Rotation Goals and Objectives

Year: PGY2

Site/Location: VGH, RCH(effective July/05), or SPH (effective July/05; elective in Halifax
Rotation Coordinator: Candace Cheung
Program Director: Dr. Clinton Wong

Holiday requests: Ask Candace Cheung
Where to show up: Ask Candace Cheung
Rounds/Educational Activities on services: As per Anesthesia Program.
Evaluation: Submit daily evaluation slip to each supervising staff anesthesiologist at the end of each shift.

GOALS

1. Develop airway management skills.
2. Learn how to monitor various patient parameters with invasive and non-invasive techniques.
3. Become familiar with fluid resuscitation and pharmacological agents used in anesthesia.
4. Learn relevant pre-operative historical and physical exam considerations including evaluation of airway difficulty.
5. Learn principles of pain management including use of sedation techniques, local nerve blocks, epidural and spinal anesthesia.
6. Appreciate the unique characteristics of anaesthesia practice and the operating room environment,

OBJECTIVES

Upon completion of the rotation, residents should be able to:

Medical Expert
1. Describe the anatomy of the upper airway.
2. List the differences between the adult and pediatric airway, related head and neck anatomy and innervation of the airway.
3. List the indications for, and demonstrate appropriate judgement around invasive airway management.
4. Recognize and manage an obstructed airway.
5. List the contraindications and complications of various airway management techniques including oral and nasal airway insertion, bag-valve-mask ventilation, blind nasal intubation, oral intubation, cricothyrotomy and tracheostomy.
6. State the dosages, mechanism of action, indications, contraindications and potential complications of inhalation anesthetic agents, intravenous analgesic and anesthetics, induction agents and neuromuscular blocking agents.
7. Demonstrate familiarity with advanced airway techniques including fibreoptic (bronchoscopic) intubation, retrograde intubation, lighted stylet, laryngeal mask airway.
8. Demonstrate correct use of the bag-valve-mask device, nasal and oral airways in both the adult and child.
9. Demonstrate skill in nasotracheal and endotracheal intubation as well as management of complications
10. Demonstrate skill in the use of anesthetics and neuromuscular blocking agents including conscious sedation and rapid sequence intubation.
11. Demonstrate the ability to perform percutaneous transtracheal jet ventilation.
12. Demonstrate ability to obtain a surgical airway including cricothyrotomy and tracheostomy.
13. Demonstrate ability to use standard non-invasive monitoring techniques including heart monitors, blood pressure monitors, oxygen saturation monitor, end tidal CO2 monitors.
14. Demonstrate ability to manage a patient on a ventilator and discuss the advantage and disadvantages of different ventilation techniques.
15. Coordinate the ongoing assessment and management of the intubated patient.
16. Demonstrate ability to administer local anesthetics and be familiar with agents, dosing, side effects, and techniques to monitor pain.
17. Perform procedural sedation under faculty supervision and then independently.
18. Demonstrate knowledge of the principles of regional anesthesia and successfully perform metacarpal, digital, radial, median, ulnar, tibial, supraorbital, infraorbital, mental, auricular and sural nerve blocks.
19. Demonstrate ability to perform dental blocks

Communicator
1. Converse effectively and sensitively with seriously ill patients and their families.
2. Discuss relevant issues around surgical procedures.
3. Demonstrate knowledge of the health care consent act.
4. Communicate effectively to all members of the operating room team.

Collaborator
1. Work effectively as part of a health care team.
2. Describe the role, expertise and limitations of all members of the operating room team required to optimally achieve a goal related to patient care.
3. Contribute to healthy team functioning, respecting the opinions and roles of team members and contribute his/her own expertise to the team's task.
4. Assume team leadership.
5. Demonstrate an understanding of the unique interaction of peri-operative care with every component of the hospital, especially the emergency department and acute care units.

Manager
1. Demonstrate an appreciation of the efficient and responsible use of anaesthesia resources.
2. Demonstrate proper documentation around management of critically ill patients.
3. Manage time efficiently.
4. Identify medico-legal risks and take steps to address them.

Health Advocate
1. Demonstrate an appreciation of the efficient and responsible use of anaesthesia resources.
2. Demonstrate proper documentation around management of critically ill patients.
3. Manage time efficiently.
4. Identify medico-legal risks and take steps to address them.

Scholar
1. Critically evaluate the literature as it pertains to airway management and the practice of anaesthesia.
2. Demonstrate inquisitiveness around clinical cases.
3. Apply the principles of evidence-based medicine.

Professional
1. Adhere to the code of ethics of the CMA and the institution.
2. Treat patients and colleagues with respect.
3. Self-evaluate, including insight into strengths and weaknesses.
4. Demonstrate commitment to life-long learning.
5. Be responsible, reliable and accountable for one’s actions.

Feedback/Pearls from previous EM residents:

  • You are usually allowed to select which OR you work in for the day - try to avoid long cases.
  • Let the staff know your primary interest is in airway management, but not the exclusion of other aspects of the specialty.
  • Ask to see various advanced airway techniques if appropriate.
  • Erik Vu had an exceptional experience with a Difficult Airway elective in Halifax (2004/05).
  • Make sure you use a daily evaluation form- bring some of ours from VGH ED in case they don't have any of their own!!

PGY1 Year

Internal Medicine (CTU - Clinical Teaching Unit)

Year: PGY1 (implemented July 1, 2005)
Site/Location: VGH and/or St. Paul's
Rotation Coordinator: Hazel Wilcox
Program Director: Dr. Mark Roberts
Holiday Requests: As per CTU
Where to show up: As per CTU
Rounds/educational activities on services: As per CTU
Evaluation: Web-based as per CTU

GOALS

1. Assimilate general concepts of Internal Medicine, history taking and physical examination skills to develop a systemic evaluation for patients presenting with a variety of undifferentiated medical problems.
2. Learn the pathophysiology, presentation, and management of diseases related to the alimentary tract.
3. Develop knowledge of the pathophysiology, presentation, and management of common hematologic diseases.
4. Master the understanding of the components of the immune system, and the disorders of hyer and hypofunction of the immune system.
5. Know the major systemic infectious disorders, their diagnosis and treatment.
6. Learn the pathophysiology, evaluation, and treatment of renal disorders.
7. Develop knowledge of the etiologies, manifestations, and treatment of endocrine and metabolic disorders.
8. Master an understanding of the diseases of the respiratory system, including pathophysiology, evaluation, and treatment.
9. Learn the anatomy, pathophysilogy, presentation, and management of common nervous system disorders.
10. Develop skill in the performance of a screening and detailed neurologic evaluation
11. Develop skill in the use and performance of diagnostic procedures in the evaluation of neurological disorders.

OBJECTIVES 

Medical Expert
1. Appropriate history taking skills for all patients presenting with medical problems.
2. Demonstrate the ability, based on the history.
3. Combine the knowledge defined in the objectives below with the history and physical examination, to develop an appropriate differential diagnosis for all presentations.
4. Demonstrate knowledge of and the ability to perform the following procedural skills: ABG sampling, insertion of peripheral IV, Foley catheter insertion and NG tube insertion.
5. Demonstrate an understanding of the indications, technique and complications of the following procedural skills: lumbar puncture, bone marrow aspiration, thoracentesis, arthrocentesis and paracentesis.

GI
6. Demonstrate knowledge of the causes, presentation, and management of esophageal problems.
7. Describe the etiologic agents, pathophysiology, and managemnent of infectious diarrhea.
8. Demonstrate the ability to evaluate, manage, and appropriately deal with patients with gall bladder and liver disorders.
9. Demonstrate knowledge of the presentation, diagnosis, and management of obstructive lesions of the alimentary tract.
10. Demonstrate the ability to perform NG tube insertion.
11. Describe the presentations, work-up, and appropriate treatment of patients with inflammatory processes of the alimentary tract.
12. Demonstrate familiarity with the evaluation, treatment, and appropriate disposition of patients with gastrointestinal bleeding.

Hematology/Oncology
13. Demonstrate knowledge of the proper evaluation and treatment of the patient with sickle cell disease.
14. Describe the appropriate steps in the assessment and treatment of the patient with bleeding disorders.
15. Demonstrate knowledge in the work-up treatment, and appropriate disposition of the patient with anemia, platelet disorders and myeloproliferative disorders.
16. Demonstrate understanding of the appropriate use of transfusions of blood components, including diagnosis and treatment of transfusion reactions.
17. Demonstrate knowledge of the presentation, treatment, and disposition of patients with malignancies of the hematopoietic system.
18. Demonstrate knowledge of pathophysiology, presentation, diagnosis and treatment of oncologicical emergencies.

Immunology
19. Demonstrate familiarity with the mechanism and manifestations of immune compromise including that caused by infection with HIV
20. Discuss the manifestations, initial treatment, and appropriate disposition of patients with rheumatologic and autoimmune diseases.
21. Demonstrate understanding of the work-up and treatment of patients with hypersensitivity reactions including transplant rejection.

Infectious Disease
22. Demonstrate knowledge of the presentation, treatment and disposition of patients with needle stick injuries.
23. Demonstrate familiarity with the manifestations of, evaluation for, and treatment of bacterial infections.
24. Describe the diagnostic criteria for, and the treatment of, toxic shock syndrome.
25. Know the characteristics of sepsis in different age groups.
26. Demonstrate knowledge of the appropriate initial treatment of the patient with possible sepsis.
27. Discuss the manifestations of, treatment of, appropriate disposition for, and immunization (when appropriate) of patients with viral infections.

Nephrology
28. Demonstrate familiarity with the causes, presentation, initial management and disposition of patients with infections of the renal system.
29. Describe the common etiologic agents, and appropriate work-up and disposition of patients with infections of the renal system.
30. Discuss the common causes, metabolic manifestations, treatment (including dialysis) and disposition of patients with renal failure.
31. Describe the common complications of dialysis therapy and how they manifest in patients.
32. Define the etiologies, and demonstrate understanding in the evaluation and treatment of patients with acid/base disorders.
33. Demonstrate understanding of the etiologies, manifestations, and treatment of fluid and electrolyte abnormalities.

Endocrinology
34. Demonstrate knowledge of the manifestations, work-up, treatment, and disposition of patients with disorders of glucose metabolism.
35. Demonstrate understanding of the common endocrine abnormalities, especially regarding etiology, presentation , initial evaluation and management and disposition.
36. Demonstrate a knowledge of the evaluation, management and disposition of diabetic ketoacidosis and acute glucocorticoid insufficiency

Respirology
37. Demonstrate knowledge in the etiologic agents, presentation and evaluation, and treatment of patients with infections of the respiratory system.
38. Describe the etiology manifestation, and treatment of patients with acute and chronic airway disease including criteria for intubation and intubation/ventilator management.
39. Discuss the predisposing factors, presentation, and appropriate treatment of patients with pulmonary embolus.
40. Demonstrate knowledge of the potential presentation, work-up, treatment and appropriate disposition of patients with chest masses.
41. Demonstrate knowledge of the presentation, work-up, treatment, and disposition of patients with chronic granulomatous disease.

Neurology
42. Demonstrate brief and detailed neurological-directed history taking and physical examination.
43. Demonstrate the ability to recognize and manage the following: cerebrovascular disorders, cranial nerve disorders, demyelinating disorders, seizure disorders,
headache, peripheral neuropathy, neurological infections, neurological tumours and neurological inflammatory states.
44. Demonstrate knowledge of basic neuroanatomy and application of this knowledge in the neurological examination to localize neurological disorders.

45. Describe the main classifications of headaches and state the doses, indications and contraindications for agents used to manage each of these types of headaches.
46. Demonstrate skill in the performance and interpretation of spinal fluid studies.
47. Demonstrate knowledge of the proper sequence for evaluation and management of patients with seizures and neurological infections.

Cardiology
48. Demonstrate the ability to perform an appropriate cardiovascular history and physical examination.
49. Describe the pathophysiology, diagnosis and treatment of acute coronary syndrome.
50. Demonstrate knowledge of ACLS guidelines
51. Describe the clinical presentation, etiology pathophysiology and current therapy for acute congestive heart failure.
52. Outline the pathophysiology and treatment of hypertension.
53. Demonstrate a knowledge of manifestations and treatment of hypertensive urgency and hypertensive emergency.

Geriatrics
54.Describe the changes in anatomy, physiology, pharmacology, and psychology that occur with aging.
55.Perform a formal mental status exam for the elderly patient in the emergency department environment.
56.Assess decision making capacity in the elderly; discuss the types and meaning of advance directives.
57.Discuss which common diseases (appendicitis, myocardial infarction, etc.) present in elderly patients with atypical signs and symptoms that are different than the presentations in younger patients.
58.Perform functional assessments evaluating activities of daily living (ADL) of elderly patients in an emergency department setting.
59.Define and diagnose dementia and delirium in elderly patients.
60.Discuss the management of elderly patients who present with polypharmacy.
61.Demonstrate the ability to detect and manage elder mistreatment, including physical abuse, sexual assault, physical neglect, and psychological abuse and neglect.

Communicator
1. Converse effectively and sensitively with medical patients and their families.
2. Be able to discuss relevant issues around interventions.
3. Demonstrate knowledge of the health care consent act.
4. Demonstrate ability to deliver bad news effectively with compassion and sensitivity.
5. Demonstrate sensitivity to the needs of elderly patients and respect for their ability to make decisions.
6. Maintain appropriate documentation of progress and treatment decisions.
7. Communicate efficiently and effectively with all members of the health care team.
8. Participate meaningfully and lend expertise to family and case management meetings.

Collaborator
1. Act as chief care-giver (under supervision) and communicate with the patient, family, family physician, consultants, other health care professionals and social agencies.
2. Communicate and coordinate with the health care team both short and long term therapeutic decisions regarding patients presenting to the Emergency Department.
3. Detail the proper and appropriate transfer of patients from one health care setting to another including listing of issues of patient transfer, transfer of medical documents and medical legal concerns.
4. Demonstrate ability to work effectively as part of a health care team in the inpatient setting.
5. Demonstrate an understanding of the roles of various participants in inpatient care.

Manager

1. Coordinate care for patients, including the appropriate utilization of consultant specialists and community resources.
2. Manage time efficiently.
3. Identify medico-legal risks and take steps to address them.
4. Learn the ethical principles involved in medical decision-making with regard to advance directives and life sustaining treatment.
5. Assume a leadership role in the care of the medical patient.

Health Advocate
1. Demonstrate an understanding of the determinants of health affecting medical patients and their families.
2. Act as an advocate for the individual patient and affected populations.
3. Demonstrate knowledge of routine preventive health initiatives. (eg. Discuss the etiologies and pathophysiology of falls in the elderly.)
4. Understand societal biases regarding aging in the context of the emergency health care system.
5. Learn the concept of functional status as the interaction of age, disease, and environment.

Scholar
1. Demonstrate ability to critically evaluate the literature as it pertains to medical patient care.
2. Demonstrate inquisitiveness around clinical cases.
3. Demonstrate ability to apply the principles of evidence-based medicine.

Professional
1. Adhere to the code of ethics of the CMA and the institution.
2. Treat patients and colleagues with respect.
3. Self-evaluate, demonstrating insight into strengths and weaknesses
4. Demonstrate commitment to life-long learning
5. Be reliable, responsible and accountable for his/her actions and for patient care.

PGY2/3 Year

Coronary Care Unit

Year: PGY2 and PGY3
Site/Location: VGH and SPH (effective July 2005)
Rotation Coordinator: Angela Campden
Program Director: Dr. Graham Wong
Holiday Requests: Ask Angela Campden
Where to show up: Ask Angela Campden
Rounds/Educational Activities on services: As per Cardiology Service.
Evaluation: By attending cardiologists.

GOALS

1. Demonstrate the ability to stabilize patients who present in cardiopulmonary arrest.
2. Develop skills in the evaluation of patients who present with chest pain.
3. Demonstrate the ability to evaluate , stabilize, treat, and arrange for appropriate disposition of patients with cardiac disease processes.
4. Demonstrate the ability to develop a differential diagnosis for patients presenting with cardiac symptomatology (chest pain, shortness of breath, weakness, palpitations) etc.
5. Demonstrate skill in the interpretation of diagnostic modalities (ECG, chest x-ray, cardiac enzymes)
6. Develop a familiarity with cardiac pharmacologic agents.
7. Demonstrate skill at cardiac related procedures: venous line and CVP pressure monitroring, pericardiocentesis, defibrillation and cardioversion, transcutaneous and transvenous cardiac pacing, and Swan ganz catheterization
8. Demonstrate the ability to diagnose, stabilize and apply thrombolytic therapy to patients presenting with acute early myocardial infarction.

OBJECTIVES

Medical Expert
1. Demonstrate the ability to perform an appropriate history and physical examination on the patient presenting with cardiac symptomatology.
2. List items elicited from the history of patients with chest pain to suggest a risk for cardiac etiology.
3. Discuss limitations in differentiation of cardiac chest pain from non-cardiac pain in patients with risk factors.
4. Describe the pathophysiology of cardiac ischemia, acute angina chest pain, and acute myocardial infarction.
5. Describe the typical electrocardiograph findings of patients with myocardial ischemia, subendocardial infarctionand myocardial and transmural infarction.
6. Discuss differential diagnosis of atypical chest pain.
7. Discuss atypical presentations for acute cardiac ischemia and myocardial infarction.
8. Discuss the sensitivity and specificity of ancillary studies for chest pain presentations including ECG, chest x-ray, cardiac enzymes, and arterial blood gases.
9. Discuss the sensitivity and specificity of troponin and myoclobin levels in the investigation of patients presenting to the Emergency Department with chest pain.
10. Describe the appropriate triage considerations for patients presenting to the Emergency Department with chest pain.
11. Differentiate between stable and unstable angina and outline the initial treatment of patients with unstable angina including the use of nitrates, beta blockers, calcium
channel blockers, intravenous heparin, ASA etc.
12. Discuss the concept of ‘silent’ myocardial infarction and ischemia.
13. Differentiate between transmural versus subendocardial infarction.
14. Discuss the significance of acute complete atrio-ventricular block with inferior myocardial infarction versus anterior myocardial infarction.
15. Demonstrate knowledge of current ACLS recommendations for the treatment of acute ventricular fibrillation, ventricular tachycardia, asystole, pulseless electrical activity, atrial flutter and fibrillation,junctional ectopy, pre-exitation, supraventricular tachycardia, and bradycardia, sick-sinus syndrome, atrial ventricular blocks (first degree, second degree and third degree) and bundle branch blocks.
16. Describe the clinidal findings of cardiogenic shock and outline therapy for cardiogenic shock.
17. Differentiate cardiogenic shock from other etiologies for shock.
18. Describe the clinical presentation for pericardial disease and outline the appropriate initial therapy and management for pericardial disease.
19. Describe the presentations for myocardial infarction and their association with vessel involvement and outline initial treatment for myocardial infarction.
20. List the indications, contraindications and complications of thrombolytic therapy for acute myocardial infarction.
21. Discuss other therapeutic interventions in the patient presenting with acute myocardial infarction i.e. emergency cardiac catheterization with subsequent CABG, angioplasty or
stent insertion.
22. Describe the clinical presentation, etiologies, pathophysiology, and current therapy for acute congestive heart failure.
23. Describe the valvular anatomy of the heart and list etiologies for valvular heart disease.
24. Describe the clinical findings of a mitral valve prolapse, valvular aortic stenosis, aortic regurgitation, tricuspid stensosis, tricuspid regurgitation, and pulmonary stenosis, mitral regurgitation and mitral stenosis and discuss management of each of these valvular abnormalities.
25. List complications of prosthetic cardiac valves and appropriate Emergency Department management.
26. Differentiate between congestive cardiomyopathy ,hypertrophic cardiomyopathy and restrictive cardiomyopathy and discuss therapy for each.
27. Define myocarditis and describe the ECG findings and acute management of myocarditis.
28. Discuss the pathophysiology of acute pulmonary embolismand the predisposing factors for pulmonary embolism.
29. Discuss the sensitivity and specificity of the various tests used to diagnose pulmonary embolism including arterial blood gases, ECG, spiral CT scan, D-dimers, chest x-ray, etc.
30. Discuss the sensitivity and specificity of ventilation perfusion scan in acute pulmonary embolism
31. Outline treatment for acute pulmonary embolism
32. Differentiate between acute hypertensive emergencies, hypertensive urgency, and uncomplicated hypertension.
33. Discuss the indications for treatment of hypertension in the Emergency Department.
34. Describe the syndrome of hypertensive encephalopathy.
35. Outline the treatment for acute hypertensive emergency and differentiate treatment in the setting of thoracic aortic dissection36. Differentiate between primary agents for hypertensive emergency to include their advantages and disadvantages.
37. Describe the clinical presentation of acute mesenteric ischemia and discuss the inherent difficulties in the diagnosis as well as the Emergency Department management.
38. Discuss the pathophysiology, etiology,and overall morbidity and mortality of patients presenting with acute aortic dissection.
39. Explain the Emergency Department management of acute aortic dissection
40. Discuss the sensitivity, specificity of the various tests to diagnose acute thoracic aortic dissection including: angiography, transthoracic ultrasound, trasesophageal ultrasoundand CT scanning
41. Describe the pathophysiology and clinical presentation for acute peripherl ischemia and outlilne the Emergency Department management.
42. Differentiate between superficial and deep venous thrombosis
43. Outline the emergency management of acute thrombophlebitis
44. Discuss the pathophysiologic connection between thrombophlebitis and pulmonary embolism
45. Discuss the use of thrombolysis in acute thrombophlebitis.
46.Describe the indications for cardiac monitoring, telemetry, and 24 holter monitoring
47.List the types of permanent pacemakers commonly used and describe pacemaker terminology.
48.Demonstrate an approach to the systematic workup and treatment of pacemaker-related problems.
49.List complications of prosthetic cardiac valves and appropriate emergency department management.

Communicator
1. Converse effectively and sensitively with seriously ill patients and their families.
2. Discuss relevant issues around cardiac procedures such that patients and/or families are informed and involved in treatment decisions.
3. Demonstrate knowledge of the health care consent act.

Collaborator
1. Work effectively as part of an acute care health care team.
2. Demonstrate an understanding of the roles of various participants in the care and management of the cardiac patient, including the primary care physician.
3. Organize multiple professionals and interventions quickly in response to a seriously ill patient.
4. Assume team leadership, especially in resuscitation scenarios.

Manager
1. Describe the appropriate triage considerations for patients presenting to the emergency department with chest pain.
2. Effectively and efficiently use cardiac care resources, including those in a regionalized system.
3. Demonstrate proper documentation involving management of cardiovascular patients.
4. Manage time efficiently.
5. Identify medico-legal risks and take steps to address them.

Health Advocate
1. Demonstrate an understanding of health determinants affecting cardiac patients and their families.
2. Counsel patients effectively about risk reduction and health improvement.
3. Direct patients to proper resources to effect health improvement.
4. Act as an advocate for the individual patient and affected populations.
5. Demonstrate an understanding of "Do not resuscitate" orders, advance directives, living wills, competency, power of attorney and brain death criteria.

Scholar
1. Critically evaluate the literature as it pertains to cardiac and vascular conditions.
2. Demonstrate inquisitiveness around clinical cases.
3. Apply the principles of evidence-based medicine.
4. List and describe the "landmark" trials affecting the management of acute coronary syndromes.

Professional
1. Adhere to the code of ethics of the CMA and the institution.
2. Treat patients and colleagues with respect.
3. Demonstrate ability to self-evaluate, including insight into strengths and weaknesses
4. Demonstrate commitment to life-long learning
5. Be responsible, reliable, and accountable for his/her actions.

Feedback/Pearls from previous EM residents:

  • Up until July 2005, all rotations were at VGH. There has been excellent feedback on the teaching from VGH cardiologists. Less is known about the SPH cardiologists. There is reputed to be a more diverse patient population at SPH (arrhythmias, valvular disease).

ICU Adult

Year: PGY3

Site/Location: VGH
Rotation Coordinator: Kiran Davey or Ana Palomino
Program Director: Dr. Vinay Dhingra

Holiday Requests: Contact Ana Palomino
Where to show up: VGH ICU
Rounds/Educational Activities on services: As per the ICU service.
Evaluation: As per the ICU service.

GOALS

1. Develop the ability to rapidly evaluate, diagnose, stabilize, and expedite the disposition of critically ill patients.
2. Learn respiratory, cardiovascular, renal and neurologic physiology and the pathophysiology of trauma, toxins, shock, sepsis, cardiac failure, and respiratory failure which affect critically ill patients.
3. Learn the principles of medical instrumentation and hemodynamic monitoring and be able to utilize them in the care of critically ill patients.
4. Learn the indications and develop the technical skills needed to perform diagnostic and therapeutic interventions in critically ill patients.
5. Learn the rational use of other consultants, laboratory, radiographic and other diagnostic tests in the management of critically ill patients.

OBJECTIVES

Upon completion of the rotation, residents should be able to:

Medical Expert
1. Rapidly perform an efficient and effective history and physical exam on critically ill patients.
2. Determine the need for admission to the ICU.
3. Perform the following procedures: fibreoptic endotracheal intubation, chest reopening, lumbar puncture, thoracentesis, pulmonary artery catheter insertion, endotracheal intubation, nasotracheal intubation, central line placement, transvenous cardiac pacing and arterial line placement.
4. Use and interpret data from ECG monitors, 12 lead ECGs, cardiac and hemodynamic monitors, arterial blood gases, pulse oximetry, end tidal CO2 monitors, ventilators and ICP monitors.
5. Diagnose and treat shock, sepsis, fluid and electrolyte abnormalities, toxicologic emergencies and end-organ failure.
6. Initiate and maintain treatment consistent with current recommendations for early goal-directed sepsis management.
7. Demonstrate appropriate prioritization of diagnostic and therapeutic interventions in critically patients.
8. Order appropriate fluids, blood, blood products and blood substitutes necessary for the resuscitation of critically ill patients.
9. Describe the dosages, indications and contraindications of pharmacologic interventions for shock, cardiac failure, dysrhythmias, sepsis, trauma, toxins, respiratory failure, hepatic failure, renal failure, and neurologic illnesses.
10. Manage a patient on a ventilator including ventilator types, appropriate use of ventilation techniques, indications for extubation as well as weaning and extubation techniques.
11. Demonstrate an understanding of CPAP and BIPAP modes of positive airway pressure.
12. Demonstrate the ability to care for several critically ill patients concurrently, including the ability to appropriately triage and delegate.
13. Demonstrate and understanding of the various modalities of dialysis/hemoperfusion and their indications for treating renal failure, fluid and electrolyte imbalances and toxicologic emergencies.

Communicator
1. Converse effectively and sensitively with seriously ill patients and their families.
2. Discuss relevant issues around critical care procedures such that patients and/or families are well-informed and participatory in patient care.
3. Demonstrate knowledge of the health care consent act.
4. Deliver bad news effectively with compassion and sensitivity.
5. Efficiently and effectively summarize a patient???s condition and treatment plan.
6. Effectively and efficiently discuss a plan of care with a multidisciplinary team.

Collaborator
1. Appropriately advise physicians consulting the intensive care unit either in person or by phone. To aid in arranging safe, appropriate and timely transportation of a critically ill patient, including determining the need for land or air transport or invasive procedures prior to transport.
2. Demonstrate an understanding of the appropriate use of consultants in critically ill patients.
3. Develop an understanding of the multidisciplinary team in the management of the ICU patient, including but not limited to the roles of the nursing staff, respiratory technicians, dietitians, occupational therapist, physiotherapists and consulting staff.
4. Assume a team leader role in acute resuscitation efforts and in executing plans of care.

Manager
1. Demonstrate an appreciation for the administrative priorities of a critical care unit (eg. closed vs. open).
2. Use resources responsibly and appropriately.
3. Demonstrate an understanding of the ethical and legal principles applicable to the care of critically ill patients.
4. Demonstrate proper documentation involving management of critically ill patients.
5. Manage time efficiently.
6. Identify medico-legal risks and take steps to address them.
7. Demonstrate knowledge of significant health policy developments pertaining to critical care (eg. regionalized care).

Health Advocate
1. Demonstrate an understanding of the health determinants of critically ill patients and their families.
2. Act as an advocate for the individual patient and affected populations.
3. Demonstrate an understanding of "Do not resuscitate" orders, advance directives, living wills, competency, power of attorney and brain death criteria.

Scholar
1. Critically evaluate the literature as it pertains to critical care.
2. Demonstrate inquisitiveness around clinical cases.
3. Apply the principles of evidence-based medicine.

Professional
1. Adhere to the code of ethics of the CMA and the institution.
2. Treat patients and colleagues with respect.
3. Self-evaluate, including insight into strengths and weaknesses
4. Demonstrate commitment to life-long learning
5. Demonstrate a willingness to accept responsibility for one's actions and for patient care.

Feedback/Pearls from Previous EM Residents:

  • All EM residents have done VGH as opposed to SPH.
  • High acuity.
  • Excellent teaching.

PGY1 Year

Intensive Care Unit

Year: PGY1 (implemented July 1, 2005)
Site/Location: Royal Columbian Hospital
Rotation Coordinator: Kathleen McIntosh
Program Director: Dr. Sean Keenan
Medical Director - ICU, RCH - Dr. Dale Stogryn. Dr. Stogryn is the PGY1 site coordinator for all rotations at RCH.

Holiday Requests: Ask Kathleen McIntosh
Where to show up: Ask Kathleen McIntosh
Rounds/Educational Activities on services: Evaluation: As per the ICU service.

GOALS

1. Develop the ability to rapidly evaluate, diagnose, stabilize, and expedite the disposition of critically ill patients.
2. Learn respiratory, cardiovascular, renal and neurologic physiology and the pathophysiology of trauma, toxins, shock, sepsis, cardiac failure, and respiratory failure
which affect critically ill patients.
3. Learn the principles of medical instrumentation and hemodynamic monitoring and be able to utilize them in the care of critically ill patients.
4. Learn the indications and develop the technical skills needed to perform diagnostic and therapeutic interventions in critically ill patients.
5. Learn the rational use of other consultants, laboratory, radiographic and other diagnostic tests in the management of critically ill patients.

OBJECTIVES

Upon completion of the rotation, residents should be able to:

Medical Expert
1. Rapidly perform an efficient and effective history and physical exam on critically ill patients.
2. Determine the need for admission to the ICU.
3. Perform the following procedures: fibreoptic endotracheal intubation, chest reopening, lumbar puncture, thoracentesis, pulmonary artery catheter insertion, endotracheal intubation, nasotracheal intubation, central line placement, transvenous cardiac pacing and arterial line placement.
4. Use and interpret data from ECG monitors, 12 lead ECGs, cardiac and hemodynamic monitors, arterial blood gases, pulse oximetry, end tidal CO2 monitors, ventilators and ICP monitors.
5. Diagnose and treat shock, sepsis, fluid and electrolyte abnormalities, toxicologic emergencies and end-organ failure.
6. Initiate and maintain treatment consistent with current recommendations for early goal-directed sepsis management.
7. Demonstrate appropriate prioritization of diagnostic and therapeutic interventions in critically patients.
8. Order appropriate fluids, blood, blood products and blood substitutes necessary for the resuscitation of critically ill patients.
9. Describe the dosages, indications and contraindications of pharmacologic interventions for shock, cardiac failure, dysrhythmias, sepsis, trauma, toxins, respiratory failure, hepatic failure, renal failure, and neurologic illnesses.
10. Manage a patient on a ventilator including ventilator types, appropriate use of ventilation techniques, indications for extubation as well as weaning and extubation techniques.
11. Demonstrate an understanding of CPAP and BIPAP modes of positive airway pressure.
12. Demonstrate the ability to care for several critically ill patients concurrently, including the ability to appropriately triage and delegate.
13. Demonstrate and understanding of the various modalities of dialysis/hemoperfusion and their indications for treating renal failure, fluid and electrolyte imbalances and toxicologic emergencies.

Communicator
1. Converse effectively and sensitively with seriously ill patients and their families.
2. Discuss relevant issues around critical care procedures such that patients and/or families are well-informed and participatory in patient care.
3. Demonstrate knowledge of the health care consent act.
4. Deliver bad news effectively with compassion and sensitivity.
5. Efficiently and effectively summarize a patient???s condition and treatment plan.
6. Effectively and efficiently discuss a plan of care with a multidisciplinary team.

Collaborator
1. Appropriately advise physicians consulting the intensive care unit either in person or by phone. To aid in arranging safe, appropriate and timely transportation of a critically ill patient, including determining the need for land or air transport or invasive procedures prior to transport.
2. Demonstrate an understanding of the appropriate use of consultants in critically ill patients.
3. Develop an understanding of the multidisciplinary team in the management of the ICU patient, including but not limited to the roles of the nursing staff, respiratory technicians, dietitians, occupational therapist, physiotherapists and consulting staff.
4. Assume a team leader role in acute resuscitation efforts and in executing plans of care.

Manager
1. Demonstrate an appreciation for the administrative priorities of a critical care unit (eg. closed vs. open).
2. Use resources responsibly and appropriately.
3. Demonstrate an understanding of the ethical and legal principles applicable to the care of critically ill patients.
4. Demonstrate proper documentation involving management of critically ill patients.
5. Manage time efficiently.
6. Identify medico-legal risks and take steps to address them.
7. Demonstrate knowledge of significant health policy developments pertaining to critical care (eg. regionalized care).

Health Advocate
1. Demonstrate an understanding of the health determinants of critically ill patients and their families.
2. Act as an advocate for the individual patient and affected populations.
3. Demonstrate an understanding of "Do not resuscitate" orders, advance directives, living wills, competency, power of attorney and brain death criteria.

Scholar
1. Critically evaluate the literature as it pertains to critical care.
2. Demonstrate inquisitiveness around clinical cases.
3. Apply the principles of evidence-based medicine.

Professional
1. Adhere to the code of ethics of the CMA and the institution.
2. Treat patients and colleagues with respect.
3. Self-evaluate, including insight into strengths and weaknesses
4. Demonstrate commitment to life-long learning
5. Demonstrate willingness to accept responsibility for one???s actions and for patient care.

Feedback/Pearls from previous EM residents:

  • In previous years this has been rated one of the best PGY1 rotations at RCH, particularly due to the high degree of independence given to PGY1's.

Emergency Health Services

Year: PGY3

Site/Location: BC Ambulance Service
Rotation Coordinator: Dr. Joseph Ip
For Air Transfer ride alongs, contact Dr. Erik Vu

Holiday Requests: Contact Dr. Ip
Where to show up: Contact Dr. Ip
Rounds/Educational Activities on services: Contact Dr. Ip
Evaluation: By Dr. Joseph Ip

GOALS

1. Learn common organizational structures of emergency medical services.
2. Learn the educational requirements and skill levels of various EMS providers.
3. Learn principles of EMS system operations.
4. Learn basic principles of disaster management.
5. Learn principals of prehospital triage and emergency medical care delivery.
6. Learn basic principals of EMS research.
7. Learn medicolegal principals relating to EMS.

OBJECTIVES

Medical Expert
1. Actively participate in EMS system management.
2. Describe local, provincial and national components of EMS.
3. Demonstrate ability to use all elements of the EMS communication system.
4. Demonstrate ability to provide initial and continuing education to all levels of EMS personnel.
5. Demonstrate familiarity with research methodologies relating to EMS and disaster management.
6. Discuss medicolegal liability issues relating to EMS.
7. Participate in EMS continuous quality improvement.
8. Participate as an observer or team member in EMS transport systems.
9. Discuss development of EMS prehospital care protocols.
10. Discuss basic concepts of disaster management.
11. Demonstrate understanding of appropriate utilization practices for ground and air medical services.
12. Discuss the process of disaster notification,, response, and medical care on a local, provincial and national level.
13. Discuss the importance of and methods for medical control in EMS systems.
14. Discuss the differences in education and skill level of various EMS providers.
15. Describe common environmental, toxicologic, and biological hazards encountered in the prehospital care setting as well as injury prevention techniques.

Communicator
1. Demonstrate ability to use all elements of the EMS communication system.
2. Effectively and efficiently communicate remotely with prehospital care personnel.

Collaborator
1. Describe the educational requirements and skill levels of various EMS providers.
2. Demonstrate an appreciation and respect for the perspective of prehospital care personnel, including their interaction with emergency department personnel.
3. Participate as an observer or team member in ground and air medical transport systems.
4. List the roles and responsibilities of the base hospital physician and medical director in the EMS system.
5. List the drugs carried by the land and flight paramedics.
6. List those drugs which the flight paramedics may administer in addition to those which they carry.

Manager
1. Describe common organizational structures of emergency medical services, including that of Metro Toronto.
2. Describe principles of EMS system operations.
3. Describe the provincial and national legislation and standards for EMS systems.
4. Discuss medicolegal liability issues relating to EMS.
5. Participate in EMS continuous quality improvement including tape and chart review.
6. Discuss development of EMS pre hospital care protocols.
7. Discuss the role of dispatch in the system.
8. Demonstrate understanding of appropriate utilization practices for ground and air medical services.
9. Discuss the process of disaster notification, response, and medical care on a local, provincial and national level.
10. Discuss the principles behind and methods for medical control in EMS systems.

Health Advocate
1. Describe common environmental, toxicologic, and biological hazards encountered in the pre hospital care setting and implement injury/disease prevention techniques.
2. Demonstrate an appreciation for how patients can access care via the EMS system and the impact of policy and process decisions on that access.
3. Demonstrate understanding of how patient advocacy is incorporated into design and operation of an EMS system.

Scholar
1. Demonstrate ability to critically evaluate the EMS literature.
2. Demonstrate inquisitiveness about EMS design and operation.
3. Apply the principles of evidence-based medicine.
4. Demonstrate an understanding of the unique characteristics and methodologies of EMS research.
5. Demonstrate ability to provide initial and continuing education to all levels of EMS providers.

Professional
1. Adhere to the code of ethics of the CMA and the institution
2. Treat patients and colleagues with respect.
3. Self-evaluate, demonstrating insight into strengths and weaknesses
4. Demonstrate commitment to life-long learning
5. Be reliable, responsible and accountable for his/her actions and for patient care.

Year: PGY1 (implemented July 1, 2005)

Site/Location: VGH
Rotation Coordinator: Pam Itterman at Pamela.Itterman@vch.ca or gensurg@interchange.ubc.ca
Program Director: Dr. Eric Webber
Holiday Requests: Ask Pam Itterman. The UBC Department of Surgery has quite strict rules regarding the dates when holidays are allowed, and the deadline of holiday requests.
Where to show up: Ask Pam Itterman
Rounds/educational activities on services: As per General Surgery service.

GOALS

1. Develop familiarity with common general surgical problems
2. Develop relevant history and physical exam skills
3. Develop procedural skills relevant to General Surgery
4. Develop skill in the overall assessment of the general surgical patient
5. Recognize indications for consultation and surgical intervention in patients with acute abdominal pain.
6. Learn the principles of care of the perioperative patient.

OBJECTIVES

Medical Expert
1. Demonstrate ability to perform an appropriate history and physical exam in patients with general surgical disorders, including an appropriate preoperative evaluation.
2. Discuss the differential diagnosis of acute abdominal pain and demonstrate ability to evaluate, treat and obtain appropriate consultation.
3. Demonstrate ability to perform common procedural skills including gastric intubation, thoracostomy, wound closure, and incision and drainage of superficial abscesses.
4. Demonstrate ability to assist in the operative and perioperative therapy of surgical patients.
5. Discuss the common fluid and electrolyte disturbances in surgical patients and demonstrate ability to manage patients with these disorders.
6. Demonstrate appropriate prophylaxis and treatment of surgical infections.
7. Recognize and initiate management of patients with postoperative complaints such as postoperative wound infections, respiratory problems and ileus
8. Demonstrate ability to manage pain in surgical patients.
9. Discuss the role of diagnostic imaging in the evaluation of abdominal pain and demonstrate ability to appropriately order and interpret imaging modalities such as abdominal films and basic CT scans in surgical patients.
10. Demonstrate ability to diagnose and treat common general surgery conditions such as breast disease, colorectal disease, abdominal wall hernias and gall bladder disease.
11. Assess and manage common postoperative conditions including pain, infection, wound dehiscence, atelectasis, abscess formation, fluid and electrolyte imbalances, and device (ostomy applicance, drains, catheters, etc) malfunction.

Communicator
1. Converse effectively and with sensitively with surgical patients and their families.
2. Discuss relevant issues around procedures.
3. Demonstrate knowledge of the health care consent act.
4. Deliver bad news effectively with compassion and sensitivity.
5 Communicate effectively in the operating room.
6 Properly document care of surgical patients.
7. Effectively and efficiently provide a case summary to other health care professionals.

Collaborator
1. Work effectively as part of a health care in the operating room setting.
2. Demonstrate an understanding of the roles of various participants in the care and rehabilitation of general surgery patients.
3. Assume a leadership role in resuscitation of critically ill patients.

Manager
1 Demonstrate ability to manage time efficiently.
2. Demonstrate ability to identify medico-legal risks and take steps to address them.
3. Demonstrate an understanding of the operating of a surgical service including the prioritization of operating room cases, booking procedures for operations, and the interactions between various physicians groups and health care professionals during and around operations.

Health Advocate
1. Demonstrate an understanding of the determinants of health affecting surgery patients and their families.
2. Act as an advocate for the individual patient and affected populations.
3. Implement preventive health initiatives pertaining to surgery patients including counselling, community resource referrals and professional consultation.

Scholar
1. Demonstrate ability to critically evaluate the literature as it pertains to surgery.
2. Demonstrate inquisitiveness around clinical cases.
3. Apply the principles of evidence-based medicine.

Professional
1. Adhere to the code of ethics of the CMA and the institution.
2. Treat patients and colleagues with respect.
3. Self-evaluate, demonstrating insight into strengths and weaknesses.
4. Demonstrate commitment to life-long learning.
5. Be reliable, responsible, and accountable for his/her actions and for patient care.
6. Practice self-control in stressful situations and recognize how emotional stress can affect judgement and behaviour.

Feedback/Pearls from Previous EM Residents:

  • There are four teams on the General Surgery Service at VGH. Dr. Webber has assigned our residents to the team he believes most appropriate (BC).

Neurosciences (NEUROLOGY)

Year: PGY3

Site/Location: VGH
Rotation Coordinator: Kitty Pong or Yvonne Ng
Program Director: Dr. Jeff Beckman 
Holiday Requests: N/A as only a two week rotation
Where to show up: Contact Kitty Pong or Yvonne Ng
Rounds/Educational Activities on services: As per Neurology service.

Evaluation: As per Neurology service.

Neuroscience (NEUROSURGERY)

Year: PGY3
Site/Location: VGH
Rotation Coordinator: Sachiyo Kaneko, (604) 875-4142
Program Director: Dr. Gary Redekop
Holiday Requests: N/A due to two week rotation.
Where to show up: Contact Sharon Sanderson.
Rounds/Educational Activities on services: As per the Neurosurgery Service. Try to sit in with Neuroradiologists to read CT’s whenever possible.
Evaluation: As per Neurosurgery Service.

GOALS

1. Develop history taking and physical examination skills that identify and localize injury to the central nervous system.
2. Effectively utilize radiologic studies to diagnose neurological disease or injury.
3. Diagnose, stabilize and provide initial treatment of injuries and diseases of the brain, spinal cord, bony spine and peripheral nerves.
4. Learn how CSF shunts function and learn to evaluate patients with possible shunt malfunction.

OBJECTIVES

1. Demonstrate a brief and a complete neurological history and examination on patients with various levels of consciousness, including trauma patients.
2. Demonstrate an understanding of neuroanatomy and function by localizing the site of pathology in these patients.
3. Demonstrate the ability to recognize and manage cerebrovascular and spinal cord disorders that are amenable to neurosurgical intervention.
4. Describe the indications, techniques, and contraindications for neurologic imaging procedures including plain skull and spinal radiography, computerized tomographic scan (with and without contrast), tomography, and magnetic resonance imaging.
5. Demonstrate ability to interpret skull and spinal radiographs (cervical, thoracic, lumbar, sacral), and CT scans of the head.
6. Describe initial management of fractures, subluxations, and dislocations of the spine.
7. Demonstrate spinal immobilization techniques.
8. Demonstrate skill in the initial evaluation and management of blunt and penetrating traumatic injuries of the CNS.
9. Demonstrate the ability to evaluate CSF shunt malfunction.
10. Demonstrate ability to recognize and manage spinal cord compression due to non-traumatic causes.
11. Describe the indications and techniques for control of intracranial pressure.
12. Describe the main classifications of headaches and state the doses, indications, and contraindications for agents used to manage each of these types of headaches.
13. Demonstrate skill in the performance and interpretation of spinal fluid studies.
14. Demonstrate knowledge of the proper sequence for evaluation and management of patients with shunt malfunction , seizures, spinal cord compression, neurological tumours and
neurological infections.
15. Discuss the indications, contraindications, and dosages of agents used to treat neurological infections in pediatric and adult populations.
16. Demonstrate graduated, progressive skill in intraoperative techniques, halo vest application and appropriate ways to drain CSF urgently.
17.Name and describe the spinal cord syndromes.
18.Provide ongoing care of ICP monitors and epidural drains.
19.Demonstrate the ability to evaluate CSF shunt malfunction, including evaluation and treatment of blocked and infected shunts.
20.Demonstrate the proper technique for lumbar puncture.
21.List the criteria for the declaration of brain death as well as developing an approach to the assessment of patients for organ donation.
22.Demonstrate an appreciation for the functional impairment and resource utilization of patients with severe neurologic disability.

Communicator
1. Converse effectively and sensitively with neuroscience patients and their families.
2. Be able to discuss relevant issues around interventions.
3. Demonstrate knowledge of the health care consent act.
4. Demonstrate ability to deliver bad news effectively with compassion and sensitivity.
5. Describe and discuss the issues of brain death and organ donation with the lay public.
6. Provide an effective and efficient case summary to another health care professional.
7. Conduct a history and physical examination from a patient with neurologic disability including: decreased level of consciousness, dysarthria and behaviour problems.
8. Demonstrate proper documentation involving management of neurosciences patients.

Collaborator
1. Communicate and coordinate with the health care team both short and long term therapeutic decisions regarding patients presenting to the Emergency Department.
2. Detail the proper and appropriate transfer of patients from one health care setting to another including listing of issues of patient transfer, transfer of medical documents and medical legal  concerns.
3. Work effectively as part of a health care team in the inpatient environment.
4. Demonstrate ability to organize and coordinate proper aftercare and rehabilitation of the neurosciences patient.
5. Demonstrate an understanding of the roles of various participants the care of the neurosciences patient.

Manager
1. Coordinate care for patients, including the appropriate utilization of consultant specialists, intensive care, and community resources.
2. Demonstrate ability to manage time efficiently.
3. Demonstrate ability to identify medico-legal risks and take steps to address them.

Health Advocate
1. Demonstrate an understanding of the determinants of health affecting patients and their families.
2. Act as an advocate for the individual patient and affected populations.
3. Demonstrate knowledge of routine preventive health initiatives. (eg. Head injury reduction), and the ability to implement prevention initiatives.

Scholar
1. Demonstrate ability to critically evaluate the literature as it pertains to the neurosciences.
2. Demonstrate inquisitiveness around clinical cases.
3. Demonstrate ability to apply the principles of evidence-based medicine.

Professional
1. Adhere to the code of ethics of the CMA and the institution
2. Treat patients and colleagues with respect.
3. Self-evaluate, demonstrating insight into strengths and weaknesses
4. Demonstrate commitment to life-long learning
5. Be reliable, responsible, and accountable for his/her actions and for patient care.

Feedback/Pearls from previous EM residents

Neurology

  • There are two different components to the Neurology service –‘consult’ and ‘ward’.
  • Request to do both weeks of the ‘consult’ service by asking Chief resident, as these are ED consults.
  • If possible, try to attend one of the stroke clinics as this is where EP’s send TIA patients from the ED.
  • Some have also attended Dr. Beckman’s clinic - excellent.
  • Excellent teaching.
  • Still some value to ‘ward’ service - seeing how admitted patients get worked up for TIA/CVA.

Neurosurgery

  • No other rotation has generated more discussion about the pros/cons of the prototypical surgical rotation.
  • PRO = comfort/familiarity with head injuries, intracranial hemorrhage and acutely raised ICP.
  • Opportunity to go to OR on patients seen in ED craniotomy, burr holes, and follow up in Neuro ICU.
  • Use downtime to review CT with neuroradiology.
  • CON ??? little formal teaching from staff or senior residents (few, overworked)
  • Lots of service.

Obstetrics/Gynecology

Year: PGY1 (implemented July 1, 2005)

Site/Location: BC Women's Hospital/VGH
Rotation Coordinator: Scott Lewis
Program Director: Nancy Kent
Holiday Requests: Ask Scott Lewis for Chief Resident
Where to show up: Ask Scott Lewis - May need to pick up pager from Scott at BCWH Room 2H30.
Rounds/Educational Activities: As per Obstetrical Service Gyne service
Evaluation: As per Obs/Gyne service

GOALS

1. Learn the principle of contraception.
2. Develop expertise in the diagnosis and management of emergent complications of pregnancy.
3. Develop expertise in the management of uncomplicated and complicated labor and delivery.
4. Develop expertise in the management of sexual assault.
5. Learn the principles of management of gynecologic and obstetrical trauma.
6. Learn diagnosis and treatment of genital and pelvic infectious diseases.
7. Develop expertise in the diagnosis and management of abdominal pain in females.
8. Develop expertise in the diagnosis and management of vaginal bleeding.

OBJECTIVES

Upon completion of the rotation, residents should be able to:

Medical Expert
1. Effectively and efficiently perform a complete gynecological exam.
2. Discuss the differential diagnosis and evaluate and treat patients with: pelvic pain, dysmenorrhea,genitourinary infections including PID,UTI,STD and vaginitis, vaginal bleeding in pregnant and non-pregnant women, toxic shock syndrome, suspected ectopic pregnancy, placenta previa, abruptio placenta, preeclampsia and eclampsia, genital ulcerations, ovarian torsion, and hyperemesis gravidarum.
3. Demonstrate ability to perform perinatal and neonatal resuscitations.
4. Describe the relative effectiveness and complications of various contraceptive methods, including post-coital douche, coitus interruptus, condoms, diaphragm, rhythm method, oral contraceptives, injectable hormonal agents and IUD.
5. Discuss the normal stages of labor and the time course for each.
6. Demonstrate ability to determine the APGAR score and discuss the significance of different values.
7. Demonstrate ability to perform uncomplicated full-term deliveries.
8. Discuss the diagnosis and treatment of complicated labor including premature rupture of membranes, premature labor, failure to progress, fetal distress, and ruptured uterus.
9. Describe the management of complicated deliveries, including prolapsed cord, uncommon presentations, dystocia, uterine inversion, multiple births and stillbirth.
10. Demonstrate ability to diagnose and manage postpartum complications including retained products, endometritis and mastitis.
11. Discuss Rh incompatibility.
12. Demonstrate the ability to evaluate and treat sexual assault victims, including evidence collection, appropriate counselling and pregnancy prevention.
13. Discuss the indications for perimortem caesarian section and describe the technique.

Communicator
1. Converse effectively and sensitively with OB/GYN patients and their families.
2. Discuss relevant issues around interventions.
3. Demonstrate knowledge of the health care consent act.
4. Demonstrate ability to deliver bad news effectively with compassion and sensitivity.
5. Provide an efficient and appropriate case summary to another health care professional.

Collaborator
1. Act as chief care-giver (under supervision) and communicate with the patient, family, family physician, consultants, other health care professionals and social agencies.
2. Demonstrate appreciation for the unique interaction between patients, families, nurses, physicians, midwives in the peripartum period.
3. Demonstrate ability to work effectively as part of a health care team in the inpatient and L&D environment.
4. Demonstrate ability to address the health concerns of both mother and baby, using the expertise of OB/GYN, anaesthesia, and pediatrics consultants.
5. Assume a leadership role in resuscitation and delivery care.

Manager
1. Coordinate care for patients, including the appropriate utilization of consultant specialists and community resources.
2. Demonstrate proper documentation involving management of OB/GYN patients and infants.
3. Manage time efficiently.
4. Identify medico-legal risks and take steps to address them.

Health Advocate
1. Demonstrate an understanding of the determinants of health affecting patients, families and neonates.
2. Act as an advocate for both mother and child.
3. Identify and address at-risk populations.
4. Demonstrate knowledge of routine preventive health initiatives and ability to implement them. (e.g. Rh isoimmunization, group B streptococcus screening).
5. Demonstrate an appreciation for the unique process of childbirth and advocacy on behalf of the patient and families.

Scholar
1. Critically evaluate the literature as it pertains to airway management and anaesthesia.
2. Demonstrate inquisitiveness around clinical cases.
3. Apply the principles of evidence-based medicine.

Professional
1. Adhere to the code of ethics of the CMA and the institution
2. Treat patients and colleagues with respect.
3. Self-evaluate, demonstrating insight into strengths and weaknesses
4. Demonstrate commitment to life-long learning
5. Demonstrate willingness to accept responsibility for one???s actions and for patient care.

Feedback/Pearls from previous EM residents:

  • Nick Rose asked about doing an outpatient infectious disease clinic at BC Centre for Disease Control for more STD experience. Unfortunately, they only take electives of one month duration.

Year: PGY2 and PGY3

Site/Location: VGH - some have started to do one month of elective time in Whistler. VGH rotation is generally preceptor based with one of the staff orthopedic surgeons (Drs. O’Brien, Broekhuyse, Blachut, or Guy). You are on call with the surgeon and attend his clinics. There is a new group of orthopedic surgeons at SPH, one of them (Dr. Tom Goetz) has a particular interest in hand injuries. It is not yet established enough for a resident to do a full rotation, but it may be possible in the future (or even to do drop-ins on his follow up clinics).

Pediatric Orthopedics Clinics: Available, but no pursued so far.
Rotation Coordinator: Liz Denton
Program Director: Dr. Henry Broekhuyse
Holiday Requests: Ask Liz Denton
Where to show up: Ask Liz Denton
Rounds/Educational Activities on services:  As per Orthopedics Service.
Evaluation: By staff Orthopedic Surgeon.

 

GOALS

1. Develop relevant history and physical exam skills for the musculoskeletal system
2. Learn the use of the diagnostic imaging modalities available for the evaluation of orthopedic
disorders.
3. Develop skill in the evaluation and management of musculoskeletal trauma
4. Develop skill in the diagnosis and treatment of inflammatory and infectious disorders of the
musculoskeletal system
5. Learn principles of acute and chronic pain management in patients with musculoskeletal
disorders.

 

OBJECTIVES

Medical Expert
1. Develop ability to correctly perform a history and physical in patients with musculoskeletal disorders.
2. Demonstrate ability to correctly order and interpret radiographs in patients with orthopedic injuries.
3. Demonstrate understanding of the anatomy, mechanism of injury, presentations, complications, management and prognosis of common musculoskeletal injuries.
4. Demonstrate knowledge of standard orthopedic nomenclature.
5. Demonstrate knowledge of appropriate aftercare and rehabilitation of common orthopedic injuries.
6. Demonstrate knowledge of the differences in pediatric and adult skeletal anatomy and indicate how those difference are manifest in clinical and radiographic presentations.
7. Demonstrate ability to apply orthopedic devices, including casts, compressive dressings, splints and immobilizers.
8. Demonstrate skill in performance of the following procedures: fracture/dislocation immobilization and reduction of dislocations of the shoulders , elbow, knee, ankle,and hip, reduction of Colles fractures, arthrocentesis, extensor tendon repair.
9. Demonstrate ability to prioritize and manage the treatment of orthopedic injuries in multiple trauma patients.
10. Describe the presentation of patients with inflammatory and infectious disorders and demonstrate ability to diagnose and treat them.
11. Demonstrate ability to diagnose and treat soft tissue foreign bodies.
12. Describe the presentations, complications, diagnosis, management and prognosis of patients with human and animal bites.
13. Describe the presentations, complications, diagnosis and management of compartment syndromes.
14. Demonstrate ability to provide regional anesthesia, including hematoma blocks, Bier blocks and radial, ulnar, median, axillary, posterior tibial and sural nerve blocks.
15. Discuss the dosages, indications, contraindications and side effects of standard analgesic and sedative agents used to treat patients with acute orthopedic trauma and demonstrate skills in their use.
16. Discuss the dosages, indications, contraindications, side effects and relative potency of standard oral analgesics used in treatment of patients with musculoskeletal disorders.
17. Discuss the differential diagnosis, historical features, physical examination findings, diagnostic modalities and treatment of patients with low back pain.
18. Demonstrate ability to recognize and treat soft tissue infections involving muscle, fascia, and tendons.
19. Describe diagnosis and treatment of overuse syndrome.
20. Describe how to evaluate and preserve amputated limb parts.
21. Demonstrate knowledge of joint injuries, evaluation and grading of joint injuries, treatment of joint injuries and prognosis.
22. Discuss the treatment of soft tissue injuries such as strains, penetrating soft tissue injuries, crush injuries, and high-pressure injection injuries.
23. Demonstrate knowledge of the anatomy and physical examination of the hand as well as treatment of simple hand injuries including lacerations, dislocations and fractures.
24. Demonstrate an understanding of which orthopedic conditions warrant immediate and elective referral to an Orthopedic Surgeon.

Communicator
1. Converse effectively and sensitively with orthopedics patients and their families.
2. Discuss relevant issues around procedures.
3. Demonstrate knowledge of the health care consent act.
4. Deliver bad news effectively with compassion and sensitivity.
5. Communicate efficiently and effectively in the operating room environment.
6. Provide a concise, appropriate description of orthopedic injuries to other health care professionals using commonly accepted orthopedic terminology.
7. Demonstrate proper documentation involving management of orthopedic patients.

Collaborator
1. Communicate and coordinate with the health care team both short and long term therapeutic decisions regarding orthopedics patients.
2. Detail the proper and appropriate transfer of patients from one health care setting to another including listing of issues of patient transfer, transfer of medical documents and medical legal concerns.
3. Demonstrate ability to coordinate appropriate aftercare and rehabilitation of the orthopedics patient.
4. Demonstrate ability to work effectively as part of a health care team both in and around the inpatient and operating room environments.
5. Demonstrate an understanding of the roles of various participants in emergency department, inpatient and outpatient care and rehabilitation of orthopedic patients.
6. Assume a leadership role in the overall care of acute orthopedic conditions.
7. Function as part of a team in the initial care of a multiply-injured patient.

Manager
1. Coordinate care for patients, including the appropriate utilization of consultant specialists and community resources.
2. Manage time efficiently.
3. Identify medico-legal risks and take steps to address them.
4. Demonstrate understanding of the multiple factors influencing wait times for both acute and chronic orthopedic conditions and the effects of these on patients, their families, and health care professionals.

Health Advocate
1. Demonstrate understanding of the determinants of health affecting patients and their families.
2. Act as an advocate for the individual patient and affected populations.
3. Demonstrate knowledge of, and implementation of routine preventive health initiatives. (eg. Discuss the prevention of wrist injuries in recreational activities)

Scholar
1. Critically evaluate the literature as it pertains to orthopedics.
2. Demonstrate inquisitiveness around clinical cases.
3. Apply the principles of evidence-based medicine.

Professional
1. Adhere to the code of ethics of the CMA and the institution
2. Treat patients and colleagues with respect.
3. Self-evaluate, demonstrating insight into strengths and weaknesses
4. Demonstrate commitment to life-long learning
5. Be reliable, responsible and accountable for his/her actions and patient care

Feedback/Pearls from previous EM residents:

  • Dr. O’Brien on the quiet side.
  • Dr. Guy an excellent teacher.
  • Teaching/back up ER consults depends upon the senior resident
  • There are a variety of learning opportunities, and some service responsibilities, which are difficult to balance at times.
  • Service - rounds/taking care of wards.
  • Learning opportunities - ER consults, fracture clinics, OR While the clinics may not offer formal teaching all of the time, they offer great exposure to ED, consults, follow up and teaching from staff surgeons.
  • As in all surgical rotations, the surgical residents want to be in the OR and are happy to leave the beeper for the off service resident to handle the wards and ER consults.
  • You must be assertive at times to make sure that you do not get stuck on the wards at all times and thus, missing clinics.

Year: PGY4

Site/Location: BC’s Children-s Hospital
Rotation Coordinator: Denise Taylor
Program Director: Dr. Cathy Stephenson
Holiday Requests: Contact Denise Taylor
Where to show up: Contact Denise Taylor
Rounds/Educational Activities on services: As per the Pediatric Anesthesia service.
Evaluation:  As per Pediatric Anesthesia service.

GOALS AND OBJECTIVES

Medical Expert
1. Preoperative Assessment
2. Anatomical, Physiological and Pharmacologic Considerations in Newborns, Infants and Children
3. Monitoring and Specialized Equipment for Paediatric Anaesthesia
4. Perioperative Fluid and Electrolyte Management - Fasting Guidelines
5. Perioperative Temperature Management
6. Anaesthetic Management of the Paediatric Patient
7. Common Paediatric Syndromes and Emergencies: TE fistula, FB in airway, epiglottitis, pyloric stenosis, Ex-premie
8. Child with Recent URTI
9. Difficult Airway
10. Trauma
11. Congenital Heart Disease for non-cardiac surgery
12. Pain Management and Regional Anaesthesia
13. Anaesthesia outside the OR
14. Intravenous/Vascular accesss

Communicator
1. Converse effectively and sensitively with seriously ill patients and their families.
2. Discuss relevant issues around surgical procedures.
3. Demonstrate knowledge of the health care consent act.
4. Communicate effectively to all members of the operating room team.

Collaborator
1. Work effectively as part of a health care team.
2. Describe the role, expertise and limitations of all members of the operating room team required to optimally achieve a goal related to patient care.
3. Contribute to healthy team functioning, respecting the opinions and roles of team members and contribute his/her own expertise to the team's task.
4. Assume team leadership.
5. Demonstrate an understanding of the unique interaction of peri-operative care with every component of the hospital, especially the emergency department and acute care units.

Manager
1. Demonstrate an appreciation of the efficient and responsible use of anaesthesia resources.
2. Demonstrate proper documentation around management of critically ill patients.
3. Manage time efficiently.
4. Identify medico-legal risks and take steps to address them.

Health Advocate
1. Demonstrate an understanding of the determinants of health affecting patients and their families.
2. Act as an advocate for the individual patient and affected populations.
3. Demonstrate an understanding of "Do not resuscitate" orders, advance directives, living wills, competency, power of attorney and brain death criteria.

Scholar
1. Critically evaluate the literature as it pertains to airway management and the practice of anaesthesia.
2. Demonstrate inquisitiveness around clinical cases.
3. Apply the principles of evidence-based medicine.

Professional
1. Adhere to the code of ethics of the CMA and the institution.
2. Treat patients and colleagues with respect.
3. Self-evaluate, including insight into strengths and weaknesses.
4. Demonstrate commitment to life-long learning.
5. Be responsible, reliable and accountable for one's actions.

Feedback/Pearls from previous EM residents:

  • Excellent staff and teaching.
  • If possible, try to arranged this before Peds ICU.

Year: PGY4

Site/Location: BC Children's Hospital
Rotation Coordinator: Christine Carriere
Program Director: Dr. Adam Cheng
Holiday Requests: Contact Christine Carriere
Where to show up: Contact Christine Carriere
Rounds/Educational Activities on services:
Senior residents (PGY4 and PGY5) are scheduled on the Peds Emergency Fellows schedule, giving them more responsibility while in the ED

There are also specific educational activities:

1. Pediatric Fellow Rounds
- occur every week (Thursday a.m.)
- aimed at senior resident/fellow level

2. Dr. Haughton Sessions
- as in junior years
- contact Dr. Haughton well in advance of your rotation

Evaluation: As per Pediatric Emergency service.

GOALS

1. Developing skill in infant/pediatric resuscitation.
2. Developing skill in performance of appropriate pediatric history and physical exam, including general growth and development, assessment and knowledge of current immunization requirements.
3. Developing the skills to recognize a child with serious illness compared to a well-looking child.
4. Learn about the needs of a child admitted to hospital.
5. Learn the indications of social and/or psychological disturbances.
6. Learn the social, emotional, and physical implication of severe childhood illness on the family unit.

OBJECTIVES

Medical Expert
1. Describe the relevant anatomy, pathophysiology, natural history, investigative modalities and management of all acute disorders of body systems important to the pediatric population. (These systems include the core content of the RCPS emergency medicine program and the ACEP Core Content for Emergency Medicine: refer to references which follow).
2. Demonstrate efficient and focused pediatric history taking and physical examination skills.
3. Efficiently and effectively investigate and manage all important pediatric presentations, including the ability to appreciate the implications of the patient's age on management strategies.
4. Efficiently, safely, and effectively carry out procedures relevant to pediatric Emergency medicine practice, including but not limited to: Lumbar puncture, Acute resuscitation, Airway management, Intraosseous infusion, Intravenous access, Complex wound and fracture care.
5. Effectively lead a health care team through a resuscitation from beginning to end.

Communicator
Upon completion of the rotation, senior residents should be able to:
1. Break bad news such as that of death or serious illness or injury to patients, parents, and/or their family members in a way that is sensitive to the special circumstances of the parent-child relationship.

Health Advocate
Upon completion of the rotation, senior residents should be able to:

1. Demonstrate an appreciation for, and response to determinants of health specific to the pediatric population, including the effects on patient development of: home and learning environments, nutrition, emotional well-being, and cultural diversity.
2. Demonstrate a knowledge of, and response to the various forms of child abuse, including neglect, physical, sexual, and emotional abuse.

Collaborator
The specialist in Emergency Medicine is characterized as a collaborator when he/she works in partnership with others, as a member of an interdisciplinary team, to reach a common goal. Depending on the task at hand, the partnership/collaboration may include, besides the Emergency Medicine specialist, patients and their families, other physicians (primary care and specialist), allied health professionals, community organizations, alternative care providers, administrative bodies, researchers, and educators.

General Requirements:

  • Consult effectively with other physicians and health care professionals.
  • Contribute effectively to other interdisciplinary team activities.

Specific Requirements:

1. Understand the roles and expertise of the other individuals involved, inform and involve the patient and his/her family in decision-making, and explicitly integrate the opinions of the patient and care givers into management plans.
2. Recognize team members’ areas of expertise, respect the opinions and roles of individual team members, contribute to healthy team development and conflict resolution, and contribute his/her own expertise to the team’s task in hospitals, practice settings, and other institutions, such as committee work, research, teaching and learning.
3. Demonstrate an ability to function effectively within the unique environment of the emergency department, recognizing the unpredictable nature of patient presentations, and the demands of working with a multidisciplinary team.
4. Identify and describe the role, expertise and limitations of all members of the multidisciplinary team required to optimally achieve a goal related to patient care, a research problem, an educational task, or an administrative responsibility.
5. Demonstrate the ability to assume a team leadership and effective participant role in the complex multidisciplinary environment of the emergency department.
6. Demonstrate an understanding of the unique interaction of the emergency department with every component of the health care system including the hospital, its relationship to the community, and other agencies such as Emergency Medicine Services (EMS).
7. Demonstrate an ability to promote the autonomy of patients and families and to promote their involvement in decision-making.
8. Participate in multidisciplinary team meetings, demonstrating the ability to accept, consider and respect the opinions of other team members, while contributing specialty-specific expertise.
9. Describe how health care governance influences patient care, research, and educational activities at a local, provincial, regional, and national level.
10. Demonstrate effective consultation skills in response to requests from another health care provider and will manifest appropriate clinical judgment when requesting consultation expertise from colleagues in other specialty disciplines. This includes presenting well-documented patient assessments and recommendations in both written and verbal form.

 

Manager
Emergency specialists function as managers when they make everyday practice decisions involving resources, coworkers, tasks, policies and their personal lives.  They do this in the settings of individual patient care, practice organizations, and in the broader context of the health care system.  Thus, Emergency specialists require the abilities to prioritize and effectively execute tasks through teamwork with colleagues, and make systematic decisions when allocating finite health care resources.  As Managers, Emergency specialists take on positions of leadership within the context of professional organizations and the dynamic Canadian health care system.

General Requirements:

  • Utilize resources effectively to balance patient care, learning needs, and outside activities.
  • Allocate finite health care resources wisely.
  • Work effectively and efficiently in a health care organization.
  • Utilize information technology to optimize patient care, life-long learning and other activities.

Specific Requirements:

  1. Employ effective time management and self-assessment skills to formulate realistic expectations and a balanced lifestyle.
  2. Make sound judgments on resource allocation based on evidence of the benefit to individual patients and the population served.
  3. Understand the roles and responsibilities of specialists in Canada, the organization and function of the Canadian Health Care system, and the forces of change. This includes the ability to work effectively within teams of colleagues, manage a practice and function within broader organizational management systems (e.g. hospital committees).
  4. Use patient-related databases, access computer based information, and understand the fundamentals of medical informatics.
  5. Function effectively in health care organizations, ranging from an individual clinical practice to organizations at the local, regional and national level.
  6. Understand the structure, financing, and operation of the Canadian Health System and its facilities, function effectively within it and be capable of playing an active role in its change.
  7. Will be cognizant of the particular circumstances that foster positive relationships between the emergency Department, the hospital and the community.
  8. Access and apply a broad base of information to the care of patients in ambulatory care, hospitals and other health care settings.
  9. Make clinical decisions and judgments based on sound evidence for the benefit of individual patients and the population served. This allows for an advocacy role primarily for the individual but in the context of societal needs when monitoring and allocating needed resources.
  10. Work effectively as a member of a team or a partnership and to accomplish tasks whether one is a team leader or a team member.
  11. Understand population-based approaches to health care services and their implication for medical practice.
  12. Will participate in the planning of programs directed towards utilization and quality improvement in the emergency department.
  13. Manage concomitantly a number of ill and injured patients at any given time with a view to both providing these patients with excellence of care as well as ensuring the continued smooth flow of patients through an Emergency Department.
  14. Understand the supervisory and administrative aspects of Emergency Medical Services systems (i.e. rationalization of Emergency Services, communications systems, prehospital care programs, ambulance services, paramedical emergency services and disaster medicine).

 

Scholar
Emergency specialists function as scholars whether they are learning new knowledge from personal continuing education, applying knowledge to their daily practice or sharing knowledge with those related to their practice. This latter group may include patients, the public, medical students or residents, physicians, and other professional healthcare workers. Interpretation of new information requires critical appraisal skills, as well as the capacity to assess clinical applicability. Scholarly activity is a life-long endeavor that ensures professional competence, and guarantees optimal care of patients. As Scholars, Emergency specialists will take on positions of leadership within the context of ongoing professional development and learning by all professionals involved in Emergency medical care.

General Requirements:

  • Develop, implement and monitor a personal continuing education strategy.
  • Critically appraise sources of medical information.
  • Facilitate learning of patients, medical trainees/students and other health professionals.
  • Contribute to development of new knowledge.

Specific Requirements:

  1. Analyze and interpret the validity and applicability of evidence contained in the medical literature.
  2. Apply new knowledge to daily practice.
  3. Provide constructive feedback to these learners.
  4. Act as a role model and as a resource for other colleagues and health care professional.
  5. Establish a sustainable pattern of reading that will allow him/her to schedule sufficient time to maintain a current knowledge base.
  6. Learn how to efficiently track new literature pertinent to his/her practice, including studies published outside the Emergency Medicine literature.
  7. Learn the principles of biostatistics and critical analysis, allowing proper interpretation of original research publications. This can be best learned either with specific university courses or through a series of core lectures and assignments, complimented by regular participation in Journal Clubs.
  8. Acquire the basic principles of clinical bedside teaching.
  9. Acquire the basic principles of didactic teaching and public speaking, including the use of multimedia software and the basic skills for moderating small group discussion.
  10. Acquire the skills necessary to apply new knowledge in an evidence-based fashion to clinical practice.
  11. Learn the basic principles of clinical research methodology, further improving the ability to interpret original research.
  12. Learn the principles of distance learning, including video-conferencing, cyber sessions and web-based interactive learning.
  13. Become aware of patient information and patient support groups. Become aware of web sites capable of providing comprehensive information to patients pertinent to illness or injury treated in the emergency department.
  14. Pose an appropriate patient-related question, execute a systematic search for evidence, and critically evaluate medical literature and other evidence in order to optimize clinical decision-making.

Professional
Specialists have a unique societal role as professionals with a distinct body of knowledge, skills, and attitudes dedicated to improving the health and well-being of others. Specialists are committed to the highest standards of excellence in clinical care and ethical conduct, and to continually perfecting mastery of their discipline.

General Requirements:

  • Deliver highest quality care with integrity, honesty and compassion.
  • Exhibit appropriate personal and interpersonal professional behaviours.
  • Practise medicine ethically consistent with obligations of a physician.

Specific Requirements:

  1. Be aware of racial, cultural, and societal issues that impact on the delivery of care and an ability to maintain and enhance appropriate knowledge, skills and professional behaviours.
  2. Be accountable for personal actions, have a high degree of self-awareness, maintaining an appropriate balance between personal and professional roles, and addressing interpersonal differences in professional relations.
  3. Practice medicine in an ethically responsible manner that respects the medical, legal and professional obligations of belonging to a self-regulating body. This implies: an understanding of and adherence to legal and ethical codes of practice, the recognition of ethical dilemmas and the need for help to resolve them when necessary and the ability to recognize and respond to unprofessional behaviours in clinical practice, taking into account local and provincial regulations.
  4. Display expertise in each of the following areas:
    1. Discipline-Based Objectives:
      1. display attitudes commonly accepted as essential to professionalism;
      2. use appropriate strategies to maintain and advance professional competence; and
      3. continually evaluate one's abilities, knowledge and skills and know one's limitations of professional competence.
    2. Personal/Professional Boundary Objectives:
      1. adopt specific strategies to heighten personal and professional awareness and explore and resolve interpersonal difficulties in professional relationships; and
      2. consciously strive to balance personal and professional roles and responsibilities and to demonstrate ways of attempting to resolve conflicts and role strain.
    3. Objectives Related to Ethics and Professional Bodies:
      1. know and understand the professional, legal and ethical codes to which physicians are bound;
      2. recognize, analyze and attempt to resolve in clinical practice ethical issues such as truth-telling, consent, advanced directives, confidentiality, end-of-life care, conflict of interest, resource allocation and research ethics;
      3. understand and be able to apply relevant legislation that relates to the health care system in order to guide one's clinical practice; and
      4. recognize, analyze and know how to deal with unprofessional behaviours in clinical practice, taking into account local and provincial regulations.

Feedback/Pearls from previous EM residents:

  • Contact Dr. Haughton early to schedule teaching sessions.

 

PGY5Year

Pediatric Emergency Senior Resident
Year: PGY5
Site/Location: BCs Children's Hospital, as per the PGY4 Pediatric Emergency rotation.
Usually 2 month rotation in winter of PGY5 year to consolidate Pediatrics component of exam preparation.

PGY2 Year

Site/Location: VGH
Rotation Coordinator: Maureen Berard
Program Director: Dr. Peter Lennox
Holiday Requests: Ask Maureen Berard
Where to show up: Ask Maureen Berard
Rounds/Educational Activities on services: Tuesday a.m.-Combined Orthopedics/Plastics/Hands/Burns; Thursday p.m.- teaching session
Evaluation: Contributions from entire resident staff and plastic surgeons. Staff surgeons generally spend only one week every three months at VGH site on a rotating basis.

GOALS

1.Understand the pathophysiology of wound healing.
2.Learn effective wound evaluation and management skills.
3.Learn wound closure techniques appropriate for outpatient, traumatic wounds.
4.Learn appropriate methods for control of pain in patients with traumatic wounds.
5.Learn appropriate follow-up techniques and management of the complications of traumatic wounds.
6.Learn the evaluation and management of facial trauma.
7.Learn the evaluation and management of hand trauma.
8.Learn the evaluation and management of the burn patient.
9.Learn the evaluation and management of the patient with cold injuries.
10.Learn the evaluation and management of the patient with a chemical burn.

OBJECTIVES

Medical Expert
1.Demonstrate ability to perform appropriate history and physical exams in patients with traumatic wounds.
2.Demonstrate an understanding of wound pathophysiology, including cellular response, static and dynamic wound tensions, growth factors and tensile strength.
3.Demonstrate an understanding of the predictors of wound sepsis.
4.Demonstrate effective wound cleansing skills.
5.Describe the appropriate use, limitations and potential complications of wound cleansing solutions.
6.Describe the appropriate use, limitations and potential complications of antimicrobials in the management of traumatic wounds.
7.Demonstrate an understanding of various imaging modalities in the detection of soft tissue foreign bodies.
8.Demonstrate skill in various wound closure techniques including intradermal suture, fascial closure, interrupted skin sutures, running skin sutures, vertical and horizontal mattress sutures, half-buried horizontal mattress sutures, tape closure and use of staples. 9.Demonstrate appropriate use of delayed closure techniques.
10.Demonstrate appropriate management of special wound types, including skin ulcers, human bites, animal bites, snake bites, plantar puncture wounds, dermal abrasions and tar burns.
11.Demonstrate skill in the management of complex lacerations. List potential complications of complex lacerations.
Demonstrate skill in the provision of analgesia and anesthesia to patients with traumatic wounds including use of local infiltration, topical administration and conscious sedation.
12.Demonstrate ability to apply wound dressings.
13.Describe indications for specialty referral of traumatic wounds.
Demonstrate ability to evaluate and manage disorders of the mandible, including fractures, dislocations, and infections.
14.Demonstrate ability to evaluate and manage trauma to the head, neck, face and teeth.
15.Demonstrate the ability to perform facial nerve blocks including infraorbital, mental, auricular and dental blocks.
16.List 2 regional anatomic considerations of injuries to the following: forehead, eyelids, ears, nose, cheeks, chin, lips, intraoral mucosa and musculature, parotid gland, Stenson's duct, muscles of mastication and expression, branches of the facial nerve.
17.Given a patient with either a blunt or penetrating injury to the neck, describe the anatomical regions and their importance to the wound.
18.Describe the following facial fractures and discuss their diagnosis and treatment: LeForte I, II and II, zygoma, mandible, nose, orbit and tripod fractures.
19.Using surface landmarks identify the following structures: pisiform, motor branch of the ulnar nerve, hook of the hamate, superficial palmar arch, deep palmar arch, motor brand of median nerve, metacarpal heads, median and ulnar nerves, longus tendon, flexor carpi radialis and ulnaris tendon, extensor hallucis longus and abductor pollicis longus tendon.
20.Identify the sensory distribution of the ulnar, median and radial nerve and demonstrate the technique of 2-point discrimination.
21.Describe the testing of the muscles and tendons including:

  • flexor pollicis longus
  • flexor digitorum profundus
  • flexor digitorum superficialis
  • flexor carpi ulnaris and radialis
  • palmaris longus
  • extensor pollicis longus
  • abductor pollicis longus
  • extensor carpi radialis longus
  • extensor pollicis longus
  • extensor digitorum communes
  • extensor indices proprius
  • extensor digiti minimi
  • extensor carpi ulnaris
  • flexor pollicis brevis
  • opponens pollicis
  • abductor pollicis
  • abductor pollicis brevus
  • abductor digiti minimi
  • opponens digiti minimi

22.Describe Boutonniere and Swan Neck deformities.
23.Give the signs of tenosynovitis and discuss the complications and treatment. Describe the presentation of DeQuervain's tenosynovitis.
Identify the signs, complications and treatment of the following: paronychia, felon, herpetic felon/Whitlow, septic arthritis, deep palmar space abscess.
24.Describe the typical history and physical exam and mechanism of injury (if appropriate) for the following:

  • carpal tunnel syndrome
  • claw hand
  • Dupuytren's contracture
  • trigger finger
  • mallet finger
  • extensor tendon laceration

25.Discuss the mechanism of injury, clinical findings and treatment of the following:

  • phalangealvolar plate
  • Bennett's
  • Boxer's
  • Colle's
  • Smith's
  • ip joint dislocations
  • mcp joint dislocation
  • lunate dislocation
  • perilunate dislocation
  • carpal metacarpal dislocation,
  • scapholunate dissociation
  • Gameskeeper's thumb
  • collateral ligament sprain

27.Discuss evaluation and treatment of soft tissue injuries such as strains, penetrating soft tissue injuries, crush injuries, and high pressure injection injuries.
28.Demonstrate the ability to perform the following blocks: digital, metacarpal, wrist block of the radial, median and ulnar nerves.
29.Demonstrate the correct care of the burn victim, including the ability to calculate surface area burned for various age groups
30.Demonstrate the method for determining the correct maintenance fluid regimen for the burned patient
31.State the admission criteria for the burned patient, including criteria for admission to the burn unit.
32.For the patient presenting with cold injury differentiate between frost nip and frost bite.
33.Outline the components of evaluation and treatment of patients with frostbite.
34.State the chemical mechanism of injury and the treatment for hydrochloric and sulfuric acids, hydrofluoric acid and alkali burns, and white phosphorus burns.
35.List the differences between alkali and acid burns.
36.State the common injuries/conditions associated with electrical injuries and list the potential complications.

Communicator
1. Converse effectively and sensitively with plastic surgery patients and their families.
2. Discuss relevant issues around procedures.
3. Demonstrate knowledge of the health care consent act.
4. Deliver bad news effectively with compassion and sensitivity.
5. Communicate efficiently and effectively in the operating room environment.
6. Provide a concise, appropriate description of plastic surgery/hand/burn injuries to other health care professionals using commonly accepted terminology.
7. Demonstrate proper documentation involving management of plastic surgery patients.

Collaborator
1. Communicate and coordinate with the health care team both short and long term therapeutic decisions regarding plastic surgical patients.
2. Detail the proper and appropriate transfer of patients from one health care setting to another including listing of issues of patient transfer, transfer of medical documents and medical legal concerns.
3. Demonstrate ability to coordinate appropriate aftercare and rehabilitation of the plastic surgical patient.
4. Demonstrate ability to work effectively as part of a health care team both in and around the inpatient and operating room environments.
5. Demonstrate an understanding of the roles of various participants in emergency department, inpatient and outpatient care and rehabilitation of plastic surgical patients.
6. Assume a leadership role in the overall care of acute plastic surgical conditions.
7. Function as part of a team in the initial care of a multiply-injured patient.

Manager
1. Coordinate care for patients, including the appropriate utilization of consultant specialists and community resources.
2. Manage time efficiently.
3. Identify medico-legal risks and take steps to address them.
4. Demonstrate understanding of the multiple factors influencing wait times for both acute and chronic plastic surgical conditions and the effects of these on patients, their families, and health care professionals.

Health Advocate
1. Demonstrate understanding of the determinants of health affecting patients and their families.
2. Act as an advocate for the individual patient and affected populations.
3. Demonstrate knowledge of, and implementation of routine preventive health initiatives. (eg. Discuss the prevention of burn or hand injuries in recreational activities)

Scholar
1. Critically evaluate the literature as it pertains to plastic surgery.
2. Demonstrate inquisitiveness around clinical cases.
3. Apply the principles of evidence-based medicine.

Professional
1. Adhere to the code of ethics of the CMA and the institution
2. Treat patients and colleagues with respect.
3. Self-evaluate, demonstrating insight into strengths and weaknesses
4. Demonstrate commitment to life-long learning
5. Be reliable, responsible and accountable for his/her actions and patient care

Feedback/Pearls from previous EM residents:

  • there are a variety of learning opportunities and some service responsibilitites which are difficult to balance at times.
  • service: rounds on the wards
  • learning opportunities - ED consults, hand clinics, burn clinics, OR
  • while the clinics may not offer formal teaching all of the time, they offer great exposure to ED consults/follow-up and teaching from staff surgeons
  • as in all surgical rotations, the surgical residents want to be in the OR and are happy to leave the beeper to the off service resident to handle the wards and the ED consults
  • you must be assertive at times to make sure you do not get stuck on the wards at all times and thus missing clinics
  • teaching/back up on ER consults will depend on the senior residents
  • be sure to ask about certain ER procedures if you have not seen them (eg. extensor tendon/finger tip repairs)

Psychiatry - Adult

Year: PGY2

Site/Location: VGH - Psychiatric Assessment Unit (PAU)
Rotation Coordinator: Dr. Mark Levy
Program Director:
Holiday Requests: Ask Dr. Levy
Where to show up: Ask Dr. Levy
Rounds/Educational Activities on services:
As per PAU rotation.
Evaluation:
By staff psychiatrists in PAU.

GOALS

1. Understand the major categories of psychiatric illness.
2. Learn relevant interviewing techniques to deal with patients with various psychiatric
disorders.
3. Develop familiarity with common psychopharmacologic agents.
4. Learn principles of managing the violent patient.
5. Develop knowledge of the support offered in a community for patients with
psychiatric illness.

OBJECTIVES

Medical Expert
1. Demonstrate ability to conduct an interview in patients with acute psychiatric disorders.
2. Demonstrate ability to perform a mental status exam in patients with normal and altered mental status.
3. Discuss the indications for emergent psychiatric consultation.
4. Discuss the indications for routine psychiatric consultation.
5. Demonstrate ability to assess suicide risk.
6. Demonstrate ability to interact with violent emergency department patients and discuss protection techniques for patients and staff members.
7. Define major categories of psychiatric illness including thought, mood, anxiety, somatoform and personality disorders.
8. Discuss the pharmacokinetics, indications, contraindications and side effects of the major classes of psychopharmacologic agents including antipsychotics, sedative/hypnotics, and antidepressants.
9. Discuss the process of voluntary and involuntary commitment.
10. Discuss the indications for physical and chemical restraint and demonstrate ability to use restraint appropriately.
11. Discuss the difference between pseudodementia (depression) and true dementia in the elderly.
12. Discuss organic causes of altered mental status including dementia and delirium.
13. Demonstrate ability to differentiate organic and functional causes of altered mental status.
14. Demonstrate ability to diagnose and manage common intoxication and withdrawal syndromes.
15. Discuss the common complications of alcohol and drug abuse and demonstrate ability to diagnose and manage these complications.
16. Demonstrate ability to interact effectively with patients with personality disorders including antisocial, borderline, compulsive, dependent, histrionic and passiveaggressive
personalities.

Communicator
1. Conduct an effective interview of patients with acute psychiatric disorders.
2. Communicate effectively with patients suffering from a variety of psychiatric conditions to minimize likelihood of an acute psychiatric crisis and maximize the transfer of information for decision-making.
3. Establish a therapeutic relationship with psychiatric patients incorporating the principles of boundary-setting, providing autonomy and recognizing the effects of transference.
4. Effectively and efficiently provide a case summary to other health care professionals.

Collaborator
1. Assemble appropriate community resources and referral sources for patients with mental health problems.
2. Work collaboratively with a multidisciplinary team, including social workers, psychologists, psychiatric nurses and occupational therapists.
3. Construct an effective consultant/consultee relationship.
4. Work collaboratively with an acute care psychiatry team and understand their role in the management of an acutely ill psychiatric patient.
5. Work collaboratively to effect a proper medical and psychiatric work-up of undifferentiated presenting complaints.

Manager
1. Demonstrate an understanding of appropriate resource utilization.
2. Demonstrate an understanding of the ethical and legal principles applicable to the care of psychiatric patients, including: medicolegal issues of competence, consent, restraint and involuntary hospitalization including the proper use of mental health act forms.
3. Demonstrate proper documentation involving management of psychiatric patients including the Forms used by the Mental Health Act.
4. Demonstrate ability to manage time efficiently.
5. Demonstrate ability to identify medico-legal risks and take steps to address them.
6. Ameliorate the effects of psychiatric work-ups on emergency department flow.

Health Advocate
1. Demonstrate an understanding of the determinants of health affecting mental health patients and their families.
2. Act as an advocate for the individual patient and affected populations.
3. Demonstrate an appreciation for the need to intervene in the decision-making pertaining to incompetent patients.
4. Describe the principles of substitute decision-making.

Scholar
1. Critically evaluate the literature as it pertains to psychiatric conditions.
2. Demonstrate inquisitiveness around clinical cases.
3. Apply the principles of evidence-based medicine.

Professional
1. Adhere to the code of ethics of the CMA and the institution
2. Treat patients and colleagues with respect.
3. Self-evaluate, demonstrating insight into strengths and weaknesses
4. Demonstrate commitment to life-long learning
5. Be reliable, responsible and accountable for his/her actions and for patient care.

Feedback/Pearls from previous EM residents:

  • volume is variable, so there is potential for a lot of down time
  • be keen to see new consults from Emergency
  • take advantage of teaching from staff psychiatrists who review every consult with you
  • rotation is useful to review discharge disposition options as well (eg. shelters, Detox)

GENERAL OBJECTIVES

Upon completion of training, a resident is expected to be a competent emergency physician capable of assuming a consultant’s role in the specialty.  The specialist emergency physician employs per­tinent methods of prioritization, assessment, intervention, resuscitation and further management of patients to the point of transfer. Appropriate procedural and pharmacotherapeutic manoeuvres are central to these abilities. The specialist emergency physician possesses organizational skills in emergency department and disaster management and the ability to interface with and play a leadership role in the development and organization of the emergency medical services and prehospital care.

Residents must demonstrate the knowledge, skills and attitudes relating to gender, culture and ethnicity pertinent to Emergency Medicine.  In addition, all residents must demonstrate an ability to incorporate gender, cultural and ethnic perspectives in research methodology, data presentation and analysis.

ST. PAUL’S SPECIFIC OBJECTIVES

Medical Expert
Develop knowledge base and demonstrate proficiency in application to patient population with different demographics ie inner city

Communicator/Collaborator
Understand potential differences and difficulties in establishing relationships with patients of different demographics

Manager
Function effectively in a diiferent physical plant, with different resource utilization patterns

Advocate
Understand the determinants of health care in an inner city population, and respond appropriately

Scholar/Professional
Appreciate the learning environment where teachers have different specialty certifications

 

SPECIFIC OBJECTIVES

At the completion of training, the resident will have acquired the following competencies and will function effectively as a:

Medical Expert/Clinical Decision-Maker

Specialists possess a defined body of knowledge and procedural skills which are used to collect and interpret data, make appropriate clinical decisions, and carry out diagnostic and therapeutic procedures within the boundaries of their discipline and expertise. Their care is characterized by up-to-date, ethical, and cost-effective clinical practice and effective communication in partnership with patients, other health care providers, and the community. The role of medical expert/clinical decision-maker is central to the function of specialist physicians, and draws on the competencies included in the roles of scholar, communicator, health advocate, manager, collaborator, and professional.

General Requirements:

  • Demonstrate diagnostic and therapeutic skills for ethical and effective patient care.
  • Access and apply relevant information to clinical practice.
  • Demonstrate effective consultation services with respect to patient care, education and legal opinions.

Specific Requirements:

1. Elicit a relevant, concise, and accurate history and efficiently conduct an effective physical examination; carry out relevant procedures to collect, analyze, and interpret data; reach a diagnosis and perform appropriate therapeutic procedures to help resolve a patient's problem.
2. Demonstrate medical expertise in situations other than in direct patient care. This includes the ability to provide testimony as an expert medical witness and to give presentations.
3. Recognize personal limits of expertise by self-assessment. This includes the ability to decide if and when other professionals are needed to contribute to a patient's care, and the ability to implement a personal program to maintain and upgrade professional medical competence.
4. Apply the knowledge and expertise to the performance of specific psychomotor skills relevant to the specialty.
5. Use the best available evidence to select medically appropriate investigative tools that are informative, ethical and cost-effective.
6. Manifest a systematic and cognitive approach to clinical reasoning in order to solve the individual patient’s problems.
7. Access continuously new and relevant clinical information to ensure that the care provided to patients meets contemporary “best practice” circumstances.
8. Demonstrate medical expertise in situations other than those involving direct patient care (educational supervision, presentations, providing expertise and medico-legal cases)

 

Communicator
To provide humane, high‑quality care, Emergency specialists establish effective relationships with patients, other physicians, and other health professionals. Communication skills are essential for the functioning of an Emergency Physician, and are necessary for obtaining information from, and conveying information to patients and their families. Furthermore, these abilities are critical in eliciting patients' beliefs, concerns, and expectations about their illnesses, and for assessing key factors impacting on patients' health.

General Requirements:

  • Establish therapeutic relationships with patients/families.
  • Obtain and synthesize relevant history from patients/families/communities.
  • Listen effectively.
  • Discuss appropriate information with patients/families and the health care team.

Specific Requirements:

  1. Establish and maintain rapport and foster an environment characterized by understanding, trust, empathy, and confidentiality.
  2. Explore patient's beliefs, concerns, and expectations about the origin, nature, and management of his/her illness. Specialist Emergency Physicians need to be able to assess the impact of such factors as age, gender, ethno-cultural background, social support, and emotional influences on a patient's illness.
  3. Inform and counsel a patient in a sensitive and respectful manner while fostering understanding, discussion, and the patient's active participation in decisions about their care. This includes the ability to listen to the patient and to communicate effectively with other health providers, to ensure optimal and consistent care of the patient and his/her family. This also implies the ability to maintain clear, accurate, and appropriate records.
  4. Establish relationships with the patient that are characterized by understanding, trust, respect, empathy and confidentiality.
  5. Demonstrate the ability to break bad news such as that of death or serious illness or injury to patients and/or their family members in a way that is sensitive, thorough and understandable.
  6. Demonstrate the ability to screen for sensitive issues such as those of substance abuse, physical or sexual abuse and risk factors for HIV and other sexually transmitted diseases.
  7. Demonstrate the ability to discuss issues of advanced directives, living wills and DNR orders with patients and their families.
  8. Understand and demonstrate the importance of cooperation and communication among health professionals involved in the care of individual patients such that the roles of these professionals are delineated and consistent messages are delivered to patients and their families.
  9. Demonstrate skills in working with others who present significant communication challenges such as an ethno‑cultural background different from the physician's own or a physical or emotional impairment.  This would include the ability to communicate with patients  who pose a risk for  violent or aggressive behaviours using strategies that focus on identification and the defusing of potential adverse situations.
  10. Demonstrate the ability to recognize and minimize the negative effects that one’s emotions (anger, frustration, anxiety, fear) have on one’s ability to communicate effectively and take steps to minimize these effects.
  11. Provide effectively information to the general public and media about areas of local concern.
  12. Communicate effectively with the members of a multidisciplinary team in the resolution of conflicts, provision of feedback, and where appropriate, be able to assume a leadership role.

 

Collaborator
The specialist in Emergency Medicine is characterized as a collaborator when he/she works in partnership with others, as a member of an interdisciplinary team, to reach a common goal. Depending on the task at hand, the partnership/collaboration may include, besides the Emergency Medicine specialist, patients and their families, other physicians (primary care and specialist), allied health professionals, community organizations, alternative care providers, administrative bodies, researchers, and educators.

General Requirements:

  • Consult effectively with other physicians and health care professionals.
  • Contribute effectively to other interdisciplinary team activities.

Specific Requirements:

  1. Understand the roles and expertise of the other individuals involved, inform and involve the patient and his/her family in decision-making, and explicitly integrate the opinions of the patient and care givers into management plans.
  2. Recognize team members’ areas of expertise, respect the opinions and roles of individual team members, contribute to healthy team development and conflict resolution, and contribute his/her own expertise to the team’s task in hospitals, practice settings, and other institutions, such as committee work, research, teaching and learning.
  3. Demonstrate an ability to function effectively within the unique environment of the emergency department, recognizing the unpredictable nature of patient presentations, and the demands of working with a multidisciplinary team.
  4. Identify and describe the role, expertise and limitations of all members of the multidisciplinary team required to optimally achieve a goal related to patient care, a research problem, an educational task, or an administrative responsibility.
  5. Demonstrate the ability to assume a team leadership and effective participant role in the complex multidisciplinary environment of the emergency department.
  6. Demonstrate an understanding of the unique interaction of the emergency department with every component of the health care system including the hospital, its relationship to the community, and other agencies such as Emergency Medicine Services (EMS).
  7. Demonstrate an ability to promote the autonomy of patients and families and to promote their involvement in decision-making.
  8. Participate in multidisciplinary team meetings, demonstrating the ability to accept, consider and respect the opinions of other team members, while contributing specialty-specific expertise.
  9. Describe how health care governance influences patient care, research, and educational activities at a local, provincial, regional, and national level.
  10. Demonstrate effective consultation skills in response to requests from another health care provider and will manifest appropriate clinical judgment when requesting consultation expertise from colleagues in other specialty disciplines. This includes presenting well-documented patient assessments and recommendations in both written and verbal form.

 

Manager
Emergency specialists function as managers when they make everyday practice decisions involving resources, coworkers, tasks, policies and their personal lives.  They do this in the settings of individual patient care, practice organizations, and in the broader context of the health care system.  Thus, Emergency specialists require the abilities to prioritize and effectively execute tasks through teamwork with colleagues, and make systematic decisions when allocating finite health care resources.  As Managers, Emergency specialists take on positions of leadership within the context of professional organizations and the dynamic Canadian health care system.

General Requirements:

  • Utilize resources effectively to balance patient care, learning needs, and outside activities.
  • Allocate finite health care resources wisely.
  • Work effectively and efficiently in a health care organization.
  • Utilize information technology to optimize patient care, life-long learning and other activities.

Specific Requirements:

  1. Employ effective time management and self-assessment skills to formulate realistic expectations and a balanced lifestyle.
  2. Make sound judgments on resource allocation based on evidence of the benefit to individual patients and the population served.
  3. Understand the roles and responsibilities of specialists in Canada, the organization and function of the Canadian Health Care system, and the forces of change. This includes the ability to work effectively within teams of colleagues, manage a practice and function within broader organizational management systems (e.g. hospital committees).
  4. Use patient-related databases, access computer based information, and understand the fundamentals of medical informatics.
  5. Function effectively in health care organizations, ranging from an individual clinical practice to organizations at the local, regional and national level.
  6. Understand the structure, financing, and operation of the Canadian Health System and its facilities, function effectively within it and be capable of playing an active role in its change.
  7. Will be cognizant of the particular circumstances that foster positive relationships between the emergency Department, the hospital and the community.
  8. Access and apply a broad base of information to the care of patients in ambulatory care, hospitals and other health care settings.
  9. Make clinical decisions and judgments based on sound evidence for the benefit of individual patients and the population served. This allows for an advocacy role primarily for the individual but in the context of societal needs when monitoring and allocating needed resources.
  10. Work effectively as a member of a team or a partnership and to accomplish tasks whether one is a team leader or a team member.
  11. Understand population-based approaches to health care services and their implication for medical practice.
  12. Will participate in the planning of programs directed towards utilization and quality improvement in the emergency department.
  13. Manage concomitantly a number of ill and injured patients at any given time with a view to both providing these patients with excellence of care as well as ensuring the continued smooth flow of patients through an Emergency Department.
  14. Understand the supervisory and administrative aspects of Emergency Medical Services systems (i.e. rationalization of Emergency Services, communications systems, prehospital care programs, ambulance services, paramedical emergency services and disaster medicine).

Health Advocate
Specialists recognize the importance of advocacy activities in responding to the challenges represented by those social, environmental, and biological factors that determine the health of patients and society. They recognize advocacy as an essential and fundamental component of health promotion that occurs at the level of the individual patient, the practice population, and the broader community. Health advocacy is appropriately expressed both by the individual and collective responses of specialist physicians in influencing public health and policy.

 General Requirements:

  • Identify the important determinants of health affecting patients.
  • Contribute effectively to improved health of patients and communities.
  • Understand various approaches to health care advocacy and policy change
  • Recognize and respond to those issues where advocacy is appropriate.

 Specific Requirements:

  1. Identify the determinants of health that affect a patient, so as to be able to effectively contribute to improving individual and societal health in Canada. This includes the ability to recognize, assess, and respond to the psychosocial, economic, and biologic factors influencing the health of those served. The specialist incorporates information on the health determinants into his/her practice behaviours — both with individual patients and their community. At the doctor-patient level, this involves adapting patient management and education so as to promote health, enhance understanding, foster coping abilities, and enhance active participation in informed decision-making.
  2. Recognize and respond to those issues, settings, circumstances, or situations in which advocacy on behalf of patients, professions, or society is appropriate. This involves the ability to: identify populations at risk, identify current policies that affect health, and recognize the fundamental role of epidemiological research in informing practice. At a broader level, this includes the ability to describe how public policy is developed and employ methods of influencing the development of health and social policy.
  3. Demonstrate an understanding of the following:
    1. Determinants of health by identifying the most important determinants of health (i.e., poverty, unemployment, early childhood education, social support systems), being familiar with the underlying research evidence, and applying this understanding to common problems and conditions encountered in emergency medicine.
    2. Public policy for health by describing how public policy is developed; identifying current policies that affect health, either positively or negatively (i.e., communicable diseases, tobacco, substance abuse); and citing examples of how policy was changed as a result of actions by physicians.
  4. Demonstrate an understanding of these concepts as applied to the following three levels:
    1. In the management of individual patients by identifying the patient's status with respect to one or more of the determinants of health (i.e., unemployment); adapting the assessment, management and disposition accordingly (i.e., the medical history to the patient's social circumstances); and assessing the patient's ability to access various services in the health and social system.
    2. In the analysis of the emergency medicine patient population work with relevant associations in identifying current "at risk" groups within the practice of emergency medicine and applying the available knowledge about prevention to "at risk" groups within the practice; identify impediments to good, efficient, effective emergency medicine patient care and take steps to publicize and address these issues; and contribute "group data" for better understanding of health problems within the population.
    3. In relation to the general population by describing, in broad terms, the key issues currently under debate regarding changes in the Canadian health care system, indicating how these changes might affect societal health outcomes and advocating to decrease the burden of illness (at a community or societal level) of problems related to emergency medicine through a relevant specialty society, community-based advocacy group, other public education bodies, or private organizations.

 

Scholar
Emergency specialists function as scholars whether they are learning new knowledge from personal continuing education, applying knowledge to their daily practice or sharing knowledge with those related to their practice. This latter group may include patients, the public, medical students or residents, physicians, and other professional healthcare workers. Interpretation of new information requires critical appraisal skills, as well as the capacity to assess clinical applicability. Scholarly activity is a life-long endeavor that ensures professional competence, and guarantees optimal care of patients. As Scholars, Emergency specialists will take on positions of leadership within the context of ongoing professional development and learning by all professionals involved in Emergency medical care.

General Requirements:

  • Develop, implement and monitor a personal continuing education strategy.
  • Critically appraise sources of medical information.
  • Facilitate learning of patients, medical trainees/students and other health professionals.
  • Contribute to development of new knowledge.

Specific Requirements:

  1. Analyze and interpret the validity and applicability of evidence contained in the medical literature.
  2. Apply new knowledge to daily practice.
  3. Provide constructive feedback to these learners.
  4. Act as a role model and as a resource for other colleagues and health care professional.
  5. Establish a sustainable pattern of reading that will allow him/her to schedule sufficient time to maintain a current knowledge base.
  6. Learn how to efficiently track new literature pertinent to his/her practice, including studies published outside the Emergency Medicine literature.
  7. Learn the principles of biostatistics and critical analysis, allowing proper interpretation of original research publications. This can be best learned either with specific university courses or through a series of core lectures and assignments, complimented by regular participation in Journal Clubs.
  8. Acquire the basic principles of clinical bedside teaching.
  9. Acquire the basic principles of didactic teaching and public speaking, including the use of multimedia software and the basic skills for moderating small group discussion.
  10. Acquire the skills necessary to apply new knowledge in an evidence-based fashion to clinical practice.
  11. Learn the basic principles of clinical research methodology, further improving the ability to interpret original research.
  12. Learn the principles of distance learning, including video-conferencing, cyber sessions and web-based interactive learning.
  13. Become aware of patient information and patient support groups. Become aware of web sites capable of providing comprehensive information to patients pertinent to illness or injury treated in the emergency department.
  14. Pose an appropriate patient-related question, execute a systematic search for evidence, and critically evaluate medical literature and other evidence in order to optimize clinical decision-making.

 

Professional
Specialists have a unique societal role as professionals with a distinct body of knowledge, skills, and attitudes dedicated to improving the health and well-being of others. Specialists are committed to the highest standards of excellence in clinical care and ethical conduct, and to continually perfecting mastery of their discipline.

General Requirements:

  • Deliver highest quality care with integrity, honesty and compassion.
  • Exhibit appropriate personal and interpersonal professional behaviours.
  • Practise medicine ethically consistent with obligations of a physician.

Specific Requirements:

  1. Be aware of racial, cultural, and societal issues that impact on the delivery of care and an ability to maintain and enhance appropriate knowledge, skills and professional behaviours.
  2. Be accountable for personal actions, have a high degree of self-awareness, maintaining an appropriate balance between personal and professional roles, and addressing interpersonal differences in professional relations.
  3. Practice medicine in an ethically responsible manner that respects the medical, legal and professional obligations of belonging to a self-regulating body. This implies: an understanding of and adherence to legal and ethical codes of practice, the recognition of ethical dilemmas and the need for help to resolve them when necessary and the ability to recognize and respond to unprofessional behaviours in clinical practice, taking into account local and provincial regulations.
  4. Display expertise in each of the following areas:
    1. Discipline-Based Objectives:
      1. display attitudes commonly accepted as essential to professionalism;
      2. use appropriate strategies to maintain and advance professional competence; and
      3. continually evaluate one's abilities, knowledge and skills and know one's limitations of professional competence.
    2. Personal/Professional Boundary Objectives:
      1. adopt specific strategies to heighten personal and professional awareness and explore and resolve interpersonal difficulties in professional relationships; and
      2. consciously strive to balance personal and professional roles and responsibilities and to demonstrate ways of attempting to resolve conflicts and role strain.
    3. Objectives Related to Ethics and Professional Bodies:
      1. know and understand the professional, legal and ethical codes to which physicians are bound
      2. recognize, analyze and attempt to resolve in clinical practice ethical issues such as truth-telling, consent, advanced directives, confidentiality, end-of-life care, conflict of interest, resource allocation and research ethics;
      3. understand and be able to apply relevant legislation that relates to the health care system in order to guide one's clinical practice; and
      4. recognize, analyze and know how to deal with unprofessional behaviours in clinical practice, taking into account local and provincial regulations.

Revised into CanMEDS format – November 2003

Year: PGY2 and PGY3

Site/Location: BC Children's Hospital, Emergency Department
Rotation Coordinator: Gisela Murray
Program Director: Dr Adam Cheng, PEM Fellowship Director, or Dr Simi Khangura, EM Rotation Coordinator
Holiday Requests: Ask Gisela Murray or contact Pediatric Chief Res.
Where to show up: Ask Gisela Murray

Rounds/Educational Activities on services

There are many educational activities:

1. Pediatric EM Academic Rounds
- occur every week, Friday mornings
- a schedule of core topics is covered
- aimed at junior resident level
- residents are required to make a presentation at these rounds

2. Dr. Haughton Sessions
- Dr. David Haughton offers
- private teaching sessions with specific readings
- scheduled on a weekly basis (schedule permitting)
- contact Dr. Haughton well in advance of your rotation at haughton-art@shaw.ca

Evaluation: As per Pediatric Emergency Physicians, perhaps using daily evaluation slips.

GOALS

1. Developing skill in infant/pediatric resuscitation.
2. Developing skill in performance of appropriate pediatric history and physical exam, including general growth and development, assessment and knowledge of current immunization requirements.
3. Developing the skills to recognize a child with serious illness compared to a well-looking child.
4. Learn about the needs of a child admitted to hospital.
5. Learn the indications of social and/or psychological disturbances.
6. Learn the social, emotional, and physical implication of severe childhood illness on the family unit.

OBJECTIVES

Medical Expert

1. Describe the relevant anatomy, pathophysiology, and natural history, of acute disorders of body systems common to pediatric patients. (These systems include the core content of the RCPS emergency medicine program and the ACEP Core Content for Emergency Medicine: refer to references which follow). Specifically, the trainee will be able to recognize, diagnose and initiate management of children with:

  • convulsions
  • coma
  • acute respiratory difficulties
  • shock
  • physical or sexual abuse
  • drowning
  • multiple injuries
  • drug intoxication
  • burns
  • SIDS
  • foreign body aspiration
  • frostbite
  • common orthopaedic injuries
  • common plastic surgery problems
  • head injury

2. Demonstrate proficiency in clinical skills specific to the pediatric population, including aspects of history taking and physical examination.
3. Demonstrate an appreciation for the pediatric implications of laboratory and diagnostic imaging investigations.
4. Demonstrate knowledge of the basic principles of the initial steps in pediatric resuscitation.
5. Demonstrate competency in basic acute care pediatric procedures including I.V. and venous access, lumbar puncture, simple laceration management, plastering techniques, nasogastric lavages, and eye and ear examination.

Communicator
Upon completion of the rotation, junior residents should be able to:
1. Communicate effectively with children of various ages.
2. Effectively solicit and incorporate the needs of parents into care plans.

Health Advocate
Upon completion of the rotation, junior residents should be able to:

1. Demonstrate an appreciation of the unique determinants of health pertaining to the pediatric patient, including the effects on patient development of: home and learning environments, nutrition, emotional well-being, and cultural diversity.
2. Demonstrate a knowledge of the various forms of child abuse, including neglect, physical, sexual, and emotional abuse
Collaborator

The specialist in Emergency Medicine is characterized as a collaborator when he/she works in partnership with others, as a member of an interdisciplinary team, to reach a common goal. Depending on the task at hand, the partnership/collaboration may include, besides the Emergency Medicine specialist, patients and their families, other physicians (primary care and specialist), allied health professionals, community organizations, alternative care providers, administrative bodies, researchers, and educators.

General Requirements:

  • Consult effectively with other physicians and health care professionals.
  • Contribute effectively to other interdisciplinary team activities.

Specific Requirements:

  1. Understand the roles and expertise of the other individuals involved, inform and involve the patient and his/her family in decision-making, and explicitly integrate the opinions of the patient and care givers into management plans.
  2. Recognize team members’ areas of expertise, respect the opinions and roles of individual team members, contribute to healthy team development and conflict resolution, and contribute his/her own expertise to the team’s task in hospitals, practice settings, and other institutions, such as committee work, research, teaching and learning.
  3. Demonstrate an ability to function effectively within the unique environment of the emergency department, recognizing the unpredictable nature of patient presentations, and the demands of working with a multidisciplinary team.
  4. Identify and describe the role, expertise and limitations of all members of the multidisciplinary team required to optimally achieve a goal related to patient care, a research problem, an educational task, or an administrative responsibility.
  5. Demonstrate the ability to assume a team leadership and effective participant role in the complex multidisciplinary environment of the emergency department.
  6. Demonstrate an understanding of the unique interaction of the emergency department with every component of the health care system including the hospital, its relationship to the community, and other agencies such as Emergency Medicine Services (EMS).
  7. Demonstrate an ability to promote the autonomy of patients and families and to promote their involvement in decision-making.
  8. Participate in multidisciplinary team meetings, demonstrating the ability to accept, consider and respect the opinions of other team members, while contributing specialty-specific expertise.
  9. Describe how health care governance influences patient care, research, and educational activities at a local, provincial, regional, and national level.
  10. Demonstrate effective consultation skills in response to requests from another health care provider and will manifest appropriate clinical judgment when requesting consultation expertise from colleagues in other specialty disciplines. This includes presenting well-documented patient assessments and recommendations in both written and verbal form.

 

Manager
Emergency specialists function as managers when they make everyday practice decisions involving resources, coworkers, tasks, policies and their personal lives.  They do this in the settings of individual patient care, practice organizations, and in the broader context of the health care system.  Thus, Emergency specialists require the abilities to prioritize and effectively execute tasks through teamwork with colleagues, and make systematic decisions when allocating finite health care resources.  As Managers, Emergency specialists take on positions of leadership within the context of professional organizations and the dynamic Canadian health care system.

General Requirements:

  • Utilize resources effectively to balance patient care, learning needs, and outside activities.
  • Allocate finite health care resources wisely.
  • Work effectively and efficiently in a health care organization.
  • Utilize information technology to optimize patient care, life-long learning and other activities.

Specific Requirements:

  1. Employ effective time management and self-assessment skills to formulate realistic expectations and a balanced lifestyle.
  2. Make sound judgments on resource allocation based on evidence of the benefit to individual patients and the population served.
  3. Understand the roles and responsibilities of specialists in Canada, the organization and function of the Canadian Health Care system, and the forces of change. This includes the ability to work effectively within teams of colleagues, manage a practice and function within broader organizational management systems (e.g. hospital committees).
  4. Use patient-related databases, access computer based information, and understand the fundamentals of medical informatics.
  5. Function effectively in health care organizations, ranging from an individual clinical practice to organizations at the local, regional and national level.
  6. Understand the structure, financing, and operation of the Canadian Health System and its facilities, function effectively within it and be capable of playing an active role in its change.
  7. Will be cognizant of the particular circumstances that foster positive relationships between the emergency Department, the hospital and the community.
  8. Access and apply a broad base of information to the care of patients in ambulatory care, hospitals and other health care settings.
  9. Make clinical decisions and judgments based on sound evidence for the benefit of individual patients and the population served. This allows for an advocacy role primarily for the individual but in the context of societal needs when monitoring and allocating needed resources.
  10. Work effectively as a member of a team or a partnership and to accomplish tasks whether one is a team leader or a team member.
  11. Understand population-based approaches to health care services and their implication for medical practice.
  12. Will participate in the planning of programs directed towards utilization and quality improvement in the emergency department.
  13. Manage concomitantly a number of ill and injured patients at any given time with a view to both providing these patients with excellence of care as well as ensuring the continued smooth flow of patients through an Emergency Department.
  14. Understand the supervisory and administrative aspects of Emergency Medical Services systems (i.e. rationalization of Emergency Services, communications systems, prehospital care programs, ambulance services, paramedical emergency services and disaster medicine).

 

Scholar
Emergency specialists function as scholars whether they are learning new knowledge from personal continuing education, applying knowledge to their daily practice or sharing knowledge with those related to their practice. This latter group may include patients, the public, medical students or residents, physicians, and other professional healthcare workers. Interpretation of new information requires critical appraisal skills, as well as the capacity to assess clinical applicability. Scholarly activity is a life-long endeavor that ensures professional competence, and guarantees optimal care of patients. As Scholars, Emergency specialists will take on positions of leadership within the context of ongoing professional development and learning by all professionals involved in Emergency medical care.

General Requirements:

  • Develop, implement and monitor a personal continuing education strategy.
  • Critically appraise sources of medical information.
  • Facilitate learning of patients, medical trainees/students and other health professionals.
  • Contribute to development of new knowledge.

Specific Requirements:

  1. Analyze and interpret the validity and applicability of evidence contained in the medical literature.
  2. Apply new knowledge to daily practice.
  3. Provide constructive feedback to these learners.
  4. Act as a role model and as a resource for other colleagues and health care professional.
  5. Establish a sustainable pattern of reading that will allow him/her to schedule sufficient time to maintain a current knowledge base.
  6. Learn how to efficiently track new literature pertinent to his/her practice, including studies published outside the Emergency Medicine literature.
  7. Learn the principles of biostatistics and critical analysis, allowing proper interpretation of original research publications. This can be best learned either with specific university courses or through a series of core lectures and assignments, complimented by regular participation in Journal Clubs.
  8. Acquire the basic principles of clinical bedside teaching.
  9. Acquire the basic principles of didactic teaching and public speaking, including the use of multimedia software and the basic skills for moderating small group discussion.
  10. Acquire the skills necessary to apply new knowledge in an evidence-based fashion to clinical practice.
  11. Learn the basic principles of clinical research methodology, further improving the ability to interpret original research.
  12. Learn the principles of distance learning, including video-conferencing, cyber sessions and web-based interactive learning.
  13. Become aware of patient information and patient support groups. Become aware of web sites capable of providing comprehensive information to patients pertinent to illness or injury treated in the emergency department.
  14. Pose an appropriate patient-related question, execute a systematic search for evidence, and critically evaluate medical literature and other evidence in order to optimize clinical decision-making.

 

Professional
Specialists have a unique societal role as professionals with a distinct body of knowledge, skills, and attitudes dedicated to improving the health and well-being of others. Specialists are committed to the highest standards of excellence in clinical care and ethical conduct, and to continually perfecting mastery of their discipline.

General Requirements:

  • Deliver highest quality care with integrity, honesty and compassion.
  • Exhibit appropriate personal and interpersonal professional behaviours.
  • Practise medicine ethically consistent with obligations of a physician.

Specific Requirements:

  1. Be aware of racial, cultural, and societal issues that impact on the delivery of care and an ability to maintain and enhance appropriate knowledge, skills and professional behaviours.
  2. Be accountable for personal actions, have a high degree of self-awareness, maintaining an appropriate balance between personal and professional roles, and addressing interpersonal differences in professional relations.
  3. Practice medicine in an ethically responsible manner that respects the medical, legal and professional obligations of belonging to a self-regulating body. This implies: an understanding of and adherence to legal and ethical codes of practice, the recognition of ethical dilemmas and the need for help to resolve them when necessary and the ability to recognize and respond to unprofessional behaviours in clinical practice, taking into account local and provincial regulations.
  4. Display expertise in each of the following areas:
    1. Discipline-Based Objectives:
      1. display attitudes commonly accepted as essential to professionalism;
      2. use appropriate strategies to maintain and advance professional competence; and
      3. continually evaluate one's abilities, knowledge and skills and know one's limitations of professional competence.
    2. Personal/Professional Boundary Objectives:
      1. adopt specific strategies to heighten personal and professional awareness and explore and resolve interpersonal difficulties in professional relationships; and
      2. consciously strive to balance personal and professional roles and responsibilities and to demonstrate ways of attempting to resolve conflicts and role strain.
    3. Objectives Related to Ethics and Professional Bodies:
      1. know and understand the professional, legal and ethical codes to which physicians are bound;
      2. recognize, analyze and attempt to resolve in clinical practice ethical issues such as truth-telling, consent, advanced directives, confidentiality, end-of-life care, conflict of interest, resource allocation and research ethics;
      3. understand and be able to apply relevant legislation that relates to the health care system in order to guide one's clinical practice; and
      4. recognize, analyze and know how to deal with unprofessional behaviours in clinical practice, taking into account local and provincial regulations.

Feedback/Pearls from Previous EM Residents:

  • This rotation is very busy due to the readings from Dr. Haughton sessions, Pediatric Half Day and the required presentation.
  • Contact Dr. Haughton early for scheduling his teaching sessions - they are valuable.
  • Some natural variability of patients according to time of year (eg. croup season in fall/winter).
  • Higher volume of patients in fall/winter.
  • Less volume in summer.
  • Not a lot of pediatric trauma no matter what time of year.
  • There are rotations in PGY2, PGY3, PGY4 and PGY5, so you can request different times of year to see a variety of patients.

Year: PGY4

Site/Location: BC's Children's Hospital
Program Director: Dr. Mary Bennett
Holiday Requests: Contact Dr. Bennett
Where to show up: Contact Dr. Bennett
Rounds/Educational Activities on services: As per the Pediatric ICU service.
Evaluation: As per Pediatric ICU service

GOALS
1. Developing efficient and effective airway management skills.
2. Learning the principles of medical instrumentation and hemodynamic monitoring and be able to utilize them in the care of critically ill children.
3. Learning the rational use of laboratory, radiographic and other diagnostic tests in the management of critically ill children.
4. Learning the social, emotional, and physical implication of severe childhood illness on the family unit.
OBJECTIVES

Medical Expert
1. Rapidly perform history and physical exams in critically ill children.
2. Demonstrate the ability to assess children for the presence of severe illness and the appropriateness of ICU admission and preoperative screening.
3. Discuss the indications for, contraindications to, complications of, and perform the following procedures: fibreoptic endotracheal intubation, thoracentesis, pulmonary artery catheter, endotracheal intubation, nasotracheal intubation, tube thoracostomy, central line placement, and arterial line placement.
4. Obtain and interpret data from ECG monitors, 12 lead ECGs, cardiac and hemodynamic monitors, arterial blood gases, pulse oximetry, end tidal CO2 monitors, ventilators and ICP monitors in children.
5. Diagnose and treat shock, sepsis, fluid and electrolyte abnormalities, cardiac failure, cardiac dysrhythmias, renal failure, hepatic failure, and toxicologic emergencies.
6. Demonstrate understanding of the etiologies, diagnosis , and treatment of respiratory distress syndrome and multisystem organ failure.
7. Order appropriate fluids, blood, blood products and blood substitutes necessary for the resuscitation of children.
8. Describe the dosages, indications and contraindications of pharmacologic interventions for shock, cardiac failure, dysrhythmias, sepsis, trauma, toxins, respiratory failure, hepatic failure, renal failure, and neurologic illnesses.
9. Deal with complications of volume resuscitation and pharmacologic interventions.
10. Manage a patient on a ventilator including ventilator types, appropriate use of ventilation techniques, indications for extubation as well as weaning and extubation techniques.
11. Demonstrate an understanding of CPAP and BIPAP modes of positive airway pressure.
12. Rapidly assess and treat "emergencies" in the OR or ICU including but not limited to: dysrhythmias, cardiac arrest, pneumothorax, tension pneumothorax, dislodged endotracheal tubes, occluded endotracheal tubes, anaphylaxis, pulmonary embolism, hemorrhage, increased ICP.
13. Develop an understanding of the multidisciplinary team in the management of the seriously ill child, including but not limited to the roles of the nursing staff, perfusionists, respiratory technicians, dietitians, occupational therapist, physiotherapists and consulting staff.
14. Demonstrate the ability to manage the airway of a sick child, including bag-valve mask ventilation, and indications and complications of definitive airway techniques.
15. Demonstrate the ability to deliver safe conscious sedation and deep sedation to children
16. Demonstrate an understanding of the ethical and legal principles applicable to the care of critically ill children.

Communicator
1. Establish an effective physician/patient relationship with pediatric patients.
2. Obtain a history from patients of various ages where possible.
3. Converse effectively and sensitively with seriously ill patients and their families.
4. Be able to discuss relevant issues around critical care procedures.
5. Demonstrate knowledge of the health care consent act.
6. Deliver bad news effectively with compassion and sensitivity.
7. Summarize and synthesize information in a concise and coherent format.
8. Communicate effectively in the operating room environment.

Collaborator
1. Appropriately advise physicians consulting to the intensive care unit either in person or by phone.
2. To aid in arranging safe, appropriate and timely transportation of a critically ill patient, including determining the need for land or air transport or invasive procedures prior to transport.
3. Demonstrate an understanding of the appropriate use of consultants in critically ill patients.
4. Develop an understanding of the multidisciplinary team in the management of the ICU patient, including but not limited to the roles of the nursing staff, respiratory technicians, dietitians, occupational therapist, physiotherapists and consulting staff.
5. Function effectively as part of a team, including the assumption of leadership roles in resuscitation and ongoing patient care.

Manager
1. Demonstrate an appreciation for the administrative priorities of a critical care unit (eg. closed vs. open).
2. Demonstrate an understanding of appropriate resource utilization.
3. Demonstrate an understanding of ethical and legal principles applicable to critically ill patients.
4. Demonstrate proper documentation involving management of critically ill patients.
5. Demonstrate ability to manage time efficiently.
6. Demonstrate ability to identify medico-legal risks and take steps to address them. Demonstrate an understanding of appropriate resource utilization.
7. Organize and lead a family or care team meeting.

Health Advocate
1. Demonstrate an understanding of the determinants of health affecting patients and their families.
2. Act as an advocate for the individual patient and affected populations.
3. Demonstrate an understanding of "Do not resuscitate" orders, advance directives, living wills, competency, power of attorney and brain death criteria.
4. Demonstrate knowledge of relevant health policy pertaining to critical care (eg. regionalized care).
5. Demonstrate knowledge of the detection and management of child abuse, including the obligation to protect children from suspicious circumstances.

Scholar
1. Demonstrate ability to critically evaluate the literature as it pertains to pediatric critical care.
2. Demonstrate inquisitiveness around clinical cases.
3. Demonstrate ability to apply the principles of evidence-based medicine.

Professional
1. Adhere to the code of ethics of the CMA and the institution.
2. Treat patients and colleagues with respect.
3. Demonstrate ability to self-evaluate, including insight into strengths and weaknesses
4. Demonstrate commitment to life-long learning
5. Demonstrate willingness to accept responsibility for one???s actions and for patient care.

Feedback/Pearls from previous EM residents:
This rotation was 2 months duration up until 2002/03.
Residents commented that 2 months was too long and that a significant portion of the patients were post-op congenital hear patients.
Despite the need to be comfortable with ‘sick’ pediatric patients, it was felt that 1 month of Peds ICU was enough, so an additional month of Pediatric EM in PGY4 was substituted.
Residents need to express interest in doing procedures early, due to competition with other trainees, fellows.
Try to go on Infant Transports if possible.

Year: PGY4

Site/Location: New York Poison Control Centre
Bellevue Hospital, New York
OR
BC Drug & Poison Information Centre
St. Paul's Hospital - Vancouver

New York Rotation Coordinators
Dr. Louis Goldfrank
Tel: 212 561-4141
Fax: 212 561-3001

OR Dr. Lewis Nelson
New York Poison Control Centre
455 First Avenue, Room 123
New York, New York
10016

Vancouver Rotation Coordinators
Dr. Debra Kent
Dr. Jeff Brubacher

Program Directors:
For New York - see above, and very bottom of this e-mail.
For Vancouver -see above.
Holiday Requests: Contact Dr. Brian Chung
Where to show up: Contact Drs. Goldfrank/Nelson or Drs. Kent/Brubacher
Rounds/Educational Activities on services: As per the NYC Poison Control Centre. In Vancouver, individually arranged with Drs. Kent/Brubacher/Purssell
Evaluation:  As per NYC Poison Control Centre.

GOALS
1. Learn the pertinent aspects of the history and physical exam relative to acute poisoning with particular emphasis on clinical recognition of major toxic syndromes (toxidromes).
2. Learn the generic aspects of clinical management of poisoning, including stabilization and decontamination.
3. Understand the principles, methods, and controversies of decontamination and enhancement of elimination of toxins.
4. Learn the presenting signs, symptoms, laboratory findings, pathophysiology and treatment of common therapeutic drug poisonings, drugs of abuse, natural toxins, and general
household poisons as delineated in the core curriculum of Emergency Medicine.
5. Learn the common hazardous materials (HAZMAT) of the workplace and prehospital operations with regard to HAZMAT incidents.
6. Learn the principles of clinical operational toxicology and the major occupational toxins of Western society.
7. Learn the fundamentals of poisoning epidemiology, pharmokinetics, and biotransformation, including the effects of pregnancy and lactation.
8. Learn to recognize, diagnose, assess and emergently manage acute and chronic complications of substance abuse.
9. Learn the use of adjunctive services, including the toxicology laboratory and poison center, in the management of acute poisonings.
10. Learn the specific indications and implementation of specific therapeutic modalities, such as the use of antidotes, hemodialysis, and hyperbaric oxygen.

OBJECTIVES
1. Demonstrate the ability to perform gastric lavage, whole bowel irrigation, skin and eye decontamination, and administration of activated charcoal.
2. Discuss the indications, contraindications, dosages, and side effects of the currently available antidotes and antivenoms.
3. Demonstrate clinical recognition of toxidromes associated with drug overdose and drug withdrawal.
4. Demonstrate knowledge of the principles of hemodialysis and hemoperfusion and the toxic agents that can be removed by these methods.
5. Demonstrate ability to recognize common venomous animals and oisonous plants and their clinical presentations and treatments.
6. Demonstrate knowledge of the diagnostic laboratory including methods, limitations and costs.
7. Demonstrate knowledge of the drug interactions, side effects, and therapeutic levels of the commonly used therapeutic agents.
8. Demonstrate the proper technique for handling a HAZMAT contaminated patient in the emergency department and the prehospital environment.
9.Demonstrate knowledge of common household exposures including acids (esp. hydrofluoric), bases (bleaches, cleaners, dishwasher detergents) and cleaning agents
10. Demonstrate knowledge of the common household poisons, pesticides, hydrocarbons and metals, their effects and treatments.
11. Demonstrate the knowledge and clinical skills necessary to manage a patient poisoned by any of the following: acetaminophen, amphetamines, anticholinergics, aspirin, barbiturates,
benzodiazepines, beta blockers, calcium channel blockers, carbon monoxide, caustics, cocaine, cyanide, cyclic antidepressants, digitalis, ethanol, ethylene glycol, INH, iron, lithium, methanol, opiates, organophosphates, phenytoin, theophylline and venomous animals.
12. Demonstrate knowledge of basic principles of drug absorption, redistribution, metabolism, and elimination.

CanMeds Specific Goals and Objectives

Expert
Develop consultant level knowledge base in Toxicology.

Communicator
Although the Bellevue rotation does not involve direct patient care, there is still communication in the form of telephone follow-up, and thus allows the refinement of these skills

Collaborator
Understand and learn the collaborative approach of the attending toxicologists in dealing with consultations from other disciplines

Manager
Recognize the differences of the American health care system

Advocate
Understand how the determinants of health care differ in the Bellevue setting

Scholar/Professional
Gain insight into Toxicology as a subspecialty of various disciplines, including Emergency medicine

Feedback/Pearls from previous EM residents:

  • Housing in NYC is best arranged EARLY!!
  • When crossing border, do not say that you are "working" in New York due to VISA problems. Purpose of visit is study. You will have a letter saying that you are being paid by UBC as a resident.
  • Excellent rotation.
  • Excellent teaching.

Contact info, as per Chad from Jan 07, as follows:

Lewis Nelson is the contact MD email is : lnelson@pol.net RE: NYCPCC Rotation

Thanks for inquiring about a rotation at the New York City Poison Control Center. Just a little about the elective. Although the rotation is strongly clinical, it is didactic in nature and involves little, if any, primary patient care. The mornings are spent following up cases managed the prior day by the NYCPCC, reading up on the relevant subjects and discussing the cases with the medical toxicology fellows. In the afternoon is rounds with one of our faculty. There are also lectures, media presentations and a weekly journal club to add variety. There are a few issues that you need to be aware. The City of New York requires that all rotating physicians provide a letter from their home institution specifying that they will have their salary and malpractice coverage provided. If this is a problem at your institution, please contact me and we can discuss potential alternatives. Please have the letter forwarded to me at the address below. Medical students must be in their 4th year and have completed their core clinical rotations. If you are a medical student interested in the elective, please contact Alice Wilson at 212-263-5291 to make arrangements. She is in the Registrars' Office and the point person for rotating medical students. You can tell her that we had discussed the dates and that they are fine. Hopefully you have housing in the NYC area. If you need to arrange housing through us, I should warn you that it is very limited. We have two rooms available but they are very highly subscribed and may not be available during the dates you want them. Please call Margaret at 212-562-3346 or contact her at maggiekay48@hotmail.com to check availability. Let me know the exact dates when arranged. Good luck, and I look forward to meeting you.

Sincerely,

Lewis Nelson, M.D.
NEW YORK CITY POISON CONTROL CENTER
455 First Avenue, Room 123
New York, New York 10016
nycpcc@yahoo.com
Phone Number: 212-447-8150
Fax Number: 212-447-8223

PGY1 Year

Trauma - Junior Resident
Year: PGY1 (implemented July 1, 2005) and PGY2
Site/Location: VGH
Rotation Coordinator: Eleni.Tsakumis
Program Director: Dr. Morad Hameed
Holiday Requests: Ask Eleni Tsakumis. The UBC Department of Surgery has quite strict rules regarding the dates when holidays are allowed, and the deadline of holiday requests.
Where to show up: Ask Elsie Taylor
Rounds/educational activities on services: Organized sessions using Human Patient Simulator. Trauma/Resuscitation Rounds every Wednesday afternoon at 4:00 p.m.

 

GOALS
1. Gaining experience in the recognition and investigation of common trauma problems.
2. Developing procedural skills relevant to the emergent management of traumatic conditions.
3. Understanding the surgical and non-surgical management of common traumatic problems, including the indications for consultation and surgical intervention in patients with traumatic conditions and the need for emergent, urgent and elective referral of traumatic conditions
4. Learning the principles of care of the perioperative and post-operative patient.
5. Assessing and managing both penetrating and blunt trauma patients.

 

OBJECTIVES
Upon completion of the rotation, residents should be able to:

Medical Expert
1. Perform an appropriate history and physical exam in patients with traumatic conditions
2. Develop a differential diagnosis for, evaluate, treat and carry out the disposition of, patients presenting with acute traumatic conditions
3. List the indications, contraindications and complications for, and perform common procedural skills including nasogastric tube placement, tube thoracostomy, central line placement, pericardiocentesis and open thoracotomy surgical airway, arterial line access, femoral venipuncture, open thoracotomy
4. Assess and manage common postoperative conditions including pain, infection, wound dihescence, atelectasis, abcess formation, fluid and electrolyte imbalances, and device (ostomy applicance, drains, catheters, etc) malfunction.
5. Demonstrate proper prioritization in the assessment of the trauma patient.
6. Develop a differential diagnosis for, evaluate, treat and carry out the disposition of, patients presenting with all traumatic injuries, including: traumatic aortic injury, diaphragmatic injury, possible abdominal trauma, penetrating neck injuries, penetrating thoracoabdominal injuries, and musculoskeletal trauma.
7. Select appropriate diagnostic imaging tests for specific injury patterns such as computed tomography with and without contrast, emergency department ultrasound (including ability to perform and interpret FAST scans), plain film radiography, magnetic resonance imaging, venography and arteriography.

Communicator
1. Converse effectively and with sensitively with trauma patients and their families.
2. Discuss relevant issues around procedures.
3. Demonstrate knowledge of the health care consent act.
4. Deliver bad news effectively with compassion and sensitivity.
5. Communicate effectively as the leader of a trauma resuscitation and facilitate communication among members of the team.
6. Communicate effectively in the operating room.
7. Properly document care of trauma patients.
8. Effectively and efficiently provide a case summary to other health care professionals.

Collaborator
1. Work effectively as part of a health care team during trauma resuscitation and in the operating room setting.
2. Demonstrate an understanding of the roles of various participants in the care and rehabilitation of trauma patients.
3. Assume a leadership role in resuscitation of critically ill patients, including trauma resuscitations.

Manager
1. Demonstrate an understanding or triage principles for trauma patients and the design and implications of regionalization of trauma care.
2. Demonstrate ability to manage time efficiently.
3. Demonstrate ability to identify medico-legal risks and take steps to address them.
4. Demonstrate an understanding of the operationg of a trauma service including the prioritization of operating room cases, booking procedures for operations, and the interactions between various physicians groups and health care professionals during and around operations.

Health Advocate
1. Demonstrate an understanding of the determinants of health affecting trauma patients and their families.
2. Define the characteristics of the high-risk trauma patient.
3. Act as an advocate for the individual patient and affected populations.
4. Implement preventive health initiatives pertaining to surgery/trauma patients including counseling, community resource referrals and professional consultation.
5. Demonstrate an understanding of common injury prevention initiatives such as helmet laws, seatbelt laws, passive restraints, etc.

Scholar
1. Demonstrate ability to critically evaluate the literature as it pertains to trauma.
2. Demonstrate inquisitiveness around clinical cases.
3. Apply the principles of evidence-based medicine.

Professional
1. Adhere to the code of ethics of the CMA and the institution.
2. Treat patients and colleagues with respect.
3. Self-evaluate, demonstrating insight into strengths and weaknesses.
4. Demonstrate commitment to life-long learning.
5. Be reliable, responsible, and accountable for his/her actions and for patient care.
6. Practice self-control in stressful situations and recognize how emotional stress can affect judgement and behaviour.

GUIDELINES FOR GRADED RESPONSIBILITY
EMERGENCY MEDICINE RESIDENCY TRAINING PROGRAM
UNIVERSITY OF BRITISH COLUMBIA

Training in Emergency Medicine is a five year process that involves the acquisition of skills in Clinical Medicine, Administration, Teaching and Research. This document is intended to provide an overview of the progression in each of these areas as the Resident completes the five years of training.

These guidelines are intended to describe the minimum level of responsibility that each Resident should assume. Residents may assume more responsibility if this warranted by their performance. However, this should not occur at the expense of adequate supervision and teaching.

CLINICAL PERFORMANCE

PGY 1
In the first year of training the Resident consolidates the broad, undifferentiated knowledge base and clinical skills acquired in medical school. He or she assumes a greater responsibility for patient care, more professional autonomy and begins to develop an identity as a practicing physician. The emphasis in the first year is on basic principles and understanding areas of medicine in primary care and sub-specialty areas related to Emergency Medicine. Reading should be case related according to the rotation and in preparation for core seminars.

Attending Physicians should confirm findings from the history and physical examination at the bedside. Residents should be expected demonstrate examination techniques and specific physical findings. In addition the Resident should be observed while performing histories and physical examinations when time permits.

PGY 2
In the second year of the program the Resident begins to focus more on Emergency Medicine. Emphasis is placed on the diagnosis and management of one or a few patients simultaneously in the Emergency Department with close supervision of the Attending Physician.

The Attending is involved after the initial assessment of the patient and before diagnostic and therapeutic maneuvers are initiated. The Resident observes and participates in major trauma and medical resuscitations. Emphasis is placed on clinical presentations and fundamental principles of Emergency Medicine. At this point the Resident should have ATLS, ACLS and ideally ABLS certification. He or she should be gaining experience and confidence with basic airway management, respiratory and cardiovascular support. Reading should include the basic principles sections of Rosen dealing with airway, shock, respiratory problems, cardiovascular problems, and multiple trauma. This is in addition to preparing for the core seminars.

Attending Physicians should confirm findings from the history and physical examination at the bedside. Residents should be expected demonstrate examination techniques and specific physical findings. In addition the Resident should be observed while performing histories and physical examinations when time permits.

PGY 3
In the third year of the program the Residents should become comfortable with rapid sequence induction, advanced airway, respiratory and cardiovascular support, fluid administration and inotropes. Further emphasis is placed on basic diagnosis and management in the Emergency Department. At the same time the Resident becomes skilled in the simultaneous management of two or three patients in the Emergency Department with close supervision. The Attending Physician should be involved after the initial assessment of a potentially serious or complicated patient and before the initiation of diagnostic and therapeutic procedures. However, simple, relatively minor cases may be managed to the point of disposition at the discretion of the Resident and Attending Physician. The Resident plays a more active role in resuscitations of seriously ill or injured patients under the direct supervision of the Attending Physician. Residents should occasionally be observed performing histories and physical examinations. Emphasis should be placed on more complex presenting complaints. The Attending should accompany the Resident to the bedside to confirm difficult histories and subtle physical findings.

PGY 4
At this point in the residency the basic principles of Emergency Medicine should have been mastered. Emphasis is now placed on the finer points of diagnosis and management. The Resident gains expertise with more complicated and difficult cases. The management of multiple patients simultaneously to the limits of the Resident's capabilities is emphasized.

The majority of cases may be managed to the point of disposition prior to discussion with the Attending Physician. Case presentations may be more succinct and concentrating on key elements of the history and physical in straight forward cases. Complicated cases should still be discussed in detail, although the Residents should be encouraged to have arrived at a firm diagnosis and plan prior to presenting the case whenever possible.

The Resident plays an active leadership role in major trauma and medical resuscitations. He or she may act a leader of the trauma team where appropriate. The Attending Physician should be aware of the progression of serious cases although he or she may not directly supervise the ongoing care in every instance. The Resident may begin to take paramedic calls, and gain experience in the triage of patients and management of resources under the direct supervision of the Attending Physician. Residents should occasionally be observed performing histories and physical examinations.

Emphasis should be placed on more complex presenting complaints. The Attending should accompany the Resident to the bedside to confirm difficult histories and subtle physical findings.

In the second half of this year the Resident begins to develop sub-specialty expertise in a chosen area of Emergency Medicine through completion of the first six months of the elective block.

At this point the Resident is approaching the point of being a Consultant in Emergency Medicine. Emphasis is placed on controversial and advanced aspects of Emergency Medicine.

PGY 5
During the first half of this year, the resident completes training in a chosen subspecialty in Emergency Medicine. In the second half of the year, the resident returns to the Emergency Department and assumes the role of Attending Physician. They are responsible for the following activities under the direct supervision of the attending Emergency Physician:

1. Triage of patients within the Emergency Department.
2. Assessment and management of all patients in the Emergency Department.
3. Decisions regarding disposition and patient transfer.
4. Receiving all calls regarding incoming patients from referring physicians and paramedics.
5. Supervision of medical students and junior residents within the ED.
6. Trauma Team Leader

By this time, the resident should be completely facile and comfortable with all advanced resuscitative techniques, airway intervention, thoracotomy, trauma resuscitation and cardiac arrest. Emphasis is placed on the finer points of patient management. The resident gains experience in dealing with multiple simultaneous patients. He or she becomes skilled in resource management, patient flow, and triage.

At this point in the program, the resident has a high degree of autonomy in patient management. The majority of patients are managed to the point of disposition prior to being formally presented to the attending Emergency Physician. However, the attending should still be aware, in general terms, of the complaint and clinical course of all patients in the ED. At this point, the resident should be dealing directly with patients, families, and consulting services. The senior resident should observe students and junior residents performing histories and physicals when time permits. They should return to the bedside with junior house staff to confirm findings on the history and physical examination.

SPECIFIC OBJECTIVES

At the completion of training, the resident will have acquired the following competencies
and will function effectively as a :

 

Medical Expert/Clinical Decision-Maker
Specialists possess a defined body of knowledge and procedural skills which are used to collect and interpret data, make appropriate clinical decisions, and carry out diagnostic and therapeutic procedures within the boundaries of their discipline and expertise. Their care is characterized by up-to-date, ethical, and cost-effective clinical practice and effective communication in partnership with patients, other health care providers, and the community. The role of medical expert/clinical decision-maker is central to the function of specialist physicians, and draws on the competencies included in the roles of scholar, communicator, health advocate, manager, collaborator, and professional.

General Requirements:
• Demonstrate diagnostic and therapeutic skills for ethical and effective patient care.
• Access and apply relevant information to clinical practice.
• Demonstrate effective consultation services with respect to patient care, education and legal opinions.

Specific Requirements:

1. Elicit a relevant, concise, and accurate history and efficiently conduct an effective physical examination; carry out relevant procedures to collect, analyze, and interpret data; reach a diagnosis and perform appropriate therapeutic procedures to help resolve a patient's problem.

2. Demonstrate medical expertise in situations other than in direct patient care. This includes the ability to provide testimony as an expert medical witness and to give presentations.

3. Recognize personal limits of expertise by self-assessment. This includes the ability to decide if and when other professionals are needed to contribute to a patient's care, and the ability to implement a personal program to maintain and upgrade professional medical competence.

4. Apply the knowledge and expertise to the performance of specific psychomotor skills relevant to the specialty.

5. Use the best available evidence to select medically appropriate investigative tools that are informative, ethical and cost-effective.

6. Manifest a systematic and cognitive approach to clinical reasoning in order to solve the individual patient’s problems.

7. Access continuously new and relevant clinical information to ensure that the care provided to patients meets contemporary “best practice” circumstances.

8. Demonstrate medical expertise in situations other than those involving direct patient care (educational supervision, presentations, providing expertise and medico-legal cases)

 

Communicator
To provide humane, high quality care, Emergency specialists establish effective relationships with patients, other physicians, and other health professionals. Communication skills are essential for the functioning of an Emergency Physician, and are necessary for obtaining information from, and conveying information to patients and their families. Furthermore, these abilities are critical in eliciting patients' beliefs, concerns, and expectations about their illnesses, and for assessing key factors impacting on patients' health.

General Requirements:
• Establish therapeutic relationships with patients/families.
• Obtain and synthesize relevant history from patients/families/communities.
• Listen effectively.
• Discuss appropriate information with patients/families and the health care team.

Specific Requirements:

1. Establish and maintain rapport and foster an environment characterized by understanding, trust, empathy, and confidentiality.
2. Explore patient's beliefs, concerns, and expectations about the origin, nature, and management of his/her illness. Specialist Emergency Physicians need to be able to assess the impact of such factors as age, gender, ethno-cultural background, social support, and emotional influences on a patient's illness.
3. Inform and counsel a patient in a sensitive and respectful manner while fostering understanding, discussion, and the patient's active participation in decisions about their care. This includes the ability to listen to the patient and to communicate effectively with other health providers, to ensure optimal and consistent care of the patient and his/her family. This also implies the ability to maintain clear, accurate, and appropriate records.
4. Establish relationships with the patient that are characterized by understanding, trust, respect, empathy and confidentiality.
5. Demonstrate the ability to break bad news such as that of death or serious illness or injury to patients and/or their family members in a way that is sensitive, thorough and understandable.
6. Demonstrate the ability to screen for sensitive issues such as those of substance abuse, physical or sexual abuse and risk factors for HIV and other sexually transmitted diseases.
7. Demonstrate the ability to discuss issues of advanced directives, living wills and DNR orders with patients and their families.
8. Understand and demonstrate the importance of cooperation and communication among health professionals involved in the care of individual patients such that the roles of these professionals are delineated and consistent messages are delivered to patients and their families.
9. Demonstrate skills in working with others who present significant communication challenges such as an ethno cultural background different from the physician's own or a physical or emotional impairment. This would include the ability to communicate with patients who pose a risk for violent or aggressive behaviours using strategies that focus on identification and the defusing of potential adverse situations.
10. Demonstrate the ability to recognize and minimize the negative effects that one’s emotions (anger, frustration, anxiety, fear) have on one’s ability to communicate effectively and take steps to minimize these effects.
11. Provide effectively information to the general public and media about areas of local concern.
12. Communicate effectively with the members of a multidisciplinary team in the resolution of conflicts, provision of feedback, and where appropriate, be able to assume a leadership role.

 

Collaborator
The specialist in Emergency Medicine is characterized as a collaborator when he/she works in partnership with others, as a member of an interdisciplinary team, to reach a common goal. Depending on the task at hand, the partnership/collaboration may include, besides the Emergency Medicine specialist, patients and their families, other physicians (primary care and specialist), allied health professionals, community organizations, alternative care providers, administrative bodies, researchers, and educators.

General Requirements:
• Consult effectively with other physicians and health care professionals.
• Contribute effectively to other interdisciplinary team activities.

Specific Requirements:

1. Understand the roles and expertise of the other individuals involved, inform and involve the patient and his/her family in decision-making, and explicitly integrate the opinions of the patient and care givers into management plans.
2. Recognize team members’ areas of expertise, respect the opinions and roles of individual team members, contribute to healthy team development and conflict resolution, and contribute his/her own expertise to the team’s task in hospitals, practice settings, and other institutions, such as committee work, research, teaching and learning.
3. Demonstrate an ability to function effectively within the unique environment of the emergency department, recognizing the unpredictable nature of patient presentations, and the demands of working with a multidisciplinary team.
4. Identify and describe the role, expertise and limitations of all members of the multidisciplinary team required to optimally achieve a goal related to patient care, a research problem, an educational task, or an administrative responsibility.
5. Demonstrate the ability to assume a team leadership and effective participant role in the complex multidisciplinary environment of the emergency department.
6. Demonstrate an understanding of the unique interaction of the emergency department with every component of the health care system including the hospital, its relationship to the community, and other agencies such as Emergency Medicine Services (EMS).
7. Demonstrate an ability to promote the autonomy of patients and families and to promote their involvement in decision-making.
8. Participate in multidisciplinary team meetings, demonstrating the ability to accept, consider and respect the opinions of other team members, while contributing specialty-specific expertise.
9. Describe how health care governance influences patient care, research, and educational activities at a local, provincial, regional, and national level.
10. Demonstrate effective consultation skills in response to requests from another health care provider and will manifest appropriate clinical judgment when requesting consultation expertise from colleagues in other specialty disciplines. This includes presenting well-documented patient assessments and recommendations in both written and verbal form.

 

Manager
Emergency specialists function as managers when they make everyday practice decisions involving resources, coworkers, tasks, policies and their personal lives. They do this in the settings of individual patient care, practice organizations, and in the broader context of the health care system. Thus, Emergency specialists require the abilities to prioritize and effectively execute tasks through teamwork with colleagues, and make systematic decisions when allocating finite health care resources. As Managers, Emergency specialists take on positions of leadership within the context of professional organizations and the dynamic Canadian health care system.

General Requirements:
• Utilize resources effectively to balance patient care, learning needs, and outside activities.
• Allocate finite health care resources wisely.
• Work effectively and efficiently in a health care organization.
• Utilize information technology to optimize patient care, life-long learning and other activities.

Specific Requirements:

1. Employ effective time management and self-assessment skills to formulate realistic expectations and a balanced lifestyle.
2. Make sound judgments on resource allocation based on evidence of the benefit to individual patients and the population served.
3. Understand the roles and responsibilities of specialists in Canada, the organization and function of the Canadian Health Care system, and the forces of change. This includes the ability to work effectively within teams of colleagues, manage a practice and function within broader organizational management systems (e.g. hospital committees).
4. Use patient-related databases, access computer based information, and understand the fundamentals of medical informatics.
5. Function effectively in health care organizations, ranging from an individual clinical practice to organizations at the local, regional and national level.
6. Understand the structure, financing, and operation of the Canadian Health System and its facilities, function effectively within it and be capable of playing an active role in its change.
7. Will be cognizant of the particular circumstances that foster positive relationships between the emergency Department, the hospital and the community.
8. Access and apply a broad base of information to the care of patients in ambulatory care, hospitals and other health care settings.
9. Make clinical decisions and judgments based on sound evidence for the benefit of individual patients and the population served. This allows for an advocacy role primarily for the individual but in the context of societal needs when monitoring and allocating needed resources.
10. Work effectively as a member of a team or a partnership and to accomplish tasks whether one is a team leader or a team member.
11. Understand population-based approaches to health care services and their implication for medical practice.
12. Will participate in the planning of programs directed towards utilization and quality improvement in the emergency department.
13. Manage concomitantly a number of ill and injured patients at any given time with a view to both providing these patients with excellence of care as well as ensuring the continued smooth flow of patients through an Emergency Department.
14. Understand the supervisory and administrative aspects of Emergency Medical Services systems (i.e. rationalization of Emergency Services, communications systems, prehospital care programs, ambulance services, paramedical emergency services and disaster medicine).

 

Health Advocate
Specialists recognize the importance of advocacy activities in responding to the challenges represented by those social, environmental, and biological factors that determine the health of patients and society. They recognize advocacy as an essential and fundamental component of health promotion that occurs at the level of the individual patient, the practice population, and the broader community. Health advocacy is appropriately expressed both by the individual and collective responses of specialist physicians in influencing public health and policy.

General Requirements:
• Identify the important determinants of health affecting patients.
• Contribute effectively to improved health of patients and communities.
• Understand various approaches to health care advocacy and policy change
• Recognize and respond to those issues where advocacy is appropriate.

Specific Requirements:

1. Identify the determinants of health that affect a patient, so as to be able to effectively contribute to improving individual and societal health in Canada. This includes the ability to recognize, assess, and respond to the psychosocial, economic, and biologic factors influencing the health of those served. The specialist incorporates information on the health determinants into his/her practice behaviours — both with individual patients and their community. At the doctor-patient level, this involves adapting patient management and education so as to promote health, enhance understanding, foster coping abilities, and enhance active participation in informed decision-making.
2. Recognize and respond to those issues, settings, circumstances, or situations in which advocacy on behalf of patients, professions, or society is appropriate. This involves the ability to: identify populations at risk, identify current policies that affect health, and recognize the fundamental role of epidemiological research in informing practice. At a broader level, this includes the ability to describe how public policy is developed and employ methods of influencing the development of health and social policy.
3. Demonstrate an understanding of the following:
a. Determinants of health by identifying the most important determinants of health (i.e., poverty, unemployment, early childhood education, social support systems), being familiar with the underlying research evidence, and applying this understanding to common problems and conditions encountered in emergency medicine.
b. Public policy for health by describing how public policy is developed; identifying current policies that affect health, either positively or negatively (i.e., communicable diseases, tobacco, substance abuse); and citing examples of how policy was changed as a result of actions by physicians.

4. Demonstrate an understanding of these concepts as applied to the following three levels:
a. In the management of individual patients by identifying the patient's status with respect to one or more of the determinants of health (i.e., unemployment); adapting the assessment, management and disposition accordingly (i.e., the medical history to the patient's social circumstances); and assessing the patient's ability to access various services in the health and social system.
b. In the analysis of the emergency medicine patient population work with relevant associations in identifying current "at risk" groups within the practice of emergency medicine and applying the available knowledge about prevention to "at risk" groups within the practice; identify impediments to good, efficient, effective emergency medicine patient care and take steps to publicize and address these issues; and contribute "group data" for better understanding of health problems within the population.
c. In relation to the general population by describing, in broad terms, the key issues currently under debate regarding changes in the Canadian health care system, indicating how these changes might affect societal health outcomes and advocating to decrease the burden of illness (at a community or societal level) of problems related to emergency medicine through a relevant specialty society, community-based advocacy group, other public education bodies, or private organizations.

 

Scholar
Emergency specialists function as scholars whether they are learning new knowledge from personal continuing education, applying knowledge to their daily practice or sharing knowledge with those related to their practice. This latter group may include patients, the public, medical students or residents, physicians, and other professional healthcare workers. Interpretation of new information requires critical appraisal skills, as well as the capacity to assess clinical applicability. Scholarly activity is a life-long endeavor that ensures professional competence, and guarantees optimal care of patients. As Scholars, Emergency specialists will take on positions of leadership within the context of ongoing professional development and learning by all professionals involved in Emergency medical care.

General Requirements:
• Develop, implement and monitor a personal continuing education strategy.
• Critically appraise sources of medical information.
• Facilitate learning of patients, medical trainees/students and other health professionals.
• Contribute to development of new knowledge.

Specific Requirements:

1. Analyze and interpret the validity and applicability of evidence contained in the medical literature.
2. Apply new knowledge to daily practice.
3. Provide constructive feedback to these learners.
4. Act as a role model and as a resource for other colleagues and health care professional.
5. Establish a sustainable pattern of reading that will allow him/her to schedule sufficient time to maintain a current knowledge base.
6. Learn how to efficiently track new literature pertinent to his/her practice, including studies published outside the Emergency Medicine literature.
7. Learn the principles of biostatistics and critical analysis, allowing proper interpretation of original research publications. This can be best learned either with specific university courses or through a series of core lectures and assignments, complimented by regular participation in Journal Clubs.
8. Acquire the basic principles of clinical bedside teaching.
9. Acquire the basic principles of didactic teaching and public speaking, including the use of multimedia software and the basic skills for moderating small group discussion.
10. Acquire the skills necessary to apply new knowledge in an evidence-based fashion to clinical practice.
11. Learn the basic principles of clinical research methodology, further improving the ability to interpret original research.
12. Learn the principles of distance learning, including video-conferencing, cyber sessions and web-based interactive learning.
13. Become aware of patient information and patient support groups. Become aware of web sites capable of providing comprehensive information to patients pertinent to illness or injury treated in the emergency department.
14. Pose an appropriate patient-related question, execute a systematic search for evidence, and critically evaluate medical literature and other evidence in order to optimize clinical decision-making.

 

Professional
Specialists have a unique societal role as professionals with a distinct body of knowledge, skills, and attitudes dedicated to improving the health and well-being of others. Specialists are committed to the highest standards of excellence in clinical care and ethical conduct, and to continually perfecting mastery of their discipline.

General Requirements:
• Deliver highest quality care with integrity, honesty and compassion.
• Exhibit appropriate personal and interpersonal professional behaviours.
• Practise medicine ethically consistent with obligations of a physician.

Specific Requirements:

  1. Be aware of racial, cultural, and societal issues that impact on the delivery of care and an ability to maintain and enhance appropriate knowledge, skills and professional behaviours.
  2. Be accountable for personal actions, have a high degree of self-awareness, maintaining an appropriate balance between personal and professional roles, and addressing interpersonal differences in professional relations.
  3. Practice medicine in an ethically responsible manner that respects the medical, legal and professional obligations of belonging to a self-regulating body. This implies: an understanding of and adherence to legal and ethical codes of practice, the recognition of ethical dilemmas and the need for help to resolve them when necessary and the ability to recognize and respond to unprofessional behaviours in clinical practice, taking into account local and provincial regulations.
  4. Display expertise in each of the following areas:

A. Discipline-Based Objectives:

  1. display attitudes commonly accepted as essential to professionalism;
  2. use appropriate strategies to maintain and advance professional competence; and
  3. continually evaluate one's abilities, knowledge and skills and know one's limitations of professional competence.

B. Personal/Professional Boundary Objectives:

  1. adopt specific strategies to heighten personal and professional awareness and explore and resolve interpersonal difficulties in professional relationships; and
  2. consciously strive to balance personal and professional roles and responsibilities and to demonstrate ways of attempting to resolve conflicts and role strain.

C. Objectives Related to Ethics and Professional Bodies:

  1. know and understand the professional, legal and ethical codes to which physicians are bound;
  2. recognize, analyze and attempt to resolve in clinical practice ethical issues such as truth-telling, consent, advanced directives, confidentiality, end-of-life care, conflict of interest, resource allocation and research ethics;
  3. understand and be able to apply relevant legislation that relates to the health care system in order to guide one's clinical practice; and
  4. recognize, analyze and know how to deal with unprofessional behaviours in clinical practice, taking into account local and provincial regulations.

Revised into CanMEDS format – November 2003