General Program Description
Pediatric Residency Program –McGill University Overall Program Description and Curriculum:
Description of the Program
The McGill University Pediatric Residency Training program is fully accredited by the Royal College of Physicians and Surgeons of Canada, Le Collège des médecins du Québec, and complies to the requirements for admission of candidates to the certification process of the American Board of Pediatrics.
Our program provides full training in pediatrics, as outlined in the Objectives of Training and Specialty Training Requirements (see information by specialty at the Royal College). Note also that all rotations have rotation specific educational objectives of training.
There are no mandatory inter-university affiliations in the McGill University Residency Training Program in Pediatrics. However, this is the only city in Canada with two great pediatric programs, so residents are encouraged to take advantage of the training opportunities available at Hôpital Ste Justine.
Usual Course of Training a Resident would Follow in this Program:
Residents admitted through CaRMS normally enter training in pediatrics directly from medical school. International Medical Graduates (from the Gulf States or other countries) normally have at least one year of training in pediatrics in their home country prior to entry into the program (this time is not counted towards their training in Canada).
Pediatrics is a 4 year program. After the 3rd year, residents continue to train in general pediatrics (after which fellowships are offered in Academic Pediatrics, Social Pediatrics and Neonatal) or they may go on to specialize in one of the pediatric subspecialties.
The first three years of training aim to give trainees a solid foundation in the breadth of pediatrics, including adequate exposure to general pediatrics, acute care pediatrics (NICU, PICU, and ER), subspecialties, and longitudinal care.
The first year of training is mostly devoted to provide exposure to general pediatrics. Residents acquire major experience to inpatient pediatrics, and rapidly become comfortable with acute care neonatology. They also get exposure to the care of the critically ill child through the pediatric intensive care and Emergency medicine rotations. Four weeks of junior night float are now part of the first year. Outpatient exposures include home care, developmental pediatrics and the Residents Continuity Clinic. RAMQ funded residents complete their first of three rural rotations while internationally sponsored residents are offered an additional general pediatrics rotation. The general philosophy of the programming of this year is to have residents gain rapid comfort in the assessment and preliminary treatment of the ill child in preparation for the significant autonomous functioning that occurs starting in the second year with the senior nightfloat rotation.
The second year of training continues with increased graded responsibility in the areas described above, but with significant elective time. For the elective time, priority is given to candidates' career choices, as this is the time when most will need to make decisions about their fourth and fifth years. The senior nightfloat rotation (night duty on the general pediatrics wards) represents the first major rotation where residents' capacity for autonomous function is challenged. The general philosophy of the programming of this year is to provide subspecialty electives to aid the resident in career planning and to develop and exercise skills in autonomous function.
The third year of training includes three months as the senior on the general inpatient CTU's. This experience could be characterized as the apex of the three core years of training. Residents function as the team leader for a diverse group of residents and students, under the tutelage of a staff physician, and consolidate their judgement, leadership, and teaching skills. In all of the environments where they rotate, the graded responsibility is appropriately increased to reflect their more senior level. The general philosophy of the programming of this year is to develop skills in executive function (leadership, decision making), teaching (and important part of the specialist's job), and excellence in clinical care.
The fourth year includes rotations aiming to develop competences in a junior staff role (Short Stay Unit, Medical Day hospital, Community Pediatrics and Development) as well as sufficient elective time to prepare residents for their future practice or further training plans.
The continuity clinics run throughout the residency in pediatrics and continue into the advanced years of training for residents who continue in one of the Advanced Pediatrics Training streams.
With respect to location, residents may undertake elective rotations at one of the other schools in Quebec via the CREPUQ system.
There are three mandatory months of rotations in rural centres in the three core years of training for RAMQ funded residents. Gatineau and Val d'Or are our primary sites. The program views these exposures as an important part of training in that they help to provide perspective and exposure to another very important type of pediatric practice.
Increasing Professional Responsibility
Graded responsibility is provided in all of the key CTU areas of the program, which are discussed separately below:
General In-patient Pediatrics: Junior residents have a clearly defined role as team members on the wards. They follow their own patients, and as they gain experience, begin assuming a teaching and reviewing role with the medical students. They are never on call alone on the general inpatient wards. PGYII residents have their first taste of significant autonomous function during their nightfloat rotation. The senior residents (PGYIII) consolidate their leadership and team management skills during their CTU months. Finally, for residents in the Advanced Academic Pediatrics streams there is a junior attending rotation where residents function in a quasi-attending role with a clinical supervisor available for back up. Each of these roles has a set of specific educational objectives.
Medical Emergency: Similar to the general inpatient wards, there is a progression in roles with specific teaching as well for junior and senior residents in the emergency room. As their training increases, residents are expected to assume a greater responsibility for patient flow in the emergency room, as well as an aggressive involvement in the critical cases. There are specific objectives for the different levels of core pediatrics trainees. The advanced trainees function as junior attendings in the ER, with staff back up.
Neonatology: As residents progress through neonatology rotations they are expected to take on a greater supervisory role over the medical students and short cycle residents. Residents rotate through neonatology in each of the 3 core years have a substantial change in role at these different times.
PICU: Due to the nature of the work in PICU the rotations in the PGYI and PGYII year involve increasing consolidation of knowledge, and thus graded responsibility based upon this, but residents do not function as team leaders in general in the PICU given the complexity of the patients there.
On-call Duties of Residents:
In compliance with the new collective agreement between the Quebec Medical Residents' Federation and the Ministry of Health and Social Services for the Province of Quebec, our program has moved to a universal nightfloat call coverage system as of July 2012.
Every service to which residents provide call has a corresponding attending physician on call, usually from home except in the medical emergency room, which always has an ER physician in house. Junior residents are always supervised by a more senior resident on the medical wards and by a fellow or staff physician in the intensive care units (perinatology, neonatology, and PICU). In general, the more senior fellows and/or attendings are always available or present if there are any significant clinical issues. Explicit feedback is provided to the nightfloat resident by the chief resident during the nightfloat rotation.
Environment for Teaching and Learning
The McGill University Pediatric Residency Program applies the standards set forth in the American Association of Medical Colleges Residents' Compact in assuring the highest possible standards for the environment for teaching, learning, and patient care. We hold residents, faculty, and the learning environment to these standards.
Resident Compact [.pdf]
The program and the program director have an explicit zero tolerance policy to harassment and intimidation in the residency education environment, and this is made clear to the new residents yearly. All residents have received a copy of the hospital's harassment policies and McGill universities harassment policies (as covered in the Student Rights and Responsibilities handbook from the University).
Residents need not tolerate intimidation and harassment and are invited to report any such occurrences immediately to the chief residents and/or the program director.
Please consult the following related weblinks:
Student and Resident Affairs
Residents are strongly encouraged to report incidents of harassment and intimidation in the workplace to the program director, or to the chief residents if they feel this to be the most comfortable way. The chairman of the department is fully supportive of a zero tolerance policy to harassment and intimidation in the program.
Policy on Harassment
McGill's Policy on Harassment can be viewed at McGill Post Graduate Medical Education from where you must first select Welcome to McGill Postgrad followed by Standards of Behaviour.
All core clinical rotations begin the day with patient care rounds. Sign-in rounds are moderated by the chief medical resident and revolve around the transfer of care from on-call residents to daytime residents. A brief clinical topic is presented each morning by the CMRs.
There is a minimum of 4 hours of weekly teaching sessions.
Protected Teaching Time: The curriculum is guided by a 3-year template; 3 hrs/wk
Chief of Service rounds: case-based CPCs, presented by residents; 1 hr/wk
Grand Rounds: 1 hr/wk
Other academic activities (weekly, unless specified)
Research Institute Rounds
Ambulatory Pediatric Rounds
Service-specific rounds: topics and journal clubs
For PGY-1s only:
Introductory Pediatric Seminar (summer lecture series)
Pediatric Advanced Life Support training
Neonatal Advanced Life Support Course
Monthly Assessments: Resident performance is evaluated by rotation supervisors every month. Written and verbal feedback is provided at the end of every rotation.
ABP In-Training Exams: All residents write the American Board of Pediatrics In-Training Exam each summer. Exam scores are available in the fall. The ABP distributes mean scores for each year of training and internal mean scores are calculated each year.
OSCE: Residents participate in one Objective Structured Clinical Exam per year. These exams may use simulated patients or parents to test specific residency objectives. Feedback on performance is provided individually to residents on the day of the exam.
Observed H+Ps: Each resident is assigned to a staff person to complete an observed history and physical examination. Cases are appropriate to the level of training. Feedback is given immediately after. Each year, the resident is assigned to a different staff person.
Residents who have satisfactorily completed 3 years of pediatrics residency are eligible for the American Board of Pediatric Examinations.
Residents who will have completed 4 years of pediatrics residency within 54 months of commencing the program are eligible to write the Royal College Pediatric Exams. Of note, candidates for the Collège des Médecins du Québec certificates currently need to complete a fifth year of training in order to receive their certification.
The Montreal Children's Hospital is a 178-bed tertiary care pediatric hospital that serves a large multicultural population. The Emergency Department is one of the busiest in Canada, with over 80,000 visits per year. Both medical and surgical cases are seen in the ED and residents rotate through both sectors. Approximately 8,000 children are admitted to the hospital each year, with 3,200 admissions to the medical teaching units or about 10 medical admissions/day. All pediatric subspecialties are represented at MCH. Neonatology rotations are offered on two other sites of traning: the Royal Victoria Hospital and the Jewish General Hospital.
Montreal Children's Hospital
Graduates of Canadian medical schools apply through the Canadian Resident Matching Service (CaRMS). Applicants are requested to submit three letters of reference, preferably with one from the pediatric medical school clerkship director, in addition to a personal statement and curriculum vitae. The Residency Selection Committee reviews applications and interviews are offered from mid-December through mid-January.
Graduates of American medical schools who are US citizens may apply through CaRMS or may apply directly to the program. In addition to CaRMS entry positions, qualified US applicants may be eligible for non-CaRMs positions. Interested US applicants are encouraged to contact the program director for more information.
International medical graduates should apply directly to the McGill University Faculty of Medicine.
The interview process takes place at the Montreal Children's Hospital. Chief residents meet with all candidates on the day of the interview and present an overview of the program. There is ample time for candidates to have all of their questions answered. Each applicant is interviewed by 3 staff members and then are given a tour of the hospital by one of the current resident housestaff. The interview process takes approximately 3 hours.
Medical students who are interested in clinical electives are welcome. It is highly recommended that a core pediatric clerkship be completed prior to scheduling the elective. Electives are open to non-McGill medical students in their final year only. Further information can be obtained at the Medicine web site.
Journals: Complimentary subscriptions to PREP and to Pediatrics and Child Health (the journal of the Canadian Pediatric Society)
Malpractice insurance: The Hospital Association provides malpractice insurance for all residents. No additional coverage is required
Vacations: 1 month of paid vacation is permitted per year as per the collective agreement of the FMRQ.
Conference leave: Up to 10 days of paid leave is permitted for attendance at approved medical conferences.