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Program Letters of Agreement (PLA)


1.  There must be a program letter of agreement (PLA) between the program and each participating site (outside of the Sponsoring Institution) that governs the relationship between the program and the site providing a required assignment. (Core) (I.B.2.) 

     A participating site is defined as an organization providing educational experiences or educational rotations for residents. 

  • There must be a PLA for any away rotation, whether it is required or elective.
  • A PLA is not required for the following on/off campus sites as long as the supervising physician has a faculty appointment at SIUSOM:  nursing/assisted living homes, hospice facilities, ambulatory clinics/offices, ambulatory surgical centers, diagnostic centers (imaging, lab, etc), treatment centers (dialysis, rehab, chemotherapy, etc).

2.  The Office of Graduate Medical Education (OGME) has developed a PLA template for programs to use that has the Designated Institutional Official’s (DIO) approval and meets all stated requirements.

3. The PLA must be signed by the Program Director, Site Director, and Director of Graduate Medical Education (DGME).  Once signed by the DGME, OGME will enter and upload the PLA into New Innovations.  If there is a document with original signatures, it will be returned to the program coordinator. 

4. The DIO will review PLAs for the institution on a quarterly basis.

5. The PLA with each participating site is valid for 10 years as long as there are no changes to the rotation, site supervisor, or program director.  If an aforementioned change occurs, a new PLA will need to be initiated.

Click here to see the current PLA template.  To request an editable copy of PLA template, contact the Office of Graduate Medical Education at 217-545-8853 or email


Following is a table that outlines when a PLA is needed versus an affiliation agreement. 

                                                         PLA vs AFFILIATION AGREEMENT


Program Letter of Agreement

Affiliation / Institutional Agreement


The PLA meets ACGME educational requirements for programs.

More complex document that addresses the legal issues of a resident going to another institution for training.

When is it necessary?

A PLA is required between a program and all sites to which residents rotate for required education or assignments.

An AA is required between institutions when all residents in at least one program rotate for a required educational experience or one of the institutions requests a full AA vs PLA for away rotations. 

Example:  Affiliation Agreement in place between Plastic Surgery program, SIU, SJH/MMC, and receiving hospital/ institution

What’s included?

Details regarding:

  • Faculty
  • supervision of resident
  • evaluations
  • educational content of training
  • length of assignment/rotation
  • policies / procedures that will apply during training

Legal information including:

  • Who is paying the salary
  • Who is covering benefits
  • Who is paying for malpractice insurance
  • If housing is involved, who is providing/covering housing

Who originates the agreement?

The program of the resident.

The program/institution of the resident should initiate it.

Who signs? (minimally)

Program Director, Site Director, GME Director (SIU requirement)

GME Direcctor or DIO, Dr. Kruse, Hospital/Institution CEOs, sometimes Program Director

Length of agreement

Must be reviewed every five years. If there are no changes, an amenement should be signed by all parties stating that it was reviewed and there are no changes.  If PD changes, each PLA should be updated with new PD.

Must be reviewed every five years. If there are no changes, an amendment can be signed by all parties stating that it was reviewed and there are no changes.