Various health care institutions across the province of Ontario have supported the use of existing human health resources to act in advanced practice or extended roles to improve access to care by the right health care provider, at the right time. Over the last decade, several advanced practice/extended role models have been developed to improve access to a variety of musculoskeletal conditions throughout the province and beyond. This has included models where physiotherapists, occupational therapists, nurses, and chiropractors provide triage and supportive management for patients with a variety of rheumatic and musculoskeletal diseases (RMDs) living in urban and rural regions.
This trend toward traditional role expansion has led to the development of innovative programs to train physiotherapists, occupational therapists and other non-physician health care professionals in the advanced assessment and treatment of patients with RMDs. One such program is the Advanced Clinician Practitioner in Arthritis Care (ACPAC) Program administered through the Office of Continuing Professional Development, Temerty Faculty of Medicine at the University of Toronto and the Schroeder Arthritis Institute, University Health Network.
The ACPAC program is an innovative, comprehensive and highly structured competency-based, post-licensure education program to ensure that practitioners are appropriately trained to assume extended roles and scopes of practice. The ACPAC program is responding to the rapidly evolving healthcare environment by producing extended role practitioners who work in a variety of clinical settings. The program consists of an academic and clinical training program focused on the field of musculoskeletal health. Graduates of this program have the expertise to provide competent assessment, collaborative management with appropriate education and referral to community services, as indicated. Several studies examining the impact of the ACPAC program have been published and demonstrate improved access to appropriate care in a timely manner, high patient and provider satisfaction, improved clinical outcomes and enhanced interdisciplinary care. To date, the program has graduated 133 Advanced Clinician Practitioners in Arthritis Care.
ACPAC Program Overview
The ACPAC program is a hybrid academic and clinical training program that prepares select and experienced physical therapists, occupational therapists, nurses, and chiropractors for extended practice roles in the diagnosis and management of patients with RMDs. The program focuses on the assessment, diagnosis, triage and independent management of select musculoskeletal (MSK) and arthritis disorders. It is an adult-learner, competency-based, rigorous, interprofessional program currently delivered in episodic format over a 10-month period in Toronto.
Components
The program is focused on the entire spectrum of advanced RMD care. There are five intensive one-week sessions held either on-site or virtually between September and June, each academic year. The four components of the program are:
- Component I: Advanced Rheumatic and Musculoskeletal Disease Theory (synchronous and asynchronous learning)
- Component II: Advanced Assessment and Management Integrative Sessions
- Component III: Advanced Rheumatic and Musculoskeletal Disease Clinical Training
- Component IV: Health Promotion, Advocacy and Leadership in Rheumatic and Musculoskeletal Disease Care
Program Goals
- To offer a curriculum of rigorous, current post-entry-to-practice basic science, clinical science and therapeutic management learning experiences as they relate to rheumatic and musculoskeletal disease care fields.
- To facilitate the participant's learning of best practices through extensive clinical experience in the rheumatic and musculoskeletal disease care fields.
- To develop and prepare select healthcare practitioners (Physical Therapists, Occupational Therapists, Nurses, and Chiropractors) to be competent, independent clinicians who engage in extended practice roles in selected areas of rheumatic and musculoskeletal disease care.
- To develop and prepare healthcare practitioners to triage patients with osteoarthritis, inflammatory arthritis and other musculoskeletal conditions.
- To promote a novel model of rheumatic and musculoskeletal disease management and care that optimizes scarce healthcare resources by utilizing highly trained health professionals to promote and implement interprofessional patient-centred collaborative care.
System Level Goals
- To improve accessibility to rheumatic and musculoskeletal disease care, as a result of the participant's expanded ability to identify, assess and manage (treatment and referral) selected disorders associated with these conditions.
- To develop and prepare the ACPAC program, train practitioners to become leaders in interprofessional patient-centred education and care in the management of rheumatic and musculoskeletal diseases.
- To continue to monitor and evaluate these roles in the context of health services delivery as new models of rheumatic and musculoskeletal disease care develop.
Learning Objectives
After active engagement in and successful completion of the ACPAC Program, learners will be able to:
- Integrate the basic and clinical science underlying rheumatic and musculoskeletal diseases.
- Identify and assess patients with rheumatic and musculoskeletal diseases to formulate a differential diagnosis.
- Differentiate inflammatory from degenerative arthritic and other musculoskeletal disorders.
- Evaluate and interpret musculoskeletal radiographs and other investigations such as laboratory tests, diagnostic ultrasound, magnetic resonance imaging, computerized axial tomography, and dual-energy x-ray absorptiometry.
- Apply acquired knowledge and skills to triage patients with rheumatic and musculoskeletal diseases across diverse clinical settings.
- Collaborate interprofessionally within the health care system as a unique health human resource to address care gaps across a variety of healthcare settings.
Evaluation
Evaluation of both the ACPAC trainee and the program is rigorous. Both program and candidate evaluation will occur using the following array of assessment tools:
- CANMEDS/360 evaluation at the end of the program
- Theory/Knowledge: Pre and Post-Integrated Key Theory, Case-Based Evaluation.
- Practical Skills Evaluation: Pre and Post-Program Objective Structured Clinical Examination (OSCE)
- Clinical Performance/Competency Appraisals/Clinic logs with record of engagement in defined specialty/subspecialty clinics
Self-Directed Learning:
- Five clinical case reports: Trainees will be responsible for the identification of five content-defined clinical cases for written appraisal by ACPAC Program Medical Directors
- Problem-based Learning: Clinical scenarios/vignettes (n=11)
- Self-Directed Learning: Topic of choice (n=5)
- Model of Care Project (Baseline and End of Program)
- Asynchronous Learning Modules (n=6)
Note: It is suggested that all the above self-directed learning activities and clinic logs be compiled in an electronic professional portfolio for mid-term and final review by program directors.
Accreditation
Royal College of Physicians and Surgeons of Canada – Section 1
This program is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, approved by Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto. You may claim a maximum of 176.0 hours (credits are automatically calculated).
Upon successful completion of the ACPAC program, each candidate will earn a certificate accredited by the Division of Continuing Professional Development, Faculty of Medicine at the University of Toronto.
Faculty
The ACPAC program is hosted by the University Health Network (Schroeder Arthritis Institute) in collaboration with Mount Sinai Hospital, The Hospital for Sick Children and other healthcare institutions. The program is offered at the post-licensure level in association with the Office of Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto and benefits from the expertise of the interprofessional faculty (n=70+) who practise across a broad base of academic and community-based healthcare institutions in the Greater Toronto Area.
Solid in-kind partnerships have been established for the ACPAC Program. Included in, and integral to, this circle of support are academia (CPD, Temerty Faculty of Medicine, University of Toronto), academic healthcare institutions (University Health Network, Mount Sinai Hospital, and The Hospital for Sick Children) and industry.
Program Directors
-
Dr. Amanda Steiman, MD MSc FRCPC
ACPAC Program Medical Director-Rheumatology
Assistant Professor, University of Toronto
Staff Rheumatologist, Rheumatology, Mount Sinai Hospital/UHN -
Dr. Christopher Nielsen, MD FRCS(C)
ACPAC Program Medical Director-Orthopaedics
Assistant Professor, University of Toronto
Staff Orthopaedic Surgeon, Spine, Toronto Western Hospital/UHN
Clinician Investigator, Krembil Research Institute -
Laura Passalent, BScPT MHSc ACPAC
ACPAC Co-Director, Operations
Assistant Professor, University of Toronto
Physiotherapist Practitioner, Schroeder Arthritis Institute, Toronto Western Hospital-UHN
Clinician Investigator, Krembil Research Institute -
Leslie Soever, BScPT MSc ACPAC
ACPAC Co-Director, Operations
Physiotherapist Practitioner
Schroeder Arthritis Institute
Toronto Western Hospital-UHN
Curriculum Content Leads
Imaging
- Dr. Rakesh Mohankumar, MBBS FRCR FRCPC
Assistant Professor of Medical Imaging at the University of Toronto
Musculoskeletal Radiologist at the Joint Department of Medical Imaging
Pharmacology
- Carolyn Whiskin, RPh BScPhm NCMP
Clinical Pharmacist, Charlton Health - Kunal Bhatt, RPh BScPhm NCMP
Clinical Pharmacist, Charlton Health
Paediatrics
- Dr. Deborah Levy, MD MS FRCPC
Associate Professor, University of Toronto
Rheumatologist, Hospital for Sick Children
