NOSM U PGY3 Family Medicine Enhanced Skills:

Self-Directed Hospital Medicine

Sault Area Hospital Department of Medicine

 

Overview

NOSM University offers a 6-month PGY3 Self-Directed residency in Hospital Medicine.  The program is in partnership with the Sault Area Hospital Department of Medicine and is part of the NOSM Family Medicine Enhanced Skills Program.

The Hospital Medicine Enhanced Skills program is for physicians who have completed training in Family Medicine and wish to acquire additional expertise and experience in managing complex medical inpatients. Learners will gain competencies in areas such as management of common acute medical conditions, health system navigation, quality improvement, patient safety, communication skills, and teamwork. Residents will work as a member of a clinical team that provides a full breath of longitudinal hospital-based care to medical patients.

Sault Ste. Marie, Ontario is located on the St. Mary’s River between Lake Huron and Lake Superior on the U.S. /Canadian border. The Sault has all the amenities of a regional urban centre, with both the Canadian wilderness and extraordinary vacation areas in Michigan just minutes away.  There is a strong cultural and arts basis in the community, and both winter and summer outdoor activities abound. The Sault has an excellent school system and offers a multitude of sports and artistic opportunities for children and adults alike.  Sault Ste. Marie is served by three Canadian airlines as well as one major U.S. airline.

Sault Area Hospital (SAH) is a new state-of-the-art facility recently opened in 2011. With Ministry of Health funding for 293 inpatient beds and 14 Intensivist led ICU beds, SAH provides emergency, primary, secondary, selected tertiary and long-term care healthcare services to the city and the District of Algoma with a catchment population of approximately 115,000.

Core Curriculum

The Hospital Medicine Enhanced Skills Program will adhere to the competencies as listed by CanMEDS-FM. Through the program, by means of rotations, learning sessions and mentorship, learners will be provided with the necessary skills in order to practice hospital medicine.

Clinical Training

The Hospital Medicine Enhanced Skills program offers 24 weeks of training, including orientation and rotations in the following areas:

• Hospitalist Medicine  – 8 weeks with the inpatient hospitalist medicine team

• General Internal Medicine (GIM) – 8 weeks with the GIM team including the GIM unit (GIMU), Emergency Department Medical Consultative (EDMC) and outpatient GIM clinics

• Internal Medicine Subspecialty Selectives – (including Cardiology, Critical Care, Dermatology, Gastroenterology, Hematology, Infectious Diseases, Nephrology, Respirology) – 8 weeks of selective as chosen by the learner based on available

Didactic Learning

Academic rounds participation during rotations include:

• Internal Medicine Grand Rounds – monthly

• Internal Medicine Learning Rounds – 1-2 times per week

• Infectious Diseases Rounds – monthly

• Journal Club – monthly

• SIM lab – monthly

Academic opportunities:

Trainees are expected and encouraged to participate in mentorship and clinical teaching with undergraduate medical students and junior medical residents on service.

Trainees also have the option of engaging in the following academic activities with local mentorship:

• Research

• Quality Improvement

• Medical leadership

 

Evaluation

• Evaluation Reports provide summative feedback during each block rotation.

• Field notes are provided multiple times during the block for in the moment feedback.

• Academic work including teaching sessions prepared by the trainee will also be evaluated and feedback provided to the learner by department members.

• The learner will be able to provide site specific and program feedback through a formal evaluation survey.

 

Remuneration, Vacation, Leave

• This will be followed as laid out as per the NOSM U Family Medicine PGY3 ES program

NOSM U PGY3 Family Medicine Enhanced Skills:

Self-Directed Chronic Pain

Important Information

NOSM University offers one 3-6 month PGY3 residency in Chronic Pain Management. The program is offered under the Enhanced Skills in Family Medicine program. This program is a first of its kind residency offered in Northern Ontario to prepare family physicians to work in a focused care of chronic pain practice. This program prepares physicians to provide care in an underserviced population that constitutes a significant portion of many family medicine practices. It also prepares residents to bring into the community the skills to care for chronic pain patients outside large tertiary care centres where there are often few specialty supports. Pain medicine is an area of medicine that is undergoing rapid advancement, and this is an innovative opportunity for residents to be a part of the positive changes and supports being developed for people living with chronic pain. Physicians will acquire the knowledge and skills necessary to assess and manage pain issues such as neuropathic pain, headaches, musculoskeletal issues including back pain, widespread pain syndromes including fibromyalgia, and pelvic pain.

The NOSM U Family Medicine Enhanced Skills Programs are fully accredited by the College of Family Physicians of Canada. Residents in the Chronic Pain Management program will work in an interdisciplinary setting throughout their training predominantly in Thunder Bay, with the option for targeted specialty rotations in other communities of the resident’s choice based on priority learning objectives identified and subject to approval by the program director.

Program Highlights

The PGY3 Family Medicine Chronic Pain Management enhanced skills program is a groundbreaking training experience for residents who wish to enter practice with a strong skill set to support their patients living with chronic pain. Mentorship begins prior to program start, working with the program director to create a curriculum that is driven by the resident’s career goals.

Competencies of this program centre around advanced medical management of a wide variety of chronic pain conditions such as fibromyalgia, headaches, back pain, pelvic pain, and others with opportunity to practice detailed assessment and physical examinations. The learner will have opportunity to expand knowledge on pharmacological management of pain, including best practices for management of neuropathic pain, opioid stewardship, and management of comorbid conditions including mental health issues. There is opportunity to learn procedural skills in trigger point injections, ultrasound-guided joint injections and simple nerve blocks if desired, along with how to appropriately identify appropriate patients for interventional pain care. Observation of advanced interventional pain procedures if desired will allow learners to understand indications for procedures and how to counsel patients. Exposure to allied health professionals in the chronic pain program will build knowledge on how to appropriately engage interprofessional approaches to chronic pain care.

NOSM University has a core value of social accountability. To provide for the unique needs of specific subsets of chronic pain patients, learners expressing interest in advancing expertise in a subspecialty will have the opportunity with optional elective rotations. Examples could include rotations at a pediatric pain clinic, pelvic pain programs, headache clinic, or the Ehlers Danlos clinic.

 

Additional highlights include:

• Early integration as a key member of an interdisciplinary health care team dedicated to professionalism, high quality patient care and excellent medical education

• Financial support for resident travel to and from core clinical placements away from the home-base and all mandatory education activities at non home-base locations

• Housing supports for core rotations away from home-base

• Funding available for research, professional development and conference participation

• Access to advanced technology and informatics that allows 24/7 access to electronic search engines, and electronic indexes, as well as an extensive collection of electronic medical/health journals and textbooks

• Exceptional lifestyle balance with a wide variety of outstanding Northern Ontario recreational opportunities, and work-life balance with no call shifts or weekends

Program Curriculum

This program is a minimum of 3 months, with an option for up to 6 months duration.

Training occurs in a horizontal fashion, with a typical week at the pain clinic consisting of:

• About 10 new patient consultations, either as an observer or supervised by a preceptor

• 20-30 follow-up visits

• Attendance at the interdisciplinary group teaching sessions for patients and possible involvement as a facilitator later in the program

• Half day observations required with each of the allied health members of the team throughout the program include, but are not limited, to psychology, physiotherapy, occupational therapy, nursing will be scheduled

• Injection clinics once weekly with opportunity to practice skills in trigger point injections, ultrasound-guided joint injections, and simple nerve blocks

• Optional training in onabotulinum toxin A treatment of chronic migraines

• Observation of advanced interventional pain procedures one half day every second week

• Optional exposure to nerve conduction studies/electromyography

• Weekly one-on-one lecture with preceptors on core knowledge topics of neuropathic pain, opioid stewardship, approach to back pain, approach to headache, approach to pelvic pain, approach to fibromyalgia, approach to pediatric pain care, management of comorbid mental health issues, and others

• Exposure to pain care across the lifespan, with involvement in the pediatric pain program, care of adults, care of the elderly, and auxiliary support to the palliative care service

• Optional longitudinal FM component based on learner career goals

There is no on-call requirement during the program, with rare exception of consultation requests on an urgent basis requested for inpatient admissions for acute on chronic pain crises or cancer pain consultations.

There is no required scholarly activity during the program, but residents are encouraged to consider supporting active ongoing research projects underway at the pain clinic. Residents interested in research in chronic pain can discuss their goals with the program director and will be supported in doing so as feasible.

Residents are expected to participate in monthly Pain Rounds for lectures on developments and advancements in Pain Medicine and will be required at minimum to provide 2 lectures on approved pain topics during a 3-month period of the progra

It is the expectation of the Enhanced Skills PGY3 programs at NOSM University that residents’ learning objectives can reasonably be completed in Northern Ontario, clinical rotations will be undertaken in Northern Ontario. If however, it is felt that there is insufficient patient volume to ensure development of a specific skill, or lack of sufficient specialty preceptor numbers in the North, residents can undertake their learning in other Ontario centers. In most instances, residents are expected to find, confirm and schedule their own rotations outside of Northern Ontario.

To be eligible for NOSM U’s Enhanced Skills Programs candidates must be either:

• Currently enrolled as a PGY2 in a Canadian Family Medicine Residency Program at the time of application. Residents must start their PGY3 within 12 months of completing their PGY2 year.

• *A physician currently practising in Canada (for a minimum of 12 consecutive months) who meets program funding eligibility requirements according to the Ministry of Health and Long-Term Care (MOHLTC).

*Note: Practising physicians interested in taking the program must apply separately through the MOHLTC Re-Entry Program. Additional information about the Re-Entry Program and application requirements are available on the MOHLTC Central Forms Repository.

Enhanced Skills Exam Policy for Entry

Postgraduate training appointment/entry into the NOSM U PGY3 Family Medicine Enhanced Skills program is conditional upon the candidate’s successful completion of the Family Medicine Certification Exam (CFPC exam). As such, NOSM U holds the right to terminate a candidate’s postgraduate training appointment and release them from any existing contracts/obligations to the program, should this requirement not be met by the anticipated training start date.

Preference will be given to those residents with a demonstrated interest in northern or rural practice, seeking four or more months of training. In addition, residents able to describe how the Enhanced Skills training they are seeking will meet a specific community need will be given preference.

Application opening date: July 30, 2024
Application closing date: September 9, 2024
Interview period: Starting October 11, 2024
Offer letters: December 11, 2024
Resident Responds By: January 10, 2025

A complete application should be submitted online and consist of:

• Personal letter
  • State the reasons for applying to the self-directed program and how these skills will benefit your career and the community where you plan to practice.
  • Outline your personal learning objectives and what experiences you will need to achieve them
  • How you will assess your learning and progress by incorporating critical self-reflection in your learning plan
• Updated Curriculum Vitae
• Preferred start date and schedule including rotation, preceptor, and community preferences
• Completed Program Director Reference Questionnaire from current residency program
• Two letters of reference from clinical supervisors

Apply Online Opens on July 30, 2024

Dr. Fred Sarrazin
Self-Directed Enhanced Skills Program Director

Melanie Pilon
Program Coordinator
PGY3 Enhanced Skills Programs
NOSM University – Sudbury
Sudbury ON P3E 2C6
Tel:  705-662-7247
Email:  mpilon@nosm.ca