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					University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009




                                             Table of Contents

                                                                  Page
                        Emerg Med R1 – R5                         2 - 26
                        Emerg Administration                        27
                        Anesthesia                                  31
                        CCU                                         35
                        EMS                                         37
                        General Surgery                             41
                        ICU                                         45
                        Internal Medicine                           49
                        Neurosurgery                                83
                        Obstetrics & Gynecology                     57
                        Ophthalmology                               61
                        Ortho & MSK                                 64
                        Peds Emergency R1 – R5                   67 - 82
                        Peds ICU                                    83
                        Plastics                                   103
                        Psychiatry                                 108
                        Research                                   112
                        Aero Medical Transport                     114
                        Trauma                                     117




Revised: June 2009                                                         Page 1 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
                                         EMERGENCY MEDICINE - R1


Medical Expert:

       Able to independently perform appropriate, thorough and directed history and physicals in
        common clinical presentations. Also able to do thorough pediatric, gynecological and
        psychiatric assessments.
       Understands and orders appropriate, cost effective, basic lab and diagnostic imaging tests.
       Begins to independently make decisions on disposition in common clinical problems in
        consultation with attending staff.
       Demonstrate a good general clinical knowledge in common problems.
       Begins to execute a systematic search for evidence and learns the importance of critically
        evaluating the medical literature.
       Shows solid evidence of self-assessment by recognizing when personal limits are exceeded
        and demonstrating timely consultation with the staff emergency physician.
       Develop progression in the development of a systematic and cognitive approach to clinical
        reasoning in order to solve the individual’s patient problems.
       Able to demonstrate competency in IV insertion, venipuncture, ABGs, simple suturing, casting
        and splinting, beginning airway management, foley catheter insertion, urinalysis, NG tube
        insertion and lumbar puncture.
       Able to perform CPR, defibrillation, and basic airway management including intubation with
        close staff supervision.
       Beginning to manage the poisoned patient with staff supervision.
       Demonstrate proficiency of objectives outlined in off-service rotations completed in the PGY -1
        year including anaesthesia, general surgery, internal medicine, obstetrics, gynecology,
        psychiatry, pediatrics, pediatric emergency, trauma surgery.


Communicator:

    The resident should begin to develop the following skills:

       Establish and maintain rapport and fostering an environment characterized by understanding,
        trust, empathy and confidentiality.
       Explore patient’s beliefs, concerns, and expectations about the origin, nature, and management
        of his/her illness. Assess the impact of such factors as age, gender, ethno-cultural background,
        social support and emotional influences on a patient’s illness.
       Inform and counsel a patient in a sensitive and respectful manner while fostering understanding,
        discussion, and the patient’s active participation in decisions about their care. This includes the
        ability to listen to the patient and to communicate effectively with other health providers, to
        ensure optimal and consistent care of the patient and his/her family.
       Maintain appropriate and concise charting.
       Demonstrate the ability to screen for sensitive issues such as those of substance abuse,
        physical or sexual abuse and risk factors for HIV and other sexually transmitted diseases.
       Learn the importance of cooperation and communication among health professionals involved
        in the care of individual patients such that the roles of these professionals are delineated and
        consistent messages are delivered to patients and their families.
       Recognize the importance of the skills in working with others who present significant
        communication challenges such as anger or confusion, an ethno-cultural background different
        from the physician’s own, physical or emotional impairment. This includes the ability to
Revised: June 2009                                                                         Page 2 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
        communicate with patients with the potential for violent behavior in a way that may defuse the
        potential for violence.
       Demonstrate the ability to recognize and minimize the negative effects that one’s emotions
        (anger, frustration, anxiety, fear) have on one’s ability to communicate effectively and take steps
        to minimize these effects.
       Enroll in the faculty wide Communication Skills course.


Collaborator:

The resident should be able to:

       Develop a care plan for a patient they have assessed, including investigation, treatment and
        continuing care, in collaboration with the staff Emergency physician.
       Maintain collegial and respectful relationships with medical and para-medical staff.
       Understand the roles and expertise of the other individuals involved, inform and involve the
        patient and his/her family in decision-making, and explicitly integrate the opinions of the patient
        and care givers into management plans.
       Demonstrate an ability to promote the autonomy of patients and families and to promote their
        involvement in decision-making.
       Perform as a team member in medical and trauma resuscitations.



Health Advocate:

The resident should be able to:

       Identify the patient’s status with respect to one or more of the determinants of health (i.e., the
        medical history to the patient’s social circumstances); and assessing the patient’s ability to
        access various services in the health and social system so as to promote health, enhance
        understanding, foster coping abilities, and enhance active participation in informed decision-
        making.

Manager:

The resident should be able to:

       Effectively care for several patients while working in the Emergency department and follow them
        through their ED course.
       Be open to working effectively as a member of a team or a partnership.
       Effectively use patient-related databases, access computer-based information and understand
        the fundamentals of medical informatics.
       Employ effective time management and self=assessment skills to formulate realistic
        expectations and a balanced lifestyle.




Scholar:

Revised: June 2009                                                                         Page 3 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
The resident should be able to:

       Develop a personal study strategy.
       Provide support for clinical clerks rotating through ED.
       Identify learning needs and make use of available learning resources.
       Demonstrate critical thinking and integrate critical appraisal of the literature into the bedside
        approach.
       Analyze and interpret the validity and applicability of evidence contained in the medical
        literature.
       Apply new knowledge to daily practice


Professionalism:

The resident should be able to:

       Be punctual for Emergency shifts and educational events.
       Follow through on assigned tasks.
       Be respectful, honest and compassionate care when dealing with patients, families and other
        professionals.
       Demonstrate an enthusiasm for learning.
       Demonstrate good self-assessment ability by being aware of own limitations and seeking
        feedback.
       Be aware of racial, cultural, and societal issues that impact on the delivery of care and an ability
        to maintain and enhance appropriate knowledge, skills and professional behaviors.
       Be accountable for personal actions, have a high degree of self-awareness, maintaining an
        appropriate balance between personal and professional roles, and addressing interpersonal
        differences in professional relations.
       Recognize, analyze and know how to deal with unprofessional behaviors in clinical practice,
        taking into account local and provincial regulations.




Revised: June 2009                                                                          Page 4 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
                                        EMERGENCY MEDICINE - R2



GOALS:

       To improve on the knowledge and skills developed from PGY -1.
       Develop a clearer understanding of the role of the Emergency Physician.
       Develop more analytical and accurate approaches to patient management.


Medical Expert:

       Able to independently perform appropriate, thorough and directed history and physicals in more
        complex, clinical presentations than as a PGY -1.
       Able to order appropriate, cost effective, focused investigations in straightforward cases with
        emphasis based on sound evidence-based criteria.
       Demonstrate appropriate strategies in ruling out more complicated diagnoses.
       Formulizes more complex management and disposition plans in consultation with the
        Emergency staff physician.
       Progressive independence in directing care of patients with common ED complaints including
        managing care of patients with non life threatening problems (history, physical, investigations,
        treatment, disposition and follow up) independently by the end of the 2nd year. (All patients
        must be discussed with the attending Emergency Physician prior to discharge).
       Improved and good knowledge base in common clinical problems with and understanding of
        pathophysiology in medical and surgical areas.
       Demonstrates competency in objectives outlined from completed PGY – 1 and 2 off – service
        rotations including neurosurgery, orthopedic surgery, plastic surgery, intensive care, coronary
        care, ophthalmology, otolaryngology sports medicine and pediatric emergency medicine.
       Demonstrate improved proficiency in skills mentioned in PGY 1 and in addition: Chest tube
        insertion, thoracentesis, arterial line insertion, central line insertion, endotracheal intubation,
        reduction of simple fractures and dislocations, I and D of abscesses, removal of corneal foreign
        bodies, arthrocentesis, pediatric would management (suturing and tissue glue) and assisting
        with procedural sedation.
       Increasing independence in initiating care and disposition in patients with acute coronary
        syndromes.
       Able to manage care of patients with common serious medical and surgical problems with staff
        supervision.

Communicator:

The resident should demonstrate improved skills from the PGY -1 year including:

       Maintain appropriate and concise charting including pertinent history and physical findings and
        an approach to a diagnosis, treatment plan and follow-up displayed.
       Increasing role as team member in medical and trauma resuscitations.
       Establish and maintain rapport and fostering an environment characterized by understanding,
        trust, empathy and confidentiality.



Revised: June 2009                                                                         Page 5 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
       Explore patient’s beliefs, concerns, and expectations about the origin, nature, and management
        of his/her illness. Specialist Emergency Physicians need to be able to assess the impact of
        such factors as age, gender, ethno-cultural background, social support and emotional
        influences on a patient’s illness.
       Inform and counsel a patient in a sensitive and respectful manner while fostering understanding,
        discussion and the patient’s active participation in decisions about their care. This includes the
        ability to listen to the patient and to communicate effectively with other health providers, to
        ensure optimal and consistent care of the patient and his/her family.
       Establish relationships with the patient that is characterized by understanding, trust, respect
        empathy and confidentiality.
       Demonstrate the ability to screen for sensitive issues such as those of substance abuse,
        physical or sexual abuse and risk factors for HIV and other sexually transmitted diseases.
       Learn the importance of cooperation and communication among health professionals involved
        in the care of individual patients such that the roles of these professionals are delineated and
        consistent messages are delivered to patients and their families.
       Recognize the importance of the skills in working with others who present significant
        communication challenges such as anger or confusion, an ethno-cultural background different
        from the physician’s own, physical or emotional impairment. This includes the ability to
        communicate with patients with the potential for violent behavior in a way that may defuse the
        potential for violence.
       Demonstrate the ability to recognize and minimize the negative effects that one’s emotions
        (anger, frustration, anxiety, fear) have on one’s ability to communicate effectively and take steps
        to minimize these effects

Collaborator::

       Develop an increasingly more comprehensive care plan for a patient they have assessed,
        including investigation, treatment and continuing care, in collaboration with the staff Emergency
        physician.
       Maintain collegial and respectful relationships with medical and para-medical staff.
       Understand the roles and expertise of the other individuals involved, inform and involve the
        patient and his/her family in decision-making and explicitly integrate the opinions of the patient
        and care givers into management plans.
       Demonstrate an ability to promote the autonomy of patients and families and to promote their
        involvement in decision making.
       Increasing role as team member in medical and trauma resuscitations.
       Recognize team members’ areas of expertise, respect the opinions and roles of individual team
        members.

Health Advocate:

The resident should be able to:

       Identify the patient’s status with respect to one or more of the determinants of health (i.e.,
        unemployment); adapting the assessment and management accordingly (i.e., the medical
        history to the patient’s social circumstances); and assessing the patient’s ability to access
        various services in the health and social system so as to promote health, enhance
        understanding, foster coping abilities, and enhance active participation in informed decision-
        making.

Manager:
Revised: June 2009                                                                         Page 6 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009

The resident should be able to:

       Efficiently manage individual patients and start beginning to see higher numbers of patients as
        the year progresses.
       Making clinical decisions and judgments based on sound evidence for the benefit of individual
        patients and the population served.
       Be open to working effectively as a member of a team or a partnership.
       Effectively use patient-related databases, access computer-based information and understand
        the fundamentals of medical informatics.
       Employ effective time management and self-assessment skills to formulate realistic
        expectations and a balanced lifestyle.

Scholar:

The resident should be able to:

       Complete course work in Critical Appraisal and Research Methodology.
       Research project developed, literature search completed and plan presented at annual resident
        research day.
       Identify learning needs and make use of available learning resources.
       Demonstrate critical thinking and integrate critical appraisal of the literature into the bedside
        approach.
       Analyze and interpret the validity and applicability of evidence contained in the medical
        literature.
       Apply new knowledge to daily practice.

Professionalism:

The resident should be able to:

       Be punctual for Emergency shifts and educational events.
       Follow through on assigned tasks.
       Be respectful, honest and compassionate when dealing with patients, families and other
        professionals.
       Demonstrate an enthusiasm for learning.
       Demonstrate good self-assessment ability by being aware of own limitations and seeking
        feedback.
       Be aware of racial, cultural, and societal issues that impact on the delivery of care and an ability
        to maintain and enhance appropriate knowledge, skills and professional behaviors.
       Be accountable for personal actions, have a high degree of self-awareness, maintaining an
        appropriate balance between personal and professional roles, and addressing interpersonal
        differences in professional relations.
       Recognize, analyze and know how to deal with unprofessional behaviors in clinical practice,
        taking into account local and provincial regulations.




Revised: June 2009                                                                          Page 7 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009


                                        EMERGENCY MEDICINE - R3


Medical Expert:

       Demonstrates history and physical exam findings as described for PGY -1 and PGY -2
        objectives and now uses these skills to diagnosis increasingly more complex and subtle clinical
        presentations.
       Proficient use of appropriate, evidence based, cost effective lab and diagnostic imaging tests.
       Exhibits very good clinical judgment in common presentations and shows improved judgment in
        patients with complex and subtle presentations.
       Recognizes personal limits of expertise by self-assessment and learning the ability to decide if
        and when other professionals are needed to contribute to a patient’s care.
       Demonstrates increasing independence in decision-making process.
       Demonstrates effective consultation skills.
       Demonstrates an improved systematic and cognitive approach to clinical reasoning in order to
        solve the individual patient’s problems.
       Meets learning objectives for all off service rotations covered in first three years of residency.
       Able to pose an appropriate patient-related question, execute a systematic search for evidence
        and critically evaluate medical literature and other evidence in order to optimize clinical decision
        making.
       Beginning to meet learning objectives in Environmental disorders, Toxicology, Trauma, EMS,
        procedural skills and Critical Appraisal. Knowledge base in all of these areas developed to an
        increasing depth including pathophysiology and current literature.
       In addition to skills mentioned for PGY 1 and 2: Rapid sequence induction intubation (performs
        with supervision), synchronized cardioversion, pericardiocentesis, transcultaneous pacemaker
        application, procedural sedation (directs with supervision), anoscopy, interosseous infusion,
        fiberoptic laryngoscopy. Able to repair complicated lacerations. Able to teach procedural skills
        to medicall and Junior residents.
       Directs all resuscitation (medical, pediatric and trauma) cases with close staff supervision and
        support.
       Treats acute coronary syndromes independently after discussion with staff Emergency
        Physician.
       Manages toxicology cases with increasing independence.

Communicator:

In addition to the skills developed during the first 2 years:

       Maintain appropriate, complete and concise charting including pertinent history and physical
        findings and a clear diagnosis, treatment plan and follow-up displayed.
       Increasing amount of independence in management of patients while still under close
        supervision of the staff Emergency Physician.
       Establish and maintain rapport and fostering an environment characterized by understanding,
        trust, empathy and confidentiality.
       Explore patient’s beliefs, concerns, and expectations about the origin, nature, and management
        of his/her illness. Specialist Emergency Physicians need to be able to assess the impact of
        such factors as age, gender, ethno-cultural background, social support and emotional
        influences on a patient’s illness.
Revised: June 2009                                                                          Page 8 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
       Inform and counsel a patient in a sensitive and respectful manner while fostering understanding,
        discussion and the patient’s active participation in decisions about their care. This includes the
        ability to listen to the patient and to communicate effectively with other health providers, to
        ensure optimal and consistent care of the patient and his/her family.
       Develop leadership role in medical and trauma resuscitations.
       Establish relationships with the patient that is characterized by understanding, trust, respect
        empathy and confidentiality.
       Demonstrate the ability to break bad news such as that of death or serious illness or injury to
        patients and/or their family members in a way that is sensitive, thorough and understandable.
       Demonstrate the ability to screen for sensitive issues such as those of substance abuse,
        physical or sexual abuse and risk factors for HIV and other sexually transmitted diseases.
       Demonstrate the ability to discuss issues of advanced directives, living wills and DNR orders
        with patients and their families.
       Demonstrate skill in cooperation and communication among health professionals involved in the
        care of individual patients such that the roles of these professionals are delineated and
        consistent messages are delivered to patients and their families.
       Recognize the importance of the skills in working with others who present significant
        communication challenges such as anger or confusion, an ethno-cultural background different
        from the physician’s own, physical or emotional impairment. This includes the ability to
        communicate with patients with the potential for violent behavior in a way that may defuse the
        potential for violence. Demonstrate the ability to recognize and minimize the negative effects
        that one’s emotions (anger, frustration, anxiety, fear) have on one’s ability to communicate
        effectively and take steps to minimize these effects.


Collaborator:

The resident should be able to

       Understand the roles and expertise of the other individuals involved, inform and involve the
        patient and his/her family in decision making, and explicitly integrate the opinions of the patient
        and care givers into management plans.
       Begin to recognize team members’ areas of expertise, respect the opinions and roles of
        individual team members, contribute to healthy team development and conflict resolution, and
        contribute his/her own expertise to the team’s task in hospitals, practice settings, and other
        institutions, such as committee work research, teaching and learning.
       Begin to learn the ability to function effectively within the unique environment of the emergency
        department, recognizing the unpredictable nature of patient presentations, and the demands of
        working with a multidisciplinary team.
       Begin to demonstrate the ability to assume a team leadership and effective participant role in
        the complex multidisciplinary environment of the emergency department.
       Begin to demonstrate an understanding of the unique interaction of the emergency department
        with every component of the health care system, including the hospital, its relationship to the
        community, and other agencies such as Emergency Services (EMS).
       Demonstrate an ability to promote the autonomy of patients and families and to promote their
        involvement in decision making.



Health Advocate:

Revised: June 2009                                                                          Page 9 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
The resident should be able to:

       Identify the determinants of health that affect a patient, so as to be able to effectively contribute
        to improving individual and societal health in Canada. This includes the ability to recognize,
        assess, and respond to the psychosocial, economic, and biologic factors influencing the health
        of those served. The specialist incorporates information on the health determinants into his/her
        practice behaviors – both with individual patients and their community. At the doctor-patient
        level, this involves adapting patient management and education, so as to promote health,
        enhance understanding, foster coping abilities, and enhance active participation in informed
        decision making.
       Recognize and respond to those issues, settings, circumstances, or situations in which
        advocacy on behalf of patients, professions or society is appropriate. This involves the ability
        to: identify populations at risk, identify current policies that affect health, and recognize the
        fundamental role of epidemiological research in informing practice. At a broader level, this
        includes the ability to describe how public policy is developed and employ methods of
        influencing the development of health and social policy.
       Demonstrate an understanding of the management of individual patients by identifying the
        patient’s status with respect to one or more of the determinants of health (i.e., poverty,
        unemployment, early childhood education, social support systems), being familiar with the
        underlying research evidence and applying this understanding to common problems and
        conditions encountered in emergency medicine.
       Demonstrate an understanding of the management of individual patients by identifying the
        patient’s status with respect to one or more of the determinants of health (i.e., unemployment);
        adapting the assessment, management and disposition accordingly (i.e., The medical history to
        the patient’s social circumstances); and assessing the patient’s ability to access various
        services in the health and social system.
       Demonstrate an understanding of the analysis of the emergency medicine patient population
        work with relevant associations in identifying current “at risk” groups within the practice; identify
        impediments to good, efficient, effective emergency medicine patient care and take steps to
        publicize and address these issues’ and contribute “group data” for better understanding of
        health problems within the population.

Manager:

The resident should be able to:

       Employ effective time management and self-assessment skills to formulate realistic
        expectations and a balanced lifestyle.
       Make sound judgments on resource allocation based on evidence of the benefit to individual
        patients and the population served.
       Use patient related databases, access computer based information and understand the
        fundamentals of medicine informatics.
       Begin to understand the relationship between the emergency department and the hospital and
        between the emergency department and the community.
       Make clinical decisions and judgments based on sound evidence tfor the benefit of individual
        patients and the population served.
       Work effectively as a member of a team or partnership and to accomplish tasks whether one is
        a team leader or a team member.
       Manage concomitantly a number of ill and injured patients at any given time.



Revised: June 2009                                                                           Page 10 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
       Understand the supervisory and administrative aspects of Emergency Medical Services
        systems (i.e. rationalization of Emergency Services, communications systems, pre-hospital care
        programs, ambulance services, paramedical emergency services and disaster medicine).
       Beginning to understand the dynamic of running an entire emergency department.
       Beginning to demonstrate the leadership skills during patient management.

Scholar:

The resident should be able to:

        Analyze and interpret the validity and applicability of evidence contained in the medical
        literature.
       Apply new knowledge to daily practice.
       Provide constructive feedback to learners.
       Establish a sustainable pattern of reading that will allow him/her to schedule sufficient time to
        maintain a current knowledge base.
       Learn how to efficiently track new literature pertinent to his/her practice, including studies
        published outside the Emergency Medicine literature.
       Learn the principles of biostatistics and critical analysis, allowing proper interpretation of original
        research publications. This can be best learned either with specific university courses or
        through a series of core lectures and assignments, complimented by regular participation in
        Journal Clubs.
       Acquire the basic principles of clinical bedside teaching.
       Acquire the basic principles of didactic teaching and public speaking, including the use of
        multimedia software and the basic skills for moderating small group discussion.
       Acquire the skills necessary to apply new knowledge in an evidence based fashion to clinical
        practice.
       Learn the basic principles of clinical research methodology, further improving the ability to
        interpret original research.
       Become aware of patient information and patient support groups. Become aware of web sites
        capable of providing comprehensive information to patients pertinent to illness or injury treated
        in the emergency department.
       Begin to acquire the basic principles of clinical bedside teaching.

Professionalism:

The resident should be able to:

       Be punctual for Emergency shifts and educational events.
       Serve as a role model for more junior learners.
       Follow through on all assigned tasks.
       Be respectful, honest and show compassionate care when dealing with patients, families and
        other professionals.
       Demonstrate an enthusiasm for learning.
       Demonstrate good self-assessment ability by being aware of own limitations and seeking
        feedback.
       Be aware of racial, cultural, and societal issues that impact on the delivery of care and an ability
        to maintain and enhance appropriate knowledge, skills and professional behaviors.



Revised: June 2009                                                                             Page 11 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
       Be accountable for personal actions, have a high degree of self-awareness, maintaining an
        appropriate balance between personal and professional roles, and addressing interpersonal
        differences in professional relations.
       Recognize, analyze and know how to deal with unprofessional behaviors in clinical practice,
        taking into account local and provincial regulations.




Revised: June 2009                                                                   Page 12 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009

                                        EMERGENCY MEDICINE - R4


Medical Expert:

       Very good independent decision making skills – close to consultant-level.
       Adept at all skills listed in PGY 1-3 objectives.
       Able to perform rapid sequence induction intubation, difficult airway management and
        procedural sedation. Also, able to perform complex tasks and orders such as extensor tendon
        laceration repair, gastric lavage and whole irrigation for toxicology. The resident should
        possess an excellent understanding of all aspects of each procedure (indication, complications,
        follow-up required, interpretation of results obtained and alternate ways to complete the
        procedure).
       By PGY 4 the resident should be adept at leading all types of resuscitation with decreasing staff
        supervision and should able to teach these skills to others during resuscitation effort.
       Elicit a relevant, concise, and accurate history and efficiently conduct an effective physical
        examination; carry out relevant procedures to collect, analyze, and interpret data; reach a
        diagnosis and perform appropriate therapeutic procedures to help resolve a patient’s problem
        with decreasing amount of staff reliance.
       Pose an appropriate patient-related question, execute a systemic search for evidence, and
        critically evaluate medical literature and other evidence in order to optimize clinical decision-
        making for most patient encounters.
       Begin to demonstrate medical expertise in situations other than in direct patient care. This
        includes the ability to provide testimony as an expert medical witness and to give thorough,
        concise and state of the art presentation.
       Recognize personal limits of expertise by self-assessment. This includes the ability to decide if
        and when other professionals are needed to contribute to a patient’s care.
       Demonstrate effective consultation skills. This includes presenting well-documented patient
        assessments and recommendations in both written and verbal form, in response to a request
        from another health professional.
       Apply the knowledge and expertise to the performance of specific psychomotor skills relevant to
        the specialty.
       In the majority of patient encounters, use the best available evidence to select medically
        appropriate investigative tools that are informative, ethical and cost-effective.
       Manifest a systematic and cognitive approach to clinical reasoning in order to solve the
        individual patient’s problems.
       Demonstrate effective consultation skills in response to requests from another healthcare
        provider and will manifest appropriate clinical judgment when requesting consultation expertise
        from colleagues in other specialty disciplines
       Access continuously new and relevant clinical information to ensure that the care provided to
        patients meets contemporary “best practice” circumstances.
       Begin to develop medical expertise in situations other than those involving direct patient care
        (educational supervision and presentation).




Revised: June 2009                                                                        Page 13 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
Communicator:

       Develops excellent communication skills with paramedics and flight crews during ASL patch
        calls.    Establish and maintain rapport and fostering an environment characterized by
        understanding, trust, empathy, and confidentiality.
       Explore patient’s beliefs, concerns and expectations about the origin, nature, and management
        of his/her illness. Specialist Emergency Physicians need to be able to assess the impact of
        such factors as age, gender, ethno-cultural background, social support and emotional
        influences on a patient’s illness.
       Inform and counsel a patient in a sensitive and respectful manner while fostering understanding,
        discussion and the patient’s active participation in decisions about their care. This includes the
        ability to listen to the patient and to communicate effectively with other health providers to
        ensure optimal and consistent care of the patient and his/her family. This also implies the ability
        to maintain clear, accurate and appropriate records.
       Establish relationships with the patient that are characterized by understanding, trust, respect,
        empathy and confidentiality.
       Demonstrate the ability to break bad news such as that of death or serious illness or injury to
        patients and/or that is sensitive, thorough and understandable.
       Demonstrate the ability to screen for sensitive issues such as those of substance abuse,
        physical or sexual abuse and risk factors for HIV and other sexuality transmitted diseases.
       Demonstrate the ability to discuss issues of advance directives, living wills and DNR orders with
        patients and their families.
       Understand and demonstrated the importance of cooperation and communication among health
        professionals involved in the care of individual patients such that the roles of these
        professionals are delineated and consistent messages are delivered to patients and their
        families.
       Demonstrated skills in working with others who present significant communication challenges
        such as anger or confusion, an ethno-cultural background different from the physician’s own,
        physical or emotional impairment. This includes the ability to communicate with patients with
        the potential for violent behavior in a way that may defuse the potential for violence.
       Demonstrate the ability to recognize and minimize the negative effects that one’s emotions
        (anger, frustration, anxiety, fear) have on one’s ability to communicate effectively and take steps
        to minimize these effects.
       Communicate effectively with the members of a multidisciplinary team in the resolution of
        conflicts, provision of feedback, and where appropriate, be able to assume a leadership role.


Collaborator:

       Understand the roles and expertise of the other individuals involved, inform and involve the
        patient and his/her family in decision making, and explicitly integrate the opinions of the patient
        and care givers into management plans.
       Recognize team members’ areas of expertise, respect the opinions and roles of individual team
        members, contribute to healthy team development and conflict resolution, and contribute his/her
        own expertise to the team’s task in hospitals, practice settings, and other institutions, such as
        committee work research, teaching and learning.
       Demonstrate an ability to function effectively within the unique environment of the emergency
        department, recognizing the unpredictable nature of patient presentations, and the demands of
        working with a multidisciplinary team.


Revised: June 2009                                                                         Page 14 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
       Identify and describe the role, expertise and limitations of all members of the multidisciplinary
        team required to optimally achieve a goal related to patient care, a research problem, an
        educational task or an administrative responsibility.

       Begin to demonstrate the ability to assume a team leadership and effective participant role in
        the complex multidisciplinary environment of the emergency department.
       Begin to demonstrate an understanding of the unique interaction of the emergency department
        with every component of the health care system, including the hospital, its relationship to the
        community, and other agencies such as Emergency Services (EMS).
       Demonstrate an ability to promote the autonomy of patients and families and to promote their
        involvement in decision making.
       Participate in multidisciplinary team meetings, demonstrating the ability to accept, consider and
        respect the opinions of other team members, while contributing specialty-specific expertise.


Manager:

       Employ effective time management and self-assessment skills to formulate realistic
        expectations and a balanced lifestyle.
       Make sound judgments on resource allocation based on evidence of the benefit to individual
        patient and the population served.
       Begin to understand the roles and responsibilities of specialists in Canada, the organization and
        function of the Canadian Health Care system and the forces of change. This includes the ability
        to work effectively within teams of colleagues and function within broader organizational
        management systems (e.g. hospital committees).
       Use patient related databases, access computer based information, and understand the
        fundamentals of medical informatics.
       Understand the relationship between the Emergency Department and the hospital and between
        the Emergency Department and the community.
       Access and apply a broad base of information to the care of patients in ambulatory care,
        hospitals and other health care settings.
       Make clinical decisions and judgments based on sound evidence for the benefit of individual
        patients and the population served. This allows for an advocacy role primarily for the individual
        but in the context of societal needs when monitoring and allocating needed resources.
       Work effectively as a member of a team or a partnership and to accomplish tasks whether one
        is a team leader or a team member.
       Understand population based approaches to health care services and their implication for
        medical practice.
       Manage concomitantly a number of ill and injured patients at any given time with a view to both
        providing these patients with excellence of care as well as ensuring the continued smooth flow
        of patients through an Emergency Department.
       Understand the supervisory and administrative aspects of Emergency Medical Services
        systems (i.e. rationalization of Emergency Services, communications systems, pre-hospital care
        programs, ambulance services, paramedical emergency services and disaster medicine).




Revised: June 2009                                                                        Page 15 of 119
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Rotation Specific Objectives Revised July 2009
Health Advocate:

The resident should be able to:

       Identify the determinants of health that affect a patient, so as to be able to effectively contribute
        to improving individual and societal health in Canada. This includes the ability to recognize,
        assess, and respond to the psychosocial, economic, and biologic factors influencing the health
        of those served. The specialist incorporates information on the health determinants into his/her
        practice behaviors – both with individual patients and their community. At the doctor-patient
        level, this involves adapting patient management and education, so as to promote health,
        enhance understanding, foster coping abilities, and enhance active participation in informed
        decision making.
       Recognize and respond to those issues, settings, circumstances, or situations in which
        advocacy on behalf of patients, professions or society is appropriate. This involves the ability
        to: identify populations at risk, identify current policies that affect health, and recognize the
        fundamental role of epidemiological research in informing practice.
       Demonstrate an understanding of the of the determinants of health by identifying the most
        important determinants of health (i.e., poverty, unemployment, early childhood education, social
        support systems), being familiar with the underlying research evidence and applying this
        understanding to common problems and conditions encountered in emergency medicine.
       Demonstrate an understanding of these concepts as applied to the following three levels:

               In the management of individual patients by identifying the patient’s status with respect
                to one or more of the determinants of health (i.e., unemployment); adapting the
                assessment, management of disposition accordingly (i.e., the medical history to the
                patient’s social circumstances); and assessing the patient’s ability to access various
                services in the health and social system.
               In the analysis of the emergency medicine patient population work with relevant
                associations in identifying current “at Risk” groups within the practice of emergency
                medicine and applying the available knowledge about efficient, effective emergency
                medicine patient care and take steps to publicize and address these issues; and
                contribute :group data” for better understanding of health problems within the population.
               In relation to the general population by describing, in broad terms, the key issues
                currently under debate regarding changes in the Canadian health care system,
                indicating how these changes might affect societal health outcomes and advocating to
                decrease the burden of illness (at a community or societal level) of problems related to
                emergency medicine through a relevant specialty society, community-based advocacy
                group, other public education bodies, or private organizations.

Scholar:

        Analyze and interpret the validity and applicability of evidence contained in the medical
        literature.
       Apply new knowledge to daily practice.
       Act as a role model and as a resource for other residents.
       Provide constructive feedback to these learners.
       Establish a sustainable pattern of reading that will allow him/her to schedule sufficient time to
        maintain a current knowledge base.
       Learn how to efficiently track new literature pertinent to his/her practice, including studies
        published outside the Emergency Medicine literature.

Revised: June 2009                                                                           Page 16 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
       Learn the principles of biostatistics and critical analysis, allowing proper interpretation of original
        research publications.
       Bedside teaching of medical students and junior residents.
       Acquire the basic principles of didactic teaching and public speaking, including the use of
        multimedia software and the basic skills for moderating small group discussion.
       Acquire the skills necessary to apply new knowledge in an evidence based fashion to clinical
        practice.
       Learn the basic principles of clinical research methodology, further improving the ability to
        interpret original research.
       Become aware of patient information and patient support groups. Become aware of web sites
        capable of providing comprehensive information to patients pertinent to illness or injury treated
        in the emergency department.

Professionalism:

       Be aware of racial, cultural, and societal issues that impact on the delivery of care and an ability
        to maintain and enhance appropriate knowledge, skills and professional behaviors.
       Be accountable for personal actions, have a high degree of self-awareness, maintaining an
        appropriate balance between personal and professional roles, and addressing interpersonal
        differences in professional relations.
       Practice medicine in an ethically responsible manner that respects the medical, legal and
        professional obligations of belonging to a self regulating body. This implies: an understanding
        of and an adherence to legal and ethical codes of practice, the recognition of ethical dilemmas
        and the need for help to resolve them when necessary and the ability to recognize and respond
        to unprofessional behaviors in clinical practice, taking into account local and provincial
        regulations.
       Use appropriate strategies to maintain and advance professional competence; and continually
        evaluate one’s abilities, knowledge and skills and know one’s limitations of professional
        competence.
       Adopt specific strategies to heighten personal and professional awareness and explore and
        resolve interpersonal difficulties in professional relationships; and consciously strive to balance
        personal and professional roles and responsibilities and to demonstrate ways of attempting to
        resolve conflicts and role strain.
       Know and understand the professional, legal and ethical codes to which physicians are bound.
       Recognize, analyze and attempt to resolve in clinical practice, ethical issues such as truth-
        telling, consent, advanced directives, confidentiality, end-of-life care, conflict of interest,
        resource allocation and research ethics.
       Understand and be able to apply relevant legislation that relates to the health care system in
        order to guide one’s clinical practice.
       Recognize, analyze and know how to deal with unprofessional behaviors in clinical practice,
        taking into account local and provincial regulations.




Revised: June 2009                                                                             Page 17 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
                                        EMERGENCY MEDICINE - R5


General Objectives:

Upon completion of training, a resident is expected to be a competent emergency physician capable of
assuming a consultant’s role in the specialty. The specialist emergency physician employs pertinent
methods of prioritization, assessment, intervention, resuscitation and further management of patients to
the point of transfer. Appropriate procedural and pharmacotherapeutic maneuvers are central to these
abilities. The specialist emergency physician possesses organizational skills in emergency department
and disaster management and the ability to interface with and playa leadership role in the development
and organization of the emergency medical services and pre-hospital care.

Residents must demonstrate the knowledge, skills and attitudes relating to gender, culture and ethnicity
pertinent to Emergency Medicine. In addition, all residents must demonstrate an ability to incorporate
gender, cultural and ethnic perspectives in research methodology, data presentation and analysis.

Medical Expert:

Specialists possess a defined body of knowledge and procedural skills which are used to collect and
interpret data, make appropriate clinical decisions, and carry out diagnostic and therapeutic procedures
within the boundaries of their discipline and expertise. Their care is characterized by up-to-date,
ethical, and cost-effective clinical practice and effective communication in partnership with patient,
other health care providers and the community. The role of medical expert/clinical decision maker is
central to the function of specialist physicians, and draws on the competencies included in the roles of
scholar, communicator, health advocate, manager, collaborator and professional.

General Requirements:
    Demonstrate diagnostic and therapeutic skills for ethical and effective patient care.
    Access and apply relevant information to clinical practice.
    Demonstrate effective consultation services with respect to patient care, education and legal
      opinions.

Specific Requirements:

       Elicit a relevant, concise, and accurate history and efficiently conduct an effective physical
        examination; carry out relevant procedures to collect, analyze, and interpret data; reach a
        diagnosis and perform appropriate therapeutic procedures to help resolve a patient’s problem.
       Pose an appropriate patient-related question, execute a systematic search for evidence, and
        critically evaluate medical literature and other evidence in order to optimize clinical decision-
        making.
       Demonstrate medical expertise in situations other than in direct patient care. This includes the
        ability to provide testimony as an expert medical witness and to give presentations.
       Recognize personal limits of expertise by self-assessment. This includes the ability to decide if
        and when other professionals are needed to contribute to a patient’s care, and the ability to
        implement a personal program to maintain and upgrade professional medical competence.
       Demonstrate effective consultation skills. This includes presenting well-documented patient
        assessments and recommendations in both written and verbal form, in response to a request
        from another health professional.
       Apply the knowledge and expertise to the performance of specific psychomotor skills relevant to
        the specialty.

Revised: June 2009                                                                        Page 18 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
       Use the best available evidence to select medically appropriate investigative tools that are
        informative, ethical and cost-effective.
       Manifest a systematic and cognitive approach to clinical reasoning in order to solve the
        individual patient’s problems.
       Demonstrate effective consultation skills in response to requests from another health-care
        provider and will manifest appropriate clinical judgment when requesting consultation expertise
        from colleagues in other specialty disciplines.
       Demonstrate the appropriate attitudes and communication skills necessary to ensure the
        emergency department-based healthcare services are meeting the needs and expectations of
        the community.
       Access continuously new and relevant clinical information to ensure that the care provided to
        patients meets contemporary “best practice” circumstances.
       Demonstrate medical expertise in situations other than those involving direct patient care
        (educational supervision, presentations, providing expertise and medico-legal cases).

Communicator:

To provide humane, high-quality care, Emergency specialists establish effective relationships with
patients, other physicians, and other health professionals. Communication skills are essential for the
functioning of an Emergency Physician, and are necessary for obtaining information from, and
conveying information to patients and their families. Furthermore, these abilities are critical in eliciting
patients’ beliefs, concerns, and expectations about their illnesses, and for assessing key factors
impacting on patients’ health.

General Requirements:

       Establish therapeutic relationships with patients/families.
       Obtain and synthesize relevant history from patients/families/communities.
       Listen effectively.
       Discuss appropriate information with patients/families and the health care team.

Specific Requirements:

       Establish and maintain rapport and fostering an environment characterized by understanding,
        trust, empathy, and confidentiality.
       Explore patient’s beliefs, concerns and expectations about the origin, nature, and
        management of his/her illness. Specialist Emergency Physicians need to be able to assess the
        impact of such factors as age, gender, ethno-cultural background, social support and emotional
        influences on a patient’s illness.
       Inform and counsel a patient in a sensitive and respectful manner while fostering
        understanding, discussion, and the patient’s active participation in decisions about their care.
        This includes the ability to listen to the patient and to communicate effectively with other health
        providers, to ensure optimal and consistent care of the patient and his/her family. This also
        implies the ability to maintain clear, accurate and appropriate records.

       Establish relationships with the patient, that are characterized by understanding, trust, respect,
        empathy and confidentiality.
       Demonstrate the ability to break bad news such as that of death or serious illness or injury to
        patients and /or their family members in a way that is sensitive, thorough and understandable.
       Demonstrate the ability to screen for sensitive issues such as those of substance abuse,
        physical or sexual abuse and risk factors for HIV and other sexually transmitted diseases.

Revised: June 2009                                                                          Page 19 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
       Demonstrate the ability to discuss issues of advanced directives, living wills and DNR orders
        with patients and their families.
       Understand and demonstrate the importance of cooperation and communication among health
        professionals involved in the care of individual patients such that the roles of these
        professionals are delineated and consistent messages are delivered to patients and their
        families.
       Demonstrate skills in working with others who present significant communication challenges
        such as anger or confusion, an ethno-cultural background different from the physician’s own,
        physical or emotional impairment. This includes the ability to communicate with patients with
        the potential for violent behavior in a way that may defuse the potential for violence.
       Demonstrate the ability to recognize and minimize the negative effects that one’s emotions
        (anger, frustration, anxiety, fear) have on one’s ability to communicate effectively and take steps
        to minimize these effects.
       Provide effectively, information to the general public and media about areas of local concern.
       Communicate effectively with the members of a multidisciplinary team in the resolution of
        conflicts, provision of feedback, and where appropriate, be able to assume a leadership role.


Collaborator:

The specialist in Emergency Medicine is characterized as a collaborator when he/she works in
partnership with others, as a member of an interdisciplinary team, to reach a common goal. Depending
on the task at hand, the partnership/collaboration may include, besides the Emergency Medicine
specialist, patients and their families, other physicians (primary care and specialist), allied health
professionals, community organizations, alternative care providers, administrative bodies, researchers,
and educators.

General Requirements:
   Consult effectively with other physicians and health care professionals.
   Contribute effectively to other interdisciplinary team activities.

Specific Requirements:
    Understand the roles and expertise of the other individuals involved, inform and involve the
       patient and his/her family in decision-making, and explicitly integrate the opinions of the patient
       and care givers into management plans.
    Recognize team members’ area of expertise respect the opinions and roles of individual
       team members, contribute to healthy team development and conflict resolution, and contribute
       his/her own expertise to the team’s task in hospitals, practice settings, and other institutions,
       such as committee work, research, teaching and learning.
    Demonstrate an ability to function effectively within the unique environment of the emergency
       department, recognizing the unpredictable nature of patient presentations, and the demands of
       working with a multidisciplinary team.
    Identify and describe the role, expertise and limitations of all members of the multidisciplinary
       team required to optimally achieve a goal related to patient care, a research problem, an
       educational task, or an administrative responsibility.
    Demonstrate the ability to assume a team leadership and effective participant role in the
       complex multidisciplinary environment of the emergency department.
    Demonstrate an understanding of the unique interaction of the emergency department with
       every component of the health care system including the hospital, its relationship to the
       community, and other agencies such as Emergency Medicine Services (EMS).

Revised: June 2009                                                                         Page 20 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
       Demonstrate an ability to promote the autonomy of patients and families and to promote their
        involvement in decision making.
       Participate in multidisciplinary team meetings, demonstrating the ability to accept, consider and
        suspect the opinions of other team members, while contributing specialty-specific expertise.
       Describe how health care governance influences patient care, research, and educational
        activities at a local, provincial, regional, and national level.


Manager:

Emergency specialists function as managers when they make everyday practice decisions involving
resources, coworkers, tasks, policies and their personal lives. They do this in the settings of individual
patient care, practice organizations, and in the broader context of the health care system. Thus
Emergency specialists require the abilities to prioritize and effectively execute tasks through teamwork
with colleagues, and make systematic decisions when allocating finite health care resources. As
managers, Emergency specialists take on positions of leadership within the context of professional
organizations and the dynamic Canadian Health Care system.

General Requirements:
   Utilize resources effectively to balance patient care, learning needs and outside activities.
   Allocate finite health care resources wisely.
   Work effectively and efficiently in a health care organization.
   Utilize information technology to optimize patient care, life-long learning and other activities.

Specific Requirements:
    Employ effective time management and self-assessment skills to formulate realistic
       expectations and a balanced lifestyle.
    Make sound judgments on resource allocation based on evidence of the benefit to individual
       patients and the population served.
    Understand the roles and responsibilities of specialists in Canada, the organization and function
       of the Canadian Health Care system and the forces of change. This includes the ability to work
       effectively within teams of colleagues, manage a practice and function within broader
       organizational management systems (e.g. hospital committees).
    Use patient related databases, access computer based information and understand the
       fundamentals of medical informatics.
    Function effectively in health care organizations, ranging from an individual clinical practice to
       organizations at the local, regional and national level.
    Understand the structure, financing, and operation of the Canadian Health System and its
       facilities, function effectively within it and be capable of playing an active role in its change.
    Understand the relationship between the Emergency Department and the hospital and between
       the Emergency Department and the community.
    Access and apply a broad base of information to the care of patients in ambulatory care,
       hospitals and other health care settings.
    Make clinical decisions and judgments based on sound evidence for the benefit of individual
       patients and the population served. This allows for an advocacy role primarily for the individual
       but in the context of societal needs when monitoring and allocating needed resources.
    Work effectively as a member of a team or a partnership and to accomplish tasks whether one
       is a team leader or a team member.
    Understand population based approaches to health care services and their and their implication
       for medical practice.
    Participate in planning, budgeting, evaluation and outcome of a patient care program.
Revised: June 2009                                                                         Page 21 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
       Manage concomitantly a number of ill and injured patients at any given time with a view to
        both providing these patients with excellence of care as well as ensuring the continued smooth
        flow of patients through an Emergency Department.
       Understand the supervisory and administrative aspects of Emergency Medical Services
        systems (i.e. Rationalization of Emergency Services, communications systems, pre-hospital
        care programs, ambulance services, paramedical emergency services and disaster medicine).

Health Advocate:

Specialists recognize the importance of advocacy activities in responding to the challenges represented
by those social, environmental, and biological factors that determine the health of atients and society.
They recognize advocacy as an essential and fundamental component of health promotion that occurs
at the level of the individual patient, the practice population, and the broader community. Health
advocacy is appropriately expressed both by the individual and collective responses of specialist
physicians in influencing public health and policy.

General Requirements:

       Identify the important determinants of health affecting patients.
       Contribute effectively to improved health of patients and communities.
       Understand various approaches to health care advocacy and policy change.
       Recognize and respond to those issues where advocacy is appropriate.

Specific Requirements:

       Identify the determinants of health that affect a patient, so as to be able to effectively contribute
        to improving individual and societal health in Canada. This includes the ability to recognize,
        assess, and respond to the psychosocial, economic, and biologic factors influencing the health
        of those served. The specialist incorporates information on the health determinants into his/her
        practice behaviors – both with individual patients and their management and education so as to
        promote health, enhance understanding, foster coping abilities, and enhance active
        participation in informed decision making.

       Recognize and respond to those issues, settings, circumstances, or situations in which avocacy
        on behalf of patients, professions or society is appropriate. This involves the ability to: identify
        populations at risk, identify current policies that affect health, and recognize the fundamental
        role of epidemiological research in informing practice. At a broader level, this includes the
        ability to describe how public policy is developed and employ methods of influencing the
        development of health and social policy.




Revised: June 2009                                                                           Page 22 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009

       Demonstrate an understanding of the following:

                  Determinants of health by identifying the most important determinants of health (i.e.
                   poverty, unemployment, early childhood education, social support systems), being
                   familiar with the underlying research evidence, and applying this understanding to
                   common problems and conditions encountered in emergency medicine.
                  Public policy for health by describing how public policy is developed; identifying
                   current policies that affect health, either positively or negatively (i.e., communicable
                   diseases) changed as a result of actions by physicians.

       Demonstrate an understanding of these concepts as applied to the following three levels:

                      In the management of individual patients by identifying the patient’s status with
                       respect to one or more of the determinants of health (i.e., unemployment);
                       adapting the assessment, management and disposition accordingly (i.e., the
                       medical history to the patient’s social circumstances); and assessing the patient’s
                       ability to access various services in the health and social system.

                      In the analysis of the emergency medicine patient population work with relevant
                       associations in identifying current “at risk” groups within the practice of emergency
                       medicine and applying the available knowledge about prevention to “at risk”
                       groups within the practice; identify impediments to good, efficient, effective
                       emergency medicine patient care and take steps to publicize and address these
                       issues; and contribute “group data” for better understanding of health problems
                       within the population.

                      In relation to the general population by describing, in broad terms, the key issues
                       currently under debate regarding changes in the Canadian Health Care system,
                       indicating how these changes might affect societal health outcomes and
                       advocating to decrease the burden of illness (at a community or societal level) of
                       problems related to emergency medicine through a relevant specialty society,
                       community based advocacy group, other public education bodies, or private
                       organizations.

Scholar:

Emergency specialists function as scholars whether they are learning new knowledge from personal
continuing education, applying knowledge to their daily practice or sharing knowledge with those
related to their practice. This latter group may include patients, the public, medical students or
residents, physicians, and other professional healthcare workers. Interpretation of new information
requires critical appraisal skills, as well as the capacity to assess clinical applicability. Scholarly activity
is a life-long endeavor that ensures professional competence, and guarantees optimal care of patients.
As scholars, Emergency specialists will take on positions of leadership within the context of ongoing
professional development and learning by all professionals involved in Emergency medical care.

General Requirements:
   Develop, implement and monitor a personal continuing education strategy.
   Critically appraise sources of medical information.
   Contribute to development of new knowledge.


Revised: June 2009                                                                              Page 23 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
       Analyze and interpret the validity and applicability of evidence contained in the medical
        literature.
       Apply new knowledge to daily practice.
       Provide constructive feedback to these learners.
       Act as a role model and as a resource for other colleagues and health care professionals.
       Establish a sustainable pattern of reading that will allow him/her to schedule sufficient time to
        maintain a current knowledge base.
       Learn how to efficiently track new literature pertinent to his/her practice, including studies
        published outside the Emergency Medicine literature.
       Learn the principles of biostatistics and critical analysis, allowing proper interpretation of original
        research publications. This can be best learned either with specific university courses or
        through a series of core lectures and assignments, complimented by regular participation in
        Journal Clubs.
       Acquire the basic principles of clinical bedside teaching.
       Acquire the basic principles of didactic teaching and public speaking, including the use of
        multimedia software and the basic skills for moderating small group discussion.
       Acquire the skills necessary to apply new knowledge in an evidence-based fashion to clinical
        practice.
       Learn the basic principles of clinical research methodology, further improving the ability to
        interpret original research.
       Learn the principles of distance learning, including video-conferencing, cyber sessions and
        web-based interactive learning.
       Become aware of patient information and patient support groups. Become aware of web sites
        capable of providing comprehensive information to patients pertinent to illness or injury treated
        in the Emergency Department.


Professionalism:

Specialists have a unique societal role as professionals with a distinct body of knowledge, skills, and
attitudes dedicated to improving the health and well-being of others. Specialists are committed to the
highest standards of excellence in clinical care and ethical conduct, and to continually perfecting
mastery of their discipline.

General Requirements:

       Deliver highest quality care with integrity, honesty and compassion.
       Exhibit appropriate personal and interpersonal professional behaviors.
       Practice medicine ethically consistent with obligations of a physician.

Specific Requirements:

       Be aware of racial, cultural, and societal issues that impact on the delivery of care and an ability
        to maintain and enhance appropriate knowledge, skills and professional behaviors.

       Be accountable for personal actions, have a high degree of self-awareness, maintaining an
        appropriate balance between personal and professional roles, and addressing interpersonal
        differences in professional relations.

       Practice medicine in an ethically responsible manner that respects the medical, legal and
        professional obligations of belonging to a self-regulating body. This implies: an understanding
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        of and adherence to legal and ethical codes of practice, the recognition of ethical dilemmas and
        the need for help to resolve them when necessary and the ability to recognize and respond to
        unprofessional behaviors in clinical practice, taking into account local and provincial regulations.

       Display expertise in each of the following areas:

                  Discipline-Based Objectives:

                         display attitudes commonly accepted as essential to professionalism;
                         use appropriate strategies to maintain and advance professional competence;
                         continually evaluate one’s abilities, knowledge and skills and know one’s
                          limitations of professional competence.

                  Personal/Professional Boundary Objectives:

                         adopt specific strategies to heighten personal and professional awareness and
                          explore ad resolve interpersonal difficulties in professional relationships;

                         consciously strive to balance personal and professional roles and
                          responsibilities and to demonstrate ways of attempting to resolve conflicts and
                          role strain.

                  Objectives Related to Ethics and Professional Bodies:

                         know and understand the professional, legal and ethical codes to which
                          physicians are bound;

                         recognize, analyze and attempt to resolve in clinical practice ethical issues such
                          as truth-telling, consent, advanced directives, confidentiality, end-of-life care,
                          conflict of interest, resource allocation and research ethics;

                         understand and be able to apply relevant legislation that relates to the health
                          care system in order to guide one’s clinical practice;

                         recognize, analyze and know how to deal with unprofessional behaviors in
                          clinical practice, taking into account local and provincial regulations.




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                 SPECIALTY TRAINING REQUIREMENTS IN EMERGENCY MEDICINE

These specialty training requirements apply to those who began training on or after June 1, 1989.

Five years of approved resident training. This period consists of:

    1. One year of basic clinical training.

    2. a) mandatory three years of approved residency training in Emergency Medicine, to include:

                i.      a minimum of six months as a senior resident in the emergency department.
                ii.     a minimum of three months in an emergency department with pediatric
                        educational emphasis, a portion of which is as a senior resident.
                Iii.     a specific program of training in pre-hospital and administrative aspects of
                        emergency medicine.
                Iv.     a minimum of one year of training in the emergency aspects of anesthesia,
                        critical care, (including CCU), general surgery, internal medicine,
                        neurosciences, orthopedic surgery, pediatrics, and psychiatry
                        (including crisis intervention).

    2 b) one year of approved resident training which may include:

      i. further training in emergency medicine.
      ii. further training in any of the mandatory core rotations (2.a.iv).
                iii.      elective assignments in the emergency aspects of ENT, obstetrics and
                         gynecology, ophthalmology, plastic surgery, radiology, trauma service,
                         toxicology and other appropriate clinical subspecialty areas.
                iv.      research (Please see “Policies and Procedures” Section IV.)
                  v.     an approved course of study and education, related to the objectives of
                         Emergency Medicine, and acceptable to the director of the residency program
                         and to the credentials committee, at a hospital or university centre in Canada or
                         abroad.
The educational program should incorporate the principle of graded increasing responsibility. Senior
residency is defined as experience in which the resident is regularly entrusted with the responsibility for
the diagnosis, resuscitation, stabilization, evaluation and disposition of acutely ill and injured patients.
No other resident shall intervene between the senior resident and the attending staff emergency
physician.

NOTE:     On the recommendation of the director of a Royal College accredited residency program in
          Emergency Medicine,

A. Applicants who have completed residency training in Family Medicine acceptable to the College of
   Family Physicians of Canada for residency eligibility for their examinations may be granted credit
   for up to twelve months under Section 2.a.iv and/or 2.b. above.
B. Residents in Emergency Medicine who have satisfactorily undertaken residency training in
   specialties related to Emergency Medicine may be granted credit for up to twelve months of training
   under Section 2.a. iv and/or 2.b.




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                                             Emergency Medicine
                                       Rotation Specific Objectives

                                                 ADMINISTRATION

Goals:

        Learn basic principles of leadership and administration.
        Develop and understanding of quality improvement and its application to the operation of an
         emergency department.
        Develop an understanding of risk management and its application to the operation of an
         emergency department.
        Develop an understanding of the function of Emergency Medicine within the institution and its
         relationship with other departments.
        Develop and understanding of the function of accrediting agencies and their relationship with
         emergency medicine.
        Outline the principles of confidentiality and obligatory reporting as related to Emergency
         Medicine in Canada.
        Understand important medicolegal aspects of Canadian Emergency Medicine practice.

Medical expert

Complaints management:

        Understand the legal, ethical and human implications dealing with a complaint regarding patient
         care.
        Understand the process by which patient complaints should be managed.
        Describe the process by which patient complaints should be investigated.
        Demonstrate a non-confrontational approach in dealing with the staff and the complainant.
        Compare and contrast the types of cases in which hospital Senior Management, the College
         and other outside agencies need to be involved in the complaints.
        Categorize complaints and usual percentages of each.

Emergency Department design:

        Understand the principles involved in the Emergency Department physical plant design and
         function.
        List the components of patient flow through the emergency department.
        Describe the various design options for the emergency department and compare and contrast
         the pros and cons of each design.
        Understand how to assess the staffing needs and scheduling models.
        Discuss accepted Canadian guidelines relating to the Emergency Department with emphasis on
         staffing, (including number of patients per hour per physician), equipment and supplies, facility
         design (options for departments and square meters required to handle a specific patient
         volume) and patient transfer regulations.

Quality improvement:

        Describe the principles of quality improvement.
        Describe how quality improvement is being instituted in the Emergency Department.
        Evaluate the benefits of an integrated approach to quality improvement.

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Physician Credentialing:

        Describe the recruitment and hiring process.
        Describe the re-appointment process.
        Describe the termination process.
        Describe a system of performance review for physicians.
        Understand the process of evaluating physician competence.
        State the methods by which performance can be enhanced.
        Describe the legal issues surrounding termination of privileges.

Budgetary Issues:

        Understand the budget process for the Department of Emergency Medicine.
        Understand the principles and terminology of resource utilization.
        Define cost effectiveness and cost utility.

Medicolegal:

        Outline the principles of confidentiality and obligatory reporting as related to Emergency
         Medicine in Canada.
        List situations of mandatory reporting in Alberta.
        Understand the principles of negligence.
        State the principles required to prove negligence.
        List the common law principles as they apply to medicine.
        Discuss how to manage issues surrounding a colleague with substance abuse problems.
        List the resources available for the impaired physician.

Administrators:


        Understand the different models of Emergency Department administrative structures.
        Understand the relationship between the Emergency Department and the hospital and between
         the Emergency Department and the community.
        Understand the job description of the Emergency Department medical director.

Organization:

        Understand the various organizational options available for Emergency Medicine within the
         overall context of the Canadian Health Care System.
        Describe the variety of options for structuring Emergency Medicine within the hospital and
         university environment in Canada and the United States.
        Evaluate the pros and cons of each system.
        Outline the typical Canadian hospital organization.

Other:

        Evaluate the need for a Critical Incident Stress Debriefing program in the Emergency
         Department.
        Be familiar with information databases and their role in education and patient care.

Communicator:

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The resident should be able to:

       Recognize communication factors between patients and physicians that can be improved to
        reduce miscommunication and patient complaints.
       Demonstrate skills in working with others who present significant communication challenges
        such as anger or confusion, an ethno-cultural background different from the physician’s own,
        physical or emotional impairment.
       Describe a non-confrontational approach in dealing with the staff and the complainant.
       Demonstrate an approach to performance appraisal for physicians.
       Provide effectively information to the general public and media about areas of local concern.
       Outline the principle components of a medical legal report.
       Understand how to formulate a written response as an expert witness.

Collaborator:

The resident should be able to:

       Describe how health care governance influences patient care, research, and educational
        activities at a local, provincial, regional and national level.
       Recognize team members’ areas of expertise, respect the opinions and roles of individual team
        members, contribute to healthy team development and conflict resolution, and contribute his/her
        own expertise to the team’s task in hospitals, practice settings, and other institutions such as
        committee work.
       Understand how the administrative group of the Emergency Department contributes to the
        health and well being of the patients, their families and the community in general.

Manager:

The resident should be able to:

       Learn effective management of patient complaints with the patient and medical staff.
       Understand the importance of employing effective time management and self-assessment skills
        to formulate realistic expectations and a balanced lifestyle.
       Learn how the administration of the hospital must use sound judgment on resource allocation
        based on evidence of the benefit to individual patients and the population served.
       Understand the roles and responsibilities of specialists in Canada, the organization and function
        of the Canadian Health Care system, and the forces of change. This includes the ability to work
        effectively within teams of colleagues, manage a practice and function within broader
        organizational management systems (e.g. hospital committees).
       Understand the structure, financing, and operation of the Canadian Health System and its
        facilities, function effectively within it and be capable of playing an active role in its change.
       Understand the relationship between the Emergency Department and the hospital and between
        the Emergency Department and the community.
       Work effectively as a member of a team or a partnership and to accomplish tasks whether one
        is a team leader or team member.
       Understand population-based approaches to health care services and their implication for
        medical practice.
       Participate in planning, budgeting, evaluation and outcome of a patient care program.
Health Advocate:

The resident should be able to:

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       Understand public policy for health by describing how public policy is developed; identifying
        current policies that affect health, either positively or negatively (i.e. communicable diseases,
        tobacco, substance abuse); and citing examples of how policy was changed as a result of
        actions by physicians.

Scholar

The resident should be able to:

       Analyze and interpret the validity and applicability of evidence contained in the medical literature
        for administrative issues such as emergency department design and quality improvement.

Professionalism:

The resident should be able to:

       Be aware of racial, cultural and societal issues that impact on the delivery of care and an ability
        to maintain and enhance appropriate knowledge, skills and professional behaviours.
       Be accountable for personal actions, have a high degree of self-awareness, maintaining an
        appropriate balance between personal and professional roles, and addressing interpersonal
        differences in professional relations.
       Practice medicine in an ethically responsible manner that respects the medical, legal and
        professional obligations of belonging to a self-regulating body. This implies: and understanding
        of and adherence to legal and ethical codes of practice, the recognition of ethical dilemmas and
        the need for help to resolve them when necessary and the ability to recognize and respond to
        unprofessional behaviours in clinical practice, taking into account local and provincial
        regulations.
       Understand and be able to apply relevant legislation that relates to the health care system in
        order to guide one’s clinical practice.
       Recognize, analyze and know how to deal with unprofessional behaviours in clinical practice,
        taking into account local and provincial regulations.




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                                             Emergency Medicine
                                       Rotation Specific Objectives

                                                 ANAESTHESIA


Goals:

        Develop airway management skills. (normal through difficult)
        Develop intravenous access skills.
        Develop familiarity with pharmacological agents used in anaesthesia
        Learn standard monitoring techniques.
        Learn relevant pre-operative historical and physical exam considerations.
        Learn principles of pain management.

Medical Expert

Airway techniques

The resident should perform the following procedures and list their indications, contraindications and
complications.

        Patient positioning.
        Choosing and applying a facemask.
        Bag-valve mask technique.
        Endotracheal tube insertion.
        Technique of safe extubation.
        Management of laryngospasm.
        Management of comatose patient.
        Management of patient with full stomach.
        Manage ventilator parameters.
        Manage fluid requirements during anaesthesia.
        Demonstrate skill in obtaining peripheral and central venous access.
        Perform a safety check on the anaesthetic machine.
        Assessment of problems relating to the anaesthetic.
        Assessment of problems under general anaesthetic: Hypotension, hypertension, arrhythmias,
         and cyanosis.
        Manage anaesthetic problems associated with specific conditions (e.g. diabetes, asthma,
         myasthenia, Malignant hyperthermia).

Intubation:

        List the indications and contraindications for intubation.
        Describe complications of oral endotracheal and nasotracheal intubation.
        Describe an approach to rapid sequence intubation by briefly outlining preparatory steps and
         appropriate medications.
        Discuss alternative airway management approaches to oral endotracheal intubation and
         describe indications and contraindications for these methods, (including laryngeal mask, lighted
         stylet, light wand, bougie introducer, fibroptic transtracheal jet and surgical airway).
        Discuss the management of the patient with the difficult airway.
        Describe the hallmarks of the patient with a difficult airway.
        Recognize and manage an obstructed airway.
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       Demonstrate an understanding of the indications and the technique of obtaining a surgical
        airway.
       Compare and contrast adult and pediatric airway.
       Demonstrate relevant peripheral and central venous anatomy knowledge.

Conscious sedation:

       Discuss the role of medications in conscious sedation.
       Discuss the technique of conscious sedation including indications and contraindications.
       Describe the role for inhalational anaesthesia in the emergency department and demonstrate
        knowledge of the systemic effects of nitrous oxide.

Local anaesthetics:

       Compare and contrast the classes of local anaesthetics.
       Classify local anaesthetics and describe their mechanism of action.
       Discuss the maximum dose and side effects of lidocaine and bupivacaine.
       Describe an approach to someone with possible local anaesthetic hypersensitivity.
       Describe the indications and contraindications for topical anaesthesia.
       List the landmarks and describe an approach to common regional nerve blocks in the face
        hands and feet.

Opioids:

       Describe the dose, metabolism, and systemic effects of opioid used in the emergency
        department setting.
       Describe the use of narcotic and non-narcotic medication in management of acute and chronic
        pain.
       Describe the indications, potential side effects dose and of narcotic antagonists in an
        emergency setting.
       Discuss the theories describing the mechanism of pain perception.

Physiology:

       Discuss the concepts of dead space, shunt and VQ match.
       Discuss the concepts of control of respiration and CO2/ventilation curves.
       Discuss the concepts of pulmonary compartments, changes of FRC/closing and volume under
        anaesthesia.
       Discuss the concepts of reflexes under anaesthesia and response of DVS to various agents and
        techniques.
       Discuss the concepts of parasympathetic, sympathetic, neuromuscular physiology as applied to
        anaesthesia.

Pharmacology:

       Discuss concepts of MAC.
       Discuss concepts of common inhalational agents including advantages, disadvantages and
        relative contraindications.
       Discuss concepts of Induction agents (thiopental, ketamine, propofol).
       Discuss concepts of neuromuscular blocking drugs (depolarizing and nondepolarizing) and
        reversal drugs.
       Discuss concepts of post fasciculation myalgia and pseudocholinesterase deficiency.
Revised: June 2009                                                                    Page 32 of 119
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       Discuss autonomic nervous system drugs (epinephrine, ephedrine, phenylephrine vasodilators,
        NTG, nitroprusside, hydralazine).

Communicator:

The resident should be able to:

       Establish and maintain a therapeutic relationship with patients, their families and the medical
        team while fostering an environment characterized by understanding, trust, empathy and
        confidentiality.
       Provide an accurate verbal or written summary evaluation to describe a patient’s clinical
        condition to consultants using appropriate terminology.
       Keep thorough and accurate records.
       Communicate effectively with patients, family members and the medical team.

Collaborator:

The resident should be able to:

       Develop a care plan for a patient they have assessed, including investigation, treatment and
        continuing care, in collaboration with the members of the interdisciplinary team.
       Participate in an interdisciplinary team meeting, demonstrating the ability to accept, consider
        and respect the opinions of other team members, while contributing speciality-specific expertise
        him/herself.
       Maintain collegial and respectful relationships with medical and para-medical staff.
       Identify and describe the role, expertise and limitations of the members of the general surgery
        interdisciplinary team.
       Demonstrate an ability to promote the autonomy of patients and families and to promote their
        involvement in decision-making.

Manager:

The resident should be able to:

       Understand common issues around managing patients in the recovery room
       Make clinical decisions and judgments based on sound evidence for the benefit of individual
        patients and the population served.
       Be open to working effectively as a member of a team or a partnership and to accomplish tasks
        whether one is a team leader or team member.
       Effectively use patient-related databases, access computer-based information and understand
        the fundamentals of medical informatics.
       Employ effective time management and self-assessment skills to formulate realistic
        expectations and a balanced lifestyle.




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Health Advocate:

The resident should be able to:

       Identify the patient’s status with respect to one or more of the determinants of health (i.e.
        unemployment); adapting the assessment and management accordingly (i.e. the medical
        history to the patient’s social circumstances); and assessing the patient’s ability to access
        various services in the health and social system so as to promote health, enhance
        understanding, foster coping abilities, and enhance active participation in the informed decision-
        making.

Scholar

The resident should be able to:

       The resident will identify learning needs and make use of available learning resources.
       The resident should demonstrate critical thinking and integrate critical appraisal of the literature
        into the bedside approach.
       Analyze and interpret the validity and applicability of evidence contained in the medical
        literature.
       Apply new knowledge to daily practice.

Professionalism:

The resident should:

       Be punctual for operating times and educational events.
       Follow through on assigned tasks.
       Be respectful, honest and compassionate care when dealing with patients, families, and other
        professionals.
       Demonstrate an enthusiasm for learning.
       Demonstrate good self-assessment ability by being aware of own limitations and seeking
        feedback.
       Be aware of racial, cultural, and societal issues that impact on the delivery of care and an ability
        to maintain and enhance appropriate knowledge, skills and professional behaviors.
       Be accountable for personal actions, have a high degree of self-awareness, maintaining an
        appropriate balance between personal and professional roles, and addressing interpersonal
        differences in professional relations.
       Recognize, analyze and know how to deal with unprofessional behaviors in clinical practice,
        taking into account local and provincial regulations.




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                                             Emergency Medicine
                                       Rotation Specific Objectives

                                  CARDIOLOGY/CORONARY CARE UNIT


Goals:

        Understand the management of patients with acute coronary syndromes.
        Understand the investigations available in making the diagnosis of acute chest pain.
        Understand the management of patients with dysrhythmias, with heart failure and cardiogenic
         shock

Medical Expert:

        Discuss the evaluation, etiology, differential diagnosis and management of atypical chest pain,
         acute coronary syndromes and acute congestive heart failure.
        List the indications, contraindications and complications for the use of thrombolytic therapy.
        List indications for primary angioplasty
        Describe the treatment of choice for the various dysrhythmias in both hemodynamically stable
         and unstable patients.
        List the common life threatening causes of chest pain and describe the clinical presentation of
         each.
        Discuss the appropriate avenues of diagnostic testing to evaluate the patient’s symptoms i.e.
         treadmill testing, nuclear perfusion scan, echo, coronary angiography.
        Offer a consultant opinion regarding medical management i.e. selection of appropriate cardiac
         investigations and/or medications.
        Conduct, record, and verbally report cardiac physical examination findings. These will include
         at a minimum; a description of the height of the JVP and specific waveforms, evaluation and
         interpretation of precordial impulses, assessment of cardiac murmurs including all appropriate
         maneuvers, presence of additional heart sounds, and evidence of congestive heart failure. The
         resident will be able to demonstrate all reported findings at the bedside.
        Support choice of medical management based on evidence in the current literature regarding
         benefit in terms of symptom relief and/or survival advantage.
        Independently interpret ECG’s and exercise ECG’s within the clinical context of the patient’s
         problem including the identification of acute myocardial infarction, rhythm abnormalities and
         variants of normal.
        Understand the pharmacology (indications, complications, side effects, toxic effects) of common
         cardiac medications.
        Describe the prognostic information derived from non-invasive testing, (treadmill, nuclear or
         stress echo) and to apply this information to specific patient problems.
        List and quantitate the risks of invasive investigations for individual patients.
        Demonstrate an ability to interpret the results of invasive procedures in the context of individual
         patient problems, and to recommend a course of therapy based on this information.
        Recognize personal limits of expertise by self-assessment. This includes the ability to decide if
         and when other professionals are needed to contribute to a patient’s care.
        Manifest a systematic and cognitive approach to clinical reasoning in order to solve the
         individual patient’s problems.
        Discuss indications and procedures of transcutaneous and transvenous pacing.

Communicator:

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The resident should be able to:

       Establish and maintain a therapeutic relationship with patients, their families and the medical
        team while fostering an environment characterized by understanding, trust, empathy and
        confidentiality.
       Provide an accurate verbal or written summary evaluation to describe a patient’s clinical
        condition to consultants using appropriate terminology.
       Gather information not only about the disease but also about the patient’s beliefs, concerns and
        expectations about the illness, while considering the influence of factors such as the patient’s
        age, gender, ethnic, cultural and socio-economic background, and spiritual values on that
        illness.
       Keep thorough and accurate records.
       Communicate effectively with patients, family members and the medical team.
       Deliver information to the patient and family in a humane manner and in such a way that it is
        understandable, encourages discussion and promotes patient’s participation in decision-making
        to the degree that they wish.

Collaborator:

The resident should be able to:

       Develop a care plan for a patient they have assessed, including investigation, treatment and
        continuing care, in collaboration with the members of the interdisciplinary team.
       Participate in an interdisciplinary team meeting, demonstrating the ability to accept, consider
        and respect the opinions of other team members, while contributing specialty-specific expertise
        him/herself.
       Maintain collegial and respectful relationships with medical and para-medical staff.
       Understand the roles and expertise of the other individuals involved, inform and involve the
        patient and his/her family in decision-making, and explicitly integrate the opinions of the patient
        and care givers into management plans.
       Demonstrate an ability to promote the autonomy of patients and families and to promote their
        involvement in decision-making.




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Manager:

The resident should be able to:

       Effectively manage the care of multiple patients while working in the Emergency department,
        the coronary care unit and the wards.
       Make clinical decisions and judgments based on sound evidence for the benefit of individual
        patients and the population served.
       Be open to working effectively as a member of a team or a partnership and to accomplish tasks
        whether one is a team leader or a team member.
       Effectively use patient-related databases, access computer-based information and understand
        the fundamentals of medical informatics.
       Employ effective time management and self-assessment skills to formulate realistic
        expectations and a balanced lifestyle.
       Make clinical decisions and judgments based on sound evidence for the benefit of individual
        patients and the population served. This allows for an advocacy role primarily for the individual
        but in the context of societal needs when monitoring and allocating needed resources.
       Work effectively as a member of a team or a partnership and to accomplish tasks whether one
        is a team leader or a team member.


Health Advocate:

The resident should be able to:

       Identify the patient’s status with respect to one or more of the determinants of health (i.e.
        unemployment): adapting the assessment and management accordingly (i.e. the medical
        history to the patient’s social circumstances): and assessing the patient’s ability to access
        various services in the health and social system so as to promote health, enhance
        understanding, foster coping abilities, and enhance active participation in informed decision-
        making.
       Understand the health determinants for cardiovascular disease and develop counseling
        technique dealing with these.



Scholar:

The resident should be able to:

       Identify learning needs and make use of available learning resources.
       Demonstrate critical thinking and integrate critical appraisal of the literature into the bedside
        approach.
       Analyze and interpret the validity and applicability of evidence contained in the medical
        literature.
       Apply new knowledge to daily practice.




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Professional

The resident will/should:

       Be punctual for rounds, family conferences and educational events.
       Follow through on assigned tasks.
       Be respectful, honest and compassionate care when dealing with patients, families and other
        professionals.
       Demonstrate an enthusiasm for learning.
       Demonstrate good self-assessment ability by being aware of own limitations and seeking
        feedback.
       Be aware of racial, cultural, and societal issues that impact on the delivery of care and an ability
        to maintain and enhance appropriate knowledge, skills and professional behaviors.
       Be accountable for personal actions, have a high degree of self-awareness, maintaining an
        appropriate balance between personal and professional roles, and addressing interpersonal
        differences in professional relations.
       Recognize, analyze and know how to deal with unprofessional behaviors in clinical practice,
        taking into account local and provincial regulations.




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Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
                                             Emergency Medicine
                                       Rotation Specific Objectives

                                                    EMS

Goals:

        Learn common organizational structures of emergency medical services.
        Learn the educational requirements and skill levels of various EMS providers.
        Learn principles of EMS system operations.
        Learn basic principles of disaster management.
        Learn principals of pre-hospital triage and emergency medical care delivery.
        Learn basic principals of EMS research.
        Learn medico legal principals relating to EMS.
        Participate on EMS scene calls.

Medical Expert:

        List and elaborate upon the essential components of local, provincial and national EMS
         systems.
        Compare and contrast levels of training – vis a vis EMT, EMT-1 and EMT-P.
        Explain the concepts of direct and indirect medical control.
        Describe the components, the role and the application of Quality Improvement in the pre-
         hospital setting.
        Outline the principles of disaster medicine.
        Outline the components of a disaster plan.
        Describe the City of Calgary EMS, and a typical hospital Disaster Plan.
        Describe the principles of EMS communication and dispatch including 911 systems.
        Describe the components of the City of Calgary response to an emergency call.
        Describe the level of service of the ambulance services, which respond to Calgary hospitals.
        Compare and contrast the advantages and disadvantages of medical based dispatch of pre-
         hospital caregivers.
        Demonstrate familiarity with research methodologies relating to EMS and disaster management.
        Describe common environmental, toxicologic and biological hazards encountered in the pre-
         hospital care setting as well as injury prevention techniques.
        Discuss development of EMS pre-hospital care protocols.
        Understand the role of the Medical Director and his/her specific responsibilities.
        Define the role and legal responsibilities of each of the following in rendering pre-hospital
         emergency care:
              Physicians
              EMT’s (Health Disciplines Act)
              EMS Agencies
        Be able to describe the principles of the following medical-legal problems:
              Refusal of care
              Incompetent patient
              Terminally Ill patients
              Termination of CPR at the scene
              Physician and the scene




Revised: June 2009                                                                       Page 39 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
    Communicator:

    The resident should be able to:

       Demonstrate the ability to communicate effectively with the base hospital, nurses, physicians
        and EMS personnel using numerous types of communication devices.
       Establish relationships with the patient and family that are characterized by understanding, trust,
        respect, empathy and confidentiality.
       Demonstrate the ability to break bad news such as that of death or serious illness or injury to
        patients and/or their family members in such a way that is sensitive, thorough and
        understandable.
       Demonstrate skills in working with others who present significant communication challenges
        such as anger or confusion, an ethno-cultural background different from the physician’s own,
        physical or emotional impairment. This includes the ability to communicate with patients with
        the potential for violent behavior in a way that may defuse the potential for violence.
       Communicate effectively with the members of a multidisciplinary team in the resolution of
        conflicts, provision of feedback and where appropriate, be able to assume a leadership role.

Collaborator:

The resident should be able to:

       Participate as an observer or team member in EMS transport systems and maintain collegial
        relationships with EMS and hospital staff.
       Actively participate in EMS system management.
       Understand the roles and expertise of the other individuals involved, inform and involve the
        patient and his/her family in decision-making and explicitly integrate the opinions of the patient
        and care givers into management and transport plans.


Manager:

The resident should be able to:

       Demonstrate an ability to provide initial and continuing education to all levels of EMS personnel.
       Manage patient care effectively during stressful situations.
       Understand how to implement a disaster plan.
       Understand how a triage system works to manage patients in the most effective and fair
        manner.

Advocate:

The resident should be able to:

       Demonstrate an understanding of appropriate utilization practices for ground and air medical
        services.
       Recognize current “at risk” groups within the practice of emergency medicine and EMS and
        applying the available knowledge about prevention to improve patient outcome.
       Participate, when possible, in EMS preventive measure campaigns such as helmet safety etc.

Scholar

Revised: June 2009                                                                         Page 40 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009

The resident should:

       Demonstrate familiarity with research methodologies relating to EMS and disaster management.
       Identify learning needs and make use of available learning resources.
       Demonstrate critical thinking and integrate critical appraisal of the literature into the EMS
        practice.

Professionalism:

The resident will display professional attitudes and behaviors, including:

       Punctuality for rounds, family conferences, and educational events and following through on
        assigned tasks.
       Respectful when dealing with patients, families, and other professionals.
       Considering racial and cultural issues in selecting treatment regimens for patients.
       Demonstrating responsibility by being reliable and dependable.

The resident should:

       Demonstrate an enthusiasm for learning.
       Demonstrate good self-assessment ability by being aware of own limitations and seeking
        feedback.
       Respect personal, cultural and gender issues.
       Understand the consent and surrogate decision.




Revised: June 2009                                                                    Page 41 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009

                                             Emergency Medicine
                                       Rotation Specific Objectives

                                             GENERAL SURGERY

Goals:

        Develop familiarity with common general surgical problems.
        Develop relevant history and physical exam skills.
        Develop procedural skills relevant to General Surgery.
        Develop skill in the overall assessment of the general surgical patient.
        Recognize indications for consultation and surgical intervention in patients with acute abdominal
         pain.
        Learn the principles of care of the perioperative patient.

Medical Expert:

The resident should be able to:

        Perform an appropriate history and physical examination to assess patients with general
         surgical disorders.
        Discuss the evaluation, etiology, differential diagnosis and management of adolescent, adult,
         geriatric and pregnant patients presenting with abdominal pain.
        Compare and contrast the utility of various diagnostic tests in the evaluation of abdominal pain
         patient including CT scan, ultrasonography, MRI, urethrogram, arteriography and cystogram.
        Demonstrate the ability to perform common procedural skills including gastric tube insertion,
         thoracostomy, wound closure and incision and drainage of superficial abscesses and external
         thrombosed hemorrhoids.
        Demonstrate the ability to assist in the operative and perioperative therapy of surgical patients.
        Discuss the common fluid and electrolyte disturbances in surgical patients and demonstrate
         ability to manage patients with these disorders.
        Demonstrate appropriate prophylaxis and treatment of surgical infections.
        Recognize and initiate management of patients with postoperative complaints such as
         postoperative wound infections, respiratory problems and ileus.
        Demonstrate ability to manage pain in surgical patients.
        Describe the principles of wound management and wound healing.
        List the indications and contraindications to organ transplantation.
        Discuss the pathophysiology, evaluation, etiology, differential diagnosis and management of
         common general surgical problems such as:
                     ■ Esophageal, stomach, small bowel and large bowel obstructions
                     ■ Surgical complications of inflammatory bowel disease
                     ■ Neoplasms of the esophagus, liver, biliary tree, pancreas, stomach,
                          duodenum, small bowel, colon and anorectum
                     ■ Cholecystitis and biliary colic
                     ■ Pancreatitis
                     ■ Appendicitis and mesenteric adenitis
                     ■ Volvulus (cecal, sigmoid)
                     ■ Diverticular disease
                     ■ Intussusception
                     ■ Hernia
                     ■ Anorectal disorders
Revised: June 2009                                                                          Page 42 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
                     ■   Perforated viscous
                     ■   Ischemic bowel


Communicator:

The resident should be able to:

       Establish and maintain a therapeutic relationship with patients, their families and the medical
        team while fostering an environment characterized by understanding, trust, empathy and
        confidentiality.
       Accurately describe a patient’s clinical condition to consultants using appropriate terminology.
       Gather information not only about the disease but also about the patient’s beliefs, concerns and
        expectations about the illness, while considering the influence of factors such as the patient’s
        age, gender, ethnic, cultural and socio-economic background, and spiritual values on that
        illness.
       Provide an accurate verbal or written summary evaluation of the general surgical assessment.
       Keep thorough and accurate records.
       Communicate effectively with patients, family members and the medical team.
       Demonstrate an appreciation of issues related to patient confidentiality.
       Deliver information to the patient and family in a humane manner and in such a way that it is
        understandable, encourages discussion and promotes patient’s participation in decision-making
        to the degree that they wish.


Collaborator:

The resident should be able to:

       Develop a care plan for a patient they have assessed, including investigation, treatment and
        continuing care, in collaboration with the members of the interdisciplinary team.
       Participate in an interdisciplinary team meeting, demonstrating the ability to accept, consider
        and respect the opinions of other team members, while contributing specialty-specific expertise
        him/herself.
       Maintain collegial and respectful relationships with medical and para-medical staff.
       Identify and describe the role, expertise and limitations of the members of the general surgery
        interdisciplinary team.
       Demonstrate an ability to promote the autonomy of patients and families and to promote their
        involvement in decision-making.
Manager:

The resident should be able to:

       Effectively manage the care of multiple patients while in the Emergency department, the wards,
        the recovery room and the operating room.
       Make clinical decisions and judgments based on sound evidence for the benefit of individual
        patients and the population served.
       Work effectively as a member of a team or a partnership and to accomplish tasks whether one
        is a team leader or a team member.
       Effectively use patient-related databases, access computer-based information and understand
        the fundamentals of medical informatics.

Revised: June 2009                                                                       Page 43 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
Health Advocate:

The resident should be able to:

       Identify the patient’s status with respect to one or more of the determinants of health (i.e.
        unemployment); adapting the assessment and management accordingly (i.e., the medical
        history to the patient’s social circumstances): and assessing the patient’s ability to access
        various services in the health and social system so as to promote health, enhance
        understanding, foster coping abilities, and enhance active participation in informed decision-
        making.

Scholar:

The resident should be able to:

       The resident will identify learning needs and make use of available learning resources.
       The resident should demonstrate critical thinking and integrate critical appraisal of the literature
        into the bedside approach.

Professional:

The resident will display professional attitudes and behaviors, including:

       Punctual for rounds, family conferences, and educational events.
       Following through on assigned tasks.
       Respectful, honest and compassionate care when dealing with patients, families, and other
        professionals.
       Considering racial and cultural issues in selecting treatment regimens for patients.
       Demonstrating responsibility by being reliable and dependable.

The resident should:

       Demonstrate an enthusiasm for learning.
       Demonstrate good self-assessment ability by being aware of own limitations and seeking
        feedback.
       Respect personal, cultural, and gender issues.
       Understand the consent and surrogate decision.




Revised: June 2009                                                                          Page 44 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
                                             Emergency Medicine
                                       Rotation Specific Objectives

                                                 INTENSIVE CARE


Goals:

        Develop the ability to rapidly evaluate, diagnose, stabilize, and expedite the disposition of
         critically ill patients.
        Learn respiratory, cardiovascular, renal and neurologic physiology and the pathophysiology of
         trauma, toxins, shock, sepsis, cardiac failure, and respiratory failure which affect critically ill
         patients.
        Learn the principles of medical instrumentation and hemodynamic monitoring and be able to
         utilize them in the care of critically ill patients.
        Learn the indications and develop the technical skills needed to perform diagnostic and
         therapeutic interventions in critically ill patients.
        Learn the rational use of other consultants, laboratory, radiographic and other diagnostic tests in
         the management of critically ill patients.

Medical Expert:

The resident should:

        Develop the capacity to make sound decisions and the ability to recognize potentially
         dangerous and manifestly life-threatening conditions.
        Develop a fundamental understanding of the prevention, diagnosis, incidence, etiology,
         pathophysiology, signs, symptoms, therapies, prognosis and complications of:
             ▪ cardiac arrest, cardiac crises (arrhythmias, diminished organ perfusions,
                 pulmonary edema, myocardial infarction and severe hypertension) and
                 shock.
             ▪ respiratory failure
             ▪ multi-system organ failure syndrome
             ▪ severe sepsis and septic shock
             ▪ coma, status epilepticus, acute neuromuscular disease and brain-stem
                death
             ▪ acid-base disorders and fluid and electrolyte disorders
             ▪ renal preservation and support
             ▪ the acute abdomen, gastrointestinal hemorrhage, hollow viscus
                dysfunction and hepatobiliary disease
             ▪ vascular crises
             ▪ endocrine disturbances in the critically ill related to water and/or
                glucose metablolism and adrenal, parathyroid and pituitary dysfunction


             ▪   coagulation disturbances and blood replacement therapy
             ▪   nutrition: enteral and parenteral
             ▪   drugs: general pharmacology of commonly used drugs in the critically ill
             ▪   hypothermia and hyperthermia
             ▪   trauma
             ▪   burns
             ▪   perioperative high risk conditions
Revised: June 2009                                                                          Page 45 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
             ▪   pain anxiety and sleep
             ▪   intoxications
             ▪   transportation of the critically ill
             ▪   severity of illness evaluative scoring

           Demonstrate ability to rapidly perform history and physical exams in critically ill patients.
           Demonstrate the ability to perform the following procedures: oral endotracheal intubation,
            cricothyrotomy, tube thoracostomy, central intravenous placement, swan ganz placement,
            transvenous cardiac pacing, arterial line placement, ABG and foley catheterization.
           Demonstrate the ability to use and interpret data from ECG monitors, ECG’s, cardiac
            outputs, hemodynamic monitoring, arterial blood gases, pulse oximetry, end tidal CO2
            monitors and respirators.
           Describe the dosages, indications and contraindications of pharmacologic intervention for:
            shock, cardiac failure, dysrhythmias, sepsis, trauma, toxins, respiratory failure, hepatic
            failure, renal failure and neurologic illnesses.
           Describe common ventilator modes and the indications for each including adjustments and
            complications
           Demonstrate appropriate judgment in the management of critically ill patients.
           Demonstrate appropriate prioritization of diagnostic and therapeutic interventions in critically
            ill patients.
           Demonstrate ability to diagnose and treat shock, sepsis, fluid and electrolyte abnormalities,
            cardiac failure, cardiac dysrhythmias, renal failure, hepatic failure, and toxicologic
            emergencies.
           Demonstrate an understanding of the appropriate use of consultants in critically ill patients.
           Demonstrate an understanding of the ethical and legal principles applicable to the care of
            the critically ill patients.
           Demonstrate the ability to work as a member of the team in a critical care environment and
            understand the roles of the multidisciplinary team members required.
           Demonstrate the necessary communication skills to deal with the critically ill patient, family
            and friends as well as the other staff involved with the patient’s care.
           Recognize and accurately diagnose brain death, and potential tissue and organ donor.
           Understand the responsibility and the liability involved with the transfer of patient from one
            institution to another.
           Demonstrate the skills to organize (monitoring, transport, venue) and supervise a safe
            transfer.




Revised: June 2009                                                                          Page 46 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
Communicator:

The resident should be able to:

       Develop and approach to discussing end of life and level of care issues with patients and their
        families
       Establish and maintain a therapeutic relationship with patients, their families and the medical
        team while fostering an environment characterized by understanding, trust, empathy and
        confidentiality.
       Accurately describe a patient’s clinical condition to consultants using appropriate terminology.
       Gather information not only about the disease but also about the patient’s beliefs, concerns and
        expectations about the illness, while considering the influence of factors such as the patient’s
        age, gender, ethnic, cultural and socio-economic background, and spiritual values on that
        illness.
       Provide an accurate verbal or written summary evaluation of the intensive care assessment.
       Keep thorough and accurate records.
       Communicate effectively with patients, family members and the medical team.
       Demonstrate an appreciation of issues related to patient confidentiality.
       Deliver information to the patient and family in a humane manner and in such a way that it is
        understandable, encourages discussion and promotes patient’s participation in decision-making
        to the degree that they wish.

Collaborator:

The resident should be able to:

       Develop a care plan for a patient they have assessed, including investigation, treatment and
        continuing care, in collaboration with the members of the interdisciplinary team.
       Participate in an interdisciplinary team meeting, demonstrating the ability to accept, consider
        and respect the opinions of other team members, while contributing specialty-specific expertise
        him/herself.
       Maintain collegial and respectful relationships with medical and para-medical staff.
       Identify and describe the role, expertise and limitations of the members of the general surgery
        interdisciplinary team.
       Demonstrate an ability to promote the autonomy of patients and families and to promote their
        involvement in decision-making.

Manager:

The resident should be able to:

       Effectively manage the care of multiple patients while working in the Intensive Care Unit.
       Make clinical decisions and judgments based on sound evidence for the benefit of individual
        patients and the population served.
       Be open to working effectively as a member of a team or a partnership and to accomplish tasks
        whether one is a team leader or a team member.
       Effectively use patient-related databases, access computer-based information and understand
        the fundamentals of medical informatics.
       Understand the importance and necessity of allocation of finite health care resources.
       Develop a working understanding of quality improvement programs, clinical practice guidelines
        and critical care patient databases.

Revised: June 2009                                                                       Page 47 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
Health Advocate:

The resident should be able to:

       Identify the patient’s status with respect to one or more of the determinants of health (i.e.,
        unemployment): adapting the assessment and management accordingly (i.e., the medical
        history to the patient’s social circumstances): and assessing the patient’s ability to access
        various services in the health and social system so as to promote health, enhance
        understanding, foster coping abilities, and enhance active participation in informed decision-
        making.
       Recognize and respond to those issues where advocacy is appropriate.
       Develop proficiency with informed consent and measurement of capacity.
       Demonstrate a good understanding of living wills, advanced directives, durable power of
        attorney, personal directives and the “Freedom of Information and Privacy Act.”
       Develop proficiency when substitute decision making is considered or required.
       Understand the concept of futility. Demonstrate an understanding of how and when to
        appropriately institute, maintain or discontinue life-sustaining treatment.
       Demonstrate an understanding of the diverse psychological and social effects of life-threatening
        illness on patients and their families.

Scholar:

The resident should be able to:

       The resident will identify learning needs and make use of available learning resources.
       The resident should demonstrate critical thinking and integrate critical appraisal of the literature
        into the bedside approach.

Professional:

The resident will display professional attitudes and behaviors, including:

       Punctual for rounds, family conferences, and educational events.
       Following through on assigned tasks.
       Respectful, honest and compassionate care when dealing with patients, families and other
        professionals.
       Considering racial and cultural issues in selecting treatment regimens for patients.
       Demonstrating responsibility by being reliable and dependable.

The resident should:

       Demonstrate an enthusiasm for learning.
       Demonstrate good self-assessment ability by being aware of own limitations and seeking
        feedback.
       Respect personal, cultural and gender issues.
       Understand the consent and surrogate decision.




Revised: June 2009                                                                          Page 48 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
                                             Emergency Medicine
                                       Rotation Specific Objectives

                                             INTERNAL MEDICINE

                                       Medical Teaching Unit Rotation

Medical Expert:

       The emergency resident will be able to:

       Elicit a complete history relevant to the presenting problem and addressing the concerns of the
        referring physician. This will include pertinent past medical history.

       Perform an accurate physical exam that is based on the presenting complaint and working
        differential diagnosis. The physical exam will include an assessment of the degree of organ
        dysfunction.

       Demonstrate knowledge of the diagnostic value of physical exam findings.

       Order appropriate investigations both laboratory and imaging: including cultures, serology, other
        blood tests and demonstrate interpretation of these tests in the context of the patient problem.

       Order and justify initial management given the history, examination and preliminary
        investigations. Discuss benefits and side effects of proposed therapies including interactions
        with other therapies or diseases.

       Modify treatment as further data becomes available.

       Provide counselling to the patient and family, allied health workers and referring physicians
        regarding the natural history of the disorder and the impact of therapy.

       Recommend preventative measures to prevent progression or complications of the disease or
        treatment.

       Seek guidance from the senior resident and attending staff appropriately.


For the common medical problems listed below the resident is expected to be able to:

       Discuss the pathophysiology
       List likely etiologies
       List differential diagnoses
       Order appropriate investigations
       Initiate and monitor therapy
       Consult other specialists when required
       Formulate a discharge plan including follow-up

Problem list:


Revised: June 2009                                                                         Page 49 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
       Sepsis, pneumonia, meningitis, SBE, empyema, urosepsis, biliary sepsis, SBP, HIV, fever in the
        immunocompromised patient, cellulitis and deep soft tissue infections.
       DKA, HONK, adrenal insufficiency, hyper/hypothyroidism
       COPD, asthma, respirator failure, pleural effusions, hemoptysis, aspiration
       Upper and lower GI bleeding, pancreatitis, jaundice, ascites, liver failure and cirrhosis,
        inflammatory bowel disease
       Fluid and electrolyte disorders: volume depletion/overload, hyper/hyponatremia, kalemia, and
        calcemia.
       Acid/base disorders
       Acute and chronic renal failure, hematuria, proteinuria
       Anemia, thrombocytopenia, thrombocytosis, neutropenia, neutrophilia, pancytopenia
       Headache, altered mentation, dementia
       Vasculitis

Procedures:

       The resident should demonstrate competence in the following procedures including knowledge
        of the associated benefits and complications. The resident should also be able to obtain
        consent.

     Thoracentesis
     Paracentesis
Joint aspiration
     Spirometry


Communicator:

       With the admitted patients on the MTU the resident will be able to:

       Provide a verbal and written summary of the patient’s medical problems, keeping accurate
        records of admission, daily care and disposition.

       Explain to the patient his/her condition and the proposed plan for investigation and
        management.

       Outline the potential risks and benefits of any treatment.

       Discuss with the patient any serious diagnosis using the principles of “breaking bad news.”

       Obtain information in a sensitive and non-judgmental fashion. E.g. sexual history, substance
        abuse.

       Establish goals of care designation in a respectful manner that takes into account the medical
        prognosis and the patient’s and family’s wishes.

       Break bad news to family members in the case of death; ask for autopsy/tissue donation in a
        sensitive and caring way.

       Communicate the treatment plans to all team members to ensure seamless transfer of care.

Revised: June 2009                                                                         Page 50 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009

Collaborator:

The resident will be able to:

       Maintain collegial relationships with colleagues, nurses, unit clerks, students and allied health
        professionals.

       Work with team members to optimize patient care and for a smooth transfer of the patient to the
        community.

       Obtain consultation appropriately for patient care.

       Ensure that the education needs of other residents and students are met.

Health Advocate:

The resident will be able to:

       Council patients on smoking cessation, cessation of alcohol and other addictions, and harm
        reduction.

       Articulate the principles of public health including immunization and mandatory reporting of
        infectious diseases.

Manager:

The resident will be able to:

       Set priorities according to level of acuity new patients.

       Divide tasks appropriately among colleagues, including students and supervise these

       Provide direction to ancillary staff regarding priorities of resource allocation among several
        patients including resources such as CT and laboratory.

       Manage time commitments to ensure clinical and educational responsibilities do not overlap.

       Consider socioeconomic (cost) issues regarding investigations, therapies, and discharge.

Scholar:

The resident will:

       Identify learning needs and make use of available resources.

       Attend rounds and participate in presentation and discussion of cases.

       Review current literature when confronted with a difficult clinical problem.


Revised: June 2009                                                                           Page 51 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
       Provide clinical and didactic teaching to students, residents and staff.

Professional:

The resident will:

       Display professional attitudes and behaviors.
       Be punctual
       Complete assigned tasks
       Respectful when dealing with patients, families, and other professionals
       Maintain confidentiality




Revised: June 2009                                                                 Page 52 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
                                             Emergency Medicine
                                       Rotation Specific Objectives

                                                 NEUROSURGERY


Goals:

        Develop history taking and physical examination skills that identify and localize injury to the
         central nervous system.
        Effectively utilize radiologic studies to diagnose neurological disease or injury.
        Diagnose, stabilize and provide initial treatment of injuries and diseases of the brain, spinal
         chord, bony spine and peripheral nerves.
        Learn how CSF shunts function and learn to evaluate patients with possible shunt malfunction.

Medical Expert:

The resident should be able to:

        Demonstrate a clear set of priorities in the acute management of the multiply traumatized
         patient into which neurosurgically emergent conditions can be appropriately stratified and dealt
         with to the benefit of the whole patient.
        Assess rapidly and follow sequentially significant cranio-cerebral and spinal injury.
        Demonstrate knowledge of the urgency and effectiveness of acute bedside neurosurgical
         interventions and manifest knowledge of appropriate indications.
        Demonstrate a brief and a complete neurological history and examination on patients with
         various levels of consciousness.
        Demonstrate the ability to recognize and manage cerebrovascular and spinal cord disorders
         that are amenable to neurosurgical intervention.
        Develop approaches to CT interpretation for both trauma and headache.
        Know CT findings for conditions requiring neurosurgical intervention: SDH, EDH, venous sinus
         thrombosis, hydrocephalous
        Identify the common locations for SAH on CT
        Recognize patterns of intra-axial and extra-axial bleeding.
        Manage the unstable spine with or without cord defects with regard to acute spinal
         immobilization.
        Demonstrate a clear concept of the bedside indications for acute trephination of the skull for
         release of extra-axial pathological fluid collections, and manifest manual skills and knowledge to
         carry out such a procedure.
        Manifest a methodical, broadly based bedside approach to the assessment of the comatose
         patient, which incorporates neurosurgical conditions.
        Understand the pathophysiology of acute cranial, intra-cranial, spinal and spinal cord injury with
         specific reference to mechanisms of acute injury and further de-compensation, early decision-
         making and therapy, and prevention of iatrogenic or secondary advancement of neurologic
         injury.




Revised: June 2009                                                                          Page 53 of 119
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Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009

       Understand the basic pathophysiologic principles and acute treatment of:
        ▪ Acute and/or decompensating presentations of intra-cranial mass lesions or
            intra/extra axial collections
        ▪ Increased ICP, ventricular shunts and intra-cranial pressure monitoring
        ▪ Cranial nerve, plexus and nerve root lesions with special reference to
            localization of levels
        ▪     Spinal musculoskeletal anatomy with specific reference to radiological diagnosis of injury
            and stability thereof
        ▪ Basic CT interpretation of cranial and spinal column scans
        ▪ The mechanism and meaning of bedside signs in acute neurosurgical assessment
        ▪ A clinical approach to coma
       Demonstrate an understanding of the guidelines for brain death and the associated legal and
        ethical principles.
       Demonstrate the ability to evaluate CSF shunt malfunction.
       Demonstrate ability to recognize and manage spinal cord compression due to non-traumatic
        causes.
       Describe the indications and techniques for control of intracranial pressure.
       Describe the main classifications of headaches and state the doses, indications, and
        contraindications for agents used to manage each of these types of headaches.
       Demonstrate skill in the performance and interpretation of spinal fluid studies.
       Demonstrate knowledge of the proper sequence for evaluation and management of patients
        with shunt malfunction, seizures, spinal cord compression, neurological tumors and neurological
        infections.
       Discuss the indications, contraindications, and dosages of agents used to treat neurological
        infections.
       Demonstrate graduated, progressive skill in intra-operative techniques, halo vest application
        and appropriate ways to drain CSF urgently.

Communicator:

The resident should be able to:

       Establish and maintain a therapeutic relationship with patients, their families and the medical
        team while fostering an environment characterized by understanding, trust, empathy and
        confidentiality.
       Accurately describe a patient’s clinical condition to consultants using appropriate terminology.
       Gather information not only about the disease but also about the patient’s beliefs, concerns and
        expectations about the illness, while considering the influence of factors such as the patient’s
        age, gender, ethnic, cultural and socio-economic background, and spiritual values on that
        illness.
       Provide an accurate verbal or written summary evaluation of the neurosurgical assessment.
       Keep thorough and accurate records.
       Communicate effectively with patients, family members and the medical team.
       Demonstrate an appreciation of issues related to patient confidentiality.
       Deliver information to the patient and family in a humane manner and in such a way that it is
        understandable, encourages discussion and promotes patient’s participation in decision-making
        to the degree that they wish.




Revised: June 2009                                                                       Page 54 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009

Collaborator:

The resident should be able to:

       Develop a care plan for a patient they have assessed, including investigation, treatment and
        continuing care, in collaboration with the members of the interdisciplinary team.
       Participate in an interdisciplinary team meeting, demonstrating the ability to accept, consider
        and respect the opinions of other team members, while contributing specialty-specific expertise
        him/herself.
       Maintain collegial and respectful relationships with medical and para-medical staff.
       Identify and describe the role, expertise and limitations of the members of the general surgery
        interdisciplinary team.
       Demonstrate an ability to promote the autonomy of patients and families and to promote their
        involvement in decision-making.

Manager:

The resident should be able to:

       Effectively manage the care of multiple patients while working in the Emergency department,
        the wards, the recovery room and the operating room.
       Make clinical decisions and judgments based on sound evidence for the benefit of individual
        patients and the population served.
       Be open to working effectively as a member of a team or a partnership and to accomplish task
        whether one is a team leader or a team member.
       Effectively use patient-related databases, access computer-based information and understand
        the fundamentals of medical informatics.

Health Advocate:

The resident should be able to:

       Identify the patient’s status with respect to one or more of the determinants of health (i.e.,
        unemployment): adapting the assessment and management accordingly (i.e., the medical
        history to the patient’s social circumstances): and assessing the patient’s ability to access
        various services in the health and social system so as to promote health, enhance
        understanding, foster coping abilities, and enhance active participation in informed decision-
        making.

Scholar:

The resident should be able to:

       The resident will identify learning needs and make use of available learning resources.
       The resident should demonstrate critical thinking and integrate critical appraisal of the literature
        into the bedside approach.




Revised: June 2009                                                                          Page 55 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
Professionalism:

The resident will display professional attitudes and behaviors, including:

       Punctual for rounds, family conferences and educational events.
       Following through on assigned tasks.
       Respectful, honest and compassionate care when dealing with patients, families and other
        professionals.
       Considering racial and cultural issues in selecting treatment regimens for patients.
       Demonstrating responsibility by being reliable and dependable.

The resident should:

       Demonstrate an enthusiasm for learning.
       Demonstrate good self-assessment ability by being aware of own limitations and seeking
        feedback.
       Respect personal, cultural and gender issues.
       Understand the consent and surrogate decision.




Revised: June 2009                                                                Page 56 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
                                             Emergency Medicine
                                       Rotation Specific Objectives

                                     OBSTETRICS AND GYNECOLOGY

Goals:

        Learn the principles of contraception and complications.
        Develop expertise in the diagnosis and management of emergent complications of early and
         late pregnancy.
        Develop expertise in the management of uncomplicated and complicated labor and delivery.
        Develop expertise in the management of sexual assault.
        Learn the principles of management of gynecologic and obstetrical trauma.
        Learn diagnosis and treatment of genital and pelvic infectious diseases.
        Develop expertise in the diagnosis and management of abdominal pain in females.
        Develop expertise in the diagnosis and management of vaginal bleeding.

Medical Expert:

Gynecology:

        Discuss the evaluation, etiology, differential diagnosis and management of life threatening
         gynecological problems.
        Discuss the evaluation, etiology, and formulate differential diagnosis and management of
         women who present to the emergency department with acute pelvic pain.
        Discuss the evaluation, etiology, and formulate differential diagnosis and management of
         women who present to the emergency department with chronic pelvic pain.
        Demonstrate the appropriate technique for pelvic examination including methods to obtain
         cervical and vaginal cultures.
        Discuss methods of contraception and their effectiveness, their indications, contraindications
         and complications for each method.
        Describe physiology of normal menses.
        Outline the pathophysiology of the common etiologies of abnormal vaginal bleeding.
        Formulate a differential diagnosis of abnormal vaginal bleeding and describe appropriate
         investigations and therapy.
        Describe the evaluation, differential diagnosis, initiate initial investigation and management of a
         woman with vaginal discharge.
        Demonstrate ability to evaluate and treat patients with genitourinary infections including PID,
         UTI, STI, vaginitis and genital ulcerations.
        Learn to recognize abnormal vaginal and cervical lesions.
        Describe the symptoms and differential diagnosis and management of toxic shock syndrome.
        Demonstrate ability to evaluate and treat sexual assault victims, including evidence collection,
         appropriate patient counseling and pregnancy prevention.
        Demonstrate knowledge of risk factors pertaining to STD screening.




Revised: June 2009                                                                          Page 57 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
Obstetrics:

       Compare and contrast the sensitivity and specificity of the different types of pregnancy tests.
       Describe the physiologic changes of pregnancy in the mother.
       Outline the structures and functions of the fetal placental unit.
       Discuss the effects of medications and teratogens on the developing fetus.
       Outline the features of a high-risk pregnancy.
       Diagnose and manage hyperemesis gravidarum.
       Evaluate the woman who presents with first trimester bleeding, formulate a differential diagnosis
        and select the appropriate initial management.
       Demonstrate ability to evaluate and manage the care of patients with suspected ectopic
        pregnancy.
       Discuss the implications of Rh typing and recommendations for prophylaxis.
       Compare and contrast the causes of ante-partum hemorrhage and outline the principles of
        stabilization.
       Define preeclampsia and the syndromes of hypertension in pregnancy.
       Outline the pathophysiology of pregnancy induced hypertension and describe appropriate
        investigations and management.
       Describe the common pathogens associated with premature rupture of the membranes and the
        implications to the mother and the fetus.
       Discuss risk factors, etiology and principles of assessment and management of the woman who
        presents in pre-term labour.

Labour and postpartum:

       Outline the stages of normal labour.
       Evaluate the progress of labour by history and physical examination.
       Describe maternal and fetal monitoring methods and interpret the results.
       Outline the predisposing factors and management principles of fetal distress, fetal death in utero
        and fetal macrosomia.
       Interpret major abnormalities in fetal heart tracings.
       Manage a normal labour and delivery.
       Describe the procedure for an episiotomy and discuss the indications for the procedure.
       Select a safe and effective technique for analgesia during labour.
       Describe the signs and symptoms of uterine rupture and amniotic fluid embolism.
       Diagnose and initiate management of peurperial complications.
       Outline the pathophysiology of Sheehan’s syndrome and post partum thyroiditis.
       Describe the complications that may result from the hypercoagulable state of pregnancy.
       Diagnose post partum mood disturbance and psychosis.
       Describe the evaluation, etiology of a patient with postpartum hemorrhage, formulate a
        differential diagnosis and describe the initial management plan.
       Discuss the management of trauma during pregnancy.
       Discuss the indications for perimortem caesarian section and describe the technique.
       Discuss the evaluation, etiology, differential diagnosis and management of women with
        postpartum complications including retained products, endometritis and mastitis.

Neonatology:

       Describe the evaluation of a distressed newborn, formulate a differential diagnosis and describe
        the initial management plan.
       Perform an initial assessment of the newborn and determine an APGAR score.

Revised: June 2009                                                                         Page 58 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
Communicator:

The resident should be able to:

       Establish and maintain a therapeutic relationship with patients, their families and the medical
        team while fostering an environment characterized by understanding, trust, empathy and
        confidentiality.
       Provide an accurate verbal or written summary evaluation to describe a patient’s clinical
        condition to consultants using appropriate terminology.
       Gather information not only about the disease but also about the patient’s beliefs, concerns and
        expectations about the illness, while considering the influence of factors such as the patient’s
        age, gender, ethnic, cultural and socio-economic background, and spiritual values on that
        illness.
       Keep thorough and accurate records.
       Communicate effectively with patients, family members and the medical team.
       Deliver information to the patient and family in a humane manner and in such a way that it is
        understandable, encourages discussion and promotes patient’s participation in decision-making
        to the degree that they wish.

Collaborator:

The resident should be able to:

       Develop a care plan for a patient they have assessed, including investigation, treatment and
        continuing care, in collaboration with the members of the interdisciplinary team.
       Participate in an interdisciplinary team meeting, demonstrating the ability to accept, consider
        and respect the opinions of other team members, while contributing specialty-specific expertise
        him/herself.
       Maintain collegial and respectful relationships with medical and para-medical staff.
       Identify and describe the role, expertise and limitations of the members of the general surgery
        interdisciplinary team.
       Demonstrate an ability to promote the autonomy of patients and families and to promote their
        involvement in decision-making.
       Involve ancillary team members (nursing, social worker) in care of early pregnancy loss.

Manager:

The resident should be able to:

       Effectively manage the care of multiple patients while working in the Emergency department,
        the wards, the recovery room, the operating room and the delivery room.
       Make clinical decisions and judgments based on sound evidence for the benefit of individual
        patients and the population served.
       Be open to working effectively as a member of a team or a partnership and to accomplish tasks
        whether one is a team leader or a team member.
       Effectively use patient-related databases, access computer-based information and understand
        the fundamentals of medical informatics.


Health Advocate:


Revised: June 2009                                                                       Page 59 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
The resident should be able to:

       Identify the patient’s status with respect to one or more of the determinants of health (marital
        status / social economics / education / substance abuse) adapting the assessment and
        management accordingly (i.e., the medical history to the patient’s social circumstances): and
        assessing the patient’s ability to access various services in the health and social system so as
        to promote health, enhance understanding, foster coping abilities, and enhance active
        participation in informed decision-making.

Scholar:

The resident should be able to:

       The resident will identify learning needs and make use of available learning resources.
       The resident should demonstrate critical thinking and integrate critical appraisal of the literature
        into the bedside approach.

Professionalism:

The resident will display professional attitudes and behaviors, including:

       Punctual for rounds, family conferences, and educational events.
       Following through on assigned tasks.
       Respectful, honest and compassionate care when dealing with patients, families, and other
        professionals.
       Considering racial and cultural issues in selecting treatment regimens for patients.
       Demonstrating responsibility by being reliable and dependable.

The resident should:

       Demonstrate an enthusiasm for learning.
       Demonstrate good self-assessment ability by being aware of own limitations and seeking
        feedback.
       Respect personal, cultural and gender issues.
       Understand the consent and surrogate decision.




Revised: June 2009                                                                          Page 60 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009

                                             Emergency Medicine
                                       Rotation Specific Objectives

                                             OPHTHALMOLOGY

Goals:

        Understand the emergency presentations.
        Learn relevant techniques to examine patients with ophthalmologic disorders.
        Develop familiarity with common pharmacologic agents.
        Learn principles of managing ophthalmologic emergencies.
        Evaluate the need for consultation.

Medical Expert:

     On completion of the ophthalmology rotation the resident should be able to:
     Discuss the indications for emergent and routine consultation.
     Demonstrate ability to perform a thorough exam in patients with normal and altered vision
     Recognize and provide initial care for vision threatening conditions
     Demonstrate knowledge of traumatic injuries including globe rupture, orbital wall fractures, and
       retrobulbar hemorrhages.
     Demonstrate knowledge of injuries to the cornea and conjunctiva including chemical burns,
       thermal and radiation injuries
     Demonstrate knowledge in evaluating and treating cornal abrasions, foreign bodies and rust
       rings.
     Demonstrate knowledge in the diagnosis of hyphema, iridocyclities, traumatic pupilarly changes,
       lens dislocation
     Demonstrate knowledge in evaluating penetrating injuries of the lids and adjacent structures,
       correctly identifying those that require consultation.
     Recognize risk factors for introcular foreign bodies and develop an approach for identifying
       these
     Demonstrate knowledge in common and emergent disorders of the cornea including
       conjunctivitis (viral, bacterial, allergic, toxic and chronic) keratitis, ulcers, herpes simplex,and
       herpes zoster
     Demonstrate knowledge in common and emergent disorders of the lilds including chelazion,
       dacryocystitis blepharitis
     Demonstrate an understanding of the pathophysiology, the presentation, diagnosis, emergency
       management and subsequent referral of primary angle closure glaucoma.
     Demonstrate an understanding of the pathophysiology, the presentation, diagnosis, emergency
       management and subsequent referral of central retinal artery occlucion, central retinal vein
       occlusion, retinal detachment and vitreal hemorrhage.
     Identify neurophthalmologic visual loss
     Understand the pharmacology of commonly used ophthalmologic medications: anesthetics,
       antibiotics, antivirals, steroids, antiallergy, glaucoma medications, cycloplegics, nonsteroidals,
       lubricants




Revised: June 2009                                                                         Page 61 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
PROCEDURAL SKILLS

       Demonstrate skills in the general emergency examination of ophthalmologic patients including
        assessment of visual acuity, lid eversion, and pupil dilation,
       Demonstrate slit lamp use and fluorsescein examination
       Demonstrate tonometry
       Discuss irrigation techniques and pH monitoring
       Demonstrate corneal foreign body removal including rust and contact lenses
       Demonstrate patching and shielding
       Discuss globe massage for CRA
       Discuss lateral canthotomy for orbital compartment syndrome


Communicator:

The resident should be able to:

       Establish and maintain a therapeutic relationship with patients, their families while fostering an
        environment characterized by understanding, trust, empathy and confidentiality
       Provide an accurate verbal or written summary evaluation to describe a patient’s clinical
        condition to consultants using appropriate terminology.
       Keep thorough and accurate records.
       Communicate effectively with patients, family members and the medical team.
       Deliver information to the patient and family in a humane manner and in such a way that it is
        understandable, encourages discussion and promotes patient’s participation in decision-making
        to the degree that they wish.

Collaborator:

The resident should be able to:

       Develop a care plan for a patient they have assessed, including investigation, treatment and
        continuing care, in collaboration with the members of the interdisciplinary team.
       Maintain collegial and respectful relationships with medical and para-medical staff.
       Identify and describe the role, expertise and limitations of referring and consultant staff
       Demonstrate an ability to promote the autonomy of patients and families and to promote their
        involvement in decision-making.

Manager:

The resident should be able to:

       Effectively priortize the care of multiple patients including those with ophthalmologic complaints
        while working in the Emergency department
       Make clinical decisions and judgments based on sound evidence for the benefit of individual
        patients and the population served.
       Effectively use patient-related databases, access computer- based information and understand
        the fundamentals of medical informatics.




Revised: June 2009                                                                             Page 62 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009


Health Advocate:
The resident should be able to:
    Identify the patient's status with respect to one or more of the determinants of health (i.e.,
       unemployment); adapting the assessment and management accordingly (i.e., the medical
       history to the patient's social circumstances); and assessing the patient's ability to access
       various services in the health and social system so as to promote health, enhance
       understanding, foster coping abilities, and enhance active participation in informed decision-
       making.

Scholar:

The resident should be able to:

       The resident will identify learning needs and make use of available learning resources.
       The resident should demonstrate critical thinking and integrate critical appraisal of the literature
        into the bedside approach.

Professionalism:

The resident will display professional attitudes and behaviors, including:

       Punctual for clinics, rounds, conferences, and educational events
       Following through on assigned tasks
       Respectful, honest and compassionate care when dealing with patients and other professionals.
       Demonstrating responsibility by being reliable and dependable.

The resident should:

       Demonstrate an enthusiasm for learning.
       Demonstrate good self-assessment ability by being aware of own limitations and seeking
        feedback.
       Respect personal, cultural, and gender issues.
       Understand the consent and surrogate decision




Revised: June 2009                                                                          Page 63 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
                                             Emergency Medicine
                                       Rotation Specific Objectives

                         ORTHOPEDICS AND MUSCULOSKELETAL MEDICINE


Goals:

        Develop relevant history and physical exam skills for the musculoskeletal system.
        Learn the use of the diagnostic imaging modalities available for the evaluation of orthopedic
         disorders.
        Develop skill in the evaluation and management of musculoskeletal trauma.
        Develop skill in the diagnosis and treatment of inflammatory and infectious disorders of the
         musculoskeletal system.
        Learn principles of acute and chronic pain management in patients with musculoskeletal
         disorders.

Medical Expert:

Orthopedics:

        Recognize and manage life or limb-threatening orthopedic injuries including potential vascular
         or neurologic injury and seek timely consultation.
        Demonstrate ability to prioritize and manage the treatment of orthopedic injuries in multiple
         trauma patients.
        Demonstrate understanding of the anatomy, mechanism of injury, presentations, complications,
         management and prognosis of common musculoskeletal injuries.
        Discuss the implication of orthopedic trauma in the acutely injured trauma patient in the acute
         and convalescent care.
        Describe the techniques of splinting, immobilizers and casting and discuss the complications
         related to both.
        Define open fracture and discuss the implications of this in patient management.
        Discuss the definition, clinical features, assessment and initial management of the patient with
         compartment syndrome.
        Describe the importance of providing analgesia and splinting in acute orthopedic injuries.
        Demonstrate ability to correctly order and interpret radiographs in patients with orthopedic
         injuries.
        Demonstrate knowledge of appropriate aftercare and rehabilitation of common orthopedic
         injuries.
        Demonstrate skill in performance of the following procedures: fracture/dislocation immobilization
         and reduction of dislocation of the shoulders, elbow, knee, ankle and hip, reduction of Colles
         fractures, arthrocentesis, reduction of ankle fracture.
        Describe the presentation of patients with inflammatory and infectious musculoskeletal
         disorders and demonstrate ability to diagnose and treat them.
        Demonstrate ability to recognize and treat soft tissue infections involving muscles, fascia, and
         tendons.
        Describe the presentations, complications, diagnosis and management of compartment
         syndromes.
        Demonstrate ability to provide regional anesthesia, including hematoma blocks, Bier blocks and
         radial, ulnar, median, posterior tibial and sural nerve blocks.


Revised: June 2009                                                                         Page 64 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
       Discuss the dosages, indications, contraindications and side effects of standard analgesic and
        sedative agents used to treat patients with acute orthopedic trauma and demonstrate skills in
        their use.
       Discuss the differential diagnosis, historical features, physical examination findings, diagnostic
        modalities and treatment of patients with low back pain.
       Demonstrate an understanding of which orthopedic conditions warrant immediate and elective
        referral to an Orthopedic Surgeon.
       Demonstrate knowledge of the diagnosis and management an overuse injury.
       Demonstrate proper performance of a complete knee examination in the acutely injured patient.
       Discuss medical coverage of the sporting event.
       Gain clinical competencies in history taking, physical examination skills, diagnosis,
        investigations, patient education/interaction, treatment, medical rehabilitation and activity
        modification for acute and overuse musculoskeletal injuries.
       Describe assessment and management of field emergencies in sports.
       Describe assessment and management of on-field management of acute injuries.
       Describe return to play criteria.
       Discuss knowledge of diagnosis, appropriate investigations and management of core sport
        medicine topics including:

         Shoulder: deltoid strain, A-C sprain, dislocation, bursitis, clavicle fracture, impingement
              syndrome, dicipital, supraspinatus tendinitis.
         Elbow: medial and lateral epicondylitis, olecranon bursitis, elbow sprains, ulnar neuritis, loose
              bodies, little leaguers elbow.
         Wrist: carpal sprains, Dequervains tendonitis, scaphoid fracture, triangular fibrocartilage
              injury.
         Hand: metacarpal and phalangeal sprains, tendon avulsion, subungual hematoma.
         Neck: musculo-ligamentous sprains, burners and stingers and disc disease.
         Back: mechanical back pain, spondylolysis and lystesis, disc protrusion and ‘sciatica’,
              sacroiliitis.
         Head: concussion, cauliflower ear, swimmer’s ear, exercise induced headache, eye
              protection.
         Pelvis & Hip: osteitis pubis, hip pointer, trochanteric bursitis, arthritis, Legge-Perthes, pelvic
              avulsion injuries, iliopsoas bursitis, piriformis syndrome, hernias.
         Thigh: quadriceps strain, thigh contusion and hematoma, myositis ossificans, hamstring
              strain, adductor strain.
             Knee: PFPS, patellar tendinitis, ITB syndrome, patellar dislocation and subluxation,
              bursitis, Osgood-Schlatters meniscal injuries, ligamentous injuries of various severities,
              arthritis, osteochondritis dessicans, plica, Baker’s cyst, stress fractures.
             Leg: gastro-soleus strain, popliteus tendinitis, Achilles tendinitis, acute and chronic
              compartment syndrome, tibial and tibular stress fracture, anterior and posterior tibial
              tendinitis, periostitis.
             Ankle: sprains, chronic instability, osteochondritis dessicans, tarsal coalition dislocating
              peroneal tendon, arthritis.
             Foot: plantar fascitis, retrocalcaneal bursitis, calcaneal and metatarsal stress fractures,
              tarsal tunnel syndrome, accessory navicular, dorsal exostosis, bunion, turf toe, extensor
              tendinitis, Morton’s neuroma, ingrown nails, sesamoiditis, fractures, black toenail, pes
              planus and cavus, metatarsalgia, Saver’s disease.
             Procedures: joint injection, detailed exam of the MSK system, knee aspiration, casting..
             Radiology: ordering and interpretation of plain film x-rays, bone scans.
             Other: exercise induced hives and asthma, heat stroke and exhaustion, hypothermia.

Communicator:
Revised: June 2009                                                                          Page 65 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009

The resident should be able to:

       Demonstrate and communicate compassion for the stress imposed on the patient’s lifestyle by
        this injury, and the difficulty they may have with the rehabilitation process.
       Be capable of explaining the nature of the injury in layman’s terms, and communicate the long-
        term prognosis of the injury.
       Communicate the information regarding the prognosis to the patient in a manner that
        demonstrates an awareness of the dramatic effect such a diagnosis will have on a young, active
        patient.
       Demonstrate empathy while advising a participant who is ill or injured to discontinue
        participation.
       Establish and maintain a therapeutic relationship with patients, their families and the medical
        team while fostering an environment characterized by understanding, trust, empathy and
        confidentiality.
       Provide an accurate verbal or written summary evaluation to describe a patient’s clinical
        condition to consultants using appropriate terminology.
       Keep thorough and accurate records.
       Communicate effectively with patients, family members and the medical team.
       Deliver information to the patient and family in a humane manner and in such a way that it is
        understandable, encourages discussion and promotes patient’s participation in decision-making
        to the degree that they wish.

Collaborator:

The resident should be able to:

       Develop a care plan for a patient they have assessed, including investigation, treatment and
        continuing care, in collaboration with the members of the interdisciplinary team.
       Participate in an interdisciplinary team meeting, demonstrating the ability to accept, consider
        and respect the opinions of other team members, while contributing specialty-specific expertise
        him/herself.
       Maintain collegial and respectful relationships with medical and para-medical staff.
       Identify and describe the role, expertise and limitations of the members of the orthopedic
        interdisciplinary team.
       Demonstrate an ability to promote the autonomy of patients and families and to promote their
        involvement in decision-making.

Manager:

The resident should be able to:

       Effectively manage the care of multiple patients while working in the Emergency department,
        the wards, the recovery room and the operating room.
       Make clinical decisions and judgments based on sound evidence for the benefit of individual
        patients and the population served.
       Be open to working effectively as a member of a team or a partnership and to accomplish tasks
        whether one is a team leader or a team member.
       Effectively use patient-related databases, access computer-based information and understand
        the fundamentals of medical informatics.

Health Advocate:
Revised: June 2009                                                                      Page 66 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009

The resident should be able to advocate for healthy lifestyle choices regarding diet and exercise:
    Identify the patient’s status with respect to one or more of the determinants of health (i.e.,
       unemployment); adapting the assessment and management accordingly (i.e., the medical
       history to the patient’s social circumstances); and assessing the patient’s ability to access
       various services in the health and social system so as to promote health, enhance
       understanding, foster coping abilities, and enhance active participation in informed decision-
       making.

Scholar:

The resident should be able to:

       The resident will identify learning needs and make use of available learning resources.
       The resident should demonstrate critical thinking and integrate critical appraisal of the literature
        into the bedside approach.

Professionalism:

The resident will display professional attitudes and behaviors, including:

       Punctual for rounds, family conferences, and educational events.
       Follow through on assigned tasks.
       Respectful, honest and compassionate care when dealing with patients, families, and other
        professionals.
       Considering racial and cultural issues in selecting treatment regimens for patients.
       Demonstrating responsibility by being reliable and dependable.

The resident should:

       Demonstrate an enthusiasm for learning.
       Demonstrate good self-assessment ability by being aware of own limitations and seeking
        feedback.
       Respect personal, cultural, and gender issues.
       Understand the consent and surrogate decision.




Revised: June 2009                                                                          Page 67 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
                                             Emergency Medicine
                                       Rotation Specific Objectives

                                     Pediatric Emergency Medicine - R1


Medical Expert:

           Able to independently perform appropriate, thorough and directed history and physicals in
            common pediatric clinical presentations.
           Understands and orders appropriate, cost effective, basic lab and diagnostic imaging tests.
           Begins to independently make decisions on disposition in common clinical problems in
            consultation with attending staff.
           Demonstrate a good general clinical knowledge in common pediatric problems.
           Begins to execute a systematic search for evidence and learns the importance of critically
            evaluating the medical literature
           Shows solid evidence of self-assessment by recognizing when personal limits are exceeded
            and demonstrating timely consultation with the staff pediatric emergency physician.
           Develop progression in the development of a systematic and cognitive approach to clinical
            reasoning in order to solve the individual’s patient problems.
           Able to demonstrate competency in IV insertion, venipuncture, simple suturing, casting and
            splinting, beginning airway management, and lumbar puncture.
           Able to recognize ill patients and outline management.
           Able to perform CPR, defibrillation, and basic airway management including intubation with
            close staff supervision.
           Beginning to manage the poisoned patient with staff supervision.
           Develop an approach to common orthopedic injuries.

Communicator:

The resident should begin to develop the following skills:

           Establish and maintain rapport and fostering an environment characterized by
            understanding, trust, empathy, and confidentiality.
           Explore patient's and their family’s beliefs, concerns, and expectations about the origin,
            nature, and management of his/her illness. Assess the impact of such factors as age,
            gender, ethno-cultural background, social support, and emotional influences on a patient's
            illness.
           Inform and counsel a patient and their families in a sensitive and respectful manner while
            fostering understanding, discussion, and the patient and their family’s active participation in
            decisions about their care. This includes the ability to listen to the patient and their families
            and to communicate effectively with other health providers, to ensure optimal and consistent
            care of the patient and his/her family.
           Maintain appropriate and concise charting.
           Learn the importance of cooperation and communication among health professionals
            involved in the care of individual patients such that the roles of these professionals are
            delineated and consistent messages are delivered to patients and their families.
           Recognize the importance of the skills in working with others who present significant
            communication challenges such as anger or confusion, an ethno-cultural background
            different from the physician's own, physical or emotional impairment. This includes the
            ability to communicate with patients and their families with the potential for violent behavior
            in a way that may defuse the potential for violence.
Revised: June 2009                                                                           Page 68 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
           Demonstrate the ability to recognize and minimize the negative effects that one’s emotions
            (anger, frustration, anxiety, fear) have on one’s ability to communicate effectively and take
            steps to minimize these effects.


Collaborator:

The resident should be able to:

           Develop a care plan for a patient they have assessed, including investigation, treatment and
            continuing care, in collaboration with the staff Emergency physician.
           Maintain collegial and respectful relationships with medical and para-medical staff.
           Understand the roles and expertise of the other individuals involved, inform and involve the
            patient and his/her family in decision-making, and explicitly integrate the opinions of the
            patient and care givers into management plans.
           Demonstrate an ability to promote the autonomy of patients and families and to promote
            their involvement in decision-making.
           Performs as team member in medical and trauma resuscitations.
           Develop precision in case presentation.

Health Advocate:

The resident should be able to:

           Identify the patient's status with respect to one or more of the determinants of health (i.e.,
            unemployment); adapting the assessment and management accordingly (i.e., the medical
            history to the patient's social circumstances); and assessing the patient's ability to access
            various services in the health and social system so as to promote health, enhance
            understanding, foster coping abilities, and enhance active participation in informed decision-
            making.

Manager:

The resident should be able to:
           Effectively care for several patients while working in the Emergency department and follow
            them through their Emergency department course.
           Begin to understand the importance of making clinical decisions and judgments based on
            sound evidence for the benefit of individual patients and the population served.
           Be open to working effectively as a member of a team or a partnership.
           Effectively use patient-related databases, access computer- based information and
            understand the fundamentals of medical informatics.
           Employ effective time management and self-assessment skills to formulate realistic
            expectations and a balanced lifestyle.




Revised: June 2009                                                                         Page 69 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
Scholar:

The resident should be able to:

              Provide support for clinical clerks rotating through ED.
              Identify learning needs and make use of available learning resources.
              Demonstrate critical thinking and integrate critical appraisal of the literature into the bedside
               approach.
              Analyze and interpret the validity and applicability of evidence contained in the medical
               literature.
              Apply new knowledge to daily practice.


Professionalism:

The resident should be able to:

             Be punctual for Emergency shifts and educational events
             Follow through on assigned tasks
             Be respectful, honest and compassionate care when dealing with patients, families, and other
              professionals.
             Demonstrate an enthusiasm for learning.
             Demonstrate good self-assessment ability by being aware of own limitations and seeking
              feedback.
             Be aware of racial, cultural, and societal issues that impact on the delivery of care and an
              ability to maintain and enhance appropriate knowledge, skills and professional behaviors.
             Be accountable for personal actions, have a high degree of self-awareness, maintaining an
              appropriate balance between personal and professional roles, and addressing interpersonal
              differences in professional relations.
             Recognize, analyze and know how to deal with unprofessional behaviors in clinical practice,
              taking into account local and provincial regulations.




Revised: June 2009                                                                              Page 70 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
                                             Emergency Medicine
                                       Rotation Specific Objectives

                                   Pediatric Emergency Medicine m - R2

Goals:

            To improve on the knowledge and skills developed from PGY-1
            Develop an enhanced understanding of the role of the Pediatric Emergency physician
            Develop more analytical and accurate approaches to patient management

Medical Expert:

            Able to independently perform appropriate, thorough and directed history and physicals in
             more complex clinical presentations than as a PGY-1.
            Able to order appropriate, cost effective, focused investigations in straightforward cases with
             emphasis based on sound evidence-based criteria.
            Demonstrate appropriate strategies in ruling out more complicated diagnoses.
            Formulizes more complex management and disposition plans in consultation with the
             Pediatric Emergency staff physician.
            Progressive independence in directing care of patients with common ED complaints
             including managing care of patients with non life threatening problems (history, physical,
             investigations, treatment, disposition and follow up) independently by the end of 2nd year.
             (All patients must be discussed with the attending Pediatric Emergency Physician prior to
             discharge).
            Improved and good knowledge base in common clinical problems with an understanding of
             pathophysiology in medical and surgical areas.
            Demonstrates success in meets learning objectives for PGY-1 and completed PGY-2 off-
             service rotations and applies this knowledge, when appropriate, to the care of patients in
             Pediatric Emergency medicine.
            Able to manage care of patients with common serious medical and surgical problems with
             staff supervision.
            Participate in orthopedic procedures.

Communicator:

The resident should demonstrate improved skills from the PGY-1 year including:

            Maintain appropriate and concise charting including pertinent history and physical findings
             and an approach to a diagnosis, treatment plan and follow-up displayed.
            Increasing role as team member in medical and trauma resuscitations.
            Establish and maintain rapport and fostering an environment characterized by
             understanding, trust, empathy, and confidentiality.
            Explore patient's beliefs, concerns, and expectations about the origin, nature, and
             management of his/her illness. Specialist Emergency Physicians need to be able to assess
             the impact of such factors as age, gender, ethno-cultural background, social support, and
             emotional influences on a patient's illness.
            Inform and counsel a patient in a sensitive and respectful manner while fostering
             understanding, discussion, and the patient's active participation in decisions about their
             care. This includes the ability to listen to the patient and their families and to communicate
             effectively with other health providers, to ensure optimal and consistent care of the patient
             and his/her family.
Revised: June 2009                                                                          Page 71 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
           Establish relationships with the patient that is characterized by understanding, trust, respect,
            empathy and confidentiality.
           Learn the importance of cooperation and communication among health professionals
            involved in the care of individual patients such that the roles of these professionals are
            delineated and consistent messages are delivered to patients and their families.
           Recognize the importance of the skills in working with others who present significant
            communication challenges such as anger or confusion, an ethno-cultural background
            different from the physician's own, physical or emotional impairment. This includes the
            ability to communicate with patients and their families with the potential for violent behavior
            in a way that may defuse the potential for violence.
           Demonstrate the ability to recognize and minimize the negative effects that one’s emotions
            (anger, frustration, anxiety, fear) have on one’s ability to communicate effectively and take
            steps to minimize these effects


Collaborator:

           Develop an increasing more comprehensive care plan for a patient they have assessed,
            including investigation, treatment and continuing care, in collaboration with the staff
            Pediatric Emergency physician.
           Maintain collegial and respectful relationships with medical and para-medical staff.
           Understand the roles and expertise of the other individuals involved, inform and involve the
            patient and his/her family in decision-making, and explicitly integrate the opinions of the
            patient and care givers into management plans.
           Demonstrate an ability to promote the autonomy of patients and families and to promote
            their involvement in decision making.
           Increasing role as team member in medical and trauma resuscitations.
           Recognize team members’ areas of expertise, respect the opinions and roles of individual
            team members.



Health Advocate:

The resident should be able to:

           Identify the patient's status with respect to one or more of the determinants of health (i.e.,
            unemployment); adapting the assessment and management accordingly (i.e., the medical
            history to the patient's social circumstances); and assessing the patient's ability to access
            various services in the health and social system so as to promote health, enhance
            understanding, foster coping abilities, and enhance active participation in informed decision
            making.




Revised: June 2009                                                                          Page 72 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
Manager:

The resident should be able to:
           Efficiently manage individual patients and beginning to see higher numbers of patients as
            the year progresses.
           Make clinical decisions and judgments based on sound evidence for the benefit of individual
            patients and the population served.
           Be open to working effectively as a member of a team or a partnership.
           Effectively use patient-related databases, access computer- based information and
            understand the fundamentals of medical informatics.
           Employ effective time management and self-assessment skills to formulate realistic
            expectations and a balanced lifestyle.

Scholar:

The resident should be able to:

           Identify learning needs and make use of available learning resources.
           Demonstrate critical thinking and integrate critical appraisal of the literature into the bedside
            approach.
           Analyze and interpret the validity and applicability of evidence contained in the medical
            literature.
           Apply new knowledge to daily practice.

Professionalism:

The resident should be able to:

           Be punctual for Emergency shifts and educational events
           Follow through on assigned tasks
           Be respectful, honest and compassionate care when dealing with patients, families, and
            other professionals.
           Demonstrate an enthusiasm for learning.
           Demonstrate good self-assessment ability by being aware of own limitations and seeking
            feedback.
           Be aware of racial, cultural, and societal issues that impact on the delivery of care and an
            ability to maintain and enhance appropriate knowledge, skills and professional behaviors.
           Be accountable for personal actions, have a high degree of self-awareness, maintaining an
            appropriate balance between personal and professional roles, and addressing interpersonal
            differences in professional relations.
           Recognize, analyze and know how to deal with unprofessional behaviors in clinical practice,
            taking into account local and provincial regulations.




Revised: June 2009                                                                           Page 73 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
                                             Emergency Medicine
                                       Rotation Specific Objectives

                                    Pediatric Emergency Medicine - R3

Medical Expert:

            Demonstrates history and physical exam findings as described for PGY-1 and PGY-2
             objectives and now uses these skills to diagnosis increasingly more complex and subtle
             clinical presentations.
            Proficient use of appropriate, evidence- based, cost effective lab and diagnostic imaging
             tests.
            Exhibits very good clinical judgment in common presentations and shows improved
             judgement in patients with complex and subtle presentations.
            Recognizes personal limits of expertise by self-assessment and learning the ability to
             decide if and when other professionals are needed to contribute to a patient’s care.
            Demonstrates increasing independence in decision-making process.
            Demonstrates effective consultation skills.
            Demonstrates an improved systematic and cognitive approach to clinical reasoning in order
             to solve the individuals patient’s problems
            Demonstrates success in meets learning objectives for all off service rotations covered in
             first three years of residency and applies this know, when appropriate, to the care of
             patients in Pediatric Emergency medicine.
            Able to pose an appropriate patient-related question, execute a systematic search for
             evidence and critically evaluate medical literature and other evidence in order to optimize
             clinical decision making
            Knowledge base is developed to an increasing depth including pathophysiology and current
             literature.
            Demonstrate increasing skills: rapid sequence induction intubation (performs with
             supervision), synchronized cardioversion, pericardiocentesis, transcutaneous pacemaker
             application, procedural sedation (directs with supervision), interosseous infusion,
             complicated lacerations.
            Able to teach procedural skills to medical students and Junior residents.
            Directs all resuscitation (medical, pediatric and trauma) cases with close staff supervision
             and support.
            Manage toxicology cases with increasing independence.
            Manage with supervision orthopedic reductions.

Communicator:

        In addition to the skills developed during the first 2 years:

           Maintain appropriate, complete and concise charting including pertinent history and physical
            findings and a clear diagnosis, treatment plan and follow-up displayed.
           Increasing amount of independence in management of patients while still under close
            supervision of the staff Pediatric Emergency physician.
           Establish and maintain rapport and fostering an environment characterized by
            understanding, trust, empathy, and confidentiality.
           Explore patient's beliefs, concerns, and expectations about the origin, nature, and
            management of his/her illness. Specialist Pediatric Emergency Physicians need to be able
            to assess the impact of such factors as age, gender, ethno-cultural background, social
            support, and emotional influences on a patient's illness.
Revised: June 2009                                                                        Page 74 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
           Inform and counsel a patient and their families in a sensitive and respectful manner while
            fostering understanding, discussion, and the patient's active participation in decisions about
            their care. This includes the ability to listen to the patient and to communicate effectively
            with other health providers, to ensure optimal and consistent care of the patient and his/her
            family.
           Begin to develop leadership role in medical and trauma resuscitations.
           Establish relationships with the patient that is characterized by understanding, trust, respect,
            empathy and confidentiality.
           Demonstrate the ability to break bad news such as that of death or serious illness or injury
            to patients and/or their family members in a way that is sensitive, thorough and
            understandable.
           Demonstrate the ability to discuss issues of advanced directives, and DNR orders with
            patients and their families.
           Demonstrate skill in cooperation and communication among health professionals involved in
            the care of individual patients such that the roles of these professionals are delineated and
            consistent messages are delivered to patients and their families.
           Recognize the importance of the skills in working with others who present significant
            communication challenges such as anger or confusion, an ethno-cultural background
            different from the physician's own, physical or emotional impairment. This includes the
            ability to communicate with patients and their families with the potential for violent behavior
            in a way that may defuse the potential for violence.
           Demonstrate the ability to recognize and minimize the negative effects that one’s emotions
            (anger, frustration, anxiety, fear) have on one’s ability to communicate effectively and take
            steps to minimize these effects

Collaborator:

The resident should be able to:

           Understand the roles and expertise of the other individuals involved, inform and involve the
            patient and his/her family in decision-making, and explicitly integrate the opinions of the
            patient and care givers into management plans.
           Begin to recognize team members’ areas of expertise, respect the opinions and roles of
            individual team members, contribute to healthy team development and conflict resolution,
            and contribute his/her own expertise to the team’s task in hospitals, practice settings, and
            other institutions, such as committee work, research, teaching and learning.
           Begin to learn the ability to function effectively within the unique environment of the
            emergency department, recognizing the unpredictable nature of patient presentations, and
            the demands of working with a multidisciplinary team.
           Begin to demonstrate the ability to assume a team leadership and effective participant role
            in the complex multidisciplinary environment of the emergency department.
           Begin to demonstrate an understanding of the unique interaction of the emergency
            department with every component of the health care system including the hospital, its
            relationship to the community, and other agencies such as Emergency Medicine Services
            (EMS).
           Demonstrate an ability to promote the autonomy of patients and families and to promote
            their involvement in decision-making.

Health Advocate:

The resident should be able to:

Revised: June 2009                                                                          Page 75 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
           Identify the determinants of health that affect a patient, so as to be able to effectively
            contribute to improving individual and societal health in Canada. This includes the ability to
            recognize, assess, and respond to the psychosocial, economic, and biologic factors
            influencing the health of those served. The specialist incorporates information on the health
            determinants into his/her practice behaviors - both with individual patients and their
            community. At the doctor-patient level, this involves adapting patient management and
            education so as to promote health, enhance understanding, foster coping abilities, and
            enhance active participation in informed decision-making.
           Recognize and respond to those issues, settings, circumstances, or situations in which
            advocacy on behalf of patients, professions, or society is appropriate. This involves the
            ability to: identify populations at risk, identify current policies that affect health, and
            recognize the fundamental role of epidemiological research in informing practice. At a
            broader level, this includes the ability to describe how public policy is developed and employ
            methods of influencing the development of health and social policy.
           Demonstrate an understanding of the determinants of health by identifying the most
            important determinants of health (i.e., poverty, unemployment, early childhood education,
            social support systems), being familiar with the underlying research evidence, and applying
            this understanding to common problems and conditions encountered in emergency
            medicine.
           Demonstrate an understanding of in the management of individual patients by identifying the
            patient's status with respect to one or more of the determinants of health (i.e.,
            unemployment); adapting the assessment, management and disposition accordingly (i.e.,
            the medical history to the patient's social circumstances); and assessing the patient's ability
            to access various services in the health and social system.
           Demonstrate an understanding of the analysis of the emergency medicine patient population
            work with relevant associations in identifying current "at risk" groups within the practice of
            emergency medicine and applying the available knowledge about prevention to "at risk"
            groups within the practice; identify impediments to good, efficient, effective emergency
            medicine patient care and take steps to publicize and address these issues; and contribute
            "group data" for better understanding of health problems within the population.

Manager:

The resident should be able to:

           Employ effective time management and self-assessment skills to formulate realistic
            expectations and a balanced lifestyle.
           Make sound judgments on resource allocation based on evidence of the benefit to individual
            patients and the population served.
           Use patient-related databases, access computer based information, and understand the
            fundamentals of medical informatics.
           Begin to understand the relationship between the Emergency Department and the hospital
            and between the Emergency Department and the community.
           Make clinical decisions and judgments based on sound evidence for the benefit of individual
            patients and the population served.
           Work effectively as a member of a team or a partnership and to accomplish tasks whether
            one is a team leader or a team member.
           Manage concomitantly a number of ill and injured patients at any given time.
           Beginning to understand the dynamic of running an entire emergency department.
            Beginning to demonstrate the leadership skills during patient management.

Scholar:
Revised: June 2009                                                                          Page 76 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009

The resident should be able to:

              Analyze and interpret the validity and applicability of evidence contained in the medical
               literature.
              Apply new knowledge to daily practice.
              Provide constructive feedback to these learners.
              Establish a sustainable pattern of reading that will allow him/her to schedule sufficient time
               to maintain a current knowledge base.
              Learn how to efficiently track new literature pertinent to his/her practice, including studies
               published outside the Emergency Medicine literature.
              Acquire the basic principles of clinical bedside teaching.
              Acquire the basic principles of didactic teaching and public speaking, including the use of
               multimedia software and the basic skills for moderating small group discussion.
              Acquire the skills necessary to apply new knowledge in an evidence-based fashion to
               clinical practice.
              Learn the basic principles of clinical research methodology, further improving the ability to
               interpret original research.
              Become aware of patient information and patient support groups. Become aware of web
               sites capable of providing comprehensive information to patients pertinent to illness or injury
               treated in the emergency department.
              Bedside teaching of medical students and junior residents. .

Professionalism:

The resident should be able to:

             Be punctual for Emergency shifts and educational events
             Follow through on assigned tasks
             Be respectful, honest and compassionate care when dealing with patients, families, and other
              professionals.
             Demonstrate an enthusiasm for learning.
             Demonstrate good self-assessment ability by being aware of own limitations and seeking
              feedback.
             Be aware of racial, cultural, and societal issues that impact on the delivery of care and an
              ability to maintain and enhance appropriate knowledge, skills and professional behaviours.
             Be accountable for personal actions, have a high degree of self-awareness, maintaining an
              appropriate balance between personal and professional roles, and addressing interpersonal
              differences in professional relations.
             Recognize, analyze and know how to deal with unprofessional behaviors in clinical practice,
              taking into account local and provincial regulations.




Revised: June 2009                                                                            Page 77 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009

                                             Emergency Medicine
                                       Rotation Specific Objectives

                                  Pediatric Emergency Medicine - R4 & R5


Medical Expert:

       Very good independent decision making skills – close to consultant level.
       Adept at all skills listed in PGY1-3 objectives.
       Able to do rapid sequence induction intubation, difficult airway management and procedural
        sedation. Also, able to do extensor tendon laceration repair, gastric lavage and whole bowel
        irrigation for toxicology. The resident should possess an excellent understanding of all aspects
        of each procedure (indications, complications, follow up required, interpretation of results
        obtained, and alternate ways to complete the procedure).
     By PGY 4 the resident should be adept at leading all types of resuscitation with decreasing staff
        supervision and should be able to teach these skills to others during the resuscitation effort.
     Elicit a relevant, concise, and accurate history and efficiently conduct an effective physical
        examination; carry out relevant procedures to collect, analyze, and interpret data; reach a
        diagnosis and perform appropriate therapeutic procedures to help resolve a patient's problem
        with decreasing amount of staff reliance.
     Pose an appropriate patient-related question, execute a systematic search for evidence, and
        critically evaluate medical literature and other evidence in order to optimize clinical decision-
        making for most patient encounters.
     Recognize personal limits of expertise by self-assessment. This includes the ability to decide if
        and when other professionals are needed to contribute to a patient's care.
     Demonstrate effective consultation skills. This includes presenting well-documented patient
        assessments and recommendations in both written and verbal form, in response to a request
        from another health professional.
     Apply the knowledge and expertise to the performance of specific psychomotor skills relevant to
        the specialty.
     In the majority of patient encounters, use the best available evidence to select medically
        appropriate investigative tools that are informative, ethical and cost-effective.
     Manifest a systematic and cognitive approach to clinical reasoning in order to solve the
        individual patient’s problems.
      Demonstrate effective consultation skills in response to requests from another health-care
        provider and will manifest appropriate clinical judgment when requesting consultation expertise
        from colleagues in other specialty disciplines.
      Access continuously new and relevant clinical information to ensure that the care provided to
        patients meets contemporary “best practice” circumstances.
      Begin to develop medical expertise in situations other than those involving direct patient care
        (educational supervision and presentations)




Revised: June 2009                                                                        Page 78 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
Communicator:

       Develops excellent communication skills with paramedics and flight crews during ALS patch
        calls. Establish and maintain rapport and fostering an environment characterized by
        understanding, trust, empathy, and confidentiality.
       Explore patient's beliefs, concerns, and expectations about the origin, nature, and management
        of his/her illness. Specialist Emergency Physicians need to be able to assess the impact of such
        factors as age, gender, ethno-cultural background, social support, and emotional influences on
        a patient's illness.
       Inform and counsel a patient and their families in a sensitive and respectful manner while
        fostering understanding, discussion, and the patient's active participation in decisions about
        their care. This includes the ability to listen to the patient and to communicate effectively with
        other health providers, to ensure optimal and consistent care of the patient and his/her family.
        This also implies the ability to maintain clear, accurate, and appropriate records.
       Establish relationships with the patient and their families that are characterized by
        understanding, trust, respect, empathy and confidentiality.
       Demonstrate the ability to break bad news such as that of death or serious illness or injury to
        patients and/or their family members in a way that is sensitive, thorough and understandable.
       Demonstrate the ability to screen for sensitive issues such as those of substance abuse,
        physical or sexual abuse and risk factors for HIV and other sexually transmitted diseases.
       Demonstrate the ability to discuss issues of advanced directives, living wills and DNR orders
        with patients and their families.
       Understand and demonstrate the importance of cooperation and communication among health
        professionals involved in the care of individual patients such that the roles of these
        professionals are delineated and consistent messages are delivered to patients and their
        families.
       Demonstrate skills in working with others who present significant communication challenges
        such as anger or confusion, an ethno-cultural background different from the physician's own,
        physical or emotional impairment. This includes the ability to communicate with patients with
        the potential for violent behaviour in a way that may defuse the potential for violence.
       Demonstrate the ability to recognize and minimize the negative effects that one’s emotions
        (anger, frustration, anxiety, fear) have on one’s ability to communicate effectively and take steps
        to minimize these effects
       Communicate effectively with the members of a multidisciplinary team in the resolution of
        conflicts, provision of feedback, and where appropriate, be able to assume a leadership role.

Collaborator:

       Understand the roles and expertise of the other individuals involved, inform and involve the
        patient and his/her family in decision-making, and explicitly integrate the opinions of the patient
        and care givers into management plans.
       Recognize team members’ areas of expertise, respect the opinions and roles of individual team
        members, contribute to healthy team development and conflict resolution, and contribute his/her
        own expertise to the team’s task in hospitals, practice settings, and other institutions, such as
        committee work, research, teaching and learning.
       Demonstrate an ability to function effectively within the unique environment of the emergency
        department, recognizing the unpredictable nature of patient presentations, and the demands of
        working with a multidisciplinary team.
       Identify and describe the role, expertise and limitations of all members of the multidisciplinary
        team required to optimally achieve a goal related to patient care, a research problem, an
        educational task, or an administrative responsibility.
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       Begin to demonstrate the ability to assume a team leadership and effective participant role in
        the complex multidisciplinary environment of the emergency department.
       Demonstrate an understanding of the unique interaction of the emergency department with
        every component of the health care system including the hospital, its relationship to the
        community, and other agencies such as Emergency Medicine Services (EMS).
       Demonstrate an ability to promote the autonomy of patients and families and to promote their
        involvement in decision-making.
       Participate in multidisciplinary team meetings, demonstrating the ability to accept, consider and
        respect the opinions of other team members, while contributing specialty-specific expertise.


Manager:

       Employ effective time management and self-assessment skills to formulate realistic
        expectations and a balanced lifestyle.
       Make sound judgments on resource allocation based on evidence of the benefit to individual
        patients and the population served.
       Begin to understand the roles and responsibilities of specialists in Canada, the organization and
        function of the Canadian Health Care system, and the forces of change. This includes the
        ability to work effectively within teams of colleagues and function within broader organizational
        management systems (e.g. hospital committees).
       Use patient-related databases, access computer based information, and understand the
        fundamentals of medical informatics.
       Understand the relationship between the Emergency Department and the hospital and between
        the Emergency Department and the community.
       Access and apply a broad base of information to the care of patients in ambulatory care,
        hospitals and other health care settings.
       Make clinical decisions and judgments based on sound evidence for the benefit of individual
        patients and the population served. This allows for an advocacy role primarily for the individual
        but in the context of societal needs when monitoring and allocating needed resources.
       Work effectively as a member of a team or a partnership and to accomplish tasks whether one
        is a team leader or a team member.
       Understand population based approaches to health care services and their implication for
        medical practice.
       Manage concomitantly a number of ill and injured patients at any given time with a view to both
        providing these patients with excellence of care as well as ensuring the continued smooth flow
        of patients through an Emergency Department.
       Understand the supervisory and administrative aspects of Emergency Medical Services
        systems (i.e. rationalization of Emergency Services, communications systems, prehospital care
        programs, ambulance services, paramedical emergency services and disaster medicine).

Health Advocate:

       Identify the determinants of health that affect a patient, so as to be able to effectively contribute
        to improving individual and societal health in Canada. This includes the ability to recognize,
        assess, and respond to the psychosocial, economic, and biologic factors influencing the health
        of those served. The specialist incorporates information on the health determinants into his/her
        practice behaviors — both with individual patients and their community. At the doctor-patient
        level, this involves adapting patient management and education so as to promote health,
        enhance understanding, foster coping abilities, and enhance active participation in informed
        decision-making.
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       Recognize and respond to those issues, settings, circumstances or situations in which
        advocacy on behalf of patients, professions or society is appropriate. This involves the ability to:
        identify populations at risk, identify current policies that affect health, and recognize the
        fundamental role of epidemiological research in informing practice.
       Demonstrate an understanding of the determinants of health by identifying the most important
        determinants of health (i.e., poverty, unemployment, early childhood education, social support
        systems), being familiar with the underlying research evidence, and applying this understanding
        to common problems and conditions encountered in emergency medicine.
       Demonstrate an understanding of these concepts as applied to the following three levels:
               In the management of individual patients by identifying the patient's status with respect
                to one or more of the determinants of health (i.e., unemployment); adapting the
                assessment, management and disposition accordingly (i.e., the medical history to the
                patient's social circumstances); and assessing the patient's ability to access various
                services in the health and social system.
               In the analysis of the emergency medicine patient population work with relevant
                associations in identifying current "at risk" groups within the practice of emergency
                medicine and applying the available knowledge about prevention to "at risk" groups
                within the practice; identify impediments to good, efficient, effective emergency medicine
                patient care and take steps to publicize and address these issues; and contribute "group
                data" for better understanding of health problems within the population.
               In relation to the general population by describing, in broad terms, the key issues
                currently under debate regarding changes in the Canadian health care system,
                indicating how these changes might affect societal health outcomes and advocating to
                decrease the burden of illness (at a community or societal level) of problems related to
                emergency medicine through a relevant specialty society, community-based advocacy
                group, other public education bodies, or private organizations.




Scholar:

       Analyze and interpret the validity and applicability of evidence contained in the medical
        literature.
       Apply new knowledge to daily practice.
       Provide constructive feedback to these learners.
       Act as a role model and as a resource for other residents.
       Establish a sustainable pattern of reading that will allow him/her to schedule sufficient time to
        maintain a current knowledge base.
       Learn how to efficiently track new literature pertinent to his/her practice, including studies
        published outside the Emergency Medicine literature.
       Learn the principles of biostatistics and critical analysis, allowing proper interpretation of original
        research publications.
       Begin to acquire the basic principles of clinical bedside teaching.
       Acquire the basic principles of didactic teaching and public speaking, including the use of
        multimedia software and the basic skills for moderating small group discussion.
       Acquire the skills necessary to apply new knowledge in an evidence-based fashion to clinical
        practice.
       Learn the basic principles of clinical research methodology, further improving the ability to
        interpret original research.
Revised: June 2009                                                                             Page 81 of 119
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       Become aware of patient information and patient support groups. Become aware of web sites
        capable of providing comprehensive information to patients pertinent to illness or injury treated
        in the emergency department.

Professionalism:

       Be aware of racial, cultural, and societal issues that impact on the delivery of care and an ability
        to maintain and enhance appropriate knowledge, skills and professional behaviours.
       Be accountable for personal actions, have a high degree of self-awareness, maintaining an
        appropriate balance between personal and professional roles, and addressing interpersonal
        differences in professional relations.
       Practice medicine in an ethically responsible manner that respects the medical, legal and
        professional obligations of belonging to a self-regulating body. This implies: an understanding of
        and adherence to legal and ethical codes of practice, the recognition of ethical dilemmas and
        the need for help to resolve them when necessary and the ability to recognize and respond to
        unprofessional behaviours in clinical practice, taking into account local and provincial
        regulations.
       use appropriate strategies to maintain and advance professional competence; and
       continually evaluate one's abilities, knowledge and skills and know one's limitations of
        professional competence.
       adopt specific strategies to heighten personal and professional awareness and explore and
        resolve interpersonal difficulties in professional relationships; and
       consciously strive to balance personal and professional roles and responsibilities and to
        demonstrate ways of attempting to resolve conflicts and role strain.
       know and understand the professional, legal and ethical codes to which physicians are bound;
       recognize, analyze and attempt to resolve in clinical practice ethical issues such as truth-telling,
        consent, advanced directives, confidentiality, end-of-life care, conflict of interest, resource
        allocation and research ethics;
       understand and be able to apply relevant legislation that relates to the health care system in
        order to guide one's clinical practice; and
       recognize, analyze and know how to deal with unprofessional behaviours in clinical practice,
        taking into account local and provincial regulations.




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                                             Emergency Medicine
                                       Rotation Specific Objectives

                                        PEDIATRIC INTENSIVE CARE


Goals:

To understand the management of critically ill and injured pediatric patients
To actively participate in the care of these patients in a tertiary pediatric intensive care unit
To develop expertise in life saving pediatric skills.

Medical Expert:

The resident should have knowledge of:
    Physiology of CPR
    Pharmacology of resuscitation drugs
    Thorough knowledge of ATLS, PALS, NALS, and ACLS guidelines
    Physiology of shock and fluid resuscitation
    Early goal directed therapy for septic shock
    Stabilization of patients with congenital heart disease
    Trauma management
    Hematologic emergencies including transfusion, anticoagulation, DIC
    Use of sedation including pharmacology of sedatives, analgesics and neuromuscular blockade
    Tracheostomy care
    Initiation of ventilator settings
    Post-arrest management
    Pharmacology of inotropes and pressors
    Extubation management

The resident should acquire proficiency in:
    Bag/mask ventilation
    Insertion of oral / nasal airways
    Rapid sequence intubation
    Endotracheal / nasotracheal intubation
    Central venous access
    Arterial line insertion
    Needle decompression of chest
    Chest tube insertion
    Cardioversion

Communicator:

            Establish therapeutic relationships with patients/families.
            Discuss end of life decisions with families.
            Obtain and synthesize relevant history from patients/families.
            Listen effectively.
            Discuss appropriate information with patients/families and the health care team.


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Collaborator:

           Perform consultations with verbal and written communication in the emergency department
            and on wards
           Obtain effective input from other physicians and health care professionals.
           Contribute effectively to other interdisciplinary team activities.
           Participate in the coordination of transport of critically ill children

Manager:

           Develop skills in leading bedside rounds and organizing unit work flow.
           Utilize resources effectively to balance patient care, learning needs, and outside activities.
           Allocate finite health care resources wisely, specifically with respect to PICU beds and
            transport resources.
           Work effectively and efficiently in a health care organization.
           Utilize information technology to optimize patient care, life-long learning and other activities.

Health Advocate:

           Identify the important determinants of health affecting patients.
           Contribute effectively to improved health of patients and communities.
           Understand various approaches to health care advocacy and policy change.
           Recognize and respond to those issues where advocacy is appropriate.

Scholar:

           Develop, implement and monitor a personal continuing education strategy.
           Critically appraise sources of medical information.
           Facilitate learning of patients, medical trainees/students and other health professionals.
           Contribute to development of new knowledge.

Professionalism:

           Deliver highest quality care with integrity, honesty and compassion.
           Exhibit appropriate personal and interpersonal professional behaviors.
           Practice medicine ethically consistent with obligations of a physician.




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                        Addendum supplied by PICU Alberta Children's Hospital
                                   Pediatric Intensive Care Unit

                                                 Introduction

                                      Objectives Common to all Rotations

                                                  PGY 1 / 2

                                                   PGY 3

                                                  PGY 4 / 5

                                Appendix: General Objectives CanMEDS 2000




                                             D. Patton, MD, FRCPC
                                                   May, 2000
                                                     Ver 2.0

                                     Based on an outline developed by
                         Drs D Clark, R Connors, BC Ross, D Patton, and K Tobler
                                            December, 1998




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                                           Alberta Children's Hospital PICU
                                       Pediatric Emergency Resident Objectives

Introduction:

      The following objectives define the responsibilities and the cognitive and procedural skills that Pediatric
      Emergency Medicine residents should possess on completion of each of their postgraduate rotation in
      the Pediatric Intensive Care Unit (PICU) at Alberta Children's Hospital. The objectives are based on
      recommendations of the Royal College of Physicians and Surgeons of Canada (1), the American
      College of Critical Care Medicine (2,3), the Society of Critical Care Medicine (4)This document defines
      detailed objectives for each postgraduate year. For general objectives, one should refer to shorter
      general objectives document in CanMEDS 2000 format (see Appendix).

      On completion of general pediatric residency training, the pediatrician should achieve proficiency in the
      recognition and initial management of common critical pediatric illnesses (2). This proficiency includes,
      but is not limited to:

                      - acute respiratory failure - neurological insults
                      - hemodynamic instability - acute renal failure
                      - sepsis     - overdoses and poisonings
                      - electrolyte disorders - endocrine emergencies
                      - trauma

      Although one cannot develop complete proficiency in the management of problems to the level
      practiced by a specialist in critical care medicine, the pediatrician should be able to recognize, stabilize,
      and begin resuscitation of critically ill patients. During the ICU core rotations, therefore, the resident will
      gain a knowledge base that allows him or her to assess the critically ill child rapidly, formulate a
      differential diagnosis, initiate a plan for stabilization and management, and request appropriate
      consultation (6).

      It is expected that residents will mature in their understanding of and comfort with critical care theory
      and practice over the course of a 3 or 4 year general program. During the PGY1 and 2 years, the
      resident should concentrate on communication skills, data gathering/synthesis, and understanding of
      basic pathophysiology, rather than on procedures (other than airway management skills and peripheral
      intravenous access). As the resident progresses, he/she will be expected to display more sophisticated
      clinical judgment, make more complex decisions, and develop team leadership skills. PGY1 and 2
      residents should be able to develop a history, perform a thorough physical examination, gather
      appropriate data, and present a patient in a comprehensive yet concise manner. The PGY1 or 2
      resident is expected to formulate a plan of care and make treatment decisions with the guidance of the
      ICU senior resident, clinical assistant, or attending physician. More senior residents will be able to
      formulate a comprehensive plan of treatment and/or evaluation for most patients, as well as coordinate
      team care and triage patient acuity along with the ICU clinical assistant or attending (7).

      With regard to procedures, it is realized that not all residents will achieve the objectives for the
      procedures listed within any given rotation, as each resident’s case mix will vary and so, therefore, will
      their types of procedures. It is, therefore, suggested that each resident complete and maintain a
      current procedure log that will be reviewed regularly (5, 8-10).




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Objectives common to all rotations:

1. Responsibilities:

Follows the general outline of responsibilities in the Introduction to PICU manual as to:

           Service Commitment
           Participation in Educational Activities and Rounds
           Daily Routine and General Responsibilities
           Admission Procedures to ICU
           Physician Order Formats
           Discharge and Transfers from ICU
           Patient Events and Procedures
           Attendance at Trauma Codes and Cardiopulmonary Arrest Codes

Patient Care

     Actively manages medical and surgical patients in the intensive care unit.

        In the context of these objectives, manage is defined as identifying the nature of the problem,
        determining methods of alleviating or resolving the problem, and carrying out diagnostic or
        treatment plans in conjunction with more senior medical or surgical staff.

     Knows all patients in sufficient detail so as to provide a comprehensive sign-over to the on-call
      resident or clinical assistant.

     Examines patients daily before morning rounds, and more frequently as required by severity of
      illness.

     Notifies ICU attending of any significant changes in patient’s status. Updates patient’s family,
      family physician, or pediatrician as required.

     In consultation with the ICU attending, participates in admission, transfer, and discharge
       planning, and determines which patients can be managed on a general inpatient ward, and
       which require higher levels of care and expertise in a critical care unit.


Communication

         Communicates effectively with patients, families, and health professionals.

         Documentation:
           Writes chart notes that are clear, helpful, and understandable.
           Performs and documents an independent, accurate, well-organized, problem-focused,
             and concise pediatric history and physical examination on all new admissions.
             Updates the history when additional information emerges, particularly if the patient’s
             family is initially unavailable.
           Documents a post-operative note on patients admitted or returning to ICU from the
             operating room. This note will include the relevant details of the patient’s preceding
             history, physical examination, investigations, medications, and problem list, as well as
             the indication for surgery, operative procedure, anesthetic technique, operative findings,

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                perioperative fluid balances, complications, post-operative physical exam, assessment
                and new problem list, and plan.
               Writes a daily progress note that conveys the patient’s hospital day, post-op day,
                problems, physical assessment, investigations, diagnoses, and plan as discussed on
                rounds in a logical and readable manner.
               Documents all significant changes in a patient’s status or care plan.
               Completes orders discussed on rounds promptly and accurately, and discusses with
                bedside nurse.
               Dictates discharge and death summaries within seven working days.
               Dictates q 2 weekly interim summaries on chronic ICU patients.
               Provides detailed and relevant transfer summaries for ICU patients. As a minimum, the
                transfer note will include the date of ICU admission, admitting diagnoses, transfer
                diagnoses or problem list, summary of ICU course, invasive monitoring or procedures
                done in ICU, medications and feeds, plan to continue on cluster, and the names of the
                primary physician accepting care as well as names of consultants involved in care of the
                patient.

     Meets daily with patients’ families (alone, or with the senior resident or attending).

     Attends and provides input to multidisciplinary and family meetings. Documents the content of
      the meeting and information discussed with families.

1. Education

     Participates in clinical discussions, rounds, and conferences in a manner that promotes a
      professional spirit of inquiry, respect, and scholarship. Reads around patient cases and
      prepares for discussion on rounds. Develops verbal presentations that are coherent and
      concise. Prepares and presents a minimum of one after-rounds topic for discussion per rotation.

     Teaches and supervises more junior housestaff.

     Maintains a current log of cases followed, to be reviewed at entrance and exit interviews or the
      rotation.

Personal

     Works cooperatively with other team members and families.

     Is punctual, enthusiastic, and responsive.



2. Procedures:

   Is exposed to and taught procedural skills appropriate for a general pediatrician (4, 10) in a
    graduated manner such that these skills are built and maintained throughout the training program.

   Obtains appropriate consent prior to procedures, according to the CRHA’s consent policies.

   Informs the ICU attending when procedures are planned for a patient.


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   Knows the indications, contra-indications, equipment required, technique, and potential
    complications and their treatment before undertaking any procedure.

   Practices universal precautions for preventing blood-borne or other infection.          Demonstrates
    knowledge of infection control.

   Asks for help or supervision as necessary, as dictated by level of training and expertise.

   Develops an understanding of non-invasive and invasive monitoring procedures for support of
    pulmonary, cardiovascular, cerebral, and metabolic functions, including: indications, contra-
    indications, physiology and biomechanics, implementation, cost, and limitations.

   On extubating a patient, develops a plan for airway management and re-intubation if required.
    Ensures additional help is available on the unit prior to extubation. Assesses the patient
    immediately prior to and following extubation, and remains at the bedside until stability of the airway
    is certain.

 Promptly documents all procedures. The procedure note will contain date and time of procedure,
  notation that informed consent was obtained where appropriate, indication, sedation or anesthesia
  used, specifics of procedure, and any complications and how they were managed. In certain
  instances, such as for central line placement, documents how correct placement was determined
  (e.g. blood return, radiography, etc.)

 Maintains a current log of procedures, to be reviewed at the entrance and exit interviews or the
  rotation.


3. Knowledge

 Gains exposure to and develops skills required to care for an unstable, or potentially unstable,
  infant or child.

 Understands variations in organ system dysfunction by age. Recognizes and manages isolated
  and multi-system organ dysfunction and assesses its reversibility.

 Understands the management of a child with chronic illness having special needs or technology
  dependence.

 Develops a family-centered approach to the critically ill pediatric patient.

 Predicts and identifies early warning signs of critical illness, and responds rapidly and effectively, or
  seeks assistance, to prevent potential complications.

 Rapidly assesses and treats infants and children with critical illness. Analyzes and integrates
  relevant basic science information, clinical data, and investigations into a logical management
  strategy. Presents differential diagnoses of common PICU problems, and justifies these diagnoses
  from the above data. Considers and evaluates alternative methods of management, and assesses
  risks and benefits to the patient.

 Selects appropriate investigations in an appropriate order. Understands the costs, limitations, and
  predictive value of such investigations.

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 Evaluates patient response to therapy frequently, and responds to rapidly changing data by
  modifying the patient’s management plan.

 Understands the multidisciplinary nature of intensive care, and respects and seeks advice from
  other health professionals. Demonstrates appropriate and timely use of consultants in an ICU
  setting.

 Understands personal strengths and limitations, and knows when to seek guidance or consultation.
  Shows insight as to areas of improvement required in clinical or cognitive skills.

 Gains exposure to psychosocial, legal, and ethical aspects of ICU care.

 Develops a compassionate understanding of critical illness and death. Realizes the limits of ICU
  care, monitoring, and technological support.

 Progresses through a graduated experience in the ICU toward a teaching and supervisory role as a
  senior resident or fellow.

 Understands the principles of research in critical care, and applies current research to the
  management of patient problems.




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                                                       PGY 1 / 2

                       The following objectives particularly apply to PGY2 residents
                             who first rotate through the unit for the first time.

Responsibilities, procedures, and knowledge as above, and, in addition:

      Responsibilities:

         Maintains active involvement in patient care with supervision of the ICU senior resident, clinical
          assistant, or ICU attending.

         Reviews admissions, management plans / decisions / orders with and seeks assistance from ICU
          senior resident, clinical assistant, or ICU attending.

         Responsible for night and weekend in-house call (PGY2 or higher).

         Covers patients of the post call resident.

         Generates detailed differential diagnoses and management plans, and teaches / supervises more
          junior residents and students.


      Procedures:

         Attends 3 days per month in the operating room to obtain the skills of airway management and IV
          access.

         Shows knowledge of oxygen therapy (nasal prongs, face mask, non-rebreather mask, oxygen tent)
          and ventilation by bag-mask systems.

         Develops proficiency in maintenance of an open airway in a non-intubated patient, and
          demonstrates the use of nasal trumpets and oral airways. Demonstrates proper suctioning and bag-
          mask techniques.

         Recognizes a patient with an inadequate, unprotected, or difficult airway.

         Recognizes the need for intubation and the safest route to accomplish this end. Experience with
          intubation in the ICU will depend on the nature of the patient population in the unit, and is not a
          main objective for one’s first PICU rotation. However, elective tracheal intubations in ICU with
          supervision, once proficiency in airway management is demonstrated, may be performed at the
          discretion of ICU attending.

         Performs tracheotomy tube change with supervision.

         Manages pneumothorax or pleural effusion. Undertakes thoracentesis / thoracostomy tube
          placement with supervision. Understands function of a closed drainage system and evaluation of
          persistent air leak in system. Removes chest tubes safely and effectively.

         Attempts peripheral intravenous line placement in stable patients.
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   Places arterial lines and femoral central venous lines in children age > 1 year at discretion of ICU
    attending with supervision.

   Attempts lumbar puncture, NG and Foley catheter placement, UAC / UVC placement.

   Records rhythm strip and/or 12 lead ECG and documents own interpretation on chart.


Knowledge:

   Discusses knowledge topics without significant prompting for organization or content. Demonstrates
    increasing integration of basic physiology to patient care, and relies less on rote recall or protocols.

   Develops an understanding of fundamentals of cardiopulmonary resuscitation and airway
    management:
     Successfully completes PALS / NALS provider certification, and maintains current certification.
     Describes algorithms and management sequences for airway, breathing, and cardiovascular
       management.
     Knows age and weight specific dosing for cardioversion and resuscitation medications.
     Proposes a process for delegated actions during a resuscitation process.

   Rapidly assesses the ill child. Knows normal vital signs for age
   Understands basic fluids and nutrition (enteral and parenteral) appropriate for patient age. Writes
    correct TPN orders, and orders appropriate TPN bloodwork for monitoring.

   Orders, follows up, interprets, and documents appropriate investigations in consultation with senior
    staff.

   Ventilation:
     Discusses basic ventilatory management and interpretation of blood gases with senior staff and
       respiratory therapists before implementing ventilator changes. Develops an approach to acute
       hypoxemic, hypercapnic, combined, and acute-on-chronic respiratory failure for age as per
       PGY1 objectives.
     Determines the need for ventilatory support based on history, physical examination, and blood
       gas analysis.
     Chooses appropriate initial ventilator settings for patients with normal lung compliance.
     Describes the distinguishing characteristics of the different modes of mechanical ventilation,
       and the advantages / disadvantages of specific modes. Specifically: Understands the difference
       between pressure and volume ventilation; differentiates between CPAP, PEEP, pressure
       support, SIMV and control modes and describes how each of these modes may be used in
       certain clinical situations.
     In consultation with more senior staff, makes basic ventilator adjustments according to clinical
       course and physical examination, blood gas analysis, CXR, and pulmonary mechanics.
     Lists and anticipates common complications of mechanical ventilation.
     Lists modalities for monitoring patients receiving mechanical ventilation.
     Recognizes and treats causes of hypotension associated with initiation of mechanical
       ventilation.
     Recognizes the differences between arterial and capillary gases.


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   Develops a basic approach to:

           Tracheal Intubation: Describes differences in airway, and respiratory anatomy with
            development. Describes proper preparation for intubation, including airway assessment.
            Describes correct procedure for rapid sequence intubation Chooses correct laryngoscope
            blade and size of endotracheal tube. Discusses differences between cuffed and uncuffed
            endotracheal tubes, and importance of cuff pressure. Knows indications and
            contraindications of common intubation medications (e.g. atropine, thiopental, midazolam,
            succinylcholine, non-depolarizing muscle relaxants). Knows potential complications of
            intubation and appropriate management. Describes alternative methods for establishing an
            airway when endotracheal intubation cannot be accomplished.

           Sedation, analgesia, paralysis: Describes pharmacology of I.V. morphine and midazolam;
            correctly calculates and orders morphine and midazolam infusions. Understands indications
            for narcotics, sedatives, and paralytics as well as side effects of such drugs including drug
            withdrawal.

           Antibiotic choices for prophylaxis, treatment of pneumonia in differing age groups, and
            empiric treatment of suspected sepsis in neutropenic or normal patients.

           Pharmacology and indications for inotropes, including calculation of infusions (“Rule of Six”)
            for dopamine and norepinephrine.

           Transfusion medicine: Understands indications, methods, and complications of RBC,
            platelet, albumin, FFP, IVIG transfusions.

       Recognizes normal and abnormal ICU radiographs for the following conditions: endotracheal
        tube and central line position, feeding tube position, pneumonia, pleural effusion, atelectasis,
        pulmonary edema, pneumothorax, cardiomegaly, bowel obstruction, bowel perforation.


 Develops a clinical approach to, and describes the pathophysiology of:

       Common respiratory illnesses including RSV, croup, epiglottitis, tracheitis, pertussis,
        pneumonia / empyema, asthma (see also next point below), pneumothorax, and airway foreign
        body.
         Acute respiratory failure
            Defines and classifies acute respiratory failure
            Reviews causes and describes pathophysiology of respiratory failure
            Highlights clinical presentation of acute respiratory failure
            Outlines management strategies of respiratory failure
         And specifically: Severe asthma
            Understands the pathophysiology of severe asthma, and drugs used for asthma
              management in the ICU, including oxygen, beta-agonists (inhaled and IV), steroids,
              ipratropium bromide, leukotriene antagonists, magnesium, theophylline, and anesthetics.
            Recognizes the patient with severe asthma and prescribes escalating therapy as
              required. Follows response to therapy.
            Recognizes the patient in respiratory failure due to asthma, and indications for
              intubation. Appreciates issues involved in intubation and ventilation of the severe
              asthmatic.

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       Apnea and bradycardia / Acute life threatening events: Evaluation and differential diagnosis,
        investigation, management and follow-up; requirements and duration for monitoring.


   Develops an approach to management of common neurological problems in ICU:
     Status epilepticus: Initiates treatment and investigation of a seizure, including knowledge of
       types of oral, rectal, and intravenous anticonvulsants and their side effects, stabilization of the
       airway, and further investigations including electrolytes, Ca, Mg, glucose, CT, LP, etc. as
       necessary.
     Meningitis: Pathophysiology, causative organisms for age, diagnosis, treatment, follow-up and
       complications
     Coma
            Recognizes and grades severity of coma (Glascow Coma Scale).
            Relates an initial approach to the evaluation of the comatose child: GCS, vital signs,
              brain-stem evaluation, general examination, lab work, imaging studies, neurological
              support and monitoring.
     Hydrocephalus and shunt malfunction
     Agitation / psychosis
     Intraventricular and intracerebral hemorrhage, subdural effusion or hemorrhage, epidural
       hemorrhage
     Neuromuscular diseases causing respiratory failure (congenital or acquired, e.g. Guillain-Barre
       syndrome)
     Congenital central nervous system and cranial malformations requiring surgery: e.g.
       myelomeningocoele with or without hydrocephalus, craniosynostosis.
     Understands the pathophysiology of the intracranial vault: regulation of cerebral blood flow,
       cerebral edema, theories of cerebral resuscitation.
     Recognizes common abnormalities on cranial CT: edema, mass, increased intracranial
       pressure, epi- and sub-dural bleed.


       Hypotension and shock states:
        Pathophysiology of hypovolemic, septic, cardiac, anaphylactic shock:
         Defines shock and identifies its major categories
         Outlines management principles for different types of shock
         Discusses goals of fluid resuscitation
         Discusses physiologic effects of common vasopressors and inotropes
         Discusses the differential diagnosis of oliguria
         And specifically:
               Understands cardiorespiratory interactions, with emphasis on the interaction
                  between positive pressure ventilation and cardiovascular status
               When presented with a patient with hypotension, recognizes and begins treatment
                  for shock differentiating between distributive / septic, cardiogenic, and hypovolemic
                  shock.
               Understands the indications for placement of arterial, central venous, and
                  intraosseous lines.
               Recognizes importance of adequate fluid resuscitation (crystalloid, colloid, blood).
               Orders and adjusts vasoactive medications in conjunction with the intensivist.

   CHF / Pulmonary edema
    When presented with a child with suspected CHF or pulmonary edema:
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               Determines whether the pulmonary edema is cardiogenic or noncardiogenic.
               Elicits a history and physical examination that confirms CHF; knows historical and
                physical features of CHF.
               Develops a differential diagnosis of the cause of CHF, relates this to the
                pathophysiology of CHF, and orders appropriate investigations.
               Intervenes appropriately with modifications of preload, afterload, and / or contractility;
                Understands the general care of the patient with CHF including the need for nutrition,
                oxygen, normal hemoglobin. Understands indications for ventilation in severe CHF.


   Arrhythmias and anti-arrhythmic medications:
        Differentiates sinus tachycardia from SVT.
        Knows and implements algorithms and drug sequences for SVT, VT, VF, bradycardia, and
          asystole.
        Describes indications, method of administration, and side effects of procainamide, lidocaine,
          beta-blockers, digoxin, and adenosine.


   Develops an approach to the cyanotic newborn; With information gained from history, physical
    examination, CXR, ECG, and hyperoxic test, determines cause of cyanosis as pulmonary, cardiac,
    or combined; describes use of PGE1 including its common side effects; derives an anatomic
    cardiac diagnosis and management plan based on clinical data and investigations. Describes
    common surgical interventions.

   Dehydration: Correctly estimates degree of dehydration; institutes a plan for rehydration;
    discusses differences in management of children with hypo-, hyper-, or iso-natremic dehydration.

   Temperature disorders: Develops a management plan for evaluation and treatment of fever and
    hypothermia in the ICU. Understands risk factors for hypothermia in the infant and young child.

   Renal:
        Recognizes and develops a differential diagnosis and initial management plan for acute
           renal failure.
        Recognizes and treats acute fluid and electrolyte derangements in the critically ill patient;
           SIADH / DI; hypo- and hyper- natremia, kalemia, calcemia, magnesemia, phosphatemia
        Knows indications for dialysis, technique of peritoneal dialysis.
        Modifies ICU drug dosing in renal failure.
        Describes pharmacology of common diuretics: furosemide, thiazides, spironolactone
        Presents an approach to management of hypertensive emergencies.

   Trauma:
        Has an approach to management of simple trauma; participates in trauma team care of the
         patient with multi-system trauma.
        Identifies and responds to significant changes in the status of the patient that may be
         observed after injury (“Maintaining survey”)
        Assesses and treats acute volume depletion.
        Manages the patient with blunt abdominal trauma / splenic laceration.
        Presents a plan for initially managing a patient with severe head injury: safe intubation and
         ventilation, C-spine precautions and evaluation, mannitol, fluid therapy, indications for more
         intense therapy and monitoring. Reviews principles of primary and secondary brain insult.

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            Uses serial neurological examinations to establish baseline parameters and follow patient
            status.
           Describes an approach to near-drowning.

       Post-op surgical care:
         Documents a detailed post-operative assessment.
         Arrives at a post-operative care plan after consultation with the surgeon and intensivist.
         Orders appropriate fluids, bloodwork, and analgesia/sedation.
         Understands the role of post-operative antibiotic prophylaxis.
         Orders appropriate NG loss replacements and stress ulcer prophylaxis.
         Follows suggestions of surgical team regarding wound, feeding, tube, and line care.
         Notifies intensivist and surgeon of any significant changes in patient status.

   Describes methods, indications, and limitations of basic monitoring techniques: ECG, pulse
    oximetry, arterial line, non-invasive BP. Expands knowledge of monitoring techniques: CVP, end
    tidal CO2, TcPO2 / TcPCO2.




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                                                 PGY-3

                  All criteria of PGY 1/2 are met and ongoing, and in addition:


Responsibilities:

 Cares for more complex pediatric / neonatal patients.

 Helps with resuscitation of sicker patients together with the PGY 4/5, clinical assistant, and/or
  attending.

 If the most senior resident during the rotation, assumes some PGY4 responsibilities (see below).

 Sees his/her actions in terms of long-range goals or plans. Develops an ability to manage several
  complex patients with multisystem disorders at one time. Problem-solving skills are becoming well-
  honed, and is developing increasing speed and proficiency in clinical assessments. Works pro-
  actively, anticipating and planning for possible adverse events, rather than reacting to unplanned
  events.


Procedures:

   Performs nasal intubations at discretion of PICU attending.

   Places femoral CVLs, including patients < 1 year at discretion of PICU attending.

   Understands access, care, and complications of central venous catheters.

   Attempts peripheral arterial line insertions, including neonates.

   Describes the principles, role, and logistics of interhospital transport of ICU patients.      May
    undertake interhospital transport of stable patients at discretion of ICU attending.

   Attends OR approximately 1 day per month, to practice intubations/IVs/CVLs at discretion of
    resident.

   Cardioversion: chemical (e.g. adenosine) or electrical with supervision.


Knowledge and Teaching:

   Determines degree of invasive or non-invasive monitoring required in various disease states.

   Respiratory:
     Implements or describes differing ventilation strategies for common respiratory problems:
       ARDS, asthma, bronchiolitis, CHF, HMD, BPD, pulmonary hypertension.
     Understands methods of weaning of ventilatory support.
     Knows indications and side effects of inhaled nitric oxide.
     Understands the pathophysiology of pulmonary hypertension, ARDS.
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       Describes concepts of oscillatory and high frequency ventilation.

   Cardiovascular:
     Discusses the factors that influence O2 delivery and consumption.
     Expands understanding of the use of inotropes (dopamine, dobutamine, epinephrine,
       norepinephrine, phenylephrine), inodilators (amrinone), and vasodilators (nitroprusside,
       nitroglycerin, hydralazine); Given differing shock states, chooses appropriate vasoactive drug
       therapy.

   Knows appropriate nutritional and fluid requirements, for age and disease state.

   Trauma: Understands pathophysiology of, and initiates:
     Management of the complex multiple trauma patient on arrival in the PICU.
     Initial management of spinal cord injury.
     Chronic care of the head-injured patient
     ICP monitoring: indication, and interpretation, including CPP calculation. Limitations of ICP
       monitoring.
     Burn management.
     Investigation and management of child abuse in the ICU.
     Investigation and treatment of severe poisoning or unknown poison.
     Management of ASA, acetaminophen, TCA, ethylene glycol, sedative/narcotic, iron,
       hydrocarbon ingestion/overdose.

   Gastrointestinal disorders:
     Assesses and treats gastrointestinal bleeding (lower and upper).
     Recognizes risk factors for and need for prophylaxis against stress ulcers.
     Recognizes the acute surgical abdomen or perforation of viscus.
     Recognizes and initially manages acute hepatic failure.
     Diagnostic and anatomical considerations in the surgical management of the neonate with
       intestinal obstruction or perforated NEC.

   Sepsis and sepsis syndromes:
     Recognizes predisposing conditions for the development of infection, and risk factors for
       hospital-acquired and nosocomial infection.
     Identifies systemic and site-specific manifestations of life-threatening infection.
     Understands the use of lab testing in the diagnosis and management of suspected infection.
     Outlines principles of empiric antimicrobial therapy.
     Lists antimicrobial strategies for organ-specific infections.

   Oncology:
     Develops a management plan for complications associated with treatment for childhood
      leukemia and tumours, including bone marrow transplantation. Recognizes oncological
      emergencies: SVC syndrome, tumour lysis syndrome, hyperleukocytosis, acute graft versus
      host disease, and fever / neutropenia.

   Hematologic emergencies:
     Recognizes and manages defects of hemostasis and coagulation / DIC.
     Understands hemolytic and thrombotic disorders.
     Describes management of a patient with sickle cell crisis: chest syndrome, stroke, splenic
      sequestration.
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       Manages complications of large volume transfusions.
       Discusses identification and management of acute transfusion reactions.
       Understands role of anticoagulation (heparin, LMWH, warfarin) and fibrinolytic therapy (e.g.
        rTPA); initiates and monitors heparin therapy.
       Relates role of plasmapheresis in acute neurologic and hematologic disorders.

   Endocrine and metabolic problems:
     Manages severe diabetic ketoacidosis.
     Develops a logical approach to adrenal crisis, physiological and stress dose steroid therapy
     Develops an investigation and treatment plan for inborn errors of metabolism.

   Assesses and manages complex pre-op and post-op surgical patients:
     Participates in the management of surgical diseases of the neonate: omphalocoele,
       gastroschisis, tracheo-esophageal fistula, diaphragmatic hernia, bowel obstruction,
       Hirschsprung’s disease, necrotlizing enterocolitis.

   Understands use of sedatives/analgesics, antibiotics, and neuromuscular blockers. Provides
    conscious sedation for simple procedures in the ICU with assistance of the intensivist. Monitors and
    adjusts deeper sedation on ventilated patients using narcotics and sedatives in an effective and
    safe manner.

   Describes criteria for and evaluation of brain death, and assessment for organ donation.

   Demonstrates understanding of principles of informed consent, do not resuscitate orders, and
    withdrawing life support. Outlines a process of decision-making in clinical ethics.




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                                                 PGY - 4 / 5

                   All criteria of PGY3 are met and ongoing, and in addition:

Responsibilities:

 Leads daily rounds at the discretion of the attending.

 Supervises all complex patients, reviews daily notes and new admissions, and examines all
  patients daily. Ensures investigations are followed up daily and results are documented in each
  patient’s chart note. Solves problems at an advanced level.

 Teaches and supervises junior residents.

 May participate in transports at discretion of resident and ICU attending. Organizes transport and
  offers / documents telephone advice to referring physician.

 Performs consults in the ICU in the role as a junior ICU attending. Assesses patients on the ward or
  in the Emergency Department for possible ICU admission when ICU consulted.

 Demonstrates familiarity with the consultation process. Writes consultations that communicate
  diagnosis, effective suggestions, and management in a relevant and focused manner.

 Attends all family meetings.

 Attends all trauma codes.


Procedures:

   Demonstrates excellent ability in airway management and tracheal intubation.

   Assesses the difficult airway with confidence.

   May act as code team leader.

   Undertakes arterial line and femoral line insertions.

   Performs pericadiocentesis with supervision; recognizes symptoms and signs of cardiac
    tamponade.


Knowledge and Teaching:

   Has ATLS certification - optional at discretion of resident.

   Understands use of neuromuscular blockade, sedative agents, and inotropic medications.

   Understands and teaches pathophysiology of cardiac and respiratory failure and differences with
    age.

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   Assesses the stages of the SIRS – Sepsis - Severe Sepsis/MODS/ARDS - Septic Shock - Death
    continuum.

   Utilizes various ventilators and modes of ventilation; describes indications for inverse ratio
    ventilation, permissive hypercapnia, HIFOV, ECMO, liquid ventilation.

   Familiar with theory, indications, and limitations of advanced monitoring techniques: Respiratory
    mechanics from ventilator (e.g. expiratory hold pressure and autoPEEP, plateau pressure,
    resistance, compliance), PA catheter (vascular pressures, thermodilution cardiac output, calculation
    of shunt, oxygen delivery and consumption, vascular resistance), EEG monitoring, jugular bulb
    monitoring.

   Manages complex hematologic / oncologic, infectious, gastrointestinal, endocrine, fluid / electrolyte,
    and immune / transplantation problems.

   Understands ICU support of the immunocompromised patient: AIDS, oncology, transplant.

   Displays knowledge of principles of transplantation medicine: organ donation and procurement,
    donor maintenance, immunosuppression, post-op care, acute and chronic immune suppression,
    outcome, outpatient follow-up.

   Understands role of the Medical Examiner in sudden or unexplained deaths.               Develops an
    understanding of communication and documentation required at the time of death.

   Describes prognostication and ICU scoring systems – e.g. PRISM, TISS, disease specific scores.

   Arranges didactic sessions to include relevant literature reviews with “state of the art” papers and
    recommendations.




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REFERENCES

    1. Royal College of Physician and Surgeons of Canada, Paediatric Programme Objectives, Sections
       5.1 – 5.4 (?date, supplied by Dr. T. Jadavji, December, 1998).

    2. A Spevets, RJ Brilli, J Warren et al. Guidelines for resident physician training in critical care
       medicine. Crit Care Med 23:1920-3, 1995.

    3. A Spevets, RJ Brilli. General guidelines for resident training in critical care medicine. Crit Care Med
       : New Horizons, 6: 255-9, 1998.

    4. DJ Powner et al (ed). Fundamental Critical Care Support: A Standardized Curriculum of the
       Principles of Critical Care, 2nd edition (Anaheim, CA: Society of Critical Care Medicine, 1998), 346
       pages.

    5. Accreditation Council for Graduate Medical Education. “Program Requirements for Residency
       Education in Pediatrics” and “Subspecialty Education – Intensive Care Experience (NICU and
       PICU)”, In: Graduate Medical Education Directory 1998-99, Chicago: American Medical
       Association, 1998, pp 211-20, 226-8, 1146-64.

    6. TE Grissom, JC Farmer. Ongoing education of the non-CCM physician: fundamental critical care
       support course and other methods. Crit Care Med : New Horizons, 6: 300-6, 1998.

    7. EJ Cullen, ST Lawless, VM Nadkarni, et al. Evaluation of a pediatric intensive care residency
       curriculum. Crit Care Med 25:1898-1903, 1995.

    8. PL Rogers, A Grenvik, RL Willenkin. Teaching medical students complex cognitive skills in the
       intensive care unit. Crit Care Med 23: 575-81, 1995.

    9. PL Rogers. Developing a curriculum for medical students in critical care medicine. Crit Care Med :
       New Horizons, 6:248-54, 1998.

    10. TK Oliver, DW Butzin, RO Guerin, and RC Brownlee. Technical skills required in general pediatric
        practice. Pediatrics 88: 670-3, 1990.




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                                             Emergency Medicine
                                       Rotation Specific Objectives

                                                 PLASTIC SURGERY

Goals:

        Develop relevant history and physical exam skills for the assessing patients referred to a plastic
         surgery service.
        Learn the use of the diagnostic imaging modalities available for the evaluation of plastic surgery
         disorders.
        Develop skill at treating common hand injuries
        Develop an understanding of burn therapy.

Medical Expert:

Wounds

        Describe appropriate suture materials, techniques, and the timing of suture removal for the
         following wounds: Face, scalp, ears, trunk, extremities, tongue, fascia/muscle.
        Recite major biologic factors influencing wound healing and the resultant management choices
         and decisions (e.g., primary closure, delayed primary closure, or suture selection of wounds in
         the emergency department).
        List treatment considerations (e.g., potential complications) in the care of animal and human
         bites.
        List factors involved in the mechanism of wounding in regards to the propensity for infection,
         techniques for closure, after wound care and use of drains.
        List possible complications and infections associated with the closure of wounds in the
         emergency department.
        Describe the sequence of normal wound healing.
        List factors that increase risk of wound infection.
        Describe three types of wound closure.
        Describe techniques of appropriate wound preparation.
        Demonstrate various wound closure techniques for simple lacerations, stellate lacerations, deep
         and parallel lacerations.
        Demonstrate knowledge of various suture materials and indications.
        Discuss the appropriate tetanus immunization regimen for different wounds.
        Categorize burn wounds and describe the management of the wounds.
        Describe appropriate wound care instructions.
        List factors or components regarding abrasions as follows: mechanism of injury, propensity for
         infection, treatment regiments and after wound care instructions.

Foreign Bodies

     List specific complications and difficulties related to foreign body removal for glass, wood,
      organic material and chemicals.
    List reasons why foreign bodies in the wound are:
                    So difficult to locate
                    Increase the possibility of litigation
                    Predispose the wound to infection
Needlestick injuries

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       Outline the major steps and criteria in evaluating a patient with a needlestick.

Environmental Agents

       Describe three general principles of treatment of electrical burns and discuss three associated
        injuries found with electrical burns (include also high energy, high voltage injuries, and lightning
        injuries).
       Outline 2 general principles of treatment in the emergency department and distinguish between
        acute and chronic radiation problems.
       List a prioritized, evaluative and treatment protocol in a patient with thermal burns.
       Describe the evaluation of the magnitude of the burn injury with an estimation of the burn
        surface area and depth, and classification of the burn as critical, moderate, or minor.
       Determine the appropriate fluid replacement therapy for a major burn patient according to a
        standard replacement fluid formula.
       List depth, region, and surface area criteria for major burns to identify those requiring
        admission.
       Cite possible complications of burn injuries, including respiratory tract injury, shock, infection,
        Curling’s ulcer, bone and joint abnormalities, and metabolic considerations.
       For a patient with a thermal burn not requiring admission; describe appropriate outpatient
        management.
       Compare and contrast frost nip and frost bite and outline the evaluation and treatment of
        patients injured with frostbite.

Trauma

    Head and Neck
     List the immediate considerations in the acutely injured patient sustaining head, face, or neck
       injuries.
     Describe the initial care, diagnosis, and treatment of soft tissue injuries of the face, including the
       following areas and topics:
         Anaesthesia (to include the pros and cons of epinephrine, the selection and placement of
            regional blocks and use of topical agents and techniques).
         Bites, contusions, abrasions, tattoos, retained foreign bodies, puncture wounds, simple
            lacerations, avulsion flaps.
     List 2 regional anatomic considerations of injuries to the:
         forehead, branches of the facial nerve, ears, nose, cheeks, chin, lips, intraoral injuries,
            parotid gland, stenson’s duct, eyelids, muscles of mastication and expression.
     Given a patient with either a blunt or penetrating injury to the neck, describe the 3 anatomical
       regions and their importance to the wound.
     In a patient with a neck injury, describe the 3 components of the approach and repair of a
       superficial posterior neck laceration, an anterior laceration with obvious bleeding, but not arterial
       and a penetrating neck wound.
     Describe the evaluative approach and suggested treatment plan for injury of the internal
       auditory canal and evaluate for inner ear injury.
     List 2 regional anatomic considerations and treatments for repair of external ear injuries.
     Outline a prioritized, evaluative and treatment protocol for a patient with facial bone fractures
     Classify the following facial fractures and discuss their diagnosis and treatment:
       Lefort I, II, and III, zygoma, mandible, nose, orbit including blowout and tripod injuries.
     Given a patient with a traumatic injury to the scalp or forehead, discuss the initial evaluation,
       hemostasis, regional anaesthesia, and repair of the scalp, forehead and Injuries involving galea
       and bony structures.

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Hand
       Demonstrate knowledge of the bones in the hand.
       Demonstrate motor and sensory innervation of the hand.
       Describe the compartments of the hand as well as the fascial planes.
       Describe the motions of the thumb.
       Describe the assessment of the flexor digitorum profundus and superficialis.
       Describe the extensor zones of the hand.
       Demonstrate management of fractures and dislocations of phalanxes.
       Describe management of metacarpal shaft and neck fractures.
       Describe the mechanism of injury and management of mallet fingers and bouteniere deformity.
       Describe “gamekeeper” thumb injury and outline management.
       Demonstrate extensor tendon repair in the hand.
       Describe management of partial and full digit amputation.
       Demonstrate knowledge of how to transport amputated tissue.
       Describe and demonstrate split thickness skin grafting.
       Differentiate between felon, paronychia and whitlow and describe the management of each.
       Describe the signs and management of tenosynovitis.
       Describe the anatomy of the nail bed and plant and discuss the injury management.

Manipulative Skills
   Outline the factors involved in the choice of anaesthetic agents, toxicity, expected duration, and
      decision between regional block, field block, or topical anaesthesia, as well as the choice of use
      of epinephrine.
   Define, discuss, and demonstrate the ability to perform the following techniques:
       Simple sutures, running sutures, mattress stitch (both horizontal and vertical), layered
          closures, subcuticular closure, Z plasty, simple skin grafts, excision of the dog ear.
       Demonstrate closure techniques of vermillion border of lip as well as tongue and ear
          laceration repair.


Communicator

The resident should be able to:

           Establish and maintain a therapeutic relationship with patients, their families and the medical
            team while fostering an environment characterized by understanding, trust, empathy and
            confidentiality
           Provide an accurate verbal or written summary evaluation to describe a patient’s clinical
            condition to consultants using appropriate terminology.
           Gather information not only about the disease but also about the patient's beliefs, concerns
            and expectations about the illness, while considering the influence of factors such as the
            patient's age, gender, ethnic, cultural and socio-economic background, and spiritual values
            on that illness.




Revised: June 2009                                                                          Page 105 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009

           Keep thorough and accurate records.
           Communicate effectively with patients, family members and the medical team.
           Deliver information to the patient and family in a humane manner and in such a way that it is
            understandable, encourages discussion and promotes patient’s participation in decision-
            making to the degree that they wish.

Collaborator:

      The resident should be able to:

           Develop a care plan for a patient they have assessed, including investigation, treatment and
            continuing care, in collaboration with the members of the interdisciplinary team.
           Participate in an interdisciplinary team meeting, demonstrating the ability to accept, consider
            and respect the opinions of other team members, while contributing specialty-specific
            expertise him/herself.
           Maintain collegial and respectful relationships with medical and para-medical staff.
           Identify and describe the role, expertise and limitations of the members of the plastic surgery
            interdisciplinary team.
           Demonstrate an ability to promote the autonomy of patients and families and to promote
            their involvement in decision-making.


MANAGER

The resident should be able to:

           Effectively manage the care of multiple patients while working in the Emergency
            department, the wards, the recovery room and operating room.
           Make clinical decisions and judgments based on sound evidence for the benefit of individual
            patients and the population served.
           Be open to working effectively as a member of a team or a partnership and to accomplish
            tasks whether one is a team leader or a team member.
           Effectively use patient-related databases, access computer- based information and
            understand the fundamentals of medical informatics.

HEALTH ADVOCATE

        The resident should be able to:

             Identify the patient's status with respect to one or more of the determinants of health (i.e.,
             unemployment); adapting the assessment and management accordingly (i.e., the medical
             history to the patient's social circumstances); and assessing the patient's ability to access
             various services in the health and social system so as to promote health, enhance
             understanding, foster coping abilities, and enhance active participation in informed
             decision-making.




Revised: June 2009                                                                          Page 106 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
SCHOLAR

The resident should be able to:

       The resident will identify learning needs and make use of available learning resources.
       The resident should demonstrate critical thinking and integrate critical appraisal of the literature
        into the bedside approach.

PROFESSIONALISM

The resident will display professional attitudes and behaviors, including:

             Punctual for rounds, family conferences, and educational events
             Following through on assigned tasks
             Respectful, honest and compassionate care when dealing with patients, families, and
              other professionals.
             Considering racial and cultural issues in selecting treatment regimens for patients
             Demonstrating responsibility by being reliable and dependable.

The resident should

       Demonstrate an enthusiasm for learning.
       Demonstrate good self-assessment ability by being aware of own limitations and seeking
        feedback.
       Respect personal, cultural, and gender issues.
       Understand the consent and surrogate decision




Revised: June 2009                                                                          Page 107 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
                                             Emergency Medicine
                                       Rotation Specific Objectives

                                                 PSYCHIATRY

Goals:

        Understand the emergency presentations.
        Learn relevant interviewing techniques to deal with patients with various psychiatric disorders.
        Develop familiarity with common psychopharmacologic agents.
        Learn principles of managing the violent patient.
        Develop knowledge of the support offered in a community for patients with psychiatric illness.
        Evaluate the need for consultation with psychiatry.

Medical Expert:

        Discuss the indications for emergent and routine psychiatric consultation.
        Demonstrate ability to perform a mental status exam in patients with normal and altered mental
         status.
        Recognize and provide initial care for a patient presenting with a mood disorder.
        Elicit signs and symptoms of depression through mental status exam.
        Demonstrate knowledge of DSMR criteria for diagnosis of depression.
        Discuss medical conditions that may manifest with depressive symptoms.
        Differentiate between dysthymia, bipolar disorder, and major depression.
        Demonstrate knowledge of medications and their side effects that are used in treatment of
         mood disorders.
        Demonstrate ability to assess suicide risk.
        Diagnose and manage the acutely psychotic patient in the emergency setting.
        Differentiate between organic and functional causes of psychosis.
        Perform mental status exam to elicit signs and symptoms of schizophrenia.
        Demonstrate a basic knowledge of DSMR criteria for diagnosis of schizophrenia.
        Classify and describe the pharmacology and side effects of anti-psychotic medications,
         sedative/hypnotics, and antidepressants.
        Outline treatment plan for management of potential violent patient in the Emergency
         department.
        Determine criteria that must be present in order to hold a patient against their will.
        Discus mental health certification, competency and refusal of treatment.
        Discuss the indications for physical and chemical restraint and demonstrate ability to use
         restraint appropriately.
        Diagnose anxiety disorders and outline an effective management plan.
        Differentiate between normal and pathological anxiety states.
        Distinguish between panic disorder, generalized anxiety disorder, and post traumatic stress
         disorder.
        Discuss the role of anxiolytic medications and other approached to therapy.
        Interpret the manifestations of somatic complaints with anxiety disorders.
        Recognize and manage various types of substance abuse syndromes.
        Perform an appropriate assessment to elicit signs and symptoms of substance abuse.
        Outline management principles of common withdrawal states.
        Describe risk factors for addiction.
        Differentiate between organic and psychiatric cause for altered mental state.
        Compare and contrast delirium, dementia and pseudodementia.

Revised: June 2009                                                                          Page 108 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
       Describe differential diagnosis for altered mental state.
       Elicit the symptoms and signs to differentiate between dementia and delirium.
       Select appropriate investigative tests to rule out an organic cause for altered mental state.
       Define critical incident stress.
       Define post traumatic stress disorder.
       Demonstrate an empathetic assessment of a patient who has been involved in critical incident
        stress.
       Describe the diffusion process and its indications.
       Define the different types of personality disorders
       Demonstrate ability to interact effectively with patients with personality disorders including
        antisocial, borderline, compulsive, dependent, histrionic and passive-aggressive personalities.
       Assess in an empathetic manner the patient who has been assaulted and recognize the need
        for the follow-up.
       Identify key problem issues in patients who have been sexually assaulted.
       Provide crisis counseling as needed or refer the patient to the appropriate counseling service.

Communicator:

The resident should be able to:

       Establish and maintain a therapeutic relationship with patients, their families while fostering an
        environment characterized by understanding, trust, empathy and confidentiality
       Provide an accurate verbal or written summary evaluation to describe a patient’s clinical
        condition to consultants using appropriate terminology.
       Gather information not only about the disease but also about the patient's beliefs, concerns and
        expectations about the illness, while considering the influence of factors such as the patient's
        age, gender, ethnic, cultural and socio-economic background, and spiritual values on that
        illness.
       Keep thorough and accurate records.
       Communicate effectively with patients, family members and the medical team.
       Deliver information to the patient and family in a humane manner and in such a way that it is
        understandable, encourages discussion and promotes patient’s participation in decision-making
        to the degree that they wish.
       Demonstrate an empathetic assessment of a patient who has been involved in critical incident
        stress.
       Identify personal reactions to certain patients and respond in a professional, empathetic and
        constructive manner.
       Demonstrate the ability to provide an empathetic assessment of the patient who is the victim of
        assault.

Collaborator:

The resident should be able to:

       Develop a care plan for a patient they have assessed, including investigation, treatment and
        continuing care, in collaboration with the members of the interdisciplinary team.
       Participate in an interdisciplinary team meeting, demonstrating the ability to accept, consider
        and respect the opinions of other team members, while contributing specialty-specific expertise
        him/herself.
       Maintain collegial and respectful relationships with medical and para-medical staff.
       Identify and describe the role, expertise and limitations of the members of the psychiatric
        interdisciplinary team.
Revised: June 2009                                                                         Page 109 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
       Demonstrate an ability to promote the autonomy of patients and families and to promote their
        involvement in decision-making.


Manager:

The resident should be able to:

       Effectively manage the care of multiple patients while working in the Emergency department
        and the psychiatric ward.
       Make clinical decisions and judgments based on sound evidence for the benefit of individual
        patients and the population served.
       Be open to working effectively as a member of a team or a partnership and to accomplish tasks
        whether one is a team leader or a team member.
       Effectively use patient-related databases, access computer- based information and understand
        the fundamentals of medical informatics.


Health Advocate:
The resident should be able to:

       Identify the patient's status with respect to one or more of the determinants of health (i.e.,
        unemployment); adapting the assessment and management accordingly (i.e., the medical
        history to the patient's social circumstances); and assessing the patient's ability to access
        various services in the health and social system so as to promote health, enhance
        understanding, foster coping abilities, and enhance active participation in informed decision-
        making.

Scholar:

The resident should be able to:

       The resident will identify learning needs and make use of available learning resources.
       The resident should demonstrate critical thinking and integrate critical appraisal of the literature
        into the bedside approach.

Professionalism:

The resident will display professional attitudes and behaviors, including:

       Punctual for rounds, family conferences, and educational events
       Following through on assigned tasks
       Respectful, honest and compassionate care when dealing with patients, families, and other
        professionals.
       Considering racial and cultural issues in selecting treatment regimens for patients
       Demonstrating responsibility by being reliable and dependable.

The resident should:

       Demonstrate an enthusiasm for learning.

Revised: June 2009                                                                          Page 110 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
       Demonstrate good self-assessment ability by being aware of own limitations and seeking
        feedback.
       Respect personal, cultural, and gender issues.
       Understand the consent and surrogate decision




Revised: June 2009                                                              Page 111 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
                                             Emergency Medicine
                                       Rotation Specific Objectives

                                                 RESEARCH

Goal:

Three main goals are to be achieved by the resident during their research experience:

             1) To participate in a project(s) to gain research skills
             2) To understand the research process allowing sophisticated interpretation of medical
                literature
             3) To advocate for ongoing advancement of emergency medicine through research

These goals are achieved through the introductory Resident Research Block in PGY-2 and allotted
research time in the PGY 3-5 years and monthly journal clubs.

During the introductory block the resident will develop a practical project: complete literature review, an
answerable question, appropriate methodology with statistics, discussion of ethics and budget.

Subsequently the resident will
       Obtain scientific and ethical approval
       Obtain required funding
       Implement the project to gather data
       Synthesize and analyze results
       Present the project at the University of Calgary Research Day
       Submit the project for presentation at a national meeting
       Prepare a manuscript suitable for publication

Medical Expert:

The resident will understand the basic components of a research project:
        The study question, background literature, hypothesis, methodology, statistics, results and
          discussion
        Be familiar with various study designs including randomized control trials, case –control
          trials, cohort observational studies, chart reviews, case reports
        Have introductory concepts of statistical methods: alpha and beta errors, sample size,
          confidence intervals, types of data, basic inferential tests
        Know how the principles of ethics (autonomy, beneficence, confidentiality, justice,
          nonmaleficence, integrity) apply to research
        Understand budget concepts and apply them to a project

Communicator:

The resident should communicate well with patients and family members who are involved in research
studies.




Revised: June 2009                                                                         Page 112 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
Collaborator:

The resident should understand the roles of various health experts in research including
biostatisticians, research advisors, ethics committee members, research aids (nurses, data support
personnel) and clinical personnel.

Communicate effectively, verbally, in writing, and by posters/reminders with these groups.

Manager:

The resident should be capable of managing the financial and human resources available for research
projects.

Scholar:

Demonstrate critical thinking and integrate critical appraisal of the literature into the bedside approach.

Demonstrate ongoing generation of ideas suitable for literature review and potential research.

Professional:

       Demonstrate responsibility by being reliable and dependable.
       Demonstrate an enthusiasm for research.
       Demonstrate good self-assessment ability by being aware of own limitations and seeking
        feedback.
       Respect personal, cultural, and gender issues.
       Understand the consent and surrogate decision making process.




Revised: June 2009                                                                           Page 113 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
                                             Emergency Medicine
                                       Rotation Specific Objectives

                                 AERO MEDICAL TRANSPORT MEDICINE


Goals:

        Understand the principles of aeromedical medicine and how they differ from ground treatment of
         patients.
        Learn to work as a team with ground crews and the aeromedical team.

Medical Expert:

        List the similarities and differences between ground ambulance, rotary, and fixed-wing methods
         of pre-hospital transport.
        List the indications and contraindications for aeromedical transport.
        List the various trauma-scoring systems available for triage of adult and pediatric patients, and
         the pros and cons of each.
        Discuss each of the following laws and how they apply practically to aeromedical transport of
         the critically injured patient:
         • Boyle’s law
         • Dalton’s law
         • Charles’ law
         • Henry’s law
         • Gravitational forces
        Describe the role of each of the following team members:
         • RN
         • Paramedic
         • Pilot
         • Physician
        Describe the pros and cons of RN/RN, RN/Paramedic, and Paramedic/Paramedic flight teams.
        Describe the pros and cons of having a physician aboard each flight.
        Describe the principles of on-scene management of the critically ill patient.
        Describe the pre and in-flight management issues for the following groups of patients:
         • Head injury
         • Myocardial infarction/CHF
         • Asthma & COPD
         • Pediatric cases
         • Hypothermia
         • Pregnancy
        Learn to communicate effectively with each of the following:
         • Referring hospital staff
         • Receiving hospital
         • Emergency link centre
         • Flight crew
        Learn how to operate and develop cases for the STARS METI high fidelity human patient
         simulator.
        Actively participate in aero-medical missions
        Participate as on-call physicians with attending physician with back-up.

Communicator:
Revised: June 2009                                                                         Page 114 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009

The resident should be able to:

       Demonstrate the ability to communicate effectively with the base hospital, nurses, physicians
        and EMS personnel using numerous types of communication devices.
       Establish relationships with the patient and family that are characterized by understanding, trust,
        respect, empathy and confidentiality.
       Demonstrate the ability to break bad news such as that of death or serious illness or injury to
        patients and/or their family members in such a way that is sensitive, thorough and
        understandable.
       Demonstrate skills in working with others who present significant communication challenges
        such as anger or confusion, an ethno-cultural background different from the physician’s own,
        physical or emotional impairment. This includes the ability to communicate with patients with
        the potential for violent behavior in a way that may defuse the potential for violence.
       Communicate effectively with the members of a multidisciplinary team in the resolution of
        conflicts, provision of feedback and where appropriate, be able to assume a leadership role.

Collaborator:

The resident should be able to:

       Participate as an observer or team member in STARS or EMS transport systems and maintain
        collegial relationships with STARS, EMS and hospital staff.
       Actively participate in STARS management.
       Understand the roles and expertise of the other individuals involved, inform and involve the
        patient and his/her family in decision-making and explicitly integrate the opinions of the patient
        and care givers into management and transport plans.

Manager:

The resident should be able to:

       Demonstrate an ability to provide initial and continuing education at all levels of STARS and
        EMS personnel.
       Manage patient care effectively during stressful situations.
       Understand how a triage system works to manage patients in the most effective and fair
        manner.

Advocate:

The resident should be able to:

       Demonstrate an understanding of appropriate deployment of ground and air medical services.
       Recognize current “at risk” groups within the practice of emergency medicine and STARS and
        apply the available knowledge about prevention to improve patient outcome.




Revised: June 2009                                                                         Page 115 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
Scholar:

The resident should:

       Identify learning needs and make use of available learning resources.
       Demonstrate critical thinking and integrate critical appraisal of the literature into the aeromedical
        practice.

Professionalism:

The resident will display professional attitudes and behaviors, including:

       Punctual for rounds, family conferences, and educational events and following through on
        assigned tasks.
       Respectful when dealing with patients, families and other professionals.
       Considering racial and cultural issues in selecting treatment regimens for patients.
       Demonstrate responsibility by being reliable and dependable.

The resident should:

       Demonstrate an enthusiasm for learning.
       Demonstrate good self-assessment ability by being aware of own limitations and seeking
        feedback.
       Respect personal, cultural and gender issues.
       Understand the consent and surrogate decision.




Revised: June 2009                                                                           Page 116 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
                                             Emergency Medicine
                                       Rotation Specific Objectives

                                                  TRAUMA

Goals:

        To be comfortable with the assessment, resuscitation, stabilization and treatment of the trauma
         patient.
        Understand the mechanism of injury in both penetrating and blunt trauma.
        Understand the principles of neurosurgical and plastic surgical repair of traumatic injuries.
        Perform procedures necessary for the emergency stabilization for an acutely traumatized
         patient.


Medical Expert:

        Assess the mechanism of injury and diagnose and manage acute illness in the victim of trauma.
        Describe the principles of trauma resuscitation.
        Compare and contrast the presentation and treatment of the adult, pediatric, geriatric and
         pregnant trauma patient.
        Discuss definitive diagnostic studies in the trauma patient with regards to radiological studies
         and their indications/contraindications, interpretations and complications.
        Describe the various scoring systems in multiple traumas (pre-hospital and hospital).
        List the indication for thoracotomy and laparotomy in the trauma patient.
        Discuss indications, contraindication and complications of/and perform tube thoracotomy,
         pericardiocentesis nasogastric tube insertion, Foley catheter insertion, veing catheter
         cannulation/cutdown, central line insertion(internal jugular, femoral, and subclavian) and intra-
         osseious insertion for venous access.
        Discuss the stabilization, assessment, and possible intervention of specific intra-abdominal
         injuries including blunt/penetrating injury to the stomach, duodenum, bowel mesentery,
         anorectal, liver, biliary system, spleen, pancreas and urogenital.
        Discuss special considerations in the evaluation and management of the pregnant trauma
         victim.
        Discuss special considerations in the evaluation and management of the pediatric or geriatric
         trauma victim.
        Discuss the principles of pre-hospital care.
        Demonstrate the ability to manage fluid resuscitation of trauma patients.
        Discuss the definitive care of the trauma victim, including operative, postoperative and
         rehabilitative phases of care.
        Understand the management of cervical spine trauma including investigations and “clearance”




Revised: June 2009                                                                         Page 117 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
Communicator:

The resident should be able to:

       Establish and maintain a therapeutic relationship with patients, their families and the medical
        team while fostering an environment characterized by understanding, trust, empathy and
        confidentiality.
       Provide an accurate verbal or written summary evaluation to describe a patient’s clinical
        condition to consultants using appropriate terminology.
       Gather information not only about the disease but also about the patient’s beliefs, concerns and
        expectations about the illness, while considering the influence of factors such as the patient’s
        age, gender, ethnic, cultural and socio-economic background, and spiritual values on that
        illness.
       Keep thorough and accurate records.
       Communicate effectively with patients, family members and the medical team.
       Deliver information to the patient and family in a humane manner and in such a way that it is
        understandable, encourages discussion and promotes the patient’s participation in decision-
        making to the degree that they wish.

Collaborator:

The resident should be able to:

       Develop a care plan for a patient they have assessed, including investigation, treatment and
        continuing care, in collaboration with the members of the interdisciplinary team.
       Participate in an interdisciplinary team meeting, demonstrating the ability to accept, consider
        and respect the opinions of other team members, while contributing specialty-specific expertise
        him/herself.
       Maintain collegial and respectful relationships with medical and para-medical staff.
       Identify and describe the role, expertise and limitations of the members of the trauma surgery
        interdisciplinary team
       Demonstrate an ability to promote the autonomy of patients and families and to promote their
        involvement in decision-making.

Manager:

The resident should be able to:

       Effectively manage the care of multiple patients while working in the Emergency department,
        the wards, the recovery room and the operating room.
       Demonstrate the ability to establish priorities in the initial management of victims with life-
        threatening trauma.
       Make clinical decisions and judgments based on sound evidence for the benefit of individual
        patients and the population served.
       Be open to working effectively as a member of a team or a partnership and to accomplish tasks
        whether one is a team leader or a team member.
       Effectively use patient-related databases, access computer-based information and understand
        the fundamentals of medical informatics.

Health Advocate:

Revised: June 2009                                                                       Page 118 of 119
University of Calgary
Emergency Medicine Royal College Residency
Rotation Specific Objectives Revised July 2009
The resident should be able to:

       Identify the patient’s status with respect to one or more of the determinants of health (i.e.
        demographics, substance use, gang violence); adapting the assessment and management
        accordingly (i.e. the medical history to the patient’s social circumstances); and assessing the
        patient’s ability to access various services in the health and social system so as to promote
        health, enhance understanding, foster coping abilities, and enhance active participation in
        informed decision-making.
       Demonstrate knowledge of injury prevention strategies.


Scholar:

The resident should be able to:

       Identify learning needs and make use of available learning resources.
       Demonstrate critical thinking and integrate critical appraisal of the literature into the bedside
        approach.


Professionalism:

The resident will display professional attitudes and behaviors, including:

       Being punctual for rounds, family conferences, and educational events.
       Following through on assigned tasks.
       Respectful, honest and compassionate care when dealing with patients, families, and other
        professionals.
       Considering racial and cultural issues in selecting treatment regimens for patients.
       Demonstrating responsibility by being reliable and dependable.

The resident should:

       Demonstrate an enthusiasm for learning.
       Demonstrate good self-assessment ability by being aware of own limitations and seeking
        feedback.
       Respect personal, cultural and gender issues.
       Understand the consent and surrogate decision.




Revised: June 2009                                                                        Page 119 of 119

				
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