To ensure that PGME programs always strive for excellence and make progress towards addressing weaknesses identified at the most recent accreditation visit.
The following reviews are conducted periodically during the eight-year cycle:
Internal Preparatory Review
This review is considered a quality assurance survey, conducted by the PGME Accreditation office by a team of two faculty members and one resident over a full day. Reviews are conducted in the same manner as would be expected in a full accreditation survey visit, with review team members granted temporary access to the program’s CanAMS profile as well as documents from the program e.g. meeting minutes; with learner consent, access to trainee confidential assessment information). This team conducts interviews with each stakeholder group of the training program. The resultant internal review report summarizes triangulated information around the discipline-specific standards and is submitted to the PGME Accreditation Committee. Finalized reports are returned to the program director and residency program committee to allow for a process of reflection and to find solutions for any identified areas for improvement (AFIs).
The goals of an internal preparatory review are:
- As a program quality assurance process conducted by PGME on a regular cycle between full accreditation survey visits. For programs requiring Action Plan Outcome Reports, preparatory reviews will be conducted prior to the formal mandated 18-24 month reporting period to the College.
- To allow PGME to understand how the program is performing against accreditation standards and to deploy support where required. If any signals indicate problems, further internal reviews will be conducted as decided by the Accreditation Subcommittee.
- To allow common AFI themes across multiple programs to be identified and addressed centrally through creation of policy or educational resources.
- To notify programs as to any existing deficits (AFIs) requiring action
- To prepare programs for any upcoming mandated internal or external review or for an upcoming accreditation visit.
Preparatory review follow-up occurs within 18-24 months and may include a written report from the program to PGME Accreditation Subcommittee on the progress/resolution of any identified AFIs, or another full team review conducted by PGME. Information from written reports is reviewed by the Director of Accreditation, Committee representative(s), and may be forwarded to Departmental Vice-Chairs of Education and/or Chairs as appropriate for monitoring of program status.
Mandated Internal
This type of review is carried out by three reviewers (2 faculty and 1 resident) over a full day period. uOttawa reviewers approved by the Director of Accreditation, conduct these reviews. A report is produced and reviewed by the Accreditation Subcommittee. The Director of Accreditation completes the Action Plan Outcomes Report (APOR) on CanAMS and submits to the respective College before the required deadline. Programs are able to review the report generated by the review team but will be required to wait for a decision letter from the College regarding the final determination of accreditation status.
External Review
Reviewers for a mandated external review are appointed by the responsible accrediting College (RCPSC or CFPC). The PGME office will facilitate communication to the program and access to the documents as required. At the end of this review, the surveyors will transmit to the Program Director and PG Deans, a recommendation to the relevant College’s Accreditation Committee. That College’s Accreditation Committee will at its next meeting, issue the final accreditation status in a decision letter to the PG Deans.
Further information about accreditation process and residency program status can be obtain by contacting the Postgraduate Medical Education Office.