Jumelage MF/Médecine d'urgence (R-3)

Descriptions de programmes

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Mise à jour 12 septembre 2011

University of Toronto

College of Family Physicians of Canada
Emergency Medicine Residency Program CFPC-EM

Supporting Documents

1. Reference Letters
   Three (3) references are required. At least two references must be from emergency physicians.
   Click here to access the "Referee assessment form"
   
   
2. Assessment by Program Director
   One letter from your family medicine program director which must be accompanied by the "Family Medicine Program Director's Assessment of Applicant".
   Click here to access the "Family medicine program / site director's assessment of applicant form"
   
   
3. Personal Letter
   A personal statement of your reasons for wanting to do an emergency medicine fellowship year. (2 pages maximum).
   
   
4. Research Experience
   List of Research experience, including titles of publications.

Interviews

All applications will be reviewed by the selection committee, and selected applicants will be invited for an interview by October 2010. Applicants will be notified by e-mail the date and time of the interview.

Interviews will be conducted in November 2010.

The interview team will consist of the Program Director, two emergency physicians and a resident.

Interviews will run for 1/2 hour.

Program Information

Overview

The Emergency Medicine Residency Program is a full 12-month program leading to a CCFP Certificate of Special Competence in Emergency Medicine. The program is affiliated with the University of Toronto Department of Family & Community Medicine and currently retains full accreditation status with the College of Family Physicians of Canada.

Training at the University of Toronto involved a number of community and teaching hospitals. Core rotations include emergency medicine (5 months, including 2 months pediatric emergency medicine), trauma at Shock Trauma Hospital in Baltimore, anesthesia, plastics/orthopedics, ICU (2 months), CCU (1 month), and elective (1 month). Tuesday mornings are academic half day with case based workshops, resident case presentations, and grand rounds. There are monthly journal clubs, an administrative course and a structured mock exam process. Residents have the opportunity to spend time with pre-hospital care: one air and one land ambulance ride out. Residents are expected to design a research project/audit which is due at the end of the year.

A one day-long introductory ER ultrasound course is a recent addition to the curriculum.

Curriculum

General Emergency Department	3 months
Pediatric Emergency Department	2 months
Anesthesia (Adult and Pediatric)	1 month
Orthopedics and Plastics	1 month
Elective	1 month
Intensive Care Unit	2 months
Coronary Care Unit	1 month
Shock Trauma,  Baltimore	1 month

General Curriculum Considerations:

ACLS is a prerequisite but update and reviews should also be included within the program.

ATLS must be accomplished prior to the completion of the program.

Involvement in cardiac arrests should be part of each resident's responsibilities during the rotations in the Adult Emergency Department, as well as during the Pediatric Emergency and CCU rotations.

Each resident should be involved in journal reviews, seminar presentations and teaching of interns and medical students.

During the year, each resident should attend at least one CME program in Emergency Medicine (maximum of 5 days).

Each resident will be expected to attend weekly core Tuesday morning teaching sessions.

Each resident may have a regular half day per week throughout the year during which he/she returns to work in his/her base hospital Family Practice Unit.

Each resident should develop an understanding of pre-hospital care and will be assigned time to be spent with the Metro Toronto Ambulance Services (2 days).

Training in Emergency Department Ultrasound (EDE) will be provided.

Location of Training

Program Site
The resources of several Toronto area hospitals will be utilized with the home hospital of the program director designated as the base hospital.  Electives may be arranged outside of the Toronto area, with the approval of the program director.

Service Contacts

Emergency Departments:		The Credit Valley Hospital:	Dr. Eric Letovsky
		Mount Sinai Hospital:	Dr. John Foote
		North York General Hospital:	Dr. Kuldeep Sidhu
		Hospital for Sick Children:	Dr. William Mounstephen

SPECIALTY	HOSPITALS	DIRECTORS
Intensive Care Unit	Toronto Western Hospital Toronto General Hospital Credit Valley Hospital	Dr. Tom Stewart
Coronary Care Unit	Sunnybrook Health Sciences Centre	Dr. Jeffrey Pang
Anaesthesia	Toronto East General Hospital	Dr. Vaibhav Kamble
Pediatrics	Hospital for Sick Children	Dr. William Mounstephen
Plastic Surgery	Toronto Western Hospital	Dr. Dimitri Anastakis
Orthopedics	Toronto East General Hospital	Dr. Paul Wong
Trauma	Baltimore	Dr. Amy Sisley

Goals and Objectives

The educational objectives for Emergency Medicine have been developed to complement those areas of family medicine training which are relevant to Emergency Medicine. The following objectives should therefore be considered in association with the objectives for Certification in Family Medicine. The resident must achieve knowledge and skills which will enable them as follows.

Emergency Department Rotations

• Distinguish the seriously-ill patients from the patients with minor illness or injury.
• Recognize, evaluate and initiate the management of all life-threatening conditions.
• Support and stabilize the acutely-ill patient and arrange appropriate management and referral.
• Recognize, evaluate an initiate management of non-acute illness and injury.
• Establish priorities and concurrently manage multiple patients.
• Understand the natural history of illness and injury presenting as an emergency; the social and family implications, the concept of continuity of care and the community resources for follow-up care that are available within and outside the hospital.
• Develop, support and implement emergency medical services for pre-hospital care within the community, ie, paramedics, ambulance service, communication systems, first-aid programs, poison control, public education programs, organization of emergency medical services and disaster planning.
• Commensurate with ability, experience and level of expertise, there will be delegated responsibilities, such that the Emergency Medicine Resident will be involved in the co-ordination and implementation of major resuscitation (medical and surgical) in the Emergency Department.
• Assume increasing levels of responsibility in teaching emergency medicine to medical students, interns, and other residents, in the Emergency Department both in seminars as well as bedside teaching.
• Be capable of assuming responsibility of the Emergency Department and facilitating patient flow through the Department.
• Develop communication skills with house staff, consultants, and ancillary personnel necessary to run the Emergency Department.
• Communicate directly with the staff emergency physician regarding any problems or concerns that may arise regarding house staff education, patient care, consultant interactions

Anaesthesia

• To develop the expertise and the technical skills necessary for airway management in all age groups.
• To develop an understanding of the indications, contraindications and complications of a variety of airway management procedures, including bag-valve-mask ventilation, nasotracheal intubation, oral endotracheal intubation, cricothyrotomy, and tracheostomy.
• To develop the expertise and technical skills necessary to obtain central venous access, and an understanding of indications, contraindications, and complications of this procedure.
• To develop the technical skills necessary to perform regional anaesthesia, and to develop an understanding of indications, contraindications and complications of this form of anaesthesia.
• To gain an understanding of the pharmacology of anaesthetic agents utilized in emergency situations.
• Re: paediatric patients - procedures should include IV insertion, airway management, (i.e, intubation) use of fluids and electrolytes, and CPR. The experience should promote an understanding of paediatric anaesthetic pharmacology and an understanding of the indications and contraindications of paediatric anaesthesia procedures.

The objectives of this rotation would best be achieved in a high volume rapid turnover operating room exposure combined with responsibility for emergency room consultations.

Orthopedic Surgery

• To develop an understanding of referral and disposition practices -what requires admission versus outpatient management? - what requires surgery today versus delayed surgery? - what can be handled primarily in the Emergency Department?
• To develop an approach and obtain the skills pertinent to the management of the multiple trauma patient.

This would best be achieved by a constant exposure to Emergency Department referrals (first call Orthopaedics), and a structured outpatient department clinic exposure. General ward duty and major operating room exposure are not expected to be a regular part of this rotation.

Intensive Care

• To participate in the ongoing management of life-threatening multi-system and surgical illness and injury.
• Acquisition of principles of monitoring techniques, and technical skills of invasive intervention, specifically central venous access, arterial lines, airway management, ventilation and oxygenation skills, pericardiocentesis, and tube thoracotomies.
• To develop an understanding of the equipment utilized for continuous monitoring and treatment of the critically ill patient.

These goals would best be achieved through active participation and increasing graded responsibility as the on-call Intensive Care resident.

Coronary Care Unit

• To develop the skills required to interpret electrocardiograms and rhythm strips.
• To participate actively in the management of patients with acute myocardial infarction, arrhythmias, heart failure and other cardiac emergencies.
• To become skilful in the techniques of cardioversion, defibrillation external pacemaker application, and pericardio-centesis

This rotation is to be based in the CCU rather than the cardiology ward and should include a major responsibility for emergency room consultations.

Plastic Surgery

• Wound care - principles of management.
• Hand injuries - evaluation and treatment
• Immunization and antimicrobial prophylaxis in the Emergency setting.
• Regional anaesthesia - its application to the evaluation and management of Emergency patients.
• Tendon and neurovascular injuries - Emergency Department and Outpatient Surgery: immediate delayed vs management.
• Hand Infections - management and follow-up care: outpatient management of cat bites, dog bites and human bites; deep space infections in the hand; and other infections as they pertain to the practice of plastic surgery.
• Amputations - the role of the Emergency physician in maintaining viability of amputated digits or extremities: decision-making process regarding referral to a tertiary care centre with re-implantation capabilities.
• Grafts - their role in Emergency Room Care.
• Burns - resuscitation and stabilization of the major burn victim; outpatient decision-making; decision-making process regarding transfer of the burn victim to a major burn centre.
• Complications - pitfalls and problems associated in the longitudinal care of plastic surgical problems which present initially to the Emergency Department.

The objectives of this rotation would best be met by involving the Resident in a centre with a large volume of Emergency Department consultations, as well as exposure to a busy outpatient clinic. Ward and regular operating room assignments are not expected to be a part of this rotation.

Additional Information

Certification
Successful completion of the program would lead to eligibility to sit the CCFP Certification Examination in Emergency Medicine.

Eligibility
Applicants for the third year emergency medicine program must be enrolled in the second year of a Family Medicine residency program leading to CCFP certification. The Ministry of Health currently prohibits the hiring of re-entry physicians for these positions.

Further Information:

For further information please contact the Program Director or Program Assistant at the address or telephone, fax, e-mail numbers listed above.

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