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AYA ONCOLOGY 1
APPLICATION FOR ACCREDITATION OFAN AREA OF FOCUSED COMPETENCE PROGRAM IN
ADOLESCENT AND YOUNG ADULT ONCOLOGY
This questionnaire is to provide the Royal College with a complete description of the AFC program. The completed questionnaire must be signed by the AFC director and submitted to the decanal unit within the faculty of medicine responsible for oversight of AFC programs.
Please submit completed applications by e-mail to:[email protected]
University The University of TorontoDate of Application August 14, 2018Name of AFC Director Dr. Abha A. GuptaContact Information for AFC Director Address: 555 University Avenue, Toronto ON M5G 1X8
Telephone: (416) 813-8795Email: [email protected]
University Appointment of AFC Director Associate ProfessorName of AFC Administrator Samantha SinghContact Information for AFC Administrator Address: 555 University Avenue, Toronto ON M5G 1X8
Telephone: (416)813-8795Email: [email protected]
Department Responsible for AFC Program Department of MedicineName of Department Head (or equivalent) Dr. Gillian HawkerProgram Website / URL (if applicable)
The following information MUST BE INCLUDED with the application:
Attachment Electronic Weblink Access – Provide URL Address
N/A
Appendix ‘A.1’ - Covering letter indicating that the Faculty has approved and supports this program Appendix ‘A.2’ - Covering letters from the Chief Executive Officer of each of the participating institutions indicating support for the program Appendix ‘B’ Terms of Reference for the AFC program committee (if applicable) (C1)Appendix ‘C’ Research grants of faculty (for past 12 months) (C1)Appendix ‘D’ Publication record of faculty (during past 12 months) (C1)
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Appendix ‘E’ Objectives for the educational experiences (C3)Appendix ‘F’ Interuniversity affiliation agreement(s), if required (C3)Appendix ‘G’ Curriculum of the program (C3)
STANDARD C1: ADMINISTRATIVE STRUCTURE
"There must be an appropriate administrative structure for each AFC program."
1. AFC Director
a) Provide the specialty qualifications of the AFC director. (Standard C1.1.1)
The AFC director is a Canadian trained specialist in paediatric hematology/oncology. Dr. Gupta has additional training in Adolescent and Young Adult Oncology as well as in adult sarcoma.
Degrees2000 MD, Faculty of Medicine, University of Toronto, Ontario, Canada1996 MSc, Immunology, McMaster University, Hamilton, Ontario, Canada1994 BSc Honours, Biochemistry, McMaster University, Hamilton, Ontario, Canada
Postgraduate, Research and Specialty Training 2006 - 2007 AFLAC Fellow, Adolescent and Young Adult Oncology, Aflac Cancer Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, United States2004 - 2005 Chief Fellow, Paediatric Haematology/Oncology, The Hospital for Sick Children, Toronto2003 - 2006 Fellow, Paediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario2001 - 2003 Postgraduate Training in Paediatrics Year II, III, Paediatrics, Children’s Hospital of Eastern Ontario, Ottawa2000 - 2001 Postgraduate Training in Paediatrics Year I, Paediatrics, Yale-New Haven Hospital, New Haven, Connecticut, United States
Qualifications, Certification, and Licenses 2008 FRCPC, Specialty, Paediatric Haematology/Oncology, Royal College of Physicians and Surgeons of Canada, Canada2004 FRCPC, Paediatrics, Royal College of Physicians and Surgeons of Canada, Canada
Years in Specialty PracticeDr. Gupta is cross-appointed as a staff oncologist at the Hospital for Sick Children and Princess Margaret Cancer Centre. She the Co-Medical Director, SickKids Fertility Preservation Program and Medical Director, Adolescent & Young Adult Oncology Program at Princess Margaret Cancer Centre (PMCC).
2014 - Present Associate Professor, Paediatrics, University of Toronto, Ontario, Canada2007 - Present Staff Oncologist, Hematology/Oncology, The Hospital for Sick Children, Toronto, 2007 - Present Staff Oncologist, Medical Oncology, Mount Sinai Hospital, Toronto, Ontario, Canada2007 - Present Staff Oncologist, Medicine, Medical Oncology, Princess Margaret Cancer Centre, Toronto
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b) Describe the resources (time and support) that will be available to the AFC Director to administer the AFC program. (Standard C1.1.3)
The AFC Director has 0.1 FTE dedicated time to fulfil the responsibilities of the program. The AFC Director is responsible for the overall program and also acts as the site director for the trainee at the Hospital for Sick Children (SickKids). Dr. Meredith Guiliani is the site director at the University Health Network - Princess Margaret Cancer Centre (UHN-PM) location.
The site director(s) manage local issues at their respective site(s). Advice and support are readily available from the PGME Office at University of Toronto and site-based program faculty.
The AFC Administrator has approximately 0.05 FTE dedicated to the program. The AFC Director and Program Administrator both have office space at SickKids, electronic and communications resources required to operate the program adequately.
The training program will primarily be supported by 4 physicians at SickKids (oncology, palliative care, and aftercare) and 10-12 physicians at PMCC (oncology, palliative care, fertility, cardio-oncology, and endocrinology).
2. AFC Program Committee
a) Briefly describe how the AFC program committee functions OR attach a copy of the Terms of Reference of the AFC program committee as Appendix B. (Standard C1.2; C1.3)
Please see Appendix ‘B’ for Terms of Reference for the AFC Program Committee.
b) Committee membership (underline the name of the Chair of the Committee) (Standard C1.2; C1.2.1)
Name Major Responsibility within the Program
Abha Gupta AFC Director and Site Director, Hospital for Sick Children
Paul Nathan Director, Pediatric Aftercare Program, Staff Oncologist, Hospital for Sick Children
Meredith Giuliani Site Director, Princess Margaret Cancer Centre, Radiation Oncologist, General Member, The Wilson Centre for Research in Education
Etian Amir Staff Medical Oncologist (breast) PMCC, Medical Oncology Fellowship Director
Taymaa May Staff Surgeon, Department of Surgical Oncology, PMCC
Raymond Jang Program Director, Medical Oncology Residency Program, PMCC, Staff Medical Oncologist
Jim Whitlock Division Head, Hematology/Oncology, SickKids
Amit Oza Division Head, Medical Oncology, PMCC
Peter Chung Fellowship Program Director, Radiation Oncology, PMCC
AFC trainee Represent trainee perspective
c) How will AFC trainees be chosen to be members of the AFC program committee? (Standard C1.2.1)
A single AFC trainee will be selected annually for a one year term. The trainee will attend all meetings
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of the AFC Program Committee.
3. AFC Selection Process
a) Describe the process that will be used to select candidates into the AFC program. (Standard C1.3.3)
The AFC Committee, which includes representation from both SickKids and PMCC oversees the selection process ensuring that approved policies are followed. Eligible applicants are Royal College certified in pediatric oncology, medical oncology, hematology or radiation oncology.
Applications are available to prospective candidates from the University of Toronto Fellowship website http://www.lmp.utoronto.ca/postgraduate/fellowship-training-programs Applications will include a CV, personal statement for intent of training and 3 reference letters.
Each file is reviewed by the AFC Committee members. Reviewers use a standard form for the review, with scoring for specified criteria, which includes the quality of the personal letter, letters of reference, scholarly activity, academic excellence, interest in Adolescent and Young Adult Oncology, work-life balance, and unexplained gaps in training.
Applicants will be offered an in-person or Skype interview. Dr. Abha Gupta (AFC Director) and at least 2 other members from the AFC Program Committee will be responsible for the interviews. A standardized interview process will be utilized for all candidates with pre-written questions.
File reviewers recommend the applicants to be offered interviews. There is not a specified cut-score for invitation to interview. Candidates are invited for an interview, providing they have met the CaRMS requirements, presented good supporting letters, and there are no serious “red flags” found on file review.
There are 2 main sites where the fellowship will be held: PMCC and SickKids. AFC trainees will also attend clinics at University Health Network-Toronto General Hospital (Cardio-oncology) and Mount Sinai Health System (Lunenfeld Oncofertility). The primary site of appointment will be PMCC where all credentialing and administration will be implemented.
Screening and selection criteria have been outlined and include:
1. AFC candidates must be Royal College certified or eligible for Royal College examinations in Pediatric Hematology/Oncology, Medical Oncology, Adult Hematology or Radiation Oncology. Internationally educated applicants require documentation of equivalency.
2. Applications will include a CV, personal statement for intent of training and 3 reference letters.
3. Applicants will be offered an in person interview. Abha Gupta (AFC Director), and at least 2 other members from the AFC Program Committee will be responsible for the interviews.
b) How many AFC trainees are expected to be admitted to the program on a yearly basis?1
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4. AFC Trainee Assessment (Standard C1.3.4)
a) Describe the role of the AFC Program Committee in the review of trainee assessment and decisions about completion of training.
The AFC trainee will complete 13 4-week blocks during the 12-month program.
Each site director ensures the goals and objectives for the specific rotation and the subset of the Portfolio milestones relevant to that rotation is met. The site director completes the assessment tools identified for the rotation. The 2 site directors listed will also co-supervise at University Health Network-Toronto General Hospital (Cardio-oncology) and Mount Sinai Health System (Lunenfeld Oncofertility) since they are cross-appointed faculty.
The AFC Committee will meet in-camera (excluding the trainee representative) to review trainee progress quarterly and at completion of training. The file review includes all evaluation data collected regarding the performance of the AFC trainee.
At the end of year-1 the AFC Committee review will determine if the required competencies have been attained to allow a recommendation for completion of the program.
The promotion decision is based on performance in all components of the Training Program’s evaluation system. Review will be based upon:
1) Evaluation by AFC Site Directors2) Competency Portfolio
The Site Director provides each trainee with a formal review in a face-to-face meeting and in writing every six months to address their overall progress. Trainees are welcome to discuss their progress on an individual basis with the Site Director at any time between the formal reviews.
b) Describe briefly the appeals process for decisions regarding trainee assessments including how trainees are informed of the process.
The AFC appeals process will follow the principles and recommended process of the University of Toronto Governing Council Policy on Academic Appeals. The PGME appeals process is described on the PGME website and the annual Postgraduate Medical Education Information Booklet.
Trainees are informed of the appeals process directly when presented with a performance concern or failure to be promoted to the next level. Trainees may appeal the decision on evaluation to an Appeals Committee which will include Adolescent and Young Adult Oncology Director, Postgraduate Training Program in Medical Oncology, University of Toronto in addition to two other staff subspecialists from another teaching institute.
Trainees opting to launch an appeal will do so in writing. Their notice will describe the nature and grounds of their appeal and will provide the Appeals Committee with any relevant documents in support of their appeal. Trainees have the right to a hearing before the committee to present their evidence and arguments. The process will ensure confidentiality of the disclosed information.
If a trainee’s performance exhibits significant deficiencies and there are concerns regarding progress towards achieving the fellowship goals and objectives through the standard AFC program, the AFC committee will propose a remediation plan in accordance with the University of Toronto PGME Guidelines for Educational Responsibility in a Clinical Fellowship.
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5. Ongoing Review of the AFC Program
a) Describe the process that will be used to review the educational environment of the AFC program. (Standard C1.3.6)
The AFC Program Committee will formally review the educational environment and all of its components annually. Review will include:1. formal rounds2. opportunities for case load and case mix 3. opportunities for procedural experience4. feedback from trainees5. fellows participation in National and International forums
The Site Director will carefully examine the case mix and logbook of each trainee every four months to ensure that adequate opportunity to gain competency in each of the Competency Training Requirement domains.
b) Describe the process that will be used to assess and provide feedback to the teachers participating in the AFC program, including the role of trainees in providing this feedback. (Standard C1.3.7)
The on-line system for registration and evaluation is known as “Postgraduate Web Evaluation and Registration System (POWER)”. Trainees have the ability to evaluate all teachers using the University of Toronto POWER Web evaluation system. Trainees have the choice over how many and which teachers they will evaluate on a given rotation. The evaluations are stored on the central POWER site.
Teachers have access to summary aggregate reports for prior years once a minimum of three evaluations are complete.
Departmental education leads and rotation coordinators have a higher level of access that allows review of individual evaluations for individual teachers in real time.
An ‘alert’ system is built into POWER so that identified individuals are alerted whenever a teacher or rotation receives a score below a minimum threshold. These are investigated in real time to ensure no threat to resident well-being and educational integrity are present and appropriate action is taken.
The PGME office provides a ‘report card’ each year to the program detailing the completion rates for teacher evaluation forms and comparators including year-over-year change and PGME benchmarks. Finally, an annual report is produced by the PGME office that outlines average teaching and rotations scores for each rotation across all hospitals, again comparing sites and year over year change.
Written feedback will be obtained from trainees at completion of the fellowship.
6. Environment of Inquiry and Scholarship (Standard C1.4)
a) Attach as Appendix C, the research support in the form of operating grants of Faculty members in the Area of Focused Competence during the PAST TWELVE MONTHS. Include the annual dollar amounts and the source of research funds.
b) Attach as Appendix D, the peer-reviewed publications of faculty members in the Area of Focused Competence during the PAST TWELVE MONTHS.
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STANDARD C2: RESOURCES
“There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all trainees in the AFC program to achieve the educational objectives and receive full training as defined by the AFC requirements.”
1. Teaching Faculty (Standard C2.1)
List the members of the teaching faculty who have a major role in the AFC program, including members from other departments.
Name Specialty and AFC-specific Qualifications
Role in the Program
Dr. Abha Gupta Paediatric Haematologist/Oncologist
AFC Director and SickKids Site Director
Aaron Schimmer Medical Oncologist Teaching faculty
Meredith Guilliani Radiation Oncologist Teaching faculty, PMCC Site Director
Pamela Mosher Psychiatrist Teaching faculty
Taymaa May Fertility Specialist Teaching faculty, fertility expert
Sumit Gupta Hematologist Teaching faculty
Eitan Amir Medical Oncologist Teaching faculty
Ahmed Al-Awamer Palliative Care physician Teaching faculty
Raymond Kim Geneticist Teaching faculty
Shereen Ezaat Endocrinologist Teaching faculty
Raymond Jang Medical Oncologist Teaching faculty
Paul Nathan Pediatric Oncologist and Survivorship
Teaching faculty
2. RESOURCES
Does the adult cancer centre associated with your program see at least 5000 new patients annually? Yes No
3. Information/Space Resources
a) Do AFC trainees have adequate administrative space to carry out their daily work?
Yes No Partially If “No” or “Partially”, please explain.
There is a desk, computer and phone available at the PMCC home-base site for the AFC trainee to carry out their daily work. At SickKids, there is enough space within the clinic to carry out short term work.
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b) Do AFC trainees have access to computers with access to email, internet, laboratory information system and patient electronic chart (or equivalent), and a microscope?
Yes No Partially If “No” or “Partially”, please explain
There is a desk; computer, access to email, internet, laboratory information system and patient electronic chart and phone available at the PMCC site for the AFC trainee carry out their daily work. A microscope will not be needed. At SickKids, there is enough space within the clinic to carry out short term work.
4. Summary of Adequacy of Resources (Standard C2)
Comment on the adequacy of the resources in the overall AFC program. In particular, comment as to whether the facilities are sufficient to provide adequate teaching and experience for trainees in this program.
The AFC program has sufficient resources to meet the training objectives for the trainee over their one year training period:
Clinical Services Specific to AYA Oncology: AFC trainees will receive their training at Princess Margaret Cancer Centre (PMCC) where The Adolescent & Young Adult (AYA) Oncology Program is well established. The AYA Oncology Program provides personalized, supportive care related to concerns common to over 1200 new adolescent and young patients with cancer seen annually. (i.e., fertility, sexual health, school and work concerns, peer support and wellness. The interprofessional team includes a clinical nurse specialist, nurses, allied health professionals and researchers.
Training will also occur at The Hospital for Sick Children, the largest volume pediatric cancer centre in Canada. There is an established Pediatric Aftercare Program responsible for monitoring late effects of cancer therapy as well as a pediatric palliative care consultative service. There are ~80 new adolescents diagnosed with cancer annually. There is a unified transition program for survivors of pediatric cancer between the 2 hospitals.
The AFC program will have access to all ambulatory clinics and consultative services as required.
University Health Network-Toronto General Hospital (Cardio-oncology) service is the most specialized cardiology service in the country with a focus on the cancer related effects on the heart. There is a clinical and research program that the diplomate will have exposure to.
Mount Sinai Health System (Lunenfeld Oncofertility) is the center that sees the highest volume of cancer patients for fertility preservation in the Toronto area. It is situated geographically close to PMCC and therefore will be easily accessible to the diplomate.
Teaching Faculty: The program is supported by faculty members who have an interest, clinical and/or research expertise in issues related to Adolescent and Young Adult Oncology. All faculty members are highly active clinically and academically productive and offer the required expertise to provide training, supervision and assessment of all competencies at each site. A fertility expert is a member of the AFC program committee and teaching faculty.
Number and Variety of Patients: The program has adequate numbers and variety of patients to provide the full breadth of patient management experience. The program’s total patient volume of adolescents with a new diagnosis of cancer is 1280 annually. The Hospital for Sick Children sees 80 new adolescents diagnosed with cancer annually. The Princess Margaret Cancer Centre sees 12,000 new patients annually, of which approximately 1200 are young adult cancer patients. While procedural volumes exceeded the suggested Royal College requirements for accreditation in most areas there are three procedures that need to be managed. The site is a teaching hospital that will facilitate broad learning experiences related to age, ethnicity, gender and culture.
Supporting Facilities and Services:
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All the clinics and rotations referred to in the CTR will be completed within SickKids and Princess Margaret Cancer Centre. Both hospitals have well equipped medical imaging and diagnostic services in pathology and laboratory medicine and offer supporting services in palliative care and psychosocial oncology. Fertility services are based at Princess Margaret Cancer Care. Both sites have access to clinical ethicists, psychologists and spiritual service providers.
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STANDARD C3: EDUCATIONAL PROGRAM
“There must be a defined educational program that includes clinical, academic and scholarly content relative to the AFC discipline. The program must be designed to ensure that each AFC trainee is able to achieve all the competencies as outlined in the AFC-specific Training Requirements.”
1. Goals & Objectives (Standard C3.1; C3.2)
Attach as Appendix E, a copy of the objectives for the educational experiences of this program. The document should indicate how each objective will be achieved.
a) How will the trainees and faculty be provided with the objectives:
i) Yearly ii) At start of rotationiii) Other
b) How often will these objectives be reviewed by the AFC Program Committee:
i) Yearlyii) Bi-yearlyiii) Other, please describe
c) Describe the process for reviewing objectives.
The AFC Committee will review the objectives of the education program bi-annually. Input from supervisors, teachers and trainees will be included. The AFC Committee will make decisions about changes to facilitate competency outcomes desired by the program and to add objectives as new techniques and new diagnostic and management techniques evolve.
Data is gathered annually through POWER for formal curriculum and facilities via the clinical experience and teacher evaluations. Tracking / monitoring mechanisms for Portfolio review will be used.
d) Describe how the program works with the AFC trainee at the beginning of each educational experience to develop individual learning strategies to meet the objectives.
The trainee will meet with the AFC program director at the beginning of every other month to reviewthe past experience and ensure the objectives and expectations of the upcoming 2 months areclear.
2. Educational Experiences (Standard C3.3)
a) Describe the mandatory educational experiences required in this program, including the duration and location of the experiences.
The AYAO AFC is a 1-year program composed of 13 4-week blocks including one 4-week vacation. The year is designed as a sequence of monthly clinical blocks, including two elective blocks with an expectation of a longitudinal clinical and scholarly activity. The breadth of experiences will complement prior training since diplomates will be entering from either pediatric oncology, medical oncology, hematology or radiation oncology. In order to obtain enough exposure, various oncology-specific plus ancillary blocks will be offered:
The AYAO AFC program is composed of the following six clinical rotations: 1. Fellow’s longitudinal clinic (equivalent to 1 block but conducted concurrently with other blocks
across the year) – i.e. Lymphoma, sarcoma, leukemia, breast, gynecological, testes, and/or CNS.2. Disease specific rotations (5 blocks) – i.e. Lymphoma, sarcoma, leukemia, breast, gynecological,
testes, and/or CNS.
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3. Concurrent theme-based clinics (3 blocks) (cardiology, endocrinology, pediatric aftercare, cancer genetics, Oncofertility)
4. Elective rotations (2 blocks) – conference, reading, research, other5. Palliative care (1 block)6. Psychosocial oncology (1 block)7. Vacation (1 block)
Please see Appendix ‘E’ for the objectives for the educational experiences.
REQUIRED TRAINING EXPERIENCES1. Perform clinical assessments and manage the ongoing care of AYA patients with cancer in an
ambulatory clinic setting at all stages of the cancer journey. (PMCC)2. Act as an AYA Oncology consultant for ambulatory and hospitalized patients. (PMCC)3. Participate in oncofertility and sexual health consultations to understand the breadth and
variety of available treatments. (PMCC)4. Participate in palliative care consultations in the pediatric or AYA age group, either in the
inpatient or ambulatory setting. (SickKids and PMCC)5. Participate in psychosocial oncology consultations for AYA patients. (SickKids and PMCC)6. Perform clinical assessments of AYA patients in a survivorship/late effects clinic (SickKids)7. Present AYA oncology topics at site group rounds. (SickKids and PMCC)8. Participate in multidisciplinary tumour board rounds. (SickKids and PMCC)9. Participate on a committee or action group relevant to AYA Oncology at the local institution, or
at a provincial or national level. (SickKids and PMCC)10. Participate in a scholarly project. (SickKids and PMCC)
RECOMMENDED TRAINING EXPERIENCES1. Attend a conference relevant to AYA Oncology2. Complete a scholarly project and submit an abstract for a relevant meeting3. Participate in the clinical care of AYA patients with cancer outside the scope of the AFC trainee’s
entry discipline (Pediatric Hematology/Oncology, Radiation Oncology, Medical Oncology, Hematology)
4. Participate in the process of transitioning patients to an alternate level of care (e.g., to aftercare/survivorship from active care, or to adult setting from pediatric)
Examples of items that will need to be submitted for assessment include:1. Examples of consultation, clinic notes2. Royal College patient and family feedback tool3. Multi-source feedback from social workers, nurses, other MDs, patients/families, etc.4. Reflective critique/analysis of clinical trials5. Teaching evaluations for rounds/lectures candidate has given6. Scholarly project
b) Describe the elective opportunities available in this program.
There will be elective time incorporated into the year program. This will be discussed on an individual basis with each candidate.
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3. Affiliations
Will the AFC program require any mandatory affiliations? YES NO
If yes, attach as Appendix F, a copy of the signed agreement.
4. Increasing Professional Responsibility and Supervision of AFC Trainees (Standard C3.5)
Describe how the program will ensure that all trainees are provided with appropriate supervision and increasing professional responsibility.
Trainees are competent oncologists when they enter the program.
Initially, all clinical activities of the trainees are under direct supervision of an attending staff/faculty member. Trainees never work in the facility without a faculty member present in the department. Within each new clinical experience, trainees are initially asked to observe the practice of experienced clinicians, then are assigned patients of their own to manage under supervision.
5. Academic Program (Standard C3.4)
Attach, as Appendix G, the planned curriculum for the program. Indicate the teaching format for each element of the curriculum.
a) Describe how the curriculum is established.
Competency Training Requirements have been established by the Royal College of Physicians and Surgeons of Canada for the Adolescent and Young Adult Oncology AFC. The University of Toronto AFC Committee will establish and review the overall program curriculum to be implemented at this institution, with adherence to requirements set by the Royal College. The AFC director, Dr. Abha Gupta, with the support of the AFC Committee, will adhere to the administrative structure as determined by the Royal College.
CANMEDS COMPETENCIES
TEACHING METHODS
Medical Expert Didactic lectures Interactive teaching rounds Feedback during consultations Attendance at pediatric and adult tumor board rounds Attendance of clinics with cancer genetics service Attendance on a palliative care service Rotation through radiation therapy service with focus on AYA tumors Attendance of clinics in long term follow up of patients with cardiac,
pulmonary, endocrine, pulmonary, mental health illness Attendance as observer in clinical ethics consult committees Attendance as observer in vocational/occupational assessments Attendance as an observer in fertility clinics Exposure to distress screening experts Exposure to provincial cancer screening/prevention programs
Communicator
Feedback during consultations Opportunity to lead observed consultations Observation of experts in the areas described above Simulated patients/families
Collaborator Modelled behavior of professional interacting with AYA patients and
families Participate in multidisciplinary teams for AYA care
Leader Participate in Canadian and other relevant AYA planning conferences Participate on Quality Indicator committee Participate in Children’s Oncology Group and other cooperative group trial
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research Participate in provincial drug approval process committee
Health Advocate Participate in Canadian and other relevant AYA planning conferences including at the level of the Ministry of Health
Attendance with social worker to learn sources of support for AYA patients Participate in cooperative group trial conduct Attend cancer advocacy group meetings
Scholar Teach medical students/residents Mentorship in research project
Professional Modelled behavior of supervisors in interacting with AYA patients and
families Didactic lectures/seminars
The development and implementation of clinical rotations will be established in accordance with these guidelines and feasible in the local clinical and academic setting. The teaching hospitals and clinics at the University of Toronto meet the patient volume requirements established in the Royal College AFC documents. Rotation specific goals and objectives and evaluations have been developed. The AFC director and AFC Committee will also oversee the Competency Portfolios and scholarly requirements of the trainees. Trainee representation on the AFC Committee as per Royal College Administrative Structure requirements will allow for trainee feedback, and components of the curriculum will be revised over time with ongoing review by the AFC Committee to ensure an optimal education experience and learning environment is maintained in accordance with Royal College requirements.
The curriculum is designed to support trainees to function as a competent specialist diplomate in Adolescent and Young Adult Oncology capable of an enhanced practice in this area of focused competence.
Please see Appendix E: Objectives for the educational experiences and Appendix G: Curriculum of the program.
b) How will trainees be ensured of protected time to attend academic sessions? (Standard C3.4)
The AFC trainee will select in advance the rounds/lectures he/she would like to attend at the beginning of each block, and be encouraged to attend those that do not interfere with clinical duties. There are many choices of rounds/education sessions and we will ensure there is opportunity to attend the rounds suitable for this program. Trainees will be asked to keep a log of all sessions attended and learning objectives.
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6. CanMEDS Specific Teaching (Standard C3.2; C3.4)
Describe the teaching methods for the relevant CanMEDS competencies as described in the AFC Competency Training Requirements.
CanMEDS
Competencies
Teaching Tools
Medical Expert
Didactic lectures Interactive teaching rounds Feedback during consultations Literature review Journal club
Communicator
Review of the notes in the chart of the patient Participation in multi-disciplinary family meetings Performing patient consultations
Collaborator
Participation in a multidisciplinary rounds
Leader Participation on a committee Quality improvement – participate in AYA Program meetings Resource stewardship – Supportive Care Meetings
Health Advocate
Participation in a multidisciplinary round Direct observation of trainee’s advocating health to patient and the community
Scholar Reflective critical/analysis of articles/clinical trials Scholarly project Teaching rounds
Professional
http://canmeds.royalcollege.ca/uploads/en/professional/Professional_T4%20Case%20Report_Learner%20selected%20case%20report%20and%20reflection.pdf
Please see Appendix E and G for further information.
7. Scholarly Activity
a) Is research or scholarly activity mandatory? YES NO
What amount of time will be provided to allow trainees to participate?
Each trainee will complete a scholarly project with the objective to learn how to create, disseminate, apply and translate medical knowledge.
Diplomates are responsible for identifying a research project with the help of an attending physician who acts as a mentor.
Generally, the project will have a focus within Adolescent and Young Adult Oncology or in a disease site relevant to AYA Oncology.
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Trainees will receive support from attending faculty that has expertise in research design and methodology, established records in publication of research with access to multiple ongoing research projects and opportunities to develop new research ideas.
Elective time which is scheduled in the year can be used to complete the scholarly project. The mentor and the trainee will meet on a regular basis (at least monthly) in order to monitor progress. Where a need for additional blocks of research time is identified the schedule will be adjusted as needed.
b) What support will be available to trainees?
SupervisionFundingMaterial support including infrastructure Other, please describe:
Trainees may apply for research grants from U of T (resident research award). Mentorship with an established investigator. CV methods centre as needed.
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STANDARD C4: COMPETENCY BASED ASSESSMENT OF TRAINEE PERFORMANCE
"There must be mechanisms in place to ensure the systematic collection and interpretation of assessment data on each trainee enrolled in the AFC program."
1. Trainee Assessment
a) Describe the in-training assessment processes (written, oral and other) that will be used to assure satisfactory mastery of core competencies of the AFC program. Include a description of who will perform the assessment and how it will be related to the goals and objectives of the AFC program. (Standard C4.1)
The trainee is evaluated at the end of each experience by an In-Training Evaluation Report (ITER) completed by the site supervisor.
The AFC portfolio is the main means of assessing overall progress. The portfolio milestones include inter-professional assessment (by other health professionals, on non-medical expert CanMEDS roles), and committee participation assessment. At the end of the training period, the AFC program committee meets to discuss and approve the trainee for graduation.
Examples of assessment methods that will be used include min-cex, multisource feedback tool, patient/family evaluations, referral note evaluations, reflective case study evaluation, reflective critique analysis of clinical trials, and assessment of scholarly presentation. Please see Appendix E for details.
b) How will the program ensure that feedback is regularly provided to the trainees? Indicate how often the AFC director will meet with each trainee and how it will be done. (Standard C4.1.1; C4.1.2)
Each trainee will meet formally with the Site Director and program committee every 6 months to assess feedback. Trainees will receive feedback monthly at the end of each block.
c) How and by whom will the “Competency Portfolio for the Diploma” be completed for subsequent submission to the Royal College? (Standard C4.2)
The competency portfolio will be completed by the AFC program director by amalgamation of all items from the ITER, block evaluations, presentation evaluations, and research supervisor comments.
SUMMARY
1. Summarize the strengths of the proposed AFC program.
1. Highest volume paediatric and adult oncology centres in Canada. (C2.2)2. Formal embedded clinical AYA program at Princess Margaret Cancer Centre. (C1, C2)3. Range of clinicians and scientists with academic interest in AYA oncology. (C2.1)4. Close geographic proximity of training sites permits easy travel between hospitals for clinics,
rounds, meetings; the trainee will in effect be known at both sites and thus be a the representative of AYA Oncology for U of T. (C21.3)
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2. Summarize any potential difficulties associated with offering the program.
1. Staff is busy and will need prompting to complete assessments. (C4.1.1)2. Clinics are site specific, not age specific; diplomates may see patients with a range of ages.
(C2.3)
Signature of AFC Director Signature of the Vice DeanPostgraduate Medical Education
Date
