Clerkship

Organisation of fourth year

• 4 weeks of mandatory selectives (two weeks in Internal Medicine and two weeks of Surgery)
• 18 weeks of electives*
• 2 mandatory formative exams (September & January)
• Portfolio on core competencies (2 meetings, one post per meeting, and a final ePortfolio)
• 4 weeks of Back to basics sessions: revision of your medical studies (three sessions are mandatory)

You will have 2 weeks of vacation for the winter break and 3 weeks reserved for residency interviews.

*Any student who has not done the mandatory 4 consecutive weeks of community placement during 3^rd year will be required to complete it during 4^th year.

2020-2021 Schedule

The 4^th year schedule is divided into six groups and you will be assigned to one of these groups via a lottery in early January.

The difference between the six groups is the period of dates for the mandatory selective. Each group will have the same pathway from September to mid-November (first 10 weeks of electives), then the pathway will change depending on the groups.

Your group choice must be based on your academic needs. For example, if you plan to attend a conference, you must ensure it is not during your mandatory selective as 100% attendance is required for the selective.

Note that the admission interviews will be held from February to March (with a training in January), therefore you must be assigned to group 5 or group 6 if you want to participate.

See course schedule here.

Two lotteries

There will be two (2) lotteries for the organization of the 4^th year program and they will be done through one45. These lotteries are very similar to the ones done for 3^rd year.

1. The first lottery will be to match you to one of the six (6) groups in the schedule.
2. The second lottery will be to match you to a subspecialty for your mandatory selectives.

Note that there are no distinctions between both streams anymore for the 4^th year program. This means that both streams will be part of the same lotteries.

Your participation to both lotteries is important and must be made within the specified dates. If you don’t, one45 will assign you to an empty spot once the lottery is activated at the closure date. There won’t be any possibilities for you to do if after the closure date.

To ensure you won’t miss the deadline, one45 will send you a reminder.

But if it does not matter for you to be assigned to any of these groups, please do not participate in the lottery. By not participating, this will increase the chances of other students to be assigned to their first or second choice.

Lotteries Instructions

The instructions on how to proceed for the lotteries will be sent to you via you uOttawa e-mail address in early January.

1. First lottery – January 8-16, 2020

Through that first lottery, you will rank the 6 groups you wish to be assigned to by order of preference. There will be a maximum of 28 students per group.

You will receive the result by e-mail a week or two after the closing date. If ever you are not satisfied with the result at that point, we will give you a period of one week to find a colleague (from both streams) that will accept to do a switch with you. Both will have to notify Christiane Raymond at medyear4@uottawa.ca.

After that period, your assignment to a group will be final and we will send you the new result.

1. Second lottery – March 2020

Through that second lottery, you will rank all the subspecialties you wish to be assigned to by order of preference.

The process will be the same as for the first lottery.

Mandatory Selectives in Internal Medicine and Surgery

You will be required to do a 2-week rotation in an Internal Medicine subspecialty and a 2-week rotation in a Surgery subspecialty at The Ottawa Hospital.

After finalizing the 4^th year groups and schedule, each student will be asked, through a lottery, to pick their choices of Internal Medicine and of Surgery subspecialties within a certain time frame.

Once these have been assigned and the internal medicine rotation schedule has been finalized, any spots that have not been filled will be made available for elective placements.

For further information, please contact the coordinator for the appropriate Selective.

Internal Medicine Selective

Once you are assigned to a group, the second lottery will allow you to rank the following subspecialties for the mandatory Selective in Internal Medicine:

Surgery Selective

Once you are assigned to a group, the second lottery will allow you to rank the following subspecialties for the mandatory Selective in Surgery:

The duration of your Surgery Selective is of 2 weeks for the majority except for oncology which is 1 week.

ONCOLOGY: Some oncology unit offer you to do one week in one of their subspecialties and a second week in another subspecialty. Therefore if you choose an oncology subspecialty, you must automatically choose another subspecialty for one week.

* PLASTIC: You cannot choose this subspecialty if you have done it during your 3^rd year or if you are planning or have booked a 4^th year elective at TOH. A student is allowed to have only one (1) placement in Plastic (TOH) during their clerkship. If you select plastic, but are not eligible, you will be placed in another specialty without consultation.

In 4^th year of medical school, you will have more freedom to adapt your electives to meet your specific needs with regards to career choices.

The 18 weeks of electives in 4^th year is placement time that should be used to learn more about the discipline that may be selected for residency or to enhance competencies in a clinical field which was not sufficiently explored in the 3^rd year. A majority of students use their elective time to explore possible residency programs or to make themselves known to the programs they are interested in.

One of the key elements to admission in a residency program is to have completed electives in the selected discipline. It is very unlikely that a student will be admitted to a residency program in a discipline for which they have not demonstrated an interest and commitment by doing 1 or 2 electives in the given specialty. However, it is not necessary to complete an elective in every residency program in the country to be matched in that discipline. You can refer to the description of the programs on the CaRMS website for more information on what programs are looking for in their candidates. Electives in other areas including research are encouraged.

Electives usually last 2 to 4 weeks (one week is also accepted) and every student has the responsibility to organize their own placements. It is recommended to not wait too long as places are sometimes quite scarce and greatly coveted by many students from across the country.

You may undertake electives at any Canadian, North American LCME/CACMS accredited medical school, Distributed Medical Education (DME) provincial network, or approved community setting. You may also choose to complete international electives.

It is recommended to wisely use the first 10 weeks of electives to gain exposure to potential programs however all weeks before the December vacation are also very important for networking. While it is important to use this elective time to explore residency training programs, every effort should be made to diversify the electives and balance clinical strengths.

See the following resources to help in planning your career:

Career planning: Students Affairs

Residency programs:  Canadian Resident Matching Service (CaRMS) 

General conditions

It is expected that an elective will be comprised of 35 hours per week.

You are required to complete a total of 18 weeks before the end of 4^th year. The only electives that will be counted toward the 18-week requirement are those that have been approved and entered in your Clinical Placement account and for which evaluations confirming successful completion have been received.

These electives can be either clinical or non-clinical in nature, however you are not allowed to do more than four (4) weeks of non-clinical electives throughout 4^th year.

Your supervisor must be a practicing physician, not a resident.

It is expected that you will be in Canada and the continental USA on CaRMS Match Day. That being said, international electives are not permitted during that period. This is to ensure the students can be easily contacted and are able to urgently return to Ottawa should the need arise. Our concern lies in the event of an "unmatch" as timelines involved in this process can require less than 24 hours turnaround.

Conflict of interest in clinical placements

Students cannot be supervised in any clinical placements (i.e., core rotation, selective or elective) by a member of their immediate family, extended family including in-laws treating physician or others close to them who could compromise the objectivity of the student's assessment.

In addition, students are not permitted to do clinical placements with his or her treating physician. Students must immediately notify the Medical Education Office or Rotation Coordinators to request reassignment if their assigned placement is in violation of this policy. If a physician has treated a student in the past, they should make efforts to avoid any future situation that would put them in a position of evaluating that student.

Students are not permitted to participate in clinical placements at our affiliated clinical care facilities, including University of Ottawa Health Services, with a physician that has treated them in the past.

Cancellations

Please select your elective carefully as switching or cancelling electives once they are booked is discouraged. If it is absolutely necessary to cancel an elective, you must notify your Year 4 Liaison Officer, department coordinator and/or preceptor in writing or through the AFMC Student Portal at least 6 to 8 weeks (depending on the policy) before the start of the elective. Failure to adhere to this national policy will be considered a breach of professionalism and will be reported to the Director of Electives and the Assistant Dean - Academic Affairs, Undergraduate Medical Education.

National 8-week notification policy

It is your responsibility to keep track of the status of your submitted applications. Just as you are required to provide a cancellation notice at least 6 to 8 weeks before an elective start date, all Canadian medical schools are also committed to working on visiting elective applications up to EIGHT (8) WEEKS prior to an elective start date. If schools cannot place you by the 8-week mark, they will notify you so that you are still able to secure an elective at your home school for that elective period.

When planning your electives, make sure to follow the appropriate process for the service you are applying to as these can vary by school and location. It is best practice to communicate with all contacts via your uOttawa student email so that they can clearly identify you as a uOttawa student.

Electives in Ottawa

You can browse the Elective Opportunities section of the Electives website to find all the opportunities offered to uOttawa students by the departments in Ottawa. It provides a description of the elective as well as information on how to request an elective. Make sure to get a written confirmation of the elective. There are no fees related to these requests and they are made directly with the coordinators. See the Contacts section for the complete list of department coordinators.

Note: Clinical and hospital settings in Hull and Gatineau (Outaouais region) are affiliated with McGill. You must therefore apply through McGill.

Electives at other Canadian Universities

The AFMC Student Portal is now the principal tool to set up clinical electives at Canadian universities. You will be required to pay a one-time fee to create your profile and will then be able to apply to elective opportunities offered by each school at their listed fees.

Before applying for an elective, please keep in mind the following:

• Each school has its own application guidelines. It is crucial you carefully review the guidelines listed on the Institution Profile page for the school you are interested in. Look at application fees, pre-requisites, application timelines, special rules (ex. being able to submit only 1 application or complete 1 elective at a certain school per year; coordinating electives outside the Portal before officially applying...), etc.
• You may be required to complete the IELTS-Academic exam for language proficiency (for electives as well as CaRMS). You should verify this early on and make the appropriate arrangements in advance. Test results are valid for 2 years.

Once you submit an application on the AFMC Student Portal, the uOttawa Electives Coordinator will receive a notification to complete the Home School Verification to confirm your academic status. Your application will then move on to the next step for processing.

For detailed information on how to use the AFMC Student Portal, the AFMC has posted Help Documents for students (under Quick Links at the bottom of the Portal’s website). You can also contact their help desk if needed.

Letter of good standing

There are many organizations who will request a letter of good standing from your school. You will have to request one through the StudentZone.

The Undergraduate Office will provide you the letter if you meet the following requirements:

1. Your tuition fees must be paid for the current session
2. You must comply with the risk management requirements. You will find more details below in the section of the CLINICAL PLACEMENT RISK MANAGEMENT REQUIREMENTS.

Other elective resources

There are numerous options available to you when planning your electives. Other great resources can include:

• Rural Canadian Electives
• International Electives

You are not limited to clinical electives in 4^th year. There are a variety of non-clinical electives offered during the year, including research electives which are a great way to get additional exposure to a specialty:

• Non-Clinical Electives

In order to meet the accreditation requirements, all electives must be pre-approved by the Faculty of Medicine, Undergraduate Medical Education Office (Liaison Officer, Year 4) in order to be eligible and credited.

You must request an approval for all your electives through your Clinical Placement account. All requests must be made at least one month prior the start of any elective. This will be monitored regularly.

If you do not have a pre-approved elective in your Clinical Placement account 2 weeks prior to a given date, it will be brought to the attention of the Clerkship Director. 

Any changes to your registered approved electives must be done through your Clinical Placement account by entering a new request. Then you must delete the entry that is no longer valid.

IMPORTANT: An elective cannot be started if it has not been pre-approved and will not be credited if you do not comply with this procedure. If you complete an elective without having it pre-approved, it will potentially be considered a professionalism issue and will be brought to the attention of the Clerkship Director. 

How to request approval for your electives

To request approval for your electives, please follow these steps:

1. Plan your elective.
2. Go to the Student Tools application.
3. Enter your username and password (the same as the ones used to access your ONE45 account).
4. Open your file by choosing "Clinical Placement".
5. Choose: "Request approval for an elective".
6. Make sure to complete all sections of the form and then choose "Submit".
7. Once the Medical Education Office has approved your elective (in a delay of 48-72 hours), your Clinical Placement account will automatically be updated.

NOTE:

For electives in the City of Ottawa: Choose the preceptor name from the dropdown menu.

• If the preceptor does not appear in the dropdown menu, select the option “Preceptor does not appear in list” enter the full name, and email address of preceptor in the comment box. The Electives Coordinator will add the preceptor to the menu and will contact you to get supplementary information if needed.
• If no supervisor has been assigned to you at the moment you receive a confirmation, select the option “Elective confirmed by Department Coordinator”. At the end of the elective, update the elective with the preceptor who supervised you.

For electives outside the City of Ottawa: Enter the preceptor's name and email in the free-text boxes that appear.

• If no supervisor has been assigned to you at the moment you receive a confirmation, you must enter the name of the coordinator who confirmed the elective. You will be able to modify this entry at the end of your elective. Requests with TBD, TBA, Multiple preceptors, do not know, etc., will not be approved.

All clinical electives have been categorized into groupings according to the CaRMS’ list of disciplines*. When registering your electives in your Clinical Placement account, you will need to tag your elective to the appropriate grouping.

In 4^th year you must cover a minimum of 3 groupings, by doing at least 2 weeks in each grouping. A maximum of 10 weeks of clinical electives is allowed in the same grouping. Therefore a student cannot do more than 10 weeks in the same specialty.

Non-clinical electives do not count towards groupings.

*A grouping is created from the CaRMS’ list of disciplines:

In general agrouping is determined by the CaRMS entry point to get into a discipline (or the main specialty of a preceptor). However there might be exceptions. For example:

• If a student is on elective with a family physician doing only emergency medicine, it will count as the Emergency Medicine grouping.
• If a student is following a family physician and doing both emergency medicine and also seeing patients at the clinic, then it will count as the Family Medicine grouping.

NEW Diversification Policy for Year 4 Electives for the MD2021 Class

«Following extensive discussion over the prior 2 years, in April 2018 at CCME, the Association of Faculties of Medicine Canada’s (AFMC) Undergraduate Medical Education (UGME) Committee (which is a Committee of the 17 Canadian UG Deans) reached a consensus, agreeing to the following proposal:»
«Undergraduate programs recognize their dual responsibility to ensure students undertake a full educational experience that prepares them for any potential career choice, while also optimizing their ability to engage in the increasingly competitive postgraduate match process. Undertaking elective experiences exclusively in a single discipline is pedagogically unsound and fails to provide students with a full exposure to potential career options. Consequently, we commit that, beginning with the Class of 2021, student elective opportunities cannot exceed a maximum of eight weeks in any single entry-level discipline.» 

«The AFMC PGME Committee (the 17 Canadian PG Deans) expressed unanimously in support of this proposal when it was discussed with them at CCME.»

«The AFMC UGME Committee undertook consultation with the CFMS as well as through each school’s curriculum committee and/or local student leadership. This feedback, including a written report submitted to the UG Deans by the CFMS was discussed at the October 26, 2018 UG Deans’ meeting at the AFMC.»

Therefore, in accordance with the AFMC National Elective Diversification Policy, all clinical electives have been categorized according to the CaRMS list of «Entry-level disciplines».  An entry-level discipline is an Entry Route in the PGY-1 (R1) match.

When registering your electives in your Clinical Placement account, you will need to tag your elective to the appropriate discipline.

In 4^th year, you must cover a minimum of three (3) disciplines, by doing at least two (2) weeks in each discipline.  A maximum of eight (8) weeks of clinical electives is allowed in the same discipline.

PGY1 Entry-level disciplines:

D1 Anatomical Pathology
D2 Anesthesiology
D3 Cardiac Surgery
D4 Dermatology
D5 Diagnostic Radiology
D6 Emergency Medicine
D7 Family Medicine
D8 General Pathology
D9 General Surgery
D10 Hematological Pathology
D11 Internal Medicine (General) – CTU and CT
D12 Medical Genetics and Genomics
D13 Medical Microbiology
D14 Neurology
D15 Neurology - Pediatric
D16 Neuropathology
D17 Neurosurgery
D18 Nuclear Medicine
D19 Obstetrics and Gynecology
D20 Ophthalmology
D21 Orthopedic Surgery
D22 Otolaryngology - Head and Neck Surgery
D23 Pediatrics (General)
D24 Physical Medicine & Rehabilitation
D25 Plastic Surgery
D26 Psychiatry
D27 Public Health and Preventive Medicine
D28 Radiation Oncology
D29 Urology
D30 Vascular Surgery

Non-clinical electives and Year 4 selectives do not count towards a discipline.  However, for tracking purposes you will be asked to tag them as follows:  D31 Non-Clinical.

In general, a discipline is determined by the main specialty of a preceptor. However, there might be exceptions. For example:

• If a student is following a Family Medicine physician doing only Emergency Medicine, it will count as the Emergency Medicine discipline.
• If a student is following a Family Medicine physician doing both Emergency Medicine and seeing patients at the clinic, then it will count as the Family Medicine discipline.

«While the majority of medical students studying in Canada apply only to the Canadian residency match (through CaRMS), some students also apply (or apply exclusively) to the U.S. residency match (through ERAS).  As this Canadian policy applies to all Canadian UGME programs, all students enrolled in these programs are subject to the same policies. The 8-week maximum applies irrespective of the student’s decision about residency applications.»

PGY-3 Subspecialties

Electives in subspecialties that are part of a PGY-3 match, such as the subspecialties in Internal Medicine and Pediatrics, are counted separately, i.e. weeks in these subspecialties do not count as weeks in the disciplines.

However, for tracking purposes you will be asked to tag them as follows:

D32 PGY3 Internal Medicine Subspecialties
D33 PGY3 Pediatrics Subspecialties

After week #10 (between November and March), students must do a minimum of 4 weeks of electives (which do not have to be consecutive) outside The Ottawa Hospital (TOH).

Any student who has not done the mandatory 4 consecutive weeks of community placement during 3^rd year must do it in 4^th year.

Please visit the Distributed Medical Education (DME) website for more information or contact them at dme@uOttawa.ca.

All placements (selective & elective) must be validated with an evaluation.

We must receive one evaluation per placement.

Elective evaluations must be completed by practicing physician, not a resident.

At the end of 4^th year (end of March), your file will be considered as complete only if all evaluations have been received and are successfully passed.

You must succeed in all your placements to be eligible to the M.D. degree.

If you fail a placement, remediation will be mandated after meeting with the clerkship director.

You must always keep a copy of your evaluations for your personal records.

Elective Evaluations

A few days before the end of each elective, you must return to your Clinical Placement account to indicate that your elective has been completed. Then you must complete 3 mandatory steps:

• Evaluation of preceptor by student;
• Evaluation of elective experience by student;
• Evaluation of student by preceptor – Send evaluation to preceptor

Each student must comply with the deadlines provided.

For any problems with elective placements, please inform the Liaison Officer, Year 4 at 613-562-5800 ext. 3808 or by email at medyear4@uottawa.ca or the Electives Coordinator at 613-562-5800, ext. 8552 or by email at elective@uottawa.ca.

Selective Evaluations

Evaluation of mandatory Selectives will be done through one45.

The Selective coordinators will send you the evaluation forms in your One45 To Do page.

1. You will select your preceptor and send the evaluation. Only one preceptor is responsible to complete your evaluation even if you have worked with multiple preceptors.
2. You must evaluate each preceptor and resident you have worked with even if it is only for a half day.

Registered students at the University of Ottawa are covered by the University’s Commercial General Liability Insurance with a limit per occurrence in excess of C$5.000,000 inclusive for medical malpractice, bodily injury, personal injury and property damage as described in detail in the policy while on clinical placements during the academic year, whether in Canada or abroad.

Note that the University of Ottawa’s Commercial General Liability insurance policy only applies to placements when students are receiving academic credit. Therefore, students are only covered by our insurance when they are successfully completing the required 18 weeks of Electives and 4 weeks of Selectives. If you voluntarily undertake additional placements, you will not be covered by the University’s insurance for these additional weeks and will place yourself, the receiving institution and the physician you are working with at risk. You will not receive academic credit for those weeks.

Mandatory Formative Exams

During the 4th year, there will be two formative exams. The first one will be held in September and the second in February. These exams have two parts: MCQ and CDM. They will cover five disciplines: Internal Medicine, Surgery, Pediatrics, Obstetrics & Gynecology, and Psychiatry.

It will take place from a Saturday morning (7:00 AM) to the Monday evening (11:59 PM). Students will be able to access their online exam at the time it fits their schedule during those three days. The exam can be done from home or from any places that have a good Internet access. 

Please read carefully the attendance policy in Clerkship which applies to the 3^rd and 4^th year.

Back to Basics

Back to Basics is an opportunity to student to review their medical study to help them prepare to the Medical Council of Canada Qualifying Examination (MCCQE) part I.

The Back to Basics will be held at the Roger Guidon Pavilion over a four-week period from Monday to Friday. 

Each lecture will be based on the Medical Council of Canada Examination objectives: https://mcc.ca/objectives/

The details of the Back to Basics will be provided later.  

ePortfolio on Core Competencies, Part 4

This course will be the last part of the electronic Portfolio (ePortfolio) program. This is mandatory and consist of two meetings, two posts, and one final ePortfolio. 

Due to the complexity of the 4^th year program, it could be challenging to find mutually convenient times for the meetings, as many students will be in various elections/selectives in different dates and location. However, students can also meet through teleconference, Skype, or any other media.

Kelsea Anstey, the Academic Coordinator (coormed@uottawa.ca), will send you all the information before the beginning of your 4th year.

Year 4 Important Contacts

Doyen adjoint, Études médicales de premier cycle, Affaires scolaires
Buu-Khanh Lam, MD, 613 562-5800 poste 8911 / 613 562-5800 poste 8561, bklam@ottawaheart.ca

Clerkship Director, Francophone
Dr. Michelle Anawati, 613-590-0533, manawati@uottawa.ca

Clerkship Director, Anglophone
Laurie McLean, MD, lmclean@uottawa.ca

Liaison Officer 4^th Year
Christiane Raymond, 613-562-5800 ext. 3808, medyear4@uottawa.ca

Elective Coordinator
Nathalie Pellerin-Tessier, 613-562-5800 ext. 8552, elective@uottawa.ca

Internal Medicine Hospital Coordinators (Mandatory Selective)
Matthew Armour, 613-798-5555, ext 18724, marmour@toh.ca                                                                                         Melanie McCallum, 613-798-5555 ext. 18723, InternalMedCoordCIVIC@toh.on.ca

Surgery Hospital Coordinator (Mandatory Selective)
Elizabeth Donohue, 613-798-5555 ext. 10604, edonohue@toh.on.ca

Academic Assistant, Undergraduate Medical Education Office
Reception 613-562-5800 ext. 8551, medaca@uottawa.ca

ePortfolio, Academic Coordinator
Kelsea Anstey, 613-562-5800 ext. 1712, coormed@uottawa.ca

University of Ottawa toll free number
1-877-UOTTAWA (868-8292) press # and the extension

Need assistance?

If there are any problems with your elective, please inform the Liaison Officer, Year 4 at 613-562-5800 ext. 3808 or in writing at medyear4@uottawa.ca or the Electives Coordinator at 613-562-5800 ext. 8552 or in writing at elective@uottawa.ca.

If you experience difficulties such as personal well-being or stress related issues during an elective, please do not hesitate to contact the Electives Coordinator at elective@uottawa.ca or by phone at 613-562-5800 x8552 or toll free at 1-877-868-8292, press # and the extension 8552.

The Office of Student Affairs also offers a confidential counseling and referral service to undergraduate medical students. Students who are experiencing difficulty with stress related to personal and academic demands are encouraged to consult with a professional counselor in Student Affairs. You may find their contact information following this link.

Appropriate appearance in clinical settings

We strongly encourage you to familiarize yourself with the guidelines regarding appearance while encountering patients. Policy and Procedures, Academic, Clinical Setting – Procedure.

Professionalism

We strongly encourage you to familiarize yourself with the professional standards under the section Policies and Procedures, Faculty Policies, Professionalism Policy.

Accident in the clinical setting

We strongly encourage you to familiarize yourself with the procedures to follow in case of injury while on elective or selective. You may find this information by consulting the StudentZone, Health and Safety.

Clinical Placement Risk Management Requirements

It is your responsibility, as a medical student, to ensure your immunization record, your CPR certification, and N95 mask fitting are up-to-date for the upcoming academic year or before they expire. You also have to submit, on a yearly basis, a current copy of your police record check.

For more information, please consult the Office of Risk Management website. 

Students who do not meet these requirements will not be eligible to participate in their clinical placement.

4th year is based on your individual needs. Learn to recognize them and take advantage of the various options available to you. If there is a major problem with your schedule, we are available to help you out. Some requests for changes may be approved, depending on availability.