1. CRITICAL CARE:
I used my 4th year subspecialty time to do a fellowship in Critical Care Medicine.
This had a profound impact on my career. As a result of this training, I was able to
become dual-certified in both Emergency Medicine and Critical Care. Now I split my
clinical time between the ICU and the ED at St. Michael’s Hospital. Working
clinically and conducting research in both specialties in the same institution allows
me to maximize my contribution to each field. My ICU training has also allowed me
to improve my care of the critically ill in the Emergency Department, my EM training
helps my diagnostic and resuscitation activities in the ICU and my breadth of training
allows me to be a resource to my colleagues in both areas. Overall, my subspecialty
year was invaluable to my education and future career. I am currently applying to
Health Policy Graduate work to develop my skill set and academic track record in
research on medical error in critical care. I hope to return to a clinician scientist or
clinician investigator position in EM and Critical Care.
2. CLINICAL EPIDEMIOLOGY:
I spent my fourth year working towards a Masters of Health Sciences degree at the
University of British Columbia. This is a research degree focused on clinical
epidemiology, biostatistics and health research methodology. Significant papers that
I wrote were research proposals entitled: "A randomized, placebo-controlled,
multicenter trial of intravenous proton pump inhibitor administered in the emergency
department prior to endoscopy for the treatment of high risk bleeding peptic ulcers",
and "A randomized-controlled trial of hyperbaric oxygen therapy in the treatment of
acute stroke identified in the emergency department". My most recent work has been
with the International Liason Committee on Resuscitation and the American Heart
Association on the 2005 AHA ECC Guidelines and the 2005 CoSTAR treatment
recommendations. I reviewed the literature and made recommendations regarding the
efficacy, safety and feasibility of prehospital 12-lead ECG in patients with suspected
AMI. I was also on the writing committee for the Acute Coronary Syndrome chapter
of the guidelines and have been asked to act as a clinical expert on ACS by the Heart
and Stroke Foundation of Ontario. I will be completing my Master's degree next year
as part of my research fellowship at the University of Toronto. My future work will
focus on writing a 12-lead PHECG systematic review and I will be working on the
design of a RCT on prehospital ECG in patients with AMI. I will be pursuing my
research interest in Prehospital Care and Transport Medicine, and seeking a clinicianscientist role in an EM department. I have been supported in my studies by the
Ontario Graduate Student Scholarship Trust and the University of Toronto.
3. TOXICOLOGY:
I have been fortunate enough to begin a newly developed Fellowship in Toxicology
during my subspecialty year in the U of T FRCPC Emergency Medicine program.
The Fellowship involves a Royal College Certification in Clinical Pharmacology with
specialization in Toxicology, the details of which, including curriculum and timeline
are currently being designed to mimic the U.S. Toxicology Fellowship. To date I have
undertaken 6 months of this Fellowship and my interest in the field is growing
exponentially. This fellowship will allow me to gain the knowledge base that is
essential for the practice of clinical, educational and administrative toxicology, which
is an increasingly popular area of emergency medicine. Practically, the Fellowship is
based out of the Ontario Poison Centre which is located in Toronto. Mentorship and
supervision are provided by an Emergency Physician who is a Board Certified
Toxicologist and Medical Director of the Poison Centre, as well as from other
toxicologists affiliated with the Centre. Time is spent learning clinical toxicology by
way of taking call for the Poison Centre, as well as focused toxicology rounds,
readings, informal teaching sessions and academic projects. Other components of
learning involve exposure to occupational toxicology, mother risk, and pediatric and
adult clinical pharmacology and drug interactions. I will be equipped to function as a
toxicologist and expert resource to my colleagues upon completion of the Fellowship.
4. FORENSIC MEDICINE:
My subspecialty in Emergency Medicine was based out of the Centre for Forensic
Sciences under the supervision of the Chief Coroner of Ontario, Dr. Barry
McLellan. It consisted of 7 months of autopsy work, 3 months of on scene
coroner's investigation. I completed a 2 month project examining the rise of
accidental fentanyl related deaths in Ontario. This subspecialty helped me consolidate
the pathology of preventable deaths and the mechanisms of injury that are common
presentations in the Emergency Department. As well, I gained a valuable
appreciation of the role of the Emergency physician in the acquisition and
documentation of injuries and injury patterns for patients presenting to the
ED. The academic portion of the subspecialty was a valuable experience that
allowed for an epidemiologic study evaluating a previously unknown association
between rising transdermal narcotic use and unexpected deaths in Ontario. This
culminated with a presentation at the Annual Coroner's Conference in Ontario.
5. CLINICAL EPIDEMIOLOGY/PREHOSPITAL CARE:
Within the Royal College Emergency Medicine Residency Training Program, I chose
to undertake a subspecialty year in research. This involved a Master of Science in
Clinical Epidemiology, through the Department of Health Management, Policy &
Evaluation at the University of Toronto. The Department of Medicine ClinicianScientist Training Program provided funding and support for a second research year
to complete the program. The Royal College of Physicians and Surgeons of Canada
Clinician Investigator Program, and the Massey College Junior Fellowship enriched
this graduate training. The Clinical Epidemiology Unit at the Institute for Clinical
Evaluative Sciences was my base for this subspecialty year. Upon graduating from
our residency program, I spent a year in Adelaide, South Australia. Here, I completed
a one-year fellowship in Retrieval Medicine, which is an Australasian hybrid of
critical care and prehospital care. This fellowship involved working with the rescue
helicopters and with the Royal Flying Doctors Service of Australia. The Australasian
College for Emergency Medicine accredits this period of training for Australian and
New Zealand trainees. Having returned to Canada, I am now working as a staff
physician at Sunnybrook & Women’s College Health Sciences Centre, and as a
scientist with the Clinical Epidemiology Unit at Sunnybrook. My subspecialty
training allowed me to begin my career as an academic emergency physician on solid
ground.
6. INNER CITY HEALTH:
I developed a curriculum to learn the principles of inner city health. With the
direction of the EM residency training committee, I was able to put together a series
of rotations including street youth clinic, infectious diseases/travel medicine, forensic
medicine, Addiction medicine, and methadone clinic. The year gave me a broad
appreciation for the special challenges of caring for an inner city population,
introduction to research involving this population, and greater skill in addressing the
population’s needs in my daily clinical practice. I have since been approached locally
and for distance CME providers to provide clinical updates on areas of interest in
inner-city health.
7. PEDIATRIC EMERGENCY MEDICINE
I completed a year of subspecialty training in Paediatric Emergency Medicine. I was
fully integrated into the existing fellowship for Paediatricians completing emergency
medicine training and much of my core RCPSC EM training counted towards the
Paediatric EM program. I completed rotations in Paediatric Critical Care, Emergency
Medicine and some subspecialties and was a part of their research and academic
program. Upon completion of the program, I now work at both adult and pediatric
EDs in Toronto, have a research interest in Paediatric EM education, and am the
founding director of a new simulation-based course in acute care Paediatrics.
8. MASTER’S OF HEALTH SCIENCES, PUBLIC HEALTH
This degree has allowed me to obtain further training in the field of public health and
population health epidemiology which I plan to combine with emergency medicine
now and in my future career as a practicing emergency physician. The degree
combines coursework in population health methods with electives in my areas of
interest including health policy, emergency preparedness and international health.
The degree will also give me the opportunity to pursue a research practicum to further
enhance the theoretical skills learned. Prior to undertaking this degree, I was working
on a provincially funded project to develop a curriculum for women’s health. Overall
I feel that the MHSc degree has been a great way to combine my personal interests in
emergency medicine and broader population health issues.