The four hospital sites (St. Michael's Hospital, Toronto General Hospital, Sunnybrook Health Sciences Centre, and The Hospital for Sick Children) all employ clinical fellows. Clinical fellows are surgeons from Canada, or international countries who have already attained cardiac surgery specialist status from their country of origin. Cardiac fellowship training provides advanced level training in the various aspects of tertiary level and quaternary level cardiac surgery as outlined below. 

Applicants must be a certified cardiac surgeon in Canada or their country of origin, or have successfully passed MCQEE. All International Medical Graduate fellows must undergo a period of observation of clinical performance lasting 4-12 weeks at University of Toronto hospitals. This period of observation, called PEAP (Pre Entry Assessment Period), is done in the initial 4-12 weeks of the clinical fellowship. Successful completion of the PEAP is mandatory in order to continue in the clinical fellowship.

International Medical Graduates who graduated from a medical school where the language of instruction was NOT in English must pass The Test of English as a Foreign Language (TOEFL) and The Test of Spoken English (TSE) OR the new TOEFL-Ibt

• TSE: Minimum score 50
• TOEFL: Minimum score 237, or minimum score 580 for paper based test
• TOEFL-Ibt: Minimum score of 93 including a minimum score of 24 on the speaking section. 

Work related issues will be outlined in a "Letter of Clinical Fellowship Job Offer" that the applicant and his or her supervisor both sign. Educational issues and responsibilities are clarified in the "Letter of Job Offer" and the "Goals and Objectives" documents before starting the fellowship. All clinical fellows receive evaluations every 6 months.  Salaries for clinical fellows are varied. Some fellows are self funded such as Canadian fellows with an Ontario license to practice medicine, some are sponsored by their country of origin or other external agency, and some are funded by the hospital division itself.