T3: Transparent Thursday Topics
February 27, 2020: "The residents clearly stated that in order for them to feel that their concerns are heard and that their feedback is both useful and impactful, some kind of mechanism needs to be put in place."
Thank you so much we completely agree!!
There are some kind of feedback loops, which are challenging to close For example, when there is a complaint about a specific supervisor for confidentiality reasons it is difficult for us to let learners know about the result of a faculty review. However, learners are absolutely entitled to know virtually all other aspects of postgraduate functioning. We already send important information and alerts via email. In addition, we have the monthly CBD newsletters. We have just agreed that all minutes from PRPC, PEAC and CBD operations committee will also be circulated to residents so that they can be aware of agenda items, discussions and decisions. In addition, we are working hard with PRAT, PGY representatives, and Chief Residents to make sure that they are regularly informed of any information that they can then pass on to the wider resident body.... and of course this very paragraph you are reading is meant to help as well.
March 5, 2020: ”EPA interfact difficult, having to log on with our phones – it’s very unnatural when discussing feedback; awkward to sit around and wait for supervisors to fill something out when they’ve already provided verbal feedback.”
This is a common concern in all specialties across the country. It is an absolute mandatory Royal College requirement. You should know that EPAs can be completed on a desktop computer, laptop, tablet, or phone, but the Royal College requires that the data be captured for review by the Competence Committee. This is an accreditation standard. In our experience so far, the competence committee is able to pick up on themes across rotations/EPAs that would not previously have been recognized. This is being fed back to residents to help them improve.
We also know that in most cases, faculty were already observing and providing feedback to residents on their performance but where this was previously not happening this new system will necessitate more observation and conversation which we think is to the benefit of learners.
As far as the useability/interface.... stay tuned as we're switching to Elentra July 1, 2020. This is the platform being used by all programs at U of T and about half of the Universities across the country. It's a little more pretty, a little more slick and has a few more features.
March 12, 2020: ”Why has the nature of the book allowance changed?”
The book allowance was a wonderful feature of our program for many years. It was entirely funded by psychiatrists out of their own pockets. It does not come from any university or AFP or any other source of funding. Recently, as we have tried to put into place all kinds of extra supports for residents including longitudinal coaching (which is Royal College requirement), as well as the Competence Committees and increased observation, we have been asking more of our partner hospital sites. In addition, some aspects of patient flow and billing have changed as a result of the LAE. Sites were expressing reservations about continuing to contribute their own money to a resident book fund in the context of all these other accreditation/programmatic/curricular changes.
There was real risk that the book fund was going to disappear completely. Please note that book funds are not mandatory and not an accreditation standard but one of the many ways we have been delighted to voluntarily support residents. Rather than completely eliminating the book fund, we were able to negotiate with the psychiatrists in chiefs for them to take 75% of the book allowance money and reallocate it directly back into education. They continue to contribute the remaining 25% directly to residents, but, appropriately insisted that there be some kind of adjudication process for receiving the funds. We struck a joint committee between several residents and psychiatrists in chiefs to determine the terms of reference. In the end, we were delighted to offer academic awards which previously did not exist. Every year we receive requests for funding for conferences, seminars or research and we had no ability to fund those requests. Although it would have been nice to continue to have staff psychiatrists give money to residents - in a time of university, provincial, and OHIP cutbacks, which also coincides with the increased educational infrastructure it just was not possible. We are very happy to have preserved some funds to support the scholarly development of our learners. We have enough money to ensure that every single learner who has a viable application will receive a "resident scholarly development award" at least once over the course of their training.
March 19, 2020: "Why have you changed the format the PGY2 academic day? (hint: it wasn’t social distancing)"
The structure of the PGY2 academic day was changed for a number of important reasons.
1) There is loads of evidence to suggest that teaching and clinical experience should be aligned as closely as possible. In the old system you could have a lecture on a relevant topic in September but may not encounter a clinical situation until February. The new system allows us to better target lectures that relate specifically to the rotations on which residents are working. This is an evidence-based approach that we developed with consultation from educational scientists.
2) As the size of our residency program has grown, space and comfort has become an increasing issue. We did not have access to a room that was large enough to consistently accommodate all PGY2s for every week of the year. Furthermore smaller lectures promote better learning and participation. The new curriculum structure allows us to have groups of approximately 12-13 residents instead of 40 at each lecture.
3) Despite years of effort, resident attendance at core lectures and in large groups has been extremely poor. This led to a sense of inequity amongst residents. In addition, we were routinely receiving complaints from faculty who had taken the time to prepare lectures only to have 1-2 residents show up in the room. Some of our expert faculty were refusing to teach under these conditions.
4) The "new" structure for PGY2 lectures mirrors the structures we have always had in PGY3 and 4. Those have always been well-received and well-attended.
5) With the introduction of a longitudinal clinic (which was strongly requested by previous resident cohorts, more to come in a future question) having a full additional academic day would mean that residents were only present on their core rotations 3 days a week. We considered the possibility of half days of either LAE or teaching but that would absolutely necessitate significant travel for a large majority of residents, and we received feedback that this would not be well-received.
While this new structure is different for the PGY2 year it has been tried and tested in PGY3 and 4. It allows for an LAE that was requested by residents and is aligned with educational principles and literature. We do understand that some social aspects of the day have been lost - but we continue to protect and support a weekly resident lunch. We continue to protect and support 2 PRAT retreats. We are certainly open to other ideas that may promote friendship and collegiality in our program - send those ideas to us directly!
March 26, 2020: ”Why isn’t the Longitudinal Ambulatory Experience standardized across all our hospital sites? It seems there are drastically different expectations around documentation, frequency of new assessments, level of supervision etc."
We understand that there is bound to be variability in a program of our size. To some extent, this is desirable. We want sites to offer slightly different experiences. We also appreciate that different residents learn and perform at different rates. The goal of CBD is actually to allow for more individualization of the educational curriculum.
However, we also want to have some shared standards and "floors". There is already a document available on our Departmental Website (Longitudinal Rotation Structure under Departmental Policies and Guidelines: https://www.psychiatry.utoronto.ca/policies-and-guidelines) that outlines how an LAE should function. In addition, our LAE Working Group surveyed PGY1 and 2 residents as well as supervisors at our sites in January 2020. The group is currently reviewing the data to provide recommendations to the LAE sites so we can change those guidelines in accordance with feedback or help sites come into alignment with them.
Please remember that we started 6 brand new PGY2 clinics about 7 months ago. Some amount of learning and adjustment is to be expected. Bear with us, we're on it!