Clinical Scholars Program

This program was established to provide an extra period of time for specialized post certification training for selected individuals. During the interval, the applicant will undertake either additional specialized training in clinical procedures or formal research training at the Masters or Doctorate level. In some cases the appointees have joined the full-time faculty following their Clinical Scholar year. This category of appointment has also been used on occasion to provide research leave replacement.

Basic Regulations and Policies

• Candidates must be either Canadian citizens or have permanent resident status in Canada (i.e. landed immigrant status) or an appropriate work permit/Visa.
• They must have successfully completed the requirements for the Royal College of Physicians and Surgeons of Ontario or equivalent certification, hold an independent practice licence with appropriate scope from the College of Physicians and Surgeons of Ontario, and have an OHIP provider number and malpractice insurance from the CMPA.
• A Clinical Scholar is permitted to admit patients only under the care of a designated hospital staff member. However, admitting privileges may be granted to certain scholars who are certified by the Royal College of Physicians and Surgeons of Canada or by the College of Family Physicians on the recommendation of the Chief of Hospital Department.
• The appointment is usually for one academic year (July 1st to June 30th) and can be renewed for a subsequent academic year(s).  Appointment for less than one academic year will usually on June 30th.  However, the clinical scholar will not be eligible for benefits since eligibility for benefits is restricted to appointments of one year in duration or longer.
• Remuneration provided is comprised of a base salary and a draw on professional earnings or ceiling payment. Rates are set annually at July 1. The total remuneration of the Clinical Scholar is determined by the academic Department in accordance with the clinical practice plan.  The total income of the Clinical Scholar is benchmarked against the PAIRO scale where the Clinical Scholar’s total compensation should exceed their last year of residency training.  It is also benchmarked against the total compensation of an Assistant Professor in the same specialty/subspecialty and their income would not exceed this starting salary.  Normally, there is an income progression if the Clinical Scholar is reappointed for a second or subsequent years.  Total compensation is negotiated between the Clinical Scholar, their clinical and research mentors, and the University Department Chair.  Final approval rests with the Dean and Vice-President, Health Sciences.  The minimum base salary is $10,000 per annum and is funded through the Clinical Practice Plan.  In many cases, the salary is recovered from the AHSC Alternative Funding Plan.  If the candidate has an external research fellowship or other source of research support, then the base salary will be increased to include that amount and the ceiling adjusted to maintain the negotiated total compensation.
• Required OHIP earnings are established for each Clinical Scholar, and decisions with respect to guaranteed ceiling payments and/or eligibility for incentive payments are made at a departmental level.  In several instances candidates have been awarded Fellowships to support their additional year of training. If an external Research Fellowship award is received, the base salary becomes the amount of the Fellowship, the ceiling the difference between the established total remuneration and the Fellowship.  In selected disciplines (Pathology, Medical Oncology, Radiation Oncology, Pediatrics), the clinical activities of the scholar may be funded from a non-OHIP source such as an alternate funding plan and/or HRLMP.  In this event, the appropriate adjustments will be made to the Salaries and Earnings Schedule to recognize the source of clinical earnings. 
• Fringe benefits from the University will be limited to those normally offered for a one-year appointment and are usually funded from the Clinical Practice Plan. These are group coverage for major medical insurance plan, life insurance, salary continuation and long-term disability. Excluded is participation in the pension plan.  Participation in the dental care plan and/or the voluntary Personal Accident Insurance Plan is optional.  The premium(s) is paid by the Clinical Scholar.
• In addition to salary, a professional development allowance of $1,000 per year is normally provided for travel, professional books or memberships funded by the clinical earnings of the clinical scholar.
• The scholar will be a member of Regional Medical Associates (RMA) and will participate in the Allowed Business Expense (ABE) of RMA in the form of parking expenses at sites of clinical responsibility, paging services, annual licensing costs with the College of Physicians and Surgeons of Ontario, the Royal College of Physicians and Surgeons of Canada, and the Canadian Medical Protective Association.  The cost of the ABE package is recovered from the clinical earnings of the clinical scholar.  Note that initial registration fees with the Ontario and Royal College are not covered, only the annual dues.
• The program is intended to be self-sustaining financially, i.e. clinical revenues accruing in the scholar’s name for the period of the appointment should be sufficient to cover total costs of the appointment. These clinical revenues should be new RMA revenues, which would not otherwise be realized by current full-time faculty members.
• Secretarial needs of the scholar must be met from within the existing clerical/secretarial complement at the appointee’s base institution, or the scholar must agree to generate the clinical revenues required to hire additional secretarial time.
• Recommendations for appointment are submitted to the Dean/VP Health Sciences for the approval of the Council of the Michael G. DeGroote School of Medicine at the May meeting.
• The Clinical Scholar must apply for medical staff membership and privileges at the relevant hospital(s) either Hamilton Health Sciences or St. Joseph’s Healthcare Hamilton in addition to completion of the appointment package for the University appointment.  At least three months is required for hospital approval of this application.
• Clinical Scholars are eligible to enroll in the AHSC AFP alternate funding plan as a participating physician.
• As per the Yellow Document, time spent as a Clinical Scholar may be used to adjust the academic start date for tenure and promotion should the individual become a full-time faculty member in the future.

Note: CLINICAL SCHOLAR reference in current HHS By-Laws (March 2007):

“Clinical Scholars” means Physicians who wish an additional period of specialized post-residency training involving clinical care and academic pursuits. Appointment to the hospital medical staff will be granted in conjunction with an appropriate Faculty of Health Sciences appointment.  When credentialed, they are usually privileged under the LOCUM [Clinical Scholar] staff category in the Hospital.

 

Instructions to Sponsoring Faculty Supervisor

If you wish to recommend a candidate for a Clinical Scholar appointment, please contact Dr. James Bourgeois (x36659; bourgej@mcmaster.ca), Vice-Chair Education. The following information should be forwarded to Wendy Mattingly (mattingl@mcmaster.ca) prior to meeting with the Vice-Chair.

• Location of the scholar’s clinical work and confirmation that the required clinical time and facilities are available.  It is essential that approval be obtained from the Division Director (McMaster University), the Service Head (host hospital), the CEO or VP Medical (host hospital), and the Department Chief (host hospital).  The signed application form must be sent to the Department Chair who will subsequently recommend the appointment to the Dean/VP.
• A detailed estimate of projected clinical revenues and a statement of assurance that the scholar’s clinical work will be a net addition to RMA billings and not a re-allocation from the billings of yourself or another RMA member (See No. 9 on the attached Faculty “Regulations and Procedures for Appointment of Clinical Scholars”)
• A statement indicating whether adequate space and secretarial support is available (See No. 10 on the attached Faculty “Regulations and Procedures for Appointment of Clinical Scholars” - Appendix B)
• A description of the academic (research, education) and clinical activities for the scholar and the name of the clinical and research mentors
• A copy of the candidate’s curriculum vitae (in McMaster format).

• Evidence of external funding (re CIHR research fellowship or internal AFP funding or internal research funding).  Indicate relevant university account numbers on payroll forms.

If the proposal is considered viable and is accepted, it will then be submitted to the Dean/VP for the next agenda of Council of the Michael G. DeGroote School of Medicine for approval.

This form must be completed and submitted to the Office of the Department Chair not later than April 15 each year

Application Form and Approvals

               

Clinical Investigator Training Program (CITP)

Description of program

OBJECTIVE:  There is increasingly wide recognition that Canada lacks sufficient numbers of well trained clinical investigators to meet the challenges presented by the assessment and treatment of mental disorder in the community.  The Clinical Investigator Training Program (CITP) is an educational program developed in the late1980s by the Department of Psychiatry and Behavioural Neurosciences at McMaster University to recruit and train clinical investigators interested in researching the continuum of mental health and disorder in children and adults. Postgraduate programs in psychiatry in Canada have emphasized clinical training and have not generally fostered careers in research. As a result, most graduates from residency programs in psychiatry have not been well equipped to address important questions in the etiology and treatment of mental disorders. The CITP was developed by a group of senior clinical investigators at McMaster to provide exceptional students with a structured training program in psychiatric research so that they may eventually become independent investigators in their own field. The program provides CITP Fellows with a unique combination of academic instruction in research methodology and an apprenticeship as an active member of an established research team.                  

DESCRIPTION OF EDUCATION SETTING: There are exceptional opportunities for research training in psychiatry at McMaster. The Faculty of Health Sciences is internationally recognized for innovation in medical education and an emphasis on multi-disciplinary collaboration in research and teaching.  As a result, the Department of Psychiatry and Behavioural Neurosciences has very strong links with the other departments in the Faculty of Health Sciences and in the University.  This has allowed the Department to develop impressive research programs in psychiatric epidemiology, community-based interventions, mood disorders, neuropsychiatry, neurosciences, women’s health and child psychiatry. 

PROGRAM CONTENT:   Once an applicant is accepted into the program, he/she is assigned to a faculty mentor, a senior clinical investigator, who will be responsible for setting specific goals and objectives.  The mentor acts both as a research supervisor and as a facilitator of the Fellow's career development.  The Fellow and the mentor establish a supervisory committee composed of faculty members in the Faculty of Health Sciences, possibly including some from outside the Department of Psychiatry and Behavioural Neurosciences. Each supervisory committee represents balanced interests so that the Fellow can benefit from input from other related areas particularly in methodology, research design, and measurement. Concrete goals are set out for each year of the program and the supervisory committee meets at least quarterly to review the Fellow's progress. 

During the tenure of the program, the fellow:

1. Applies for personnel support from a provincial or national granting agency
2. Completes two half courses in research design and biostatistics offered by the Department of Clinical Epidemiology and Biostatistics and one other course in the fellow's area of interest
3. Works as a member of the research team in which the mentor is a leader 
4. Collaborates with the mentor on an aspect of his/her work
5. Chooses a related but separate piece of work which can be expected to result in a publication with the resident as first author
6. Completes a critical review of the literature that is suitable for publication
7. Writes up an article for publication based on the work and data of the research team
8. Presents his/her work at a national or international meeting
9. Serves for at least six months on the departmental research committee to acquire experience in research administration

Fellows are also members of the faculty’s Clinical Investigator Program and will follow all guidelines.

Fellows can also acquire further training as graduate students (Master's degree or Ph.D) in any of the Faculty's graduate programs.  The duration of the program depends on the Fellow's previous background.  Generally, it takes three years from the beginning of the  fifth year of residency; three years after a Masters degree, and perhaps one year for an M.D. with a Ph.D. in a basic science area.  Residents are able to receive salaries equal to their peers while at the same time, being able to devote 80% of their time to research activities. 

ELIGIBILITY:  Postgraduate students from both medical (psychiatry, neurology, pediatrics etc.) and nonmedical disciplines who show exceptional promise for careers as independent investigators are eligible to apply.  It is most likely that a resident will enter the program during his or her last year of residency but graduate students from social work, psychology, sociology, etc. are also welcome to apply if clinical research in mental disorders is seen as desirable. Junior faculty members in the Faculty of Health Sciences can also be admitted to the CITP as part of their research training with the permission of the chair of their department.  If the applicant is a physician, he/she must be eligible to apply for a license to practice medicine in Ontario.

ADMISSION PROCEDURES:  An applicant should first contact the Director of the CITP (Dr. Harriet MacMillan, at macmilnh@mcmaster.ca) to see if their research interests coincide with that of a potential mentor in the Department.  The applicant and the mentor then prepare a brief written proposal to outline areas of study, educational objectives, and other educational activities to be pursued during the course of the training program.  Members of the CITP management committee, the Chairman of the Department of Psychiatry and Behavioural Neurosciences, and the Faculty’s Director of the Clinical Investigator Program then interview the applicant.  Applicants are accepted into the CITP if they are judged to have excellent potential as independent investigators on the basis of the interviews, their academic record and letters of reference.  Applicants are initially admitted for one year and evaluated six months after the date of admission, prior to being accepted to complete the program.

EVALUATION:  To graduate from the program, Fellows must have maintained a B+ average in required courses, and successfully completed all components of the CITP as outlined above.

The Fellow's progress is continually evaluated by the mentor who reports regularly to the CITP management committee, the departmental Research Committee and directly to the Chairman. Funded research from outside granting agencies and publications in peer-reviewed journals are given special importance. 

Before completing the CITP, the management committee reviews all written documents (papers and grant proposals) provided by the resident.  If the committee feels the standard of work is acceptable and all requirements have been met, a recommendation of completion of the CITP is made to the Chairman of the Department.  A Diploma is then awarded at a special occasion.

Role of Faculty Mentor

The mentor is accountable to the CITP management committee and to the Chair of the Department of Psychiatry and Behavioural Neurosciences for the structure of the fellow's program:

• Set research training objectives with the Fellow that are consistent with the goals of the program and the fellow's own interests 
• Meet regularly with the fellow (at least twice per month) to discuss ideas and possible projects, assess progress and plan for future work
• Help the fellow work productively on a research team of which the mentor is a member
• Arrange meetings of the supervisory committee to review the fellow's work to date

Role of the Department of Psychiatry and Behavioural Neurosciences

The Department will provide:

• Adequate secretarial services; for Faculty, a part-time secretary; for residents and graduate students, secretarial services available on request
• Money for activities such as xeroxing, literature searches, etc.
• Seed monies for pilot work, generally coming from grants to a supervisor
• Funds to attend scientific meetings

Funding to Fellows

• In the case of psychiatric residents, funding for the first year of enrolment in the Program (final year of residency) will be provided by the Department through the assignment of existing residency slots to the Program.
• After their residency, Fellows should receive salaries comparable the amount earned by others in similar positions.  There are two sources of income for physicians: a fellowship and clinical earnings derived from part-time clinical work, preferably not more than one day per week.

Unique aspects of the CITP

We are not aware of any other highly structured research training program in psychiatry in Canada.  The CITP has proved to be an exciting and viable way of training and recruiting students into research careers.  The program is highly visible in Canada and is valued by external granting agencies that fund mental health research.  There are several reasons the program has been so successful: 

• Combination of formal course work  and the ongoing apprenticeship relationship with a mentor
• Expertise of the faculty
• Structure of the supervisory committee,
• Close links with other departments in the Faculty of Health Sciences,
• Emphasis on learning fundamentals of research design
• Freedom to specify goals and objectives that best meet the Fellows needs.

Summary

The CITP is developing a cadre of well trained clinical investigators who will be able to advance psychiatric research.  Only in this way can new knowledge be created and disseminated in order to meet the needs of children and adults with mental disorder and reduce the burden of suffering associated with psychiatric illness.  The CITP, based on the McMaster traditions of innovative medical education, evidenced-based clinical practise, and critical appraisal, has become a leading training ground in Canada for the development of new clinical investigators in psychiatry.  The program continues to attract exceptional candidates who will be well prepared to train the next generation of clinical investigators.

2004
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