Name:	Julianna van den Beuken
Title:	Program Administrator
E-mail:	jvandenbeuken2@exchange.hsc.mb.ca
Phone:	(204) 787-8623

1. Positions are only available to Canadian citizens or landed immigrants in Canada.
2. Must have completed at LEAST two four week rotations in a tertiary care critical care unit during their base specialty training.
3. Will consider candidates who have completed their base specialty training prior to entry into Critical Care.
4. Happy to accept applications from residents who are currently doing PGY4 years in Medicine who are looking for additional training in Critical Care.
5. Happy to accept applications from physicians who have completed base specialty training or subspecialty training but who would like to do additional training in Critical Care.

The program only accepts residents when we have space to train them and meet the goals and objectives of the program.

Document	Mandatory	Optional
Reference letter Number of letters: 3 One must be from your current program director (or immediate clinical supervisor if out of residency for more than 1 year), one must be from an intensivist familiar with your work in ICU, the third can be from anyone.	X
Personal letter Tell us a little bit about yourself; detail why you are applying to Manitoba & the Critical Care training program. Let us know what you bring to the program, and what are you expecting from the program.	X
Proof of Citizenship	X
Photograph	X
Curriculum Vitae Including a list of publications, articles submitted for publication, and presentations at meetings.	X
MCCEE	X
Proof of good standing in current residency program or of completion if training in base specialty is complete.	X

Applications submitted after the file review has opened on August 24, 2011 :

- will be considered

References and other supporting documents which arrive after the file review has opened on August 24, 2011

- will be considered

Date(s) of Interview: September 6, 12, 14 and 16, 2011

Invitation/ Notification Information: Details regarding Interview:

Pre-requisites for entry into training program

1. A minimum of three years of base specialty training before applying to Critical Care. At present base specialty training can be in: Internal Medicine; General Surgery, Cardiac Surgery, Anesthesia; or Emergency Medicine.
2. All candidates must have completed at LEAST two four week rotations in a tertiary care critical care unit during their base specialty training.
3. At present the only overlap with base specialty training (outside of general Internal Medicine) which is possible at the University of Manitoba is Emergency Medicine and Critical Care.

In addition to the above entry routes we are happy to consider candidates who have:

1. Completed Royal College base specialty training in Internal Medicine, General Surgery, Cardiac Surgery, Anesthesia, or Emergency medicine.
2. Have done 4 years of Internal Medicine training but who are looking for two additional years of Critical Care training
3. Completed Royal College base specialty training in a specialty not on the list above but who have contacted the Program Director and the Royal College for a ruling.
4. Completed training in a Medicine subspecialty (pulmonary, nephrology, ID etc) who wish to do two additional years of Critical Care training.

Selection

The program only accepts residents when there are sufficient ICU rotations available to train them and meet the goals and objectives of the program. The PGME committee establishes at the beginning of the recruiting cycle how many new residents can be added to the program. Residents are then selected on the basis of their CV, letters of reference, and interview performance. Residents are ranked by members of the University of Manitoba Critical Care program and we attempt to recruit the most highly ranked residents until our program reaches full capacity.

Critical Care residents are trained in a unique Critical Care environment that exhibits interfacility coordination, managerial role discipline and collegial communication directed towards the goal of providing maximum patient access regardless of resource limitation.

Critical Care residents work in an environment where all intensivists in the region collaborate to accept and share responsibility for all patients referred to Critical Care in the province of Manitoba and beyond including Nunavut, northwestern Ontario and occasionally eastern Saskatchewan.

The teaching hospital units are the only tertiary care units for over 1,000,000 people in this area. All tertiary units are staffed by full time trained Critical Care academic physicians who are truly multidisciplinary (Medicine, Anesthesia, Surgery, Emergency, and Cardiac Surgery).

The training program has a tradition extending over 30 years and has had full Royal College approval since 1989. The program was recently reviewed and accredited by the Royal College. We are confident that trainees are exposed to adequate numbers and complexity of critically ill patients during residency.

The program has developed specific goals and objectives for rotations in the four “core” teaching units. These goals and objectives are specific to each unit, and differ for trainees at various levels of training. They are available for review on the program website: http://www.umanitoba.ca/faculties/medicine/units/intmed/students/ccproginforoticus.html

Critical Care is a two-year residency with a Royal College requirement for resident’s to spend ‘12 months’ doing rotations in critical care units during training. The University of Manitoba program has elected to meet this requirement by scheduling Critical Care residents for a minimum of 52 weeks of work in the units during the training period, and requiring the resident to do in-hospital call during both years of training.

Residents in the program must provide a total of 1360 hours of in-hospital coverage in critical care units during the two-year residency. Residents are paid a stipend above and beyond their PGY level salary in recognition of this in-house coverage. The stipend is not deducted at source and can be considered as “professional income” for taxation purposes. The stipend is reviewed annually and is in excess of $10,000 currently.

Residents also participate in patient transports via the Provincial Air Ambulance (“Lifeflight”) and are remunerated for this activity.

The program has traditionally facilitated some work in the base specialty during the second year of training if the resident is progressing satisfactorily. This has been requested by trainees from Surgery/Anesthesia. Opportunities often exist for internal medicine certified trainees to work in the medicine CTU’s in the WRHA.

The program has supported a full academic day on Wednesday for several years. Residents are excused from clinical duties to attend the full academic day. A typical day has lectures from 0900-1200 on critical care topics, afternoon advanced physiology/ventilator sessions shared with respiratory medicine, respiratory clinical rounds, and an evening session which could include journal club, visiting professor, clinical presentations, or lectures from faculty.

First Year

The program assigns residents to rotations in seven day blocks starting on a Monday and ending on a Sunday. This is similar to the rotations worked by attending physicians. Residents will generally be assigned to units for four consecutive weeks, but longer and shorter assignments are used to accommodate vacations and conferences. Residents will attempt to fulfill the goals and objectives set out in the University of Manitoba Goals and Objectives Document during unit assignments. http://www.umanitoba.ca/faculties/medicine/units/intmed/media/CC_General_Goals_and_Objective.pdf

They will need to look at the specific goals in the document for the unit they are assigned, and the overall program goals and objectives document. http://www.umanitoba.ca/faculties/medicine/units/intmed/media/CC_Specific_Goals_and_Objectives.pdf

The work during the FIRST YEAR will be structured as follows:

Clinical ICU Rotations

30-40 weeks in the teaching ICU are at the University of Manitoba. After the resident has worked in the units for more than 30 weeks, they will be expected to take more of a leadership role in the units. This is outlined in the Rotation Specific Objectives the program has developed for each unit.

Residents will rotate in all teaching units used by the University of Manitoba program. In general, over the 52 total weeks, residents from internal medicine backgrounds will spend more than 50% of their rotations in surgical units. Residents from anesthesia, surgery, and emergency backgrounds will spend more than 50% of their rotations in medical units.

Research - Four to Eight Weeks

This rotation is intended to give the resident a chance to develop their research/quality improvement project, conduct a literature review, and do preliminary studies design. The intent is to facilitate completion of projects during the second year.

Electives - Four to Eight Weeks

These rotations can be selected by the resident, but must be approved by the program director and/or the RTC. Some of this time could be done off site with approval. The program has developed goals and objectives for common elective rotations. There are also some specific ITER’s for these rotations.

If the resident is doing an elective that has not got program set goals and objectives, the resident and program director will work together to develop appropriate goals and objectives and an evaluation strategy.

Vacation - Four Weeks

Vacation can be taken in as four continuous weeks or can be split into one or two week blocks. Requests must be received by the program director prior to September 15. In general, it is better to have requests earlier as vacation requests are considered when constructing the schedule of rotations for all residents.

SECOND YEAR

There are another 52 available weeks this year. Residents continue to fulfill the goals and objectives set out in the University of Manitoba Goals and Objectives Document.

The year is designed to be flexible to accommodate the individual needs of residents. The intent is to provide background for the career path they are on.

The flexibility of the year means the structure may not be the same for all residents. In general all residents will experience the following:

Mandatory Clinical ICU Rotation

The remaining weeks to reach a minimum of 52 weeks ICU experience will be scheduled this year. Residents doing rotations with more than 30 total weeks of ICU experience will be expected to function at a senior level during this period. This will be facilitated by the supervising attendings.

The expectations are outlined in the rotation specific goals for each unit.

Additional Clinical Experience/ICU Rotations

This is a joint resident/RTC decision. If research is not anticipated to be a major future career path some residents might wish additional clinical rotations. The RTC can mandate additional ICU rotations if there are concerns about the overall progress of a resident.

Research or Quality Assurance Project

All residents starting their training after July 2001 must complete a project during the two-year residency. The project must be approved by the RTC. Time is provided in both first and second year to facilitate this activity. Research activities will be facilitated by Dr. Anand Kumar.

Project Time:

Up to 40 weeks may be devoted to completion of a project during this year if the resident has performed well on ICU rotations and the residency training committee believes that additional clinical rotations are not required.

The resident needs to communicate their plans and receive approval from the program. In the past, residents have worked on several different approved activities during this time depending on their future career goals:

• Research projects
• Quality improvement projects
• Educational projects including course work for Masters of Medical education

Vacation- Four Weeks as Outlined Above.

HSC MICU

This is a 15-bed closed unit in the tertiary care hospital which accepts major trauma and houses the bone marrow transplant, and lung transplant programs. The unit has moved into a newly constructed ICU in 2007. The unit is busy as beds often are in short supply in the region.

All requests outside of Winnipeg for Critical Care beds are primarily directed through the attending physicians in the tertiary Intensive Care Units. Most of this activity is co-coordinated by the Medical Intensive Care unit attending physician at the Health Sciences Centre. The Central Bed Registry identifies the status of all ICU beds in the Winnipeg region and facilitates the identification of available beds at any time of the day or night.

An independent Critical Care transport service has been established to provide safe and timely interfacility transport of critically ill patients to the most appropriate available ICU bed in the region during periods of intensive pressure on Critical Care beds.

Attending physicians actively triage and negotiate interfacility transfers of the most stable patients in tertiary Intensive Care units to community hospital ICUs in order to accommodate patients in urgent need of tertiary or quaternary care.

The rotation in the Medical Intensive Care Unit at HSC is designed to allow the resident to encounter patients with tertiary care medical problems requiring ICU admission.

Common problems encountered will include cardiorespiratory failure, immunocompromised patients, patients with hepatic failure, poisoning, post cardiac arrest patients, and patients with multiorgan system failure/dysfunction. Experience with these patients will enable the resident to develop the knowledge, skills, and attitude necessary to be a Critical Care physician as outlined in the “Goals and Objectives” document of the University of Manitoba program.

Residents will also encounter surgical patients as (in times of bed shortage in SICU) surgical patients will be admitted to the MICU and cared for by the MICU team.

The unit has full invasive monitoring capabilities, access to CRRT machines, invasive (including High Frequency Oscillation) and non invasive ventilation capability, IABP support, and ICP monitoring. There is a satellite pharmacy to support this unit.

Residents see consults from the hospital wards and the Emergency Department. Staff in this unit is responsible for responding to cardiac arrests within the HSC complex. On average one-four consults are received each day.

HSC SICU

This is an 12-bed semi-open unit in the tertiary care hospital which accepts major trauma and houses the bone marrow transplantation, and lung transplant programs. It too has recently moved into a newly constructed ICU in 2007.

The rotation in the Surgical Intensive Care Unit at Health Sciences is designed to allow the resident to encounter pre and post operative surgical patients and enable the resident to develop the knowledge, skills, and attitude necessary to be a Critical Care physician as outlined in the “Goals and Objectives” document of the University of Manitoba program. Specifically, those goals and objectives that deal with Surgical Intensive Care, neurosurgery, trauma, lung transplantation, and burns are to be considered during this rotation.

A large portion of the population in this unit is neurosurgical and neuro trauma patients. Multisystem trauma patients are also accommodated in SICU. Cardiac Surgery has been consolidated at St. Boniface Hospital effective January 15, 2007, but cardiac patients (primarily trauma patients who require cardiac surgery) can still be accommodated in this unit.

The unit has full invasive monitoring capabilities, access to CRRT machines, invasive and non invasive ventilation capability, IABP support, and ICP monitoring. The satellite pharmacy also supports this unit. The residents see consults from the hospital wards, recovery and operating rooms, and the Emergency Department.

At times the unit staff will care for more than 12 patients as ICU patients may be accommodated in the Recovery room when beds are in short supply. On average two-three consults are received each day.

St. Boniface Medical/Surgical ICU

This is a 10-bed unit in the non trauma tertiary care hospital in Winnipeg. There is potential for this unit to expand to 14 beds in the future. The unit moved into newly renovated space in 1998. The hospital is developing as the main clinical site for the WRHA Cardiac Sciences Program. Routine cardiac surgery has been consolidated at this site effective January 2007. Most of the invasive cardiology in the city is occurring at this site.

The rotation in the Med/Surg Intensive Care Unit at St. Boniface is designed to allow the resident to encounter a broad range of patients with tertiary care medical and surgical issues who require ICU admission, and enable the resident to develop the knowledge, skills, and attitude necessary to be a Critical Care physician as outlined in the “Goals and Objectives” document of the University of Manitoba program.

Common problems encountered include cardiorespiratory failure; post cardiac arrest patients; poisoning; septic, cardiogenic and hypovolemic shock; high-risk general and vascular surgery patients; high-risk patients from other surgical services (Obstetrics and Gynecology, Urology, Otolaryngology, and Plastic Surgery); and patients with multiorgan system failure/dysfunction.

Residents and attendings working in the Med/Surg ICU are also responsible for responding to Code Blue calls in the St. Boniface Hospital complex.

The unit has full invasive monitoring capabilities, access to CRRT machines, invasive (including HFO) and non invasive ventilation capability, and IABP support. The residents see consults from the hospital wards and the Emergency Department. At times the unit staff will care for more than 10 patients as MICU patients maybe accommodated in the Recovery room when beds are in short supply. On average two-four consults are received each day.

The St. Boniface site has implemented an electronic medical record including physician order entry.

St. Boniface Intensive Care Cardiac Sciences

This unit was created January 15, 2007. In March 2011, a new 10 bed unit was constructed in the St. Boniface Hospital complex. The unit is the major support for Cardiac Surgery in the WRHA. Current targets for Cardiac Surgery case volume are 1200 cases per year.

Three cardiac OR’s run most days with 25-30 cases targeted per week. The unit is unique in the Winnipeg system as there is an attending intensivist assigned to the unit and present in the hospital at all times. For continuity of patient care one intensivist is assigned for 58 hours per week (five ten hour day shifts Monday to Friday, and two four hour day shifts Saturday and Sunday). The remaining 110 hours in the week are covered by other intensivists working 14 hour night and 20 hour weekend shifts. As a result the unit is not dependent on house staff to provide clinical service. House staff rotating in this unit have an opportunity to work with cardiac anesthetists and get experience with TEE, and intraoperative management.

The unit has full invasive monitoring capabilities, access to CRRT machines, invasive (including HFO) and non invasive ventilation capability, and IABP support. Over the past two years an active mechanical cardiovascular support program has been established in the WRHA and ECMO and VAD patients are commonly resident in this unit. Medical staff in the unit are responsible for responding to Code Blue calls from the cardiac surgery inpatient ward and the Asper Centre.

FAQ’s

How much do I get paid?

	Level IV	Level V	Level VI	Level VII	Level VIII
Effective Date	PGY4	PGY5	PGY6	PGY7	PGY8
July 1, 2010	$66,409	$71,153	$75,898	$80,548	$86,838

There is also an on call stipend for EACH in house call as follows:

Date	Weekday	Weekend/holiday
July 1, 2010	$105.00	$120.00

In addition, residents in the program are paid a yearly stipend above and beyond the base salary. This is not deducted at source allowing residents to claim this income as “professional income” and deduct some expenses. This should be done with advice from a competent tax professional.

What is ‘Lifeflight?’

Life Flight is the Manitoba Provincial Air Ambulance Program. The plane is a Cessna Citation jet run by the Provincial government with high safety standards. Medical coverage is provided by Critical Care residents and Emergency physicians. Expansion to include rotor wing transport is currently underway.

Lifeflight is run and administered by the Manitoba Health & Healthy Living Emergency Services Branch. Life Flights shifts run from 8 a.m. - 8 a.m. the following day. Physicians covering the service become the ‘in-charge’ physician when they arrive to pick up the patient. This is an opportunity for autonomy and graded responsibility. Backup is provided by the intensivists in the unit the patient is destined for and from the medical director of the Air Ambulance (who is a practicing intensivist). Specific academic sessions on aeromedical transport are provided.

Residents are paid regardless of whether they fly or not. The catchment area is Manitoba, Northern Ontario and Northern Saskatchewan.

Shift reimbursement for Lifeflight is as follows:

- Adult, Pediatric and Obstetrics/Gynecology: $1,305.20

- Adult and Pediatrics only: $1,138.27

Internal medicine background residents receive funding for a PALS course to help make them more comfortable with pediatric transports. Advice/backup for pediatric calls can be obtained from the PICU attending on call. Pediatric issues will also be covered during academic day sessions.

On-Call Requirements.

There is a requirement to do in-house call during both years of the program. The requirement is 45 call equivalents during year one and 35 call equivalents during year two. A 17-hour (1600-0900h) shift is one call equivalent. A 24-hour shift (0900-0900h) is 1.5 call equivalents.

ICU program residents will generally do four-five calls per four week ICU rotation. They may do call in ICU during elective or research rotations. On occasion, the call shift for a Critical Care Program resident may be to provide direct in hospital back up for an inexperienced junior resident. These shifts count as a full call equivalent for the Critical Care Residents.

In return for providing this in hospital coverage the program has arranged an extra stipend in addition to their Resident salary. This is paid via the Winnipeg Regional Health Authority (WRHA). If a resident does more than 45 call equivalents in year one or 35 call equivalents in year two, they are additionally remunerated at the current Resident replacement rates established by the WRHA.

When assigned to an ICU the resident is excused from clinical duties after morning rounds if they were on call the night before. Resident duties must terminate within two hours of a 24-hour on call shift, including time for sign over and residents can do in-hospital call no more than seven times in a 28 day rotation.

How cold is it?

http://www.livingin-canada.com/climate-winnipeg.html

Supports the contention that it is a “dry cold”!

Mosquitoes?

http://www.virtualtourist.com/travel/North_America/Canada/Province_of_Manitoba/Winnipeg-902705/Warnings_or_Dangers-Winnipeg-Mosquitoes-BR-1.html

Don’t say we didn’t warn you! On the plus side you will be spending lots of time in the units…….

Lifestyle

Winnipeg is a friendly, multi-cultural city of approximately 700,000, situated in the centre of Canada. It is fairly laid back as a city with a friendly atmosphere, but has more culture than most of the large cities across Canada.

Winnipeg is home to the Royal Winnipeg Ballet, the Winnipeg Symphony Orchestra, Manitoba Opera, and many theatre companies, including Rainbow Stage and Manitoba Theatre Centre. We are also known for our variety of excellent restaurants, serving food from all parts of the world. The Winnipeg Blue Bombers, and the Winnipeg Goldeyes are ever popular for the sports fan. A new NHL team will begin their season in the MTS Centre downtown this year.

Summers in Winnipeg are filled with festivals, including the Folk Festival (which is outstanding!), the Jazz Festival, the Fringe Festive, and unique to Winnipeg, Folklorama.

As Winnipeg is in close proximity to numerous lakes, parks and beaches, there is no shortage of places to camp, fish and hike. The summers are sunny and very hot for the most part. This also makes ideal weather for many summer sports including ultimate Frisbee, football and running (through our numerous parks).

Winnipeg is also known for its cold winter months. The readily-available snow allows for a variety of winter sports and gives an ideal setting for the Festival du Voyageur. We are also home to many professional and amateur sports teams, including the Winnipeg Blue Bombers (football) and the, Winnipeg Goldeyes (baseball).

Finally, Winnipeg has an affordable cost of living in Canada. It is easy to find a very nice apartment within ten minutes of either hospital for a reasonable cost. Food, gas and car insurance are also quite a bit less expensive than other provinces, so your money goes further.