Standard of Practice – Entering Practice in Manitoba Effective November 1

November 1, 2026 |

The Standard of Practice – Entering Practice in Manitoba is effective November 1, 2026.

The new Standard of Practice – Entering Practice in Manitoba (the Standard) sets expectations for both registrants entering a new practice environment in Manitoba for the first time and the physician leaders and colleagues (CPSM registrants) who receive them.

Council approved the Standard on June 24.

View the Standard here.

What Is the Purpose of the Standard?

The Standard was designed to ensure registrants entering practice in Manitoba—whether newly licensed or transitioning from another jurisdiction—are effectively supported in their integration into the local clinical and community context.

Significant gaps shape International Medical Graduates’ (IMGs) early practice experiences, especially in mentorship, along with variability in community support and colleague acceptance.

Discrimination and harassment compound this already challenging transition period for both IMG and non-IMG registrants, underscoring a clear need for coordinated, actionable change.

New registrants have a responsibility to learn, ask questions and seek feedback.

Registrants entering practice in Manitoba bring diverse training, perspectives, and experience. Many also arrive with limited familiarity with local clinical expectations, community context, administrative processes, cultural norms, and patient expectations.

Established colleagues, leaders, and practice teams play an equally important role in providing orientation, guidance, and support.

Structured support, clear expectations, and shared accountability among all registrants support safe patient care and effective integration of IMGs into practice.

Components of the Standard of Practice for Entering Practice in Manitoba

The Standard reflects research, focus groups and a profession-wide survey examining the experiences of IMGs and other registrants entering practice in Manitoba. The work identified the importance of practical orientation, mentorship, clear expectations, constructive feedback, respectful workplaces and supportive professional relationships.

Part 1: Building relationships

Clarify roles and responsibilities in practice settings.
Foster mentorship, collaboration, and shared accountability.
Promote an environment where asking questions and seeking support is welcome.
Work within your competence.

Part 2: Orientation

Provide structured onboarding which includes:
- Patient-centred care and cultural competency.
- Preventing anti-racist care.
- Communication.
- Administrative systems (i.e. patient records, billing).

Part 3: Self-care and peer support

Make wellness a shared responsibility: creating a practice culture that is inclusive, culturally and psychologically safe.
Encourage seeking physical, mental and well-being supports.
Encouraging open dialogue.

Part 4: Workplace culture and professionalism

Fostering inclusivity and belonging.
Demonstrating cultural humility.
Supporting colleagues who experience harm from harassment or discrimination.

How the Standard Developed & Supporting Evidence

The Standard was informed by feedback collected through multiple, diverse focus groups of IMGs, responses from a profession-wide survey, and partners’ engagement. All strongly supported the need for a Standard.

Focus Groups

IMGs make up 37% of Manitoba’s physician workforce and are essential for addressing major gaps in care, including shortages in remote, rural, and Northern remote communities (see identified gaps outlined in this Doctors Manitoba report).

Despite this diversity, IMGs flagged several concerns to CPSM about barriers they encounter when registering and entering practice. Repeated concerns included registration issues, assessment processes, orientation gaps, not enough mentorship and resources, and experiences of discrimination in practice.

CPSM held two Focus Groups to explore the issues further. The groups highlighted the need for systemic improvements to support IMGs entering practice in Manitoba.

International Medical Graduates Working Group

In response, CPSM established an IMG Working Group to address longstanding concerns. The working group’s mandate was grounded in CPSM’s public-interest responsibility and its obligations related to patient safety, fair registration practices, and promoting respectful, culturally safe, and supportive practice environments.

The IMG Working Group was chaired by Dr. Nader Shenouda, a family and emergency medicine physician, CPSM past president, and an IMG. The group also included representatives from the Manitoba College of Family Physicians, the IMG Program at the University of Manitoba, Manitoba Health, Shared Health, Doctors Manitoba, CPSM staff, IMGs, a clinical assistant and public representatives.

The group reviewed literature and publications, supported the development of a new orientation program, and provided input into developing the survey and Standard of Practice for Entering Practice in Manitoba.

Survey

A major component of the working group’s work was developing a province-wide survey of CPSM registrants. The survey was open from September 17 to October 17, 2025. It was designed to compare the experiences of IMGs and Canadian-trained physicians entering and establishing practice in Manitoba. It examined registration and assessment pathways, orientation needs, integration into practice settings and communities, discrimination and harassment, mentorship, workplace culture, satisfaction, and retention-related factors.

Public Consultation

A public consultation on the draft standard of practice was held from April 17, 2026, to May 21, 2026. We received responses from registrants and interest-holders. Responses were mostly favourable and included suggestions for contextual information, which were considered and incorporated.

Report: Strengthening Integration into Practice

CPSM’s working group report on the experiences of IMGs entering practice in Manitoba has been released and strongly supports the need for the Standard of Practice – Entering Practice in Manitoba. It includes a detailed analysis of survey results prepared by Dr. Ada Man.

View the Strengthening Integration into Practice Report

Resources

Contextual Information and Resources for the Standard of Practice for Entering Practice in Manitoba

Contextual information addresses questions and concerns we heard during the consultation process.

Strengthening Integration into Practice Report

A report of CPSM’s working group on the experiences of IMGs entering practice in Manitoba extensively covers the literature reviewed by the group, focus group details, and detailed analysis of survey data, including themes and recommendations.

Related Standards of Practice:

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