Policies

Canadian Medical Association (CMA) Code of Ethics

Professional Responsibilities in Postgraduate Medical Education

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:

1. Unexpected serious illness of the resident.
2. Academic difficulties such as failure of a rotation or the requirement for remediation or probation.

CPSO Policy

http://www.med.uottawa.ca/edg/eng/conflict_resolution.html 

Assessment Verification Period (AVP) Policy

Immunization Policy

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

Introduction

The Faculty of Medicine wishes to ensure that there is a fair and transparent evaluation system for postgraduate trainees enrolled in postgraduate training programs at the Faculty of Medicine. It is also important that this evaluation system be consistent with the requirements of the Royal College of Physicians and Surgeons of Canada, the College of Family Physicians of Canada, the College of Physicians and Surgeons of Ontario and other relevant bodies.

Purpose

The purpose of the Policy for the Evaluation of Postgraduate Trainees (“Policy”) is to provide the steps that need to be taken when evaluating a trainee, to provide guidance to a trainee when a trainee encounters significant academic difficulties, and to outline the actions to be taken in the case of an unsatisfactory performance by a trainee.

Definitions

For the purposes of this Policy:

Principles of Trainee Evaluation

During their postgraduate training program, trainees will receive formative and summative assessment through objective tests as well as performance assessment through in-training evaluations. The principles governing the performance assessment are as follows:

• There must be rotation-specific objectives provided to trainees and faculty in advance of the rotation to guide trainee learning and assessment strategies.
• The objectives should be reviewed by the trainee prior to each rotation.
• The evaluation process must be tied to educational objectives.
• Objectives should be evaluated with a range of evaluation tools as appropriate.
• An assessment should evaluate the performance in a setting as close to clinical practice as appropriate.
• There should be documented, mid-rotation, formative feedback when the rotation is two blocks or longer.
• There should be regular feedback to trainees on an informal basis.
• Trainees should be informed whenever serious concerns exist and given the opportunity to correct their performance.
• The final rotation evaluation should be reviewed with the trainee individually and as close to the completion of the rotation as possible.
• There must be a written evaluation and ideally oral feedback at the end of each rotation.
• Objective examinations should be given that reflect RCPSC or CFPC certification examinations.

Systems of grading must be clear and uniformly applied.

The evaluation outcome will be confidential within the scope of the evaluation process. At times, future rotation supervisors may be apprised of performance deficits in order to provide focused education and evaluation.

The rules and regulations covering evaluation, promotion and appeals will be made available to trainees. Trainees are responsible for becoming familiar with such rules and regulations. 

Promotion

It is the responsibility of the Residency Program Committee to review trainee performance on an annual basis and make decisions about promotion.

The promotion of a trainee in any program may be delayed based on any of the following:

• Pending completion of an extension of training, a remedial or probation period, or a failure of a rotation;
• The trainee is under suspension;
• The trainee has encountered difficulties identified throughout the year that are considered by the program’s Residency Program Committee to warrant a non-promotion, in the absence of an unsatisfactory performance;
• The trainee has not met the training requirements for that postgraduate year level.

Where the promotion of a trainee has been delayed, the trainee’s training will be addressed in accordance with Section 14. 

Unsatisfactory Performance

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

• The trainee has received an unsatisfactory evaluation in any domain of the rotational ITER;
• It has been documented that a trainee, regardless of the trainee’s clinical performance during the rotation, has not satisfied the standards of ethical and professional behavior including, but not limited to, disruptive behaviour;
• The trainee has been absent from a component of the rotation for reasons that are not sanctioned by the program director; or
• The trainee has failed to meet the objectives of the rotation. 

Where there has been an unsatisfactory performance, the program’s Residency Program Committee may determine that the trainee has failed a rotation. If so, the trainee must repeat the rotation as well as undertake any further actions as set out in Section 14. Otherwise, the unsatisfactory performance will be addressed in accordance with Section 14.

Options for Unsatisfactory Performance

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

• Extension of training;
• Remediation;
• Probation; or
• Extra educational activities. 

Note: These options are defined below.

Note: The above options are in no particular order. A trainee may be placed into whichever one is most relevant to his/her academic situation.

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 of training because he/she has encountered difficulties during the year, but such difficulties are not significant enough to warrant a formal period of remediation or probation. In such cases, the trainee will be required to continue training at the same level for a pre-determined amount of time, not to exceed one year.

Remediation is a structured period of training during which the trainee is expected to correct identified weaknesses and/or deficiencies. Remediation shall normally be for a period of two to six clinical blocks except where external assessment schedules require a longer period.

Probation is similar to remediation except that an unsatisfactory probation outcome leads to dismissal. Probation will be applied where a trainee:

• Has not successfully completed a period of remediation;
• Has successfully completed two remediation periods and subsequently has a failed rotation; or
• Has encountered serious academic or other difficulties such that the program’s Residency Program Committee determines that an immediate period of probation is warranted.

Extra educational activities are intended to augment the trainee’s knowledge and/or skills in one or more specific CanMEDS role. These activities are undertaken concurrently with the trainee’s usual rotations, and therefore do not extend training time. Examples of extra educational activities include: a conflict resolution course; skill practice in a simulated setting; assessment and monitoring of professionalism concerns; communications skills training.

Immediate Suspension

A rotation supervisor or program director may immediately suspend a trainee from clinical responsibilities if it is deemed that patient safety is at risk.

A serious incident of unprofessionalism or a series of incidents of unprofessionalism may also justify a rotation supervisor or program director imposing a suspension.

Dismissal From the Program

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

• A trainee has a second failure of remediation;
• A trainee fails a probation period;
• A trainee does not maintain the standards of the profession as described in the standards of ethical and professional behavior; or
• A trainee meets the criteria of the Regulated Health Professions Act of Ontario for clinical incompetence or incapacitation. 

Procedures

The Faculty of Medicine Postgraduate Medical Education Committee shall establish procedures relating to the implementation of this Policy.

General

This policy replaces any previous versions of the policies on PGME evaluations. Any active appeals at the time of policy change will follow the processes of the replaced policy unless otherwise mutually agreed to use the newer version.

Review

This Policy will be reviewed one year after adoption and every three years subsequently.

Definition

The Council of Ontario Faculties of Medicine (COFM), defines ‘Moonlighting’:

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 College of Physicians and Surgeons of Ontario.

Moonlighting has been more recently called ‘restricted registration for residents. The Ontario Faculties of Medicine does not support resident moonlighting. Moonlighting compromises postgraduate programs and undermines the educational environment.

Application

Expanding on the definition provided by the COFM, the University of Ottawa does not permit resident moonlighting and states that moonlighting exists when a trainee practices medicine for remuneration while not in possession of an Independent Practice Certificate of Registration issued by the College of Physicians and Surgeons of Ontario (CPSO).

Residency training takes priority over all other extracurricular work. Extracurricular work is only to be performed outside of regular residency commitments and must not interfere with trainees’ performance in the residency program.

Exceptions

The only exception to this policy will be for those who choose to participate in the Province of Ontario Restricted Registration pilot project.

Purpose

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

Application

Where a resident:

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

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

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

Remediation Periods

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

An initial 3-6 month remediation period includes:

1. 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.
2. 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.
3. 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.
4. Educational modules may be recommended, based on specific “Red” and “Yellow” range behavioural skill deficits. The resident must pass all associated multiple choice tests.
5. 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.
6. 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:

1. 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.
2. Additional maintenance coaching, as determined by the follow-up PULSE 360 scores. Additional coaching must be approved by the Assistant Dean, PGME.
3. A continued reminder/reinforcement program using the automated PULSE software.

Funding

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

The Physician Behaviour in the Professional Environment policy sets out the Royal College’s expectations of physician behaviour in the professional environment and identifies a subset of unprofessional behaviour known as disruptive behaviour.

Read the policy at the following link.

Policy 67b on the Prevention of Sexual Violence was adopted by the Senate on Monday, June 13, 2016 and by the Board of Governors on Monday, June 27, 2016.

Read Policy 67b on the Prevention of Sexual Violence.

Professionalism Policy

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.

A. Definition:

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

B. Requirements:

• A postgraduate fellow must have a medical degree from an accredited institution and must have completed a residency program before the beginning of the fellowship. The fellow must already be certified by the Royal College or CFPC (or other recognized international certification board) or at a minimum, have completed a residency program and be admissible to take the RCPSC, CFPC or USA certification exams.
• 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.
• Fellowships must be affiliated with an accredited residency training program. There must be a designated fellowship director who works in collaboration with the residency program director. An annual review should be done with Residency Program Committee on number and selection to maximize training.
• All fellowships must be supervised by an assigned preceptor (responsible to the affiliated program director) who holds a Faculty of Medicine appointment at the University of Ottawa.
• Fellowships must include formal periodic and final evaluations 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 one month and can be up to three years. Any additional period must be approved by the College of Physicians and Surgeons of Ontario.

Introduction

1. The Postgraduate Medical Education (PGME) Office acknowledges its role in providing postgraduate trainees with a safe environment during their training. The Faculty of Medicine, affiliated training sites, clinical departments and trainees themselves are responsible  for promoting a culture and environment of safety for postgraduate trainees. This includes physical, emotional and professional safety. This policy may be augmented by the Residency Program Committee (RPC) in response to a program-specific context.

2. Residents who feel that their personal safety is threatened should remove themselves from the situation as quickly as possible and seek immediate assistance.

Reporting

3. Trainees who identify a threat to personal safety must report it to their immediate supervisor or program director.

4. Accidents, incidents and environmental illnesses occurring during a resident’s training should be reported and handled according to the reporting policies and procedures of the university, hospital or clinical teaching location.

Key Responsibilities

5. Of postgraduate trainees:

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

6. Of residency training programs:

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

Note: These policies apply only during postgraduate trainee activities related to the performance of training duties.

Physical Safety

7. When postgraduate trainees are travelling for clinical or other academic assignments by private vehicle, they should maintain their vehicle adequately and travel with appropriate supplies and contact information.

8. For long distance travel for clinical or other academic assignments, postgraduate trainees should ensure that a colleague or the home program office is aware of their itinerary.

9. Postgraduate trainees must not 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, trainees must request that they not be on call on the last day of the preceding rotation. If this cannot be arranged, then trainees must be provided with a designated travel day on the first day of the new rotation before the start of any clinical activities.

10. Postgraduate trainees should not travel long distances during inclement weather for clinical or other academic assignments. If weather prevents travel, the trainee must contact the program office promptly. Assignment of an alternate activity is at the discretion of the Program Director.

11. Postgraduate trainees should not work alone after hours in health care or academic facilities without adequate support from Protection Services.

12. Postgraduate trainees should not make unaccompanied home visits unless they have had appropriate training for the situation.

13. 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.

14. Call rooms and lounges should be clean, smoke-free and located in safe locations, and have adequate lighting, a phone, fire alarms and smoke detectors. Any appliances supplied should be in good working order. There must be adequate locks on doors.

15. Postgraduate trainees should not walk alone at night through any potentially unsafe area.

16. Postgraduate trainees should arrange safe transportation home if they feel unduly fatigued after their duty hours.

17. Postgraduate trainees must not assess potentially violent or psychotic patients without security backup and knowledge of accessible exits.

18. The physical space requirements for management of violent patients must be met where appropriate.

19. Special training must be provided to postgraduate trainees who are expected to encounter aggressive patients.

20. 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.

21. Postgraduate trainees should familiarize themselves with the location and services offered by the institution’s occupational health and safety office. This includes policies and procedures for infection control and protocols following exposure to contaminated fluids, needle stick injuries and reportable infectious diseases.

22. Postgraduate trainees must observe universal precautions and isolation procedures.

23. Postgraduate trainees must keep their required immunizations up to date. Overseas travel immunizations and advice should be sought well in advance when travelling abroad for rotations or meetings.

24. Postgraduate trainees working in areas of high and long term exposure to toxic substances, including but not limited to chemotherapeutic agents and reagent dyes, must follow the institutional safety policies.

25. Postgraduate trainees working in areas of high and long-term exposure to radiation must follow radiation safety policies and minimize their exposure according to current guidelines.

26. Radiation protective garments, such as aprons, gloves and neck shields, must be worn by all postgraduate trainees during fluoroscopy.

27. Pregnant trainees should be aware of specific risks to themselves and their fetus in the training environment and request accommodations where appropriate.

Psychological Safety

28. Learning environments must be free from intimidation, harassment, discrimination and violence. See University of Ottawa Policy 67a — Prevention of Harassment and Discrimination and Policy 67b — Prevention of Sexual Violence

29. When a postgraduate trainee’s performance is affected or threatened by poor health or psychological conditions, the trainee should be granted a leave of absence and receive appropriate support. Such trainees must not to return to work until an appropriate assessor has declared them ready.

30. 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 and Professional Association of Residents of Ontario.

Professional Safety

31. Postgraduate trainees may experience conflicts between their ethical or religious beliefs and the training requirements and professional obligations of physicians. Resources must be made available to residents to deal with such conflicts.

32. Programs must make reasonable accommodations for religious holidays

33. Postgraduate trainees must have adequate support from the program following an adverse event or critical incident.

34. 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.

35. When programs collect postgraduate trainees’ personal information and evaluations, they must keep this material responsibly and securely,  to maintain confidentiality. Disclosure is appropriate where required for the purposes of ongoing education and to facilitate and maintain patient and workplace safety.

36. Programs must be aware of and comply with the Freedom of Information and Protection of Privacy Act (FIPPA) provisions regarding postgraduate trainee files.

37. Postgraduate trainee feedback and complaints must be handled in a manner that ensures trainee anonymity, unless the trainee explicitly waives anonymity. In the event of a complaint regarding a highly serious matter or one that concerns a threat to others, however, a Program Director may be obliged to proceed against the complainant’s wishes. Depending on the nature of the complaint, the affiliated institution and/or the College of Physicians and Surgeons of Ontario may need to be informed and involved. In general, the Program Director should serve as a resource and advocate for the resident in the complaint process.

38. Residents must be members of the CMPA and follow CMPA recommendations in the event of real, threatened or anticipated legal action.

39. In addition to CMPA coverage for patient actions, residents are covered, either by the University itself or its insurer, for actions arising from their participation (acting reasonably) in University committees (e.g., tenure, appeals, residency training) on which they may serve.

Review

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

Policy 67a: Prevention of harassment and discrimination

Please refer to the Faculty of Medicine bylaws, section 9.3: Faculty Council Appeals Committee. 

Procedure for an Appeal to the Senate Appeals Committee

Authorization: Postgraduate Education Committee

Purpose

The purpose of this procedure is to establish the specific steps in the evaluation of trainee performance and to establish the contents of the options that are available in case the trainee’s performance is deemed to be unsatisfactory.

Steps in the Evaluation of Performance

• The evaluation of a trainee’s performance must follow the following steps:
• The evaluation process must be described for the trainee at the outset of a training program; this includes discussion of the tools for and timing of evaluation.
• Identification of the supervising physician(s) who will be doing the evaluation should occur at the beginning of each rotation.
• A written evaluation must be completed in a timely fashion at the end of a rotation. When an item is rated below expectations, supporting comments or examples should be included. Both the supervising physician and the trainee should sign the evaluation with the understanding that the trainee’s signature does not necessarily imply that he/she agrees with the evaluation. The trainee must have the opportunity to add written comments to the evaluation. In the exceptional case when the trainee refuses to sign, this should be documented on the evaluation.
• Semi-annually, there will be a documented progress review made by the program director, or delegate, and discussed with the trainee.
• The Residency Program Committee makes decisions regarding the successful completion of an assessment period, rotation, academic year or the program as well as completion of the CITER, STACER and FITER.
• All decisions regarding dismissal, completion of program or the implementation of extra educational activities and periods of extension of training, remediation or probation must be ratified by the Vice-Dean, PGME or delegate; this applies to all aspects of a remediation or probation plan including the RPC recommendation for remediation or probation, the remediation or probation plan as well as the outcome of the remediation or probation period.

Immediate Suspension

• Where a trainee has been suspended from clinical duties, in accordance with section 19-20 of the Evaluation Policy, the Vice-Dean, Postgraduate Medical Education (PGME) or delegate must be notified as soon as is practical by the trainee’s program director. The Vice-Dean, PGME or delegate will refer the issue to the Professionalism Subcommittee of the PGEC for investigation and adjudication during which time the trainee will remain suspended from training.
• Possible outcomes of the Professionalism Subcommittee’s investigation and adjudication may include recommendations for any of the following:
  • Reinstatement into clinical training;
  • Extra educational activities;
  • Remediation;
  • Probation; or
  • Dismissal

as outlined in sections  14 and 21 of the Policy for the Evaluation of Postgraduate Trainees.

• As required by Schedule 2 (Health Professions Procedural Code) of the Regulated Health Professions Act, the PGME office will notify the CPSO that the trainee is suspended from clinical duties pending investigation and adjudication of the issue leading to suspension.

Failure of a Rotation

Supervising physicians will make recommendations pertaining to trainee performance. However, the program’s Residency Program Committee will make final pass/fail decisions for all rotations based upon all available documentation.

Options for Unsatisfactory Performance - Extra Educational Activities

• Recommendations for extra educational activities must be brought to the program’s Residency Program Committee by the program director. A decision regarding extra educational activities will only be taken by the program’s Residency Program Committee.
• The nature and length of the extra educational activities will be determined by the program’s Residency Program Committee, having given the trainee opportunity to comment, which shall inform the supervising physician(s) of the details of the activities.
• If rotation(s) or learning experiences are required outside the trainee’s program, these will be discussed and arranged with the respective program director(s) or involved individual/organization prior to finalizing the extra educational activities plan.
• The decision and plan for extra educational activities must be ratified by the Vice-Dean, PGME or delegate prior to its implementation.
• Upon completion of the extra educational activities, the Residency Program Committee will review the trainee’s performance in the planned activities and evaluate the success of these activities in addressing the perceived gaps in knowledge and/or skills.

Extension of Training

• Recommendations for extension of training must be brought to the program’s Residency Program Committee by the program director. A decision regarding an extension of training will only be taken by the program’s Residency Program Committee. The decision must be ratified by the Vice-Dean, PGME or delegate.
• The nature and length of the extension of training period will be determined by the program’s Residency Program Committee; having given the trainee opportunity to comment.
• An Extension of Training form must be completed by the program which must include the following:
  • Details delineating the reasons for an extension of training;
  • The duration of the extended period of training; and
  • The activities to be undertaken by the trainee during the extension of training period.
• The extension of training must be described for the trainee; the discussion should include all the steps described in section 14.
• If rotation(s) 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.
• The program’s plan for the Extension of Training period must be ratified by the Vice-Dean, PGME or delegate prior to its implementation.
• At the end of the Extension of Training period, the Residency Program Committee will review the trainee’s performance and determine the appropriate outcomes as per the Evaluation Policy.

Remediation

• Recommendations for remediation must be brought to the program’s Residency Program Committee by the program director. A decision regarding remediation will only be taken by the program’s Residency Program Committee. The decision must be ratified by the Vice-Dean, PGME or delegate.
• The nature and length of the remediation period will be determined by the program’s Residency Program Committee, having given the trainee opportunity to comment, which shall inform the supervising physician(s) of the details of the remediation.
• A remediation plan must be completed by the program which must address the following:
  • Details regarding the reasons for remediation;
  • The specific areas of deficiency;
  • The educational objectives during remediation;
  • The methods of assessment during the remediation; and
  • The possible outcomes of the remediation.
• The remediation plan must be described for the trainee; the discussion should include all the steps described in section 21.
• If rotation(s) 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.
• The remediation plan must be ratified by the Vice-Dean, PGME or delegate prior to its implementation.
• At the end of a remediation period, the program’s Residency Program Committee, 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 decision(s) of the RPC. The outcome of the remediation must be ratified by the Vice-Dean, PGME or delegate.
• A trainee may receive credit for training that is successfully completed during a period of remediation as decided by the RPC.
• 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.

Probation

• Recommendations for probation must be brought to the program’s Residency Program Committee by the program director. A decision regarding probation will only be taken by the program’s Residency Program Committee. The decision must be ratified by the Vice-Dean, PGME or delegate.
• The nature and length of the probation period will be determined by the program’s Residency Program Committee, having given the trainee opportunity to comment, which shall inform the supervising physician(s) of the details of the remediation.
• A probation plan must be completed by the program which must address the following:
  • Details regarding the reasons for probation;
  • The specific areas of deficiency;
  • The educational objectives during probation;
  • The methods of assessment during the probation; and
  • The possible outcomes of the probation.
  • The probation plan must be described for the trainee; the discussion should include all the steps described in section 30.
  • If rotation(s) 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.
• The probation plan must be ratified by the Vice-Dean, PGME or delegate prior to its implementation.
• At the completion of the probation period, the trainee will be placed on leave from clinical duties pending the deliberations of the RPC.
• At the end of the probation period the program’s Residency Program Committee, 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 decision(s) of the RPC. The outcome of the probation must be ratified by the Vice-Dean, PGME or delegate.
• A trainee may receive credit for training thst is successfully completed during a period of probation as decided by the RPC.

Dismissal

• A decision regarding dismissal of a trainee will only be taken by the program’s Residency Program Committee. The decision must be ratified by the Vice-Dean, PGME or delegate.

Appeals

• A trainee has the right to appeal an RPC decision regarding extra educational activities, extension of training, remediation, probation, suspension or dismissal as ratified by the Vice-Dean, PGME or delegate to the Faculty Council Appeal Committee. The procedures of the Faculty Council Appeals Committee will apply.
• While a trainee may appeal an RPC decision regarding extra educational activities, extension of training, remediation or probation, as ratified by the Vice-Dean, PGME or delegate, to the Faculty Council Appeals Committee he/she is required to undertake the planned activities, period of extension, remediation or probation plan pending the results of the appeal. Failure to do so will result in his/her 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.
• While a trainee may appeal an RPC decision regarding suspension or dismissal, as ratified by the Vice-Dean, PGME or delegate to the Faculty Council Appeals Committee, he/she will remain on leave from training pending the results of the appeal.

Application

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).

Requirements

Admissible residents must be either:

1. Canadian Medical Graduates (CMG); or
2. International Medical Graduates (IMG) with Canadian citizenship or permanent resident status, currently registered in a postgraduate residency program in Canada or the USA.
    

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 Associate 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:    (https://web30.uottawa.ca/v3/riskmgmtfrm/aioreport.aspx?lang=en)

Questions or requests for additional information concerning workplace injuries may be sent by e-mail to hrhealth@uOttawa.ca or by phone at 613-562-5800 ext.1473.

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 (B Standards):

B 1. 5

There must be an identified faculty member to oversee involvement of residents in research and other scholarly work aided by a sufficient number of faculty members with the responsibility to facilitate and supervise this involvement.

B 1.6

There must be an environment of inquiry and scholarship in the program. There must be a satisfactory level of research and scholarly activity must be maintained among the faculty identified with the program as evidenced by:

• peer-reviewed research funding;
• publication of original research in peer-reviewed journals and/or publication of review articles or textbook chapters;
• involvement by faculty and residents in current research projects;
• recognized innovation in medical education, clinical care or medical administration.

Procedures

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

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

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 do not preferentially rank applicants who have only pursued electives in one discipline or sub-discipline.

Each program is responsible for the establishment of a selection process for prospective residents, which must be in accordance with the general standards of accreditation, the Ontario Human Rights Code and adhere to the Faculty of Medicine’s professionalism policy. Adhering to these standards ensures a fair and transparent selection process free from discrimination, harassment and preferential treatment. 

For PGY1 entry positions, medicine subspecialty, family medicine, emergency and pediatric subspecialty matches, programs must also adhere to the policies and procedures of the Canadian Residency Matching Service (CaRMS) and manage the process in accordance with their policies and guidelines.

Interactions Between the Faculty of Medicine and the Pharmaceutical, Biotechnology, Medical Device, and Hospital and Research Equipment and Supply Industries.

PURPOSE

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.

APPLICATION

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.

Committee                                            Approval Date
Clinical Fellowship Committee              March 5, 2018
Faculty Council                                     June 27, 2018

Preamble

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

Policy

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

Process

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

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

CFPC policy  

RCPSC policy

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.

Decision responsibility:

• Program director, based on Residency Performance Committee recommendation;
• Vice-Dean, PGME approves decision.

Criteria:

• Must be subsequent to the first on-service year (with the exception of Family Medicine):
  • Objective assessments (e.g., OSCE, mini CEX, multiple choice exams, oral examinations, short answer questions)
    • Must pass all exams.
    • Must be above “meets expectations” at least 75% of the time.
    • ITERs – “meets expectations” or above at least 75% of the time on all ITERs.
• 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);
  • Probation;
  • Suspension;
  • 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.