Registration Form for Fellows
Registration of Fellows with Postgraduate Medical Education is necessary if they are involved in any clinical work. This includes patient
contact or the interpretation of laboratory or other investigative data for inclusion in a patient’s medical record.
NAME (Legal Name as it appears on Passport)
Surname
Address
First Name
City
Middle Name
e-mail address
Province
Country
Medical discipline/specialty in which training is to be obtained
Postal Code
Sites
Start Date
Appointment Dates
Categorization
(see reverse)
Day
Month
End Date
Year
Day
Clinical Fellow
Clinical Research Fellow
Name of University where medical degree was obtained
Month
Year
Teaching Fellow
Research Fellow
Country
Year of Graduation (MD)
Name of Funding Agency (include approximate salary if internally funded)
If funding from outside Canada, indicate
the country
Country of Birth
Date of Birth
day / month / year
Citizenship
Educational Supervisor (please print)
Signature
Date
Phone Number
Divisional Director, if applicable (please print)
Signature
Date
Phone Number
Department Chair (please print)
Signature
Date
Phone Number
Attach Candidate’s CV and Letter of Acceptance from Candidate
Attach a detailed description of the training program (include specific learning objectives)
Confirmation of funding if externally funded
Evidence of English language proficiency - IELTS or TOEFL (test must be taken within 24 months of application)
IELTS academic version: minimum 7.0 in each of the 4 components. TOEFL IBT academic version: minimum of 24 in each of the
4 components. Candidates are exempt from English language proficiency testing if their medical education and patient care experience
was in one of the countries that have English as a first and native language.
CPSA Licensure: The Fellow will be required to obtain placement
on the Provisional Register of CPSA. The candidate will be
required to provide documentation to CPSA including evidence of
English Language Proficiency, references, Certificates of
Professional Conduct, and verification of their medical degree
through Physician Credentials Registry of Canada (PCRC) if
degree was obtained outside of Canada.
Work Permit: The PME office will advise the candidate of the
process of applying for a work permit.
Health Care: If the term of appointment is more than 6 weeks but
less than 12 months, a Fellow will automatically be registered in
the University of Alberta Health Insurance Plan (UAHIP). If the
term is less than 6 weeks, the candidate should purchase private
insurance. If the term of appointment is 12 months or longer, the
individual should apply for coverage through Alberta Health and
Wellness.
CMPA (Canadian Medical Protective Association) – Membership
with CMPA is mandatory. Fees responsibility of program, fellow,
or sponsor.
Registration: Supervisor must advise site Medical Education Office
to ensure fellow is properly registered for that site.
Evaluation: The Educational Supervisor is responsible to provide
documentation to the PGME Office of formal written evaluation of the
Fellow annually, and at completion of training. If certificate is
required, send ‘Request for Certificate of Completion of Training Fellows’ form to PGME Office when submitting final evaluation.
Return to: PGME Office, 2-76 Zeidler Ledcor Centre
A minimum of four months is required for processing before
the candidate begins training. Please call Sandy at 492-9553 if
you require further information.
Fees: Fee assessment of approximately $960.00 per annum
(subject to change) will be issued by the Registrar’s Office.
z\common/fellows/forms/Registration Form for Fellows
revised April 2013
Definition of the Terms
"RESIDENT" and "FELLOW"
RESIDENT
A post-M.D. trainee registered in an approved postgraduate training program whose training for
that contract term is accreditable towards certification by the Royal College of Physicians and
Surgeons or the College of Family Physicians of Canada.
FELLOW
A post-M.D. trainee who is registered with the Postgraduate Medical Education Office and is
pursuing supervised clinical and/or research training which is NOT accreditable towards fulfilling
certification eligibility requirements of existing residency programs recognized by the College of
Family Physicians of Canada (CFPC), or the Royal College of Physicians and Surgeons of
Canada (RCPSC).
Examples of post-M.D. trainees who should be classified as Fellows are:
1. Any trainee who has completed Canadian specialty training requirements and is pursuing
clinical training or research within their own specialty field beyond the requirements for
specialty or subspecialty certification.
2. Any trainee who may be ineligible for Canadian certification because previous training is not
accreditable by the CFPC or RCPSC.
3. Any trainee who is registered for the purpose of obtaining specific experience in a
specialty/subspecialty which is not currently recognized by the RCPSC, or for which there is
no accredited program at the University of Alberta.
At the University of Alberta, we attempt to subcategorize Fellows as follows:
Clinical Fellow
-
primary duties relate to supervised clinical care.
Clinical Research Fellow
-
primary duties relate to defined clinical research under
direction of a designated supervisor.
Research Fellow
-
primary activity is to conduct a defined basic research
project with a designated supervisor in which there is a
minor degree of clinical activity or interpretation by the
Fellow.
Teaching Fellow
-
primary duty is teaching.
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