Canadian internal medicine programs

Applications are submitted through the sponsorship office. More details here. In the past decade, both medicine and society have seen a shift towards improving Equity, Diversity and Inclusion EDI for its populations.

It is important for healthcare teams to understand and address the needs of marginalized patients and diverse communities. As residents and future licensed physicians, EDI plays a crucial role in our mandate of patient-centred care and life-long learning and as such, medical education has shifted to prioritize these values in its learners.

The program has recently developed a Resident Education Subcommittee for Equity, Diversity and Inclusion co-chaired by a resident and a faculty supervisor. The purpose of this committee is to improve and incorporate the EDI curriculum into our Internal Medicine training. We invite you to watch the videos to learn more about Residency Programs at McMaster and feel the warmth of Hamilton. Internal Medicine residency at McMaster is a fast-paced program organized to build a strong skillset within the first year of training to serve as a solid platform for learning.

Residents will care for a diverse population with a broad range of diseases. A by-product of our busy services is the tremendous clinical experience to be gained. To accommodate the impact of CBME and the PGY3 Royal College examinations, significant changes have been made to reduce the service load to protect teaching time and promote resident wellness. Our program is structured with the goal of preparing residents for a gratifying career of their choosing.

McMaster is a rich environment for learning and innovation in clinical practice, education, and research. Foundations for learning are solid and there are many opportunities for enrichment that are readily available to all residents. Some features of our program include:. Our expert faculty is strong, collegial, and committed to teach.

Our program is responsive to change. A time-sensitive approach is taken to respond to feedback from residents and faculty. A positive approach to new and innovative models of teaching will keep the program fresh and strong. We are prepared. Rapid adaptation to a virtual curriculum and methods for residents to continue to learn and to retain credit for training during COVID imposed quarantines and redeployment are in place.

McMaster Postgraduate Medical Education responded to the COVID pandemic by putting policies and procedures in place to protect the safety, wellness and educational mandate for all residents. The Internal Medicine Residency Program has a customized plan to accomplish the same goals within our own training program. Our residents are valued as agents of change. Our program is highly resident-centred.

Every committee is populated by resident members from all three years who stimulate important changes based on collective feedback from their cohorts. Patient selection is diverse and varied. The Hamilton community serves over 1. A CTU is placed within each of the three teaching sites, and each of these facilities has been designated as a center of excellence for at least one of the medical subspecialties.

The curriculum and scheduled rotations are designed for PGY1 residents to acquire fundamental skills in acute care medicine early in training.

The elective is supervised by McMaster Internal Medicine faculty with interest in Global Health and who have developed close ties with the healthcare team at the Mulago Hospital in Kampala, Uganda. Please see the Departmental Global Health website for more details.

The resident learns to be a leader by participating in committees and project work in areas involving program planning, educational scholarship, research, advocacy, etc. Our program encourages professional growth by providing faculty mentorship to residents who step forward into a committee role as a Co-Chair or as a leader of resident innovations.

Recent examples of resident-initiated proposals that have enhanced our program include the development of:. The resident learns to be an educator with the opportunity to participate in the teaching of clinical skills to undergraduate medical students. The program attracts applicants who are dedicated to delivering high-quality care and who are enthusiastic about the discipline of internal medicine; who demonstrate intelligence, dedication, efficiency and commitment to patient care; who wish to learn the skills of evidence-based medicine so that they can ultimately practise medicine in accord with its tenets.

There are four active hospital sites that offer inpatient and ambulatory clinical training experiences. There are 13 blocks per year filled by a combination of clinical experiences as listed under each PG designation. PGY2 residents can apply for a fully-funded competitive block elective in Uganda. Community electives in remote, underserviced areas may be funded by the Ontario government for lodging, travel, etc.

Aside from the necessary clinical experience, the program offers a well-developed academic and research curriculum that allows residents to obtain the skills necessary for a successful career. A variety of methods for non-clinical teaching are organized to address individual styles of learning with a focus on activities that are targeted to maximize resident participation. There is protected time for a weekly academic half-day, Grand Medical Rounds as well as regularly scheduled CTU Rounds, Journal Clubs, subspecialty rounds, workshops, and retreats.

The formal teaching activities are tailored to the various stages of resident training. Each teaching hospital houses a simulation room for on-site training during clinical duty hours. The curriculum is customized in terms of content and skill level to target residents during each of the three years of training. Internists generally restrict their field of specialization to a particular organ system eg.

Because surgery is not used in treatment, internists often have a wide knowledge in various other medical therapies and drug administration. British Columbia. Greater Toronto Area. Greater Vancouver. Canadian general internists are perceived to perform many procedural skills in practice. Two studies have looked at the procedural skills performed by Canadian General Internists [ 17 , 18 ], without solid conclusions as to which procedural skills would be particularly needed by graduates of a General Internal Medicine training program.

Many procedures are performed by very few individuals. We would therefore propose that flexible, individually tailored programs would best fit the needs of individual residents and presumably society. This would be in addition to the eight skills in the Royal College of Physicians and Surgeons of Canada Internal Medicine objectives central venous catheter insertion; lumbar puncture; peripheral arterial catheter insertion; abdominal paracentesis; endotracheal intubation; thoracentesis; knee joint aspiration; and electrocardiographic interpretation.

For other skills an individualized training program for each resident taking into account their eventual needs and where they are likely to practice is proposed versus a long list of required competencies for each resident.

Tailoring of training to the various contexts example in hospital, academic, outpatients within which general internists may practice was suggested by the SGIM task force in the United States [ 19 , 20 ] along with the suggestion that general internal medicine residents should have options to tailor their final 1 to 2 years to fit their practice goals, earning a certificate of added qualification in generalist fields [ 19 , 20 ].

Although much less has been written about the fit of general internal medicine into the Canadian health care system [ 7 — 9 ] we would propose a similar training pattern for Canadian general internists.

In Linda Snell undertook a survey of practicing Internists in Canada [ 1 ]. There were perceived deficiencies in training in ambulatory care, in the management of complex disorders over time, in management of geriatric patients and those with psychosocial problems. Other areas of perceived deficiency included procedures, especially ICU and endoscopy, teaching skills, continuing self-education skills as well as administration and office management. There was over preparation in other areas. Shamekh and Snell in a survey of graduates of one University found that the current ambulatory care structure in their training program did not satisfy the needs of the graduates [ 21 ].

Like these previous studies our data illustrates a gap between importance and preparation for training particularly in the areas of ambulatory care and chronic disease management. There is also a gap perceived for preparation for perioperative care and medical disorders of pregnancy. This is particularly disturbing in that in Canada these have been 'traditionally' felt to be key aspects of GIM practice.

Ambulatory care and community general internal medicine are the rotations being pointed out as needing to be strengthened. In other specialties evidence has shown a gap in training in such non-clinical skills as health service delivery and non-clinical roles [ 22 ].

Whether this is true in Canadian GIM programs was suspected by the authors but not documented in the literature. In New Zealand one of these gaps was overcome by developing a national forum for all registrars in several non-clinical skills [ 22 ]. Our study shows a dramatic discrepancy between preparation for set-up of an office and importance suggesting that areas of instruction outside the CanMEDs role of medical expert need to be strengthened, perhaps with such a national forum.

A recent study looking at paediatric residency programmes in Canada [ 23 ] also indicated less than adequate preparation for manager of an office practice. There are limitations to this study. The response rate is low and was hampered by trying to find individuals in programs that are not registered by the Royal College of Physicians and Surgeons of Canada directly.

This made it difficult to find many of the addresses and respondents. To avoid this we could have surveyed those individuals who are currently practicing GIM in Canada and sought out these individuals either through communities directly or through the Canadian Society of Internal Medicine to which many general internists in Canada belong.

Many of the general internists particularly in rural community areas in Canada are not trained in Canada and many come from other countries. As the intent of this study was to look specifically at the discrepancy between preparation and importance for those who have trained in Canadian training programs we chose to identify our respondents this way.

As with many survey studies our results are individual's perceptions only. Individuals may not feel prepared in a topic but may actually able to practice the competency quite well.

This data is unknown and is not captured in this study. We do want to take into account the perspectives of those practicing GIM as we develop the objectives for GIM in Canada thus although it is not a gold standard for competence we do believe the perspectives of these respondents is important.

As the number of respondents in each year cohort is small we are unable to assess whether more recent graduates feel more confident in areas such as office management which may be emphasized to a greater extent since the introduction of the Royal College of Physicians and Surgeons CanMeds competency framework in We propose that:. There are core competencies that each general internist should learn, and there should be national standards for these.

These should include:. Beyond these core competencies, training needs to be flexible including length of training and adapted to each trainee for their anticipated role in health care delivery.

Optional competency based modules should be developed example specialty interest, medical education. Access to training in procedural skills needs to be ensured, improved, individualized and a rigorous evaluation process developed. Advanced procedural skills training would only be undertaken by those who need these skills to meet societal needs.

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Lieberman L, Hilliard RI: How well do paediatric residency programmes prepare residents for clinical practice and their future careers?. Download references. You can also search for this author in PubMed Google Scholar. Correspondence to Sharon E Card.

All authors are members of the Canadian Society of Internal Medicine which provided support for this study. SEC, LS and BO'B were involved in the development and piloting of the survey instrument, design of the study, interpretation of the data and writing of the manuscript. All authors read and approved the final manuscript.

This article is published under license to BioMed Central Ltd. Reprints and Permissions. Card, S.