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AC Task Force Executive Summary (May 2022)

AC Task Force Executive Summary

May 2022

THE PROBLEM:

In November 2020, the Royal College of Physicians and Surgeons of Canada did a review of the Core Internal Medicine residency program at Temerty Medicine’s Department of Medicine. In November 2020, the RCPSC conferred a “Notice of Intent to Withdraw Accreditation” to the program, as a result of its findings.

The RCPSC identified two themes for Improvement that are the focus of the Task Force:

  1. There is an ongoing issue with resident supervision in the clinical environment, and perceived lack of support, particularly of junior learners on subspecialty services and on CTU during weekends. Residents feel this is impacting patient safety.
  2. Residents are afraid to raise substantial questions or issues with the program, for fear of repercussions both within their training program and related to future employment in Toronto. This perception arises from observation of the treatment of residents who have spoken out.


RECOMMENDATIONS:

  1. The Task Force recommends that the Department of Medicine leadership develop a policy for supervision by attending physicians on all services with Internal Medicine residents.
  2. The Task Force recommends that Department of Medicine leadership and TAHSN hospital leadership bolster efforts to address chronic shortages on high volume services across all teaching sites.
  3. The Task Force recommends that Department of Medicine leadership and TAHSN leadership determine how best to offload residents from tasks that can be streamlined, including the reduction of administrative duties.
  4. The Task Force recommends limiting distractions and maximizing efficiencies for residents, by addressing processes for paging, test booking, and order entry and other tasks.
  5. The Task Force recommends that the program improve process and flexibility for residents around requests for vacation time. This will enhance residents’ wellness and markedly improve efforts to ensure residents’ earned lieu days and educational time are honoured.
  6. The Task Force recommends that each rotation ensures that its teaching, outpatient clinics and procedures are organized to enable residents to complete their routine work consistently by 5 p.m. EST, in order to allow appropriate time for sign-over to the on-call team.
  7. The Task Force recommends that attending physicians on inpatient MRP and consultation services ensure they adjust their outpatient clinical responsibilities, as well as academic and administrative responsibilities, to ensure residents are adequately supported throughout the day and are able to consistently complete their workday on time.
  8. The Task Force recommends that Academic Half Days (AHD) be protected across all PGY levels.
  9. The Task Force recommends that each hospital service develops explicit policies that describe the expectation of residents, fellows and attending physicians (including junior attendings) in the daily care of patients on their services.
  10. The Task Force recommends that admission guidelines for patients through the Emergency Department be made more explicit and, as much as possible, be standardized across sites to minimize conflict between clinical services.
  11. The Task Force recommends that consults for stable patients between the hours of 5 a.m. to 8 a.m. be held by the ED physician to allow overnight on-call trainees to complete admissions in a timely manner, where appropriate. New consults can thereafter be handed over to the daytime team by the  ED.
  12. The Task Force recommends that attending physicians ensure that formal post-call teaching is efficient and focused.
  13. The Task Force recommends that hospital sites regularly seek anonymous and/or confidential feedback from residents on the support they receive. We recommend this feedback be shared with individual attending physicians in a constructive fashion to promote positive change.
  14. The Task Force recommends that the program and Department of Medicine improve the way in which feedback is sought and received at all levels by building a culture of continuous improvement that empowers meaningful change and actively seeks and welcomes feedback.
  15. The Task Force recommends that, both at individual hospital sites and program-wide, there is transparency with residents about what will happen with feedback obtained from them, and specific plans to address the concerns raised in a timely fashion.
  16. The Task Force recommends that the program and Department actively involve residents as partners in designing and implementing change initiatives. Ideally, this should be at all stages of development of initiatives and include resident leadership beyond the Chief Medical Residents.
  17. The Task Force recommends that the program seek out and implement best practices from other programs regarding incorporating resident feedback, rotation organization, and change management.
  18. The Task Force recommends that the Internal Medicine program resume the cycle of annual site visits.
  19. The Task Force recommends that the program reviews its rotation and site debriefings to ensure residents perceive these to be safe spaces. We also recommend that confidential and anonymous mechanisms to provide feedback are incorporated.
  20. The Task Force recommends that an ombudsperson is identified that residents can contact to provide feedback or seek advice from.
  21. The Task Force recommends that the Department rethink the use of Town Halls to seek feedback from residents.
  22. The Task Force recommends that professional development be offered to both residents and faculty on how to provide and receive constructive feedback for system change.
  23. The Task Force recommends that time off and protected study time for the Royal College examination be prioritized by the program as per the Professional Association of Residents of Ontario (PARO) contract.
  24. The Task Force recommends that the program follow contractual obligations including special arrangements with PARO, and where found to be in non-compliance, immediately resolve such issues.

 
NEXT STEPS:

The key findings and preliminary recommendations will be shared through sessions with faculty and residents.