This residency program is for 1 year.

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

There are 13 blocks (4 weeks each) per academic year.  A typical schedule is reflected below, but may vary based on resident needs, rotation availability, etc.

Content and Sequence of Rotation Blocks

Palliative Medicine Rotations

 Introductory blocks:  Most residents will start their program with eight weeks with a palliative care service in the tertiary setting, including a palliative care unit. The resident is part of the interdisciplinary team, under the direct supervision of palliative physicians.  This allows the resident to be well supported in his/her initial palliative care experiences, and also allows an assessment of the resident’s current knowledge, skills and vulnerabilities. During this foundational 8-week rotation, there is the opportunity to learn about basic principles of pain and symptom management, working with the interdisciplinary team and gaining some perspective on counseling and facilitating team meetings. Interventional anaesthesia approaches to pain management in palliative patients, palliative care for non-malignant conditions and care for patients with a history of substance use will also be introduced during this time.

Community Palliative Care:  This rotation allows the resident to provide palliative consultation services to patients in their homes as part of the Home Hospice Palliative Care Service.  It may also involve palliative support for patients in long term care and hospice facilities. During this 8-week period, the resident sees patients at home on a continuing basis.  Attendance at community rounds, providing support and care for home deaths, and facilitating transitions of care from acute care to home, home to acute care, and hospice are key to the learning experience. The resident will also learn about other community resources that palliative patients and their families may use, such as visiting a funeral home, meeting with alternative care practitioners and attending grief support groups. This rotation stresses the Palliative Care Clinicians role as lead, support and educator to the Primary Care team and Physician.

Advanced Palliative blocks:  The resident works both on a tertiary palliative care unit (TPCU) and provides palliative consultation to other parts of the hospital throughout the rotation.  The TPCU experience broadens the resident’s scope and solidifies the residents’ role as consultant.  During the advanced rotation the resident will take on progressive responsibility.  Some of the ways this progression may be demonstrated is through increased patient volume, participation in patient triage for admission to the PCU, and ownership of education for junior learners.

Oncology

Oncology is primarily experienced in outpatient clinics, 2 weeks each of medical and radiation oncology, usually done at one of the provincial BC Cancer locations, plus the two-week General Practitioner in Oncology Course.

Ambulatory Palliative Care

These clinics give the resident the opportunity to participate in medical sub-specialty non cancer clinics with a palliative focus, and provide symptom support to outpatients in the Pain and Symptom Palliative Care clinics at the BC Cancer Agency.

 Sub-specialty areas may include: Cardiology, Gastroenterology, Infectious Diseases/HIV, Nephrology, Neurology, Rheumatology and Respirology.

Geriatrics

 The resident gains insight into ethical decision making for patients with dementia, and assessing cognitive abilities and decision-making capacity.  The resident learns how to effectively manage delirium in the frail elderly.

Scholarly Project

Completion of a scholarly project is a requirement of the residency program.  To facilitate this, as well as other scholarly activity, dedicated time is part of the rotation schedule.  Residents have the opportunity to present their work at the annual division research day.

Electives

Elective experience will be determined by resident learning needs and expressed areas of interest.  They may be clinical or non-clinical and can include rotations out of province or out of country.

Possible electives:

• Canuck Place Children’s Hospice or other Pediatric Facility
• Chronic Pain Service
• Neurology and neuromuscular diseases clinic
• Psychiatric issues in palliative care
• Palliative Care Community i.e. Kelowna, Downtown East Side Vancouver, and many other community palliative care programs.
• Palliative Care in remote settings or smaller urban centres, i.e. Northern health, Nanaimo
• St. Paul’s Hospital with an emphasis on care for those with HIV/AIDS
• Pastoral Care Fellowship
• International Electives in Clinical and/or Structural Programs
• Research Projects in Clinical, Economic and/or Operational Issues of Palliative Medicine.