Vision

  The vision of the Northern Health Authority is to be a model of excellence in rural health care.

Mission

The mission of the Northern Health Authority is as follows:

1. The Northern Health Authority will build and strengthen the health of communities, relationships, and people in Northern BC;
2.  We do this through community partnerships, health promotion, health services, learning, and research;
3.  We will monitor progress by continually measuring service quality, access to service, our work life quality, and costs. 

 Value Statement

  The key value of the Northern Health Authority is to live by our mission.

Link to Chief Operating Officer, Northern Interior HSDA Welcome Letter

Link to Program Director Welcome Letter

UNIVERSITY OF BRITISH COLUMBIA
Department of Family Practice
Prince George Site
ORGANIZATIONAL LIST FOR PROGRAMS

Lead Faculty: 
Curriculum Dr. Garry Knoll
Faculty Development Dr. Garry Knoll

Research Dr. Catherine Hagen
Behavioural Medicine Dr. Susan Knoll
Medical Informatics Dr. Bill Clifford
Geriatrics Dr. Ian Schokking

Family Practice Clinic: 
Dr. Garry Knoll Dr. Ed Turski Dr. Tony Eckersley
Dr. Susan Knoll Dr. Galt Wilson Dr. Scott Lennox
Dr. Dick Raymond Dr. Ian Schokking Dr. Kasandra Joss
Dr. Catherine Textor Dr. Sasha Riome-York Dr. Tammy Attia

Specialty Rotations:
Internal Medicine Dr. Winston Bishop
Surgery: Clinical Dr. James Appleby
Academic Dr. Clark Jamieson
Orthopaedics Dr. Michael Moran
Paediatrics Dr. Bill Abelson
Psychiatry Dr. Johannes Giede
Emergency Dr. Patrick Rowe
Obstetrics and Gynaecology Dr. Bill Kingston
Critical Care TBA

Rural Rotation, Hazelton BC
Dr. Bent Hougeson

ACADEMIC CURRICULUM PG SITE

Throughout the year from September to June an academic curriculum is provided by many of the preceptors from PGRH, visiting consultants, and other community resource people. They give of their time freely and eagerly to help with your education. IT IS VERY IMPORTANT that you attend the lectures faithfully and on time. Many of these people have voluntarily spent several hours in preparation for the seminar they are leading. The material provided has been highly rated by your predecessors for its applicability to practice. Of course if you are sick, out of town, on elective or holidays you may be excused.

If you are post call and catching up on sleep I would encourage you to attend as soon as you are fit.

Below is a rough outline of the two year program.

Each month the academic schedule is published in its completed form for you.

Given annually –

Patient-centered Interviewing
Emergency Wound Management
Depression Screening (Community initiative: Cnd. Mental Health Assoc)
Essential Surgical Skills (four full days-hands-on, care-based format)
• General Surgery
• Anaesthesia and Resuscitation
• Orthopaedic Essentials
• Obstetrical Essentials
Presented by the PG Branch of the Canadian Network for International Surgery
Neonatal Resuscitation Program (one full day)
ACLS Update (most years)
Research Skills: The R1 Quality Audit and the R2 Resident’s Project
Searching the Electronic Literature

Ongoing – (September to June, inclusive)

Internal Medicine Rounds (weekly – residents and staff doctors alternating)
Obstetrics Rounds (month-20 topics)
Paediatric Rounds
Surgical/Orthopaedic Rounds
Emergency Rounds (monthly) and Journal Club
Friday Rounds (weekly) – varied topics
Behavioural Medicine (monthly – 20 topics, see below)
Dermatology (five didactic sessions annually and four office sessions in the R2 year)
Clinical Decision Making (EBM curriculum and applications – 10 per year)
Geriatrics (6 per year)
Practice SOO’s (3 times per year)
SAMP of the Week (10 months a year)

CME Sessions in the Community – (examples from recent past include…)Resident attendance encouraged but not mandatory, usually subsidized.

Northern Doctors’ Day (annual regional CME event)
Children & Families Conference (annual multidisciplinary educational event)
CAEP MI Roadshow
CAEP Dysrhythmia Roadshow
PALS
Disability Management Conference (co-sponsored by Canfor and their unions)
Palliative Care Workshop (multidisciplinary, sponsored by Hospice)
Stroke Workshop
Rural Health Conference, UNBC
Contraceptive Workshop, UNBC
Contraceptive Workshop, Planned Parenthood

Academic Half Day Core Topics, by Discipline – (2 year cycle, 10 months per year Case based format)

Family Medicine (Dr. Galt Wilson) – mostly Doctor/Patient Relationship Issues

Patient-Centered Interviewing
Principles of Effective Communication
APLS (Advanced Personality Life Support)
When Newborns have Problems
Chronic Pain/Whiplash Injury
Chronic Fatigue/Fibromyalgia Syndrome
Traumatic Brain Injury
Principles (and Perils) of Prevention (after Dr. Ken Marshall)
HIV/AIDS
Discharge Planning

Clinical Decision Making (Drs. Catherine Hagen and George Deagle)

Principles of Critical Appraisal of the Literature and EBM
Use of Epi-Info
Applications (clinical topics, presented by residents)

Internal Medicine –

Respiratory Medicine: Adult pneumonia
COPD
Adult Asthma
Cardiovascular Medicine: Acute MI
Ischemic Heart Disease and CHF
Lipid Disorders in Family Practice
Diabetes: 3 sessions –Content of CDA Diabetic Care Course
GI: Chronic Diarrhea
Non-Surgical Abdominal Pain
Rheumatology: Rheumatic Disorders in Family Practice
Renal: Hyponatremia/hyperkalmeia (proposed)
Chronic Renal Failure (in progress)

General Surgery –

Essential Surgical Skills (see above)
Management of Breast Lumps

Palliative Care (Dr. George Deagle) 2 sessions:

Principles of Palliative Care and Hospice House
Symptom Management

Geriatrics (Dr. Ian Schokking) –

Geriatric Assessment Sessions (4 half days – R1)
Psychogeriatric Sessions (4 half days – R1)
Case Conference (resident chairing multidisciplinary team – R2 x4)
Six Seminar Sessions per year, from:
Confusion, Delirium and Agitation
Dementia
Depression, Anxiety and Insomnia
Falls, Instability and Osteoporosis
Incontinence
Pressure sores and common skin problems
Principles of drug therapy and practical prescribing
DNR, levels of intervention and competency issues
Chronic Pain in the Elderly
Parkinson’s Disease and Subcortical Dementias
Constipation
Geriatric Risk Assessment

Legal Issues –

The Doctor in Court
Death Certificates, Medicolegal Report Writing, and other legal obligations

Practice Management –

Arranging Locums
Other topics currently covered at Residents days and Research days

Nutrition – (facilitated by the Community Nutritionist)

Adult topics: obesity, diabetes, lipid disorders
Children and Adolescents: Infant Nutrition, Eating Disorders

Radiology –

Review of Emergency Radiology

Paediatrics –

Breastfeeding (presented by the lactation consultant)
Chronic Recurrent Abdominal Pain
Asthma
Fever in Childhood
Lower Respiratory Infection

Obstetrics & Gynaecology

10 sessions over 2 year cycle
Pelvic Mass and Ovarian Cyst Management
Contraception
Menopause
Pap Smears and Cervical Disease
Mennorhagia
Management of Labor and Delivery
Bleeding in Early Pregnancy
Post Dates Pregnancy
Pregnancy – Induced Hypertension
Complicated Deliveries
Premature Rupture of Membranes
Antepartum Hemorrhage
Abdominal Pain and Vomiting in Pregnancy

Sports Medicine – 3 sessions with Dr. Janet Ames (Chief of Canadian
Medical Staff, Nagano Olympics!)

Ophthalmology –

Family Practice topics (acute red eye, eye trauma, etc)

Ethics – (Dr. Galt Wilson)

Introduction of Medical Ethics
Consent for Treatment

Urology – 3 sessions including bladder and prostate disorders

Emergency Medicine – (Dr. Patrick Rowe)

Toxidromes
The Unconscious Patient in the ER
Airway Management Workshop

Behavioural Medicine – (Dr. Susan Knoll 20 sessions)

Depression Screening Prep
Psychological Testing
Breaking Bad News
Substance Use Disorders
Adolescent Issues
Sexual Assault/Child Sexual Abuse (2 sessions, same day)
Childhood Issues (Add, depression, common FP presentations)
Childhood: suicide risk assessment, urgent response protocols
Childhood: sexually intrusive behaviour/healthy sexual behaviours
Childhood: family issues, relationships, bed/school refusal, discipline
Occupational Medicine: chronic pain behaviour, workplace dynamics
Progressive Relaxation Techniques
Grief Counseling
Depression
Panic Disorder and Other Anxiety Syndromes
Schizophrenia and Other Psychotic Disorders
Bipolar Disorders
Personality Disorders
Cognitive Behavioural Therapy
Eating Disorders

FAMILY PRACTICE TIME

BEING THERE

 

 

One of the crucial features of a successful Family Practice Residency is getting yourself incorporated into the work of the Family Practice office. This happens in two contexts: block time and half days back. It is your responsibility to see that the medical office assistant knows when you will be attending well in advance. Changes should be made only in exceptional circumstances and with adequate notice.

 

SOME SPECIFICS:

 

•  The Medical Office Assistant (MOA) should have your schedule at least one month in advance. (Three months would be better!). Let her know when you will be away on vacation. Make sure she is aware of time scheduled elsewhere (Geriatrics, Dermatology, electives, special rounds) as soon as you are.

 

•  If you intend to personally follow up a patient problem, make sure you communicate that clearly with both the patient and the receptionist.

 

•  During surgery and orthopaedics in the R1 year, you may be required to see a patient in the ER during a Family Practice half day. Make sure the receptionist is aware of this and books lightly for you. Patients referred in the ER are the only surgical problem that takes precedence. And (except in dire emergencies) you have half an hour to respond. You cannot be required to do assists during this time. You are expected to be at surgical rounds. If they are taking place at 1630, make sure you communicate that in ample time as well.

 

Keeping your assistant informed of your commitments is an essential practice management habit. You should observe it from the first day of your residency.

PRINCE GEORGE FAMILY PRACTICE RESIDENCY PROGRAM
PGY 1
FAMILY PRACTICE BLOCK TIME

First year residents will spend two months in Family Practice block time. They will be under the supervision of their preceptors and responsible to them for their clinical work.

DUTIES INCLUDE:

 •  Active involvement in the care of patients who attend the practice of the preceptor, including office visits, inpatient care, house calls and nursing home care, palliative care, and obstetrics. These will also include working with other community agencies on behalf of the preceptors and their patients, as the preceptors themselves would do.

•  Two half days weekly are available for part-time electives either selected from the list provided or organized by the resident and approved by the program director.

•  Elective time will sometimes be pre-empted by Geriatric Clinics. Residents should refer to the schedule for these.

Normal Hours of Work:	0800 - 1700 h.
Evening and Weekend Call:	1:4, as per the Internal Medicine/Paediatrics Rota. Friday nights off.

Residents will be released from clinical duties for academic time, usually on Thursday mornings.

VIEWING

Direct Observation is a required element of evaluation. Residents must be observed at work by their preceptors on a regular basis. This includes making planned use of the videotaping equipment and getting the preceptor into the room to watch the resident at work. It is suggested that you divide the visit up and only observe one element (history taking, examination or formulation of treatment plan) of any visit.

There is a viewing log in each practice. We are asking residents to ensure that this is used. Documenting direct observation is crucial to keeping your program accredited.

OBSTETRICS:

Over the course of the two years during family practice block time it is hoped that all residents will deliver six expectant mothers from your base practice(s). Residents are asked to take the initiative here and do what they can. Attention is drawn to the next page which describes obstetrical hierarchy.

PRESCRIBING:

The current policy of the College of Physicians limits out of hospital prescribing to R2's who have passed both parts of the LMCC, completed 44 weeks of core training, and applied for the privilege. It is the law. It is of very limited use in the two year program.

Officially your prescriptions must be countersigned. In some offices you may use the rubber stamp for computerized signature. You must always make the identity of the responsible attending physician very clear. If you speak on the phone to a pharmacist make the identity of the responsible physician likewise crystal clear.

PRINCE GEORGE FAMILY PRACTICE RESIDENCY PROGRAM
PGY 1
EMERGENCY BLOCK TIME

First year residents will spend one month working in the Emergency Department. They work under the supervision of the physicians working in the Department and are accountable to them for their clinical work.

Duties Include:

1. Attending patients in the Emergency Department, assessing their presenting problems and formulating a diagnosis and treatment plan.

2. Assisting in cardiac and trauma resuscitation and other urgent clinical situations.

Normal Hours of Work: ER shifts are staggered shifts. Contact Dr. P. Rowe at teh beginning of the rotation and he will supply you with a schedule.

After Hours Call: None

Residents will be released from clinical duties for academic time (usually Thursday mornings) and one afternoon weekly for ongoing family practice experience.

PROGRAM LIAISON: Dr. Patrick Rowe

HINT: Read the accompanying material carefully. The flow of work in the ER is, by its nature, unpredictable. Don't leave the department when you are in the midst of caring for sick patients. Don't leave loose ends unresolved.

RESIDENCY ORIENTATION
EMERGENCY DEPARTMENT ROTATION
PRINCE GEORGE REGIONAL HOSPITAL

Welcome to your rotation with us. We hope it will be educational, stimulating, challenging and fun. As a group, the emergency physicians are committed for fulfilling your education objectives. We wish to outline our expectations of you.

If there is a trauma patient/arrest in a Trauma Bay , you are expected to go immediately to the Trauma Bay to help.

Notify the appropriate emergency physician, immediately, if a patient appears seriously ill or if there is a deterioration in the patient's condition.

Discuss ALL cases before discharge with the appropriate emergency physician. The emergency physician MUST sign all emergency charts.

Make sure that all your charts are completed each day before you go home.

In addition to the seriously ill, we see many patients who are moderately ill and some who are minimally ill. You are expected to acquire the skill of caring for patients expediently. You must learn to simultaneously care for three to five patients. You should be seeing a minimum of 20 in an 8 hour shift (2.5/hour) to make sure your exposure to common emergencies is complete.

Your participation in rounds is mandatory while in ER then more than welcome when in other rotations.

GUIDELINES FOR RESIDENTS:

  This is mandatory reading for your Emergency Rotation

Your encounter with patients in the Emergency Department (ER) is unique. The information presented here will help you to understand the issues, guide you through the process of charting on the ER form, demonstrate some pitfalls and establish the standards we expect.

WHAT IS UNIQUE ABOUT THE ER?

•  A large number of patients are cared for in a short period of time. Make sure you are writing on the correct chart and conveying your orders to the nurses on the correct patient (e.g. 4 patients in the department with the surname McDonald).

•  As opposed to an office practice, a large number of patients will be quite ill and some will be critical.

•  Invasive procedures are performed on multiple patients.

•  The patient's condition may evolve from benign to critical during the same time that we are responsible for their care.

•  Many patients have altered mental status due to trauma or intoxicants, thus complicating your ability to assess their condition.

•  The volume of sick patients, the noise level, the abusive patients, the interminable delays, your disrupted circadian rhythms, the need to push the load and personal insecurity, all culminate in stress and frustration. This must not affect decision making and technical skills.

•  We work shifts: responsibility for ill patients may be assumed from the previous shift and delegated to the next shift.

•  We only see the patient once: appropriate arrangements for follow-up must be made and charted. Remember that we often see patients at an early point during the evolution of their disease and they must understand the warning signs of a worsening condition (e.g., blow to the head, subdural; abdominal pain NYD, peritonitis).

WHO IS TAKING PATIENT'S HISTORY?

•  Sometimes it seems that everybody is! The paramedics take excellent histories and record the information. Read their notes. The period of hypotension, the lucid interval, the coma reversed by D50 are all there.

•  The nurses are very experienced and chart much useful information. Read their notes, some of which may be kept at the bedside.

•  You are negligent when you ignore the information provided by these works and fail to elicit this information yourself.

Did you ever notice how patients will change their history? If you are sure that your information is correct, but it is at variance with that recorded by others, you should note that discrepancy (e.g. nurse records severe crushing chest pain radiating to the jaw with diaphoresis and you record fleeting, sharp, reproducible chest wall pain).

WHO LOOKS AT VITAL SIGNS ANYWAY?

The unexplained vital sign will get you every time. The nurses chart on the patient very hour, including vital signs. Please look at these carefully. The patient with abdominal pain NYD is in our care for at least three hours if x-ray and lab tests are done. A pulse of 130 persistently during that time must mean something.

The respiratory rate is the most frequently ignored sign and often is recorded by estimation, rather than measurement. An elevated rate is a clue to metabolic acidosis, hypoxia and fever.

ALLERGIES AND DRUG INTERACTIONS;

Think before you prescribe, even if you are 20 patients behind.

Common errors include:

•  Rx Indocid for an asthmatic sensitive to ASA.
•  Rx Erythromycin without considering effect on theophylline levels (especially in kids).
•  Failure to note patient taking Coumadin.

SOME SUGGESTIONS FOR BEDSIDE MANNER:

  •  Introduce yourself to the patient.

•  Focus your attention on your patients. Try to make them feel that their problem is the most important issue for you at the moment.

•  Apologize for delays. Don't let the patient's anger make you angry.

•  Apologize when you are interrupted at the bedside.

•  Respect the patient's confidentiality, but address their relatives' anxieties.

•  Tell the patient you will be reviewing your findings with the attending staff physician. DO NOT give a diagnosis until you have reviewed your patient.

•  If you leave before the patient does, tell him/her what arrangements you have made for continuity of care. You must sign off your patients or transfer care before going home.

A common myth is that patients like to go to see the doctor. There is a small minority of ER abusers, but most people do not like to go to the ER. They are usually frightened, they worry about wasting the doctor's time, they don't like to smell of dirty feet and urine, and they hate waiting around for test results, etc. Take their presenting symptoms seriously and satisfy their reason for coming. Try to expedite the flow through the ER; would you like to wait around for 1 ½ hours for a sprained ankle evaluation?

Continue to see patients when shift change approaches and you know you will be handing them over in a short time.

WORRIED ABOUT A PATIENT, BUT AFRAID TO ASK YOUR ATTENDING?

We provide 24-hour-a-day on site coverage because we want to ensure quality medical care and we enjoy teaching. The ultimate responsibility for ER patient care rests with us. If you need help in any aspect of caring for a patient, please ask us.

LAB AND X-RAY

You must record your interpretation of every x-ray on the pink sheet enclosed with thex-ray. This is our fail-safe mechanism for missed x-ray diagnosis. The radiologist will bring errors to your or our attention the next day.

•  If you reassess a patient, or if there is a change in his condition, you need to note the time and progress on the chart.

•  If there is a long ER course, you must chart the patient's course in the ER and the final condition at the time of discharge. Consider dictating a report on the hospital system on complicated patients.

•  If you perform a procedure, write a procedure note, including complications.

It is simple: You are responsible, legally, for the patient until he is seen by another physician.

All charts must have a statement clearly recorded of the follow-up instructions that you give to the patient. This point cannot be stressed enough; use our follow-up sheets.

You must pay particular attention to follow-up in cases of head injury, abdominal pain NYD, chest pain NYD, fractures, when a disability is to be expected and when there is a language barrier.

Specific Cases:

•  Burns: make sure you say exactly when the next dressing change should be done. Patients may return to the ER for dressing changes, or use the Quick Response Program Social Worker for homecare.

•  Casts: all casts MUST be rechecked in 24 hours for fit, neurovascular function, and pressure areas. All fractures reduced in the ER must be x-rayed within one week, and again at two weeks, usually in the FP's office or to be followed in the Ortho Fracture Clinic.

REMEMBER: Extremity trauma is the #1 reason Emergency doctors call CMPA, mostly over follow-up problems.

•  Eye Injuries: remember that GPs don't have a slit lamp in their office. Patients with corneal abrasions should be pain free and have clear vision after 24 hours in a patch. Be liberal with return visits for re-examination with the slit lamp.

•  Patients with abdominal pain NYD must be re-examined the next day if they continue to have any pain at all.

•  If a C&S is done, make sure the patient understands how to get the report and what to do with the information.

•  Cellulitis and infections: the patient should know what the signs of treatment failure are and when he/she is to be rechecked. Patients are followed in the IV Therapy Outpatient Clinic.

•  We have printed sheets for head injuries, cast care, etc. It is not enough just to give out the sheet. Make sure the patient or a relative understands the instructors.

 

Think about follow-up on every patient you see.
Document your follow-up instruction.

Perils and Pitfalls

 •  Make sure your write-up accurately reflects the severity or the benign nature of the patient's condition.

•  Chart the patient's tetanus status whenever the skin is violated. Remember that older women and immigrants may not have had a primary immunization so arrange to complete this and cover them with tetanus immune globulin.

•  Chart the neurologic, vascular, and tendon status before you perform any procedure on an injured part and again at the completion of the procedure.

•  When a patient returns to the ER a second time for a problem that has not been diagnosed, strongly consider getting a consultation.

•  Undress patients with altered mental status to detect trauma that the patient may not perceive.

•  Put the side rails up on every patient after you finish your examination. If they fall out of bed, you are responsible for their injury.

•  If you must change any information that you have charted, a single stroke through the words, plus your initials and date are required.

•  The patient who is combative and non-cooperative due to injury or intoxicants is a special problem. Never assume they are "just drunk". He/she cannot sign our AMA if they have a potentially disabling problem. You are responsible for them until they are sober and can make rational decisions.

•  In terms of data collection, please:

• write the diagnosis clearly and press hard for the carbon.
• indicate all procedures, including ABGs
• if you have sutured an area and there are other injuries or diagnoses, list the diagnoses (e.g., laceration scalp sutured, PIP dislocation reduced, ruptured spleen).

You will meet with the emergency liaison physician at midterm and at the end of your rotation and an evaluation of your performance will be given. This will be a synopsis of evaluations given by each physician you have been working with. Areas of weakness and strengths will be addressed. Evaluation will be based on such areas as knowledge, rapport with patients and staff, procedures, examining technique and skills and efficiency.

Problems:

Department Head	Dr. John Ryan
Resident Affairs and Medical Students	Dr. Patrick Rowe

References:

Emergency Medicine: A Comprehensive Study Guide

1. Micromedix Information System. Regularly updated on CD-ROM information pertaining to all aspects of emergency medicine, including toxicology.
2. Annals of Emergency Medicine (library).
3. Clinics of North America Emergency Medicine, series (library)
4. Your staff emergency physician, please use as much as possible!
5. Keats, Emergency Radiology (in the department).
6. Harris and Harris, Emergency Radiology (in the department).
   

PRINCE GEORGE FAMILY PRACTICE RESIDENCY
PGY1
INTERNAL MEDICINE BLOCK TIME

 Education objectives are summarized on the education form and provided in detail in the UBC Departmental Residents' Handbook.

First year residents will spend two months on Internal Medicine. Six of our medical specialists do general internal medicine and maintain a subspecialty focus (Winston Bishop - Oncology, Michael Buchanan - Rheumatology, and Khalid Bashir and Robin Lowry - Nephrology, Donald MacRitchie - Cardiology and Diabetology, John Smith - Respirology). During each month, the resident will be assigned to work with one of them. The four consultants who practice strictly within their subspecialty areas (Joseph Sidorov - Gastroenterology, Lyle Daly and Gurwant Singh - Neurology, Michael Martindale - Dermatology) will involve the first year resident in clinics and cases of special interest. There is special provision for office Dermatology in the second year. Do not approach Dr. Martindale about this in the R1 year.

Hours of work will depend in part on the schedules of the preceptors. Call will be 1:4 with Friday evenings off, in accordance with the Medicine/Paediatrics Rota.

Residents will be released for academic time (usually Thursday morning) and one afternoon per week for Family Practice time.

DUTIES:

To assist the preceptors with patients under their primary care. This requires a thorough understanding of the history, physical and other investigative findings, diagnoses, and treatment plans for these patients. Provision of daily care, follow up of investigations and other tasks will be undertaken at the direction of the attending internist.

1. To see patients in consultation, in the Emergency Department and on hospital wards, as directed by the preceptors.
2. To present cases at clinical rounds.

EVALUATION:

At the conclusion of the rotation, the preceptors will complete a standard evaluation form.

PROGRAM LIAISON: Dr. Winston Bishop

    Some Suggestions for the Internal Medicine Rotation

•  Arrive earlier than your preceptor.

•  Try to know the patients better than he or she dos (a tall order to be sure, but something to shoot for!).

•  Anticipate the kind of information that your preceptor might require and get it.

•  Become a good friend to the nurses. Always treat them with courtesy and respect especially when they call you at night!

•  Do not initiate consultation with other specialists without the approval of the attending internist or family physician. Consultations should be arranged by direct, personal contact with the consultant.

•  Read the following document carefully.

•  Anesthetists have agreed to give you the opportunity to start central lines, arterial lines and other invasive monitoring in the operating room. You should contact the anesthetist to join them usually on their first case of the morning while on Internal Medicine rotation. This is your best chance to do these interventions in a controlled situation. Be sure your preceptor knows where you are.

RESIDENTS' DUTIES AND RESPONSIBILITIES
IN THE
DEPARTMENT OF MEDICINE

The resident will spend a period of two months in the Department of Medicine under the guidance of two separate internist/preceptors.

He/she is expected to learn through active and enthusiastic participation in patient care and with hands on involvement.

PATIENTS ADMITTED TO THE DEPARTMENT OF MEDICINE

 •  The resident is expected to carry out daily rounds on the internist/preceptor's patients and join the internist on his/her rounds at a pre-arranged frequency per week. At these rounds the resident should present his/her findings and working diagnosis as well as plan of management. Problems encountered will be discussed with the internist/preceptor.

•  The resident is expected to develop a treatment plan and write orders and is obliged to enter relevant progress notes.

•  The resident is expected to dictate histories, physical findings and other pertinent data on all new patients admitted to his/her internist preceptor's care and is expected to do the discharge summaries at the discretion of the internist.

•  The resident may transfer a patient from the ward to the Intensive Care Unit only after discussion with the internist.

•  Major changes in patient management should be made by the resident only after discussion with the internist.

ON-CALL RESPONSIBILITIES

•  During the usual working hours (0800 - 1730) the resident will take first call for the internist with whom he/she is working that month.

•  After the usual working hours if on call he/she will take first call for all patients in the Department of Medicine.

•  It is the responsibility of the resident to call the internist when in doubt about managing a patient problem.

•  It is also the responsibility of the resident to inform the internist if there is a significant change in clinical status.

PATIENTS IN EMERGENCY

The resident will see patients in the Emergency Department with the internist when on call, or as first call at the discretion of the internist.

Patients should not be admitted from the emergency by the resident without prior discussion with the internist.

RESIDENTS' ROLE IN ICU

Resident 1:

•  Make rounds with internist.
•  Orders written with the approval of the internist.
•  No first call role.

Resident 2:

•  Participate in patient care by daily patient examination and progress notes.
•  Write orders with approval of the internist.
•  Make rounds with internist.
•  Hands on learning of simple invasive procedures as insertion of arterial lines, central line insertion, chest tube insertion, lumbar puncture, etc.

CME ACTIVITIES

•  The resident during his/her rotation in internal medicine is expected to present at least three cases at medical rounds, preferably cases with whose care he/she was involved.

•  The resident is expected to search the literature and become knowledgeable of the conditions that are encountered during patient care.

•  The resident will attend other CME activities that may be put on by the Department of Medicine (eg: monthly journal club).

ABSENCE OF INTERNIST/PRECEPTOR

When the internist/preceptor is away the resident will continue to follow patients he/she has been following on his/her preceptor's service and consider involvement in the following electives:

Neurology
Oncology
Rehabilitation

PRINCE GEORGE FAMILY MEDICINE RESIDENCY PROGRAM
PGY1
OBSTETRICS & GYNAECOLOGY BLOCK TIME

First year residents will spend 8 weeks on Obstetrics and Gynaecology. They will be under the supervision of the Obstetrician/Gynaecologists and accountable to them for their clinical work.

Duties Will Include:

•  Being available to the Labour Delivery Room as required to provide care in the assessment of patients presenting to the unit, following the course of their stay there, and performing deliveries and other procedures under supervision. When patients are admitted to the unit and initially assessed, the nurse or resident that informs the attending physician of the situation should let him or her know of the resident's involvement. Dr. H. Tsang requests that you stay in close touch and seek direction from him. Occasional patients will also ask their physicians not to involve trainees. This should be recorded on the antenatal sheet. In an urgent situation, the resident should render needed care and contact the attending physician at his/her earliest opportunity.

•  Attending patients in the Emergency Room referred to the Gynaecologists. Please write your name next to the gynaecologist's name on the board in the ER when you are around and notify the gynaecologist on call. Contact Dr. Kingston about attending at the office as well (arrange this well in advance).

•  Following the progress of patients treated in the LDR and Emergency Room.

•  Presenting cases at rounds.

Normal Hours of Work: In general, 24 hours on, 24 off, 8 on; if there is little activity on the unit on a given day, the resident may wish to change the schedule accordingly.

Residents will be released from clinical duties for academic time (usually Thursday morning) and one afternoon weekly for ongoing family practice experience.

Some Suggestions :

Our nurses are very supportive of the residency program, but they also bear an enormous burden of responsibility for the care their patients receive. When you first arrive on the unit, they will have no idea what your strengths and weaknesses are. You must work very closely with them, particularly in the early going (but also, for that matter, for the rest of your career!), to keep them informed of what you are thinking and wanting to do. The LDR is a place where teamwork is the rule. The LDR nurses have worked with a good many residents and students over the years. They have found that, when the unit is very busy, it is often best to focus on one or two patients at a time, especially in the early going.

FURTHER SUGGESTIONS:

 •  Establishing a balanced working relationship with a relatively large group of nurses and physicians is your challenge on this rotation (and in your Obstetrical practice, for that matter).

•  Dr. H. Tsang usually does biophysical profile ultrasound in LDR on weekdays 1230 to 1400 hours. Residents are welcome to participate and pick up some skills in this area.

•  Maintain a high profile, as elsewhere.

•  Dr. H. Tsang also does amniocentesis. If you are interested to observe and to learn about this, please contact him.

•  Never put up a " call me " sign.

•  Establish your anticipated work schedule at the outset (use the calendar provided by the nurses, if you like) and keep them informed of changes.

•  If you are going to be away, post a notice to that effect.

•  Nurses, doctors, and patients expect you to be very actively involved in the care of patients you deliver. Don't expect to sail in for the conclusion, if you haven't been involved in the tough going.

•  Keep the most responsible doctor (and the GP, if they are not the same person!) informed of what is happening.

•  Work up a sensitive way to sound out the attending doctor (when time allows) on what his or her preferences are regarding various interventions during delivery. Some feel strongly about a "hands off, let things unfold as nature intended" approach. Others are more interventionist. Often there is a surprising intensity of feeling about how these very personal issues should be dealt with. Be sensitive to that.

•  This is a " feast or famine" business. Try to savour the quiet time. Be sure to gather the source books at the beginning of the rotation (Erkin, ALSO Manual, BCRCP Manual, Breastfeeding materials) and work through them.

•  Maintain your sense of humour. Try not to take it personally!

•  Review Obstetrical Hierarchy.

OBSTETRICAL HIERARCHY

(Review of Performing Deliveries with an FP Block Time Person Already Attached to Patient)

One of the themes and learning objectives in this case is collegiality. We aim to help all of you get comfortable with the role of family practice in a relatively small town setting. The core value of managing that happily and successfully is working together. Truth-be-told, towns with perennial recruiting problems often suffer from a revolving door built in part of poor relationships.

We are required to strive to provide R2's with the opportunity to follow and deliver six women during their block time. Having said that, many R2's are quire comfortable following the course of labour with the on-site R1 and having the R1 catch the baby. If anything unexpected and/or infrequent comes up, both residents are able to learn from the experience.

Our hope is that R1's doing block time will be able to follow their own practice patients too. R1's who have not yet done their OB block time need to be even more sensitive to working collaboratively with LDR nurses than the rest of us must be for our entire lives. In general, if you haven't done a stint with them, they won't have any basis for confidence in you. And you can't do much there without that. So R1's who haven't yet done OB are well advised to be deferential in all things. (I regard that as good practice-except for very rare, acute situations. I make a point of explicitly involving LDR nurses in every decision I make there. Good medicine is good theatre.)

As an aside, I'm sure you've noticed both here and at Med School that LDR nurses have their favorites and often don't hide that fact. The good news is that they are prepared to change their minds-in either direction. If you aren't one of the favorites, I'd challenge you to look at your own approach and see about correcting the situation. This isn't a residency program directive. It's a prescription for future happiness, wherever you choose to live and work.

In summary, an outline:

•  As far as it depends on you, live at peace with everyone wise words.
•  Get along, Get along. Get along.
•  R2s on FP block time get priority for patients they have been following in their own practices. R1s on OB should defer to them. Rationale: the global R2 theme is running a general practice and managing your own OB patients is obviously an important part of that. (R2s are welcome and encouraged to find a way of including the OB R1s and, where appropriate, to use deliveries as opportunities to provide some teaching themselves for their junior colleagues).
•  R1s on FP block time should defer to the R1s on OB. Rationale: it's not easy to get the foundation experience required to achieve R1 OB block time objectives for a number of reasons (the feast or famine pace of work there, the growing numbers of trainees at all levels, and declining opportunities at both the undergrad and residency level to get this experience.not helped by a plummeting birth rate here and elsewhere in Canada).
•  The involvement of residents is not an excuse for the family doctor to take his/her time coming in (we bear professional and legal responsibility for all the work that you do). The LDR nurses are suspicious that we are getting a bit lax about that and we need to correct that impression.

PRINCE GEORGE FAMILY MEDICINE RESIDENCY PROGRAM
INFORMATION SHEET FOR OBSTETRICAL EXPERIENCE
FROM THE LDR NURSES

Hello! And Welcome to Prince George Regional Hospital Labour Delivery Unit.

The nurses of the unit have prepared this information sheet to help optimize the obstetrical portion of your residency. It is, after all, to our mutual benefit.

Our shifts change at 0730 and 1930. You are welcome to attend report in the nurse's lounge at these times, and to join in on the plan of care.

We suggest that if you are on-call overnight and are not on the unit at 1930 hours, that you call in so the new shift of nurses are aware if you wish to be called.

If you have not seen a labouring patient, and have not been involved in her care, you will generally not be called for the delivery. It is to your benefit to be on the unit and visible if you wish to be actively involved in a woman's labour process, and to be called for vaginal examinations and decisions on her management. There is a sleep room on the unit if you wish to be around overnight.

If you wish to have any related experience while doing your obstetrical rotation (e.g. starting IV's, marking NST's, etc) let us know. If you are uncertain about your assessments, especially vaginal examinations please feel free to ask the nurse to double-check.

Please discuss any ideas about the plan of care with the nurse caring for the patient, prior to contacting the attending physician. Teamwork is a big part of our focus.

Inductions and Booked Caesarian Sections are recorded in our "Day Book" at the main nursing station. If you wish to be involved in these cases, you should be on the unit to meet the patient for the inductions, or go to the Operating Room to assist with the caesarian section. Most physicians welcome your involvement in their patient's care.

Teaching aids (neonatal resuscitation practice equipment, scalp leads, as well as a doll and pelvis) are available on the unit. Just ask the nurses for their locations.

The best local to call to contact LDR is 565-2334 (2334). The 2335 number is connected to voice mail and we don't always answer it if we are busy.

If you get our local on your pager, and a 911, or the other way around (e.g.2334911 or 9112334), on your beeper, that means "GET HERE NOW". Please don't call the unit to see what is happening - we are busy with the emergency that neces si tated the emergency call.

We have a CODE PINK Protocol, which is a designation for a true obstetrical emergency - prolapsed cord, severe fetal bradycardia without resolution, or a severe ante-partum hemorrhage. This is the cue for an emergency caesarian, and is the only time the OR will set up for one without the obstetrician contacting them.

Occasionally it will not be appropriate, or possible, to be involved with every patient on the unit, especially if the unit is very busy. If patient status is changing quickly, it is best to stay involved with only one or two patients, and not worry about the other patients. Sometimes you just can't be involved with all the patients to give optimum care to each one.

Remember to speak to the delivery physician about completing your Maternity Care Experience Log. They are far more likely to provide meaningful feedback at the time than a few days later when they check their mailbox and find the form there.

Be flexible. Each obstetrician handles things differently and each family phy si cian does things differently. It can be confu si ng but is a good educational experience. Spending a part of an afternoon with Dr. Tsang doing biophy si cal profiles is valuable.

Past Residents have suggested that:

It is valuable to use the "on call" board and communicate with nurses how involved you want to be i.e., when to call you for vaginal exams, assessments etc. Assessments are helpful and an important part of the rotation to learn to assess common complaints in pregnancy and is a good way to meet patients before they are in active labour and at the same time are a good way to gain experience managing common complaints such as urinary tract infections, preterm labour, PROM, etc., as well as learning to assess the latent phase of labour.

If you feel comfortable going in and repeating questions that the nurse has already asked, volunteer to do the occa si onal assessment start to finish. The nurse will supply you with a Maternal Assessment Form, and the patient's antenatal record, and previous assessments, if available.

Please, let us know if there is something that we, the nurses, can do to make this a more po si tive experience.

THANK YOU
LDR NURSES

UNIVERSITY OF BRITISH COLUMBIA

DEPARTMENT OF FAMILY PRACTICE

Prince George Site

Maternity Care Experience Log

 

 RESIDENT :  __________________________________________Date:____________________             

Document all that you did. This will be important for your future granting of hospital privileges.

 

            

		N/A	Satisfactory	Needs Improvement
The Resident:
Antenatal
	1. Assessed Patient
Intrapartum
	1. Managed Labour
	2. Managed Induction
	3. Managed Vaginal Delivery
	4. Performed Operative Delivery:
	*vacum extraction
	*forceps delivery
	*c-section assist
	5. Manged 3rd stage of labor
	*laceration/episiotomy repair
	*3 deg or 4 deg repair

Other/Emergency Intervention(s)

  Describe:____________________________________________________________________________________________

________________________________________________________________________________________________ 

 

Postpartum		N/A	Satisfactory	Needs Improvement
	1. Followed the patient on CFCU (are there progress notes?)

 

Resident's Performance:		Inadequate	Average	Superior
	1. Knowledge Base
	2. Case Management
	3. Procedural Skills
	4. Teamwork/Attitude

                                                         

Did the resident demonstrate a particular area of stength?
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Were there significant concerns? Please be objective and specific.
________________________________________________________________________________________________
________________________________________________________________________________________________

                                                                                                     

 

EVALUATOR'S SIGNATURE: _________________________________________________   

 

PRINCE GEORGE FAMILY PRACTICE RESIDENCY PROGRAM
PGY 1
PAEDIATRIC BLOCK TIME

 

 

First year residents spend 8 weeks (generally one warm-weather and one cold-weather month!) on the Paediatric service, under the supervision of a consultant preceptor. Educational objectives are summarized on the evaluation form and provided in more detail in the UBC Residents' Handbook.

 

Duties Include:

 

• Active involvement in the care of inpatients under the primary care of your preceptor. This will include making rounds daily, following the progress of each patient, and rendering care, as appropriate.
  
• Assisting your preceptor in office and clinic work.
  
• Responding to calls for paediatric consultation from the Emergency Department, as assigned by the on-call paediatrician. We will try to schedule you on call with your preceptor. When on call, during your paediatric rotation, priority shall be given to paediatric consultations and emergencies and urgent care. The internists have been made aware of this arrangement and if there are conflicting consultations remind your preceptors of this.
  
• Preparing a case for presentation at service rounds, as directed by the paediatrician designated for that month.

Normal Hours of Work:      0800 to 1700 h.

 

Evening and Weekend Call:    1:4, as per the Internal Medicine/Paediatrics Rota . Friday night off.

 

Residents will be released from clinical duties for academic time (usually Thursday morning) and one afternoon weekly for ongoing family practice experience.

 

PROGRAM LIASON:   Dr. Bill Abelson

Suggestions for Making the Most of The

Paediatric Rotation  

 

• Maintain a high profile, on the ward, in the ER, in the LDR, and in the SCN.
• Get to know the nurses. Ask about the discharge planning meetings and other multidisciplinary events. Make it clear that you are interested in what they do.
  
• Arrive early and make sure you know what is happening with your preceptor's patients before s/he makes rounds.
  
• Be sensitive to the kind of day the paediatrician is having. If it is Monday after a long weekend on call and no sleep, behave accordingly!
  
• Communicate with the family doctors and the non-paediatrican specialists, where appropriate.
  
• Take advantage of clinics at the Child Development Centre and the Northern Child and Family Clinic (ask Dr. Marie Hay about these).

PRINCE GEORGE FAMILY MEDICINE RESIDENCY PROGRAM
PGY 1
PSYCHIATRY BLOCK TIME

   

 

First year residents spend one month on Psychiatry. They are under the supervision of the Psychiatrists and accountable to them for their clinical work.

 

Duties Include:

•  Active involvement in the care of patients admitted by the resident and assigned by the preceptor(s).

 

•  Attending patients referred from the ER to the care of a Psychiatrist.

 

•  Attending off service patients where psychiatric consultation is requested, at the request of the consulting  Psychiatrist.

 

•  Participation in ward activities, as appropriate.

 

•  Presentation of cases at rounds.

 

 

On Call Responsibilities:

 

Varies. It is suggested that the resident place him or herself on call with one of the consultants, as they see fit, usually Dr. Giede.

 

Residents will be released from clinical duties for academic time (usually Thursday morning) and one afternoon weekly for ongoing family practice experience.

 

The psychiatrists are all good teachers and, by most standards, resident friendly. Touch base with Dr. Giede before beginning the rotation. See who is likely to be around during your month (the call schedule will be a good measure of this). Connect with those people particularly. As usual, maintain a high profile in the ER and make it clear to the on-call person each day that you are available to do consults.

 

PRINCE GEORGE FAMILY MEDICINE RESIDENCY PROGRAM
PGY 1
SURGERY BLOCK TIME

First year residents will spend six weeks in General Surgery and six weeks in Orthopaedics.. One month of postgraduate experience is a bare minimum as preparation for independent full service family practice, particularly in smaller communities. In order to make the most of this time, the surgical rotations are a bit more intense than some of the others.

 

Our aim is to give you a good start in acquiring confidence and competence in the assessment and management of acute surgical concerns. These things present at all hours of the day and night. A little extra time and energy invested for a month now has the potential to make life better for you and your patients as the years go by. That means making sure you spend as much time as permissible and possible on call.

 

The Collective Agreement limits weekend call to 1:4 in a three month period. You will be assigned two weekends in each of the surgical months. For most of you, General Surgery (two weekends) and ER (no call) are back-to-back, so that won't be a problem. Otherwise, weekend call frequency in other rotations will be adjusted accordingly.

 

These rotations are among the highlights of the year for most residents, but they can be grueling. You need to be sure to catch up on sleep when not on call.

 

DUTIES INCLUDE:

•  Active participation in the care of patients admitted to the surgeons the resident is working with at any given time. This includes being familiar with the history, physical findings, other investigations, and progress of the patients. In general, you will be primarily responsible to the surgeon on-call each day (or as otherwise assigned by Dr. Appleby or Dr. Moran). Your inpatients include those you scrub for and those you admit.
  
• Responding to requests for consultation in the Emergency Department.
  
•  Responding to calls from the ward concerning patients in the surgical discipline you are working with. And to do STAT call for all surgical patients.
  
• Presenting cases at rounds, as required.

 

NORMAL HOURS OF WORK:    0700 until the work is done.

Residents will be released from clinical duties for academic time (usually Thursday morning) and one afternoon weekly for ongoing family practice experience. During the half-day in the base practice, you may also be asked to cover the ER. You will not be asked to assist in the OR or cover the ward. As noted, one month of general surgery and orthopaedics is considered to be a bare minimum as preparation for independent family practice. If program objectives are not met during this time period (residents are referred to the UBC Resident Handbook and to the evaluation form) residents will be required to spend up to a month of additional block time in general surgery or orthopaedics during second year elective time, at the discretion of Dr. Appleby or Dr. Moran, as the case may be. Be sure to take the initiative and arrange a meeting with the liaison surgeon or his designate midway through the rotation. It may not be possible to meet these objectives if vacation time is taken during a surgical rotation. The assignment of additional time in surgery should not be construed as a failing assessment, but rather as an opportunity to gain the surgical experience needed for small town practice.

 

PROGRAM LIAISONS: Dr. James Appleby - Surgery, Dr. Michael Moran - Orthopaedics

 

SOME SUGGESTIONS:

 

•  Maintain a positive attitude during these rotations. If you are to survive them, you must learn to love the work. The surgeons do and they won't understand if you don't. They also know just how crucial this stuff is to your future happiness in family practice. Trust them. Five years from now, you will be glad you did.

 

•  Arrive early enough to get the work done. On evenings off, don't schedule activities before 1900h. It isn't worth it. That way, getting off on time will be a treat. Staying an hour late won't wreck your plans.

 

•  Become an expert at making rounds on surgical patients.

 

•  Make friends with the nurses.

 

•  Find out what Dr. Moran's favourite questions are before you go to work with him.

 

•  The orthopaedic surgeons suggest the residents plan their family practice half day for either Friday morning or Friday afternoon. They tend to use Fridays as a paperwork day and it is not very instructive for the residents.

 

PRINCE GEORGE FAMILY MEDICINE RESIDENCY PROGRAM
PGY 1
ON-CALL MEDICINE/PAEDIATRICS 

 

This rota is shared by the residents assigned to Internal Medicine, Paediatrics and Family Practice. Call is 1:4. Friday is a common night off, with no resident coverage. Resident vacation schedules may cause gaps in coverage at other times.

 

DUTIES:

 

•  To take first call for patients under the primary care of an internist or paediatrician.

 

•  During medicine and paediatric block time, the discipline you are in takes precedence. In particular, if you are doing Paediatrics, speak to both on-call consultants early on about that.

 

 

•  On evenings, to attend the first patient referred to each of internal medicine and paediatrics. A complete history and physical examination will be performed and recorded legibly (or dictated, with a brief written summary,) along with a differential diagnosis and treatment plan. If admission is contemplated, appropriate orders should be written. The on-call internist or paediatrician will be contacted directly by the referring doctor in the Emergency Department. Do not allow your involvement to cause a delay in notifying the consultant of the referral. Depending on the circumstances, he or she might attend and review the case immediately or follow up later. You should indicate your availability by writing your name alongside that of the on-call consultant on the board in the department and by contacting him or her earlier in the day.

 

•  On weekends, additional consultations will be assigned, as time permits, at the discretion of the on-call consultant.

 

Please refer to the Department of Medicine description of residents' duties.

AVOID ON CALL PITFALLS

 

•  Be aware of clinical red flags: potentially life and limb-threatening conditions that might initially appear less sinister. Among them, pulmonary emboli, electrolyte disturbances (particularly hyponatremia and hyperkalemia), occult sepsis (including perforated viscus and bacterial endocarditis), tuberculosis, ischemic limbs, compartment syndromes, premature labour, occult fractures (I invite you to add to the list. The CMPA is a good source!).

 

•  Significant problems must be communicated in a timely fashion to the responsible consultant. This is your job. But what if it is 4 a.m. and you aren't sure whether to call right then? Why not pay the emergency doctor a visit first? We are familiar with your dilemma. While not officially part of the job (a cap-in-hand, deferential approach is recommended), I think you will find few of us reluctant to provide advice in these situations. (Often your brief visit will be viewed as welcome relief from some of the more challenging middle-of-the night clientele!). Just make sure you are able to present the case succinctly and accurately. We aren't there to do your job for you.

 

•  In any event, you must document your findings and your actions in a legible note. As you prepared to leave the ward, I suggest the following mental exercise: imagine having to explain and defend your management of this case, if it turns out badly. In that light, there may be a few more things you want to do or write. (All of this assumes that you have in fact seen the patient. You can't make clinical judgments without assessing the situation yourself. Spare yourself the pain of learning this the hard way!).

 

•  If you have opted not to contact the attending physician at the time, be sure to call first thing in the morning.

CALL

 

 

There continue to be on-call periods where the consumers of our services (i.e. switchboard) have the wrong name. This is easy to understand, given the complexity and number of arrangements in the community.

 

The one best way to ensure you are called when you are on-call is to contact the appropriate people (switchboard for R1/in-house and inpatient; your Family Practice preceptor back up for community call) at the beginning of the coverage period and as often as necessary thereafter to be sure they have the correct information. That is your responsibility.

 

When doing R2 community call remember to page forward the after hours phone number to your pager.

 

Call forwarding 6148811

At each prompt enter the following

 

•  "0" in greeting.

 

•  "1995"

 

•  "16"

 

•  "62-pager number#"

 

•  "2-pager number-#"

 

And a reminder: members of the medical staff assigning weekend coverage of inpatients to others are required to do this in writing on the Doctors Order sheet before they leave.

 

Thank you.

 

 

 

Galt Wilson

 

IMPORTANT - It is important to notify the hospital switchboard when you are out of town. If you happen to switch call with another resident it is also important that you notify the switchboard, the units, and the doctor you would be working with.

 

 

FAMILY PRACTICE RESIDENTS

YEAR 1 PRINCE GEORGE SITE

ROTATIONS

July 1, 2004 - June 30, 2005

Resident

July 1-Aug 1

Aug 2-Aug 29

Aug 30-Sept 26

Sept 27-Oct 24

Oct 25- Nov 21

Nov 22 -Dec 19

Dec 20 - Jan 16

Jan 17 - Feb 13

Feb 14 - Mar 13

Mar 14 - Apr 10

Apr 11 - May 8

May 9 - June 5

June 6- June 30

1

M

M

GS

GS/O

O

O/G

O/G

Paeds

FP

FP

Pysch

ER

Paeds

2

Paeds

Psych

M

M

GS

GS/O

O

O/G

O/G

Paeds

FP

FP

ER

3

ER

Paeds

FP

FP

M

M

GS

GS/O

O

Paeds

O/G

O/G

Psych

4

FP

FP

Paeds

O/G

O/G

Paeds

M

M

ER

Psych

GS

GS/O

O

5

GS

GS/O

Paeds

O

ER

Pysch

FP

FP

Paeds

M

M

O/G

O/G

6

O/G

O/G

FP

Psych

Paeds

FP

O

O/GS

GS

ER

M

M

Paeds

7

FP

FP

O

O/GS

GS

M

M

ER

Paeds

O/G

Paeds

Psych

O/G

8

O/G

ER

Psych

FP

FP

O/G

Paeds

M

M

GS

O/GS

O

Paeds

9

Psych

Paeds

ER

Paeds

O/G

O/GS

GS

O

O/G

FP

FP

M

M

10

Paeds

O/G

O/G

ER

Paeds

FP

Psych

FP

M

M

O

O/GS

GS

11

O

O/GS

GS

O/G

Psych

Paeds

ER

O/G

FP

FP

Paeds

M

M

 

FAMILY PRACTICE RESIDENTS

YEAR 2 PRINCE GEORGE SITE

ROTATIONS

July 1, 2004 - June 30, 2005

 

Resident

July 1-Aug 1

Aug 2-Aug29

Aug 30-Sept 26

Sept 27-Oct 24

Oct 25-Nov 21

Nov 22-Dec 19

Dec 20-Jan 16

Jan 17-Feb 13

Feb 14-Mar 13

Mar 14-Apr 10

Apr 11-May 8

May 9-June 5

June 6-June 30

1

FP

FP

FP

FP

Critical Care

PG Elective

Elective

Elective

ER

ER

Rural

Rural

GP

2

ER

ER

Rural

Rural

FP

FP

FP

FP

GP

Elective

Elective

PG Elective

Critical Care

3

Critical Care

PG Elective

ER

ER

Rural

Rural

GP

FP

FP

FP

FP

Elective

Elective

4

Rural

Rural

Elective

Elective

GP

FP

FP

FP

FP

Critical Care

PG elective

ER

ER

5

FP

FP

FP

FP

Elective

Elective

ER

ER

Rural

Rural

Critical Care

GP

PG Elective

6

Elective

Elective

PG Elective

GP

ER

ER

Rural

Rural

Critical Care

FP

FP

FP

FP

 

FP - Family Practice

GP - Geriatrics/Palliative Care

Rural - Hazelton

VACATIONS

  I have an inescapable management responsibility to keep track of how much time you folks take off. The Collective Agreement says you get twenty (20) working days and that that means a benefit of four (4) calendar weeks; a week is defined as seven (7) consecutive days. We are to make every effort to permit a Resident at least his/her third choice.

 

The interpretation for Prince George is: You may not take less than one full week at a time. There are a number of reasons for this. These should be real vacations. A real vacation needs to last long enough for you to wind down and relax. It needs to be administratively simple both for us and for the people you are working with to keep track of.

 

I have the impression we are getting a bit sloppy about all this. I understand some of you are taking a day or two here and there. Please, therefore, note that:

 

•  All vacation requests must be submitted in writing to Lisa and approved by me in advance (you will receive written notice of approved vacation periods).

 

•  Vacation periods are normally set before the start of the academic year; any changes must, once again, be requested in writing with appropriate notice.

 

•  Vacation periods of less than a week will be approved only in extraordinary circumstances; vacation periods should be in multiples of one calendar week; residents will not be scheduled on call for the weekend at either end of a vacation period.

 

I don't like having to be legalistic about all this, but it is the only fair way to do it.

 

 

STATUTORY HOLIDAYS

 

 

There appears to be some confusion about this issue though I believe it has been made very clear at the time of resident orientation.

 

No Prince George resident is required to work on any statutory holiday. The program essentially shuts down on stat holidays. Having said that, sometimes (primarily during emergency rotations) a resident may prefer to work on the stat holiday because it is busier and educationally more valuable. In that case, the resident (in the words of the Collective Agreement) "... shall receive an alternate day off without loss of pay to be taken at a time by mutual agreement within the academic year".

 

If it is your preference to cover a statutory holiday, please let me know. I will in-turn request that you choose some other day with the approval of the preceptor responsible for that day.

 

 

 

CHRISTMAS HOLIDAYS

 

The Collective Agreement provides for five consecutive days off during the Christmas/New Year period (that period comprises all the STAT holidays and the two full weekends that are attached to them - as it turns out a total of 12 days). The local custom has been to shut down for five days (including the nearest weekend) around Christmas and to throw in the New Year's STAT holiday where it falls just because we always shut down for STAT days.

 

Therefore, the Residency Program will close from December 24 to 28, 2003 inclusive and on January 1, 2004 .

 

 

THE DISCRETIONARY DAY OFF

 

 

PAR-BC has pointed out that much of the end-of-June, pre-R1 orientation activity is administrative and not really educational. They contend it should be paid time.

 

Unfortunately, we have no money.

 

What we do have is the potential for flexibility. In fact, just about every resident, at tome point during the two years, needs us to be flexible in providing an extra day off for something that falls outside what the collective agreement provides for. For example, there is no clause to deal with family weddings or the desire to accompany a relative to a doctor's appointment (!).

 

From this day forward, all residents shall have a discretionary day off, in lieu of pay for the orientation. You aren't obliged to have a particular reason for this, but you do need to ensure that service disruptions are minimized. For example, in normal circumstances you will give your preceptor and medical office assistant lots of notice.

 

I do expect the availability of the discretionary day to cut down on the number of special requests for days off. Thanks, in advance, for your help with this.

 

Enjoy.

 

 Ed Turski, MD

ATTENDANCE AT ACADEMIC

PROGRAM SESSIONS AND ROUNDS

 

 

We appreciate that the demands of patient care, preceptor expectations, and personal and family needs are a constant struggle for residents. Regular attendance at rounds and our own didactic program can sometimes become a casualty of this pressure. Don't let it.

 

You are a relatively small group. When you aren't there, you are missed. Many presenters get one chance in a two year cycle to share an important topic with you. They put a lot of effort into their sessions. It isn't fair, if you don't make every effort to be there. The credibility of the program suffers. Besides, it is, strictly speaking, part of your job.

 

Legitimate excuses for lateness and/or non-attendance include:

 

•  Vacation

 

•  Out of town electives and Hazelton rotation.

 

•  In accordance with the Collective Agreement, less than four hours of sleep while on call the night before.

 

•  Disabling illness or injury.

 

Travel to Friday sessions in Vancouver is not an acceptable excuse.

 

Attendance will be taken at our own academic sessions (not at hospital rounds). If you are absent, please provide Lisa with a note giving the reason.

 

Sometimes academic sessions will fall at times other than the usual Thursday mornings. When you receive your schedule, please review it and mark your personal calendar or whatever you do to keep track of such things.

UNIVERSITY OF BRITISH COLUMBIA

DEPARTMENT OF FAMILY PRACTICE PRINCE GEORGE SITE

PART-TIME ELECTIVES

 

 

PART TIME ELECTIVES

 

Up to two half days of Family Practice block time may be spent doing electives. Some of these might be fitted in at other ties. Contact the person indicated to set these up. Feel free to follow up other opportunities, as you find them. We will be seeking your assessment of electives and your suggestions as to what we might add to the list. Please let us know about the elective experiences you do complete by using the short form that Lisa has.

 

ANAESTHESIA
Intubation Skills	Dr. Michael Whitehead
Pain Management Concepts	and
Inserting Arterial and Central Lines	Colleagues
FAMILY PRACTICE
ADP/Detox/Nechako	Dr. Lawrence Fredeen
Acupuncture	Drs. M. O'Malley, I. Schokking, P. O'Malley
Autogenic Training	Dr. Dick Raymond
Eating Disorder Clinic	Dr. Laura Brough
Hospice/Palliative Care	Dr. Phil Staniland
Hypnosis	Dr. Dick Raymond
Infant Circumcision, Vasectomy	Dr. Garry Knoll
Minor Procedures	Check List Daily
Native Health Society	Drs. Riome, Lennox, York
Occupational Health	Dr. Michael O'Malley
Sexual Assault Examination	Dr. Susan Knoll
Workers' Compensation Board	Dr. Norm Byrne, Dr. Anne Pousette
LABORATORY MEDICINE (and appearing in court)
Post Mortem Examinations	Dr. R. McGuinness, Dr. K. Tsang, Dr. E. Van Iderstine, Dr. C. Zhou, and Dr. G. Roden
MEDICAL IMAGING
Topics on Request	Dr. Larry Breckon and Colleagues
PAEDIATRICS
Child Development Centre	Dr. Marie Hay
Child Abuse Assessments	Dr. Marie Hay
PSYCHIATRY
Intersect (Child and Adolescent Clients)
Forensic Psychiatry	Dr. Barbara Kane
PUBLIC HEALTH	Dr. Lorna Medd
SPORTS MEDICINE	Dr. Janet Ames
	Brian Farrence (Pedorthist)
SURGERY
Hand Clinic	Dr. L. Boileau, Dr. Purnell, Dr. Bengezi
Plaster Room	Orthopaedic Surgeons
Minor Procedures	Dr. Bill Simpson
Urology	Drs. C. Jamieson, R. Hampole, G. Palmer
Flex or Rigid Sigmoidoscopy	Dr. James Appleby
Hemorrhoid Banding	Dr. James Appleby & Barry Hagen
Ophthalmology	Drs. Aleksandra Veselinovic, Marion Roesch, John Konkal
ENT
OTHER PROFESSIONALS
ALS Paramedics

 

OTHER PROFESSIONALS

ALS Paramedics

 

The above are truly electives, in the sense that you are not required to include any of them, if remaining full-time in your base rotation is what best meets your needs. Having said that, a minimum of seven half-days per week is considered full-time in Family Practice Blocks. Other mandatory time includes the Thursday mornings, scheduled Geriatric activities and (when doing specialty rotations...) Family Practice half days. R-2's are entitled to take ½ day weekly during Family Practice time, to work on their projects, if they wish.

 

OUT OF PROVINCE ELECTIVES

 

 

Residents doing electives outside BC should take note of the following section of the Medical Practitioners Act Rules (Part X, Sub 73);

 

An applicant for registration shall satisfy the Registrar as to the applicant's good character and good professional conduct in such manner as the Registrar sees fit and shall comply with the following conditions:

  

•  applicants who have previously practiced outside the province must provide written proof of their good standing and conduct from the licensing body or bodies where they practiced.

 

Residents doing an out of province elective (in Canada or in another country) must acquire a Certificate of Good Standing from the local licensing body. This certificate needs to be provided to the College of Physicians and Surgeons of BC to ensure that your licensing application in the future will not be jeopardized.

 

All applicants for licensure and all licensed physicians who work outside the Province of BC must produce a certificate of good standing from every jurisdiction that they have previously worked in prior to being granted full registration, or prior to resuming practice in BC. This is to ensure that any patient complaints or concerns in other jurisdictions are identified to the BC College that has as its mandate the protection of the public.

 

Anyone who does not identify having practiced in another jurisdiction, even as a resident, is breaking the law. The College takes these matters very seriously.

 

If you need further information, please contact the College of Physicians and Surgeons of British Columbia at (604) 733-7758.

SOME REFLECTIONS ON THE R-1 EXPERIENCE HERE IN PRINCE GEORGE

 

 

All of you have numerous years of post-secondary education behind you. You have a wide range of experiences that extend well beyond medicine. And yet, your clinical experience is limited.

 

This year is your best opportunity to gather up a bank of medical experience, to draw from for the rest of your career. It's no fun being a novice, but the staff at this hospital are ready to accept you as a medical colleague. They ask only one thing in return: that you put your heart and soul into the challenge. That, I submit, is the key to a rewarding R-1 year.

 

PGRH is not what you are used to. It is not a tertiary centre. It is not even a teaching hospital, really. I don't know anyone on staff with ambitions to make professor. It is a place where a good many mostly enthusiastic, invariably-busy clinicians deal with a fascinating variety of clinical problems.

 

Several aspects of the situation here may make it seem tougher than the other sites:

 

•  On-call tends to be busy and more frequent. It is a lot like the pace you will find in a small northern community that doesn't have many doctors. We want you to feel prepared for that kind of work when you leave us. Even if you don't practice in a place like that, we think you will benefit from the confidence gained.

 

•  On-call can be a lonely time. There aren't a lot of other house staff people sitting around the lounge at 22300 hours. There is always a group of us to be found somewhere, though, whether in the Emergency Department, the LDR, or the surgeons' lounge.

 

•  You won't often have a senior resident immediately at hand to give you direction.

 

•  The learning opportunities won't often fall into your lap. If you aren't around, the people you are working with will just push on without you. A " please phone me" note won't be very effective.

 

•  It will often be up to you to give structure to your rotations. Even most of the willing teachers are primarily there to see the patients. It is frustrating to have to anticipate their movements. But you do.

 

I think the opportunities here more than compensate, but making good use of them is a challenge:

 

•  Being the only resident on a service means you have no competition for the good stuff.

 

•  I'm not expecting you to agree, but being almost-overwhelmed and learning to priorize and survive in a setting where sympathetic attending staff are available to bail you out is a rare opportunity these days. I think you will someday appreciate it. Perhaps not while you are in the midst of it.

 

•  If your specialist-preceptor is a bit aloof, it is a stretch for you. A moderate amount of tension is necessary for learning to take place.

 

•  I think several aspects of the program here (particularly family practice, emergency, obstetrics, and orthopaedics) are the best you are likely to find anywhere. You be the judge.

 

Some survival strategies:

 

•  Sleep when you have the chance! I can't emphasize this point enough. The best remedy for sleep deprivation is to catch up. I know that makes for a depressing personal life, but this won't go on forever. Next year call ends at 2300h. You have one year to cram a lot in. Go home, read a book, and go to bed.

 

•  Support each other. No one understands your difficulties like your colleagues do. And when attending staff colleagues tell you how much tougher it was when they were at your stage. Well, every generation says that. I don't expect you to be impressed. I'm not sure they do.

 

•  Make sure you come back from vacations refreshed. Be a bit less ambitious with holiday plans than you might have been in the past.

 

•  Learn to love the work. It is the best job in the world. That's why you chose it. When you start to feel badly about the abuse we doctors think we must endure , well - I expect you already have your own strategy for putting things in perspective. I won't bore you with mine.

TEN TIPS FOR FIRST AND SUBSEQUENT

CALL NIGHTS

("Staying Human During Residency Training" - Alan D. Peterkin)

 

 

•  Pay close attention at evening sign-out rounds to particular problems with patients. Make a "scut" list. Clarify instructions.

 

•  Clarify with your senior how to proceed during call if you have questions and how to reach him or her to discuss cases. Clarify your role with the medical student as well. Do not hesitate to ask for teaching or help - that is why you are there.

 

•  Make sure your beeper works.

 

•  Prevent rather than treat. When you see a patient on a ward, ask if there are other concerns/problems while you're there.

 

•  When you are called to assess someone, see the patient, and write a note on every patient (as legal documentation and medical update). Leave clear instructions with the nurse about when to call you again. If the nurse calls to inform you of something, discuss whether the patient needs to be seen.

 

•  Carry good pocket manuals for differential diagnosis and treatment guidelines.

 

•  Organize your time strategically. Deal with all problems and review all laboratory and x-ray results service by service or floor by floor. Assessing the patient and writing orders in the emergency department will save you travel time and even "scut" work because most tests and blood sampling can be done there.

 

•  Although you have backup and may not even be the first to see patients, discipline yourself to conduct thorough physical exams, differential diagnoses, work ups and treatment plans to avoid the temptation, especially when tired, to readily accept someone else's management. After residency you will not have this opportunity to test yourself under supervision.

 

•  Rehearse particular emergency management plans in your mind on the way to assess the patient. This will reduce anxiety and increase efficiency. On-Call Principles and Protocols is an excellent book that takes you step by step through key on-call problems and their management.

 

•  Determine sign-over time the next morning and your role then (eg presentation of new admissions). Look after yourself the next day!

TIPS FOR REGULAR SLEEP

 

 

•  Aim for a consistent post-call sleeping pattern or ritual.

 

•  Take a 20-minute "wind down" period or warm bath before going to bed - reduce the frequency of large meals and intake of greasy foods before retired, but eat enough to prevent your waking hungry.

 

•  Reduce or eliminate alcohol, caffeine and tranquilizer consumption before retiring.

 

•  Increase exercise, but not immediately before bedtime.

 

•  Use the bed for sleep only; if you cannot sleep, do something else out of bed and delay your usual bedtime by 1 or 2 hours.

 

•  Use earplugs, unplug the phone and make sure the temperature and noise levels of your sleeping quarters are comfortable.

 

EXERCISE

 

 

Regular exercise seems almost impossible to most interns and residents because of fatigue and time pressure. It takes some inventiveness to incorporate exercise into a busy schedule. Aerobic exercise, at intervals of 20 - 30 minutes, three times a week, is an ideal solution to emotional stress because it enhances relaxation through endorphin release, decreases depressive symptoms, increases energy levels, improves sleep, dampens the fight-or-flight response and improves the physiologic response to emotional and physical challenge. Many residents walk or run to work and climb stairs at work rather than take the elevator. Others buy an exercycle or rowing machine for home use, live in an apartment complex with a pool or sports facilities or join a gym near the hospital for use during the less busy rotations. Others arrange for coverage and take an hour off to use hospital facilities such as the pool or Nautilus machines in the Physiotherapy Department.

 

Besides regular exercise, various simple techniques of relaxation can significantly reduce physical tension, anxiety and fatigue.

 

University of British Columbia

Department of Family Practice, Prince George Site

 

Travel to Residents' Day, Research Day, and

Other Out-of-Town Events

 

 

At present, the Prince George Program is in a position to pay up to $500.00 per resident per event for Residents' and Research Days - truth is we depend on the fact that most residents stay with relatives or friends and everyone does their best to book cheap travel. Don't assume West Jet is always cheaper. It isn't. The budget doesn't provide for the full amount for all residents and hasn't needed to. Any money saved by booking excursion rates may be divided equally to help offset the cost of travel to events like CCFP exam or the LMCC II.

 

Local activities will be scheduled assuming that residents will take advantage of air travel, to keep time lost from the program to a minimum. For example, there will often be Thursday morning academic sessions scheduled the day before Friday Vancouver events. You are required to attend both. If you wish to take an extra day to drive each way or to extend the trip and visit your family, you must use holiday time and this requires advance planning and my approval.

 

When Vancouver events fall on a Friday or a Monday, Saturday night lay-overs are permitted, but residents are expected to keep accommodation costs reasonable (so that the 14-day excursion fare applies). A resident on call for the weekend after a Friday event should take the first flight on the Saturday and head for work upon arrival back in Prince George (this will often end up costing more than $550 - we will cover the full amount in this instance).

 

Experience has taught us that a clear statement of policy on this issue is needed. I hope this is clear. Please let Lisa or myself know if you have questions.

 

Your responsibility is to be clear on these dates well in advance and to make your travel arrangements accordingly. We appreciate your assistance with this.

FINANCIAL ASSISTANCE:   2003-2004

 

 

The Prince George Program is funded mostly by a block grant from government established at our inception in 1995. Over the years we have done our best to offer assistance to Residents in attending various Program events (Residents' and Research Days), CME, and Examinations. This amount was recently augmented by additional Resident Activity Fund money from UBC. Amounts vary from year to year, depending on other Program demands. For Residents' and Research Days, we rely on the fact that most residents do stay with family or friends and do not require the full amount - any money you save is available to assist others. We appreciate your help with this.

 

For 2003 - 2004 amounts will be:

 

Residents' and Research Days:

 

Receipted expenses (fare, airport transfers, accommodation and up to $40/event day cab fare-sharing a rented car is encouraged) up to a maximum of $500 for each of the two events. This is where we need your help.

 

Site Retreat:

 

A group event. Our contribution: $75 per resident attending. We need receipts.

 

Prince George Site CME assistance $550 per year with the Prince George Site.

 

Resident Activity Fund:

 

All UBC Residents are eligible for up to $500 over the two years for registration at relevant courses and other educational events. These need prior site director approval.

 

LMCC/CCFP:

 

R2s are eligible for a maximum of $450 total to help with receipted expenses relating to these examinations.

RESIDENT ACTIVITY FUND USAGE

Department of Family Practice, Postgraduate Program

 

 

Funding is provided through the Postgraduate Dean's Office to support resident educational group activities such as ACLS, ATLS, ALSO, books, and software.

 

In addition, a total of $500 will be available to each resident, over the period of the two-year residency program, which may be applied with the consent of the Site Director to individual educational activities.

 

The use of these latter funds by individual residents must be approved by the resident's Site Director.

 

It is expected that the $500 resident funding will go to support registration at conferences or other educational events, or items deemed appropriate and worthwhile by the resident and Site Director.

 

In general, the funding will be applied in the second year of the residency program; however, some adaptability is acceptable from site to site (for instance, to allow the Aboriginal Program residents to attend appropriate aboriginal networking events in the first year of the residency program).

RESIDENCY TRAINING

GUIDELINES CONCERNING THE PHARMAECEUTICAL INDUSTRY

 

 

The following document from the McMaster Medical Residency Program contains guidelines regarding house staff interaction with the pharmaceutical industry. This document reviews the underlying assumptions of the document, the philosophy and the Residency Program and suggests specific guidelines concerning interaction of residents with pharmaceutical industry.

 

Underlying Assumptions

 

•  The pharmaceutical industry has many activities and values which are beneficial to society. These include improving patient well being by making better drugs available, and improving physician prescribing. Nevertheless, within the structure of our society the appropriate primary goal of the industry is making a profit. This primary motive is likely to influence all aspects of industry behaviour.

 

•  Reflecting a commitment of the pharmaceutical industry to physician education, the industry has some unique and very valuable educational material which should be made available to residents.

 

•  Given the university's financial climate, it is sensible to obtain support from the industry for worthwhile educational endeavors.

 

•  Gifts from the industry (including free lunches) should not be accepted.

 

•  Financial contributions to residency program activities should not result in special or increased access to residents by pharmaceutical industry representatives.

 

Philosophy of the Medical Residency

 

A number of principles of the educational philosophy of the McMaster Medical Residency Program can be seen to bear on the optimal approach to the industry and its activities.

 

•  Learning should, as far as possible, be problem-based and self-directed.

 

•  The objectives and the learning agenda should be set by the residents and faculty.

 

•  Residents should be encouraged to practice evidence-based medicine. This implies that one's clinical decisions should, as far as possible, be based on an objective assessment of available evidence.

 

•  The opportunities for the residents to interact in a vigorous and stimulating fashion with the academic faculty should be maximized.

•  Medical residents should be encouraged to take a broad view of their practice, the influences of their practice, and the relation between their practice and society as a whole.

 

 

 

 

Guidelines for Interaction with the Industry

 

•  If it is known that the industry has a particular educational resource which would help fulfill an independently derived educational goal, that resource should be sought.

 

•  Industry sponsorship for educational events which are seen as high priority for the Residency Program, and for which funding is not available from the department may be sought. This could include activities such as resident research, the academic half-day, or resident travel to conferences designated as a priority for residents of the Residency Program.

 

•  Industry representatives should be invited by each CTU Director to submit education materials. These materials can be reviewed by the CTU Director and, if they desired, by senior residents. If judged suitable, the materials could be kept in a CTU library. Particularly valuable material could be incorporated in educational sessions.

 

•  The Residency Program should not be party to residents being the beneficiary of non-educational largesse from the industry (such as food, pens, stationery, conferences or meetings which are not perceived as being an educational priority by either the residents or the Residency Program, etc).

 

•  The Residency Program should not facilitate access of drug representatives to the residents. Specifically, industry sales representatives should not be invited to residents' closed sessions (such as the academic half-day or noon-hour rounds on the CTUs). This proscription is not intended to apply to educational events intended for wider audiences (such as grand rounds or citywide regional rounds).

 

•  Any funding from industry can be acknowledged with, for instance, a statement at the beginning or end of the session that support comes from a particular company, or that materials have been produced with the help of industry funding. These are a number of expectations that the industry might have if they are sponsoring educational activities. These may include participation in the nature of the educational activity (showing a film of the drug company's choice, for instance), or allowing an industry representative to attend, and subsequently talk with the residents. If funding is contingent on such industry input into the program, or the Residency Program making residents accessible to representatives of the industry, the funding should be declined.

 

FIRST YEAR FAMILY PRACTICE RESIDENTS

Make Sure You Get a Family Doctor of Your Own

 

 

I'll admit to some bias in this, but my advice is that the most important support person for you to contact in the early weeks of your re si dency program is a family doctor.

 

Even if you don't anticipate needing the services of an MD, give the office of the doctor of your choice a call and get on the list. And, if you aren't feeling well, don't he si tate to see that doctor and take advice.

 

I'd suggest a first class physician not directly connected with the Residency Program. We have a great many who might qualify, including:

 

Dr. Ruth Powell	614-2330
Dr. Don Bond	563-2622
Dr. Lawrence Fredeen	562-2644

 

All four have expressed a willingness to take residents into their practices.

UNIVERSITY OF BRITISH COLUMBIA

Department of Family Practice, Prince George Site

1230 Alward St. , Prince George BC V2M 7B1

Telephone (250) 565-2599 Fax (250) 565-2569

 

 

Galt Wilson , MD , CCFP, FCFP

Clinical Professor

Site Program Director

Telephone: (250) 563-3024

E-mail: galt@netbistro.com

 

 

Dear Doctor:

RE:   DR.

 

I have concerns about the health of Dr._______________________           .

 

I am obliged to in si st that Dr._____________   put him/herself in the care of a family physician and provide documentation of his/her compliance with his/her doctor's advice and his/her fitness to care for patients.

 

The diagnosis is, of course, none of my bu si ness unless you and Dr. _________ wish to share that information with me as part of facilitating an appropriate return to work.

 

To that end, I would be grateful if you would complete the attached form and return it to me. I will promptly pay your usual fee for this service.

 

Sincerely,

 

 

 

 

Ed Turski, MD

Site Program Director

 

UNIVERSITY OF BRITISH COLUMBIA

Department of Family Practice, Prince George Site

1230 Alward St. , Prince George BC V2M 7B1

Telephone (250) 565-2599 Fax (250) 565-2569

 

Date:

 

 

 

I hereby certify that Dr.  ___________________________________  
     

•   Is medically fit to provide patient care in his/her capacity as a family practice resident..
  
•   Is under my care and complying with my treatment plan for him/her.
  
• I have Dr.____________________    permission and will notify Dr. J. Galt Wilson, Site Program Director immediately, should Dr.         's medical condition deteriorate to the point where it may impair his/her ability to provide safe and effective care or should he/she fail to follow my treatment plan for him/her or should he/she leave my practice. 

 

 

Signed: Dr.

 

Name (Printed)__________________________________________________________________________________

 

 

I, Dr.  ____________ do consent to the release of the information provided above to Dr. J. Galt Wilson and give permis si on to my doctor to communicate with Dr. Wilson in accordance with the terms set out above.

 

 

 

Signed:                 Date:

 

To view policy regarding the resident in difficulty:

http://www.familymed.ubc.ca/residency/about/educresidiff.htm

EXTRACURRICULAR ACTIVITIES

Prince George Medical Staff

 

Dr. Jamie Appleby - General Surgeon	Men's Hockey
Dr. Janet Ames - GP	Kayaking, Sports Medicine, Canoeing
Dr. Winston Bishop - Internist	Tennis, Fishing
Dr. Laura Brough	Running   , Swimming, Keep Fit Classes
Dr. Steven Chang - GP	Men's Hockey, Fishing, Hiking, Ultimate Frisbee, Canoeing
Dr. Bill Chow - GP	Golfing
Dr. Bill Clifford - GP	Computers, Hiking, Canoeing
Dr. Pierre Ducharme - GP	Theatre Workshop
Dr. Barry Hagen - GP	Long Distance Running
Dr. Catherine Hagen - GP	Mountaineering, X-Country Skiing
Dr. Kasandra Joss - GP	Hiking, Rock climbing, Vegetable Gardening
Dr. Barb Kane - Psychiatrist	Wind Surfing
Dr. Garry Knoll - GP	Squash, Water Skiing, Golf
Dr. Susan Knoll - GP	Coffee/Home Cooked Meals, First Baptist Church , X-Country Skiing
Dr. Al Leighton - Radiologist	Kayaking
Dr. John Paget - GP	Cycling, X-Country Skiing
Dr. Anne Pousette - GP	Figure Skating, Downhill Skiing
Dr. Dick Raymond - GP	Theatre Workshop, squash, fishing
Dr. Dave Rutledge - GP	Skijoring
Dr. Ian Schokking - GP	Mountain Running, X-Country Skiing
Dr. Michelle Sutter - Surgeon	Figure Skating
Dr. Sasha Riome York - GP	Cantata Singers, fishing
Dr. Linda Wilson - GP	Dragon Boat Racing

 

 

 

 

 

 

 

UNIVERSITY OF BRITISH COLUMBIA

Department of Family Practice, Prince George Site

 

 

Instructions for Residents and Preceptors:

 

Making use of the Practice SOO Score Sheet

 

The CFPC scores Simulated Office Oral Examination performance according to how the candidate applies the principles of Patient Centre Interviewing, as articulated in various papers published in this country over the years. This material is distilled in the form of a score sheet very much like the generic one we have prepared for your use.

 

The candidate is expected to:

 

Identify the two or three main biopsychosocial problems presenting

 

Flesh out salient social and developmental context issues

 

Formulate a management plan for each problem, in consultation with the patient

 

Conduct the interview with an effective structure and a relaxed style

 

The blank Simulated Office Oral Score Sheets are provided to guide the re si dent in the conduct of patient encounters and in self-assessment. Preceptor reviews of re si dent interview performance (either direct observation or videotape) should follow the same format.

 

We encourage residents to choose one appropriate patient encounter per office half day to evaluate in this manner.

 

EXAMPLE

 

University of British Columbia , Department of Family Practice

Prince George Site.

SIMULATED OFFICE ORAL SCORE SHEET

(Hint: try videotaping an interview and scoring yourself!)

 

1. IDENTIFICATION: Problem 1

                        

		Problem:	Illness Experience
	Superior	Covers: 1. 2. 3. 4. 5.	Arrives at in-depth understand of illness experience, achieved through verbal and nonverbal technique.
	Certificant	Identifies 1, 2 and 3.	Inquires about the illness experience to arrive at a satisfactory understanding of it.
	Non-Certificant	Misses 1 or 2.	Shows minimal interest in the illness experience and so gains little understanding of it.

 

2. IDENTIFICATION: Problem 2

 

		Problem:	Illness Experience
	Superior	Covers: 1. 2. 3. 4. 5.	Arrives at in-depth understand of illness experience, achieved through verbal and nonverbal technique.
	Certificant	Identifies 1, 2 and 3.	Inquires about the illness experience to arrive at a satisfactory understanding of it.
	Non-Certificant	Misses 1 or 2.	Shows minimal interest in the illness experience and so gains little understanding of it.

 

 

3. IDENTIFICATION - Lifestyle Issues             

 

 

 

	Superior	Covers: 1. 2. 3. 4. 5.	Arrives at in-depth understand of illness experience, achieved through verbal and nonverbal technique.
	Certificant	Covers 1 or 2.	Arrives at a satisfactory understanding of the illness experience.
	Non-Certificant	Does not cover any points.	Little understanding of illness experience. Little acknowledgement of patient's cues or cuts patient off.

 

4. MANAGEMENT -

 

	Superior	The patient must develop a precise plan specifically: 1. 2. 3. 4 5.	Actively inquires about the patient's ideas and wishes for management. Involves the patient in the development of a plan and encourages participation and deci si on making.
	Certificant	Suggest one or two plans to follow for patient and family.	Involves patient in the development of a plan. Demonstrates flexibility.
	Non-Certificant	Suggest one or fewer options.	Does not involve the patient in the development of a plan.

 

 

5. MANAGEMENT - Lifestyle Issues               

 

	Superior	The candidate must develop a precise plan specifically.	Involves patient in development of a plan and seeks feedback about it. Encourages full participation in deci si on making.
	Certificant	Covers 1 and 2 or 3.	Involves patient in the development of a plan. Is flexible.
	Non-Certificant	Does not cover 1.	Does not involve the patient in the development of a plan.

 

   

 

6. INTERVIEW PROCESS AND ORGANIZATION         

 

	Superior	Demonstrates advanced ability in conducting an integrated interview, with clear evidence of a beginning, middle and an end. Prompt conversation and discus si on by remaining flexible and by keeping the interview flowing and balanced. Very efficient use of time with effective prioritization.
	Certificant	Demonstrated average ability in conducting an integrated interview. Has a good sense of order, conversation and flexibility. Uses time efficiently.
	Non-Certificant	Demonstrates limited or insufficient ability to conduct an integrated interview. Interview frequently lacks direction or structure. May be inflexible and/or overly rigid with an overly interrogative tone. Uses time ineffectively.

 

 

HOSPITAL POLICY ON THE WEARING OF COLOGNE 'S, PERFUMES, AND OTHER SCENTS:   PLEASE DON'T !

 

 

 

A hospital staff member who is quite allergic to commonly used perfumes (laryngeal edema, bronchospasm, ER visits, time lost from work etc.) has asked me to make you aware that health care workers here, as elsewhere, are not permitted to wear scented products of any kind on the job.

 

The call was prompted by a brief encounter she says she had with one of you that left her gasping. (I have no idea who the resident might have been).

 

For the sake of co-workers and patients with sensitivities, please take note.

 

PRINCE GEORGE REGIONAL HOSPITAL

ADMISSION CRITERIA

 

 

•  PAEDIATRICS and PAEDIATRIC SPECIAL CARE UNIT - patients 16 years of age and younger are routinely admitted to these units. Any physician may admit - specialist consultation mandatory in PSCU.

 

•  NEWBORN NURSERY AND INTENSIVE CARE NURSERY - for the admission of 'newborns'. All Family Practitioners and Paediatricians may admit - specialist consultation mandatory in ICN.

 

•  COMBINED FAMILY CARE - all antepartum and postpartum patients, with the exclusion of those patients diagnosed as ectopic pregnancies and inevitable/incomplete abortions. Patients for elective gynaecological surgery may be admitted at the discretion of the in-charge-nurse if other surgical units are full. All Family Practitioners and Obstetricians/Gynaecologists may admit.

 

•  PSYCHIATRIC UNIT - patients with a psychiatric diagnosis. Family Practitioners/Psychiatrists may admit.

 

•  MEDICAL UNITS - (Medical patients over 16 years of age)

FOURTH FLOOR - any Family Practitioner/Internist may admit.

INTERNAL MEDICINE- priority is given to those with a diagnosis of cardiac disease and/or requiring telemetry. Any Internist may admit.

ADMISSIONS AND TRANSFERS TO THE MEDICAL UNITS MAY ONLY BE MADE WITH THE PRIOR APPROVAL OF THE FAMIY PRACTITIONER OR INTERNIST TO WHOM THE PATIENT IS BEING ADMITTED/TRANSFERRED.

 

•  ICU/CCU - patients over 16 years of age requiring coronary/intensive care. Any physician may admit - specialist consultation mandatory.

 

•  SURGICAL UNITS - (Surgical patients over 16 years of age)

Admissions and transfers to the surgical units may only be made with the prior approval of the surgeon to whom the patient is being admitted/transferred.

 

•  REHABILITATION UNIT - patients are only admitted to the Rehabilitation Unit as elective admissions following screening by the Rehab Admissions Committee.

 

•  JUBILEEE LODGE - admissions to the extended care unit is elective only and screened by the Continuing Care Division.

 

All admissions to the Prince George Regional Hospital must be discussed with the Admitting Department before arrival.

No admission will be accepted unless the patient is admitted to a SINGLE attending physician.

Patient Transfers - When a physician transfers care of a patient to another physician who has admitting privileges to another unit, the receiving physician must indicate acceptance of the transfer and WRITE THE ORDER TO TRANSFER THE PATIENT TO ANOTHER UNIT.

TRAUMA MANAGEMENT PROTOCOL

CODE BLUE

Prince George Regional Hospital

 

 

The contents of this document are based upon recommendations presented to the Prince George Regional Hospital Emergency Services Committee on February 22, 1983 by Dr. R. Crous FRCSC and Dr. W. Simpson FRCSC. The Emergency Services Committee revises this protocol on an ongoing basis.

INTRODUCTION

 

The primary objectives of trauma management must be the rapid and accurate assessment of the patient's condition, the provision of resuscitation and stabilization on a priority basis, and rapid availability of definitive treatment.

 

Trauma is the leading cause of death in the first three decades of life and ranks fourth among causes of death overall.

 

Many of the lessons learned from military and large trauma centre experience indicate strongly that the patient with life threatening multiple injuries is best managed with a team approach, with the overall responsibility resting with one physician. This physician must be capable of managing all acute problems that present including immediate surgical intervention as part of the resuscitative process if necessary. The physician best qualified to take this responsibility in this hospital is the general surgeon on call for the day.

 

The initial evaluation and resuscitation upon arrival of the patient in the Emergency is the responsibility of the emergency physician. Overall responsibility of the patient is transferred to the general surgeon upon his arrival.

 

It has been estimated that mortality rates from massive injury increase threefold for each 30 minutes delay between injury and definitive medical care. Without an organized response of all of the resources necessary to provide this care, delays occur that are often long enough to preclude survival. The CODE BLUE PROTOCOL is intended for use with only the most seriously injured patients. Those patients with injuries that will likely require life saving definitive treatment within the hour.

 

 

A.   TRAUMA CATEGORIES

 

CATEGORY I - IMMEDIATE THREAT TO LIFE

 

It is most important to realize that in this category, rapid resuscitation to an "operable" condition is paramount. Hence, the anaesthetist is an integral member of the Trauma Team.

CATEGORY II - MULTIPLE INJURIES/OR BURNS - NOT IMMEDIATELY LIFE THREATENING

 

These injuries do not constitute an immediate threat to survival. Multiple fractures, stable head injuries, some stab wounds, chest/abdominal trauma without major hemorrhage (ie Class I or II Hemorrhage) or airways obstruction. They may require surgery within 1-2 hours. A full CODE BLUE alert need not be called but various components of the trauma protocol may be implemented at the discretion of the physician in charge. ALL STAFF MUST BE AWARE THAT PATIENTS WITH CATEGORY II INJURIES CAN QUICKLY DETERIORATE TO CATEGORY 1. A high index of suspicion and continuous monitoring of the patient's condition must be maintained with Category II injuries.

 

   

CATEGORY III - SUSPECTED INTERNAL INJURY

 

These patients may have significant abdominal or chest injury based on physical examination or mechanism of injury, but are stable. There is time for extensive examination and investigation. All staff must be aware that patients with Category III injuries can quickly deteriorate to Category II or even I. A HIGH INDEX OF SUSPICION AND CONSTANT MONITORING OF THE PATIENTS'S CONDITION IS NECESSARY.

 

CATEGORY IV - TRAUMATIC ARREST

 

Those patients who exhibit no signs of life at the scene of the accident and/or have asystole on the EKG monitor are considered to be un-salvageable. The Trauma Team is NOT to be mobilized. On arrival in emergency, the status of the patient is to be reassessed and at the discretion of the emergency physician, a full response can be initiated. The EHS personnel are to notify the emergency of a traumatic arrest "AND NOT A CODE BLUE".

 

•  THE TRAUMA TEAM

 

Listed in order of contact:

•  Ambulance Personnel

•  Emergency Nursing Staff

•  Hospital Switchboard Operator

•  Emergency Physician (Hospital Call Doctor)

•  General Surgeon and Surgical Resident

•  Anaesthetist

•  Laboratory Technologist

•  Pathologist

•  Respiratory Technologist

•  X-Ray Technologist

•  Orderly when available

•  Operating Room Team

 

Emergency Health Services Ambulance personnel are the first members of the Trauma Team to have contact with the multiply injured patient. The EHS technicians are trained to recognize life threatening injury and initiate basic resuscitation. It is the responsibility of the EHS technician to activate the Trauma Protocol. This will be accomplished by radio contact with the charge nurse in the emergency. The message given should be " CODE BLUE", followed by an estimated time of arrival at the emergency (ETA). Any clinically significant information should then be transmitted to the emergency staff. It is important to indicate the number of seriously injured patients.

 

A large bore intravenous catheter is to be placed at a peripheral site if this can be accomplished without causing unreasonable delay in transfer of the patient to the hospital. Up to 40 cc's of blood should be collected and placed in red top tubes if this can be accomplished without causing undue delay in transfer to the hospital. The ambulance personnel should remain in the emergency area long enough to provide further history of the event to the medical staff and assistance that might be needed. They must provide proper labeling (Hollister #) of specimens they have collected.

 

EMERGENCY NURSING STAFF

 

Nurse in Charge - Emergency

The charge nurse in emergency routinely answers the ambulance radio. Upon receiving a CODE BLUE message, the charge nurse accurately records the ETA and clinical details provided by the ambulance personnel. The Hospital switchboard operator is alerted to call a CODE BLUE and given the ETA. The emergency staff then put the appropriate number of trauma bays in a state of readiness to receive the patient/s.

 

The charge nurse will anticipate team needs and obtain additional staff, equipment and supplies required to manage the CODE BLUE and the routine operation of the Emergency Department.

 

EMERGENCY ROOM RESPONSE

 

At least two litre bags of Ringer's Lactate are to be removed from the warming cupboard and hung in the Level I fluid warmer rapid infuser. The Trauma Carts are to be in place and equipment made ready. IV insertion units should be large bore 16 or 14 gauge. Cut down sets are to be prepared.

 

EOR Nurse I

This nurse will be designated by the charge nurse to provide assistance with maintenance of the airway and control of the cervical spine. After this has been satisfactorily achieved, attention is turned to the monitoring of vital signs as required and notification of changes in vital signs with progression of the resuscitation.

 

EOR Nurse II

This nurse will be designated by the charge nurse to start an intravenous line or assist the doctor in starting intravenous lines. Following the satisfactory completion of this, attention is turned to the administration and monitoring of IV fluids and medication; obtain, labeling, and transfer of blood samples to the laboratory technician; and provision of assistance to the emergency physician where required.

 

Anaesthetist

The role of the anaesthetist is the early establishment and maintenance of an effective airway.

 

 

LABORATORY TECHNOLOGIST

 

The laboratory technologist or a courier will be present in the emergency room upon the arrival of the patient with appropriate material for the collection and transport of specimens. If sufficient blood is available from the ambulance personnel, this blood will be received, checked for appropriate Hollister labeling and taken to the laboratory immediately. If there is not sufficient blood, then more blood will be provided by the emergency staff. All specimens must be labeled with appropriate Hollister stickers provided by the ambulance personnel. The following analysis will be performed in order:

 

•  Blood group determination and full cross-match started. FOUR units unless otherwise directed.

•  CBC

•  Electrolytes

•  Blood Sugar

•  BUN & Creatinine

 

PATHOLOGIST

 

The pathologist on call fro the day is notified of a CODE BLUE along with the other physician members of the team. His function is to supervise the activities of the laboratory staff and provide clinical liaison with the team treating the patient/s.

 

RESPIRATORY TECHNOLOGIST

 

The respiratory technologist will arrive at the emergency room prepared to take arterial blood samples unless directed otherwise, then the respiratory technologist will provide what respiratory assistance is requested by the medical staff (relieve emergency operating room nurse I), and institute monitoring of O2 saturation.

 

X-RAY TECHNOLOGIST

 

The X-Ray technologist on call will come to the emergency room bringing a portable x-ray machine and film cassettes necessary to take the following shots:

 

•  Lateral Cervical Spine

•  Portable Chest

 

ORDERLY

 

The orderly comes to the emergency room prepared to provide assistance with transfer and positioning of the patient as required for management. Urinary catheterization is to be performed at the direction of the medical staff. The orderly will assist with provision of equipment and supplies as may be required for management of the patient/s. If an orderly is not available, emergency operating room (EOR) nurse I or II will perform these duties.

 

 

OPERATING ROOM TEAM

 

The operating room staff on call will be called in by the Hospital switchboard operator. They will put an operating room in a state of readiness. Clinical information will be provided as available in order to prepare the appropriate equipment and instruments. However, because of the potential uncertainty of diagnosis in multiply injured patients, standard trauma packs for major body cavities must be immediately available (ie abdomen, chest and head packs) with duplicates in reserve in case of multiple casualties.

 

CODE BLUE REVIEW

 

Quarterly or at the discretion of the Chief of Emergency. Code Blue cases will be reviewed at open rounds. Physicians involved should attend and nursing and EHS personnel are invited.

NOTIFICATION OF CORONER

Reference Coroner's Act

 

The Coroner will be notified when death occurs as a result of any one of the following:

•  Every person who has reason to believe that a person died:

a.   As a result of:

• I. violence

• II. misadventure

• III. negligence

• IV. misconduct

• V. malpractice

• VI. suicide

•  By unfair means;

•  During pregnancy or following pregnancy in circumstances that might reasonable be attributable to pregnancy;

•  Suddenly or unexpectedly;

•  From disease, sickness, or unknown cause for which he/she was not treated by a Medical Practitioner ;

•  From any cause other than disease under circumstances that may require investigation;

•  In a correctional institution, lock-up or prison;;

Shall immediately notify a Coroner or a Peace Officer of the facts and circumstances relating to the death, and where a Peace Officer is notified, he/she shall in turn immediately notify the Coroner of the facts and circumstances.

 

•  Where a person dies:

•  While a resident or an inpatient of:

• I. a community care facility as defined in the Community Care Facilities Licensing Act;

• II. a place for the examination, diagnosis, treatment, or rehabilitation of mentally disordered persons to which the Mental Health Act applies, and;

• III. a public or private hospital to which the person was transferred from a facility or place referred to in sub-paragraphs l) or ll).

•  While he/she is:

l.   a patient of a place referred to in paragraph a) ll);

•  committed to a correctional centre, penitentiary, or police lock-up, but when not on the premises or in actual custody;

 

the person in charge thereof shall immediately give notice of the death to a Coroner.

 

No person who has reason to believe that a person died in any of the circumstances mentioned in the above shall interfere with or alter the body or its condition in any way until the Coroner so directs.

  

 

 

In addition to this power to direct a post-mortem examination for the purpose of an inquest, a Coroner may authorize a post-mortem examination:

•  in connection with any inquiry authorized by an Act of Canada into the cause of any aircraft accident, of the body of a person who died in, or as the result of, the accident and

 

1. of a body of a person who has died in a hospital or other institution, on the request and the expense of the Board of Management of that hospital or institution.

 

A post-mortem examination so authorized may be carried out notwithstanding objection thereto by a person entitled to the custody of the body.

 

NB:   NOTIFYING THE CORONER DOES NOT AUTOMATICALLY RESULT IN AN AUTOPSY - THE CORONTER DECIDES THIS BASED ON THE "FACTS AND CIRCUMSTANCES" OF WHICH HE IS INFORMED.

 

DISASTER PLAN

Prince George Regional Hospital

 

 

The Head of the Emergency Department is designated by the Medical Staff Rules and Regulations to be the Chairman of the Disaster Plan. This physician sits as a member, along with the Medical Director of the Hospital Emergency Planning Committee. This committee has prepared an Emergency Plans Manual which is available to any member of staff in the hospital Library. The manual covers topics such as; Bomb Threat Procedure, Hostage Incident and Missing Patient Search, as well as the External Disaster Plan.

 

1. External Disaster Plan

 

The decision to activate this Disaster Plan is taken by the Executive Director or alternate. A medical staff telephone fan out will then be initiated by the Executive Director's notification of the Medical Director. The Medical Director will notify his alternate, the Chief of Staff and the Chairman of the Disaster Plan (Head of the Emergency Department) or his alternate (Head of the Department of General Practice). The Medical Director will then notify the Heads of the Medical Staff Departments and the Department Heads will proceed to notify members of their department. In the event of activation of the External Disaster Plan, the hospital switchboard operator will announce "ATTENTION - CODE ORANGE, ALL HOSPITAL STAFF TAKE NECESSARY ACTION". All available members of the medical staff are asked to immediately assemble in the medical staff triage lounge. The designated hospital command centre is the Outpatient Laboratory Desk. The Chairman of the Disaster Plan will normally remain at the command centre. The Medical Director will act as Medical Staff Coordinator and will be based in the medical staff lounge to assign personnel and liaise with the command centre. On reporting to the medical staff lounge all physicians will be logged in and assigned a specific function. The hospital lobby will be the main arrival/triage area.

1.   Triage Officer

2.   Emergency Department Coordinator-ER

•  Unit Evacuation Physician - evacuation will begin with 2 Northwest

•  Operating Room Coordinator-OR

•  ICU/CCU Coordinator - ICU/CCU

•  Blood Bank Coordinator - Laboratory

•  Non - Urgent Treatment Centre Physician - Room 121 and Psychiatric Outpatients

•  Physician Casualty Teams - hospital lobby

•  Surgical Teams - OR

It is important to note that the extent of activation of this plan will depend on the extent of the actual disaster. However, where evacuation of the hospital, partial or complete is required, the Medical Staff Rules and Regulations reads:

"All physicians on the medical staff of the hospital specifically agree to relinquish direction of the professional care of their patients to the Chairman of the Disaster Plan in cases of such emergency."

 

The equipment to be kept in the medical staff lounge should include: a log, action cards with the various job descriptions, blue OR caps to be used as ID and a full list of the office and telephone numbers of all the members of the medical staff.

 

 

Triage Categories

 

0 deceased - BLACK

->   to morgue

I   emergent - RED->Emergency Department

II   YELLOW - > Emergency Department

III   non urgent - GREEN - > Room 121 or psychiatric Outpatients

Last updated December 22, 2004