International Electives (Policy for Residents Requesting)

Policy for Residents Requesting International Electives (June 2005)

Requests for electives outside of Canada must comply with the following:

  1. The resident complies with any requirements outlined by their program beyond those sited in this policy,
  2. The resident complies with the requirements outlined in the International Health Office/Postgraduate Medical Education Office International Elective Instruction Sheet,
  3. Any elective that is completed by a trainee who does not fulfil the above requirements will not be counted towards his/her residency training.

In addition, electives taken in an unaccredited setting may be accepted towards specialty or subspecialty training requirements if all the following conditions are met:

  1. In Royal College programs, the total duration of unaccredited elective rotations must not exceed six months of the total training for the specialty or subspecialty. 
    In Family Medicine programs not more than 4 weeks should be taken outside the Maritime Provinces. Exceptions for extending this time beyond 4 weeks include the following: 1) compassionate grounds, 2) training in areas that are not available at Dalhousie (eg. International electives);

  2. The resident must be enrolled in a recognized program at the time the elective is taken.

    The program direcror and the resident, that is then accepted by the program director as meeting the specialty training requirements, plan the elective period.

  3. There is a clearly designated elective supervisor.

  4. There are clearly defined and understood educational objectives.

  5. There is a well defined in-training evaluation system to include evaluation of the resident during the elective period that is based on the educational objectives of the elective and that is clearly understood beforehand by the resident, the elective supervisor, and the program director.

International Elective Application

The Global Health Office provides support to Residents participating in a global health elective. If you are planning on doing an international elective please follow the steps in the pre-departure section of our Residents’ Page

Note that this information is part of the approval process for your elective.  Please be sure to check with your department to ensure that you have met all of their requirements as well.

Also, please note that electives in countries where Foreign Affairs Canada has issued a Level 3 “Avoid Non-essential Travel” advisory or higher will not be approved. For up to date travel reports, please visit the Foreign Affairs Canada website  

Dalhousie Univesity Policy on Resident Education Abroad

Approved by: Faculty Council, Dalhousie Faculty of Medicine on June 24, 2014

 

1. PURPOSE

The Office of Postgraduate Medical Education (PGME) at Dalhousie University provides opportunities, support and guidance for residents in postgraduate training programs to engage in education activities abroad, in approved clinical settings that fulfill elective or core requirements of the Royal College of Physicians and Surgeons or College of Family Physicians of Canada for post graduate training programs (“International Rotations”).   

The PGME Office recognizes the great potential of international educational experiences to enhance local clinical training, and to generate insights that will guide residents’ career development. This document outlines PGME Office’s policies and recommendations for residents seeking to participate in International Rotations in both well-resourced and low resource health care settings. Dalhousie’s Global Health Office collaborates and coordinates international global health activities including resident education abroad with PGME Office and Program Directors.   

Information relating to international and global health opportunities can be found on the global health website (www.gho.medicine.dal.ca) and through Dalhousie’s Global Health Office.   

Travel abroad may expose a resident to certain risks. Residents participating in International Rotations are subject to the terms of the Faculty of Medicine POLICY ON RESIDENT EDUCATION ABROAD and mustfulfill the requirements of the policy by reviewing the Pre-departure Checklist, register with Dalhousie’s International Travel Registry, and complete mandatory online pre-departure training. 

2. SCOPE

This policy pertains to all Dalhousie residents, including visa trainees. The  Global Health Office will have a list of current partner institutions, which will be reviewed on an annual basis in partnership with Departments. 

3. DEFINITIONS

There are two types of locations for an international elective: high-income country and
low-middle income country. 

  1. A high-income country is classified by the World Bank as countries having a GNP per capita of $12,476 or more in 2012.
  2. A low-middle income country is classified by the World Bank as having an income of $1,035 or less (low-income country); $1,036 - $4,085 (lower-middle income country); or $4,086-$12,615 (upper middle income) in 2012. http://data.worldbank.org/about/country-classifications

4. INTERNATIONAL ELECTIVES

Strengthening partnerships between institutions can contribute to the advancement of global health, when these relationships are carried out in the spirit of equity and fairness (Canadian Coalition for Global Health Research, 2009). Strong institutional partnerships also contribute to effective monitoring and evaluation of international resident electives. 

Electives are approved based on compliance with the institutional partnership criteria:

  1. The partner has a shared vision or principles with Dalhousie University
  2. An education and/or research relationship between Dalhousie and the partner institution is emerging, established, or ongoing
  3. The partner institution meets Dalhousie’s recommended legal requirements and this is confirmed in an appropriate written agreement between the parties
  4. Infrastructure for visiting residents and faculty at the partner institution can accommodate the resident’s learning objectives without straining institutional resources
  5. There is mutual benefit for both institutions and the relationship is sustainable
  6. The following information will be assessed and available, as appropriate, to inform the program’s review of the learning experience prior to approval:

    -Potential risks to the health and safety of patients, residents, and the community
    -Availability of emergency care
    -Possibility of natural disasters, political instability, and exposure to disease
    Need for additional preparation prior to, support during, and follow-up after the elective
    -Level and quality of supervision
    -Any potential challenges to the code of medical ethics adopted by home institution

  7. Any other criteria, which may be relevant to the specific elective being proposed

5. RISK MANAGEMENT

All electives must meet the university-wide risk management policy. Additionally, the following conditions must be met: 

I. Security Status

The Global Health Office monitors the travel advisory reports from the Department of Foreign Affairs, Trade and Development (DFATD). Circumstances beyond the control of the University may arise including war, civil unrest, or natural disasters that may require a modification or termination of the rotation. Therefore, international electives will not be approved in locations where DFATD has issued an elevated travel warning, as per Dalhousie’s International Travel Policy. 

II. Travel Health Requirements

The resident is responsible for obtaining any vaccinations or inoculations that are recommended or required by the government of a foreign country in which the resident will be traveling, or by the Canadian government for persons entering Canada from a foreign country. A visit to a travel clinic or family physician who advises on vaccines, medications and appropriate health measures for travel abroad is highly recommended 

III. Travel Requirements

The resident is required to obtain, at the resident’s expense, extended medical travel insurance (including Evacuation Insurance) that will cover medical or hospital expenses that the resident may incur during the International Rotation and any travel period before or after the International Rotation. The resident is responsible for obtaining any visas or permits that may be required to travel to foreign countries.   The resident is responsible for obtaining appropriate permits (licenses) required to provide clinical care and for providing proof of malpractice insurance. The resident is responsible for making all travel arrangements associated with the International Rotation and, notwithstanding that the University or PGME may provide information with regard to travel arrangements, neither the University nor PGME warrants the safety of any carrier and neither is responsible for the acts or omissions of any carrier.  The resident is responsible for making all arrangements for accommodation during the PGME or Independent International Rotation and, notwithstanding that either the University or PGME may provide information to the resident with regard to accommodations, neither the University nor PGME warrants the quality or safety of any accommodation and neither the University nor PGME is responsible for the acts or omissions of the operators of any place of accommodation. 

IV. Travel Registries

The resident must register with the Registry of Canadians Abroad (ROCA) when travelling to another country during an elective. The resident must register through Dalhousie University’s online international travel registry. 


6. ACADEMIC CRITERIA
Additional criteria must be met for each resident’s elective to be approved. These criteria address language, elective length, pre-departure requirements and academic standing.

I. Language

The resident complies with any requirements outlined by their program beyond those sited in this policy. Additional language criteria must be met for each resident’s elective to be approved. The working language of the resident matches the partner institution. The partner institution may provide interpretation only when it does not strain institutional resources. 

II. Elective Definition and Length

Eligibility to undertake an elective for specialty or subspecialty training is explained in Section IV, Item 4.6.1 of the Royal College of Physicians and Surgeons of Canada Policies and Procedures for Certification and Fellowship publication. 

•   In Royal College programs, under normal circumstances not more than 3 months should be taken outside the parent program. Exceptions for extending this time beyond 3 months to a maximum of 6 months include the following: 

1) training in areas that are not available at Dalhousie, 

2)  compassionate grounds.

 •  In Family Medicine programs not more than 4 weeks should be taken outside the Maritime Provinces. Exceptions for  extending this time beyond 4 weeks include the following:     

1) compassionate grounds

2)  training in areas that are not available at Dalhousie 

•  Electives taken in an unaccredited setting may be accepted  towards specialty or subspecialty training requirements if all of the following conditions are met:

  1. The resident must be enrolled in a recognized program at the time the elective is taken.

  2. The total duration of rotations taken at unaccredited sites must not exceed six (6) months of the total  training for the specialty or subspecialty.

  3. The elective period is planned by the program director and the resident, which is then accepted by the program director as  meeting the specialty training requirements.

  4. There is a clearly defined elective supervisor.

  5. There is a well defined in-training evaluation system to include evaluation of the resident during the elective period that is based on the educational objectives of the elective and that is clearly understood beforehand by the resident, the elective supervisor, and the program director. 


III. Pre-Departure Requirements

The resident is required to complete the online pre-departure training through the Global Health Office. Contact the Global Health Office to register at gho@dal.ca. The Pre-Departure Training Module must be completed no later than 3 weeks prior to the resident’s departure date.

•  Residents planning an international elective in a High Income Country must participate in an abridged online pre-departure training provided by the Global Health Office that focuses on     safety and logistics.

•  Residents planning an international elective in a Low-Middle Income Country must articipate in the full online pre-departure training with the Global Health Office that includes safety, logistics, ethics, cultural competency, travel health and working in low resource settings as per recommended online guidelines. The Global Health Education Committee, comprises of staff, faculty and residents, will conduct an annual review of pre-departure training and resources to     ensure relevance and that best practices are applied in this training.


IV. Post Elective Debriefing

Debriefing may be needed upon return from an international elective. Residents should schedule a post-trip debriefing with a faculty member in your department and/or the Global Health Office.

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