PROGRAM HIGHLIGHTS
THE CITY
As Canada’s largest and most diverse city, Toronto presents a unique opportunity for residents both in
and away from the residency program. Not only is our program now the largest of its kind in the
country, but our core sites are among the busiest in the nation and provide residents with valuable
exposure to diverse patient populations (including inner city and at-risk patients) as well as to a high
variety of pathology. The diversity of its population is also well-reflected in Toronto’s incredible mix of
unique cultural, nightlife, dining and shopping options. The city offers many natural escapes, as well,
including Toronto Island, the Harbourfront and numerous parks and recreational facilities.
FACULTY & TRAINING SITES
There are 53 faculty members with academic appointments as of June 2009 including 3 professors, 28
assistant professors, 5 associate professors and 17 lecturer or equivalents. Clinical ratios depend on the
site and rotation. At the core emergency medicine sites, there is from one to four staff on duty at all
times.
Core emergency medicine sites are Sunnybrook (SHSC), St. Michael’s Hospital (SMH), and University
Health Network (UHN), which includes Toronto General and Toronto Western sites. Additional training
sites include Hospital for Sick Children (HSC), North York General Hospital (NYGH), and Ornge, the air
ambulance and transport medicine service for the province of Ontario.
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SUNNYBROOK HEALTH SCIENCES CENTRE
Sunnybrook Health Sciences Centre (SHSC) is a tertiary care hospital and trauma referral centre for
southern Ontario. It is also the base hospital for the dedicated air ambulance program of southern
Ontario and the paramedic program of Metropolitan Toronto. The emergency department provides care
to the adjacent community and also acts as a referral centre for trauma, oncology, psychiatry, geriatrics
and critical care. The trauma research program is active and has received many peer-reviewed research
grants. The emergency faculty members have shown special interest in prehospital care, trauma,
medical education and research.
On-site electronic medical resources include: newly designed department with dedicated emergency
conference room; emergency medicine website (WEBER) with learning modules and procedural videos;
free internet access and MDConsults subscription at training sites; and full health sciences library
resources. (Emergency Department Annual Volume: 43,000)

ST. MICHAEL’S HOSPITAL
St. Michael’s Hospital (SMH) is a tertiary care hospital and trauma referral centre for southern Ontario.
The emergency department provides care to the adjacent community and also acts as a referral centre
for trauma, neurosurgery, cardiovascular disease, psychiatry, nephrology and subspecialty medicine. St.
Michael’s Hospital has a very strong internal medicine program and provides exposure to complex
clinical cases. The hospital is located in the downtown core and plays a lead role in the inner city health
program. The program provides the residents with an excellent educational opportunity, exposing them
to issues of substance abuse, infectious disease, penetrating trauma and homelessness. The emergency
medicine faculty members have developed expertise in trauma, toxicology, internal medicine, inner city
health, medical education, pediatrics and research. (Emergency Department Annual Volume: 59,000)

UNIVERSITY HEALTH NETWORK (TORONTO GENERAL & TORONTO WESTERN SITES)
Our newest core training sites, the University Health Network (UHN) mixes complex quartenary (TGH)
and community (TWH) emergency care. The patient population collectively includes transplant,
oncology, complex cardiopulmonary, pediatric and multicultural groups. The staff is committed to
teaching excellence and a detailed formal teaching program is in place. (Emergency Department Annual
Volume: _______ [TGH] & ______ [TWH])

THE HOSPITAL FOR SICK CHILDREN
The Hospital for Sick Children (HSC) is a quaternary care pediatric hospital with an international
reputation. It is a pediatric trauma referral centre for southern Ontario. The emergency department
provides a unique opportunity to see a great diversity of clinical conditions and disease states. It
provides excellent exposure to all pediatric subspecialties. The Ontario Poison Control Centre located at
the hospital receives greater than 75,000 calls a year and is supported by a strong faculty. (Emergency
Department Annual Volume: 54,000)

NORTH YORK GENERAL HOSPITAL
North York General Hospital is a community-based hospital which functions as one of the core hospitals
during the first year of training. It offers a unique teaching environment and allows the residents a
greater degree of autonomy and direct interaction with staff physicians. (Emergency Department Annual
Volume: ________)

ORNGE
Ornge, a non-profit organization, was appointed in July 2005 by the province of Ontario by the province
of Ontario Ministry of Health to coordinate all aspects of Ontario’s air ambulance system and began
operations in January 2006. The program began in 1977 with a single rotor-wing aircraft based in
Toronto. Today, with 33 aircraft stationed at 22 bases across the province, Ornge operates the largest
and most sophisticated program of aero-medical transport in North America. Over 18,000 admissions
are dispatched annually making Ornge North America’s largest operator in the field of transport
medicine.
PATIENT LOAD
Average patient load depends on the site and skills of the resident. Junior residents are closely
supervised; more senior residents are given autonomy while still being supervised and learn how to
manage patient volume and flow as well as concurrent administrative duties in the emergency
department during shifts.
NUMBER OF RESIDENTS
The program admits up to 10 residents each year. In the 2009-2010 academic year, there are 38
residents in total.
PROGRAM CURRICULUM

PGY-1
The PGY-1 year provides comprehensive basic clinical training in: emergency medicine; internal
medicine; plastic surgery; pediatrics; neurosciences; obstetrics and gynecology; psychiatry; community
orthopedics; and orthopedic surgery. Two months of combined family medicine and emergency
medicine is also a component of the core training. This year of training will prepare the resident for the
Medical Council of Canada qualifying examination part II. Residents will rotate through Sunnybrook,
North York General Hospital, St. Michael’s Hospital and Toronto East General Hospital. Effective July 1,
2008, all University of Toronto residents entering PGY-1 are required to complete the web-based
PGCorEd* core competency modules as part of their residency program certification. These modules
provide the foundation for the non-Medical Expert roles for the Royal College of Physician and Surgeons
of Canada Specialty Programs. Completion of these modules is required before the end of the PGY-2
year.

PGY-2
The PGY-2 year provides comprehensive training in both emergency medicine and critical care rotations.
Rotations include: adult and pediatric emergency medicine; trauma surgery; anesthesia; and ICU.
Residents select one elective during their PGY-2 year.

PGY-3
The PGY-3 year provides comprehensive training in rotations that have a particular subspecialty interest
to the practice of emergency medicine. Rotations include: emergency medicine; pediatric anesthesia;
prehospital care/trauma; CCU; PCCU; and internal medicine consults. Residents select one elective
during their PGY-3 year.

PGY-4 (Subspecialty year)
The PGY-4 year is a subspecialty year in which each resident designs their own curriculum to formally
pursue subspecialty training (in or out of province) to develop expertise in an area relevant to
emergency medicine and the resident’s career goals. The subspecialty year may be done off-site or in
non-clinical areas with relevance to emergency medicine. Training opportunities and suggested topics
include the following: Pediatric Emergency Medicine; Masters of Clinical Epidemiology; Masters of
Medical Education; Masters in Health Administration; Inner City Health; International Health;
Toxicology; Trauma; Critical Care Medicine; Sports Medicine; Prehospital Care; Medical Informatics;
Research; Aeromedical Transport; Clinician Scientist Program; Bioethics; International Emergency
Medicine; Ultrasound; and Geriatric Emergency Medicine. The pursuit of subspecialty training is strongly
recommended. These subspecialty proposals need to be approved by EMRTC midway through the PGY-3
year.

PGY-5
The PGY-5 year provides comprehensive training in emergency medicine and pediatric emergency
medicine. Six months of adult emergency medicine and two months of pediatric emergency medicine
must be completed during the senior (PGY-4 – 5) years. Residents may select one or more electives
during their PGY-5 year.
ELECTIVES
Residents can do up to six months at a non-accredited site or any elective time approved by the program
at an accredited site. Areas that have been pursued by our previous residents have been Masters
Degree, Medical Education, Toxicology, Trauma, ICU, Ultrasound, Inner City Health, Clinical
Epidemiology, Transport Medicine, EMS and International Emergency Medicine.
UNIQUE CURRICULUM
ULTRASOUND – A hybrid ultrasound training program has been established. This is Emergency
Department Echo (EDE)-based training and includes full Canadian Emergency Ultrasound Society
Independent Practitioner Program (CEUS IP) certification. Training in ultrasound commences in PGY1.
GERIATRIC EMERGENCY MEDICINE – This program is the only program in Canada that now offers
dedicated curriculum in geriatric EM. This training occurs in PGY-3 year.
CURRICULUM MODULES
Academic rotations are available throughout the resident’s training, thus allowing the resident to pursue
and develop an interest in research, medical education, ethics, medical legal practice and clinical
epidemiology and statistics. Formal courses are provided in clinical epidemiology (PGY-1), ethics (PGY-2),
geriatrics (PGY-3) and emergency medicine administration (PGY-5), as well as in communications and
advocacy.
JOURNAL CLUB
Monthly journal club events focus on evidence-based medicine and are held on one Tuesday afternoon
each month from September to May (excluding December). PGY-1 residents act as observerparticipants; PGY-2 through PGY-5 residents act as hosts and article reviewers. One clinical consultant
and one epidemiological consultant provide faculty input and guidance. Journal clubs are designed to
cover current emergency medicine topics as well as to reinforce formal evidence-based methodology
with regard to reading the literature.
MENTORSHIP
This program has a well-established and hierarchical mentorship program. Each incoming resident has a
PGY-2, senior resident (PGY-3 – 5), faculty and research mentor. Mentors act as a resource to the
resident, providing advice about the program, the profession, or the lifestyle of the staff emergency
physician. Ideally, the resident will identify a faculty member themselves with the Program Director
assisting in the decision when needed.
RESEARCH
Residents can explore research to a level compatible with their career interest. Each resident must
present an academic project at Resident Academic Day, an annual event held in May, twice during their
residency.
Research is supported by the Scholarly Activities Director, by the Program Director and by the faculty
research mentors. Residents are responsible for completing at least one academic project suitable for
submission to a peer-reviewed process.
Residents are also encouraged to present at national and international meetings. There is divisional
funding support provided.
Formal training in Critical Appraisal and Epidemiology is provided for all residents during PGY-1 year.
These sessions are interactive and precepted by the faculty. Teaching modules based on emergency
medicine literature have been designed to meet the needs of future specialists. An advanced research
teaching series is included in the curriculum.
The University of Toronto offers a unique opportunity in the Clinician-Scientist Program. Individuals may
apply for up to three years of financial support while completing training in research. One year of
research may be considered as subspecialty training by the residency program.
SEMINARS
Teaching rounds are held weekly on Tuesdays. Attendance is mandatory and residents are excused from
their clinical responsibilities from 8:00 a.m. – 5 p.m. so that they can attend rounds and work on
scholarly projects. Seminars, workshops and simulation sessions are designed to be interactive, casebased learning opportunities. Junior and senior residents have separate tutorials, precepted by the
faculty of the affiliated teaching hospitals.
Residents are provided with a gifted copy of Rosen's Emergency Medicine: Concepts and Clinical Practice
in PGY-1 to serve as their core EM reading guide. Residents are responsible for presenting short cases
during the Resident Rounds. Weekly Grand Rounds focus on state-of-the-art reviews of emergency-
related subjects. Workshops on critical care procedures, prehospital care, medico-legal issues, ethics
and medical education occur throughout the training program.
EXAMS
Practice oral and written exams are given twice per year – in June and December – with the ABEM
taking place in February of the PGY-3 year. The exams are designed by the Program Director and
modeled to the Royal College format.
EMERGENCY MEDICINE RESIDENCY TRAINING COMMITTTEE
The Emergency Medicine Residency Training Committee (EMRTC) is an advisory committee to the
Program Director and provides guidance for decision-making and process issues pertaining to the
residency program. Resident representation is encouraged on this committee. Resident members
include a PGY-1 member; junior and senior representatives; and chief residents.
CHIEF RESIDENTS
The chief residents are appointed by the Program Director, after consultation with the current chief
resident and the EMRTC, for a term of 12 months. Normally, the senior chief resident is a PGY-4 resident
and junior chief residents (2) are PGY-3. Chief residents are responsible for duties related to Group B
Rounds, Attendance and Journal Club. Chief residents function as a liaison between the group of
residents and the faculty or administration. Each of the three chief residents represents one of the three
core teaching sites.
JUNIOR REPRESENTATIVE
The junior representative is elected by the residents for a 12-month term. They are a voting member of
the EMRTC and are responsible for selected duties pertaining to Clinical Epidemiology, Group A Rounds,
Grand Rounds and Attendance.
SENIOR REPRESENTATIVE
The senior representative is elected by the residents for a 12-month term. They are a voting member of
the EMRTC and are responsible for selected duties pertaining to Group B Rounds, including evaluations,
summary evaluations and thank you letters.
FELLOWSHIPS
Fellowships are offered in 1) Pre-hospital and Transport Medicine, 2) Trauma, 3) Research or 4) Clinical
Emergency Medicine. With the exception of Research Fellowships incorporating a Masters Degree
program (2 years), fellowships are one year in length.