Frequently Asked Questions
What is CanRAC?
CanRAC is the Canadian Residency Accreditation Consortium, comprised of the Collège des Médecins du Québec (CMQ), the College of Family Physicians of Canada (CFPC), and the Royal College of Physicians and Surgeons of Canada (Royal College). In collaboration with other residency accreditation stakeholders, CanRAC partners have led and facilitated the development of CanERA.
What is CanERA?
CanERA (Canadian Excellence in Residency Accreditation) is the new conjoint system of accreditation for residency education which includes ten 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.
Why are we changing accreditation?
In 2012, interviews and focus groups conducted with the postgraduate (PG) deans of Canadian Faculties of Medicine regarding the current system of accreditation identified the need for change; more than 50% of PG deans felt that transformative changes were required. The challenges and strengths of the current system enumerated through this process were confirmed by additional residency accreditation stakeholders. As such, beginning in 2013, CanRAC examined the identified strengths and challenges, explored opportunities for change and subsequently embarked on the development of CanERA.
When can I expect changes?
The implementation of CanERA includes a multi-phased approach of prototype testing prior to full implementation, which is planned for July 1, 2019. It is important to note that prior to July 1, 2019, the new system of accreditation, CanERA, will be applicable only to the regular onsite accreditation reviews of the two Prototype 3 Universities (i.e., Dalhousie University and McGill University). Prior to July 1, 2019, CanERA will not be applicable to any other accreditation reviews such as those programs with off-cycle accreditation reviews (i.e. mandated internal reviews, external reviews, or progress reports) or applications. As of July 1, 2019, CanERA will be applicable to all universities and their residency programs.
CanERA Implementation Plan
For additional details, please visit When am I affected?
Who has been consulted?
The development of CanERA has been a collaborative process from its onset to ensure an accreditation system focused on markers of quality residency education, while also taking into consideration the need to improve clarity of expectations and efficiency of processes to decrease the unnecessary burden on residency programs and postgraduate offices.
Collaborative efforts began with the partnering of the three colleges as CanRAC and quickly evolved to include a number of working groups and committees: the Standards Development Integration Committee, six standards development working groups, the Accreditation Process Advisory Committee, and the Conjoint Taskforce on Resident Input into the Accreditation Process. Membership on the various working groups and committees includes representation from residents, resident organizations, postgraduate deans, postgraduate managers, program directors, faculty, program administrators, the Federation of Medical Regulatory Authorities of Canada (FMRAC), CFPC, CMQ, and the Royal College.
In addition, between November 2016 and February 2017, national consultations were conducted to solicit stakeholder feedback on the draft standards and process components of CanERA via online survey. A total of 231 respondents completed the survey, from more than 1400 invited stakeholders, including residents, postgraduate deans, program directors, the residency accreditation committees, and specialty committee chairs. The feedback collected was reviewed by CanRAC and the various applicable working groups for consideration and has informed subsequent development of the new accreditation system.
CanRAC also recently hosted the fourth annual Conjoint Accreditation Summit on June 7, 2017. Individuals invited to attend the 2017 accreditation summit included leadership, staff, and accreditation committee members of the three colleges, as well as postgraduate deans (or their respective PGME office delegate), members of APAC and the Standards Development Integration Committee, and staff and resident representatives from the Resident Doctors of Canada (RDOC) and the Fédération des médecins residents du Québec (FMRQ). The summit was a rich day of discussions with participants indicating high levels of support and understanding of the new accreditation system as well as the need for training, tools and support to facilitate transition to the new system.
Moving forward CanRAC will continue working with key stakeholders, providing regular updates and soliciting feedback as well as general and individualized training and support.
How have the General Standards of Accreditation changed?
A key feature of CanERA is the new General Standards of Accreditation for Institutions with Residency Programs and new General Standards of Accreditation for Residency Programs. In comparison to the current general standards, the new general standards increase focus on outcomes (“show me that it works”), allowing for flexibility; increase clarity of expectations, including with respect to the information required in the Accreditation Management System (AMS); renew emphasis on the learning environment and continuous improvement; and accommodate both time- and competency- based education models. The new standards are also written in alignment with a new standards organization framework. However, despite the changes, it is important to note that a program is still a program, and as such, while expectations have evolved in alignment with the improvements noted above, the core expectations of a residency program remain the same (e.g. an appropriate education program, system of assessment, an appropriate structure to oversee residency education etc.).
How have the discipline-specific standards of accreditation changed? (i.e. the CFPC Red Book & the specific standards of accreditation for each Royal College discipline)
With respect to Family Medicine programs, the CFPC is currently in the process of seeking feedback on draft new Standards of Accreditation for Programs in Family Medicine. The new standards incorporate the new General Standards of Accreditation for Residency Programs, in addition to discipline-specific expectations; this document will effectively replace the current “Red Book”. The version finalized following the conclusion of the national consultation process that is presently underway will be in effect for Prototype 3 testing, and will subsequently be applicable to all Family Medicine Programs July 1, 2019 and onwards.
With respect to Royal College disciplines, in preparation for Prototype 3 and full implementation, the Royal College, in consultation with each specialty committee, has been converting the current standards of accreditation for each discipline to a new template aligned with the new General Standards of Accreditation for Residency Programs. It is important to note that the conversion is not intended to maintain expectations as set out in the current discipline specific standards but to reflect these expectations in a format and presentation consistent with the new general standards. Modifications to these standards that would alter the intent of the current standards (e.g., raise the bar) may be made to a subsequent iteration of the standards, under the auspices of the Specialty Committee in question, which may occur as part of the drafting of new standards associated with the transition under Competence by Design or a separate update to the standards, which could apply no earlier than accreditation reviews post-Prototype 3.
What are two-year touch points? Are there specific expectations of the postgraduate offices and/or residency programs every two years?
The new progressive accreditation cycle includes a robust external review process for those institutions and programs requiring follow-up between regular onsite reviews, with external reviews scheduled according to predictable, two-year intervals. External reviews at the institution and program levels (for a given institution) are bundled into a single two-year visit, which is conducted by a team of surveyors (in proportion to the number of reviews). The survey team may also review or validate any mandated Action Plan Outcomes Reports (APORs), which are due at the time of this two-year checkpoint.
How does the new accreditation system work for programs that have transitioned to a CBME model under the CFPC’s Triple C Curriculum or as part of Competence by Design?
With the advent of CBD, as well as the College of Family Physicians of Canada’s (CFPC’s) Triple C curriculum, and given previous feedback from postgraduate deans and other stakeholders, CanRAC believes that outcomes-based education deserves outcomes-based accreditation. The new conjoint accreditation processes and standards:
- Align accreditation with the educational design of both Triple C and CBD as well as CanMEDS 2015/CanMEDS FM;
- Align with the education continuum and the recommendations of the Future of Medical Education in Canada – Postgraduate; and
- Increase focus on outcomes while maintaining essential process markers of program and institution quality.
While the ongoing roll-out of CBD is by discipline, the new accreditation system is being implemented by university, to ensure that Schools/Faculties of Medicine, the colleges, and survey teams are not required to run two systems of accreditation simultaneously. Recognizing that the transition to CBME for Royal College programs via CBD will take several years, the new general accreditation standards have been written to apply to both CBD and traditional cohorts; as such, Triple C, CBD and non-CBD programs will be held to the same general standards of accreditation.
The colleges’ precedent is that programs are held to the specialty-specific standards in place at the time that the university began its preparations for accreditation, which is typically approximately one year before the onsite accreditation review. Accordingly, those programs that have transitioned to a CBME model one year prior to an onsite accreditation review will be reviewed against the new competency-based document suite, including the discipline-specific standards. Recognizing that these programs will simultaneously include learners following both the pre-CBD and CBD programs, the accreditation process will ensure that the quality of the whole program is evaluated by collecting additional information such as: 1) the main differences between the residency program for CBD residents versus non-CBD residents, 2) the steps being taken to ensure that no residents are disadvantaged throughout the transition of the program to CBD, and 3) how innovations or practices from the implementation of CBD are being leveraged for the benefit of non-CBD residents. It is anticipated that by 2024, all disciplines will have transitioned to CBD.
What is data integration and how will it be implemented?
Data integration refers to the introduction of new sources of information regarding institution and program quality that will be generated on an ongoing basis, not necessarily in the context of a specific accreditation review. The introduction of data sources is proposed to occur in stages that will require consultation, testing, and evaluation before additional stages would be considered for implementation. As such, data integration will be implemented iteratively over the course of the next accreditation cycle, following full implementation of accreditation reform (expected for 2019). For Prototype 3, data integration will be minimal, consisting of an initial deployment of an annual survey of residents and faculty with the data mapped to the new standards. Ultimately, it is envisioned that data will be integrated with the AMS and available only in aggregate form.
When will the College(s) intervene based on data integration?
First-time concerns identified through data integration sources will be managed by residency programs as part of the continuous quality improvement process, with the postgraduate office receiving a general notification to maintain oversight. Repeat identification of the same concern(s) will require the postgraduate office to become involved in the CQI process, with the expectation that the program complete an APOR for submission to and review by the postgraduate office. If issues remain ongoing following two notification instances, and actions are not followed up as denoted in the APOR, the postgraduate dean will be required to write a response to the appropriate residency accreditation committee. Following receipt of the letter, the residency accreditation committee will review the response and determine what, if any, additional follow-up is required (e.g., APOR, External Review).
Who will own the data associated with residency accreditation data integration?
With respect to ownership of the data, postgraduate users will own the data collected. Furthermore, the data will be collected anonymously and will be de-identified, when accessed by the colleges and specific programs; that is, CanRAC users will not be able to review any individual’s identified data.
What are the benefits of an Accreditation Management System (AMS)?
The development and implementation of an AMS has been identified as a key enabler of residency accreditation reform. The implementation of an AMS to support residency accreditation activities is intended to streamline and improve the residency accreditation process. Speaking specifically to postgraduate offices and their residency programs, the AMS will provide the tools necessary to shift current efforts associated with accreditation to higher value activities, more beneficial to residency education. Most notably, the AMS will transform the current process of preparation for accreditation-related activities (e.g. the labour intensive process of populating the pre-survey questionnaire) to a process of reviewing the institution and residency program profiles within the AMS to validate that information is up to date. The AMS will also support the continuous improvement activities of the postgraduate office and its programs, providing tools and new sources of information regarding institution and program quality (e.g. self-study). These tools will also provide evidence for institutions and programs to demonstrate alignment with the new General Standards of Accreditation for Institutions with Residency Programs and General Standards of Accreditation for Residency Programs.
What work has been undertaken to date associated with AMS development?
In the fall of 2013, CanRAC began exploring opportunities and new directions in the development of new Canadian conjoint standards and processes for residency education accreditation. Soon thereafter, the development of an AMS was identified as a key component of residency accreditation reform, and as such, CanRAC partners began analyzing business requirements, which included a short-term contract to provide a detailed analysis of business requirements prior to moving forward with a request for proposal process.
In 2016, CanRAC, in collaboration with Association of Faculties of Medicine of Canada, developed a request for proposal (RFP) based upon a common business requirements document (BRD) across the accreditation continuum. Subsequent to vendor demonstrations and comprehensive proposal evaluations conducted conjointly among the four organizations, a preferred vendor was selected. In addition, a detailed phased timeline for the AMS was developed, with phase 1 driven by the timelines identified by CanRAC for the roll-out of the new accreditation process for residency education.
Throughout spring and summer 2017, CanRAC partners have been working with the AMS vendor to develop the first iteration of the AMS (version 1.0) to support testing associated with Prototypes 2 and 3. This first iteration will include key functionality for prototype testing; subsequent versions are anticipated prior to providing all Universities with access to the AMS on July 1, 2018. AMS updates will reflect feedback received during internal, external and Prototype testing, as well as planned developments.
Will postgraduate offices be required to contribute to the costs associated with AMS development?
Postgraduate offices will not be expected to contribute to the costs associated with the development of the AMS (e.g. software development, licensure). It is however acknowledged that there will be an impact on postgraduate offices and their residency programs with respect to the initial adoption of and transition to the AMS, and to increase understanding of the level of impact we will be undertaking a baseline and future workload impact analysis, beginning with testing associated with the implementation prototypes.
What support will be provided to postgraduate offices and residency programs related to the implementation of CanERA, including the AMS?
Acknowledging that CanERA is a new system, CanRAC will be providing training to all Universities, which will include training with respect to the use of the AMS (e.g. how to navigate the system, how to upload information, etc.).
For Prototype 3, which is a test of all reform components, efforts have already begun with respect to anticipating and addressing training and support required for these schools, including ongoing communication, AMS training, and additional pre-survey visits. CanRAC will also provide access to ongoing technical support to assist with enquiries that may arise.
In addition, while the intent of the AMS is to decrease the administrative burden associated with preparing for accreditation reviews, refocusing these efforts to higher value activities, it is acknowledged that in the short term, there will be a need for the initial upload of documentation/information to the institution/program profile. To assist with this, CanRAC will be uploading all basic profile information available (e.g. name of programs, last accreditation date, decision, name of program director and program administrator(s), IIA information, previous areas for improvement identified, etc.); however, the postgraduate office and residency programs will be responsible for the initial uploading and ongoing maintenance/updating of all other information/documentation required in the AMS institution and program profiles.
The AMS design is intended to be user-friendly, and particular attention is being focused on balancing the need for information to evaluate alignment with accreditation requirements with the need to ensure collection and ongoing maintenance of this information is not overly burdensome. To this end, CanRAC will be evaluating these aspects of the AMS, including collection of user feedback. Furthermore, many stakeholders are or will be involved in the testing of the AMS throughout its development.