An initiative of
Dr. Marcus Blouw
Program Director
Kathy Nowak
Critical Care residents are trained in a unique Critical Care environment that exhibits inter-facility coordination, managerial role discipline and collegial communication with the overall goals of optimizing clinical service delivery and medical education.
Critical Care residents work in an environment where all Intensivists collaborate to accept and share responsibility for patients referred from a catchment population in excess of 1 million people. Winnipeg is the Critical Care hub for all Manitoba and parts of Nunavut, Northwestern Ontario and occasionally Eastern Saskatchewan. All tertiary units are staffed by full time trained Critical Care academic physicians who are truly multidisciplinary (Base specialty training in Internal Medicine, Medicine subspecialties, Anesthesia, Surgery, Emergency, and Cardiac Surgery).
The training program has a tradition extending over 35 years and has had full Royal College approval since 1989. The program was recently reviewed (2022) and accredited by the Royal College. We are confident that trainees are exposed to adequate numbers and complexity of critically ill patients during residency.
The program has developed specific goals and objectives for rotations in the four “core” teaching units, as well as goals for a junior attending rotation based in a community hospital ICU. These goals and objectives are specific to each unit, and differ for trainees at various levels of training.
Critical Care is anticipated to be a two-year residency with a Royal College recommendation for residents to spend “12 months” doing rotations in critical care units during training. The University of Manitoba program has elected to meet this requirement by scheduling Critical Care residents for a minimum of 52 weeks of work in clinical units during the training period, and requiring the resident to do in-hospital call during both years of training.
Residents in the program must provide in-hospital coverage in critical care units during the two-year residency. While on a core ICU rotation, residents in the program will provide 3 weekdays (24 hours each) and 2 weekend days (24 hours each) of in-house call coverage in a four-week rotation. Any number of in-house calls provided above and beyond this minimum requirement are compensated at the provincial HMO physician or Resident Replacement pay rate. Residents are also paid a stipend above and beyond their PGY level salary in recognition of this in-house coverage. The stipend is not deducted at source and can be considered as “professional income” for taxation purposes. The stipend is variable depending on the PGY-level of each trainee and is intended to promote every Critical Care Resident to a level of pay equivalent to the negotiated pay rate for a PGY8 trainee in Manitoba.
The program has traditionally facilitated some work in the resident’s base specialty during the second year of training if the resident is progressing satisfactorily. This has particularly been requested by trainees from Surgery and Anesthesia for the purpose of maintaining specialty-specific procedural skills.
The program includes a full academic day on Wednesdays from late August until late June every year. Residents are excused from clinical duties to attend the full academic day. A typical day has lectures from 0900-1200 on critical care topics, afternoon advanced physiology/ventilator sessions shared with respiratory medicine, followed by respiratory clinical rounds. The academic curriculum includes a substantial element of simulation-based learning, with an emphasis on development of mental models, crisis resource management, the high performance physician, and biofeedback in the setting of acute stress. The academic curriculum also has a rapidly growing POCUS curriculum. This includes a didactic lecture series (focussed on preparing the learner to write the NBE Echocardiography exam), POCUS rotations, and ample simulation experience with ultrasound equipment.
Critical Care Journal Club occurs once monthly (either virtually or in the form of an in-person catered event as allowable). Additional education sessions are on Thursdays after the lunch hour from September to June in a city-wide session attended by Critical Care attendings and residents. The Thursday sessions are either case discussions, research in progress presentations or visiting professor lectures.
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.
This residency program is anticipated to cover 2 years.
Program length of training does not exceed the Royal College standard.
As of July 1, 2019 all Critical Care Training Programs follow the RCPSC Competence By Design curriculum for training, coaching and evaluating trainees. It is anticipated that most trainees will require 2 years to complete the requirements outlined by CBD.
The process for evaluating residents under the CBME structure will be different from that to which many residents are accustomed. The published goals and objectives for each rotation are complemented by a set of milestones and entrustable professional activities (EPA’s). The overarching goals, practices, and traditions of the Critical Care Training Program at the University of Manitoba remain largely unchanged since the implementation of CBME in 2019.
The program assigns residents to rotations in 7-day blocks starting on a Monday and ending on a Sunday. This mirrors the weekly rotations worked by attending physicians (in order to maximize the potential for meaningful collaboration and evaluations). Residents will generally be assigned to units for four consecutive weeks, but longer and shorter assignments are used to accommodate vacations and conferences. Residents will attempt to fulfill the goals and objectives set out in the relevant University of Manitoba Goals and Objectives Documents during unit assignments.
http://www.umanitoba.ca/faculties/medicine/units/intmed/media/CC_General_Goals_and_Objective.pdf
Residents will be expected to have reviewed the specific goals in the document for the unit to which they are assigned, and the overall program goals and objectives document. http://umanitoba.ca/faculties/medicine/units/intmed/students/criticalcareeducindex.html
The work during the FIRST YEAR will be structured as follows:
The resident will complete 30-40 weeks in the teaching ICUs at the University of Manitoba. As the trainee progresses through the initial stages of CBD Training (Transition to Discipline, Foundations, and Core), they will be expected to take on progressively more of a leadership role in the Intensive Care Units. This is outlined in the RCPSC list of EPA’s for Critical Care and in the Rotation Specific Objectives the program has developed for each unit.
Residents will rotate in all teaching units used by the University of Manitoba program. In general, over the 52 total weeks of critical care service, residents from internal medicine backgrounds will spend more than 50% of their rotations in surgical or blended units. Residents from anesthesia, surgery, and emergency backgrounds will spend more than 50% of their rotations in medical units.
This rotation is intended to give the resident a chance to develop their research (optional) or quality improvement project (mandatory if not participating in a formal program of research), conduct a literature review, and do preliminary studies design. The intent is to facilitate completion of projects during the second year.
Each resident will spend one month (minimum) performing point of care ultrasound assessments on critically ill patients under the supervision and guidance of a local Intensivist with advanced training in point of care ultrasound use. This rotation includes a refresher of basic ultrasound knowledge, training in image acquisition, image interpretation, advanced review of cardiac physiology and cardio-pulmonary interactions, and quality assurance. A didactic lecture series focussed primarily on echocardiography is delivered during the academic half day and is distinct from the POCUS rotation.
These rotations can be selected by the resident from the list provided by the Royal College Specialty Training Requirements, and must be approved by the program director and the RPC. Some of this time could be done off site / out of province with approval. The program has developed goals and objectives for common elective rotations. Evaluation tools are also in place for these common elective rotations.
If the resident is doing an elective for which specific goals and objectives have not yet been developed, the resident and program director will work together to develop appropriate goals and objectives and an evaluation strategy.
Vacation can be taken as four continuous weeks or can be split into one or two week blocks. Requests must be received by the program director prior to September 15 of each year of training (after this point vacation dates may be assigned by the Program Director). In general, it is better to submit requests earlier as vacation requests are considered when constructing the schedule of rotations for all residents.
During the second year of training the resident will generally be expected to progress through the Core and Transition to Practice stages of CBD Education. Residents continue to fulfill the goals and objectives set out in the University of Manitoba Goals and Objectives Document and the Royal College Specialty Training Requirements.
The year is designed to be flexible to accommodate the individual needs of residents. The intent is to develop a solid footing for a future career path specific to each resident.
The flexibility of the second year means that the structure may not be the same for all residents. In general all residents will experience the following:
Each resident will complete the remaining weeks to reach a minimum of 52 weeks ICU experience. Rotation in a Community Hospital ICU will be included in the second year. As residents progress through the stages of training the level of independence and ability to competently manage the ICU are expected to increase. This will be facilitated by the supervising attendings.
The expectations are outlined in the RCPSC documents for the relevant stages of training (EPA’s for Core and Transition to Practice) as well as in the rotation specific goals for each unit.
Residents may choose to complete additional ICU rotations or elective rotations to gain specific experience. In the event that a resident has struggled to meet the expectations of the training program, additional ICU rotations may be recommended by the RPC or Competence Committee in order to help the resident achieve the necessary proficiencies.
All residents not involved in a formal program of research must complete a longitudinal quality improvement project during the two-year residency. The project must be approved by the QI Director and specific mentorship will be required and assigned for each trainee. Time is provided in the first or second year to facilitate this activity.
In addition, residents joining the program will become part of the ongoing quality improvement circles that are active in the Intensive Care Units throughout Winnipeg.
A substantial period of time may be devoted to completion of a scholarly project or advanced degree during the second year if the resident has performed well on ICU rotations and the residency training committee / competence committee both believe that additional clinical rotations are not required.
The resident needs to communicate their plans and receive approval from the program for any protected time for scholarly work. In the past, residents have worked on several different approved activities during this time depending on their future career goals:
Vacation- Four Weeks as Outlined Above.
The applicants must indicate which publications are in peer reviewed versus non-peer reviewed journals/publications. If the applicant has submitted an article for publication at the time of CaRMS application, the applicant must provide evidence of journal notification of submission. The applicants must indicate all presentations at local resident research day as well as national and international conferences, and any prizes awarded. If a presentation (oral or abstract) has been submitted to a conference, the applicant should include any letter of acceptance by conference organizers.
A current curriculum vitae (CV) including all relevant information required for assessment of education, leadership, administrative and research experience is mandatory. Where applicable, please document whether activities are voluntary or reimbursed. Your CV should be downloaded to the document section. For research papers that have been submitted but not yet published, please include acknowledgement of submission from the journal. See comments above under Research/Publications for information regarding how to document your work.
International or US Medical Graduates Only – you must provide a RCPSC assessment of training form from the Royal College of Physicians and Surgeons of Canada: website: www.rcpsc.medical.org
For the CaRMS Match which will take place in the Fall of 2022, all interviews will be conducted electronically. The applicant may meet electronically with a panel of interviewers, or with interviewers individually, or a combination of both.
Please be advised that the 2023 PGME New Resident Orientation Day is scheduled for Thursday, June 29, 2023.
This Orientation is mandatory for all incoming residents.
