Royal College of Surgeons of Canada Maintenance of Competence Program

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1 Royal College of Surgeons of Canada Maintenance of Competence Program W. Donald Buie MD, MSc, FRCSC Associate Professor of Surgery University of Calgary

2 Disclosures No disclosures

3 Outline Brief history of the Royal College Beginings of CME Maintenance of competence (MOC) program CanMEDs roles The future

4 Royal College of Physicians and Surgeons of Canada Responsible for all aspects of specialty training in Canada: Setting general and specialty specific standards Accrediting postgraduate education programs Certifying specialists by examination (81 specialties) (FRCSC) Defining core competencies (CANMeds) Continuing medical education; Maintenance of certification (MOC) Not responsible for licensing although the designation of FRCSC is required for licensing as a specialist

5 Royal College of Physicians and Surgeons of Canada (RCPSC) 1920 CMA Committee struck to examine the possibility of a Canadian College for specialty training April 19, 1929 bill passed in House of Commons to act as an incentive to medical men, both physicians and surgeons to aspire to higher qualifications and therefore higher standards of service to the public June 14, 1929 passed Senate and received Royal Assent

6 RCPSC Early History Two division medicine and surgery Nov. 29, 1930 fist annual meeting charter members (212 medicine, 276 surgery) 1932 first examinations in medicine and surgery 1940s subspecialty recognition specialties with examination

7 ROYAL COLLEGE OF PHYSICIANS AND SURGEONS OF CANADA FINAL EXAMINATION SURGERY Toronto, October 12 th, :30-12:30 In answering the questions, Candidates are requested to confine themselves to what is asked, and are informed that no credit will be given for irrelevant matter. 1. Discuss the pathology and treatment of Hirschsprung s disease. 2. What are the causes of flat feet? Describe the pathological anatomy of the condition. Discuss treatment. 3. Describe the apparatus used in the modern non-operative treatment of fracture of the shaft of the femur and indicate their uses. 4. Describe the arterial blood supply of the colon and indicate its influence on the operative treatment of carcinoma

8 RCPSC Early history 1947 program to approve hospitals for graduate training 1960 direct inspection of hospitals 1965 standards for approval of programs 1972 only route to specialty certification in Canada

9 RCPSC The Beginnings of CME 1975 all programs had to be University based 1976 all specialties: general accreditation standards for specialty training programs guidelines for In training evaluation Committee for Continuing Education (1976): Recognition that the RC needs to assist and promote CME not in favour of mandatory recertification because of the lack of reliable and practical methods of evaluating performance in clinical practice supported self assessment programs peer reviewed audit and medical audit annual scientific meeting

10 RCPSC Beginnings of CME 1988 Maintenance of competence pilot project (MOCOMP) Principles: Continuous improvement and enhancement of competence rather than a punitive or coercive approach Proactive based self managed education

11 RCPSC MOCOMP MOCOMP CME audit system Voluntary Annual profile PC diary and question library; e-tools for self education and learning Only 13% of the Fellows engaged in MOCOMP

12 RCPSC Development of the MOC Program 1997 recommendation to make participation in MOC mandatory 1998 work started on the Continuous Professional Development program (CPD) Renamed Maintenance of Certification Program (MOC)

13 Principles MOC Maintenance of Certification (2000) Commitment to life long learning Commitment to learner centered professional education No set curriculum No mandated learning activities

14 Goals of MOC Planned continuing professional development based on identified practice needs Fellows build evidence based practices that enhance the quality of specialty care Learning outcomes and practice enhancements are documented and validated for purposes such as licensure or privileges to practice

15 MOC Education Principles 1. Personal - individual professional development plan tailored to scope of practice 2. Needs based selected learning activities that address perceived needs and non perceived needs 3. Scope of practice learning activities relevant to knowledge and skills of a Fellow s specialty, (professional roles, responsibilities, expertise) 4. Reflection critical thinking about current practices 5. Continuous improvement continuously engage in learning activities promoting excellence 6. Choice choosing appropriate learning methods 7. Inter-professional integration of learning with health care teams groups

16 MOC Role of the Royal College Establish framework of CPD to support three types of Continuing Professional Development Activities: Group learning Self learning Practice assessment Establish educational, ethical and documentation standards for all activities included in the program Documentation is central to validating learning

17 MOC Registration and Participation Fellows are automatically registered in the program and are required to meet all requirements All Fellows engaged in full or part time clinical, laboratory or community practice, research administration, and/or teaching MOC is mandatory for: Admission to and renewal of Fellowship Use of the FRCSC designation Listing on the public Directory of Fellows

18 MOC Program Requirements Fellows must complete A minimum of 40 credits of CPD each year A minimum of 400 credits of CPD in each 5 year cycle To earn credits Fellows must select learning activities included in the program in one of six different sections of learning activities Self reporting of learning activities on or before January 31 st following each calendar year using MAINPORT (

19 MOC Credit Validation Each year a stratified random sample of 3% of Fellows are required to submit documentation to support their MOC credits Participants who fail to submit documentation - all self reported credits are transferred to Section 2 or removed from the submission

20 CPD Framework: Options for Maintenance of Certification Section Definition Examples credits 1. Accredited group learning activities Education activities from accredited CPD providers Rounds, journal clubs, workshops conferences 1 credit per hour no maximum Documentation 2. Other learning activities Educational activities not associated with accredited providers Non accredited rounds meetings, journals, Medline, videotapes, online CME 1 credit per hour maximum of 100 per 5 years 3. Accredited self assessment program Programs designed to assist the specialist in identifying their needs Self assessment programs developed by NSS, faculties colleges. Virtual reality trainers developed for self assessment 2 credits per hour no max. Documentation 4. Structured learning projects Learning activities are planned and the outcome is recorded and evaluated Personal learning projects (PLP), traineeships, preceptored courses, MSc, PhD 1 credit per hour no max Documentation 5. Practice review and appraisal Activities that assist the specialist to review their practice Practice audits and patients surveys, institutional audits, incident reports, utilization studies 2 credits per hour no maximum Documentation 6. Educational development, teaching and research Activities that involve setting standards for practice Publications (manuscript reviews) Preparation of presentations, teaching, examinations (question writing) Research (grant proposals, trials) Standard setting (CPGs) 1 credit per hour max of 100 credits per 5 year Documentation

21 Rewards Fellows who develop personal plans for professional development based on practice and professional needs Use of self administered tests to assess their knowledge and audits to review their practice earn double credits Credit for practice based learning and improvement by creating personal learning projects (PLPs)

22 Emphasis on reflective learning in practice Recognizes the need for fellows to be competent in the management of clinical situations of uncertainty, ambiguity, conflict as well as the practice of evidence based medicine

23 Non Adherence policies Notification from the College at the end of the first year of non- adherence Information provided to enhanced their understanding and selection of relevant activities Required to participate in Credit Validation Program in one of the remaining years of the cycle If non adherent for a second year, additional information is sent and they are required to participate in Credit validation for 1 or more of the remaining years of the cycle

24 Termination of Fellowship Fellows who have not met the minimum requirement of 400 credits by the end of their cycle will have their Fellowship terminated for non compliance

25 Additional Specifics Credits cannot be carried forward Semi retired physicians are included Committee work is not included Activities outside of the Canada are valid provided they are sponsored by a physician organization, proof of attendance is given along with the number of hours.

26 Strengths Applies to all specialists Credits are relatively easy to collect Ease of use On line technology for record keeping Database maintained by the Royal College one stop shopping MAINPORT web site to enter and monitor MOC credits in real time

27 Is it Working? % voluntarily submitted CPD hours % submitted (mandatory) % submitted 2009 close to 100% Are we better physicians?

28 The Future of MOC Integration of CanMEDS roles: Medical expert Communicator Collaborator Manager Health advocate Scholar Professional

29 CanMEDs roles 1. Medical expert Applying medical knowledge clinical skills and professional attitudes in the provision or patient centered care 2. Communicator Effectively facilitating the doctor patient relationship Collaborator Working effectively as a member for the health care team Manager Participant in health care organization, allocating resources, contributing to effectiveness Health advocate Using expertise and influence to advance the health of individual patients, communities and populations Scholar Life long commitment to reflective learning creation dissemination, application and translation of medical knowledge Professional Committed to the health and well being of individual and society through ethical practice, professional led regulation and high personal standards of behaviour

30 The Future of MOC Physician Achievement Review program (PAR) Alberta College of Physicians and Surgeons (Provincial) 5 year 360 practice review (patients, allied professional colleagues Requirement to keep license provincial (state) jurisdiction