Post MD Annual Report 2019-2020

COVID-19 required Canadian medical schools to quickly adapt to the repercussions for both medical students and residents seeking entry and subspecialty residency positions. Similarly, residency programs had to adapt to a very different process of selecting candidates for their programs.

Throughout the Spring of 2020, the Association of Faculties of Medicine of Canada (AFMC) Residency Matching Committee (ARMC) convened working groups to address a compressed CaRMS timeline, the challenge of virtual interviews and virtual program promotion and applications and file review. PGME at the University of Toronto is well represented on the ARMC by Dr. Glen Bandiera as PG Dean and Caroline Abrahams as a representative for national PG Managers.

As a result of the national efforts, key changes were made to CaRMS processes including: virtual interviews only for the Fall 2020 Medical Subspecialty, Pediatric Subspecialty and Family Medicine -Enhanced Skills CaRMS matches; a delayed and compressed 2021 PGY1 match which begins for residency programs with file review starting February 8th and a first iteration match day on April 20^th, online tools for programs to promote their events and features to candidates and more national standardization and structure of key documents used to assess suitability of applicants for programs.

PGME is supporting our residency programs during this challenging time by continuing to offer our Best Practices on Application and Selection workshops with updated content to assist programs with strategies and techniques in this unique environment. In addition, we are providing support and training for program selection committees to ensure they are attentive to equity, diversity and inclusion principles and that members are aware of conflict of interest guidelines and declarations.

The PGME and MD programs also adapted their upcoming accreditation visits to fit with the current COVID-19 restrictions. Both visits this Fall were held virtually. The PGME accreditation visit was conducted by the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada from Sunday, November 22^nd to Friday December 4^th. The visit was extended to two weeks long to accommodate the new virtual format.  PGME programs and committees were busy preparing documents and over 100 different schedules as all active programs (residency and AFC) and the PG institution were reviewed during this two-week period.  We are confident that our programs and institution put their best foot forward as they took part in this continuous improvement process.

The Postgraduate Medicine Leadership Certificate Program (PGLC) is founded on the understanding that all physicians are leaders and play an important leadership role in health care. The PGLC is a centralized offering from PGME that fills a gap for trainees seeking to enhance their leadership capabilities through innovative learning and development of a relevant action learning project.

Applications for the second iteration of the program were triple those of last year, attesting to positive reports from the first group of participants, and increasing recognition of the role leadership plays in optimizing quality health care for individual patients and for society as a whole. Building on the success of last year and to meet the increased demand, the total number of participants was increased to 31, and for the first time included fellows.

The course was successfully adapted to a virtual platform and continued to feature informal fireside chats with medical leaders and interactive workshops. Educational imperatives such as ‘Leadership through an EDI Lens’ were added to this year’s curriculum. The online offering has afforded the opportunity to invite all undergraduate and postgraduate medical learners to the fireside chats, and to launch a synchronous satellite pilot at Queen’s University with 6 trainees and a local supervisor.  In response to feedback from last year’s participants a facilitated small group mentorship program, which combines small-group networking with faculty mentorship, was started. The University of Toronto’s Postgraduate Medicine Leadership Certificate Program is unique in Canada and we are proud of its role in fostering medical leadership.

The COVID-19 pandemic forced the PGME team to reconsider the training needs of current PGME trainees. In March and April, COVID-19 resources such as establishment of goals of care and management of the critically ill patient with COVID-19 were curated and posted on the PGME website; many of the resources were adapted specifically to the University of Toronto context.

Next, PGME supported the practical training of residents and fellows for clinical redeployment as required to meet COVID-19 service needs. With the help of Dr. Filipe Santos from the Department of Anesthesia and in collaboration with TAHSN simulation centres at Mount Sinai hospital, Sunnybrook Health Science centre and Unity Health systems, trainees received practical training in the safe donning and doffing of personal protective equipment (PPE), including for Protected Code Blue. The focus of training was on residents involved in internal redeployment and those on the PGME redeployment list which included the following departments: Anesthesia, Otolaryngology/Head & Neck Surgery, Department of Surgery, Neuroradiology, Obstetrics, Ophthalmology, Diagnostic Radiology, Family Medicine, Medical Genetics and Dermatology.

In June, our attention shifted to prepare incoming PGME trainees for their July start. Due to the COVID-19 pandemic and restricted clinical activities in the Spring, many trainees were entering residency with potential gaps in clinical training and encountering new infection control guidelines. To ensure their safety, a two-pronged approach was taken: a PPE Virtual Orientation and In-Person PPE Trainings at their training site. The Virtual Orientation included i) an infection control seminar about the ‘new normal’ clinical setting, ii) a video on human factors to enhance PPE safety, and iii) a knowledge and skills check with attestation that all components were completed.

Pivoting to meet our trainees’ needs during COVID-19 was done expeditiously and successfully. Over 300 residents/fellows received simulated training on PPE Safety, and an additional 100 participated in the virtual orientation. We were pleased to support, and continue to support the PGME trainees to function safely in the ‘new normal’.