INSTITUTIONAL PROGRAM LETTER OF AGREEMENT FOR
INTERNATIONAL RESIDENCY ROTATION
THIS PROGRAM LETTER OF AGREEMENT is between NAME OF
INSTITUTION of LOCATION (“Participating Site”) and the Regents of the University of Colorado, a body corporate, for and on behalf of the University of Colorado School of
Medicine, Office of Graduate Medical Education, Enter name of program
(“CUSOM”).
WHEREAS, Participating Site provides health care services and medical treatment to its patients;
WHEREAS, CUSOM provides education and training in medicine and the health sciences to medical interns, residents, and fellows through their participation in supervised patient care and treatment;
WHEREAS, CUSOM considers a clinical training experience outside the United
States to be an essential and fundamental feature of a contemporary and comprehensive medical education;
WHEREAS, CUSOM and Participating Site share a mutual interest in providing a short-term clinical training experience (“residency rotation”) to CUSOM medical residents in Enter name of country and believe the present Agreement will serve to further the interests of both parties to their mutual benefit;
WHEREAS, Participating Site offers to host and may supervise CUSOM medical residents during the course of short-term residency rotations at Participating Site’s health care facilities listed in Appendix B;
NOW, THEREFORE, in consideration of the covenants and agreements hereinafter set forth and other good and valuable consideration, the receipt of which is hereby acknowledged, CUSOM and Participating Site agree as follows:
I. THE CLINICAL EDUCATIONAL EXPERIENCE
1. During the duration of this Agreement, Participating Site will provide supervised clinical medical training to selected CUSOM medical residents at
Participating Site’s health care facilities listed in Appendix B, attached hereto and incorporated herein.
2. Educational goals and objectives to be obtained by the residents while on rotation at the Participating Site have been developed jointly by the CUSOM
Program Director and Teaching Faculty and the Participating Site Director and
Teaching Faculty and are outlined in Appendix A, attached hereto and incorporated herein. To assure that the educational goals and objectives are obtained by the residents, the recommended period of assignment will be for a period of Enter number of months for Enter number of residents.

The Participating Site (rotation) Director who is responsible for the educational experience and supervision of residents shall be:
Enter Name and Credentials
Enter Academic Appointments
Enter Academic Institution
Participating Site will ensure that CUSOM medical residents have opportunities to participate in patient care activities of sufficient variety and significance and with sufficient frequency to achieve the competencies relevant to the individual residency rotation.
3. CUSOM medical residents will perform those medical activities as stated in the educational goals and objectives and permitted by local law and regulation under the guidance of a supervisory physician. CUSOM medical residents will participate in the treatment and care of patients under the supervision of a supervisory physician to the extent permitted by local law and regulation and the policies of the Participating Site.
4.
Mechanism for evaluating resident performance: Each resident will be evaluated in a manner consistent with GME policies. Evaluations are to be completed by both the Participating Site Teaching Faculty and the rotating resident(s) at the end of each rotation and sent to the CUSOM Program Director.
Enter specific information as to how evaluations will be performed, e.g., end of rotation online evaluations will be completed by attending faculty.
5.
CUSOM medical residents will work a schedule comparable to that of
Participating Site’s own medical residents, if any, and will participate in the care and treatment of patients at a level of responsibility comparable to that performed by Participating Site’s own medical residents, if any, to the extent permitted by local law and regulation and Participating Site’s policies.
6.
While at the Participating Institution the residents shall comply with all the
Participating Institution‘s applicable rules, regulations, polices, and other provisions addressing patient care activities, education experiences, research and other scholarly activities, and use of institution facilities. However, all CUSOM
Graduate Medical Education Committee (“GMEC”) Policies and Procedures, in particular those related to benefits, disciplinary actions, grievance procedures and requirements to comply with duty hour standards, shall govern the resident(s) while at the Participating Institution.
7.
Participating Site reserves the right to request the removal of any CUSOM medical resident who fails to follow the rules and procedures of Participating Site, exhibits disruptive or unprofessional behavior, presents a threat to the safety or welfare of others, or whose performance is deemed to be unsatisfactory by
Participating Site.
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II. OBLIGATIONS OF CUSOM
1. CUSOM medical residents will be responsible for obtaining any required or recommended vaccinations and immunizations prior to travel to Enter name of country.
2. CUSOM medical residents are responsible for their international medical insurance. Domestic health insurance has network and copay limitations for international treatment that may limit coverage and ability to respond abroad.
Residents are required to purchase through the Office of Global Education international medical insurance to cover their clinical rotation period. This coverage provides emergency medical insurance and evacuation coverage for medical, political and natural disasters.
3. All CUSOM medical residents will continue to receive their stipend and benefits per their training agreement for an approved international residency rotation unless otherwise determined.
4. All CUSOM medical residents who are permitted to participate in an international residency rotation have passed a criminal background check in the
United States.
5. All CUSOM medical residents have participated in training related to the standards of patient privacy and the confidentiality of medical records and related information.
6. CUSOM medical residents have undertaken and completed training on occupational safety and health precautions as prescribed by the U.S. Center for
Disease Control and Prevention.
7.
CUSOM medical residents are licensed to practice medicine or have a physician training license in the State of Colorado.
8. CUSOM will provide workers’ compensation insurance to cover any workplace injuries that may occur to CUSOM medical residents during the international residency rotation.
9. Both parties acknowledge and agree that CUSOM shall not provide professional liability insurance coverage for residents while they are participating in an international residency rotation at Participating site. CUSOM does not assume liability for the actions or omissions of its medical residents during the course of their residency rotations at Participating Site.
III. TERM
The Agreement is effective as of the date it is executed by both parties and expires five years thereafter unless there is a change in the named Program Director or the Rotation/Site Supervisor, or the Agreement is terminated by either party upon 90 days written notice. The Agreement may be extended beyond the initial term by the written
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mutual agreement of the parties. Termination of the Agreement shall not affect activities already in progress as of the date of notice of termination.
IV. PARTY REPRESENTATIVES
Each party to this Agreement will designate a representative to interact and communicate with the representative of the other party concerning all matters arising under this Agreement. The contact information for the designated representative of each party to this Agreement is set forth below:
For Participating Site:
Name:
Title:
Address:
Phone Number:
Email Address:
For CUSOM:
Name:
Title:
Address:
Phone Number:
Email Address:
V. RELATIONSHIP OF THE PARTIES
Nothing contained in this Agreement shall be deemed to create or constitute a partnership, joint venture, or relationship of principal and agent between the parties.
VI. ASSIGNMENT
Neither party shall assign its rights or obligations hereunder without the prior written consent of the other party and any purported assignment without such prior written consent shall be null and void.
VII. ENTIRE AGREEMENT
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This Agreement sets forth the entire understanding and agreement of the parties and supersedes any and all oral or written communications or understandings between the parties as to the subject matter of this Agreement and may not be changed, modified, or discharged, in whole or in part, except by a writing signed by both parties.
IN WITNESS WHEREOF , the parties hereto have caused this Agreement to be executed as of the date set forth herein by their duly authorized representatives .
Enter name of participating site Regents of the University of Colorado, a body corporate, for and on behalf of the
University of Colorado School of
Medicine, Office of Graduate Medical
Education
By: By:
Name: Richard D. Krugman, MD Name:
Title: Vice Chancellor for Health Affairs
Dean, School of Medicine
Date:
Title:
Date:
Name and Signature of Supervisor of Resident (if different than above):
___________________________________
Program Director Date
Enter program director name
Enter program name
Carol M. Rumack, MD Date
Associate Dean for GME
ACGME Designated Institutional Official
University of Colorado School of Medicine
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APPENDIX A
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APPENDIX B
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