Canadian Diploma in Hyperbaric Medicine Now “LIVE”!

What you need to know….

It has been a long process, but the Diploma in Hyperbaric Medicine from the Royal College of Physicians and Surgeons of Canada (Royal College) is now fully active and able to accept applications.The Diploma is part of the Royal College Areas of Focused Competence (AFC) program.There are two main agencies that certify physician qualifications in Canada, the Royal College and the College of Family Physicians of Canada (CFPC).Any licensed physician with either agency may apply for the Diploma in Hyperbaric Medicine. In addition, there is also a provision that permits a family doctor that entered practice before the requirement for CFPC registration to apply for the Diploma.Specialists that are awarded the Diploma are referred to as a Diplomate of the Royal College and may use “DRCPSC (Hyperbaric) after their name.Family doctors that are awarded the Diploma are referred to as a Diplomate-Affiliate of the Royal College and may use “D-Affiliate Royal College (Hyperbaric).”

It is important to understand that there are two “streams” for the Diploma, namely Clinical Hyperbaric Medicine (which focuses on hyperbaric oxygen treatment of approved medical conditions) and Diving Medicine (which focuses on medical aspects of diving). There is also a “combined” or “third” stream for physicians that meet the requirements for both streams of the Diploma in Hyperbaric Medicine.However, there is only one Diploma and therefore one application fee and one annual fee to maintain annual certification.If a physician later decides to transition from one stream to the combination, this would require a separate assessment process and application fee, but thereafter just a single annual fee to maintain certification.

There are two routes to physician certification with the Diploma.The first is by successful completion of a training program that is accredited by the Royal College based at a University medical school.There are no accredited training programs at present but these are expected to develop over time and Universities would charge a fee for participation.However, the training program is a route available for a physician that wants to apply with either no previous experience of Hyperbaric Medicine, less than two years of hyperbaric practice or with less experience than required in the training portfolio.The duration of training would depend on particular circumstances at the University and for the trainee.However, training would be completed once all the necessary competencies had been achieved.Universities could offer the training on a part-time basis so that a physician could continue to work while participating.The second route to the Diploma is called the PER – Practice Eligibility Route for Areas of Focused Competence (PER-AFC).This is for physicians already in hyperbaric practice for at least two years and that meet the detailed eligibility requirements.A physician could also plan to satisfy the training requirements for the PER-AFC over a period of time while working in their primary discipline.This means there is quite a lot of flexibility in how a physician can meet the requirements of the Diploma.

The application process involves a sophisticated online system called “eDiploma” that is accessed from the Royal College website.Once a physician registers for the Diploma application with the Royal College, they will get access to eDiploma.Any physician or member of the public is able to see all the requirements by going to the Royal College website.Navigating around the website to find everything is not completely intuitive however.To help this process, links are included below but not every page can be accessed from a direct link to the system and for this reason finding the necessary information will now be explained in more detail.

The Hyperbaric Medicine Diploma may be found by going to the main public website for the Royal College or paste the following into the browser: www.royalcollege.ca

Finding the information for the Hyperbaric Medicine AFC from the main page above is less than obvious:

  • Choose / click the arrow next to the word “Examinations” from the top banner of the main page
  • Then choose Information by Discipline
  • Then at the bottom of the next page from Information by AFC-Diploma choose Hyperbaric Medicine from the drop-down menu.
  • This opens a page where key Diploma documents may be found:AFC-Standards of Accreditation (for training program); Competency Training Requirements; Practice Eligibility Route (PER-AFC) Competency Portfolio; Competency Portfolio (for training program)

To find out how to apply, click the following link again or paste into browser:

www.royalcollege.ca

  • This time, instead of clicking the arrow next to the word “Examinations” click the word “Examinations” itself. This opens a new page.
  • On the left side, under “Quick Links” choose “Area of Focused Competence (AFC) diploma”
  • This opens a new page with three clickable links at the bottom:Apply; eDiploma; Roles and responsibilities.Before clicking any of them read the introductory text.
  • Following each of these links will lead to more pages, each with additional links
  • Following the different links will open pages with all the information needed to apply for the Diploma

In order to apply for the Diploma, click the “Apply” link described above.This opens a key page that can also be accessed by clicking this link:

http://www.royalcollege.ca/rcsite/credentials-exams/exam-eligibility/afc/apply-afc-practicing-e

For the PER-AFC application, go to the bottom link on the page “are currently practicing in the AFC (Diploma) Discipline”

Follow the links at the bottom of the page.

Under the bottom link “Becoming a Royal College Diplomate or Diplomate Affiliate” there is important information that should be read.This can also be accessed with the following link:

http://www.royalcollege.ca/rcsite/membership/join-the-royal-college/become-diplomate-e

The Royal College application fee for the Diploma for the PER-AFC is $1872 and for the Training Program route is $925.It is anticipated that Universities will offer training programs on the basis of at least recovering costs but what those fees may is not known at this time.The annual Dues for Diplomates and Diplomate Affiliates is $250.However, Diplomate Affiliates must also pay a separate fee of $655 to participate in the Maintenance of Competence (MOC) program1.This fee does not apply to Royal College Fellows who are already participating in the MOC program.Questions and concerns have been raised by the AFC Committee in Hyperbaric Medicine about the implications for family physicians.The key issues at present are:

  • Any requirement to pay the MOC fee to both the Royal College and the CCFP would increase the costs for family physicians.
  • There is no process to electronically transfer CPD activities between the CCFP and the Royal College, so that it would require entering information twice – once for each of the separate websites, which is inconvenient and takes more time.
  • MOC for the Royal College requires 40 credits per year.There are no specific restrictions on what can be entered into the Royal College Mainport system and nothing that prohibits the same activity being entered for both the CCFP and the Royal College.CPD activities do not all need to be accredited and for some types of CPD there is no accreditation.
  • However, it is NOT necessary to have 40 separate credits for each organization (that would require 80 credits total).Nevertheless, there is potential for confusion.On the Royal College MainPro MOC site, some types of activity ask whether the CPD was accredited (yes / no).It does not specify accredited by the Royal College.At present therefore, a physician could answer “YES” even if the activity was accredited by the CCFP or by any other organization.It is not known if the Royal College will change this in the future.
  • The Royal College Continuing Professional Development Unit has confirmed that the required MOC credits can be met from activities related to the physician’s primary (sub)specialty or AFC and not entirely relating to Hyperbaric Medicine.
  • Quebec family physicians may opt out of using the CCFP for MOC documentation and instead keep a personal journal of CPD activities.This would not suffice for the Diploma at this time.
  • Physician licensing at provincial level (except Quebec) requires participation in MOC through the Royal College or the CCFP.It would appear therefore that a physician working in Hyperbaric Medicine with the Diploma could opt to participate only through the Royal College and that this would satisfy licensure requirements.In that event however, the CCFP could require a physician registered only with the Royal College MOC program to stop using “CCFP” after their name.
  • The relationship between the Royal College and the CCFP is subject to on-going discussions and it is not known at this time whether there will be agreements between the two organizations that resolve some of the areas of duplication and uncertainty.

Royal College MOC activities are entered on the Mainport section of the website.There are three categories of CPD activity, each with subcategories:

  • Section 1 – Group Learning Activities
    • Conference
    • Journal Club
    • Rounds
    • Small Group Session
  • Section 2 – Self Learning Activities
    • Fellowship
    • Formal Course
    • PLP (Personal Learning Project)
    • Traineeship
    • Reading
    • Bulk Journal Reading with Transcript
    • Bulk Online Reading / Scanning with Transcript
    • Podcast / Audio
    • Video, Internet Searching
    • POEMS
    • Poster Viewing
    • Clinical Practice Guideline Development
    • Quality Care / Patient Safety Committee
    • Curriculum Development
    • Examination Development
    • Peer Review
    • Other Systems Learning Activity
  • Section 3 – Assessment Activities
    • Practice Assessment
    • Accredited Self-Assessment Programs
    • Accredited Simulation Activities
    • Multi-Source Feedback
    • Direct Observation
    • Chart Audit and Feedback
    • Feedback on Teaching
    • Annual Performance Review

Category 3 credits involve some type of self-assessment or simulation and these are given triple credit by the Royal College.For this reason, participation for a day in the Hyperbaric Emergency Training Simulation (HETS) course held each year in conjunction with the CUHMA Annual Scientific Meeting (ASM) would on its own account for just over half of the credits required.And attending the ASM as well would then come close to the total required for the year.Personal Learning Projects are a simple way to meet MOC requirements.Many CPD activities would be relevant to both the Royal College and the CCFP, such as a conference, BLS or ACLS training, ethics, opioid prescribing, wound care, diabetes care and many others.Attendance at rounds, participation on a committee, reading about a topic and other activities also may be counted.

To complete the application for the Diploma, all required evidence must be uploaded to eDiploma.This evidence requires anonymized case summaries, consultations and other clinical documentation of patients assessed and managed.For a training program the documents would be uploaded contemporaneously.For the PER-AFC applicant, assembling all of the evidence required will involve some effort but there is greater flexibility in what would be acceptable because getting information from the past is not as straightforward.However the same standard of competency is expected whatever the route to certification.For PER-AFC applicants pursuing the Clinical Hyperbaric Medicine stream, the applicant must also provide the names of two referees familiar with their practice and provide their referees with a brief “Scope of Practice” document.For a training program, the training director, committee and supervisors will provide documentation to support the application.For the PER Diving Medicine stream a third referee from a diving operator, diving medical support service or similar is required – however, since eDiploma does not support three referees this additional referee and their reference must be sent separately by email.When applications by either route are submitted, they are reviewed by two Assessors who make a recommendation on whether to approve a candidate.In the event of a disagreement, a third Assessor is required.Assessors must have expertise in the applicable stream(s) of the Hyperbaric Medicine Diploma.If the reports from the Assessors are marked as achieved, the candidate will be contacted by the Royal College to confirm the portfolio assessment was successful.

Getting the Diploma to this stage has involved a lot of hard work over a period of years by past and present members of the Royal College Hyperbaric Medicine Committees.The AFC-Diploma in Hyperbaric Medicine is not static.It must be reviewed and updated regularly and the AFC Committee in Hyperbaric Medicine is responsible for this and the oversight of applications and for working with the Royal College and other AFC and Specialties on the issues above and many others.Questions may be directed to the Chair of the committee and to the Royal College Membership or Credentials Units that are responsible for the processing of applications.As physicians become certified in Hyperbaric Medicine through the Royal College, we can expect that the Diploma will become respected and admired worldwide.

Summary:

  • 2 physician certification agencies (Royal College & CCFP)
  • 2 steams of the Diploma (Clinical Hyperbaric Medicine & Diving Medicine)
  • 1 combined stream (Clinical Hyperbaric Medicine PLUS Diving Medicine)
  • 2 routes to Diploma certification (Training Program & PER)
  • 2 Assessors, selected to minimize any potential conflicts of interest, are appointed to review completed applications
  • 2 referees are needed for the PER, applicants provide the names of two physician referees familiar with their practice (for the Diving Medicine stream a third non-physician referee that is a diving operator or involved in some aspect of diving is also expected.Since eDiploma can only presently accept two referees per applicant then the third reference for Diving Medicine must be emailed to the Royal College.)
  • For a training program, the Program Committee and training director provide assessments of the applicant and no referees are required.
  • The Diploma is based upon assessment of competence as determined by assessment of a range of evidences, but there is no final examination for the applicant.

Note 1:Fees are subject to change; for the most up-to-date fee information, please see the Royal College website.