Clerkship Electives

1.1. To state elective expectations regarding approved sites, duration, Clerk assessment forms and elective evaluations, the appropriate procedure for elective approval and change/cancellation requests, immunization requirements, as well as malpractice and personal insurance.

1.2. To outline the importance of additional electives with the understanding that Clerks need vacation time to support their mental, physical, and spiritual wellness.

1.3. To ensure compliance with Accreditation Standards:

- Standard 6.5a: There are opportunities for elective experiences in the medical curriculum particularly in the later years of the educational program that permit medical Clerks to gain exposure to and deepen their understanding of medical specialties reflecting their career interests and to purse their individual academic interests.

- Standard 6.5b: The medical school has policies or practices that encourage medical Clerks to use electives to pursue a broad range of interests in addition to their chosen specialty.

UGME: Undergraduate Medical Education.

CACMS: The Committee on Accreditation of Canadian Medical Schools (CACMS) was founded to act as the reliable authority for the accreditation of programs of medical education leading to the MD degree in Canada. The CACMS accredits complete and independent medical schools whose students are geographically located in Canada for their education, and which are offered by universities that are chartered and operated in Canada. (Reference: https://cacms-cafmc.ca/about-cacms)

Summative assessment: The quantitative assessment used to measure students’ understanding and theoretical application skills after a predetermined period of instruction of a section, chapter, unit, module, or course.

Formative assessment: The assessment used formally and informally to monitor as well as support students’ learning progress during instruction of a course/rotation. It typically involves qualitative or narrative feedback (rather than quantitative scores) to focus on specific content details and aspects of performance. CaRMS: Canadian Resident Matching Service.

AFMC: Association of Faculties of Medicine of Canada.

This policy applies to U of S College of Medicine undergraduate students in the graduating class of 2018 and onward.

Clerks are responsible for arranging their electives. Electives may be completed at:

- Any CACMS accredited medical school and/or LCME accredited North American medical school.

- Approved international sites.

- Other sites as approved by the UGME Year Chair.

Clerks will not be granted credit for an elective supervised by a member of their immediate or extended family as well as anyone with whom they have a personal relationship with or have another conflict of interest. Additionally, Clerks will not be granted credit for an elective with any physician providing care to them, or physicians with the Office of Student Affairs. https://medicine.usask.ca/policies/conflict-of-interest.php

Clerks are strongly encouraged to meet with a Career Advisor from the Office of Career Advising & Mentorship (OCA&M) prior to their electives application to develop a personalized learning plan for their elective year. Appointments can be scheduled here: https://medicine.usask.ca/students/undergraduate/career.php#SpeakwithaCareerAdvisor. Clerks can contact OCA&M (med.careeradvising@usask.ca) for questions about electives as they relate to their career planning.

All elective applications must be requested through the appropriate Department Coordinators. Electives cannot be scheduled directly with an individual preceptor or site as this impedes departmental scheduling and coordination of Clerks. Clerks looking for a certain experience must include this request in their elective form or speak with the Department Coordinator. Clerks must ensure pertinent information regarding each elective is current and accurate in One45. The Clerk is responsible for ensuring an Elective Assessment form is completed by the preceptor and submitted on One45 within 4 weeks of the elective end date. If no assessment is completed, then it will be considered a failed elective and no credit will be granted. The Clerk is responsible for completing the appropriate elective evaluation within 4 weeks of the elective end date and submitting it on One45.

All Clerks must complete a minimum of 20 weeks of electives. There are 24 weeks of electives scheduled, with the potential for 1 week (plus 1 week carry over from Year 3) of vacation time, and 2 weeks of bookable independent learning/remediation time to a maximum of 26 weeks total elective time in Clerkship. Students may book/schedule 1 or 2 weeks of independent learning during any block set aside for electives. Should remediation be required, or electives need to be rescheduled due to illness, then this time may be required for remediation or rescheduling of electives. Please note, students must have something booked for all of the weeks in Year 4. If they do not have vacation or independent learning weeks left, they will need to do additional elective time.

In Year 3, a 1-week elective can be scheduled December 4 to December 10, 2023. The Year 3 Clerk must be in good academic standing as well as meeting expectations on all rotations to be considered and approved for elective time. Students completing a 1-week elective from December 4 to December 10 do not need pre-approval from the Year Chairs before submitting an application on SharePoint. Before starting an elective, Clerks must have final approval from the Year Chairs or Year Site Coordinator. If a Clerk wants to apply for an early elective outside of December 4 to December 10, then they will require pre-approval from the Year Chairs.

Please note the maximum amount of time away from an elective to be considered complete is 3 days out of a 2-week elective. One-week electives can be counted towards the total number, but no vacation time will be allowed during this week. Please note, 1-week electives are not allowed on weeks where there is a stat holiday.

An elective must be passed to receive credit. If a student fails an elective for whatever reason, they may be required to remediate, even if they have met the 20-week minimum. Most electives are a minimum of 2-weeks in duration. Typically, a maximum of 6 weeks will be allowed. Electives start on Monday (Tuesday in the case of statutory holidays) and end on Friday. Weekends are for travel time. It is recommended that Clerks choose to participate in electives in Saskatchewan during the CaRMS match results to facilitate working on the second iteration and accessing the support to do so.

5.1 Electives in Saskatchewan – Home Electives

Clerks must apply through SharePoint for all home electives and independent learning/remediation time. Application timelines are 22 weeks prior to the start date of the elective. The application window will open on the Sunday at 7PM (Saskatchewan Time).

*Civic Holiday – electives will start on Tuesday

Elective SharePoint Site: https://usaskca1.sharepoint.com/sites/ugme_electives/  Select “New Request” to create an application. Please add the following information:

• Name
• Start date (must be a Monday); End date (must be a Sunday)
• Learning objectives
• Comments regarding how you want your application processed or preceptor preference. Please note that Clerks can request a preceptor, but it is not guaranteed that you will be scheduled with that physician.
• Top 3 specialty preferences, including location.
  Select “SAVE” to submit your application.

Student Status:

• Pending (application has been submitted to Elective Coordinator)
• Accept elective offer
• Decline elective offer
• Cancel application

Clerks can only have 1 active home elective application for a given period. Please cancel the original application, by selecting “Cancel Application” under the “Student Status” section of the application form, before submitting a new application on SharePoint.

If an elective opportunity is extended, the Clerk will have 7 days to accept or decline the opportunity. Once the elective is accepted, it will be considered finalized and the information will be added to One45. If an elective offer is declined this cancels your entire application, and no further electives on that application will be considered.

The Clerk is responsible for ensuring an Elective Assessment form is completed by the preceptor(s) and submitted on One45 within 4 weeks of the elective end date. If no assessment is completed, then it will be considered a failed elective and no credit will be granted. The Clerk is responsible for completing the appropriate elective evaluation within 4 weeks of the elective end date and submitting it on One45.

Please note, it is important to let the Clerkship Coordinator at your non-site electives know you are coming so they can set up SCM access, etc. Please contact them at least a week before.

5.2 Visiting Electives

5.2.1 12-2 Policy

• 12-week cap for visiting electives
• Each elective must be a minimum of 2-weeks

Please note, international electives are included in the 12-2 policy.

5.2.2 Electives in Other Canadian Provinces

Clerks will apply for out-of-province electives on the AFMC Portal 2.0 (https://afmcstudentportal.ca/). Portal accounts will be created for all eligible students and Clerks will receive an account activation email from “InPlace Network”. Once the account has been activated, Clerks must complete the student profile with their personal and academic information and upload all required documents, including the AFMC immunization form.

Clerks are not required to provide the UGME office with confirmation of an out-of-province elective. This information will be collected by the UGME office on the AFMC Portal and added to One45. The Clerk is responsible for ensuring that the information is correct on One45. If an elective is incorrect or missing, please contact ugme.electives@usask.ca.

The Clerk is responsible for ensuring an Elective Assessment form is completed by the preceptor(s). Clerks must first set up a temporary account for external assessors by submitting a ticket through the SharePoint site: https://wiki.usask.ca/x/ixN1dw. Once the temporary account has been set up, the Clerk can then distribute the assessment to the preceptor(s) from their One45 To Dos. Clerks will be notified within 2 weeks of the end date of the elective if an Elective Assessment form has not been received. It is their responsibility to ensure the assessment has been completed within 4 weeks of the elective end date. If no assessment is completed, then it will be considered a failed elective and no credit will be granted. The Clerk is responsible for completing the appropriate elective evaluation within 4 weeks of the elective end date and submitting it on One45.

5.2.3 International Electives

Clerks are responsible for coordinating their own international elective. There are no set requirements on the location of the elective, but it must have oversight with an MD. The University of Saskatchewan has reciprocal agreements with the Royal College of Surgeons in Ireland (RCSI) and the Ludwig-Maximilian University (LMU) of Munich.

The minimum elective duration is 2 weeks with a maximum of 8 weeks. Clerks must submit the international electives application form to the Year Chair for approval at least 6 months before the startdate of the proposed elective. The application can be found on the SharePoint site. A closer application time may be considered if the DSA pre-departure orientation from the Division of Social Accountability has already been completed; however, a minimum of 2 months prior to the start date of the elective is required. Clerks must meet with the Global Health Manager, Division of Social Accountability and participate in the DSA pre-departure orientation course, if they have not already done so. Participation is tracked. Please note that if the pre-departure orientation from the Division of Social Accountability has not been completed, this must be completed prior to the elective being approved.

Clerks must register with the International Student and Study Abroad Center (ISSAC). ISSAC requires all students to complete the Travel Safety Plan as well as provide emergency contact information and confirmation of insurance. If the elective is deemed to be in a high-risk area as per ISSAC criteria, the Year Chair (or designate) will be notified and the elective will be denied. Appeals of denied international electives can be made to the Dean of Medicine with a carbon copy (cc) to the Manager, Undergraduate Medical Education.

The Clerk is responsible for ensuring the UGME Office (Clerkship Coordinator) has received confirmation of registration with the ISSAC office as well as the Division of Social Accountability. Once confirmations and the international elective form are received, the elective will be considered for final approval. The Year Chair will give final approval or rejection of the elective application and Clerks will be notified of either status. For approved electives to be added to One45, the Clerk must email the official confirmation of DSA orientation completion from the ISSAC to the Clerkship Coordinator. Once submitted, the elective will be considered finalized. Failure to do so will result in the elective not counting towards the minimum number required.

Clerks may be required to purchase additional malpractice insurance depending on the elective location (Refer to article 15. Insurance for more details). Extra funding opportunities may exist through the Division of Social Accountability in the form of research and travel awards. Please contact the Division of Social Accountability Office for inquiries and/or additional information.

The Clerk is responsible for ensuring an Elective Assessment form is completed by the preceptor(s). Clerks can send the Elective Assessment Form through One45 by setting up a temporary account for external assessors by submitting a ticket through: https://wiki.usask.ca/x/ixN1dw. Once the temporary account has been set up, the Clerk can then distribute the assessment to the preceptor(s) from their One45 To Dos. Clerks will be notified within 2 weeks of the end date of the elective if an Elective Assessment form has not been received. It is their responsibility to contact the preceptor and ensure the Elective Assessment form is completed within 4 weeks of the elective end date. If no elective assessment is completed, then it will be considered a failed elective and no credit will be granted. The Clerk is responsible for completing the appropriate elective evaluation within 4 weeks of the elective end date and submitting it on One45.

The Clerk must participate in a post-elective debriefing with the Division of Social Accountability. This meeting will include feedback on the elective learning environment, overall learning experience, and any challenges faced. The Clerk should notify the UGME upon their return from their elective. If the Clerk requires further supports related to experiences during their elective, these will be facilitated through the Office of Students Affairs.

5.2.4 Worker’s Compensation on Visiting Elective

U of S students participating in electives outside the province of Saskatchewan are not covered by Saskatchewan Workers’ Compensation Board (WCB). The College of Medicine cannot guarantee access to the host province equivalency of Saskatchewan WCB. However, the University of Saskatchewan does have agreements with the province of Ontario Workplace Safety & Insurance Board for provincial coverage. In addition, learners can opt into provincial coverage through the Alberta Workers Compensation Board. The College of Medicine encourages you to maintain insurance sufficient to meet your needs.

Electives should be cancelled by the Clerk at least 6  weeks prior to the start date of the elective. The 6-week cancellation policy is for electives taking place in Saskatchewan, as well as out-of-province electives. Failure to do so will result in a discussion regarding professionalism and possible documentation through a Professionalism Report/Discussion Form. Exceptional circumstances requiring an elective cancellation will be considered.

To cancel a home elective, select “Cancel Application” under the “Student Status” section of the SharePoint elective application form. Clerks must also follow-up with the relevant Department Admin to verify that they received the cancellation notification. mailto:med.electives@usask.ca

To cancel a visiting elective at least 6-weeks prior to the start date, withdraw your Portal application and contact the Elective Coordinator at the host school. If you must cancel a visiting elective within 6-weeks of the start date, submit your request to med.electives@usask.ca and the U of S Student Affairs office. If the cancellation is supported, the U of S Electives Office will notify the host school of the cancellation, on behalf of the student.

Please note that electives done at international schools may have their own cancellation policy. Clerks will be expected to adhere to individual school’s guidelines and procedures.

Clerks must complete a minimum of 3 electives, each a minimum of 2 weeks in length, each in a different general area. The general areas are: Anesthesia, Chronic Pain, Dermatology, Emergency Medicine, Environmental Medicine, Family Medicine, Indigenous Health, Internal Medicine, Leadership, Medical Education, Neurology, O&G, Palliative Care, Pathology, Pediatrics, PM&R, Psychiatry, Public Health, Radiology, Research and Surgery. Please refer to the “General Area Category” column of the elective summary table.

Elective diversity allows the Clerk to experience a broader scope of medicine and may help with residency preparation. In addition, The University of Saskatchewan College of Medicine abides by the AFMC diversification policy.

AFMC Student Electives Diversification Policy:

“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. An entry-level discipline is an Entry Route in the PGY-1 (R1) match. Each of these entry-level disciplines leads to specialty certification with either the RCPSC or the CCFP. Electives in subspecialties that are part of a PGY-3 (R3) match (such as the subspecialties in Internal Medicine and Pediatrics) are counted as separate disciplines. As such, electives in these subspecialties do not count towards the 8-week maximum in the general specialty”.

As such, the maximum time allowed in any one direct-entry specialty will be 8 weeks.

7.2 Noncompliance

Being outside the 8-week maximum in a specialty area (other than Internal Medicine and Pediatrics subspecialties), may put the student at a disadvantage when applying through CaRMS for a Residency position. If a student is found to have greater than 8 weeks in any one specialty (with the exception of Internal Medicine and Pediatrics subspecialty areas), the additional weeks will not count towards the minimum number electives required for completion of the electives course, and the student may be required to do remediation. Additionally, none of the comments from those electives will be allowed on the MSPR. The student may also be subject to a professionalism citing.

Please refer to the “8-Week Cap Category” column of the elective summary table. All students are responsible for counting their own number of weeks in each area. However, students should be aware that there will be random audits done with One45 to ensure compliance.

Please note that Year 5 is unique and while this year must abide by the diversity policy, their previous years’ electives do not count towards the maximum.

Completion of all EPAs is mandatory and is a requirement to successfully complete Year 4 and graduate medical school. Failure to complete the required number of EPAs, at a level that is satisfactory to the competency committee, will have academic and/or professionalism consequences, including being ineligible for graduation. Further, if students are found to be missing EPAs, additional clinical time may be required to complete missing EPAs or demonstrate an acceptable level of clinical competency. It is up to the student to determine which EPAs are most achievable during each of their clinical experiences. The student should formulate a plan which EPAs to achieve in each elective/selective. This plan should be submitted 1 month prior to the start of electives/selectives courses to UGME.Electives@usask.ca for approval by the Year 4 Chair or Site Director.

In Year 4, Clerks are entitled to 3 weeks of vacation: 1 week of their choice and 2 weeks during the December break. To ensure proper work-life balance and maintenance of overall wellness, it is strongly encouraged that all Clerks utilize the entirety of their allotted vacation time. Clerks may defer up to 1 week of vacation time from Year 3 in to Year 4. There is no time away allowed during a one-week elective.

Please note the maximum amount of time away from an elective for any reason in order to be considered complete is 3 days out of a 2-week elective. One-week electives can be counted towards the total number, however they cannot be combined with a week of vacation and count as 2 weeks of electives. Clerks are discouraged from taking electives during the holiday break in December due to potential supervision concerns, as many clinical learning sites have fewer staff and residents during this time. If a Clerk proposes to undertake an elective during this time, the clerk must provide written documentation from their preceptor stating they will receive adequate supervision.

The Clerk must submit a written request to the Year 3 and 4 Chairs no later than 1 month prior to the start date of the elective. The request must include a description of the additional elective and rationale for why the additional elective time is needed. Additional elective time requested during the December break must be accompanied by correspondence from the proposed elective Department Coordinator indicating that there

will be adequate clinical supervision of the Clerk. The Clerk must also apply for and have vacation time approved prior to applying for elective.

The relevant Year Chair reviews additional elective requests. If the following criteria are met, the additional elective time will typically be approved:

- The Clerk is in good academic standing;

- The request does not exceed the maximum 25 weeks of electives; and

- There is clear rationale for the additional elective time.

The Year Chair will communicate the application status to the Clerk as soon as possible, but ideally within 2 weeks of the request submission. If a request is rejected, the Clerk will be provided with an explanation. Application appeals can be submitted by the Clerk to the Assistant Dean, Academic

Clerks can be considered for 2 weeks of early elective time during Year 3 (to a maximum of 26 weeks total of electives). The Clerk must be in good academic standing as well as meeting expectations on all rotations to be considered and approved for additional elective time.

For additional electives scheduled outside of December 4 to December 10, 2023, the Year 3 and 4 Chairs must approve the extra elective time prior to beginning the elective application process. Clerks will not be approved, nor will receive credit, for more than 26 weeks of electives. Please note that even if an elective is completed in Year 3, all scheduled weeks of electives in Year 4 must still be completed (outside of vacation and education time).

10.1 Application Procedure for Additional (Early) Elective Time

For additional electives scheduled outside of December 4 to December 10, 2023, the Clerk must submit a written request to the Year 3 and 4 Chairs no later than 6 weeks prior to the start date of the elective. The request must include a description of the additional elective and rationale for why the additional elective time is needed. Additional elective time requested during the December break must be accompanied by correspondence from the proposed elective Department Coordinator indicating that there will be adequate clinical supervision of the Clerk. The Clerk must also apply for and have vacation time approved prior to applying for elective.

The relevant Year Chair reviews additional elective requests. If the following criteria are met, the additional

elective time will typically be approved:

- The Clerk is in good academic standing;

- The request does not exceed the maximum 26 weeks of electives; and

- There is clear rationale for the additional elective time.

The Year Chair will communicate the application status to the Clerk as soon as possible, but ideally within 2

weeks of the request submission. If a request is rejected, the Clerk will be provided with an explanation.

Application appeals can be submitted by the Clerk to the Assistant Dean, Academic.

All Clerks must have received their mandatory immunizations OR shown proof of immunity prior to the start date of all electives. This is generally required during the application process. Any Clerk not having met this requirement must report to the Occupational Health and Safety Office to update any missing immunizations. Immunization and testing requirements are listed at:  https://afmcstudentportal.ca/immunization  

For patient protection, all Clerks (who do not have medical contradictions) are expected to be immunized for influenza for visiting electives at the majority of Canadian medical schools. Clerks will be advised of any updates to provincial or regional public health policies for Saskatchewan electives.

The majority of Canadian medical schools require a Tuberculin Skin Test (TST) once during medical school.  A small number of schools may require a recent (within 12 months of elective start date) TST. See  https://afmcstudentportal.ca/immunization  for school-specific details. 

Additional immunization requirements (i.e. international electives) will be at the student’s expense.

All Clerks are required to have a current and valid N95 mask fitting.

External electives generally require a current criminal record and may require a vulnerable person’s check. These can be organized through the local Police Department. Please check the AFMC portal for individual school requirements. It is the student’s responsibility to provide the UGME and CPSS with any changes to the original Criminal Record Check submitted for Clerkship.

The Medical Student Exposure to Infectious and Environmental Hazards Policy and local health region/authority occupational health procedure can be accessed at:  http://medicine.usask.ca/policies/medical-student-exposure-to-infectious-and-environmental-hazards.php

University of Saskatchewan Clerks are covered under the U of S CURIE insurance policy for up to 26 weeks of electives. This includes any contractual liability, professional and malpractice liability, cross liability, and tenant’s legal and employer’s liability arising out of their elective duties. Coverage applies to any electives taken within Canada.

This policy will be distributed to students as well as Department Coordinators and Site Directors.

The Assistant Dean, Academic, is responsible for providing oversight to the overall administration of the Clerkship Electives Policy within the College of Medicine.

The Manager, Undergraduate Medical Education, with the assistance of the Undergraduate Medical Education Office, is responsible for the implementation, monitoring, maintenance, and evaluation of the Clerkship Elective Policy within the College of Medicine campus in Saskatoon, Saskatchewan.

Clerks not complying with the procedures outlined above will have their elective cancelled and no credit received. Instances or concerns of non-compliance with the U of S Clerkship Elective Policy should be brought to the attention of the Vice-Dean, Education or the Associate Dean, Undergraduate Medical Education, within the College of Medicine.

Sherry Pederson
Manager, UGME
Email: sherry.pederson@usask.ca
Phone: (306) 966-6142
Fax: (306) 966-2601