Areas of Focused Competence (AFCs)

Areas of Focused Competence (AFCs) are areas of specialty medicine that address a legitimate societal and patient population need that was unmet by the system of primary and subspecialty disciplines. Akin to current clinical fellowship or post-residency training in that they are equivalent to one to two years of additional training, the AFC category is intended to:

  • Establish national standards for training and specialist competence, designed to improve quality of care and patient safety,
  • Prevent unnecessary fragmentation of specialty training, care and practice by providing credentials in highly focused areas of practice that may otherwise be considered for recognition as a subspecialty,
  • Provide Fellows with additional opportunities to acquire nationally and internationally portable credentials — the Diploma of the Royal College of Physicians and Surgeons of Canada (DRCPSC), and
  • Offer universities opportunities to enhance the academic environment.

AFCs and the System of Specialty Medicine

An AFC is a category of discipline that builds upon a physician’s certification (either specialty or subspecialty) through supplemental or advanced training/practice as defined by the Royal College national standards. AFCs do not create a “backdoor” entry route to primary or subspecialty certification, and should not be considered “residency light.”

The scope of AFC disciplines may be narrow or quite broad. For example, Cardiology is the entry route to numerous AFC disciplines, each of which has a narrow yet highly-specialized range of clinical competencies. In comparison, the AFC in Patient Safety and Quality Improvement allows entry from any specialty and includes specialized, non-clinical competencies. The Committee on Specialties can offer guidance on eligibility criteria.

Pathways to designation

Once an AFC is established, the AFC program provides two pathways to the credential and designation:

  1. In-training route
    The in-training route is available through medical schools with accredited AFC training programs. AFC training programs provide competency-based, post-residency medical education. One must demonstrate their competency, skills and knowledge of the discipline through the successful completion of an evidence-based, summative portfolio. Once completed to the program’s satisfaction, the trainee is deemed eligible for the diploma and designation.
  2. Practice eligibility route (PER-AFC)
    The practice eligibility route is available to physicians who have gained competence in the discipline through their own practice. PER-AFC is an application-based process and, if successful, deems the physician eligible for the diploma and designation.

Learn more about the pathways to designation as a Diplomate of the Royal College (DRCPSC).

The designation of Diplomate

All physicians and surgeons who are deemed eligible for the designation by an accredited program or assessor pool (PER-AFC) may become a Diplomate of the Royal College and use the designation DRCPSC.

Members with a DRCPSC are known nationally and internationally as individuals who have sought to advance their knowledge and expertise with additional complementary skills and competencies.

Recognized AFC disciplines

As of November 2022, the Royal College has recognized the following AFC disciplines:

  • Acute Care Point of Care Ultrasonography
  • Addiction Medicine
  • Adolescent and Young Adult (AYA) Oncology
  • Adult Cardiac Electrophysiology
  • Adult Congenital Heart Disease
  • Adult Echocardiography
  • Adult Glomerular Diseases
  • Adult Hepatology
  • Adult Interventional Cardiology
  • Adult Thrombosis Medicine
  • Advanced Heart Failure and Cardiac Transplantation
  • Aerospace Medicine
  • Antimicrobial Stewardship
  • Brachytherapy
  • Child Maltreatment Pediatrics
  • Clinician Educator
  • Consultation Liaison Psychiatry
  • Cytopathology
  • Hematopoietic Stem Cell Transplantation and Cellular Therapy
  • Hyperbaric Medicine
  • Neuro-Intervention
  • Neuromuscular Medicine
  • Patient Safety and Quality Improvement
  • Pediatric Anesthesiology
  • Pediatric and Perinatal Pathology
  • Pediatric Urology
  • Prehospital and Transport Medicine
  • Retina
  • Sleep Disorder Medicine
  • Solid Organ Transplantation
  • Spine Surgery
  • Sport and Exercise Medicine
  • Neonatal Hemodynamics and Targeted Neonatal Echocardiography
  • Neonatal Neurocritical Care
  • Transfusion Medicine
  • Trauma General Surgery