Changes to Clinical Rotations: Administrative Procedure
It is the expectation that residents will complete the rotation schedule as published at the beginning of the academic year.
A program director may switch a resident out of a rotation with a minimum of 6 weeks’ notice to the receiving program. Otherwise a resident may not be switched out unless the donating program supplies an alternate resident.
The exceptions to this policy wherein a resident may be switched out of a rotation without due notice or supplying an alternate are:
Unexpected serious illness of the resident.
Academic difficulties such as failure of a rotation or the requirement for remediation or probation.
Pandemic or other disaster-related redeployment.
Postgraduate Medical Education Committee (PGEC)
January 20, 2021
A fellow is a postgraduate medical education trainee undertaking post-certification educational training outside the specialty or subspecialty training requirements of the RCPSC or CFPC. A fellowship cannot be credited toward national certification requirements.
A postgraduate fellow must be eligible for a license with the College of Physicians and Surgeons of Ontario (refer to the CPSO website for specific requirements).
All clinical fellowships must have clearly defined written educational goals and objectives, as per the standards of the College of Physicians and Surgeons of Ontario.
There must be a designated Fellowship Director.
New fellowship programs must be reviewed and approved by the Vice-Dean, PGME prior to offering a candidate a fellowship position.
The fellowship director must review the planned number of fellows with any affiliated residency program director and Department Chair to ensure it will not negatively impact residency training. The Department Chair or delegate will make the ultimate decision on number of fellows.
Fellowships must include formal periodic and final evaluation of performance (ITER).
All fellows who wish to have their training recognized by the University of Ottawa must be registered as a postgraduate trainee with the Faculty of Medicine. A registered fellow will receive a certificate of completion of training, upon confirmation of satisfactory completion by the fellowship director and/or affiliated program director.
The term of a fellowship is a minimum of 6 months and a maximum of 3 years. Any fellowship shorter than 6 months requires the approval of the Vice Dean of PGME or delegate. Any trainee who wishes to complete more than 3 years of fellowship training at the University of Ottawa requires approval of the Clinical Fellowship Committee. In such cases, the fellowship program director must present to the committee in person to justify the fellowship.
uOttawa PGME full-time Clinical Fellows are required to have the opportunity to earn or be provided a minimum of $60,000/ year as their fellowship salary, as per the “Salary for Clinical Fellows Policy”.
Fellows are only permitted to begin training on the 1st of the month or the first business day that follows. In the case of delays, the 15th of the month is the next possible start date.
Each fellowship program is required to institute a regular formalized review of the program. The individual ultimately responsible for oversight of regular formalized reviews is the Departmental Fellowship Lead.
Approval: Clinical Fellowship Committee
College of Physicians and Surgeons of Ontario (CPSO) Policies
The following serves to provide a structured and systematic remediation program for residents who have skill deficits in quality-associated competencies, and who have come to the attention of the Program Director(s) and/or the Postgraduate Medical Education (PGME) office.
Where a resident:
has one (1) or more "Red Range" behaviours on the Quality PULSE 360;
his/her Program Director(s) has received verbal or written complaints, even if de-identified;
the Assistant Dean, PGME, concurs that the resident would benefit from an Intensive Program (i.e. residents’ remediation program);
THEREFORE a Recommendations Report (i.e. performance improvement plan) will be requested from PULSE. Recommendations Reports are based on the Quality PULSE 360 findings and/or input from the Program Director(s) and/or Assistant Dean, PGME.
The Assistant Dean, PGME, or his/her delegate, will review the Recommendations Report and determine if the recommendations are approved.
The following recommendations reflect the typical components of a remediation plan.
An initial 3-6 month remediation period includes:
A debriefing meeting with a coach, as approved by the PGME office, will be scheduled. The resident and the coach will create a “PULSE Plan” (i.e. excellence goals derived from the Quality PULSE 360 and associated feedback). The PULSE Plan must be approved by the Program Director(s) and/or Assistant Dean, PGME before it is finalized.
A reminder/reinforcement program will be launched, using the automated PULSE software which generates weekly reminders of established excellence goals in the form of texts and/or emails.
An intensive coaching program will begin after the debriefing. The maximum number of coaching sessions is calculated based on the “Red-Yellow Formula”, which recommends up to a maximum of one (1) coaching session (one hour) for each "Red Range" question score, and for each three (3) "Yellow Range" question scores. Coaching sessions may be divided into 20 or 30 minute segments. The frequency of sessions is determined at the discretion of the resident and the coach: coaching frequency might be weekly for the first few weeks, then bi-weekly, and then monthly.
Educational modules may be recommended, based on specific “Red” and “Yellow” range behavioural skill deficits. The resident must pass all associated multiple choice tests.
A follow-up PULSE 360 test must be performed after three (3) months. Additional tests may be performed more frequently, as required, for example monthly rotation 360s.
Other developmental recommendations may be required, as approved by Program Director(s) and/or Assistant Dean, PGME.
A second 3-6 month remediation period, as applicable, includes:
A follow-up PULSE 360 test must be performed after three (3) months. Additional tests may be performed more frequently, as required, for example monthly rotation 360s.
Additional maintenance coaching, as determined by the follow-up PULSE 360 scores. Additional coaching must be approved by the Assistant Dean, PGME.
A continued reminder/reinforcement program using the automated PULSE software.
This program is funded by Postgraduate Medical Education; twenty (20) hours of coaching is the lifetime maximum per resident.
Policy for the Assessment of Postgraduate Trainees
Effective date: Immediately following approval from the Executive Committee of University Senate.
1.1 This policy of The Faculty of Medicine ensures that there is a fair and transparent assessment system for postgraduate trainees enrolled in postgraduate residency training programs and Area of Focused Competency (AFC) diploma programs at the University of Ottawa Faculty of Medicine
1.2 This policy has been developed to be in compliance with the accreditation standards of the Royal College of Physicians and Surgeons of Canada (RCPSC) and the College of Family Physicians of Canada (CFPC). This policy is also designed to be consistent with the following University of Ottawa academic policies, and policies of the following medical organizations:
The University of Ottawa Faculty of Medicine Professionalism Policy;
The College of Physicians and Surgeons of Ontario (CPSO) Policy on Professional Responsibilities in Postgraduate Medical Education; and
The Canadian Medical Association Code of Ethics (CMA).
2.1 The purpose of this policy, the Policy and Procedure for the Assessment of Postgraduate Trainees (“policy”), is to outline the processes governing assessment for all postgraduate trainees enrolled in accredited residency programs and Area of Focused Competency (AFC) diploma programs at the University of Ottawa Faculty of Medicine.
3.1 This policy sets out the procedures for the assessment of trainees. Trainees are responsible for becoming familiar with this policy.
3.2 This policy is designed to apply to both time based and competency based educational experiences and programs.
3.4 In this policy, the word “must” is used to denote something that is required, and the word “should” is used to denote something that is highly recommended.
For the purposes of this Policy,
4.1 “AFC” means Area of Focused Competence and is a post-residency diploma program that provides additional training and is accredited by the Royal College of Physicians and Surgeons of Canada.
4.2 “Assessment” is the process of gathering and analyzing information in order to measure a trainee’s competence or performance and compare it to defined criteria.
4.3 “AVP” means Assessment Verification Period. The AVP is a period of assessment to determine if an international medical graduate (IMG) can function at their appointed level of training prior to full acceptance into the residency program to which they have been accepted. Successful completion is a requirement to obtain an unrestricted postgraduate medical education certificate of registration (educational license) from the College of Physicians and Surgeons of Ontario. A successful AVP should be credited towards residency training time. An extension of an AVP, which must be accompanied by a remediation, may or may not be credited towards residency training.
4.4 “Competence Committee” as defined by the RCPSC is a subcommittee of the Residency Program Committee (RPC) and is the committee that makes recommendations about promotion and needed academic support to the RPC and the program director. Recommendations are made using highly integrative data from multiple observations and other sources of data, as well as feedback from clinical practice. All recommendations must be reviewed and approved by the RPC and the Program Director.
4.5 “Designated assessment tools” means assessment tools approved by the RPC and Fellowship Program Committee (FPC) of each program for inclusion in the assessment plan of residents and fellows which are appropriately tailored to the specialty, level or stage of training, and the national training standards.
4.6 “Educational experience” refers to the activity or setting in which the trainees have the experiences that allows them to achieve pre-defined goals and objectives and/or milestones and competencies. Examples of words commonly used to describe discrete clinical training experiences include rotation, longitudinal clinics, call, etc.
4.7 “EPA” means entrustable professional activity and is an authentic task of a discipline.
4.8 “Fellow” means a physician registered in an AFC Diploma training program accredited by the RCPSC and who is registered in the Postgraduate Medical Education Office of the Faculty of Medicine of the University.
4.9 “Fellowship Program” means the RCPSC AFC postgraduate fellowship training program.
4.10 “FPC” means the Fellowship Program Committee and it is the committee that assists the Fellowship Program Director in the planning, organization, and supervision of the fellowship training program and includes representation from the fellows in the program.
4.11 “Formative assessment” refers to assessments done to monitor a trainee’s progress and to give ongoing feedback.
4.12 “IMG” means International Medical Graduate and is an individual who has graduated from a non-Liaison Committee on Medical Education/Committee on Accreditation of Canadian Medical Schools (non-LCME/CACMS) medical school, who is either a Canadian citizen or a permanent resident and who meets the criteria of an IMG as defined by the CPSO.
4.13 “Milestone” is an observable marker of an individual’s ability along a developmental continuum.
4.14 “PGEC” means the Faculty Postgraduate Medical Education Committee and is the committee responsible for the development and review of all aspects of postgraduate medical education within the Faculty of Medicine and is chaired by the PGME Vice-Dean.
4.15 “PEAP” means Pre-Entry Assessment Program. The PEAP is an assessment process that evaluates a VISA trainee to determine whether they can function at the appointed level of training. Successful completion of the VISA residency PEAP determines eligibility to enter residency training and therefore is not recorded as part of the residency training program. Successful completion of the VISA fellow PEAP provides an assessment of the candidate’s general knowledge and competency in the specialty in which he/she is certified and if successfully completed, can be counted towards fulfillment of the AFC diploma.
4.16 “Program Director” is the Faculty member responsible for the overall conduct of the residency program in a discipline or diploma program in an AFC discipline and is responsible to the Chair of the University department concerned and to the PGME Vice-Dean.
4.17 “Residency Program” means the RCPSC or CFPC postgraduate residency training program.
4.18 “RPC” means the Residency Program Committee and it is the committee that assists the Residency Program Director in the planning, organization, and supervision of the residency training program and includes representation from the residents in the program.
4.19 “Resident” means a physician registered in a residency training program accredited by the RCPSC or the CFPC and who is registered in the Postgraduate Medical Education Office at the Faculty of Medicine of the University.
4.20 “Senior physician leader” means the head or chief of the medical staff, regardless of the position title, appointed by the health organization (for example: hospitals, medical clinics, primary care agencies, health regions, long-term care organizations, public health agencies) as the senior leader accountable to the board of directors or highest governing body of the health care organization for the quality of patient care at the health organization or for matters in relation to public health.
4.21 “Scoring rubrics” are the scoring guides used to assess performance for individual assessments.
4.22 “Stages of Training” means the four developmental stages in RCPSC Competency Based Medical Education (CBME) programs. They are: Transition to Discipline, Foundation of Discipline, Core of Discipline, and Transition to Practice. Each stage has defined EPAs and milestones for learning and assessment.
4.23 “Summative assessment” refers to a formal written summary of a trainee’s performance against established expectations which is carried out at specified intervals within each program and across assessment plans.
4.24 “Supervisor” means an individual who has taken on the responsibility for their respective training programs to guide, observe and assess the educational activities of trainees.
4.25 “Time Based Program” means a program whose structure is based on goals and objectives and time-based educational experiences.
4.26 “VISA trainee” means an individual who has graduated from a non-LCME/CACMS medical school and who is training at the University of Ottawa without Canadian legal status (i.e. training under a VISA).
5. STANDARDS OF ASSESSMENT
5.1 It is the responsibility of the PGEC to maintain standards for the assessment, promotion, reclassification, remediation, probation, suspension, extension of training, reintegration and dismissal of trainees in all residency and AFC programs. The PGEC will review the assessment process of each residency and AFC program on a regular basis as defined by accreditation standards to ensure that assessment processes and practices are consistent with this Policy, and the minimum standards set by the related professional organizations, including the CPSO, CFPC and the Royal College. The PGEC will monitor the performance of programs either directly or through the relevant subcommittee of the PGEC.
6. PRINCIPLES OF TRAINEE ASSESSMENT
6.1 Every program must have an Assessment Framework that includes designated assessment tools and scoring rubrics tailored to the specialty or fellowship and level or stage of training which would meet the national training standards.
6.2 The purpose of the Assessment Framework is as follows:
6.2.1 To provide a framework for the assessment of the trainee’s knowledge, skills, attitudes and competencies by the supervisor;
6.2.2 To facilitate feedback to the trainee by a supervisor or the Program Director;
6.2.3 To serve as a record of the performance and progress of the trainee for the program;
6.2.4 To enable the Program Director to assist supervisors in ongoing supervision of the trainee;
6.2.5 To establish a basis for confirmation of progress, identification of needs, evidence for promotion, reclassification, extension of training, remediation and probation.
Assessment and feedback
6.3 During their postgraduate training program, trainees will receive fair, timely, equitable and unbiased formative and summative assessments and feedback on an ongoing basis. The principles governing assessment are as follows:
6.3.1 The assessment process must be tied to educational objectives, or to EPAs and milestones.
6.3.2 Goals and objectives, EPAs and milestones must be assessed with a range of assessment tools.
6.3.3 Goals and objectives, or EPAs and milestones must be made available to trainees and faculty at the beginning of each rotation or educational experience to guide trainee learning and assessment strategies. The goals and objectives, or EPAs and milestones, should be reviewed by the trainee.
6.3.4 Assessment and feedback is the joint responsibility of both the resident and the program. When written feedback is completed, residents should read written feedback within 14 days of being notified that it has been completed.
6.3.5 All trainees must receive a written summative assessment at least quarterly. The summative assessment must outline the progress that has been made by a trainee in addressing any areas of concern that have been identified.
126.96.36.199 In traditional time-based programs where in-training evaluation reports (ITERs) are used as summative assessments, ITERs should be completed within 14 days of the completion of the rotation/educational experience.
188.8.131.52 In traditional time-based programs, there should be documented, mid- rotation, formative feedback when the rotation is two blocks or longer.
184.108.40.206 In situations where trainees are ‘on trajectory’, the program director or delegate must discuss summative assessments with the trainee at least twice per year. This discussion should occur face-to-face. When logistics make face-to-face impossible, the communication must occur in a real time mode such as phone, Facetime or Skype.
220.127.116.11 In situations where trainees are ‘off trajectory’, the program director or delegate must discuss the summative assessment with the trainee. This discussion should occur within 14 days of the completion of the ITER or summative assessment, and must also be given face-to-face. When logistics make face-to-face impossible, the communication must occur in a real time mode such as phone, Facetime or Skype.
6.3.6 In CBD programs, the Competency Committee must provide the RPC with quarterly summative assessments and recommendations.
6.3.7 There must be regular, verbal informal feedback provided to trainees as well as formal feedback and assessment as required by this policy.
6.3.8 Residents must be informed of performance deficiencies in a timely manner so that they can have adequate opportunity to remedy them prior to the end of the educational experience. The feedback must be documented and entered into the resident’s file.
6.3.9 Both the supervising physician or program director or delegate and the trainee should sign or validate the summative assessment within 14 days. The trainee’s signature/validation does not necessarily imply that he/she agrees with the summative assessment; rather the signature/validation indicates that it has been seen by the trainee. Failure of the trainee to sign/validate the form does not invalidate the summative assessment or the discussion.
6.4 The Residency Program Committee makes decisions regarding the successful completion of an assessment period, educational experience, rotation, stage of training and academic year or of the program as well as completion of the CITER, STACER and FITER, where applicable.
6.5 The Competence Committee’s mandate is to review and discuss trainee’s performance and progress in order to advise/guide resident learning and growth, modify a resident’s learning plan, make decisions on a trainee’ achievement of EPAs, and recommend trainee status changes to the Residency Program Committee as per the Royal College.
6.6 Decisions regarding completion of program, reclassification, extension of training, remediation, probation, suspension or dismissal must be ratified by the Vice-Dean, PGME or delegate. If any of these decisions are made by the PGME Professionalism Subcommittee, ratification by the Vice-Dean of PGME, or delegate, is not required. Decisions by the Vice-Dean, PGME or delegate, PGME Professionalism Subcommittee regarding remediation, probation or reintegration/reassessment must be ratified by the senior physician leader of the health organization where the trainee’s rotation or training experience is taking place. In cases of suspension or dismissal, ratification by the senior physician leader is not required, however, the PGME office will notify the senior physician leader of the suspension or dismissal.
6.7 All residents who are put on a remediation measure should be referred for a wellness assessment (e.g. Faculty Wellness Program, OMA PHP) as part of the support provided during this process. The program director or delegate should review the process of referral, including the confidential nature of the referral with the trainee.
7.1 The Program Director, in consultation with the Residency Program Committee (RPC) for the program, will determine the rotation or educational experience requirements for each year or stage of the program. The rotation or educational experiences requirements may be amended from time to time and must be communicated to the trainees.
7.2 Trainees will be promoted to the next academic year or stage when all requirements have been met for the level or stage of training. This determination shall be made by the RPC, or delegate.
7.3 The promotion of a trainee to the next year or next stage of training in any program may be delayed based on any of the following:
7.3.1 pending completion of an extension of training, or a remedial or probationary period, or repeat of a failed rotation;
7.3.2 the trainee is under suspension;
7.3.3 the trainee has not met the training requirements for that postgraduate year or stage;
7.3.4 the trainee has taken an extended leave of absence from training which has resulted in an incomplete educational experience for stage or year of training
7.4 Where the promotion of a trainee has been delayed as a result of unsatisfactory performance, the trainee’s training will be addressed in accordance with the options for unsatisfactory performance as outlined in section 10 below.
7.5 Trainees will not be promoted during a period of reintegration, remediation, probation or suspension.
7.6 For trainees completing a period of remediation or probation, the Residency Program Committee will review rotations and training experiences completed during the remediation or probation period and will determine whether any of these may receive credit towards RCPSC or CFPC training requirements. If adequate credit is awarded, a retroactive promotion may be granted in cases where promotion may have otherwise occurred during the remedial or probation period.
8. REINTEGRATION / REASSESSMENT
8.1 Where a trainee has been on an extended leave of absence, a period of reintegration/reassessment to assess knowledge, skills and competencies may be warranted prior to resuming formal training. Trainees will be placed at the appropriate level or stage as determined by the RPC, at the completion of the reintegration/reassessment period. If the trainee has lost knowledge, skills or competencies, it may be determined that the trainee should be reclassified to a more junior level of training (year or stage), it may be determined that the trainee requires a period of remediation, or it may be determined that both are required.
8.2 A trainee may receive credit for training which is successfully completed during a period of reintegration/reassessment as decided by the RPC or FPC but this will only be determined at the completion of the period of reintegration/reassessment period.
8.3 The nature and length of the reintegration/reassessment period will be determined by the program’s RPC or FPC. The period of reintegration/reassessment will generally be four to eight weeks and should not exceed 12 weeks. The trainee must be consulted about the plan and must be provided with a copy of the plan before the reintegration/reassessment period begins.
8.4 A reintegration/reassessment plan must be completed by the Program which must
address the following:
8.4.1 details regarding the reasons for the reintegration/reassessment period;
8.4.2 the specific areas of reintegration/reassessment, and goals and objective or EPAs and milestones the trainee is to be benchmarked to;
8.4.3 the goals and objectives or EPAs and milestones that are to be assessed in determining the trainee’s stage or level of training;
8.4.4 the methods of assessment to be used during the reintegration/reassessment;
8.4.5 the duration of the reintegration/reassessment period;
8.4.6 the possible outcomes of the reintegration/reassessment; and
8.4.7 outline the methods by which the final decision will be made around whether the trainee has successfully completed a period of reintegration/reassessment and how stage or level will be determined.
8.5 The plan must be drafted by the RPC or delegate and must be ratified by the Vice-Dean PGME or delegate and the senior physician leader of the health organization where the trainee’s rotation or training experience is taking place.
9.UNSATISFACTORY AND INCOMPLETE PERFORMANCE
Unsatisfactory or incomplete performance may be identified when it is determined that the trainee did not meet the defined educational objectives, EPAs or milestones.
9.1 Reasons why a trainee’s performance may be deemed unsatisfactory include:
9.1.1 a summative assessment or a decision by the competency committee demonstrates that the trainee has not met the required objectives or competencies;
9.1.3 a trainee is in breach of the policies of the health organization where the trainee’s rotation or training experience is taking place;
9.1.4 the trainee has been absent without receiving appropriate approval from their Program Director, as per the processes set out by the PARO-CAHO Collective Agreement and/or the PGME Leave of Absence Policy.
9.1.5 the Program Director, RPC, or Competence Committee determines that the trainee has not satisfactorily completed a rotation or educational experience.
9.1.6 an unsatisfactory rotation or educational experience can be identified using any of the following language (as defined by individual Program standards and outlined on Assessments): “marginal”, “borderline”, “inconsistently” or “partially meets expectations for level of training”, “unsatisfactory”, “does not meet expectations for level of training”, “off trajectory”, or any other language explicitly defined by the program to denote unsatisfactory performance
9.1.7 any serious patient safety issue/concern may be defined as a performance deficiency and lead to an unsatisfactory completion of a rotation or educational experience. This must be documented in the trainee’s file.
9.1.8 uncorrected performance deficiencies on any type of assessment may contribute to an unsatisfactory completion of a rotation or educational experience, and/or may independently contribute subsequently to an extension of training, remediation, probation and dismissal decision.
9.2 Incomplete rotations indicate that:
9.2.1 The supervisor has been unable to properly and fully assess the trainee because the trainee’s time spent on the training experience was insufficient to support meaningful assessment. As the training experience is incomplete, time will have to be made up to fulfill the requirement. The amount of time will be determined by the competence committee, RPC or FPC.
9.2.2 The determination of whether a trainee can or cannot be assessed should be made on an individual, case-by-case basis. The assessment should take into account factors such as the trainee’s individual performance and experience, the total length of the rotation or training experience, the future time a trainee may spend on the same rotation, and the nature of the educational experience being missed.
9.3 Where there has been an unsatisfactory performance, the program’s RPC or FPC must decide what action is required and whether to recommend that the trainee be required to enter one of the following remedial periods listed below. In programs with a competency committee, this decision would be guided by the committee’s recommendations. In cases where the trainee has been referred to the Professionalism Committee for professionalism concerns as per the Faculty of Medicine Professionalism Policy, the Professionalism Committee may decide that the trainee be required to enter one of the following remedial measures listed below. A decision of the Professionalism Committee does not require ratification by the Vice-Dean, PGME or delegate.
9.4 Where concerns have been raised regarding a trainee’s performance, the Program Director, or delegate, must review the concerns with the trainee. The purpose of this communication is to ensure a full assessment of the issues as well as disclosure of the evidence and rationale for the concerns.
9.5 The program’s RPC or FPC will review all relevant supporting documentation prior to making a decision regarding a trainee’s unsatisfactory performance. The trainee must be provided with the opportunity to address the concerns with the RPC or FPC; this communication may be verbal or written.
10. REMEDIAL MEASURES
10.1 In the event that a trainee’s performance has been deemed unsatisfactory or incomplete, the trainee may be required to undergo one or more of the following:
10.1.1 extension of training;
10.1.2 remediation; or
10.2 These remedial measures are intended to deal with problems which are not expected to be readily corrected in the normal course of the residency program.
10.3 A trainee may be placed into whichever one/ones of these remedial measures is most relevant to his/her academic situation.
10.4 In general, it is recommended that a period of probation be preceded by a period of remediation as part of a progressive approach. However, under certain circumstances (e.g. unsatisfactory performance in several CanMEDS domains; level 2 or 3 professionalism concerns), the trainee may be placed on probation without having first been placed on remediation.
11. EXTENSION OF TRAINING
11.1 An extension of training may be utilized to allow a trainee to achieve a required level of competence prior to assuming more responsibilities. This option may be used where it has been determined that a trainee should not be promoted to the next level or stage of training because he/she has encountered difficulties during the year, difficulties obtaining a stage of the program or is on a slower trajectory to obtain competency, but such difficulties/trajectory are not significant enough to warrant a formal period of remediation or probation, or because the trainee has failed a rotation or educational experience that must be repeated. In such cases, the trainee will be required to continue training at the same level for a predetermined amount of time, not to exceed 12 weeks. An extension of training may follow a reintegration/reassessment if deemed necessary by the RPC or FPC.
11.2 Recommendations for extension of training must be brought to the Program’s RPC or FPC by the Program Director or competency committee. A decision regarding an extension of training will be taken by the Program’s RPC or FPC. The decision must be ratified by the Vice-Dean, PGME or delegate.
11.3 The nature and length of the extension of training will be determined by the program’s RPC or FPC. The trainee must be consulted about the plan and must be provided with a copy of the plan before the period begins.
11.4 An Extension of Training plan must be completed by the Program which must include the following:
11.4.1 details regarding the reasons for extension of training;
11.4.2 the specific areas of deficiency, EPAs and milestones where the trainee is off their educational trajectory;
11.4.3 the objectives during the extension of training; EPAs and milestones that need to be met for the expected educational trajectory at the trainee’s stage of training;
11.4.4 the methods of assessment during the extension of training;
11.4.5 the duration of the extension of training;
11.4.6 the possible outcomes of the extension of training; and
11.5 If rotation(s) or training experiences are required outside the trainee’s program, these will be discussed and arranged with the respective Program Director(s) prior to finalizing the extension of training.
11.6 The extension of training plan must be ratified by the Vice-Dean, PGME or delegate prior to its implementation.
11.7 At the end of the Extension of Training period, the RPC, FPC, or delegate, will review the trainee’s performance and determine the appropriate outcomes as per this policy.
12.1 Remediation is a formal program of individualized training during which the trainee is expected to correct identified weaknesses and/or deficiencies where it is anticipated that those weaknesses can be successfully addressed to allow the trainee to meet the standards of training. Remediation shall normally be for a period of two to six clinical blocks (approximately equivalent to 2 to 6 months).
12.2 Recommendations for remediation must be brought to the Program’s RPC or FPC by the Program Director or competency committee. A decision regarding remediation will be taken by the Program’s RPC or FPC. The decision must be ratified by the Vice-Dean, PGME or delegate.
12.3 A remediation plan must be completed by the Program which must include the following:
12.3.1 details regarding the reasons for remediation;
12.3.2 the specific areas of deficiency, EPAs and milestones where the trainee is off their educational trajectory;
12.3.3 the objectives during the formal remediation; EPAs and milestones that need to be met for the expected educational trajectory at the trainee’s stage of training;
12.3.4 the methods of assessment during the remediation;
12.3.5 the duration of the remedial period;
12.3.6 the possible outcomes of the remediation; and
12.4 If rotation(s) or training experiences are required outside the trainee’s program, these will be discussed and arranged with the respective Program Director(s) prior to finalizing the period of remediation.
12.5 The remediation plan must be ratified by the Vice-Dean, PGME or delegate and the senior physician leader of the health organization where the trainee’s rotation or training experience is taking place prior to its implementation.
12.6 At the end of a remediation period, the program’s RPC, FPC, or delegate, must complete a Final Remediation Outcome form. The Program Director will inform the trainee in person and in writing as to the results of the remediation and the recommendation(s) of the RPC or FPC. The outcome of the remediation must be ratified by the Vice-Dean, PGME or delegate.
12.7 A trainee may receive credit for training which is successfully completed during a period of remediation as decided by the RPC or FPC.
12.8 If the trainee’s performance in remediation is unsatisfactory, he/she will be placed in his/her home program pending the deliberations of the RPC or FPC, or may be placed on a paid interruption in training. Where the remediation is unsuccessful, the RPC or FPC may recommend to the Vice-Dean PGME or delegate that the trainee enter a further period of remediation or probation.
12.9 A trainee may have a maximum 2 remedial periods at any time during a residency program. Dismissal may be considered as an outcome of a second remedial period; these remedial periods do not need to be consecutive.
13.1 A trainee will be placed on probation in circumstances where the trainee is expected to correct identified serious problems which are not subject to usual remedial training including but not limited to, academic or professionalism issues that are assessed to jeopardize successful completion of the residency or fellowship program. Probation may be applied where a trainee:
13.1.1 has failed a period of remediation;
13.1.2 has successfully completed two remediation periods at any time during their training and subsequently has encountered difficulties; or
13.1.3 has encountered serious academic, patient safety or professionalism issues where the program’s Residency Program Committee determines that an immediate period of probation is warranted.
13.2 Recommendations for probation must be brought to the program’s RPC or FPC by the Program Director or competency committee. A decision regarding probation will be taken by the program’s RPC or FPC. The decision must be ratified by the Vice-Dean, PGME or delegate.
13.3 The nature and length of the probation period will be determined by the program’s RPC or FPC. Probation should not exceed 3 blocks/months. In cases where it has been determined that a trainee has acted unprofessionally, probation will be managed in accordance with Faculty of Medicine Professionalism Policy.
13.4 A probation plan must be completed by the program which must address the following:
13.4.1 details regarding the reasons for probation;
13.4.2 the specific areas of deficiency; EPAs and milestones where the trainee is off their educational trajectory;
13.4.3 the objectives during probation; EPAs and milestones that need to be met for the expected educational trajectory at the trainee’s stage of training;
13.4.4 the methods of assessment during the probation;
13.4.5 the duration of the probation period;
13.4.6 the possible outcomes of the probation; and
13.5 If rotation(s) or training experiences are required outside the trainee’s program, these will be discussed and arranged with the respective Program Director(s) prior to finalizing the period of probation.
13.6 The probation plan must be ratified by the Vice-Dean, PGME or delegate and the senior physician leader of the health organization where the trainee’s rotation or training experience is taking place prior to its implementation.
13.7 At the completion of the probation period, the trainee shall be placed on a paid interruption in training pending the deliberations of the RPC or FPC.
13.8 At the end of the probation period, the program’s RPC or FPC must complete a Final Probation Outcome form. The Program Director will inform the trainee in person and in writing as to the results of the probation and the recommendation(s) of the RPC or FPC. The outcome of the probation must be ratified by the Vice-Dean, PGME or delegate.
13.9 A trainee may receive credit for training which is successfully completed during a period of probation as decided by the RPC or FPC.
13.10 Where the probation has been unsuccessful, the Program Director on the advice of the RPC or FPC will recommend to the Vice-Dean, PGME or delegate that the trainee be dismissed from the program.
14.1 Suspension is a temporary interruption of a trainee’s participation in the residency or fellowship program, and includes interruption of clinical and educational activities.
14.2 The conduct of trainees is governed by the policies of professional bodies such as the CPSO and by the Professionalism Policy of the Faculty of Medicine, University of Ottawa. Violation of any of these standards and policies may constitute improper conduct warranting suspension. A single serious incident of unprofessionalism or a series of incidents of unprofessionalism may justify suspension.
14.3 A supervisor may immediately remove a trainee from clinical or non-clinical responsibilities if the trainee’s conduct is deemed to pose a safety risk to patients, staff, students, or the public that uses the setting, and the supervisor must notify the program director as soon as possible. Only a program director, Vice-Dean of PGME or delegate, or the PGME Professionalism Subcommittee may formally suspend a trainee. If the program director suspends a trainee, the suspension must be ratified by the Vice Dean of PGME or delegate.
14.4 The Vice-Dean or delegate must notify the trainee in writing of the suspension and the notification must include the reasons for and duration of the suspension. The trainee will continue to be paid during the suspension as per the terms of the PARO-CAHO agreement pending review by the Vice-Dean or delegate, and/or the Professionalism Subcommittee.
14.5 The PGME office will notify the senior physician leader of the health organization where the trainee’s rotation or training experience took place that the trainee is suspended from clinical duties pending investigation and adjudication of the issue leading to suspension.
15. DISMISSAL FROM THE PROGRAM
15.1 A trainee may be dismissed from the program if any of the following conditions exist:
15.1.1 a trainee has a second failure of remediation;
15.1.2 a trainee fails a probation period;
15.1.3 a trainee does not maintain the standards of the profession as described in the Faculty’s Professionalism Policy;
15.1.4 a trainee meets the criteria of the Regulated Health Professions Act of Ontario for clinical incompetence or incapacitation; or,
15.1.5 lack of a training site/faculty available to train as a result of professionalism or patient safety concerns.
15.2 A decision regarding dismissal of a trainee will only be taken by the program’s RPC or FPC on the recommendation of the Program Director or by the Professionalism Committee. When the decision has been made by the program’s RPC or FPC, the decision must be ratified by the Vice-Dean, PGME or delegate. Decisions of the Professionalism Committee do not require Vice- Dean PGME ratification.
15.3 The trainee must be informed of the decision in writing. The notification must include the reason(s) for dismissal.
15.4 The PGME office will notify the senior physician leader of the health organization where the trainee’s rotation or training experience took place that the trainee is dismissed from the program.
16.1 A trainee has the right to appeal a final decision regarding extension of training, reclassification, remediation, probation, suspension or dismissal as ratified by the Vice-Dean, PGME or delegate or by the Professionalism Committee to the Faculty Council Appeals Committee. A decision regarding rotation failure for which the consequences are limited to repeating the rotation and/or reducing time available for electives is not eligible for appeal.
16.2 An appeal referred to in 16.1 may be made on the basis of a final decision that is incorrect due to the following: an error in procedure or of fact; or there are new facts relevant to the final decision that were not available and could not have been provided during the process leading up to the final decision.
16.3 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/governance/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.
17.1 When a trainee is assessed by the RPC or FPC near the end of the training program as having met the prerequisites for certification by the Royal College or the CFPC, the PGME Vice- Dean will notify the Royal College or the CFPC of this in the required manner.
18.1 This policy replaces any previous versions of the policies and procedures on PGME evaluations.
19.1 This policy will be reviewed 1 year after adoption and every 3 years subsequently.
January 30, 2019
June 4, 2019
Executive Committee of the Senate
October 1, 2019
Policy on Postgraduate Trainees Undertaking International Electives
Increasingly postgraduate medical trainees are requesting electives in international settings. The medical and cultural benefits of these electives are recognized by the faculty and the medical literature. However, these electives pose potential risks for the trainee and the receiving community/institution, therefore proper preparation, supervision and follow up are required.
For international electives (not including the United States of America), trainees may be required to carry out special preparation, particularly important for those planning to work in low resource settings.
Note: Trainees are responsible for application and cost of any passport, visa, insurance, health related and other requirements, as appropriate.
This policy will outline the requirements for application and successful completion of international elective to receive faculty support and recognition for these activities.
The International & Global Health office (IGHO), Postgraduate Medical Education office and trainee’s specialty or subspecialty program jointly approve these placement activities. Trainees are required to comply with instructions from the Postgraduate Medical Education Office and the IGHO, as well as their respective Programs/Program Directors.
Section 1: ELIGIBILITY CRITERIA
Trainees must have permission from their Program Directors to participate in an international elective.
International electives should be a minimum of four weeks in duration.
Request for approval for international electives must be submitted a minimum of two months prior to the start date.
Trainees must receive academic credit from their program for the elective time.
Section 2: APPLICATION PROCESS
2.1 Applications for international electives must be submitted to the trainee’s respective program a minimum of four months prior to their placement start date. This will allow the trainee to properly prepare for the elective and allow enough time for required immunizations, visas, passports, and pre-departure training. Once the trainee’s program approves the dates and confirms the trainee is in good academic standing the application is sent to the IGHO for processing.
2.2 Trainee to complete “Application Form to request approval for an International Elective” and “Release of Liability Form” available on the IGHO website (online form being built by IT).
2.3 The international elective will be pre-approved by the IGHO if the following requirements are met:
Trainee is in good academic standing according to their Program Director and the Postgraduate Medical Education office
The Program Director approves of the planned elective
Trainee requires an international supervisor who must be a practicing physician or researcher (for research electives). The trainee must provide contact information for their supervisor.
NOTE: Trainees must not be supervised by an immediate, extended, or in-law family member.
The destination region for the elective does not carry a warning of “Avoid non-essential travel” and/or “Avoid all Travel” on the Global Affairs Canada Travel Advice and Advisories webpage.
Trainee to provide appropriate educational objectives, approved by their Program Director.
Trainee to provide all required information requested on the application. Incomplete applications may lead to delays or refusal.
NOTE: Once the elective has been approved, it is possible to revoke this decision and cancel due to changes in conditions in the country, loss of in-country supervisor, OR arising academic or professional concerns on the part of the trainee.
2.4 Pre-departure training for international electives
2.4.1 Trainee must participate in a mandatory pre-departure training session, offered by the IGHO. This training is required for all those undertaking electives in low and middle resource settings as defined by the World Bank’s income classification, which is based on a measure of national income per person, or GNI (Gross national income) per capita: 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 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.
3.1 International Electives are, ideally, expected to be a minimum of four weeks in length. Although there are no routine funds available for elective activities, the IGHO website outlines possible funding opportunities. Trainees are encouraged to contact the IGHO if they have any questions.
Section 4: MEDICAL-LEGAL COVERAGE DURING ELECTIVE
4.1 Trainees undertaking international electives require medical-legal coverage. Those under the direct supervision of Canadian physicians with CMPA coverage should be covered by CMPA during their elective. Trainees are required to contact CMPA to confirm their coverage and to inform CMPA of their planned activities. For those not supervised by a physician with CMPA coverage, approved electives through the process outlined above should have coverage through the University of Ottawa.
“Learning outside Canada - Members who travel outside of Canada for residency/fellowship training and continuing medical education may be involved in clinical care and thus exposed to possible medical-legal difficulties. The CMPA generally will not provide assistance with medical-legal matters arising from the provision of such clinical care outside of Canada, whether a legal action arises inside Canada or outside Canada.
In those instances where a resident/fellow accompanies his/her CMPA member supervisor on a humanitarian trip abroad, the trainee’s eligibility for assistance will match the eligibility of the supervisor. Both the supervisor and trainee must verify their eligibility and make arrangements with the CMPA prior to leaving Canada.”
In cases where CMPA coverage doesn’t apply, the University’s Commercial General Liability insurance policy, which includes malpractice, would apply as long as:
The trainee is registered as a uOttawa student during the time of the “work”/placement in question
The university has a written placement agreement which covers the trainee’s work prior to the start of the placement, and
The trainee receives academic credit (approved by the University) for the time in question when the event causing the loss occurs.
Section 5: ALIGNMENT WITH THE POSTGRADUATE TRAINEE SAFETY POLICY
5.1 Trainees and Program Directors should note that all the conditions outlined in the Postgraduate Trainee Safety Policy (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
Trainees must have their application approved PRIOR to undertaking the international elective. Application must be approved by the Program Director, IGHO and Postgraduate Medical Education Office.
Trainee must complete pre-departure training, as directed by the IGHO.
Trainee must submit the post-elective reflective summary to the IGHO Coordinator.
Trainee must complete post-elective debriefing, as directed by the IGHO.
Trainee must complete the evaluation In-Training Evaluation Report (ITER).
Trainee must submit or ensure submittal of evaluation form by supervisor to the Program Director.
This policy will be reviewed in 1 year after adoption and every 3 years subsequently.
Postgraduate Medical Education Committee (PGEC)
June 17, 2020
August 25, 2020
Potential Conflict of Interest During Clinical Supervision Due to a Personal Relationship
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.
Process for vacant MOHLTC funded residency positions
From time to time, the Ministry of Health and Long Term Care (MOHLTC) funded residency positions become vacant due to either transfer outside of the University of Ottawa, resignation, or the dismissal of a resident. Program Directors may fill the position with an admissible resident at the same level of training within the same specialty training program (including Family Medicine) as the vacant position within three (3) months of the position becoming vacant.
If a position is not filled within the three (3) month period, it is released to the Vice-Dean of Postgraduate Medical Education (PGME), who has the discretion to fill it with a transfer request from an admissible resident - as defined below - who is currently enrolled in any of the accredited residency programs (i.e. any CMG or IMG enrolled in any program anywhere in Canada or USA).
Admissible residents must be either:
Canadian Medical Graduates (CMG); or
International Medical Graduates (IMG) with Canadian citizenship or permanent resident status, currently registered in a postgraduate residency program in Canada or the USA.
Postgraduate Medical Education Committee
September 30, 2015
February 2, 2016
Professional Responsibilities in Postgraduate Medical Education
Reporting Workplace Accidents and Occupational Illnesses
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.
Resident Research and Scholarly Project Policy
All residency programs must ensure that residents are provided opportunities to participate in research or other scholarly projects as defined within the goals and objectives of each program. Resident research or scholarly projects during the course of their residency program could include: basic science; primary care research, experimental medicine; clinical medicine; epidemiology; quality assurance; medical education; ethics; humanities and medicine or any research aligned with health care.
According to the General Standards Applicable to All Residency Programs.
Element 3.2 : The residency program provides educational experiences designed to facilitate residents’ attainment of the outcomes-based competencies and/or objectives.
Requirement 3.2.5 : The educational environment supports and promotes resident learning in an atmosphere of scholarly inquiry.
Indicator 18.104.22.168 : Residents have access to, and mentorship for, a variety of scholarly opportunities, including research as appropriate.
Indicator 22.214.171.124 : Residents have protected time to participate in scholarly activities, including research as appropriate.
Indicator 126.96.36.199 : Residents have protected time to participate in professional development to augment their learning and/or to present their scholarly work.
Element 4.2 : The residency program has the appropriate human resources to provide all residents with the required educational experiences.
Requirement 4.2.1 : Teachers appropriately implement the residency curriculum, supervise and assess trainees, contribute to the program, and role model effective practice.
Indicator 188.8.131.52 : There are sufficient competent individual supervisors to support a variety of resident scholarly activities, including research as appropriate.
Indicator 184.108.40.206 : There is a designated individual who facilitates the involvement of residents in scholarly activities, including research as appropriate, and who reports to the residency program committee.
Each Program must have an assigned Resident Research Director to facilitate resident participation in research and other scholarly projects.
There must be appropriate faculty members identified to facilitate and supervise resident involvement in a research or scholarly project.
Resources to support resident research are a Departmental/Divisional responsibility.
Programs are required to maintain a list of all research and scholarly projects completed by their residents.
All projects are to conform to the Faculty of Medicine’s policy on Research.
January 26, 2021
Postgraduate Medical Education Committee
December 9, 2020
The University of Ottawa believes that the best residents are those who have been able to explore the breadth of the medical profession through a variety of electives while enrolled in medical school. We encourage trainees to use elective time to establish a broad portfolio of expertise as opposed to focusing exclusively on a single specialty.
Each program is responsible for establishing a selection process for prospective residents, which must be in accordance with the General Standards of Accreditation, the Ontario Human Rights Code, Best Practices in Resident Applications and Selection (BPAS) and adhere to the Faculty of Medicine’s Policy on Professionalism. Adhering to these standards ensures a fair and transparent selection process free from discrimination, harassment and preferential treatment.
For PGY1 entry positions, the Family Medicine 3rd year enhanced skills match, as well as other subspecialty matches, programs must also adhere to the policies and procedures of the Canadian Residency Matching Service (CaRMS), the Association of Faculties of Medicine of Canada (AFMC) as well as manage the process in accordance with their own policies and guidelines. Failure to do so may result in the application of sanctions to that program, which may include forced withdrawal from the match by the program.
Postgraduate Medical Education Committee
January 20, 2021
Residents Working Additional Hours for Pay (Formerly known as "Moonlighting Policy")
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
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.
PGME Clinical Fellows are post-residency physicians undergoing specialized training in a fellowship that may or may not be accredited by the RCPSC or CFPC. Clinical Fellows are not residents and as such, do not follow the PARO-CAHO contract. In order to assure that Clinical Fellows have a living wage, it is imperative to set a base earning level.
uOttawa PGME full-time Clinical Fellows are required to have the opportunity to earn a minimum of $60,000 / year for fellowship training. This can be achieved by but is not limited to:
a) External Funding by a third party, e.g Hospital Foundation, Charitable Organization, Governmental Agency
b) Salary Support by Hospital / University Department / Research Institute
c) Own clinical earnings i.e. have the ability to generate at least this amount through clinical practice.
Committee Approval Date
Clinical Fellowship Committee March 5, 2018
Faculty Council June 27, 2018
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.
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.
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.
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.
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.
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.
40. This Policy will be reviewed 1 year after adoption and every 3 years subsequently.
Postgraduate Medical Education Committee
October 26, 2016
May 2, 2017
Executive Committee of the Senate
October 10, 2017
The Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada are the national bodies that set the minimum standards and requirements of training for the approximate 80 specialties recognized for physicians in this country. It is the responsibility of the Faculty of Medicine Postgraduate Medical Education Committee (PGEC) to oversee these training programs ensuring that these minimal standards are maintained. Equally, this committee shall oversee the occasional modifications in training requirements as requested by the program Residency Training Committee. The requested modifications, which may be specific to the training program itself or programs under the umbrella of a department, would be required due to the inapplicability of the existing general rules and regulations. Such modified requirements will need to be guided by principles of natural justice and pedagogical soundness. Such decisions will require the consensus of the PGEC.
The Postgraduate Medical Education Committee shall be responsible for approving residency training requirements which are in addition to the minimum specialty training requirements defined by the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada where the failure for a resident to meet such enhanced requirements would result in prolonging the period of training.
Programs seeking enhanced training requirements need to make application, both in writing and with an in camera presentation to the PGEC outlining the following:
The nature of the training
The logic for the requirement
The process and timeline for addressing a resident’s failure to meet the training requirements within the stipulated range
Approval will be by simple majority of the PGEC
Residents will be given at least one year’s notice before any changes are enacted.
Postgraduate Medical Education Committee
January 27, 2016
Waiver of Training After a Leave of Absence
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.