C-sectionInternational Medical Graduates

A large number of Canada’s enhanced surgical skills (ESS/OSS) family practitioners were recruited overseas, acquiring postgraduate surgical training, up to and including a foreign fellowship, prior to immigrating to rural Canada.

Training in Surgery and Operative Delivery

There is one Canadian medical school which offers a third year Residency (R3) 12 month postgraduate ESS program – the University of Saskatchewan at Prince Albert.

Training in Operative Delivery including Caesarean Section

Many of Canada’s medical schools offer a 3-6 month R3 training program for rural family physicians seeking to offer surgical services limited to operative delivery:


University of Manitoba 

University of British Columbia 


  1. Iglesias S, et al. Advanced skills by Canada’s rural physicians. Can J Rural Med, 1999, 4(4); 227-233


Certificates of Added Competence

The training programs in both ESS and OSS are presently being elevated to Category 1 status within Postgraduate Family Medicine with the adoption of national training standards. Graduates from these programs will receive a Certificate of Added Competence (CAC). Read more about CACs here.