University of Manitoba Pre-Survey Meeting with Resident Representatives & Senior Residents

1. University of ManitobaPre-Survey Meeting withResident Representatives &Senior Residents Date: July 3, 2013 Time: 2:00 to 4:00 p.m. Room: Pharmacy Apotex, Theatre # 264

2. Objectives of the Meeting To review the: • Accreditation Process • Categories of Accreditation • Standards of Accreditation • Role of residents in the accreditation process

3. Role of Residents in the Accreditation Process • Program Administration • Member of the Residency Program Committee • Must be elected • Communication to and from Residency Program Committee • Evaluations • Evaluation of the program • Rotations, teachers, teaching • Understand the Standards • Feedback on how program is meeting standards

4. Principles of Accreditation • Continuing quality improvement process • Peer-reviewed • Medical education experts • Outside discipline • Based on Standards • Includes competency framework • Categories of Accreditation • Regular Schedule

5. Six Year Survey Cycle 1 6 5 Monitoring 2 3 4 Internal Reviews

6. The Survey Team • Chair - Dr. Sarkis Meterissian • Responsible for general conduct of survey • Deputy chair – Dr. Maureen Topps • Visits teaching sites / hospitals • Surveyors • Resident representatives – CAIR • Regulatory authorities representative – FMRAC • Teaching hospital representative– ACAHO

7. Information Given to Surveyors • Questionnaires and appendices • Completed by program • Program-specific Standards (OTR/STR/SSA) • Report of last regular survey • Specialty Committee comments • Also sent to PGD / PD prior to visit • Exam results for last six years • Reports of mandated Royal College reviews since last regular survey, if applicable

8. The Survey Schedule Includes: • Document review (30 min) • Meetings with: • Program director (75 min) • Department head (30 min) • Residents – per group of 20 (60 min) • Teaching staff (60 min) • Residency Program Committee (60 min)

9. The Survey Schedule Document review (30 min) • Residency Program Committee Minutes • Resident Assessments Files

10. Meeting Overview • Program director • Overall view of program • Evaluation of Standards • Department head • Support for program • Resources available to program • Teaching faculty • Involvement with residents • Communication with program director

11. Meeting with ALL Residents • Group(s) of 20 residents (60 min) • If off-site, tele- or video- conferencing • Looking for balance of strengths & challenges • Focus on Standards • Evaluate the learning environment

12. 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

13. Preparing for the SurveyRole of the Resident • Complete the CAIR questionnaire • Confidential, not given to survey team • Meet together as a group to discuss the strengths & challenges of your program • 1 to 2 months before survey • Obtain a copy of the pre-survey questionnaires and the previous survey report • If you feel you need more time with surveyor, request it • Be open and honest with surveyor • Comments in meetings are anonymous

14. Meeting with Residency Program Committee All members of RPC attend meeting, including resident members • Review Committee responsibilities • Opportunity for surveyor to provide feedback on information obtained during survey

15. The Recommendation • Survey team discussion • Evening following review • Feedback to program director • Exit meeting with surveyor • Survey team recommendation • Category of accreditation • Strengths & weaknesses

16. Categories of Accreditation New terminology – June 2012 • Approved by the Royal College, CFPC and CMQ.

17. Categories of Accreditation Accredited program • Follow-up: • Next regular survey • Progress report (Accreditation Committee) • Internal review • External review Accredited program on notice of intent to withdraw accreditation • Follow-up: • External review

18. Categories of Accreditation Definitions • Accredited program with follow-up at next regular survey • Program demonstrates acceptable compliance with standards.

19. Categories of Accreditation Definitions • Accredited program with follow-up byCollege-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

20. 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

21. Categories of Accreditation Definitions • Accredited program onnotice 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.

22. After the Survey survey team Reports specialty committee royal college university Report & Response Reports Responses Recommendation Reports & Responses accreditation committee

23. The Accreditation Committee • 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 [CAIR & FMRQ] (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)

24. Information Available to the Accreditation Committee • All pre-survey documentation available to the surveyor • Survey report • Program response • Specialty Committee recommendation • History of the program

25. The Accreditation Committee • Decisions • Accreditation Committee meeting • May/June 2014 • Dean & postgraduate dean attend • Sent to • University • Specialty Committee • Appeal process is available

26. General Standards of Accreditation “A” Standards • Apply to University, specifically the PGME office “B” Standards • Apply to EACH residency program “C” Standards • Apply to Areas of Focused Competence (AFC) programs

27. “A” Standards A1University Structure A2Sites for Postgraduate Medical Education A3Liaison between University and Participating Institutions

28. “B” Standards B1 Administrative Structure B2 Goals & Objectives B3 Structure and Organization of the Program B4Resources B5 Clinical, Academic & Scholarly Content of the Program B6 Assessment of Resident Performance

29. B1 – Administrative Structure There must be an appropriate administrative structure for each residency program. • Program director • Time & support • Residency Program Committee • Representative from each site and major component • Resident member(s) • Must include at least ONE elected resident • Meets regularly, four times a year • Minutes

30. B1 – Administrative Structure • Responsibilities of the Residency Program Committee • Selection, assessment & promotion of residents • Ongoing review of program • Assessment of program / teachers / rotations • Research environment • Appeal mechanism • Career & stress counseling • Resident safety

31. B1 – Administrative Structure“Pitfalls” • Program director autocratic • Residency Program Committee dysfunctional • Unclear Terms of Reference (membership, tasks and responsibilities) • Agenda and minutes poorly structured • Poor attendance • Department head unduly influential • RPC is conducted as part of a Dept/Div meeting • No resident voice

32. B2 – Goals & Objectives There must be a clearly worded statement outlining the goals of the residency program and the educational objectives of the residents. • Rotation-specific • Structured to reflect CanMEDS Competencies • Circulated to residents & teaching staff • Used in planning and assessment of residents

33. CanMEDS Competencies • Medical Expert • Communicator • Collaborator • Manager • Health Advocate • Scholar • Professional

34. 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 assessment • Goals and objectives not reviewed regularly

35. B3 – Structure & Organization of the Program There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to fulfill the educational requirements and allow residents to achieve competence in the specialty. • Include all components of specialty • Equivalent opportunity • Senior residency

36. B3 – Structure & Organization of the Program • Increasing professional responsibility • Appropriate supervision • Balance of service and education • Safe learning/educational environment • Promotes resident safety • Free from intimidation, harassment or abuse

37. B3 – Structure & Organization“Pitfalls” • Graded responsibility absent • Service/education imbalance • Service provision by residents should have a defined educational component including evaluation • Educational environment poor

38. B4 – Resources There must be sufficient resources to provide the opportunity for all residents to achieve the educational objectives. • Teaching faculty • Variety & number of patients, specimens and procedures • Physical and technical facilities • Inpatient, ambulatory, emergency, ICU • Educational

39. B4 – Resources “Pitfalls” • Insufficient faculty for teaching/ supervision • Insufficient clinical/technical resources • Infrastructure inadequate

40. B5 – Clinical, Academic & Scholarly Content of Program There must be a clinical, academic and scholarly program that prepares residents to fulfill all the roles of the specialist. • Academic program • Organized curriculum • Organized teaching in basic & clinical sciences • Evidence of teaching the CanMEDS Competencies • Attendance • Staff, residents

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

42. B6 – Assessment of Resident Performance There must be mechanisms to ensure systematic assessment of each resident. • Based on goals & objectives • Uses appropriate and varied assessment methods • Feedback • Formal, timely, appropriate • Face-to-face • Adequately documented

43. B6 – Assessment of Resident Performance “Pitfalls” • Mechanism to monitor, promote, remediate residents lacking • Formative feedback not provided and/or documented • Assessments not timely, not face to face • Summative assessment (ITER) inconsistent with formative feedback, unclearly documents concerns/ challenges

44. University of ManitobaOn-site Survey February 23 to 28, 2014

45. Contact Information at theRoyal College accred@royalcollege.ca 613-730-6202 Office of Education Sarah Taber Assistant Director Education Strategy & Accreditation Educational Standards Unit Sylvie Lavoie Survey Coordinator