Curriculum – Clinical, Experiential, and Academic

5 Blocks – Tertiary Care Emergency Medicine

The EM blocks are set in Sudbury or Thunder Bay depending on your home base.  Each site is recognized as having some of the highest volumes and/or acuity in Ontario.  Both Health Sciences North and Thunder Bay Regional Health Sciences Centre are designated as two of the eleven recognized lead trauma hospitals in Ontario.   Rotational experiences include full scope adult and pediatric emergency medicine exposure.  These rotations are procedurally rich with few competing senior residents.  Longitudinal trauma team exposure is completed throughout the five blocks.  A significant exposure to and management of complex orthopedic and plastic surgery cases occurs longitudinally throughout these blocks.

Longitudinal Selectives may be accommodated throughout the EM experience to facilitate a niche educational experience.

In addition to the Trauma rotation (1 block), our residents participate in Trauma Team call, during Emergency rotations, to further enhance their exposure to traumatized patients.

Available Sites:
Health Sciences North
Thunder Bay Regional Health Sciences Centre

 

1 Block – Community or Rural Emergency Medicine

Available Community Locations:
Huntsville
North Bay
Sault Ste. Marie
Timmins

Available Rural Locations:
Espanola
Kenora
Sioux Lookout
Sturgeon Falls

 

1 Block – Anesthesia

This is a four week procedurally rich rotation with a focus on developing competence in simple and complicated airway management, central lines, peripheral IV’s and spinal access.  Objectives around acute management of the unstable patient, procedural sedation and troubleshooting.

Available Sites:
Health Sciences North
Thunder Bay Regional Health Sciences Centre

 

2 Blocks – Combined Intensive Care Unit / Cardiac Care Unit

Two blocks of ICU are completed to advance critical care patient management and procedures.  At Health Sciences North, time is spent in both ICU and the Cardiac Care Unit for post-op cardiac patients while in Thunder Bay all cardiac patients are looked after in the main ICU and a combined experience occurs throughout.

Available Sites:
Health Sciences North
Thunder Bay Regional Health Sciences Centre

 

1 Block – Selectives : Including Ortho & Plastics

Orthopedic surgery and plastic surgery, particularly hand injury exposure, are key aspects of emergency medicine and experiences in each of these areas are arranged during this block. Residents may recognize additional areas of training that they wish to supplement.

Two weeks of selective opportunities in the resident’s home site are available to choose from may include, thoracics, neurology, ophthalmology, and cardiology.

Orthopedic Surgery:
Time is spent in the Ambulatory Care Unit with the orthopedic surgeons and casting technicians fine-tuning sports medicine injuries and orthopedic fractures.

Available Sites:
Health Sciences North
Thunder Bay Regional Health Sciences Centre

Plastics Surgery:
Time is spent in the Ambulatory Care Unit with the plastics surgeons and casting technicians managing hand, burn and facial trauma patients.

Available Sites:
Health Sciences North
Thunder Bay Regional Health Sciences Centre

 

1 Block – Pediatric Emergency Medicine

Four weeks are experienced as a senior resident at one of two tertiary care hospitals in Ontario.  Opportunities include simulation teaching, pediatric procedures, and high volume pediatric emergency department presentations.

Available Sites:
Children’s Hospital of Eastern Ontario (Ottawa)
Sick Kids Hospital (Toronto)

 

1 Block – Trauma

A four week supplemental Trauma rotation in a high volume trauma service.  Experiences include increased penetrating trauma presentations and functioning as part of a multidisciplinary trauma team.

Available Sites:
Sunnybrook Hospital (Toronto)
St. Michael’s Hospital (Toronto)

 

1 Block – Elective

Residents choose their Elective rotation experience to meet their personal learning goals through discussion with the Program Director.
Longitudinal Selectives may also be available upon discussion with the Program Director.

Residents will take part in EMS land ambulance ride-outs, ORNGE air ride-out and/or base hospital physician shifts during their PGY3 year.  Opportunities in pre-hospital education and research and combination flight and rural rotations may be available.

Acknowledging the increased independence and resuscitative skills required of Northern and rural Emergency physicians, NOSM University provides funding towards an advanced resuscitation course, such as ATLS or PALS, to all NOSM U PGY3 FM-EM residents. These courses are often available at our teaching sites, particularly in Sudbury and Thunder Bay. Residents must have ACLS certification prior to starting their EM residency and if they have not completed ACLS prior to starting their residency should complete it in their first few months of training.

Residents are provided with regular written, formative feedback during rotations and on-call experiences. These assessments (of both clinical and academic performance) are compiled into oral and written summative evaluations at mid- and end-rotation. This allows residents maximal opportunities to improve their skills.  All residents are assigned a faculty advisor to review ongoing evaluations and optimize each resident’s learning outcomes. 

The NOSM University PGY3 FM-EM program kicks off with an intensive bootcamp involving high fidelity simulation and hands-on procedural skills workshops. The focus is on developing foundational skills for the EM year.   Throughout the year there are two more multi-day full group bootcamps involving simulation, teaching and common procedural skills as well as HALO procedural skills (such as U/S guided central line placement, canthotomy, etc. ).  These are also great team building opportunities as the residents are all together at one site.  

The NOSM University PGY3 FM-EM program is a national leader in POCUS training. The program recognizes the importance of POCUS integration into clinical practice in both tertiary and rural settings.  Dr. Steve Socransky, the creator of the EDE2 course is a core faculty member and is key in delivering this curriculum. EDE course training, tailored to previous experience, is provided at the beginning of the year to all the EM residents during the initial NOSM University EM Orientation days with acquisition of IP status over a multi day POCUS bootcamp.  A POCUS resuscitative training bootcamp also occurs during the year with the goal of obtaining full independent practitioner certification in POCUS with the Canadian Emergency Ultrasound Society (CEUS) by the end of the training year. If IP certification is obtained prior to entry then additional opportunities as instructor or higher training levels may be available.

Residents participate in a formative high fidelity Simulation Series throughout the year, in addition to three separate two-day simulation events during the year (Orientation and Unified Rounds x 2). During these sessions, residents have the opportunity to hone their skills in leadership, communication, resuscitation, teaching and teamwork in a supportive environment.  Residents also experience two simulation based assessment cases with direct, individualized feedback. There are also opportunities to learn how to deliver and teach simulation curriculum for undergraduate and postgraduate learners.

The residents have opportunities to interact with and teach off-service residents and medical students in “Residents as Teachers” teaching sessions.  Residents present at M&M Rounds and at Pan Northern Emergency Medicine Grand Rounds throughout the year.  

The PULSE (P.hysicians U.niversal L.eadership S.kills E.ducation) Survey is a “360°” educational tool that is a multisource feedback process meant to help individuals and departments gain awareness of how they are perceived by others in the workplace in order to foster more effective professionalism, interpersonal communication, leadership development, and teamwork. PGY3 FM-EM residents undertake this survey partway through their training year and results are reviewed with their Faculty Advisor to help them understand their perceived strengths and areas for improvement.

Academic teaching is provided in weekly half-day rounds. The year is divided into thirteen, four-week blocks, each with a specified theme (e.g. Acute Coronary Syndromes, Toxicology, Urology, Trauma, etc.). Each academic round is mapped to the priority topics and delivered in a case based, exam focused, small-group learning format. The emphasis is on advanced management skills and evidence-based practice. Residents participate in the PGY3 FM/EM Academic Half Day (AHD) on all rotations using online communications technology.

Practice oral exams occur longitudinally throughout the year with dedicated sessions including an introduction to the written and oral exam and multiple practices throughout the year beginning in the fall.  Written exams are delivered formally throughout the year and integrated into academic rounds.  Practice exams are also integrated into resident clinical experiences time permitting throughout the year.

Journal Club is held approximately once each block, to review developments in the EM literature and help develop critical appraisal skills and practice statistics calculations necessary for clinical practice and exam success.

Residents are expected to complete a small scholarly project during the year, for presentation at Research Day near the end of the academic year. Options include chart audits, surveys, practice guideline development or implementation, etc.. Educational and statistical support is provided for this endeavor.  With our excellent research tutors, several research projects have won national recognition at CAEP in recent years.

The hospitals have a variety of clinical and educational software, and the major information sources relevant to Emergency Medicine. Residents also have access to the Northern Ontario Health Information Network library system.