Introduction & Overview
Introduction & History
The McGill Family Medicine – Emergency Medicine program will be starting its 39th year as of July 2024. It continues to flourish and is one of Canada’s largest CCFP-EM programs with 12 residents.
During 1985-86 several members of the Department of Family Medicine of McGill University met and discussed the need to form a third-year program in Family Medicine - Emergency Medicine at McGill. At the time, there were several such programs across Canada with limited positions. Dr. Judith Levitan, then the Director of Family Medicine at the Queen Elizabeth Hospital, coordinated the submission to the College to initiate the third-year program. Dr. Levitan and Dr. Victor Einagel were the driving force that enabled the development of the program. Dr. Levitan became the first Program Director and Dr. Einagel was the first Academic Coordinator. Dr. Einagel also assisted in the cooperation and collaboration with the FRCP Emergency Medicine Specialty Program. Dr. Brian Connolly, Dr. Marc Afilalo, and Dr. Peter Duffy completed the committee in 1986 and were instrumental in its development. Dr. Unger was Program Director from 1995 until January 2007 and had been instrumental in maintaining the premiere status of the program and in creating the largest Family Medicine Emergency Medicine program in Canada. Dr. Richard Kohn was the next Program Director for 4 years and was recognized for his mentorship and dedication. There is now a CAEP Mentorship award in his memory. Debbie Pollack was the coordinator for 16 years, we hold her in our memories as well, for her contribution and for the good-hearted support she gave the residents. Dr. Zachary Levine served as the next Program Director for over eight years before recently stepping down in 2019. He is now Department Chief at the MUHC.
By the end of the 2023-2024 academic year, three hundred and twenty-four residents from across Canada will have completed the third-year program in Enhanced Skills in Emergency Medicine at McGill. Many graduates have continued in an academic centres where they teach learners and conduct research. Countless others are practicing in rural and community hospitals combining Emergency Medicine and Family Medicine practice. Many of these graduates are involved in the leadership and administration of their respective Emergency Departments.
In short, our residents go on to become leaders in their Departments, hospitals and communities.
Program Overview
The main goal of Enhanced Skills in Emergency Medicine programs is to provide the Family Doctor with added competency in the management of acutely ill and injured patients. As a result, these physicians will serve as a resource to their community – from the rural family doctor who is called upon when a patient is crashing to the Emergency physician in a busy academic Department. The training year is necessarily intense, as all fundamental Emergency Medicine topics are covered. In particular, the resident is expected to become competent and confident in the resuscitation of unstable patients. Maintenance and recovery of the ABC’s (Airway, Breathing, and Circulation) is paramount.
The academic component of the year is comprised of several elements: clinical rotations, Academic half-days, interactive and written exams, oral examinations, POCUS training with IP certification, Simulation sessions, and a Critically Appraised Topic project.
The clinical rotations, described later in detail, consist of time in Trauma/Emergency Medicine, tertiary Emergency Medicine, community Emergency Medicine, Pediatric Emergency Medicine, tertiary Intensive Care, community Intensive Care, Anesthesia, Musculoskeletal Medicine, and ER-Administration/Foundations of Emergency Medicine rotation. Residents have one month for an ER-related elective.
Academic half-days (AHD) are held every Wednesday morning. During the 1st and 4th Wednesdays of the Period, residents attend rounds with their FRCP-EM colleagues. Fundamental EM topics are covered. Journal club is included in these sessions. It is during these rounds that residents present their Critically Appraised Topics.
On the second Wednesday of each Period, residents attend a session to review the topic specified for that Period (see overall teaching schedule). Residents are expected to have prepared the topic by reading the relevant chapters in Tintinalli and other sources. A written examination is held and then reviewed as a group. The third Wednesday of each period is reserved for oral examination practice sessions covering that Period’s topic.
The POCUS training consists of an online introductory course, further teaching sessions on more advanced topics throughout the year, and, as of 2017, an Ultrasound/Emergency Medicine rotation at the Jewish General Hospital. During the course of this rotation residents will have the opportunity to complete the remaining scans needed to challenge the IP exam at the end of the Period.
Simulation sessions are held throughout the year with the FRCP-EM residents. In addition, the program has a Simulation curriculum to ensure that core Emergency Medicine topics are covered annually. Residents can expect a high quality, high fidelity Simulation session approximately once per month, led by local SIM experts.
The program benefits greatly from a close relationship with the FRCP-EM residency program. The benefits extend beyond the academic enrichment residents enjoy by attending rounds, simulations, and resuscitation sessions with their FRCP-EM colleagues. The groups also hold social functions together. This collegial relationship continues in (and, no doubt, is a reflection of) the function of the Academic Department of Emergency Medicine at McGill, which is comprised of a mixture of CFPC and FRCP-trained Emergency doctors who work together in an amicable and constructive environment. The McGill CCFP-EM training program provides a very strong academic foundation in Emergency Medicine. McGill’s Department of Family Medicine, including all of its Enhanced Skills programs, was accredited by the CFPC in 2022.
Newly formed in 2018, the Competency Committee is responsible for following the academic trajectory of residents throughout the rigorous year of training, ensuring their readiness for practice. Each resident is paired with a Faculty Advisor. Faculty Advisors compile their respective residents' evaluations on a quarterly basis and meet to discuss performance and develop a learning plan. These evaluations are based on clinical rotations, presentations, participation in academic activities and participation in resident life. The CanMEDS model is the framework on which the overall evaluation of residents will be conducted. These evaluations also take into account benchmarks residents’ should be meeting in their training, ensuring a linear progression. A platform is also given to residents to ensure feedback of their experiences during the year.
A review of each resident is held on a quarterly basis ensuring they are meeting these benchmarks. Shared recommendations are made during those meetings ensuring a safe and positive learning environment for both residents and Advisors. Furthermore, the Committee identifies and supports residents who are not progressing as expected. This is done by designing a detailed remediation plan specific to the resident's needs, with regular follow-up. If deemed necessary, the Committee will follow McGill PGME protocols for extensions of training.
The program believes in Continuous Quality Improvement and, as such, is constantly evolving in response to feedback. As of 2018-19 there is a new MSK rotation at the Lakeshore Hospital. This is a high volume community hospital that serves all ages where residents have the opportunity to be the most senior resident present. During this rotation the residents consolidate their skills in management of MSK and Orthopedic issues as well as managing resuscitation cases. The rotation has been found to be very high yield. Residents are encouraged to provide feedback through Advisors and Mentors, on one45 (for example rotation evaluations), on the Exit Survey, and through the chiefs at quarterly RPC meetings.
Another great strength of the program is the people who are involved year after year. There is a core group of highly dedicated staff doctors and Administrative Coordinator, who are invested in the residents’ success. There is an established Mentor program wherein each resident is matched with a staff person whose role is to provide support outside of the evaluation process. Residents are encouraged to use their Mentor for support in dealing with any problems that may arise in the course of a challenging year. The Program Director checks in frequently with residents and is available anytime for support.
The most important factor in our program’s success is the residents. Over the past 38 years we have consistently benefitted from talented groups of residents. These groups enjoy a warm and supportive dynamic that results in an intense, unforgettable year with lifelong friendships formed. Our graduates practice throughout Canada and around the globe. Some do international and humanitarian work, others work in small rural communities, and others in large academic centres. Many are leaders in their fields. Wherever they go and whatever they do, they will always be part of the McGill CCFP-EM program.
Administrative Structure 2024-2025
C.F.P.C. Emergency Medicine Program Director:
Dr. Andrew Reid
C.F.P.C. (EM) Academic Secretary:
Anna De Palma 514-934-1934 x34277
anna.depalma [at] muhc.mcgill.ca
C.F.P.C. Emergency Medicine Assistant Directors:
Dr. Tan Le (JGH)
Dr. Jerman Chirgwin (SMH)
Dr. Elise Papillon (RVH)
Competency Committee Chair:
Dr. Dat Nguyen Dinh
Ultrasound Directors:
Dr. Paul Brisebois (JGH)
Dr. Joel Turner (JGH)
Simulation Directors:
Dr. Marc Richard-Albert (MGH/RVH)
Dr. Errol Stern (JGH)
CAT Project, stats, epidemiology Curriculum Director:
Dr. Carina Antczak
Wellness Leader:
Dr. Katya Ghannoum
Administrative Month Directors:
Dr. Akina Fay
Dr. Elise Papillon
Practice Exam:
Dr. Fannie Fortier-Tougas
C.F.P.C. (EM) Curriculum Committee Members:
Dr. Tan Le (JGH)
Dr. Jerman Chirgwin (SMH)
Dr. Nare-Gacia Topouzian
Dr. David Lasry (MGH)
Dr. Jennifer Alper (JGH)
Dr. Josh Chinks (MUHC)
Dr. Steven Herskovitz (SMH)
Dr. Kaviraj Gosal
Dr. Adrian Florea (SMH)
Dr. Jennifer Moscovitz (SMH)
Dr. Elise Papillon (RVH/SMH)
Dr. Marc Richard-Albert (MGH/RVH)
Dr. Haran Balendra (JGH)
Dr. Carina Antczak
Dr. Chanel Fortier-Tougas (LGH)
Dr. Fannie Fortier-Tougas
Dr. Paul Brisebois (JGH)
Dr. Robin Nathanson (LGH)
Dr. Arzu Chaudry (JGH)
Dr. Zachary Levine (RVH)
Dr. Devin Hopkins (JGH)
Dr. Katya Ghannoum (JGH)
Dr. Emmeline Ruka
Dr. Yao Victoria Xiao
Dr. Madeleine Yona
Dr. Joana Jiang
Dr. Akina Fay
Dr. Kamy Apkarian
Dr. Judith Martel
Dr. Stephanie Goudreau
Dr. Rob Primavesi
Dr. Raphael Hamad
Dr. Tamer Waly
Dr. Jason Freder
Dr. Paola Moresoli
McGill Enhanced Skills Program Director:
Dr. Robert Carlin
E-mail: robert.c.carlin [at] mcgill.ca
McGill Family Medicine Postgraduate and Enhanced Skills Coordinator:
Ms. Alana Walsh-Ferland 514-399-9126
E-mail: enhancedskills.fammed [at] mcgill.ca
Overall Educational Objectives
The McGill University C.F.P.C. (EM) Program is trained family physicians to take on a leadership role in rural, community or urban hospital Emergency Departments, and to be future teachers of Family Medicine residents in university-affiliated hospitals. This concurs with the official goals of the College of Family Physicians of Canada in Emergency Medicine which are:
The goals of the College of Family Physicians of Canada in emergency medicine (EM) are:
- To improve the standards and availability of emergency care from practicing family physicians.
- To establish guidelines for the development and administration of training programs in emergency medicine for family physicians.
- To ensure the availability of teachers for training programs in family medicine/emergency medicine.
McGill University and the Department of Family Medicine have played a leadership role in recognizing the need for establishing a third-year program for Family Physicians with increased interest in Emergency Medicine. The McGill University Family Medicine Department, along with Laval University, pioneered the third-year program for the Family Medicine - Emergency Medicine Competency Certificate Program in Quebec in 1986 and since then, the other faculties in Quebec have developed their own third-year program.
The educational objectives of the McGill University Family Medicine - Emergency Medicine Program are:
- To expand the knowledge, clinical, and research skills of the Family Physician in Emergency Medicine required during his/her future practice.
- To educate the physician in developing expertise in managing a broad spectrum of problems presenting in the emergency.
- To develop diagnostic and technical skills that will allow the physician to be a teacher and leader in the rural, community or urban Emergency Department.
- To educate the physician in assessing current Emergency Medicine literature and essentials of research in Emergency Medicine in order to assume leadership in continuing education in the rural, community or urban Emergency Department.
The Family Medicine Emergency Medicine Program Directors Committee has updated the program objectives as of January, 2014.
A list of priority topics in emergency medicine that residents are expected to master can be found here: CFPC Priority Topics in EM
Curriculum - Academic Activities
- Oral, Written and Interactive Sessions
- Teaching Schedule
- Core Teaching Rounds
- Hospital Rounds
- Critical Appraisal Topic
- Simulation Program
- Core Ultrasound Training
Oral Exams, Written Exams and Interactive Sessions
Oral, Written and Interactive Sessions are held on a monthly basis and are a compulsory part of the curriculum. The purpose of these sessions is three-fold:
- To encourage the resident to review and study a large body of information in a systematic manner.
- To prepare the resident for the written and oral components of the Certificate of Added Competence (CAC) exam.
- To monitor the resident's progress throughout the year.
These sessions take place on Wednesday mornings, corresponding to weeks 2 & 3 of the Period. They generally run from 8:30 am to 12:00 pm. The details of these sessions will be coordinated between the Chief Residents and the site director for that Period. Most of the time the Oral Exams will take place week 3. The Written Exam could be week 2 or 3.
These sessions are compulsory. In order to ensure and monitor progress through the year, residents will be evaluated during these sessions, both on exam performance as well as participation and preparedness during the sessions. There will be introductory sessions in July to review the basic approach to oral exams.
The textbook that serves as the basis for these sessions is the American College of Emergency Medicine Study Guide (Tintinalli), though other sources are also suggested (e.g. - ACLS / ATLS texts, Rosen, FOAMED sites, etc.).
At the beginning of the academic year, residents are given a schedule for these sessions. Prior to each session, it is the responsibility of each resident to review that topic, often using the above text as the main reference, with other references being used on an as needed basis.
Oral Examinations
The site director will coordinate the Oral Exam logistics based on room availability and number of staff and residents present. Each resident can expect to do at least two Oral Exams per Period. These exams are given by a staff physician and observed by several resident colleagues. Staff are informed of any format changes to the CAC exam and are expected to reflect this in how they administer their exam.
Following each Oral Exam, a debrief will take place between the staff physician, the examinee, and the other residents in the group. These sessions have been found to be quite valuable in preparing the residents for the CAC exam with respect to the format and approach. The opportunity to observe and critique other resident’s performance is also an important part of the learning process.
After each Oral Exam, the examinee must submit a request for evaluation (on one45) to the staff physician who administered their exam.
Written Exams
The site directors are strongly encouraged to prepare a SAMP-style Written Exam for each Period. The goal is to assess the resident’s knowledge and, more importantly, to prepare them for the CAC written component.
Please note that a majority of the Oral and Written Exams have to be passed. A failure of 50% or more will be equivalent to a borderline evaluation and trigger an extension of training.
Interactive Sessions
“Interactives” are 1-1.5 hour teaching sessions given by staff physicians. There may be 2-3 per Period, usually one after the other on the second Wednesday. The physician’s objective is to cover some parts of that Period’s topic in an engaging and interactive way. It is not expected that they “cover everything”. There is no formal evaluation component to Interactive Sessions but residents are expected to be prepared and participate.
Schedule: Orals/Written/Interactives 2024-2025
Week 2 - Interactive sessions / Written examination
Week 3 - Oral examinations
Period |
Dates |
Topics |
Examiners |
Tintinalli |
---|---|---|---|---|
1 |
July 1- July 28 |
Introduction |
JGH/SMH staff |
|
2 |
July 29 - Aug. 25 |
Cardiovascular & Pulmonary Emergencies |
SMH-ED staff |
Sections 7, 8 |
3 |
Aug. 26 - Sept. 22 |
Trauma / Shock / Resuscitation |
MGH-ED staff |
Sections 3, 4, 21 |
4 |
Sept. 23 - Oct. 20 |
Endocrinologic, Heme, Oncological Emergencies |
RVH-ED staff |
Sections 17, 18 & Sections ch. 19-21 |
5 |
Oct. 21 - Nov. 17 |
Analgesia/Wound care/ MSK/Orthopedic Emergencies |
JGH-ED staff |
Sections 5, 6, 22, 23 |
6 |
Nov. 18 - Dec. 15 |
Toxicologic Emergencies |
RVH-ED staff |
Sections 15 |
7 |
Dec. 16 - Jan. 12 |
Opth-Ent/ Derm/ Interactive Only |
SMH-ED staff |
Sections 19, 20 |
8 |
Jan. 13 - Feb. 9 |
Environmental Emergencies |
JGH-ED staff |
Sections 16 |
9 |
Feb. 10 - Mar. 9 |
Pediatrics |
Lakeshore ED staff |
Sections 12 |
10 |
Mar.10 - Apr. 6 |
Obstet – Gyneco / Urological / |
JGH-ED staff |
Sections 10,11 |
11 |
Apr. 7 - May 4 |
Infectious Emergencies/ |
SMH-ED staff |
Sections 9, 13 |
12 |
May 5 – June 1 |
Neurological Behavioural Emergencies |
SMH-ED staff |
Sections 14, 24, 25 |
13 |
June 2 – June 30 |
Final Orals |
Program Staff |
|
Academic Half-Days (AHD)
On weeks 1 and 4 residents attend Academic Half-Day with the FRCP-EM residents. Topics include new advances in Emergency Medicine, review of controversial topics, Procedure practice (i.e Airway Day), POCUS, and Wellness amongst others. FRCP residents also prepare Journal Club as part of AHDs. CCFP-EM residents will present their CAT projects during these rounds. AHD Rounds are held mainly on Zoom, with some sessions now being held live at our teaching sites. Participation and attendance by all residents is MANDATORY.
These AHDs are a wonderful opportunity to hear from internationally recognized figures in Emergency Medicine, review important topics, and socialize with our FRCP colleagues. Furthermore, socially relevant topics such as EDI in Emergency Medicine, Indigenous Health Issues, Physician Stress and Burnout are now being covered more deliberately.
Hospital Rounds
Daily Teaching - St. Mary’s /Jewish General/Montreal General/Royal Vic/Montreal Children’s
Colloquially referred to as “3 o’clock teaching”, these small group sessions covering core topics in Emergency Medicine are held daily throughout most of our Emergency Medicine rotations. Residents may be responsible for leading one of these sessions per rotation. Learners range from medical students to staff physicians.
Residents only attend sessions at the site they are presently working. In other words, a resident rotating at St. Mary’s is only expected to attend rounds at St. Mary’s.
Attendance at these rounds is mandatory for residents working that day/evening. Residents not working that day/evening are excused. Finally, as of Period 9, residents finishing a day shift have the option to attend teaching or stay in the ED to finish their shift.
Critical Appraisal Topic (CAT) Project
Each resident is expected to research and present a CAT project. This project’s purpose is to practice answering a clinically-relevant question using a focused review of the existing literature. This is an exercise in Evidence-Based Medicine where the purpose is efficient, practical and clinically relevant utilization of the medical literature. It is also designed to foster the skills needed for self-directed, life-long learning.
It entails first formulating a good clinical query that is relevant to Emergency Medicine. Residents are encouraged to use a question that comes up during a shift or their readings. It should be in “PICO” format. Once the question is clearly delineated, they are expected to use the various EBM resources available to answer it.
Each resident must prepare one CAT project and present it at AHD rounds. The presentation schedule will be determined at the beginning of the year.
Here are some resources for understanding CAT projects, PICO questions and general EBM information:
- A “CAT maker” from Oxford: https://www.cebm.ox.ac.uk/resources/ebm-tools/catmaker-and-ebm-calculators
- User’s Guide to the Medical Literature – JAMA evidence: https://jamaevidence.mhmedical.com/book.aspx?bookid=847
- Centre for Evidence-Based Medicine – Oxford:
- University of Alberta CAT Walk: https://guides.library.ualberta.ca/catwalk
Resources for searching the medical literature abound. An excellent site that has links to all the usual suspects and more is the McGill Emergency Medicine webpage. You are strongly encouraged to visit this site: www.mcgill.ca/emergency/portal/links/
As an aside, the landscape of medical education is changing with the omnipresence of social media. Twitter is fast becoming a forum for teaching and sharing of ideas and current evidence, especially in Emergency Medicine. Go ahead and “follow” us @mcgillccfpem.
Goals & Objectives
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.
Simulation Program
McGill CCFP(EM) Simulation Program
The CCFP-EM Simulation Program allows replication of challenging clinical scenarios and provides rich opportunities to teach with action and reflection. Our simulation-based education curriculum is an excellent adjunct to real patient encounters where clinical and communication skills can be enhanced through experiential learning.
The simulation program uses resources available at the McGill Steinberg Centre for Simulation and Interactive Learning (SCSIL), as well those at the JGH Emergency Medicine Simulation Centre. Established in 2006, McGill’s SCSIL is an interprofessional centre of excellence that uses the latest medical simulation technologies to enhance the skills of health care professionals. The JGH EM Simulation hosts state-of-the-art equipment with a life-like mannequin and a cardiac monitor which displays vital signs as well as EKG’s and X-ray images, with Point-of-Care Ultrasound (PoCUS) videos incorporated into all scenarios.
The CCFP-EM Simulation Program coordinators are Dr. Marc Richard Albert and Dr. Errol Stern.
Under the guidance of Dr. Albert, CCFP-EM residents will have training at the McGill’s SCSIL with realistic high-fidelity resuscitation scenarios covering a wide breath of Emergency Medicine topics. Residents learn Crisis Resource Management (CRM) principles while leading the resuscitation team and participating as a team with effective communication. Residents will have an opportunity to directly observe their colleagues. Debriefing covers both the communication and medical aspects of the scenario / resuscitation. Feedback has been excellent with residents appreciating the opportunity to enhance their communication and clinical skill sets.
Approximately 4-6 times per academic year, CCFP-EM residents will join Simulation workshops coordinated by the FRCP-EM Program. In 2020, the simulation teaching program, Preparing Emergency Medicine Residents for Obstetrical Emergencies, was recognized by McGill’s “Proud to Teach” campaign.
The Jewish General Hospital Emergency Medicine (EM) Simulation Program, under the leadership of Dr. Stern, fosters an academic milieu with six dedicated emergency physician simulation educators as well as an ED clinical nurse specialist (Drs. Kamy Apkarian, Haran Balendra, David Benyayer, Julia Bernard, Errol Stern, Madelaine Yona and Melanie Sheridan (RN).
The JGH Sim Centre’s studio-quality audio & video feeds of the sessions is capable of broadcasting few participant-learners to many observer-learners in an adjacent conference room on a large screen monitor, and most recently during the pandemic, broadcasting to remote Zoom observers at home. Feedback from all participants is submitted using a simulation-specific forms. The data collated in an anonymous fashion helps to continuously improve the Program.
The simulation scenarios incorporate clinical and ethical issues which foster scholarship, leadership, communication skills and the other dimensions of the CanMEDS framework of medical expert.
CanMEDS Objectives
Scholar
Residents develop a lifelong commitment to excellence in practice through continuous learning, evaluating evidence and teaching others. The CCFP-EM Sim Program at the JGH is unique in that residents are assisted by staff to develop their own simulation scenarios based upon real patients they have cared for. The program includes topics of rare medical conditions, or those which require timely and coordinated care of common emergent conditions. As teachers, they facilitate in the debriefing, thus contributing to the education of their colleagues and co-workers. Teaching extends to EM nurses by the opportunity to assist with nursing resuscitation simulation courses and facilitating in-situ ED simulation sessions.
Collaborator
Residents work collaboratively with other health care professionals in simulation sessions to provide safe, high-quality, patient-centered care. Scenarios developed by facilitator-learner are implemented with multidisciplinary participation of nurses and / or respiratory therapists (RT’s), and on occasion with other medical specialists. All quickly appreciate that healthcare is a team endeavor.
Communicator
Residents practice patient-centered communication by exploring the patient’s symptoms with active listening to the description of his or her illness. Topics such as discussing level of care, breaking bad news and issues of diversity are incorporated into sim scenarios. Communication skills are heightened while caring for a simulated patient / actor or a life-like manikin who engages the participants with conversation, breathing and blinking. To maintain fidelity, a confederate nurse and / or respiratory therapists assists in the delivery of care. Together, they explore the patient’s perspective about his / her illness and their expectations. Closed loop communication and crisis resource management (CRM) is key to the management of all cases. Staff and resident facilitators, confederates and participants explore communication and medical aspects of simulation scenarios during the debriefing process.
Leader
Resident team “leaders” are encouraged to share their mental model with the other members of the healthcare team (physicians, nurses +/- RT’s), while team members / “followers” actively deliver high-quality health care and give suggestions to the team leaders for consideration. The cooperative principles of valuable leadership and effective followership are essential to team management.
Health Advocate
As health advocates, residents contribute their expertise and influence. During debriefing, facilitator-learner follow advocacy & inquiry principle by exploring and appreciating the teams’ frames of mind which led to their actions, while advocating for best practice. Process and system issues are explored during simulations; residents learn to appreciate that they can influence and mobilize resources to effect change in simulation and the real world.
Professional
Residents are committed to the health and well-being of individual patients through ethical practice and high personal standards of behavior. In all simulation activities, the “learning contract”, that the learners are professional, intelligent, motivated, care about doing their best and want to improve, is reiterated. Maintaining a safe learning environment in simulation sessions is of the highest priority!
In addition to an innovative teaching program, there are also Research and Emergency Medicine simulation fellowship opportunities. Please direct enquiries to errol.stern [at] mcgill.ca (Dr. Errol Stern).
Core Ultrasound Training
McGill CCFP (EM) Emergency Ultrasound Program
The core ultrasound training consists of an introductory course at the beginning of the year, further teaching sessions on more advanced topics throughout the year, and, as of 2017, an Ultrasound/Emergency Medicine rotation at the Jewish General Hospital. During the course of this rotation residents will have the opportunity to complete the ultrasound scans needed to become eligible to take the examination to become IP (Independent Practitioner) certified. Once eligible they will be given the opportunity to take the examination.
The residents practice point-of-care ultrasound (POCUS) throughout the year at all of the McGill Emergency Medicine teaching sites during their emergency medicine rotations. A popular ultrasound elective may also be offered for those with a special interest or who want extra training in the modality.
Residents benefit from exposure to a POCUS culture at McGill that is truly second to none! There are respected POCUS leaders teaching at all of our sites. Many of our graduates have gone on to POCUS fellowships before starting their careers as true experts in the field.
Curriculum - Clinical Rotations
- Overview
- Family Medicine Clinics
- Adult Community Emergency Medicine
- Adult Tertiary Emergency Medicine
- Emergency Ultrasound
- Pediatric Emergency Medicine
- Adult Community Intensive Care
- Adult Tertiary Intensive Care
- Trauma
- Toxicology
- Administration & Core EM
- Musculoskeletal
- Anesthesia
- Elective
Overview
Core Rotation | Periods |
---|---|
Family Medicine Clinics (Optional) |
Longitudinal |
Adult Community Emergency Medicine |
2 |
Adult Tertiary Emergency Medicine |
1 |
Emergency Ultrasound Rotation |
1 |
Pediatric Emergency Medicine |
2 |
Adult Community Intensive Care |
1 |
Adult Tertiary Intensive Care |
1 |
Emergency Medicine & Trauma |
1 |
Emergency Medicine & Toxicology |
1 |
Administration and Core EM Topics |
1 |
Musculoskeletal (MSK) |
0.5 |
Anaesthesia |
0.5 |
Elective (must be approved by the program director) |
1 |
Family Medicine Clinics
Congruent with its mandate to produce Family doctors with enhanced skills in Emergency Medicine, the McGill University CCFP-EM program allows its residents to maintain a regular part-time family medicine practice during their training year. The program tries to facilitate residents’ maintenance of a continuity clinic by informing the rotations of this protected time and requesting that rotations take into account this extra commitment when making their respective schedule.
Residents who may be interested in pursuing this are encouraged to communicate with the Program Director and Administrator well before the start of the Academic year in order to set up an appropriate schedule.
Adult Community Emergency Medicine - St. Mary's Hospital
Introduction
St. Mary's Hospital is a 440-bed acute care McGill University community teaching Hospital which provides training in Emergency Medicine to Family Medicine and third-year Family / Emergency Medicine residents. About thirty-seven thousand patient visits are made to the Emergency Department annually; of these approximately 13,000 are stretcher cases, consistent with a high acuity level. Over 50% of all hospital admissions are through the Emergency Department. All consult services are available on site with the exception of Neurosurgery. Staffing for the Department consists largely of C.C.F.P. and C.C.F.P. (E.M.) certificants and several F.R.C.P. certificants.
General Description
The purpose of the training program for third year residents at St. Mary's Hospital is to provide teaching and exposure to commonly encountered adult medical problems in a community hospital Emergency Department. Learning is accomplished through a combination of didactic early morning teaching sessions given by attending staff and resident colleagues and discussions around diagnosis and management of individual cases, as well as, reading of the emergency medical literature. The R-3 will, upon completion of his/her training, be able to investigate adequately and treat all acute and non-acute patient medical problems presenting to the Emergency Department.
The R-3 will learn to categorize patients into one of three groups; admission, D/C home with appropriate follow up and instructions or short-term / focused observation in the Emergency Department. Consults and investigations will be requested only if they are necessary for diagnosis or treatment. As part of the third year of training, the R-3 will gain exposure to skills necessary to manage flow in the Emergency Department. He/she will be given the opportunity to manage his/her own patients, review cases with more junior residents and decide on patient disposition (home, admission, observation) based on hospital and consultant resources and demands made on her/him by community based ambulatory services.
In conclusion, while rotating through the Emergency Department at St. Mary’s, the R-3 will learn principles of care for all adult patients presenting in the Emergency Department. He/she will be able to examine, investigate, diagnose and consult appropriately and determine patient disposition early in the course of treatment. He/she will be given the opportunity to teach junior residents and organize the flow in the Emergency Department. Upon completion of the Family-Emergency Residency training, the candidate will have all the skills and knowledge necessary to successfully complete the C.F.P.C.(EM) examination. He/she will be capable of efficiently managing a community hospital Emergency Department and have the knowledge necessary to aid in organization of hospital and pre-hospital emergency medical services.
Rotation-Specific Learning Objectives
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
Adult Tertiary Emergency Medicine - Jewish General Hospital
Introduction
The Jewish General Hospital is a 637-bed McGill University tertiary care centre strongly committed to research, academia, and medical education. This includes training both CCFP EM and FRCP residents. The Emergency Department (ED) has been recognized as a "Department of Excellence" by the hospital having received full support for research and academic growth.
The ED receives approximately 85,000 visits per year. It is now the busiest adult ED in the province and one of the busiest in the country. These visits include a high percentage of elderly patients, in addition to a wide range of ethnic backgrounds representative of the surrounding Cote-des-Neiges area. The hospital is also a referral center for many sub-specialties, notably cardiac surgery, neuro/neurosurgery, and oncology amongst others.
The recently renovated ED is 80,000 square feet with a capacity of 53 beds. It boasts a dedicated CT scanner, as well as private stretcher areas with a negative pressure system to prevent and contain the spread of infection. Our innovative ED has implemented a rapid assessment zone (RAZ) to provide expedited assessment, diagnosis, and discharge of moderately ill patients. This, and many other, innovations result in improved patient flow and shorter length of stay in the ER.
The ED is staffed by 48 physicians, many of whom are CCFP (EM) trained. The others are CCFP, ABEM, FRCPC or CSPQ in Emergency Medicine. In addition to their clinical roles, all physicians are involved in extra-clinical activities - research, medico-administrative, academic/ teaching. As an example, CCFP EM residents benefit from multiple SIM sessions organized and run at the new high-fidelity SIM Centre at the JGH ED. This commitment to all facets of Emergency Medicine makes the JGH ED a unique and exciting place for resident training.
The Canadian College of Family Physicians (CCFP) has described, in its Outcomes of Training document, what a graduate with a Certificate of Added Competence (CAC) in Emergency Medicine should be able to provide. Graduating residents should be prepared (competent, confident and adaptive) to meet the criteria of all 7 EM Core Professional Activities (CPA). This includes providing advanced level care for adult patients presenting to the ED while contributing to the management of the depatment.
General Description
As a high-volume adult tertiary care hospital, with the highest percentage and number of seriously ill patients in the province, and as a research and academic oriented ED, the JGH offers residents an intense academic Emergency Medicine experience.
Throughout their 1-month rotation, the resident will demonstrate the ability to recognize acute illnesses and injuries and be able to gather appropriate data, develop a differential diagnosis and suggest management plans including treatment and disposition. (EM CPA 1, 6)
The resident will be working in a high-volume ED where they will learn how to improve efficiency. Furthermore, there are flow supervisor shifts during which the resident will be exposed to flow management in the ED and the hospital. (EM CPA 2, 3)
The JGH ED is also one of the most advanced POCUS centres in Quebec. All ED staff are IP-certified, and several staff have extensive advanced POCUS skills. With many available ultrasound machines and a highly experienced team, the resident will have ample opportunity to improve their scanning skills. (EM CPA 1, 4, 5, 6)
There are informal teaching opportunities at every shift such as bedside teaching/case discussions. There are also didactic teaching sessions at 3:00PM every weekday. These have been on hold since the COVID pandemic, but are expected to resume in the near future. (EM CPA 1, 7)
CCFP (EM) residents are encouraged to review cases with junior learners and contribute to the management of the ED, especially in the later months of the year. The JGH ED has a friendly and collaborative environment where residents get to practice the critical skills required to work with a team of allied health professionals. Residents will have ample opportunity to practice Crisis Resource Management (CRM) in many resus/code scenarios. (EM CPA 3, 4, 5, 7)
By the end of the rotation, residents are expected to have an improved understanding of basic sciences and pathophysiology as they apply to the ED. They should be more comfortable providing expert EM care in an efficient manner. (EM CPA 1 and 2)
Rotation-Specific Learning Objectives
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
McGill CCFP(EM) Emergency Ultrasound Rotation
The core ultrasound training consists of an introductory course at the beginning of the year, further teaching sessions on more advanced topics throughout the year, and, as of 2017, an ultrasound/emergency medicine rotation at the Jewish General Hospital. During the course of this rotation residents will have the opportunity to complete the ultrasound scans needed to become eligible to take the examination to become IP (Independent Practitioner) certified in point of care ultrasound. Once eligible they will be given the opportunity to take the examination.
The residents practice point-of-care ultrasound throughout the year at all of the McGill emergency medicine teaching sites during their emergency medicine rotations. A popular ultrasound elective may also be offered for those with a special interest or who want extra training in the modality.
Rotation-Specific Learning Objectives
Medical Expert
- Understand the knobology of the ultrasound machine
- Demonstrate understanding and proficiency with the use of various probe types
- Demonstrate proper ultrasound technique including probe manipulation and image optimization
- 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
- 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
- Understand the importance of rejecting indeterminate scans
- To be able to apply emergency ultrasound findings in clinical management of emergency patients
- Understand the limitations of emergency ultrasound
Role of Communicator
- Converse effectively and sensitively with patients and their families
- Ensure patients understand the differences between emergency ultrasound and radiology-performed scans
- Communicate and document ultrasound findings appropriately
- Demonstrates effective communication skills when teaching ultrasound skills to others
Role of Collaborator
- Work effectively as part of a health care team
- Understands how emergency ultrasound contributes to the overall care of the patient
- Develops understanding of how other specialties incorporate bedside ultrasound into their practice
Role of Leader
- Demonstrates proper documentation of ultrasound scans
- Manages time efficiently
- Demonstrates proper care of the ultrasound equipment
- Understands the background of emergency ultrasound and the role that it has played in changing the bedside diagnostic environment
- Understands the medico-legal implications of emergency ultrasound in patient care and in physician
certification process
Role of Health Advocate
- Acts as an advocate for individual patients in the emergency department
- Understands the importance of access to emergency ultrasound devices for all resuscitation and acute care areas of the emergency department
- Understands the importance of training all acute care physicians in the use of point-of-care ultrasound to improve patient care
- Advocates for increased point-of-care ultrasound resources for the emergency department, hospital, and university
Role of Scholar
- Critically evaluate the literature as it pertains to emergency ultrasound
- Stays up-to-date on new evidence as it pertains to point-of-care ultrasound
- Understand the evidence supporting the commonly performed emergency ultrasound scans
- Understand the limitations of emergency ultrasound literature and the need for further high-quality research in this area
Role of Professional
- Be sensitive to any discomfort caused by ultrasound scans, especially when performing training scans or when scanning volunteers
- Adhere to the code of ethics of the CMA and the institution
- Treat patients and colleagues with respect
- Self-evaluate, including insight into strengths and weaknesses
- Demonstrate commitment to lifelong learning
- Be responsible, reliable, punctual, and accountable for one’s actions
Pediatric Emergency Medicine - Montreal Children's Hospital
Introduction
The Canadian College of Family Physicians (CCFP) has described, in its Outcomes of Training document, what a graduate with a Certificate of Added Competence (CAC) in Emergency Medicine should be able to provide. Graduating residents should be prepared (competent, confident and adaptive) to meet the criteria of all 7 EM Core Professional Activities (CPA). This includes, of course, providing advanced level care and consultation for all pediatric patients presenting to the ED.
General Description
The McGill CCFP (EM) Residency Training Program includes a mandatory 2 period rotation in the Pediatric Emergency Medicine department of the Montreal Children's Hospital, part of the McGill University Health Center.
In addition residents are encouraged to participate in one of the Pediatric Advanced Life Support courses run by the MCH three to four times per year. This is usually accomplished in their Admin Month. (EM CPA 1, 6, 7)
The Montreal Children's Hospital was founded in 1904 and was Quebec ‘s first dedicated pediatric hospital. It is a tertiary care pediatric teaching hospital and is the only pediatric facility serving the McGill Réseau universitaire intégré santé (RUIS).
On May 24th 2015, the MCH inaugurated its new facilities at the MUHC Glen Site situated at 1001 Decarie Boulevard. It is a state of the art institution comprising 154 single-patient rooms, a 28-bed pediatric intensive care unit, 52-bed neonatology unit, 6 operating rooms and 6 intervention rooms. The emergency department includes 6 crashrooms, an 18-bed observation unit, as well as distinct procedure and cast rooms.
It is one of the busiest pediatric emergency departments in North America, accommodating on average eighty thousand visits per year. In addition to representation from all subspecialty services, the MCH boast both neonatal and pediatric critical interhospital transport teams. Coverage of the transport team is provided by staff from the PICU and PED. (EM CPA 1, 2)
The Emergency Department of the MCH has a longstanding tradition of strong commitment to the teaching of students and residents. There are 24 full-time attending staff working in the Emergency Department, all with faculty positions and varying fields of interest including simulation, Advanced ultrasound use in the ED, International Health, EDI, Disaster planning, Transport Medicine, Medical Informatics, and research, to name a few. This richness of talent provides residents with many opportunities to learn from role models with various areas of expertise. (EM CPA 7)
Educational exposure at the emergency department of the MCH includes extensive patient exposure divided into three patient categories : ambulatory, urgent and high care which includes immediate resuscitation care and trauma. (EM CPA 1)
Over the course of their rotations, FM-ER residents will receive increasing exposure and primary responsibility for care of patients in critical areas of the department and during overnight shifts, in preparation for independent practice. (EM CPA 1 and 2)
Procedural exposure in the ED includes acute airway management, lumbar puncture, POCUS, wound management including foreign body removal, trauma stabilization, management of the acute distressed and agitated mental health patient, procedural sedation and fracture reduction and stabilization. (EM CPA 1)
In addition, weekly mid-fidelity resuscitation simulation rounds are held in the crashroom with an optic to integrate members of the nursing team for a more multi-disciplinary exposure. Wherever possible a nurse educator is part of the debriefing discussions. QR codes are provided at the end of each session for trainees to provide feedback and document attendance. (EM CPA 1, 3, 4, 5, 7)
As part of their scholarly roles, FM-ER residents will be asked to do the following :
- Ahead of their second rotation, FM-ER residents will be asked to prepare one case scenario with the assistance of a PEM fellow or staff, and oversee the simulation at the end of their rotation. (EM CPA 4, 5, 6)
- Residents will be preferentially paired with medical students and junior trainees during the course of their second rotation and encouraged by the attending staff to take on a teaching role. (EM CPA 3, 5, 6, 7)
As part of the leader and manager role, in preparation for independent practice, when reviewing and discussing cases with staff, trainees will be asked to consider how the approach and management of the cases they are being exposed to in our tertiary setting might differ if it presented in a regional center with special consideration for the preparation of the acutely ill patient for transfer and transport. (EM CPA 2, 3, 6)
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
Adult Community Intensive Care - St. Mary's Hospital
Introduction
C.F.P.C. (EM) Residents spend a total of 2 months in an adult ICU setting - one at St. Mary's Hospital Center (a 7-bed ICU, 7-bed step down care Unit, and, a 5-bed Coronary Monitoring Unit).
The objectives set out for these two months coincide with the overall objectives of the C.F.P.C.(EM) Program. Residents will become more proficient in caring for critically ill patients and all facets of their care - an experience readily pertinent to the Emergency Physician. More specifically, residents will gain knowledge in the use of important pharmacologic agents during both the resuscitative and post-resuscitative phases. This will enable residents an opportunity to monitor responses to such agents over relatively long periods of time - an experience often not possible in the Emergency Department due to time constraints. In addition, residents will become more adept in certain procedures e.g. intubations, peripheral arterial line insertions, and central line insertions. Lastly, because the C.F.P.C. (EM) Residents are the most senior amongst the ICU house staff at St. Mary's Hospital Center, they take on more responsibility, both in the ICU as well as responding to calls within the Hospital and Emergency Department.
Staffing
The staffing of the ICU differs somewhat from the traditional approach. Two levels of staffing operate the ICU:
- A Family Physician with special interest in intensive care, and
2. An attending intensivist acting primarily as senior consultant in the ICU.
The involvement of the Family Medicine Department is in keeping with the prominent role overall of the daily operations of this adult community based hospital.
There is always one intensivist responsible for the ICU patients per week (out of a pool of approximately nine). These Physicians also round at other tertiary ICU facilities in the McGill system. There is always an intensivist on 1st or 2nd call. He/she shares the 1st call with the F.P. Staff.
Residents benefit by having two "staff" physicians rounding weekly and overall during a month being exposed to eight staff physicians and eight different styles of practice.
Teaching
Rounds are based on this "two tier" system:
- Work Rounds 08:00 - 09:30: The Family Physician leads house staff in making appropriate decisions regarding patient care e.g. tests needed during day, etc...
- Bedside Rounds 09:30 - 12:00 noon: Led by the intensivist on a daily basis who incorporates a didactic approach to overall patient management.
- Didactic Teaching Rounds afternoons (3 times per week): Given by either an attending staff physician or house staff presenting various topics of pertinence.
- Morbidity and Mortality Rounds once per month: Include involvement of other groups in the Hospital e.g. Emergency Physicians, Internists, Cardiologists, Pathologists and Surgeons.
During their month rotation, C.F.P.C.(EM) Residents are also supervised and guided during procedures. C.F.P.C. (EM) Residents, on average, do approximately 4 arterial lines, 2 intubations, and 2 central line insertions per week.
Call
C.F.P.C. (EM) Residents are on call usually one in four and are responsible for the care of the ICU patients; step down care Unit (i.e. Intermediate Unit or IU) and Coronary Monitoring Unit in addition to responding to consults in the Emergency Department of all potential ICU or CMU candidates. They are expected to be involved early during resuscitative manoeuvres in the Emergency Department. Because the C.F.P.C.(EM) Residents are most senior, they are encouraged to assess themselves in decision - making, especially while on call. However, they are given ample opportunity to confer with or receive assistance from 1st or 2nd call Attending Staff (or both). This differs from the rotation in the adult tertiary care centre ICU where the residents are not necessarily the most senior house staff and often are given less autonomy.
Adult Community Intensive Care - Lakeshore General Hospital
Introduction
The LGH ICU is a 15-bed community, mixed ICU. We manage medical and surgical and obstetrical adult patients who are critically ill. Patients are referred from the Emergency Ward, the Operating Room, or a hospital ward. Daily rounds are conducted on all patients by one or two intensivists, who are on-call from home during the evening and night. In general nurse to patient ratios are 1:1-1:3, depending on the severity of illness. One or two respiratory therapists are present on the unit at all times. The ICU benefits from the support of a clinical nutritionist and a hospital pharmacist (as-needed).
Many different types of support are available to our patients, including:
- Ventilatory: High-flow nasal cannula, Non-invasive ventilation, Mechanical ventilation
- Nutrition: Enteral & parenteral
- Cardiovascular: Vasocative & Inotropic infusions
- Renal: Intermittent hemodialysis
- Medical & Surgical specialists (exceptions: dermatology, immunology, vascular surgery, cardio-thoracic surgery, neurosurgery, transplantation, interventional cardiology)
- There is a limited amount of interventional radiology capacity
Our sister ICUs within the CIUSSS-ODIM are at St. Mary’s and Lasalle hospitals. Corridors of service for more specialized care exist with the MUHC and Jewish General Hospital.
Expectations:
For three weeks, residents are expected to be ready for AM rounds at 8:30, or as agreed upon with the staff physician. The other week will consist of evening shifts from approximately 3:00-23:00. The resident can expect to be on call for two weekend days. A short presentation, usually in week 3 or 4, will be given to the treating team. Attendance at M and M rounds is expected.
Rotation-Specific Learning Objectives
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
Adult Tertiary Intensive Care
Jewish General Hospital / Montreal General Hospital / Royal Victoria Hospital
Introduction
ICU rotations offer the resident the opportunity to manage critically ill patients with various problems of the type they would encounter in the Emergency Department setting. As the ICU experience allows residents to follow these patients for a longer period of time, a greater understanding of pathophysiology and prognosis can be gleaned which will ultimately aid the resident in his future decisions and therapies initiated in the Emergency Department. A number of useful skills and procedures, which have Emergency Department applications, are also learned.
The three sites available for tertiary care ICU are the Jewish General Hospital, a high volume multi-ethnic centre, the Royal Victoria Hospital, a transplant and cardiac surgery centre, and the Montreal General Hospital, a trauma centre. Each offers the resident a unique experience in managing acutely ill patients under the tutelage of intensive care specialists.
Rotation-Specific Learning Objectives
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
Emergency Medicine & Trauma - Montreal General Hospital
The Montreal General Hospital is a 323 bed acute care McGill University tertiary care teaching hospital. The ED sees 37640 patients per year. The MGH is mandated as a Level 1 Trauma Center that sees 1500 trauma cases per year.
The Department is staffed by 38 dedicated emergency physicians. The physicians are either C.C.F.P., C.C.F.P. (EM), FRCPC or CSPQ certified in Emergency Medicine. In addition to their clinical roles, all physicians are involved in extra-clinical activities - research, medico-administrative, and/or academic/ teaching.
In their R3 CCFP-EM training year, residents spend one period (4 weeks) rotating in the MGH ER. During the rotation, residents are assigned shifts exclusively in the Monitored Care Area (MCA). As such they are the first to have contact with the sickest patients and all significant trauma cases. With respect to traumas, the role of the R3 is to quickly assess, diagnose and manage all severity of traumas coming through our doors. Backup is provided by the staff physician assigned to the MCA, as well as through our dedicated Trauma Team and Trauma Team Leader.
The R3 will likely have opportunities to perform procedures during this rotation including intubation, central line insertion, fracture and dislocation reduction and immobilization, perform procedural sedation, as well as other techniques, such as thoracostomy. On top of the ABC's of trauma care, the R3 will be expected to learn to request appropriate imaging, manage an intubated patient, use sedatives/hypnotics/paralytics safely, care for injuries, decide on appropriate consultation, and generally manage the trauma patient from admission to disposition. They must be able to handle multiple sick patients simultaneously, as well as to liaise and coordinate with multiple consultants working on the same patient. This is on top of the R3's responsibilities in managing the rest of the medical and surgical patients in the MCA.
Rotation-Specific Learning Objectives
Medical Expert
Basic Scientific Knowledge
- 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
- Compare blunt and penetrating mechanisms of injury, further differentiating gunshot wounds and stab wounds.
- 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
- Knowledge of the principles of fluid therapy in a multiply injured patient.
- Learn a systems approach to trauma management at local and provincial levels.
- Learn the principles of pre-hospital trauma care
Basic Clinical Knowledge:
- 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
- Describe special considerations in the evaluation and management of the pregnant, Pediatric and geriatric trauma patient.
- Demonstrate the principles of trauma resuscitation, stabilization, and disposition.
- Describe principles of burn management.
- Describe principles of inhalation injuries.
- 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.
- 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
- Competently complete a clinical assessment of a trauma patient in an organized and timely fashion.
- Demonstrate knowledge of common signs of major traumatic injuries.
- Demonstrate knowledge of the Glasgow Coma Scale.
Interpretation and Utilization of Information
- 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.).
- Compare / contrast the use of diagnostic peritoneal lavage, ultrasound and CT scan in the evaluation of abdominal trauma.
- Come / contrast the use of CT scanning, echocardiography and angiography for thoractic aortic injuries.
Clinical Judgement & Decision Making
- Identify indications for immediate laparotomy and thoracotomy.
- Set the priorities, and initiate the required resuscitation, stabilization, investigation and disposition of the traumatized patient.
- Identify the needs for consultations/admission/transfer of such patients presenting to the Emergency Department.
- 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
- 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
- Perform the required manipulative/procedural skills.
- 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
- Communicate effectively with the multi-disciplinary team.
Communications with Patients
- Demonstrate skill and behaviour towards alleviating patient anxiety, appropriate for patient age and gender.
- Demonstrate ability to discuss the patient’s care and counsel regarding risk modification with the patient and family.
- Show skill in explaining risks, benefits and obtaining consent for relevant procedures and surgeries.
Communications with Families
- Demonstrate ability to discuss and explain to families “bad news” in a sensitive, concise and understandable manner.
- Demonstrate ability to discuss living wills, advanced directives and do not resuscitate orders.
Written Communication and Documentation
- 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
- The resident will recognize the role of each health care team member with respect to the patient’s care.
- Demonstrate ability to resolve common team conflict problems.
- Demonstrate ability to work in a multi-disciplinary team, work as part of a trauma team.
- Consults appropriate services for the definitive care of the patient.
Delegates Effectively
- Demonstrates ability to delegate various parts of the evaluation and procedures during trauma resuscitation.
Role of Leader
Uses Health Care Resources Cost-Effectively
- Recognize resources of tertiary care trauma centres and the use and rationalization of these for the individual patient and the population served.
- Demonstrate knowledge of trauma systems and the function it serves to the hospital and the region.
- Comprehend the rationale, organization and resources required to create trauma centers and systems.
Organization of Work & Time Management
- Ability to establish priorities in a single complex trauma patient under stressful conditions.
- Be capable of managing multiple ill patients concurrently.
Role of Health Advocate
Advocates for the Patient
- Be capable of discussing with patients risk and harm reduction strategies.
- Be the patient’s advocate at all times, particularly when they are unable to do so themselves.
Advocates for the Community
- Learn principles of disaster management.
- Be able to discuss and promote injury prevention.
- Be aware of organ procurement procedures.
Role of Scholar
Motivation to Read and Learn
- Be consistent in reading around clinical cases and improving trauma knowledge base.
Critically Appraises Medical Literature
- Demonstrate knowledge and applicability of landmark (specialty relevant) studies in trauma care.
Teaching Skills
- 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.
Emergency Medicine & Toxicology - Royal Victoria Hospital
Introduction
The Toxicology rotation for CCFP EM residents is a 4-week experience that provides residents with the knowledge and tools to expertly manage poisoned patients in rural, community, and urban emergency departments. The core of the rotation consists of 12 tailored small group sessions bookended by pre-reading and post-session assignments. Sessions are led by Dr. Martin Laliberté and Dr. Josh Wang who are both consultant toxicologists at the centre antipoison du Québec and full-time emergency physicians. The clinical component consists of Emergency Department shifts at the Royal Victoria Hospital. By the end of this rotation, residents should demonstrate proficiency in the diagnosis and management of common toxicologic conditions, rare but consequential poisonings, and the undifferentiated poisoned patient in the emergency context.
Educational Objectives
- Recognition and Assessment (CPA 1):
- Develop the ability to recognize signs and symptoms of common toxicological exposures.
- Learn appropriate history-taking techniques to assess potential toxic exposures.
- Demonstrate proficiency in conducting thorough physical examinations, including toxicological screening tests.
- Diagnostic Skills (CPA 1):
- Understand the principles of toxicology testing and interpretation.
- Gain knowledge of the diagnostic approach to different classes of toxins, including pharmaceuticals, chemicals, and environmental toxins.
- Interpret laboratory results and diagnostic imaging findings in the context of toxicological emergencies.
- Management Strategies (CPA 1):
- Develop treatment plans for patients with toxic exposures based on a sound understanding of toxicokinetics and pharmacodynamics.
- Understand the indications and contraindications for specific antidotes and adjunctive therapies.
- Learn strategies for decontamination, including activated charcoal, whole bowel irrigation, and gastric lavage.
- Toxicological Emergencies (CPA 1, 2):
- Gain exposure to a wide range of toxicological emergencies, including drug overdoses, poisonings, environmental exposures, and occupational hazards.
- Develop skills in managing specific toxicological emergencies, such as opioid overdoses, carbon monoxide poisoning, and pesticide exposures.
- Multidisciplinary Collaboration (CPA 2, 3, 4, 5, 6, and 7):
- Learn to collaborate effectively with toxicologists, pharmacists, poison control centers, and other healthcare professionals in managing toxicological emergencies.
- Understand the role of toxicology experts and services in individual patient care.
- Understand the role of toxicology experts as a resource to the community (remote health, transfers, etc).
- Recognize that expertise in this field is required to effectively advocate for certain disadvantaged patient groups.
Rotation Structure
The rotation will span 4 weeks and consist of:
- Clinical Responsibilities (CPA 1, 2, 3, 4 and 6):
- 6 supervised clinical shifts at the Royal Victoria Hospital.
- Residents will have the opportunity to evaluate and manage patients with toxicological exposures under the guidance of attending physicians who are emergency physicians and medical toxicologists
- Residents will have the opportunity to complete toxicology consults on poisoned emergency department, ward, and ICU patients
- Didactic Sessions (CPA 1, 4, 5, 6):
- Didactic sessions will cover topics such as principles of toxicology, toxidromes, withdrawal states, drug-dependence, antidotes, toxicological emergencies, advanced decontamination, procedures, advanced extracorporeal treatment procedures, ethical challenges in clinical toxicology, maternal-fetal exposures, and poisoning in special populations (e.g. pediatrics, the pregnant, the elderly, and socially marginalized persons)
- Residents will participate in case-based discussions, formal lectures, debates, and journal clubs on current toxicologic topics.
- Research and Scholarly Activities (CPA 5, 6 and 7):
- Residents will critically appraise current toxicologic literature and to discuss their application to patients in the emergency department
- Residents are required to deliver a 1-hour toxicology lecture to residents and medical students on rotation at the Royal Victoria Hospital emergency department
Assessment and Evaluation
Residents will be evaluated based on their performance during clinical shifts and participation in group activities. Assessment tools will include direct observation, case presentations, quizzes, and feedback from preceptors.
Resources
- Textbooks: Goldfrank’s toxicologic emergencies 11th edition, Critical care toxicology (2017), Rosen’s emergency medicine 10th edition, Tintinalli’s emergency medicine 9th edition
- Audio resources: CRACKcast podcast
Rotation-Specific Learning Objectives
Medical Expert and Clinical Decision-Maker
- Obtain a history that is accurate, pertinent, and concise for the nature of the problem
- Perform physical examination that is sufficient to initiate a diagnosis or management plan
- Discriminate types of poisoning with the knowledge of the different toxidromes.
- Diagnose and treat withdrawal states
- Identify the need for gastrointestinal decontamination and the benefits and risks of activated charcoal, whole bowel irrigation, gastric lavage, and other decontamination techniques
- 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
- Demonstrate knowledge in pharmacokinetics, pharmacodynamics, and how these considerations change in poisoning (toxicokinetics, toxicodynamics)
- 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)
- 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
Administration & Core EM Topics
The focus of the Medical Administrative rotation is educating the resident on global ER function. In addition, this period is a time when specific topics in EM are reviewed and reinforced, largely based on the resident’s needs. It is based at the Jewish General Hospital.
Goals & Objectives
This four-week rotation is designed to teach effective management and administration skills as they relate to the practice of Emergency Medicine. The resident will be exposed to all levels of administration. The resident will be expected to learn basic principles of leadership and administration develop an understanding of the function of the Emergency Department within the institution and its relationship with other departments. Other key objectives will include: understanding important medico-legal aspects of emergency medicine, understand aspects of quality assurance, professionalism, risk management, and crisis resource management.
Structure
- During this rotation, the resident will receive lectures in ED administration and hospital topics covering interdepartmental protocols and policies. Some of the topics presented include:
- ED Design
- Information Technology and the Medical Health Record
- Canadian Triage System
- Trauma Systems
- Morbidity and Mortality Review Process
- Patient Complaints
- Quality Assurance
- Legal Aspects of Emergency Medicine
- Career Planning
- Time Management
- Protocol and Procedure development
- Overcrowding and Bed utilization
- Lean philosophy on patient flow
- Role of the DPS, Role of the Department Chief
- Negotiation and Conflict Resolution
- Practice Management seminar
- The resident will familiarize themselves with the process of responding either to a patient complaint letter, or to investigating and completing a Morbidity and Mortality project investigating the various issues related to medical and system errors. Both projects are completed under the supervision of a faculty mentor and it is expected that the resident present his/her findings at Rounds.
- The resident will participate directly in the ED as a flow coordinator at the JGH learning how to handle different flow situations and cases. Clinical responsibilities will include 6 shifts at the JGH with a focus on ED flow.
Evaluation
Evaluation of the resident will be bases on their attendance and participation in lecture, the feedback during their reassessment shifts in the ED, as well as their administrative project (M & M or patient complain letter).
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.
Rotation-Specific Learning Objectives
Medical Expert
The resident will be expected to
- Participate in the management of difficult cases
- Learn efficient decision making in cases of unclear disposition
- Deciding on admissions/discharge vs. consultations
- 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.
- 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.
Musculoskeletal (MSK) - Lakeshore General Hospital
Introduction
This two-week rotation is designed to expose the Emergency Medicine resident to general musculoskeletal pathology as well as resuscitation commonly encountered in the field of Emergency Medicine. This experience will be uniquely based at the Lakeshore General Hospital (LGH).
The Lakeshore General Hospital is a community and McGill University affiliated hospital that cares for adult and paediatric populations. The Emergency Department receives a high volume of MSK-related visits, traumas and acutely sick patients creating an ideal learning environment for the MSK/resucitation rotation. Furthermore, the resident will be the most senior learner in the department (often being the only resident) and get the opportunity for a more hands on and personalised learning experience.
The resident is expected to consolidate their knowledge and skills in the primary ED management and appropriate referral for follow-up and ongoing care of common MSK problems as well as manage P1 & P2 resuscitation cases. A suggested reading list and attendance at rounds will supplement the clinical learning experiences.
The rotation supervisors/coordinators are:
Dr. Robin Nathanson & Dr. Chanel Fortier-Tougas
Structure
During this rotation, the resident will participate in direct clinical patient care in the following settings:
- Emergency Department of the Lakeshore General Hospital
- Outpatient Orthopedics Clinics
During their time in the ED, the resident will be under the direct supervision of the attending ED staff working on the ambulatory side. They will be expected to see patients presenting with MSK complaints and will be responsible for the initial evaluation, ongoing care and disposition of these patients. They will also be paired to the attending staff on the acute care section and will be expected to co-manage P1&P2 resuscitation cases. Finally, they will participate in orthopedic outpatient follow up clinics.
Rotation-Specific Learning Objectives
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
Anesthesia - St. Mary's Hospital
The anaesthesia rotation will be a 2 week rotation which will give residents the opportunity to become familiar with the pharmacology of common anaesthetic agents, hemodynamics and respiratory physiology.
During this rotation, residents are paired daily with great anaesthesiologists in the St Mary’s Hospital operating room. In addition to developing a deeper understanding of the underlying science, residents have hands-on opportunity to master techniques of airway management and vascular access.
Rotation-Specific Learning Objectives
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
Elective
The elective month is an opportunity for the resident to gain exposure to an area related to Family Medicine-Emergency Medicine that is of special interest, that exposes them to a new environment, or in which they feel they could benefit from more training.
Over the years, residents have arranged electives both locally and internationally, in emergency departments, clinics, and other settings. Electives must be approved by the Program Director. Electives outside the province of Quebec must be approved by the College des Medecins du Quebec.
Rotation-Specific Learning Objectives
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.
Varia
- Mentorship Program
- Chief Resident
- Evaluations
- Letter of Reference Policy
- Office of Medical Learner Affairs (Wellness)
- Reading List
- Links
- Previous Graduates
Mentorship Program
Each resident will be assigned a mentor at the beginning of his/her residency. Barring special circumstances, the mentor will maintain this role until the resident graduates.
The responsibilities of the mentor include (but are not limited to) the following:
- Meet with his/her mentee at the beginning of the year and help him/her feel welcome and part of the Program.
- Act as a resource person to the resident.
- Together with the Program Director help resident develop fields of interest or sub specialization.
- Assist resident to recognize his/her individual strengths and weaknesses and support activities to enrich the resident’s experience.
- Attend the different presentations of the mentee (Case Presentations, CAT Project, and teaching sessions) that are mandatory to the Program, and be available to discuss different aspects of their presentations ahead of time.
- Give feedback on the various presentations using a summary of the valuations completed by the audience.
- Be available to discuss the 3 month evaluations after it has been reviewed by the Promotions Committee. The Program Director maintains the right to discuss evaluations with the resident alone or at the request of the resident. In the case of a borderline or unsatisfactory evaluation, assist to outline corrective measures in an effort to address weaknesses.
- The mentor will hopefully develop a special kinship towards his/her mentee(s).
- The mentor should be a role model and conduct him/herself professionally and maturely.
- The mentor is expected to provide career counseling to their resident, and help them navigate the process of obtaining a license and a position.
Chief Resident Role & Responsibilities
There are 2 chief resident positions with shared responsibilities, which will be divided equally by the chief residents at the start of their mandate.
Selection Process
Two co-chiefs will be selected by their peers each year. The Program Director and Program Administrator will initiate this process in order to have the co-chiefs named before May 1. Interested candidates will submit their name and a brief letter of intent. All incoming residents get one vote. The two candidates with the most votes will be the co-chiefs. The only exception is if neither leading vote-getter is a McGill Family Medicine resident, in which case the 2nd place candidate will cede to the highest-ranking McGill candidate. Familiarity with the McGill system is imperative to the successful functioning of this leadership unit.
CCFP-EM Chief Resident
Role Description
1. Liaise between CCFP-EM residents and the Program Director and Program Administrator
2. Facilitate planning and implementation of core curriculum, including academic half days alongside the FRCP chief residents
3. Facilitate planning and implementation of administrative month alongside administrative month coordinators
4. Advocate for residents in matters relating to Wellness, curriculum, rotations, and schedules via attendance at quarterly RPC meetings
5. Facilitate navigation of Wellness resources (Wellness representative, Program Director, Post Graduate Program Director, Wellness Office, Occupational health, and safety)
6. Promote Wellness and a sense of community among CCFP-EM residents
7. Participate in CaRMS process: file review, interviews, and organizing social activities (meet and greet, hospital tours) for prospective applicants
8. Organize and support resident social events to help create a sense of community and collegiality within the ER Department, Enhanced Skills Programs, and Family Medicine
9. Serve as a resident contact for prospective applicants to the CCFP EM Program
10. Orient incoming chief residents to facilitate transition
11. Represent the McGill CCFP-EM program nationally at CAEP resident meetings
Evaluations
Resident evaluations occur mostly via the one45 system. For the ER based rotations, it is the responsibility of the resident to “push” to each staff the daily evaluation forms. Residents must also push one45 forms to staff after an oral exam. ICU evaluations, also on one45, are sent to the staff supervisor. This could be after 1 or 2 weeks of supervision.
Residents will be unable to view rotation evaluations until they have completed their anonymous evaluation of the rotation and their staff.
Quarterly Evaluations with Faculty Advisors are also done on one45. Residents should meet in person with their Advisor to discuss their progress. Residents are expected - in the meetings and on the one45 form – to provide feedback about their experiences. They are also expected to create, with guidance from the Advisor, a Learning Plan for the next quarter.
Evaluations that are not submitted to one45 include the National Practice Exam (done in April) and SAMP/written exams, and the CAT project. Other curriculum components with no formal evaluation but where attendance and active participation is required include Academic Half-Days, SIM sessions, ACLS, and POCUS IP certification.
Letter of Reference Policy
Preamble: Prospective candidates to the program (Family Medicine residents at McGill or others on visiting electives) face challenges in acquiring Letters of Reference (LOR). They work with a limited number of supervising physicians. Some of these physicians, when asked, feel conflicted because they are part of the RPC and may, in any given year, be on the Selection Committee. However, due to their knowledge of the program, they are also some of the best judges of which residents will succeed.
Decision: Due to an elevated risk of conflict of interest, the following McGill Faculty are NOT considered eligible to write LOR for Enhanced Skills in Emergency Medicine at McGill:
- CCFP(EM) Program Director
- CCFP(EM) Competency Committee Chair
- CCFP(EM) Assistant Program Director
- CCFP(EM) Site Directors (JGH/SMH)
All other physicians, regardless of position in RPC and/or Selection Committee, are encouraged to write LORs for candidates they deem worthy. Potential conflicts of interest are mitigated by wide representation of sites on our diverse Selection Committee.
DRAFT – May 18, 2022
For re-evaluation in 4 years
Office of Medical Learner Affairs (Wellness)
The School of Medicine (Montreal and Outaouais campuses) is pleased to announce the launch of the new Office of Medical Learner Affairs as of June 21. This office will house the same services and resources currently offered to UGME and PGME learners through the Faculty’s WELL Office.
The rationale for creating the new Office of Medical Learner Affairs for our School is three-fold:
- to provide a dedicated Office for the School of Medicine learners to better meet their needs,
- to eliminate confusion with the University’s “Wellness Hub” experienced by many learners,
- to better promote the dedicated wellness support, academic counseling specific to time and stress management, as well as leaves, and UGME career advising.
The creation of this Office is also part of the new School of Medicine’s organizational evolution. It is the outcome of many months of review and consultations with the School’s faculty members and staff, and input from learners.
A safe and confidential space for support
Under its new name, the Office of Medical Learners Affairs remains a confidential and safe place for learners to seek support. Rest assured: all services remain the same. The Office is composed of the expert team already in place, including Assistant Deans Nathalie Saad (Student Affairs), Olivia Tse (Resident Affairs), Director Shelly Sud (Student and Resident Affairs, Campus Outaouais), Wellness Consultants, Career Advisors, and administration staff committed to accompanying learners along their career journey with us.
Do note, however, that the website and email addresses in officemedlearneraffairs [at] mcgill.ca (Montreal) and affairesetudiantespostdocmed.co [at] mcgill.ca (Campus Outaouais) have changed.
Important: Learners will continue to report any concerns about mistreatment directly to the Office for Respectful Environments, which is your dedicated confidential resource for this purpose.
Please also note that The WELL Office continues to exist to support non-medicine health professions learners (i.e., students in the Ingram School of Nursing, School of Physical and Occupational Therapy and School of Communications Sciences Disorders).
Visit the Office of Medical Learner Affairs website to learn more. Should you have any questions, please do not hesitate to contact the team at the new email addresses, officemedlearneraffairs [at] mcgill.ca (Montreal), and affairesetudiantespostdocmed.co [at] mcgill.ca (Campus Outaouais).
Updated June 21, 2023
Reading List
Recommended
Tintinalli
Emergency Medicine: A Comprehensive Study Guide
McGraw Hill
Goldfrank
Toxicologic Emergencies, Appleton and Lange
Rosen and Barken
Emergency Medicine: Concepts and Clinical Practice, Mosby
Rosen and Barken
Emergency Pediatrics: A guide to ambulatory care Mosby
Suggested Reading
Simon and Koenigsknecht - Emergency Orthopedics Appleton and Lange
Keats - Emergency Radiology Year Book,
Roberts and Hedges - Clinical Procedures in Emergency Medicine Saunders,
Barken - Pediatric Emergency Medicine
Links
Residents are encouraged to review the following guidelines established by the Postgraduate Medical Education office and the FMRQ:
- FMRQ Collective Bargaining agreement: https://www.fmrq.qc.ca/entente-collective
- The McGill Post Graduate policy on intimidation and harassment: https://www.mcgill.ca/medhealthsci-respectful-environments/
- The McGill Post Graduate policy on Resident health and safety: TBA
- Harassment, Sexual Harassment, and Discrimination Office: https://www.mcgill.ca/medhealthsci-respectful-environments/
- Standards of behaviour in the learning environment: https://www.mcgill.ca/medhealthsci-respectful-environments/
- McGill Handbook on Student Rights and Responsibilities: https://www.mcgill.ca/students/srr/
- The Quebec Physicians’ Health Program – QPHP: https://www.pamq.org/
Previous Graduates
1986-1987
Helene Chenard
Bernard Unger
1987-1988
Marie-Rose Chateauvert
Pierre Soucis
1988-1989
Khalid Al-Sahlawi
Jacques Blanchette
David Goranson
Jean-Francois Prevost
1989-1990
Stan Bernbaum
Richard Kohn
Fran Mondor
Robert Primavesi
Norman Sabin
1990-1991
Marie-Josee Belanger
Wilis Grad
Michael Klar
Jeffrey Sirzyk
1991-1992
Keith Martin
Chrysi Paraskevopoulos
Chantal Rondeau
John Rowen
Michael Vonniessen
1992-1993
Eddy Lang
Thomas Mele
Howard Stuart
Mike Taylor
Phyllis Vetere
1993-1994
Jerman Chirgwin
Robert Drummond
Ryan Hunt
Gary Lee
Richard Lee
1994-1995
Nicholas Chan
Paula Kebarle
Jonathan Singerman
Mitch Sullivan
Roger Yao
1995-1996
Ken Berger
Sandra Dykhuis
Ashok Oomen
Jean Papacotsia
Vincent Tan
Thu-Hang Tran
1996-1997
Glenn Duns
Michael Engo
Edward Luke
Mitch Stendel
1997-1998
Brian Bell
Stephen Harrison
Anika Lefebvre
Claudine Maari
Marie Therese Prest
Stephen Sharp
Shaun Visser
1998-1999
Geoffrey Fine
David McCaughey
David Lasry
Megan Perrson
Paul Perlon
Aviva Rappaport
1999-2000
Marie-Pierre Carpentier
Julian Carrasco
Atiemo Kessie
Patrick Martel
Craig Murray
Didier Serero
Alan Azuelos
Davis Vas
2000-2001
Edward Boushey
Tracy Steintz
Roger Brunner
Greg Clark
Christine Dube
Jose Jilwan
Chris Meilleur
Yoel Moyal
2001-2002
Genevieve Garneau
Steven Herskovitz
Elliot Jacobson
Tatiana Jevremovic
Collin Lee
Santosh Kanjeekal
Genevieve Forest
Jean Su
Julie Thibault
Jennifer Tupper
Yana Simice
2002-2003
Louis Charbonneau
Kamil Haider
Albert Lau
Pham Dinh Tan Le
Mai-Ahn Levan
Bernice Mitelman
Jonathan Simons
Craig Smith
Melissa Yuan Innes
2003-2004
John Bitangcol
David Chong
Jamieson Clark
Jerrod Hendry
Kirsten Johnson
Lilia Malkin
Robert Sawoniak
Sean Staniforth
Marta Strakacz
Mathieu Turcotte-Lagace
Jason Yue
2004-2005
Isabel Alonzo-Proulx
Tyler Anderson
Assunta Cecere
Sukhbinder Dhiman
Esther Grunau
David Levy
Laura Maclaren
Margaret May Raymond
Rajat Upadhyay
Rajani Vairavanathan
Tania Welters
Katherine Whitehead
2005-2006
Naveed Alam
Riyaaz Alikhan
Rene Coulombe
Gillian Kumka
Jennifer Kwong
Daniel Merritt
Derek Poon
David Rauchwerger
Anik Rawji
Catherine Troung
2006-2007
Marianne Collin
Anita Crerar
Susan Finkelberg
Yanick Ouellet
Kashif Pirzada
Nazanine Rahnema
Stephane Rhein
Emilia Rydz
Neil Verma
Hugo Viladevall
Karol Wroblewski
David Zlotnick
2007-2008
Christine DiLullo
Alana Hirsh
Courtney Howard
Julie Leonard
Jesse McLaren
Maria Rif
Sanjeet Saluja
Sarah Sebbag
Quoc-Huy Ton-That
2008-2009
Evan Blauer
Patrick Chen
Julie Cormier
Mathew Hewitt
Maral Kanadjian
Andrew Khalil
Sabrina Narbonne
Evelyne Papillon
Andrew Reid
Blazej Szczygielski
Philip Vayalumkal
Nadia Waterman
2009-2010
Jennifer Alper
Karl Cernovitch
Joshua Chinks
Pascal Gellrich
Jaclyn Herman
Mark Lobel-Buch
Rebecca Keyston
Janelle Piche
Leila Salehi
Debbie Schwarcz
Meryl Tabah
Simone Wong
2010-2011
Christine Ames
Paula Cleiman
Anastasiya Damyanova
Renaud Dutrisac
Paulina Gasiorowska
Tiffany Gasse
Kris Macmahon
Dorota Nowodworski
Ognjen Papic
Kaleena Patel
Sunita Swaminathan
Danie Ty
2011-2012
Marie-Renee Lajoie
Danielle deJong
Erik Holody
Aisha Khatib
Cecilia Kim
Adam Lenny
Erin Sandilands
Rachel Sheps
Olga Wrezel
Eddie Xie
Eric Lee
2012-2013
Elise Papillon
Emily Moras
Marta Karczewska
Katharine Hudson
Katya Ghannoum
Julia Vallieres-Pilon
Adrian Florea
Rory O’Sullivan
James Fairbairn
Charles Giroux
Soojin Yi
2013-2014
Andrea Chabot Naud
Aneesh Chhabra
Lars Grant
Dahlia Guttman
Devin Hopkins
Jacob Alexander Hunting
Tajinder Kaura
Danish Meraj Khan
Andrei Liveanu
Marian Neelamkavil
Christopher Newcombe
Thu An Nguyen
Signe Richer
2014-2015
Haran Balendra
Julia Bernard
Daria Denissova
Marie-Hélène Dupuis Vaillancourt
Austin Gagné
Margaret Hull
Jennifer Hulme
Jesse Janssen
Marc Richard-Albert
Yumi Tanaka
Bryan Wise
Yao Xiao
2015-2016
Rafael Aroutiunian
Pooja Aysola
Paul Brisebois
Jan de Waal
Kaviraj Gosal
Garud Iyengar
Jennifer Moscovitz
Reuben Ostrofsky
Hubert Pineau
Tamer Waly
Lilyana Zhelyazkova
2016-2017
Carina Antczak
Chanel Fortier-Tougas
Rohit Gandhi
Andrew-Robert Gibson
Isabelle Imamedjian
Jinnie Kim
Valerie Morin
Jonathan Chanler Munzar
Robin Nathanson
2017-2018
Hussain Alkhadra
Kamy Apkarian
Camille Bertrand
Erin McKay
Jonathan Minz
Jason Parnes
Shuo Peng
Cyrus Shayegan-Salek
2018-2019
Nathalie Codsi
Alexandre Dostaler
Brian Lubelsky
Keir Maharaj
Michael Richard
Olivier Saleh
Aharon Silberman
Maryam Taheri-Tanjani
Samantha Thonnard-Karn
Madelein Yona
2019-2020
Brittany Cameron
Mark Dunn
Fannie Fortier-Tougas
Jason Freder
Jefferson Hayre
Vanessa-Lyne Knight
Allan Lim
Stephanie Mokrycke
Daniel Rabipour
Jonathan Séguin-Bigras
2020-2021
Arzu Chaudry
Kate Gong
Stephanie Gourdeau
Joanna Jiang
Kyle Ng
André Richard
François Roux-Leblanc
Emmeline Ruka
Michel Samra
Mathieu Toupin
2021-2022
Holly Abbott-Brewin
Gemma Cox
Alexandre Elhalwi
Justin Kozak
Judith Martel
Anh Nguyen
Nadia Omri
Tanishq Suryavanshi
Naré-Gacia Topouzian
Marta Yesgat
2022-2023
Krista Dunn
Akina Fay
Miriam Ghaly
Raphael Hamad
Rashi Hiranandani
Catherine Michaud-Germain
Paola Moresoli
Aidan Steinmetz-Wood
Aaron Sweeney
Marc Whoriskey
Quentin Wong
2023-2024
Olumide-Adekola Adeleye
Mila Beauvais
Inna Ermeichouk
Julian Hughes
Alan Huynh
Nicholas Haralabos Koziris
Vivian Wing-Yee Leung
Madison Meehan
Leanne Ronciere
Ronak Saluja
Tarsan Sangarapillai
Vignesh Shankar Sethuraman