For postings or rotations to a clinical site outside the Sponsoring Institution’s home country, the following must occur:

1. the site, if a hospital, must be accredited by an entity with standards reasonably equivalent to those of The Joint Commission International (JC-I), as determined by the ACGME-I Review Committee;

2. there must be on-site qualified faculty members, headed by a site supervisor, who provides or ensures a structured educational program with appropriate:

1. goals and objectives;
2. clinical experiences, including any pre- and post-operative care;
3. supervision;
4. structured didactics, as needed;
5. teaching;
6. resident/fellow formative and summative evaluations; and,
7. routine resident/fellow feedback,



3.  Residents/fellows provide end of posting evaluations of their faculty members and the assignment; and,

4. the evaluations are taken into account during the annual program evaluation.

The above conditions should be described in the program letter of agreement (PLA) with the out-of-country clinical site that names a site supervisor, goals and objectives of the posting, routine feedback, formative and summative evaluations of residents/fellows, and duration of posting. A program faculty member may accompany the resident/fellow to the site to ensure these requirements are met.