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Fellowship Information

Outline

Resuscitation medicine traces its roots back to the Mid-15th century, when Burhan-ud-din Kermani, an Iranian physician first described the process known today as Cardiopulmonary Resuscitation (CPR). Fast forward 500 years and resuscitation medicine today is a collection of ever changing complex algorithms and sophisticated technology capable of virtually keeping a person alive indefinitely. Whether in-hospital or out-of-hospital, emergency physicians often find themselves having to resuscitate critically ill medical, surgical and trauma patients in a variety of听environmental and clinical settings, often constrained by sub-optimal conditions and various limiting human factors. Moreover, with an ever increasing number of critically ill patients, prolonged ICU boarders, and increased expectations from the public, emergency physicians are increasingly tasked with providing a more complex and advanced level of care in the emergency department.

Background

Quebec is the largest province in Canada by area, and Montreal is the second most populous metropolitan area in Canada, with over 4 million residents, almost half the entire province's population, the Mcgill University Health Centre and its affiliated hospital Emergency Departments (ED) are some of the busiest in North America.

The fellowship will be based out of the 3 major tertiary and quaternary care centers affiliated with 平特五不中

1. The Montreal General Hospital (MGH), a designated Level I trauma center since 1997, responsible for providing care to over 2 million people (including the downtown Montreal), in addition to serving as the major referral site for significant regions of Northern Quebec. The MGHemergency department receives over 10,000 trauma victims per year (approximately 10% referred from outside institutions) and approximately 350 trauma team activations making it the busiest stand-alone trauma institution in Canada.
2. The Royal Victoria Hospital (RVH), a tertiary and quaternary academic center, houses one of the busiest emergency departments in Canada that receives well over 20,000 patients a year ranging from oncological, transplant, palliative, surgical, pediatrics and obstetric patients. The RVH along with the Montreal Children's Hospital are among only eight centers in Quebec that provide Adult Extracorporeal Membrane Oxygenation (ECMO) and transplant care.
3. The Jewish General Hospital (JGH), is the busiest emergency department in Quebec and serves one of the most diverse patient populations in Canada. Its emergency department receives more than 95,000 visits a year. Collectively, these sites employ highly trained and certified academic trauma/acute care surgeons, traumatologists, emergency medicine and acute care specialists.

The Program

The Postgraduate Fellowship in Resuscitation Medicine is a one year intensive, supervised clinical training program dedicated to enhancing the fellow鈥檚 approach and management of critically ill and injured patients as well as their resuscitative skills and knowledge.The program is open to qualified post-graduate trainees who have completed a post-graduate Royal College specialty program in Emergency Medicine or equivalent (having completed at least 4 years of formal Emergency Medicine training).

During their training, fellows will acquire an in-depth understanding of modern resuscitation science, a more detailed and structured approach to the management of critically ill and injured patients, as well as an expertise in crisis resource management.

Structure

This flexible one-year clinical fellowship includes a total of thirteen four-week blocks. During this time, the fellow will be exposed to direct clinical patient care activities, dedicated academic teaching and simulation activities.

• Clinical activities consist of a core of:
  • Four blocks of adult emergency medicine rotation (JGH/RVH/MGH/outside of 平特五不中 option).
  • Two blocks of trauma team leader (TTL) (MGH, outside of 平特五不中 option).
  • Three blocks of critical Care/Trans-Esophageal echo(TEE)/ECMO exposure (RVH/JGH, outside of 平特五不中 option)
  • Two blocks of cardiac critical care (CCU)/code blue team
  • The remaining two blocks can be taken as an elective and are tailored to the individual learner鈥檚 area of interest and needs and may include: additional blocks of critical care, trauma, toxicology, pediatric emergency medicine/ICU, pre-hospital care, advanced POCUS.
    
    Fellows must demonstrate flexibility in their scheduling. Fellows will be paired up with an Emergency Medicine staff during their adult emergency medicine block and will cover mainly high acuity/horizontal areas. Special attention will be taken during scheduling to prevent fellows and residents overlapping during shifts.
    
    Fellows will be expected to work sixteen, eight hour shifts during their adult emergency medicine rotation and will be expected to adhere to the different departmental scheduling while on their ICU, CCU, TTL and electives block.
• Academic activities consist of:
  • Journal club: No less than four sessions during the academic year. Journal clubs are aimed at critically appraising the latest literature on the science of resuscitation as well as encouraging the implementation of evidence based medicine in daily practice.
  • Simulation rounds: No less than ten sessions during the academic year. The simulation rounds focus on providing the fellows with an opportunity to practice their approach to the management of high acuity, low frequency clinical cases as well as providing a safe environment for the development of communication and interpersonal skills required for effective team functioning and optimal patient care. Fellows will be given the opportunity to take an active part in organizing and participating in simulation sessions organized by the Critical Care Department as well as the TTL program and the FRCP EM programs at the MUHC.
  • Technical skills: No less than three sessions throughout the year. These sessions will be focused on practicing and perfecting advanced resuscitation and diagnostic procedures including, but not limited to: Fiberoptic intubation, trans-esophageal echo, advanced POCUS, chest tubes, surgical airways, arterial lines insertion etc.
  • Resus core rounds: No less than fifteen sessions focusing on discussing key high yield resuscitation topics such as: principles of transfusion medicine, ventilator emergencies, ECMO, pediatrics resuscitation etc.

Academically, fellows will be expected to keep up to date with the latest literature surrounding resuscitation medicine, attend regular academic activities including journal clubs, simulation session, resus core rounds and technical skills. They will have the option to carry out at least one longitudinal research project or continuous quality improvement (CQI) project.

General Responsibilities

Resuscitation Medicine fellows will be expected to be actively involved in, coordinating, and leading resuscitation for the critically ill and injured patient. They will be expected to act as responsible and supportive team leaders in various critical clinical scenarios and to be directly involved in the teaching of residents and In In In addition, fellows will be expected to take an active part in one of the following committees: MUHC Code Blue committee, the 平特五不中 Department of Emergency Medicine Resuscitation committee, the MUHC Airway Management Committee or the Trauma Committees depending on their area of interest.

Clinical Assessment

• Emergency Medicine rotations:
  Fellows will receive daily informal constructive verbal feedback based on clinical performance during the shift from each staff member they will be working. Supervising staff will also be asked to fill an online daily assessment form which will be reviewed by the fellowship director at mid-way and the end of the rotation.
• During off-service rotations:
  Fellows will receive daily informal verbal assessment and constructive feedback from supervising staff members. A formal end of rotation online assessment form will be completed by the rotation supervising staff and submitted to the fellowship director for review.
• Progress assessment:
  The fellowship director will meet with the fellow every 3 months to assess general performance and progress as well as highlighting potential areas of improvement.
• Logbook:
  Fellows will be required to keep a logbook of clinical encounters and procedures performed which will be periodically reviewed to assess the fellow鈥檚 clinical exposure and skill acquisition.

Specific goals and objectives

Miscellaneous

Candidates must secure funding in order to apply for this Fellowship.