Royal College Consultation: Neonatal Echocardiography Discipline

Stakeholder of the Royal College:


We are writing to seek your feedback on a newly proposed AFC (diploma) in targeted neonatal echocardiography. As a key stakeholder of the Royal College, you are being consulted to provide your perspective and to offer you an opportunity to voice any benefits or concerns you foresee with the proposed new discipline.

What is the AFC (Diploma) category and what is its intent?

The AFC diploma category was developed to create national standards, not to replace specialists’ existing scopes of practice. Akin to current clinical fellowship or post-residency training in that they are equivalent to one to two years of additional training and do not receive funding from the provincial/territorial governments, the AFC (diploma) category is intended to:

  • Help 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 certification 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.

For additional information regarding the AFC category and its goals, please click here.

Please also read the section ‘What is my role as a respondent’ for details about how to submit your completed questionnaire by August 19, 2019.

What is the purpose of this consultation?

The Royal College regularly conducts consultations on pending decisions regarding the recognition of new disciplines to ensure that the point of view of its stakeholders are taken into consideration and to avoid unintended consequences to the system of specialty medicine. This feedback will be presented to the Committee on Specialties (COS) at their next meeting. The COS values the feedback from consultations as it helps the committee to make critical decisions of importance to the entire system of specialty medicine.

You have received this consultation invitation because a new AFC (diploma) in targeted neonatal echocardiography has been proposed by the Pan-American Hemodynamics Collaborative. As one of our key stakeholders, you have been selected, along with many of your peers in specialty medical education/regulation, to provide input through this process.

What is currently being proposed?

The application highlights the importance of this discipline for the following reasons:

  • That, due to a significant evolution to the approach to cardiovascular care in neonates and the role of echocardiography, targeted neonatal echocardiography has become the standard of care in many Neonatal Intensive Care Units (NICU) in Canada,
  • Similar to the AFC in Adult Echocardiography for adult populations, the proposed AFC in targeted neonatal echocardiography would provide additional competencies for neonatologists to improve the outcomes of the neonatal population by assessing cardiovascular health, obtaining physiologic information relevant to the clinical situation, formulating a diagnostic impression, making a therapeutic recommendation and evaluating the response to treatment.
  • As the primary physicians administering clinical care, neonatal intensivists are uniquely positioned to conduct, interpret and integrate in-time echocardiographic information to direct therapeutic interventions aimed at achieving cardiorespiratory stability.

What have been the results of the Committee on Specialties’ discussion thus far?

Following their review at the spring 2019 meeting, the committee agreed that that the proposal clearly articulated and demonstrated an increasing evidence of need and a gap in associated care. Ultimately, the committee voted to approve the application at Part I and asked the applicant to:

  • Further explore the suitability of Pediatric Cardiology as an entry route via an elaboration on the degree of overlap with Pediatric Cardiology, including how much training in targeted neonatal echocardiography is already included in their scope of practice, and what additional competencies trainees would need to acquire in neonatology to be eligible for this diploma, and
  • Further articulate the distinction between the competencies in Neonatal-Perinatal Medicine and the advanced skills intended to be part of the AFC in targeted neonatal echocardiography.

The applicant’s response to the requested clarifications is included in the consultation package, available through

What is my role as a respondent?

  • Review the PDF package (available through , which includes the application document, a draft of the competency training requirements (CTR) for the discipline, letters from stakeholders, and any other supplemental material.
  • Complete the questionnaire (available through This information is important as it aids the Royal College in accurately categorizing respondents, and ensures that we do not misinterpret any of our stakeholders’ responses.
  • If applicable, include a supplemental letter in addition to the questionnaire if you have further comments or questions.
  • Review the supplemental documents (available through for additional details about the AFC category and criteria for recognition.
  • Submit the questionnaire by August 19, 2019 by clicking the SUBMIT button, found at the bottom of the questionnaire form. If you prefer, your response may be sent in hard copy to:

Royal College of Physicians and Surgeons of Canada

Office of Specialty Education – ESID

774 Echo Drive

Ottawa, ON K1S 5N8


What happens next?

The COS will meet November 14-15, 2019, and will consider, at Part II, the application for an AFC (diploma) in targeted neonatal echocardiography, including the results of this consultation. Should this AFC (diploma) application be approved by the COS at that stage, the application would proceed to the Royal College’s Committee on Specialty Education for final approval.

In response to stakeholders’ feedback, and to improve the transparency of our decision-making processes, once a decision has been made by the COS (and the CSE, as appropriate) in fall 2019, the Royal College will issue a memorandum to all stakeholders informing you of the outcome, including a summary of the national consultation results as well as the resulting decision(s). This memo will be issued approximately six weeks after the November COS meeting.

Thank you for taking the time to share your comments and observations with us on these important topics. Should you have any questions concerning these consultations, please do not hesitate to contact our office by email at or by telephone at 1-800 668-3740 extension 243. Ms. Emma Huck, Program Coordinator, will be happy to assist you.

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