Royal College Pain Residency Training Program

Royal College Pain Residency Training ProgramStakeholders Engagement Strategy for funding training positions2011-2017

Objectives•Review the Royal College of Physicians

and Surgeons of Canada ▫Mandate▫Committees

•Review the Pain Sub-Specialty▫Application▫Residency Documents

•Review the University Pain Residency application requirements

RCPSC•Mandate – for Medical Specialists

▫Set Standards Accredit University Residency Training

programs Administer Certifying exams

▫Maintenance of Certification program To facilitate ongoing learning

▫Interact with National and International Groups To further medical education, research,

public policy

▫Participate in research, plus awarding of grants

RCPSC

RCPSC•Specialty Committees

▫67 Specialties and Sub-Specialties

•Anesthesia Specialty Committee

•Pain Sub-Specialty Committee

Pain Sub-Specialty

•Formal Pain Specialty Programs have existed in the UK, US, and ANZ for more than 10 years

•The IASP Core Curriculum on Pain – first published in 1990

•The Canadian application had strong ties to the ANZ program (which was probably the best developed of the three)

Canada’s Pain Sub-Specialty •Royal College Application for Specialty or

Sub-Specialty status a three phase process

•Pain Application initiated as a Sub-Specialty of Anesthesia (A common way to start, and then may grow to become self-sufficient)▫Phase 1 - 2007▫Phase 2 – 2009 (18 people in the group)▫Phase 3 – 2010

•Pain Sub-Specialty created October 2010

Canada’s Pain Sub-Specialty

•Current Royal College Committee is a “Working Group”, until Specialty documents are finalized.

•This is a technicality that allows the group to be larger and more diverse while creating the necessary documents

Canada’s Pain Sub-Specialty•Working Group Members

▫Pat Morley Foster - Chair▫Dan Gray - Vice-Chair▫Brenda Lau - Region 1▫Ian Sutton - Region 2▫Phillip Peng - Region 3▫Mary-Ann Fitzcharles - Region

4/Rheumat.▫Benoit Tousignant - Region 4▫Ian Beauprie - Region 5

Canada’s Pain Sub-Specialty•Working Group Members

▫Marie-Claude Gregoire - Pediatrics▫Martin Katzman - Psychiatry▫Mohan Radhakrishna - PM&R▫Dwight Moulin - Neurology▫Pam Squire - Family Med.▫Mary Lynch - Observer, CPS▫Catherine Smyth - Observer, CAS

Canada’s Pain Sub-Specialty•Royal College mandate is to set standards

for:▫Accreditation▫Examination

•Since Fall 2010, Royal College Specialty Accreditation documents anticipated completion in 2012▫STR▫OTR▫SSA▫PSQ▫FITER

•

“STR” Sub-Specialty Training Requirements•Who is eligible: Royal College

Certification in ..▫Anesthesiology▫Neurology▫Rheumatology▫Physical Medicine and Rehabilitation▫Psychiatry▫Other Specialties, by consideration▫? Family Medicine (supported by working

group)

“STR” Sub-Specialty Training Requirements•Minimum Training: 26 blocks/24 months

▫13 in outpatient multidisciplinary clinic▫2 in Ambulatory Psychiatry/Addiction

Medicine▫1 in Neurology▫1 in PM&R▫1 in Acute Pain Service▫1 in Cancer Pain and Symptom

Management▫1 in Pediatric Pain Service▫6 blocks of elective

“STR” Sub-Specialty Training Requirements•Certification in Pain Medicine also

requires:▫Participation in and dissemination of the

findings of a clinical, research, quality assurance or education project

▫Successful completion of the certification exam (only written exam)

•The Royal College does not “grandfather” Specialist Certification*, but there will be a Practice Eligibility Route (PER)

“OTR”Objectives of Training•Detailed list of what the Resident needs to

learn, in a CanMEDs framework, which describes the core knowledge, skills, and abilities of Specialist Physicians in seven roles:

Medical Expert Communicator Collaborator Manager Health Advocate Scholar Professional

“SSA”Specific Standards of Accreditation•Outlines the Residency Program

Structure: ▫“To provide Program Directors and

Surveyors with an interpretation of the General Standards of Accreditation as they relate to the accreditation of programs in Pain Medicine”

•Draft document for viewing**

•B1:Administrative Structure▫an appropriate administrative structure for

each residency program

“SSA”Specific Standards of Accreditation•B2: Goals and Objectives

▫clearly worded statement outlining the goals of the residency program and the educational objectives of the residents

•B3: Structure and Organization of the Program▫an organized program of rotations and

other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfill the educational requirements and achieve competence in the sub-specialty

“SSA”Specific Standards of Accreditation•B4: Resources

▫teaching faculty ▫the number and variety of patients ▫physical and technical resources▫supporting facilities and services

“SSA”Specific Standards of Accreditation•B5: Clinical, Academic and Scholarly

content of the program▫appropriate for university postgraduate

education to fulfill all of the CanMEDs roles of the Specialist

•B6: Evaluation of Resident Performance▫systematic collection and interpretation of

evaluation data on each resident enrolled

“PSQ” - Pre-Survey Questionnaire/Application for Accreditation •The 50 page document filled out by the

Pain Program Director every 6 years

•Anesthesia Review: took 2 days with 2 external reviewers

•Based on the Royal College General Standards of Accreditation, “B” Standards (applied to all residency programs).

•“A” Standards apply to the University structure

“PSQ” - Pre-Survey Questionnaire/Application for Accreditation •“B” Standards cover the following areas:

1. Administrative Structure2. Goals and Objectives3. Structure and Organization of the

Program4. Resources5. Clinical, Academic, and Scholarly

Content of the Program6. Evaluation of Resident Performance

•Draft document for viewing**

“FITER” Final In-Training Evaluation Report•Responsibility of the Program Director

•Done at the completion of the Residents’ training

•Prerequisite to sitting the certifying exam

Current State of Pain Fellowships in Canada

•Fellowship Positions advertised

•No established funding (self-funded, department grant or locum work)

•Fellows accepted for a 1 year Pain Fellowship

•No curriculum; arbitrary structure

•No accreditation; no formal recognition

Future Pain Residency Applications •‘old’ Pain Fellowship Programs will be

obsolete

•Self-funded fellows would require Pain Program director consideration

Next Steps: Establishing Pain Residency positions•Spring 2012: (See also ‘Application’ Spring

2013)▫***Support of respective ACUDA lead and

anesthesia department▫Establish interdisciplinary Pain Residency

Steering Committee (led by anesthesia) including:

Psychiatry, physiatry, internal medicine (neurology/rheumatology), pediatric pain if available

▫Update respective anesthesia department leads: anesthesia residency director, respective academic pain clinics

•December 2012: ▫Pending finalized RC Specialty Documents

likely

Next Steps: Establishing Pain Residency positions•December 2012:

▫Discussions with post-grad dean to secure funding

a. Funding for program director and office space (eg. 1/2 day/week) B1

b. Funding for secretarial support for the program (eg. 1/2 day/week) B1

•Spring 2013: Respective university Post-grad Dean’s office/ACUDA Pain application▫receives the 6 Pain Specialty documents▫Prepare/submit application to the Royal

College

•

•Spring 2013: Pain Residency Application▫Creation of rotation specific educational

objectives in the CanMEDS Format (B2)▫Organized program of rotations, mandatory

and elective (B3)▫Adequate information resources made

available (computer, reference materials) (B3)

▫Adequate resources (teaching faculty, patients, physical/technical resources) (B4)

▫Identify teaching faculty and sites (B4)Multidisciplinary pain centers,

Psychiatry/addictions, PM&R, neurology, rheumatology, oncology, pediatric pain

Next Steps: Establishing Pain Residency positions

Next Steps: Establishing Pain Residency positions•Spring 2013: Pain Residency Application

▫The “PSQ” – written by the Pain Division members

▫Terms of reference for the Pain Residency Program Committee (B1)

▫Documentation of an Appeals process for Resident Evaluations (B1)

▫Documentation of the ongoing review process (B6)

▫Identify faculty members responsible for resident research

▫Policy for Resident Safety (B1) ▫Adapt post-graduate policy regarding

intimidation and harassment (B3)


▫Appropriate academic content (B5)▫Structure to teach CanMEDS roles outlined in

SSA: -Academic half-day -Organized teaching in basic and clinical

sciences -Mandatory and optional rounds,

courses, seminars, journal clubs

-Research component and support


▫Number of residents per year▫Academic intent of the proposed program

including the societal need the program will meet

▫The academic staff and faculty involved (existing and new)

▫If multiple program applications exist within a province, all must have unanimous support in approaching post-grad dean’s office

▫MOH endorsement in funding new positions

•Spring-Summer 2013: ▫Applications reviewed by the Royal College

Accreditation Committee and the Pain Specialty Committee

▫a survey team would be sent to assess the program for approval

• Fall 2013• Approval by Royal College Accreditation

Committee and the Pain Specialty Committee



•Spring 2014 ▫advertise for Residency positions

•Summer 2014▫first Residents would then apply/interview

•Summer 2015▫Fellowship start date

•Summer 2017▫First graduates

Canada’s Pain Medicine Residency▫Academic Pain Directors of Canada

(APDOC) will evolve to a recognized group supported by the Royal College like ACUDA

Pain Specialist support▫Development of subsection on pain

specialists in respective provincial medical associations

▫Discussion and recognition by respective Colleges of pain specialists

▫Development of fees specific to the pain specialty

▫Development of pain societies in respective provinces