TRAINING REQUIREMENTS
The program consists of 26 periods (each period is 4 weeks) over the 2-year fellowship. There are 13 mandatory periods, 11 elective periods, and 2 periods that may be taken as vacation. Admission to the General Internal Medicine program requires successful completion of 3 core years of internal medicine training.
The resident must meet with the General Internal Medicine Program Director before commencement of the R4 year to begin planning the 2-year schedule. Any changes to the schedule must be communicated to the General Internal Medicine Program Director (see Appendix; Important Contact Numbers).
The 13 required periods (mandatory component) and 16 elective periods (flexible component) are outlined below. The timing of the mandatory and flexible components need not be sequential and can be distributed throughout the two years. While it is anticipated that those individuals choosing community General Internal Medicine will focus on procedural skills and further clinical training in the subspecialties of Internal Medicine, and those choosing an academic career in General Internal Medicine will focus on research or medical education, it is recognized that training should be flexible to meet the needs of individual residents.
A. MANDATORY COMPONENT OF TRAINING (13 Periods)
1. General Internal Medicine Consultation (3 periods) During this rotation, the resident is called upon to assess and manage internal medicine problems on non-medical services (e.g. surgery, obstetrics, psychiatry). These may be done at any of the McGill hospitals. It is required that one of these blocks be done outside the trainee's base hospital. The 3 hospitals have different patients’ profiles; for example, there is no orthopedic surgery at the RVH, and no obstetrics or vascular surgery at the MGH. Attendance at a weekly preoperative assessment clinic is available at the MGH. These rotations can be arranged via each hospital's Division of Internal Medicine office (see Appendix; Important Contact Numbers).
2. Critical Care Medicine (ICU and/or CCU) (2 periods) General internists, particularly those working outside tertiary care centers, are typically required to function as critical care specialists. Hence, 2 periods of critical training are mandatory. The trainee can choose to do their critical care training in ICU or CCU. The trainee will function as Critical Care fellow during that period, supervising or co-supervising (i.e. if there is a cardiac or critical care fellow also assigned that month) the team of residents. Refer to the Appendix for names and contact information of Critical Care directors.
3. General Internal Medicine in an Outlying Region (3 periods) These rotations should be arranged early, via the outlying region site contact person, due to limited availability at some sites. Please consult the section on Community Hospital Rotations in this document for further details on sites and contact persons. Please notify the administrative coordinator of the Outlying Regions Program as soon as you have booked your rotation so that the necessary paperwork can be completed (see Appendix).
4. Medical Problems in Pregnancy (2 periods) Exposure to medical problems in pregnancy will be achieved in the following manner:
i. It is recommended that two (2) blocks in Medical Problems in Pregnancy be done at St. Justine's Hospital. This should be arranged early due to limited availability. A good knowledge of French is required for this rotation. Alternately, a rotation can be set up at the Royal Victoria Hospital. Please consult the Appendix for contact names and numbers.
ii. During the fellowship, the resident will complete the Obstetric Medicine Curriculum from Brown University School of Medicine, Rhode Island (available online at http://www.obmed.org/curric.htm); pre-test and post-test can be ordered by e-mail (see the website) and is to be self-administered by the trainee at the beginning and end of training to assess progress).
iii. A Medical Problems in Pregnancy logbook should be kept by the trainee throughout the fellowship. For each pregnant patient with medical problems seen during each of the trainee's rotations (e.g. pregnant asthmatics seen during Pulmonary rotation, pregnant woman with epilepsy seen during Neurology rotation), the resident should record the problem, important diagnostic or management issues, references retrieved, controversial issues, etc. Similar documentation should be performed when the resident attends a lecture or conference symposium pertaining to medical problems in pregnancy. This will allow the resident to assess cumulative exposure to different aspects of this field, and will help direct further independent learning required to meet exam and practice requirements.
5. Non-invasive Cardiology: ECG reading, Holter monitoring, and exercise stress testing (1 period) The resident will devote a period to learning risk stratification of cardiology patients, a practice which most general internists in outlying regions perform. Specifically, the resident will be expected to perform and interpret the results of exercise treadmill testing, as well as familiarize oneself with pharmacological nuclear stress testing and echocardiography. This rotation can be at any of the three hospitals. Please consult the Appendix for contact information.
6. Co-attending on Internal Medicine Clinical Teaching Unit (2 periods) The resident will spend 2 periods during the 2 year training period as a trainee co-attending on one of the Clinical Teaching Units (CTU) of the three hospitals. The attending must be a member of the Division of Internal Medicine. The first period should not occur earlier that the latter part of the first year of fellowship in order that the resident gain sufficient expertise. The resident should be familiar with the Department of Medicine Guidelines for Attending Physicians at their respective hospitals. Please contact the coordinator of the General Internal Medicine Program for the CTU Attending schedule of the three hospitals. It is the resident’s responsibility to contact the attending and arrange the rotation. A list of all Internal Medicine Division members at the three hospitals and their contact information is provided in the Appendix.
7. Longitudinal Ambulatory clinic (1/2 day per week) The resident must set up a half day per week ambulatory Internal Medicine clinic to run longitudinally throughout the 2 year fellowship. The clinic is usually set up at the resident’ s base hospital, but by special request may be done at one of the other McGill University teaching hospitals. The resident must identify a supervisor (whose name should be given to the General Internal Medicine Program coordinator) who will evaluate the resident every 6 months over the course of the 2-year fellowship. If desired, the supervisor can be changed for the R5 year. The resident must attend the clinic each week, except when he/she is out of town on an outlying regions rotation, rotating through critical care, or on vacation.
To set up the clinic, the resident must call the Internal Medicine divisional secretary at the hospital where the clinic will take place (see Appendix). The clinic should be set up prior to or early in the first rotation, to ensure an adequate volume of patients in the first few months.
B. FLEXIBLE COMPONENT OF TRAINING (11 Periods)
A further 11 periods of training should be tailored to the needs of the resident based on interests and on skills and knowledge required in anticipation of future practice location. These rotations must be approved by the General Internal Medicine Program Director and Residency Training committee. The resident should meet with the Program Director to discuss and plan elective rotations.
This training can incorporate any one or more of the following:
- Further clinical training in ambulatory General Internal Medicine or any recognized subspecialty of Internal Medicine
- Further training in critical care
- Further training in outlying regions
- Further clinical training in any recognized subspecialty of Internal Medicine
- Further procedural skills training, such as gastroscopy and bronchoscopy
- Further clinical training in Medical Problems of Pregnancy
- Further clinical training in peri-operative assessment
- Further training in non-invasive cardiology
- Training in cardiac echocardiography
- Clinical research
- Pursuit of advanced training in medical research or medical education including course work for advanced degrees such as, but not limited to, a Masters of Science in Epidemiology and Biostatistics, Masters of Science in Education, Masters of Science in Ethics, Masters of Business Administration, Masters of Health Administration
- Other training as approved by the General Internal Medicine Program Director in consultation with the General Internal Medicine Residency Training Committee
In addition, if the resident wishes to plan a rotation devoted solely to ambulatory clinics (e.g. specialty clinics), it is recommended, for maximum pedagogical benefit, that 3 consecutive periods be devoted to this rotation. Participation in a minimum of 8 half-day clinics per week is required. Exceptions can be made, with the Program Director’s approval, for residents who wish to use part of their time during the block for a defined scholarly activity (e.g. research project, case write-up). For trainees who are performing Chief Resident duties during a given block but who wish to do a clinics rotation concurrently, a minimum of 5 half-day clinics per week is required. It is the resident's responsibility to arrange and coordinate the various clinics that make up this rotation, according to his/her interests and needs. The resident's plan for an ambulatory clinics rotation must be approved ahead of time by the Program Director.
2. OTHER REQUIREMENTS
A. PARTICIPATION IN ALL DIVISION ACTIVITIES
The resident is expected to participate in all divisional academic activities, as described below.
Interdivisional Rounds: These rounds are held quarterly in the evening. The schedule of dates will be available in early fall, and will be mailed to all residents. Residents are expected to attend all Interdivisional Rounds (unless out of town). Residents may be asked to present cases, or topics, or ongoing research at these rounds.
Hospital Division Rounds: These are held weekly at the RVH and MGH, and monthly at the JGH. Residents are encouraged to attend these rounds throughout the year, and are required to attend these rounds when they are rotating on the Internal Medicine Consultation Service or clinic rotations at that particular hospital. There is also a weekly divisional journal club at the MGH that residents are strongly encouraged to attend (whether or not they are based at the MGH).
Schedule of Rounds:
The resident, during each of his/her rotations, is also encouraged to attend all of the relevant weekly Department of Medicine conferences (see postings at individual hospitals). Twice a year, the General Internal Medicine Program Director will arrange a special session for all trainees. The content of these sessions is flexible, but may include a journal club on ambulatory care issues, a quality assurance topic, a session on medical problems in pregnancy, or a general preparation session for the spring Oral Exams in Internal Medicine. All residents are expected to participate in these sessions.
B. SCHOLARLY ACTIVITY
During the fellowship, the trainee is expected to engage in a scholarly project, which may take the form of:
A clinical or basic science research project that can be completed during the two years for purposes of a publication and/or presentation at a local, national and/or international meeting. This can include a research project already started, but not completed during the core years. Interested residents should identify a project and supervisor early in the R4 year, and may use elective blocks to conduct the research. Careful planning, an experienced supervisor, and a high degree of structure are key elements to the successful completion of a project.
and/or
Writing up of a case report for publication (a supervisor should be chosen) or submission of an abstract (a clinical vignette for presentation at the Resident's Research Day and/or one of 4 Canadian or U.S. meetings that accepts clinical vignettes: Canadian Society of Internal Medicine (fall); Association of Internists of Quebec (late spring); American College of Physicians Annual Meeting (March/April); Society of General Internal Medicine Annual Meeting (April/May). See appropriate websites or the coordinator of the General Internal Medicine Training Program for abstract forms- abstract deadlines are usually 4-6 months before meeting.
and/or
In-depth, critically appraised review of a topic (e.g. related to a case, new treatment, clinical controversy, etc.) to be presented by the resident at Interdivisional Rounds (a supervising co-presenter should be chosen) and to be written up for publication.
and/or
A project related to Quality Assurance, with identification of an appropriate supervisor. The trainee is also encouraged to enroll in courses provided by the McGill Summer Program in Epidemiology and Biostatistics, which takes place during the months of May and June (see "Appendix" for important contact names and numbers).
C. ATTENDANCE AT THE ANNUAL CANADIAN SOCIETY OF INTERNAL MEDICINE CONFERENCE
The trainee is strongly encouraged and financially supported to become a member of the Canadian Society of Internal Medicine during the duration of their fellowship. Membership information and forms are available at the office of General Internal Medicine Program Director (contact the coordinator of the General Internal Medicine Training Program). As well, trainees are strongly encouraged to attend the annual meeting of the Canadian Society of Internal Medicine as a presenter and/or observer. Please refer to the Canadian Society of Internal Medicine website (www.csim.medical.org) for membership and conference information.
3. METHOD OF EVALUATION
The resident will be evaluated in a number of ways:
The resident will be evaluated by their rotation supervisor at the end of each rotation.
The resident will be evaluated on the 7 CanMEDS roles as defined by the Royal College of Physicians and Surgeons. These roles are 1) medical expert, 2) com-municator, 3) collaborator, 4) manager, 5) health advocate, 6) scholar, and 7) pro-fesssional. Further descriptions and information on these roles are available at http://www.medicine.mcgill.ca/postgrad/welcometopostgrad_evaluationpromo.... It is the resident's responsibility to ensure that the supervisor completes the McGill evaluation sheet before the end of the rotation. A sample of the evaluation form is provided in the Appendix.
The resident will meet with the Program Director at 6-month intervals to discuss the evaluations and overall progress, or earlier in the case of borderline or unsatisfactory evaluations
The resident will have 2 formal oral exams followed by feedback on performance. The first must be scheduled in the first 6 months of the R4 year and the second in the first 6 months of the R5 year. The written evaluation will be forwarded to the Program Director
The resident's teaching skills will be evaluated on at least 2 formal presentations at interdivisional or hospital division rounds.
Furthermore, all residents are expected to be familiar with the evaluation and promotion regulations as put forth by the Office of Postgraduate Medical Education, Faculty of Medicine, McGill University. Faculty policy is formalized in an official document which is available online at http://www.medicine.mcgill.ca/postgrad/welcometopostgrad_evaluationpromo...
It should be noted that the trainee must also complete an evaluation of each rotation and return to the General Internal Medicine Program Director.