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2020-21 PGMEAC

Agendas, Minutes & Attachments

April 30, 2021

1. Resident Report
The Community Building Fund
At our March General Council meeting, PARO discussed that current PGY1s are feeling particularly isolated during the pandemic as they were off for months before starting residency and since then have had little opportunity to meet their colleagues in person to be able to bond. To mitigate this challenge, the PARO Board has approved a specific initiative which provides us with the ability to organize and fund targeted events specifically for current PGY1s, (i.e., 2020-2021), the Community Building Fund. While the Toronto PARO GC team is currently brainstorming events to host using this fund, proposals for events can also come from general PARO members and programs.  If your program is interested in hosting a virtual event for current PGY1s using this budget, please contact Sarah Reyes (sreyes@paroteam.ca), to obtain more information and the proposal form.

In addition, PARO would like to emphasize the importance of programs hosting socials for the incoming PGY1s. This will help create those social connections and bonds amongst residents in the program early on.

PARO Face Masks
As mentioned at the last PGMEAC meeting, PARO has produced 3-ply non-medical face masks that we are distributing to all residents. To date we have delivered face masks to most Toronto hospitals, with the last remaining hospitals of Toronto General, Sunnybrook, Princess Margaret, and Humber River, receiving the face masks next week. We want to thank everyone for your help delivering these face masks to Toronto residents.

PARO Awards Celebration for University of Toronto
The upcoming PARO Awards Celebration is being held virtually over two evenings to recognize U of T award winners on Tuesday May 4, and Thursday May 13, 2021. Awards include: Resident Teaching Award, Medical Student Citizenship Award, Clinical Teaching Award, Program Excellence Award, and the Dr. Robert Conn Resident Advocate Award for a Clinician.

2. PAAC Report

  • PAAC held their annual appreciation event on April 28, 2021 in a virtual format. The PAAC Awards for 2020 and 2021 were presented. Congratulations to all the winners and nominees – you are all so vital to all we do!
  • Award Winners:
  • 2020 Administrative Excellence & Leadership
    • Karianne Mintz, Education Coordinator, Department of Psychiatry, Sunnybrook Health Sciences Centre
  • 2021 Administrative Excellence & Leadership
    • Sandra Gauci, Education Coordinator, Department of Ophthalmology and Vision Sciences, U of T
  • 2020 Quality Improvement and Innovation
    • Robert Gardin, Postgraduate Officer, Department of Psychiatry, U of T
  • 2021 Quality Improvement and Innovation
    • Andrea Donovan, Postgraduate Assistant, Department of OHNS, U of T
  • An inaugural award in memory and recognition of Dan Stojimirovic’s exemplary commitment and program support as a Program Administrator will be presented to a long service Program Administrator (15 years+) who embodies similar attributes in their service to the trainees and program. The award will be presented in 2022.
  • PAAC has received their accreditation results / feedback and the new executive will be looking at opportunities to address the gaps/areas for improvement in the next two years.
  • PAAC is looking forward to receiving the final report of our survey on Information Sharing and Collaboration between Hospitals Medical Education Office and the Postgraduate programs. The information is currently being evaluated and will be presented to PAAC at our May meeting.
  • PAAC is recruiting Program Administrators as committee members for a two-year term. If you believe your Program Administrator would be interested, please let the PAAC executive know.

3. COFM/HUEC
COFM
No official meeting since the last PGMEAC meeting, but the PG Deans continue to correspond weekly with updates and best practices.

HUEC

  • The Guideline on Managing Disclosures about Learner Mistreatment were shared with the committee to ensure everyone was acquainted with them, which is already proving to be a well-served document.
  • Ongoing efforts to advocate to hospitals to make onboarding for redeployed trainees as streamlined as possible.
  • TFOM has agreed to reimburse redeployed trainees who have incurred duplicate parking costs.

4. Accreditation Follow Up/IRC Update
An update on accreditation follow up and IRC activities included:

  • The Accreditation committees for both the RC and CFPC are meeting on May 3 and 4 to discuss all the programs that were reviewed in November of 2020.
  • PG will receive the final reports a few weeks following these meetings – no expected changes to AFIs, but if there are, PG will notify as required.
  • IRC has been reviewing the Action Plan Outcome Report (APOR) programs (11 out of 13 have been reviewed) to determine the minimum evidence required to demonstrate that the AFIs have been addressed collaboratively with each program. These programs will receive letters with the action plan and suggestions for changes with a response turnaround in a timely, yet flexible time frame due to the demands of the current pandemic situation. The last two programs will be reviewed at the June IRC meeting.
  • IRC has met with all the programs (5) who require a follow up by an external review and two programs with an intent to withdraw after an external review to ensure all issues are being addressed with an action plan and follow up. These seven programs will have an internal review in the fall of 2022.

G. Bandiera provided full narrative on the institutional review and requirement of an Action Plan Outcome Report (APOR), updating the committee on the rationale behind the AFIs and PGME’s action plans.

5. CaRMS 2021 Results for PGME
The CaRMS Match showed favourable results including:

  • U of T was the only school to fill all 407 positions in first iteration, and the U of T MD match rate after first iteration was 96% (vs 94% nationally)
  • All students unmatched in the 2020 cycle obtained positions in the 2021 match
  • There are 249 vacancies in the second iteration
  • Canadian medical schools have decided that there will not be any visiting electives for the 2021-2022 year

6. COVID Updates
Medical Resident Redeployment Program
A formal announcement from the MOH as a result of an Orders in Council, and in collaboration with OHA and PARO that hospitals can now hire residents and any other licensed professional to do work on their behalf that aligns with COVID needs (i.e. covering extra call, working a shift on the weekend, etc). This work must be done outside of the residency program, must not interfere with residency training responsibilities, and does not replace residency work. Residents are allowed to travel across the province to meet the pandemic needs at other hospitals and will be organized through HealthForce Ontario – more details to follow in the next week from PARO and MOH. This Order in Council will be in effect until July 31, 2021.

Redeployment

  • Leadership continues to meet weekly to evaluate the redeployment system to discuss the needs and ensure the residents are redeployed as equitably as possible and only to the areas that have need. The areas that have need are part of these discussions and will continue to meet weekly until the pressures from the pandemic settle down.
  • All leadership and staff recognize and are grateful for the efforts of the PG trainees being redeployed during this ever-changing situation.

Parking Reimbursement

For all of our postgraduate trainees who have been redeployed to an alternate site and incurred additional parking costs, the Dean’s COVID Priority Fund is now providing reimbursement for their parking expenses associated with the redeployed hospital. Trainees can email lisa.bevacqua@utoronto.ca with the receipts from parking expenses incurred at their base hospital and the additional parking expenses incurred at their redeployment site.

Vaccination Status of PG Trainees – Reminder

  • If your trainees have received both doses of the COVID Vaccination, please ask them to email postgrad.med@utoronto.ca with an attestation that they have received the full vaccination (please provide date of final dose).
  • If your trainees have received the first dose and have a second dose scheduled, please also let us know (include date of first dose and anticipated date of second dose). If any trainees are experiencing barriers to receiving one or both of their vaccination doses, please let us know so we can advocate on their behalf.

Attachments

March 26, 2021

1. Associate Dean, Postgraduate Medical Education Position

Applications are invited for the position of Associate Dean, Postgraduate Medical Education, Temerty Faculty of Medicine at the University of Toronto.  This is a five-year term appointment effective September 1, 2021, renewable once following a favourable review. The closing date for applications to this position is Wednesday, April 21, 2021, 12:00 p.m. (EST). For any questions about this position, please contact Prof. Patricia Houston, Vice Dean Medical Education (patricia.houston@utoronto.ca). The Advisory Committee for the appointment of Associate Dean, Postgraduate Medical Education invites applications. Interested individuals must submit a letter of interest and CV to Vice Dean Medical Education, Prof. Patricia Houston, c/o Andrew McLeod, search coordinator at md.vicedean@utoronto.ca. Full job description is available online.

2. Resident Report
Lounge Review

After the last PGMEAC meeting results from PARO’s lounge review was shared with the committee, a couple of hospital sites have gotten back to us to thank the team for their hard work, but to also ask what residents feel is an example of a good lounge. We took this question back to our GC team and we created a list of what residents would like to have included in their ideal lounge. Please note that this is for lounges in non-COVID times when residents do not have practice physical distancing.

  • Computers should be in lounges, as the call rooms with computers can be far away.
  • A fridge and microwave are essential.
  • The square footage and the size of the lounge is important. It should be large enough to allow comfortable use by many residents.
  • The location is also important. Some sites have the resident lounges in the furthest location of the hospital, which discourages residents from using it.
  • Good lounges are either associated with call rooms, so people on call can use the lounge, or program specialty lounges. Standalone general resident lounge ends up not being used because of location.
  • Making lounges have badge access would be helpful instead of asking residents to learn various codes.

Call Room Review
This year, PARO is conducting a province-wide review of the resident on-call facilities to ensure that the rooms are in keeping with requirements under Article 18.2 of the PARO-CAHO Collective Agreement. The review will be taking place over the next few months and once it is complete, we would be pleased to share the results of our review with the hospitals.

PARO Face Masks
PARO has produced 3-ply non-medical face masks that we are distributing to all residents. If the learners at your hospital did not receive a mask , please contact Sarah Reyes (sreyes@paroteam.ca)  and we will work together to get them delivered to your location.

Redeployment
Again, we wanted to reiterate the importance that PGME make every effort to be transparent and flexible in redeployment needs, as we have heard from residents how much they would appreciate regular updates from PGME regarding COVID and redeployment.

3. PAAC Report

  • PAAC Accreditation Feedback Survey was conducted early February and PAAC is looking forward to receiving the results shortly.
  • PAAC Awards Adjudication Committee recently met and have simplified the PAAC award criteria and nomination process, which includes only a nomination letter submission is required. Information about nominating for the 2021 awards will be emailed within the next few days. The nomination deadline is Wednesday, April 14th.
  • PAAC held a virtual wellness session on Friday March 26, 2021. Over 60 Program Administrators, Education Coordinators participated.  We focussed on PA collaboration between programs / institutions, organizing a program / hospital PA committee for local issues, wellness and professional development. We also had a short presentation on Zoom Fatigue followed by breakout discussions on wellness, working remote and combating zoom fatigue.
  • PAAC is currently planning a virtual appreciation event which will be held Wednesday, April 28th. The presentation to the PAAC awardees for 2020 and 2021 will occur as well as other activities. More details coming soon. All education admins will be encouraged to attend.

4. COFM/HUEC
COFM
Important updates included:

  • Combined UG and PG committee meeting took place recently with the Ministry of Health, where the MOH presented on HHR Planning – no new data released, but we are on target with physician numbers in the province with no compelling need to increase spots. The Deans have been lobbying with the Minister around increased UG and PG spots – these discussions are going quite well, but no final decision yet.
  • Resident redeployment discussions around the principles of resident learner response in times of crisis including pandemics and other situations. This detailed document highlights the important role of the PD and their involvement in decision-making for redeployment as the license is tied to program activities.
  • PARO reps thanked all who advocated for the CPSO to temporarily exempt the cohorts of residents from taking the MCCQEII.
  • CPSO movement to increase the rigour and parameters around extra clinical training for people who want to change their scope of practice – similar to the Colleges’ movement towards putting extra training and supervisory obligations on physicians entering practice, there is a movement to move that into an academic setting under the auspices of a university training program. Leadership has flagged numerous concerns about capacity, conflict of interest, impact of current PG learners, etc More details will be shared once a decision is made.

HUEC
No meeting since last PGMEAC. The TASHn education group continues to meet weekly about vaccinations and redeployment.

5. Accreditation Follow Up/IRC Update
An update on accreditation team activities included:

  • Accreditation preliminary program reports have been sent to programs with returned factual corrections. RC and AFC reports submitted March 1st; FM reports sent March 31st
  • The Internal Review Committee (IRC) resumed meeting at the beginning of March.  Membership has changed to fill the spots of those whose terms ended; will be adding a diversity role member in line with EDI goals; call for resident membership will be later in the spring; currently updating the terms of reference and will be presented to PGMEAC at a later date.

6. COVID Updates
Redeployment

  • The third wave is much more dramatic than the first two waves. ICU admission numbers are going up very quickly and the patients seem to be sicker and much younger, which creates different challenges for the caregiving team this time around.  There are two dedicated groups meeting regularly to plan for CTU and ICU needs and what skill sets are required to fulfill these needs.  PGME is matching needs with program availability of trainees and their skills.
  • PGME will continue to provide a report to programs on redeployments at the end of each block.

Vaccination/Isolation Requirements

  • PGME is centrally working on the impact of vaccinations on isolation requirements. Nationally and local hospitals are currently requiring 14-day isolation after exposure to an outbreak. The need to re-visit this policy has been brought to the IPAC leads for further discussion.
  • PGME and TASHn leads will draft a letter with Barry Pakes to send to the Chief Medical Officer and the Premier’s office about how significant an issue this is and the need to have consistencies in place.

7. Elentra for CBD Enhancements
An update on the enhancements in Elentra include:

  • Real-time progress of a program’s learners’ completion of their EPAs
  • Detailed information of completed EPAs
  • Detailed information of outstanding EPA requirements; stage completion; program statistics
  • Learner dashboard

8. BPEA Update
An update on BPEA quality improvement activities include:

  • A QI project on Competence Committee documentation review – the results were shared and are in the attached slides
  • A different QI survey is planned for April consulting residents and frontline faculty who have completed three or more assessments in comparison to the survey done last year

9. VOTR Survey
The Voice of the Resident survey is in the field right now – response rates are a bit low – a reminder to encourage learners to complete.

9. Learner Environment

  • If a hospital-based complaint is filed against a PG trainee and if HR is involved, please notify either Reena Pattani or Glen Bandiera for situational awareness and so that support can be provided to the affected learner.
  • If a chief resident is the recipient of a complaint, it must be re-directed to a faculty member so they can provide guidance in adherence to the Guideline on Managing Disclosures about Learner Mistreatment

Attachments

January 29, 2021

1. Resident Report
Redeployment

  • With these latest redeployment there is a growing concern for Resident Wellness, mental health and risk of burnout. Is there anything PG or the programs can do to support residents?
  • Toronto GC reps have heard from residents that they would appreciate and find it helpful to receive more regular updates from PG in regards to COVID and redeployment
  • PARO advices that, where the hospital can honour existing vacation and leave requests and/or approve requests in keeping with their responsibilities under the PARO-CAHO Collective Agreement, they should continue to do so. Being able to take vacation will prevent resident burnout and fatigue and improve resident wellness
  • Ensuring residents are provided the choice to attend longitudinal clinics/protected academic time from their base program while redeployed
  • Continuing to try to prevent unnecessary extension of training as a result of redeployment (See PARO’s Extension of Training Principals)

Vaccinations

  • Some programs have a disadvantage when it comes to the “first come first serve” policy some hospitals have employed for vaccination sign-up. For example, as surgery residents are in the OR all day they are unable to register for vaccinations quickly and often miss the opportunity before the list fills-up. A new type of registration system should be considered for the next round of vaccinations.
  • It is important for resident vaccination to consider not just where residents are (rotation, site) but where they are going (ie next rotation in ICU though right now on rheumatology). In addition, some residents have encountered barriers and confusion in coordinating vaccination sign-up between different hospital sites. For example, if a resident is at St. Michael’s on Friday, but rotates to SickKids on Monday, should they register for the vaccination at St. Michael’s or SickKids?
  • It is important for programs to be accommodating in clinical coverage for residents to leave for 1-2 hours to receive the vaccine at their assigned time, especially for their rescheduled times for the second dose.
  • It is important to remember to include DME residents – ensuring they are appropriately included in vaccination rollout plan
  • Consider how redeployment plan impacts who needs to be prioritized for the vaccine

Hospital IPAC Regulations
In relation to the COVID19 pandemic residents have noted that different IPAC regulations at each hospital, and specifically, different COVID-19 protocols, leads to confusion (for example at some hospitals you have to wear face shield, at others you do not). It would be helpful if all hospital IPACs have consistent regulations.

Lounge Review
In 2018-2019 the PARO GC team reviewed 29 resident lounges at all hospital sites. We hope to share/email the results of this lounge review with all committee members.

2. PAAC Report

  • PAAC circulated a survey in December with a reminder going out last week. The purpose of the survey is to determine how trainee rotation/block scheduling information is shared between the programs and the Hospital Medical Education Offices.
  • Another survey is being drafted to send out to Program Administrators for feedback on Accreditation – focusing on preparing the AQ and the meetings they had with the survey team. The results will be shared with Laura Leigh and the PGME team.
  • The Award Adjudication Committee met last week to review the PAAC award criteria and nomination process for this year. Information about the nomination process should be sent out within the next couple of weeks.
  • We have been planning a couple of upcoming virtual sessions for education administrators which include a wellness session to be held in late March and an appreciation event in April focusing on Zoom fatigue and a panel discussion from our peers to share some tips and tricks for working from home.

3. COFM/HUEC
COFM
Important updates included:

  • Continue to lobby with the Ministry of Health for increased residency spots. The Deans are confident there will be some increase in the near future – not sure in which directives will be included (i.e. geographically or specific specialties), but this will improve the UG to PG ratio of spots. More details to follow.
  • CPSO informed that they are in receipt of a recommendation to eliminate the requirement of the MCCQEII exam as a route to restricted registration, which would increase the pool of residents eligible for that.
  • CPSO is contemplating an alternative route for full licensure for this coming year for those who are not able to take the MCCQEII exam. Still reviewing the processes and policies related to this.
  • PARO/OHA negotiations resume in February.  PG Deans were asked to provide input to contract/financing issues including leaves and time away from clinical training and how tight it is to fit in the curriculum.  PG Deans requested to be included in the discussions if the amount of time is going to be extended.

HUEC
A presentation by the Director of Sexual Violence university office provided an overview of the resources available and presented it to hospital partners should they need help or advice.

4. Guidelines for Managing Disclosures of Learner Mistreatment 

These new updated guidelines were circulated prior to the meeting for committee members input.  This guideline was approved by all PGMEAC members with minor changes.

5. Accreditation Follow Up – AFI Summaries

  • The top 10 most common requirements were presented
  • There are 56 programs with follow-up in 8 years at the next regular review (RR), 13 with follow-up in 2 years by Action Plan Outcome Reports (APOR), 5 with follow-up in 2 years by External Reviews and 2 with follow-up in 2 years on Notice of Intent to Withdraw
  • The Internal Review Committee (IRC) will reconvene in March. The committee will review the reports and determine what follow-up is required to help programs prepare for their follow-up

6. COVID Updates
Redeployment

  • The ICUS are being hit hard during this second wave with a shifting landscape and the needs will likely change with redeployment to meet this demand.  In summary, very little redeployment in the first six blocks, but an increase has been since in block eight. With 10 different departments involved in their residents being deployed shows the breadth of impact and response to the needs.  PG is working closely with specific departments and experts on the ICU to work out the needs with the aim to fill the gaps of the cascading effects.
  • The goal is to maintain trainee vacation requests to ensure wellness and rest, but with the increased need and ensure that nobody is disproportionately disadvantaged more than they need to be.  Trainees are expected to take their vacation this academic year as there is no guarantee that the Ministry of Health will pay out unused vacation this year.
  • Trainees are encouraged to still maintain the educational continuity (attend academic half days, etc) to the extent possible.
  • PG has asked PDs to advise of any of their at risk trainees for vaccinations so that PG can advocate on behalf of programs for those who need it the most
  • P. Houston shared she is advocating to the Academic Recovery Table that it would be very difficult to support the ongoing expanded critical care needs if there is not an concerted effort to decrease the surgical loads so that surgery and anesthesia trainees and faculty are available to help with hospital needs to lift the burden of those currently carrying the load for almost one year now.

7. Operation Remote Immunity
The Temerty Faculty of Medicine is assisting Ornge to promote opportunities, as a volunteer initiative, for  teams to participate in Ornge’s Operation Remote Immunity initiative with the goal of delivering and administering COVID-19 vaccines to 31 of Ontario’s Northern Indigenous Communities that are remote and/or only accessible by air. Vaccination planning has been completed for each community in conjunction with a community leader. Each multidisciplinary team will consist of 3 Ornge personnel (a Lead, Associate Lead and an Administrator) as well as 3 to 4 medical personnel – 1 Clinician and 2 to 3 MD Clerkship Students, Residents and/or Fellows. Teams will be scheduled for one-week deployments into the remote Indigenous Communities. More details to follow.

Attachments

November 13, 2020

1. Resident Report

  • The RDOC pre-accreditation survey was sent out to all the Toronto residents in May 2020 and the report has been compiled by PARO, sent to RDOC and will be used by the survey team at the upcoming accreditation
  • PARO sent a message to all trainees outlining the process for the onsite virtual surveyor meetings and the steps that will be taken to ensure confidentiality during these meetings
  • In 2018 – 2019, PARO General Council had reviewed 29 resident lounges throughout the city at all the different hospital sites.  Their findings will be brought to PGMEAC in January after accreditation

2. PAAC Report

  • At the last PAAC meeting, the committee prepared for the accreditation meeting with the surveyors
  • PAAC Awards will be announced in the near future

3. COFM/HUEC

COFM

Important updates included:
A collective letter was sent to the CPSO Policy Branch around supervisory relationships in medical education. This document is meant to replace the two separate current documents (UG and PG) by harmonizing all of the provision and guidance into one document for both groups.  Both UG and PG Deans provided consolidated feedback to the CPSO as part of the consultation process from the Deans.

HUEC
TASHN operations now has a harmonized agreement on how to manage trainees during an outbreak. This guideline will be referred to by all TASHN hospitals. Undergrad is currently working on a process and aligning it with PG wherever possible
The Guideline for Managing Disclosures of Mistreatment was discussed with considerable feedback provided.

4. Guidelines for Managing Disclosures of Learner Mistreatment 

These new updated guidelines were circulated prior to the meeting for committee members input.  The document will be shared at a variety of groups including Vice Chairs Education and the Diversity Advocacy Group as well as input from PARO and the legal department.  The guideline will be brought back to this committee in January for approval.

5. Accreditation 2020

  • Reminder to review and familiarize yourself with the updated Briefing Note for all committees and groups that will be meeting with the reviewers will be sent out shortly. It provides relevant information to help you with questions you may be asked by the reviewers – the questions are going to be based around the Indicators
  • All preparation workshops with PDs, PAs, residents, Chairs, Division Heads, VC Education are complete
  • Institutional schedule is confirmed and invitations have been sent

UG Accreditation Update

  • Part one of the UG virtual accreditation was completed the first week of November
  • The reviewers will be back for a one-day follow up visit in the first week of December
  • A final update will be provided after the second part of the review is complete

6. COVID Updates

Redeployment

In preparation for the second wave, the redeployment lists will be used on a block-by-block basis as needed over the coming months, addressing the hospitals, the service involved and the needs as they arise.  PGME is committed to consulting broadly with program directors, hospitals and leadership to co-create a solution for every situation of redeployment.  We will continue to do our best to minimize any negative effects on the training, balance service needs with impact on the residents’ needs, their well-being and their educational continuity.

Remuneration for Resident Work

G. Bandiera addressed the important issue of remuneration for resident work. PGME is aware this has been happening and it has been addressed broadly to stop immediately. Restricted registration is allowed, and the application process is very swift with a 48-hour turnaround.  Secondly, G Bandiera reminded the committee that redeployment must align with residents’ competencies and scope of practice, it must have the program’s involvement, and the reassignment must balance service to education needs for the system in order to not disrupt regulatory constraints.

PG Trainees Vacation Payout

PG is still awaiting an update from the Ministry of Health regarding payout for unused vacation.  Once the MOH confirms the funding package and timelines, PG will send out an update.

Outstanding Registration Requirements for PG Trainees

The TB Testing results and Mask Fit results grace period ended September 30th.  A reminder that all trainees must complete their TB test and Mask Fit results as part of their registration requirements as soon as possible.

Attachments

October 23, 2020

1. Resident Report

Virtual Events
Given the continuing increase in COVID-19 cases in the province, as of September 25, 2020, the PARO Board has determined that the responsible course of action is to continue to not to hold any in-person PARO events, including local social events.

Residents have continued to work through the spring and summer caring for patients across the country. Though we continue to go to work and interact with others – many of us are in fact socially isolated. As we move into fall and winter, social isolation will be an even more pressing concern, and PARO will help foster the wellbeing of our members by facilitating opportunities to connect with one another. As a Site Team we are planning and facilitating virtual events that will help to mitigate feelings of loneliness and isolation, especially with the arrival of winter and second wave.

Accreditation
From May – September 14, 2020 PARO sent out to all Toronto residents the RDOC pre-accreditation questionnaire. Over 1000 responses were gathered from residents and a summary of the comments and information were collected and will be a part of the information provided to the RDoC resident representatives/surveyors. All responses were confidential and not shared with the program, university, RCPSC or CFPC. PARO is also helping to prepare residents for the on-site review process, including helping them prepare for the meeting with the surveyors.

Access to Food While On-Call
Based on an environmental scan conducted last year, looking at which hospitals provide food to residents when on call, a formal report with suggested changes will be provided to PG with follow up to have 24/7 access to food.

2. PAAC Report

  • No PAAC meeting since last PGMEAC although our sub-committees have been active.
  • The PAAC award judging is underway and the awardees will be announced at our next meeting on October 27, 2020.
  • The PAAC Committee will be participating in Accreditation on Tuesday, November 24, 2020. Dr. Bandiera will be meeting with the PAAC on October 27th to provide a presentation about the upcoming institutional review.
  • We continue to plan a virtual admin retreat in January 2020.  As Accreditation is now two weeks in length, it was determined the next session should be in January, so we have something to look forward to after the winter break. The Committee is discussing various ideas for the event and more information will be sent out once determined.
  • ICRE was well attended by affiliated program admins.  Several of Toronto Program Administrators including a PAAC member – Massih Bidhendi – have been active participants on the ICRE 2020 PA Steering Committee and presented at the conference.

3. COFM/HUEC

COFM

Important updates included:
Discussion around harmonized approaches to vacation and trainee extensions related to COVID.  Most programs/schools have a good approach that works for them (along with working with PARO).

COFM province-wide policy on learners identifying workplace mistreatment.  All schools now have a rigorous approach for how to deal with it locally that refers to specific structures individual schools have in place.  COFM has sunsetted this policy as schools address any matters within their institution now.

Full COFM Deans and stakeholders met recently and they continue to advocate for the return of the reduced residency spots in Ontario as well as the promised expansion from years back with an ask to the Ministry.  A renewed business case was submitted addressing the observations and vulnerabilities in the system that have been exposed by COVID to re-emphasize the importance of a robust physician workforce, including the numbers, the type and the distribution.

The CPSO has committed to having a solution for individuals on a restricted licence because they were unable to write their exams. The Medical Council of Canada (MCC) have had to cancel the MCCQEII iteration at all sites because they won’t have a reference cohort due to cancellation at some large sites to write.  The CFPC had data issues and the inability to provide a passing score on their exam and are working through it.  PGME continues to support those individuals who are affected by these, including the Postgraduate Wellness Office. PGME continues to advocate with the MCC to go virtual with their exam delivery and it appears they have rededicated some work to find a solution.  The CPSO continues to provide solutions for individuals to continue to work until this matter is resolved.

HUEC

Ongoing efforts continue to manage the pandemic, trying to keep sites functional, trying to preserve educational continuity to the extent possible for trainees.  Redeployment is underway due to the recent outbreaks.  There remains heterogeneity in terms of the approach that certain occ health offices take and with the interpretation of the comprehensive pathway document about how to manage certain scenarios and issues are being worked through.  Sites will be contacting all individuals through contact tracing, and PGME has sent correspondence to all trainees with instructions on the procedure process.  The key principle for trainees is if they don’t know what to do, contact the hospital they are working at to seek advice and when doing so, to provide as much information as possible.

4. Guidelines for Accommodations for PG Trainees with a Disability

These newly developed guidelines to accommodate PG trainees with a disability were presented at September’s meeting.  PARO provided input and the revised version was presented today for approval. All members accepted the changes, and this guideline was approved.

5. Accreditation 2020

  • The schedules are in the process of being finalized and they will be sent to the RC and the CFPC for approval
  • Document review files for programs will be uploaded via SharePoint – the deadline for upload is Wednesday, October 28th 
  • PGMEAC will be meeting with the RC review team on November 26th at 11:15 am – 12:15 pm
  • PGME Leads continue to meet with programs’ RPC meetings
  • Workshops continue for Program Administrators
  • Specialty Committee will send their comments to PGME around November 9th with a one-week turnaround for programs to respond with any comments
  • Briefing Note for all committees and groups that will be meeting with the reviewers will be sent out shortly. It provides relevant information to help you with questions you may be asked by the reviewers – the questions are going to be based around the Indicators

6. BPEA Update

The committee met last week to discuss a proposal to create action plans based on feedback from the user data (both qualitative and quantitative) from faculty and residents.  Also reviewed data from the Elentra system in terms of EPA completion numbers and the impact of the new expiry after 7-days feature. Specific actions that PGME will be implementing based on consultation with residents and faculty with their experiences in CBD, include:

  • Establish a Resident Advisory Working Group on faculty development (co-chaired by Evan Tannenbaum and Sue Glover Takahashi)
  • Entrustment scale changes for EPA assessments will continue to be monitored for impact due to that change
  • Continued work on system improvements (i.e. completion rates, clarity, etc)
  • Audit samples of Competency Committee documentation to ensure they’re consistent with PGMEAC and BPEA guidelines
  • Review the impact of EPA completions and the numbers that were expiring

7. MD-PGME Data Management Advisory Group

As part of continuous improvement, the Data Management Advisory Group (DMAG) was formed to align with the social accountability mandate. The advisory group serves as a forum for coordinated discussion, consultation and development of recommendations regarding the collection, evaluation/analysis and reporting of MD and PGME learning experience/environment data in a harmonized and aligned manner.

Key responsibilities of the group are:

  • To recommend operational principles, guidelines and processes
  • To enable and support harmonized and aligned learning experience environment, data collection, evaluation/analysis and reporting
  • Development and revision to data collection tools (“Voice of The” surveys) and co-ordinated and transparent reporting
  • Examine the methodology of the learning environment and standardize the learning tools in the MD program and PGME
  • Reviewing the reporting structures, permissions and the pathways for dissemination and disclosure of data
  • Data management roles and responsibilities
  • Support the ongoing communication on what is available and how it is used
  • Ensure consistency across the Temerty Faculty of Medicine and with UofT policies and guidelines

8. Guidelines for Managing Disclosures of Learner Mistreatment

This newly revised guideline on managing disclosures of mistreatment for PG learners was presented for consultation and to inform on the processes in place at the Temerty Faculty of Medicine. The revised guidelines will be sent to PGMEAC members for input and relevance to their environments (university-based and hospitals), with an accompanying briefing note and a feedback form. We want to ensure these procedures don’t create new disparities or widen disparities. The guideline will be re-visited at the November meeting for review/discussion and final approval at the January meeting.

Overview:

  • Last guidelines were reviewed in February 2016
  • Change to title
  • Updated definitions for mistreatment to align with MD Program
  • Greater clarity to who is counted as a learner in PGME
  • Aligned guided principles after discussion with PG-SMART, building on the work done in the MD Program
  • More clearly delineated process for intake of learner concerns, trying to centralize it where possible so that we can have consistent application of procedures

Improvements:

Built on the existing review and management steps that could be undertaken when an investigation is required whether lead by a university, clinical program, or hospital.  Caveats include:

  • Strive for diverse and representative members on investigational committees
  • Unconscious Bias training for members prior to participation in the investigation
  • Committee should meet in advance with the complainant and respondent to pre-specify the steps and planned actions
  • Reviewed the potential resolution mechanisms and clarified the recommendations
  • Outlined a more clear appeals process
  • Created a companion document to address the steps learners may want to pursue

9. Online Asynchronous Video Interview

Guest speaker, Dr. David Latter presented his experience with online asynchronous video interviews.  The virtual interview process allows equal accessibility to all applicants, even more so with the restrictions during the pandemic. This cost-efficient method proved itself beneficial in many ways including: allowing increased number of applicant interviews, ensure a fair process, interactive town halls with applicants, opportunity to practice for applicants where they learned the format of the interview and answered a practice question to prepare for the actual interview.  The amount of preparation and practice offered reduced the number of “failed interviews”.  An objective rater reviewed the interviews and provided their ratings.  The third-party provider will record the interviews. The stations assess the applicants’ response to one of four topics: Ethics, Values, Collaboration and Reflection.  Their maturity and professionalism and communication are also assessed.  The reliability is comparable to in-person interviews.  Feedback from applicants and raters was very positive overall.

Attachments

September 18, 2020

1. Resident Report

  • The RDoC Pre-Accreditation survey that was sent to all Toronto residents in May 2020, (and new PGY1s in July 2020), was closed on September 14th. The Survey results are now being compiled into reports to be sent to RDoC.
  • PARO is also in the process of helping residents prepare for the virtual on-site accreditation review.
  • Dr. Ari Cuperfain, Dr. Shannon Willmott and Dr. Sejal Doshi will help present the RDoC Pre-Accreditation Review presentation on Thursday September 24th

2. PAAC Report

  • The PAAC award deadline was extended. Judging is underway and the award winners will be announced shortly.
  • Will soon be releasing the survey on “Information Sharing between Postgraduate Programs and Hospital Medical Education Offices. This is an environmental scan PAAC will send out to get an understanding of how trainee rotation/block scheduling information is shared between Postgraduate programs and Hospital Medical Education offices. All program admins will be sent the survey, and we hope they participate.
  • Planning an admin retreat in December/January after Accreditation. Details will be sent out once they are confirmed.

3. COFM/HUEC

COFM

Three major items were discussed:

  • Quotas Allocation – the MOH was looking at the aggregate proposal across the six schools in Ontario for trends.  Still awaiting approval on submitted proposal.
  • Statement regarding electives was submitted by the UG and PG Deans across Ontario around no travelling electives this current year, which protects from inequities of those who can travel and those who can’t.  This decision also created shifts in how candidates are reviewed and assessed for suitability in residency programs. Due to the decrease in ability to access electives, the concern that students may use non-traditional means to gain access to programs and PDs (attending ward rounds, call shifts on weekends) is also an inequity and a safety/liability issue, so a statement was sent from PG stating that this is not allowed.  Activities “open to the public” (city-wide rounds, academic rounds, virtual curricular activities) can be available to candidates as long as it doesn’t interfere with core activities in UG.
  • One-on-one formal discussions with candidates must be an “all or nothing” principle to ensure equity amongst all candidates.
  • Principles of redeployment and engagement of residents during a pandemic – addressing the concerns were brought forward by PARO around accommodation and continuity of training to ensure that training is not unnecessarily prolonged.  PG has a principle document guiding this to ensure needs are met at both hospital sites and for trainees.

HUEC

  • Ongoing efforts continue for pandemic planning with TASHN and community affiliates around PPE use and redeployment. Key points include:
    • Heterogeneity of how occupational health offices manage risk.  Every institution is responsible to make the decision for their staff but vary at different hospitals for the exact same circumstance.  Hospital CEOs are committed to trying to harmonize to the extent possible, but until a decision is made, residents must adhere to the hospital policies where they are assigned. These principles pertain to return to work after exposure to COVID-19 and back to school.
    • Preparing for accreditation for both UG and PG continues.
    • If you are having trouble accessing PPE at your site, please reach out to PGME who may be able to assist.
  • Virtual program profiling and virtual interviews are a key focus for the AFMC.  They have created an online portal for programs to showcase what they have to offer candidates. More information about the virtual program guide can be found here
  • The grace period for TB testing and Mask Fit are a mandatory registration requirement will end on September 30th. All trainees with outstanding testing will receive reminders to complete these before the deadline.

4. Recommendations – COVID App and Return to School

A formal guideline is in the works, but currently there is no provision to take leave should a trainee’s family members get sick.  PGME is encouraging programs to be flexible and explore options to support a trainee should they need to be off by allowing research work or virtual care that they could be doing from home.  Although, if this is not possible, then the leave will have to be without pay.  PARO is reviewing this matter as well.

5. FoM Expert Panel – Management for At Risk Trainees 

Guidelines were developed by Infection Prevention & control (IPAC) with a statement of recommendation for those who have an increased susceptibility to acquiring COVID-19 and are recommending that people adhere to the PPE recommendations at their site and if they feel they (or a family member they live with) are at increased risk and the application of these guidelines cannot be achieved the case will be referred to the Expert Panel for adjudication.  Please refer to this to help inform your decisions when needed.  Trainees who have been working with the PG Wellness Office for accommodations, will have their case reviewed and updated or continue as planned based on this guideline.

6. Quotas Allocation

The quotas allocation proposal was shared with the committee members for approval. The proposal was approved without changes and will be submitted to the MOH.

7. PGME-Wide Social Justice Curriculum

Guest speakers G. Lorello and L. Richardson shared their broad-based, multi-factorial initiatives to try to advance key priorities around equity, diversity and inclusion in residency training programs.

The key points included:

  • Eliminating inequitable healthcare and continual “othered categories” for all visible minorities and differently abled people and incorporating social justice issues during postgraduate training.
  • Changing the medical education system from a biomedical framework to social constructionism, humanism and transformative learning amongst the medical education community.
  • Proposing a PGME longitudinal social justice issues curriculum for trainees initiating with a needs assessment and a modified Delphi technique to determine the pertinent subject areas, followed by curricular design and implementation.  One program has implemented a longitudinal curriculum, but would like PGME to pool together resources to make this a standardized transformative curriculum across all programs.
  • Request to work with programs to develop individualized principles, provide mentorship and support for each program’s needs to improve the learning environment.

PGME has PGCorED modules in place but it is very limited. All committee members agreed that this is an important initiative to embed in the curriculum learning in the clinical environment and half-days and other forms of learning and support this impactful and engaging initiative moving to the next step of getting the right model and these principles are very sound.  A briefing note and syllabus will be shared with the PGME leadership for review and approval.

8. Accreditation 2020 (See attached)
Important information and updates were shared, including:

  • Virtual Site Visit has been extended to two weeks: November 22nd to December 4th
  • Zoom meeting links will be organized by the individual programs with support by PGME accreditation team to organize it
  • Document reviews by the surveyors (Competency Committees, RPCs, etc) will be shared via SharePoint and will be sent to the RC two weeks prior to the onsite visit
  • Accreditation meetings will take place on Monday, Tuesday and Thursday of both of the weeks
  • As the accreditation is virtual with shorter meeting times during the days, and given the various time zones of the reviewers, meetings with the individual programs will take place over two days instead of the usual one day only.
  • Reminder that this is the opportunity to provide highlights of your program including specific examples and ensuring all those involved with the program have had time to review the AQ
  • A lot of important information will be provided at the upcoming accreditation workshops for PDs and PAs and you are encouraged to attend
  • New continuous improvement accreditation standard – please ensure you provide examples of how you manage it in your program
  • Patricia, Glen and Linda are presenting to all RPCs to provide an overview of what to expect during accreditation
  • Programs will have access to Sharepoint to review their AQs in the next week or so

Full details and timelines can be found in the attached document.

9. BPEA Update (See attached)

Guidance around the updated EPA scale which was launched in early July 2020, will be sent as an accompanying document soon.  Focus of the recent meeting was to review a consultation that took place with faculty and residents about what was working, what the limits were of their experience with EPAs, the online platform or model.  This survey went to learners and assessors who had completed three or more assessments. This survey took place right before COVID started so with the shifted focus due to a pandemic, the response rate was lower than normal, and follow up analysis will take place before making any other changes.  The platform is working well with reporting and tracking as the important next steps.

10. Continuous Improvement Working Group

In compliance with the institutional standard of continuous improvement ensuring that sites receive important information and feedback on improving the learning environment.  The Data Management Committee was formed to coordinate data from UG and PG to be more efficient in collection and dissemination (what we do with the data, how we use it to make changes and how we will follow through on it).  The Data Management Committee will be presented at a future PGMEAC meeting. More information can be found in the attachment.

Attachments