Internal Medicine Residency Accreditation (AC) Task Force

Terms of Reference (Revised June 7, 2021)

Context

The first week in May 2021, the Department of Medicine received the Preliminary Accreditation Outcome for the Internal Medicine Program conveying the Royal College of Physicians and Surgeons (RCPSC) Accreditation Committee (AC) decision to confer the status of “Accredited Program on Notice of Intent to Withdraw Accreditation”. The RCPSC issues such a notice when it finds “Major and/or continuing non-compliance with one or more standards, which calls into question the educational environment and/or integrity of the program.” As a result of this decision, the program will undergo an external review in November 2022. The onus will be on the program to demonstrate why the accreditation should not be withdrawn. The final report, when received, will be provided to all faculty and residents for full transparency.

The review report highlighted numerous strengths of the program, but also identified the following thematic areas for improvement:

  1. There is an ongoing issue with resident supervision in the clinical environment, and perceived lack of support, particularly of junior learners on subspecialty services and on the Clinical Teaching Units, CTUs, during weekends. This is felt (by the residents) to be impacting patient safety.
  2. Residents are afraid to raise substantial questions or issues with the program, for fear of repercussions, both within their training program and related to future employment in Toronto. This perception arises from observation of the treatment of residents who have spoken out.
  3. Although the individual learning sites are reviewed regularly, overall distribution of learning sites is not reviewed by the RPC.
  4. Central curricular mapping should be more comprehensive.

The entirety of leadership of the Department of Medicine (DOM) considered the report and recommendations as an urgent call to action. The leadership feel that the Program Director and Residency Program Committee of the Internal Medicine Program are best suited to lead the program’s response to items 3 and 4, above. However, the nature of the concerns raised in items 1 and 2 go beyond the program itself, and require a “whole of department response”.

To address the two weaknesses identified above (items 1 and 2), the Department is establishing the Internal Medicine Residency Program Accreditation Task Force (AC Task Force), to be co-chaired by an Internal Medicine resident and a Department of Medicine faculty member. The AC Task Force is being struck to ensure a safe, arms-length process to collect information on residents’ experiences in the program and their advice on ways to address the perception of lack of support within components of the program and the potential of repercussions for speaking out.

Appointment of AC Task Force Co-Chairs

The Department is delighted to report that Dr. Kevin Imrie, Division of Hematology, Department of Medicine, has agreed to serve as the Faculty Co-Chair, AC Task Force. Dr. Imrie is uniquely suited to this role having held previous leadership roles as IM Program Director, Vice Chair, Education, Associate Dean in PGME, PIC at Sunnybrook and President, Royal College of Physicians and Surgeons of Canada. Notably, he also led the CAHO-PAIRO ‘working hours’ committee and the pan-Canadian Resident Duty Hour and Fatigue Risk Management Task Forces. (KI bio/picture)

In consultation with the resident members of the IM Residency Program Committee (RPC), the Resident Co-Chair for the AC Task Force will be selected through a nomination process and election by the IM residents themselves. Nominations (for self or others) are being collected by the Postgraduate Medical Education Office (PGME) through a brief survey.  Those interested in this opportunity, or who would like to nominate a colleague for the role, are asked to complete the survey with a brief statement of interest (maximum 150 words). Nominations will be accepted until Friday June 11th 2021.  If you have any questions about the nomination process, please contact laura.murgaski@utoronto.ca

The Resident Co-Chair, AC Task Force, will be selected from among eligible nominees by the IM program residents through an election, to be held the week of June 14th 2021. The formal posting for this position can be found on our website; due to the short timeline for response to the RCPSC review report, nominations will be accepted until Friday June 11th 2021 at 5 pm. From among eligible resident nominees, IM program residents will be invited to vote for the candidate of their choice in an election conducted by PGME the week of June 14th 2021.

Structure

The AC Task Force co-chairs will approve the appointment of all other committee members, either role-based or in an advisory capacity. Residents interested in participating as members of the task force will be invited to submission a brief statement of interest. Composition of the task force will be balanced with respect to numbers of faculty and residents (majority residents) and reflect the Department’s values of equity, diversity and inclusion. For efficient function, it is recommended the membership not exceed 12.  A project manager has been appointed in a non-voting capacity.

Members of the AC Task Force are expected to espouse the principles of the Department and the code of professional conduct. The co-chairs will ensure task force members receive unconscious bias training and that task force work is conducted in a safe environment.

Timeline and Key Milestones

The Task Force is expected to have completed its work by November 2022. The following high-level work plan is preliminary and will be modified by the task force as needed:

  • May-July 2021: Recruit co-chairs, task force members, establish detailed work plan, develop survey tools and methodology;
  • July-September 2021: Conduct interviews, iterate survey tools and methodology based on identified themes;
  • September-October 2021: Conduct data analysis and develop recommendations;
  • October 2021: Present results and preliminary recommendations to Department of Medicine Executive and the program RPC;
  • November 2021-March 2022: Assist the program RPC in assessing the impact of changes and conducting further data collection, as needed, in advance of anticipated PGME internal review in early 2022; and,
  • March-November 2022: Assist RPC in responding to PGME recommendations in advance of RCPSC review in November 2022.

Note: the timing of the external reviews by PGME and the RCPSC are tentative. If the timing changes, the work plan of the task force will be adjusted.

Confidentiality

Ensuring confidentiality of individual resident input will be a top priority for the task force. Task force members will be asked to sign a confidentiality agreement. Participation of residents in interviews will be encouraged but optional. Interviews will not be conducted by individuals personally known to individual residents. Responses will not be linked to individual residents and will be reported only in aggregate form. The task force will ensure that reporting of aggregate data does not allow for identification of individual residents.

The AC Task Force will have no direct formal accountability to the IM program or departmental education leadership in order to protect the confidentiality of all input received. Information obtained through interviews, focus groups, surveys, or other forms of data collection, will be held in the strictest confidence by the interview team. Participant demographics will be summarized for reporting purposes only; no identifiable data regarding participants will be provided to the AC Task Force.

Reporting and Accountability

The AC Task Force members will report directly to the two Co-Chairs, who in turn will report directly to the Executive Committee of the Department of Medicine.  The Co-Chairs will provide progress reports to the Executive Committee at monthly committee meetings at a minimum.

Though the AC Task Force will not formally report into the IM program, it will communicate extensively with the IM Program Director and RPC, keeping them informed on the status of its work and seeking advice from the IM RPC in order to align work and inform the program’s overall accreditation response.  The task force will also communicate themes identified with the program leadership in an iterative fashion while ensuring strict confidentiality of individual resident input.

The AC Task Force will provide a written report, addressed to the DoM Executive Committee, summarizing findings and recommendations, at the conclusion of their work. Copies of the report along with the Chair’s response will be provided to the RPC and to the PGME office. The recommendations must speak directly to the education environment and the integrity of the program. They must be actionable by November 2021 and expected to be reasonable effective by November 2022.  However, the Task Force is not limited by this time frame and may conclude ongoing, longer term efforts are required. The Chair welcomes this perspective.