Program Manual

CAT Project Goals & Objectives

Scholar

To keep residents and staff abreast of current cutting edge literature and best literature.
To learn the techniques of critical appraisal as they apply to different study designs.
To learn the three general critical appraisal skills of evaluation the validity of study methods, appreciating the strength and precision of results and applying the results with an eye to changing practice or informing decision-making.
To learn and apply the EBM concepts and skills.
To learn skills and habits that will allow lifelong reading behaviour and learning habits.
To become aware of important publications outside the EM literature.

Medical Expert

To develop knowledge on key topics and the supporting literature.
To improve clinical practice consistent with the latest research findings and critically appraised best evidence.
To integrate critically appraised best evidence into decision making through considerations that include values and perspectives that relate to the ethical, managerial, professional and health advocate dimensions of an emergency physician.

Communicator

To develop and hone interactive teaching and presentation skills.
Based on the knowledge and insights gained, to effectively and impressively communicate with your patients and colleagues in other specialities on critical and up to date issues.
Consideration should be given to reaching a wider audience of EM colleagues through peer-reviewed publication of your Journal Club summaries (posting on website, writing letters to editors, publishing summaries).

Collaborator

To work as a team with other residents (both FRCPC and CCFPEM)
To invite and interact in a dynamic learning environment with special guests who are experts on the topic or issues being presented.

Overall Goal of the Rotation

To utilize the relevant competencies contained within the CanMEDS-FM roles to develop the skills necessary to manage undifferentiated patient presentations to a community emergency department.  To develop and appreciate the management of emergency department patients in a setting with more limited resources.

Education Objectives:

Role of Family Medicine-Emergency Medicine (FM-EM) Expert

The resident should:

• Develop the ability to evaluate, diagnose, treat and arrange definitive care for patients in a community emergency department setting.
• Develop skills in the assessment and management of a variety of medical, surgical and psychiatric presentations to a community emergency department, across a spectrum of severity of such illnesses.
• Develop good judgement regarding the decision to transport a patient to a tertiary care hospital, and effectively prepare the patient for that transport
• Develop proficiency in the initial stabilization and arrangement of definitive care for a variety of clinical conditions which may include the following:

·         Trauma

·         Shock from any cause

·         Acute Coronary syndromes

·         Acute CVA

·         Gastrointestinal Hemorrhage

·         Cardiac Dysrhythmias

·         Poisoning

·         Psychiatric Illness including the acutely agitated or suicidal patient

·         Sepsis

·         Respiratory Failure from any cause

·         Vascular Crises including aortic aneurysm or dissection

·         Status epilepticus

·         Hypothermia and Hyperthermia

·         The acute abdomen and hepatobiliary disease

• Develop proficiency in the assessment and management of common fractures and dislocations.  Develop proficient skills in the reduction, splinting and casting of common fracture and dislocations.  Describe and demonstrate proficiency in a variety of analgesia and sedation options specific to these fractures and dislocations. 
• Examples:

·         Distal Radius/Ulna fracture

·         Scaphoid fracture

·         Metacarpal fracture

·         Humeral fractures including shaft, head/neck, and supracondylar

·         Radial and ulnar shaft fractures and fracture dislocations

·         Hip fractures

·         Femoral shaft fractures

·         Tibial plateau fractures

·         Tibial/fibular shaft fractures

·         Ankle fractures and fracture-dislocations

·         Elbow dislocations

·         Shoulder dislocations

·         Hip dislocations

·         Patellar dislocations

·         Knee dislocations

• Clinically assess skin integrity, limb alignment, neurovascular status and patient lifestyle factors and demonstrate an understanding of how these factors influence management of these orthopaedic injuries.
• Learn the rational use of consultants, as well as laboratory, radiographic and other diagnostic tests with limited availability when managing patients in more rural areas.
• Understand the responsibility and the liability involved with the transfer of patients from one institution to another.
• Demonstrate the skills to organize (monitoring, transport, venue) and supervise a safe transfer.

Role of Communicator

Overall Goal

The resident will act to facilitate the doctor-patient relationship and establish positive therapeutic relationships with patients and their families that are characterized by understanding, trust, respect, honesty and empathy.

The resident should be able to:

• Discuss a wide variety of medical conditions and their treatments with patients and their families in language that they can understand.
• Establish and maintain a therapeutic relationship with patients, their families and the medical team while fostering an environment characterized by understanding, trust, empathy and confidentiality.
• Accurately describe a patient’s clinical condition to consultants using appropriate medical terminology.
• Initiate appropriate telephone consultation with other specialists at local and remote locations
• Using the patient centered clinical model, gather information not only about the disease but also about the patient’s beliefs, concerns and expectations about the illness, and how the illness affects the patient’s family and the patient’s life as a whole. 
• Work to enhance the patient’s continuing relationship with their family physician.
• Keep thorough and accurate written medical records.
• Communicate effectively with patients, family members and the health care team.
• Whenever appropriate, involve the patient’s family physician in the acute care and follow up related to the patient’s emergency visit.

Role of Collaborator

Overall Goal

The resident will work cooperatively with patients, families, and other members of the healthcare team to achieve optimal patient care.

The resident should be able to:

• Develop a care plan for a patient they have assessed, including investigation, treatment and continuing    care, in collaboration with the members of the interdisciplinary team.
• Utilize medical expertise available within the local community.
• Collaborate with members of the health care team that are at a site distant to the site of the patient to arrange telephone advice, interhospital transfer, and follow up care where necessary.
• Maintain collegial and respectful relationships with medical and paramedical staff in the more rural area.
• Demonstrate an ability to promote the autonomy of patients and families and to promote their involvement in decision-making.

Role of Leader

Overall Goal:

The resident will play a central role in the organization of the care delivered to the patient during their community emergency department visit. They will coordinate the members of the health care system and utilize resources in a way that sustains and improves the health of their patient population.

The resident should be able to:

•    Effectively manage the care of multiple patients while working in the community emergency department.
•    Effectively triage patients and manage emergency department flow in a single physician coverage emergency department with limited radiologic, laboratory, nursing and paramedical staff resources.
•    Develop and/or reflect on the management plan for a mass casualty incident in their rural community hospital.
•    Make clinical decisions and judgments based on sound evidence for the benefit of individual patients and the population served.
•    Work effectively as a member of a team.

Role of Health Advocate

Overall Goal

The resident will use their role as an emergency department physician in a rural area to influence and advance the health and wellbeing of patients

The resident should be able to:

•    Expedite transfer of patients to referral centres where necessary.
•    Identify the medical, social, economic, and familial needs of patients, the interactions of these factors, and offer community resources and referrals where appropriate.
•    Respect and foster patient autonomy in all decision making where appropriate.
•    Develop proficiency with informed consent and measurement of capacity.
•    Have knowledge of and utilize community resources where appropriate to assist in the management of illness.
•    Communicate with the patient’s family physician where appropriate to obtain further history, ensure follow up care, and enhance continuity of care. Encourage participation of the patient’s family physician in the acute medical care of the patient where appropriate.

Role of Scholar

Overall Goal

To demonstrate a commitment to self-learning and the creation, translation, and dissemination of medical knowledge.

The resident should be able to:

•    Identify his/her own learning needs and make use of available learning resources including members of the medical team unique to the rural area with local expertise.

•    Demonstrate critical thinking and integrate critical appraisal of the literature into the bedside approach.
•    The interested resident may wish to pursue research or a CAT topic related to rural emergency medicine or medicine involving a social, environmental, industrial or recreational phenomenon involving the community in which he/she is practicing.

Role of Professional

Overall Goal

To display commitment to an ethical practice and high personal standards of behaviour in a manner that is commensurate with the importance of the doctor-patient relationship.

The resident will display professional attitudes and behaviours, including:

•    Being punctual for shifts, meetings, and educational events.
•    Following through on assigned tasks.
•    Being respectful, honest and compassionate care when dealing with patients, families and other professionals.
•    Considering racial and cultural issues in selecting treatment regimens for patients.
•    Demonstrating responsibility by being reliable and dependable.
•    Developing the ability to respectfully collaborate with other medical and paramedical professionals in a small community.
•    Take an interest in aspects of the community that are outside of the medical setting.
•    Maintain an appearance that conveys a sense of dignity commensurate with the importance of the patient-physician interaction

Overall Goal:

Improve all facets of the CanMEDS-FM roles by learning in a fast paced, high volume ED. This is evaluated on a continuum to becoming prepared (competent, confident and adaptable) for the 7 CPAs expected of a graduating CCFP(EM) resident.

Educational Objectives:

Role of Family Medicine-Emergency Medicine (FM-EM) Expert

The CCFP(EM) resident will develop expertise in the ability to:

• Identify and treat conditions requiring immediate resuscitation or stabilization
• Synthesize all available data, including interview, physical exam, and lab data to define each patient’s central clinical problem
• Formulate an appropriate differential diagnosis listing life-threatening and common (most likely) disorders
• Develop a strategy of investigation and treatment appropriate to the patients presenting complaint
• Modify differential diagnosis, investigations and treatment based on clinical course

The resident will develop expertise in the assessment and management of common emergency presentations including:

General

• Airway obstruction
• Respiratory Distress
• Shock
• Sepsis
• Trauma (blunt and penetrating)
• Syncope
• Fever
• Allergic reactions including anaphylaxis
• Burns

Cardiovascular

• Cardiac Arrest
• Arrythmias (SVT, Afib, Vtach, Bradycardias)
• Acute Coronary Syndromes
• Sudden death/asystole
• Palpitations
• Chest Pain
• Hypertensive crises
• CHF/Pulmonary Edema
• PE
• Ischemic limb
• Aortic dissection/Aneurysm

Neurologic

• Coma and Altered Level of Consciousness
• Seizure
• Acute neurologic deficit/CVA/TIA
• Weakness
• Headache
• Vertigo

Environmental and Toxicology

• Hypothermia and hyperthermia
• Intoxicated patient
• Burns and frostbite

Respiratory

• Dyspnea
• Asthma/COPD
• Cough/Pneumonia
• Hemoptysis

Endocrine/Metabolic

• Hyper or hypoglycemia
• DKA
• Hyper/hypothyroidism
• Dehydration and electrolyte abnormalities
• Acute Kidney Injury

Psychiatry

• Psychosis and agitation
• Anxiety and panic
• Behavioural and personality disorders
• Suicidal Ideation and mood disorders

Ophthalmology

• Vision loss or disturbance
• Ocular pain
• The red eye
• Foreign body or chemical exposure

Gastrointestinal Disorders

• Abdominal Pain including the acute abdomen
• Vomiting, Diarrhea or constipation
• Gastrointestinal hemorrhage
• Jaundice
• Dysphagia
• Anal disorders
• IBD

Genitourinary Disorders

• Urinary Retention, dysuria, hematuria or flank pain
• Scrotal pain or swelling
• Non-pregnancy pelvic pain, bleeding, or vaginal discharge
• STI’s

Pregnancy

• Vaginal bleeding or pelvic pain in pregnancy or postpartum
• Labour and emergency department vaginal delivery
• Hyperemesis
• Pre-eclampsia, eclampsia

Dermatologic

• Rash
• Pruritis
• Abscess/Cellulitis

Musculoskeletal

• Fracture
• Lacerations
• Dislocations
• Amputations
• Swollen limb
• Foreign bodies
• Back pain and soft tissue injuries
• Joint pain or swelling
• Needlestick injuries

Ear, Nose and Throat

• Epistaxis
• Sore throat
• Neck swelling
• Ear pain
• Acute hearing loss
• Dental pain

Other

• Sexual Assault
• Domestic Violence

Pediatric

• Neonatal resuscitation
• Neonatal Jaundice
• Neonatal cyanosis
• Irritability or lethargy
• Fever
• Non-accidental trauma
• Stridor, wheeze, and respiratory distress
• Limp or painful joint
• Vomiting, diarrhea and dehydration
• Soft tissue infections
• Gastrointestinal bleeding
• Rash

The Resident will develop expertise in the following procedural skills:

• Airway Management
  • Bag-valve mask ventilation
  • Endotracheal intubation with standard laryngoscopy
  • Alternative airway management techniques which may include: gum elastic bougie, laryngeal mask airway (LMA), lighted stylet, intubating LMA, glide scope, combitube, trans-tracheal jet ventilation, cricothyroidotomy, retrograde intubation, and flexible fiberoptic bronchoscopy

• Tube Thoracostomy (pigtail catheter and standard chest tube)
• Circulatory access
  • Peripheral vein access
  • Central venous catheterization (POCUS-guided)
  • Intraosseous insertion
• Cardiac Defibrillation
• Transcutaneous pacemaker set up
• Nasogastric and orogastric tube insertion
• Foley catheter insertion
• Paracentesis
• Thoracentesis
• Lumbar puncture
• Fracture reduction, casting and splinting
• Reduction of a dislocated joint
• Arthrocentesis

• Knee
  • Shoulder
  • Ankle
  • Elbow

• Abscess incision and drainage
• Nail trephination/wedge resection/removal
• Regional anesthesia blocks
  • Supraorbital nerve
  • Infraorbital nerve
  • Mental nerve
  • Radial, median and ulnar nerve blocks
  • Digital blocks
  • Dental blocks
• Wound management
  • Repair of lacerations
  • Simple debridement of wounds including burns
  • Extensor tendon repair
• Opthalmological
  • Slit lamp examination of the eye
  • Corneal foreign body removal
• ENT                               
  • Nasal Packing
  • Nasal cautery
• Procedural Sedation including airway assessment
• Emergency Department Ultrasound
• Orogastric lavage
• Whole Bowel Irrigation

The resident will develop expertise in the indications for, risks of and interpretation of the following diagnostic tests:

• Arterial and venous blood gas
• O2 Sat
• Electrocardiogram
• Common Lab tests including ESR,CRP, drug levels, osmolar gap, anion gap
• X-ray

                         Chest

                       Abdomen

                      Head, C-spine

                      MSK

• Computed Tomography (basic interpretation)

                         Abdomen and Pelvis

                      Head

                      Chest

• MRI (basic interpretation
• Ventilation/Perfusion Scan (basic interpretation)
• Bone Scan (basic interpretation)

Role of Communicator

Overall Goal

The resident will communicate effectively with members of the healthcare team. The resident will facilitate the doctor-patient relationship and establish positive therapeutic relationships with patients and their families that are characterized by understanding, trust, respect, honesty and empathy

The resident should demonstrate expertise in the ability to:

• Rapidly establish rapport with patients and families in such a way as to develop an understanding of patients’ experiences of illness including their ideas, feelings, and expectations and of the impact of illness on the lives of patients and families
• Incorporate into the individual patient interaction an understanding of the human condition, especially the nature of suffering and patients’ response to illness
• Overcome barriers to communication such as language, patient disabilities, cultural differences and age group differences
• Manage the difficult patient encounter
• Explain complex medical issues in language adapted to the needs of the individual patient
• Deliver bad news in a compassionate and humane manner including “death telling”
• Maintain clear (legible), accurate and concise medical records
• Discuss a “Goals of Care” designation level with patients and families
• Field paramedic patch calls with ability to give succinct, clear orders

Role of Collaborator

Overall Goal

The resident will work cooperatively with patients, families and other members of the healthcare team to achieve optimal patient care.

The resident will demonstrate expertise in the ability to:

• Participate in a team based model in the care of emergency department patients
• Recognize and respect the diversity of roles, responsibilities and competencies of other professionals in relation to their own and consult other specialists in such a way as to respect the consultants individual skills
• Maintain respect for the principle of effective resource allocation
• Participate effectively in inter-professional team meetings, either as a team leader or a member of the team
• Demonstrate the use of crisis resource management skills when needed (communication, teamwork, situational awareness, and leadership)
• The resident will demonstrate a respectful attitude towards other colleagues and members of an inter-professional team
• The resident will function as a resource to the community as a consultant in emergency medicine
• Work to enhance the patient’s continuing relationship with their family physician

Role of Leader

Overall Goal:

The resident will play a central role in the organization of the care delivered to patients during their emergency department visit. They will coordinate the members of the health care system and utilize resources in a way that sustains and improves the health of their patient population.

The resident will develop expertise in the ability to:

• Understand the principles of Quality Improvement (QI)
• Allocate finite healthcare resources appropriately
• Understand the issues that affect emergency department patient flow
• Work collaboratively with other health care professionals and community organizations to provide coordinated care for patients
• Use appropriate (electronic) decision support tools and references
• Provide safe medical hand-over

• The resident will seek some experience in Emergency Department administration through participation in QI/QA activity including participation in an x-ray discrepancy reporting system and through attendance at academic sessions covering administrative issues in the Emergency Department

Role of Health Advocate

Overall Goal

The resident will use their role as an emergency department physician to influence and advance the health and wellbeing of patients

The resident will develop expertise in the ability to:

• Evaluate patients with respect to determining their status regarding determinants of health and potential barriers to care and implement a disease prevention strategy tailored to each patient’s unique status regarding those determinants of health
• Identify and respond to the health needs of the communities that they serve including vulnerable or marginalized population
• Understand the concepts of informed consent and measurement of capacity
• Develop an understanding of living wills, advanced directives, durable power of attorney, personal directives and the “Freedom of Information and Privacy Act”
• Understand the concept of medical futility and understand how to discuss this idea with patients and their families

Role of Scholar

Overall Goal

To demonstrate a commitment to self-learning and the creation, translation, and dissemination of medical knowledge.

The resident should be able to:

• Adapt and increase their skills and knowledge to meet the needs of their Emergency Department patients
• Critically appraise the literature and its relevance to their practice
• Attend Journal club to facilitate critical appraisal skills
• Incorporate into their emergency department practice the relevant published Clinical Practice Guidelines
• Facilitate the medical education of patients, families, emergency department learners, health professional colleagues and the public
• Take part in clinical teaching of junior learners in the Emergency Department

• Contribute to the creation, application and translation of new medical knowledge and practices
• Utilize local computer information systems and Computerized Physician Order Entry Systems

Role of Professional

Overall Goal

To display commitment to an ethical practice and high personal standards of behaviour in a manner that is commensurate with the importance of the doctor-patient relationship.

The resident should:

• Exhibit professional behaviours in practice including honesty, integrity, reliability, compassion, respect, altruism, and a sincere commitment to patient well-being
• Be punctual for clinical and educational events
• Follow through on assigned tasks
• Demonstrate respect for colleagues and team members
• Recognize the principles and limits of patient confidentiality
• Maintain appropriate professional boundaries

• Balance personal and professional priorities to ensure personal health during the rotation

• The resident will respect the appropriate boundaries of the doctor patient relationship
• The resident will respect patient confidentiality and privacy.
• The resident will have respect for patient autonomy as a major guiding principle in the doctor-patient relationship
• Take part in evaluation systems for learning events in order to provide/contribute feedback to colleagues/teachers

Medical Expert

1. Understand the knobology of the ultrasound machine

1. Demonstrate understanding and proficiency with the use of various probe types

1. Demonstrate proper ultrasound technique including probe manipulation and image optimization

1. Demonstrate proficiency at image generation and interpretation in the following areas:

• Cardiac: views including parasternal long, parasternal short, apical 4 chamber, subxiphoid. Assessment of cardiac function, chamber size, fluid responsiveness, pericardium, aorta
• Abdomen: including detection of free fluid in the upper quadrants and the pelvis
• First trimester obstetrics: including detection of intrauterine pregnancy and findings suggestive of ectopic pregnancy
• Aorta: including detection of abdominal aortic aneurysm
• Lung: including detection of pneumothorax, pulmonary edema and pleural effusion
• Gallbladder: including detection of gallstones and cholecystitis. DVT: including detection of thrombosis
• Ocular: including detection of retinal detachments, posterior vitreous hemorrhages and papilledema
• IVC: including assessing size/collapsibility and applying this in the context of the patient’s fluid status
• Joints: including detection of fluid and, if necessary, subsequent aspiration under ultrasound guidance
• Nerves: including understanding the technique and optimal locations to provide analgesia for different indications
• Renal and bladder: including detection of hydronephrosis, ureteric jets, bladder volume, and foley catheter placement
• Procedural ultrasound: including thoracentesis, paracentesis, pericardiocentesis, lumbar puncture
• Vascular access: including central venous access, intravenous access, arterial lines, intraosseous lines
• Soft tissue: including detection of cellulitis, abscess, necrotizing infections, foreign body detection and removal

1. Understands principles of integrated point-of-care ultrasound protocols in assisting with patient resuscitation.   Examples include:

• BLUE protocol for shortness of breath
• Extended FAST (eFAST) for trauma

1. Understand the importance of rejecting indeterminate scans

1. To be able to apply emergency ultrasound findings in clinical management of emergency patients

1. Understand the limitations of emergency ultrasound

Role of Communicator

1. Converse effectively and sensitively with patients and their families

1. Ensure patients understand the differences between emergency ultrasound and radiology-performed scans

1. Communicate and document ultrasound findings appropriately

1. Demonstrates effective communication skills when teaching ultrasound skills to others

Role of Collaborator

1. Work effectively as part of a health care team

1. Understands how emergency ultrasound contributes to the overall care of the patient

1. Develops understanding of how other specialties incorporate bedside ultrasound into their practice

Role of Leader

1. Demonstrates proper documentation of ultrasound scans

1. Manages time efficiently

1. Demonstrates proper care of the ultrasound equipment

1. Understands the background of emergency ultrasound and the role that it has played in changing the bedside diagnostic environment

1. Understands the medico-legal implications of emergency ultrasound in patient care and in physician

      certification process

Role of Health Advocate

1. Acts as an advocate for individual patients in the emergency department

1. Understands the importance of access to emergency ultrasound devices for all resuscitation and acute care areas of the emergency department

1. Understands the importance of training all acute care physicians in the use of point-of-care ultrasound to improve patient care

1. Advocates for increased point-of-care ultrasound resources for the emergency department, hospital, and university

Role of Scholar

1. Critically evaluate the literature as it pertains to emergency ultrasound

1. Stays up-to-date on new evidence as it pertains to point-of-care ultrasound

1. Understand the evidence supporting the commonly performed emergency ultrasound scans

1. Understand the limitations of emergency ultrasound literature and the need for further high-quality research in this area

Role of Professional

1. Be sensitive to any discomfort caused by ultrasound scans, especially when performing training scans or when scanning volunteers

1. Adhere to the code of ethics of the CMA and the institution

1. Treat patients and colleagues with respect

1. Self-evaluate, including insight into strengths and weaknesses

1. Demonstrate commitment to lifelong learning

1. Be responsible, reliable, punctual, and accountable for one’s actions

Overall Goal

To utilize the relevant competencies contained within the CanMEDS-FM roles to develop the skills necessary to manage undifferentiated pediatric patient presentations to the emergency department.

Educational Objectives:

Role of Family Medicine-Emergency Medicine (FM-EM) Expert

The FM-EM resident will develop expertise in the ability to:

• Identify and treat pediatric conditions requiring immediate resuscitation or stabilization
• Learn to recognize the “toxic” versus “non-toxic” looking child
• Synthesize all available data, including interview, physical exam, and lab data to define each patient’s central clinical problem
• Formulate an appropriate differential diagnosis listing life-threatening and common (most likely) disorders
• Develop a strategy of investigation and treatment appropriate to the patient’s presenting complaint
• Modify differential diagnosis, investigations and treatment based on clinical course

The resident will develop expertise in the assessment and management of common pediatric emergency presentations and learn management principles in dealing with less common critical care presentations.

These presentations may include:

General

• Airway obstruction
• Neonatal / pediatric resuscitation
• Neonatal/pediatric cyanosis
• Respiratory Distress
• Shock
• Major and minor trauma (blunt and penetrating)
• Child Abuse and non-accidental trauma

Allergy/ Immunology

• Allergic reactions including anaphylaxis
• Angioedema

Cardiac

• Cardiac Arrest
• Arrythmias (SVT, Bradycardia)
• Sudden death (including SIDS)
• Congenital Heart Disease

Dentistry

• Dental trauma
• Dental abcesses

Dermatologic

• Rash
• Pruritis
• Abscess/Cellulitis
• Dermatologic presentations of systemic illnesses

Ear, Nose and Throat

• Epistaxis
• Sore throat
• Facial and Neck swelling
• Ear pain

Environmental

• Hypothermia and hyperthermia
• Acute or Chronic poisoning
• Burns and frostbite
• Submersion injury/near drowning/drowning
• Electrocution
• Animal bites

Endocrine/Metabolic

• Hyper or hypoglycemia
• DKA
• Hyper/hypothyroidism
• Dehydration and electrolyte abnormalities

Gastrointestinal Disorders

• Abdominal Pain including the acute abdomen (appendicitis, intussusception, hernias, volvulus, ovarian torsion, ectopic pregnancies)
• Vomiting, Diarrhea or constipation
• Jaundice in the newborn
• Food intolerances
• GERD/PUD
• Ingested foreign body
• Inflammatory bowel disorders

Genito-urinary Disorders

• Urinary Retention, dysuria, hematuria or flank pain
• Scrotal pain or swelling (including torsion, hydroceles, epididymitis)
• Non-pregnancy pelvic pain
• Vaginal bleeding, or vaginal discharge (vaginal Foreign bodies)
• Phimosis/ paraphimosis (and reduction)
• STI’s in the adolescent

Haematologic

• Sickle cell disease and acute crises
• Febrile Neutropenia
• Acute/initial presentations of leukemia/lymphoma
• Bleeding disorders
• Approach to anemia

Infectious Disease

• Approach to the febrile infant
• Fever in the returning traveler
• COVID/PIMS
• Approach to common infectious illnesses

Neurologic

• Coma and Altered Level of Consciousness
• Seizure
• Headaches
• Syncope/Vertigo
• Weakness/paralysis

Ophthalmology

• Vision loss or acute disturbance
• Eye trauma /Ocular pain
• The red eye
• Foreign body or chemical exposure
• Preseptal and orbital cellulitis

Orthopedic/MSK

• Classification of childhood fractures
• Immobilization of childhood fractures/ with distinctions based on gender and age with regards to type of immobilization
• Splinting and casting techniques- choice of material
• Hip pain/painful joint
• Limping child
• Acute back pain

Respiratory

• Dyspnea, stridor or wheeze (including bronchiolitis, croup, asthma)
• Cough
• Airway Foreign Bodies

Rheumatology

• Kawasaki
• Arthritis/ joint pain
• Systemic rheumatologic illnesses

The Resident will develop expertise/familiarity in the following procedural skills:

• Airway Management
  • Bag-valve mask ventilation
  • Endotracheal intubation with standard laryngoscopy

• Alternative airway management techniques which may include use of LMA
• Non-invasive assisted ventilation pediatric indications, including CPAP/BIPAP/HFNC
• Circulatory access
  • Peripheral vein access
  • Intraosseous insertion
• Lumbar puncture
• Fracture reduction, casting and splinting
• Radial head subluxation reduction
• Reduction of a dislocated joint
• Abscess incision and drainage
• Nail trephination/wedge resection/removal
• Regional anesthesia blocks
  • Supraorbital and occipital nerve
  • Radial, median and ulnar nerve blocks
  • Femoral blocks
  • Digital blocks
• Wound management
  • Repair of lacerations
  • Simple debridement of wounds including burns
• Ophthalmological
  • Corneal foreign body removal
• ENT
  • Foreign body removal techniques
  • Nasal Packing
• Procedural Sedation including airway assessment

The resident will develop expertise in the indications for, risks of and interpretation of the following diagnostic tests:

• Age-based interpretation of vital signs including HR, RR, BP
• Interpretation of O2 saturation based on underlying conditions
• Arterial and venous blood gas pros, cons and limitations
• Pediatric electrocardiogram
• Common Lab tests including ESR, CRP, osmolar gap, anion gap
• POCUS vs radiology executed US

• Interpretation of Xray imaging of the:
• Chest
• Abdomen/pelvis
• Head, C-spine
• MSK

• Computed Tomography (basic interpretation)

• Abdomen and Pelvis
• Head
• Chest

• MRI (basic interpretation)

Role of Communicator

Overall Goal

The resident will communicate effectively with members of the healthcare team. The resident will facilitate the doctor-patient relationship and establish positive therapeutic relationships with patients and their families that are characterized by understanding, trust, respect, honesty and empathy.

The resident should demonstrate expertise in the ability to:

• Rapidly establish rapport with patients and families in such a way as to develop an understanding of patients’ experiences of illness including their ideas, feelings, and expectations and of the impact of illness on the lives of patients and families
• Incorporate into the individual patient interaction an understanding of the human condition, especially the nature of suffering and patients’ response to illness
• Overcome barriers to communication such as language, patient disabilities, cultural differences and age group differences
• Manage the difficult patient (or family) encounter
• Explain complex medical issues in language adapted to the needs of the individual patient
• Deliver bad news in a compassionate and humane manner including “death telling”
• Maintain clear (legible), accurate and concise medical records
• Discuss a “Goals of Care” designation level with patients and families

Role of Collaborator

Overall Goal

The resident will work cooperatively with patients, families and other members of the healthcare team to achieve optimal patient care.

The resident will demonstrate expertise in the ability to:

• Participate in a team based model in the care of emergency department pediatric patients
• Recognize and respect the diversity of roles, responsibilities and competencies of other professionals in relation to their own and consult other specialists in such a way as to respect the consultants individual skills
• Maintain respect for the principle of effective resource allocation
• Participate effectively in inter-professional team meetings, either as a team leader or a member of the team
• Demonstrate the use of crisis resource management skills when needed (communication, teamwork, situational awareness, and leadership)
• The resident will demonstrate a respectful attitude towards other colleagues and members of an inter-professional team
• The resident will function as a resource to the community as a consultant in emergency medicine
• Work to enhance the patient’s continuing relationship with their family physician

Role of Leader

Overall Goal:

The resident will play a central role in the organization of the care delivered to patients during their emergency department visit. They will coordinate the members of the health care system and utilize resources in a way that sustains and improves the health of their patient population.

The resident will develop expertise in the ability to:

• Understand the principles of Quality Improvement (QI)
• Allocate finite healthcare resources appropriately
• Understand the issues that affect emergency department patient flow
  • Increased ability to manage patient volumes in the ED
• Work collaboratively with other health care professionals and community organizations to provide coordinated care for patients
• Use appropriate (electronic) decision support tools and references

Role of Health Advocate

Overall Goal

The resident will use their role as an emergency department physician to influence and advance the health and wellbeing of patients

The resident will develop expertise in the ability to:

• Evaluate patients with respect to determining their status regarding determinants of health and potential barriers to care and implement a disease prevention strategy tailored to each patient’s unique status regarding those determinants of health
• Identify and respond to the health needs of the communities that they serve including vulnerable or marginalized population
• Understand the concepts of informed consent with patients and families

Role of Scholar

Overall Goal

To demonstrate a commitment to self-learning and the creation, translation, and dissemination of medical knowledge.

The resident should be able to:

• Adapt and increase their skills and knowledge to meet the needs of their pediatric emergency department patients
• Critically appraise the literature and its relevance to their practice
• Attend academic rounds to facilitate critical appraisal skills
• Incorporate into their emergency department practice the relevant published Clinical Practice Guidelines
• Facilitate the medical education of patients, families, emergency department learners, health professional colleagues and the public
• Take part in clinical teaching of junior learners in the Emergency Department
• Contribute to the creation, application and translation of new medical knowledge and practices
• Utilize local computer information systems and Computerized Physician Order Entry Systems

Role of Professional

Overall Goal

To display commitment to an ethical practice and high personal standards of behaviour in a manner that is commensurate with the importance of the doctor-patient relationship.

The resident should:

• Exhibit professional behaviours in practice including honesty, integrity, reliability, compassion, respect, altruism, and a sincere commitment to patient well-being
• Be punctual for clinical and educational events
• Follow through on assigned tasks
• Demonstrate respect for colleagues and team members
• Recognize the principles and limits of patient confidentiality
• Maintain appropriate professional boundaries

• Balance personal and professional priorities to ensure personal health during the rotation

• The resident will respect the appropriate boundaries of the doctor patient relationship
• The resident will respect patient confidentiality and privacy.
• The resident will have respect for patient autonomy as a major guiding principle in the doctor-patient relationship
• Take part in evaluation systems for learning events in order to provide/contribute feedback to colleagues/teachers

The over-arching goal is utilize the relevant competencies contained within the CanMEDS-FM roles to rapidly evaluate, diagnose, and treat the critically ill ICU patient, with special emphasis on those clinical presentations and procedures common to the Emergency Department.

Of course, you are not expected to gain experience in all of the objectives listed below, but they represent the more common pathologies and interventions that we deal with in ICU at the LGH.

Role of Medical Expert

The resident should:

· Develop the ability to rapidly perform a history and physical exam appropriate for a critically ill patient

· Develop sound judgment regarding the assessment and management of critically ill patients

· Develop the ability to generate a differential diagnosis and initiate immediate stabilization of the critically ill patient

· Develop a fundamental understanding of the pathophysiology, presenting signs and symptoms, diagnosis, and management of critically ill patients who may present with the following disease states:

Neuro

Decreased level of consciousness: differential diagnosis and work up.

Seizures: causes and acute management.

Stroke: diagnosis and management.

Sedative medications and monitoring.

Neurologic death and transplantation.

Cardiovascular

Applied physiology

Congestive heart failure: causes, clinical features, acute and long-term management.

Acute coronary syndromes: acute and long-term management.

- STEMI

- NSTEMI

- Angina

ACLS: asystolie, PEA, ventricular fibrillation, ventricular tachycardia, atrial fibrillation, supra ventricular arythmias, bradycardia, hypothermia.

Circulatory shock: cardiogenic, hypovolemic, obstructive, distributive.

Chest pain: differential diagnosis and work up.

Pulmonary Hypertension: pathophysiology & management.

Invasive and non-invasive monitors of blood pressure and cardiac output.

Inotropes and vasopressors.

Respiratory

COPD: treatment of acute exacerbations and long term management.

Respiratory failure: hypercapnic and hypoxemic, differential diagnosis.

Pulmonary embolism: risk factors, clinical features, diagnosis and management.

Pneumonia: community vs hospital acquired, choice of antibiotic.

Invasive and non-invasive ventilatory support & weaning.

Difficult and failed airway management.

Tracheostomy: placement & management

ID & Immunity

Septic shock: Definition, SIRS criteria, physiopathology, clinical features, complications, work up and management.

Oncologic emergencies & Immune dysfunction.

Infection prevention & control.

Renal

Acid-base disorders: interpretation, causes and management.

Electrolyte abnormalities: (K, Na, PO4, Mg) causes and management.

Acute renal failure: prerenal, renal and post renal, causes, diagnosis and management.

Indications for hemodialysis: continuous vs intermittent.

Endo & Metabolism

Diabetic ketoacidosis and hyperosmolar hyperglycemic state: precipitants and management.

Hypothermia.

Intoxication.

Critical care of the pregnant patient.

GI

Acute abdomen: differential diagnosis, work up and management.

GI bleed: differential diagnosis, work up and management.

Acute pancreatitis: diagnosis, severity criteria, management.

Liver dysfunction, cirrhosis, paracentesis.

Nutrition: enteral vs parenteral.

Trauma & Surgical Considerations

Perioperative management.

Volume resuscitation, coagulopathies, and blood components.

Intra-abdominal pressure.

Critical Care Management

Triage of patients & consultations.

Criteria for ICU admission & discharge.

Transfer of care to receiving service.

Transport of ICU patients.

Scoring Systems for ICU severity: SOFA, APACHE, SAPS, etc.

Procedures

Central/peripheral venous access

IO

Endotracheal intubation

Arterial line insertion

Thoracostomy tubes & thoracentesis

Fiberoptic bronchoscopy

Lumbar Puncture

Defibrillation, cardioversion, cardiac pacing.

POCUS

Free fluid, cardiac (ventricle size & function, pericardial effusion), pneumothorax, pleural effusion, vascular access, intravascular volume status.

Role of Communicator

Overall Goal

The resident will act to facilitate the doctor-patient relationship and establish positive therapeutic relationships with patients and their families that are characterized by understanding, trust, respect, honesty and empathy.

The resident will demonstrate expertise in the ability to:

· Communicate with the patient and their family in a way that takes into account the patient’s own experience of the illness (feelings, expectations, and ideas) and the impact of the illness and ICU experience on the lives of patients and families, considering such factors as age, gender, socio-economic status, cultural and religious/spiritual values.

· Communicate with the members of the ICU health care team in a way that respects the skills of team members and facilitates an optimal team based approach to the care of the critically ill patient

· Effectively communicate with consultants

· Keep legible, coherent and complete written medical records including the ability to summarize a patients ICU care when the patient is transferred to the ward

· Clearly articulate a summary of a patient’s problem list and care plan to the multidisciplinary ICU team during daily rounds

· Compassionately deliver bad news including death-telling

· Understand issues related to patient confidentiality

· Communicate effectively with the emergency department care team when acting as a representative of the ICU team that has been consulted

Role of Collaborator:

· Develop an understanding of the role of specialist consultants in the ICU

· Maintain collegial relationships with the team members in the ICU including ICU attending physicians, resident colleagues, consultants, nurses, respiratory therapists, spiritual care representatives and physiotherapists

· Participate in interdisciplinary team meetings, demonstrating the ability to respect both the expertise and limitations of the other team members

· Respect team ethics including confidentiality, resource allocation and professionalism

Role of Leader

Overall Goal:

The resident will play a central role in the organization of the care delivered to patient during their stay in the intensive care unit. They will coordinate the members of the health care system and utilize resources in a way that sustains and improves the health of their patient population.

· The resident should be able to effectively manage the care of multiple critically ill patients in the ICU

· The resident should be able to serve equally effectively as a leader or member of a team

· Understand the effective use of patient-related databases, computer based medical information and the use of medical informatics

· Demonstrate an ability to understand the importance of appropriate allocation of healthcare resources

· Develop an approach to balancing patient care responsibilities with other personal and family responsibilities

· Develop an understanding of the principles of Quality Improvement as they relate to the care of critically ill patients

Role of Health Advocate

Overall Goal

The resident will use their role as an ICU resident to influence and advance the health and wellbeing of patients

The resident will develop expertise in the ability to

· Evaluate patients with respect to determining their status regarding determinants of health (i.e. unemployment) and implement a disease prevention strategy tailored to each patient’s unique status regarding those determinants of health

· Obtain informed consent and measurement of capacity

· Understand living wills, advanced directives, durable power of attorney, and personal directives.

· Understand the concept of medical futility and understand how to discuss this idea with patients and their families

Role of Scholar

Overall Goal

To demonstrate a commitment to self-learning and the creation, translation, and dissemination of medical knowledge.

Demonstrate expertise in the ability to

· Self-identify learning needs and make use of available learning resources in the ICU setting including the Human Patient Simulator, medical data bases on-line in the

ICU, and the local expertise of physicians, nurses, respiratory therapists, social workers, spiritual care representatives and other members of the ICU team

· Understand evidence based medicine and clinical practice guidelines as they relate to the critically ill patient

· Facilitate the learning of students, patients, colleagues through a learner-centered approach to teaching

· Learn how to give and receive effect feedback regarding teaching skills

Role of Professional

Overall Goal

To display commitment to an ethical practice and high personal standards of behaviour in a manner that is commensurate with the importance of the doctor-patient relationship.

· The resident will display professional attitudes and behaviours, including:

· Honesty, integrity, reliability, compassion, respect, altruism and a sincere commitment to patient well being

· The resident will be punctual for all learning activities and patient care events

· The resident will follow through on assigned tasks

· The resident will maintain an appearance that conveys a sense of dignity commensurate with the importance of the patient-physician interaction

· The resident will balance personal and professional priorities to ensure maintenance of personal health during a 4 week rotation in the ICU

Overall Goal of the Rotation

To utilize the relevant competencies contained within the CanMEDS-FM roles to rapidly evaluate, diagnose, and treat the critically ill ICU patient, with special emphasis on those clinical presentations and procedures common to the Emergency Department.

Educational Objectives

Role of Family Medicine Expert:

The resident should:

• Develop the ability to rapidly perform a history and physical exam appropriate for a critically ill patient
• Develop sound judgment regarding the assessment and management of critically ill patients
• Develop the ability to generate a differential diagnosis and initiate immediate stabilization of the critically ill patient
• Develop a fundamental understanding of the pathophysiology, presenting signs and symptoms, diagnosis, and management of critically ill patients who may present with the following disease states:

• acute coronary syndromes

• cardiac arrhythmias
• pericarditis and myocarditis
• respiratory failure
• pneumonia
• multisystem organ failure syndrome
• sepsis
• the acute abdomen
• gastrointestinal hemorrhage
• perforated hollow viscous
• renal failure
• hepatic failure

• coma, status epilepticus, and neuromuscular diseases
• endocrine disturbances of the critically ill patient
• disturbances of water and electrolytes in the critically ill patient
• acid base disorders
• hypothermia and hyperthermia
• polytrauma and head injury
• burns
• the severely poisoned patient

•  Develop expertise in procedural skills relevant to the management of the critically ill patient including:

• Endotracheal intubation
• Bag valve mask ventilation
• CPAP/BiPAPCricothyrotomy *
• Tube thoracostomy
• Arterial line placement
• Central Venous Access (including the use of US for line placement)
• Transvenous cardiac pacing
• Nasogastric Tube insertion
• Foley catheter insertion

*rare procedure – if not actually performed, should be able to describe technique

• Develop expertise with monitoring critically ill patients including:

• ABG interpretation
• Invasive hemodynamic monitoring
• Intracranial pressure monitoring
• Pulse oximetry
• End tidal CO2 monitoring
• ECG rhythm monitors
• Ventilator monitoring

• Demonstrate a working knowledge of common ventilator modes and the indications for each as well as troubleshooting common ventilator problems
• Develop expertise in safe use of medications common in the resuscitation of critically ill patients suffering from shock, sepsis, fluid and electrolyte abnormalities, cardiac failure, cardiac dysrhythmias, renal failure, hepatic failure and toxicologic emergencies

• Develop a fundamental understanding of the pathophysiology, presenting signs and symptoms, diagnosis, and management of the various forms of shock
• Demonstrate a working knowledge of the following problems of long term ICU patients:

• Coagulation disorders
• Nutrition
• Transportation of the critically ill patient

• Pain, anxiety and sleep
• Rehabilitative needs

• Demonstrate the appropriate use of consultants and multidisciplinary team members in critically ill patients
• Demonstrate an understanding of the legal and ethical issues surrounding the care of critically ill patients
• Demonstrate a fundamental understanding of the diagnosis of brain death and issues around tissue and organ donation

Role of Communicator

Overall Goal

The resident will act to facilitate the doctor-patient relationship and establish positive therapeutic relationships with patients and their families that are characterized by understanding, trust, respect, honesty and empathy.

The resident will demonstrate expertise in the ability to

• Communicate with the patient and their family in a way that takes into account the patient’s own experience of the illness (feelings, expectations, and ideas) and the impact of the illness and ICU experience on the lives of patients and families, considering such factors as age, gender, socio-economic status, cultural and religious/spiritual values.
• Communicate with the members of the ICU health care team in a way that respects the skills of team members and facilitates an optimal team based approach to the care of the critically ill patient
• Effectively communicate with consultants
• Keep legible, coherent and complete written medical records including the ability to summarize a patients ICU care when the patient is transferred to the ward
• Clearly articulate a summary of a patient’s problem list and care plan to the multidisciplinary ICU team during daily rounds
• Compassionately deliver bad news including death-telling
• Understand issues related to patient confidentiality
• Communicate effectively with the emergency department care team when acting as a representative of the ICU team that has been consulted

Role of Collaborator:

Overall Goal

The resident will act to facilitate the doctor-patient relationship and establish positive therapeutic relationships with patients and their families that are characterized by understanding, trust, respect, honesty and empathy.

• Develop an understanding of the role of specialist consultants in the ICU
• Maintain collegial relationships with the team members in the ICU including ICU attending physicians, resident colleagues, consultants, nurses, respiratory therapists, spiritual care representatives and physiotherapists
• Participate in interdisciplinary team meetings, demonstrating the ability to respect both the expertise and limitations of the other team members
• Respect team ethics including confidentiality, resource allocation and professionalism

Role of Leader

Overall Goal:

The resident will play a central role in the organization of the care delivered to patient during their stay in the intensive care unit. They will coordinate the members of the health care system and utilize resources in a way that sustains and improves the health of their patient population.

• The resident should be able to effectively manage the care of multiple critically ill patients in the ICU
• The resident should be able to serve equally effectively as a leader or member of a team
• Understand the effective use of patient-related databases, computer based medical information and the use of medical informatics
• Demonstrate an ability to understand the importance of appropriate allocation of healthcare resources
• Develop an approach to balancing patient care responsibilities with other personal and family responsibilities
• Develop an understanding of the principles of Quality Improvement as they relate to the care of critically ill patients

Role of Health Advocate

Overall Goal

The resident will use their role as an ICU resident to influence and advance the health and wellbeing of patients

The resident will develop expertise in the ability to

• Evaluate patients with respect to determining their status regarding determinants of health (i.e. unemployment) and implement a disease prevention strategy tailored to each patient’s unique status regarding those determinants of health
• Obtain informed consent and measurement of capacity
• Understand living wills, advanced directives, durable power of attorney, and personal directives.
• Understand the concept of medical futility and understand how to discuss this idea with patients and their families

Role of Scholar

Overall Goal

To demonstrate a commitment to self-learning and the creation, translation, and dissemination of medical knowledge.

Demonstrate expertise in the ability to

• Self-identify learning needs and make use of available learning resources in the ICU setting including the Human Patient Simulator, medical data bases on-line in the ICU, and the local expertise of physicians, nurses, respiratory therapists, social workers, spiritual care representatives and other members of the ICU team
• Understand evidence based medicine and clinical practice guidelines as they relate to the critically ill patient
• Facilitate the learning of students, patients, colleagues through a learner-centered approach to teaching
• Learn how to give and receive effect feedback regarding teaching skills

Role of Professional

Overall Goal

To display commitment to an ethical practice and high personal standards of behaviour in a manner that is commensurate with the importance of the doctor-patient relationship.

• The resident will display professional attitudes and behaviours, including:
• Honesty, integrity, reliability, compassion, respect, altruism and a sincere commitment to patient well being
• The resident will be punctual for all learning activities and patient care events
• The resident will follow through on assigned tasks
• The resident will maintain an appearance that conveys a sense of dignity commensurate with the importance of the patient-physician interaction
• The resident will balance personal and professional priorities to ensure maintenance of personal health during an 8- week rotation in the ICU

Medical Expert

Basic Scientific Knowledge

1.  Discuss the principles of anatomy and physiology specifically relating to traumatic disorders, in particular:

• The various zones of the neck
• The posterior chest
• The posterior abdomen and flanks

1. Compare blunt and penetrating mechanisms of injury, further differentiating gunshot wounds and stab wounds.

1. Describe the indications and limitations, mechanism of actions, interactions and complications of pharmacologic agents used in the context of trauma:

• Analgesic agents
• Sedatives and induction agents
• Paralytic agents
• Antibiotics
• Vasopressor agents
• Corticosteroids

1. Knowledge of the principles of fluid therapy in a multiply injured patient.

1. Learn a systems approach to trauma management at local and provincial levels.

1. Learn the principles of pre-hospital trauma care

Basic Clinical Knowledge:

1. Describe the presentation, pathophysiology, natural history and therapy of various injuries/syndromes related to trauma of body systems in the adult, paediatric and geriatric population.  More specifically, knowledge about:

• Immediately life-threatening injuries
• Potentially life-threatening injuries
• Limb-threatening injuries
• Closed head injuries
• Raised ICP
• Facial trauma
• Blunt and penetrating neck trauma
• Zone I,II, III injuries
• Airway injuries
• Esophageal injuries
• Blunt and penetrating chest trauma
• Tracheobronchial injuries
• Pneumothorax
• Hemothorax
• Aortic injuries
• Lung confusion
• Diaphragmatic injuries
• Blunt and penetrating abdominal trauma
• Posterior chest and abdominal injuries
• Pelvic trauma including uro-genital trauma
• Spinal cord trauma and syndromes
• Extremity trauma, including peripheral vascular injuries, partial or complete amputations, fractures, tendons injuries, lacerations
• Compartment syndrome

1. Describe special considerations in the evaluation and management of the pregnant, Pediatric and geriatric trauma patient.

1. Demonstrate the principles of trauma resuscitation, stabilization, and disposition.

1. Describe principles of burn management.

1. Describe principles of inhalation injuries.

1. Assess and develop the appropriate differential diagnoses of clinical presentations in the trauma patient, describing the various potential lesions associated with specific mechanisms of injury.

1. Acquire knowledge of indications and limitations of the following tests with respect to the trauma patient:  plain radiography, CT scanning, echography, angiography, endoscopy, blood work.

History & Physical Examination

1. Competently complete a clinical assessment of a trauma patient in an organized and timely fashion.

1. Demonstrate knowledge of common signs of major traumatic injuries.

1. Demonstrate knowledge of the Glasgow Coma Scale.

Interpretation and Utilization of Information

1. Assess and develop the appropriate differential diagnoses of specific clinical presentations in the adult, paediatric and geriatric population (e.g. abdominal pain, UGI bleed, LGI bleed etc.).

1. Compare / contrast the use of diagnostic peritoneal lavage, ultrasound and CT scan in the evaluation of abdominal trauma.

1. Come / contrast the use of CT scanning, echocardiography and angiography for thoractic aortic injuries.

Clinical Judgement & Decision Making

1. Identify indications for immediate laparotomy and thoracotomy.

1. Set the priorities, and initiate the required resuscitation, stabilization, investigation and disposition of the traumatized patient.

1. Identify the needs for consultations/admission/transfer of such patients presenting to the Emergency Department.

1. Initiate the appropriate management of acute traumatic conditions in the adult, paediatric and geriatric patient according to injuries identified.

Technical Skills Required in the Specialty

1.  List the indications, techniques and complications of manipulative procedural skills;

• Endotracheal intubation with C-spine recautions
• Cricothyroidotomy
• Needle decompression of chest
• Chest tube insertion
• Resuscitative thoracotomy
• Cardiorrhaphy (suturing the heart)
• Diagnostic peritoneal lavage
• F.A.S.T exam

• Venous cut down
• Insertion of large bore peripheral lines
• Insertion of central venous lines (IJ, subclavian and femoral)
• Naso and orogastric tube insertion
• Suturing of basic and complex wounds
• Reduction of major joint dislocations
• Pelvis immobilization
• Foley catheter insertion
• Proper splinting and reduction of extremity fractures
• Local would exploration in penetrating trauma

1.  Perform the required manipulative/procedural skills.

1.  Ability to interpret specific radiological tests in a trauma patient:

• Plain films of the cervical thoracic, lumbar spine; chest; pelvis, extremity
• Focused ultrasonography of the abdomen/pericardium
• CT of the head for the presence of the epidural and subdural hematoma, cerebral confusion, subarachnoid hemorrage
• Perform and interpret a retrograde urethrogram

Role of Communicator

Interprofessional Relationships with Physicians and With Other Allied Health Professionals

1. Communicate effectively with the multi-disciplinary team.

Communications with Patients

1.  Demonstrate skill and behaviour towards alleviating patient anxiety, appropriate for patient age and gender.
2.  Demonstrate ability to discuss the patient’s care and counsel regarding risk modification with the patient and family.
3.   Show skill in explaining risks, benefits and obtaining consent for relevant procedures and surgeries.

Communications with Families

1.   Demonstrate ability to discuss and explain to families “bad news” in a sensitive, concise and understandable manner.
2.   Demonstrate ability to discuss living wills, advanced directives and do not resuscitate orders.

Written Communication and Documentation

1.  Ability to document concisely and precisely pertinent findings on history and examination as relevant to the trauma patient.

Role of Collaborator

Interacts and Consults Effectively With All Health Professionals by Recognizing and Acknowledging Their Roles and Expertise

1. The resident will recognize the role of each health care team member with respect to the patient’s care.

1. Demonstrate ability to resolve common team conflict problems.

1. Demonstrate ability to work in a multi-disciplinary team, work as part of a trauma team.

1. Consults appropriate services for the definitive care of the patient.

Delegates Effectively

1.  Demonstrates ability to delegate various parts of the evaluation and procedures during trauma resuscitation.

Role of Leader

Uses Health Care Resources Cost-Effectively

1.  Recognize resources of tertiary care trauma centres and the use and rationalization of these for the individual patient and the population served.

1.  Demonstrate knowledge of trauma systems and the function it serves to the hospital and the region.

1.  Comprehend the rationale, organization and resources required to create trauma centers and systems.

Organization of Work & Time Management

1. Ability to establish priorities in a single complex trauma patient under stressful conditions.

1. Be capable of managing multiple ill patients concurrently.

Role of Health Advocate

Advocates for the Patient

1. Be capable of discussing with patients risk and harm reduction strategies.

1. Be the patient’s advocate at all times, particularly when they are unable to do so themselves.

Advocates for the Community

1. Learn principles of disaster management.

1. Be able to discuss and promote injury prevention.

1. Be aware of organ procurement procedures.

Role of Scholar

Motivation to Read and Learn

1. Be consistent in reading around clinical cases and improving trauma knowledge base.

Critically Appraises Medical Literature

1. Demonstrate knowledge and applicability of landmark (specialty relevant) studies in trauma care.

Teaching Skills

1. Demonstrate ability to supervise students and more junior residents in the evaluation of the traumatised patient and performance of procedure.

Role of professional

• Show respect at all times for the patient’s;

• Race/Ethnic background
• Language
• Religion /belief system
• Gender/sexuality
• Confidentiality

• Be insightful of one’s own strengths and weaknesses (and when to call for back up).

• Be able to receive and accept constructive feedback.

• Display ethical behaviour compatible with a physician at all time with;

• Patients and their families
• Allied health staff
• Attending staff, residents, and students.

• Be a role model for colleagues and other health care professionals.

Medical Expert and Clinical Decision-Maker

1. Obtain a history that is accurate, pertinent, and concise for the nature of the problem
2. Perform physical examination that is sufficient to initiate a diagnosis or management plan
3. Discriminate types of poisoning with the knowledge of the different toxidromes.
4. Diagnose and treat withdrawal states
5. Identify the need for gastrointestinal decontamination and the benefits and risks of activated charcoal, whole bowel irrigation, gastric lavage, and other decontamination techniques
6. Demonstrate the ability to interpret accurately the results of common diagnostic tests including but not limited to the anion gap, osmol gap, lactate, acetaminophen, salicylate, iron, and lithium
7. Demonstrate knowledge in pharmacokinetics, pharmacodynamics, and how these considerations change in poisoning (toxicokinetics, toxicodynamics)
8. Demonstrate some knowledge in the mechanisms of toxicity, principles of stabilization and treatment modalities of analgesics (e.g. acetaminophen, NSAIDs, salicylates, opioids), autonomic agents (e.g. anticholinergics, cholinergics, adrenergic agonists), sedative-hypnotics (e.g. ethanol, benzodiazepines, Z-drugs), anticonvulsants, antidepressants, antipsychotics, mood stabilizers, cardiovascular medications, antidiabetics, other endocrine medications, anticoagulants, toxic gasses, occupational exposures, heavy metals, and natural toxins (e.g. fungal, botanical, animal)
9. Demonstrate knowledge of mechanisms of action and indications for critical antidotes (e.g. naloxone, N-acetylcysteine, sodium bicarbonate, atropine, thiamine, physostigmine, flumazenil, sedatives, and lipid emulsion)

Role of Communicator

Residents should be able to demonstrate effective communication skills by their ability to work harmoniously with the team; formulate a clear plan of action and convey information to other colleagues, deliver information to patient and families in a sensitive manner using the appropriate vocabulary for their understanding of the situation; understand the different levels of risk perception and elaborate a strategy for effective risk communication to patients, family and other professionals; link effectively with the provincial Poison Center; summarize the evidence to allow for better consultation and follow-up on the cases; leave legible and pertinent written documentation enabling another professional to access the information pertaining to the case.

Role of Collaborator

Residents should be able to act as leader of the multidisciplinary team required for the management of poisoned patients in the Emergency Department. More specifically, residents should contact and request assistance of other allied health professionals when dealing with high risk suicidal patients, highly aggressive patients, suspicious poisonings, occupational poisoning with other potential victims, patient requiring enhanced elimination modalities, patient requiring ventilatory or monitoring support

Role of Leader

Residents should understand and be able to apply in their practice

• principles of HAZMAT
• principles of risk assessment
• principles of telephone consultation and interaction with Poison Control
• principles of administration of a regional Poison Control and quality assurance
• providing effective consultation and liaison with the Poison Control Centre when referral from an outside hospital is requested and be able to utilize resources judiciously in suggesting a transfer for an intoxicated patient.

Role of Health Advocate

Residents should be able to recognize and advise patients and their families regarding the general epidemiology and prevention of poisonings and more specifically:

• inappropriate use of medications
• inappropriate use of medications
• dangerous interactions between medications
• risks of polypharmacy and inappropriate over-the-counter medication use.
• health issues pertaining to drug and illicit substance abuse
• social issues relating to the behaviour of deliberate self-harm and poisoning.
• use of Poison Control Center for prevention and surveillance of poisonings

Role of Scholar

Residents should be able to demonstrate an intellectual approach to medical practice in the following areas during participation on patient rounds, teaching sessions, journal clubs and interdisciplinary meetings:

• Continuing medical education

• Show interest in self-education skills by demonstrating knowledge in the evolving concepts in the management of poisoned patients and new pharmacological developments.

• Critical appraisal of the medical literature
• Demonstrate the ability to research the medical literature (papers, online information, databases, conference abstracts), and identify the best available evidence for any patient related question.

• Identify limitations in current toxicological research
• Competently summarizing the evidence to date and develop potential research ideas to fill these gaps

• Model the teaching of clinical toxicology to peers and students

Role of Professional

Residents should be familiar with medical, legal, psychiatric and social aspects of medical toxicology. They should approach situations with the highest level of integrity and honesty. They should show responsibility and reliability in the exercise of their function and demonstrate awareness of their own limitations and seek advice appropriately.

Resident should more specifically demonstrate professionalism in the following issues:

• Obtain consent for therapeutic modality or research study inclusion by the patient or the next of kin
• Respect patient’s rights to confidentiality and neutrality in the face of legal authority involvement whilst fulfilling legal obligations as per the provincial medical code of ethics and local regulations
• Recognize the limitation of medical practice in the face of threat or aggression and decide when appropriate to involve legal authorities
• Recognize the impact on the delivery of care to patients with impaired judgment or inability to decide for oneself that can be created by intoxicated states
• Seek appropriate advice from allied consultants to achieve the best therapeutic plan for complex patients

Medical Expert

The resident will be expected to

1. Participate in the management of difficult cases
2. Learn efficient decision making in cases of unclear disposition
3. Deciding on admissions/discharge vs. consultations

1. The resident will focus on re-assessment of cases already present in the ED, and learn the evolution of the patient stay and decide on appropriate work-up bases on their current state which may have evolved during the patient’s stay in the ED.
2. The resident will be required to learn the key protocols and policy guidelines as they apply to each of the ED sites.

Role of Communicator

The resident will learn to deal effectively with patients and families in increasingly difficult and challenging patient encounters.  He-She will need to be able to communicate effectively at meetings.  The resident will also need to provide effective written response to ta patient complaint letter or M+M case.

Role of Collaborator

The resident will be expected to become comfortable communicating and collaborating with residents, other health care providers, consultant staff physicians.

Role of Leader

The resident will be expected to demonstrate organizational skills in ED administration; learn to organize, manage and lead committees both on an ED level and a hospital level.  This may include budgeting and staffing according to objective measures. 

Role of Health Advocate

The resident will be expected to be able to recognize the determinants of illness and injury seen in the Emergency Department and able to act on these findings; advocating for the patients in the ED, sometimes through a long stay in the emergency.

Role of Scholar

The resident will be expected to familiarize themselves with the concepts of medical and system errors, and how to determine the roles they play in undesirable patient outcomes.  A Mandatory project will be required to be completed.  This will include either a response to a patient complaint letter, or to an M+M case.  Residents are encouraged to read academic EM material relevant to topics addressed. 

Role of Professional

The resident will be expected to treat patients and fellow staff with non-judgmental respect, prepare for meeting and learning encounters, exhibit professional demeanour (appearance, punctuality work ethic).  He/she will be required to exhibit the following qualities:  reliability, honesty, maturity, respect for others, accept constructive criticism and demonstrate sincere concern for others.  The resident will need to demonstrate understanding of physician wellness issues and be aware of ethical considerations of Emergency Medicine practice.

In addition, the rotation is used as an opportunity to teach and reinforce topics in Emergency Medicine tutorials and sessions include the following;

• Critical Appraisal
• MSK
• Casting
• Reductions and splinting
• EKG
• Flow
• Reading radiological films
• Mass Casualty
• Humanitarian work
• CMPA/professional liability
• Quality Assurance/CQI
• Ophthalmology
• ACLS refresher
• PALS refresher
• E-charting
• Time Management
• EMS
• Successful CME
• ED Design
• Disaster Plan
• Addressing Complaints
• DPS Role -- DPS
• Billing

Many of these sessions are given by experts in the respective field. In addition, refresher courses in ACLS, PALS, and ATLS are offered.

Residents also benefit from continued U/S tutorials and practice during the period.

Overall Goal:

To utilize the relevant competencies contained within the CanMEDS-FM roles to develop the skills necessary to manage common orthopedic presentations to the emergency department. 

Educational Objectives:

Role of Family Medicine-Emergency Medicine (FM-EM) Expert

Orthopedics Objectives

• Develop ability to correctly perform a history and physical in patients with orthopedic complaints
• Demonstrate understanding of the anatomy and mechanism of injury of common orthopedic injuries
• Demonstrate knowledge of the differences in paediatric and adult skeletal anatomy and how those differences are manifest in clinical and radiographic presentations.
• Demonstrate knowledge of standard orthopedic nomenclature
• Clinically assess skin integrity, limb alignment and neurovascular status
• Learn the use of the diagnostic imaging modalities available for the evaluation of orthopedic disorders
• Demonstrate ability to apply orthopedic devices, including casts, splints and immobilizers
• Demonstrate knowledge of the appropriate aftercare, rehabilitation and follow up of common orthopedic injuries
• Demonstrate an understanding of which orthopedic conditions warrant immediate and elective referral to an Orthopedic Surgeon
• Develop skills in the evaluation and management of orthopedic trauma
• Demonstrate ability to prioritize and manage the treatment of orthopedic injuries in multiple trauma patients
• Discuss the dosage, 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

Develop expertise in the assessment and management of common emergency orthopedic presentations including:

• Fractures: basic principles of fracture management, including closed reductions
• Dislocations: including shoulder, elbow, hip, knee, ankle and fingers
• Sprains/strains: including ankle, knee, hip, rotator cuff, tennis/gold elbow, Achilles tendon rupture
• Joint injuries: including arthritis, bursitis, gout
• Approach to lower back pain: including sprain, disc hernia, fracture, cauda equina, spinal epidural abscess, non MSK causes
• Infectious disorders: including osteomyelitis, septic joint
• Orthopedic emergencies: including open fracture, crush injuries, certain dislocations, compartment syndrome, high pressure injection injuries
• Paediatric presentations: including an approach to the limping child, Toddler’s fracture, pulled elbow, Legg-Perthe’s-Calvé, slipped femoral epiphysis, Osgood-Schlatter’s disease

Resuscitation Objectives

• Perform a history and physical exam appropriate for a critically ill patient
• Develop sound judgment regarding the assessment and management of critically ill patients
• Develop the ability to generate a differential diagnosis and initiate immediate stabilization of the critically ill patient
• Develop an approach to the critically ill patient who may present with the following disease states: respiratory failure, hypo and hyperthermia, drowning, polytrauma and head injury, burns, severe poisoning, acute abdomen, gastrointestinal haemorrhage, altered mental status, seizure, acute coronary syndrome, cardiac arrhythmias, multisystem organ failure syndrome etc.
• Develop an approach to the patient in cardio-pulmonary arrest
• Develop expertise in safe use of medications common in the resuscitation of critically ill patients
• Develop skills in leading a multidisciplinary team in resuscitating a critically ill patient: preparing for the resuscitation (role assignment), closed loop communication, summarising and asking for suggestions during the code, debriefing etc.

NOTE: the following list contains broad categories of clinical presentations only. For a more complete list of clinical presentations the resident is referred to the document entitled “Educational Reference Manual: Core Emergency Medicine Training in Family Medicine Residency Programs” https://www.hhr-rhs.ca/en/tools/library/english/educational-reference-ma...

Role of Communicator

Overall Goal

The resident will communicate effectively with members of the healthcare team. The resident will facilitate the doctor-patient relationship and establish positive therapeutic relationships with patients and their families that are characterized by understanding, trust, respect, honesty and empathy.

The resident should demonstrate expertise in the ability to:

• Rapidly establish rapport in such a way as to efficiently and effectively delineate the nature of the problem including for ex: mechanism of injury for orthopedic injuries, gathering collateral information for the critically ill patient etc.
• Overcome barriers to communication such as language, patient disabilities, cultural differences and age group differences
• Manage the difficult patient encounter
• Explain orthopedic issues in language adapted to the needs of the individual, including immediate and follow-up care plans
• Communicate with the members of the resuscitation team in a way that respects the skills of the team members and facilitates an optimal team base approach to the care of the critically ill patient
• Use specific communication methods to optimally lead a resuscitation (team preparation, closed loop communication, summaries and suggestions, debriefing)
• Effectively communicate with consultants
• Compassionately deliver bad news including death-telling
• Maintain clear (legible), accurate and concise medical records.

Role of Collaborator

Overall Goal

Maintain collegial relationships with the team members of the resuscitation team and orthopaedics team.

Role of Leader

Overall Goal

The resident will play a central role in the organization of the care delivered to the patient during their stay in the emergency room or orthopedics clinic. They will coordinate the members of the health care system and utilize resources in a way that sustains and improves the health of their patient population.

The resident should:

• Manage effectively the care of multiple critically ill patients as well as patients presenting with orthopedic complaints

• Demonstrate an ability to understand the importance of appropriate allocation of health care resources.
• Manage time effectively to attend to patient needs in the clinic or emergency room setting and to recognize when urgent care is needed

• Learn the rational use of consultants, as well as laboratory, radiographic and other diagnostic tests with limited availability

Role of Health Advocate

Overall Goal

The resident will use their role in the ED and orthopedic clinic to influence and advance the health and wellbeing of patients

The resident will develop expertise in the ability to

• Evaluate patients with respect to demining their status regarding determinants of health (i.e. unemployment) and implement a disease prevention strategy tailored to each patient’s unique status regarding those determinants of health
• Obtain informed consent and measurement of capacity
• Assess and determine the level of care of a critically ill patient
• Understand the concept of medical futility and understand how to discuss this idea with patients and their families

Role of Scholar

Overall Goal

To demonstrate a commitment to self-learning and the creation, translation and dissemination of medical knowledge

Demonstrate expertise in the ability to

• Self identify learning needs and make use of available learning resources
• Understand evidence based medicine and clinical practice guidelines
• Facilitate the learning of students, patients, colleagues through a learner-centered approach to teaching
• Learn how to give and receive feedback

Resident rotation project (on HOLD for now)

Contribute to the creation and translation of medical knowledge by creating a blog entry for the McGill Emergency Orthopedic website (mskmcgill.com): The resident will be asked during the two week rotation to create a blog entry on a specific MSK/orthopedic related topic of their choice. They should choose a relatively precise orthopedic diagnosis (as to avoid repetition) and publish a succinct description of the clinical presentation, diagnosis and treatment with use of images and radiographs being encouraged. Specific description of patient encounters can be included. A member of the curriculum staff will then review this entry before it is published. With time, we hope that this resource will be a useful tool for residents, students and staff.

Role of Professional

Overall Goal

To display commitment to an ethical practice and high personal standards of behaviour in a manner that is commensurate with the importance of the doctor-patient relationship

The resident will:

• Display professional attitudes and behaviours including: honesty, integrity, compassion, respect, altruism and a sincere commitment to patient well-being
• Be punctual for all learning activities and patient care events
• Follow through on assigned tasks
• Maintain an appearance that conveys a sense of dignity commensurate with the importance of the patient-physician interaction
• The resident will balance personal and professional priorities to ensure maintenance of personal health

Overall Goal

To utilize the relevant competencies contained within the CanMEDS-FM roles to develop anesthesia skills relevant to the emergency physician including the management of airway emergencies, performance of procedural sedation and regional anesthesia. Residents will manage patients as a member of the anaesthesia team in the perioperative and operative setting.

Specific Educational Objectives:

Family Medicine Expert

The resident should:

• Develop expertise in airway management skills
• Develop knowledge and skills required for procedural sedation
• Develop familiarity with pharmacological agents used in airway management, procedural sedation, and pain management.
• Perform a relevant pre-operative history and physical exam
• Manage the anesthesia for a patient in the operative setting
• Develop and enhance skills for regional anaesthesia

Airway Management skills

• Describe the optimal timing and method of airway intervention in emergency situations such as CNS depression, trauma, shock, respiratory infections, asthma, and COPD
• Demonstrate the ability to assess airway protection and patency
• Describe the hallmarks of a difficult airway and discuss the management of the difficult airway
• Recognize and manage an obstructed airway
• Compare adult, adolescent, pediatric and neonatal airways and differentiate their management
• Perform interventions (e.g. patient positioning, oxygen delivery, airway adjuncts) appropriate to the situation to maintain airway patency
• Perform bag valve mask ventilation effectively
• Discuss equipment and appropriate sizes required for intubation of adult and pediatric patients
• Perform endotracheal intubation, understanding the indication, contraindications, and complications
• Describe or perform nasotracheal intubation understanding the indication, contraindications and complications
• Perform rapid sequence intubation (RSI) with appropriate preparatory steps and medications
• Describe variations of RSI in patients with hemodynamic compromise, intracranial pathology and acute bronchospasm
• Describe manoeuvres to confirm endotracheal tube placement
• Describe the technique of an awake endotracheal intubation
• Discuss and/or perform alternative airway management techniques such as  gum elastic bougie, laryngeal mask airway (LMA), lighted stylet, intubating LMA, glide scope, combitube, trans-tracheal jet ventilation, cricothyroidotomy, retrograde intubation, and flexible fiberoptic bronchoscope while understanding the indications, contraindications, and complications
• Demonstrate an understanding of the indications and the technique of obtaining a surgical airway.
• Describe the criteria for extubation, and perform extubation and post-extubation care
• Understand the role of measuring end tidal CO2 and oxygen saturation in intubated patients
• Demonstrate the ability to assess ventilatory failure
• Understand the basic concepts and use of mechanical ventilators

Procedural sedation:

• Discuss the role of procedural sedation including risks and benefits
• Understand the ASA classification system                                       
• Discuss and perform procedural sedation for adult and pediatric patients, including indications and contraindications
• Describe the indications, contraindications, side effects, advantages and disadvantages of the pharmacologic agents used for procedural sedation
• Describe the standard monitoring techniques required for procedural sedation
• Describe the various levels of sedation

Pharmacologic agents:

• Discuss concepts of common inhalational agents including advantages, disadvantages and relative contraindications
• Discuss concepts of induction agents (ie: thiopental, ketamine, propofol, etomidate).
• Discuss concepts of neuromuscular blocking drugs (depolarizing and nondepolarizing) and reversal drugs
• Discuss concepts of post fasciculation myalgia and pseudocholinesterase deficiency
• Discuss vasopressors and inotropes Including epinephrine, ephedrine, phenylephrine, vasodilators, NTG, nitroprusside, hydralazine).

• Compare and contrast the classes of local anaesthetics
• Classify local anaesthetics and describe their mechanism of action
• Discuss the maximum dose and side effects of lidocaine and bupivacaine
• Describe an approach to someone with possible local anaesthetic hypersensitivity
• Describe the indications, contraindications and technique for topical anaesthesia

• Discuss the dose, metabolism, and systemic effects of narcotics and benzodiazipines used in the emergency department setting
• Discuss the indications, potential side effects and dose of narcotic and benzodiazipine antagonists in an emergency setting
• Discuss the theories describing the mechanism of pain perception

Pre-operative and operative patient management

• Perform a pre-operative history and physical exam
• Discuss pre-operative preparation, sedation, and operative monitoring
• Perform a safety check on the anaesthetic machine
• Demonstrate relevant peripheral and central venous anatomy knowledge
• Demonstrate skill in obtaining peripheral and central venous access

• Manage fluid requirements during anaesthesia
• Assess and manage problems relating to the anaesthetic

• Assess and manage problems under general anaesthetic including hypotension, hypertension, and arrhythmias
• Discuss anaesthetic problems associated with specific conditions including diabetes, asthma, myasthenia, and malignant hyperthermia

Regional Anaesthesia

• Identify the landmarks and describe an approach to common regional nerve blocks
• Describe the indications, contraindications and complications of regional nerve blocks
• Perform spinal anesthesia

Role of Communicator

Overall Goal

The resident will communicate effectively with members of the healthcare team. The resident will act to facilitate the doctor-patient relationship and establish positive therapeutic relationships with patients and their families that are characterized by understanding, trust, respect, honesty and empathy.

The resident should:

• Demonstrate an ability to discuss the risks and benefits of various anaesthetic techniques relevant to the patient and procedure

• Demonstrate the ability to communicate with the patient and their family in the perioperative period in a way that takes into account the patient’s own experience of the illness (feelings, expectations, ideas) and the impact of the illness on the lives of the patients and their families, considering such factors as age, gender, socio-economic status, cultural and religious/spiritual values.

• Demonstrate an ability to communicate with the members of the emergency and surgical health care team in way that respects the skills of team members and facilitates an optimal team based approach to the care of the patient undergoing an anesthetic

• Demonstrate an ability to keep legible, coherent and complete peri-operative history and physical exam notes and procedural sedation records.

• Demonstrate an appreciation of issues related to patient confidentiality

Role of Collaborator

Overall Goal

The resident will work cooperatively with patients, families and other members of the healthcare team to achieve optimal patient care.

The resident should:

• Develop a pre-operative, operative, and post-operative care plan for a patient in collaboration with the surgical health care team.
• Participate in interdisciplinary team meetings, demonstrating the ability to accept, consider and respect the opinions of other team members.
• Maintain collegial and respectful relationships with surgeons, physicians and other health care professionals.
• Identify and describe the role, expertise and limitations of the members of the emergency and surgical health care team including anesthesia technicians, respiratory technicians and OR and post-op nurses.
• Demonstrate an ability to promote the autonomy of patients and families and to promote their involvement in decision-making.

Role of Leader

Overall Goal

The resident will play a central role in the organization of the anesthesia care delivered to the patient. They will coordinate the members of the health care system and utilize resources in a way that sustains and improves the health of their patient population.

The resident should be able to:

• Appropriately triage and prioritize patients requiring urgent airway intervention
• Effectively assemble the health care team and prepare for procedural sedation in a busy department
• Understand common issues around managing patients pre-operatively, in the operating room and recovery room
• Make clinical decisions and judgments based on sound evidence for the benefit of individual patients and the population served
• Work effectively as a member of the health care team, whether as a team leader or team member

• Effectively use patient-related databases, access computer-based information and understand the fundamentals of medical informatics
• Employ effective time management and self-assessment skills to formulate realistic expectations and a balanced lifestyle.

Role of Health Advocate:

Overall Goal

The resident will use their role as a resident in anesthesia to influence and advance the health and wellbeing of patients

The resident should be able to:

• Identify the health needs of an individual patient and advocate for individual patients
•  Identify opportunities for health promotion and disease prevention in pre-operative assessments
• Identify the determinants of health, including barriers to accessing care and resources
• Identify vulnerable or marginalized populations and provide appropriate care and resources to these patients
• Demonstrate proficiency in obtaining informed consent
• Advocate for patient safety in the operating room

Role of Scholar

Overall Goal

To demonstrate a commitment to self-learning and the creation, translation, and dissemination of medical knowledge.

The resident should be able to:

• Demonstrate an enthusiasm for learning
• Identify learning issues during the rotation
• Access the available resources to address a learning issue, including staff anaesthetists, respiratory therapists, nurses as well as medical databases.
• Critically appraise the literature and Integrate new knowledge and skills into clinical care

• Improve presentation skills through rounds presentations (if available)
• Learn how to provide effective feedback to teachers

Role of Professional

Overall Goal

To display commitment to an ethical practice and high personal standards of behavior in a manner that is commensurate with the importance of the doctor-patient relationship.

 The resident should:

• Exhibit professional behaviours in practice including honesty, integrity, reliability, compassion, respect, altruism, and a sincere commitment to patient well-being

• Be punctual for clinical and educational events
• Follow through on assigned tasks
• Demonstrate respect for colleagues and team members
• Recognize the principles and limits of patient confidentiality
• Maintain appropriate professional boundaries

Balance personal and professional priorities to ensure personal health during the rotation

Overall Goal:

The overall goal of the elective rotation is to allow the resident opportunity to gain further clinical and/or academic exposure within an area of special interest.

NOTE: The resident will develop specific goals and objectives pertinent to their chosen elective and submit them with their application for approval to the Program Director.

The following are general educational objectives and key competencies pertinent to all electives:

Educational Objectives:

Role of Family Medicine-Emergency Medicine (FM-EM) Expert

The FM-EM resident will develop expertise in the ability to:

• Integrate the CanMEDS roles to provide ethical, effective and patient-centred medical care
• Establish and maintain clinical knowledge, skills and attitudes appropriate to their practice;
• Perform a complete and appropriate assessment of a patient;
• Use preventive and therapeutic interventions effectively;
• Demonstrate proficient and appropriate use of procedural skills, both diagnostic and therapeutic;
• Seek appropriate consultation from other health professionals, recognizing the limits of their expertise.

Role of Communicator

Overall Goal

The resident will communicate effectively with members of the healthcare team. The resident will facilitate the doctor-patient relationship and establish positive therapeutic relationships with patients and their families that are characterized by understanding, trust, respect, honesty and empathy.

The resident should demonstrate expertise in the ability to:

• Develop rapport, trust and ethical therapeutic relationships with patients and families;
• Accurately elicit and synthesize relevant information and perspectives of patients and families, colleagues and other professionals;
• Accurately convey relevant information and explanations to patients and families, colleagues and other professionals;
• Develop a common understanding on issues, problems and plans with patients and families, colleagues and other professionals to develop a shared plan of care;
• Convey effective oral and written information about a medical encounter.

Role of Collaborator

Overall Goal

The resident will work cooperatively with patients, families and other members of the healthcare team to achieve optimal patient care.

The resident will demonstrate expertise in the ability to:

• Participate effectively and appropriately in an interprofessional healthcare team;
• Effectively work with other health professionals to prevent, negotiate, and resolve interprofessional conflict.

Role of Leader

Overall Goal

The resident will play a central role in the organization of the care delivered to patients during their clinical encounter. They will coordinate the members of the health care system and utilize resources in a way that sustains and improves the health of their patient population.

The resident will develop expertise in the ability to:

• Participate in activities that contribute to the effectiveness of their healthcare organizations and systems;
• Manage their practice and career effectively;
• Allocate finite healthcare resources appropriately;
• Serve in administration and leadership roles, as appropriate.

Role of Health Advocate

Overall Goal

The resident will use their role as a CCFP-EM resident/clinician to influence and advance the health and wellbeing of patients

The resident will develop expertise in the ability to:

• Respond to individual patient health needs and issues as part of patient care;
• Respond to the health needs of the communities that they serve;
• Identify the determinants of health of the populations that they serve;
• Promote the health of individual patients, communities and populations.

Role of Scholar

Overall Goal

To demonstrate a commitment to self-learning and the creation, translation, and dissemination of medical knowledge.

The resident should be able to:

• Maintain and enhance professional activities through ongoing learning;
• Critically evaluate information and its sources, and apply this appropriately to practice decisions;
• Facilitate the learning of patients, families, students, residents, other health professionals, the public, and others, as appropriate;
• Contribute to the creation, dissemination, application, and translation of new medical knowledge and practices.

Role of Professional

Overall Goal

To display commitment to an ethical practice and high personal standards of behavior in a manner that is commensurate with the importance of the doctor-patient relationship.

The resident should:

• Demonstrate a commitment to their patients, profession, and society through ethical practice;
• Demonstrate a commitment to their patients, profession, and society through participation in profession-led regulation;

Demonstrate a commitment to physician health and sustainable practice.