Department of Medicine Fellowship Standards

Fellows have completed their residency training (in Canada or elsewhere) and are doing advanced post-residency training in a clinical area and an area of academic scholarship (research, quality and innovation, education scholarship, etc.). As are residents, fellows are trainees at the University of Toronto, irrespective of the type of fellowship they are completing and must be registered as trainees through Post MD Education .

Residents are not fellows. Residents are trainees in CARMS-matched positions and paid for by the Ministry of Health.

The Department of Medicine has created fellowship standards that all programs must abide by. These standards have been created to ensure all fellowships being offered within the department are of high educational value. 

Types of Fellowships

Some of our fellows have graduated from Canadian residency programs and hold independent licenses, while our other fellows are international medical graduates who will require educational licenses. Individuals require one of these licenses to practice medicine, which can be obtained through the CPSO. These individuals will register with Post MD Education as ‘clinical’ fellows and seek an appointment at a hospital for clinical and/or research activities.

Duration of Fellowships

The minimum requirement for fellowships within the Department of Medicine is full-time (five days per week) for six months. All fellows will be assessed by the Department of Medicine upon re-appointment and clinical fellows who wish to be appointed beyond 36 months will have to be reviewed by the CPSO registration committee before being approved.

Fellow Remuneration Requirements

Fellows must be funded (remunerated) according to Guidelines for the Remuneration of Clinical Fellows , with very few exceptions allowed. The Fellowship Education Advisory Committee (FEAC) recommends that clinical fellows be remunerated at a rate at least equal to that of a PGY-1 trainee and urges departments to review the funding arrangements that do not meet this threshold. According to the PARO annual salary scale , below are the minimum standards that must be met by all fellowship programs:

* effective starting January 1, 2025 the Fellowship Standards salary reflects the PARO PGY3 Salary guidelines.

As the University of Toronto is not the employer of the fellow, DoM is not required to manage the funding. Funding should be coordinated by the hospital site or by the sponsoring agency. WSIB must be in place for the trainee. Citizenship and Immigration Canada requires that all foreign national fellows (VISA trainees) be remunerated at a rate commensurate with that of a Canadian fellow performing the same duties, in the same location of work.

Sources of Funding for Fellowships

There are multiple potential funding sources for fellowships:

• University, e.g. through divisional funds or an endowed fellowship
• TAHSN-affiliated hospital-based funding, e.g. through a divisional unrestricted educational fund, practice plan or hospital-based program
• Sponsored fellowships, e.g. a country or institution funds a fellow to come to Toronto for specific training

Fellowships may not be funded directly by a pharmaceutical industry partner. If industry partners wish to support fellowship training programs, they may do so by providing unrestricted educational grant to the program/division/hospital. Further, the industry sponsor must adhere to University standards and thus remain at arms-length to the trainee.

Fellowship Approval Process

Before a fellowship is approved, the New Fellowship Application must be completed with appropriate sign offs before submission to DoM.

Fellowship supervisors should contact fellowship directors for assistance with this process. They are also required to get signoff from fellowship directors and Department Division Directors.

1. Develop a Clear Fellowship Description and complete the New Fellowship Application

• Educational objectives (as per Post MD Education application), e.g., mastery of a clinical area, completion of a scholarly project, graduate degree, formal course work, etc.
• Duration of the fellowship (start and end dates) - pre-determined for each fellowship and in alignment with those required for any concurrent master’s or other graduate course
• Amount and type of clinical work, including on-call responsibilities if any (this must be consistent with the educational goals of the fellowship) (the ratio of residents to fellows on any service cannot be such that the residency program is negatively impacted)
• Expectations regarding scholarship, e.g. completion of a graduate degree program or scholarly project and if any, percent protected time for these activities
• Teaching expectations – level of trainee, percent time
• Source, method (e.g., T4 income from hospital) and amount of payment (salaries and benefits) must be stated and meet minimum standards ( Guidelines for the Remuneration of Clinical Fellows )
• Primary fellowship supervisor – name and frequency of contacts with fellow – and responsible division director (in general, fellowship supervisors should have no more than two fellows at any time) and plan for fellow mentorship
• Frequency and method of evaluation – see below for details
• Draft posting and proposed sites for posting of the fellowship opportunity
• Process of selection of candidates for the fellowship
• Plan for orientation of VISA sponsor and non-Toronto trained fellows to the University of Toronto
• Indication of support for the fellowship from relevant senior administrative lead, e.g. hospital PIC or division head

Opportunities to add value to the curriculum:

Consider the following:

• Enabling graduated clinical independence – role in triaging new referrals
• Provide clinical exposure to other specialties that participate in the multidisciplinary care of subspecialty patients
• Engage fellows in delivery of teaching and education (formal sessions, informal, reference manager, librarian assisted PubMed alerts weekly, etc.)
• Engage fellows in research administration, as appropriate (secondment to the REB; participation in research methodology workshops)
• Links with basic science lab meetings
• Mentorship for PGY-4/5s
• Social interactions with other fellows

2. Obtain Approval of the Relevant Departmental Divisional

The fellowship application must be presented for review and discussion at the relevant divisional executive committee(s) to ensure it meets the requirements for fellowships and that introducing the fellowship will not have a negative impact on existing undergraduate or residency training programs. 

3. Obtain Approval of the University Department of Medicine

Once divisional approval is received for the fellowship, the new fellowship application should be sent (via email) to the fellowship director in the University Department of Medicine fellowship office , along with the final fellowship description, draft posting, and goals and objectives . Fellowships will be reviewed for adherence to best practice and University requirements.

Once the fellowship has been approved, potential candidates submit applications for review and approval to the University of Toronto Post MD Education Online Application Tracking System (OATS – non-sponsored fellows) or the Sponsored Trainee Application Registry (STAR).

Posting and Vetting Fellowship Applicants

• Fellowships must be posted on the departmental / divisional website, and elsewhere as appropriate, with firm deadlines. Supervisors and fellowship program directors will submit postings to DoM for uploading
• Required documents for fellowship application must be clearly specified and include: the candidate’s CV, three letters of reference, MD certificate, subspecialty certificate, TOEFL if not trained in English or French; and proof of citizenship.
• Fair and transparent fellowship selection process includes
  • Selection committee consisting of at least two people, including the supervisor
  • File review process
  • Formal interview process
  • Criteria used for selection of candidates for interview and for the position
  • Attention to equity and diversity

Finalizing the Preferred Candidate (signing the contract)

The preferred candidate must be approved by the divisional fellowship program director before a final offer of fellowship is made.

Evaluation of Fellows

Fellows must receive face-to-face feedback mid-fellowship and at the time of completion of the fellowship-specific ITER (three months post-start and then at six months). Divisional program directors/fellowship directors are expected to meet with all registered fellows at least annually, including performing a fellow de-brief at the end of the fellowship.

Evaluation of the Fellowship

Fellows should be encouraged to evaluate their experiences through completion of RES and RATE scores for the fellowship and supervisor. These should be reviewed at least annually by the program director/fellowship director and division director.

For fellows engaged in advanced research training, the productivity of the trainee during fellowship should also be considered (was a degree completed, publications, presentations, awards)