To provide guidance to support and to promote the training of residents with documented disabilities through reasonable accommodation, in compliance with applicable laws and University of Saskatchewan governing documents, including the University of Saskatchewan policy “Students with Disabilities: Academic Accommodation and Access” http://policies.usask.ca/policies/student-affairs-and-activities/students-with-disabilities.php
Scope of Policy: This policy applies to all individuals with disabilities who:
1. are considering applying to the PGME residency training programs
2. have applied to the PGME residency training programs
3. have been accepted into a PGME residency training program
4. are currently enrolled in a PGME residency training program
The Saskatchewan Human Rights Code defines disability in section 2(d.1) and identifies that all individuals be accorded equality of opportunity, and that reasonable accommodation be made for those with special needs.
The University of Saskatchewan, College of Medicine, PGME is committed to reasonable accommodation of the needs of residents with documented disabilities by making efforts to create a barrier-free learning environment and by providing other supports and services within the limits of available resources and facilitate the integration of learners with disabilities into the university and clinical community.
Within the College of Medicine -PGME, each resident with a documented disability is entitled to reasonable accommodation that will assist her or him to meet the academic as well as the technical standards.
- However, such accommodation cannot compromise patient safety and well-being and must take into consideration the rights and needs of other residents. Examples of reasonable accommodation include without limitation: Participation restrictions, Activity limits, Special equipment and Attendant/companion/interpreter.
- Performance: Regardless of disability, all residents must meet educational standards for certification and independent practice, which are determined by the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada. Further, residents, including residents with disabilities are responsible for maintaining a high level of academic performance, exhibiting professional behaviours as well as adhering to PGME and program-specific requirements. The resident with a disability must be able to demonstrate the knowledge and perform the necessary skills independently. There are a few circumstances in which an intermediary may be appropriate. In certain circumstances an intermediary may be necessary to assist ineffecting a reasonable accommodation. The appropriateness of an intermediary will be assessed on a case-by-case basis. However, no disability can be accommodated if the intermediary has to provide cognitive support, substitute for cognitive skills, perform a physical examination and/or in any way supplement clinical judgment.
- The University of Saskatchewan, College of Medicine, PGME will endeavour to meet the identified needs of each resident through reasonable accommodation by adapting services, courses, and programs if feasible and as resources allow (and may require members of the University and clinical community to exercise creativity and flexibility in responding to the needs of students with disabilities), while maintaining appropriate academic standards.
- Accommodation is a shared responsibility: It is most effectively provided when those involved, including the resident, approach the process with fairness, sensitivity, respect for confidentiality and co-operation. This requires the exchange of relevant information to the appropriate parties, and constructive negotiation to reach mutually acceptable solutions. It is expected that the responsibility for making reasonable accommodations will be shared by the resident, employer, instructors and support staff.
Integrity of the postgraduate medical education (residency) training programs: The following are integral to the PGME programs and inform decisions related to provision of accommodation as it relates to undue hardship.
1. Accreditation: The PGME programs are accredited by the two national colleges (RCPSC and CFPC) and must adhere to the accreditation standards. The national accreditation standards have adopted a continuous quality improvement approach. The programs must be accredited to provide quality educational training for the residents to be eligible for certification by the national colleges. In addition, the accreditation status is a credential for the College of Medicine that publicly states that it is meeting the national standards for educational quality.
a. Each residency training program must meet specialty-specific standards for accreditation (SSAs), provide training to meet objectives of training (OTRs) and meet specialty specific requirements (STRs). Each program has some flexibility in how to provide training, the curriculum, training requirements, clinical experience, and resident assessment) must not be waived or compromised.
2. Essential skills and abilities required for the practice of medicine in PGME programs: There are specific skills and abilities for the practice of medicine; in addition there may be program-specific requirements. See separate document, “ESSENTIAL SKILLS AND
ABILITIES REQUIRED FOR THE PRACTICE OF MEDICINE IN POSTGRADUATE MEDICAL EDUCATION PROGRAMS.”
a. The College of Medicine, PGME must abide within the context of affiliation agreements with health regions and health care facilities to provide clinical education placements for residents. These affiliation agreements outline thelegal-ethical requirement for learners participating in clinical placements. The terms of these agreements are idiosyncratic and are subject to change.
All residents must demonstrate competency and adherence in regards to these essential skills and abilities.
Statement of Policy
1. The College of Medicine, PGME is committed to using reasonable accommodations and progressive efforts to ensure that residents with documented disabilities are considered for selection to residency programs for which they are academically qualified, ensuring full and safe access to the educational and learning environment and to the University facilities and services.
2. Residents, or those applying for a residency with a documented disability, are entitled to reasonable accommodation(s) that will assist them in meeting the essential skills and abilities associated with the residency program in which they have been accepted.
3. The duty to provide reasonable accommodation must be determined on a case-by-case basis, taking into account all relevant factors.
4. A reasonable accommodation must not lower the educational standards required of the resident as set out in the document entitled Essential Skills & Abilities Required for Postgraduate Medical Education.
5. If the resident would be unable to fulfill his/her duties and/ or meet the educational standards required of the resident even after Reasonable Accommodation to the point of undue hardship, then accommodation is not appropriate. Consideration of undue hardship will include, but will not be limited to the following factors:
a. The nature of the requested or required accommodation
b. Patient health and safety concerns
c. Benefit of the accommodation
e. Impact on other protected rights
f. Impact on other Residents, members of health care teams and service users
g. Disruption to collective agreements
h. Financial costs of the accommodation
6. The test of undue hardship is assessed on a case by case basis at the University level with input from the residency program, department/division, the Regional Health Authority (RHA) and may also include input from other relevant bodies.
7. A reasonable accommodation cannot place incremental patient care responsibilities on other members of the health care team.
8. A reasonable accommodation must take into consideration the needs of other residents and must not negatively impact the ability of other learners to achieve their learning goals and objectives.
9. It is the resident’s responsibility to declare a disability that may require accommodation to the Disabilities Services for Students (DSS) Office in a timely and proactive fashion. In certain instances a resident requiring an Accommodation Plan (AP) may be temporarilyremoved from the program while an AP is created. The timing of this process may have the consequence that the normal time frame for completing the program is not met.
10. The objectives for achieving certification and the essential competencies are determined by each individual residency program in accordance with the RCPSC / CFPC objectives of training and specialty requirements. To become certified, all residents, including those residents with a disability must demonstrate a full understanding of the required competencies of the residency program they are enrolled in.
11. Confidential records of all information regarding accommodation will be kept secured in both the DSS Office and in the Office of the Resident Resource Coordinator (RRC).
a. Any medical documents or documents containing information regarding diagnosis will be kept on file with DSS.
b. The AP, Accommodation Planning Committee (APC) minutes, dates of implementation, and any subsequent modifications to the original accommodation will be kept on file with the RRC as well as DSS.
12. Information on the recommended accommodations, the dates of implementation, as well as any subsequent modification to the original accommodation will be kept in the resident’s active file housed within DSS and the Resident Resource Office.
a. Access to the active resident files is governed by the PGME guidelines.
13. Residents will be informed that in order for a requested accommodation to be implemented it may be necessary to share relevant information on a need to know, confidential basis with individuals involved in providing the accommodation (e.g., medical faculty, clinical supervisors, the RHA, physical plant, etc.)
a. All personal information, including personal health information, shall be kept confidential in accordance with Local Authority Freedom of Information and Protection of Privacy Act (LAFOIP). The information will be shared with only those who need to know in order to give effect to the Policy and assist the resident in obtaining reasonable accommodations.
b. The specific logistical requests for accommodation will be forwarded to those responsible for facilitating them and disclosure of the nature of the disability may be required.
c. PGME will seek consent of residents in writing to this degree of disclosure in order to permit the College of Medicine to meet their needs.
14. In situations where residents do not agree with a decision for an AP as determined by the APC, they may appeal. The appeal process is outlined in the Students with Disabilities: Academic Accommodation and Access document (Section 5 Dispute Resolution Process)
15. Any resident within a residency program who cannot attain the required competencies, despite reasonable accommodation, may be terminated from the residency program.
16. A resident who disagrees with termination related to accommodation from the residency program has the right to appeal through the standard appeal process within the PGME, College of Medicine. If this does not satisfy the resident, he or she may appeal to the University (initial contact for an appeal at this level is the University Secretary). Any resident of Saskatchewan may also appeal to the Provincial Human Rights Commission.
17. Residents who chose not to disclose their disability and request accommodation prior to a rotation may not appeal unsuccessful evaluations on the basis of their disability.
18. When there is uncertainty or disagreement between the residents request for accommodation and what the program determines reasonable, with the resident’s permission, the case should be referred to the APC.
Resident with a communicable disease: Accommodations for residents who have been identified with a communicable disease are reviewed by the Faculty’s Expert Panel on Infection Control. The Panel reviews the procedures the resident will perform according the Level of risk for blood borne pathogen transmission as outlined in the Society for Healthcare Epidemiology of America (SHEA) Guideline for Management of Healthcare Workers Who Are Infected with Hepatitis B Virus, Hepatitis C Virus, and/or Human Immunodeficiency Virus, March 2010. Program Directors (PDs) are involved in the Panel’s discussion of rotation service and call modification required to accommodate.
It is the responsibility of the resident/ learner to self-identify and initiate the process for accommodation needs, organizing their assessment of disability and accommodation requirements. The primary resource is the DSS Office at the University of Saskatchewan. The College of Medicine – PGME (RRC, PD) may be able to direct residents/learners to other resources.
It is the resident’s/learner’s responsibility to register in a timely fashion with DSS. As disability registration and APC meeting may take time, residents/learners are responsible for meeting all
prescribed deadlines related to disability accommodation. Residents/learners are required to actively participate in the APC meeting in order to receive appropriate accommodation.
Prospective applicants and current residents should be aware that the assessment of residents/learners in PGME is according to the CanMEDS framework (assessment of all seven CanMEDS / CanMEDS-Family Medicine roles). All residents/learners must have the required skills and abilities as described in the preceding section on Technical Standards.
All applicants and residents/learners are expected to review this document to assess their ability to meet these standards. This policy does not preclude individuals with disabilities. Residents/learners who anticipate requiring disability-related accommodation are responsible for notifying the PGME office and/or individual programs.
Because of the comprehensive, additive and integrative nature of the competencies residents/learners are expected to complete the residency training within the timeframe for the respective programs. Residents/learners with a disability may be granted an extension of time within which to complete the residency. These requests are considered on a case-by-case basis. All other requests for a leave of absence are handled separately.
It is the resident’s/learner’s responsibility to self-identify to the RRC in a timely proactive fashion. Accommodations cannot be made retroactive to an exam or clinical evaluation.
Residents/learners who chose not to disclose their disability and request accommodation prior to a rotation may not appeal unsuccessful evaluations on the basis of their disability.
Given the intensive nature of the residency training, as well as the specialized needs of the medical profession, investigation of the feasibility of accommodation options may take some time. In addition, the implementation of APs, when deemed feasible, may involve some modifications to the scheduling of components of the residency program. As such, the sooner a student registers, the sooner the process for accommodation can begin.
- Council of Ontario Faculties of Medicine (COFM), Policy Document Essential Skills and Abilities Required for the Study of Medicine, November 2003
- Frank JR, Snell L, Sherbino J, editors. The Draft CanMEDS 2015 Physician Competency Framework – Series IV. Ottawa: The Royal College of Physicians and Surgeons of Canada; 2015 March.
- College of Family Physicians of Canada, Specific Standards for Family Medicine Residency Programs Accredited by the College of Family Physicians of Canada, Red Book 2013
- Accommodation for Postgraduate Medical Residents with Disabilities. University of Manitoba, College of Medicine, Faculty of Health Sciences Policy.
- PGME Statement of General Principles for Accommodation. Postgraduate Medical Education, University of Toronto.
- Essential skills and abilities required for the Study of Medicine. College of Medicine University of Saskatchewan MD Program Document.
- School of Physical Therapy Disability Accommodation Policy.
- Houston P, Conn R, Rajan, M, Sinha R, Issues Related to Residents as Workers and Learners. Future of Medical Education in Canada, Postgraduate Project consortium; 2011.
- Royal College of Physicians and Surgeons of Canada, Candidates requiring special accommodations, 2013
- CaRMS, Accessible Customer Service Policy, April 2012