In response to feedback from residency accreditation stakeholders, and in light of changes underway in medical education (e.g. competency based medical education), the Collège des médecins du Québec, the College of Family Physicians of Canada, and the Royal College of Physicians and Surgeons of Canada – The Canadian Residency Accreditation Consortium (CanRAC), in 2013, partnered to explore opportunities and new directions in the development of a new conjoint system of residency accreditation, with an aim to:
- Reflect a rigorous, balanced accreditation system, designed to reflect alignment with the principles of competency-based medical education (CBME) as well as leading practices in accreditation.
- Preserve the strengths of the current system, such as having national standards, onsite evaluation of programs, and peer review.
- Introduce new standards of accreditation that provide increased clarity for institutions, programs, and surveyors (without being unnecessarily prescriptive, and allowing for innovation), while increasing focus on outcomes and accommodating both CBME and non-CBME programs.
- Improve the accreditation process with a focus on making the most efficient use of the time dedicated to accreditation related activities by residency education stakeholders decreasing any unnecessary administrative burden.
The work of CanRAC since 2013 has ultimately resulted in the development and ongoing testing/implementation of CanERA – Canadian Excellence in Residency Accreditation, the new conjoint new system of residency accreditation, which includes 10 key features:
- New standards for institutions and programs with a new evaluation framework and an emphasis on high-yield markers and outcomes;
- A more continuous accreditation cycle, with regular accreditation visits every eight years, supported by new sources of information for continuous evaluation as well as quality assurance and improvement (data integration);
- An enhanced institution review process with a conjoint accreditation decision;
- Introduction of a digital Accreditation Management System (AMS), with tools to enhance quality improvement;
- Increased emphasis on self-evaluation and continuous improvement;
- An enhanced onsite review process, with new techniques such as tracer methods;
- A renewed emphasis on the quality and safety of learning environments;
- New decision categories, with tools to streamline and improve the consistency of decision-making;
- Tools to identify and share innovations and leading practices, including “exemplary” practices identified in the standards; and
- A systematic approach to evaluation, research, and continuous improvement of the system.
What is staying the same?
The proposed plan aims to preserve the strengths of the current system, including national standards, onsite visits conducted by peer reviewers, and input from specialists in the discipline. There will still be general accreditation standards that apply at both the institutional and program level, as well as specialty specific standards, where available.
We recognize that many aspects of the accreditation process remain pertinent, and will remain the same as the new system rolls out. For example, standards will still be used to determine accreditation status, and surveyors will still go onsite to gather data.
How will standards change?
The new general standards will:
- Provide greater clarity, without being overly prescriptive
- Ensure alignment with the CanMEDS 2015 Framework
- Support the transition to competency-based medical education (CBME)
- Place greater emphasis on the learning environment and outcomes
How will the accreditation process change?
The proposed changes aim to:
- Shift the focus of effort from manual, paper-based work to a digital platform that helps programs be prepared for accreditation at any time.
- Provide programs and postgraduate deans with the systems and tools to promote continuous evaluation
- Reward continuous quality improvement
- Integrate innovative practices into the accreditation system