PARO PROGRAM TRANSFER GUIDE

PARO PROGRAM TRANSFER GUIDE

Contents GETTING STARTED... 5 TIMELINES... 7 DOCUMENTS AND POLICIES... 8 TRANSFER OPTIONS... 11 CAIR PRINCIPLES ON RESIDENT TRANSFERS 14 PRINCIPLES FOR TRANSFERS IN ONTARIO RESIDENCY PROGRAMS 20

Have you been contemplating a program transfer? Well, you ve come to the right place to initiate your journey. Our comprehensive handbook will help you manage the transition with confidence and ease. The first thing you need to know? It s not as overwhelming as you may have imagined especially when you use our step-by-step guide, developed with input from doctors who have already negotiated this very path. 3

An inside view It only takes a few collegial conversations to realize that everyone knows someone who s gone through a transfer. That makes it seem commonplace, but when you drill down, few of us actually know how the process works or, more importantly, how to make it work smoothly. Enter a group of dedicated PARO members who recently took on the task of investigating this issue, collecting information from residents at all Ontario universities who had transferred internally, to a different Ontario university, or from out of province. Throughout the process of assembling this document, we ve come to realize that making change is more common than one may think. Most doctors make the choice part way through their program, for either academic or personal reasons. Topping the list are ACADEMIC preference for a different type of medicine concern about job prospects in the field specialty-related factors such as patient acuity and setting of practice PERSONAL location and/or hours cultural fit family ties. Debunking Challenges Our PARO team also found that regardless of the reason for the transfer, residents typically face common issues, which include: Dealing with the administrative process; concern about perceived stigma, and; lack of transparency in the transfer process. Let s break that down. In terms of the administrative process, many residents worry about securing additional funding, not knowing about available spots, ability to carry over rotations for credits, and adhering to various timelines and requirements of the transfer process. As for perceived stigma either from a home program or transfer program this has given pause to many a resident. In actuality, most of those we surveyed acknowledged that they did not experience any negativity throughout the process or afterward. That s an empowering message. You should never be made to feel like you are giving up or burning bridges. This is your decision and should be fully backed by all involved. If you do end up in a situation where you don t feel supported, seek out the resources that are readily available to you (including your local PARO General Council representatives). Finally, lack of transparency: Most residents concur that this has been the greatest hurdle when contemplating a transfer. In fact, it was the impetus behind creating this document. Thankfully, that s now a thing of the past. In the following pages you ll find university-specific policy information, document checklists and helpful links, all with the aim of demystifying this process. So, let s begin! 1. GETTING STARTED 2. TIMELINES 3. DOCUMENTS AND POLICIES 4. TRANSFER OPTIONS 4

GETTING STARTED GETTING STARTED If you re considering a residency program transfer, it is your responsibility to initiate the process. Here s a helpful list of the key individuals/offices you need to contact depending on which program you are transferring out of/in to: Council of Ontario Faculties of Medicine (COFM) In October 2013, COFM released a document Principles for Transfers in Ontario Residency Programs. You can find it here. Resident Doctors of Canada (RDoC) In addition, RDoC published a helpful document in June 2013 called RDoC Principles on Resident Transfers. You can find it here. Documented Policies on Transferring Residency Programs Specific to the University Each university has its own policy and guidelines on transferring residency programs, mostly derived from the COFM document. You can find your school here: Northern Ontario School of Medicine (NOSM) - Transfer of Residency Program Policy University of Ottawa - Guidelines for trainees wishing to change programs - Resident Transfer Ad HOC Committee Prioritization Criteria 5

University of Toronto - U of T PGME Transfer Principles and Policies Queen s University - Transfers within Queen s - Transfers to other universities in Ontario McMaster University - Transfer Guidelines for Residents Western University - Resident Transfer Policy Post-Graduate Medical Education (PGME) Office If you re a resident wishing to transfer to another program, you should inform the PGME Office at your home school, as they can provide guidance on initial steps. Some PGME Offices keep statistics on previous years transfer rates and can provide useful information for starting the transfer application. PGME Offices have advised that transfer requests for medical or disability reasons are treated with the highest priority. Program Directors of Desired Programs You should also contact the Program Director of the program you are interested in transferring into for information about the program, to know whether there is any availability or capacity for a transfer, when there may be availability for a transfer and to gauge whether the program is a good fit. Program Directors may also help facilitate electives. Residency Wellness Director/Officer Transfers require a great deal of planning and prep, which may impact your personal life, relationships and psychosocial wellbeing. The Residency Wellness personnel at your home school can be an invaluable source of support given that they have experience in counselling other transfer residents. Program Directors of Home Programs Although the PGME Office is the first point of contact, you will eventually need to request a release from your home program, usually via letter from the home Program Director. It is important, at some point during the transfer process, to inform the Program Director of your home program about your intent to transfer. Refer to the PGME Office for guidance on when is the best time to do this, based on your specific circumstances. CaRMS Website Utilizing the second iteration of the CaRMS match is one of the methods recommended by (and sometimes the only method accepted by some) residency programs. Refer to our CaRMS-specific section for more details. Other Residents It s a good idea to connect with other residents senior or chief residents currently in the program you are interested in for preliminary information. Also helpful is reaching out to residents who have gone through the transfer process themselves. There s no substitute for a first-hand account of an experience. 6

TIMELINES TIMELINES It s important to note that the process of transferring is variable it can take anywhere from 2 months to 1 year to complete. So, once you decide to pursue a transfer, the first thing you need to do is contact your PGME Office to understand the requirements. See next section Documents and Policies for specific information on your institution s transfer policy and requirements. Putting together an application can take several weeks as most programs request reference letters and ITERs. As well, some programs may require you do an elective with them prior to applying. Then, once submitted, review of your application may take several weeks or even months, during which time you would continue working in your current program. The last step is usually an interview with the accepting program director. Acceptance is generally granted shortly after this and you are then required to obtain a letter of release from your current program director. Even after an acceptance of transfer and a release from your home program there may be a lag in start time while you wait for a spot to open up. The quickest processes are those in which the accepting program is within the same university, is familiar with the resident already, and has an open spot. For your own planning purposes, be aware that applications done through CaRMS tend to take longer as the CaRMS process is several months long and transfers are dependent on whether there are spots in that subspecialty available in the second round, which is the only round open to transfer residents. 7

DOCUMENTS AND POLICIES DOCUMENTS AND POLICIES Each university has its own process for program transfers, but there are documents you will need regardless of the school. Here s an at-a-glance checklist to help you start to get organized. WHAT YOU MAY NEED Cover letter of intent Written request to receiving Program Director Written release from current Program Director Curriculum Vitae ITERs Foreign medical school transcripts - if applicable For more specific information, simply search below and find your home school and its transfer requirements. MCMASTER UNIVERSITY 1. Transfer Request Form: All residents seeking transfer must complete this form and submit to the PGME Office. The form is available on medportal: http://postgrad.medportal.ca/, under Policies and Procedures 2. Letter of Offer: Once this has been received from the program you are applying to, a copy must be given to the PGME Office. 8

3. Letter of Written Release: You may receive a conditional offer of acceptance into a program, contingent on release from your current program. You should meet with your current program director to request written release. Then, a copy must be given to the PGME Office. WESTERN UNIVERSITY 1. Email or Letter to Manager of PGME Office: Residents need to send a letter to initiate the inquiry into the transfer process, which may result in a meeting with the Postgraduate Dean and/or the Associate Dean for Learner Equity and Wellness.. After January 31, the PGME Office will contact the program to which the transfer request has been made to inquire about their capacity. 2. Notification to the Current Program Director: If the receiving program accepts you for transfer, the current program director should be notified of the transfer and a transfer date should be agreed upon. NORTHERN ONTARIO SCHOOL OF MEDICINE 1. Email or Letter to PGME Office: Submit your name and preferred programs by January. 2. Additional documentation: The receiving program director will contact you directly to request documentation for review. 3. Letter of Appointment: This will be issued by the PGME Office to successfully transferred residents. UNIVERSITY OF OTTAWA Proposal for Transfer: You initiate the process with either an email, letter, or discussion with the Assistant Dean. 1. Written Offer: This will be issued by the receiving Program Director and should be sent to the PGME Office. It should include the expected date of transfer and level of training. 2. Request for Release: This is joint request made by you and the PGME Office. 3. Written Release: This will be issued by your current program, and must be in writing and include all conditions of release. It should be sent to the Assistant Dean, PGME, and the receiving program, and indicate the transfer date. UNIVERSITY OF TORONTO 1. Email or Letter to PGME Office: Submit your name and preferred programs by January. 2. Additional documentation: The receiving program director will contact you directly to request documentation for review. 3. Letter of Appointment: This will be issued by the PGME Office to successfully transferred residents. 9

QUEEN S UNIVERSITY 1. Email or Letter of Request: You must make this request to the PGME Office. 2. Email or Letter of Intent: You should contact the program you are interested in to determine capacity, possibly arrange an elective, and to gather information. 3. Curriculum Vitae, ITERs, and other documents: You will be required to submit these as requested by the receiving program. 4. Release from Current Program: You need to initiate the release request from your current program, and forward it to the PGME Office. 5. Email or Letter contacting RCPSC or CFPC: This is to ensure prior training is assessed and credited towards the new program. 10

TRANSFER OPTIONS TRANSFER OPTIONS There are 3 different transfer options available to you. These include: a) Internal Transfers b) Transfers Between Universities/Provinces c) Transfers via CaRMS Internal + External a) Internal Transfers Internal Transfers transferring to a different residency program within the same university are the most common, and are usually the easiest to organize. You have two options when transferring within the same university. The first is through your university s Internal Transfer Process and the second is through the CaRMS Process as outlined in Transferring via the CaRMS Process. The earliest that you can apply for an Internal Transfer is after January 1 st of your PGY1 year. Beyond that initial timeframe, some universities will allow you to apply for Internal Transfers at any time up until 6 months before the end of your residency, while others have an annual or biannual Internal Transfer application process, usually in January. This process lasts several months, and internal transfers are complete at most schools before transfers between different universities or provinces are processed. Check out your own university s transfer policy for more information. Requirements Before you can be considered for an Internal Transfer, most universities specify that you need to 11

complete at least 6 months of residency. If you originally matched into your program through the second iteration of CaRMS, this may increase to 12 months. There is usually also a requirement to have completed at least one rotation in your current program s discipline i.e. you haven t only completed off-service rotations. Finally, Internal Transfers are generally not allowed if you are in the final 6 months of your current program. This requirement is often waived if there is significant overlap between the program you are in and the program you are hoping to transfer into for example, from Family Medicine into Population Health and Preventive Medicine. Generally, programs that you are hoping to transfer into will want you to be as qualified and competitive as an applicant matching to that program through the CaRMS match. Usually, you are expected to have completed an elective or rotation in the program you wish to transfer into, either in the past year or in medical school. Finally, if you submitted a CaRMS application to your target program when you were in medical school, this application will often be reviewed as part of your transfer application. You will also need to prepare several documents as part of your transfer application. Check out our Documents and Policies section for more details. Next Steps Some schools will email residents periodically in their first and second years of residency to outline the transfer process. However, at most schools, the onus is on residents to know the timeline and to contact their PGME Office to initiate the transfer process. Check out Getting Started for more information on the initial steps to starting a transfer application, as well as your own university s transfer policies and timelines. b) Transfers Between Universities and Other Provinces The process for internal transfers and for transferring between universities in Ontario and between other provinces is really quite similar. We encourage you to make use of the informational resources as outlined in Getting Started. Some key differences are highlighted here. There are two ways to transfer programs from one university or province to another. The first is through CaRMS, as outlined in Transferring via the CaRMS Process. The second process is by direct transfer. If you initially attempt to switch programs within your university and no space is found, you may be placed on an applicant list, or you can inquire whether there is such a list at your institution. Your other option is to contact programs at other universities you would be interested in transferring to by email. If a spot is available at another desired university, you may need to do an elective at the transfer site prior to consideration for them to work with you. Think of this as an opportunity to build relationships. Once there is a potential spot for you, submit your application. You ll then have to wait for the transfer program residency committee to meet to present your case and gain approval. You may need to wait until after 2 nd iteration of CaRMS to see whether funding is available after the initial 1 st iteration CaRMS match (institution dependent). The accepting PGME office can provide you with guidance for this timeline. Because of this delay, some residents transferring universities also choose to begin preparations to go through the second iteration of CaRMS as well. See Transferring via CaRMS for more details. 12

Stories from the Inside A number of residents shared their experiences about transferring programs between universities and between provinces with PARO. Most transferred to programs of the same specialty, and followed a similar process as described above. May actually informed their home Program Director early in the process and found they had great support from them, though it should be noted that this is not required. On average, residents said this process was approximately a year long, and that the greatest delays were in arranging electives and securing funding. However, all noted that the accepting program was helpful in facilitating the process. c) Transferring via CaRMS Matching through CaRMS is only available to hopeful transfer residents through the second iteration. After deciding to apply for a transfer, it is important to keep track of milestones these are not actual deadlines but dates recommended by CaRMS to help keep you on schedule. These can be found on the CaRMS website www.carms.ca under R-1 Main Residency Match then Second Iteration timetable. The online request for registration is open from early December until early January for international medical graduates, United States medical graduates, prior-year Canadian medical graduates, transfer residents and any unmatched medical students. The online application opens in early January and you will be able to log in using your electronic token, which will be emailed to you after payment has been made. Once logged in, you will be able to complete the registration and begin your online CaRMS application. In late February/early March, the online CaRMS application will close and you will have no further access to your application. Once file review has been completed, the online CaRMS application will re-open and you will have access to your application. At this time, a list of unfilled residency positions will become available and you will be able to select programs you are interested in. In early March, applicants who were not able to register for second iteration will be given the opportunity to do so. An additional fee will be added for applicants who request registration after this date. Following the interview period, in late March, the rank order list (ROL) period begins and gives applicants an opportunity to rank their programs online. The ROL deadline is the only firm deadline in CaRMS; if your ROL is not submitted by this deadline then you will be automatically withdrawn from the second iteration. Finally, mid April is MATCH DAY! Good luck. If you feel like you require additional information or support, please contact the PARO Office at paro@paroteam.ca or 1-877-979-1183. 13

next page CAIR PRINCIPLES ON RESIDENT TRANSFERS CAIR PRINCIPLES ON RESIDENT TRANSFERS June 2013 Preamble The transfer process is one by which a resident transfers from one residency program to another. Residents may want to transfer for many reasons including changes in professional interests, evolving personal circumstances, or employment prospects in a particular discipline. Medical education as well as the job situation in Canada has changed significantly over the past few years. At the undergraduate level, medical students are required to make decisions about which career path they will take very early in their medical education experience. Consequently, it is difficult for medical students to predict the long-term viability and employment prospects of specialties at the time of their decision, as well as understand the breadth of opportunities that are present in a multitude of specialties, subspecialties, fellowships and areas of focused competence. The consequence of this is that potentially more medical students are entering residency programs they may not be suited for, thereby making it necessary for more residents to engage in the transfer process during residency. Additionally, limited employment opportunities in certain specialties might require more flexibility in residency to allow transfers to a different program because of the lack of projected employment opportunities. With residents more inclined to undertake further training after primary specialty training to increase their potential for gaining employment after residency, the impact of evolving job market trends and patient health care needs on specialty choice may be felt more strongly. In 2012 and 2013, the CAIR Education and Professionalism Committee evaluated the official resident transfer policies of postgraduate medical education at Canadian faculties of medicine. Attention was given to determine whether official protocols and an appeal process exist, and if there was a time frame for transfers. The analysis revealed that resident transfer policies differ significantly between faculties of medicine offering postgraduate medical education. The research also revealed that the total number of transfer requests (including successful and unsuccessful formal transfer requests and informal enquiries) has not been consistently documented. Given the elements highlighted above, the lack of a consistent transfer process, and the fact that residents will eventually make up the population of physicians on which the Canadian population relies, this issue should be of concern to educators, residents, and the public. CAIR has developed national principles on transfers to promote flexibility, consistency and efficiency in the transfer process across Canadian residency programs. This is intended to increase resident awareness of the inter- and intra-provincial transfer process and promote transparency amongst educators, residents and programs. 14

PRINCIPLES Transparency 1. Postgraduate medical education at Canadian faculties of medicine should have a transfer document that explicitly outlines the policies and procedures for transfers between programs within the same institution, between institutions within the same province, and between institutions across provinces. This document should be made readily available to all current and incoming residents, and it should be reviewed with residents (on respected provincial committee or resident representative committee) on a regular basis. 2. In order to ensure clarity, every transfer policy should outline the transfer procedure with clear stepwise instructions. 3. Each policy should provide a clear timeline for the transfer process, including the earliest and latest period during one s training when a transfer can be initiated. 4. If a postgraduate office has preferred time periods in the academic year during which transfer requests will be considered, then these should be clearly stated in the policy, and residents should be notified when these dates approach. Preferred times should be consistent across all programs within an institution, and aligned across institutions such that they do not hinder application for transfer between postgraduate institutions. 5. Each policy must outline who is responsible for the final decision regarding the transfer (i.e. an appointed individual from postgraduate medical education, or the program director of the accepting program, or a transfer committee etc). 6. The maximum number of transfer requests per resident should be outlined in the policy; however residents should not be limited to a single lifetime transfer so as to respect the principle of Flexibility. 7. If and when a transfer is declined, written notification to the resident must include the rationale for the decision. 8. There must be a clear and fair transfer appeal process which is made readily available to all residents, and specifically provided to those residents who were unsuccessful in their transfer request. 9. Anonymized data on the total number of transfer requests, detailing the number of successful and unsuccessful formal transfer requests, should be consistently documented by each postgraduate department. This data should be made publicly available. Consistency 1. With respect to Fairness, any transfer policy must be consistently applied to all residents, and all residents must follow the formal procedure for transfer. 2. Transfer policies must align with any current Collective Agreements regarding conditions established between the Provincial Housestaff Organizations (PHOs) and their respective employer. 3. Policies should be reviewed and updated on a regular basis, and changes should at least reflect any relevant additions to newly negotiated Collective Agreements. Flexibility 1. Programs should be flexible and receptive to changes that facilitate residents future career plans. 2. The transfer process must be flexible to accommodate extenuating circumstances where they arise, including, but not limited to, personal health concerns or family obligations. 3. If no positions are available for transfer to the desired program, alternative options should be presented, including but not limited to: a. Application to a different program b. Continue training in current program c. Application through the second iteration of CaRMS to another program 15

Fairness 1. Whenever possible, transfers should not subvert the CaRMS match. 2. All requests must be considered, however it is understood that not all requests will be granted. 3. Residents should be given sufficient time to complete all components of the application process established by the program to which they are seeking acceptance. 4. Only programs with sufficient resources to appropriately train additional residents are eligible to accept transfer candidates. Any concerns regarding funding to support the transfer should be made clear to the resident. Funding should be secured before the transfer is approved. 5. There should be a process by which appropriate credit is awarded for training completed in the original training program. The following is suggested: a. Residents in Royal College Programs should apply to the Royal College for review of their training and a ruling on how much of that training would be recognized. b. The Royal College ruling would set the upper limit on how much of the prior training could be applied to the new training program. c. The final decision as to how much credit will be applied will rest with the receiving Program Director in consultation with the Program Committee. This decision must be based on: i. Applicability of prior training to meeting the objectives of training in the new program. ii. A standard of performance demonstrated by the resident that implies that the resident will be able to meet the training objectives within the remaining training period. d. It may not be possible to determine, a priori, the amount of credit that should be applied to the resident s new program. In such cases, unless there are extenuating circumstances, this should be determined within 1 year of entry into the program. e. For residents transferring into a Family Medicine Training program, credit will be given based on regulations outlined in the College of Family Physicians of Canada Red Book (Specific Standards for Family Medicine Residency Programs Accredited by the College of Family Physicians of Canada) and determination made by the Program Director of the Family Medicine residency. 6. It is understood that residents will continue to fulfill all existing clinical and educational responsibilities to their original program until a transfer is complete and they officially begin their new program. Freedom from Intimidation or Undue Influence 1. It is imperative that residents involved in transfers should be treated with respect and dignity. 2. Residents considering a transfer should be encouraged to discuss their case with an appointed postgraduate medical education representative (i.e. Postgraduate Transfer Facilitator as discussed below in Administrative Structure) who is responsible for transfers (and who is not directly involved in the decision), or anyone on the transfer committee before the resident makes a final decision to submit a formal transfer request. These discussions should be held in strict confidence and are not to be considered official until the resident initiates a formal transfer request in writing. a. The purpose of such discussions would be to assist the resident in evaluating their career goals including the optimum pathway to reach those goals, and to outline the process, timelines and obligations of the resident with respect to transfers. b. The appointed individual should also be able to assist the resident in determining if the proposed recipient program is able to accept another resident and, if not, what alternatives are available to the resident. c. Residents holding existing contracts who are contemplating a career change through the second iteration of CaRMS are also encouraged to discuss this with the appointed individual to ensure that they are aware of the regulations applicable to such a transfer. 16

3. Official requests for transfers should be considered confidential to those directly involved in the transfer until the resident has secured a position in another program, or the resident themselves discloses it to another party. Administrative Support and Oversight 1. In keeping with Transparency, there should be an appointed individual at each postgraduate medical education office who is responsible for helping residents navigate the transfer process (Postgraduate Transfer Facilitator). The contact information for this person should be made readily available, and all discussions with them should be deemed confidential between the resident, the appointed individual, and the Postgraduate Dean (ex officio). 2. Each postgraduate medical education department should have a Resident Transfer Committee to review official transfer requests and to review the postgraduate medical education transfer policy and process on a regular basis. The suggested basic composition of the Resident Transfer Committee is: a. Dean or Assistant Dean of Postgraduate Medical Education. b. Postgraduate transfer facilitator/administrator. c. At a minimum, one faculty member, who meet the following criteria: i. A member of the Postgraduate Medical Education Committee, and ii. Not actively involved in a transfer iii. Not faculty in the exiting or entering programs. d. At a minimum, one resident representative who meet the following criteria: i. A representative from the respective PHO, and ii. Not actively involved in a transfer iii. Not residents in the exiting or entering programs. 3. Every transfer policy and procedures document should outline the transfer process with clear stepwise instructions. This includes listing all requirements and documents that are to be provided by the resident for a transfer to be considered. SUGGESTED TRANSFER PROCESS 1. Residents considering a transfer should be encouraged to discuss their case with the Assistant Dean Postgraduate Medical Education or the appointed postgraduate medical education representative (Postgraduate Transfer Facilitator) before the resident makes a final decision to submit a formal transfer request. These discussions should be held in strict confidence and are not to be considered official until the resident initiates a formal transfer request in writing. The purpose of this discussion would be to assist the resident in evaluating their career goals and to outline the process, timelines and obligations of the resident with respect to transfers. The resident should be informed if the recipient program is able to accommodate another resident at the appropriate level, and, if not, what alternatives are available to the resident. a. Residents holding existing contracts who are contemplating a career change through the second iteration of CaRMS are also encouraged to discuss this with the Assistant Dean PGME or appointed postgraduate medical education representative, to ensure that they are aware of the application transfer regulations. b. It is also advisable, but not necessary, that the resident approach the program director of the program they are interested in and ask about their suitability for that program in principle. 2. If the resident decides at this point to continue to pursue a transfer, the resident must submit a formal written transfer request to the Assistant Dean PGME. 3. The written request will be referred to the Transfer Committee for review and a decision within a specified period of time (preferably one month). In its decision, the committee should take into account, at a minimum, written submissions from, or interviews with, the resident and the receiving program director and all relevant documents. 17

4. If the transfer is approved by the Transfer Committee, the resident must submit a formal application to the recipient program according to the program s procedures and guidelines. The recipient program must review the resident s application and give a final decision within a specified period of time (preferably within one month). 5. If the recipient program approves the transfer, then the resident must submit a letter to their current program director regarding his/her intent to withdraw. The current and recipient program directors must then discuss and agree to a mutually acceptable transfer date (no longer than 6 months from the time of decision). Residents must also meet with their current program director to review outstanding responsibilities and expectations at least one month prior to the transfer. These expectations should be outlined in writing and placed in the resident s file. A copy should be provided to the resident. 6. If the transfer is not approved by the Transfer Committee, the committee should forward its rationale in writing to the Assistant Dean PGME or the appointed postgraduate medical education representative, who will meet with the resident to review the decision. CAIR would like to acknowledge all the official transfer policies from Canadian postgraduate medical education Faculties of Medicine, and, in particular, the transfer policy of the University of Saskatchewan PGME Resident Transfer Policy and Procedures (Revised June 24, 2011). These policies proved to be a valuable and informative component in the drafting of these National Principles on Resident Transfers. 18

Map of Suggested Transfer Process Resident contemplates transfer Confidential and unofficial preliminary discussion with Assistant Dean PGME about reasons for wanting to transfer, transfer options (including second round CARMS) and funding availability to support a transfer If funding is available and resident wishes to proceed, resident then approaches proposed program director and discusses suitability and acceptability to program in principle (an unofficial and confidential discussion that does not guarantee acceptance into program) If resident still wishes to proceed with transfer, he/she then submits a written request outlining reasons to Assistant Dean PGME Transfer committee members meet and determine whether or not to approve or decline the transfer within a specified time period that ideally is no longer than 1 month If transfer is approved, the resident submits a formal application to the new program (i.e. formal statement of intent, reference letters, CV, etc). The new program must make their decision within a specified time period (i.e. no longer than 1 month). Ideally at this point the resident also notifies their current program diretor of their intent to transfer so that appropriate preparations can be initated (i.e. alterations in call or academic schedule). If resident is accepted by program then the resident must notify, in writing, their current program director of their intent to withdraw Both program directors then discuss and agree to a mutually acceptable transfer date by a specified maximum time period* (i.e. 6 months) * All transfer dates and notifications must adhere to the conditions outlined in collective agreement between provincial resident association and provincial hospital association. Page 6 of 6 19

council COUNCIL OF ONTARIO FACULTIES OF MEDICINE An Affiliate of the Council of Ontario Universities PRINCIPLES FOR TRANSFERS IN ONTARIO RESIDENCY PROGRAMS The Ontario medical schools and Ministry of Health and Long Term Care (MOHLTC) support a system of improved flexibility in postgraduate medical education. As of October 1, 2013, all transfer requests are handled in accordance with the principles outlined in this document, and under local transfer policies in force at each Ontario medical school. Transfers will be accommodated through funding from: the usual local recoveries (e.g. vacated positions), and within the up-to numbers allocated in the Transfer Payment Agreement (TPA). General Principles The following general principles apply to all resident transfer requests: Wherever possible, transfers should not subvert the CaRMs Match. Discussions regarding transfers will remain confidential until such time as the resident consents to disclosure. Overall, transfers should not significantly alter the distribution of residency position allocation across schools and within disciplines. Residents must be acceptable to the program to which they are seeking transfer. It is strongly encouraged that residents utilize the second iteration of CaRMS as a route to change programs that residents may use outside of the regular transfer process. Capacity, funding, and other constraints may limit the availability of program transfers; it is therefore not possible to accommodate all requests. Specific Principles In addition to fulfilling the requirements of the general principles, the following specific principles apply: Transfers should optimize the supply and distribution of physicians in Ontario to meet provincial and /or societal needs that facilitate access to health care for all Ontarians. 20

Each transfer request is unique and will be considered on its own merit; however priority will be given to transfers based on evidence of wrong career choice or demonstrated need, e.g. disability, health issues that prevent residents from completing their initial program, etc. Internal transfer requests will be considered by each school after January 1 st of each year. In most cases, intra-provincial transfers will be considered after the school s internal transfer process is complete. Intra-provincial PGY1 transfer requests can be made to the PGME Office of the resident s home school after January 1 st each year, but will not be approved until after the second iteration of the CaRMS Match. PGY2 or higher internal transfer requests can be made at any time and will be forwarded to the programs at the discretion and internal procedure/schedule of each school. Final approval of any transfer lies with the Postgraduate Dean. Resident Responsibilities Residents are responsible for the facilitation of a transfer. A Resident requesting a transfer to another Ontario school should initially inform the Postgraduate Medical Education Office at the Resident s home school. A Resident should contact the program they are interested in to determine capacity, possibly arrange an elective and gather information regarding fit. A Resident must submit a curriculum vitae, ITERS and other documentation as requested by the program. Prior to accepting a transfer position, the Resident must request a release from his/her current program. Program Directors will then determine whether the resident may be released by their home program and will advise the Postgraduate Medical Education Office. Residents who apply for a transfer through CaRMS do not have to request a release from their home program. The formal decision will be made by the Postgraduate Office. It should be noted that IMG s who transfer out of province when in a base specialty are in breach of contract with the Ministry. PGY1 Transfers (PGY1 covers the entire first 12 months of training) Residents must have at least 6 months of active training within the residency with ideally one block in the discipline from which they request transfer. Residents should have sufficient exposure to the discipline to which they are requesting transfer either in the last year of medical school or during their residency. Residents must be of similar aptitude to successful candidates through the CaRMS match by the receiving program, utilizing similar selection methods and rating systems where they are used; and 21

If the resident applied through CaRMS to the program that they wish to transfer into, that program should ordinarily have ranked them favorably. PGY2 or Higher Transfers Transfers within the last six months of a program will not normally be accepted, except in cases in which the programs significantly overlap i.e. Family Medicine to Public Health and Preventative Medicine. The transferring resident is responsible for contacting the RCPSC or CFPC to have their prior postgraduate training assessed for credit towards the new program. Until notification has been received from the appropriate College, the resident will be registered at the lowest applicable PGY level to ensure adequate funds are available for a complete training path. The resident will be advanced, as appropriate, once the assessment notices have been received, accepted by the program and approved by the Postgraduate Dean. Inter-provincial and U.S. Transfer Requests Ontario Ministry of Health funded residents are free to seek transfer of residency programs outside Ontario schools, but funding is not transferrable/portable outside the province. Residents should advise the Postgraduate Medical Education Office that they are seeking a transfer to another province. Any resident in an Ontario school accepted for transfer must be officially released by his/ her Program Director, as well as approved by the Postgraduate Dean. A letter from the Postgraduate Medical Education Office approving the release will be sent to the Postgraduate Dean at the receiving school. Residents from other Canadian or U.S. medical schools are free to contact PGME Program Directors at Ontario medical schools directly regarding program capacity and transfer possibilities. Residents should indicate their interest in a transfer to their home Postgraduate Medical Education office. Program Directors may review such transfer requests according to the General Principles outlined above, and must contact the Postgraduate Dean s office regarding funding. Such requests will be considered after the internal, intra-provincial transfer request processes, and the 2nd iteration of CARMS are complete. Special Case A transfer request that does not meet the principles outlined in this document may be brought forward to PGM: COFM as a special case at the discretion of the Postgraduate Deans. 22

TRANSFER OF RESIDENCY PROGRAMSLINK HEAD TRANSFERS OF RESIDENCY PROGRAMS Approved: November 10, 2011, PGEC, Revised January 7, 2014 Responsible Office: Postgraduate Education Responsible Officer (s): Associate Dean, Postgraduate Education INTRODUCTION INTRODUCTION The Northern Ontario School of Medicine recognizes that there are occasions where a resident may The decide Northern that transferring Ontario School to another of Medicine residency training recognizes program that would there be are beneficial. occasions NOSM where tries a to resident may decide provide that opportunities transferring for to program another transfer residency to its residents, training program while recognizing would that be beneficial. funding, capacity NOSM and tries to provide other constraints opportunities may limit for program the availability transfer of transfer to its residents, requests. while recognizing that funding, capacity and other constraints may limit the availability of transfer requests. All Ontario medical schools handle transfers in accordance with Principles for Transfers In Ontario All Residency Ontario Programs medical approved schools handle by the Council transfers of Ontario in accordance Universities with on Principles October 2013 for found Transfers here: In Ontario Residency COU - Transfer Programs Principles. approved Residents by should the Council familiarize of Ontario themselves Universities with these on principles October as well 2013 as found the here: COU- NOSM Transfer specific Principles. process below. Residents should familiarize themselves with these principles as well as the NOSM specific process below. At the beginning of January each year, the Postgraduate (PGE) Office informs NOSM residents of this At opportunity the beginning and advising of January them each of the year, principles the Postgraduate and procedures (PGE) of the Office transfer informs process, NOSM as follows: residents of this opportunity and advising them of the principles and procedures of the transfer process, as follows: A. GENERAL PRINCIPLES: 1. Wherever possible, transfers should not subvert the CaRMS match. A. GENERAL 2. It is strongly PRINCIPLES: encouraged that residents utilize the second iteration of CaRMS as a route to 1. Wherever change possible, programs transfers that residents should not may subvert use the outside CaRMS of the match. regular transfer process. 2. It 3. is strongly Resident encouraged must be released that residents by their utilize home the program. second iteration of CaRMS as a route to change programs that residents may use outside of the regular transfer process. 4. Residents must be accepted by their requested program. 3. Resident must be released by their home program. 4. Residents 5. Final approval must be accepted of any internal by their transfer requested lies program. with the Postgraduate Dean. 5. Final 6. Capacity, approval of funding any internal and other transfer constraints lies with the may Postgraduate limit the availability Dean. of program transfers; it is therefore not possible to accommodate all requests. 6. Capacity, funding and other constraints may limit the availability of program transfers; it is therefore not possible to accommodate 7. The Postgraduate all requests. Deans at the respective Ontario schools will have the final approval regarding intra- provincial transfers, including funding availability. 7. The Postgraduate Deans at the respective Ontario schools will have the final approval regarding intra- provincial B. SPECIFIC transfers, PRINCIPLES: including funding availability. In addition to fulfilling the requirements of the general principles above, the following specific principles B. will SPECIFIC apply to all PRINCIPLES: transfer requests: In addition to fulfilling the requirements of the general principles above, the following specific principles 1. Residents will apply must to have all transfer at least requests: 6 months of residency in the discipline from which they request transfer. PGY- 1 transfer requests will be considered after January 1st each year. 1. Residents must have at least 6 months of residency in the discipline from which they request transfer. PGY-1 transfer requests will be considered after January 1st each year. PG- 1.9 Transfer of Residency Programs 1 23

2. Residents should have sufficient exposure to the discipline to which they are requesting transfer either in the last year of medical school or during their residency. 3. Residents must be of similar quality to successful candidates through the CaRMS match by the receiving program, utilizing similar selection methods and rating systems where they are used. 4. Consideration of transfer requests from residents in specialty programs at the PGY2 level and above will be based on evidence of wrong career choice or demonstrated need, e.g. disability, health or family issues that prevent residents from completing their initial program, etc. 5. Transfers at the PGY2 or higher level will be dependent on availability of funding/capacity. 6. Transferring residents are responsible for contacting the RCPSC or CFPC to have their prior training assessed for credit towards the new program. Until notification has been received from the appropriate College, the resident is registered at the lowest applicable PGY level. The resident will be advanced once the assessment notices have been received and approved by the Postgraduate Education Associate Dean. C. PROCESS: Internal Transfer Process 1. Residents wishing to transfer programs will submit their names and preferred programs to the PGE Office in January of each year. Correspondence is sent annually to confirm the process for submission of requests. 2. Requests will be compiled and reviewed by the PGE Office. The PGE office will immediately contact residents whose transfer requests are not approved by the Postgraduate Dean and therefore will not be forwarded to Program Directors. 3. The PGE office will send approved program transfer requests to the Program Director with the residents name and contact information as well as the number of positions the program may potentially fill. All requests are sent at the same time to the Program Directors. 4. Program Directors are not obligated to accept residents who do not meet admission requirements. Also, some Program Directors may not be able to increase their numbers even by one, if clinical training resources do not permit this. 5. Program Directors will contact residents individually to request documentation for review and possible interview and prepare a rank list of its acceptable applicants and discuss with the PGE Office regarding funding availability. 6. After consultation with the PGE Office, the Program Director will inform the transfer applicant of acceptance/refusal verbally or by email. This process should be completed by the end of February. Transfer of Residency Programs 3 7. The PGE Office will treat transfer requests as confidential and will not advise current Program Directors of the acceptance of residents to other programs this is the responsibility of the resident. An applicant who is accepted as a transfer resident must arrange a meeting or contact his/her current Program Director to request a release from the program as of July 1st or a date which is mutually acceptable to both Program Directors. Due to rotation and call schedule requirements, both Program Directors must agree on the start/release date if other than July 1st. 8. The PGE Office will issue a revised Letter of Appointment to successfully transferred residents after receipt of authorization letters from the new and former Program Directors. Intra-provincial Process 9. An intra- provincial (within Ontario) transfer process takes place in March, following the internal transfer process and first iteration of CaRMS. Transfer requests to programs in other Ontario schools will be considered during this period to accommodate residents who are requesting a transfer of medical school, or have been unsuccessful in the internal transfer process. However, as funding years are not transferable among schools, direct and equal swaps are usually 24

sought during this process. 10. Residents at each school who wish to be considered for the intra- provincial transfer process must register their transfer request with the PGE Office following the annual call for transfer request submissions in January. PGE Managers in Ontario review the intra- provincial transfer list together and broker communication within their institutions to invite transfer applicants where there is capacity available. 25

26