles• Teaching of the individual

competencies• Resident / faculty participation in

conferences

B5 – Clinical, Academic & Scholarly Content of Program

•Organized academic curriculum lacking or entirely resident driven

– Poor attendance by residents and faculty

•Teaching of essential CanMEDS roles missing

•Role modelling is the only teaching modality

B5 – Clinical, Academic & Scholarly Content of Program “Pitfalls”

There must be mechanisms in place to ensure the systematic collection and interpretation of evaluation

data on each resident.

• Assessment must be -• Regular, timely, formal• Face-to-face• Based on objectives• Include multiple evaluation techniques

B6 – Assessment of Resident Performance

• Mechanism to monitor, promote, remediate residents lacking

• Formative feedback not provided and/or documented

• Evaluations not timely (particularly when serious concerns identified), not face to face

• Summative evaluation (ITER) inconsistent with formative feedback, unclearly documents concerns/ challenges

B6 – Evaluation of Resident Performance “Pitfalls”

What are the processes in place to resolve problems / issues?

Appropriate faculty / resident interaction and communication must take place in an open and collegial atmosphere so

that a free discussion of the strengths and challenges of the program can

occur without hindrance.

Learning Environment

Scheduled from April 7 to 12, 2013 • PGME and teaching sites – A Standards

• Residency programs – B Standards

Pilot Accreditation Process

ALL residency programs• Complete PSQ• Undergo a review, either by

– On-site survey, or– PSQ/documentation review, and input from various

stakeholders

Process varies depending on group• Mandated for on-site survey• Eligible for exemption from on-site survey• Selected for on-site survey

Pilot Accreditation Process

Scheduled for On-site Reviewin April 2013

Criteria• Core specialties

– General Surgery, Internal Medicine, Obstetrics & Gynecology Pediatrics, Psychiatry

• Palliative Medicine– Conjoint Royal College/CFPC program

• Program Status– Not on full approval since last regular survey– New program which has not had a mandated internal

review conducted

Programs Mandated for On-site Survey

Process remains the same• PSQ Review

– Specialty Committee

• On-site survey by surveyor• Survey team recommendation• Survey report• Specialty Committee• Final decision by Accreditation Committee

– Meeting in October 2013– Dean & postgraduate dean attend

Process for Programs Mandated for On-site Review

Criteria• Program on full approval since last regular

on-site survey

Programs Eligible forExemption from On-site Review

• PSQ and documentation review– Accreditation Committee reviewer– Specialty Committee

• Recommendations to exempt– Accreditation Committee reviewer– Specialty Committee– Postgraduate dean– Resident organization (CAIR)

• Steering Committee (AC) Decision– Review of recommendations

•Exempted: on-site survey not required•Not exempted: program scheduled for on-site survey in April

– Selected program (random)– University notified in January 2013

Process for Programs Eligible for Exemption

accred@royalcollege.ca

613-730-6202

Office of Education

Margaret KennedyAssistant Director

Accreditation & Liaison

Educational Standards Unit

Lise DupéréManager

Sylvie LavoieSurvey Coordinator

Contact Information at theRoyal College