Minimum Standards for the Assessment of Clinical Fellows

Date of original approval: February 2025
Date of last revision and approval: May 2025
Date for next review:

INTRODUCTION:

The Minimum Standards for the Assessment of Clinical Fellows at Temerty Faculty of Medicine at the University of Toronto contains the rules governing the assessment and promotion of all clinical fellows in postgraduate training programs at the University of Toronto. For the purposes of this document, a clinical fellow (hereby termed ‘trainee’) is a physician registered in any post-residency clinical training program associated with Postgraduate Medical Education at the University of Toronto.

This guideline is adjunct to the Guidelines for the Assessment of Postgraduate Residents, which outlines best practices in assessment as applied to all trainees in programs subject to accreditation by the Royal College of Physicians and Surgeons of Canada (Royal College) or the College of Family Physicians of Canada (CFPC). The purpose of Minimum Standards for the Assessment of Clinical Fellows is to maintain the high standard of educational practice and best practices in assessment expected at Temerty Faculty of Medicine in programs for which the Guidelines for the Assessment of Postgraduate Residents do not apply.

GUIDELINES:

Assessment is a critical process in medical training used to evaluate and understand the knowledge, skills, and competencies of trainees. Effective assessment should be designed to:

• Align with clear educational goals and objectives that outline the competencies and skills required of the training program.
• Ensure a standardized Program of Assessment that is reliable (constantly producing accurate assessment), valid (measuring the competence or skill effectively), and equitable. The Program of Assessment:
  • is designed to guide supervisors in assessing trainee knowledge, skills, attitudes and competencies with the goal of supporting their growth as competent practitioners in their specialty
  • must include, at minimum, a summative assessment (e.g. In-Training Evaluation Report (ITER) or In-Training Assessment Report (ITAR)) customized to the AFC/clinical fellowship training program.
• Inform trainees and supervisors about educational performance and identify educational needs.
• Facilitate constructive feedback to the trainee from a supervisor/Fellowship Program Director.
• Document the trainee’s performance and progress within the program.
• Support the Fellowship Program Director in providing guidance to supervisors for ongoing trainee supervision.
• Provide a foundation for confirming progress, identifying areas for improvement, and supporting decisions related to promotion, remediation, or probation.
• Provide accountability for the educational experiences offered in fellowship programs and offer valuable insights to support the continuous improvement process of the program through the Fellowship Training Committee.

Note: The CPSO requires a period of assessment for International Medical Graduates (IMGs) (up to 12 weeks), called a PEAP (i.e., Pre-Entry Assessment Program) to determine if the Clinical Fellow can function at their appointed level of training prior to full acceptance in the program. Assessment of PEAP trainees is explained through the Pre-Entry Assessment Program Guidelines.

PROCESSES:

Throughout the clinical fellowship, trainees must receive accurate, transparent, and consistent formative feedback and summative assessments. The following principles guide the assessment process:

• Goals and objectives must be provided to both trainees and faculty prior to the start of a rotation to support effective learning and assessment strategies. Trainees should review their goals and objectives.
• Both the trainee and the program are responsible for assessment, feedback and coaching.
• Trainees should receive ongoing formative feedback through their training with early documentation and supports if concerns are raised.
• It is strongly suggested that summative assessments are provided at a minimum of every 4 months with an absolute minimum required assessment period of every 6 months of active training. The assessment must highlight areas of strength, areas needing improvement, and the trainees progress in addressing any previously identified areas of concern.
• Summative assessments (e.g. ITERs/ITARs) must be completed within 14 days of the completion of the rotation / block of time.
  • Trainees are expected to review written feedback within 14 days of being notified of its completion.
  • For trainees who are meeting expectations, the Fellowship Program Director/Supervisor must review the summative assessments with the trainee at least twice per academic year.
  • For trainees who are not meeting expectations, the Fellowship Program Director/Supervisor must review the summative assessments with the trainee within 14 days of completing the assessment. Trainees should be offered supports through the Office of Learner Affairs.
• Trainees must be notified promptly of any performance deficiencies and provided opportunities for feedback and coaching, ensuring they have sufficient time to make improvements before the end of their training.
• All assessments and coaching/feedback meetings with trainees must be dated and documented in the trainees' file.

A semi-annual written summary of progress should be completed by the Fellowship Program and uploaded into POWER. For one-year fellowships, the final report should be completed in the final month of the fellowship.

The Fellowship Program makes decisions regarding the successful completion of an assessment period, educational experience, rotation, and academic year for the program. Guidance can be provided by the Departmental Vice-Chair Education. The review of assessment data and decisions around progression and promotion could be delegated to an Assessment or Competence Committee (as a sub-committee of the Fellowship Program) should one be available.

CONTESTING ASSESSMENTS:

Trainees who wish to contest the contents of their assessments must follow otherwise established Postgraduate Medical Education Process for Appealing an In-Training Evaluation Report (ITER) or an In-Training Assessment Report (ITAR).