Policies

Policies and guidelines that govern the PGME program.

Postgraduate Clinical Fellowship Policy

A. Definition:

A fellow is a postgraduate medical education trainee undertaking post-certification educational training outside the specialty or subspecialty residency training requirements of the RCPSC or CFPC. A fellowship cannot be credited toward national certification requirements.

B. Requirements:

A postgraduate fellow must be eligible for a license with the College of Physicians and Surgeons of Ontario (refer to the CPSO website for specific requirements).
All clinical fellowships must have clearly defined written educational goals and objectives, as per the standards of the College of Physicians and Surgeons of Ontario.
There must be a designated Fellowship Director.
New fellowship programs must be reviewed and approved by the Vice-Dean, PGME prior to offering a candidate a fellowship position.
The fellowship director must review the planned number of fellows with any affiliated residency program director and Department Chair to ensure it will not negatively impact residency training. The Department Chair or delegate will make the ultimate decision on number of fellows.
Fellowships must include formal periodic and final evaluation of performance (ITER).
All fellows who wish to have their training recognized by the University of Ottawa must be registered as a postgraduate trainee with the Faculty of Medicine. A registered fellow will receive a certificate of completion of training, upon confirmation of satisfactory completion by the fellowship director and/or affiliated program director.
The term of a fellowship is a minimum of 6 months and a maximum of 3 years. Any fellowship shorter than 6 months requires the approval of the Vice Dean of PGME or delegate. Any trainee who wishes to complete more than 3 years of fellowship training at the University of Ottawa requires approval of the Clinical Fellowship Committee. In such cases, the fellowship program director must present to the committee in person to justify the fellowship.
uOttawa PGME full-time Clinical Fellows are required to have the opportunity to earn or be provided a minimum of $70,000 / year as their fellowship salary, as per the “Salary for Clinical Fellows Policy”.
Each fellowship program is required to institute a regular formalized review of the program. The individual ultimately responsible for oversight of regular formalized reviews is the Departmental Fellowship Lead.

Committee	Date
Clinical Fellowship Committee	February 13, 2023
Faculty Council	May 9, 2023
Executive Committee of the Senate	June 12, 2023

Purpose

The following serves to provide a structured and systematic remediation program for residents who have skill deficits in quality-associated competencies, and who have come to the attention of the Program Director(s) and/or the Postgraduate Medical Education (PGME) office.

Application

Where a resident:

has one (1) or more "Red Range" behaviours on the Quality PULSE 360;
his/her Program Director(s) has received verbal or written complaints, even if de-identified;
the Assistant Dean, PGME, concurs that the resident would benefit from an Intensive Program (i.e. residents’ remediation program);

THEREFORE a Recommendations Report (i.e. performance improvement plan) will be requested from PULSE. Recommendations Reports are based on the Quality PULSE 360 findings and/or input from the Program Director(s) and/or Assistant Dean, PGME.

The Assistant Dean, PGME, or his/her delegate, will review the Recommendations Report and determine if the recommendations are approved.

Remediation Periods

The following recommendations reflect the typical components of a remediation plan.

An initial 3-6 month remediation period includes:

A debriefing meeting with a coach, as approved by the PGME office, will be scheduled. The resident and the coach will create a “PULSE Plan” (i.e. excellence goals derived from the Quality PULSE 360 and associated feedback). The PULSE Plan must be approved by the Program Director(s) and/or Assistant Dean, PGME before it is finalized.
A reminder/reinforcement program will be launched, using the automated PULSE software which generates weekly reminders of established excellence goals in the form of texts and/or emails.
An intensive coaching program will begin after the debriefing. The maximum number of coaching sessions is calculated based on the “Red-Yellow Formula”, which recommends up to a maximum of one (1) coaching session (one hour) for each "Red Range" question score, and for each three (3) "Yellow Range" question scores. Coaching sessions may be divided into 20 or 30 minute segments. The frequency of sessions is determined at the discretion of the resident and the coach: coaching frequency might be weekly for the first few weeks, then bi-weekly, and then monthly.
Educational modules may be recommended, based on specific “Red” and “Yellow” range behavioural skill deficits. The resident must pass all associated multiple choice tests.
A follow-up PULSE 360 test must be performed after three (3) months. Additional tests may be performed more frequently, as required, for example monthly rotation 360s.
Other developmental recommendations may be required, as approved by Program Director(s) and/or Assistant Dean, PGME.

A second 3-6 month remediation period, as applicable, includes:

A follow-up PULSE 360 test must be performed after three (3) months. Additional tests may be performed more frequently, as required, for example monthly rotation 360s.
Additional maintenance coaching, as determined by the follow-up PULSE 360 scores. Additional coaching must be approved by the Assistant Dean, PGME.
A continued reminder/reinforcement program using the automated PULSE software.

Funding

This program is funded by Postgraduate Medical Education; twenty (20) hours of coaching is the lifetime maximum per resident.

Committee	Date
Postgraduate Medical Education Committee	October 26, 2016
Faculty Council	March 21, 2017
Executive Committee of the Senate	October 10, 2017

Effective date: Immediately following approval from the Executive Committee of University Senate.

1. INTRODUCTION

1.1 This policy of The Faculty of Medicine ensures that there is a fair and transparent assessment system for postgraduate trainees enrolled in postgraduate residency training programs and Area of Focused Competency (AFC) diploma programs at the University of Ottawa Faculty of Medicine

1.2 This policy has been developed to be in compliance with the accreditation standards of the Royal College of Physicians and Surgeons of Canada (RCPSC) and the College of Family Physicians of Canada (CFPC). This policy is also designed to be consistent with the following University of Ottawa academic policies, and policies of the following medical organizations:

The University of Ottawa Faculty of Medicine Professionalism Policy;
The College of Physicians and Surgeons of Ontario (CPSO) - Professional Responsibilities in Medical Education; and
The Canadian Medical Association Code of Ethics (CMA).

2. PURPOSE

2.1 The purpose of this policy, the Policy and Procedure for the Assessment of Postgraduate Trainees (“policy”), is to outline the processes governing assessment for all postgraduate trainees enrolled in accredited residency programs and Area of Focused Competency (AFC) diploma programs at the University of Ottawa Faculty of Medicine.

3. SCOPE

3.1 This policy sets out the procedures for the assessment of trainees. Trainees are responsible for becoming familiar with this policy.

3.2 This policy is designed to apply to both time based and competency based educational experiences and programs.

3.3 This policy does not cover trainees during the Assessment Verification Period (AVP), AVP Extension/remediation period or Pre-Entry Assessment Program (PEAP). For these trainees, the relevant CPSO policies (AVP_Policy_2016.pdf) apply.

3.4 In this policy, the word “must” is used to denote something that is required, and the word “should” is used to denote something that is highly recommended.

4. DEFINITIONS

For the purposes of this Policy,

4.1 “AFC” means Area of Focused Competence and is a post-residency diploma program that provides additional training and is accredited by the Royal College of Physicians and Surgeons of Canada.

4.2 “Assessment” is the process of gathering and analyzing information in order to measure a trainee’s competence or performance and compare it to defined criteria.

4.3 “AVP” means Assessment Verification Period. The AVP is a period of assessment to determine if an international medical graduate (IMG) can function at their appointed level of training prior to full acceptance into the residency program to which they have been accepted. Successful completion is a requirement to obtain an unrestricted postgraduate medical education certificate of registration (educational license) from the College of Physicians and Surgeons of Ontario. A successful AVP should be credited towards residency training time. An extension of an AVP, which must be accompanied by a remediation, may or may not be credited towards residency training.

4.4 “Competence Committee” as defined by the RCPSC is a subcommittee of the Residency Program Committee (RPC) and is the committee that makes recommendations about promotion and needed academic support to the RPC and the program director. Recommendations are made using highly integrative data from multiple observations and other sources of data, as well as feedback from clinical practice. All recommendations must be reviewed and approved by the RPC and the Program Director.

4.5 “Designated assessment tools” means assessment tools approved by the RPC and Fellowship Program Committee (FPC) of each program for inclusion in the assessment plan of residents and fellows which are appropriately tailored to the specialty, level or stage of training, and the national training standards.

4.6 “Educational experience” refers to the activity or setting in which the trainees have the experiences that allows them to achieve pre-defined goals and objectives and/or milestones and competencies. Examples of words commonly used to describe discrete clinical training experiences include rotation, longitudinal clinics, call, etc.

4.7 “EPA” means entrustable professional activity and is an authentic task of a discipline.

4.8 “Fellow” means a physician registered in an AFC Diploma training program accredited by the RCPSC and who is registered in the Postgraduate Medical Education Office of the Faculty of Medicine of the University.

4.9 “Fellowship Program” means the RCPSC AFC postgraduate fellowship training program.

4.10 “FPC” means the Fellowship Program Committee and it is the committee that assists the Fellowship Program Director in the planning, organization, and supervision of the fellowship training program and includes representation from the fellows in the program.

4.11 “Formative assessment” refers to assessments done to monitor a trainee’s progress and to give ongoing feedback.

4.12 “IMG” means International Medical Graduate and is an individual who has graduated from a non-Liaison Committee on Medical Education/Committee on Accreditation of Canadian Medical Schools (non-LCME/CACMS) medical school, who is either a Canadian citizen or a permanent resident and who meets the criteria of an IMG as defined by the CPSO.

4.13 “Milestone” is an observable marker of an individual’s ability along a developmental continuum.

4.14 “PGEC” means the Faculty Postgraduate Medical Education Committee and is the committee responsible for the development and review of all aspects of postgraduate medical education within the Faculty of Medicine and is chaired by the PGME Vice-Dean.

4.15 “PEAP” means Pre-Entry Assessment Program. The PEAP is an assessment process that evaluates a VISA trainee to determine whether they can function at the appointed level of training. Successful completion of the VISA residency PEAP determines eligibility to enter residency training and therefore is not recorded as part of the residency training program. Successful completion of the VISA fellow PEAP provides an assessment of the candidate’s general knowledge and competency in the specialty in which he/she is certified and if successfully completed, can be counted towards fulfillment of the AFC diploma.

4.16 “Program Director” is the Faculty member responsible for the overall conduct of the residency program in a discipline or diploma program in an AFC discipline and is responsible to the Chair of the University department concerned and to the PGME Vice-Dean.

4.17 “Residency Program” means the RCPSC or CFPC postgraduate residency training program.

4.18 “RPC” means the Residency Program Committee and it is the committee that assists the Residency Program Director in the planning, organization, and supervision of the residency training program and includes representation from the residents in the program.

4.19 “Resident” means a physician registered in a residency training program accredited by the RCPSC or the CFPC and who is registered in the Postgraduate Medical Education Office at the Faculty of Medicine of the University.

4.20 “Senior physician leader” means the head or chief of the medical staff, regardless of the position title, appointed by the health organization (for example: hospitals, medical clinics, primary care agencies, health regions, long-term care organizations, public health agencies) as the senior leader accountable to the board of directors or highest governing body of the health care organization for the quality of patient care at the health organization or for matters in relation to public health.

4.21 “Scoring rubrics” are the scoring guides used to assess performance for individual assessments.

4.22 “Stages of Training” means the four developmental stages in RCPSC Competency Based Medical Education (CBME) programs. They are: Transition to Discipline, Foundation of Discipline, Core of Discipline, and Transition to Practice. Each stage has defined EPAs and milestones for learning and assessment.

4.23 “Summative assessment” refers to a formal written summary of a trainee’s performance against established expectations which is carried out at specified intervals within each program and across assessment plans.

4.24 “Supervisor” means an individual who has taken on the responsibility for their respective training programs to guide, observe and assess the educational activities of trainees.

4.25 “Time Based Program” means a program whose structure is based on goals and objectives and time-based educational experiences.

4.26 “VISA trainee” means an individual who has graduated from a non-LCME/CACMS medical school and who is training at the University of Ottawa without Canadian legal status (i.e. training under a VISA).

5. STANDARDS OF ASSESSMENT

5.1 It is the responsibility of the PGEC to maintain standards for the assessment, promotion, reclassification, remediation, probation, suspension, extension of training, reintegration and dismissal of trainees in all residency and AFC programs. The PGEC will review the assessment process of each residency and AFC program on a regular basis as defined by accreditation standards to ensure that assessment processes and practices are consistent with this Policy, and the minimum standards set by the related professional organizations, including the CPSO, CFPC and the Royal College. The PGEC will monitor the performance of programs either directly or through the relevant subcommittee of the PGEC.

6. PRINCIPLES OF TRAINEE ASSESSMENT

Structure

6.1 Every program must have an Assessment Framework that includes designated assessment tools and scoring rubrics tailored to the specialty or fellowship and level or stage of training which would meet the national training standards.

6.2 The purpose of the Assessment Framework is as follows:

6.2.1 To provide a framework for the assessment of the trainee’s knowledge, skills, attitudes and competencies by the supervisor;

6.2.2 To facilitate feedback to the trainee by a supervisor or the Program Director;

6.2.3 To serve as a record of the performance and progress of the trainee for the program;

6.2.4 To enable the Program Director to assist supervisors in ongoing supervision of the trainee;

6.2.5 To establish a basis for confirmation of progress, identification of needs, evidence for promotion, reclassification, extension of training, remediation and probation.

Assessment and feedback

6.3 During their postgraduate training program, trainees will receive fair, timely, equitable and unbiased formative and summative assessments and feedback on an ongoing basis. The principles governing assessment are as follows:

6.3.1 The assessment process must be tied to educational objectives, or to EPAs and milestones.

6.3.2 Goals and objectives, EPAs and milestones must be assessed with a range of assessment tools.

6.3.3 Goals and objectives, or EPAs and milestones must be made available to trainees and faculty at the beginning of each rotation or educational experience to guide trainee learning and assessment strategies. The goals and objectives, or EPAs and milestones, should be reviewed by the trainee.

6.3.4 Assessment and feedback is the joint responsibility of both the resident and the program. When written feedback is completed, residents should read written feedback within 14 days of being notified that it has been completed.

6.3.5 All trainees must receive a written summative assessment at least quarterly. The summative assessment must outline the progress that has been made by a trainee in addressing any areas of concern that have been identified.

6.3.5.1 In traditional time-based programs where in-training evaluation reports (ITERs) are used as summative assessments, ITERs should be completed within 14 days of the completion of the rotation/educational experience.

6.3.5.2 In traditional time-based programs, there should be documented, mid- rotation, formative feedback when the rotation is two blocks or longer.

6.3.5.3 In situations where trainees are ‘on trajectory’, the program director or delegate must discuss summative assessments with the trainee at least twice per year. This discussion should occur face-to-face. When logistics make face-to-face impossible, the communication must occur in a real time mode such as phone, Facetime or Skype.

6.3.5.4 In situations where trainees are ‘off trajectory’, the program director or delegate must discuss the summative assessment with the trainee. This discussion should occur within 14 days of the completion of the ITER or summative assessment, and must also be given face-to-face. When logistics make face-to-face impossible, the communication must occur in a real time mode such as phone, Facetime or Skype.

6.3.6 In CBD programs, the Competency Committee must provide the RPC with quarterly summative assessments and recommendations.

6.3.7 There must be regular, verbal informal feedback provided to trainees as well as formal feedback and assessment as required by this policy.

6.3.8 Residents must be informed of performance deficiencies in a timely manner so that they can have adequate opportunity to remedy them prior to the end of the educational experience. The feedback must be documented and entered into the resident’s file.

6.3.9 Both the supervising physician or program director or delegate and the trainee should sign or validate the summative assessment within 14 days. The trainee’s signature/validation does not necessarily imply that he/she agrees with the summative assessment; rather the signature/validation indicates that it has been seen by the trainee. Failure of the trainee to sign/validate the form does not invalidate the summative assessment or the discussion.

6.4 The Residency Program Committee makes decisions regarding the successful completion of an assessment period, educational experience, rotation, stage of training and academic year or of the program as well as completion of the CITER, STACER and FITER, where applicable.

6.5 The Competence Committee’s mandate is to review and discuss trainee’s performance and progress in order to advise/guide resident learning and growth, modify a resident’s learning plan, make decisions on a trainee’ achievement of EPAs, and recommend trainee status changes to the Residency Program Committee as per the Royal College.

6.6 Decisions regarding completion of program, reclassification, extension of training, remediation, probation, suspension or dismissal must be ratified by the Vice-Dean, PGME or delegate. If any of these decisions are made by the PGME Professionalism Subcommittee, ratification by the Vice-Dean of PGME, or delegate, is not required. Decisions by the Vice-Dean, PGME or delegate, PGME Professionalism Subcommittee regarding remediation, probation or reintegration/reassessment must be ratified by the senior physician leader of the health organization where the trainee’s rotation or training experience is taking place. In cases of suspension or dismissal, ratification by the senior physician leader is not required, however, the PGME office will notify the senior physician leader of the suspension or dismissal.

Trainee Wellness

6.7 All residents who are put on a remediation measure should be referred for a wellness assessment (e.g. Faculty Wellness Program, OMA PHP) as part of the support provided during this process. The program director or delegate should review the process of referral, including the confidential nature of the referral with the trainee.

7. PROMOTION

7.1 The Program Director, in consultation with the Residency Program Committee (RPC) for the program, will determine the rotation or educational experience requirements for each year or stage of the program. The rotation or educational experiences requirements may be amended from time to time and must be communicated to the trainees.

7.2 Trainees will be promoted to the next academic year or stage when all requirements have been met for the level or stage of training. This determination shall be made by the RPC, or delegate.

7.3 The promotion of a trainee to the next year or next stage of training in any program may be delayed based on any of the following:

7.3.1 pending completion of an extension of training, or a remedial or probationary period, or repeat of a failed rotation;

7.3.2 the trainee is under suspension;

7.3.3 the trainee has not met the training requirements for that postgraduate year or stage;

7.3.4 the trainee has taken an extended leave of absence from training which has resulted in an incomplete educational experience for stage or year of training

7.4 Where the promotion of a trainee has been delayed as a result of unsatisfactory performance, the trainee’s training will be addressed in accordance with the options for unsatisfactory performance as outlined in section 10 below.

7.5 Trainees will not be promoted during a period of reintegration, remediation, probation or suspension.

7.6 For trainees completing a period of remediation or probation, the Residency Program Committee will review rotations and training experiences completed during the remediation or probation period and will determine whether any of these may receive credit towards RCPSC or CFPC training requirements. If adequate credit is awarded, a retroactive promotion may be granted in cases where promotion may have otherwise occurred during the remedial or probation period.

8. REINTEGRATION / REASSESSMENT

8.1 Where a trainee has been on an extended leave of absence, a period of reintegration/reassessment to assess knowledge, skills and competencies may be warranted prior to resuming formal training. Trainees will be placed at the appropriate level or stage as determined by the RPC, at the completion of the reintegration/reassessment period. If the trainee has lost knowledge, skills or competencies, it may be determined that the trainee should be reclassified to a more junior level of training (year or stage), it may be determined that the trainee requires a period of remediation, or it may be determined that both are required.

8.2 A trainee may receive credit for training which is successfully completed during a period of reintegration/reassessment as decided by the RPC or FPC but this will only be determined at the completion of the period of reintegration/reassessment period.

8.3 The nature and length of the reintegration/reassessment period will be determined by the program’s RPC or FPC. The period of reintegration/reassessment will generally be four to eight weeks and should not exceed 12 weeks. The trainee must be consulted about the plan and must be provided with a copy of the plan before the reintegration/reassessment period begins.

8.4 A reintegration/reassessment plan must be completed by the Program which must

address the following:

8.4.1 details regarding the reasons for the reintegration/reassessment period;

8.4.2 the specific areas of reintegration/reassessment, and goals and objective or EPAs and milestones the trainee is to be benchmarked to;

8.4.3 the goals and objectives or EPAs and milestones that are to be assessed in determining the trainee’s stage or level of training;

8.4.4 the methods of assessment to be used during the reintegration/reassessment;

8.4.5 the duration of the reintegration/reassessment period;

8.4.6 the possible outcomes of the reintegration/reassessment; and

8.4.7 outline the methods by which the final decision will be made around whether the trainee has successfully completed a period of reintegration/reassessment and how stage or level will be determined.

8.5 The plan must be drafted by the RPC or delegate and must be ratified by the Vice-Dean PGME or delegate and the senior physician leader of the health organization where the trainee’s rotation or training experience is taking place.

9.UNSATISFACTORY AND INCOMPLETE PERFORMANCE

Unsatisfactory or incomplete performance may be identified when it is determined that the trainee did not meet the defined educational objectives, EPAs or milestones.

9.1 Reasons why a trainee’s performance may be deemed unsatisfactory include:

9.1.1 a summative assessment or a decision by the competency committee demonstrates that the trainee has not met the required objectives or competencies;

9.1.2 a trainee has not satisfied the standards of professionalism as per the Faculty’s Professionalism Policy (Policy on Professionalism) and the level of the professionalism breach is determined to be at a level 2 or 3;

9.1.3 a trainee is in breach of the policies of the health organization where the trainee’s rotation or training experience is taking place;

9.1.4 the trainee has been absent without receiving appropriate approval from their Program Director, as per the processes set out by the PARO-CAHO Collective Agreement and/or the PGME Leave of Absence Policy.

9.1.5 the Program Director, RPC, or Competence Committee determines that the trainee has not satisfactorily completed a rotation or educational experience.

9.1.6 an unsatisfactory rotation or educational experience can be identified using any of the following language (as defined by individual Program standards and outlined on Assessments): “marginal”, “borderline”, “inconsistently” or “partially meets expectations for level of training”, “unsatisfactory”, “does not meet expectations for level of training”, “off trajectory”, or any other language explicitly defined by the program to denote unsatisfactory performance

9.1.7 any serious patient safety issue/concern may be defined as a performance deficiency and lead to an unsatisfactory completion of a rotation or educational experience. This must be documented in the trainee’s file.

9.1.8 uncorrected performance deficiencies on any type of assessment may contribute to an unsatisfactory completion of a rotation or educational experience, and/or may independently contribute subsequently to an extension of training, remediation, probation and dismissal decision.

9.2 Incomplete rotations indicate that:

9.2.1 The supervisor has been unable to properly and fully assess the trainee because the trainee’s time spent on the training experience was insufficient to support meaningful assessment. As the training experience is incomplete, time will have to be made up to fulfill the requirement. The amount of time will be determined by the competence committee, RPC or FPC.

9.2.2 The determination of whether a trainee can or cannot be assessed should be made on an individual, case-by-case basis. The assessment should take into account factors such as the trainee’s individual performance and experience, the total length of the rotation or training experience, the future time a trainee may spend on the same rotation, and the nature of the educational experience being missed.

9.3 Where there has been an unsatisfactory performance, the program’s RPC or FPC must decide what action is required and whether to recommend that the trainee be required to enter one of the following remedial periods listed below. In programs with a competency committee, this decision would be guided by the committee’s recommendations. In cases where the trainee has been referred to the Professionalism Committee for professionalism concerns as per the Faculty of Medicine Professionalism Policy, the Professionalism Committee may decide that the trainee be required to enter one of the following remedial measures listed below. A decision of the Professionalism Committee does not require ratification by the Vice-Dean, PGME or delegate.

9.4 Where concerns have been raised regarding a trainee’s performance, the Program Director, or delegate, must review the concerns with the trainee. The purpose of this communication is to ensure a full assessment of the issues as well as disclosure of the evidence and rationale for the concerns.

9.5 The program’s RPC or FPC will review all relevant supporting documentation prior to making a decision regarding a trainee’s unsatisfactory performance. The trainee must be provided with the opportunity to address the concerns with the RPC or FPC; this communication may be verbal or written.

10. REMEDIAL MEASURES

10.1 In the event that a trainee’s performance has been deemed unsatisfactory or incomplete, the trainee may be required to undergo one or more of the following:

10.1.1 extension of training;

10.1.2 remediation; or

10.1.3 probation.

10.2 These remedial measures are intended to deal with problems which are not expected to be readily corrected in the normal course of the residency program.

10.3 A trainee may be placed into whichever one/ones of these remedial measures is most relevant to his/her academic situation.

10.4 In general, it is recommended that a period of probation be preceded by a period of remediation as part of a progressive approach. However, under certain circumstances (e.g. unsatisfactory performance in several CanMEDS domains; level 2 or 3 professionalism concerns), the trainee may be placed on probation without having first been placed on remediation.

11. EXTENSION OF TRAINING

11.1 An extension of training may be utilized to allow a trainee to achieve a required level of competence prior to assuming more responsibilities. This option may be used where it has been determined that a trainee should not be promoted to the next level or stage of training because he/she has encountered difficulties during the year, difficulties obtaining a stage of the program or is on a slower trajectory to obtain competency, but such difficulties/trajectory are not significant enough to warrant a formal period of remediation or probation, or because the trainee has failed a rotation or educational experience that must be repeated. In such cases, the trainee will be required to continue training at the same level for a predetermined amount of time, not to exceed 12 weeks. An extension of training may follow a reintegration/reassessment if deemed necessary by the RPC or FPC.

11.2 Recommendations for extension of training must be brought to the Program’s RPC or FPC by the Program Director or competency committee. A decision regarding an extension of training will be taken by the Program’s RPC or FPC. The decision must be ratified by the Vice-Dean, PGME or delegate.

11.3 The nature and length of the extension of training will be determined by the program’s RPC or FPC. The trainee must be consulted about the plan and must be provided with a copy of the plan before the period begins.

11.4 An Extension of Training plan must be completed by the Program which must include the following:

11.4.1 details regarding the reasons for extension of training;

11.4.2 the specific areas of deficiency, EPAs and milestones where the trainee is off their educational trajectory;

11.4.3 the objectives during the extension of training; EPAs and milestones that need to be met for the expected educational trajectory at the trainee’s stage of training;

11.4.4 the methods of assessment during the extension of training;

11.4.5 the duration of the extension of training;

11.4.6 the possible outcomes of the extension of training; and

11.5 If rotation(s) or training experiences are required outside the trainee’s program, these will be discussed and arranged with the respective Program Director(s) prior to finalizing the extension of training.

11.6 The extension of training plan must be ratified by the Vice-Dean, PGME or delegate prior to its implementation.

11.7 At the end of the Extension of Training period, the RPC, FPC, or delegate, will review the trainee’s performance and determine the appropriate outcomes as per this policy.

12. REMEDIATION

12.1 Remediation is a formal program of individualized training during which the trainee is expected to correct identified weaknesses and/or deficiencies where it is anticipated that those weaknesses can be successfully addressed to allow the trainee to meet the standards of training. Remediation shall normally be for a period of two to six clinical blocks (approximately equivalent to 2 to 6 months).

12.2 Recommendations for remediation must be brought to the Program’s RPC or FPC by the Program Director or competency committee. A decision regarding remediation will be taken by the Program’s RPC or FPC. The decision must be ratified by the Vice-Dean, PGME or delegate.

12.3 A remediation plan must be completed by the Program which must include the following:

12.3.1 details regarding the reasons for remediation;

12.3.2 the specific areas of deficiency, EPAs and milestones where the trainee is off their educational trajectory;

12.3.3 the objectives during the formal remediation; EPAs and milestones that need to be met for the expected educational trajectory at the trainee’s stage of training;

12.3.4 the methods of assessment during the remediation;

12.3.5 the duration of the remedial period;

12.3.6 the possible outcomes of the remediation; and

12.4 If rotation(s) or training experiences are required outside the trainee’s program, these will be discussed and arranged with the respective Program Director(s) prior to finalizing the period of remediation.

12.5 The remediation plan must be ratified by the Vice-Dean, PGME or delegate and the senior physician leader of the health organization where the trainee’s rotation or training experience is taking place prior to its implementation.

12.6 At the end of a remediation period, the program’s RPC, FPC, or delegate, must complete a Final Remediation Outcome form. The Program Director will inform the trainee in person and in writing as to the results of the remediation and the recommendation(s) of the RPC or FPC. The outcome of the remediation must be ratified by the Vice-Dean, PGME or delegate.

12.7 A trainee may receive credit for training which is successfully completed during a period of remediation as decided by the RPC or FPC.

12.8 If the trainee’s performance in remediation is unsatisfactory, he/she will be placed in his/her home program pending the deliberations of the RPC or FPC, or may be placed on a paid interruption in training. Where the remediation is unsuccessful, the RPC or FPC may recommend to the Vice-Dean PGME or delegate that the trainee enter a further period of remediation or probation.

12.9 A trainee may have a maximum 2 remedial periods at any time during a residency program. Dismissal may be considered as an outcome of a second remedial period; these remedial periods do not need to be consecutive.

13. PROBATION

13.1 A trainee will be placed on probation in circumstances where the trainee is expected to correct identified serious problems which are not subject to usual remedial training including but not limited to, academic or professionalism issues that are assessed to jeopardize successful completion of the residency or fellowship program. Probation may be applied where a trainee:

13.1.1 has failed a period of remediation;

13.1.2 has successfully completed two remediation periods at any time during their training and subsequently has encountered difficulties; or

13.1.3 has encountered serious academic, patient safety or professionalism issues where the program’s Residency Program Committee determines that an immediate period of probation is warranted.

13.2 Recommendations for probation must be brought to the program’s RPC or FPC by the Program Director or competency committee. A decision regarding probation will be taken by the program’s RPC or FPC. The decision must be ratified by the Vice-Dean, PGME or delegate.

13.3 The nature and length of the probation period will be determined by the program’s RPC or FPC. Probation should not exceed 3 blocks/months. In cases where it has been determined that a trainee has acted unprofessionally, probation will be managed in accordance with Faculty of Medicine Professionalism Policy.

13.4 A probation plan must be completed by the program which must address the following:

13.4.1 details regarding the reasons for probation;

13.4.2 the specific areas of deficiency; EPAs and milestones where the trainee is off their educational trajectory;

13.4.3 the objectives during probation; EPAs and milestones that need to be met for the expected educational trajectory at the trainee’s stage of training;

13.4.4 the methods of assessment during the probation;

13.4.5 the duration of the probation period;

13.4.6 the possible outcomes of the probation; and

13.5 If rotation(s) or training experiences are required outside the trainee’s program, these will be discussed and arranged with the respective Program Director(s) prior to finalizing the period of probation.

13.6 The probation plan must be ratified by the Vice-Dean, PGME or delegate and the senior physician leader of the health organization where the trainee’s rotation or training experience is taking place prior to its implementation.

13.7 At the completion of the probation period, the trainee shall be placed on a paid interruption in training pending the deliberations of the RPC or FPC.

13.8 At the end of the probation period, the program’s RPC or FPC must complete a Final Probation Outcome form. The Program Director will inform the trainee in person and in writing as to the results of the probation and the recommendation(s) of the RPC or FPC. The outcome of the probation must be ratified by the Vice-Dean, PGME or delegate.

13.9 A trainee may receive credit for training which is successfully completed during a period of probation as decided by the RPC or FPC.

13.10 Where the probation has been unsuccessful, the Program Director on the advice of the RPC or FPC will recommend to the Vice-Dean, PGME or delegate that the trainee be dismissed from the program.

14. SUSPENSION

14.1 Suspension is a temporary interruption of a trainee’s participation in the residency or fellowship program, and includes interruption of clinical and educational activities.

14.2 The conduct of trainees is governed by the policies of professional bodies such as the CPSO and by the Professionalism Policy of the Faculty of Medicine, University of Ottawa. Violation of any of these standards and policies may constitute improper conduct warranting suspension. A single serious incident of unprofessionalism or a series of incidents of unprofessionalism may justify suspension.

14.3 A supervisor may immediately remove a trainee from clinical or non-clinical responsibilities if the trainee’s conduct is deemed to pose a safety risk to patients, staff, students, or the public that uses the setting, and the supervisor must notify the program director as soon as possible. Only a program director, Vice-Dean of PGME or delegate, or the PGME Professionalism Subcommittee may formally suspend a trainee. If the program director suspends a trainee, the suspension must be ratified by the Vice Dean of PGME or delegate.

14.4 The Vice-Dean or delegate must notify the trainee in writing of the suspension and the notification must include the reasons for and duration of the suspension. The trainee will continue to be paid during the suspension as per the terms of the PARO-CAHO agreement pending review by the Vice-Dean or delegate, and/or the Professionalism Subcommittee.

14.5 The PGME office will notify the senior physician leader of the health organization where the trainee’s rotation or training experience took place that the trainee is suspended from clinical duties pending investigation and adjudication of the issue leading to suspension.

15. DISMISSAL FROM THE PROGRAM

15.1 A trainee may be dismissed from the program if any of the following conditions exist:

15.1.1 a trainee has a second failure of remediation;

15.1.2 a trainee fails a probation period;

15.1.3 a trainee does not maintain the standards of the profession as described in the Faculty’s Professionalism Policy;

15.1.4 a trainee meets the criteria of the Regulated Health Professions Act of Ontario for clinical incompetence or incapacitation; or,

15.1.5 lack of a training site/faculty available to train as a result of professionalism or patient safety concerns.

15.2 A decision regarding dismissal of a trainee will only be taken by the program’s RPC or FPC on the recommendation of the Program Director or by the Professionalism Committee. When the decision has been made by the program’s RPC or FPC, the decision must be ratified by the Vice-Dean, PGME or delegate. Decisions of the Professionalism Committee do not require Vice- Dean PGME ratification.

15.3 The trainee must be informed of the decision in writing. The notification must include the reason(s) for dismissal.

15.4 The PGME office will notify the senior physician leader of the health organization where the trainee’s rotation or training experience took place that the trainee is dismissed from the program.

16. APPEALS

16.1 A trainee has the right to appeal a final decision regarding extension of training, reclassification, remediation, probation, suspension or dismissal as ratified by the Vice-Dean, PGME or delegate or by the Professionalism Committee to the Faculty Council Appeals Committee. A decision regarding rotation failure for which the consequences are limited to repeating the rotation and/or reducing time available for electives is not eligible for appeal.

16.2 An appeal referred to in 16.1 may be made on the basis of a final decision that is incorrect due to the following: an error in procedure or of fact; or there are new facts relevant to the final decision that were not available and could not have been provided during the process leading up to the final decision.

16.3 The trainee should consult the Faculty Council Appeals Committee procedures (Faculty Bylaws) concerning the preparation and submission of an appeal and the applicable deadlines.

16.4 While a trainee may appeal a final decision regarding extension of training, reclassification, remediation or probation as ratified by the Vice-Dean, PGME, or delegate, or a Professionalism Committee decision to the Faculty Council Appeals Committee, the trainee is required to undertake the period of extension, reclassification, remediation or probation plan pending the results of the Appeal. Failure to do so will result in the trainee being placed on leave from training for the duration of the appeal process. If the appeal is upheld for the trainee, the period of training will receive credit to the extent possible.

16.5 While a trainee may appeal a final decision regarding suspension or dismissal, as ratified by the Vice-Dean PGME, or delegate, or a Professionalism Committee decision to the Faculty Council Appeals Committee, the trainee will remain on leave from training pending the results of the Appeal.

16.6 A trainee may appeal the decision of the Faculty Council Appeals Committee to the University Senate Appeals Committee. To do this, the trainee should consult the Office of the Secretary-General concerning the preparation and submission of such an appeal and the applicable deadlines.

17. NOTIFICATION

17.1 When a trainee is assessed by the RPC or FPC near the end of the training program as having met the prerequisites for certification by the Royal College or the CFPC, the PGME Vice- Dean will notify the Royal College or the CFPC of this in the required manner.

18. GENERAL

18.1 This policy replaces any previous versions of the policies and procedures on PGME evaluations.

19. REVIEW

19.1 This policy will be reviewed 1 year after adoption and every 3 years subsequently.

Committee	Date
PGEC	January 30, 2019
Faculty Council	June 4, 2019
Executive Committee of the Senate	October 1, 2019

1. Objective & Scope

This policy clarifies acceptable qualifications for directors of Royal College-accredited residency programs, and the responsibilities of institutions and the Royal College with regard to program directors and their appointments. The policy is applicable to institutions with specialty and subspecialty residency programs1 accredited by the Royal College in Canada and internationally.

The principles on which this policy is based are:

1.1 Program director qualifications support high-quality residency education: The Royal College standards ensure postgraduate medical education (PGME) programs provide high-quality education, preparing residents to meet the health care needs of their patient populations during and upon completion of training. Program director ability is recognized as a key ingredient in a successful residency program and in the competence of program graduates. As such, appointed program directors (PDs) must have appropriate qualifications to: design, coordinate and deliver training that meets the conjoint accreditation standards of the Collège des médecins du Québec (CMQ), College of Family Physicians of Canada and the Royal College; prepare residents for success at the Royal College certification examination; and, facilitate graduate competence for safe independent practice. Although clinical competence in the scope of the discipline is required, program directors must also demonstrate familiarity with the CanMEDS Framework, effective leadership skills, the ability to effectively manage resources, and meet all requirements of the relevant accreditation standards. Furthermore, maintaining contemporary understanding of medical education trends, as well as the evolution of the relevant clinical discipline to meet societal needs, is also required to deliver high-quality PGME.

1.2 Ensuring program directors are appropriately qualified is a shared responsibility: The appointment of appropriately qualified PDs is a shared responsibility between the institution and the Royal College. As stated in the standards of accreditation for institutions, the postgraduate dean / senior education officer and relevant academic head of the discipline are jointly responsible and have authority for the recruitment and selection of PDs who meet the required credentials, and for their performance management. The Royal College, and conjointly with the CMQ for programs in Québec, is responsible for confirming the appointment and ensuring all relevant standards are met.

2. Definitions and Acronyms

Definitions and Acronyms
Acronym	Definition
APOR	Action Plan Outcomes Report
CMQ	Collège des médecins du Québec
CPD	Continuing Professional Development
ESU	Educational Standards Unit
Interim program director	An acting program director for a temporary period until a new PD is appointed
OSE	Royal College Office of Specialty Education
PD	Program director
PGME	Postgraduate medical education
Royal College	Royal College of Physicians and Surgeons of Canada

3. Policy

3.1 Directors of Canadian and international specialty and subspecialty residency programs accredited by the Royal College must:

3.1.1 Be a specialist certified by a recognized body in the same discipline as the program of which they are the director.

3.1.2 Maintain active engagement in a Continuing Professional Development program acceptable to the Royal College for the duration of their program director position.

3.2 Upon appointment to the role for the first time, all directors of Canadian and international specialty and subspecialty residency programs accredited by the Royal College must undertake:

Accepted Royal College or local program director training4 within 12 months of their appointment to the position of program director; and/or
One-on-one coaching with a Royal College Fellow / Subspecialist Affiliate who has current or recent experience as a program director of a Royal College-accredited program. Coaching must commence within three months of the appointment to the position of program director and continue for at least one year.

3.2.1 Program directors who are not certified by the Royal College must undertake both training and coaching with a Royal College Fellow / Subspecialist Affiliate who has current or recent experience as a program director of a Royal College-accredited program.

3.2.2 There are no fees associated with training provided by the Royal College. Travel and other expenses associated with the above requirements are the responsibility of the program director and/or their institution.

3.3 There must be a single designated program director who is accountable for the residency program. Co-director models and/or the appointment of associate or assistant program directors are acceptable; however, one single program director must be identified as being responsible and accountable for the residency program and as the key interlocutor with the Royal College.

3.4 Program directors should not have a real or perceived conflict of interest with the program of which they are the director due to other roles they may play within the institution, such as the chair / head of the academic or clinical department or division. In such cases where there is a real or perceived conflict of interest, that conflict must be managed appropriately, in accordance with the institution’s guidelines for managing conflicts of interest.

3.5 Programs must have continuous oversight by a designated program director. Should the program director position become vacant at any time, the position may be filled on an interim basis according to section 6 below.

3.6 For a maximum of 12 consecutive months, an interim program director who does not meet the qualifications outlined above in section 1 may be appointed. After the 12-month interim directorship, the program director position should be filled by someone who meets the above requirements for at least three years before another interim program director will be accepted by the Royal College.

3.7 For a limited time after a new discipline has been recognized, directors of programs in that discipline are not expected to be certified in the discipline.

3.7.1 The timeline will be determined by the Royal College Specialty Committee of the new discipline, and will be based, in part, on the expected length of time for a specialist in the discipline to become certified.

3.7.2 The Royal College Specialty Committee of the new discipline will determine the acceptable qualifications of program directors in that discipline until such time that a PD who meets the requirements in section 1 above would be required, not to exceed 10 years.

3.7.3 The timeline and acceptable qualifications in a and b will be determined at the outset of the discipline’s founding and overseen by the Office of Specialty Education.

3.8 The appointment of a program director who does not meet the requirements outlined in sections 3.1 and 3.3–3.7 above has implications for the program’s accreditation status. Additionally, responsibility for training and faculty development of program directors, as outlined in section 3.2 above, rests with the institution and will be reviewed during the regular cycle of accreditation for each institution. The appended procedures specify the process for verifying acceptable qualifications of program directors and implications for accreditation status.

3.9 This policy does not apply to program directors currently in the position when the policy comes into effect. The policy will be applied when program directors are newly appointed to the position with a notification to the Royal College.

4. Roles and Responsibilities with regard to program directors:

4.1 Institutions are responsible for:

4.1.1 Ensuring programs are overseen by appropriately-qualified program directors, and, through the postgraduate dean / senior education officer in collaboration with the academic lead of the discipline, are responsible for, and have authority for the recruitment and selection of program directors with acceptable qualifications.

4.1.2 Ensuring programs have continuous oversight with no gaps in the program director position, and that the requirements in section 3.6 above are followed when program directors are appointed on an interim basis.

4.1.3 Providing information to the Royal College about the credentials of each program director and for informing the Royal College within two weeks when a new program director is appointed.

4.1.4 Ensuring the information submitted for institution and program accreditation-related activities is accurate and complete.

4.1.5 Supporting newly appointed program directors within their institution to undertake the training and/or coaching required in section 3.2 above.

4.1.6 Supporting program directors within their institution to participate in the relevant Royal College Specialty Committee.

4.2 The Royal College, through the Office of Specialty Education (OSE), is responsible for:

4.2.1 Co-appointing program directors through the validation of the qualifications of program directors against the requirements. This occurs when an institution informs the Royal College of the appointment of a new program director. For programs in Québec, this is undertaken conjointly with the CMQ.

4.2.1.1 OSE will verify completion of PD training and/or coaching, and the acceptability of CPD programs.

4.2.1.2 OSE will confirm the appointment of PDs whose qualifications meet the requirements outlined in this policy.

4.2.1.3 In the case of PDs of programs in new disciplines (3.7 above), OSE will approve and oversee the timeline and interim qualifications.

4.2.2 Informing the institution if (a) program director(s) does not meet the acceptable qualification requirements, and the required follow-up and implications according to the appended procedures.

4.2.3 As part of the accreditation process:

4.2.3.1 Reviewing the institution’s process for the appointment and ongoing assessment of all residency program directors (for programs in Québec, this is undertaken conjointly with the CMQ); and

4.2.3.2 Tracking program director participation in Specialty Committee meetings.

4.2.4 Providing program directors with access to CanAMS.

4.2.5 Listing the names and contact information of program directors on the Royal College webpage of accredited programs.

4.2.6 Issuing invitations to program directors to the New Program Directors Workshop and/or other professional development opportunities for program directors organized by the Royal College, as appropriate.

4.2.7 Issuing invitations to program directors to participate in the National Advisory Committee, as appropriate

4.3 Specialty Committees are responsible for:

4.3.1 Determining the maximum length of time a program in a newly recognized discipline may have a PD who is not certified in the discipline, not to exceed 10 years.

4.3.2 Determining the acceptable qualifications of PDs of programs in newly recognized discipline until such time that a PD with certification in that discipline would be required.

4.3.3 Providing a forum for all program directors to meaningfully participate in the dialogue about the discipline.

4.4 Program directors are responsible for:

4.4.1 Completing the program director training and/or coaching, as required.

4.4.2 Fulfilling the responsibilities of a program director as set out in the general and relevant speciality-specific standards of accreditation, including, but not limited to:

4.4.2.1 Ensuring the design and delivery of accredited programs align with the general and specialty-specific standards of accreditation.

4.4.2.2 Overseeing assessment decisions regarding resident progress through the program, including identification of residents who are not progressing as expected, residents who are examination eligible, and residents who have met the requirements for certification.

4.4.2.3 Providing the required summative documents for exam eligibility and for each resident who has successfully completed the residency program; and

4.4.2.4 Participating in the relevant discipline Specialty Committee, according to the role description for a non-voting member.

5. References

Residency Accreditation Procedure: Missed Deadlines for Royal College Program Reviews

6. Contacts

For information or clarification, please contact:

Director, Specialty Education, Strategy, and Standards
Office of Specialty Education
The Royal College of Physicians and Surgeons of Canada
Ottawa, ON
[email protected]

7. Appendices

Procedures and implications of PDs without acceptable qualifications

8. Policy record

Policy number:
Most recent resolution:
Previous resolution(s):
Approved by: Committee of Specialty Education
Approval Date: December 1, 2020
Approval path:
Effective date:
Date of next review:
Royal College Office: Office of Specialty Education
Version status: Original presented for discussion
Keywords: policy, residency, program director
Information security classification

Appendix:

Procedures and implications of program directors without acceptable qualifications

1. Validation of program director qualifications

1.1 Upon receipt of notice of appointment of a new program director the Educational Standards Unit (ESU) will validate that the newly-appointed PD is certified in the relevant discipline and registered in a Continuing Professional Development program. The process and implications noted below are applied if the newly-appointed PD does not meet the requirements specified in section 3 of the policy (with the exception of policy section 3.2 which is detailed in 1.2 below).

1.2 As part of the regular accreditation review process of each accredited institution, ESU will validate that newly-appointed PDs have undertaken the required training and/or coaching specified in section 3.2 of the policy. While this information is considered in the accreditation review, the process and implications noted below are not applicable to the requirements specified in section 3.2 of the policy.

1.3 ESU will confirm via a letter to the postgraduate dean / senior education officer if a program director(s) does not meet the acceptable qualifications, the deadline by which an appropriately qualified PD must be in place (in accordance with section 3.6 above), and options to fulfill the acceptable qualifications.

1.4 The institution must provide the ESU with notice of appointment of a new PD, or evidence that that the PD meets the acceptable qualifications defined in section 3.1 or section 3.7 of the policy, as applicable, by the specified deadline.

2 Missed deadline / continuation of program director without acceptable qualifications

2.1 If the Royal College does not receive notice that the PD position is filled by someone who meets the acceptable qualifications one week prior to the deadline, the ESU will follow-up with the postgraduate dean / senior education officer with a reminder of the upcoming deadline and request for an update on the status of the PD position.

2.2 If the Royal College does not receive notice that the PD position is filled by someone who meets the acceptable qualifications by the deadline, within two business days, the ESU will follow-up with the postgraduate dean / senior education officer (copying the Dean of Medicine (or equivalent)), requesting submission by an extended due date of one week from the date of the original deadline.

2.3 If the Royal College does not receive notice that the PD position is filled by someone who meets the acceptable qualifications by the extended deadline, within two business days, the ESU will send correspondence to the postgraduate dean / senior education officer, copying the Dean of Medicine (or equivalent) of the institution, on behalf of the OSE Director of Specialty Education, Strategy, and Standards, with the final deadline (two weeks from the original deadline). This letter will also outline the implications for the program’s accreditation status as below.

2.3.1 This information will also be noted for the next institution accreditation activity (e.g., onsite review, submission of APOR, data integration), as evidence towards the fulfillment of the institution indicator regarding the institution’s responsibility to ensure program directors meet the required credentials.

3 Implications for programs’ accreditation status

3.1 If the Royal College does not receive notice that the PD position is filled by someone who meets the acceptable qualifications by the final extended deadline (in 2.3 above), the program’s accreditation status will be changed immediately. This change will be brought to the Residency Accreditation Committee (for Canadian programs) / International (residency) Program Review and Accreditation Committee (for international programs), for final ratification of the change in the program’s accreditation status.

3.1.1 In cases where the program’s pre-existing accreditation status was “Accredited program”, the program’s accreditation status will change to “Accredited program on notice of intent to withdraw accreditation” with a follow-up by external review. The external review will be arranged by the Royal College at the institution’s expense. The program will be formally notified of the due date of the external review which will be conducted by two external surveyors within six months of the final missed deadline date.

3.1.2 In cases where the program’s pre-existing accreditation status was “Accredited program on notice of intent to withdraw accreditation”, the program’s accreditation will be withdrawn.

Summary table of decisions and follow-ups for missed deadline

Summary table of decisions and follow-ups for missed deadline
Accreditation status follow-up	Accreditation status change	Follow-up (to be ratified by Res-AC / IPR-AC at its next meeting)
Regular review	Notice of intent to withdraw accreditation	External review at the institution’s expense within six months of the missed deadline
Action Plan Outcomes Report (APOR)	Notice of intent to withdraw accreditation	External review at the institution’s expense within six months of the missed deadline
External review	Notice of intent to withdraw accreditation	External review at the institution’s expense within six months of the missed deadline
Notice of intent to withdraw accreditation	Withdrawal of accreditation	New application

Introduction

Increasingly postgraduate medical trainees are requesting electives in international settings. The medical and cultural benefits of these electives are recognized by the faculty and the medical literature. However, these electives pose potential risks for the trainee and the receiving community/institution, therefore proper preparation, supervision and follow up are required.

For international electives (not including the United States of America), trainees may be required to carry out special preparation, particularly important for those planning to work in low resource settings.

Note: Trainees are responsible for application and cost of any passport, visa, insurance, health related and other requirements, as appropriate.

Purpose

This policy will outline the requirements for application and successful completion of international elective to receive faculty support and recognition for these activities.

Office Responsible

The International & Global Health office (IGHO), Postgraduate Medical Education office and trainee’s specialty or subspecialty program jointly approve these placement activities. Trainees are required to comply with instructions from the Postgraduate Medical Education Office and the IGHO, as well as their respective Programs/Program Directors.

Section 1: ELIGIBILITY CRITERIA

Trainees must have permission from their Program Directors to participate in an international elective.
International electives should be a minimum of four weeks in duration.
Request for approval for international electives must be submitted a minimum of two months prior to the start date.
Trainees must receive academic credit from their program for the elective time.

Section 2: APPLICATION PROCESS

2.1 Applications for international electives must be submitted to the trainee’s respective program a minimum of four months prior to their placement start date. This will allow the trainee to properly prepare for the elective and allow enough time for required immunizations, visas, passports, and pre-departure training. Once the trainee’s program approves the dates and confirms the trainee is in good academic standing the application is sent to the IGHO for processing.

2.2 Trainee to complete “Application Form to request approval for an International Elective” and “Release of Liability Form” available on the IGHO website (online form being built by IT).

2.3 The international elective will be pre-approved by the IGHO if the following requirements are met:

Trainee is in good academic standing according to their Program Director and the Postgraduate Medical Education office
The Program Director approves of the planned elective
Trainee requires an international supervisor who must be a practicing physician or researcher (for research electives). The trainee must provide contact information for their supervisor.

NOTE: Trainees must not be supervised by an immediate, extended, or in-law family member.
The destination region for the elective does not carry a warning of “Avoid non-essential travel” and/or “Avoid all Travel” on the Global Affairs Canada Travel Advice and Advisories webpage.

Trainee should read the profile of the country and the region within the country that they are traveling to on the Reports & Warnings website (COVID-19 – Travel Advice and COVID-19 – Conseils aux voyageurs) and attach the pages to their application.
Trainee to provide appropriate educational objectives, approved by their Program Director.
Trainee to provide all required information requested on the application. Incomplete applications may lead to delays or refusal.

NOTE: Once the elective has been approved, it is possible to revoke this decision and cancel due to changes in conditions in the country, loss of in-country supervisor, OR arising academic or professional concerns on the part of the trainee.

2.4 Pre-departure training for international electives

2.4.1 Trainee must participate in a mandatory pre-departure training session, offered by the IGHO. This training is required for all those undertaking electives in low and middle resource settings as defined by the World Bank’s income classification, which is based on a measure of national income per person, or GNI (Gross national income) per capita: Countries and Economies.

Countries considered low income countries ($1,025 or less GNI)
Lower middle income countries ($1,026 to $3,995 GNI)
Upper middle income countries ($3,996 to $12,375 GNI).
In addition, areas designated medium to high risk by the Global Affairs Canada Travel Advice and Advisories website and culturally diverse destinations require pre-departure training.

Pre-departure training includes:

Didactic presentations and small-group sessions including the following pertinent topics: personal safety while abroad, preparation for medical placements, common clinical diseases, intercultural communication, country research and cultural sensitivity, and past elective experience presentations given by medical students and postgraduate trainees.
All trainees should complete the online risk management modules
Training is provided by members of the University of Ottawa International Office and healthcare providers and trainees from CHEO, The Ottawa Hospital, Elizabeth Bruyère Family Medicine Centre, and the University of Ottawa’s Faculties of Medicine and Health Sciences.

2.4.2 Trainee is encouraged, but exempt from pre-departure training if the elective takes place in countries with similar health and economic systems, as directed by the IGHO.

2.5 Trainee will be required to take part in post-elective debriefing sessions, as appropriate. The IGHO and Faculty Wellness Office are available to trainees wishing to debrief about their experience.

2.6 Upon completion of the elective, the trainee is required to provide a post-elective summary reflecting on the given educational objectives. This document is to be forwarded to the IGHO.

2.7 A formal evaluation of the trainee is required at the end of the elective as per the policy for the Evaluation and Assessment of Postgraduate Trainees.

Section 3: DURATION AND REMUNERATION

3.1 International Electives are, ideally, expected to be a minimum of four weeks in length. Although there are no routine funds available for elective activities, the IGHO website outlines possible funding opportunities. Trainees are encouraged to contact the IGHO if they have any questions.

Section 4: MEDICAL-LEGAL COVERAGE DURING ELECTIVE

4.1 Trainees undertaking international electives require medical-legal coverage. Those under the direct supervision of Canadian physicians with CMPA coverage should be covered by CMPA during their elective. Trainees are required to contact CMPA to confirm their coverage and to inform CMPA of their planned activities. For those not supervised by a physician with CMPA coverage, approved electives through the process outlined above should have coverage through the University of Ottawa.

CMPA website: Teaching, research, and learning outside Canada

“Learning outside Canada - Members who travel outside of Canada for residency/fellowship training and continuing medical education may be involved in clinical care and thus exposed to possible medical-legal difficulties. The CMPA generally will not provide assistance with medical-legal matters arising from the provision of such clinical care outside of Canada, whether a legal action arises inside Canada or outside Canada.

In those instances where a resident/fellow accompanies his/her CMPA member supervisor on a humanitarian trip abroad, the trainee’s eligibility for assistance will match the eligibility of the supervisor. Both the supervisor and trainee must verify their eligibility and make arrangements with the CMPA prior to leaving Canada.”

In cases where CMPA coverage doesn’t apply, the University’s Commercial General Liability insurance policy, which includes malpractice, would apply as long as:

The trainee is registered as a uOttawa student during the time of the “work”/placement in question
The university has a written placement agreement which covers the trainee’s work prior to the start of the placement, and
The trainee receives academic credit (approved by the University) for the time in question when the event causing the loss occurs.

Section 5: ALIGNMENT WITH THE POSTGRADUATE TRAINEE SAFETY POLICY

5.1 Trainees and Program Directors should note that all the conditions outlined in the Postgraduate Trainee Safety Policy (Policies) may not be realistically possible to adhere to during an international elective. All steps will be taken to minimize risk for trainees and their host communities.

Section 6: SUMMARY

Trainees must have their application approved PRIOR to undertaking the international elective. Application must be approved by the Program Director, IGHO and Postgraduate Medical Education Office.
Trainee must complete pre-departure training, as directed by the IGHO.
Trainee must submit the post-elective reflective summary to the IGHO Coordinator.
Trainee must complete post-elective debriefing, as directed by the IGHO.
Trainee must complete the evaluation In-Training Evaluation Report (ITER).
Trainee must submit or ensure submittal of evaluation form by supervisor to the Program Director.

Policy Review

This policy will be reviewed in 1 year after adoption and every 3 years subsequently.

Committee	Approval
Postgraduate Medical Education Committee (PGEC)	June 17, 2020
Faculty Council	August 25, 2020

All residency programs must ensure that residents are provided opportunities to participate in research or other scholarly projects as defined within the goals and objectives of each program. Resident research or scholarly projects during the course of their residency program could include: basic science; primary care research, experimental medicine; clinical medicine; epidemiology; quality assurance; medical education; ethics; humanities and medicine or any research aligned with health care.

According to the General Standards Applicable to All Residency Programs.

Element 3.2 : The residency program provides educational experiences designed to facilitate residents’ attainment of the outcomes-based competencies and/or objectives.

Requirement 3.2.5 : The educational environment supports and promotes resident learning in an atmosphere of scholarly inquiry.
- Indicator 3.2.5.1 : Residents have access to, and mentorship for, a variety of scholarly opportunities, including research as appropriate.
- Indicator 3.2.5.2 : Residents have protected time to participate in scholarly activities, including research as appropriate.
- Indicator 3.2.5.3 : Residents have protected time to participate in professional development to augment their learning and/or to present their scholarly work.

Element 4.2 : The residency program has the appropriate human resources to provide all residents with the required educational experiences.

Requirement 4.2.1 : Teachers appropriately implement the residency curriculum, supervise and assess trainees, contribute to the program, and role model effective practice.
- Indicator 4.2.1.3 : There are sufficient competent individual supervisors to support a variety of resident scholarly activities, including research as appropriate.
- Indicator 4.2.1.4 : There is a designated individual who facilitates the involvement of residents in scholarly activities, including research as appropriate, and who reports to the residency program committee.

Procedures

Each Program must have an assigned Resident Research Director to facilitate resident participation in research and other scholarly projects.
There must be appropriate faculty members identified to facilitate and supervise resident involvement in a research or scholarly project.
Resources to support resident research are a Departmental/Divisional responsibility.
Programs are required to maintain a list of all research and scholarly projects completed by their residents.

All projects are to conform to the Faculty of Medicine’s policy on Research.

Committee	Date
Faculty Council	January 26, 2021
Postgraduate Medical Education Committee	December 9, 2020

Please note: this policy is currently undergoing approval at the faculty council.

Policy on Residents Working Additional Hours for Pay

DEFINITION

DEFINITION Residents are only permitted to undertake what is commonly referred to as “moonlighting”, and will henceforth be termed “Residents Working Additional Hours for Pay”, in the following scenarios:

When holding an Independent Practice License from the College of Physicians and Surgeons of Ontario (CPSO) and undertaking additional hours for pay outside of their regular clinical duties.
When holding a certificate of Restricted Registration from the CPSO, obtained through Restricted Registration Ontario, and undertaking additional hours for pay outside of their regular clinical duties.
The Province of Ontario has issued an Order-in-Council (OIC) permitting other forms of moonlighting arising from/during exceptional circumstances e.g. Pandemic or other disaster

The Council of Ontario Faculties of Medicine (COFM) defines practicing with a Restricted Registration as:

Residents registered in postgraduate medical education programs leading to certification with the Royal College of Physicians and Surgeons of Canada (RCPSC) or the College of Family Physicians of Canada (CFPC) who provide clinical services for remuneration outside of the residency program with a restricted registration from the CPSO. https://cou.ca/wp-content/uploads/2017/12/Restricted-Registration-Policy.pdf

APPLICATION

As per the COFM and the CPSO, residents cannot legally work additional hours for pay outside of their residency program without an Independent Practice License or certificate of Restricted Registration.

Moreover, working any additional hours for pay outside of regular clinical duties under a certificate of Restricted Registration, specifically, must not contravene the PARO-OTH Collective Agreement (e.g. exceed Maximum Duty Hours). https://www.cpso.on.ca/Physicians/Registration/Registration-Policies/Residents-WorkingAdditional-Hours-for-Pay

Information on the Restricted Registration Program, and obtaining a certificate of Restricted Registration may be found at http://www.restrictedregistrationontario.ca/

Committee	Date
PGEC	June 14, 2023
Faculty Council

POSTGRADUATE TRAINEE SAFETY POLICY

Introduction

The Postgraduate Medical Education (PGME) Office recognizes its role in providing postgraduate trainees with a safe environment during their training. The responsibility for promoting a culture and environment of safety for postgraduate trainees rests with the University, the Faculty of Medicine, program leadership, affiliated training sites, clinical departments, and trainees themselves. The concept of postgraduate trainee safety includes physical, psychological, and professional security. This central policy is augmented at the level of the Residency Program Committee (RPC) to respond to the program specific context.

Trainees who feel that their personal safety is threatened during the performance of their training duties should remove themselves from the situation as quickly as possible, seek immediate assistance and report the incident to their supervisor.

Safety policies and procedures should be available from the program, program director or clinical leader as appropriate. Standard program orientation includes informing the trainee of these policies and having the information readily available for review at any time.

Reporting

Trainees who identify a threat to personal safety must report it to their immediate supervisor or program director. Alternate avenues of reporting may include Division/Department leadership, ombudspersons and directly to the postgraduate office, as appropriate.

Reporting issues related to the learning environment with disruptive or unprofessional conduct can also be done using the uOttawa Professionalism Reporting Tool (https://app.med.uottawa.ca/professionalism/). Reporting can be submitted anonymously if needed but anonymity may limit the ability for follow-up and/or corrective action.

Accidents, incidents, and environmental illnesses occurring during postgraduate training should be reported and administered according to the reporting policies and procedures of the University, Hospital or clinical teaching location. Policies and procedures should be available from the program or clinical leader as appropriate.

Key Responsibilities

For postgraduate trainees:

to provide information and communicate safety concerns to the program.
to comply with safety policies.

2. For postgraduate training programs:

to act promptly to address identified safety concerns and incidents.
to be proactive in providing a safe learning environment.

Physical Safety

Relating to travel

When postgraduate trainees are traveling for clinical or other academic assignments by private vehicle, it is expected that they maintain their vehicle adequately and travel with appropriate supplies and contact information.
For long distance travel for clinical or other academic assignments, it is expected that postgraduate trainees will ensure that a colleague or the home program office is aware of their itinerary.
Postgraduate trainees are not to be on call the day before long distance travel for clinical or other academic assignments by car. When long distance travel is required in order to begin a new rotation, the trainee must request that they not be on-call on the last day of the preceding rotation. If this cannot be arranged, then the trainee is to be provided with a designated travel day on the first day of the new rotation before the start of any clinical activities.
Postgraduate trainees are not to be expected to travel long distances during inclement weather for clinical or other academic assignments. If such weather prevents travel, the trainee is expected to contact the program office promptly. Assignment of an alternate activity is at the discretion of the Program Director.
Postgraduate trainees, when going to or from work or as part of their clinical duties, should assess the environment if walking alone, especially at night. Trainees are not expected to walk alone through areas they assess to be unsafe. If required, the trainee should request to be accompanied by the appropriate security service.
It is expected that postgraduate trainees will arrange safe transportation home if they feel unduly fatigued after their duty hours.
Training programs where land or air transport (fixed wing or rotor) forms part of the clinical training must be addressed by that training program’s own safety policy.

Relating to patient care

Postgraduate trainees are not to work alone after hours in health care or academic facilities without accessible support from security services.
Postgraduate trainees are not expected to make unaccompanied home visits unless they have had training relevant to the context.
Postgraduate trainees should only telephone patients from a clinic or hospital telephone line. If a call must be made on a personal or mobile device, it should be done using call blocking or some other tool to prevent disclosure of the caller’s information.
Postgraduate trainees are not to assess potentially violent or psychotic patients without the backup of security, and an awareness of accessible exits.
Special training must be provided to postgraduate trainees who are expected to encounter aggressive/violent patients
The physical space requirements, including access to unimpeded exit door, for management of potentially violent patients must be available where appropriate

Relating to Facilities

Call rooms and lounges must be clean, smoke-free, located in safe locations, and be equipped with adequate lighting, a functional bed, chair, desk and telephone. Fire alarms and smoke detectors must be in good working order and maintained appropriately. General facilities should also include washrooms and showers. Appliances supplied are to be in good working order. Daily linen services and housekeeping for bed-changing and room cleaning should be provided where appropriate. There must be adequate locks on doors to ensure security and privacy.
Site orientations must include a review of local safety procedures. As with any employee of the institution, postgraduate trainees must be aware of and follow the institution’s policies and procedures, which must be readily available to all trainees. This includes appropriate Workplace Hazardous Materials Information System (WHMIS) training to understand protocols when in contact with various types of hazardous waste including substances which are
1. Ignitable
2. Corrosive
3. Radioactive
4. Toxic
5. Reactive
6. infectious

Postgraduate trainees are expected to familiarize themselves with the location and services offered by the institution’s Occupational Health and Safety Office. This includes familiarity with policies and procedures for infection control and other protocols following exposure to:

contaminated or other fluids
needle stick injuries
reportable infectious diseases

As well as protocols relating to but limited to the following:

Fire alarms and emergencies
Hospital / Facility Evacuation
Disaster (External AND Internal)
Violent / Behavioural Situation
Bomb Threat or suspicious package
Hazardous Material Spill
Hostage / Active shooter situation

Relating to personal care
- Postgraduate trainees must observe universal precautions and isolation procedures.
- Postgraduate trainees must keep their required immunizations up to date, and report these to the Clinical Placement Risk Management Office without delay. The result in not keeping immunizations current is suspension from training and stoppage of pay.
- Overseas travel immunizations and advice should be sought well in advance when traveling abroad for rotations or meeting in accordance with the policies as described by the Faculty of Medicine’s International and Global Health Office.
  1. https://med.uottawa.ca/international-global-health-office/international-mobility/faculty-medicine-learners/travel-abroad
  2. https://med.uottawa.ca/international-global-health-office/international-mobility/faculty-medicine-learners/pre-departure-training
- Postgraduate trainees working in areas of high and/or long-term exposure to toxic substances, including but not limited to chemotherapeutic agents, reagent dyes etc., must follow the institutional safety policies.
- Postgraduate trainees working in areas of high and/or long-term exposure to radiation must follow radiation safety policies and minimize their exposure according to current guidelines.
- Radiation protective garments, such as aprons and neck shields, must be available and used as appropriate to the exposure by all postgraduate trainees during fluoroscopic techniques.
- Pregnant trainees are expected to be aware of specific risks to themselves and their fetus in the training environment and request accommodations where appropriate.

Psychological Safety

Learning environments must be free from intimidation, harassment, discrimination and violence.
- University of Ottawa Policy 67a — Prevention of Harassment and Discrimination
- University of Ottawa Policy 67b - Prevention of Sexual Violence
- .University of Ottawa Policy 66 – Violence Prevention
- University of Ottawa Policy 67 – Sexual Harrassment
All postgraduate trainees have the right to work in an environment that is free from mistreatment and/or exclusion on the basis of any protected grounds as defined by the Ontario Human Rights Act (e.g. age, perceived race, ethnoreligious affiliation, gender identity, disability, sexual orientation, marital/family status). Principles of equity, diversity and inclusion must be adhered to in order to respect the rights, dignity and full participation of all postgraduate trainees within the Faculty of Medicine.
When a postgraduate trainee’s performance is affected or threatened by poor health or psychological conditions, it is expected that the trainee will be granted a leave of absence and receive appropriate support. Such trainees are not to return to work until an appropriate assessor has declared them ready and appropriate accommodations are in place, if required.
Postgraduate trainees should be aware of and have easy access to the available sources of immediate and long-term help for psychological problems, substance abuse problems, harassment, and inequity issues. Resources include, but are not limited to, the OMA Physician Health Program, Faculty of Medicine Office of Faculty Wellness, uOttawa Human Rights Office, the Professional Association of Residents of Ontario and the Employee Assistance Program of the trainee’s home/base hospital (or the Ottawa Hospital as a default for community-based trainees).

Professional Safety

As relates to religious accommodations
- Postgraduate trainees may experience conflicts between their ethical or religious beliefs and the training requirements and professional obligations of physicians. Resources are to be made available by the program or clinical service to trainees to deal with such conflicts.
- Programs must make reasonable accommodations for religious holidays.
As relates to Fatigue Risk Management
- Postgraduate trainees identified as being excessively fatigued should not be given responsibility of critical tasks or should be asked to relinquish responsibility to someone capable of performing it. The trainee may be asked to take a break in order to reenergize before returning to duties
- Postgraduate trainees self-identifying as excessively fatigued, must inform the appropriate supervisor in order to mitigate potential for unsafe patient care
As relates to critical incidents
- Postgraduate trainees providing after hours care or consultation must have adequate access to an appropriate supervisor. As required, this may include the timely attendance of the MRP to assist the trainee.
- Postgraduate trainees must have adequate support from the program following an adverse event or critical incident.
- Programs must promote a culture of safety in which postgraduate trainees are able to report and discuss adverse events, critical incidents, ‘near misses’, and patient safety concerns without fear of recrimination.
As relates to confidentiality
- Programs and the PGME Office collect and must responsibly and securely hold confidential postgraduate trainees’ personal information, including health information. Disclosure is appropriate where required for the purposes of facilitating required personal support of the trainee.
- Programs must be aware of and comply with the Freedom of Information and Protection of Privacy Act (FIPPA) in relation to postgraduate trainee files.
- Postgraduate trainee evaluation information must be handled in a manner that ensures confidentiality unless the trainee explicitly consents otherwise. Disclosure may be required for the purposes of maintaining patient and workplace safety or in the support of the trainee in difficulty but should be limited to individuals providing ongoing educational guidance where possible.
- In the case of a complaint against the trainee that must be dealt with due to its severity of threat to others, or in accordance with Bill 18 (Building Workplaces for a Stronger Economy (2014)), a program director may be obliged to disclose information against the trainee’s wishes. Depending on the nature of the complaint, the affiliated institution and/or the College of Physicians and Surgeons of Ontario may be involved. The program director should serve as a resource and an advocate for the postgraduate trainee during this process.
As relates to medicolegal protection
- Postgraduate trainees must be members of the CMPA and follow CMPA recommendations in the case of real, threatened, or anticipated legal action.
- In addition to CMPA coverage for patient actions, trainees are covered, either by the University itself or its insurer, for actions arising from their participation (acting reasonably) in University committees (e.g. tenure, appeals, residency training) on which they may serve.

Review

This Policy will be reviewed 1 year after adoption and every 3 years subsequently.

Committee	Date
Postgraduate Medical Education Committee	November 30, 2022
Faculty Council	May 2, 2017
Executive Committee of the Senate	October 10, 2017

Preamble

The Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada are the national bodies that set the minimum standards and requirements of training for the approximate 80 specialties recognized for physicians in this country. It is the responsibility of the Faculty of Medicine Postgraduate Medical Education Committee (PGEC) to oversee these training programs ensuring that these minimal standards are maintained. Equally, this committee shall oversee the occasional modifications in training requirements as requested by the program Residency Training Committee. The requested modifications, which may be specific to the training program itself or programs under the umbrella of a department, would be required due to the inapplicability of the existing general rules and regulations. Such modified requirements will need to be guided by principles of natural justice and pedagogical soundness. Such decisions will require the consensus of the PGEC.

Policy

The Postgraduate Medical Education Committee shall be responsible for approving residency training requirements which are in addition to the minimum specialty training requirements defined by the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada where the failure for a resident to meet such enhanced requirements would result in prolonging the period of training.

Process

Programs seeking enhanced training requirements need to make application, both in writing and with an in camera presentation to the PGEC outlining the following:
1. The nature of the training
2. The logic for the requirement
3. The process and timeline for addressing a resident’s failure to meet the training requirements within the stipulated range
Approval will be by simple majority of the PGEC
Residents will be given at least one year’s notice before any changes are enacted.

Committee	Date
Postgraduate Medical Education Committee	January 27, 2016

Please note this policy is still undergoing approval.

Leave of Absence Policy

UNIVERSITY OF OTTAWA, FACULTY OF MEDICINE
POLICY AND PROCEDURE FOR RESIDENCY LEAVES OF ABSENCE

PREAMBLE:

Residency programs define specific time requirements for training. It is recognized that a resident may require one or more interruptions of training for personal and professional reasons. Such interruptions are referred to as leaves of absence. This policy outlines the Postgraduate Medical Education (PGME) processes and procedures to review and grant leave of absence requests, including salary level implications, and impact on certification exam eligibility.

SCOPE:

This policy applies to all Ministry of Health (MOH) funded residents registered with the PGME Office.
AFC trainees, Clinical and Research Fellows should contact the department overseeing their training with respect to contractual leaves policies and procedures.
The PGME office will abide by any stipulations regarding leaves of absence provided for in the PARO-OTH Collective Agreement as well as in sponsorship contracts (e.g. Gulf sponsored residents from Saudi Arabia, Kuwait, Oman, United Arab Emirates, Bahrain, or Qatar); it is recognized that the PARO-OTH Collective Agreement also provides for employee benefits to sponsored residents.

DEFINITION:

A leave of absence is defined as an approved interruption of training for any reason. Leaves may be taken for a variety of reasons but are generally categorized into leaves with pay and leaves without pay.

GENERAL PRINCIPLES and RESPONSIBILITIES

Residents:

The resident’s professional responsibility is to ensure that the Program Director (PD) and Program Administrator (PA) are notified regarding their request prior to the start of the proposed leave. It is recognized that this will not always be possible in urgent circumstances and, in such cases, will not affect the approval for the resident’s leave. In urgent circumstances, the resident must notify the faculty supervisor and/or Chief Resident to ensure that an alternative can be found for the provision of clinical care.
In addition to informing their program of a medical leave, residents may be requested to send medical notes for any medical illness longer than three (3) days directly to the Wellness Office ([email protected]), who are the health information custodians for medical information. Wellness will then notify the PGME office.
Residents on approved leave will remain registered with the PGME Office, notwithstanding their inactivity and are expected to maintain a standard of conduct in keeping with the standards of the residency program, the University, and the medical profession at large.
Residents on approved leave must sign and date a Letter of Appointment for the purpose of licensure with CPSO, pay the registration fee, and complete other registration requirements annually to remain registered with the PGME Office. Refer to the PGME Website for more information.
Residents must be aware of their professional obligations to report leaves to the CPSO when applying for or renewing licenses. Failure to disclose leaves from the training program may result in delays in license renewal as a result of investigation and/or disciplinary action.
If there is a WSIB claim, please refer to this link for incident reporting.
At the end of a leave of absence, residents must return to their home residency program.
Time lost during a leave must be made up ( orthe equivalent time in the residency program) upon the resident’s return to the Program. Residents will normally be required to complete all mandatory/elective components of the Program. In special cases, a waiver of training may be requested at the discretion of the PD and the Residency Program Committee (RPC). See policy on Waiver of Training.
During a leave of absence, residents will be classified in the same postgrad year (PGY) level they are at the start of their leave.
Salary and benefits continuation is determined by the type of leave and in accordance with the PARO-OTH Collective Agreement.
Residents must notify their home PD and administrator of their return date. For leaves over six (6) months, the resident must notify the program at least four weeks in advance of the return date or of the proposed leave.

Program:

All submissions for leaves from residents will require the program to review and approve beforehand, with appropriate documentation provided to PGME.
Unless required by the PD or for purposes of the Record of Employment, leaves of seven (7) days or less are not required to be submitted to the PGME Office.
If there is a WSIB claim, please refer to this link for incident reporting.
Programs must provide PGME with plans should residents return to training with requirements for accommodations or part-time work plan.
In all cases, the PD, in discussion with the RPC and returning resident, should determine:

the required make up time;
the Competence by Design (CBD) stage of training and training level to which the resident will return following the leave; and
the necessary educational experiences required for the resident to complete the residency requirements and goals and objectives of the training program.

For Family Medicine, residents must complete twenty-four (24) months of training in accordance to CFPC guidelines. For any interruption of training, it is expected that the resident will make up time on rotations missed with equivalent time upon return to the program. Should a waiver of training be granted, the CFPA Board of Examinations and Certification must be notified prior to the submission of completion of training – the maximum length of a waiver of training is four (4) weeks.
Family medicine residents registered in enhanced skills programs for one (1) year or less must complete the entire duration of training to be eligible for CFPC examinations leading to Certificates of Added Competence and/or attestations of completion of training.

Postgraduate Office:

The PGME Office will notify the College of Physicians and Surgeons of Ontario (CPSO) and PARO (long-term leaves) of all interruptions in training greater than one (1) week, as reported by the Program Director. The PGME Office will abide by governance as established in
1. Employment Standards Act, 2000. Section XIV- unpaid leaves of absence
2. Council of Ontario Faculties of Medicine (COFM) document, Leaves from Ontario Postgraduate Residency Programs, May 2015
3. RCPSC Policy for Certification in a Competence by Design Model of Residency Training (Section III)
4. PARO-OTH Collective Agreement

TYPES OF LEAVE

Paid Leave

Pregnancy and Parental Leave: Entitlement to pregnancy and parental leave is addressed in Section 15 of the PARO-OTH Agreement.
Medical/Sick Leave: Residents are entitled to up to six (6) months of paid leave for illness or injury. If the resident requires a prolonged medical leave greater than six (6) months, they may be eligible to receive pay and benefits through Long Term Disability. Further details on Long Term Disability and other entitlements regarding illness or injury are addressed in Section 14 of the PARO-OTH Agreement. Upon return to training, it is the resident’s responsibility to inform the Program and PGME if they require accommodation(s), a gradual return to work plan, or a change to part-time status. All required documentation must be submitted to the Faculty Wellness Program prior to the resident’s return to work start date.
Medical Note: if a resident is sick for an extended period of time (more than seven (7) days), they will be required to provide a doctor’s note. Doctor’s notes must be sent to the Faculty Wellness Program (wellness@uottawa.ca), who will relay the information to the PGME office.
Professional Leave: Residents shall be granted educational leave up to a maximum of seven (7) working days per year; shall be consecutive if requested by the resident, and shall not be deducted from regular vacation entitlement. Residents shall be granted additional paid leave to take Canadian or American certification examinations. For further details, refer to Section 12 of the PARO-OTH Agreement .
Vacation: Residents are entitled to four (4) weeks of paid vacation per year. Vacation entitlement accrues while on maternity/parental leave. Vacation time must be taken within the academic session and cannot be rolled over or “stockpiled” to the next year, or counted towards waived training time. In addition, vacation time should not be carried over when the resident enters a sub-specialty program. Hospitals may not restrict the amount of vacation a resident can take in a rotation but do have the right to delay a vacation request with regard to professional and patient care responsibilities. For further details, refer to Section 11 of the PARO-OTH Agreement.
Emergency, Family, Bereavement Leave: A resident may request a leave due to a death in the immediate family or a person with whom the resident had a close relationship. A leave may also be requested due to family illness, injury, medical emergency, or other urgent family matters to which the resident must attend. A maximum of five (5) consecutive working days may be granted by the PD.

Unpaid leave

Educational Leave: A resident may request an unpaid educational leave on the basis that the time away from the residency program is relevant to his/her current program. The request must be supported by the PD, and approved by the Postgraduate Dean or designate. The maximum educational leave period is usually one (1) year. The Program must ensure there are no anticipated negative effects on return to training at the appropriate level and timely completion of the training program prior to the approval of an education leave. The PD must provide the PGME office with notification, including the duration of the educational leave and the expected return date. Leaves beyond one (1) year will be assessed by the RPC, PD and the Postgraduate Dean or designate.
Personal/Compassionate Leave: A resident may request an unpaid leave of absence due to a personal situation, career uncertainty or for other reasons. These leaves will be considered on an individual basis, discussed and reviewed for approval by the PD in consultation with the RPC and the Postgraduate Dean or designate. The maximum leave period in this category is six (6) months.

SALARY CLASSIFICATION:

Residents will normally advance to the next pay level upon their successful completion of twelve (12) months (13 blocks) of training.
During a leave of absence, residents will be classified in the same postgraduate year (PGY) level they are at the start of their leave.
Salary and benefits continuation is determined by the type of leave and in accordance with the PARO-OTH Collective Agreement.

RETURN TO TRAINING:

Residents returning after a medical leave will provide a written medical certificate from their treating physician to the Wellness office ([email protected]) indicating the resident’s capability and fitness to return to the program. The PD or the Postgraduate Dean or designate may request an additional independent medical opinion to ensure the resident’s capability to resume their residency program.
Normally residents will return to the program at the same level as when the leave was taken.
Residents returning to training after a prolonged absence may require a modified learning plan or reassessment/reclassification.
In order to decide on the appropriate training level and program structure, residents may be assigned a 4-12 week period of reassessment, structured and organized by the PD in consultation with the RPC and educational programming resources. PGME Director of Academic Support and other PGME resources may be utilized to assist the program.
The RPC, will review the results of the assessment and the PD will submit a recommendation to the Postgraduate Dean or designate regarding the resident’s re-entry to training.
If approved, the PD will discuss with the resident the modified program structure, training level, the evaluation process, and expected outcomes.
An accommodation plan must be submitted and approved by the Faculty Wellness Program and the Program. There may be changes to pay for part-time accommodation plans.
If a RPC recommends against a resident’s re-entry to the training program, the policy outlining the conditions for dismissal apply. The PD must inform the Postgraduate Dean or designate and the recommendation will be reviewed by the PGME Evaluation Subcommittee. The decision will be communicated with the resident by the PGME Office. Any appeals would follow the normal Faculty and University Appeals process.

PROCESS:

Resident requests the leave and submits it to their PD and PA for approval.
All leaves must be approved by the Resident’s Program Director.
In addition to informing the program of a medical leave, residents must send medical notes directly to the Wellness Office ([email protected]), who will then notify the PGME office.
If there is a WSIB claim, please refer to this link for incident reporting.
The Program submits a Status Change Form to inform the PGME Office of the leave.
All leaves greater than seven (7) consecutive days must be reported to the PGME Office. There may be special circumstances when the Program will report a leave for less than 7 days (i.e. a pattern of missed days by a resident within a specific time frame resulting in a resident’s ability to successfully complete training objectives), or resulting in unprofessional behaviour.
When Bereavement Leave is required, the resident will contact the PD and PA as soon as possible to specify the number of days needed and to request approval.
The Postgraduate Dean or designate must be informed of and approve all unpaid leaves. A letter of support from the PD must be sent to PGME’s Registration Coordinator ([email protected]), who will proceed with obtaining the Postgraduate Dean’s approval.
All leaves reported to the PGME Office will be reported to the College of Physicians and Surgeons of Ontario (CPSO) and PARO (LTD).
For medical leaves that extend into a new academic year, the resident or their delegate will provide a report to their PD on the status of their leave. Privacy is respected, and confidential medical information will not be required. The PD will inform/update PGME regarding the status of the resident to create a Letter of Appointment (LOA) for the resident.
While on medical leave, salary and benefits will be maintained and continued until the end of the medical leave, for up to six (6) months, or the end of the resident’s appointment year, whichever occurs first. The appointment year is determined by the resident’s training start date. During a medical leave, the resident’s salary and benefits continuance will be applied as defined by section 14.1 of the PARO-OTH Collective Agreement.

RETURNING TO TRAINING AFTER A LEAVE:

PGME must be informed if there is a change in the return date from the original leave request. The program must let PGME know through the Status Change Form. This will ensure that pay and benefits will resume on the correct date.
All residents are required to complete all mandatory and elective components of the program. PDs may consider a waiver of training if training requirements have been met and the resident has achieved the mandatory competencies of the Program.
Residents may require an accommodated or modified/gradual return to work plan or request part-time training following a medical leave. Programs are required to provide PGME with this information via the Status Change Form prior to the resident’s return to training (allowing up to a grace period of seven (7) days after the resident’s return). All parties must understand any ramifications for extension of training and/or changes to pay for part-time training and accommodation plans.
Residents must send medical or accommodations notes directly to the Wellness Office ([email protected]), who will then notify the PGME office.
For leaves under one (1) year in length, it is expected that residents will return to the same program and training level they were in prior to the leave.
After a prolonged leave (greater than twelve (12) months), Programs shall determine the level of training and required educational experiences and competencies necessary to complete the training program.

Committee	Approval Date
Postgraduate Medical Education Committee	May, 2023
Faculty Council	June 13, 2023
Executive Commitee of Senate	pending

STATEMENT:

This policy reflects the University of Ottawa (uOttawa), Faculty of Medicine’s commitment to a safe, positive, and healthy learning environment for all Postgraduate Medical Education (PGME) trainees by creating, promoting, and sustaining a culture of wellness and resilience within the environment.
The Faculty Wellness Program (FWP) at the Faculty of Medicine offers and supports wellness-related programs that assist PGME trainees in optimizing their physical, mental, and emotional well-being. The FWP also assists clinical department programs to develop and sustain a positive learning environment to optimize learning, morale, and attainment of career goals.

WHO IS AFFECTED BY THIS POLICY?

This policy applies to all trainees (residents and fellows) in PGME at uOttawa. Faculty involved in the education of PGME trainees are also supported under this policy to provide the appropriate structure for safety and wellness.

FACULTY WELLNESS PROGRAM

The FWP promotes and supports a culture of physician health and wellness to sustain a solid foundation in professionalism and patient care. A distinct part of the FWP mandate includes providing PGME trainees with a safe and confidential venue to seek out resources that protect and enhance their health and well-being.
Here, PGME trainees can discuss concerns about personal, academic, or work-related matters freely. No members of the FWP team, including the Assistant Dean FWP and the Director of Learner Wellness, play a role in the evaluation of the trainee. Therefore, discussions about concerns remain at arm’s length from Program Director, or other faculty who are involved in the evaluation of the trainee.

Wellness Support

The FWP team provides support in the following areas:

Educational sessions (i.e.: workshops, training, facilitated discussions) on wellness topics shaped to suit the needs of groups, programs, or departments
Individual counselling
Accommodations
Resident wellness needs (individual or group) for PDs
Support for development and implementation of wellness topics within a program’s curriculum
Referrals to health care providers, counsellors, coaches, and the Ontario Medical Association Physician Health Program
Administration of the Resident Wellness Committee
Administration of the Resident Peer to Peer Support Program

FWP Team:

1 Assistant Dean, Faculty Wellness Program
1 Director of Learner Wellness, Faculty Wellness Program
2 Clinical counselors
1 Program Manager
1 Program Officer

Counselors of the FWP team belong to a professional order and are bound by a strict code of ethics. This includes adherence to rules of confidentiality and conflict of interest. They offer short counselling term (typically 8-12 sessions) to PGME trainees and can accommodate daytime or evening appointments (Monday to Friday) for one-on-one wellness support. Additionally, counselors facilitate support groups and workshops designed to enhance resident resilience and well-being. Counselling services are offered either in person or virtually via a secure platform.

The FWP works with PGME programs and trainees to support peer-led wellness initiatives to further strengthen trainee well-being and enhance the environment of their respective programs.

The Faculty Wellness Program can be contacted by calling 613-562-5800 extension 8507 or by emailing [email protected]

Confidentiality

Information is collected and stored in accordance with the University of Ottawa’s Policy 90 – Access to Information and Protection of Privacy

Client electronic files are confidential and kept securely – according to PHIIPA rules. Files are kept for a period of 10 years after which time they are deleted.
Files are password-protected.
Client information can only be released with their written consent.
Access to confidential clinical notes of our client files is restricted to the clinical counsellor(s).
Confidential administrative documents are managed by authorized FWP personnel only.
The secure file transfer software Liquid files is used for the secure transfer of private and confidential information.

Conflict of interest

In cases where a FWP physician must provide medical care to a trainee, and where there is also an academic relationship, the trainee is advised that they have the right to ensure that the FWP physician recuses him/herself from all subsequent trainee evaluations. The trainee is encouraged to request a change in supervisor or teaching site when this conflict exists. Alternatively, the trainee can still be taught by this FWP physician, as long as there is an explicit understanding that they do not partake in the trainee’s evaluation process.

Resident Wellness Advisory Committee:

The Resident Wellness Committee (RWC) acts as an advisor in providing strategic direction to the PGME office and the FWP in areas of wellness supports.

The RWC will assist in identifying, goals, and implementation strategies to encourage healthy behaviours in the learning environment. The RWC will promote the development of physician health awareness and expertise within PGME programs, while advocating for policy changes aimed at bettering resident physician wellness.
University of Ottawa, Faculty of Medicine, Resident Wellness Committee term of reference

ACCOMMODATION POLICY

The uOttawa Faculty of Medicine, PGME program is committed to ensuring that appropriate accommodations are provided for PGME trainees with disabilities where possible. The purpose is to create barrier-free learning environments by providing supports and services in accordance with Human Rights obligations and aligned with the uOttawa principles for accommodations.

Accommodation is a shared responsibility. It is most effectively provided when those involved approach the process with fairness, sensitivity, respect for confidentiality and co-operation. This requires the exchange of relevant information between the appropriate parties, and a constructive discussion about the appropriate accommodation in the circumstances. Accommodations support diversity in the workplace and learning environment. They create a fair and level training environment for all trainees to thrive in.

A PGME Accommodation Policy outlines the process for accommodations including the role for an Accommodation Planning Committee (PGME APC) which is formed when necessary to develop, monitor and revise accommodation planning for UOttawa PGME trainees.

Postgraduate Medical Education (PGME) Policy and Procedures for Accommodation of Postgraduate trainees with Disabilities

PGME Accommodation Planning Committee (APC) terms of reference

RESPONSIBILITIES OF PGME TRAINEES AND PROGRAMS

PGME trainee responsibilities

Work towards an appropriate work-life balance
Understand own limitations relating to fatigue, stress, emotional or physical difficulties and other issues with self-care on capacity to work and train.
Understand hazards of alcohol or chemical dependency on personal health and capacity to work and train.
Be aware of colleagues who may be having difficulty and respond as able and necessary. Recognize and inform the PD or other faculty regarding individual or broader wellness issues in the learning environment
Be familiar with the available wellness supports and resources
Be aware of PGME policies and processes that support wellness, including those related to Accommodation, Professionalism and Intimidation and Harassment
Access and utilize appropriate available resources to seek care – including (but not exclusive to) health/psychological counselling, FWP resources, primary care physician
Communicate safety issues in the learning environment to the Program Director in a timely manner. Appropriate safety concerns may include (but not exclusive to) after hours work, fatigue risk management, exposure to hazardous materials/infectious agents/ionizing radiation, safe disclosure of patient safety, violence in the workplace, etc.
Communicate incidents of intimidation or harassment in the learning environment to the Program Director, other Faculty, or submit the Faculty of Medicine professionalism reporting tool in a timely manner
Identify own requirement for accommodation when appropriate, as consistent with PGME Accommodation Policy

Training program responsibility

Physical and emotional health concerns of all trainees are prioritized, recognized and addressed
Establish a culture of wellness support and health promotion within the program and in the learning environment
Ensure there is a strategy for fatigue risk management within the program
Maintain zero tolerance of intimidation and harassment within the program and the learning environment
Ensure trainees are familiar with and have access to the policies, reporting mechanisms and supports required for incidences where there is a breach of safety or professionalism
Maintain confidentiality and discretion for all trainees
Enable multiple points of entry for trainees to discuss wellness/safety issues
Enable a non-judgmental program and learning environment
Enable access to wellness/safety support through resources within the structure of the following organizations: uOttawa Faculty of Medicine, Hospital (occupational health), resident regulating bodies (e.g., PARO, RDocs), community and regional bodies (e.g., OMA, primary care physician)
Provide career advice/counselling and support transitions where needed to ensure appropriate development of future training or practice opportunities

FATIGUE RISK MANAGEMENT (FRM)

PGME trainees have a professional responsibility to appear for duty appropriately rested and must manage their time before, during and after clinical assignments to prevent excessive fatigue. Trainees are responsible for assessing and recognizing the signs of impairment including that which is due to illness and/or fatigue in themselves. Trainees experiencing such impairment are to notify their Program Director or designate.

PGME and programs offer educational resources and information on fatigue prevention, mitigation and recognition strategies for trainees and healthcare providers. FRM curriculum and safety policies should be incorporated in all programs. Established pathways to identify and proactively prevent fatigue related incidents should be included in the program’s process of quality assurance in the learning environment.

Within that shared responsibility, trainees have a key role in managing and reporting their own fatigue to their supervisors, peers and to the healthcare team. To support this, medical education leaders are accountable for ensuring practices are in place that enable and protect every trainee's ability to fulfill their role in the management of fatigue risk

A module on Fatigue Risk Management is available to trainees on Brightspace.

COMPLAINT MANAGEMENT

All members of the University community have a right to a learning and workplace environment that is respectful, safe, healthy and free from harassment and discrimination pursuant to the University of Ottawa Policy 67a – Prevention of Harassment and Discrimination.

PGME trainees are encouraged to submit reports of incidents of mistreatment via the Professionalism Office reporting tool, or privately and confidentially to the Vice Dean PGME, or Assistant Dean, PGME. Incidents of sexual harassment and or sexual violence are deferred and managed by the uOttawa Human Rights Office (HRO) as per Policy 67 Sexual Harassment and Policy 67b Prevention of Sexual Violence.

All levels of learners (Undergraduate, Postgraduate, Graduate, TMM, Post Doc Fellow, Clinical Fellow), and Faculty Members have a duty to adhere to the uOttawa Faculty of Medicine’s Policy on Professionalism in all clinical, academic and research settings. This includes all interactions whether in person, in writing or by electronic means (for example, email, social media, internet).

The University of Ottawa and the Faculty of Medicine reaffirms its ongoing commitment to providing, promoting, and maintaining a professional and respectful working and learning environment.

Our goal is the create and sustain a culture of equity, diversity, inclusion and belonging for all members of the Faculty of Medicine community. All Faculty members have the right to work in an environment that is free from mistreatment and/or exclusion on the basis of any protected grounds as defined by the Ontario Human Rights Act (e.g. age, perceived race, ethnoreligious affiliation, gender identity, disability, sexual orientation, marital/family status). Principles of equity, diversity and inclusion must be adhered to in order to respect the rights, dignity and full participation of all PGME trainees, staff and faculty within the Faculty of Medicine.

WAIVER OF TRAINING AFTER A LEAVE OF ABSENCE

PREAMBLE

The Postgraduate Medical Education Office allows for the possibility of granting a waiver of training after an approved leave of absence for Residents. Waivers of Training may be applied to residents in both time-based programs and in competency-based training. While the exit from training is based on demonstrated achievement in competency-based training programs, time may still be considered in recognition of the formal agreements the University of Ottawa, PGME holds with the provincial ministry of health and regulatory bodies.

Both the RCPSC and CFPC state that residents must complete all program training requirements.

To meet the CFPC certification exam eligibility requirements, Family Medicine residents must make up any leaves of absence to ensure the full duration of twenty-four (24) months training is completed. Waivers of training of four (4) weeks may be considered and granted at the discretion of the Program Director only by exception and under unusual circumstances. The CFPC must be notified of the waiver prior to submission of the completion of training notice to the College.
Where a resident in a RCPSC program will have achieved the required level of competence by the end of the final year of training, a waiver of four to twelve (4-12) weeks may be requested by the Program, to be approved by the Vice-Dean, PGME or designate.

PURPOSE AND BACKGROUND

To provide guidance to program directors and residents on exploring, applying for and granting waivers of training time.

The Vice-Dean, PGME, or designate may grant a waiver of training further to the recommendation of the resident’s program director following the resident’s approved leave of absence in accordance with the policies of the Royal College of Physicians and Surgeons of Canada (RCPSC) and the College of Family Physicians of Canada (CFPC), provided that the resident meets the criteria for an exceptional resident set out below. A waiver of training cannot be granted in any other circumstances.

SECTION 1: REQUIRED PROCESS TO REQUEST A WAIVER OF TRAINING

1.1 Residents who wish to explore whether they may be eligible to have training waived must discuss this with their program director. There may be program-specific guidelines in place, in addition to RCPSC/CFPC requirements and PGME requirements. Residents are entitled to know in advance how their performance will be evaluated to determine whether they qualify for a waiver of training. Residents are not automatically entitled to a waiver of training.

1.2 A resident can be granted a waiver of training after a leave of absence if they have met all training requirements of the RCPSC/CFPC and all of the program’s educational requirements, and the Program Director is satisfied that the resident will have achieved the required level of competence by the end date of the training. Every program must make information on the educational requirements available to residents.

1.3 When considering a waiver of training the Program Director must take into account:

any unsatisfactory, borderline or incomplete rotation evaluations
inconsistent attendance at academic activities
changes to training that resulted in an overall dilution of the educational experience
any concerns about the academic, professional, behavioural and ethical performance of the resident
performance in objective evaluations (e.g., OSCE, mini CEX, multiple choice examinations, oral examinations, short answer questions and evaluating examinations)
assurance that all training objectives outlined by the respective college will be met by the end of the training
Work based assessment such as EPAs.

1.4 The Program Director may recommend a waiver of training up to the maximum allowable times permitted by the RCPSC and CFPC, as noted below:

It is the responsibility of the College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (RCPSC) to set maximum allowable times for waivers of training that maintain eligibility for certification.
Maximum allowable times for waivers are as follows:
- Family Medicine - four weeks
- One-year programs - no waiver allowed
- Less than one year for remediation or enhanced skills - no waiver allowed
- Two-year programs (excluding Family Medicine) - six weeks
- Three-year programs - six weeks
- Four-year programs – twelve (12) weeks.
- Five-year programs – twelve (12) weeks.
- Six-year programs – twelve (12) weeks.
- For residents taking subspecialty training in the final year of a specialty program (e.g., Internal Medicine and Pediatrics), up to twelve (12) weeks is allowable in PGY4 only if the program directors in both the specialty and subspecialty programs agree that a waiver can be recommended.

1.5 In the beginning of the final year of training a resident may make a request in writing to the Program Director.

In time-based training, a decision to grant a waiver of training cannot be granted after the resident has taken the certification examinations.
In CBD programs, as exam eligibility will be determined by the program during the third stage of training, Core of Discipline, requests for waivers can be submitted after the certification exam. In programs where the oral examination is in the last six (6) months of the final year of training, new waiver requests cannot be submitted after the completion of the oral examination.

1.6 If the program approves the request for the waiver, the Program Director must then submit a letter of support to the Postgraduate Dean. The Program Director’s letter must include the following information:

resident’s name, program, level, dates of the program time leave being waived and the recommended revised end date.
confirmation that the resident has successfully completed all training requirements of the program, including in-training examinations, quality assurance projects, case logs, etc.

1.7 The Vice-Dean, PGME, or designate reviews the request, and if approved, the PGME Registration Coordination will update the Confirmation of Completion of Training (CCT) and forwards it to the Royal College or the College of Family Physicians.

If approved, the program must submit a Status Change Form advising the resident’s new end date.

SECTION 2: APPEALS

A decision not to grant a waiver of training cannot be appealed.

SECTION 3: LINKS TO RELEVANT POLICIES

CFPC policy

RCPSC policy

SECTION 4: DEFINITION OF AN EXCEPTIONAL RESIDENT

MINIMUM CRITERIA FOR THE PURPOSES OF A WAIVER OF TRAINING

NOTE: Each program can add its own criteria to define “exceptional” within the context of their specific program.

Decision responsibility

Program Director, based on the Residency Program Committee recommendation.
Vice-Dean, PGME or designate approves decision.

Criteria

Must be subsequent to the first on-service year (with the exception of family medicine):
- objective assessments (e.g., OSCE, mini CEX, multiple choice exams, oral examinations, short answer questions)
  - must pass all exams.
  - must be above “meets expectations” at least 75% of the time.
- ITERs or ITARs – “meets expectations” or above at least 75% of the time on all evaluations
No concerns re: the resident’s academic, professional, behavioral and ethical performance;
Have successfully completed all stages of training per the requirements of the accrediting body [for CBD programs]
No red or yellow zone behaviours on the PULSE 360° Survey System.
Consistent attendance at academic activities.
Includes tangible contribution to department, including in at least one of the following areas:
- administration (e.g., chief resident, RPC rep, PARO rep);
- research (e.g., published papers or presented posters during residency);
- education (e.g. resident teaching awards, consistent excellent teaching evaluations).
None of the following (each below is an exclusion criterion)
- extra educational activities as defined in the evaluation policy of PGME (formal or informal).
- remediation (formal or informal).
- probation.
- suspension.
- interruption in residency training exceeding twelve (12) months.
- failed rotations.
“Early consultant level competency”
- is prepared to challenge the certification exam at the same time as their cohort of residents, despite the decrease in training time.
- at the time the waiver is granted, would be capable of transitioning into independent practice or advanced clinical training.

Committee	Approval Dates
PGEC	May 2023
Faculty Council	June 2023
Senate	Pending

Policies

Academic Appointment Procedures Manual arrow_drop_down

Academic Promotion of Clinical Faculty: Guidelines arrow_drop_down

Accommodation Policy and Process arrow_drop_down

Appeal to the Faculty Council Appeals Committee arrow_drop_down

Applying for Postgraduate Year 3 Training in Family Medicine arrow_drop_down

Assessment Verification Period (AVP) arrow_drop_down

CMA Code of Ethics arrow_drop_down

Changes to Clinical Rotations: Administrative Procedure arrow_drop_down

Clinical Fellowship arrow_drop_down

Postgraduate Clinical Fellowship Policy

A. Definition:

B. Requirements:

College of Physicians and Surgeons of Ontario (CPSO) Policies arrow_drop_down

Conflict Resolution arrow_drop_down

Evaluation Roles and Responsibilities arrow_drop_down

Evaluation of Community Preceptors arrow_drop_down

Immunization arrow_drop_down

Leaves from Ontario Postgraduate Residency Programs arrow_drop_down

PULSE Intensive Program arrow_drop_down

Purpose

Application

Remediation Periods

Funding

Part-Time Residency Training Guideline arrow_drop_down

Physician Behaviour in the Professional Environment arrow_drop_down

Policy for the Assessment of Postgraduate Trainees arrow_drop_down

1. INTRODUCTION

2. PURPOSE

3. SCOPE

4. DEFINITIONS

5. STANDARDS OF ASSESSMENT

6. PRINCIPLES OF TRAINEE ASSESSMENT

Structure

Assessment and feedback

Trainee Wellness

7. PROMOTION

8. REINTEGRATION / REASSESSMENT

9.UNSATISFACTORY AND INCOMPLETE PERFORMANCE

10. REMEDIAL MEASURES

11. EXTENSION OF TRAINING

12. REMEDIATION

13. PROBATION

14. SUSPENSION

15. DISMISSAL FROM THE PROGRAM

16. APPEALS

17. NOTIFICATION

18. GENERAL

19. REVIEW

Policy on Appointing a Program Director arrow_drop_down

1. Objective & Scope

2. Definitions and Acronyms

3. Policy

4. Roles and Responsibilities with regard to program directors:

5. References

6. Contacts

7. Appendices

8. Policy record

Appendix:

Summary table of decisions and follow-ups for missed deadline

Policy on Postgraduate Trainees Undertaking International Electives arrow_drop_down

Introduction

Purpose

Office Responsible

Section 1: ELIGIBILITY CRITERIA

Section 2: APPLICATION PROCESS

2.4 Pre-departure training for international electives

Section 3: DURATION AND REMUNERATION

Section 4: MEDICAL-LEGAL COVERAGE DURING ELECTIVE

Section 5: ALIGNMENT WITH THE POSTGRADUATE TRAINEE SAFETY POLICY

Section 6: SUMMARY

Policy Review

Potential Conflict of Interest During Clinical Supervision Due to a Personal Relationship arrow_drop_down

Pre-entry Assessment Program (PEAP) arrow_drop_down

Prevention of Harassment and Discrimination arrow_drop_down

Prevention of Sexual Violence arrow_drop_down

Procedure for an Appeal to the Senate Appeals Committee arrow_drop_down

Process for vacant MOHLTC funded residency positions arrow_drop_down

Application

Requirements