Issue No. 11 - Advancing Recommendations Collectively
March 10, 2016
What's New and What's Next for FMEC PG?

The FMEC PG Implementation Project is approaching the end of its final year of implementation and ongoing sustainability strategies have been developed for any outstanding work. Engaged collaboration amongst FMEC PG stakeholders has been of paramount importance to the project and will serve the medical education system well in all future endeavors. Read on for the latest news about the ten recommendations:
 
Recommendation #1 (Ensure the Right Mix, Distribution, and Number of Physicians to Meet Societal Needs):
  • The Consensus Conference on Clinician Scientist Training in Canada is taking place February 21-23, 2016 in London, Ontario, bringing together national and international experts to discuss five important phases of the training pathway for clinician scientists: recruitment into medical school, scholarship in medical school, postgraduate scholarship, mentorship in early academic faculty, and interdisciplinary research. Hopefully a consensus statement to guide the future  development and support of clinician scientists will emerge from the Conference
  • Following a successful test of a proposed collaborative process around the topic of unmatched Canadian medical graduates by the Physician Resource Planning Task Force (PRPTF) in November 2015, proposed terms of reference for a sustainable pan-Canadian physician resource planning advisory committee have been developed to address an array of future topics.
  • The Conference Board of Canada (CBoC) was the successful vendor from among seven submissions to the PRPTF in an open competitive process to undertake the design, development and implementation of a pan-Canadian physician supply tool. The CBoC's initial activities include completing consultations with technical experts in several jurisdictions and a national association with comparable supply tools; developing a proposed methodology and scenario-planning approach; and meeting with the Technical Steering Committee in January 2016 to share key findings from consultations and obtain feedback on their proposed methodology and assumptions for the design of the pan-Canadian physician supply tool. 
Recommendation #2 (Cultivate Social Accountability through Experience in Diverse Learning and Work Environments):
  • A best practices guide to improve social accountability in postgraduate medical education programs has been disseminated to all medical schools.
  • A pre-conference workshop, in conjunction with the AFMC Social Accountability Group, will discuss social accountability from the micro to the macro levels. Strategies to support more focus on social accountability in residency training will be discussed The event will be held on Saturday, April 16, 2016 (12:15-4:00 pm) at the Fairmont Queen Elizabeth Hotel during the Canadian Conference on Medical Education (CCME) 2016. There will be some participants at the workshop by invitation, and you can sign up for the workshop when you register for the conference (or can modify your existing registration to include this workshop). 
Recommendation #3 (Create Positive and Supportive Learning and Work Environments):
  • An academic opinion paper is being prepared on the subject of interprofessional education as it relates to medical residency education, based on specific recommendations and ideas generated by the committee.
  • A literature review has been completed on the subject of the optimization of performance, learning, and wellness, and another review is underway regarding the provision of resident training that models and reflects patient-centred care and ensures quality, safety, and accountability.
  • Recommendations have been put forth to the Three Colleges (Royal College, CFPC, CMQ) working groups on revising and realigning the postgraduate accreditation standards related to promoting the positive aspects and mitigating the negative aspects of the hidden curriculum.
  • A poster presentation regarding the hidden curriculum and its positive and negative aspects is scheduled for Monday, April 18, 2016 (1:00-2:30 pm) at the Fairmont Queen Elizabeth Hotel during CCME 2016. 
Recommendation #4 (Integrate Competency-Based Curricula in Postgraduate Programs) and Recommendation #6 (Implement Effective Assessment Systems):
  • The implementation of these recommendations has been conjointly led by the Royal College of Physicians and Surgeons of Canada (Royal College), the College of Family Physicians of Canada (CFPC) and the Medical Council of Canada (MCC).
  • The FMEC PG Implementation Project fully supports the work and advancements made by these organizations and has been available for broader consultation on any emerging issues in the areas of Competency-Based Medical Education (CBME) and Assessment. 
Recommendation #5 (Ensure Effective Integration and Transitions along the Educational Continuum):
  • Four pilot projects are being implemented to help the transition from medical school into residency. A post-match boot camp program that provides final year medical students with specific skills/knowledge related to their matched specialty will see its second iteration at Dalhousie University in March 2016. The simulated night on-call program that provides final year medical students with simulations of common scenarios they are likely to encounter their first night on-call as a resident will soon be launched at three sites. The learner education handover protocol will help transfer relevant information on educational and professional issues/strengths of all medical students to their respective postgraduate program, and pan-Canadian EPAs will ensure all Canadian medical school graduates can be entrusted to perform a set of standard activities before entering residency.  These latter two projects are in their final phases of development.
  • The final document on consistent standards for career services has been circulated to all Canadian medical schools. Best practices in residency selection have been created and strategies for national implementation are currently being discussed. A small task force of key stakeholders is being struck to further discuss the issue of entry level disciplines.
  • The Transitions from Residency to Practice Working Group is consulting with recent graduates and early-in-practice physicians to improve areas such as practice management, mentorship, and resiliency training.
  • An oral presentation on smoothing out the transitions in medical education will take place on Sunday, April 17, 2016 (8:00-9:30 am) and a workshop on medical student career advising will take place on Monday, April 18, 2016 (10:00-11:30 am)at the Fairmont Queen Elizabeth Hotel during CCME 2016. 
Recommendation #7 (Develop, Support, and Recognize Clinical Teachers):
  • A position paper on a potential national governance structure for CPD and Faculty Development is currently being drafted and will soon be launched.
  • Recommendations for inclusion of specific language to better support clinical teachers have been made to the Three Colleges (Royal College, CFPC, CMQ) working groups looking at revising and realigning the PG accreditation standards.
  • An oral presentation regarding supporting our teaching faculty across the educational continuum is scheduled for Monday, April 18, 2016 (3:00-4:30 pm) at the Fairmont Queen Elizabeth Hotel during CCME 2016. 
Recommendation #8 (Foster Leadership Development):
  • Ongoing work includes the examination of the CanMEDS Leader role and the LEADS framework, a needs assessment of leadership resources and the feasibility of creating a repository of tools on leadership.
  • A governance model and responsible organization/committee will be needed to oversee the ongoing development of the repository of leadership tools. 
Recommendation #9 (Establish Effective Collaborative Governance in PGME):
  • The newly-formed PGME Collaborative Governance Council held a successful trial meeting on January 25, 2016 in Ottawa. The goal of the Council is to help achieve efficiency, reduce redundancy, and provide clarity on strategic directions and decisions for complex, contentious, and difficult issues in PGME, in the best interest of society, learners and the health system. The Council will officially launch on April 1, 2016. The Council is poised to tackle issues that have been difficult to solve to date and to take on new challenges to improve  PGME
  • Governance posters will be presented on Sunday, April 17, 2016 (3:00-4:30 pm) and Tuesday, April 19, 2016 (9:00-10:30 am) at the Fairmont Queen Elizabeth Hotel during CCME 2016. 
Recommendation #10 (Align Accreditation Standards):
  • The Accreditation Implementation Committee has made great strides in the area of standards alignment, having agreed upon six domains in which to group and classify all accreditation standards. Alignment of processes is ongoing, looking for opportunities to increase efficiency in many areas, as well as analyzing the unique and common data elements required across the continuum (UGME, PGME and CPD). A larger paradigm shift towards a more outcomes-based accreditation system is a key next step.
  • A poster presentation about what an aligned accreditation system looks like is scheduled for Monday, April 18, 2016 (1:00 - 2:30 pm) at the Fairmont Queen Elizabeth Hotel during CCME 2016. 
For further information about any of the specific work of any of the above ten recommendations, please send an email to fmecpg@afmc.ca with your questions or comments.

Reflections from Dr. Nick Busing, Project Lead

We are approaching the end of the formally funded portion of the FMEC PG project, but we have not reached our end goal yet and need to continue the work of implementing all of the recommendations. Tremendous progress has been made - we will have recommendations to improve and better support clinician scientist training in Canada, we have identified best practices in addressing social accountability in our residency programs, we are continuing to tackle so many issues in the medical education culture (the hidden curriculum, interprofessional education, patient centered care and quality and safety), we have  introduced  t ools
to improve transitions (for example the development of EPAs for all graduating students, career services standards, best practices in admissions for PGME and many others), we have supported the implementation of CBME and expanded assessment tools to support CBME, we have tried to advance the role and recognition of clinical teachers by suggesting enhanced accreditation standards that address their issues, we are working on repositories of tools for clinical teachers and for those who want to develop leadership skills, we have established a new Governing Council for PGME, and we are working collaboratively to align our accreditation systems and processes across the continuum.
This is only a partial list of what we have done to date, and we have so many volunteers (learners and faculty members) to thank for the changes and the improvements.
 
There is however so much more to do and now is the time to keep moving forward. Collectively, we must continue to champion the changes we have brought in, or will bring in shortly, to contribute to ongoing change, a shift in culture and to a system that is more responsive to the needs of all our patients. Our recommendations have been tackled individually during the FMEC PG Implementation project, but going forward they need to be seen as intimately linked and all collectively serving the same goal- better learning and better patient care.
 
A solid cadre of leaders has been built and is needed to keep up the momentum, but it will take the willingness of many of these players to ensure lasting change. In some areas we have a clear path forward with clear leadership (e.g. the Governance Council for PGME, the collaborative work in accreditation, the transitions pilot projects that will be rolled out by existing leaders). In other areas collective help to support the ongoing implementation of our recommendations is needed. FMEC PG is an exemplar of successful collective visioning and should continue to serve as a model to build effective leadership and coalitions to move us forward in a concerted way.  Our work and learning cultures require constant attention and require inspired leaders who are willing to speak out and take chances. Our support for clinical teachers requires clear leadership. Promoting a truly socially accountable learning and work environment involves systemic change that demands ongoing leadership at the highest levels.

Much has been achieved within our project by working collaboratively; it is my sincere hope that we continue in this manner and foster even greater collaboration. Our collective action will be the most helpful force for change into the future.

Dr. Nick Busing led transformative change from 2005-2013 as President and CEO of the Association of Faculties of Medicine of Canada. Prior to joining AFMC, Dr. Busing spent 20 years at the University of Ottawa's Faculty of Medicine. He is a past president of the CFPC and a past chair of the Canadian Medical Forum.

About the FMEC PG Implementation Project

The Future of Medical Education in Canada Postgraduate (FMEC PG) Implementation Project is helping to ensure that medical residents in this country continue to receive the best training possible and are able to meet the changing healthcare needs of Canadians.

The FMEC PG Implementation Project is funded by Health Canada and a consortium of four organizations: The Association of Faculties of Medicine of Canada (AFMC), The College of Family Physicians of Canada (CFPC), Le Collège des médecins du Québec (CMQ) and The Royal College of Physicians and Surgeons of Canada (The Royal College).

To read about all ten recommendations and their transformative actions, please consult the FMEC PG Collective Vision.