This UCalgary Medicine insert is all about PGME: Postgraduate Medical Education. My hope is that it increases awareness and appreciation for the work done by our dedicated faculty and hardworking trainees in PGME. To become a practicing physician, students must first be accepted into medical school and receive an MD (Medical Doctor) degree upon successful completion. This step is administered through the Office of Undergraduate Medical Education (UME). Upon graduation, doctors must then train and pass the certifying examinations in a medical specialty before they can be fully licensed to practice medicine independently. This period of training is called residency. It requires two to six years of training in an accredited residency program in one of the 17 faculties of medicine in Canada. Students enrolled in PGME training are designated as ‘residents.’ At the University of Calgary we have 58 residency training programs ranging in size from one to 107 residents. These programs are poised for significant growth due to expansion of the undergraduate class that began in 2006. Approximately 1/3 of our UME class remains in Calgary for their PGME training. Our other residents have received their medical degrees from across the country and around the world. They are all matched to our programs through the Canadian Resident Matching Service (CaRMS) and the Alberta International Medical Graduate (AIMG) Program. Residency training is an intense and rewarding time that prepares our trainees to function not only as Medical Experts, but also as Communicators, Collaborators, Managers, Professionals, Scholars, and Health Advocates. In this insert, some of our own residents describe their experiences and the personal significance of these roles.
As Associate Dean, Postgraduate Medical Education at the University of Calgary, I am privileged to lead the talented team at the PGME office in supporting our residents, faculty and programs. The PGME office is staffed by our Director Lori Mudrick-Donnon, PhD; Administrative Manager Janice Elliott; Coordinators Tina Vonhof, Melanie Fisher, Laurel Thompson and Liz Mauro; Assistant Dean Dr Harish Amin; and myself. The office administers our 58 residency training programs, with a current overall enrollment of 663 residents. In addition to policy development and the management of funding and contracts, the PGME office also provides educational programs for residents, program directors and program administrators throughout the year. We maintain a number of important collaborative relationships with external bodies such as the accrediting and licensing colleges, the Professional Association of Residents of Alberta (PARA), the 16 other PGME offices across Canada, the Alberta Ministry of Health and Wellness, CaRMS and the AIMG Program. Because our residents receive their clinical training in health-care delivery sites, we also enjoy a crucial partnership with Alberta Health Services (previously the Calgary Health Region). As a result each resident contributes significantly to patient care under the supervision of practicing physicians. The College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (RCPSC) set high national standards of training for residents. Many of you will be asked to participate in our next accreditation review by the CFPC and the RCPSC in February 2009. I thank you in advance for supporting this important event. Thank you also for your generous participation in the training of the next generation as Medical Experts, Communicators, Collaborators, Managers, Professionals, Scholars and Health Advocates. Through such participation, you are playing a fundamental role in creating the future of health.
Joanne Todesco MD FRCPC Associate Dean, Postgraduate Medical Education
OUR RESIDENTS ARE MEDICAL EXPERTS
Dr. Melissa Jack PGY2 Anesthesia Resident As residents, some of our most memorable stories come from our patients and their families. I was able to finish work in the operating room early one day and spend time with a patient’s anxious mother. I discussed her fears with her and reassured her that her child was in good hands. A few months later when I saw her again in the emergency room, she immediately came across the room and gave me a huge hug and thanked me. She told me that the time I took to comfort her and listen to her made all the difference. These are things you don’t forget. Of course, my first successful intubation at a code and my first unsupervised epidural—all of these were exciting moments in being trained as well! Residents are medical experts. A medical expert is one who has a full understanding of the disease process (pathophysiology), its diagnosis and options for treatment. As well, a medical expert has the experience and training to be able to educate and offer patients available options and discuss outcomes. A medical expert not only applies knowledge, but also communicates important information to their team of colleagues, the patient and the patient’s family in a manner that assists in understanding and dealing with complex medical issues. I am grateful for mentors here in Calgary. An incredible teacher allows learning that is invaluable and often not available in a textbook. There is a unique combination of young, new-to-practice physicians and veteran practitioners here. Through my training, I hope to become the kind of doctor my mom and dad would want looking after them. I also want to teach one day—to give my time as so many amazing mentors are currently doing for me.
The role of Medical Expert is central to the function of the physician and illustrates how residents learn to: 1. Function effectively as consultants, integrating all of the other roles to provide optimal, ethical, and patient-centered medical care; 2. Establish and maintain clinical knowledge, skills, and attitudes appropriate to their practice; 3. Perform a complete and appropriate assessment of each patient; 4. Use preventive and therapeutic interventions effectively; 5. Demonstrate proficient and appropriate use of procedural skills, both diagnostic and therapeutic; 6. Seek appropriate consultation from other health professionals, recognizing the limits of their expertise.*
OUR RESIDENTS ARE COMMUNICATORS
Dr. Mike Monument PGY3 Orthopedic Surgery Resident It was a great experience to complete my undergraduate medical education at UCalgary and since then I’ve been privileged to pursue specialized training within orthopedic surgery, also at UCalgary.
Residents are communicators. Communication is, undoubtedly, one of the most important skills in medicine and a skill set used every day as a resident. Effective communication enhances the delivery of patient care, develops cohesion within the medical team and is an integral component of resident education here. I have a particular interest in musculoskeletal trauma and I’m always impressed at the level of care that is provided to patients and their families here in Calgary. There is no doubt residency is challenging in many ways, but the surgical training we receive here is exceptional and I’m proud to take part in it. The role of Communicator includes the varied dynamic exchanges that occur with patients and their families before, during, and after a medical encounter. During their training our residents will: 1. Develop rapport, trust, and ethical therapeutic relationships with patients and families; 2. Accurately elicit and synthesize relevant information and perspectives of patients and families, colleagues and other professionals; 3. Accurately convey relevant information and explanations to patients and families, colleagues and other professionals; 4. Develop a common understanding on issues, problems and plans with patients and families, colleagues and other professionals to develop a shared plan of care; 5. Convey effective oral and written information about a medical encounter.*
OUR RESIDENTS ARE COLLABORATORS
From there, the collaborative process begins as the patient’s concerns are addressed by a large team of health-care professionals and hospital staff. Life as a radiology resident is exciting not only because the most advanced technology is always at your fingertips, but because you have the opportunity to interact and collaborate with specialists from a wide scope of practice: surgery, oncology, obstetrics, cardiology, nephrology, orthopedics, neurology, pediatrics – and that’s the short list. Sometimes the radiologic findings are merely a snapshot of a patient’s experience and the rest of their story is a mystery. However, as diagnostic imaging services play an ever increasing role in patient care, the collaborative experience becomes richer as each specialty pools their resources towards a common goal. The role of Collaborator is increasingly important in the modern multiprofessional environment, where the goal of patient-centred care is widely shared. Therefore, our residents:
Dr. Mark Lee PGY4 Diagnostic Radiology Resident Collaboration is vital to practicing medicine. In fact, the collaboration process begins the moment a person seeks help from a medical professional. Sometimes we need to consult a number of specialists, sub specialists, and many other members of the health care team in order to solve a problem. In a teaching hospital such as the Foothills Medical Centre, it is not uncommon for a resident to be the first physician a patient meets.
1. Participate effectively and appropriately in an interprofessional health-care team; 2. Effectively work with other health professionals to prevent, negotiate, and resolve interprofessional conflict*
OUR RESIDENTS ARE MANAGERS
Dr. Evan Matshes PGY5 Anatomic Pathology Resident Despite the fact that pathologists deal with an abundance of somber stories, I’ve had incredibly positive experiences with family members of patients. I feel as if I have been afforded the opportunity to effectively communicate complex findings to people during difficult times in their lives, while offering solace and compassion. Residents are managers. A manager is someone who successfully balances both professional and social aspects of the workplace while serving as a reliable resource for those colleagues he or she serves. The most valuable thing I’ve learned as a resident is that people (whether they be patients or co-workers) are far more complex than they may initially appear; there may be a much greater depth of emotion, understanding and comprehension than is readily visible on the surface. The University of Calgary affords incredible opportunities, rewards and program flexibilities that are not readily found elsewhere. Combined with the beautiful growing city and splendid surrounding areas, Calgary is a fantastic place to live and train.
The Manager role describes each physician’s requirement to run a sustainable medical practice and participate in the decision-making of health-care organizations. Our residents learn to: 1. Participate in activities that contribute to the effectiveness of their health-care organizations and systems; 2. Manage their practice and career effectively; 3. Allocate finite health-care resources appropriately; 4. Serve in administration and leadership roles, as appropriate*
OUR RESIDENTS ARE HEALTH ADVOCATES
system. A health advocate takes the time to learn about available resources and connects their patients with these resources. A health advocate also recognizes that advocacy can often go beyond the realm of the medical system. Health is intimately tied to socioeconomics, culture and social networks, and advocacy incorporates that understanding into patient care. Equally as important is advocacy in the realm of policy change, on governmental levels spanning from municipal to federal. We have a unique opportunity to bring our experiences at the bedside or at the front lines of primary care to the forefront to negotiate change.
Dr. Sunita Chacko
Calgary is a dynamic and growing environment with many opportunities. No matter what area you are interested in, there is someone to support you in that interest. I hope to practice in both the community and acute care setting so that I can serve a wide variety of patients as a family doctor.
PGY2 Family Medicine Resident One of the most valuable things I have learned as a family medicine resident is the importance of counseling patients on health promotion and disease prevention. Taking the time to help patients understand how lifestyle and behavioural changes can lead to healthier outcomes has great potential to change both the patient and the environment in which we work. Family medicine has given me the opportunity to train in many settings, from obstetrics to palliative care, and everything in between. I have met many patients—whether they are two or 92, people’s stories are always interesting! A health advocate is someone who assists their patients in navigating a sometimes complex and overwhelming health care
In their role as Health Advocates, physicians learn to responsibly use their expertise and influence in order to advance the health and well-being of patients, communities, and populations. We train our residents to: 1. Respond to individual patient health needs and issues; 2. Respond to the health needs of the communities that they serve; 3. Identify the determinants of health of the populations that they serve; 4. Promote the health of individual patients, communities, and populations.*
OUR RESIDENTS ARE SCHOLARS
Dr. Naminder Sandhu PGY2 Pediatrics Resident The beauty of medicine is that there is such a wide array of fields of practice to pique the interest of students and residents. I’m very happy with my decision to pursue pediatrics, but even as a second year resident, I can’t say there is one particular subspecialty that I know I’m supposed to be in, for I love all aspects of medicine. Residents are scholars. To me, a scholar is a person who has dedicated themselves to study and pursue mastery in an area of interest. It’s not a term we think of routinely, but we as residents are definitely part of the world of scholars who try to find answers and solutions to problems, with a special focus in medicine. I think the boundaries of what defines medicine are vast and can be interpreted in various ways to encompass research and academia; ethics and psychosocial and cultural principles; or clinical skills. As a resident, you become conditioned to hard work, managing an impressive learning curve, and facing the struggles of balancing work and play (for the sake of sanity!) But the most valuable point I’ve learned and carry with me on a regular basis is the appreciation of how privileged I am to be allowed into the personal and private lives of other human beings who trust me to make a difference.
In the Scholar role physicians demonstrate a lifelong commitment to: 1. Maintain and enhance professional activities through ongoing learning; 2. Critically evaluate information and its sources, and apply this appropriately to practice decisions; 3. Facilitate the learning of patients, families, students, residents, other health professionals, the public, and others, as appropriate; 4. Contribute to the creation, dissemination, application, and translation of new medical knowledge and practices.*
OUR RESIDENTS ARE PROFESSIONALS
The University of Calgary is full of professionals who give back more than they can get, and in so, truly make this a world-class place to enjoy working in e veryday. As a PGY-2 resident in internal medicine, I’m always moving forward in my internal medicine training. I recognize now that the professional must learn to be moved and touched emotionally, yet at the same time stand back objectively. This balance is an integral part of every resident and staff member here at UCalgary, making this a wonderful place to work! The role of Professional describes the societal responsibility of each physician that is guided by codes of ethics, a commitment to clinical competence and personal well-being, the embracing of appropriate attitudes and behaviors, integrity, altruism, and the promotion of the public good. Our residents:
Dr. Ben Thomson PGY2 Internal Medicine Resident As an international medical graduate from Ireland, I have been incredibly fortunate to be surrounded by world-class residents and medical and nursing staff. They have taught me that being a professional means giving back more than we get, whether it be by going beyond standard patient care, providing exceptional teaching, encouraging ground breaking research, or simply by being a caring and decent colleague who provides a superb working environment.
1. Demonstrate a commitment to their patients, profession, and society through ethical practice; 2. Demonstrate a commitment to their patients, profession, and society through participation in profession-led regulation; 3. Demonstrate a commitment to physician health and sustainable practice.*
*Š 2005 The Royal College of Physicians and Surgeons of Canada