DISCIPLINE OF FAMILY MEDICINE ANNUAL REPORT

Transcription

1 DISCIPLINE OF FAMILY MEDICINE ANNUAL REPORT

2 1 Discipline of Family Medicine Annual Report Contents Mission Statement Message from the Chair Faculty News Faculty Appointment Activity Geographic Full-Time Faculty Appointments Part Time Faculty Appointments Education Undergraduate Postgraduate NorFam Enhanced Skills in Emergency Medicine PERRT Faculty Development Health (Clinical Update) Discovery Family Medicine Unit (HSC) Ross Family Medicine Clinic Shea Heights Community Health Centre Torbay Road Family Medicine Clinic Port aux Basques Primary Healthcare Research Unit (PHRU) Publications Research Grants Contact Information Back Cover

3 Discipline of Family Medicine Annual Report Mission Statement Our mission is to enhance the health of the people of Newfoundland and Labrador by educating physicians and health researchers; promoting lifelong learning; conducting research in biomedical, clinical and applied health sciences, community health, and medical humanities; engaging communities and decision makers; and collaborating to apply the best available evidence in the formulation of policy and the organization and delivery of care.

4 3 Discipline of Family Medicine Annual Report Message from the Chair ADMINISTRATIVE COORDINATOR: ADMINISTRATIVE ASSISTANT: LUANNE AGRIESTI-CLEARY SONYA MCLEOD DR. WANDA PARSONS INTERIM CHAIR Welcome to the annual report of the Discipline of Family Medicine for The Discipline of Family Medicine has had some exciting growth over the past year. In keeping with recommendations from the Future of Medical Education in Canada Postgraduate Project (FMEC PG), we continue to offer experiences in a variety of learning environments to foster social accountability in residents and help them in their choice of future practice. There has been exciting progress in implementing and evaluating the Triple C curriculum which is competency based, learner-focused education to meet the diverse learning needs of residents and the evolving healthcare needs of Canadians as recommended by FMEC PG. Beginning in 2011 the Program of Enhanced Rural and Remote Training (PERRT) provided a select number of residents with the opportunity to gain enhanced rural and remote experience. A new academic teaching site began in Port aux Basques to allow residents to complete their academic family medicine rotation in a rural location. The Primary Healthcare Research Unit (PHRU) has elevated research in the Discipline to a whole new level and continues to expand and deliver quality, funded research. We have opened a new academic teaching clinic in St. John s on Torbay Road which gives extra capacity for training medical students and family medicine residents. We have expanded our community based option sites in the St. John s region to accommodate the second year academic family medicine rotation. The annual Fall Medical Education Forum continues to grow and provide quality faculty development for our entire faculty members who are distributed throughout Newfoundland and Labrador, New Brunswick, Prince Edward Island and the Yukon. The faculty continues to have a major involvement in undergraduate education. Several of our faculty members hold leadership positions within the Faculty of Medicine: Dr. James Rourke, Dean of Medicine Dr. Scott Moffatt, Assistant Dean for Student Affairs Dr. Mohamed Ravalia, Assistant Dean for Rural Medical Education Network (RMEN) Dr. Wanda Parsons, Assistant Dean for Admissions Dr. Pamela Snow, Academic Director (Family Medicine), Professional Development and Conferencing Services (PDCS) Dr. Marshall Godwin, Director of the Primary Healthcare Research Unit (PHRU) Dr. Gerard Farrell, Director of e-health

5 Discipline of Family Medicine Annual Report Our faculty members are involved in a variety of committees, both locally and nationally, some of which include: Admissions Committee Accreditation Committee Aboriginal Health Initiative Curriculum Committees Medical Practice Associates Promotion and Tenure Committee Provincially: Newfoundland and Labrador Medical Association Newfoundland and Labrador Chapter of College of Family Physicians of Canada Provincial Wellness Committees Medical Research Foundation Newfoundland and Labrador Centre for Applied Health Research Nationally: Canadian Pediatric Society College of Family Physicians of Canada Examination Committee Medical Council of Canada Examination Committee Advanced Life Support in Obstetrics National Advisory Committee College of Family Physicians of Canada Faculty Development College of Family Physicians of Canada Triple C Curriculum Committee Association of Faculties of Medicine of Canada Canadian Association for Medical Education With the expansion of the Medical School class, new Medical School building, and the new curriculum in 2013, we look forward to our continued involvement in this exciting new chapter of undergraduate and postgraduate education in the Faculty of Medicine. As well, we look forward to welcoming a new Chair of Family Medicine, Dr. Cathy MacLean, in Respectfully submitted, Wanda Parsons, MD, FCFP Interim Chair of Family Medicine Associate Professor of Family Medicine Assistant Dean for Admissions

6 5 Discipline of Family Medicine Annual Report PROMOTIONS The following faculty members have been promoted effective September 1, 2012: Dr. Pauline Duke Dr. Wendy Graham Dr. Pamela Snow Promoted to Full Professor Promoted to Associate Professor Promoted to Associate Professor TENURE The following faculty member was granted tenure effective September 1, 2012: Dr. Greg Brown Dr. Brown is program director for the third year enhanced skills program in Emergency Medicine (CCFP-EM). ACCOLADES The following faculty members have received distinguished honors and awards through the College of Family Physicians of Canada this year: Dr. Stephen Darcy Dr. Pauline Duke Dr. Marshall Godwin Dr. Danielle O Keefe Awarded a Janus Research Grant Awarded the Geeta Gupta Equity and Diversity Award Awarded Family Medicine Researcher of the Year Awarded the D.M. Robb Research Grant NEW FACULTY We have welcomed the following new faculty members: Dr. Susan Avery Dr. John Campbell Dr. Stephen Lee Dr. Danielle O Keefe Dr. Saeed Samet Dr. Avery does GP Obstetrics and practices at Shea Heights Community Health Centre. Dr. Campbell is Site Lead for PERRT and practices in Grand Fall-Windsor. Dr. Lee is unit director and practices at the Torbay Road clinic in St., John s. Dr. O Keefe is postgraduate program director and practices at the Torbay Road clinic in St. John s. Dr. Samet is a non-clinical faculty member working as an Assistant Professor of Health Informatics in the ehealth Research Unit.

7 Discipline of Family Medicine Annual Report GEOGRAPHIC FULL-TIME FACULTY Professors Associate Professors Assistant Professors Bethune, Cheri Duke, Pauline Godwin, Marshall Jong, Michael (Goose Bay) Rourke, James Butler, Roger Eaton, Bill Farrell, Gerard Graham, Wendy (Port aux Basques) MacDonald, Susan Miller, Robert Moffatt, Scott O Maonaigh, Conleth Parsons, Ean Parsons, Wanda Ravalia, Mohamed (Twillingate) Rourke, Leslie Snow, Pamela Tarrant, Gary Asghari, Shabnam Aubrey, Kris Avery, Susan Broderick, Vina Brown, Greg Campbell, John (Grand Falls-Windsor) Duggan, Norah Flynn, Heather Lee, Stephen Morgan, David O Keefe, Danielle Samet, Saeed Sherman, Greg Stringer, Katherine Photo by Luanne Agriesti-Cleary L-R: Dr. Bill Eaton, Dr. Roger Butler, Dr. Wanda Parsons, Dr. Pam Snow

8 7 Discipline of Family Medicine Annual Report PART-TIME FACULTY Arnold s Cove Fowlow, Geoffrey Baie Verte De Wet, Francois Osborne, Perry Bay Bulls McCarthy, Annette McCarthy, Rod Bell Island Aziz, Mohammed Laurie, Alexa Bonavista Allister, Paul Bonne Bay Bowen, Jim Botwood Barnes, Peter Woolfrey, Jody Burin Mayo, Ed Moulton, William Carbonear Becker, Regina Patey, Christopher Centreville Cutler, Michael Clarenville Brentnall, David Crewe, Harold O Reilly, Alan Pearce, Blaine Pye, Paula Salomon, Paul Van Der Linde, Etienne Corner Brook Callahan, Peter Canete, Yuri Dunn, Desiree Griffin, Tim Hayes, Megan Healey, Chris Lafferty, Kathleen Lemire, Francine (CFPC) O Driscoll, Robert Rashleigh, Dennis Smallwood, Erin Sparrow, Carl Deer Lake Kielty, John Emergency Eastern Health Angel, Melissa Angus, Karen Barter, Richard Battcock, Natalie Bobby, Rebecca Bugden, Gena Goodall, Chris Heyn, Sujiva Humes, Trevor Mack, Martin Major, Stephen Mathieson, Sarah Metcalfe, Brian Murphy, Kathleen Parsons, Michael Picco, Bridget Pollock, Cheryl Rector, Tara Rogers, Lori Rogers, Peter Sheppard, Gillian Smith, Andrew Wilson, Scott Gambo Kamel, Emad Gander Casey, Carmel St. Croix, Eileen Tiller, Shawn Goose Bay Daraei, Nemat Fitzgerald, Charlene Forsey, Robert Horwood, Karen Karaivanov, Yordan Morris, Alison Ophel, Judy Wilson, Margo Woollam, Gabe Grand Falls-Windsor Bautista, Elizabeth Butler, Jared Campbell, Susan Combden, Steven Higgins, Gina King, Jim Locke, Tony Powell, Lynette Ralph, Samuel Short, Keith Sullivan, Shelley Harbour Grace Button, Lonzel Iqaluit Breen, Katherine Cole, Madeleine Gaba, Priya Greene, Treena Kraft, Claudia Macdonald, Alexander (Sandy) Labrador City Costello, Tom Manuels Bannister, Elizabeth Jardine, Fred Verge, Jackie Marystown Power, Lyn

9 Discipline of Family Medicine Annual Report PART-TIME FACULTY Mount Pearl Halley, Kathleen Hatcher, Lydia Rideout, Gary Rossiter, Andrew Young, Michelle MUN Counseling Centre (Cross-Appointments) Doyle, Michael Hurley, George MUN School of Pharmacy (Cross-Appointments) Bishop, Lisa Davis, Erin Dillon, Carla Gamble, John Michael Law, Rebecca MUN Student Health Lee, Norman New Brunswick Atkinson, Paul Bell, David Black, Donald Blagrave, David Boulay, Robert Burton, Corey Canty, Andrea Carlos, Mary Ann Carson, Beth Chatur, Hanif Clark, Gregory Collings, James Comeau, Laurel Craig, Brian Davis, Christine Desousa, Natasha Dufour, Karlyne Fellows, Joanne Fisher, Robert Goodine, Rose Anne Grabove, Matthew Griffin, Ginette Hall, Jennifer Hall-Losier, Suzanne Hannigan, Jay Hannigan, Jennifer Hans, Jeff Hollway, Gordon Hudson, Carl Jansen, Ann Keating, Paula Keith, Kathleen Keyes, Paul Lohoar, Andrew MacCallum, Margaret MacDonald, Gerald MacNeil, Michael Graham Mah, Eugene Martin, Bill Middleton, Joanna Mutrie, William O Brien, Christopher O Leary, Debi O Neill, Brian Perley, Michael Pishe, Tushar Postuma, Paul Power, Alison Roberts, Suzanne Ross, Peter Silver, Karen Simon, Michael Sohn, Melanie Spencer, Perry Stevenson, Robert Stocek, Rudy Sutherland, Lisa Telfer, Christine Vaillencourt, Chris Verheul, Glen Way, Todd Wilson, Keith Young, Neil Zigante, Nina New World Island Hewitt, Daniel Nova Scotia Harrop, Verle (Adjunct) Howlett, Michael MacLeod, Susan Paradise White, Jeff Placentia Jamil, Fawaz Mangat, Birender Port aux Basques Butler, Matthew Taor, Richard Thomas, David Port Saunders Irfan, Mohamed Springdale Frank, Hicks Young, Todd St. Anthony O'Keefe, Mary (Trudy) Penney, Catherine St. John s Aubrey-Bassler, Christine Bennett, Erin Brown Brake, Sonya Cahill, Denise (NP) Callahan-Dyer, Deborah Colbourne, Danielle Crocker, Percy Darcy, Stephen Dawson, Collette Doulton, Bruce Elliot, Jacqueline Fardy, Noreen Goodridge, Maria Grandy, Barbara Hall, Thomas Higgins, Gordon Hollett, Bruce Howell, Oscar Joller, Petra Kieley, Lisa King, Susan Lake, Karen Matthews, Angela McCarthy, Jason McKim, Aaron O Dea, Marie O Shea, Patrick Oldford, Jim (Social Work) Parsons, Jillian

10 9 Discipline of Family Medicine Annual Report PART-TIME FACULTY St. John s Continued Patel, Kirit Pendergast, Amanda Penton, Mercedes Pike-Au, Krysta Ploughman, Michelle (Postdoc Fellow) Pushpanathan, Anita Ramjattan, Brian Rideout, Greg Robbins, Megan Saunders, Katie Scott, Amanda Seviour, Rosann Sinnott-Drover, Alison Skirving, Paul Smith, Anna Squires, Tina Tilley, Joy Tobin, Cheryl Walsh, Paula Woodland, Heather Woodland, Robert Young, Wade Stephenville McComiskey, Alan Mercer, Greg Torbay Collis, Ernest (Sonny) Twillingate Hunt, Andrew Newman, Colin White, Craig Woodman, Margie

11 Discipline of Family Medicine Annual Report EDUCATION UNDERGRADUATE PROGRAM DIRECTOR: ACADEMIC PROGRAM ADMINISTRATOR: SECRETARY: ACADEMIC PROGRAM ASSISTANT: DR. SCOTT MOFFATT PATRICIA PENTON MICHELLE HOLLOWAY MELISSA OLIVER The Discipline of Family Medicine has extensive involvement in undergraduate teaching in the Faculty of Medicine at Memorial University of Newfoundland. The teachers include both GFT and part-time faculty members who practice in a variety of settings. Family Medicine undergraduate teaching occurs throughout the four years of medical training, both in the formal and informal curriculum. It seeks to educate medical students in the Discipline of Family Medicine and promote generalism within the undergraduate experience. Year One Drs. Pauline Duke and Vina Broderick coordinate first year clinical skills and family medicine faculty members teach these sessions which occur weekly throughout the year. The First Year Rural Visit organized by Community Medicine and supported by Family Medicine, is a two-week course in community medicine during which all students spend two weeks in a rural community, focusing on the clinical objectives of advancing basic clinical skills, enhancing communication skills, and recognizing the unique characteristics of communitybased family medicine with its integrated use of resources in meeting the health needs of the population. Year Two The Black Bag is a course incorporated into Clinical Skills, in which second year students spend two weeks with a family doctor practicing clinical skills and seeing medicine in a community context. Sixty-seven students completed the second year Black Bag rotation from May 28 June 8, 2012: NL 54 (21 urban/33 rural), NB 10, PEI 3. A faculty development session is organized for preceptors (via teleconference or e-live) to prepare them for the overall experience and educate them on the updated workbook, evaluation and use of One45. Objectives and evaluation for both the Black Bag and Clerkship courses have been rewritten in the CanMEDS format. Family Medicine faculty members are also involved in clinical skills teaching in Year 2 as well as teaching in Integrated Study of Disease including Anatomy, Women s Health, Geriatrics and Palliative Care. Year Three (Clerkship) Family Medicine coordinates the eight-week core rotation in Rural Family Medicine in the clerkship and has the responsibility to develop the clinical sites, plan the curriculum, develop and implement faculty development for the rural preceptors, and do the ongoing evaluation both of the sites, preceptors and ultimately the students. Seventy-one clerks completed the eight-week rural family medicine rotation: NL - 57, NB 10 and PEI 4. As part of this, our GFT faculty members facilitate an undergraduate academic half day every Thursday morning. The academic half day session for clerkship has been expanded to

12 11 Discipline of Family Medicine Annual Report include eight topics. Accommodation has been made for the five core New Brunswick students to fully participate in these sessions. Weekly field notes are now required from all clerks. Fridays with Family Fridays with Family is a weekly, informal lunchtime session where different family physicians speak to the medical students about their own practices and roles in their communities. Many highlight their experiences working in rural communities around the Province. As well, some presenters discuss specialized interests within family medicine, such as Obstetrics and Emergency Medicine and the educational paths students would need to take to get there. Twenty sessions were held last year. Five sessions were facilitated by non-faculty presenters (community, rural, and out-of-province). Family Medicine Information Night This is an annual information session organized by family medicine which provides information to students interested in Family Medicine. This was held in November 2011 and covered nine topics and included sixteen presenters, including two from out-of-province. A similar session was held on November 19, Electives Request for urban electives, both MUN and visiting, are facilitated through the office while rural requests go through RMEN (rural APA s). Ten requests were received from MUN clerks - six were accommodated, two were not and two withdrew. Fiftyone requests were received from visiting students 31 were accommodated, 12 were not and 8 withdrew. Research Research projects are ongoing with the involvement of MESC. The first compares the previous four-week rotation to the new eight-week clerkship rotation (on hold until 2013). The second study is evaluating the academic half-day sessions which are unique in that they are facilitated through ELive (Dr. Duggan has taken the lead during her sabbatical). Goals With Medical School expansion to 80 students in 2013 and the introduction of a new undergraduate curriculum in 2013, the Discipline will: Coordinate the increased involvement of faculty members (GFT and part time) into the small group learning environment Cultivate the development of additional sites to meet the needs of the expanding program Continue to implement CanMEDS format for evaluations Conduct site visits Continue to foster interest in Family Medicine as a career

13 Discipline of Family Medicine Annual Report POSTGRADUATE PROGRAM PROGRAM DIRECTOR: ACADEMIC PROGRAM ADMINISTRATOR: INTERMEDIATE SECRETARY (SCHEDULING): SECRETARY (CORE CONTENT): SECRETARY (PROGRAM): RECEPTIONIST: DR. DANIELLE O KEEFE SUSAN CARTER BARBARA WALKER STACY HICKS PAM MURRAY STACEY MERCER The Family Medicine residency program at Memorial trains residents for urban, rural and remote practice. Over the two-year residency, residents train at sites throughout Newfoundland and Labrador, New Brunswick and Nunavut. The following is a list of Academic Family Medicine (Community Based Option) teaching sites for second year academic family medicine: Airport Heights Bay Bulls Cabot Square Medical Clinic Churchill Square Medical Clinic Complete Medical Clinic Eleven Elizabeth Avenue Major s Path Paradise Torbay Medical Clinic Wellness Clinic Rural Family Medicine teaching sites include: Baie Verte Botwood Burin Clarenville Corner Brook Gander Goose Bay Grand Falls-Winsor New Harbor Port aux Basques Placentia Twillingate Springdale

14 13 Discipline of Family Medicine Annual Report Other teaching sites include: St. Clare s Mercy Hospital Health Sciences Centre Janeway Child Health Centre L.A. Miller Centre Waterford Hospital Shea Heights Torbay Road Medical Clinic Ross Centre Outside Province teaching sites include: Nunavut (based in Iqaluit but also visit satellite communities) Fredericton, New Brunswick Miramichi, New Brunswick Waterville, New Brunswick Residency Training/Triple C/Competency Based Training Thirty-three residents were accepted into the program for the year and by 2015 the program will expand to welcome 40 residents into the first year of the residency program. In anticipation of this increase, the program is working with the various teaching sites to ensure that we have the capacity to meet this increase. The new model for Family Medicine training in Canada is to structure the curriculum to reflect a Triple C curriculum. (Triple C: Centered in Family Medicine, Continuity of Care, Comprehensive). As a result, the program has developed a number of longitudinal experiences that provide the resident with the opportunity to train under this model. To date we have been successful in developing these experiences at the Ross Family Medicine Clinic in St. John s and in Family Medicine clinics in Burin, Grand Falls, Twillingate, Corner Brook and Port aux Basques. Over the next year this training will be available in Gander, Botwood and Springdale. The NorFam program has been teaching residents under this model of training for years. The College of Family Physicians of Canada is also changing how residents progress through residency. Progression is to be based on gaining competence, as opposed to being based on a block rotation over a period of time. Our program is working to incorporate this change to competency- based assessments into our curriculum. Site Visits The Family Medicine program conducts visits to all sites where our residents train. These visits provide the opportunity to meet with the local preceptor and resident, and in addition to reviewing resident progress and any issues or concerns, give us the opportunity to provide updates and to inform preceptors of changes to the residency program. Over this past year, all sites in Newfoundland, with the exception of Goose Bay, were visited and site visits to Nunavut were conducted twice. These visits were beneficial for the reasons noted above. Over the coming year, we hope to travel to Goose Bay and to the training sites in New Brunswick.

15 Discipline of Family Medicine Annual Report Goals Over the coming year the program will: Continue to foster the PERRT experiences while working to expand Triple C opportunities Foster the development of additional sites to meet the needs of the expanding program Continue to move towards a competency based curriculum Conduct site visits Northern Family Medicine (NorFam) PROGRAM DIRECTOR: ADMINISTRATIVE ASSISTANT: DR. ROBERT FORSEY JOANNE KAVANAGH The Northern Family Medicine (NorFam) education experience was established in 1991 in Happy Valley-Goose Bay, Labrador as an integral component of the Family Medicine Residency program at Memorial University of Newfoundland. It is an eightmonth, longitudinal experience for six second year residents per academic year, offering an ideal combination of rural, remote and academic Family Medicine. There is one GFT faculty member, Dr. Michael Jong, in the NorFam program and nine part-time faculty members including the Program Director, Dr. Robert Forsey. This program has been very successful and enables residents to become competent, rural physicians and encourages them to choose rural, remote practice. Unique Experiences Continuous, comprehensive care from birth to end of life in a variety of settings from Emergency room and inpatient ward to patient s home. Learning of indigenous health is experiential through immersion. Each resident provides, with backup, visiting clinic service and telephone/videoconference support to a coastal community. Residents are actively involved in mentoring medical students. Medevacs - Air transportation of acutely ill patients from coastal Labrador to the Health Centre in Goose Bay or from Goose Bay to another referral centre. Acute and critical care - residents learn through simulations and clinical experience. Family Medicine Residents 2012

16 15 Discipline of Family Medicine Annual Report Enhanced Skills in Emergency Medicine (CCFP-EM) PROGRAM DIRECTOR: PROGRAM COORDINATOR: DR. GREG BROWN PATRICIA PENTON Family Medicine offers residents a third year of enhanced skills in Emergency Medicine. This is a one-year program designed to provide physicians with the complex skills set necessary to practice Emergency Medicine. Applicants must be enrolled in an accredited Family Medicine Residency Training Program in Canada or be in practice and hold certification with the College of Family Physicians of Canada or be eligible to sit the CCFP exam. Program Objectives Provide a formal teaching setting to prepare trainees to successfully sit the CCFP examination in Emergency Medicine. Train physicians to the high level of competence and confidence necessary for practice in rural or remote communities. Provide trainees with a broadly developed skill set appropriate to their chosen practice. Enable the emergency physician to take a leading role in the administration of emergency services in the community. Program Training Sites St. John s Anesthesia & Rural Emergency Medicine (Grand Falls-Windsor, NL) Pediatric Emergency (Ontario) EM Residents 2012 PROJECT FOR THE ENHANCEMENT OF RURAL AND REMOTE TRAINING (PERRT) PROGRAM LEAD: PROJECT MANAGER: ACADEMIC PROGRAM ADMINISTRATOR: SITE LEAD, GRAND FALL-WINDSOR: ACADEMIC LEAD, GRAND FALLS-WINDSOR: SITE LEAD, BURIN: ACADEMIC LEAD, BURIN: SITE LEAD, NUNAVUT: ACADEMIC LEAD, NUNAVUT: CURRICULUM DEVELOPMENT ASSISTANT: DR. BOB MILLER LISA GRANT GFW- SHERRI MURPHY / BURIN- JENNIFER STRICKLAND DR. JOHN CAMPBELL DR. LESLIE ROURKE DR. LYN POWER DR. ROGER BUTLER DR. MADELEINE COLE DR. EAN PARSONS PATTI MCCARTHY, (PHD CANDIDATE) We have been exceedingly fortunate to have grafted this Project for the Enhancement of Rural and Remote Training (PERRT) to our Residency Training program. Financial support in the amount of $9.4 million was acquired through an open national competition from the Government of Canada. Two projects are being run in parallel NLFam, in conjunction with the Provincial Government of Newfoundland and Labrador, involves programming in Burin and Grand Falls-Windsor and NunaFam, in conjunction with the Territorial Government of Nunavut, involves programming in Iqaluit, Nunavut.

17 Discipline of Family Medicine Annual Report The Project is focused on enhancement of recruitment and retention of Family Doctors in rural and remote communities in Canada. Our proposals were developed from our success over the years in contributing to the outstanding recruitment and retention of our graduates in Goose Bay, NL who had undertaken our NorFam Program. In 2011 the PERRT program allowed us to provide a select number of residents with the chance to gain enhanced rural and remote experience. Through this project, residents can spend up to twelve months of their second year in the rural sites of Burin or Grand Falls gaining enhanced skills. The opportunity to train in remote medicine in Nunavut offers a two-month Maternal Health experience in first year and/or a four-month Rural Family Medicine option in second year. The Project contributes financial resources for resident salaries (two/year/site), dedicated administrative staff at each site, dedicated administrative and educational space with IT and videoconferencing on site with appropriate supports. As well dedicated professional level accommodation is funded for all project residents at the sites. One Project Manager to oversee the Project, and an Educational Coordinator to support the curricular initiatives and Faculty Development needs, are also fully funded for the duration of the Project. Each site has a defined faculty lead in St. John s and a local site lead, a designated family physician in the community. These site leads are the cornerstones of the Project and are all volunteer community preceptors within our Family Medicine Residency Program. These site leads have accepted the task of developing within the context of their medical communities a longitudinal integrated comprehensive competency based family medicine experience. Active community engagement is a critical component of the Project. Initiation of the Project has had some bumps. We have learned that space is a precious commodity in rural and remote communities, engagement takes time, University bureaucracy is complex, complicated and centralist in character. However the dedication and enthusiasm of our colleagues in community practices - urban, regional, rural and remote define the unique character of our program and will make this Project a success. Research With respect to PERRT, significant research on Process and Outcome Evaluation is underway and research specific to our site visit program has started. Photo by Luanne Agriesti-Cleary

18 17 Discipline of Family Medicine Annual Report FACULTY DEVELOPMENT DIRECTOR: ADMINISTRATIVE COORDINATOR: DR. CHERI BETHUNE LUANNE AGRIESTI-CLEARY Our preceptors under the leadership of Dr. Cheri Bethune have many opportunities for faculty development activities. Fall Medical Education Forum The major faculty development activity for all our preceptors is the Fall Medical Education Forum which is held in October each year and alternates between St. Johns and other regions of the Province. It is held in conjunction with the CFPC NL Chapter s Annual Scientific Assembly. It is very well attended with over 120 registrants yearly including preceptors from all over Newfoundland and Labrador, New Brunswick, Yukon as well as the National College of Family Physicians. In 2012 there were small group teaching workshops for preceptors on a variety of topics which included: Giving Effective Feedback Evaluating Learners Teaching and Assessing Clinical Reasoning The Learner in Difficulty Teaching Using Video Completing Evaluations Online As well there are keynote speakers who spoke on: Physician Wellness Student and Resident Wellness The Triple C Curriculum Faculty Development Program 2012 Fall Medical Education Forum There are a variety of other Faculty Development activities which include: Monthly 50 minute sessions with full-time faculty: There is a curriculum of scholarship emerging with a participatory action research project involving all faculty members as participants with a build as we go framework to increase capacity for research and scholarship. Substantive outcomes have already been realized with increased research engagement by faculty members. Faculty development scholarship: Our third faculty member has enrolled in our Evidence Based Medicine Scholarship Program which is awarded annually. This scholarship supports the individual to attend two EBM courses at Oxford University, plan and undertake a research project with mentorship and travel to present this project at NAPCRG. This scholarship has been offered to increase the research capacity of our Discipline. Writing groups: These have emerged out of our monthly sessions for peer support and mentorship of nascent projects. Faculty development scholarship curriculum for distributed faculty: Expanded research is planned and initiated to develop this.

19 Discipline of Family Medicine Annual Report Site visits for community based option sites: Visitation to community based option teaching sites in and near St. John s occur to offer a faculty development agenda. Site visits for distributed sites: Visitation to distributed sites throughout the Province occurs at least once per year and includes a faculty development agenda. National involvement: Director of Faculty Development, Dr. Cheri Bethune is appointed to a national working group on Faculty Development with the College of Family Physicians of Canada. Residents as teachers workshop: This is offered to all residents annually. Certificate in Medical Teaching and Masters of Family Medicine: Several faculty members have enrolled in formal medical education courses which include Certificate in Medical Teaching and Masters of Family Medicine. Faculty development Communities of Practice : These are emerging as an important developmental step to enhance faculty development locally throughout the Province. Using Problem Based Small Group Learning modules in faculty development as the focus for local faculty development, there have been three identified sites (with coordinators) across the Province which include Grand Falls-Windsor, Corner Brook and Goose Bay. PERRT Project Funding from this project has allowed us to hire an educational specialist and curriculum developer for rural and remote faculty development. This infrastructure support greatly enhances our scholarship capacity. Photo by Luanne Agriesti-Cleary

20 19 Discipline of Family Medicine Annual Report HEALTH CLINICAL UPDATE CLINICAL COORDINATOR ST. JOHN S FAMILY MEDICINE CLINICS: EMR SPECIALIST: BARBARA MORRISSEY MIKE FOLEY We strive to provide exemplary clinical care to our patient population and experiences for our learners that are in keeping with the mission of the College of Family Physicians of Canada (CFPC) to promote high standards of care in family practice, and the Four Principles of Family Medicine: The family physician is a skilled clinician. Family medicine is a community-based discipline. The family physician is a resource to a defined practice population. The patient-physician relationship is central to the role of the family physician. To achieve this, we have four academic family medicine teaching units in St. John s and a new academic teaching site in Port aux Basques (page 27), all of which are dedicated to provide excellent clinical care to patients of the practices while teaching family medicine residents and other learners. All of the St. John s practices use an electronic medical record (Wolf), and provide a full scope of family medical practice including intrapartum care, end of life care, house calls, and an on-call service 24 hours a day/7 days a week/365 days a year. Family Medicine Unit- Health Sciences Centre UNIT DIRECTOR: CLINICAL PRACTICE CLERK: CLINICAL PRACTICE CLERK: CLINICAL PRACTICE CLERK CLINICAL PRACTICE CLERK: LICENSED PRACTICAL NURSE: LICENSED PRACTICAL NURSE: DR. LESLIE ROURKE AGNES WHELAN DEBBIE BURKE BERNICE MULLETT JODIE BENNETT DOROTHY GRANT LOUISE NOFTALL There are currently nine GFT faculty members attached to this unit: Dr. Leslie Rourke, Dr. Pauline Duke, Dr. Vina Broderick, Dr. Bob Miller, Dr. Scott Moffatt, Dr. Pamela Snow, Dr. Marshall Godwin, Dr. Ean Parsons, and Dr. Wanda Parsons. Dr. Colette Dawson and Dr. Petra Joller have been locum physicians during the past year. This site has two group practices (Team 1 and Team 2), and cares for almost 4,000 patients ranging from birth to over 100 years of age. In the past academic year, 62 resident months of supervision and teaching occurred at this site.

21 Discipline of Family Medicine Annual Report Two new initiatives in this unit over the past few months include: 1) The addition of a clinical associate position The full-time Family Medicine faculty members at this site are involved with an increasing number and size of roles in all aspects of the Medical School. These range from senior administrative positions (such as Assistant Dean for Admissions, Assistant Dean for Student Affairs, Academic Director of Professional Development for Family Physicians); a large role in undergraduate medical student teaching; participation in the renewal process of the medical student curriculum; a paradigm shift in FM residency teaching to a competency-based Triple C curriculum; an expansion in the number of postgraduate FM residents which is soon to be followed by the upcoming expansion in the number of medical students in the next academic year; further development of undergraduate medical student and FM resident distributed sites; and an increasing focus on primary health care research. The addition of clinical associates will help with patient care and learner supervision in the clinic in order to allow full-time faculty members to further pursue their required academic commitments. 2) The addition of a cross-appointed School of Pharmacy clinical pharmacist faculty member to this site The addition of Dr. J. M. Gamble in early November is an exciting opportunity for inter-professional patient care and learner teaching as well as research opportunities. There are several initiatives that are unique to the Family Practice Unit/Family Medicine Clinic at the Health Sciences Centre (HSC) site: 1. MUN Med Gateway Project - The MUN Med Gateway Project began in when two first year medical students explored the idea of a medical student led community initiative to help newly arriving refugees in the St. John s area. They developed the idea after a half-day session in Clinical Skills on Refugee Health. Faculty advisors for the Project were Dr. Fern Brunger (medical ethics) and Dr. Pauline Duke (family doctor, Discipline of Family Medicine). The Project partnered with the Association for New Canadians (ANC), the settlement agency for the Province. The main goals of the Project are to train medical students in cross-cultural medicine and engage them in community action while improving access to healthcare for refugees in Newfoundland. Visit 1A: Paired first and second year medical students meet once a week at the ANC Language School, with an interpreter arranged by the ANC, and newly arriving refugees. A medical interview is completed by the students for all participating adults and children. The history is entered into a secure database through the Faculty of Medicine, patients are matched with a participating family doctor in St. John s, an appointment is made, and the completed medical history is faxed to the family doctor for the appointment. ANC staff members follow up to ensure that all went smoothly. Medical students also participate in health fairs initiated by the ANC on a regular basis. Visit 1B: Expansion of the Project began in the winter of When the initial interview is completed, medical students perform a preliminary screening exam supervised by a family doctor, immediately after the interview process. This includes an oral exam, measurement of height/weight/bmi, growth parameters for children, BP measurement, hearing and vision screening. Referrals can then be made to the ANC public health nurse, optometry, hearing assessments, dentists and other specialists and healthcare providers as needed, for further care. TB skin testing is also undertaken at this visit for every patient since May This is in collaboration with Public Health with follow-up

22 21 Discipline of Family Medicine Annual Report done by Public Health. Visit 1A and 1B are directly attended and supervised by Dr. Duke on site on a weekly basis. Research is underway to evaluate the Project. The Project has two elected student coordinators, and a paid half-time project coordinator. The Faculty advisors are Dr. Pauline Duke, Dr. Shree Mulay (Division of Community Health and Humanities) and Dr. Gerard Farrell. The Project advisory committee meets monthly and is comprised of the 2 student coordinators, the Project coordinator, three faculty advisors, the ANC public health nurse, social worker and settlement health worker. A research committee has been added to evaluate and research the Project. A new multipurpose clinic room has been built at the ANC School for public health nurse clinics as well as Gateway initiatives. The ANC public health nurse participates in all of the Gateway sessions on a weekly basis. The sessions occur in her office and she helps direct the screening and documentation as well as provide immunization to babies of participating families at the same visit. The ANC social worker is available if necessary and the health worker participate weekly as well. This provides mentorship in interdisciplinary care for our Gateway medical students. The Gateway annual report for 2011/2012 will soon be available for review. This reports that 98 refugees and 73 medical students were involved in the Project (there are a total of approximately 120 students in the first and second year class of the Medical School). A total of 28 interview sessions occurred this past academic year, and medical students volunteered to continue the interview sessions and matching with family doctors over the summer. The Gateway Project was made an official program of the Medical School in late 2010 by the Dean of Medicine, Dr. James Rourke. It is funded by the Medical School and is a combined program of the Discipline of Family Medicine and the Division of Community Health and Humanities. 2. Refugee well woman clinics In working with the Association For New Canadians (ANC), it became apparent that many refugee women were not having well woman exams and care due to cultural barriers, knowledge about the preventive care and gender issues. Two family medicine residents, Drs. Amy Pieroway and Heather O Dea along with faculty member Dr. Pauline Duke developed a program to encourage and provide care to these women. Education sessions about well woman care, contraception, STI screening and cervical cancer screening were held for interested refugee women at the Association for New Canadians Language School in the evening. Transportation for the women was provided by the ANC. This was followed approximately two weeks later by well woman clinics in the evening at the Family Practice Unit with all female staff and physicians. Female Family Medicine faculty members and residents provided the medical care. Our staff LPN and secretary also attended to organize the clinics. Female Gateway Project medical students volunteered at the clinics to help patients with forms and help the flow of the clinic etc. In total so far this year, twenty (20) women have attended the evening clinics. They were held in April, July and October of Prenatal group clinics This site provides space for the weekly prenatal clinics run by the family physicians in St. John s that are involved in intra-partum care. This is a combination of some family medicine faculty members and some community family physicians. The clinic gives the patients the opportunity to meet all the involved physicians at their prenatal visits in the last month of their pregnancy prior to their delivery.

23 Discipline of Family Medicine Annual Report Care for specific out of town populations This site provides family medicine care to families of: 1) children hospitalized at the Janeway Hospital (e.g. NICU); and 2) Bliss Murphy Cancer Centre patients if they are from elsewhere in the Province outside St. John s. 5. Care during specific events This site provides family medicine care on an informal basis to visiting out of Province musicians during special events such as the Festival 500 choral gathering. 6. Family Medicine consultations on the in-patient HSC Psychiatry Unit This site provides family medicine consultations to patients on the in-patient psychiatry ward in the HSC. 7. Participation in in-patient care at the Miller Centre Dr. Ean Parsons participates in the in-patient ward care at the Miller Centre. 8. Sports medicine referrals Dr. Ean Parsons is a certified sports medicine physician and provides sports medicine consultations. 9. Acupuncture Dr. Marshall Godwin is a certified to perform acupuncture, and provides acupuncture consultations and therapy hour ambulatory blood pressure monitoring This site provides 24 hour ambulatory blood pressure monitoring for patients at this site and also at the other three academic teaching sites (Ross Family Medical Centre, Shea Heights Community Health Centre, and Torbay Road Mall Family Medical Clinic). Photo by Luanne Agriesti-Cleary Annual John Ross Commemorative Walk

24 23 Discipline of Family Medicine Annual Report Ross Family Medicine Clinic UNIT DIRECTOR: INTERMEDIATE SECRETARY: CLINICAL PRACTICE CLERK: CLINICAL PRACTICE CLERK: LICENSED PRACTICAL NURSE: DR. GARY TARRANT FRONIE SQUIBB MARILYN POLLARD JUANITA PEACH MAUREEN PIKE There are currently four GFT faculty members attached to this unit including Dr. Gary Tarrant, Dr. Roger Butler, Dr. Katherine Stringer, and Dr. Greg Sherman. Dr. Erin Bennett joined the unit as a locum family physician in September, In addition, Denise Cahill is a Nurse Practitioner who works full-time in the unit and Dr. Carla Dillon is a Pharmacist from the School of Pharmacy who spends one-half day a week in the unit. This is an academic teaching unit and there are PGY1 and PGY2 Family Medicine residents who do rotations at the Ross Centre. For the past year, this cohort includes PGY1s who are doing longitudinal rotations and PGY2s who are doing their Community- Based Option rotation or Care of Elderly rotations. There are also a variety of other learners such as 1 st and 2 nd medical students, clerkship students and elective students from Memorial University, from outside the Province and from outside the Country. The Nurse Practitioner, Denise Cahill, works in conjunction with the GFT faculty members and the locum physician in teaching the Family Medicine residents as well as Nurse Practitioner students who do rotations at our clinic. Dr. Carla Dillon also supervises Pharmacy students from the School of Pharmacy who do their clinical training at the unit. This year this included a recent graduate Pharmacy student. The residents and medical students benefit greatly from this exposure to interprofessional education. There are several initiatives that are unique to the Ross Family Medicine Centre: 1. Care of in-patients at the Dr. L. A. Miller Centre - Drs. Butler, Stringer and Sherman contribute to the care of inpatients at the Dr. L. A. Miller Centre where they manage two wards in the Caribou Memorial Veteran s Pavilion as well as providing on-call coverage for the Miller Centre. 2. Care of Personal Care Homes - Dr. Tarrant currently supervises the care of residents of three Personal Care Homes in the Goulds. 3. Nurse Practitioner - Denise Cahill plays a major role in house call visitation and currently has over fifty home visits on her regular rota. She also takes the lead in chronic disease management and has clinics which focus especially on the chronic care for patients with Diabetes Mellitus. 4. Geriatric Assessments - Dr. Butler is involved in geriatric assessments including patients referred from outside the practice. 5. Psychotherapy - Dr. Tarrant is involved with psychotherapy treatment and takes referrals from all the teaching units in St. John s. 6. McMorran Centre - This unit also has an association with the Nurse Practitioner at the McMorran Centre and at Buckmaster Circle. The physicians at the Ross Centre provide supportive back-up for the Nurse Practitioner with any patients who need family medicine advice.

25 Discipline of Family Medicine Annual Report Care for Emmanuel House - In the past year, the unit became a resource for Emmanuel House which has clients coming to St. John s from outside the city. Ross clinic provides care for these patients that do not have a family doctor in the city. 8. Care of nursing students - The unit also has an association with the Centre for Nursing Studies and provides medical care for nursing students from outside St. John s who do not have a family doctor in the city. In addition, the unit provides Pap smear clinics for any of the nursing students. Action plans and goals in education are to maintain the high level of activity that the Ross clinic currently is engaged in and to continue to try to accommodate as many residents as possible for the Family Medicine program. This unit is the first site to develop a longitudinal package for PGY1s going in their PGY2 year to PERRT programs. We hope to continue to modify this in the coming year to meet the needs of the residency program. Currently, Dr. Stringer and Ms. Cahill are working toward developing a clinic for adults with developmental disabilities. Also, this unit under Denise Cahill s leadership is actively seeking funding for a Pulmonary Function Clinic which could be a resource for all of the teaching units in St. John s. The Ross Centre would also like to continue its community engagement as stated above and look for further opportunities in our area to be a resource for the eastern part of the city. Photo by Luanne Agriesti-Cleary

26 25 Discipline of Family Medicine Annual Report Shea Heights Community Health Centre UNIT DIRECTOR: MEDICAL SECRETARY: MEDICAL SECRETARY: DR. CHERI BETHUNE RHONDA HOOPER SHELLY YETMAN There are currently three GFT faculty members attached to this unit: Dr. Cheri Bethune, Dr. Norah Duggan, and Dr. Susan Avery. Dr. Stephen Darcy has been a locum physician there since April Dr. Megan Hayes and Dr. Amanda Pendergast joined the unit as locum family physicians in the fall of Dr. Lisa Bishop is a Pharmacist from the School of Pharmacy who spends one-half day a week in the unit. The clinic is also staffed by a public health nurse, community health nurse, and a fulltime social worker. The Shea Heights clinic cares for almost 2000 patients ranging from birth to the very elderly. The Shea Heights Clinic operates in an urban setting but delivers service to a well-defined population and engages directly with the community through the Community Council thus enabling greater participation between the clinic and the community at large. This is an academic teaching unit and there are PGY1 and PGY2 Family Medicine residents, as well as medical students, who do rotations at this site. The clinic make-up itself is a model of interdisciplinary care fostering a unique learning environment for medical and pharmacy student learners. There have been the following new initiatives at this site over the past year: 1. Participatory Research: In partnership with the Shea Heights Community Council and St. John Bosco School, the Clinic has undertaken a participatory research project into youth mental health and addictions. The study has funding from Memorial University (SURA, School of Pharmacy), CIHR Health professional student award, the College of Family Physicians of Canada grant and a grant from NLCAHR to support its work. It is a three phase study involving: (1) Chart Audit; (2) Youth Survey and (3) Adult Focus groups. Part 1 has been completed and ethics approval has been granted for the survey which is due to go out in December of The adult focus groups are in the planning stages for the winter of New Teaching Strategies: Exploration of teaching strategies involving the Priority Topics using SNAPS and other methods of engaging students in the learning process. 3. GP Obstetrics: Shea Heights Clinic has developed an antenatal and intrapartum care service which takes referrals from local family doctors. It has excellent uptake by patients who are cared for and then referred back to their family doctors postpartum. It has also provided opportunities for Family Practice Residents to gain exposure to a continuous care obstetrical model. Photo by Luanne Agriesti-Cleary

27 Discipline of Family Medicine Annual Report Torbay Road Family Medicine Clinic UNIT DIRECTOR: CLINICAL PRACTICE CLERK: CLINICAL PRACTICE CLERK: DR. STEPHEN LEE CATHERINE TAYLOR KRISTEN PARROTT This is our newest academic teaching site which opened in August 2011 in the Torbay Road Mall. There are currently two GFT faculty members, Dr. Danielle O Keefe and Dr. Stephen Lee, and two part-time physicians, Dr. Rosann Seviour and Dr. Christine Aubrey-Bassler. The private practice of Dr. Stephen Lee and Dr. Rosann Seviour moved from its LeMarchant Road location to the new Torbay Road clinic. Not only was there a physical move of the practice but also a switch from paper to an electronic medical record. Association with the School of Pharmacy has brought Dr. Erin Davis to work there part-time as a clinical pharmacist. The most recent demographic information pulled from the EMR indicates that 1759 patients have registered with the practice so far with 668 male and 1091 female patients. The data indicates a good spectrum of patients with all age groups represented in similar proportions to the other teaching sites. This allows residents at the Torbay Road site a busy and comprehensive experience. Our residents usually see six to eight patients per half day clinic. The first resident started one month after the clinic doors opened and to date this unit has been involved with training seven residents. In addition the clinic has been involved with the Undergraduate medical program and has had several junior and senior medical students do two week electives as well as shadowing experience for first year students. There have been several pharmacy students doing their clinical rotation last winter and more are expected in January It has been a busy year with a lot of changes for patients and staff. Goals for the future are to expand the clinical space as well as to aim for more GFT positions at the clinic. Photo by Luanne Agriesti-Cleary

28 27 Discipline of Family Medicine Annual Report Port aux Basques Clinic UNIT DIRECTOR: ADMINISTRATIVE SUPPORT: DR. WENDY GRAHAM HOLLY KEEPING Dr. Wendy Graham is a full-time geographic faculty member and the main local preceptor. Dr. David Thomas also does a significant amount of teaching, not only clinical teaching but at educational rounds and during core contents, such as practice management and wilderness medicine. Over the past year they have had Dr. Matthew Butler in the Emergency Department and in July 2012 were delighted to welcome Dr. David Blecher and Dr. Heidi Brake. All of the above are MUN graduates and do considerable teaching with learners at all stages of their training. Dr. Mosawe and Dr. Razack are other physicians in the area who facilitate some shadowing experiences for junior medical students in the ER and for inpatients. There are also three Nurse Practitioners who teach mainly junior medical students at remote satellite clinics. There is a full team of interdisciplinary professionals who teach in an array of settings to learners at all stages. This might range from a first year student shadowing a physiotherapist, a third year student doing a home visit with the occupational therapist, a first year resident doing counseling with the mental health counselor, or senior resident adjusting insulin with the dietitian/diabetic nurse. The patient population stretches geographically from South Branch in the Codroy Valley to LaPoile. There are approximately 10,000 people who tend to receive health services locally, as otherwise they have to travel approximately 200 kilometers through a mountain range with the highest winds in the Country. This area is so treacherous it is known as the Wreckhouse. Being the Gateway Town to the Province and with this geography, the Emergency Department is very busy and much more trauma frequents the ER than in towns of similar size. Patients likely have similar socioeconomic issues as those from other parts of our Province, such as transient residency with many months spent away from home to work. One of the largest local issues is that many seniors require support beyond what can be provided in the home and yet a shortage of beds exists in long term care facilities. There certainly are ample opportunities to learn family medicine in general, and care of the elderly, palliative care and continuity of care in particular. Because Marine Atlantic is a major local employer, there are also many young families in this area. Learners therefore are able to meet competencies in women s health, pediatrics and adolescent health as well. Unlike many rural communities these issues form a large part of the practice. The unit has the privilege of teaching learners at all stages of their training. Each year there are first year students for two weeks in the Community Health rotation. There are also second year students for two weeks during the Black Bag rotation. Clinical clerks complete eight weeks of Rural Family Medicine in third year as well as rural electives and selectives in fourth year. There are always second year residents for Rural Family Medicine +/- Care of the Elderly and Palliative Care. Since July 2012 the site teaches first year residents as well. This is the first peripheral site to offer this rotation. The mix of learners provides a great opportunity for the layering of learning that is much enjoyed by all learners and facilitates their own development as teachers. The team of professionals also welcomes learners from numerous other disciplines. This includes nursing (RN + LPN), pharmacy, social work, occupational therapy and dietetics. This provides a wonderful clinical context to inter-professional education. In a calendar year they supervise about forty learners a year.

29 Discipline of Family Medicine Annual Report New clinical initiatives include: 1. The addition of the Dialysis Unit at LeGrow Health Centre in summer 2011: This is mostly administered through a local dialysis nurse coordinator who partners with the local physicians and a regional Nephrologist, Dr. Stephen Murphy. Learners now have an enhanced experience in nephrology by opportunity to work with Dr. Murphy during his visiting monthly clinics which are two days each month. 2. Journal club and Morbidity & Mortality rounds: These have been initiated over the past year to cross the arenas of both clinical and academic medicine. The site has had interdisciplinary clinical teaching rounds for decades. Local, unique clinical experiences include: 1. A rich and diverse interdisciplinary learning environment: Medical students and residents rotating through the site have an opportunity to experience this and involve outpatient and inpatient settings for all learners. Time is balanced in family medicine clinics, travelling clinics, Emergency Department, acute care inpatient setting, and house calls. A resident might follow the patient with diabetes in clinic, share care with the diabetic team, see the same patient in the Emergency Department, care for them in the inpatient setting and see them on a house call after discharge. Even if the patient had a myocardial infarction he/she would receive thrombolytic therapy and inpatient care within the Family Medicine setting as no consultants work in the facility. 2. Dealing with trauma: Trauma is much more prevalent than in other towns so dealing with trauma and facilitating medical escorts are common encounters for local learners. 3. Travelling clinics: These involve both time spent at the Health Centre with travelling consultants in palliative care, nephrology, cardiology and general internal medicine. In this setting the learner has the opportunity to follow the patient in many setting and with different professionals. Videoconferencing is used with specialists for surgery and oncology. In this way the learner follows the patient with the nurse, family physician and the consultant. 4. Participation in clinics at peripheral clinics: This site works with nurse practitioners who are often the main providers in these remote setting. This includes clinics in the communities of Doyles and Rose Blanche which are serviced weekly. It also includes the remote clinic in LaPoile that is visited monthly via helicopter. 5. EMR: All peripheral clinics now have MediTech over the past year. Family Medicine clinics in Port aux Basques have Nightingale as an Electronic Medical Record. 6. Partnership with local groups such as The Gateway Women s Centre: This allows the site to carry out many activities such as pap clinics. This is a great opportunity to involve learners. In the recent past the site has partnered to carry out Dr. Duke s HPV Self-Collection Project. 7. Oncology care: Port aux Basques is the original site of the Tele-oncology project that has been extended provincially and continues to be very busy in this regard. Residents in particular quickly become very familiar with following cancer patients in the community, ordering chemotherapy and often dealing with the complications in the ER or as inpatients.

30 29 Discipline of Family Medicine Annual Report Site big enough and small enough : The site is large enough to have a busy service with the right complement of professionals across the disciplines, but is small enough for people to know and respect one another on a personal level, as well as coordinate both the longitudinal and horizontal learning experiences. Learners get to follow patients across many settings and with many professionals. Future Clinical Plans No reduction in any services. Extension of travelling clinics and to have increased services via videoconferencing. This has the main advantage of reducing travel for patients. A secondary gain is increased collaboration with local physicians and learners. Healthy Aging Clinic: This is a program close to implementation that identifies at risk elderly in the ER. Using the TRST tool patients would then be referred to a multidisciplinary team for education and clinical intervention. The goals will be to prevent adverse outcomes in this population. The program will have its intake by a nurse practitioner. The team will involve other professionals such as PT, OT, social work and pharmacy. Residents and medical students will gain invaluable experience in attending these clinics. Photo by Luanne Agriesti-Cleary