Policies and guidelines that govern the PGME program.
It is the expectation that residents will complete the rotation schedule as published at the beginning of the academic year.
A program director may switch a resident out of a rotation with a minimum of 6 weeks’ notice to the receiving program. Otherwise, a resident may not be switched out unless the donating program supplies an alternate resident.
The exceptions to this policy wherein a resident may be switched out of a rotation without due notice or supplying an alternate are:
- Unexpected serious illness of the resident.
- Academic difficulties such as failure of a rotation or the requirement for remediation or probation.
- Pandemic or other disaster-related redeployment.
|Faculty Council||March 16, 2021|
Postgraduate Medical Education Committee (PGEC)
January 20, 2021
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.
- 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 $60,000 / year as their fellowship salary, as per the “Salary for Clinical Fellows Policy”.
- Fellows are only permitted to begin training on the 1st of the month or the first business day that follows. In the case of delays, the 15th of the month is the next possible start date.
- 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.
|March 16, 2021|
Clinical Fellowship Committee
January 22, 2020
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.
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.
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.
This program is funded by Postgraduate Medical Education; twenty (20) hours of coaching is the lifetime maximum per resident.
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.
1.1 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 ; and
- The Canadian Medical Association Code of Ethics (CMA).
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.
3.1 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 () 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.
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
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.
22.214.171.124 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.
126.96.36.199 In traditional time-based programs, there should be documented, mid- rotation, formative feedback when the rotation is two blocks or longer.
188.8.131.52 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.
184.108.40.206 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.
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.
7.1 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;
9.1.3 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
10.2 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.
12.1 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.
13.1 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.
14.1 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.
16.1 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.
16.4 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.
17.1 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.
18.1 This policy replaces any previous versions of the policies and procedures on PGME evaluations.
19.1 This policy will be reviewed 1 year after adoption and every 3 years subsequently.
January 30, 2019
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
|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|
|PGME||Postgraduate medical education|
|Royal College||Royal College of Physicians and Surgeons of Canada|
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.
220.127.116.11 OSE will verify completion of PD training and/or coaching, and the acceptability of CPD programs.
18.104.22.168 OSE will confirm the appointment of PDs whose qualifications meet the requirements outlined in this policy.
22.214.171.124 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:
126.96.36.199 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
188.8.131.52 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:
184.108.40.206 Ensuring the design and delivery of accredited programs align with the general and specialty-specific standards of accreditation.
220.127.116.11 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.
18.104.22.168 Providing the required summative documents for exam eligibility and for each resident who has successfully completed the residency program; and
22.214.171.124 Participating in the relevant discipline Specialty Committee, according to the role description for a non-voting member.
Residency Accreditation Procedure: Missed Deadlines for Royal College Program Reviews
For information or clarification, please contact:
Procedures and implications of PDs without acceptable qualifications
8. Policy record
Most recent resolution:
Approved by: Committee of Specialty Education
Approval Date: December 1, 2020
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
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
|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|
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.
This policy will outline the requirements for application and successful completion of international elective to receive faculty support and recognition for these activities.
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 ( and ) 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 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.
“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 () 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.
This policy will be reviewed in 1 year after adoption and every 3 years subsequently.
|Postgraduate Medical Education Committee (PGEC)||June 17, 2020|
|Faculty Council||August 25, 2020|
The Faculty of Medicine recognizes the inherent conflict of interest potential and the difficulties that arise when a close relative is involved in the supervision and evaluation of another close relative in the student or resident role.
The University of Ottawa recognizes a close relative in the context of its policy on professional ethics as any parent, spouse, son, daughter, brother, or sister, or any person who has the same home as the faculty member, or a treating physician, or an individual within whom the trainee has a close relationship.
The policy of the Faculty thus is that no faculty member should supervise or evaluate a close relative or other person with whom they have a significant personal relationship, in the performance of their academic or clinical roles, except during occasional supervision of on-call duties, if the latter cannot be avoided. Faculty must remain sensitive to all potential conflicts of interest with regard to supervision and deal with them in a professional manner.
March 24th, 2004
Revised and approved
From time to time, the Ministry of Health and Long Term Care (MOHLTC) funded residency positions become vacant due to either transfer outside of the University of Ottawa, resignation, or the dismissal of a resident. Program Directors may fill the position with an admissible resident at the same level of training within the same specialty training program (including Family Medicine) as the vacant position within three (3) months of the position becoming vacant.
If a position is not filled within the three (3) month period, it is released to the Vice-Dean of Postgraduate Medical Education (PGME), who has the discretion to fill it with a transfer request from an admissible resident - as defined below - who is currently enrolled in any of the accredited residency programs (i.e. any CMG or IMG enrolled in any program anywhere in Canada or USA).
Admissible residents must be either:
- Canadian Medical Graduates (CMG); or
- International Medical Graduates (IMG) with Canadian citizenship or permanent resident status, currently registered in a postgraduate residency program in Canada or the USA.
Postgraduate Medical Education Committee
September 30, 2015
February 2, 2016
The Hospitals agree that instances where a resident is injured during their placement, it shall make available emergency first aid care to and initial assessment of the resident.
If a resident is injured in a workplace accident while carrying out his or her duties at the Hospital, the Hospital will complete and forward a copy of an incident report or any other documentation related to the accident to the Director of Health and Wellness, in Human Resources at the University of Ottawa in order that the University file the report of injury with the Workplace Safety and Insurance Board.
The Hospital agrees that it shall be responsible for any investigation into the injury or accident, for any reporting required to the Ministry of Labour and for any corrective measures arising from the incident or accident.
In the event of injury or accident, residents are expected to:
- Get first aid immediately, or health care if needed at the Hospital’s Occupational Health and Safety or Emergency department.
- Tell their supervisor about the accident or illness as soon as possible
In instances when a report is not received from the Hospital and the University is notified by the Workplace Safety and Insurance Board that the resident was injured at work, the resident will be required to complete the University’s Incident, Accident Report Form. The form is available at:
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 126.96.36.199 : Residents have access to, and mentorship for, a variety of scholarly opportunities, including research as appropriate.
- Indicator 188.8.131.52 : Residents have protected time to participate in scholarly activities, including research as appropriate.
- Indicator 184.108.40.206 : 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 220.127.116.11 : There are sufficient competent individual supervisors to support a variety of resident scholarly activities, including research as appropriate.
- Indicator 18.104.22.168 : 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.
- 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.
January 26, 2021
Postgraduate Medical Education Committee
December 9, 2020
The University of Ottawa believes that the best residents are those who have been able to explore the breadth of the medical profession through a variety of electives while enrolled in medical school. We encourage trainees to use elective time to establish a broad portfolio of expertise as opposed to focusing exclusively on a single specialty.
Each program is responsible for establishing a selection process for prospective residents, which must be in accordance with the General Standards of Accreditation, the , Best Practices in Resident Applications and Selection (BPAS) and adhere to the Faculty of Medicine’s . Adhering to these standards ensures a fair and transparent selection process free from discrimination, harassment and preferential treatment.
For PGY1 entry positions, the Family Medicine 3rd year enhanced skills match, as well as other subspecialty matches, programs must also adhere to the policies and procedures of the , the Association of Faculties of Medicine of Canada (AFMC) as well as manage the process in accordance with their own policies and guidelines. Failure to do so may result in the application of sanctions to that program, which may include forced withdrawal from the match by the program.
|Faculty Council||March 16, 2021|
Postgraduate Medical Education Committee
January 20, 2021
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:
1. 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.
2. 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 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
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-CAHO Collective Agreement (e.g. exceed ).
Information on the Restricted Registration Program, and obtaining a certificate of Restricted Registration may be found at
|PGEC||June 17, 2020|
|Faculty Council||August 25, 2020|
PGME Clinical Fellows are post-residency physicians undergoing specialized training in a fellowship that may or may not be accredited by the RCPSC or CFPC. Clinical Fellows are not residents and as such, do not follow the PARO-CAHO contract. In order to assure that Clinical Fellows have a living wage, it is imperative to set a base earning level.
uOttawa PGME full-time Clinical Fellows are required to have the opportunity to earn a minimum of $60,000 / year for fellowship training. This can be achieved by but is not limited to:
a) External Funding by a third party, e.g Hospital Foundation, Charitable Organization, Governmental Agency
b) Salary Support by Hospital / University Department / Research Institute
c) Own clinical earnings i.e. have the ability to generate at least this amount through clinical practice.
|Clinical Fellowship Committee||March 5, 2018|
|Faculty Council||June 27, 2018|
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.
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 (). 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.
- 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.
- 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
- 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.
- 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.
- Learning environments must be free from intimidation, harassment, discrimination and violence.
- 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 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).
- 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.
This Policy will be reviewed 1 year after adoption and every 3 years subsequently.
|Postgraduate Medical Education Committee||November 30, 2022|
|Faculty Council||May 2, 2017|
|Executive Committee of the Senate||October 10, 2017|
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.
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.
- Programs seeking enhanced training requirements need to make application, both in writing and with an in camera presentation to the PGEC outlining the following:
- The nature of the training
- The logic for the requirement
- 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.
|Postgraduate Medical Education Committee||January 27, 2016|
Purpose and Background
To provide guidance to program directors and residents when exploring, applying for and granting waivers of training time.
The Vice-Dean, Postgraduate Medical Education (PGME), 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. Please note that waivers of training will NOT be granted by the PGME office for any time missed and will be made up at the end of their previously expected end of training date.
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 he or she has met all specialty 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.
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 (4) 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 (6) weeks.
- Three-year programs - six (6) weeks.
- Four-year programs - three (3) months.
- Five-year programs - three (3) months.
- Six-year programs - three (3) months.
- For residents taking subspecialty training in the final year of a specialty program (e.g., Internal Medicine and Pediatrics), up to three (3) months 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. A decision to grant a waiver of training cannot be granted after the resident has taken the certification examinations.
1.6 If the program approves the request for the waiver, the program director must then submit a letter of support to the Vice-Dean, PGME. 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 reviews the request and, if approved, writes a letter of support to the credentials committees of the Royal College or the College of Family Physicians. Notification is made prior to submission of the Final In-Training Evaluation Report (FITER).
Section 2: Appeals
A decision not to grant a waiver of training cannot be appealed.
Section 3: L:inks to Relevant Policies
Section 4: Definition of an "Exceptional" Resident
NOTE: Each program can add its own criteria to define “exceptional” within the context of their specific program.
- Program director, based on Residency Performance Committee recommendation;
- Vice-Dean, PGME approves decision.
- 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 – “meets expectations” or above at least 75% of the time on all ITERs.
- Objective assessments (e.g., OSCE, mini CEX, multiple choice exams, oral examinations, short answer questions)
- No concerns about the resident’s academic, professional, behavioral and ethical performance;
- No red or yellow zone behaviours on the PULSE 360° Survey System;
- Consistent attendance at academic activities;
- 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:
- Extra educational activities as defined in the evaluation policy of PGME (formal or informal);
- Remediation (formal or informal);
- Interruption in residency training exceeding 12 months;
- Failed rotations.
- “Early consultant level competency”
- Is prepared to challenge the certification exam at the same time as his or her 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.
Postgraduate Medical Education Committee
January 28, 2015
June 16, 2015
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.
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
- 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
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.
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
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.
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.