Important Information - Application Deadline: September 1, 2017

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MEDICAL LICENSURE PROGRAM FOR INTERNATIONAL MEDICAL GRADUATES (MLPIMG) 1-YEAR TRAINING PROGRAM INFORMATION 2018 ADMISSION Important Information - Application Deadline: September 1, 2017 The Medical Licensure Program for International Medical Graduates (MLPIMG) is a one-year training program designed to enhance the IMG physician s previous training. Physicians who successfully complete the MLPIMG Program may apply to the College of Physicians and Surgeons of Manitoba for Conditional Registration. MLPIMG Program graduates will subsequently be expected to practice in an underserviced area of the province of Manitoba (as declared by the Minister of Health for the Province of Manitoba) for return of service. For one year following the MLPIMG, the candidate will have an assigned mentor who will provide additional support and guidance to the individual physician (Mentorship and Clinical Enhancement Program). In addition, as part of the licensing requirement, physicians will have an assigned medical practice supervisor who is responsible to review issues and provide monitoring reports to the CPSM. Submitting an application does not guarantee admission to the MLPIMG. All applicants will undergo the same application and selection process. Please ensure you meet all application criteria and requirements prior to applying. Incomplete applications will not be reviewed; it is the sole responsibility of the applicant to ensure the application is complete. Application forms are available from the Rady Faculty of Health Sciences, Max Rady College of Medicine website or by calling (204) 975-7757. The deadline for the IMG Program office to receive your application is September 1, 2017. MLPIMG APPLICATION PROCESS: Eligibility criteria met Application of MLPIMG Evidence of Preregistration Physician Training acceptable to the CPSM* Program Interview Sponsorship Interview Sponsorship Confirmed Orientation MLPIMG Training Begins MLPIMG Important Information I

1. MLPIMG APPLICATION CRITERIA Applicants for the MLPIMG must meet the following requirements: must submit complete MLPIMG application package to the IMG Program at the University of Manitoba by the due date (see Important Dates schedule); must be a permanent resident (landed immigrant) or Canadian citizen; must have a minimum of one year of postgraduate medical education acceptable to the College of Physicians and Surgeons of Manitoba (Preregistration Physician Training Requirements); must have a pass standing on the Medical Council of Canada Evaluating Exam (MCCEE); must have a pass standing on the Medical Council of Canada Qualifying Examination Part 1 (MCCQE Part 1); must have a pass standing on the NAC OSCE exam. Results are to be submitted with your application by the deadline of September 1, 2017; must have practiced independently as a general or family practitioner for at least 12 months; must show evidence of Currency in Practice - minimum of 12 consecutive months of independent clinical practice as a General/Family Practitioner in 5 years immediately preceding the application deadline; must have valid proof (within 2 years) of English language proficiency. Exams dated prior to September 1, 2015 or after September 1, 2017 will not be accepted: Test of English as a Foreign Language (TOEFL) TOEFL-iBT with a total score of 96 and with minimum score of 24 in each component; or International English Language Testing System (IELTS TM Academic Module) with a minimum score of 7 in each component with an overall band score of no less than 7. 2. APPLICATION REVIEW for the MLPIMG All applications that meet the minimum stated requirements will be reviewed by the IMG Selection Committee. The Selection Committee considers previous clinical experience, results of the MCC exams, references and other factors. Preference will be given to residents of the Province of Manitoba and applicants with demonstrated commitment and experience in primary care in rural/remote settings. Following a review of all applications, applicants will be short-listed and a select number will have their postgraduate training verified by the CPSM. 3. EVIDENCE OF PREREGISTRATION PHYSICIAN TRAINING ACCEPTABLE TO CPSM Applicants must submit evidence of postgraduate clinical training to PhysiciansApply.ca for verification by the MLPIMG application due date. Since this process may take time, please ensure evidence is sent as soon as possible. It is the applicant s responsibility to ensure that all required documents are received by the deadline. The CPSM will review preregistration training documentation which has been source verified by PhysiciansApply.ca. It should be noted that source verification does not mean that the training is approved by the CPSM, only that the College is prepared to review the content of the document(s) which were submitted to PhysiciansApply.ca. 4. INTERVIEWS for the MLPIMG Top ranked applicants will be invited for an in-person interview. Multiple interviewers will administer a structured interview that will last approximately 30 minutes. The interview does NOT directly test medical knowledge but includes questions related to your professional experiences (effective communication skills, critical thinking skills, adaptability, collaborative skills and experience, understanding of the Canadian/Manitoba health care system etc.). 5. SPONSORSHIP Top ranking candidates will be invited for a sponsorship interview with representatives of the Manitoba Healthcare Providers Network and Regional Health Authorities (RHAs). Successful candidates will be required to complete a return of service in Manitoba (current duration 4 years). Only applicants who are offered and subsequently accept sponsorship by a RHA will be accepted in the MLPIMG Program. MLPIMG Important Information II

6. PRIOR TO BEGINNING TRAINING Successful applicants will be registered on the Educational Register with the CPSM for the one year of training plus the one month orientation. The CPSM will contact you directly regarding the application process for registration. All selected candidates will be directed to the Rady Faculty of Health Sciences, University of Manitoba, to be admitted to the training program, will be registered in Postgraduate Medical Education (PGME), and will be subject to PGME regulations where indicated. 7. ORIENTATION All candidates in the MLPIMG will complete a MANDATORY 4-week structured orientation prior to commencing the enhanced residency training. 8. MLPIMG PROGRAM INFORMATION Selected candidates who meet all the admission criteria and complete the orientation will be scheduled to complete the following 13 four-week PGME rotations: Emergency Medicine 2 rotations (8 weeks urban or 8 weeks rural); Family Medicine (urban and rural) 3 rotations (12 weeks); Gynecology 1 rotation (4 weeks); Obstetrics 1 rotation (4 weeks); Internal Medicine 2 rotations (8 weeks); Pediatrics (outpatient) 1 rotation (4 weeks); Pediatrics (ward) 1 rotation (4 weeks); Psychiatry 1 rotation (4 weeks); and Vacation 1 rotation (4 weeks). An evaluation is returned to the IMG Program after each rotation. Failure of any one rotation may be resolved with a successful remediation. Failure of any two rotations will result in termination from the MLPIMG training program. 9. MENTORSHIP Following the successful completion of training, MLPIMG candidates will be supported by a mandatory Mentorship Program for a one year period administered by the IMG Program. 10. LICENSURE Candidates who have successfully completed the MLPIMG may be eligible to apply for Conditional Registration with the College of Physicians and Surgeons of Manitoba. Upon receiving Conditional Registration from the CPSM, physicians may begin their practice in primary care. During this time they will work closely with a practice supervisor and mentor, have mandatory audits and will have up to 5 years to obtain the Licentiate of the Medical Council of Canada (LMCC) and the Certificate of the College of Family Physicians of Canada (CCFP). (The requirements are subject to change without notice and the terms of the legislation at the time of application for registration will prevail.) For further information on how to apply please see the Medical Licensure Program for International Medical Graduates (MLPIMG) Application Package. MLPIMG Important Information III

IMPORTANT DATES: MEDICAL LICENSURE PROGRAM FOR INTERNATIONAL MEDICAL GRADUATES (MLPIMG) DATE September 1, 2017 October 1, 2017 November 2017 (tentative) January 31, 2018 February or March, 2018 June 1, 2018 July 1, 2018 INFORMATION REQUIRED MLPIMG application package must be received by the University of Manitoba, IMG Program by this deadline date Evidence of Preregistration - Physician Training must be received by PhysiciansApply.ca by this deadline This process can take time, please ensure evidence is sent to PhysiciansApply.ca as soon as possible. It is the applicant s responsibility to ensure that all required documents are received by the deadline Shortlisted applicants are sent to the CPSM for a review of their postgraduate training. Shortlisted applicants will undergo Program Interviews Postgraduate training of selected candidates verified by the CPSM A select number of applicants are invited to Sponsorship Interviews. Applicants are advised of their acceptance into the MLPIMG within one month of the interview Mandatory One Month Orientation MLPIMG Training begins The information in this document is kept as up to date as possible by the IMG Program. Notwithstanding, please be advised that elements of the program are in ongoing development and as such may be subject to change without notice. MLPIMG Important Information IV

MEDICAL LICENSURE PROGRAM FOR INTERNATIONAL MEDICAL GRADUATES (MLPIMG) 1-YEAR TRAINING PROGRAM INFORMATION - FOR 2017 SESSION Application Package - Deadline: September 1, 2017 Eligible applicants for the MLPIMG must submit a completed application form (including all supporting documents) to: International Medical Graduate Program University of Manitoba, Rady Faculty of Health Sciences Room 260 Brodie Centre, 727 McDermot Avenue Winnipeg, MB R3E 3P5 Application forms are available from the Rady Faculty of Health Sciences, Max Rady College of Medicine website or by calling (204) 975-7757. To ensure that applications will be processed they must be received by the IMG Program office by the application deadline and must include all required supporting documentation (see Document Checklist). Late applications will not be considered. Applicants are eligible to apply to only ONE program per intake year. Submitting an application to the MLPIMG means you may NOT submit an application for the PRA-FP. The IMG Program will NOT accept applications for both programs from one individual. All supporting documentation must be in English or must include an English translation. All copies must be notarized. Please do not send original documents as documentation will not be returned. Information submitted by applicants will be used only for the administration and management of this program. It will not be shared without the applicant s written permission. Submission of falsified documents will result in rejection for current and future applications and will be reported to the College of Physicians and Surgeons of Manitoba. Included in the MLPIMG application package are: Important information (pages i-iv); a document checklist itemizing the documentation that must accompany each application (page 2); the 3-page application form; Authorization for Release of Information to the CPSM form to be completed and returned with the application; and Contact Information form to fill out with names of the individuals at the medical school at which you completed your postgraduate medical training (include phone/fax numbers, addresses, e-mail addresses as well as the date at which you submitted Evidence of Preregistration Training to Physiciansapply for verification). IMPORTANT: You will need to register and submit a source verification request to PhysiciansApply.ca (please refer to the Services tab for instructions). If you are already registered with PhysiciansApply.ca, please ensure that you update the Document Sharing section to enable the CPSM to view your profile (please refer to the Services tab on PhysiciansApply.ca for instructions). The information in this application package is kept as up to date as possible by the IMG Program. Notwithstanding, please be advised that elements of the program are in ongoing development, and as such may be subject to change without notice. MLPIMG Application 1

MEDICAL LICENSURE PROGRAM FOR INTERNATIONAL MEDICAL GRADUATES (MLPIMG) Document Checklist Name: (Please print) Please submit all documents in the following order: Completed Application Form Proof of citizenship or permanent resident status (notarized photocopy of permanent resident document IMM 1000, or citizenship card/canadian passport or by sharing through your physiciansapply.ca account with the University of Manitoba International Medical Graduate and Clinician Assessment Programs (UMIMG-CAP)) Resident of Manitoba yes no If yes provide proof of residency in Manitoba (notarized photocopy of both sides of Manitoba Health card or Manitoba Driver s license, if applicable) Authorization of Release of Information (completed form) Contact information for the University where you completed your postgraduate training (completed form and attach a copy of the documents submitted to Physiciansapply). Please ensure that all documents have been shared with the College of Physicians and Surgeons of Manitoba. Proof of pass standing on Medical Council of Canada Evaluating Examination (notarized copy of letter from Medical Council of Canada or by sharing your result through physiciansapply.ca account with the University of Manitoba International Medical Graduate and Clinician Assessment Programs (UMIMG-CAP)) Proof of pass standing on the Medical Council of Canada Qualifying Examination Part 1 (notarized copy of letter from Medical Council of Canada or by sharing your result through physiciansapply.ca account with the University of Manitoba International Medical Graduate and Clinician Assessment Programs (UMIMG-CAP)) Proof of pass standing on the Medical Council of Canada Qualifying Examination Part 2 if available Proof of pass standing on the NAC OSCE exam (notarized copy of letter from the Medical Council of Canada or by sharing your result through physiciansapply.ca account with the University of Manitoba International Medical Graduate and Clinician Assessment Programs (UMIMG-CAP)) Notarized copy of TOEFL-iBT or IELTS (Academic Module) test result Personal Letter outlining your suitability for the MLPIMG Program such as your practice profile and previous experience (max 1000 words) Three (3) current letters of reference included in the package letters should be signed and dated by the referees and be no greater than 24 months old (faxed, photocopied or emailed reference letters will not be considered). Do not submit more than three letters of reference as only the first three references will be reviewed. Please provide detailed and current contact information for your referees on the attached application form. Referees must be three persons with recent professional/educational knowledge of you none of whom may be related to you and one of whom must be: (a) for physicians who have recently completed postgraduate clinical training, your supervisor responsible for training; (b) a physician in a supervisory position in a hospital where you have practised most recently; or (c) a physician colleague with whom you have practised most recently. Curriculum vitae (current within 3 months) The Medical Licensure Program for International Medical Graduates (MLPIMG) is supported by: Max Rady College of Medicine at the University of Manitoba, The College of Physicians & Surgeons of Manitoba and Manitoba Health MLPIMG Application 2

MEDICAL LICENSURE PROGRAM FOR INTERNATIONAL MEDICAL GRADUATES (MLPIMG) Application Form - PAGE 1 of 3 Please type or print clearly. Last Name: First Name(s): Birth Date: (Day/Month/Year) Street Address: City: Province: Postal Code: Telephone: (home) (work) (Cell) Email: Citizenship: If not Canadian citizen, landed immigrant: yes no Date of Permanent Move to Canada: (Month/Year) Resident of Manitoba: yes no Date of Permanent Move to Manitoba: (Month/Year) Medical Council of Canada Evaluating Examination (MCCEE): NAC OSCE Results: (Month/Year Passed) (Date Taken/Exam Site) (Result Attached/Result Pending) Medical Council of Canada Qualifying Examination Part I (MCCQE I): Part II (MCCQE II): (Month/Year Passed) (if available) (Month/Year Passed) Medical School: Date of Graduation: (Name - Location-Country) (Month/Year) Physiciansapply/Candidate Code Number (MCC): MINC Number: PCRC ID Number: Certification in a Specialty: Postgraduate Medical Education: (Area of Specialty/Year obtained/location-country) (Area of Medical Training) (Medical School) (Day/Month/Year Start) (Day/Month/Year Complete) (Area of Medical Training) (Medical School) (Day/Month/Year Start) (Day/Month/Year Complete) (Area of Medical Training) (Medical School) (Day/Month/Year Start) (Day/Month/Year Complete) (Area of Medical Training) (Medical School) (Day/Month/Year Start) (Day/Month/Year Complete) (Area of Medical Training) (Medical School) (Day/Month/Year Start) (Day/Month/Year Complete) (Area of Medical Training) (Medical School) (Day/Month/Year Start) (Day/Month/Year Complete) Postgraduate Degrees/Qualifications & dates attained: MLPIMG Application 3

MEDICAL LICENSURE PROGRAM FOR INTERNATIONAL MEDICAL GRADUATES (MLPIMG) Application Form - PAGE 2 of 3 Name: (Please print) Details of Last 5 years of Practice Experience: Include detailed information from August 31, 2012 to August 31, 2017 in the templates below. Use additional pages if necessary. ATTESTATION TO INDEPENDENT PRACTICE: I attest that my most recent practice (listed below) has been independent, meaning that I have practised without supervision or oversight by another physician: yes no Location (city of town, province or state and country (Day/Month/Year Start) (Day/Month/Year Complete) Brief description of the practice: Hours of work per week: Contact information: Location (city of town, province or state and country (Day/Month/Year Start) (Day/Month/Year Complete) Brief description of the practice: Hours of work per week: Contact information: Location (city of town, province or state and country (Day/Month/Year Start) (Day/Month/Year Complete) Brief description of the practice: Hours of work per week: Contact information: MLPIMG Application 4

MEDICAL LICENSURE PROGRAM FOR INTERNATIONAL MEDICAL GRADUATES (MLPIMG) Application Form - PAGE 3 of 3 Currently working: yes no Type of Work: Contact Information for References: Reference #1 Name: Relationship to Candidate: Telephone: Fax: Email: Reference #2 Name: Relationship to Candidate: Telephone: Fax: Email: Reference #3 Name: Relationship to Candidate: Telephone: Fax: Email: Applied to MLPIMG in a previous year yes no if yes, what year(s): Evidence of Preregistration - Physician Training submitted to the PhysiciansApply.ca: yes no Date Submitted: (Day/Month/Year) Signature Date MLPIMG Application 5

AUTHORIZATION FOR RELEASE OF INFORMATION TO: College of Physicians & Surgeons of Manitoba 1000 1661 Portage Avenue Winnipeg, MB R3J 3T7 Tel: (204) 774-4344 Fax: (204) 774-0750 AND TO: The Medical Licensure Program for International Medical Graduates (MLPIMG) University of Manitoba, Max Rady College of Medicine Room 260 Brodie Centre -727 McDermot Avenue Winnipeg, MB R3E 3P5 Tel: (204) 975-7757 Fax: (204) 789-3911 You are hereby authorized to release to each other, any and all information received by the College of Physicians & Surgeons of Manitoba (the College) or the MLPIMG respecting my applications for registration with the College, my application (s) to participate in the MLPIMG and all information of any nature relevant to those applications, including but not limited to my postgraduate clinical training and/or practice experience. This authorization shall continue until revoked by me, in writing. Signed by me at the City of, in, this day of, 20 WITNESS Signature of Applicant Print Name of Witness Print Name of Applicant Please note that the authorization is only revocable by written, signed and dated instructions from you. If at any time you wish to revoke the authorization that you have given to the College, please contact the College immediately. MLPIMG Application 6

PREREGISTRATION PHYSICIAN TRAINING REQUIREMENTS Physicians are required to provide evidence of satisfactory completion of a 12 month postgraduate clinical training program in a hospital affiliated with an approved faculty of medicine. The following conditions must be met: 1. (a) that the physician was enrolled in a university postgraduate teaching program; (b) (c) the teaching occurred in a hospital/ medical clinic affiliated with an approved faculty of medicine whose faculties are on-site and which provided supervision and formal evaluation by the teaching staff; and that the postgraduate education is recognized for the purposes of registration in the jurisdiction of graduation. 2. That during a one year postgraduate training program, the core content (8 weeks each in general medicine, general surgery, obstetrics and gynecology and pediatrics) was under the direction of a single program director. 3. Please also include evidence of any additional postgraduate medical training received. MLPIMG Application 7

Contact Information for University where Postgraduate Medical Training was completed (See Preregistration Physician Training Requirements) To: The College of Physicians and Surgeons (To be included in MLPIMG application package) Applicant Name: Last Name First Name(s) University Name: University Address: Phone Number: Fax Number: Contacts (if applicable): 1. Title Name Position Phone Number: Fax Number: Email: 2. Title Name Position Phone Number: Fax Number: Email: Date on which you submitted Evidence of Preregistration Training to PhysiciansApply.ca for verification: (Attach a copy of the documents submitted to PhysiciansApply.ca) Applicant Signature (Day/Month/Year) Date The CPSM will review preregistration training documentation which has been source verified by PhysiciansApply.ca. It should be noted that source verification does not mean that the training is approved by the CPSM, only that the College is prepared to review the content of the document(s) which were submitted to PhysiciansApply.ca. You will need to register and submit a source verification request to PhysiciansApply.ca (please refer to the PhysiciansApply.ca Services tab for instructions). If you are already registered with PhysiciansApply.ca, Please ensure that you update the Document Sharing section to enable the CPSM to view your profile (please refer to the PhysiciansApply.ca Services tab for instructions). Please provide your PhysiciansApply.ca registration number here MLPIMG Application 8