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The Respiratory Program is a two-year program approved and accredited by the Royal College of Physicians and Surgeons.
Respirology began to evolve as a sub-specialty in the early 1950's at University of Manitoba. The post graduate medical education has been an integral part of the section since its inception. Over the past several decades, the Section of Respirology at the University of Manitoba had been one of the premier institutions in Canada for the training of specialists in Respiratory Medicine. Graduates of our program have gone on to be successful academics or community specialists not only throughout Canada but all over the world. The excellence in post graduate education has continued to date; presently our training program is one of the most sought after Respirology fellowship programs in North America. Additionally, the section provides training in Respiratory Medicine to the Internal Medicine and Anesthesia residents of the University of Manitoba. The section has been very active in providing research training at various levels leading to the Masters and Doctorate degrees. Furthermore, the section has actively trained residents and students from other universities; and has provided expert training to the physicians from other institutions in Canada and other parts of the world. The post graduate education program has the following components:
1. Fellowship program in adult Respiratory Medicine accredited
by Royal College of Physicians and Surgeons of Canada
and American Board of Specialties.
2. Training of core Internal Medicine, Anesthesia residents,
and residents from other disciplines such as Family Medicine,
Radiotherapy and Critical Care.
3. Graduate and post-graduate research training.
4. Mini-residency training for visiting physicians.
ORGANIZATION OF THE FELLOWSHIP PROGRAM
The 2-year program in respirology is designed to provide clinical training over a period of 18 months with an additional 6 months of either clinical or research training to fulfill the requirements of the Royal College of Physicians and Surgeons as well as the career goals of the fellow. During this period, the fellows rotate through clinical and laboratory services at the Health Sciences Centre and at St. Boniface Hospital. The fellowship program is organized as outlined below.
Consultation Services
There are consultation services at both the Health Sciences Centre and the St. Boniface Hospital. The fellows will spend 20 weeks at each of these. Both these rotations offer unique and different experiences and are complementary to one another. At the Health Sciences Centre, consultations originate from various medical and surgical services. Our service also has extensive involvement with hematology, oncology, and the bone marrow transplant unit. The St. Boniface rotation is a busy one, providing day-to-day experience in general respirology and exposure to complex and interesting tertiary care referrals from medical and surgical services as well as family practice and geriatrics. Further, St Boniface Hospital is the designated Cardiac Centre of Excellence, with an extremely busy Surgical Cardiac Intensive Care. Up to 6 cardiac surgical cases are performed daily, often generating pulmonary consultation. Both teaching centers have very busy tertiary care medical and general surgical intensive care units.Ward Experience
There is an important 12-week rotation on the Respiratory Ward (GH6 at HSC), a combined respirology and thoracic surgical ward. For 8 weeks, fellows rotate on the respirology inpatient service, which has 18 beds. During the months of the respiratory fellows’ rotation, the ward is converted into a closed teaching unit (CTU) supervised by one attending in 2- to 4-week blocks. The CTU usually has 10 teaching patients and a good patient turnover. This unit serves as a general respirology referral centre for the province of Manitoba as well as the only provincial tuberculosis centre. Another 4-week ward rotation is on the thoracic surgery inpatient service, where fellows are involved in pre- and postoperative care, introduced to various surgical procedures, and enabled to participate in the care of patients who have undergone volume-reduction surgery and lung transplantation. Furthermore, this rotation provides an opportunity to be involved in the assessment and management of thoracic oncology patients.
Laboratory Rotation
There are three laboratory rotations of 4 weeks each. The first is a Pulmonary Function Lab rotation at the Health Sciences Centre, a tertiary care referral laboratory for the province. Here, extensive experience with pulmonary function equipment, techniques, and interpretation is provided.
The second 4-week block is at the Sleep Laboratory. At present, the sleep lab and clinics are located at Health Science Centre. In the near future, there will be a transition to locate sleep medicine at Misericordia Health Central. During this rotation, the fellows learn basic concepts of sleep physiology and sleep disorders and are involved in the evaluation of patients with various sleep disorders including sleep-disordered breathing. The fellows are required to assist in the interpretation of a minimum of 20 polysomnographic studies.
The third 4-week block is at the Radiology Service at St. Boniface Hospital. This rotation provides fellows with expertise in the interpretation of chest radiographs, CT scans of the thorax, and the performance of related procedures, such as percutaneous transthoracic needle biopsy and chest tube insertion.
A 4-week block is reserved for exposure to thoracic oncology, allergy and immunology, occupational medicine, pulmonary rehabilitation, and community respiratory medicine. The fellows attend a full day in each of these clinics weekly for 4 weeks. This helps them to intensify their understanding in these domains and prepares them to be competent respiratory medicine consultants. The clinic schedule is as follows:
Monday: Community Respirology/ Respirology
Tuesday: Occupational Medicine
Wednesday: Thoracic Oncology
Thursday: Pulmonary Rehabilitation
Friday: Allergy and Immunology
Ambulatory Care (Outpatient Clinics)
During the fellowship, ambulatory care experience makes up 20% of the training. The fellows are required to attend two half-day outpatient clinics per week and are assigned to a longitudinal clinic and a rotating clinic, thus having the opportunity to follow patients after initial workup. Additionally, the fellows have the opportunity to work in specialty clinics devoted to tuberculosis, pulmonary hypertension, lung transplantation, and sleep disorders. During the lab rotations, the fellows continue to attend outpatient clinics as scheduled.
Critical Care Medicine
The fellows rotate through the critical care units of both hospitals for the first 3 months of their second year of training. During this rotation, each fellow is given a graded responsibility as assessed by the critical care attending staff. Extensive exposure to the critical care aspect of respirology and nonrespiratory critical care is provided during this rotation.
Procedures
During their training, the fellows perform enough procedures to become proficient in bronchoscopy, transbronchial biopsy, thoracentesis, pleural biopsy, pleurodesis, and chest tube insertion.
Second Year of Fellowship
The second year of fellowship has well-defined objectives. There is continuing clinical exposure to meet the requirement of the Royal College for 18 months of clinical training. Rotations at the Sleep Laboratory and on consultation service are scheduled. Additionally, the curriculum of the second year focuses on academic and scholarly activities including research, educational, and teaching activities. Several members of the section of respirology have major research interest in fields including basic physiology, biochemistry, immunology, epidemiology, and molecular biology. Fellows are required to initiate and complete a research project under the supervision of one of these faculty members. Furthermore, programs of respiratory research in the departments of pathology, pediatrics, and physiology provide extra opportunities for research training.
The second year of training is flexible, allowing requests for out-of-town rotations, an elective, or a community rotation to be accommodated.
The 2-year respiratory fellowship program at the University of Manitoba is designed to provide all the skills required of a respirologist by the Royal College, including the clinical and technical skills needed to function in an ICU. Although the respiratory fellowship program is highly structured, there is also a good deal of flexibility. The program is designed with a view to helping fellows evolve into the role of specialist consultants in respirology.
ACADEMIC AND SCHOLARY ACTIVITIES
Outlined below are the details of the Respiratory Section Educational Half Day as well as other teaching activities.
Academic Half Day
Each Wednesday afternoon is protected time for formal teaching activities. Fellows are expected to be present and are exempt from all other activities during this half day, which begins formally on September 1 and runs through to June 30 of the following year. During the summer months (July and August) introductory teaching sessions are organized and the chest conference is continued (see item 4 below). During July and August, trainees are encouraged to attend Department of Medicine lecture series on medical emergencies |
