Delivery of medial care
The resident shares, on an interdisciplinary basis, in the delivery of medical care in the establishment according to his competence and level of training.
He collaborates in the establishment’s teaching instruction and sits on the establishment’s different committees.
The agreement recognizes the importance of the principle of interdisciplinarity that is already part of residents’ reality. The article also adds additional protection for the resident by recognizing that he must deliver care in line with his level of training and competency.
When a resident is available to perform a medical act, only a staff physician or the attending physician may act in his place.
Within the framework of your rotation, if you are available to perform a medical act relevant to your training, a clinical clerk or other health professional may not be asked to perform that act in your place. This guarantees your right to clinical exposure in the context of your postgraduate education.
Code of ethics
The resident shall comply at all times with the same rules as are applied to physicians, in particular those with respect to the Code of Ethics, issuance of prescriptions, and record-keeping, always under the direct or indirect supervision of competent individuals.
Delegated medical act
The resident shall not be obliged to perform a medical act delegated by the Council of Physicians, Dentists and Pharmacists in the establishment in which he is working unless performance of such act is necessary for his training.
Non delegated medical act
The establishment, through its Director of Professional Services, shall refer any applications from the association to exempt residents from routinely performing all non-delegated medical acts to the Council of Physicians, Dentists and Pharmacists.
The Council of Physicians, Dentists and Pharmacists shall issue its ruling within sixty (60) days of the application. In the event of a favourable ruling from the Council of Physicians, Dentists and Pharmacists, the resident shall be exempted accordingly.
The training card issued by the Collège is not a permit to practise medicine. It does not allow you to practise solo, outside the residency framework. Thus, the training card entitles you to perform only acts corresponding to your level of training.
While you are not a member of the Order, you are nevertheless subject to the Code of Ethics of Physicians and to several regulations adopted by the Collège.
The medical resident number associated with this training card assigned by the Collège enables the provincial health insurance board (RAMQ) to pay, on beneficiaries’ behalf, the cost of pharmaceutical services and medication supplied by a pharmacist on a prescription from a medical resident.
That being said, you may treat a patient at home and write him a prescription even if the patient’s home is never mentioned on your card. The Collège believes the patient’s home need not appear on the training card, because the rotation site is not limited to the confines of the establishment. According to the Collège, the rotation site includes all locations where training activities take place, provided only that these locations are known to it. In light of the Collège’s position, you can write prescriptions when you treat a patient at home within the framework of your training.
You are not required to have every prescription for medication pre-authorized by the staff physician. But he retains the right to change it. No prescription forms may be signed in advance by the staff physician. Similarly, no prescriptions may be signed by a resident on a staff physician’s behalf.
Note that you must at all times have direct or indirect supervision from the staff physician, who must thereby ensure that you perform medical acts in line with your competencies.
Availability of staff physicians
The resident shall be able to count at all times on the immediate availability of a physician who is a member of the Council of Physicians, Dentists and Pharmacists.
When working in the emergency room, the resident shall, at all times, be able to count on the presence in the emergency room of a physician who is a member of the Council of Physicians, Dentists and Pharmacists.
The resident shall never have responsibility for a resuscitation team within six (6) months of starting residency and until he has successfully completed six (6) months’ training in a medical or surgical discipline. Also, he must hold an attestation certifying that he has passed the Advanced Cardiac Life Support (ACLS) course or the Advanced Pediatric Life Support (APLS) course, depending on the users treated in the establishment.
While you are on call, you must be able to reach a staff physician at all times. Your staff physician does not, however, have to be within the confines of the hospital. He may be on call at home.
The rule is different when you are working in Emergency, though. In that case, a staff physician has to be present at all times in the Emergency Department.
It is important to remember that residents with less than six months’ training may be part of the resuscitation team, but may not be in charge of it. Also, a resident who has not performed a rotation in a medical or surgical specialty cannot be responsible for the code team. For instance, a resident in psychiatry who performs his first six months of rotations in residency in his specialty cannot be responsible for a resuscitation team in his first year of residency.
In addition, Article 12.08 stipulates that, during the first six months of training, you may not perform call duty without the presence on-site of a staff physician or a resident other than an R1.
The resident may not be assigned duties detrimental to his training.
For instance, assigning call duty to a resident that is neither of his level of training nor in his specialty could be considered detrimental to his training. Nor, to punish a resident, could he be assigned to duties with no pedagogical value, since that would also be detrimental to the quality of his training.