Policies

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

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.

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:

1. 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).
2. 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.
3. There must be a designated Fellowship Director.
4. New fellowship programs must be reviewed and approved by the Vice-Dean, PGME prior to offering a candidate a fellowship position.
5. 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.
6. Fellowships must include formal periodic and final evaluation of performance (ITER).
7. 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.
8. 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.
9. 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”.
10. Fellows are only permitted to begin training on the 1^st of the month or the first business day that follows.  In the case of delays, the 15^th of the month is the next possible start date.
11. 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.

CPSO Policies

https://med.uottawa.ca/professional-affairs/policies/conflict-resolution-policy

Assessment Verification Period (AVP) Policy

Immunization Policy

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.

15. DISMISSAL FROM THE PROGRAM

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

15.1.1 a trainee has a second failure of remediation;

15.1.2 a trainee fails a probation period;

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

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

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

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

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

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

16. APPEALS

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

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

16.3 The trainee should consult the Faculty Council Appeals Committee procedures (section 9.3 of the Faculty of Medicine bylaws https://med.uottawa.ca/en/about/faculty-policies/bylaws) concerning the preparation and submission of an appeal and the applicable deadlines.

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

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

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

17. NOTIFICATION

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

18. GENERAL

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

19. REVIEW

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

UNIVERSITY OF OTTAWA, FACULTY OF MEDICINE

Policy on Postgraduate Trainees Undertaking International Electives

INTRODUCTION

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

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

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

PURPOSE

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

OFFICE RESPONSIBLE

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

Section 1: ELIGIBILITY CRITERIA

1.  Trainees must have permission from their Program Directors to participate in an international elective.
2. International electives should be a minimum of four weeks in duration.
3. Request for approval for international electives must be submitted a minimum of two months prior to the start date.
4. 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[DC1]  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:

1. Trainee is in good academic standing according to their Program Director and the Postgraduate Medical Education office
2. The Program Director approves of the planned elective
3. 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.
 

1. 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 (https://travel.gc.ca/travelling/advisories  and https://voyage.gc.ca/voyager/avertissements) 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[2] [JS3]  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[DC4] [JS5]  https://data.worldbank.org/country.

• 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[6]  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.  https://med.uottawa.ca/postgraduate/governance/policies)

Section 3: DURATION AND REMUNERATION

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

Section 4: MEDICAL-LEGAL COVERAGE DURING ELECTIVE

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

CMPA website: https://www.cmpa-acpm.ca/en/membership/protection-for-members/principles-of-assistance/potential-gap-in-liability-protection-when-teaching-or-learning-outside-canada

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

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

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

1. The trainee is registered as a uOttawa student during the time of the “work”/placement in question
2. The university has a written placement agreement which covers the trainee’s work prior to the start of the placement, and
3. 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 (https://med.uottawa.ca/postgraduate/governance/policies) may not be realistically possible to adhere to during an international elective. All steps will be taken to minimize risk for trainees and their host communities.

Section 6: SUMMARY

1. 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.
2. Trainee must complete pre-departure training, as directed by the IGHO.
3. Trainee must submit the post-elective reflective summary to the IGHO Coordinator.
4. Trainee must complete post-elective debriefing, as directed by the IGHO.
5. Trainee must complete the evaluation In-Training Evaluation Report (ITER).
6. Trainee must submit or ensure submittal of evaluation form by supervisor to the Program Director.

Policy Review

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

Committee                                                                                                   Approval

Postgraduate Medical Education Committee (PGEC)                          June 17, 2020
Faculty Council                                                                                       August 25, 2020
Executive Committee of the Senate          
Senate (rare)

DEFINITION

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

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 CPSO.
https://cou.ca/wp-content/uploads/2017/12/Restricted-Registration-Policy.pdf

APPLICATION

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

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

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

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.

Policy 67a: Prevention of harassment and discrimination

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.

Procedure for an Appeal to the Senate Appeals Committee

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.
    

Professionalism Policy

Public Health Emergencies

PGME Evaluation Roles and Responsibilities

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:    (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.

The Residents and Public Health Emergency Preparedness Guidelines are intended for:

• PARO members;
• Employer Hospitals and their representative organizations;
• University and residency program leadership; and
• Goverment and Public Health Agencies

https://cou.ca/wp-content/uploads/2017/12/Restricted-Registration-Policy.pdf

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

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.

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.