Remote Work
Toolkit

Information for Residents

UPDATED: JANUARY 13, 2020
The scenario is rapidly evolving, all attempts are being made to provide as current information as possible to all NOSM residents.


Vaccination

As vaccine distribution begins to occur, residents are seeking information on the plan for NOSM residents to receive COVID 19 Vaccination. As a broadly distributed School of Medicine without a single unifying academic health care system of hospitals, we expect residents will be vaccinated at training sites once available and at the present time there is not a centralized process. While NOSM does not coordinate or distribute vaccines, we are working with our partners to ensure that all NOSM residents receive timely access as front line health care workers.  We understand that distribution plans will depend on the context of rotations (Emerg., ICU, accessing LTC facilities, etc.), and availability of vaccines at the sites. Many of our NOSM faculty are also waiting “for their turn” and we are encouraging a humble and patient approach. The Vice Dean Academic’s Office at NOSM is actively working with our Northern Ontario hospital partners to determine how NOSM residents will be included. Given the mobility of residents as well, there may be timing issues with receiving the second dose should you move sites and if residents encounter this challenge with receiving one dose and then moving to another site, we ask you to contact postgrad@nosm.ca to seek advice and support of the PGME Office in connecting to your second site.

Residents who are scheduled for the Remote First Nations Fly In Vaccination initiative with ORNGE will be scheduled specifically for vaccinations as part of a requirement to participate. There will be a limited number of residents who can take part in this specific endeavour based on various scheduling factors.

At this point in time, as the vaccinations begin any residents who have been vaccinated, are asked to report to postgrad@nosm.ca with the date, location and type of vaccine and plans for the second dose.

We will continue to advocate for a cohesive plan for NOSM residents and seek your patience in the meantime and continued contact with our office to submit updates on vaccinations you may receive at the training site.

Housing

In order to enhance the safety of our learners through the winter months of the pandemic, NOSM is introducing changes to its current housing practices to account for COVID-19 concerns. NOSM housing has been identified as an important area to increase the ability for learners to be housed in single learner allocations if appropriate. As most of the NOSM Programs (now including UME, PGME, Physician Assistants, Rehabilitation Sciences, Northern Ontario Dietetic Interns, and Visiting Residents) have reentered into clinical placements, it means that there is cohabitation occurring within NOSM Housing. Understandably this can be a cause for concern as the pandemic numbers increase not only in Northern Ontario but also all of Ontario.
With the numbers rising and restriction measures from our communities continuing to be implemented, there is no way to properly or efficiently implement self-isolation measures in NOSM shared Housing – there is simply not enough physical space. The largest concern is if a new learner is coming in and needs to self-isolate for 7-14 days but is placed in a unit that already has a learner working within the community. We would need single learner allocations or everyone arriving at the same time within a unit to be properly self-isolating (if appropriate given the travel and community affected).
In order to help alleviate the amount of learners sharing space in NOSM Housing and to make it safer for all learners performing placements in our NOSM communities, NOSM is temporarily implementing a NOSM Housing reimbursement up to a maximum of $3,000 to find self-arranged accommodations which might include options like a hotel suite, an AirBnB or other rental. This will be in effect only from January 11, 2021 to May 02. 2021.
This process will be implemented in three steps.
Step 1: 
All housing that is currently allocated will stay as is (based on currently confirmed placement).
  • Re-allocation will occur if self-isolation measures are needed on a case by case basis.
  • At this point, you do not need to do anything for upcoming scheduled placements unless advised or you reach out to exercise the self-arranged option.

Step 2: 

Effective immediately, any new housing allocations moving forward (based on newly confirmed placements) will be scheduled as follows:
  • Single learner per unit basis from the January 11, 2021 (start of PGME Block 8) to May 02, 2021 (end of PGME Block 11).
  • NOSM Housing will be prioritized as such:
    • If NOSM Housing is not occupied NOSM Housing will be first come first serve for single learner allocations.
    • Once NOSM Housing is occupied, any other learners will be eligible for a maximum reimbursement of $3000 to book their own accommodations (via AirBnB, community contacts, local hotels, etc.) within the community of their confirmed placement.
    • General Rule: Any learner (internal or external) that would be provided housing will be eligible for the housing reimbursement (i.e., PGME, UME, HS, PA, Agreements, NODIP)
Procedure: Email will be sent by NOSM Housing to affected learners as their confirmed placements are entered into PaNDa, which will indicate the reimbursement option to find selfarranged housing.

Step 3: 

Any learners that currently have a confirmed placement and is funded for housing will be eligible to take $3,000 maximum reimbursement to arrange for their own housing accommodations within the respective community of their confirmed placement [email to come from respective Programs].
  • For NOSM residents: The reimbursement will be available for each clinical placement that is outside of their homebase if considered core, elective in Northern Ontario, and core external where an Interuniversity Affiliation Agreement exists and/or 4 weeks or higher in duration.
  • For NOSM residents already using Housing Option 2: You will be eligible to receive a reimbursement of up to $3,000 during this effective time period (January 11 to May 02, 2021) and should follow the reimbursement procedure detailed below.
  • For NOSM students: The reimbursement will be available for each clinical placement that is outside of their homebase if considered CBM ICE 110 or electives of 3 weeks or higher in duration at the time of allocation – 4 week prior to start date of placement.
  • For Health Sciences or Physician Assistant Program: The reimbursement will be available for any housing that is funded by NOSM.
  • For Visiting Electives and Agreements: The reimbursement will be available for any housing that is funded by NOSM.
Procedure for NOSM: Email will be transmitted to learners by respective Programs to indicating the reimbursement option to find self-arranged housing.
Procedure for Learners: Email NOSM Housing to indicate the selection of the reimbursement option for self-arranged housing.

Reimbursement Processes:

All learners not placed in NOSM housing are required to pay for the accommodation and can submit for reimbursement by NOSM as soon as the landlord/host/hotel issues a receipt for rent. Claims will be processed efficiently once received with all correct supporting documentation.
Eligible Expenses: 
*any expense that is directly attributed to the cost of housing up to a maximum of $3,000 total *all expenses must follow the guidelines and principles of the NOSM Travel Management and General Expenses Policy (TMGE)
  • Rent
  • Parking
  • Internet and Utilities (if not included in the rent)
  • Meal Allotment: only allowed if renting a hotel room with no kitchenette (receipt are mandatory & following the TMGE rules)
  • Accommodations with Family and Friends: $30/day can be claimed

For Learners:

  1. Visit www.NOSM.ca
  2. Click on ‘MyNOSM’ and choose the option ‘Expense Reimbursement’ under the Learners tab.
  3. Download a new version of the ‘Travel Expense Summary Form’ and fill out the form to the best of your ability. The Travel Expense Summary Form is a SMART form and if information is missing there will be a red marker highlighting the missing information.
  4. When completing the Travel Expense Summary Form please add the following in the comments section: ‘COVID Housing’.
  5. When submitting the claim through the portal, please select your respective program.
  6. In order to submit the claim, please include the completed Travel Expense Summary Form and all Receipt (needs to include payment or paid with credit card).
  7. Attach both required documents and submit.

NOSM understands that these are stressful times and hope these measures will help ensure the safety of all NOSM learners and help mitigate the spread of the pandemic in our northern communities. We hope that this reimbursement option provides learners with the ability to increase their level of safety throughout the winter months of the pandemic.

Wishing you all the best during your clinical placements,
NOSM’s Community Relations Unit

Resident Access to NOSM Campus and Libraries

All NOSM buildings continue to be closed during the pandemic and key card access is required for entry for anyone with authorization to be on campus. Only those who are pre-approved to be on campus and have completed the mandatory training and attestation will be provided with a key card and/ or will have their current key card activated for entry into the NOSM building. This process is coordinated and monitored to mitigate potential risks and to ensure NOSM complies with Government directives and policies of the host universities. NOSM will continue with this approach until February 1, 2021, unless otherwise directed by the Government of Ontario or the Dean, President and CEO of NOSM.

Under what circumstances can NOSM residents currently access NOSM campuses?

  • For program arranged mandatory on-site academic sessions
  • For approved library bookings (steps outlined below in 5 Steps to Accessing NOSM Campus Libraries)
  • For all other purposes, residents must request authorization to be on campus in advance of their requested access/entry date through their Program Coordinator. In this request, residents must clearly outline the reasons why they need to access the NOSM campus and why this access would be deemed essential. Programs will work with the PGME Office to grant the approval of the PGME Associate Dean for access, if deemed appropriate under the School’s current guidelines and in line with School’s capacity guidelines for the date/time/campus requested .

5 Steps to Accessing NOSM Campus Libraries

  1. Contact your Program Coordinator

As a continuation of our Return To Campus (RTC) Plan, residents who are requesting to be on campus for essential academic needs such as library access, must have prior authorization which will be facilitated by your Program Coordinators. Email your Program Coordinator to initiate the authorization process

  1. Get a key card or verify your current key card access

All NOSM buildings and libraries are only accessible using your key card. You are required to ensure your key card access is enabled prior to arriving for your reservation by verifying/updating your current access privileges via your Program Coordinator. The process to update an existing key or request a new card takes between 2-5 business days.

If you need a key card, please contact your Program Coordinator who will help to facilitate your request.

Note: Your key card will be tracked to you, cannot be shared and must be returned at the end of your residency

  1. Complete mandatory RTC Training Modules and Attestation

Those approved to be on campus must complete a mandatory RTC Training Module and then sign a one-time online Attestation confirming they have completed the training.

  1. Book your library seat

Following completion of the training and attestation, residents can then book their seat at the NOSM Lakehead or Laurentian campus library using the following link: https://libraryguides.nosm.ca/seats

Note: Seats are available to be booked Monday to Friday from: 8:30 a.m. to 11:30 a.m. and 12:00 p.m. to 3:30 p.m. NOTE – you will require key card access to access the building and library.

  1. Complete the Daily NOSM COVID-19 Screening Tool before coming to campus

In response to new provincial regulations, NOSM has created a new online screening tool survey that captures the required screening questions required to implement additional screening for all employees, learners and visitors who enter NOSM buildings.

Each employee, learner or visitor authorized and scheduled to be on campus must complete the NOSM COVID-19 Screening Tool each time prior to entering NOSM campus buildings.

This survey tool can be saved on your cell phone home screen:

Direction provided at the end of the screening survey must be followed. If you do not pass the screening, you will not be allowed to enter the workplace and will be required to self-isolate and follow instructions of the Public Health Unit.

Requirements and recommendations while using NOSM Campus Libraries

  • You may show up at any time during your library booking, but you are required to vacate your seat by the end of your booking. To reduce touch points in the library, you must only use your assigned seat while in the library. Access to the stacks and library printer are restricted to library staff only.
  • You must follow NOSM’s Return to Campus Plan including face mask requirements. The library is a communal space and therefore a designated area where face masks are required. Drinks are permitted; food is not.
  • If you suddenly feel unwell while on campus, follow the steps outlined in the Suddenly Feeling Unwell while on campus flow chart while also ensuring you have advised your program coordinator who will provide  next steps related to your training.
  • Lastly, it is recommended that all NOSM learners, faculty and staff download the Government’s COVID exposure notification app – COVID Alert.

Important Note: NOSM campus is not an authorized testing site for certification exams, if you are approved to be on campus and using NOSM campus space for the purpose of connectivity for an online external examination, residents assume all related responsibilities for the environmental requirements for remote examinations.

Core and Elective Rotation Travel Within Northern Ontario for NOSM Residents

Residents scheduled for rotations within Northern Ontario are able to move among communities. All residents are asked to send questions on scheduling matters to their program contacts including any COVID-19 screening questions. All residents must continue to report any daily absences from training due to screening issues or travel self-isolation factors to their program contacts for tracking and follow up.

Electives Outside of NOSM for NOSM Residents

Commencing in July, many Medical Schools nationally are re-opening postgraduate medical education electives (along with core rotation agreements at other Schools). Not all Medical Schools are able to open due to PPE availability and other local capacity issues at their sites.  Decisions to accept electives are entirely subject to the protocol of the receiving university and following any self-isolation and screening protocols in place in various hospitals and jurisdictions. It is recommended that residents review the receiving university elective web-sites for availability and follow the application guidelines early. Site protocols may change and vary, and residents should consider what a back-up plan might be if the situation changes. Residents can also anticipate needing to follow screening protocols upon arrival and throughout their elective and if screening isn’t passed at the site then their rotations may potentially be disrupted.

Working during a pandemic

Residents have dual roles as both trainees and health-care providers. As members of the medical profession, we are all called upon to provide care to the best of our ability during a crisis. Sometimes this means taking on elevated personal risk.

Specific depts in various hospital and clinic sites will determine levels of procedures involving residents. Individual residents also have the right to refuse unsafe work. Certain residents may be considered higher risk, including those who have chronic respiratory disease, those who are immunocompromised, those who are pregnant, and those who cohabitate with any of the above. You are not expected to serve if you fall ill or become a vector for infection.

Residents must have all the PPE and safety supports that are required to do their work at their site. We are following and support the Residents and Public Health Emergency Preparedness Guidelines.

The clinical supports required for patient care may be unpredictable over the coming weeks and residents could be deployed to areas of care that are within their scope to help support the care of patients. Again, all efforts will be made to minimize the risk to residents and optimize the care of patients.

Reporting of COVID symptoms or exposure

If you have COVID-19 symptoms or have been exposed to someone who is presumptive or positive for COVID-19 it is important that you stay home and seek advice immediately. Do not report to work and follow procedures for contacting a health professional or health unit. Follow the reporting procedures in the reporting flow chart. You will not face repercussions for being ill and programs will err on the side of supporting residents through program disruptions and time off related to COVID-19.

Quarantine and Leave

Residents who are asymptomatic and have been quarantined must report the absence to their program coordinator following normal absence procedures, however, you will not be asked to provide a medical note to return to work. Your program and/or a member of the PGME Office will be in routine contact with you and once the quarantine period is over you will return. Residents who are ill would be assessed on a case by case basis regarding clearance to return. Vacation days etc will continue to accrue during any periods of quarantine etc.

Salary and Vacation

Salary, benefits, and stipend entitlements continue during any pandemic. Due to extraordinary patient care needs, certain vacation requests may be denied. Vacation days will continue to accrue as usual.

Universal Precautions

Always follow universal precautions, like hand-washing, before and after each patient encounter and upon entering and leaving the hospital or clinic. Always strictly follow additional precautions for each patient including contact, droplet or airborne precautions. Use dedicated equipment for patients or thoroughly wash equipment after patient encounters. Avoid unnecessary encounters by rounding comprehensively. If you are uncertain how to approach a patient, contact your supervisor or infection control. Always review the specific protocols at your training site.

Wellness Resources

The PGME Resident Wellness Office

The PGME Resident Wellness Office is fully operational and has worked under physical distancing since it came into existence – at anytime just send an email

  • for direct support contact the Wellness Lead Clinician residentwellness@nosm.ca or
  • Jaimy Kiiskila our Resident Wellness Coordinator for information and logistical assistance (pgewellness@nosm.ca Office number 807-766-7458

If you have an underlying condition that puts you at high risk of severe COVID disease you can contact us to discuss some restrictions on certain types of work

Clinical Psychologist

Ms. Caroline Charette, professional psychologist, has been contracted to NOSM to support residents. She is taking referrals – just email the Wellness Lead Clinician  or the Resident Wellness Co-ordinator for individual therapy.  She also offers small and large group sessions.

EFAP at Morneau Shepell

  • Employee and Family Assistance Program for all residents across NOSM’s wider campus of Northern Ontario. Immediate support 24/7/365: 1-800-387-4765.
  • Offer various types of counseling and therapies including emotional support, financial advice, family counseling, fitness and nutrition counseling, etc.
  • Even before pandemic counselors were typically available by phone or video conference.
  • Best way to access is workhealthlife.com but they also have a hotline and an app you can download.

Crisis numbers:

  • The Physician Health Program, through the OMA, offers confidential support for trainees and practicing physicians through live counselors available between 9 am and 5 pm 1-800-851-6606
  • PARO 24-Hour Helpline: A confidential support service for residents, medical students, their partners and families. The toll-free number is accessible anywhere in Ontario, 24 hours a day, 7 days a week. PARO Help Line: 1-866-HELP DOC (1-866-435-7362).

Ontario COVID-19 Mental Health Network

Offer PRO BONO mental health services for Ontario COVID-19 healthcare providers. They are a volunteer network of Ontario-based mental health professionals dedicated to supporting frontline COVID-19 workers during the evolving crisis  Https://covid19therapists.com .

The Centre for Addiction and Mental Health (CAMH)

  • http://www.camh.ca/covid19gethelp Provides a self-referral form for all healthcare providers. This will allow healthcare providers to connect with CAMH services, supports, and assist them in navigating what supports they need.
  • CAMH also houses a website where they send all the support programs that they learn about so people can self-navigate if they want http://www.camh.ca/covid19HCW

MD led virtual chats

  • hosted by Dr. Kasra Khorsani and sponsored by the OMA. This is not psychotherapy.
  • Starting March 23, the Physician Health Program invites you to drop in virtually between noon and 1 p.m. each weekday to support one another during the COVID-19 pandemic.
  • Stay for one minute if you can and come back as many times as you like.
  • Everyone is welcome http://php.oma.org/virtual-chats/
  • The chats are meant to be a safe space where we can talk about how we are managing. Join Zoom Meeting Daily from 12:00-1:00

OMA-MD Resident Chat Sessions

  • free facilitated sessions to support each other during COVID19
  • Session Facilitator: Dr. Kasra Khorasani is a staff psychiatrist at U of T with over 20 years of experience working with residents in group therapy amongst other things and has generously set up an online support group for MD residents in Ontario.
  • Please feel free to drop in virtually 2-3 pm four times/week Monday, Tuesdays, Thursdays and Friday.
  • Stay for a minute or longer if possible and come back as many times as you like.
  • These sessions will be ongoing and will continue as they are needed. All are welcome.
  • This will occur via zoom and is meant to be a safe space to talk about how we are managing
  • They look forward to chatting with you starting Monday March 30th, 2-3 pm.

ECHO Ontario Coping with COVID Resources for residents:

ECHO Coping with COVID is designed for Healthcare Providers and Residents responding to the COVID-19 pandemic https://camh.echoontario.ca/echo-coping-with-covid/  Participants are invited to join ECHO sessions virtually through multi-point videoconference technology to share and learn about ways to build resilience and overall wellness through didactic lectures and case-based discussions

  • Wednesdays 2:00pm – 3:00pm Fridays 12:30pm -1:30pm
  • Starting: Friday, March 27, 2020

Apply here: https://edc.camhx.ca/redcap/surveys/?s=KXNTKXKFXY

Mindfulness

The COVID-19 pandemic is causing unprecedented levels of stress and anxiety in the workplace. Consider dropping in and learning short mindfulness practices to help find calm during challenge. Relax, recharge and learn how to incorporate moments of mindfulness into your day. This is not treatment. Optional discussion to follow. No OHIP required. Join the 30-minute physician mindfulness sessions

N95 mask fit

Keep your N95 mask fit card on you at all times. All residents are expected to be up to date with your mask fit test as previously outlined by the PGME Office. If you know that you cannot be fit properly due to religious or health reasons, contact your site director or program director now to understand how this will affect you work and training. Familiarize yourself with all site-specific protocols at your training site.

Principles Related to the Potential of Extended Training Due to a Pandemic

NOSM PGME, and all Ontario PGME Offices, are united with PARO in supporting the following principles related to the potential of extended training due to a pandemic:

  • Being as judicious as possible in determining whether a resident has been able to sufficiently achieve the competencies in the context of measures needed to ensure the health and safety of residents and the public, including, but not limited to, time spent redeployed, in quarantine, self-isolation, or due to time off to care for children or dependents;
  • Being willing to focus promotional decisions on the entirety of a residents training competencies and performance with a decreased focus on minimum or maximum time spent on certain rotations, particularly for those senior residents not currently enrolled in a CBME-program;
  • Recognizing that this cohort of residents are obtaining training in medicine during a pandemic where unique competencies can be achieved that should be recognized and factored into promotion decisions;
  • Recognizing that competencies achieved while redeployed will be considered as applicable and transferrable for rotations where those competencies are relevant.

NOSM programs will help to operationalize these principles and we count on the support of our faculty and training sites to recognize the challenges facing residents particularly those close to graduating. We continue to advocate with the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada on the move to competency-based training rather than time-based measures for advancement, particularly during this time.

Letter to Residents – March 25, 2020

General Principles for the Reassignment of Residents in Times of Exceptional Health System Need

Updates on Certification Examinations & Medical Council of Canada Qualifying Exams

Family Medicine Residents – Please see the latest update from the CFPC about the certification exam.

Royal College Residents – Please see the latest update from the RCPSC about the certification exam.

Medical Council of Canada Exams – Latest updates.

NOSM’s response to COVID-19

Information on NOSM’s response to the pandemic and any impact to your residency training program will come to you from postgrad@nosm.ca, jfawcett@nosm.ca or specifically from your program director or other program contact.

Global messages to the entire NOSM community will come from the Dean’s Office.