CACMS Model Affiliation Agreement
January 2016
INTRODUCTION
This document model affiliation agreement has been reviewed and approved by the CACMS as meeting the requirements of CACMS Standard 1, Element 1.4 Affiliation Agreements. It is meant to serve as a guide for Canadian medical schools to ensure that the agreements between the medical school and its clinical affiliates address the areas specified in the accreditation element. The CACMS Element 1.4 is printed at the beginning of the agreement for reference purposes. Short titles have been added in brackets following each requirement. The text in the document is highlighted and the corresponding requirement of element 1.4 and a short title is noted e.g., [1.4 a. Access to Resources]. Other accreditation elements addressed in this agreement are highlighted and the corresponding element number and short title is enclosed in [brackets]. Other explanatory notes are printed in bold text and highlighted. The document was derived from an actual affiliation agreement between a Canadian medical school and its clinical affiliates accessed from the internet (publically accessible) and revised to address the requirements of element 1.4. The CACMS Secretariat acknowledges the contribution of Dr. John Drover and Kris Bowes, Faculty of Health Sciences, Queen’s University to the development of this document.
When using this model to develop a university specific affiliation agreement the user is advised to:
1. Replace Hospital/Health Authority [HA] with the actual name
2. Replace University/Faculty/School with the appropriate name
3. Remove the Introduction, all notes and the text of element 1.4
4. Replace the names of organizations and legislation that are province specific
5. Remove references to the accreditation element(s). If desired, these references can be replaced with explanatory footnotes in another part of the document. When providing affiliation agreements in the data collection instrument (DCI) for accreditation purposes, submit a version with the references to the accreditation element(s) embedded and highlighted as they are shown in the model agreement.
1.4 AFFILIATION AGREEMENTS
In the relationship between a medical school and its clinical affiliates, the educational program for all medical students remains under the control of the medical school’s faculty, as specified in written affiliation agreements that define the responsibilities of each party related to the medical education program. Written agreements are necessary with clinical affiliates that are used regularly for required clinical learning experiences; such agreements may also be warranted with other clinical facilities that have a significant role in the clinical education program. Such agreements provide for, at a minimum:
a) The assurance of medical student and faculty access to appropriate resources for medical student education. [1.4 a) Access to Resources]
b) The primacy of the medical school’s authority over academic affairs and the education/ assessment of medical students. [1.4 b) Primacy of the Medical School for Education Program].
c) The role of the medical school in the appointment and assignment of faculty members with responsibility for medical student teaching. [1.4 c) Faculty Appointment]
d) Specification of the responsibility for treatment and follow-up when a medical student is exposed to an infectious or environmental hazard or other occupational injury. [1.4 d) Environmental Hazard]
e) The shared responsibility of the clinical affiliate and the medical school for creating and maintaining an appropriate learning environment that is conducive to learning and to the professional development of medical students. [1.4 e) Learning Environment]
THIS AGREEMENT made in duplicate as of the XXXX day of XXXXXX, 20XX
BETWEEN [NAME OF UNIVERSITY] (“THE UNIVERSITY”) OF THE FIRST PART
AND
THE COMMUNITY TEACHING HOSPITAL OR THE COMMUNITY TEACHING SITE OR HEALTH AUTHORITY (“HOSPITAL” OR “COMMUNITY TEACHING SITE” OR “HEALTH AUTHORITY” hereafter referred to as “THE HOSPITAL/HA”) OF THE SECOND PART
CONTENTS PAGE
PREAMBLE 3
I INTRODUCTION 3
I.1 OBJECTIVE OF THE UNIVERSITY 3
I.2 SHARED OBJECTIVES OF THE UNIVERSITY AND HOSPITAL/HA 3
I.3 BASIS FOR AFFILIATION 4
I.4 DEFINITIONS AND INTERPRETATION 4
I.4.1 Definitions 4
I.4.2 Interpretation 5
I.5 APPLICABILITY OF UNIVERSITY POLICIES TO THE HOSPITAL/HA AND AMENDMENT
OF UNIVERSITY POLICIES 5
II. APPOINTMENT OF STAFF AND OVERSIGHT BY UNIVERSITY DEPARTMENT CHAIRS
AND DEANS 6
II.1 INTRODUCTION 6
II.2 POLICIES GOVERNING APPOINTMENTS 6
II.3 APPOINTMENT OF HOSPITAL HEALTH PROFESSIONAL TEACHING STAFF 6
II.3.1 Hospital Appointments 6
II.3.2 Terms and Conditions of Appointments 7
II.4 UNIVERSITY APPOINTMENTS 7
III TEACHING 7
III.1 INTRODUCTION 7
III.2 HOSPITAL/HA COMMITMENT 7
III.3 STUDENTS 7
III.3.1 Placement of Students 8
III.3.2 Transfer of Students 8
III.3.3 Termination of Student Placement for Unacceptable Behaviour 8
III.4 HOSPITAL CLINICAL PROGRAM PLANNING AND REVIEW 8
III.4.1 Program Planning 8
III.4.2 Quality Control 9
III.4.3 Responsibility to Inform of Circumstances Affecting Teaching Programs 9
III.4.4 Availability of Patients for Teaching 9
III.4.5 Facilities 9
III.4.6 Faculty Development 10
IV NON-DISCRIMINATION AND HUMAN RIGHTS 10
V HEALTHCARE DELIVERY 10
VI LIBRARY AND INFORMATION SERVICES 10
VII UNIVERSITY AND HOSPITAL USE OF EACH OTHER’S NAMES AND INSIGNIAS 10
VIII NOTIFICATION AND CONSULTATION 11
IX COORDINATION AND LIAISON 11
IX.1 UNIVERSITY/HOSPITAL COMMITTEES/WORKING GROUPS/TASK FORCES 11
IX.2 LIAISON 11
IX.2.1 Hospital 11
IX.2.2 University 12
X. CONFORMITY WITH OTHER HOSPITAL/HA AGREEMENTS 12
XI MAINTENANCE OF AFFILIATION 12
XII LIABILITY IN INDEMNIFICATION AND INSURANCE 12
XII.1 LIABILITY 12
XII.2 INDEMNIFICATION 13
XII.3 INSURANCE 13
XII.4 STUDENT WORKPLACE INSURANCE 13
XII.5 IMMUNIZATION 13
XII.6 INFECTIOUS OR ENVIRONMENTAL HAZARDS/OCCUPATIONAL INJURIES 14
XIII TERM, TERMINATION AND AMENDMENT OF THIS AGREEMENT 14
XIV GENERAL TERMS 14
XIV.1 ASSIGNMENT AND ENUREMENT 14
XIV.2 INDEPENDENT CONTRACTORS 14
XIV.3 GOVERNING LAW 14
XIV.4 FORCE MAJEURE 14
XIV.5 ENTIRE AGREEMENT 15
XIV.6 COUNTERPARTS 15
SIGNATURE PAGE 15
11
CACMS Model Affiliation Agreement
January 2016
PREAMBLE
The Hospital/HA and the University share a joint mission of health and health sciences education and research. This Agreement provides a framework for that, and the parties agree to work cooperatively to respond to their evolving relationship. This relationship between the Hospital/HA and University includes a willingness to identify joint academic missions and initiatives through mutual acknowledgments that recognize each other's contributions.
I INTRODUCTION
I.1 OBJECTIVE OF THE UNIVERSITY
The objective of the University is to enhance its teaching and research for the benefit of its students, faculty and the broader community. In all its teaching and research programs the University is committed to collaborating with Hospital/HAs, community teaching sites and other public sector institutions, where appropriate, to achieve the highest academic standards, to provide the best possible facilities and electronic library resources, and to recognize excellence in teaching.
In seeking to achieve the above objective, the University is committed to the following principles:
i) Respect for intellectual integrity, freedom of inquiry and rational discussion;
ii) Academic excellence and innovation;
iii) Diversity and equity;
iv) Fair and equitable treatment of all who work and study in the University, including clinical teachers at Hospital/HAs and other community sites;
v) Social responsibility;
vi) Collegial form of governance; and
vii) Fiscal responsibility and accountability.
The above objective and principles govern the University’s relationship with institutions with which it affiliates.
I.2 SHARED OBJECTIVES OF THE UNIVERSITY AND HOSPITAL/HA
WHEREAS the Hospital /HA and the University jointly and individually recognize the following objectives:
(a) The provision of high standards of health care and health maintenance for patients and the populations in which they originate;
(b) The provision of high standards of clinical education for medical, nursing, rehabilitation students [list all applicable programs], postgraduate trainees and other future health professionals;
(c) An understanding that patient care, education and programs of research and scholarship will be efficiently directed and coordinated between the University and the Hospital /HA within available resources provided by each party;
(d) A recognition by the Board of Directors of the Hospital/HA that the presence of the University in the Hospital, through its teaching and research programs, will focus attention on, and contribute to, the quality of patient care;
(e) A recognition by the University that it can better achieve its goals in clinical education and scholarly research with access to human and other resources at the Hospital/HA.
The objectives set forth above can best be achieved by a close and harmonious relationship between the Hospital and the University and by jointly and individually accepting the responsibilities set forth in this agreement. It is understood that this Affiliation Agreement is a statement of policies and principles, in the context of which specific arrangements pertaining to programs or educational activities may be set out in separate memoranda of understanding that may be exchanged from time to time between the Hospital/HA and the University.
I.3 BASIS FOR AFFILIATION
The University and the Hospital/HA have a mutual interest in the enhancement of education of health professionals, research and evidence-based practice.
In order for the University to offer programs of education and professional training in health and health- related fields, it must have access to the facilities of healthcare institutions and organizations, so that it may offer clinical and practical experience to its learners enrolled in these programs.
Because of its mission and facilities, the Hospital/HA has resources and services necessary for the support of teaching and research and is willing to make them available to the University for teaching and research purposes as appropriate.
Because of its mission and facilities, the University has resources and services necessary for the support of teaching and research and is willing to make them available to the Hospital/HA as appropriate.
Both the University and the Hospital/HA recognize their roles and responsibilities in the provision of health care.
Both the University and the Hospital/HA recognize the importance of academic freedom and the need to safeguard the intellectual independence of all faculty members.
Notwithstanding the mutual respect of the University and the Hospital/HA for academic freedom, all faculty (as hereinafter defined) remain subject to applicable ethical and clinical guidelines or standards, laws and regulations and to the Hospital’s relevant policies or by-laws.
Therefore it is the purpose of this Affiliation Agreement to provide a foundation upon which the University and the Hospital/HA may collaborate and cooperate in their efforts to accomplish their objectives.
I.4 DEFINITIONS AND INTERPRETATION I.4.1 Definitions
In this Agreement,
a. Clinical faculty means a health practitioner with a University appointment, licensed by her or his respective college, holding a professional staff appointment at the Hospital/HA. Health Science faculty means health professional staff of the Hospital/HA who have a University appointment.
b. Clinical preceptor means a health care practitioner engaged in the teaching of students in the Hospital/HA.
c. Joint Committee means a Joint Committee as set out in section XI below.
d. Student means a person formally registered in a Faculty of the University in a program of study. A Student may be registered in an undergraduate, graduate, or a postgraduate health sciences education program. Persons present in the Hospital/HA in training situations who are not registered as Students of the University are not Students within the meaning of this section.
e. Teaching Programs means programs within various University Faculties or Departments (including, but not limited to: Medicine, Nursing, Rehabilitation Therapy [list all existing programs] that place students in the Hospital/HA and, if applicable, its research institute.
I.4.2 Interpretation
a. Subject to the terms of this agreement, the University and the Hospital/HA have the sole authority to make decisions about and to exercise their discretionary authority regarding their respective resource allocations, programmatic changes and/or use of or access to their respective premises or facilities.
b. No person who is not a party to this agreement has any right to enforce any term of this agreement.
c. Except as may be provided herein, this agreement shall not be interpreted or applied so as to fetter the respective authority, duties or responsibilities of the University or the Hospital/HA under their respective constituting statutes, letters patent, governing legislation, by-laws or policies.
d. Nothing in this agreement shall be interpreted or applied so as to interfere with statutory obligations.
e. Nothing in this agreement creates an employment relationship between any student and either the Hospital/HA or the University.
f. Where any person or position is referred to in this agreement, except where the agreement specifies that the responsibility may be delegated, such person may delegate his/her responsibilities only if the Hospital/HA and the University have approved such delegation.
g. References to specific legislation in this agreement include any amendments made from time to time to such legislation and include any regulations, as amended from time to time, made under such specific legislation.
h. In the event a provision of any Schedule to this agreement is inconsistent or conflicts with a provision of the agreement, the terms of this agreement shall take precedence and govern to the extent of any such inconsistency or conflict.
I.5 APPLICABILITY OF UNIVERSITY POLICIES TO THE HOSPITAL/HA; AMENDMENT OF UNIVERSITY POLICES AND ACCREDITATION STANDARDS
i) The Hospital/HA agrees that the University is bound by the following University policies, procedures, guidelines and protocols as found in the following [Name of University] “URL” sites as amended from time to time:
CACMS STANDARDS AND ELEMENTS
RCPSC Accreditation Standards:
CFPC Accreditation Standards
CPSO Professional Responsibilities in Undergraduate Medical Education: [Use organizations appropriate for the Province in which the Medical School resides].
CPSO Professional Responsibilities in Postgraduate Medical Education:
[Name of University] Policies:
[NAME OF UNIVERSITY] Undergraduate Medicine Policies:
[NAME OF UNVERSITY] Postgraduate Medicine Policies:
ii) Where the policies of the University referred to in this subsection and policies of the Hospital/HA are in conflict, the matter will be referred to the Joint Committee as set out in Section XI or to other committees as specified in this Agreement or as otherwise agreed by the parties.
iii) If the University proposes to implement any new policy, procedure or guideline or if there are any substantive changes to the accreditation standards, which could have an impact on the parties’ obligations under the Agreement, the University will specifically advise the Hospital/HA of those changes. If a proposed new University policy, procedure or guideline includes Hospital/HA obligations; the University will work collaboratively with the Hospital/HA with the goal of obtaining the Hospital/HA’s agreement to be bound by the proposed policy, procedure or guideline. In no event will any new University policy, procedure or guideline that is not agreed to by the parties be binding on the parties.