Welcome
Welcome to Post MD Education’s 2016-17 Annual Report. The report marks the second year in our new organizational structure which combines all medical education activities after the undergraduate medical degree. As you will see in the report, this has been a year of innovation and renewal.
Medical education is not just a program for building knowledge and skills in its recipients… it is also an experience which creates attitudes and expectations.
Through our staff, faculty and decanal leads, Post MD strives to support the medical education enterprise at the University. In partnership with our affiliated hospitals, our aim is to help faculty members, administrators, and learners achieve their goals in teaching, learning, research, clinical care, and social responsibility.
Continuing Professional Development’s excellent support allows our departments to offer accredited, outcome-based continuing education conferences and programs. CPD activities reach over 40,000 learners annually through its in-person and on-line events, including its award-winning Safer Opioid Prescribing multi-modal program. CPD also promotes cultural competence and health care provider networking through development and promotion of the bi-annual North American Refugee and Indigenous Health conferences. Associate Dean Suzan Schneeweiss also launched an ambitious five-year plan to renew CPD’s academic mission under four priority areas: Leadership, Innovation, Scholarship, and Community.
Under the leadership of Associate Dean Glen Bandiera, postgraduate medical education activities included the dissemination of Best Practices in Assessment and Evaluation and on-line system development, a transitions forum, Global Health programming and conference, the creation of the Postgraduate Administrators Advisory Committee, expansion of the learner experience survey (Voice of the Resident), and faculty development workshops for the implementation of competency-based medical education (CBME). On CBME, you will no doubt enjoy the videos of the two early adopters of the new training structure (Drs. Paola Campisi and Scott Berry) as they outline their “lessons learned”!
Other Post MD innovations include the creation of the Simulation Education Advisory Committee, chaired by Dr. Douglas Campbell which brings together the Faculty’s simulation experts and resources. In addition, a new grant to support Medical Humanities Education and an award to recognize contributions to social justice and health equity in faculty development were established.
I hope this report reflects Post MD’s ongoing commitment not only to excellent medical education, but as Flexner notes, to create in our faculty and learners “…attitudes and expectations” based on a core set of values and the desire to achieve them.
Salvatore M. Spadafora MD FRCPC MHPE
Vice Dean, Post MD Education
December 2017
Strategic Plan Integration across the continuum
Within the new Post MD Education structure there are opportunities for integration and alignment which will enhance the ability to harness more talent and increase influence across sectors. Post MD Education is working to address this through strategic planning at Postgraduate Medical Education (PGME) and Continuing Professional Development (CPD).
As PGME starts the strategic planning process, addressing the significant changes in the external environment will be a priority. This includes but is not limited to: the conversion to CBME, new accreditation standards, new accreditation processes, CanMEDS 2015, and increased accountability requirements for funding and health care provision. In keeping with the University of Toronto Faculty of Medicine Strategic Plan, the objective for the five year PGME strategic plan will be to enable and support partners and programs that establish, meet and exceed best practices in the education of physicians as emerging leaders.
For CPD, the strategic planning process has recently been completed. Over the past year, dedicated working groups representing a number of stakeholders were engaged to develop a flexible and adaptable 5-year strategy. The groups synthesized ideas from the CPD Strategic retreat to develop goals, objectives and action plans that renewed CPD’s academic focus and established the path for the next five years. In the next 6 – 12 months CPD will focus on building capacity in research and scholarship, maintaining its leadership role in continuing education with the development of internationally recognized programs and exploring technology platforms for self-directed learning. CPD will also strengthen partnerships with internal and external organizations to integrate quality improvement in its offerings.
Competency Based Medical Education A learner centred and outcomes based framework
CBME is an outcomes-based approach to medical education, which uses competencies as the organizing framework. Thus by definition, CBME demands new attention to assessment techniques (Holmboe, 2010). Challenging older norms, which prioritize learning methods of “steeping” or repeated exposure, CBME is understood to “de-emphasize time-based training and promise greater accountability; flexibility, and learner-centredness” (Frank, 2010). This framework for learning has been adopted by PGME and CPD at Post MD Education.
The postgraduate medical education landscape is actively changing and is in the early stages of implementing CBME in Canada. As these changes are being implemented across post graduate programs, it is important to focus on the development of best practices in resident evaluation and assessment that can support its adoption. To this end, the Best Practices in Evaluation & Assessment (BPEA) Working Group was established in 2016 to help inform PGME in best practices for resident evaluations and assessments. The group conducted literature reviews and focus groups with residents and faculty leaders and prepared several papers on various aspects of assessment including faculty and resident responsibilities, remediation, data management, and learner handover.
The top 5 priorities identified by the Working Group are:
- Faculty development resources (e.g. central shared repository and best practices for assessment)
- Shared repository of education and assessment tools for individual programs
- Centrally organized and supported IT for CBME, including support for reporting and data extraction
- Mobile, lightweight, flexible, easy-to-use IT
- Learner responsibility for their education, including adjustments to new assessment systems
The full BPEA report is available on the Post MD website at http://cbme.postmd.utoronto.ca/BPEA/
CPD is also participating in this new era of Canadian medical education by adopting a CBME framework. For an office that delivers approximately 400 continuing education programs each year, the shift means integrating new methods of assessment and evaluation of participants’ learning needs and the extent to which these are met. CPD’s activities and programs have been aligned to promote the core competencies identified by the Royal College’s Competency by Design (CBD) and the CFPC’s Triple C Competency Based Curriculum.
In June 2016, CPD implemented CFPC’s newly launched Mainpro+ credit system, which introduced new criteria to track physician competencies. As part of the implementation, the CPD Accreditation team revised the accreditation application form to meet the new standards outlined by the CFPC. Educational sessions were held with the CPD D&L committee in June 2016 and also with Departmental CPD administrators in September 2016 to ensure that faculty and staff were aware of the changes.
The CPD Accreditation team continues to encourage pre-and post-assessment activities which provide opportunities for self-directed learning. Demand for accredited courses that use multi-faceted methods of learning and assessment, such as ImageSim, continue to grow. It is clear that discernible efforts towards integrating principles and building a new culture of competency-based education and assessment are underway at CPD.
Scholarship at PostMD Furthering Research and Celebrating Excellence
The research and scholarship mission of Post MD Education continues to be furthered by the papers, posters and workshops facilitated at local, national and international conferences. In 2016 and 2017, 10 papers, 24 workshops, and 4 posters were produced through the PGME office. CPD related scholarship across the Faculty of Medicine included 161 papers, 45 presentations at CCME, 7 grants. In addition to this, Post MD is responsible for the adjudication and administration of 17 teaching and research awards and grant programs. These awards and grants celebrate excellence and further research across the continuum. View the complete list of the awards and grant program criteria and recent winners.
To further support scholarship activities, a new award, a new grant, and additional staff were added to the portfolio.
The Dr. Robert H. Sheppard Award for Health Equity and Social Justice was established in 2016 to acknowledge the humanitarian work of the late Dr. Robert H. Sheppard, former dean of postgraduate medicine 1977-1988. The award recognizes outstanding contributions of faculty members and medical trainees involved in activities, programs or research related to social justice and health equity in faculty development or postgraduate medical education.
In January 2017, Post MD Education initiated a grant to support projects in Medical Humanities Education. The grants will support projects that enhance humanism, compassionate care, clinical competencies and deliverables. These areas are closely aligned with the ongoing priorities of postgraduate medical education and the CanMEDS roles. There will be a call for proposals and awarding of the grant on a semi-annual basis.
Dr. Walter Tavares was appointed to the role of Scientist and Assistant Professor at the University of Toronto / University Health Network Wilson Centre in Post MD Education in the Faculty of Medicine on September 1, 2016. Dr. Tavares obtained his PhD at McMaster University in Clinical Epidemiology and Biostatistics while completing a 5-year masters and PhD fellowship at the Wilson Centre. His research examines ways of optimizing performance based assessments in work and simulation settings.
Dr. Paula Rowland was appointed to the role of Scientist and Assistant Professor at the University of Toronto/University Health Network Wilson Centre in Post MD Education in the Faculty of Medicine on October 2, 2017. Dr. Rowland previously held positions with the University Health Network’s Collaborative Academic Practice Portfolio and the University of Toronto’s Centre for Interprofessional Education. Dr. Rowland holds an appointment in the Faculty of Medicine, Department of Occupational Science and Occupational Therapy as well as the Rehabilitation Sciences Institute at the University of Toronto. Her research explores questions of professional practice, attending to the intersections of organizational contexts with the ways in which we learn and work.
Dr. Tavares and Dr. Rowland’s responsibilities include leading high quality independent research programs relevant to Post MD Education and mentoring, collaborating with, and consulting with other education scientists, education researchers, clinician investigators and graduate students in healthcare education projects.
In addition to these appointments CPD has also recruited Shiphra Ginsburg, MD, MEd, PhD as Academic Director and Morag Paton, MEd as Education Research Coordinator.
Dr. Ginsburg is a Professor in the Department of Medicine and a Scientist at the Wilson Centre for Research in Education. She joined CPD in July 2017. Her program of research involves two inter-related areas. The first explores how clinical supervisors conceptualize, assess and communicate about the performance and competence of their learners, with a focus on the language used in workplace-based assessment. The second area explores the construct of professionalism in medical education, from the perspective of learners, faculty and practicing physicians. Ms. Paton joined CPD in May 2017 from previous roles in the Office of the Education Vice-Deans and the Department of Family & Community Medicine. She is a flex-time PhD student in Higher Education at OISE. Together this group will work to build capacity on education scholarship across CPD, including providing scholarly consultations for faculty and staff. Under the new CPD Strategy, this team is currently engaged in an environmental scan of CPD scholarship across the Faculty, and is reaching out to the CPD community to identify opportunities and best practices in this area.
Transitions – From MD to Residency to Practicing Physician
On Friday, April 7, 2017, the Faculty of Medicine hosted a “Transitions Think Tank” with approximately 40 participants. The forum brought together learners and faculty from the MD program, Postgraduate Medical Education and Continuing Professional Development sectors to have honest conversations and share ideas about transitions within medical education, with consideration of ongoing activities at the provincial and national level.
The event was designed to:
- Discuss key issues related to transitions across the medical education spectrum.
- Reconcile different perspectives about key transition points along the spectrum.
- Distinguish local, provincial and national opportunities to improve transitions
- Identify ideas and recommendations about how U of T can lead innovation in transitions.
Long-standing concerns were discussed including the CaRMS selection process, true residency program requirements, medical school academic records, alternative careers, timing of residency program choices and system inflexibility, the importance of research, and readiness for practice. Possible action items emanating from the forum were a plan to standardize UG learner reports, limitations on elective rotations, improved health workforce data, and clarity from programs on the need for research experience. For more information on the discussion points of the forum, please download the PDF.
Indigenous and Global Health Expanding Education Opportunities
Indigenous and Global Health are two important areas within PostMD Education. Through CPD, the Indigenous Health and North American Refugee Health conferences explore issues and discuss solutions to address the needs of these populations. At PGME, Global Health (GH) is a department which develops and delivers coordinated, inter-specialty education and programming with a view to improving health in Canada and abroad. GH has a number of initiatives that reflect PGME’s commitment to local and global social responsibility and accountability. CPD has been working towards increasing cultural competency through several initiatives led by Dr. Anna Banerji the Faculty Lead for Indigenous and Refugee Health with Post MD Education.
Through Global Health electives, residents and fellows can gain an understanding of varied health systems and social determinants of health. For those interested in more intensive global health education, the Global Health Education Initiative (GHEI), now in its 9th year, is a two year, 25 module certificate program. Over 100+ participants, 100+ faculty, and 200+ graduates are part of a strong GHEI alumni network.
Celebrating the accomplishments of GHEI graduates and showcasing leaders within the global health field, PGME’s annual Global Health Day is dedicated to urgent global health issues and themes. In addition, regular educational and experiential opportunities such as alumni workshops lectures and seminars, journal clubs, and research day also support continuing education, teaching and professional networking in this area.
CPD’s Indigenous Health Conference was launched in 2014, the biennial conference takes the unique approach of sharing the distinct health needs of Indigenous peoples through Indigenous voices. This population continues to experience significant health disparities on every major health indicator and are underserviced for quality healthcare.
Dr. Anna Banerji, conference co-director, sees it as a way to create a space for Indigenous voices to state what is needed for their communities and for health care providers to become advocates. “So many historical and contemporary issues have had a devastating impact on the health and well-being of Indigenous populations.” She believes continued dialogue with Indigenous peoples, health experts, policy makers and health care providers are key to improve health outcomes.
Another initiative lead by Dr. Banerji through CPD is the North American Refugee Health Conference (NARHC). NARHC is the largest refugee health conference of its kind and was recently held in Toronto. Designed for those at the frontline in addressing refugee health needs, this biennial conference welcomed over 650 speakers and participants in 2017.
As interest in global, refugee and Indigenous health continues to grow, the programming offered by both PGME and CPD will continue to meet the need for education in these important areas.
Learner Statistics Across the Continuum
Programs, courses, conferences and events offered by PGME and CPD focus on all medical education after the undergraduate medical degree. Statistics from 2016 and 2017 provide insight into types and number of activities, the profiles of the learners including their specialties and the contribution of these learners to the physician supply.
Learner Profiles
CPD’s community of learners 2016-2017
Learner Profiles
CPD’s community of learners 2016-2017
Simulation Programs
Total number of programs and conferences offering simulation component in 2016-2017
Simulation Programs
Total number of programs and conferences offering simulation component in 2016-2017
E-Learning Programs
Total number online programs and conferences offered in 2016-2017
E-Learning Programs
Total number online programs and conferences offered in 2016-2017
Programs and Learners
Total number of CPD programs and learners in 2016-17
Programs and Learners
Total number of CPD programs and learners in 2016-17
Contribution to Physician Supply
Contribution to population health needs through direct clinical service, research, education and administration.
Contribution to Physician Supply
Contribution to population health needs through direct clinical service, research, education and administration.
Canadian and International resident matching
2017 PGY1 CaRMS Match Results, by Source of MD
Canadian and International resident matching
2017 PGY1 CaRMS Match Results, by Source of MD
Contribution to the Physician supply in Ontario
Contribution to the Physician supply in Ontario
2016 Practice Entry Cohort
2016 Practice Entry Cohort
2016 Contribution by Specialty
2016 Contribution by Specialty
Community New IDEAS program
The Improving and Driving Excellence Across Sectors (IDEAS) introductory 2-day program was initially launched in 2014 and designed to begin building provincial capacity in quality improvement. Funding for this program ended in 2016. University of Toronto CPD was able to provide training to 661 learners over 2 years.
In partnership with the other 5 Ontario Universities, University of Toronto Institute for Health Policy, Management and Evaluation (IHPME), and Health Quality Ontario (HQO), a new blended-learning IDEAS Foundation Program in quality improvement was launched in March of 2017. The new version has been very well received and consists of a 3-hour online component and 1-day live program to better suit needs of busy healthcare professionals.
CPD successfully delivered 3 programs in the spring 2017 with a total of 127 participants. Partnerships with a variety of groups including the Ontario Renal Network and the Toronto Central LHIN’s Regional Quality Table and Local Collaborative have led to development of customized programs increasing the relevance of quality improvement for our learners. Plans are underway to deliver 3 more programs in the fall. CPD is collaborating with the Ontario Long Term Care Association, Centre for Addiction and Mental Health (CAMH) and the Collaborative Academic Practice (CAP) fellowship program to develop customized programs for these groups.
Community Voice of the Resident
It’s no secret that residency is tough. The Voice of the Resident (VoTR) survey reveals, however, that some demographic groups of residents have a tougher time than others. The second annual VoTR survey, conducted in Spring 2017, yielded a 53% response rate from the 1035 residents who participated.
Results demonstrated the resident population diversity with respect to gender, sexual orientation, religion, place of birth, childhood socio-economic status, and race/ethnicity and highlighted inclusion, discrimination and differences in the residency experience based on socio-economic background.
Ensuring that residents feel included and have equitable access to opportunities is important to PGME. One measure of inclusion and equity is the incidence of discrimination experienced by various groups of residents. Survey respondents were shown the Ontario Human Rights Code definition of discrimination and then asked whether they had personally experienced discrimination during your U of T residency program in the past academic year.
29% of all residents say they had been discriminated against in residency at least once in the past academic year. Residents who had experienced discrimination name patients and their families (46%), U of T faculty (44%), and nurses (34%) as the top perpetrators. Discrimination does not affect residents equally. Muslim residents were most likely to be targeted by discrimination in their residency -- 54%. Among Muslim residents, the rate of discrimination varies. For example, 44% of Muslim males experienced discrimination in the past academic year compared to 61% of Muslim females, and 64% of Muslim males residents whose religion is identifiable by their appearance experienced discrimination compared to 77% of Muslim female residents whose religion was identifiable by their appearance. Among Muslim residents who had been subjected to discrimination last academic year, two-thirds (63%) say they were targeted by U of T faculty.
An additional finding from the Voice of the Resident study is the profound impact childhood socio-economic status has on the residency experience. Residents who grew up in Canada in a lower / lower-middle class family are more likely than residents who grew up in a middle class household or in an upper-middle/upper class household in Canada to have:
- Personally experienced discrimination in residency at least once in the past academic year (42% vs. 29% vs. 30%)
- Agreed moderately or strongly that they are excluded from an informal network in their program (14% vs. 7% vs. 7%)
- Been physically exhausted all or most of the time (50% vs. 41% vs. 40%)
- Felt extremely stressed all or most of the time (30% vs. 19.5% vs. 20%)
- Been burned out all or most of the time (37% vs. 21% vs. 25%).
In response to these survey findings and other observed challenges and areas for improvement, the Faculty of Medicine is focused on building a culture of inclusion led by the Chief Diversity Officer in partnership with PostMD and other departments. Plans include: creation of a Diversity Dialogue series to facilitate open conversation between learners and faculty about inclusion/exclusion issues; creating a Diversity Advisory Council; and building an Allyship Toolkit to foster a more supportive learning and working environment.
Innovation CPD Leaders and Directors recognized for innovative research
The Faculty of Medicine’s CPD Leaders and Directors were recognized for their contribution to the field of Continuing Professional Development. Dr. Rene Wong, and Drs. Sanjeev Sockalingham, David Wiljer and their team were honoured at the Society for Academic Continuing Medical Education (SACME) conference held in May in Scottsdale, Arizona.
Dr. Rene Wong was the recipient of the Fox Award. Established in 2001, this award is given to a presenting author of an original research project that links theory, methodical rigor and makes an important contribution to CPD literature. Using a theoretic lens that encompassed issues of power and hierarchies, Dr. Wong’s research examined how CPD may be having unintentional effects including: obscuring the patient voice, creating and reinforcing hierarchies between specialists and generalists, and decreasing the perceived value of continuing education. “My interest in CPD research stemmed from my experiences as a course director” said Wong,” During one of my diabetes courses targeted to family physicians, I started to question why it was that I, as a specialist, had the expertise to be able to teach an entirely different type of physician how to best practice in their local setting. I noticed the literature tended to focus on finding ways to make CPD better at increasing provider adherence to clinical practice guidelines, but no one had examined how CPD may be having unintentional effects on how clinicians interact with each other and patients”.
Drs. Sockalingam and Wiljer and their team were all awarded the Phil R. Manning Research Award in Continuing Medical Education for their project Data and Lifelong learning (LLL): Understanding Cultural Barriers and Facilitators to Accessing and Using Clinical Performance Data to Support Continuing Professional Development (CPD). This distinguished and highly competitive award is granted only every two years and this project was selected out of 24 submissions from across North America. This award recognizes original, scientific research related to physician and/or health professionals lifelong learning for their project. Together with their co-investigators (Walter Tavares, Maria Mylopoulos, Craig Campbell Allan Okrainec, Ivan Silver and Dave Davis), Drs. Sockalingam and Wiljer will explore the utilization of clinical data in psychiatry and surgery for practice improvement. The study will focus on cultural factors (defined as individual, organizational and systemic factors) that influence use of data to inform LLL, to promote practice change to support improvement in patient outcomes.
Continuing Professional Development (CPD) is a part of Post MD Education within the Faculty of Medicine at the University of Toronto. CPD offers over 400 programs and conferences for health care professionals annually. Our CPD directors and leaders represent the clinical departments and educational units within the faculty of Medicine. They play a vital role in advancing lifelong learning for health profession and improving the quality of care to patients through the design and delivery of continuing education opportunities for health care professionals.
The Society for Academic Continuing Medical Education (SACME) is an international organization dedicated to the advancement of continuing medical education for the improvement of patient care. Members represent leading medical schools, academic medical centres, teaching hospitals and medical specialty societies in the United States and Canada.
Leadership Competency Based Medical Education – Implementation at the University of Toronto 2016-17
The Royal College of Physicians and Surgeons of Canada (Royal College) implemented the Competence by Design initiative in 2015. This multi-year project will be rolled out for approximately 80 specialties in several cohorts over the next decade.
The new model for medical residency education focuses on outcomes and provides more flexibility as it incorporates the learner’s prior skills and current needs. A coaching approach with daily/regular feedback allows the preceptors and program directors to provide enhanced tracking to better assess the learners’ progress and performance. As illustrated, the new model is based on an educational continuum where the learner transitions from the MD program, progresses to the orientation and assessment stage then to the foundation of the discipline as a junior resident, acquires core discipline-specific skills as a senior resident, and then proceeds to the transition to practice phase.
Learners will be coached to achieve the independent performance of the specialty’s Entrustable Professional Activities (EPAs). Milestones will track the learner as they progress from novice to mastery of each competency as established by the individual specialty committee.
In 2016-17, PGME created the Education Integration Group (EIG). Under the direction of Dr. Susan Glover Takahashi the group oversees the implementation of CBME in the Faculty of Medicine. It is estimated that the launch of the new CBME model in a specialty area within Post MD will take about one year. This includes mapping the training experiences, competencies and EPAs, development of the assessment tools, organizing faculty development sessions, setting up the learner and site schedules, and program evaluation.
As communication is key in the implementation of any new system, EIG organized several workshops and information sessions for administrators and faculty members during the past year. These included two sessions with Dr. Eric Holmboe, the US Accreditation Council for Graduate Medical Education (ACGME) Senior Vice President, Milestone Development and Evaluation offered through PGME on March 7th and another offered through Continuing Professional Development on April 21, 2017.
In addition, several resources have been developed to assist program directors, preceptors, administrators, residents, hospital and department education leads and department chairs, and clinical chairs in their understanding of CBME and how it will change the current training structure. These resources - including newsletters, videos, one-page instructional forms, and “myth-buster” messages – are catalogued on a separate area on the Post MD Education website at cbme.postmd.utoronto.ca/.