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Definition of a clinical fellow: A clinical fellow is a medical doctor seeking postgraduate training in a specialty, or subspecialty discipline outside a recognized Royal College or CCFP training program.

Clinical fellows may be engaged in research and teaching and may provide clinical service as part of their training program, however, the primary goal of the clinical fellowship program is for the trainee to gain knowledge and skills in a particular discipline. It is NOT primarily to provide service within a department or division.

Individuals whose sole activities are laboratory based research and / or classroom teaching are NOT clinical fellows and are not covered under this document. Individuals whose primary role is service delivery should not be handled under the clinical fellowship framework.

Minimum Requirements for Clinical Fellowship Programs: This document is organized as follows:

  1. Program affiliation and standards
  2. Clinical Fellowship Standards
  3. Funding Source
  4. Approval Process – process, timelines, renewals
  5. Selection of Candidates

I. Program Affiliation and Supervision

  1. Clinical fellowship training programs should preferably but not necessarily be affiliated with an accredited training program within the College of Medicine (but are not themselves accredited training programs).
  2. The fellowship programs are subject to the similar standards (See seven CF standards below) that are applicable to residency training in order to provide an academically robust and clinically relevant training.
  3. The fellowship programs are under the direct supervision of the office of the Postgraduate Dean – in a manner similar to the residency training programs.

II. Clinical Fellowship (CF) Standards

CF-1: Program Administration

  1. There must be an identified fellowship program director who assumes oversight of candidate selection, orientation, curriculum development and delivery, and evaluation of clinical fellow.
  2. There must be a fellowship program committee at the departmental level that is responsible for the overall conduct of the program.
  3. There should be a clearly identified selection and final assessment process for the program.
  4. The fellowship committee must maintain an appeal mechanism and ensure that the fellows are aware of this mechanism.
  5. There must be a fellow safety policy.
  6. Program evaluation:
    1. There must be a defined mechanism for a rigorous and ongoing program evaluation.
    2. The evaluation findings must be reported to the relevant Department Head and Associate Dean of Postgraduate Medical Education.
    3. There should be opportunities for clinical fellows to provide feedback and evaluation of the training program, including a process for feedback that will protect the clinical fellow from any potential adverse consequences of negative feedback.

CF-2 Roles and Responsibilities

  1. The roles of the clinical fellow in clinical care and in teaching and evaluation of undergraduate and postgraduate students must be clearly articulated and disseminated appropriately.
  2. Clinical fellows who may be involved in teaching (formally or informally) in the undergraduate or postgraduate programs of the College of Medicine must complete the TIPS course as soon as possible after their engagement, and if possible, prior to engagement. Their anticipated role in teaching should be outlined, including how assessment of teaching skills will be undertaken and reported.

CF-3: Goals and Objectives

  1. There must be a statement of overall goals and objectives of the fellowship program.
  2. There must be rotation specific goals and objectives (preferably in CanMEDS format and reflecting the CanMEDS roles).
  3. The goals and objectives must be reflected in the assessment document.
  4. The goals and objectives must be used to guide acquisition of competencies.
  5. The goals and objectives must be periodically reviewed (at least every year for the active program)

CF-4: Program structure and learning environment

  1. The program structure must be designed to meet the overall and specific goals of training.
  2. Where there are existing guidelines for clinical fellowship programs in the relevant discipline, the program must review these prior to submitting an application for approval and must provide a written assessment of their ability to meet the guidelines.
  3. The learning environment should be nurturing and must be free of intimidation and harassment.
  4. There must be graded responsibilities with increasing independence appropriate to the level of experience and competence.

CF-5: Resources

  1. There must be sufficient faculty support to sustain training and evaluation of the clinical fellow(s). Clinical fellowships should not depend on the commitment of only one or two individual faculty members and must be sustainable in the absence of the Fellowship Program Director / primary mentor.
  2. There must be adequate clinical resources to meet the training goals.
  3. There must be adequate physical, academic (books etc.) and technical resources available to meet the training goals.

CF-6: Curriculum

  1. There must be a defined training curriculum.
  2. Objectives should be structured according to the CanMEDS or CanMEDS –FM format .
  3. The program must describe how the objectives will be met including a specialty appropriate balance of self study, didactic teaching, supervised clinical practice, simulations etc.
  4. The curriculum should include a defined academic and scholarly program.

CF-7: Learner Assessment

  1. A clearly defined assessment process must be in place
  2. Assessment should be addressed with the same rigor applied to Accredited CCFP or Royal College training programs
  3. Assessments must be completed in a timely manner and must be reviewed with the clinical fellow
  4. Assessments should assess clinical fellow trainees according to the CanMEDS or CanMEDS-FM frameworks. Assessments must be linked to rotation specific goals and objectives.
  5. There must be a final summative assessment report, which must be kept on file in the Department office
  6. The process for appeal of an assessment should be described and provided to clinical fellows.
  7. The program must develop and maintain a process to address academic deficiency (in any of the CanMEDS roles or CanMEDS-Family Medicine), as well as to handle complaints and grievances.

III. Funding Source

The funding source must be identified in the application for approval of the clinical fellow program.

  1. Acceptable funding sources include:
    1. Federal and Provincial government agencies
    2. Foreign government agencies
    3. Boards of corporations, hospitals, health regions, foundations.
    4. Billing for clinical services by the fellow may be used to partly supplement income for the learner provided the billing is by the Department and follows the clause IIIc below.
  2. Unacceptable funding sources include:
    1. Religious and ethnic organizations.
    2. Family or self-funding. All funding must be at arm’s length in relationship to the trainee. The trainee must not be required to repay the funds to the funding agency, but may be required to complete a return of service commitment.
  3. The funding agency must commit to funding for the full duration of training and must deposit the required funds in advance at least quarterly. The hosting department or division will be responsible to invoice, receive and deposit the required funds in an appropriate departmental or divisional account and make appropriate disbursements.
  4. Training fee for the institution: There will be an administrative / training fee to be determined in consultation with the department in which the program is based and the College of Medicine Finance Department.

IV. Program Approval Process and Timelines

  1. Clinical fellowship training programs should preferably but not necessarily be affiliated with an accredited training program within the College of Medicine (but are not themselves accredited training programs).
  2. Approval at the Departmental level: The approval of a new fellowship program will be through a process similar to that of developing a new program. Specifically, input into this approval by training programs that may be affected by a clinical fellowship program must be solicited and considered.
    1. If the program is affiliated with an accredited residency-training program, the Department Head and Program Director of the affiliated Royal College or CCFP training program must approve development of the clinical fellowship program.
    2. If the program is NOT affiliated with an accredited residency-training program, the Department Head of the clinical department must approve development of the clinical fellowship program.
  3. New programs: Departments or Divisions wishing to establish new clinical fellowship programs should consult with the PGME office early in the process for assistance. Planning should begin at least one year before any proposed intake date. Documentation demonstrating that all of the above requirements are in place should be submitted to the PGME office at least 6 months before the anticipated intake date and longer if non Canadian candidates will be entertained. The PGME office will endeavor to have a 3-4 month turn around time for approvals of new programs.
    1. Impact assessment: All proposals for Clinical Fellow programs must include an impact assessment addressing the anticipated effects of the Clinical Fellow program on existing Royal College / CCFP programs and on departmental / divisional resource. The impact assessment should indicate:
      1. the anticipated role of the clinical fellow in teaching at the undergraduate and postgraduate levels
      2. the impact of the clinical fellow on accessibility of clinical exposures for Royal College / CCFP trainees
      3. the anticipated effect of the clinical fellow on the formal academic program for Royal College / CCFP trainees
  4. PGME Office Procedure: Once all documentation is submitted to the PGME office, the application to approve a new fellowship program will be reviewed by a committee made up of 3 members of the PGME committee plus the Associate Dean of PGME and PGME Administrative Assistant. This committee will pay close attention to capacity issues and the anticipated impact of the fellowship program on existing Royal College or Family Physician training programs. The committee will make a recommendation to PGME with respect to approval or non-approval of the proposed program.
  5. Program Review: Approval status will need to be reviewed on a regular basis to ensure the program reflects current training standards. For programs, which remain active on a continuous basis, approval will be granted for a maximum of 4 years. Capacity and impact on existing training programs will need to be reviewed annually or each time a candidate is proposed for the program if the program is not continuously active. 

V. Selection of Candidates

  1. Eligibility: Clinical fellow candidates must:
    1. Be a Canadian citizen, permanent resident or landed immigrant; or be eligible for a work permit.

    2. Be eligible for an educational register license with the College of Physicians and Surgeons of Saskatchewan (CPSS) and must maintain eligibility for an educational register license throughout their entire fellowship program.

      International Medical Graduates must have their medical credentials (medical school transcripts, medical degree/diploma, postgraduate training certificates, and specialty certificates) verified by

      International Medical Graduates are required to provide proof of proficiency in the English language that meets the requirements of CPSS.

      Applicants are EXEMPT from language proficiency testing if their medical education (undergraduate and postgraduate education) and patient care experience was in one of the countries identified as having English as the first language. The following countries and dependencies listed below are recognized as having English as the first language:

      CountriesCaribbean Islands
      Australia Anguilla
      Bermuda Antigua and Barbuda
      British Virgin Islands Barbados
      Canada Dominica
      Ireland Grenada
      New Zealand Grenadines
      Singapore Jamaica
      South Africa St. Kitts and Nevis
      United Kingdom St. Lucia
      United States of America St. Vincent
      US Virgin Islands Trinidad and Tobago

      All other applicants must have achieved the required proficiency in ONE of the following English language tests:

      1. Test of English as a Foreign Language (TOEFL) iBT with a minim score of 24 in each band AND a minimum total score of 100. The TOEFL score is valid for 2 years from the date taken.
      2. International English Language Testing System (IELTS) with a minimum score of 7 in each component. IELTS will be considered valid for 2 years from the date taken.

      Scores that are less than those stated above will not be considered.

      Score results that have expired will not be considered.

      The following documents will not be accepted as proof of English language proficiency:

      • a copy of the FAIMER page for the applicant's medical school
      • a letter of English attestation from the Dean of the applicant’s medical school
    3. Be eligible for and maintain privileges within the Saskatchewan Health Region as determined by their credentialing process. Saskatchewan Health Regions require successful applicants to submit a criminal record check as part of their application for appointment.
    4. Provide proof of current ACLS certification unless there is no active patient care involved in the fellowship.
    5. Provide proof of successful completion of the MCCEE (or provide proof of exemption of the MCCEE).
    6. Applicants must provide notarized/certified copies of the required documents to the PGME office for review and verification of eligibility for the fellowship program.
  2. Candidates for existing programs: the PGME office will verify that candidates meet entrance requirements and provide approval in writing for candidates who meet the entrance criteria.
  3. New applicants for existing programs: For fully approved programs already in existence a two month turn around time should be sufficient for applicants who do not require a work permit provided all necessary information is submitted at the time of the request for approval. Where immigration issues are relevant, 4-6 months should be allowed for processing.
  4. Work Permits: Non Canadian (or non landed immigrant) applicants will require a work permit and at least 4-6 months should be allowed for processing of work permits.Departments hosting clinical fellowship programs are responsible for assisting candidates with the necessary work permit application processes. The PGME office does not provide work permit processing service for clinical fellowship applications but can provide contact information and advice if needed.
  5. Disclosure: The following must be disclosed to all applicants at the time of application
    1. Clinical fellow programs are NOT Royal College or CCFP accredited programs and that such training will not be granted credit by the Royal College or CCFP.
    2. The fellowship will be automatically and immediately terminated if the funding source does not meet the financial obligations of the program.
    3. The fellowship contract is contingent upon successful application for a work permit if the candidate is not a Canadian citizen, permanent resident or landed immigrant.
    4. There are no University or other benefits associated with Clinical Fellow appointments and applicants do not have access to grievance or appeal procedures at the College of Medicine or University levels (such procedures should be defined and maintained at the departmental / program level).
    5. The appointment is for one year only. Requests for extension of clinical fellow appointments must be made at least 4 months prior to the end of the existing term.
    6. Clinical fellows are eligible ONLY for educational licenses and must practice in an environment in which the appropriate level of supervision is guaranteed.
    7. Clinical Fellows must be advised that they are NOT registered as students of the University of Saskatchewan and therefore are not entitled to privileges of registered students. Clinical fellows are not appointed as members of PAIRS, and are not entitled to any terms of the Collective Agreement between the University of Saskatchewan and PAIRS.
  6. Other:
    1. CMPA: All fellowship trainees MUST have appropriate CMPA coverage and must show proof of same prior to commencing their program. Clinical fellow trainees must pay their own CMPA fees unless the department chooses to do this on their behalf.
    2. Contracts: Any contracts applicable to the program (whether with the trainee or any agency) must be reviewed and approved by University Corporate Administration. The program sponsoring the fellowship training is responsible for drafting the contract template and ensuring its approval through University Corporate Administration. Copies are to be provided to the PGME office prior to final approval of the candidate. Questions may be directed to the office of the Human Resources Administrator in the Dean’s Office, College of Medicine.
    3. The appointment of a fellow in a fellowship program is done through the office of the Postgraduate Dean and the offer is made under the signature of the Postgraduate Dean.
    4. Verification of training: verification of training is the responsibility of the Department. Verifications must document the unaccredited nature of the program.