Director of Postgraduate Education Dr. Marc Lipkus marc.lipkus@nygh.on.ca
Education Coordinator: Claudia Jean claudia.jean@nygh.on.ca
Overview
North York General Hospital (NYGH) is a busy community teaching hospital, affiliated with the University of Toronto. The Emergency Department (ED) sees over 100,000 patients annually in the ED. We see and treat patients of all ages and approximately 20% of our volume is pediatrics. The physician group has a culture that values teaching and we serve as a training site for medical students, family medicine, CCFP-EM, FRCPC residents and elective trainees. Staff in our group have special interests that span medical education, podcasts (EM cases), point of care ultrasound, simulation, orthopedics, paediatrics, research, quality improvement, leadership and administration.
You will be provided information on PPE, protected codes and changes to the department at orientation.
During this EM rotation you will enhance your skills, knowledge and attitudes in the following areas:
Patient Assessment Skills
Initial evaluation of patients with a wide variety of undifferentiated medical, surgical, psychological and social problems
Focused assessments based on the “symptom pursuit approach”
Cost-effective use of laboratory and radiological studies
Patient Management Skills
Understanding the concept of triage and prioritization of care in the management of multiple patients simultaneously
Organizational skills and efficiency in maintaining patient flow
Procedural skills pertaining to EM
Recognition and Management of Emergencies
Rapid recognition of acute life- or limb-threatening illnesses or injuries
Systematic, prioritized approach to resuscitation and stabilization of medical, surgical, and traumatic emergencies
Understanding of Emergency Medicine
Understanding the role of the ED in the health care system and how it relates to other hospital and community health services
Recognition that ED care is episodic and therefore that clear follow-up instructions are important
Professional Behaviours
Effective communication with patients, colleagues, and other health care professionals
Ability to establish and maintain effective working relationships with colleagues and other health care professionals
Acquisition of good documentation habits, with concise recording of pertinent positive and negative findings
Medico-legal and Ethical Problems
Recognize scenarios in which obligatory reporting is required by law
Discuss the indications and procedure for certification of involuntary status under the Mental Health Act
Demonstrate an understanding of the principles of consent and competency
Well in advance of the start of your rotation you will be contacted by our program assistant to advise regarding your core days, academic half days, clinical half days, as well as any other requests for days off. The ED at NYGH includes learners from other sites at all levels of training (eg., medical students, residents, and fellows). Therefore, it is highly advised to request vacation/conference days as soon as you are aware of them. Send your request to Raiza (see email above). Any requests for days off (including stat holidays) must be received at least 4 weeks prior to the start of your Emergency Medicine rotation. You will receive your schedule for the month, as well as a detailed orientation package. You will have an orientation session to the department on the first day, prior to beginning your shifts. You will be emailed with the time and place to meet. Attendance at this session is required unless prior arrangements are made.
You will be scheduled for approximately 16 shifts over a 4 week rotation, including 2-3 overnight shifts and 4 weekend shifts over 2 weekends. Shifts are approximately 8 hours in duration, though you may need to stay longer to complete the management of your patients. You should not be scheduled for overnight shifts before core seminar days, AHD or clinic half days. Any requests for days off (including stat holidays) must be received at least 4 weeks prior to the start of your Emergency Medicine rotation. Any request for 4+ consecutive days off must be accompanied by written and signed approval by your program director. Although every attempt is made, it may not be possible to accommodate all requests. Please note that requests for multiple days off increases the likelihood of having shifts with short turnaround times to accommodate your full complement of shift.
You will be assigned a preceptor, with whom you will be assigned 4 or more shifts. Your preceptor will compile your daily Shift Encounter Forms and will be responsible for completing your final evaluation.
Trainees are expected to attend the following activities:
North York Emergency Department Rounds
Monday Mornings, twice monthly (September - June)
North York Emergency Medicine Seminars
First Wednesday of every month 9AM - 11AM
Toronto Emergency Medicine Grand Rounds
WEDNESDAY mornings
Link to academic day calendar and topics can be found here: https://www.deptmedicine.utoronto.ca/emergency-medicine-academic-events-rounds-calendar
If you are working a shift during these seminars, you should asked to be excused for the period these rounds occur. Attendance at these sessions will be verified.
In addition, trainees are also welcome to attend the University of Toronto Emergency Medicine Grand Rounds on Tuesday mornings, which occur downtown when their schedule permits. Notices for rounds and seminars are posted in the Emergency Department and included in your orientation package.
Resources
All "Rosens Emergency Medicine" chapter and summaries in podcast form: https://canadiem.org/crackcast/
https://www.emrap.org/hd?episode-guide-publish-date=%5B568011600000%2C1589905020000%5D
CVS – ACS, CHF, PE, HTN
Resp – asthma, COPD, pneumonia
GI/GU – acute abdo, GI bleed, renal colic, scrotal pain/masses
Neuro – seizure, stroke, HA, altered LOC
Metabolic – acid-base/electrolyte disturbances, DKA
ID – sepsis, febrile neutropenia, meningococcemia, HIV
Ob/Gyne – bleeding, ectopic pregnancy, toxaemia, pelvic pain, PID
Ophtho/ENT – red eye, epistaxis, foreign bodies, ocular trauma, head and neck infections
MSK – fractures, dislocations, sprains, acute back pain
Skin – burns, wounds, infections
Pediatrics – fever, croup, epiglottitis, meningitis, abuse, abdo pain, rashes, gastro
Geriatrics – acute confusion, falls, failure to thrive, abuse
Psychiatric – acute psychosis, suicidal ideation, panic disorder, depression, substance abuse
At the end of each shift, ensure the supervising Emergency Physician completes a Trainee Evaluation Tool online. A link is available on each desktop in the department. The physician is expected to provide feedback at the end of each shift. All forms must be submitted by the supervising physician as this also verifies shift attendance. Your physician preceptor will collate the forms and use them to assist with your final evaluation.
Be sure to book some time with your Emergency physician preceptor near the end of your rotation to discuss your evaluation.
Please inform your preceptor and the rotation lead of any difficulties you may encounter during your rotation. We want to ensure that your time in the Emergency Department be educationally valuable.