Affiliation Agreements

Policy Statement

For all residency and fellowship programs, there must be an affiliation agreement between the program and each participating site outside of the sponsoring institution to which residents/fellows rotate for required education or assignments.

In addition, there must be an affiliation agreement under any of the following circumstances:

  • The participating site requires an agreement (for a list of major affiliates requiring agreements for all rotations, elective and required, see this document), OR
  • The participating site is outside of the United States, OR
  • There are financial terms associated with the resident/fellow experience at the participating site.

Programs are encouraged but not required to execute affiliation agreements for rotations not outlined above.

The agreement must identify the faculty who will assume both educational and supervisory responsibilities for residents/fellows; specify faculty responsibilities for teaching, supervision, and formal evaluation of residents/fellows; specify the duration and content of the educational experience; and state the policies and procedures that will govern the resident/fellow education during the assignment.

The agreement must be fully executed (signed and dated by all authorized signers) prior to the start date of the rotation.  The agreement must be renewed at least every ten  years or sooner if required by the University or the Participating Site. The increased length of the agreement is allowed per the ACGME Common Program Requirements as listed in the ACGME Program Director’s Guide to the Common Program Requirements.

Reason for Policy

The purpose of affiliation agreements is to protect the program’s residents/fellows by ensuring an appropriate educational experience under adequate supervision.  These agreements are educational documents which provide details on faculty, supervision, evaluation, educational content, length of assignment, and policies and procedures.  In addition, some affiliation agreements are legal documents which provide details on liability and financial arrangements.

Within the MMCGME community, affiliates rely on these agreements as part of their internal processes to track and plan for residents/fellows.

Given the value of these agreements, the University of Minnesota has adopted more stringent requirements than those outlined by the Accreditation Council for Graduate Medical Education (ACGME), and applies these requirements to all GME programs, including those not accredited by ACGME.

Responsibilities

The GME Office assists with the process of executing affiliation agreements as an administrative service and to ensure that our programs are in compliance with requirements.  It is the program’s responsibility to ensure that the content of these documents accurately reflects regular, ongoing conversations about curriculum delivery that are taking place between the program and sites to which trainees rotate.

FAQ 

  • ACGME Common Program Requirements FAQs: Pages 1-4
  • Q: My program is not ACGME-accredited.  Do I still need affiliation agreements?
  • A: Yes.  Affiliation agreements document regular, ongoing conversations between the program director and site director to ensure your trainee(s) are receiving an appropriate educational experience under adequate supervision.
  • Q: Which affiliates require agreements for elective rotations?
  • A: See this document for a current list of major affiliates who require agreements for all rotations, regardless of whether they are required or elective.  Note this list is not considered exhaustive, and you must verify with your affiliate what their agreement policy is when arranging a rotation at a new location.
  • Q: I have an agreement with ABC site for my trainees to rotate with Dr. Smith.  Dr. Smith wants the trainees to join him on rounds at XYZ site.  Can they go without an agreement with XYZ site since it’s the same supervising physician?
  • A: No.  Affiliation agreements are with site locations, not preceptors / site directors / physicians.  Each site location must be separately evaluated, and an affiliation agreement executed when necessary.

Definitions

  • Affiliate: The legal entity that is authorized to enter into legally-binding Agreements with the University, i.e.: Affiliation Agreements. Examples of Affiliates are: hospitals, clinics, pharmacies, universities, and government entities, but can be any legal business entity.
  • Participating Site: The physical location where an educational experience takes place.
  • Master Affiliation Agreement (MAA): An agreement between the University of Minnesota and an affiliate.  MAAs are created when an affiliate has sites used consistently by three or more UMN schools/colleges/departments for educational experiences.  All MAAs are negotiated by AHC Legal, and cover general terms agreed between the University and the affiliate.  Each MAA provides for further creation of associated Program Letters of Agreement (PLAs) between specific UMN programs and affiliate sites - see “Program Letter of Agreement (PLA)” below.
  • Program Letter of Agreement (PLA): A written document that addresses responsibilities between an individual program and a site other than the sponsoring institution at which residents/fellows receive a part of their education.  At the University of Minnesota, a PLA may reference back to an MAA (see “Master Affiliation Agreement (MAA)” above).  PLAs referencing back to an MAA have final execution in the GME Administration office.
  • Agreement of Institution and Program Affiliation (AIPA): At the University of Minnesota, this type of affiliation agreement is created when a Master Affiliation Agreement (MAA) is not in place and there is a need to document legal matters (e.g. when there are financial terms associated with the rotation, when the affiliate is outside the United States, etc).  The agreement is between a program or department and an affiliate, and documents legal and educational matters.  Any changes to the standard template language must be negotiated through AHC Legal, and all AIPAs have final execution via AHC Legal.
  • Financial Agreement Addendum (FAA): Financial addenda to an affiliation agreement contain the agreed-upon financial terms for each year (fiscal or calendar) during the term of the agreement.  If the parties don’t anticipate any changes to the financial arrangements during the term of the agreement, the financial arrangements may be spelled out in the body of the agreement.  If the financial terms will change each year, the agreement reflects that the terms for the first year are set forth on an attachment and that financial terms for each subsequent year must be set forth on a separate annual financial addendum (FAA) signed by the parties.
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