EXPERIENCES MASTER DOCUMENT FAMILY MEDICINE EXPERIENCE 1. CORE FAMILY MEDICINE EXPERIENCE a. This experience is meant to simulate real life family medicine as practiced by comprehensive family physicians b. Residents will spend a minimum of 2 full days of clinic a week doing Core Family Medicine clinic except if on: i. Internal Medicine Ward ii. Hospitalist week iii. Elective blocks iv. Community/Rural Family Medicine c. This will take place throughout the two years of residency d. Residents will be assigned a Primary Preceptors for PGY-1 and then based on an assessment of the residents educational needs will be assigned to a different Primary Preceptor in a different pod for PGY-2 e. Half Days are roughly defined as 0800-1230h for AM and 1230h- 1700h for PM for scheduling purposes f. Residents are expected to model themselves after family physicians that practice comprehensive family medicine and are expected to follow-up on any tests or investigations they order on their patients in a timely manner. Residents are expected to assume the role of the Most Responsible Physician for patients that they are treating in their Core Family Medicine clinic and be involved in all aspects of their care. g. Core Family Medicine includes time spent in Clinic, Home Visits, Palliative Care Visits, Retirement and Nursing Home Visits any scenario the family physician has a long-term relationship with a patient. h. Primary Preceptors are responsible for doing Interim and Final ITERs for the resident during their designated periods of time on the Master Schedule, and this includes reviewing all Field Notes the resident has obtained on the other Experiences during that period of time i. Residents are very strongly encourage to follow at least 6 patients throughout their entire pregnancy (prenatal, intrapartum, postnatal) j. Secondary Preceptors 1
i. These Preceptors are to serve as back-up to the Primary Preceptors to provide Core Family Medicine clinics in the event the Primary Preceptors are away for illness, vacation or conference etc. 2. FAMILY MEDICINE ON-CALL a. Residents will participate in doing on-call with Family Medicine at Belleville General Hospital, doing first call. b. Residents will be assigned to Family Medicine Faculty, with first preference to their Core Family Medicine Preceptors c. The on-call is the same as described in the Hospitalist Experience d. PGY-1 may be paired with PGY-2 to help with graded responsibility e. 1 in 3 home call maximum as per PAIRO i. Will be readjusted to take into account other on-call duties such as Obstetrics, General Surgery, Pediatric Week etc ii. Call is home call iii. During Hospitalist Week on-call 0800h to 0800h (24hr) iv. During a Saturday, Sunday or statutory holiday the on-call is 0800 to 0800h (24hr) v. If on-call during experiences other than Hospitalist: 1. Call starts at 1700h until 0800h unless with Primary Preceptor AND Primary Preceptor is on-call that day then on-call starts at 0800h-0800h f. Article 16.4 of PAIRO Contract -> Home call to Post-call i. Resident is called into hospital to perform duties between midnight but before 6am ii. A resident called into the hospital to perform duties for at least 4 consecutive hours with at least one hour of which extended past midnight g. Regarding Article 16.4 of PAIRO Contract i. The Site Director does not want residents put in a situation where they need to take a Post-call day as this drastically affects their scheduled Experiences the next day 1. Any disagreement between the resident and faculty on this issue is to be brought to the Site Director s attention first thing in the morning, in the interim it is the resident s decision that must be honoured ii. The Site Director s exemptions to this is if the: 1. Post-Call day does not affect any Experiences scheduled during the Post-Call day iii. Realizing for educational purposes a resident may waive the right to a Post-call day during on-call if they feel they 2
have achieved enough rest and can properly function the following day h. No resident is expected to do additional rounding on any patients post-call unless they are on Hospitalist experience i. For example resident is on-call on a Saturday and does three admissions during the day and then comes in Sunday morning at 7am to do a 4 th admission. Once the admission is completed (and it is past 0800h) the resident is relieved of duties i. The Resident is not expected to round on any of the patients the resident admitted unless Hospitalist 3. COMMUNITY FAMILY MEDICINE EXPERIENCES a. This experience is 8 weeks of a continuous block of time in a setting outside of their Core Family Medicine Preceptors. b. This experience is done during PGY-2 only. c. Current sites specific for Belleville/Quinte include Picton and Bancroft. Any other Queen s approved Rural Experience can be also be considered such as Moose Factory etc. d. For Residents that are assigned or choose to go to Picton will spend their entire 8 weeks in Picton and only return to Belleville for their Wednesday Academic Teaching afternoons. e. For Residents that are assigned or choose Bancroft they will spend their entire 8 weeks in Bancroft and videoconferencing for the Wednesday Academic Teaching afternoons will be made. f. For residents choosing any other Queen s approved Rural Experiences attempts will be made to have Academic Half Days available via Videoconferencing if the distance is to great for the resident to travel to attend in person Objectives 1. Selection of 99 Priority Topics for Family Medicine Experience a. Allergy (3) b. Breast Lump (11) c. Diabetes (20) d. Disability (28) e. Domestic Violence (Sexual, Physical, Psychological) (30) f. Gender Specific Issues (42) g. Hyperlipidemia (46) h. Hypertension (47) i. Immigrants (48) j. Insomnia (53) k. Lifestyle (58) 3
l. Loss of Weight (60) m. Obesity (68) n. Osteoporosis (69) o. Periodic Health Assessment / Screening (72) p. Prostate (77) q. Sex (82) r. Sexually Transmitted Infections (83) s. Skin Disorder (84) t. Smoking Cessation (85) u. Thyroid (91) v. Travel Medicine (93) w. Dysuria (32) x. UTI (95) y. Procedural skills checklist multiple topics (cerumen removal, suturing, etc) 2. Curriculum Objectives a. Maternity & Newborn Care for Belleville/Quinte Family Medicine & On-Call Experiences b. Palliative Care for Belleville/Quinte Family Medicine & On-Call Experiences c. Care of Children & Adolescents for Belleville/Quinte Family Medicine & On-Call Experiences d. Care of Adults for Belleville/Quinte Family Medicine & On-Call Experiences e. Care of the Elderly for Belleville/Quinte Family Medicine & On- Call Experiences f. Care of the Vulnerable & Underserviced for Belleville/Quinte Family Medicine & On-Call Experiences g. Procedural and Surgical Skills DOCC 2012 version 2 BQ h. Behavioural Medicine Belleville/Quinte Family Medicine & On- Call Experiences 4
PEDIATRIC EXPERIENCE (*FD*) 1. Clinics a. Up to 9 days of Pediatric Clinic in PGY-1 and 6 days in PGY-2 may be scheduled per year, depending on Pediatricians availability i. Dr. Vanier s clinic is utilized for this experience ii. Quinte Health Care Pediatric clinic is currently under development Objectives 1. Selection of the 99 Priority Topics for the Pediatric Experience a. Croup (20) b. Ear Ache (33) c. Eating Disorders (34) d. Fever (39) e. Immunizations (49) f. Children (50) g. Infections (51) h. Learning (57) i. Meningitis (62) j. Newborn (67) k. Upper Respiratory Tract Infection (94) l. Well baby care (99) 2. Curriculum Objections a. Care of Children and Adolescents for Pediatrics b. Maternity and Newborn Care for Pediatrics (highlighted areas) c. Procedural and Surgical Skills DOCC 2012 version 2 BQ 5
EMERGENCY EXPERIENCE (*FD*) 1. Emergency encompasses shifts in the Emergency Departments of both Belleville General Hospital and Trenton Memorial Hospital. 2. Residents will be expected to do 15 shifts during their PGY-1 year and another 15 shifts during PGY-2. a. 12 of these shifts per year will be ER Primary Doc shifts and 3 of these shifts per year will be ER Second Doc shifts 3. Residents will be assigned to various physicians in the ER department. For each shift a resident will be assigned to a specific ER physician. The resident shifts will correspond to their assigned ER physician s shifts. The ER Physician may be one of the residents Family Medicine Clinic preceptors, or another Family Physician that is working in the Emergency Room. In general, both ER Departments are made up of a combination of Family Physicians who also have clinics, Family Physicians that do only ER and Family Physicians with the extra EM year. 4. Residents will get a mix of primary and secondary ER physician shifts. a. Primary Doc Shifts i. 0700-1500h Days, 1500h-2300h Evenings, 2300h-0700h Nights for BGH ii. 0800-1600h Days, 1600h-2400h Evenings, 2400h-0800h Nights for TMH b. Second Doc Shifts i. 1300-1900 TMH ii. 1100-2100h BGH Objectives 1. Selection of the 99 Priority Topics for the Emergency Experience b. Abdominal Pain (1) c. Advanced Cardiac Life Support (2) d. Chest pain (13) e. Cough (17) f. DVT (21) g. Dehydration (22) h. Diarrhea (26) i. Dizziness (29) j. Epistaxis (36) k. GI bleed (41) l. Headache (44) m. Infections (51) 6
n. Ischemic Heart Disease (54) o. Laceration (56) p. Loss of consciousness (59) q. Meningitis (62) r. Pneumonia (74) s. Poisoning (75) t. Red Eye (79) u. Seizures (81) v. Stroke (88) w. Trauma (92) x. Upper Respiratory Tract Infection (94) y. Procedural skills checklist multiple topics (chest tube, intubation, suturing, etc 2. Curriculum Objectives a. Procedural and Surgical Skills DOCC 2012 version 2 BQ b. Care of Children and Adolescents for ER (highlighted areas) c. Care of Adults for ER (highlighted areas) d. Behavioural Medicine for ER (highlighted areas) 7
HOSPITALIST EXPERIENCE (*FD*) 1. In this experience residents will take care of Family Medicine patients in hospital in various states of health. Residents are expected to complete at 5 weeks of Hospitalist in PGY1 and up to 4 weeks in PGY-2. There are two hospitalist groups Acute (Quinte) and Rehab (Sills 3) that are involved to varying degrees. During PGY-1 residents will be exclusively scheduled for the Acute (Quinte) Hospitalist group. During PGY-2 default scheduled will be for Acute (Quinte) Hospitalist weeks but Rehab (Sills 3) Hospitalist weeks are available to PGY-2 residents after successful discsussion with the Program and their Academic Advisor. 2. Residents will be paired with a current Primary Preceptor for Core Family Medicine, 3. Hospitalist experience is run by Family Physicians, and all of these Family Physicians serve as Primary Preceptors to residents for their Core Family Medicine Clinics 4. Hospitalist weeks start on a Friday and include Saturday, Sunday, Monday through until the following Thursday. a. Residents are expected to be available from 0800-1700h on normal weekdays (ie excluding statutory holidays and Saturday/Sunday) i. If residents have finished their hospitalist work earlier in the day they are to be still available to attend to any acute or non-acute issues that arise on their Hospitalist service during the work day b. Residents are expected to be available from 0800-1700h on Saturday, Sundays and Holidays with the following provisions i. Once patient care has been completed during these times and the resident has discussed with their attending that all the hospitalist work is completed they are free to go and turn off their pager 1. Realizing there may be at times tests/investigations that are still pending and may come back during the 0800-1700h time period residents need to discuss with their attending how these tests are going to be followed up with more than likely the resident being responsible for following up. If the test does not get completed by 1700h then informing the 8
physician on-call that day of a test coming back so they are able to deal with it when it is completed. 5. If the Hospitalist is not too busy, it is expected the resident will accompany the preceptor to clinic(s) on those days after the hospitalist work is completed IF this preceptor is their CURRENTLY ASSIGNED Primary Preceptor 6. It is during these weeks that residents are expected to spend time with other allied Health Care professionals including Physiotherapy, Occupational Therapy, Speech Language Pathology, and Pharmacy to better understand the care these professionals provide to the patients. 7. Typically an average Hospitalist group will be taking care of between 15-30 patients at a time. 8. Family Medicine On-call will occur during this experience also. 9. This experience is centered at Belleville General Hospital and is run by Family Physicians that have privileges at that institution. Residents will care for a wide range of patients during the week including: a. Acute medical care on the medical ward to family medicine patients (Medical beds are currently on Quinte 5, overflow on Quinte 6 and ER) b. Medical and Rehab care for Slow Stream Rehab (SSR) c. Palliative Care patients (Quinte 5) d. Assessing and admitting patients into the hospital or between wards e. Newborn care in hospital Objectives 1. Selection of the 99 Priority Topics for the Hospitalist Experience a. Anemia (4) b. Antibiotics (5) c. Asthma (7) d. Atrial Fibrillation (8) e. Cancer (12) f. Chronic disease (14) g. COPD (15) h. Dyspepsia (31) i. Fatigue (37) j. Fever (39) k. GI bleed (41) 9
l. Hepatitis (45) m. Infections (51) n. Ischemic Heart Disease (54) o. Multiple medical problems (65) p. Pneumonia (74) q. Stroke (88) r. Upper Respiratory Tract Infection (94) s. Procedural skills checklist multiple topics (paracentesis, thoracentesis, etc) t. Palliative Care i. Breaking Bad News (9) ii. Cancer (12) iii. Palliative Care (70) u. Care of the Elderly i. Chronic disease (14) ii. Dementia (23) iii. Elderly (35) iv. Mental Competency (64) v. Multiple medical problems (65) vi. Parkinsonism (71) 2. Curriculum Objections a. Adults for Hospitalist (see highlighted areas) b. Palliative Care for Hospitalist c. Procedural and Surgical Skills DOCC 2012 version 2 BQ d. Maternity and Newborn Care for Hospitalist (see highlighted areas) e. Care of Vulnerable and Underserviced for Hospitalist (see highlighted areas) f. Care of Elderly for Hospitalist (see highlighted areas) g. Behavioural Medicine for Hospitalist (see highlighted areas) 10
INTERNAL MEDICINE WARD EXPERIENCE 1. Residents will spend four (4) week block doing Internal Medicine Ward at Belleville General Hospital. 2. This experience is to be completed prior to the end of PGY-1. 3. During this experience a resident s schedule and on-call will be determined by the Department of Internal Medicine at Quinte Health Care. Resident s will work along side other Family Medicine residents from the Belleville/Quinte program but also the Kingston/Thousand Islands program along with Internal Medicine residents. 4. Resident s will be responsible for the care of medical patients serviced by the Department of Internal Medicine at Belleville General in a hospitalist style. The Internist s that are hospitalists usually spend a week at a time on the service managing patients on the medical ward of Quinte 5, usually starting on a Friday and ending on a Thursday. Resident s are expected to take care of patients as assigned by the team or hospitalist. Resident s will do on-call with Internist s also, this may or may not be the same physician that is the hospitalist that week. 5. The Department of Internal Medicine is made up of General Internists, Cardiologists, Oncologists, Nephrologists, and Gastroenterologists. All provide General Internal Medicine care while on-call. 6. Resident s will be excused for the Wednesday Academic Half Days. 7. No Belleville/Quinte resident will be on-call on Tuesdays and will not be on-call the last day of this Experience either. 8. For a complete description of this Experience see the QHC/Queen s orientation manual Internal Medicine Clinic Experience (*FD* 1. Residents will be scheduled by the Program Coordinator for these various experiences over their two years and will attend as scheduled 2. Cardiology Clinics a. Will be based out of Cardiology Services Group in Belleville, a. Residents are expected to do 4 full days of clinic in PGY1 and up to 1 full days in PGY2 3. Gastroenterology Clinics a. This experience will involve Private Clinic experience with Dr Pritchett. 11
b. Residents will be scheduled to these experiences by the Program Coordinator and are to attend as scheduled. c. There will be a total of 3 full days of Gastroenterology during residency, aiming for 2 in PGY-1 and up to 1 in PGY-2 Objectives 1. Selection of the 99 Priority Topics for the Internal Medicine Ward & Clinic Experiences a. Internal Medicine Ward i. Anemia (4) ii. Antibiotics (5) iii. Asthma (7) iv. Atrial Fibrillation (8) v. Cancer (12) vi. Chronic disease (14) vii. COPD (15) viii. Dyspepsia (31) ix. Fatigue (37) x. Fever (39) xi. GI bleed (41) xii. Hepatitis (45) xiii. Infections (51) xiv. Ischemic Heart Disease (54) xv. Multiple medical problems (65) xvi. Pneumonia (74) xvii. Stroke (88) xviii. Upper Respiratory Tract Infection (94) xix. Procedural skills checklist multiple topics (paracentesis, thoracentesis, etc) b. Cardiology Clinics i. Advanced Cardiac Life Support (2) ii. Atrial Fibrillation (8) iii. Chest pain (13) iv. Ischemic Heart Disease (54) c. Gastroenterology Clinics i. Dyspepsia (31) ii. GI bleed (41) iii. Hepatitis (45) d. Stroke Clinic i. Stroke (88) 2. Curriculum Objectives a. Adults for Internal Medicine Clinic & Ward Experiences b. Procedural and Surgical Skills DOCC 2012 version 2 BQ 12
Obstetrics & Gynecology Clinics Experience (*FD*) 1. Residents will be scheduled for 5 full days of clinics in PGY1 and another1 in PGY2 2. These experiences will attempt to be spread evenly throughout the year 3. Clinics are meant to expose residents to a variety of Women s Health Issues with respect to Gynecology and Obstetrics. Obstetrics On-Call 1. This will consist of 24 hour in-house calls for Obstetrics main responsibilities will be the Labour and Delivery Floor but also assessing any Consults or Emergencies that the On-Call Obstetrician/Gynecologist is responding to also. 2. A total of 8 on-calls in PGY1 and up to 8 in PGY2 will be scheduled. The Program Assistant will coordinate these with QHC person responsible for doing the scheduling for other residents also. 3. These will occur in clusters including both weekends and weekdays 4. Residents are not to be scheduled on Tuesday or Wednesdays if at all possible 5. No more than 3 days in succession and no less than 2 days in succession 6. Goal is to have all shifts completed within a 2 block period if able 7. Residents will be working in a team environment, as there will be other Family Medicine residents doing rotations from Kingston/1000 Islands and Obstetrics/Gynecology residents from Queen s. Objectives 1. Selection of 99 Priority Topics for the Obstetrics & Gynecology Experiences a. Contraception (16) b. Infertility (52) c. Menopause (63) d. Pregnancy (76) e. Rape / Sexual Assault (78) f. Vaginal Bleeding (96) g. Vaginitis (97) h. Procedural skills checklist multiple topics (delivery, episiotomy repair, etc) 2. Curriculum Objectives a. Adults for Obstetrics & Gynecology Experiences (highlighted) b. Maternity & Newborn Care for Obstetrics & Gynecology Experiences c. Procedural and Surgical Skills DOCC 2012 version 2 BQ 13
GENERAL SURGERY EXPERIENCES Overview 1. In this experience residents will spend time with General Surgeons both in their office along with on-call seeing consults in the emergency room along with possibly assisting with operations that occur while on-call. 2. General Surgery Clinic (aka Office) (*FD*) a. Residents will spend a total of 3 clinic days in PGY1 and 1 clinic days for PGY2 3. Gen Surg On-Call a. On-call 1 Friday, 1 Saturday, 1 Sunday per year i. Residents will see consults 1 st for General Surgery ii. Residents then will assist the cases if they have time iii. Goal is to try to encourage continuity so if a resident sees a really interesting General Surgery consult in ER and wishes to assist resident should be able to do that iv. Call is home-call v. On-call starts on Friday at 5pm until 10pm Friday vi. On-call starts Saturday at 8am until 10pm Saturday vii. On-call starts Sunday at 8am until 10pm Sunday viii. Residents will be marked Post-Call on the Monday following a Sunday on-call Objectives 3. Selection of 99 Priority Topics for General Surgery component of the Experience a. Abdominal Pain (1) b. Trauma (92) c. Laceration (56) d. Procedural skills checklist multiple topics e. Breast Lump (11) f. Dyspepsia (31) g. Thyroid (91) 4. Curriculum Objectives for General Surgery Component a. Adults of General Surgery Experience (highlight) b. Procedural and Surgical Skills DOCC 2012 version 2 BQ 14
MINOR PROCEDURES (LUMPS AND BUMPS CLINICS (*FD*) 1. 5 over 2 years 2. Experiences with both General Surgeons and Family Physicians 3. Family Physicians at BQUFMC have access to the state of the art Minor Procedure room in the facility CARE OF ELDERLY & LONG-TERM CARE EXPERIENCE 4. Long-Term Care Facilities (*FD*) a. Up to 16 half days for PGY-2 b. Resident will spend a minimum of 6-8 half days in PGY-2 rounding on a defined cohort of LTC patients. Rounds will be alternating weeks and these will be done consecutively c. Trent Valley Lodge will be used primarily but based on scheduling Belmont LTC will also be utilized d. The half days will occur in the morning, for the afternoon they will be scheduled with their Primary Preceptor for CCFM in the afternoon and if not available will join B&J CCFM for the afternoon. Objectives 3. Selection of the 99 Priority Topics for the Care of Elderly & Long-Term Care Experience a. Chronic disease (14) b. Dementia (23) c. Elderly (35) d. Mental Competency (64) e. Multiple medical problems (65) f. Parkinsonism (71) g. Diabetes (20) h. Disability (28) i. Hyperlipidemia (46) j. Hypertension (47) k. Insomnia (53) l. Obesity (68) m. Loss of Weight (60) n. Osteoporosis (69) o. STIs (83) p. Skin Disorder (84) 15
q. Thyroid (91) r. Dysuria (32) s. UTI (95) t. Anemia (4) u. Antibiotics (5) v. Atrial Fibrillation (8) w. Cancer (12) x. Chronic disease (14) y. COPD (15) z. Dyspepsia (31) aa. Fatigue (37) bb. Fever (39) cc. GI bleed (41) dd. Infections (51) ee. Ischemic Heart Disease (54) ff. Pneumonia (74) gg. Stroke (88) hh. Upper Respiratory Tract Infections (94) ii. Breaking Bad News (9) jj. Palliative Care (70) kk. Chest Pain (13) ll. DVT (21) mm. Cough (17) nn. Dehydration (22) oo. Dizziness (29) pp. Vaginal bleeding (96) qq. Sexual Assault (78) rr. Difficulty patient (27) ss. Family Issues (37) tt. Violent/Aggressive Patient (98) 4. Curriculum Objections a. Care of Elderly for Geriatrics b. Procedural and Surgical Skills DOCC 2012 version 2 BQ c. Behavioural Medicine for BQ Care of Elderly & LTC d. Care of Adults for Belleville/Quinte Care of Elderly & LTC e. Palliative Care for Belleville/Quinte Care of Elderly & LTC 16
FLEX DAYS (*FD*) - 8 full days to be used horizontally in PGY-2, similar to horizontal electives - Additional Flex Days can be added during PGY-2 based on assessment of competencies by a resident along with their Academic Advisor, Current Primary Preceptor and Site Director. - Any experiences that are denoted by *FD* can be utilized but the Program Coordinator needs to be contact first. In addition, any Experiences that are listed in the evolving Electives List can be used. Any other experience can be used as long as its objectives are consistent with elements of the various DoCCs. 1. 17