The Internal Review Process

All residency programs and AFC training programs go through the internal review process. This multi-year process takes place within the 8-year accreditation cycle and begins approximately 3 years after the on-site survey. It continues until all residency and AFC programs are reviewed at least once, and any necessary follow-up activities (e.g., action plan outcome reports, external reviews, follow-up reviews, written reports, resident reports) are completed. The internal review cycle also includes a review of the PGME Office by external faculty.

Internal Review Committee

The internal review process is overseen by the Internal Review Committee (IRC), the Family Medicine Internal Review Subcommittee (FM-IRSC) and the Postgraduate Medical Education Advisory Committee (PGMEAC). In 2021 – 2023, the Internal Review Committee will focus on supporting the programs that have scheduled follow-up in the next 3 years. Subsequent follow-up with the remaining programs will take place during the regular internal review process. Customized reports on internal review findings are provided to departments and sites throughout the accreditation cycle.

Internal Review Committee Terms of Reference

IRC Structure

Accreditation Standards

The Canadian Residency Accreditation Consortium (CanRAC, a partnership of the Royal College, the College of Family Physicians of Canada and the Collège des Médecins du Québec) have developed Institution, Program and Discipline-Specific accreditation standards:

General Standards of Accreditation for Residency Programs (July 2020)
Standards for Accreditation for Residency Programs in Family Medicine (“Red Book”) (July 2020)
General Standards of Accreditation for Areas of Focused Competence Programs (2019)
General Standards of Accreditation for Institutions with Residency Programs (July 2021)

All institutions and their residency programs are held to the general and discipline-specific accreditation standards in place one year in advance of the relevant accreditation activity (i.e., regular accreditation review, external review, action plan outcomes report). The accreditation standards are typically updated on an annual basis.

The Accreditation Management System (AMS)

CanRAC has built an online Accreditation Management System (AMS) to help facilitate the process for surveyors to review documents in preparation for an on-site survey. The system can also be used to manage program documents throughout the 8-year accreditation cycle. All Program Directors and Program Administrators have access to the AMS.

For additional information about using the AMS (e.g., training or general inquiries), please contact

The Hidden Curriculum in Medical Education

The accreditation standards include reference to the hidden curriculum. The session below was developed as an introduction to the hidden curriculum that describes the “Hidden Curriculum” concept in medical education, explores the effects of the hidden curriculum and reflects on the day-to-day aspects of the hidden curriculum in residency programs. This session was led by Drs. Linda Probyn (Post MD Education), Heather Flett (Post MD Education) and Tina Martimianakis (Wilson Centre for Research in Education).

Presentation Slides
Hidden Curriculum Briefing Note

Transitioning to Competence By Design (CBD)

Programs are in various stages of Competence by Design planning and implementation. PGME will continue to work with programs on a case-by-case basis to ensure that the documentation provided for your accreditation activities reflects the status of your program.

For additional information on the continued roll out of Competence by Design at the University of Toronto, please visit the CBD website.

Areas of Focused Competence (AFC) Programs

The Areas of Focused Competence (AFC) Diploma Programs are a new category of fellowship programs that are accredited by the Royal College of Physicians and Surgeons of Canada. In addition to residency training programs, all AFC programs are part of the accreditation cycle, undergoing external reviews, internal reviews, and follow-up as needed.

For additional information related to AFC programs, please visit the AFC webpage.

ITERs and Goals & Objectives

If you would like to update, revise or create new ITERs and Goals & Objectives documents for your program, please contact for assistance.We will arrange for an Orientation Meeting for your program to go over the PGME Minimum Guidelines, review your documents and answer any questions you may have. We will work closely with your program to finalize your files and have them uploaded to POWER. Please see below for reference materials to assist you in this process:

PGME Accreditation Newsletters


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