Royal College of Physicians and Surgeons of Canada
Royal College of Physicians and Surgeons of Canada: Applying competency-based practices to residency education
To contribute to the success of Canadian physicians and the delivery of high-quality patient care, the Royal College of Physicians and Surgeons of Canada has embarked upon an initiative to introduce competency-based medical education (CMBE) in Canadian postgraduate specialty training and in professional practice in Canada. This initiative, called Competence by design (CBD), aims to enhance patient care by aligning medical education and lifelong learning with evolving patient needs and empowering learners to more fully engage in their education process.
CBD will use time as a framework rather than the basis for progression. It is not anticipated that the duration of training will change for the majority of trainees. Residency programs will be broken down into stages, and each stage will have a series of milestones based on required competencies. These milestones will create more targeted learning outcomes and involve more frequent, formative assessments within the clinical workplace to ensure residents are developing and receiving feedback on the skills they need.
The Royal College anticipates that all specialty and subspecialty programs in Canada will adopt CBD in gradual phases. All disciplines have been divided into seven cohort groups, each of which will adopt CBD at different times. National implementation of CBD within certain, individual programs has commenced in July 2017, with more disciplines to follow in subsequent years.
Neurosurgery has implemented these changes as of July of 2019.
All programs implementing CBD will continue to undergo the same rigorous accreditation processes as traditional programs. All CBD programs (and traditional programs) will continue to lead to Royal College approved certification. Certification for trainees in both CBD and traditional programs will include the completion of a Royal College examination; however, residents in CBD programs will also be assessed against program milestones throughout their training. Within a CBD program, all milestones (documented within an electronic portfolio) and the Royal College examination must be successfully completed to achieve certification.
For more information, please contact email@example.com.
The Ministry requests all ROS agreements before June 1 of the year they were matched. All agreements should be returned to the Ministry prior to the start of residency training. It is the responsibility of the applicant to confirm eligibility with respect to THE ROS requirements of other provinces.
Information about the Ministry’s ROS programs is available at the Return of Service Program
A letter of release from existing return of service agreements must be submitted as part of the application.
Program application language: English
Proof of valid current citizenship or permanent resident status must be provided by submitting one of the following verifications to CaRMS by the File Review Opening deadline. Failure to provide valid proof will result in your application being removed. No other forms of verification are acceptable:
CaRMS is partnering with third-party organizations to automate the verification of citizenship/legal status required by postgraduate offices for entry into residency. Third-party verification simplifies the process for applicants and programs. All applicants who do not receive third-party citizenship verification will be required to upload and assign an acceptable proof of citizenship document. Please see additional information here.
Language assessment document accepted: TOEFL-iBT
Language assessment document accepted: IELTS Academic
Language assessment document accepted: Occupational English Test (OET) -Medicine
Language assessment document accepted: Canadian English Language Proficiency Index Program (CELPIP) – General
Language assessment document accepted: Letter of language proficiency*
*Alternatively, candidates can submit a printout from the World Directory of Medical Schools which clearly states that the language of instruction is English or French.
The IELTS Indicator will be accepted as a substitute for the Academic Version of the IELTS.
The TOEFL iBT Home Edition will be accepted as a substitute for the TOEFL iBT.
Applicants must be able to communicate proficiently in the language of instruction and patient care of the matching school and training site. Please review specific program descriptions for more information.
Three letters of reference are required. If possible, one or more letters from a faculty member in Neurosurgery is helpful but not required.
We are looking for very strong reference letters, ideally based on referee's direct observation of the applicant’s performance in a clinical setting with responsibilities at least equivalent to a senior medical student, within the last 3 years.
We will accept a reference from a senior resident but faculty references are strongly preferred.
Your medical school transcript can be submitted through one of the methods below:
Photo required for memory aidMedical Student Performance Record
For International (IMGs) and United States (USMGs) medical graduates, you can submit your MSPR through either of the methods below:
The letter is an opportunity for the candidate to describe personal characteristics and information that are not elsewhere in the application (education, research or references). Most importantly, the candidate must explain why neurosurgery is their career choice and why the University of Toronto would ideally suit their training requirements.
Maximum word count: 1000 (no minimum)MCCQE Part I - Statement of Results
For more information on the MCCQE Part 1 click on the following link https://www.mcc.ca/examinations/mccqe-part-i/NAC examination - Statement of results
* MCCQE part II can be used to apply instead of the NAC
For more information on the NAC OSCE click on the following link National Assessment Collaboration | Medical Council of CanadaNAC examination - Supplemental Information Report
* MCCQE part II can be used to apply instead of the NAC
For more information on the NAC OSCE click on the following link National Assessment Collaboration | Medical Council of Canada
Applications submitted after file review has opened on January 10, 2023
Supporting documents (excluding letters of reference) that arrive after file review has opened on January 10, 2023
Letters of reference that arrive after the unmasking date on January 10, 2023
The selection process below is carried out by the CaRMS Selection Committee, which generally consists of up to 10 members: Program Director, Division Chair, 3-4 faculty RPC representatives, 4 resident RPC representatives, plus potentially 1 ad hoc invited faculty member.
File Review Process (February):
What is assessed?
Attributes assessed and relative weighting
Applicants providing evidence of the following in the CaRMS application file will be prioritized for further consideration:
Full CaRMS application, incl. provided reference letters
· Academic achievement (33%)
· Interest in neurosurgery (33%)
· Reference letters (33%)
· Where available, university and medical school transcripts demonstrating high academic standing
· Where available, high scores on standardized medical examinations (e.g., NBME or MCCQE1)
· Academic awards and scholarships based on academic achievement
· Record of research achievement in neurosurgery
· North American neurosurgical experience, within the last 3 years, of at least 4 weeks in total duration in a neurosurgical clinical teaching unit or equivalent with direct exposure to a neurosurgery residency program, involving actual clinical responsibilities in an in-patient setting with on-call responsibilities - We recognize that the COVID-19 pandemic has impacted candidates’ opportunities to arrange and complete electives and would like to reassure applicants that a lack of elective activity this year will not negatively impact their application to our program.
· Very strong reference letters - see "Reference documents" for details.
Based on this assessment, at the end of the file review process, all candidates who have received sufficient endorsement from at least a majority of Committee members will be offered interviews. Interview offers will be sent mid-late February.
Interview Process (March):
What is assessed?
Attributes assessed and relative weighting
Successful applicants will be able to demonstrate the following:
Formal interviews, plus further review of full CaRMS application.
· Interview performance (35%)
· General fit with the Program (30%)
· Academic achievement (10%)
· Reference letters (25%)
· Strong general communication skills at the time of the interviews
· Strong extemporaneous thought processing skills at the time of the interviews
· Strong interpersonal skill and suitable temperament
· Good judgement, guided by principles of ethics and compassion
· Superior academic achievement as measured by grades, academic awards, or research accomplishment
· Strong letters of reference
Based on the assessment above, at the end of the interview process, a final ranking of all candidate will be made and submitted to CaRMS. The selection committee reserves the right to adjust final rankings by consensus to address issues of program priority or diversity.
The specific goals of our Program are to produce fully trained neurosurgeons who
o excellent technical competence
o excellent judgment
o a thorough knowledge of related disciplines, including basic neuroscience, clinical research methodology, neurology, neuropathology and neuroradiology
o superior managerial, professional, communication, and health advocacy skills
o have obtained a higher research degree, such as an M.Sc. or Ph.D., in order to develop research interest, ability and training
o have teaching interest, ability and training
As such, our Program seeks a cohort of residents who have demonstrated superior academic standing, strong work ethic, dedicated interest in neurosurgery, strong interpersonal and communication skills, and characteristics of empathy and compassion. These are the personal attributes that are the foundation of an exemplary neurosurgeon and what we strive for in our trainees.
Neurosurgery is a very demanding field and places stringent requirements on candidates’ intellect, stamina, emotional fortitude, interpersonal skills, and ability to work under pressure. Given the high attrition rate seen in neurosurgery training programs, it is essential that candidates clearly demonstrate to the Selection Committee an adequate intellectual capacity, demonstrated interest in neurosurgery, demonstration of an understanding of what Canadian neurosurgery residency entails, with proven ability to work in a Canadian neurosurgical clinical teaching unit environment. The applicant must demonstrate that they have the potential to fulfill all CanMEDS competencies required of a Canadian neurosurgeon.
Review team composition : The CaRMS Selection Committee consists of 10 members: Program Director, Division Chair, 3-4 faculty RPC representatives, 4 resident RPC representatives, and possibly an additional ad hoc invited faculty member.
Average number of applications received by our program in the last five years : 0 - 50
Average percentage of applicants offered interviews : 76 - 100 %
|CV||Academic awards and scholarships based on academic achievement.|
|Electives||We recognize that the COVID-19 pandemic has impacted candidates’ opportunities to arrange and complete electives and would like to reassure you that a lack of elective activity this year will not negatively impact your application to our program.|
|Examinations||High scores on standardized medical examinations.|
|Personal letters||See "Additional Documents" for details.|
|Reference documents||See "Reference Documents" for details.|
|Research/Publications||Record of research achievement in neurosurgery.|
|Transcripts||Demonstrating high academic standing.|
Interview format :
We may accommodate requests to re-schedule interviews for applicants due to weather, technology failure, or unforeseen circumstances.
|Collaboration skills||See Interview Process details above|
|Collegiality||See Interview Process details above|
|Communication skills||See Interview Process details above|
|Health advocacy||See Interview Process details above|
|Interest in the discipline||See Interview Process details above|
|Interest in the program||See Interview Process details above|
|Leadership skills||See Interview Process details above|
|Professionalism||See Interview Process details above|
|Scholarly activities||See Interview Process details above|
|Other interview component(s)||Full details provided in Interview Process section above.|
The University of Toronto, Division of Neurosurgery, runs an active virtual didactic curriculum for residents every Friday morning (Brain School). Time to attend these teaching sessions is protected, with residents relieved of clinical and on-call duties during this time, to facilitate their attendance. Lectures are organized by topic and sub-specialty and led by faculty representatives, and overseen by an educational and curriculum director. The curriculum consists of lectures, videos, mock oral examinations, and case presentations and is a major component of neurosurgical education delivery. Lecture presentations are stored on a webpage for neurosurgery residents and is password protected. Residents studying for their written examinations or preparing for their Royal College Examination will review these lecture notes on a regular basis.
The University of Toronto, Division of Neurosurgery has opportunity for electives for its residents. Three to six month elective may be possible if scheduling permits and planned in advance. This is usually taken during the PGY-4 to 5 year level. It can be in a neurosurgical subject or a non-surgical neuroscience topic. Examples of previous electives taken by residents include Canadian private practice, academic neurosurgery in other North American or international centres, and neurosurgical outreach in low income countries.
Currently, there are 38 residents enrolled in the University of Toronto Neurosurgical Residency Training Program, 32 faculty members with 7 affiliated neurosurgery scientists.
There are no mandatory rural rotations.
This residency program is for 6 years.
Program length of training does not exceed the Royal College or College of Family Physicians of Canada standard.
PGY-1 & 2 Surgical Foundations Objectives of Training
The Division of Neurosurgery is a participant in the Core Surgical Program at the University of Toronto. The PGY-1 year consists of 4 weeks of Surgery and Neurosurgery Prep Camp Orientation, 8 blocks of adult neurosurgery (includes neurotrauma/neurocritical care), 2 blocks of pediatric neurosurgery, 2 blocks of surgical elective (selected from orthopedic-spine, vascular, cardiac, thoracic, plastics or ENT), and 1 block of emergency medicine. The PGY-2 year consists of 2 blocks of neurocritical care, 2 blocks of Neurology, and 9 blocks of neurosurgery.
Effective July 1, 2008 all University of Toronto PGY1 residents are required to complete the web based PGCorEd core competency modules as part of their residency program certification. These modules provide the foundation for the non-Medical Expert roles for the Royal College of Physician and Surgeons of Canada Specialty Programs.
These modules will be required for completion before the end of the PGY2 year. Failure to complete the modules required by their program will delay processing of their FITERs and may constitute professional misconduct.
PGY-3 to 6
The total amount of clinical neurosurgical experience required by the University of Toronto program and the Royal College is 42 months. Included in the 42 months of clinical neurosurgery are 6 blocks on pediatric neurosurgery and 13 blocks (12 months) as a Chief neurosurgical resident. Neurosurgical residents rotate through neuropathology for 1 block during PGY5.
Residents are expected to pass the Royal College Foundation of Surgery Examination in their PGY-2 year. PGY1 and PGY2 residents attend the Department of Surgery, Foundation of Surgery Lecture Series on Tuesday mornings. Throughout the program, residents are expected to develop skills in microsurgical techniques, spinal neurosurgery, cranial neurosurgery and peripheral nerve and brachial plexus surgery. Financial support toward attendance at academic conferences is provided, especially for residents whose work has been accepted for presentation at the meeting.
Research and Courses
The description of research training in the Division of Neurosurgery at the University of Toronto can be found directly at the following source: Research (http://surgery.utoronto.ca/division-neurosurgery-research)
Seminars and Other Formal Teaching Sessions
All residents have an opportunity to attend the Lougheed Microsurgical Course, and the ATLS Course.
The weekly 3-hour didactic neurosurgical and basic science lecture curriculum (Friday morning "Brain School") is supplemented with various formal rounds, journal clubs hosted at faculty residences, seminars, and annual visiting professorships.
The University of Toronto Surgical Skills Laboratory provides opportunities for technical training in Core and Specialized Neurosurgery at the PGY-1 level (see below), including an intensive "Neurosurgery Crash Course" held during the month of July of the PGY1 year. Numerous practical anatomy and dissection courses are held throughout the academic year for all residents.
PGY1 Prep Camp
As of July 1, 2013, the Department of Surgery and University of Toronto Surgical Skill Centre located at Mount Sinai Hospital introduced a new curriculum format for technical skills training for PGY1 surgical residents. The new curriculum focuses on a 2-week summer training session incorporating both technical skill programs and didactic sessions. All sessions are relevant to the Royal College CANMEDS design.
The Prep Camp program includes the following:
Each day begins at 0800 hrs with a 1 hr didactic lecture followed by hands on sessions in the Surgical Lab from 0900-1400 hrs. Between 1400-1600 hrs, this time is dedicated to independent practice and research in education opportunities within the Surgical Lab environs. Instructors for the summer sessions include nurses, residents, faculty, industry and associate health care partners.
PGY1 Neurosurgery Crash Course
Every summer, the Division of Neurosurgery runs an intensive practical introductory course for our new PGY1s to learn about the acute management of important neurosurgical conditions. This is taught by faculty and senior residents and prepares our new residents for the acuity of patients seen in neurosurgery.
There are 31 full-time neurosurgeons, and 1 part-time neurosurgeon at the University of Toronto. The Program is conducted at 4 clinical sites (Toronto Western Hospital, St. Michael’s Hospital, Sunnybrook Hospital, and SickKids Hospital), each with its own personality and profile of excellence, performing over 6000 cases per year, and with international leaders in all subspecialties. The breadth, size, and diversity of our Program allow us to tailor every resident’s training to fit their individual career goals and aspirations. Residents are exposed to the following subspecialties during their training: Epilepsy (80 adult, 80 peds cases annually); Functional (70 neuromodulation & 50 non-neuromodulation cases annually); Oncology (1000 brain & spinal tumours cases per year); Pediatrics (over 500 cases annually); Radiosurgery (200 Gamma Knife cases annually), Skull Base (over 300 cases per year); Spine (over 2000 cases annually); Trauma (Sunnybrook, St. Michael’s, and SickKids each serve as the largest Level 1 trauma centres in Ontario); Vascular and Endovascular (over 250 open vascular and 500 neuroendovascular cases annually).
This program places special emphasis on the training of neurosurgeons for academic careers. Those interested in an academic career will be encouraged to have at least a two year research experience. Opportunities are available to do research leading to the M.Sc. or Ph.D. degree in the Department of Surgery's Surgeon Scientist Program https://surgery.utoronto.ca/surgeon-scientist-training-program
Pre-residency Orientation Programs
All IMG candidates accepted to all residency programs will be required to complete either the Pre-Residency Program (PRP) or the Pre-Residency Program for Family Medicine (PRPFM) prior to entering into a residency program. Matched IMGs will be expected to attend these programs in Toronto, several weeks in advance of the start of their residency program. In some cases, this may result in a delay of the start date of the residency. Additional information on the PRP and PRP FM programs can be found at the following link: Touchstone Institute.
Assessment Verification Period
All IMG candidates accepted to residency training programs will be required to undergo an Assessment Verification Period (AVP). This assessment period is normally 12 weeks in length and is required by the College of Physicians and Surgeons of Ontario to obtain an educational license to enter a residency program. CPSO – International Medical Graduates (IMGs).
IMGs that have failed an AVP and are reapplying through CaRMS are ineligible to apply for training in the same specialty in Ontario but may apply to a different specialty in the first and/or second iteration. IMGs who have withdrawn from a program prior to completion of an AVP must declare so upon application.
Additional Ontario Information:
Further information may be obtained by contacting the above address, telephone (416) 603-5503. The description of the Neurosurgical Training Program at the University of Toronto for current and prospective residents in neurosurgery is available at the following source: Division of Neurosurgery (https://surgery.utoronto.ca/residency-division-neurosurgery)
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