The Internal Medicine Training Program consists of two teaching hospitals and two community hospitals in Winnipeg. A brief description of each hospital is given below. The catchment area for the teaching hospitals includes all of Manitoba and parts of Northwestern Ontario, Saskatchewan, Nunavut and the North West Territories (approx. 1.5 million people). The large catchment guarantees that residents receive a variety of clinical experience from a diverse patient population. The University of Manitoba is well known for the diverse pathology of its patients.
HOSPITALS
Health Sciences Centre
Number of beds - 800
Number of emergency patients/year - 40,815
Health Sciences Centre is a tertiary care referral centre formed in 1973 through an amalgamation of the Winnipeg General Hospital, the Women's Hospital, the Children's Hospital of Winnipeg and the Rehabilitation Hospital of Manitoba. As a result, the Centre provides trainees with exposure to a wide range of acute and chronic medical problems, as well as to virtually all specialty and subspecialty areas of medicine. Major renovation and expansion was completed early 2007 with a new Emergency Room, new ICU's, and new operating rooms. This hospital serves a large core population and is the major referral centre for northern communities.
St. Boniface General Hospital
Number of beds - 600
Number of emergency patients/year - 37,000
SBGH is the second largest hospital in Winnipeg. St. Boniface Hospital has a full range of specialty and subspecialty services and departments in its role as a major tertiary care referral centre. It has maintained a strong commitment to serving as a community hospital for the surrounding area. Renovations are currently in the works, with upgrades to many wards already complete.
Grace General Hospital
Number of beds - 281
Number of emergency patients/year - 25,255
With roots now more than 100 years old in Winnipeg , the Grace General Hospital came to its present site in 1967. First a rescue home for women and children and then as a maternity hospital, the Grace today provides surgical, mental health, medicine and emergency programs as well as physiotherapy, occupational therapy, pharmaceutical, laboratory and diagnostic imaging services. The newest addition to the Grace is its west wing, which was completed in 1994.
Victoria General Hospital
Number of beds: 231
Victoria General Hospital has been at its current location in South Winnipeg since 1971. Surgical, medical, emergency, mental health and oncology are all provided. After renovation, this has become the site of a second community-based CTU for the residency program. An affiliated outpatient facility affords the opportunity for further community clinic experience.
Wards
Medicine Clinical Teaching Units (CTUs) accept admissions from all medical subspecialties. There are essentially no subspecialty wards with the exception of Cardiology. This means that time spent on medicine CTU's is a broad exposure to all areas of internal medicine. All subspecialty rotations are a combination of inpatient consultative work and outpatient clinics, with minimal inpatient 24 hour coverage provided by the subspecialty (with the exception of Cardiology).
Faculty
Program faculty consist of both full-time and part-time members in all Royal College recognized internal medicine subspecialties including general medicine, infectious diseases, respirology, cardiology, nephrology, endocrinology, rheumatology, haematology/oncology, immunology, gastroenterology, geriatrics, hepatology and critical care. Sub-specialty training programs are available in all of these areas.
The Academic Half-Day
The Academic Half Day is a period of protected teaching time that is scheduled every Tuesday afternoon. The half day is resident driven with topics chosen by a committee of residents with input from the Program Director. Topics covered are mainly clinical, but also include Evidence-Based Medicine and Epidemiology. The sessions are generally given by attendings, and are generally case based. Sessions are on a three year rotation so that all topics will be covered once during the course of the three year Core program. The half-day also incorporates Case of The Week rounds and Morbidity and Mortality Rounds, three times per month and once per month respectively.
Semi-Annual Resident Retreats
Retreats allow the residents to get away from the hospital environment as a group. These occur in the spring and late summer, and are protected time. The aim of these retreats is to discuss issues that are related to internal medicine training, but are not necessarily clinical in nature. Past retreats have had such themes as presentation skills, teaching workshops, financial planning, and practice management. A core part of each retreat is a formal program review. This gives the resident body a chance to air concerns with the program and offer possible solutions. Many changes and improvements in the core training program have resulted from discussions at these retreats.
Resources for Residents
A Residents' Room is found at both teaching hospitals. This is furnished with a selection of resource books in all subspecialties of Internal Medicine, and serves as a 24 hour in-hospital library and informal meeting place for residents.
Computers with Internet and e-mail access are available at both sites in the Residents' Room and on all Clinical Teaching Units. The University subscribes to a large selection of electronic journals, which are easily accessible from home or the Residents' Rooms. The Library and Department of Medicine provide the web-based UpToDate for all residents and faculty. Residents' Rooms are also equipped with access to MKSAP questions.
All residents have access to PubMed-based document delivery and clinical librarians to assist with literature searches. A Medical Library (Neil John MacLean Health Sciences Library) is found attached to the Health Sciences Centre, for easy access to many print journals.
Internal Medicine Journal Club
The Journal Club is held several times during the year at the home of an attending. It provides an opportunity to hone the resident's evidence-based medicine skills and also serves as a social occasion where the faculty and residents can meet in an informal setting. Two articles are presented at each journal club with emphasis on critical appraisal of the trial.
Conference Leave
Residents may request financial assistance for travel to attend a meeting or conference.
ACADEMICS
Curriculum
The program consists of three core years. Each year is divided into 13 four week periods. The program is designed to provide residents with a broad clinical experience to attain the knowledge, skills, and attitudes to practise internal medicine in an exemplary manner. There is an emphasis on becoming a strong clinical physician. As residents progress through the program, they assume increasing responsibility under appropriate supervision with the flexibility to be self-directed in defining their own educational needs. Ambulatory care is emphasized in our program to expand the patient spectrum upon which to learn.
PGY-1 (core)
Clinical Teaching Unit Intern- 8 weeks
Clinical Teaching Unit Resident- 4 to 8 weeks
Cardiology Wards - 4 weeks
Cardiology Consult Service - 4 weeks
Emergency Medicine - 4 weeks
Night Float - 2 two week blocks
Elective Subspecialty Rotations** - 20 to 24 weeks periods
Vacation - 4 weeks
PGY-2 (core)
Clinical Teaching Unit Ward Resident- 16 to 20 weeks
Coronary Care Unit - 4 weeks
Elective Subspecialty Rotations** - 16 to 20 weeks
Night Float - 2 two week blocks
Vacation - 4 weeks
PGY-3 (core)
Clinical Teaching Unit Ward Resident - up to 8 weeks
Medical Intensive Care Unit - 8 weeks
Night Float - 2 weeks
Senior Rotation* - 24 weeks
Elective Subspecialty Rotations** - 10 to 14 weeks
Vacation - 4 weeks
* The senior rotation includes ambulatory care clinics (8 weeks, plus one 'continuity clinic' which runs the entire 6 months), the general internal medicine consult service and screening in the emergency rooms (16 weeks).
**Elective Subspecialty rotations are offered in every subspecialty of internal medicine and related fields. It is possible to do elective rotations in other centres. The residents may also do a 1-2 period research elective in place of doing a subspecialty rotation. Opportunities are available for doing rural internal medicine electives in several smaller Manitoba communities, as well as short visits to the Northern Medical Units in remote health centres in Manitoba and Nunavut.
RESEARCH
Residents are required to present a clinical vignette or clinical investigation in each of their Core years at the annual departmental Resident Research Day, open to residents and fellows. There are opportunities to become involved in research in every area of internal medicine, and faculty members are always looking for residents to help with projects. Upon submitting a research proposal to the Program Director, 1-2 subspecialty rotations can be devoted purely to research, allowing dedicated time to both clinical and basic science endeavours. The research project(s) must in turn be presented at Resident Research Day in either the basic or clinical science category. Prizes are awarded to the best presentation in each category. Residents from Manitoba have presented and won competitions at large meetings, including national ACP conferences.
RESIDENTS
The residents in the program come from a diverse array of backgrounds. The largest proportion are University of Manitoba grads, with representation from most programs around the country and a few schools from abroad.
We try getting together weekly after half-day for a 'cola', and many of us are on recreational sports teams together (like Ultimate Frisbee and Sponge Hockey, etc.). Other organized activities within the program are discussed elsewhere - retreats, etc. Outside the Internal Medicine program, our professional association (PARIM) sponsors many gatherings for residents from all programs with food and beverages throughout the year. There are usually two formal evenings sponsored by PARIM per year, and numerous informal events.
WINNIPEG
Lifestyle
Winnipeg is a friendly, multicultural city of approximately 750,000, situated in the centre of Canada. It is fairly laid back as a city with a friendly atmosphere, but has more culture than most of the large cities across Canada.
Winnipeg is home to the Royal Winnipeg Ballet, the Winnipeg Symphony Orchestra, Manitoba Opera, and many theatre companies including Rainbow Stage and Manitoba Theatre Centre. We are also known for our variety of excellent restaurants serving food from all parts of the world.
Summers in Winnipeg are filled with festivals including the Folk Festival (which is outstanding), the Jazz Festival, the Fringe Festival, and, unique to Winnipeg - Folklorama.
As Winnipeg is in close proximity to numerous lakes, parks and beaches, there is no shortage of places to camp, fish, and hike. The summers are sunny and very hot for the most part. This also makes ideal weather for many summer sports including ultimate Frisbee, football and running (through our numerous parks).
Winnipeg is also known for its cold winter months. The readily available snow allows for a variety of winter sports and gives an ideal setting for the Festival du Voyageur. We are also home to many professional and amateur sports teams including the Winnipeg Blue Bombers (Football), Winnipeg Goldeyes (Baseball), and the Manitoba Moose (Hockey).
Finally, Winnipeg an affordable cost of living in Canada. It is easy to find a very nice apartment within 10 minutes of either hospital for a reasonable amount of money. Food, gas, and car insurance are also quite a bit less expensive than other provinces, so your money will go further. Plus, with the new contract through PARIM, residents are able to live quite comfortably.
DISTINCTIVE FEATURES OF THE MANITOBA PROGRAM:
Morning Report
This is a one hour session lasting from 7:30 to 8:30 every Monday to Friday. However, following a complete sign over from the night float resident, he/she will be excused to leave before 8:00 am. Cases will be presented by ward residents, seniors, and residents/students on consult service during the first half of morning report. This will allow the person presenting the case to review pertinent information related to the case (i.e. Up-to-Date, relevant review article) ahead of time. This allows us to choose a variety of cases to work through, including cases relevant to the field of practice of the attending physician present. During the second half of morning report on alternating days, we practice Royal College type scenarios, read EKGs and X-rays/CTs, and go through practice MCQs as a group.
Journal Club
As described above, we meet nearly once per month to discuss and critically appraise two articles generally presented by the R3's. This is in a more social environment at an attending's house with food catered, etc.
Half-Day
Every Tuesday afternoon we have protected time to attend half-day. There are two sessions lasting 1-1.5 hours each, given by an attending. They are typically based on core clinical topics, with occasional sessions on evidence-based medicine and statistics.
Case of the Week
One hour rounds that happens three Tuesdays per month during Half-Day. Each resident will present 1 case per year. It is a discussion surrounding the work-up and management of an interesting case, with a short didactic session at the end.
Morbidity and Mortality Rounds
One hour rounds on the last Tuesday of every period during Half-Day. Residents in their R2 year are responsible for presenting one of these rounds per academic year. The aim is to identify medical errors, improve patient care, prevent similar medical errors by implementation of preventative strategies, and to learn how to design and implement a quality improvement project.
Senior Rounds
Occurring every Friday at noon, these rounds are given by an R3 on their senior block to a group of attendings and senior residents. Topics surround a specific clinical question and the evidence behind the answer.
CTU teaching Rounds
Every Friday from 12-1pm a presentation is made by the housestaff of one service to the other services, attendings, and other residents. It is directed at the intern/medical student, and usually covers core topics and interesting cases.
Emergency Rounds
Throughout the summer, sessions are held a few times a week from 12-1pm with attendings giving lectures on common medical emergencies/urgencies.
Grand Rounds
Held every Tuesday morning, guest speakers and local faculty present topics related to their area of expertise.
UpToDate access
University of Manitoba offers university wide access to UpToDate online - a medical database that is easy to search and use, and is constantly being updated. This is sponsored in large part by the Department of Internal Medicine.
Document Delivery
University of Manitoba provides Loansome Doc document delivery service free of charge to residents. What this means is that any article you need can be ordered online through PubMed and delivered to any of the University's libraries.
NIGHT FLOAT
Overnight call for internal medicine was completely changed at the University of Manitoba in 2001.
We are the first internal medicine program to introduce a comprehensive night float call system for residents covering emergency, ward consults and the clinical teaching units.
How the system works:
Residents no longer do one in four in-house call while on general medicine rotations at the two teaching hospitals. Instead, they will do two weeks of "night float", working from 7:00 pm to8:00 am five days a week. Most residents will do two of these blocks in R1 and R2 years. R3's will do one block. The advantage of this system is that it removes most call responsibilities from residents running the clinical teaching units; they are more available for their patients and housestaff during the day, and have more time to teach and study. As well, there are less "guest call" requirements for residents on subspecialties. Response to this system has been very favourable from both the medicine residents and the housestaff. This has been approved by the Royal College to count as a general internal medicine rotation.
In-house call will be covered in a traditional one in four manner on cardiology (two periods), coronary care unit rotations (one period) and as a PGY-1 intern on the clinical teaching units (two periods in R1). The intensive care unit has a one in three schedule (two periods). The remaining subspecialties require from-home call. Residents will cover a few weekend days a year for general medicine while on subspecialties as "guest call". In general, the University of Manitoba has always had less in-house call than most other programs, and the night float system is a further improvement. While on call, however, the work will be busy, interesting and rewarding.
When sited at the Grace Hospital, the ward resident will be responsible to stay until 2300 when a clinical clerk is on call. This would occur 2 or 3 times per week and does not include weekends.
Quick Facts:
There are opportunities for up to two inter-provincial and international electives in the core years, depending on trainee's performance.
There are no mandatory rural rotations, but residents are strongly encouraged to complete a rural rotation by their R3 year.
Residents may choose to do a 1-2 period research elective in the core three years, in lieu of doing a subspecialty rotation (at the discretion of the program director).
The average patient load per resident by location varies with each rotation (approx 5 -10 while on CTU).
Our institution provides residents with access to electronic medical resources (Up To Date, MD Consult, e-journals).
There is mandatory presentation of research at the annual Resident Research Day.
There are a wide variety of educational rounds.
Half-Day is based on a core curriculum that rotates on a 3 year schedule.
Our Night Float system dramatically reduces the number of overnight call shifts.
CONTACT INFORMATION
Program Director:
Dr. Kinny Lamba
Program Administrator:
Paulette Tougas
Chief Residents
CONTACT INFORMATION
Program Director (Dr. Kinny Lamba)
Program Administrator (Paulette Tougas)
Chief Residents