Principle

A Postgraduate Learner’s main responsibility is to the educational requirements and the associated training experiences of their specialty. However, it is also recognized that Postgraduate Learners may wish to engage in additional Discipline or Non-Discipline Call. The privilege of accessing these experiences can allow for a valuable contribution to patient care, while providing Postgraduate Learners with additional clinical exposure and experience, and financial remuneration.

Purpose

To outline the expectations of PGME and its programs for Postgraduate Learners who are remunerated for practicing medicine during a Postgraduate Training Program in contexts that are not part of a required training experience in a Postgraduate Training Program.

Scope

Any Learner enrolled in a Postgraduate Training Program at Memorial University (Memorial). This policy does not apply to final-year specialty locums.

Definitions

Associate Dean, Postgraduate Medical Education (PGME) — The senior faculty officer, appointed by the Dean of Medicine, who is responsible for the overall conduct and supervision of PGME in the Faculty of Medicine or delegate as appointed from time to time.

Competence Committee — The committee responsible for reviewing the progress of all Postgraduate Learners in its program and providing recommendations to the Residency Program Committee (RPC). 

Discipline Call — Provision of extracurricular, on-call duties (beyond the required number of on-call shifts) within the skillset associated with the Learner’s specialty training. The Learner is not considered the most responsible physician in the provision of on-call duties.

Educational Objectives — Describes learning outcomes and states the expectations of Learner’s performance at the successful completion of training.

Health Authority — Newfoundland and Labrador Health Services which administers and delivers health care services across the province.

Most Responsible Physician — The physician who holds overall responsibility for a patient's care, directing and coordinating their treatment and management at a specific point in time

Non-Discipline Call — The extracurricular, remunerated practice of medicine during a Postgraduate Training Program in contexts that are not directly associated with the Learner’s specialty training and that are not part of required training in a Postgraduate Training Program. The Learner is not considered the most responsible physician in the provision of on-call duties.

Postgraduate Learner (Resident) — A trainee registered in a Postgraduate Training program at Memorial accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC) or the College of Family Physicians of Canada (CFPC).

Postgraduate Training Program — A period of training in a specific program of medicine with a set of Educational Objectives prescribed by the Royal College of Physicians and Surgeons of Canada (RCPSC) or the College of Family Physicians of Canada (CFPC) leading to certification by one of these bodies.

Program Director — The faculty member assigned responsibility for the overall conduct of the Postgraduate Training Program.

Policy

1.0 Generally, a Postgraduate Learner can only perform Discipline and Non-Discipline Call after successful completion of Postgraduate Year 1 (PGY 1) in a Postgraduate Training Program.

2.0 Postgraduate Learners must have the approval of their Program Director before they can perform Discipline and Non-Discipline Call.

2.1 Postgraduate Learners must be in good academic standing to receive approval to perform Discipline and Non-Discipline Call.

2.1.2 Learners in academic jeopardy (on remediation or probation) are ineligible.

2.1.3 Learners on modified learning plans may be eligible at the discretion of the Program Director. 

2.2 The Program Director and/or PGME reserves the right to withhold or withdraw this privilege at any time.

2.3 The Program Director must maintain a record of Discipline and Non-Discipline Call by every Learner in the program and provide it to PGME on a quarterly basis.

3.0 A Postgraduate Learner can only perform Discipline and Non-Discipline Call in the areas of medical practice for which they have been deemed to be competent to perform with appropriate supervision.

4.0 A license by the College of Physicians and Surgeons of Newfoundland and Labrador (CPSNL) is required for Non-Discipline Call; doing so without a license is an offence and considered to be a major lapse in professionalism.

5.0 A Postgraduate Learner cannot perform Discipline or Non-Discipline Call:

5.1 when on required training program call, including home call.

5.2 within the eight hours before starting regular clinical work (i.e., will not work a midnight to 08:00 shift when starting work as a Postgraduate Learner at 08:00).

5.3 if they are not certified in Advanced Cardiac Life Support (ACLS) or Pediatric Advanced Life Support if the Program/department they are performing Discipline and Non-Discipline Call requires ACLS certification (see Section 3.0 in the ACLS Policy).

5.4 if they are not recognized as an active learner in a postgraduate training program at Memorial University; suspension with or without pay deems a learner’s status to be inactive.

5.5 if the Most Responsible Physician does not have specialist training in the same area of practice as on-call duties. 

6.0 It is the responsibility of the Program Director to monitor the performance of a Postgraduate Learner to ensure these activities are not contributing to diminished learning or performance or jeopardizing patient safety.

6.1 If a Postgraduate Learner develops academic difficulty, the learner will lose their privilege to perform Discipline and Non-Discipline Call (see 2.1).

6.2 The Program Director is responsible for outlining the process by which on-call shifts are assigned for each training experience within their Program.

6.3 Each Program must develop an on-call policy for their own training program, with minimum call requirements for each training experience/rotation.

7.0 A Postgraduate Learner must ensure approval from CPSNL and applicable Health Authority prior to starting Non-Discipline Call.

8.0 Discipline call performance can be subject to a review by the Competence Committee of the Learner’s Program.

8.1 PGME’s Supervision policy, Fatigue Risk Management and Assessment, Promotion and Appeal policy will continue to apply to Discipline and Non-Discipline Call.

8.1.2 Learners are encouraged to seek regular assessment of their performance during Discipline Call.

8.1.3 Minimum Assessment requirements will be determined by each Postgraduate Training Program for Discipline Call.

Procedure

Non-Discipline Call

A.0 For Non-Discipline Call, the Postgraduate Learner must: 

a. Consult with their Program Director prior to completing Non-Discipline Call.

b. Have the relevant parties complete the Extracurricular Discipline and Non-Discipline Call Request Form.

c. Contact the Canadian Medical Protective Association (CMPA) to have their liability coverage switched to code 14.

d. Contact the Health Authority and submit required professional credentials Learners are encouraged to contact the Health Authority well in advance as initial credentialling can be a lengthy process.

B.0 The Learner is responsible for ensuring that the request form is submitted to PGME six (6) days in advance of the call shift. 

B.1 Program Directors can withdraw approval at any time without providing advance notice.

B.1 PGME may decline Non-Discipline Call requests if ineligible or forms are incomplete or submitted after the specified deadlines.

B.3 Learners must contact the Health Authority and CPSNL to confirm the request has been approved prior to starting. It is an offense and a significant professional lapse to practice medicine without a license. 

Discipline Call

C.0 Prior to completing Discipline Call, the Postgraduate Learner will complete the following:

a. Complete the Extracurricular Discipline and Non-Discipline Call Request form and submit it to their Program Director no later than three (3) business days prior to the start date.

b. Confirm that approval has been received from the Program Director (or designate).

c. Ensure the respective APA is informed and copied on the request email.

D.0 All Postgraduate Training Programs must:

a. Review requests and communicate approval decisions to the Learner(s).

b. Ensure the form is submitted to the Health Authority for Learner remuneration. 

c. Submit quarterly Discipline-Call records for each Learner to the PGME office for review and oversight. 

Non-Compliance

Failure to adhere to this policy and procedures will result in future requests being denied.

1. Non-compliance may also result in insufficient liability coverage and non-payment for Discipline and Non-Discipline call.

2. Practicing medicine without a license is an offence under the Medical Act, 2011.

Related Documents

Assessment, Promotion, Dismissal and Appeal policy

Canadian Medical Protective Association (CMPA)

College of Physicians and Surgeons of Newfoundland and Labrador (CPSNL)

Fatigue Risk Management policy

Leave Management policy

Medical Act, 2011

Statement of Professional Attributes

Supervision of Postgraduate Learners policy

Procedures:

There are no procedures associated with this policy.