Embracing Accreditation

Disclosure

Objectives

• Be able to describe the benefits of accreditation standards and processes to Northern and rural community settings.

• Be able to describe the importance of their own participation in accreditation.

• Reflect on and discuss the relationships among educational best practices, accreditation standards, excellent clinical care and the health of the people of Northern Ontario.

How do accreditation standards arise?

• Best educational practices• Patients’ needs• Previously identified problems• Advocacy • Specialty committees

Best Educational Practices

B3.3The program must be organized such that residents are given increasing professional responsibility, according to their level of training, ability/competence, and experience.

B 4.5.3There must also be facilities to allow such learning activities as direct observation of clinical skills and delivery of the academic program, as well as places that offer privacy for confidential discussions.

Best Educational Practices

B5.1.2There must be a structured academic curriculum which …….should include teaching and learning with a patient-centered focus as well as skills training, seminars, reflective exercises, directed reading, journal clubs, and research conferences.

B 6.2.2

Clinical skills must be assessed by direct observation and must be documented

Best Educational Practices

B1.3.8 The residency program committee must undertake an ongoing review of the program to evaluate the quality of the educational experience and to review the resources available. B2.2 There must be clearly defined objectives for each of the CanMEDS/CanMEDS-FM competencies. – B2.2.1 The educational objectives must be functional and

reflected in the planning and organization of the program

Patients’ Needs

CanMEDS

CFPC Red Book“Care of Aboriginal populations:Residents must develop the skills to work with and provide appropriate care for aboriginal populations”

B 5.1.4 Medical Expert“Teaching must include issues of age, gender, culture, ethnicity and end of life issues as appropriate to the discipline”

Previously identified problemsB 3.5.1Service demands must not interfere with the ability of the residents to follow the academic program.

B 5.6.1The program must provide opportunities for residents to acquire knowledge and skills for effective teaching.

B 1.3.8.5.1 There must be an effective mechanism to provide teaching staff in the program with honest and timely feedback on their performance.

Lobbying

Red Book 1999, 2006All family medicine residents must spend a minimum of 8 weeks in a rural family practice as part of their core family medicine experience.

Red Book 2013A sufficient clinical experience in a rural practice setting must be provided to all residents to ensure that the competencies and experience necessary to serving the needs of rural communities are acquired

Specialty Committees

• “This is how I was trained”• View from the urban tertiary care centre

Blocks of subspecialty experience

“All residents MUST complete rotations (one block each or equivalent longitudinal rotation) in at least seven (7) of the following fourteen (14) pediatric subspecialties and MUST be involved in the care of patients in all the other subspecialties. Maximum of two (2) blocks per subspecialty will be accepted”

Fourteen (14) months or equivalent training in selectives, which must include training in at least 8 of the following: • Cardiology • Clinical Immunology and Allergy • Clinical Pharmacology and Toxicology • Critical Care Medicine • Dermatology • Endocrinology and Metabolism • Gastroenterology • etc…….

How does this relate to the health of the people of Northern Ontario

Encouraging trends

• Distribution of Med Ed• Competency based training• Increasing supply of physicians• Renewed focus on generalism• Ken Harris

We are NOSM

You are NOSM

The Royal College Needs

The Royal College Needs

NOSM

Distribution of Physicians in Canada

The Future of GeneralismRural Specialists Forum

Kenneth A. Harris MD, FRCSCDirector, Office of Specialty Education

SPRC-Specialists 2014 22

SPRC-Specialists 2014

General Surgery Recommendations (1)

1. Redesign General Surgery training and curricula through the introduction of enhanced areas of expertise that are tailored to differing practice contexts in addition to foundational training

2. General Surgery residency programs should incorporate an explicit period of training geared towards, and focused upon, an individual making the transition to independent practice

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SPRC-Specialists 2014

General Surgery Recommendations (2)

3. Support broader transition to a hybrid model of competency-based medical education in postgraduate medical education.

4. Post-General Surgery residency training, in the form of recognized subspecialty residency programs, Areas of Focused Competence (diplomas), and clinical fellowships, should be developed as complements to enhanced areas of expertise in General Surgery residency programs and undertaken as they are relevant to particular professional practice environments.

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SPRC-Specialists 2014

Potential Solutions (incomplete)

•Competency based approach• Identify foundational elements of disciplines•Facilitate skill/knowledge acquisition

• Pre-certification• Post-certification

•Facilitate bilateral transfer of required referrals

•Provide support•Communities of practice•Patient focused care

SPRC-Specialists 2014

You are the experts

•You tell me

CBD Identified Initiatives

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CanMEDS 2015

Assessment

Lifelong Learning

Create Competency Framework & Milestones

(Generic & Speciality-Specific)

In-Training Competency-Based

Assessment

In-Practice Competency-Based

Assessment

Accreditation Credentialing

ePortfolio

Redesign Policy: Outcome-Based

Focus

Faculty Development and Faculty/Education Support

Redesign Policy: Competency-Based

Focus

CBMERe-Engineer Accreditation

Process

Re-Engineer Credentialing

Process

Deliver Cohorted Roll-Out

Change Exam Governance

Re-Engineer Exam Delivery

Develop Exam Content

For Residents For Fellows

Affirmation of Continued Competence

CanMEDS 2015: Planned Updates

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