Fraser Site Program Overview

 

Fraser Assistant Program Director
Dr. Caroline Tyson
karobea@gmail.com
604-875-5262

 

Program Sites and Rotations

Candidates should apply to all four UBC EM sites separately, selecting whichever locations appeal to them.

The Fraser based UBC FRCPC EM Program welcomed the third cohort of R1s in July 2015, bringing the total number of Fraser based residents to six.  Eventually, there will be ten residents based at our site (two per year).

The Fraser Program is based out of Royal Columbian Hospital in New Westminster, BC, with rotations in other Fraser Hospitals such as Surrey Memorial and Eagle Ridge Hospital.

  • New Westminster is a 30 minute Skytrain Ride from downtown Vancouver
  • Some of our residents choose to live downtown, reaping all the benefits of city living, yet training at a hospital with far less competition for learning opportunities
  • Royal Columbian Hospital is the Trauma referral centre for all of Fraser. There is more fresh trauma at RCH than VGH.

We have access to most of the services you would expect to find at any other teaching centre, even though we are technically a community hospital. Some services (PICU, Burn Unit and Spinal Cord rehab, are located downtown, in Coastal Health Region).

Residents based at one UBC EM site are encouraged to do rotations at other sites, based on interest and availability.

Fraser residents are currently very integrated with the VGH resident group.  At present, our residents go to VGH and St Paul’s hospitals for academic day, and the VGH residents come to RCH when we are hosting (monthly).

As you might expect, in an expanding program we realize that the exact distribution of learning events will likely evolve over the coming years.

At the discretion of the program director, international and interprovincial electives are possible.

Program Curriculum
This program residency is five years in length. Program length of training does not exceed the Royal College or College of Family Physicians of Canada standard.

Royal Columbian Hospital in the Fraser site has a well-established PGY 1 (formerly internship) program, and residents matched to this program will be able to take advantage of the experienced and enthusiastic preceptors involved.  Fraser based ER residents will rotate through core rotations, customized for their learning needs.

  • Internal Medicine - CTU at RCH - 2 blocks
  • OBGYN - this is one service at RCH, so the resident will do both concurrently. 2 blocks
  • General Surgery - RCH - 1 block
  • Trauma Surgery - we have a well-established trauma service at RCH, with both General surgeons and Emergency Physician TTLs. All UBC EM residents across all sites have the opportunity to do this rotation at RCH. This past year, all but one UBC R1 chose this option. 1 block
  • ICU – Our ICU has high acuity and lots of opportunity for procedures. Currently, Vancouver Based junior residents have the option to do their ICU rotation at RCH as well, and many do. 1 block
  • ER – RCH sees around 68,000 patients per year, of which 15% are children. We are a high volume trauma referral centre, and see lots of acuity. 3 blocks
  • Pediatric ER – Even though we see a large volume of pediatric cases at RCH, we send our residents to Surrey Memorial Hospital for their Peds ER rotation, as the volume is even greater and there are dedicated Peds shifts. 1 block
  • Psychiatry - RCH has a dedicated Psych ER, and residents will spend their month seeing psychiatric emergencies. 1 block
  • Neuro – Residents will rotate with our Neurology service for the first time this coming year. We are the regional stroke center. 1 block

There is flexibility in the order and choice of rotations, based on residents’ areas of interest.

  • ER – our residents do 3 blocks of General ER each year. This year, our residents chose to do two at RCH, and one at VGH.
  • Pediatric ER – At Surrey Memorial. See above. 1 block
  • Anesthesia – currently our residents are doing their first block at Eagle Ridge Hospital, a low acuity, high turnover, low learner volume OR, which will allow them plenty of opportunities to practice straightforward adult and pediatric airway management. The second block is planned at RCH, where the acuity and complexity of patients is higher, allowing them to acquire the consultant level expertise that Emergency Physicians require. 2 blocks
  • CCU – RCH sees a high volume of cardiac cases, and is the referral center for Cath in Fraser.
  • EMS – we ran our first-ever EMS rotation out of Fraser this past year.  The rotation incorporated ride-alongs as well education around areas such as higher level management  of EMS systems.  There is also a research group in Mass Gathering Medicine active at our site, and many of our residents participate in this aspect of pre-hospital medicine as well.

Other scholarly rotations include Education (1 block) and Research (1 block). Both Education and Research are structured rotations based out of Vancouver.

In general, at the junior resident level the emphasis is on individual patient care.  The junior residents are encouraged to care for an appropriate number of patients to gain expertise in the management of patients presenting with any of the myriad of conditions seen in the Emergency Department.  Junior residents participate in major resuscitations and are responsible for performing most major procedures, such as intubations and chest tubes, etc.

Residents in the fourth and fifth years of the program are considered senior residents. In this year, residents rotate through the Pediatric Intensive Care Unit at the British Columbia Children's Hospital. Experience has demonstrated that this rotation is best handled by a senior resident.

The previous degree of flexibility that was available to our PGY4 and PGY5 residents in terms of 10 months of elective time has been limited by the new Royal College requirements which became effective in July 2008. There is now a mandatory 6 block period to pursue a specific area of subspecialty study. The exact timing of this period is flexible.

In the past, UBC residents have pursued the following areas of interest: Sports Medicine, Wilderness Medicine, Clinical Epidemiology, Public Health, Medical Education, EHS, Hyperbaric Medicine, ICU, and a dual fellowship in Anesthesia.

The fifth year resident finishes the program with six blocks of adult emergency.  During this time, they function as a junior consultant. This allows them to consolidate their knowledge base and clinical skills in order to prepare them for the Royal College examination and for entering clinical practice.

The Senior Resident is responsible for the following activities under the direct supervision of the attending Emergency Physician:

1. Triage of patients within the area

2. Assessment and management of all patients within the area

3. Decisions regarding disposition and patient transfer

4. Receiving all calls regarding incoming patients, patient inquiries from outside of the Emergency Department, calls from paramedics

5. Supervision of medical students and junior residents within the Emergency Department

6. Trauma team leader

Residents are able to do electives in a variety of disciplines. Electives in the past have included sports medicine, ophthalmology, radiology, hyperbaric medicine, and trauma in the USA and South Africa. These rotations provide the resident an opportunity to observe the functioning of a sophisticated trauma system in a large American city that has high volume of penetrating and blunt trauma, or in South Africa which has its own unique challenges. We are also in the process of starting a Trauma Fellowship at RCH.

Toxicology is a core rotation offered in Vancouver; however, some residents elect to complete this rotation at the New York City Poison Centre.

For the newly mandated 6 months of scholarly activity, some of our senior residents have chosen: Medical Informatics, Ethics, Medical Education. Other areas of interest include: Sports Medicine, Ultrasound, Clinical Epidemiology, Trauma.

Resident academic teaching is conducted in a full day every Wednesday. Residents have this academic time protected.

Academic sessions include: ECG and radiology teaching sessions, Pharmacology rounds, Research rounds, Trauma rounds, Academic/Grand rounds for resident and staff presentations in a formal podium style, and seminar sessions of 2 varieties- one based on Tintinalli which are combined with the CCFP_EM residents for the juniors, and the other based on Rosen which are for the senior FRCP residents. There are also human patient simulator sessions.

Core Curriculum Seminars. The curriculum in Emergency Medicine is covered over the five year period of the training program. Residents are provided with a 100 to 150 page reading package two weeks before the seminar. The teaching session begins with a 15 minute short answer, question. Pertinent elements from the reading material are discussed in a round table, Socratic teaching format.

Journal Club is held once per month. Assigned journal articles are reviewed. A specific topic or theme is focused upon. Issues are discussed and presentations are critiqued by emergency medicine faculty.
Distributed sites review the same articles, with access to the same experts.  Currently, Fraser and VGH are having their journal club together.  This may change as the programs get larger.

The Chief resident is responsible for organizing the rounds. Cases and topics are presented by the residents and attending Emergency Physicians. Controversies are discussed. All deaths are reviewed. These case presentations are mixed with short didactic presentations based on specific cases.

Residents write a newly developed nationally standardized practice exam in a short answer format similar to the Royal College exam once per year. Marks are collated across the country, and allows residents to benchmark their progress.

In addition, the residents have the opportunity to write the American Board In-Training Evaluation Examination every year.
Practice oral exams are given once or twice per year. Senior residents receive more practice oral exams as they approach the end of their training and prepare for the Royal College exams.

Residents attend rounds on all inpatient rotations where applicable. Each off service rotation has its own educational program.

Key articles from the medical literature are reviewed. Emphasis is placed on the research methodology. Ideas for new papers and current on-going research at Vancouver General Hospital and other sites are discussed.

There is a rotation designed for junior residents that focuses on Research design that was introduced in the 2011/12 academic year called the NERD block.  It gives residents the tools they need to design and carry out their own research projects, as well as critically appraise other research.

All residents are required to complete two research projects during the course of their residency. There is considerable flexibility in the types of projects undertaken. In general, residents are expected to complete one case report and review of the literature, and one piece of original clinical research. These projects are undertaken with a faculty adviser in an area of mutual interest. Excellent research support is available through the department's Emergency Medicine Research Division.The newly developed Research design block, specifically targeted for our junior residents, allows them to start on the research/scholarly activity that is now mandated by the Royal College.

Senior residents present their research projects at the annual CAEP meeting in their final year. In addition, residents are funded up to $1,000 in order to present their research at a conference earlier in the residency. Several residents in the past have had the opportunity to co-author chapters in Rosen's Textbook of Emergency medicine with attending Emergency Physicians.

Residents have sessions with a high fidelity human patient simulator.  We also do “low tech” sim frequently.

There are monthly ECG teaching sessions taught by staff cardiologists as well as our own residents.

There are rounds taught by members of the Department of Pharmacology, with topics tailored to the residents needs eg antimicrobial therapy, ACS drugs, inotropes, toxicology, etc. They occur approximately 4-5 times per year.

Ultrasound training for the residents has become more structured in the past year. Junior residents who have not already taken an introductory course via CAEP will be offered a course with the incoming CCFP-EM residents in July of their R1 year.

A four-week elective in Medical education was successfully introduced in 2010/11. It introduces the resident to some of the topics relevant to bedside teaching (eg one minute preceptor, how to provide effective feedback, how to teach procedures), and also incorporates teaching shifts allowing the residents an opportunity to put the techniques into practice. There are small group sessions for discussion and debriefing.