Royal College FRCPC Residency

Western is a medium sized Emergency Medicine program situated in London, Ontario with a large catchment area. We have 3 hospitals and are a level 1 trauma centre with a full compliment of clinical services and resources. We have an incredibly engaged group of residents and faculty, and provide an excellent training experience in a supportive environment. Please read through the rest of the information for further specifics. We always welcome connection from those interested in learning more about our program and London, as we are proud of the education and experience our residents get here. 

The residency at Western traditionally consisted of a five year, 65 block curriculum with a rough breakdown of one-half EM related rotations, and one-half off-service rotations, including medicine, surgical and trauma specialties, critical care environments, psychiatry, toxicology, and EMS/Pre-hospital care. The residency also supports longitudinal experiences in research, and other areas of special interest such as; Fellowships in POCUS, EMS/pre-hospital care, critical care, resuscitation, and sports medicine, and Masters Programs in medical education, epidemiology and biostatistics, public health, trauma, and disaster planning, and business administration. 

The residency has now transformed into a competency by design curriculum. The first four residents started in the CBME model in July 2018. This allows residents to traverse a wide range of medical specialties as they progress from an introductory stage to transition to EM practice. Western will continue to graduate the next generation of stellar EM clinicians who will be well equipped to practice in the ever-changing and increasingly complex environment of
academic Emergency Medicine. 

Quick Facts: 

• There are four core learning sites which include University hospital, Victoria hospital, Children’s hospital which are all a part of London Health Sciences Centre. University hospital is our Cardiac and Neurology centre, while Victoria Hospital is our trauma, Psychiatry, and Obstetrical and Gynecology site. In Addition, our Urgent Care Centre at St. Joseph’s hospital is a location that the residents rotate through regularly which also boasts our Hand and Upper Limb Clinic and Ophthalmology. 
• We have opportunities to work out our distributed sites including St. Thomas, Stratford, Strathroy, Woodstock, Chatham, Windsor etc. Our catchment area is large, providing significant opportunity to be exposed to a wide breadth of pathology and diverse populations. Our Obstetrics rotation is done in Windsor as a PGY2 and is a satellite site for our undergraduate Medical students as well. 
• There are currently 22 residents (4-5 per year) in the Emergency Medicine Residency Program spanning 5 clinical years. Currently there are 90+ faculty members at The London Health Sciences Centre and 16 full-time Pediatric Emergency physicians at the Children’s Hospital of Western Ontario and additional locums. 
• It is very common for residents to take electives in Clinical Toxicology at The Hospital for Sick Children in Toronto and also at Bellevue Hospital in New York City (NYCPC) Although these are by definition electives, the program currently supports residents for travel and accommodation. 
• There are many other electives that have been undertaken, and the program is always thrilled to support new endeavors. 
• Our program is currently making some significant changes to incorporate our community stakeholders and agencies into our education and training. This is in its early stages, but hope to have more regular teaching and involvement with local agencies that serve our various patient populations. In turn, this will provide us with the opportunity to have some additional elective potential in social medicine and with our underserved populations, and more discussion and teaching around EDI topics. We have a new addictions service and elective that began in 2022-2023 academic year, and are looking for further expansion of these opportunities on a more formal basis. We are committed to expanding our incorporation and celebration of diversity into all aspects of our program. 

The Emergency Medicine program at Western endeavors to provide an environment in which we work together, residents and faculty to flourish under any circumstances to help our patients, all of our colleagues and our community. We have recently drafted a new Mission, Vision and Values outlined below. As a group we have identified the ideals and characteristics of our program, and where we would like to strive to be. These qualities will guide our selection criteria, endeavoring to engage more students to build and support our effort to work together to build a better program, department and community.

The strengths of the program reside within the dedicated faculty, the commitment to teaching, and the extensive and varied patient population and catchment area. We are constantly looking to improve and expand our curriculum, and have a rotation of evaluating each aspect of the program, as well as regular input from the residents longitudinally to assure we are meeting the requirement of the Royal College/accreditation, as well as the needs of our learners and faculty. Our faculty are engaged and enthusiastic, as are our residents.  

Quarterly we review 2-4 rotations formally at our RPC meetings, and adjust these learning opportunities accordingly. We are in the process of adapting our objectives and target EPAs for each of these rotations to ensure there is clear competencies, EPAs and objectives associated with each rotation.  

Residents are evaluated on a quarterly by means of direct observation and in-training examinations, both written and oral in nature, EPAs, clinical mentors, presentation and teaching evaluations, Simulation, and research. The Program Director and Competence Committee review resident progress on a regular basis and feedback is regularly provided. We are currently working with our PGME for their upcoming improvements in our online EPA system to further this ability. 

Academic days 

Each Thursday we have our protected academic teaching day. These run from September to June, and July and August are “summer school” (see below). 

8am – Senior resident rounds 

9am – Grand Rounds 

10-12 – Core Rosen’s teaching 

1pm – afternoons sessions (varied, see below) 

Our senior resident rounds are organized by our PGY5 residents and consist of some clinical pearls, quizzes, games and guest speakers. Our accredited Grand Rounds is a 1 hour session conducted by faculty, a combination of faculty and residents or outside guest speakers spanning a variety of topics. These are in person, and a welcome return to this format after COVID. 

Our Core Rosen’s teaching is 2 hours, and has recently been reorganized to be on a 3 year rotation to cover all the topics in the new 10th Edition. Faculty are required to teach around the topic as per the Rosen’s chapter, but also include relevant literature, guidelines, an example of an oral case and written exam, as well as case based teaching. The information is then stored in a secure online database for the residents to access after.  The expectations prior to the teaching include reviewing the Rosen’s chapter and objectives and literature or material provided by the faculty conducting that session. These sessions have the expectation to be done in a psychologically safe fashion, with an awareness to EDI principles and information surrounding effective teaching in a didactic fashion, as well as an awareness to planetary health in this context.  

In the afternoon there is monthly high fidelity simulation that is held at another facility for all of the FRCPC residents. We have recently renovated part of our Emergency medicine space to accommodate a small simulation lab at the hospital, and look to expand the Simulation time in the 2024-2025 year. Other simulation sessions include other procedural days including canthotomies, open thoracotomies, tendon repairs, cricothyrotomy on cadavers in our anatomy lab. Our PGY2s also have a comprehensive curriculum for their sports medicine/ortho hybrid rotation with intermittent sessions dedicated to the musculoskeletal exam and management of these injuries and conditions.  

There is also an afternoon each month that is dedicated research time, the residents have this free to use for research if they choose. There is no scheduled session during this time. 

The other afternoons are a new addition as of the 2023-2024 academic year. These include varied medico-legal topics, communication, teaching as a resident, evolution of learning and studying, how to combine in person and virtual learning, learning strategies, geriatrics additional teaching, pediatric dental teaching, social medicine and engagement, leadership, styles of learners, clinical epidemiology, QA teaching, sessions from our local police surrounding human trafficking, 2SLGBTQ+ session and subsequent simulation session, indigenous sensitivity training and are working on additional sessions surrounding trauma informed care, trans health, and around our role in helping our under privileged and under served patients.  

These afternoons also allow us to enjoy team building and wellness activities as a group. 

We have an annual Airway Day, which includes extensive teaching from our local airway experts (including some AIME instructors), Anesthesiologists and Critical Care Physicians. We also have a Resident Research day annually to allow both the FRCPC and CCFP-EM and medical students to present their research.  

In addition, we have quarterly confidential Human Rounds with the PD. These were a safe space for residents to discuss the more difficult aspects of medicine and residency in a supportive group of peers. This is open to any aspect of life or residency that they want to discuss, and is completely voluntary. We are looking to expand these in this upcoming year. 

Summer School 

During July and August our Thursday teaching is organized differently, and includes orientation and ice breaker sessions for the PGY1s, an introductory POCUS course and EMS orientation and introductory Simulation sessions for the PGY1 cohort, and this is often paired with the CCFP-EM residents. The sessions during the rest of the summer include increased focus on procedures (lines, chest tubes, casting, nerve blocks, surgical airways, pericardiocentesis etc), trauma, critical care, blood gas interpretation, EPA/CBME updates, toxicology, plastics pearls, and wellness activities. 

Exam Preparation 

We have a study schedule that residents can use and modify that is provided, as well as mentorship from previous residents and faculty. With this there is formal written and oral exams performed throughout the year, as well as informal oral exams and written exams performed before or after shifts, and on other time. Our faculty is very engaged in this preparation. Should a resident have some difficult, a learning plan and additional mentorship and supervision is established if needed. Regular communication with the residents studying the PD/APD, RPC and faculty facilitate studying and mentorship throughout this challenging year. There is a shift reduction in the several months prior to the exam, and further during exam months. Our PGY4 and 5 residents self schedule with specified guidelines to facilitate exam preparation and their AFC/AFI in their PGY5 year.  

Transition to Practice 

The 2022-2023 year was the first year we had a transition to practice (T2P) cohort. They had some separate teaching with further detail about medico-legal teaching, litigation, financial transition to faculty, how to disclose errors, becoming a teacher as a faculty, and legislation and complaint processes. In addition, they had a dedicated simulation day revolving around transition to practice content. They were expected and welcomed to additional teaching roles for both postgraduate, undergraduate students, undergraduate coaching, death review committee, additional CaRMS opportunities, oral exam development and administration, learner supervision and simulation teaching. There was the ability to alter rotations and shifts based around future practice and perceived need, and support throughout to assure all aspects of clinical and non-clinical objectives were addressed. We also had the opportunity to have a T2P block which allowed the residents to focus on department flow and organization, supervision of learners, documentation, handover, billing, receiving patch calls, addressing the nursing concerns and close oversight of clinical plans. These were identified to faculty, and particular competencies were focused on in each shift with a discrete evaluation associated with this. The T2P residents enjoyed these. This was also in addition to an optional “teaching” block if the residents wanted to focus their teaching together.  

Area of Focused Competency/Interest and Fellowship  

We have had a variety of interests and here at UWO have a formally accredited PoCUS and Prehospital AFC program, as well as being a centre with a Pediatric Emergency department with the opportunity for further pursuits of Pediatric Emergency Medicine. Other pursuits have included Critical Care, Trauma, Toxicology, Resuscitation and Reanimation/Simulation, Medical Education, Addictions, Research, Clinical Epidemiology, Masters in Health Administration, Masters in Business Administration, Masters in Public Health, Narrative Medicine, Wilderness Medicine, Sports Medicine, Palliative Care and more. The opportunities are extensive and well supported by our program. We are able to individualize the T2P year, and time throughout residency to suit each resident’s particular needs and desires.  

Journal Club 

Our journal club was significantly disrupted by COVID, and is the rebuilding stage. This year likely will see each portfolio do a dedicated journal club (ie Simulation, PoCUS, Preshopital, Wilderness, FRCPC, CCFP-EM). These have been in the evening and are accompanied by a meal. The 2024-2025 year has plans to have some additional changes as our Research program evolves.  

In addition to journal club, we have “Bottom lines” sessions which are organized by our chief residents and supervised by some of our research faculty. These comprise of a collection of practice changing papers, both historical and recent. Each resident is tasked with summarizing 1-2 articles both written and orally, and then these are shared with the group.  

Mentorship and Feedback 

Each resident is provided with 2-4 clinical mentors whom they work with in each Emerg block throughout residency. These are based on both clinical, research and other non-clinical interests, and can be altered or added to as things evolve. In addition, each resident has a longitudinal Competency Committee (CC) mentor who is in touch at least quarterly, and often more frequently. 

The PD and APD meet biannually with each resident individually, and frequently if desired/requested or necessary for any reason. The PD/APD, CC and Residency Program Committee (RPC) members as well as other faculty and chief residents are very readily available should urgent issues arise. 

Our CC meet quarterly followed by our RPC to review EPAs, clinical mentor feedback, block evaluations, teaching evaluations, research progress, CITE (Canadian In Training Exam) results, oral exam results, Simulation evaluation, Grand rounds/other presentation evaluations. This is then fed back to the resident for their review, and pre and post meeting the residents are asked for input and feedback. The residents are also invited to the RPC meetings, and there is a senior and junior representative present at each RPC meeting. 

Should a resident require extra learning, we have the ability to support the with faculty and resident mentorship and learning plans. If a resident is exceeding expectations, we are also able to adjust the opportunities to meet these learners needs as well.