This residency program is for 2 years.

Program length of training does not exceed the Royal College or College of Family Physicians of Canada standard.

Overview of our Sub-Specialty Training Program

This two-year program in respirology is designed to provide clinical training over a period of 14 months of “core” general Respirology. These 14 months consist of 5 months of consults at HSC, 4 to 5 months consult service at St. Boniface, 1 month Pulmonary Function Testing and one month of Thoracic Radiology. Within these 14 “core” months there will also an equivalent of 5 months out patient exposure. Residents are allowed 6 months of elective time. The training program is organized as outlined below.

Consultation Services

There are consultation services at both the Health Sciences Centre and the St. Boniface Hospital. The residents will spend approximately 5 months at each of these. Both these rotations offer unique and different experiences and are complementary to one another.

The St. Boniface rotation is a busy one, providing day-to-day experience in general respirology and exposure to complex and interesting tertiary care referrals from medical and surgical services as well as family practice and geriatrics. Further, St. Boniface Hospital is the designated Cardiac Centre of Excellence, with an extremely busy Surgical Cardiac Intensive Care. Up to 6 cardiac surgical cases are performed daily, often generating pulmonary consultation. Both teaching centers have very busy tertiary care medical and general surgical intensive care units. The HSC rotation is a combined inpatient / consultation service. The inpatient ward functions as a dedicated respiratory Clinical Training Unit as well as the only provincial tuberculosis centre. The HSC service combines dedicated CTU experience as well respiratory consultations through out the hospital.

Laboratory Rotations

There are three laboratory rotations. The first is a one month Pulmonary Function Lab rotation at the Health Sciences Centre, a tertiary care referral laboratory for the province. Here, extensive experience with pulmonary function equipment, techniques, and interpretation is provided.

The second is at the Sleep Laboratory. The Sleep Lab is located at the Misericordia Health Centre. This is a dedicated sleep lab with ten beds. As of 2011, there are 6 sleep physicians who staff this lab. During this rotation, the residents learn basic concepts of sleep physiology and sleep disorders. The RCPSC mandates at least 2 months of dedicated sleep medicine training.

The third four-week block is at the Radiology Service at St. Boniface Hospital. This rotation provides residents with expertise in the interpretation of chest radiographs, CT scans of the thorax, and the performance of related procedures, such as percutaneous transthoracic needle biopsy and chest tube insertion.

Ambulatory Care (Outpatient Clinics)

During the training program, ambulatory care experience makes up 5 months of training. This takes the form of three dedicated months in general respirology clinics. Additionally the residents are assigned to a longitudinal clinic of a ½ day / week for the duration of the training program.

Procedures

During their training, the residents perform enough procedures to become proficient in bronchoscopy, transbronchial biopsy, thoracentesis, pleurodesis, and chest tube insertion.

Second Year of Training Program

The second year of the training program has well-defined objectives. There is continuing clinical exposure to meet the requirement of the Royal College for 14 months of clinical training. Rotations at the Sleep Laboratory and on consultation service are scheduled. Additionally, the curriculum of the second year focuses on academic and scholarly activities including research, educational, and teaching activities. Several members of the section of respirology have major research interest in fields including basic physiology, biochemistry, immunology, epidemiology, and molecular biology. Residents are required to initiate and complete a research project under the supervision of one of these faculty members. Furthermore, programs of respiratory research in the departments of pathology, pediatrics, and physiology provide extra opportunities for research training.

The second year of training is flexible, allowing requests for out-of-town rotations, an elective, or a community rotation to be accommodated.

The two-year respiratory fellowship program at the University of Manitoba is designed to provide all the skills required of a respirologist by the Royal College, including the clinical and technical skills needed to function in an ICU. Although the respiratory training program is highly structured, there is also a good deal of flexibility. The program is designed with a view to helping residents evolve into the role of specialist consultants in respirology.

Critical Care Medicine

The residents rotate through the tertiary level Intensive Care units of both hospitals for two months of their second year of training. During this rotation, each resident is given a graded responsibility as assessed by the critical care attending staff. Additional months in intensive care can be arranged if desired.

Research Expectations

Our Residents will have the opportunity to partake in a research or a scholarly project. Research projects can be presented at a major International meeting such as the annual American Thoracic Society Meeting and/or the annual Dept of Internal Medicine Resident Research Day.

Academic and Scholarly Activities

Outlined below are the details of the Respiratory Section Educational Half Day as well as other teaching activities.

Academic Half Day

Each Wednesday afternoon is protected time for formal teaching activities. Residents are expected to be present and are exempt from all other activities during this half day, which begins formally in September and runs through to June 30 of the following year. During the summer months (July and August) introductory teaching sessions are organized.

Advanced Pulmonary Physiology

This course is offered to both the first- and second-year residents. Because the subject matter is advanced, trainees often choose to reinforce what they have learned in their first year by attending this course in their second year. A list of the lectures for 2007–2008 is appended. Advanced pulmonary physiology is an accredited course at the University of Manitoba. The residents receive certification upon its conclusion and successful completion of the final examination.

Pulmonary Function Testing

This didactic course on techniques of pulmonary function testing and interpretation is scheduled from September to February of each academic year. Objectives of this course are to prepare residents for the role of consultants who can provide expert interpretation of pulmonary function tests.

Clinical Epidemiology

A short course on epidemiology and biostatistics is organized each year. Usually four lectures of 1 to 1½ hours each cover most of the following topics:

1. Epidemiologic approach to disease and intervention
   • Measuring the occurrence of disease
   • Assessing the validity and reliability of diagnostic and screening tests
   • Assessing the efficacy of preventive and therapeutic measures: randomized trials
2. Using epidemiology to identify the cause of disease
   • Cohort studies
   • Case-control and cross sectional studies
   • Estimating risk
   • Bias, confounding, and interaction
3. Applying epidemiology to evaluation and policy
   Using epidemiology to evaluate health policy, etc.
4. Biostatistics
   • Types of data analysis
   • Univariate analysis
   • Bivariate analysis
   • Multivariate
   • Probability
   • Hypothesis testing
   • Confidence intervals
   • Statistical power

Clinical Chest Conference, Wednesday

The rounds consist of the presentation of two patients, including their radiographs, relevant pulmonary function tests, and relevant pathology.

The specific objectives of the clinical conference are as follows:

• Target audience: respiratory residents and faculty, rotating residents, and students and allied health professionals.
• Develop an approach to the differential diagnosis and cost-effective evaluation of patients with respiratory disease.
• Learn a multidisciplinary approach (clinical-pathological-radiological) and teamwork.
• Develop an approach to the management of complex clinical problems.
• Provide a learning experience for the residents in identifying a clinical question, searching the medical literature, and making an informative presentation.
• Prepare the residents for clinical consultations and Royal College examinations.
• Provide scientific, evidence-based literature of the clinical topics as continuing medical education for the target audience.
• Provide an interactive presentation to include both the presenter and the audience.

Research in Progress (RIP), Wednesday

Ongoing research activity is presented at these rounds. Residents are encouraged to attend, especially if the topic is relevant to an area of research in which they intend to be active.  These rounds begin in September.

Journal Club Wednesday (alternated with Research in Progress)

Critical appraisal of literature is formally taught through the biweekly journal clubs. Articles for review are circulated to all section members a week in advance. Currently these meetings are held every other Wednesday.

The McMaster University format is recommended to critically evaluate each article. Please read the enclosed articles in the section ‘Critical Appraisal of Medical Literature.’ The objectives of the journal clubs are to provide an understanding of medical literature by:

• Reviewing articles reporting major new clinical observations.
• Learning how to review the literature critically.
• Learning the application of principles developed by the Evidence-Based Medicine Working Group about how to use an article dealing with diagnosis, therapy, and prevention. Developing an evidence-based approach to the evaluation and management of a wide variety of respiratory disorders.

Other Formal Teaching Activities

Pulmonary Review Course, Monday 0800 to 0900 hours.
A pulmonary review course organized by the residents for coverage of topics not well covered in existing teaching venues. In last few years we have invited various experts from and outside the section to either give a didactic lecture or have an interactive teaching session with the residents

• Joint Clinical-Radiology-Pathology
  These joint rounds will be held from 11:30 to 12:30 hours on the first Wednesday of the month in the Oncology Conference Room at St. Boniface General Hospital. They have been organized by radiologists, pathologists, and chest medicine. Through these rounds we hope to interact with the local thoracic surgical group on a regular basis.The purpose of these rounds is to enhance the radiologic-pathologic correlations of lung diseases, with emphasis on the radiology and pathology of both common and rare conditions. These rounds will have a different focus and different objectives from the weekly chest conference. The thoracic surgical group has agreed to present the radiologic and pathologic aspects; the clinical context will also be discussed. A large number of cases will be reviewed to increase residents’ and residents’ familiarity with a wide variety of lung diseases. These rounds will be scheduled monthlPresentations will alternate between thoracic surgery and chest medicine.
• CanMEDs Rounds
  CanMEDs rounds will be held four times per year. This is an informal round.  Discussion will centre on the CanMEDS objectives.  Target audience is the Respiratory Residents.  These rounds have a circulated agenda with minutes taken at each session.
• Multidisciplinary Sleep Rounds
  These multidisciplinary rounds are attended by the faculty interested in sleep disorders (Respirology, neurology, psychology, general internal medicine and otolaryngology), sleep technologists, home ventilatory assist devices program personnel, respiratory therapists and others interested or involved in providing care to the patients with sleep disorders. The rounds are designed to meet the educational goals of all attendees and often utilize case presentation format with didactic lecture to cover wide variety of topics. They are scheduled last Monday of each month and continue through the summer. Additionally, these rounds also serve as a forum to bring the various sleep professional together at University of Manitoba.
• Mechanical Ventilation
  This is an interactive course on invasive and noninvasive modes of mechanical ventilation. This course is delivered in the form of five one-hour discussions.