Remote Work
Toolkit

Information for Residents

UPDATED: JULY 28, 2020 | 2:40 PM EST


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

Orientation for PGY1

Information related to NOSM’s preparations for the incoming PGY1 resident cohort and orientation is available on the PGME Office 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

PARO & NOSM PGME Perspective on Self-Isolation Prior to Employment Start

NOSM supports the following PARO principles and has been already ascribing to these in preparation for the new residents:

Where the employer reasonably requires self-isolation for incoming residents to a hospital/site, for example, because of the particular needs of the patient community, because the resident has travelled internationally, or because of other personal circumstances, the resident may agree to do so prior to the start of the residency, provided that any resident who is unable to self-isolate fully before the start of residency will face no repercussions and will be permitted to self-isolate or complete self-isolation upon the start of residency, without loss of pay or benefits under the PARO-CAHO Collective Agreement or additional costs to the resident.

In addition, PGME must commit that:

  • They have support of Program Directors to permit residents, where necessary, to start or continue self-isolation after July 1, without loss of pay or benefits or other repercussions, recognizing their employment doesn’t start until July 1st.
  • Residents who self-isolate, in whole or in part, from July 1st on will not be required to use vacation/professional leave days or other such days for the period of self-isolation.
  • They expand in-place housing strategies for residents required to self-isolate when coming to new site for those residents who do not have housing already in place for that period of time.
  • They provide guidance to Programs on how to integrate residents who do not complete self-isolation before July 1 into their programs when they are able to come out of self-isolation.
  • They cooperate with hospitals to provide training online or virtually with multiple dates and times available for these sessions with a mentorship-style program and with a more senior resident, to allow for informal orientation and briefing on what to expect to ease the transition for residents who do not complete self-isolation before July 1.
  • Residents who do not self-isolate prior to their start of employment must not be disadvantaged in any way, including not being at greater risk for extension of training.
  • They provide clear communication to incoming trainees at the site, Program Directors, administrative staff and individual preceptors of all of the above.

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.  Note –  All residents who are writing MCC exams may choose to use the educational/professional days (7) alloted in their PARO contract for the purpose of exam study leave. Requests to use this leave time should follow usual program leave request processes and program coordinators can assist with any questions. Should any incoming residents encounter conflicts between the scheduling of their MCCQE Part 1 remote proctored exam and any scheduled PGME or hospital orientation activities, they are encouraged to contact their program coordinator to discuss options for accommodations to their orientation plans.

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.

Core and Elective Rotation Travel Within Northern Ontario for NOSM Residents

Residents scheduled for rotations within Northern Ontario are able to move among communities. There are some exceptions which mandate a 14-day self-isolation period upon arrival. Presently this is the case for Thunder Bay Regional Health Sciences Centre (TBRHSC) for travel from outside of Northwestern Ontario, Sault Area Hospital for travel from outside the Algoma region, and Sioux Lookout for travel outside of Northwestern Ontario. 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.

Do I have to go to work during a pandemic or crisis?

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.

I am receiving conflicting messages from my training site and NOSM regarding travel screening procedures, which do I follow?

Always follow the screening protocols at your site. As of March 13, 2020 anyone returning to a Northern Ontario training site following international travel is required to identify to the PGME Office using the NOSM screening form or in conjunction with Occupation Health procedure at your training site and self-isolate for fourteen days. Your program contacts will support and track self-quarantine time and make every effort to assign study or non-clinical work.

I am quarantined following screening measures or otherwise, do I need to apply for short term sick leave or provide documentation to return?

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.

What happens to my course of training?

NOSM’s goal is to make every effort to continue academic programs with minimum disruption. Your site director, program director or program coordinator will issue updates in the event of any disruption to academic and clinical schedules. Every effort will be made to provide alternatives in the event of clinical or academic disruption that is appropriate to training level and program resources. If you are quarantined and asymptomatic, your program will likely have expectations for some continued study or scholarly work. This will be communicated directly to affected residents.  All efforts will be made to avoid an increase in length of training however extensions may be necessary in some cases and will be supported.

Do the PARO-CAHO Collective Agreement rules still apply?

Every attempt will be made to respect the conditions outlined in the agreement. Work hour limits can be waived during a pandemic situation, if absolutely necessary.

Could there be interruptions in salary or 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.

One-time Payout for Unused Vacation: 2019-2020 Resident Cohort

PARO and the Ontario Hospitals Association have reached an agreement to provide a one-time payout for unused vacation for residents during the 2019-2020 academic year.  A communication related to the process was sent out by NOSM residency programs last week. The deadline to return your attestation form to your program is August 7, 2020. Residents are encouraged to follow-up with their Program Coordinator for further information on the the communication and verification process at NOSM as well as with PARO for any additional questions or support.

What should I do if I get sick?

If you have symptoms associated with a respiratory infection it is important that you stay home. Do not report to work and follow procedures for contacting a health professional or health unit. Follow the usual leave procedures for reporting sick leave to your program. 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.

How can I protect myself at work?

Always follow universal precautions, like handwashing, 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.

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.

I feel stressed, who can I turn to?

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

Where can I get up to date reliable information on 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.