UBC Cardiology Residency Program 2013-2014

Orientation Manual

UBC Cardiology Residency Program 2013-2014

Specialty Training Requirements

1.  Royal College Certification in Internal Medicine.

2.  Three years of approved residency in an approved Adult Cardiology residency program.

The following core experiences are required. Some learning experiences can occur simultaneously and/or longitudinally (e.g., electrocardiogram (ECG) interpretation, ambulatory clinics).

a.  15 blocks of clinical residency:

i.  4 blocks acute cardiac care (CCU)

ii.  6 blocks clinical cardiology (HF, Rehab, Consults, CSICU)

iii.  3 blocks ambulatory cardiology (may be done longitudinally)

iv.  2 blocks pediatric cardiology (which may include adult and congenital heart disease)

b.  15 blocks of laboratory based residency:

i.  3 blocks cardiac catheterization

ii.  6 blocks echocardiography

iii.  3 blocks electrophysiology/pacemaker

iv.  2 blocks ECG/ambulatory ECG monitoring/exercise stress testing

v.  2 blocks nuclear cardiology

vi.  1 Blocks of Advanced Cardiac Imaging

c.  4 blocks elective

d.  Minimum 2 blocks research (clinical and/or basic)

Rotation Contacts

Rotation / Rotation Head
Cath VGH / Dr. Jackie Saw
Cath SPH / Dr. Eve Aymong
CCU SPH / Dr. Krish Ramanathan
CCU VGH / Dr. Graham Wong
CHF, SPH (including cardiac transplant) / Dr. Andy Ignaszewski
Clinical Rotation / Various at three sites
Consults VGH / Dr. Hartmut Henning
CSICU, VGH / Dr. Rael Klein
Echo VGH including Diamond Centre outpatient clinic / Dr. John Jue
Echo SPH / Dr. Marla Kiess
Elective / Various
EP, SPH / Dr. Charles Kerr
Nuclear, SPH / Dr. Marla Kiess
Pediatrics, BCCH / Dr. Walter Duncan
Rehab, SPH / Dr. Sammy Chan
Research / Dr. John Jue, Dr. Sean Virani, Dr. Graham Wong
Adult Congenital / Dr. Marla Kiess

Cardiology Resident On-Call Guidelines

First year residents are on call 1 in 7. They are in-House during the first 6 months. All subsequent call is home call. Second year residents take call 1 in 8. Third years take call 1 in 9. If you are in house call you are expected to go home post-call after handover. If you are home call you need to exercise your discretion about going home post-call based on your level of fatigue.

The CCU directors will make every attempt to schedule a first year resident with a first year fellow so that first year residents have in-house supervision for the first 6 months of the year.

Once the call schedule is finalized it is the responsibility of the residents to make call trades amongst themselves and notify Dr. Wong’s and Dr. Ramanathan’s assistants about that trade. The chief residents must also be notified to update the master schedule.

Hand-Over

(1)  The cardiology resident on-call should be physically available for hand-over in the CCU at 17:00 unless alternate arrangements have been made (e.g. fellow to fellow hand-over when a cardiology resident is on a CCU rotation).

(2)  All critically ill patients in the CCU should be reviewed as required to assume care by the on-call resident at the time of handover.

(3)  It is not required that cardiology residents will be responsible for providing hand-over to on-call attending staff.

Communication

The on-call cardiologist should be informed in the case of:

(1)  A significant unexpected change in a patient’s clinical status (including changes requiring involvement of a subspecialist/cardiac surgeon)

(2)  The following procedures: intubations, transvenous pacemaker insertion, electrical cardioversion, PA catheter insertion and pericardiocentesis

(3)  Outside calls requesting advice or patient transfer, as well as urgent ECG interpretations when residents are unsure and require assistance. All BC Bedline calls should be directed to the attending cardiologist.

(4)  Discharging patients from the emergency room

(5)  All echocardiograms in which the results will dictate patient management

Review with Residents

Residents on weeknight call are expected to physically review all patients until 2200 hrs. All patients are then to be discussed with the cardiology resident after 2200 hrs. The cardiology residents are expected to physically review all patients who can be potentially discharged, all acutely ill patients, and must be available to supervise invasive procedures performed by more junior residents.

At Saint Paul’s Hospital, the fellows are expected to perform “night rounds” on the CCU between 20:00-22:00 with the cardiology resident and nurses.

In all cases of uncertainty, cardiology residents should err on the side of caution and review management with the on-call attending staff. If after repeated attempts you cannot reach the on-call cardiologist, you should try to reach a sub-specialty cardiology attending on-call (eg. Echo, Intervention, etc.) and explain your situation.

Evaluation Methods

All cardiology residents will receive written evaluations at the end of each rotation through WebEval at www.one45.com. Verbal evaluation should also occur at the midpoint and completion of a rotation. Evaluations of the attending’s must also be filled out by the resident before a rotation deemed completed.

It is the responsibility of residents to get a completed evaluation from each rotation, and also to keep their reverse evaluations up to date. If evaluations are not kept up to date, the residents will not be reimbursed for expenditures or conferences.

Methods of evaluation:

1.  Rotation evaluations

2.  Bi-Annual review with the program director

3.  Annual Clinical OSCE

4.  Graphics OSCEs

5.  CCU 360 Degree evaluation – evaluation by Attending and Allied Health Staff

http://postgrad.med.ubc.ca/files/2012/09/Resident-Evaluation-Policy-September-2012.pdf

Intimidation and Harassment

Intimidation and Harassment are not tolerated at UBC. In situations where residents feel that they are not being treated fairly, or where personality conflicts may arise, residents are encouraged to speak to the program director. If the problems remain unresolved, residents are encouraged to discuss this with the Head of Cardiology.

In addition, a formal mechanism is in place. Dr. V. Huckell (VGH) and Dr. C. Taylor (SPH), both cardiologists, have been appointed as internal resident advocates, and Dr. I. Mackie (general internist, prior UBC Internal Medicine Program Director) have been appointed as external resident advocates. The UBC Dean of Equity Dr. G. Parhar is a final resource for cases of discrimination. This information is included in the Orientation Manual, which all residents receive at the beginning of their training. For more information see:

http://postgrad.med.ubc.ca/files/2012/02/Policy___Process_to_Address_Unprofessional_Beahvior__Including_Harassment__Intimidation92.pdf

http://postgrad.med.ubc.ca/files/2012/02/Process_to_address_concerns__complaints_of_harassment__intimidation__unprofessional_behavior93.pdf

http://www.cfpc.ca/uploadedFiles/Education/Intimidation_and_Harassment_en.pdf

http://postgrad.med.ubc.ca/files/2012/09/RESIDENT-APPEAL-POLICYsept2012.pdf

CMPA insurance

CMPA insurance is now considered mandatory and must be obtained.

Parking Information

The program administrator will provide a parking pass that allows parking at the VGH courtyard for after-hours and weekends on call. A SPH staff placard can be obtained from the parking office in the Willow Chest Center and allow for discounted rates for parking at SPH.

Royal College Examination in Internal Medicine

First year cardiology fellows are allowed one week (5 business days) off duty for the royal college examination. If taking this time off of a 4-week rotation, a resident cannot also take vacation or conference time during this rotation. All attempts are made to ensure that clinical and academic duties are lightened for the several months prior to the royal college exam for adequate study time.

Things to Take Care of New Residents to Vancouver

·  Getting a program manual

·  Requisition of prescription privileges (voluntary)

·  Hospital ID at both sites

VGH: photo ID available from Photo ID Department, Heather Pavilion, Ground floor

SPH: photo ID available from Photo ID Department, 4th floor Burrard

·  Pager requisition

·  Computer access and training

·  Keys to residents’ room

·  Information regarding on-call room

·  Dictation information, dictation number etc.

Vacation and Conference Policy

Each year (July - July) residents are entitled to a vacation period of 4 weeks, including the weekends prior to, and following. In addition, residents are entitled to five consecutive days during either the Christmas or New Year’s period and other statutory days during the calendar year as determined by the hospital.

A resident cannot accumulate vacation or statutory holiday time from year to year unless for exceptional reasons subject to the approval of the PECC committee and the Division Head. Current policy is that residents cannot be away more than four weeks during the first six months of their training. Holiday is not allowed while scheduled on a CCU rotation. Vacation requests should be submitted in writing to the program secretary and rotation head at least 2 months in advance. All vacation requests are subject to the approval of the Program Director.

Conference time will be prioritized for those residents whose research has been accepted for oral or poster presentation. The Division will strive to provide funding for this. A request to attend any conference must be submitted in writing to the program director no later than 3 months prior to the conference. Residents can attends the CCC each year and attend an international conference twice in 3 years. Conferences are reimbursed by the program so residents can attend the Canadian Cardiovascular Congress twice (funded up to $1500) and international conferences twice (up to $2000).

1)  A request in writing must be given to the Program Administrator and rotation head three months prior to the start of rotation. In the event of too many requests per rotation, the final decision will rest with the Program Director. The Program Director has the discretion of not approving conference leave that is not appropriately requested as indicated above.

2)  One day of travel time prior to event and one day after event is allowable to a total of 5 working days.

3)  The conference must be relevant to Cardiology Training.

4)  While approval for conference leave may be granted, the resident requesting leave is ultimately responsible for ensuring appropriate call coverage and trade teaching duties during the conference period.

5)  Residents on a one month rotation will be allowed one week vacation or 5 days conference leave only, but will not be allowed to take both during the month.

Academic Schedule

Monday / 7AM – Cardiology Fellow Teaching
Tuesday / 7AM – Cardiology Fellow Teaching
12PM - CCU Resident teaching by a fellow – SPH ICU Conference Room
Wednesday / 12PM – Echo/PACH Rounds - SPH 5C/D Conference Room
Thursday / 7-9AM – Combined Rounds and Cardiology Grand Rounds – VGH/SPH
1:30-4:30PM – Cardiology Academic Half-Day
Friday / 7-8AM – CCU resident teaching by a fellow – VGH Taylor-Fidler Room
7:15-8AM – SPH M&M Rounds

A GUIDE TO BC CHILDREN’S HOSPITAL

·  On the first day of rotation, the residents will get a guided tour of the hospital. All dictation goes through the hospital central system, or through the related attending’s personal secretary. Computer work can be done on any of the several computer workstations that are available for resident use.

·  There is no night-call required at BC Children’s Hospital. During this rotation, residents will perform 2nd call on weekends at SPH or VGH as described earlier.

·  On-site parking is available at public rates.

Name / Phone / Pager / Email
Duncan, Walter / 604-875-2855 /
(Theresa)

A GUIDE TO UBC HOSPITAL

·  The rotation will be supervised by Dr. Saul Isserow. The main goals for the rotation will be to gain proficiency in all aspects of outpatient cardiology including exercise treadmill testing, supervision of the stress component of nuclear scanning, ECG and holter monitor interpretation and outpatient cardiology.

·  Residents should contact Dr. Isserow prior to starting the rotation to see where they should report to on the first day of the rotation.

Name / Phone / Pager / Email
Isserow, Saul / 604-822-1747 / 604-877-2827 / or (Sonia)

Community Cardiology Rotations

·  A formal community cardiology rotation is available through Dr. Jonathan Tang at Mount Saint Joseph Hospital. In addition, many residents do schedule elective community cardiology rotations at the breadth of hospitals across Vancouver Coastal Health and Fraser Health.