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Program Director Guide

The information below has been developed to assist Program Directors with their role, especially those who are new to the position.  It will be updated regularly and we welcome your comments for improvement.  Much of the content has been adapted from The Rookie Book - A Guide for New Program Directors, developed and compiled by Dr. S. Moffatt, MD, FRCP, in 1998.

Section One

Every Program Director (PD) has a wealth of information with which to become familiar.  It can be a daunting task, so here's a quick guide to the various sources and their contents.

PGME Website:    meds.queensu.ca/postgrad
This should be your number one source for up-to-date information and guidance.  There's a special site for Program Directors, in addition to sections for policies, committees, information for residents, admission information, and an event calendar.

PAIRO Blue Book:    The Agreement between PAIRO and CAHO
The agreement defines the orderly employment relationship between Ontario teaching hospitals (represented by CAHO) and the residents in those hospitals (represented by PAIRO).  The agreement ensures that residents are reasonably compensated for the duties that they perform as hospital employees.

RCPSC:    General Standards of Accreditation
The RCPSC website outlines what a program must provide and do to be accredited according to RCPSC standards.  This is basically a job description for a program and is essential reading.

RCPSC:    Policies and Procedures for Certification and Fellowship
This book is full of helpful rules that define what resident credentials and training will be acceptable for admission to examinations.  It addresses such issues as leaves of absence, part time training, recognition of prior training, and the deadlines and application process for examinations.

RCPSC:    General Information Concerning Accreditation of Residency Programs
This book describes the process of accreditation, and the various categories of accreditation.  This is particularly important reading before an internal review or accreditation visit.

RCPSC Specialty Committees
These committees develop documents describing the objectives and requirements for training residents in your specialty.  These two documents are:

  • The Objectives of Training and Specialty Training Requirements in (your specialty)
  • Specific Standards for Accreditation for Residency Programs in (your specialty)

Every Program Director needs to know and meet these expectations.  You should also learn the membership of your Specialty Committee.  When you are appointed as a PD, you automatically become a corresponding member of your Specialty Committee.  Get a copy of the minutes from the most recent committee meeting.  This will bring you up-to-date with the current issues.

The role of Program Director is a big one. A good PD is available and 'in touch' with his/her residents and aware of day-to-day issues which influence them.   Small and large programs alike require a lot of time and you'll need to review your schedule of other commitments to ensure that you will have time for:

  • Planning (every week)
  • Time to be available to meet with residents each week
  • Regular weekly meetings with the Chief Residents
  • Regular Residency Program Committee (RPC) meetings
  • Regular Postgraduate Medical Education Committee (PGMEC) meetings
  • Formal individual resident meetings (at least two per year, per resident)
  • Organizing and attending social events
  • Attending resident academic activities
  • Organizing resident evaluations/ interim exams
  • Corresponding with rotational supervisors and other PDs
  • Regularly reviewing:  
    • Resident Evaluations
    • Program/rotational evaluations
    • Selecting new residents

You're not alone!  A program is a partnership and there are lots of people who can provide assistance when it's needed, including:

  • Program Assistants / administrative support
    • Schedules, correspondence, maintenance of resident files

 

  • Former Program Directors
    • They can acquaint you with rules and up-to-date resident files
    • They can provide mentoring and advice

 

  • Department members and Head
    • To provide respect, time, resources,  and encouragement
    • To support the program's philosophy, particularly regarding service and education
    • To support and attend educational and research sessions

 

  • PGME Dean and Office
    • To keep you informed about current provincial and university regulations and policies
    • To be the contact with the RCPSC for accreditation and documentation
    • To advocate for issues of residency education with Department Heads and hospitals
    • To have a reliable process for internal reviews, evaluations, promotions, and appeals
    • To give advice on special circumstances, residents in difficulty, and a host of other issues

 

  • Director, Resident Affairs
    • To provide support, counseling and referrals to residents in difficulty, and to facilitate the transition from undergraduate medical student to postgraduate resident.

 

 

  • Residents
    • To provide feedback, ideas, and to participate. 

The RCPSC informs Program Directors on what needs to be accomplished, but each PD will carry this responsibility within the limits of other rules and regulations outside of the jurisdiction of the College.  This includes provincial/university limitations on funding and positions, the PAIRO contract, hospital rules, and changing service configurations.   It's recommended that you find a good mentor in an experienced Program Director, and to maintain a close and positive relationship with the PG Dean.

The Program Director, with the help of the RPC, is responsible:

  • To the PG Dean
    • To respond to the PG Dean and to attend PGMEC meetings
    • To prepare for accreditation
      • Every six years
      • Internal reviews during intervals

 

  • To the RCPSC
    • To respond appropriately to requests regarding documentation for examinations, evaluation report forms, program accreditation, specialty committee issues

 

  • To the Department
    • To be a resident advocate
    • To assign residents to services
    • To organize educational opportunities

 

  • To the Residents
    • To train them well in a positive environment


A program needs to provide career counseling and support for residents who are having academic or personal difficulty.  Some programs make available counselors or mentors with whom residents may confidentially discuss issues that they would rather not discuss formally with the Program Director.  Residents should also be aware that they may book appointments with:


There is a need to keep your Department involved and aware of the program though regular electronic, written, or verbal reports.  This will generate informed support for your initiatives and appreciation of your challenges and efforts.

The Program Director does not run a program alone.  Every program needs a functional Residency Program Committee (RPC) that will be of huge assistance to you and your program.   The RPC is representative of:

  • All institutions, including other centres if your residents do mandatory rotations there
  • Residents
  • Faculty with educational interests

The RCPSC Website clearly defines the administrative structure, including the role of the RPC, in STANDARD B.1

While it may be tempting in some smaller programs to combine the RPC and divisional meetings, this cannot be done.  The RPC needs to be a distinct committee with an educational mandate and a role in resident advocacy.  This role is too easily blurred if the program is only discussed within the context of a division or department's operational issues.

The Program Director organizes a yearly agenda of meetings to be sure that the committee regularly addresses all its responsibilities.  The RPC should meet at least four times per year, and following responsibilities need to be discussed.  The suggested frequency of these discussions is also provided.

  • Program Design (Annually)
  • Goals and Objectives (Annually)
  • Resident Selection*  (Annually)
  • Resident Progress / Evaluation  (Quarterly)
  • Rotational* and Program Evaluation  (Quarterly)
  • Academic Program and Research*  (Bi-Annually)
  • Social Events*

*These responsibilities can be delegated to an enthusiastic member of the RPC or to a small subcommittee.  This delegation is particularly important in larger programs.

Remember to ensure that minutes are kept and that members practice confidentiality.

Many of the organizational issues that occupy a Program Director's time involve non-RCPSC guidelines such as labour agreements, funding, and departmental policies.  It is worth articulating your program's guidelines for those generally predictable issues ahead of time or ensuring that they are posted on your website.

Guidelines should be fair to the residents and the department, recorded, and fairly applied.  Try to determine from the former PD what the old guidelines were, and decide if they need revision.  Record the reasons for your decisions regarding individual residents.

A resident handbook given out at the start of the year is an effective way to provide residents with your guidelines, as well as their rotational goals and objectives, information about their in-training evaluation system, and availability of resources.  This is a lot of work to write the first time but is easy to edit and saves a great deal of time and misunderstanding.  An example created by Anesthesiology can be found here.

The following are management issues that all Program Directors must eventually address, along with some suggestions for dealing with them.

Abuse and intimidation of residents

This can still happen at and between every PGY level.  Your personal availability and receptiveness will determine how much you hear about it.  Identify immediately how willing the resident is to proceed with a complaint. Seek the advice of a wise colleague and the PG Dean.  Confidentiality is critical and you’ll need to know the avenues and resources available to deal with these issues.

Academic Activities

Decide which are mandatory for your residents to attend, and how the service needs are going to be meet during those hours.  If there isn’t a provision for service coverage, residents won’t attend.  

Call

Know the contractual agreement between PARO and the hospital.  Set guidelines for requesting specific days off and respect the guidelines in the PARO agreement.  Functional guidelines regarding post-call days and total hours of work are a difficult challenge and need to be negotiated respecting provincial regulations.  Statutory holidays and rotation schedules are available on the PGME website.

Complaints

Complaints regarding interactions between residents and hospital staff must be handled promptly and carefully in conjunction with the appropriate hospital management.  The PG Dean and Department Head should normally be involved.  A written description of the complaint can help clarify the event and issues.  Depending on the situation, a mediator acceptable to both parties may be able to facilitate a helpful discussion and resolution.

Conference Leave

Each Program Director must be able to address the length, type of conference, and funding available for residents wishing to attend conferences.  Many departments have clear guidelines posted on their on their website.  Usually, residents presenting material are funded.

Holidays

Program Directors need to have a clear process in place for approving holidays.  It's important to be aware of the requirements of the PARO agreement and if there are questions, check with the PGME office or PARO directly.  Statutory holidays are posted on the PGME Website.

Pregnancy and Parental Leave

Residents who are going to become parents are entitled to a leave defined by the PARO agreement.  The dates need to be provided to the PGME office so that a change can be made to the registration status of the resident.

Moonlighting

Residents are not encouraged to moonlight but if they do so, it should not occur at the same hospital or on the same service in which they are engaged in educational programs.  The Ontario Faculties of Medicine does not support resident moonlighting as it compromises postgraduate programs and undermines the educational environment.  More information on moonlighting is available on the PG website.

Rotational Assignments

Every Program Director needs a standard resident rotational template and schedule.  It will be changed many times and a Program Director should start planning in March-May for the July 1 start.  A copy of the schedule should be sent to the PG Office and to PARO.  You should also establish guidelines for the following:

  • Dates of notification
    • When residents and other Program Directors need to make requests for specific rotations for the following year
  • Criteria for choosing between residents competing for favourite rotations, both those from your program and from others.
  • Criteria for deciding which services are not assigned residents and how often this occurs.

Remember that rotations to/from other centres and provinces may require applications for licensure or hospital privileges that must be arranged long in advance.  Residents may need help in getting accommodations, and the funding issues around that need to be clarified especially if a rotation to another centre is mandatory.  Be sure to contact the Regional Education Office at Queen’s for help.

Interaction with other programs can be difficult if their residents expect different experiences than your rotations normally provide to your own residents.  A discussion with their Program Director of the rotational goals and objectives may prevent mid-year controversies.

When residents are doing rotations on services in other programs, it is important to identify which academic sessions they are expected to attend back in their home program and how/if this can be accommodated. 

An accreditation survey occurs once every six years and the College reviews whether a program is being administered according to the Standards outlined in the RCPSC Blue Book.  A survey primarily assesses the process and apparent resident satisfaction.  The RCSPC Grey Book clearly describes the process, consequences, and terminology in detail.

One year before the survey:

  • The Head of the Accreditation Service will contact the PG Dean to set the date for the survey.  Usually the Head will meet with Program Directors and the PGME Office several months before the survey to review the process.
  • For a Program Director, the survey is a performance review.  The process begins with the preparation of a pre-survey questionnaire that asks you to describe how you are addressing the RCPSC Blue Book Standards.

It is worth, early in your term, filling out a pre-survey questionnaire as an excellent method of critically reviewing your program and knowing what the College will expect from you in a 'real' survey.  At the very least, look at the one filled out by your predecessor for the last survey to get an idea of what is required.  

Ask your Department to keep the data usually required for a pre-survey questionnaire (which is challenging to collect as the survey approaches) on hand and up-to-date (such as a yearly update of faculty and resident publications and grant listings, staff demographics, etc).  This will save hours of work as the deadline approaches.

Six months before the survey:

  • Complete the pre-survey questionnaire.  Identify your program's strengths and weaknesses.  For a small program of under five residents, it will take at least a month to prepare this document and for a larger program, it can take several months.

On the day of the survey:

  • Your program will be reviewed by a surveyor who will ask you to clarify aspects of your program, and will tour your facility.  The surveyor will meet with you, your RPC, your residents, and other teaching faculty.  A thorough surveyor will ask to review the minutes of previous RPC meetings, a selection of residents’ dossiers, evidence of regular in-training evaluation, rotational goals and objectives, and program evaluation.  This process will take three to four hours for a small program and can take several days for a very large one with several sites of training.

The surveyor will report to the survey team that night and will meet with you the following morning to discuss the team’s recommendations to the Accreditation Committee.  Approximately six weeks later, you will receive the surveyor's written report, to which you respond, and a final decision will then follow.

The surveyor is particularly interested in the perceptions of the residents and whether your program has addressed problems identified at the last survey.   Even a lot of recent paper will not disguise five years of absent process or progress.  Every program has problems but the presence of chronic deficiencies that have been present over several surveys will compromise your program’s status.

A survey is a nerve-wracking time for a Program Director but it can be a powerful tool for change.  Sometimes criticism on a survey of less than full approval may be the only way a department or institution will pay attention to a problem you have been struggling with for years.

The Internal Review is expected to occur between on-site surveys and is an excellent way of reviewing your program.  It is organized by the PGME office and is like a mini-survey.  Consider it practice for the real thing, and use it to identify and remediate problems.  The results of these reviews are not forwarded to the College unless the program is new or has been inactive.  The PGME office has developed an excellent website for Internal Reviews which will guide you through the process.

If you have the opportunity, become a surveyor. This is a great way to understand what is expected of a program, and to get fresh insights and ideas for your own program.

Goals and objectives establish what we expect residents to be able to do at various stages of their training.

Developing objectives can be a time-consuming task, even for experienced Program Directors.  They are, however, extremely helpful in defining what our residents should be learning and why specific rotations should exist.  If possible, enlist the help of someone from your RPC who is skilled in medical education and objective development to create or review your objectives.  The objectives should indicate what knowledge, skills, and attitudes residents should possess at the end of a period of training.

Review the current Objectives of Training and Specialty Training Requirements developed by your Specialty Committee. These establish the strict and necessary components of the program.  Within these requirements, it is up to each program to develop its own unique focus.  This is an opportunity for the Program Director and RPC to create a program which draws from its strengths.

In designing objectives, it might help to ask these questions:

"What kind of specialists can our program train particularly well?"
"What knowledge, skills, and attitudes do they need to do that job?"
This will identify your program's objectives.  For example, a program which is geared to training surgeons for remote communities would likely emphasize different skills or encourage different electives than one primarily geared to preparing residents for research careers in urban centres.  Both would teach the basics, but the emphasis and opportunities may be different.

"In which formats or settings can residents best learn those necessary abilities?"
This will identify the educational rotations that will be needed.  Perhaps some objectives are better achieved through a seminar or research project, rather than through direct patient care.

"What will residents learn in each rotation?"
The answers will define each individual rotation's objectives.  Objectives can be thought of (and written) as completing the sentence: 

  • "At the end of this rotation, a resident will be able to …" with the relevant knowledge, skills, and attitudes.

If a resident does a rotation several times in his/her training, but with different expectations of performance and independence, this should be reflected in the objectives.

It is more important to try and articulate the objective concepts rather than to struggle for design perfection.  Here are some rough examples of objectives which address knowledge, skills, and attitudes:

At the end of this two-month ICU rotation, a PGY2 rotating resident will be able to:

  • Describe and explain the typical hemodynamic changes of cardiogenic shock.  Given a patient with this condition, recognize the pattern and institute appropriate inotropic therapy.
  • Using the techniques taught in this rotation, correctly place a central venous introducer and PA catheter and use it to correctly measure intracardiac pressures and cardiac output.
  • Demonstrate insight into his/her own skills and limitations by appropriately seeking advice and consultation
  • Describe the usual concerns of families of critically ill patients.  Demonstrate insight and empathy to these concerns by effectively identifying and addressing them during family conferences.

Rotational Objectives are particularly useful for:

Designing the program

  • Is this rotation necessary?
  • How long/how many rotations of this does a resident need to achieve the objectives?

Evaluating a rotation

  • Are residents learning the objectives and why or why not?
  • Which of the possible services offering this rotation should get residents?

Evaluating residents

  • Did the resident learn what was expected and why or why not?
  • If the resident had problems, what specifically could he/she not do that most other residents could do at this point?

The College requires program objectives and rotational objectives for every rotation, including electives.  They should be reviewed and revised regularly and ideally rotational evaluations should be tied to them.

Section Two

Once the goals and objectives of the program and rotations have been established, it is important to construct a training sequence that is rational.  It is the Program Director’s responsibility, along with the RPC, to advocate for residency assignments that are based on educational needs, not simply service.

The service-to-education ratio is the critical balance and reflects the 'real' educational philosophy of a program and a department.  It can be a challenge for the Program Director to defend a balance that supports education; criteria need to be established for resident assignment and justified.  In this, Program Directors need the support of the department and Head.  It may help to take a fresh look at traditional assignments and ask:

What is dictating this resident assignment – service needs or educational needs?

Is the sequence of rotations rational for each resident?  Is the sequence responsive to each resident’s training needs and career goals?

It is also essential that every program, by design, permit the resident to have increasing responsibility for patient care.  This should be reflected in the objectives.  

For each rotation, the Program Director needs to designate a supervisor with whom you can liaise about scheduling and discuss resident progress and evaluation.

Other structural concerns:

In planning rotations, the Program Director needs to consider whether the program permits:

  • Electives (these must be possible and appropriate)
  • Community-based rotations (is the supervision adequate and are the objectives clear?)
  • An appropriate inpatient/outpatient mix
  • Access to academic activities and research

Finally, the Program Director needs to review the training template, both from the department's perspective (have the service issues been addressed?) and from each resident’s perspective (how does his/her chronological training map look?).

AAMC       
Association of American Medical Colleges

ACGME   
Accreditation Council for Graduate Medical Education

ACLS       
Advanced Cardiac Life Support

ACMC       
Association of Canadian Medical Colleges (old name)
now know as Association of Faculties of Medicine of Canada

ACTH       
Association of Canadian Teaching Hospitals

AFMC       
Association of Faculties of Medicine of Canada

AFP       
Alternative Funding Plan

AUCC       
Association of Universities and Colleges of Canada

AVP       
Assessment Verification Period

BCT       
Basic Clinical Teaching

CACMS   
Committee on Accreditation of Canadian Medical Schools

CAHO       
Council of Academic Hospitals of Ontario

CAIR       
Canadian Association of Interns and Residents

CAME       
Canadian Association of Medical Education

CAPER   
Canadian Post-MD Education Registry

CaRMS   
Canadian Resident Matching Service

CAU       
Clinical Academic Units

CCFP       
Certificate, College of Family Physicians

CCT       
Confirmation of Completion of Training (RCPSC Form)

CEHPEA   
Centre for the Evaluation of Health Professionals Educated Abroad

CFMS       
Canadian Federation of Medical Students

CFPC       
College of Family Physicians of Canada

CIHR       
Canadian Institute of Health Research

CITER   
Core In-Training Evaluation Report

COFM       
Council of Ontario Faculties of Medicine

CMA       
Canadian Medical Association

CMG       
Canadian Medical Graduate

CMPA       
Canadian Medical Protective Association

COU       
Council of Ontario Universities

CPD       
Continuing Professional Development (Queen's)

CPSO       
College of Physicians and Surgeons of Ontario

CSCI       
Canadian Society for Clinical Investigation

FAIMER   
Foundation for Advancement of International Medical Education & Research

FITER       
Final In-Training Evaluation Report (RCPSC Form)

FLEX       
Federal Licensing Examination (USA)

FMRAC   
Federation of Medical Regulatory Authorities of Canada

FMRQ       
Fédération des médecins résidents du Québec 
 
FMG       
Foreign Medical Graduate

FMLAC   
Federation of Medical Licensing Authorities of Canada (old name)
now Federation of Medical Regulatory Authorities of Canada

FRCPC   
Fellow of the Royal College of Physicians of Canada

FRCSC   
Fellow of the Royal College of Surgeons of Canada

FSMB       
Federation of State Medical Boards

FTE       
Full Time Equivalent

GIDRU   
Gastrointestinal Diseases Research Unit (Queen's)

HDH       
Hotel Dieu Hospital

IMG       
International Medical Graduate

ITER       
In-Training Evaluation Report

KGH       
Kingston General Hospital

KRCC       
KGH Regional Cancer Centre

LCME       
Liaison Committee of Medical Education

LHIN       
Local Health Integration Network

LMCC       
Licentiate of Medical Council of Canada

LOA       
Letter of Appointment

MCC       
Medical Council of Canada

MCCEE   
Medical Council of Canada Evaluating Examination

MCCQE   
Medical Council of Canada Qualifying Examination - Part I
Medical Council of Canada Qualifying Examination - Part II

MD       
Doctor of Medicine

MOHLTC   
Ministry of Health and Long-Term Care

MTCU       
Ministry of Training, Colleges, and Universities

NBME       
National Board of Medical Examiners

NRMP       
National Resident Matching Program (USA)

OMA       
Ontario Medical Association

OMSAS   
Ontario Medical School Application Service

OPHRDC   
Ontario Physician Human Resources Data Centre

OTPC       
Orientation to Training and Practice in Canada (for specialty programs)  
 
OSCE       
Objective Structured Clinical Examination

OUR       
Office of the University Registrar (Queen's)

PARO   
Professional Association of Residents of Ontario

PC       
Providence Care

PEAP       
Pre-Entry Assessment Program

PGME       
Postgraduate Medical Education

PGMEC   
Postgraduate Medical Education Committee (Queen's)

PGY      
Postgraduate Year

PHAC       
Public Health Agency of Canada

PHP       
Physician Health Program

PRP       
Pre-Residency Program (for Family Medicine)

PSI       
Physicians Services Incorporated

QUIC       
Queen’s University International Centre

RCPSC   
Royal College of Physicians and Surgeons of Canada

ROS       
Return of Service

RPC       
Residency Program Committee (see RTC)

RTC       
Residency Training Committee (see RPC)

SEAMO   
Southeastern Ontario Academic Medical Association

SGSR       
School of Graduate Studies and Research (Queen's)

UMEC       
Undergraduate Medical Education Committee (Queen's)

USMLE   
United States Medical Licensing Examinations

WHO       
World Health Organization

Accreditation Without Certification Subspecialties
"Accreditation Without Certification" is a process whereby the RCPSC recognizes subspecialties for the purpose of accrediting programs, but does not offer examinations leading to certification in the designated subspecialty.

Assessment of Training
All applicants must have their residency training assessed by the RCPSC to ensure that the specialty specific training requirements have been met in a program that is recognized and approved by the RCPSC.

Elective
An elective is defined as a discretionary, non-mandatory component of training.

Licensure
The RCPSC does not grant licenses to practice medicine. Applicants who intend to obtain a license to practice in one of the provinces or territories of Canada must hold appropriate registration with the provincial/territorial regulatory authority. Applicants should contact the provincial/territorial medical regulatory authority directly for more information.

Objectives of Training and Specialty Training Requirements
Each specialty and subspecialty recognized by the RCPSC has specific mandatory Objectives of Training and Specialty Training Requirements. Specific information about the objectives of training and specialty training requirements is available for each specialty and subspecialty.

RCPSC Certification Examinations
Applicants are ruled eligible to take the examinations leading to RCPSC certification if all of the criteria of eligibility and residency training requirements have been met. Candidates for the examinations must register with the RCPSC in order to take the examination.

Reciprocity
The RCPSC has no reciprocal arrangements for recognizing examinations or qualifications of any other College or Board in any specialty or subspecialty. Applicants with certification from any other specialty or subspecialty examinations, College or Board, are not exempt from any of the requirements of the RCPSC.

Residency
A residency is a specialty training program that is completed after medical school. These programs offer supervised and specific training for the resident in their chosen specialty/subspecialty.

Ruling
A ruling is a decision on examination eligibility only. Once the applicant's residency training has been assessed, the RCPSC will make a "ruling" (decision) on examination eligibility. The RCPSC retains the authority to review all applications for preliminary assessment of training on a case-by-case basis and to determine the ruling on examination eligibility. The RCPSC also retains the authority to withdraw acceptance of an applicant's credentials and/or require that an applicant complete additional training.

Specialist Certification
Certification in a specialty or subspecialty will be granted upon the satisfactory completion of all credentials, training, and examination requirements. The RCPSC certification confirms that specialist physicians and surgeons have met RCPSC standards and training requirements.