FRCPC-EM Residency

retreat

"The Royal College program is a 5 year Royal College residency, intended for those who wish an academic career as a consultant in Emergency Medicine ..."


Contacts:

Mailing address:
Emergency Medicine, Max Rady College of Medicine
Rady Faculty of Health Sciences, University of Manitoba
NA529 - 700 McDermot Ave.
Winnipeg, MB R3E 0T2


Resources: Health Sciences Centre is an adult tertiary Emergency Department which serves the core area of Winnipeg. It has a high volume of high acuity patients with significant numbers of multiple trauma, toxicology, and disturbed psychiatric patients.

The Children's Hospital, Health Sciences Centre, is situated in the core area of Winnipeg where it provides primary, secondary, and tertiary pediatric care for Winnipeg, Manitoba, NW Ontario and Nunavut. All levels of injury and illness acuity are seen in this Emergency Department with significant multiple trauma, toxicology, and child abuse.

St. Boniface Hospital Emergency Department treats patients of all ages. It serves as a community hospital for the francophone community of Winnipeg and surrounding rural francophone towns, as well as a tertiary care referral centre. Patient acuity is high with a higher proportion of internal medicine, cardiology, nephrology and geriatrics.


Strengths of the Program:

  1. High patient acuity with large volumes and high rates of pathology
  2. Full academic day
  3. Strong Ultrasound led by Dr. Chau Pham
  4. Research Director Dr. Erin Weldon has strengthened both the teaching of evidence-based medicine as well as research methods
  5. Strong simulation program under the direction of Dr. Cheryl ffrench
  6. Annual Resident Retreat
  7. Cohesive and supportive resident group
  8. Regular resident-faculty Journal Club
  9. ACLS, ATLS, PALS, AIME - all paid for under the contract
  10. Five days of conference leave once per academic year
  11. $2,000 Cdn/yr. provided to each resident for scholarly activity/conferences
  12. The program has strong ties with the pre-hospital care system, including the Winnipeg Fire Paramedic Service, the Provincial Air Ambulance (LifeFlight) and the new rotary program STARS
  13. Two clinical Toxicologists provide a strong Toxicology rotation
  14. Supportive and innovative resident wellness programs including a formal mentorship and a High Performance Physician Program
  15. Attending physicians with subspecialty training in Critical Care, EMS, Sport Medicine, Ethics, Palliative Care and Toxicology

Curriculum

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PGY-1

PGY-2

PGY-3

PGY-4

PGY-5

PERIOD 1

ER

ER

ER

ER

TTL

PERIOD 2

ER

ER

ER

ER

ER

PERIOD 3

ER

ER

ER

ER

ER

PERIOD 4

Community ER

ER

ER

Niche

ER

PERIOD 5

Ortho

EM Psych

ER

Niche

ER

PERIOD 6

Gold

CCU

ER

Admins/EMS

ER

PERIOD 7

ACSS

Plastics

MICU

Niche

ER

PERIOD 8

GIM Wards

SICU

M/SICU

Niche

Elective

PERIOD 9

GIM Wards

IM Senior

Medical Education

Niche

Elective

PERIOD 10

Obs/Gyn

IM Consults

Toxicology

Niche

Elective

PERIOD 11

Anesthesia

Adult/Peds Anesthesia

Research

PICU

Elective

PERIOD 12

Peds ER

Peds ER

Peds ER

Peds ER or PICU

Peds ER

PERIOD 13

Vacation

Vacation

Vacation

Vacation

Vacation

PGY-1
The first year of specialty training is a basic training year. Included are rotations in emergency medicine, internal medicine, surgery, pediatrics emergency medicine, anesthesia, orthopedics, emergency psychiatry, obstetrics/gynecology, and community emergency medicine.

PGY-2 and 3
In the next two years of residency training, 12 months of training is provided in the three affiliated Emergency Departments. Other rotations include Anaesthesia, Internal Medicine (ward senior and consults) Intensive Care (both surgical and medical), Toxicology, Emergency Medical Services, Plastic Surgery, Cariology/CCU, EM education and EM research.

PGY 4 & 5
During the senior years, a further 10 - 11 months of core Emergency Medicine are provided in the three affiliated emergency departments. The senior resident assumes increasing responsibility for the management of patients in the emergency department and supervises the care of patients by junior house staff. Other rotations include trauma surgery or Trauma Team leader rotation, pediatric ICU, Emergency Department administration/Emergency Medical Services.

There are 6 months in the R4 year that are available for the resident to develop an area of expertise as per the Emergency Medicine Specialty Training Requirements. If this is done via distance education or on-line, then the resident will also be scheduled on an  Emergency rotation, albeit with a decreased shift requirement.

As well, there are a further four months of elective time.Other rotations include two months in Acute and Trauma Surgery, or a Trauma Team Leader rotation based at the Health Sciences Centre Emergency Department, one month in Pediatric ICU, one month in Surgical ICU, Toxicology, and Emergency Medical Services (EMS).


Summary: The program was established in 1991 and has undergone curriculum revisions since its initiation. Refinements in the curriculum will no doubt continue. Changes are at the discretion of the Residency Program Committee which consists of faculty and residents.

As can be seen from the curriculum summary above, each resident will receive 24 months of training in Emergency Medicine, including four two-month rotations in a tertiary Pediatric Emergency Department (Children's Hospital). The remaining 20 months will be split between the Health Sciences Centre-General, which is an Adult Emergency Department and St. Boniface Hospital, which is undifferentiated (sees patients of all ages). In each case, half of the Emergency training will be provided during the first two years and the remainder during the senior portion of the residency.

Off-service rotations are provided in either the Health Sciences Centre or St. Boniface Hospital, based on the availability of the most appropriate clinical experience.

Residents are junior residents in the first 24 months of training. Junior Residents care for all types of patients in the Emergency Department and participate in resuscitation and perform major procedures under the supervision of the Attending Emergency Physician or a senior resident.

Senior Residents, as well as providing care for all patients who present to the Emergency department, will function as resuscitation team leaders and will review patients seen by medical students and other residents, typically in Family Practice and more junior Emergency Medicine residents, both in the Royal College Program and in the CCFP-EM Program. The Senior Resident will, in conjunction with the Attending Emergency Physician, assume responsibility for the orderly flow and disposition of all patients within the department. The Senior Resident should be able to manage the volume of patients typically seen in a busy Emergency Department while simultaneously caring for several acutely ill or injured patients. Attending staff Emergency Physicians should have confidence in the assessments, treatment decisions, and disposition plans of the Senior Residents.

Core Curriculum Schedule


Highlighted Programs


Academic Program: There is a weekly academic full day on Tuesdays which is protected time for the residents. Both FRCP and CCFP (EM) residents participate in academic day. The afternoon part of the academic curriculum is based on a list of core topics in Emergency Medicine and is organized so these topics are covered over a 2-year period. Additional CanMeds topics are also included in the curriculum.

The format may be didactic, case-based seminar, major article review or literature review. Presentations are by the Emergency Medicine faculty, non-Emergency Medicine faculty, or by Royal College and/or CCFP-EM residents.

The morning academic day sessions include Simulation, Ultrasound, resident and attending led topics including M & M rounds, EBM sessions, radiology, EKG and sub-specialty teaching sessions.  Grand Rounds are held approximately every 2 weeks, except over the summer and are city-wide events - with participation from emergency physicians at both teaching and community hospitals. Residents are expected to present at Grand Rounds yearly, with the exception of PGY1 and PGY5 residents.

A further mandatory resident educational activity is the Core Curriculum. These are additional education activities provided by the Postgraduate Medical Education Office at the University of Manitoba for all residents in the Faculty of Medicine.

The Department of Emergency Medicine hosts a resident-led Journal Club four times per year for residents.


Conferences: There are 5 days of conference leave per year. If the resident is on a core Emergency Rotation, the resident will be given the time to attend the conference. There may be additional financial support from the Department of Emergency Medicine for additional conferences if the resident is presenting original research.


Other Courses:
Under the PARIM contract, the following courses are paid for: ACLS, ACLS Instructor, ATLS, ATLS instructor, PALS, and Ultrasound for vascular access (during their Critical care rotations).

Required Courses

  • ACLS
  • ATLS
  • PALS or APLS
  • AIME or equivalent
  • Procedural Sedation

Research: Dr. Erin Weldon is the Program Research Director.

As per Royal College guidelines, all residents are required to produce a scholarly project that is either published in a peer reviewed publication or presented at a national or international meeting, or is considered of similar quality by the Residency Program Committee. All residents are required to present at the DEM Resident Research Day at least three times during their residency.

Residents are instructed in all aspects of a research project including study design, grant submission, implementation, data analysis, paper submission and presentation. Residents should schedule a meeting with Dr. Erin Weldon early in their program. The development of a research project from concept to publication can be a slow and tedious process, and so approaching this component of the program aggressively early on is recommended. View the Research Department's Page.


Evaluation: Upon completion of each rotation, the resident is formally evaluated on an official In Training Assessment Report (ITAR). This is to be completed by the Rotation Coordinator or delegate and should be reviewed with the resident by the person completing it.

The resident should expect feedback on his/her performance halfway through a rotation and Rotation Coordinators are informed of this expectation. However, if the resident has not received this feedback, they should actively pursue this to avoid surprises at the end of a rotation. A Mid-Rotation Assessment (MRA) allows the resident to modify his/her behaviour to enhance their performance.

Where appropriate, the resident is expected to complete a Procedures Form for each rotation.

It is the resident's responsibility to ensure that ITARs, Rotation Assessments, Preceptor Feedback, Educational Event Assessment, and Rotation Evaluation forms are completed for each rotation. The resident's academic file is used at the completion of training as part of the evaluation of training.

There are a number of practice examinations written by the residents during training. These are used to provide feedback on their training and practice in the examination process. These include the Canadian In-Training Examination, the American Board of Emergency Medicine in Training examination and formal practice oral examinations conducted by faculty.

Finally, the Program Director will meet with each resident semi-annually to provide feedback on their performance and review the resident's file. It is expected that each resident in turn will offer feedback on the adequacy of the training they are receiving.


Residency Training Committee:  The Residency Training Committee meets quarterly. The Committee comprises faculty, including site directors of the major teaching sites, the directors of Ultrasound, Simulation and Research and two residents.

Competency Committee: A Competency Committee reviews and recommends resident progress, and reports tot he Residency Training Committee. A subcommittee of the Residency Training Committee is the CaRMs committee which is tasked with selecting candidates for interview as well as conducting the annual CaRMs interviews each year.


Vacation: Residents are entitled to four weeks of vacation during the year. This may be scheduled as a single four-week block or divided into two, two-week blocks and may only be scheduled in the first two or last two weeks of the rotation. If the resident chooses to divide the vacation time, these are to be taken during either rotations at St. Boniface Emergency or the HSC Adult Emergency only.

If residents have requirements for specific days off at other times during the academic year, the schedule can usually be designed to accommodate these requests.

The four weeks of vacation time is to be used in each academic year and cannot be banked or carried from year to year. The maximum time allowed for vacation during July and August is two weeks. 


Registration: It is expected that each resident will ensure that he/she is registered with the University of Manitoba and with the College of Physicians and Surgeons of Manitoba on the Educational Register. As well, each resident is expected to have up-to-date CMPA coverage.