|Vancouver Island Assistant Program Director
Dr. Helen Ross
Although the Vancouver Island site is a new site for our distributed program, Medical Education has been taking place here for many years. There is a well established intern program, mostly for Family Medical Residents. Other programs are also beginning to distribute here, including UBC Psychiatry. Feedback from residents will be a very important part of ensuring our learning needs are met.
In July 2013, the UBC residency program became a distributed residency program, with residents based out of Vancouver Island and Fraser, as well as the previously established Vancouver site. Academic days are videoconferenced with other sites, with on-site staff support. Candidates may apply to all sites separately, selecting whichever locations appeal to them.
- Internal Medicine - 2 blocks; consultant based service.
- OBGYN - 2 blocks
- General Surgery. This is a 4 week General surgery rotation. There can be up to 8 weeks of off-service specialty rotations - thoracics, neurosurgery, vascular and plastics. These rotations would be tailored to our ER residents’ needs.
- ER - 3 blocks; our ER rotation is very popular with Vancouver based residents. We anticipate hosting them in future as well.
- Pediatric ER - 1 block; Victoria General Hospital has a strong peds population.
- Psychiatry - 1 block; RJH has a dedicated Psych ER, and residents will spend their month seeing psychiatric emergencies.
- Family Medicine - This rotations is no longer required, but is still an option for those wishing to pursue it.
As per Royal College of Physicians and Surgeons (RCPS) requirements, PGY-2 classes are required to do rotations in Research/Admin/Education and to complete 6 blocks of sub-specialty study. The exact timing of these blocks remains flexible.
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.
In PGY-2 and PGY-3, there are approximately 6 blocks of Emergency Medicine (Adult and Pediatric), and 6 - 7 blocks of off service rotations/electives each year.
The exact order of rotations in the residency is somewhat variable in order to coordinate with other services. In PGY-2, residents rotate through Adult Anesthesia , Coronary Care, Plastic Surgery, Trauma and Orthopedics.
Victoria has a trauma team, and residents will do Trauma call. There are plans for a step-down unit, though not yet finalized.
With the increase in UBC residency positions across all specialties, there are opportunities to do rotations outside Vancouver (eg Victoria/Kelowna)
The Emergency Medical Services system in British Columbia is known as one of the best in North America. Residents have a well organized rotation with a list of objectives, and ride alongs with land and air ambulance and paramedics.
Residents in the fourth and fifth years of the program are considered senior residents. At the beginning of the fourth year, residents rotate through the Pediatric Intensive Care Unit at the British Columbia Children's Hospital. These are the few off-service rotations to be scheduled in the final two years of the residency. This is because the Pediatric Intensive Care Unit rotation is a technically and personally challenging experience for the residents. They deal with a variety of very ill, unstable patients. They take first call to the Emergency Department for intubations and pediatric trauma. Experience has demonstrated that this rotation is best handled by a senior resident.
The previous degree of flexibility that was available to our PGY-4 and PGY-5 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 sub-specialty 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, Hyerbaric Medicine, ICU, and a dual fellowship in Anesthesia.
Senior residents return to the Pediatric Emergency Department for one or two blocks in their final year. 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:
- Triage of patients within the area
- Assessment and management of all patients within the area
- Decisions regarding disposition and patient transfer
- Receiving all calls regarding incoming patients, patient inquiries from outside of the Emergency Department, calls from paramedics
- Supervision of medical students and junior residents within the Emergency Department
- Trauma team captain
Residents are able to do electives in a variety of disciplines. Electives in the past have included sports medicine, ophthalmology, radiology, hyperbaric medicine, community emergency medicine in Kelowna, B.C., 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. As mentioned above, there is also a newly developed Trauma Team Leader rotation at the Royal Columbian hospital to supplement the trauma experience. It is staffed by Emergency physicians and Trauma surgeons.
Toxicology is a core rotation offered in Vancouver; however, some residents elect to complete this rotation at the New York City Poison Centre.
Two residents have recently completed the first half of the master's program in clinical epidemiology, and others have completed or are on the way to completing their Masters in Medical Education. One resident partially completed an ICU fellowship during his R5 year, and then finished his ICU training after his EM training was completed. Others have completed specialty training in Sports Medicine, 6 months of additional training in EHS and hyperbaric medicine. Another resident is currently pursuing specialty training in Wilderness Medicine, while another has just enrolled in a Masters of Informatics program.
For the newly mandated 6 months of scholarly activity, some of our senior residents have chosen: Medical Informatics, Ethics, or Medical Education. Other areas of interest include: Sports Medicine, Ultrasound, or Clinical Epidemiology.
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 two varieties: one based on Tintinalli which are combined with the CCFP-EM residents, and the other based on Rosen which are for the FRCP residents. There are also human patient simulator sessions.
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.
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 which 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.
Attending physicians or senior fellows from the Department of Radiology review X-rays/CT images for one hour each month. A brief clinical presentation is given and the films are reviewed. Teaching points are discussed
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 are discussed.
A new rotation designed for junior residents that focuses on Research design, Novel Education in Research and Design (NERD), was introduced in the 2011/12 academic year.
Funding is provided for the resident to attend a variety of conferences. In the final year of training, residents are funded to attend a relevant conference in Emergency medicine anywhere in North America.
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, NERD, 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 approximately once a month.
There are monthly ECG teaching sessions taught by staff cardiologists.
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 R2/3 year.
Residents are then allowed to complete an Ultrasound rotation at VGH, where they are supervised and examined by staff emergency physicians, and become certified as Independent Practitioners in Emergency Department Ultrasound.
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.
Candidates who have already commenced postgraduate training, plus foreign medical graduates who wish to apply at the PGY-1 level, are technically eligible through the second iteration of the CaRMS Match. However, due to the highly competitive nature of postgraduate training positions in Canada, for practical purposes, candidates should be registered in the final year of a Canadian or approved American Medical School in order to have a reasonable chance of being matched to our program.