Santiago, Beijing and Jeddah: 3 cities, 3 institutions, 1 shared feat

Andrew Padmos
October 26, 2016 | Author: Dr. Andrew Padmos

Dear colleagues,

I’m pleased to announce that, after several years of dedicated work, the Pontificia Universidad Católica de Chile (Santiago) achieved the first stage of Royal College accreditation (international recognition) earlier this year — our first international partner to do so. Just this month, two more institutions joined them in being internationally accredited by the Royal College: the Peking University First Hospital (Beijing, China) and the King Abdulaziz University — Faculty of Medicine (Jeddah, Saudi Arabia). You may be asking yourself – what does this mean?

As I explained in my last message, on the world stage, the Royal College is a small organization from a small country; but we have been extending our influence through a growing number of fruitful partnerships with institutions in the Gulf, Asia and Latin America. As our international activities are increasing, I’d like to provide a bit more context on our international (residency) accreditation efforts — what this work entails and its value, both to our partner institutions and to our organization.

Quick links

What is Royal College international (residency) accreditation?

Accreditation of residency (i.e. postgraduate) programs is a quality improvement process that evaluates programs against a set of standards. It ensures that graduating medical doctors are ready to enter practice with the skills needed to deliver excellence in care. It is a level of scrutiny that every PGME training program in Canada must undergo on a recurrent basis.

Our academic partners around the world have identified accreditation as a worthy and important goal for them. This goal has resulted in our consideration of how our standards work in environments outside of Canada. So, we created a set of international standards, based on, and equivalent to, our domestic guidelines. Like in Canada, they are divided into two categories:

  1. International Institutional Standards (i.e. A Standards) and
  2. International Program Standards (i.e. B Standards).

To achieve international (residency) accreditation by the Royal College requires several steps — work that extends over several years — and includes a/an

  • Program consultation visit (a diagnostic evaluation of a residency program).
  • Institutional review (an evaluation of the institution/department that oversees residency training to determine resources and support for residency programs).
  • Collaborative Services Agreement (a formal educational partnership between the Royal College and an institution).

Note: We have a separate set of standards and a different process for the international accreditation of simulation programs — another service we offer. This spring, we announced our first internationally accredited simulation program: The Clinical Skills & Simulation Centre at the King Abdulaziz University.


The value of Royal College international (residency) accreditation

The reason why international institutions want to partner with the Royal College on this work falls into two categories:

  1. Stature and repute: International accreditation at the institutional (or A Standards) level is recognition of stature. It is evidence that their framework and infrastructure is satisfactory and designed to operate modern residency training programs, in a variety of specialty disciplines, according to the standards of the Royal College.
  2. Pathway to certification (exams): In some cases, our international partner institutions will springboard their institutional accreditation into the next phase of accreditation: accreditation of individual specialty training programs. The successful result of an individual residency program achieving Royal College accreditation means that trainees from that accredited program would be eligible to sit our Royal College examinations.


Will opening the pathway to certification (exams) increase job competition in Canada?

To address an important question that many will ask, no, I don’t believe that accreditation of international residency programs will increase job competition in Canada. The numbers speak for themselves. We already have several thousand internationally-educated physicians in Canada as landed immigrants (more coming each year) who have been unable to practice in their discipline or specialty because they haven’t come through our registration process in Canada and been able to get a practice license. The future possibility of a small number of trainees from foreign programs having Royal College certification, which is a step towards licensure but not necessarily a step towards immigration, I don’t think will have a material effect on domestic physician employment. The purpose of this process is to help institutions provide high quality training for candidates to serve their own population and patient needs. Likewise, most of these international trainees are training because they want to be recognized for having trained in an internationally-recognized, high standard training program and are thus eligible for certification at that same high level. Those who want to come to Canada already immigrate here, regardless of our exams being open to them.


Other international work continues

I’m very energized by the level of interest by many Fellows and prospective partners in our international services. In addition to international (residency) accreditation, we are continuing to offer support by way of tailored workshops, conference support, faculty exchanges, simulation program accreditation and other activities that open up channels to share experiences, knowhow and processes. For example, effective November 1 of this year, the Royal College will formally begin a new three-year partnership with the Kuwait Institute for Medical Specialization to help them reform their postgraduate medical training programs. This is an exciting development in our relationship with this institute. We are working closely with their secretary general, Dr. Ibrahim Hadi, FRCPC, and the chair of their Office of Accreditation and Quality Affairs, Center for Postgraduate Education, Dr. Maitham Husain, FRCPC — both Fellows of our College. Dr. Hadi did training through the University of Western Ontario and was certified in Anesthesiology. Dr. Husain was certified in Pediatrics and Clinical Immunology and Allergy, following training at McMaster and the University of Toronto, respectively.


Why I think engaging with international partners is a benefit for all

I believe it is important to care about people and in what you are doing. I stand behind the Royal College’s vision of the best health for all, the best care for all. I am proud of the Royal College’s program standards. I think they are moving us closer to achieving that vision. I think they are also helping others, around the world, provide better training and ultimately better care for their patients.

In my experience, it is always worthwhile to be open to opportunity, to take the time to investigate, collaborate and consult. To quote an unknown source, a favourite expression of mine is “a mind that is expanded and stretched by a new idea never shrinks back to its original size.” The Royal College gains an incredible amount from our international partnerships. I am pleased to continue to share updates with you on this work.


Andrew Padmos, BA, MD, FRCPC, FACP
Chief Executive Officer




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Avatar Dr. Andrew Padmos | November 8, 2016
Ali, RR, M. Reslerova and Barry: Thank you for sharing your concerns. I cannot sit here and assure you that there will be no impact, but I can tell you that the purpose of this work is not to “fast track” additional physicians entering the Canadian workforce or undermine hardworking IMGs already here. The free flow of people is part of the world we live in; medical graduates or other. Our efforts to help medical education knowledge free flow around the world are to positively impact local health systems. Our goal is to help partner institutions improve their training and create sustainable capacity within their own countries (our ultimate goal: well-trained doctors, better patient care). It is not the goal of anyone for their medical trainees to leave (but those who want to will anyways); international accreditation by the Royal College creates more at-home training options that are globally-recognized, giving their graduates more options and maybe even encouraging more professionals to their own countries. In the same breath, I’d also like to assure you that we have not abandoned our work related to solving Canada’s health workforce challenges. Along with partner organizations (since this is a complex issue) we are targeting solutions to our current lack of consistent and unified data about Canada’s current and future health workforce needs. Efforts include a feasibility study to develop a new Canadian Physician Database (with the CFPC and CMA) and a Royal College Medical Workforce Knowledgebase to track trends. I hope to provide you all with a more fulsome update in my November message. If any of you would like to discuss your concerns further, please email me at with your request and we can arrange a call. – Dr. Andrew Padmos, CEO
Avatar V Barnette-Guenette | November 27, 2016
I would expect such a move to have negative effects on providing health care in this country, in the long term. Medicine in Canada has benefitted from a stringent set of standards that physicians are expected to maintain and possess. Medical training abroad is of questionable quality and cannot be accurately measured. If you look to the fields with the highest IMG contingents, they are the ones with the most frequent malpractice lawsuit burdens, the most college complaints, and the biggest problems in the news. The quality that patients expect to get from their doctors is not being met in these instances and to open borders to these doctors because "the rest of the world is doing it" is foolish and considers the practice of medicine akin to serving a coffee at Tim Hortons or making a widget in a factory. Barry mentions the influx of IMGs driving down physician negotiating power. This will repel talented dedicated individuals from medicine in the long run. The quality of doctor will go down, as will the quality of the care patients receive. Are we really serving our patients in Canada well by opening up the borders in a physician "free trade agreement"?
Avatar Barry | November 1, 2016
There is no doubt that these three sites, and others to follow, will result in a huge influx of foreign trained competition, and a decrease in negotiating power re: compensation. The relatively small number of IMGs that come to Canada do so DESPITE the fact that the likelihood of them being able to work is small. If the likelihood they would be able to work - ie they had recognized credentials already - far more will come. How could it possibly be otherwise?
Avatar V Barnette-Guenette | November 27, 2016
Consider the laboratory specialties, which might have over fifty percent of its contingent as foreign trained doctors. Partly because of this, their negotiating power has been severely weakened, as evidenced by their being the only fields that are on salary rather than fee-for-service. They serve hospital administrators, not patients. Is this the direction the Royal College wants to take all of the specialties?
Avatar M. Reslerova | October 31, 2016
Royal College certification is unattainable for most IMG specialists already residing in Canada. A "small number" of RCPSC certified IMGs will therefore significantly affect IMGs already in this country. The assumptions presented here about the lack of impact on Canadian-trained or internationally-trained specialist are oversimplified. The statement "The future possibility of a small number of trainees from foreign programs having Royal College certification...I don’t think will have a material effect on domestic physician employment" leaves me gravely concerned that the impact of such undertaking has not been considered adequately.
Avatar Sameh Barayan | October 27, 2016
Excelllent job. As a graduate of Canadian training programs and as a fellow of the college, currently residing and practicing in Saudi Arabia, I appreciate the quality and branding of the RCPSC. I agree that will pose no threats to Canadian jobs . Sameh Barayan, MD, FRCSC, FACS
Avatar Dr. Andrew Padmos | November 8, 2016
Thank you, Dr. Barayan. – Dr. Andrew Padmos, CEO
Avatar Dr. M. I . Sahadulla | October 26, 2016
How we go about if international hospitals want to get accredited and join the group.
Avatar Dr. Andrew Padmos | November 8, 2016
Hi Dr. Sahadulla, our Royal College International (RCI) team can provide you with an overview of our international accreditation process. I recommend you send your question to them by emailing – Dr. Andrew Padmos, CEO
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