Vancouver Site Program Overview

 

Dr. Brian Chung
UBC Program Director
Dr. Brian Chung
bchung@mail.ubc.ca
604-875-5262

The UBC RCPSC emergency medicine residency program was established in the 1980’s, and our graduates include many leaders in academic and clinical EM, and EM subspecialties. Our program offers training to physicians wishing to pursue a career in Emergency Medicine.  The program is accredited by the Royal College of Physicians and Surgeons of Canada and is five years in length.

Residents in the program are thoroughly trained in all aspects of emergency care. Upon completion of the program, graduates have consultant level abilities in the management of patients with any illness or injury presenting to the emergency department and are well prepared for clinical, academic or leadership roles in emergency medicine.

The program is designed to provide graded responsibilities in the emergency department and in the classroom to achieve competency in all of the CanMeds roles: medical expert, communicator, collaborator, manager, advocate, scholar and professional. The curriculum includes clinical rotations that are designed to meet the requirements of the Royal College, innovative rotations designed to achieve academic excellence such as our recently established teaching and research blocks, and elective rotations that are individualized to allow residents to achieve enhanced competency in an area of their choice related to emergency medicine.

The first three years of the residency consist of a mixture of off service and emergency medicine rotations. The majority of residents pursue an area of enhanced competency in their fourth and/or fifth years of training. Examples of such areas include (but are not limited to): EMS, Sports Medicine, Hyperbaric Medicine, Palliative Care, Ethics, Medical Informatics, Public Health, Clinical Epidemiology, Wilderness Medicine, Medical Education, Critical Care and Ultrasound.

In response to the increasing needs for RCPS-trained emergency physicians in BC and throughout Canada, our residency program expanded in July 2013. The existing Vancouver/Lower Mainland site was joined by three new sites: Victoria (including Victoria General and Royal Jubilee Hospitals), Fraser Valley (including Royal Columbian Hospital) and Kelowna (including Kelowna General Hospital). The UBC RCPSC emergency medicine residency program is now one of the largest EM residency programs in Canada.

The program begins with one year of general training similar to the traditional rotating internship. Currently, training in the PGY-1 year consists of the following rotations, which are in 4 week blocks:

Rotation, Duration, Location / Notes:

  • Internal Medicine - 2 blocks; at VGH and SPH
  • Obstetrics - 1 block; at BC Women's
  • Gynecology - 1 block; at VGH
  • General Surgery - 1 block; at VGH
  • Trauma Surgery - 1 block; at VGH
  • Family Medicine - 1 block; at Variable (Urban/Rural)
  • ICU -1 block; at RCH
  • Emergency - 3 blocks; at VGH, RCH
  • Pediatric Emergency - 1 block; at BCCH
  • Psychiatry - 1 block; at VGH

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.

Vancouver General Hospital has a well developed trauma service with dedicated trauma surgeons and a trauma unit. During their PGY-2 Trauma rotation, residents are assigned to the trauma service to add to the experience of their PGY-1 rotation. They have the opportunity to function as trauma leader in the Emergency Department under the supervision of the Emergency or Trauma Team attending physician during this rotation.

While on the Plastics and Orthopedics rotations, they carry the pager and generally respond to the Emergency Department for all cases. They also have the opportunity to participate in OR cases and attend out patient clinics and offices

Residents generally return to the Vancouver General Hospital Emergency Department at the beginning of the third year. This allows them to work alongside the first year residents and to orient them to the program. They are still considered a junior resident at this level. They are given a greater degree of responsibility during this rotation as they gain more experience in the specialty.

This is followed by off service rotations in Intensive Care, Neurosciences, CCU, EMS and Orthopedics in a variable order, alternating with Adult and Pediatric Emergency Medicine. Vancouver General Hospital is the tertiary referral center for the majority of major orthopedic trauma in the province.

During PGY-2 and PGY-3, residents also do rotations in the Emergency Department at St. Paul's Hospital and Royal Columbian Hospital. This rotation is designed to allow exposure to Emergency Medicine in a  different settings.  St Paul's allows a more inner city exposure. The emphasis at the Royal Columbian Hospital is toward a community-based style of practice. There is more involvement by family physicians and fewer residents from other services in the Emergency Department. The Royal Columbian Hospital provides an excellent community hospital experience with a large volume of pediatric emergency patients. The residents see a large volume of critically ill medical and surgical patients. The Emergency physicians at the Royal Columbian Hospital are respected as excellent teachers. Residents report that this rotation is valuable in that it gives one a broader experience in Emergency Medicine.

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.

Pediatric EM rotations are done at BC Children's Hospital each year, and there is an educational program including seminars and a pediatric simulator.

There is a newly developed Trauma Team rotation at the Royal Columbian hospital, designed for more senior residents who wish to supplement their trauma experience. The staff physicians on this rotation include RCH emergency physicians and trauma surgeons.

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 and Pediatric Anesthesia 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. Residents also spend an additional two blocks at the Royal Columbian Hospital and another block or two in the Vancouver General Hospital Emergency Department.

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 Royal College requirements; 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, Hyperbaric 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 at Vancouver General Hospital 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 captain

The Chief Resident is selected by the residency training committee. He or she has administrative responsibilities that include attendance at Vancouver General Hospital Emergency Department Faculty Meetings, and the organization of Academic, Morbidity and Mortality Rounds.

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. One 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 2 varieties- one based on Tintinalli which are combined with the CCFP-EM residents, and the other based on Rosen which are for the FRCP-EM 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 each seminar. Seminars begin with a 15 minute short answer question, with pertinent elements from the reading material 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 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.

These rounds are 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.

The training program is based at Vancouver General Hospital . The Royal Columbian Hospital, the BC's Children's Hospital and St. Paul's Hospital also participate as training sites.

With the increased number of UBC residency positions across all specialties, there are now more opportunities to do rotations outside of Vancouver/Lower Mainland ( eg Victoria/ Kelowna).

There are no mandatory rural rotations; however, residents are required to do a minimum of 2-3 mandatory rotations outside Vancouver/Lower Mainland during the course of their residency.

Residents do Adult EM rotations at St. Pauls in their PGY-2, 3 or 4 year, and rotations at RCH in all of their PGY-1 through 5 years.

Pediatric EM is done in all of their PGY1 thru 5 years.

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.