University of Toronto Emergency Medicine Residency
Orientation and Welcome Package
Hello and welcome to the University of Toronto’s Emergency Medicine program! On
behalf of the Division of Emergency Medicine, we are very excited to welcome you all to our
group. We hope to make your transition to the city and the program as easy as possible. You
will find lots of useful information in this document so keep it with you for future reference.
Cheers,
Your chiefs for 2009-2010
Jenny Chu (Junior Chief)
Steve Lin (Junior Chief)
Vico Dagnone (Senior Chief)
Useful Contacts
Program Director: Dr. Karen Woolfrey, Karen.Woolfrey@sunnybrook.ca
Executive Assistant: Karen Clark, Karen.Clark@sunnybrook.ca
Jenny Chu, jenniferchu15@gmail.com
Steve Lin, steve.lin@utoronto.ca
Vico Dagnone, vicodagnone@hotmail.com
The “Blue Book”
The website for the Division of Emergency Medicine is as follows:
http://www.emergencymedicine.utoronto.ca
This website is an invaluable source of information. If you click under the link
“Education” you will find most of the topics of relevance for you. The FRCP Residency
Program Description is our “Blue Book”. It is not a book and it’s not blue. Here you will find
all the details of the residency program to read at your leisure. Rotation specific information is
located under the link “Rotation Information” (this is how you know what your learning
objectives are and who to contact for vacation requests/call schedule requests).
Format of Academic Days
Emergency medicine residents are the only residents at the University of Toronto with a
FULL academic day. Academic days occur every Tuesday and are usually at Mount Sinai
Hospital. Karen Clark posts a schedule of academic events a week before each new month so be
sure to check the website to confirm locations of events. Click on the ‘Quick Link’ on the home
page.
Every Tuesday from 0830 to 1700 hrs is protected academic time for you. This means
that if you are on call on a Tuesday, you do not start call until 1700 hrs. Academic day is a
mandatory program function, however, you must advise all of your rotations by the 1st of the
month prior, the dates of these days. If you are on call on a Monday or do an overnight shift on
Tuesday morning, you will still be expected to come to academic day.
The format of academic day is as follows:
-0830-1000 hrs: Group A (PGY1) rounds with CCFP-EM residents. These are didactic
teaching sessions located in the ED classroom, Room 206 at Mount Sinai Hospital. Core
readings for these sessions come from Emergency Medicine: A Comprehensive Study
Guide (Tintinalli).
-1000-1100 hrs: Resident case and PLEX rounds (you will receive a schedule of when
you will be expected to present very soon). These are located on the 18th floor
auditorium at Mount Sinai Hospital.
-1100-1200 hrs: Grand Rounds (topics vary) are also held in the 18th floor auditorium at
Mount Sinai Hospital.
Afternoon: These may be filled with workshops or simulation sessions. Some days you
will have free afternoons to be used at your discretion. Generally, these days are good for
research-related activities.
Case Presentations
You will be expected to present 3-5 times at resident rounds throughout the year. Your
assignments will come out shortly. Each academic day from 1000-1100 hrs is reserved for
resident rounds. Three different residents will present in this hour. Generally speaking, the first
two rounds are case presentations of interesting patients you’ve seen. These rounds are meant to
be no more than 10 minutes long with a 5 minute question and answer period afterwards.
These are not meant to be exhaustive literature reviews of a given topic. These are meant to be
concise presentations on interesting topics highlighting 2-3 key learning points.
The third presentation is a PLEX (=procedure, lab value, ECG, xray) or wildcard case. If
you are assigned a PLEX case, you should base your presentation on the topic given to you e.g.
if you are assigned the “lab value” presentation you may wish to talk about the different causes
of a troponin rise. Be creative! The wildcard presentation means you can choose any of the
PLEX topics to present.
If you wish to change the date of your presentation (for example, if you are going on
vacation on a day you’ve been assigned to do a case presentation), you will be responsible for
finding one of your colleagues to switch with you. Once you have found someone to switch
with, you will need to email the switch request to Steve Lin. These switches need to be approved
by Steve Lin (steve.lin@utoronto.ca) and must be requested at least TWO WEEKS before the
beginning of the month of the intended case presentation date. If you are sick on a day you are
assigned to present, you must inform one of the chief residents of your absence as soon as
possible.
Journal Clubs
Usually on the third Tuesday of the month, we hold our monthly journal club meetings.
(Check rounds scheduling for confirmation of dates.) These evenings start off with dinner
followed by a scholarly discussion on two journal articles. The topic of the journal club
discussion is chosen by the resident hosts of the journal club. Topics must have applicability to
emergency medicine. Two residents are chosen for each journal club to present and discuss the
papers chosen (e.g. background, methodology, validity). Resident presenters are level PGY-2 –
5.
For your own journal club, you will be expected to choose two papers of relevance to
emergency medicine, invite a guest clinical expert and a guest clinical epidemiologist, and print
out evaluation forms for your colleagues to fill out. The details of your journal club should be
sent to Karen Clark by the first of the month of the intended journal club date. Journal club
templates are available to help facilitate the announcement of your journal club. The role of the
PGY-1 in journal club preparation is to observe the tasks completed by your seniors such that
you will be better prepared to both present and organize journal club as of your PGY-2 year.
Journal clubs take on one of the following formats:
1. Headlines – choose two articles from the current scientific literature (within the past
year) that have some new or innovative methodology or outcomes that might have an
impact on our immediate EM practice.
2. Classics – choose two articles that have already had a significant impact on EM practice
(maybe ones that we cite all the time but haven’t actually reviewed in any great detail –
like PIOPED or GUSTO).
3. Traditional – Choose two articles from the scientific literature for review and expert
discussion.
Choosing A Mentor
This term might seem confusing since you will have many different mentors during your
emergency medicine residency. To clarify:
1. You will be assigned a senior resident (PGY 3-5) to act as your “senior mentor” during your
first few years of residency. Your senior mentor will be paired with you as well as a PGY-2 to
help answer any questions you may have about residency. This senior mentor will also help
guide you through the steps involved in arranging a journal club. You will be expected to
observe the hosting and preparation of one journal club per year with the help of your resident
team. Don’t worry, it’s not that hard. Journal club assignments will be sent out soon.
2. You get to choose one of the staff FRCP emergency medicine doctors to be your residency
mentor. This mentor is responsible for being your advocate should you get into trouble and
being someone to provide career advice in the development of your career. Generally, a staff
member can mentor more than one resident. Most residents choose a staff member with similar
career/personal interests. The choice of your staff member should be made by the end of your
first PGY year.
3. Your research advisor is someone with whom you choose to undertake scholarly activities.
This person does not have to be the staff person you chose to be your mentor. Dr. Jacques Lee
(Jacques.Lee@sunnybrook.ca) is the scholarly activities director in our program and can help
you find an appropriate project advisor. Dr. Woolfrey will also oversee your mentorships and
provide any required assistance with respect to your research requirements.
That being said, do not be afraid to approach different staff persons to be your informal
mentors/sound boards. We’re all here to help!
Academic Project
Each resident is responsible for selecting, working on and presenting an academic project
a minimum of twice during your five years of residency. The projects can be in a topic of your
choosing and do not need to be formal research projects. Academic projects can be clinical
research studies or non-clinical activities such as educational projects.
The first step in selecting an academic project is to pick an area of interest (for example,
trauma or emergency medical services). In January of every year, the residents meet with Dr.
Jacques Lee (Jacques.Lee@sunnybrook.ca) to review project ideas. Guidance with respect to
your project topic, design and research mentor will be provided by Dr. Lee or Dr. Woolfrey. The
final Tuesday of May, completed academic projects will be presented at Resident Academic
Day. It should be noted that you are discouraged by the program in taking vacation that would
conflict with this event. The program strongly encourages submission of completed academic
projects to CAEP, SAEM or ACEP. In June, each resident is required to present the progress on
their academic project to the group at the annual Resident Academic Day.
FRCP Exams
In December and June, the program holds practice written and oral exams prepared by
Dr. Woolfrey. These exams consist of a 3 hour short answer written test and an oral examination
room. These exams assist in your preparation for the actual Royal College exams at the end of
your PGY-5 year.
PAIRO and the Contract
All residents in Ontario belong to the Professional Association of Interns and Residents
of Ontario (PAIRO). This is a professional organization that represents you and is responsible
for negotiating the contract that governs our work conditions and remuneration. All residents in
Ontario pay dues to PAIRO, which are automatically deducted from your paychecks. PAIRO is
made up of residents who volunteer their time to sit as representatives for their resident groups.
Aikta Verma (aikta.verma@gmail.com) and Lana Grigoriou (lgrigoriou2008@meds.uwo.ca) are
the current PAIRO representatives for the University of Toronto Emergency Medicine resident
group. They are your liaisons to PAIRO if there are any issues and are responsible for
disseminating information to the resident group.
Residents in Ontario have a contract with the Council of Academic Hospitals of Ontario
(CAHO) which outlines our work conditions and remuneration. Our current contract was
negotiated in 2008 and it expires in 2011. A copy of the contract will be mailed to every resident
and it is worth keeping since it is a useful reference when questions arise. It can become a handy
resource to help resolve disputes. In addition, a copy of the contract can be found on the PAIRO
website at www.pairo.org
The contract is cumbersome to read, so here are a few tips that you should be familiar with the
PAIRO “Top Ten”:
Call and Other Work Hour Rules
1. Call Schedules must be distributed at least 2 weeks in advance of the effective date.
2. Call Maximums are based on the total days ON Service (vacation and other time away
are deducted from the total prior to calculating maximum call). Residents cannot be
scheduled to work two or more consecutive calls unless agreed upon by the residents, the
Program Director and PAIRO. Residents cannot be required to round (or perform other
clinical duties) on weekends when not on call.
In House Call: The in-house maximum is 1 in 4. For a “one month” rotation these
maximums are:
19-22 Days = 5 calls
23-26 Days = 6 calls
27-29 Days = 7 calls
30-34 Days = 8 calls
35-38 Days = 9 calls
In hospital call maximums for rotations >1 month can be averaged over the length of the
rotation (maximum averaging length is 3 months) with a maximum of 9 calls in any
given month. The total number of calls on a rotation longer than one month can be
calculated by taking the total of number of days ON service, divided by 4 and rounded to
the nearest whole number (.5 rounds up).
Each Resident must have 2 COMPLETE weekends off per 28 days. This includes Friday
night/Saturday morning as well as Saturday & Sunday.
Home Call: Home Call Max is 1 in 3, or 10 per 30.
A resident cannot be on home call on 2 consecutive weekends
3. Shift work
On rotations where residents are scheduled in shifts, e.g. Emergency Medicine or
Intensive care: Max hours = 60 hours/week, including other scheduled responsibilities
(including academic half days).
There must be a minimum of 12 hours off between shifts
Residents doing shift work must have 2 COMPLETE weekends off per month. A
weekend starts at midnight Friday.
4. Post Call
Home by 8 am for in-hospital call for: Anesthesia, OBGYN (plus up to 1 hour of
handover) and ICU/CCU (plus up to 1.5 hours of handover)
Home After Handover:
Effective July 1, 2009, for all services with in-hospital call other than Anesthesia,
OBGYN, and ICU/CCU, residents will be relieved of duties after ensuring adequate
handover (no new duties to be assigned; handover will not exceed 2 hours). Home after
handover exception: where a service cannot meet the June 1, 2009 deadline, the status
quo will continue (home no later than noon).
5. Residents not on call/scheduled to work cannot be expected or compelled to be available
on pagers or to come in for any reason.
Vacation and Professional Leave
6. Vacation
4 weeks (a week is 7 days which includes 5 working days and 2 weekend days) of paid
vacation per year (no carry-over).
Requests must be made in writing at least 4 weeks in advance of the requested start day
of the vacation (recommend at least 6 wks), and they are to be submitted no later than
March 1st. (if you wish to take 1 of the 4 weeks of vacation for an RCPSC or CFPC
certification exam in the spring, you have up until 1 month in advance to submit your
request).
All requests must be confirmed or alternate times agreed to within 2 weeks of the request.
Denials must be in writing with the reason for denial. There can be no blanket policies
restricting the amount of vacation in any rotation.
Our emergency program requires that you submit a leave request form for all leave
requests (vacation, conference, etc.). These forms are available from our Emergency
Medicine website: EducationFRCP (EM) Resident's PageResources for Residents.
These requests must be initially approved by the program office (Karen Clark) and then
subsequently submitted to the respective rotation. You are responsible for the submission
to both the program and to the rotation. Once the form has been completely approved,
you are responsible for submitting it back to the program office.
7. Professional Leave
Maximum of 7 working days per year (Note: weekends are not considered “working
days” for this purpose). You DO NOT need to be attending a Seminar or Course to take
them. You can take leave for any Canadian or American professional certification exam.
This leave includes the day(s) of the exam and reasonable travel time to and from the
exam site. This time is in addition to other vacation or leave.
8. Parental Leave
Any requests for parental leave must be submitted to the program office a minimum of 4
weeks prior to the start of the leave.
Holidays and Lieu Days
9. All Housestaff are entitled to the following recognized holidays:
 New Year’s Day
 Family Day
 Easter Friday
 Victoria Day
 Dominion Day
 August Civic Holiday
 Labor Day
 Thanksgiving Day
 Christmas Day
 Boxing Day
 One Floating Holiday
All housestaff are entitled to 5 consecutive days off during the 12 day period
encompassing Christmas Day and New Year’s Day. These 5 days account for Christmas
Day, New Year’s Day, Boxing Day and two weekend days. Each resident must get either
Christmas or New Year’s Day off.
10. Lieu Days are granted for residents who are scheduled to work on any recognized stat
holiday (or any part thereof, including being on call the day before).
Must be taken at a mutually agreeable time within 90 days of the holiday worked. No
lieu days for Christmas Day, New Year’s Day & Boxing Day (this is included in the 5
days off over the holiday period).
Lieu days are not credited for shift-work rotations, i.e. emergency medicine rotations.
11. Religious Holidays
If you observe religious holidays that are not specifically listed in the Collective
Agreement, your program may have a duty to accommodate your religious practice to the
point of undue hardship (“undue hardship” may include a number of factors, such as
patient safety, the hospital’s service requirements, and the resident’s educational/training
requirements).
It is your responsibility to request accommodation, explain what measures of
accommodation are required and allow a reasonable time for reply. Since each request is
unique, religious accommodation is typically worked out on a case-by-case basis. In
some cases it may be possible to switch statutory holidays listed in the Agreement for
your religious holiday. Residents and programs are usually able to come to a mutually
agreeable solution once needs are discussed/clarified.
Call/Shift Stipends
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With our last contract, PAIRO successfully negotiated to be compensated by the hospitals
for being on-call and working shifts after-hours. The current compensation is as follows:
In-house call - $105
Home call - $52.50
Qualifying shift – $52.50 for any shift where 1 full hour is worked between midnight and
6am
If scheduled for home call but work more than 4 hours during the call period, with 1 hour
being after midnight, it counts as an in-house call
In order to claim your call/shift stipends, you must complete the required forms before
the FOURTH day of the following month. Stipend forms will be emailed to you or provided as
hard copies during your rotation by the administrative staff at the hospital. Each hospital site
handles their stipend requests differently. The forms are returned to the administrative staff for
each site (Bernice Baumgart at Sunnybrook Hospital at Bernice.Baumgart@sunnybrook.ca,
Bryan Abankwah at St. Michael’s Hospital at AbankwahB@smh.toronto.on.ca, and Julie
Johnston at University Health Network at Julie.johnston@uhn.on.ca). The amount earned from
call/shift stipends is automatically added to your paycheque and is paid 4 weeks after submitting
the forms. Stipends are unfortunately taxed like the rest of your income.
Benefits
As a PAIRO member, you are entitled to several health benefits, including life insurance,
disability insurance, extended health, dental and vision care. In addition, this plan covers your
dependents. You have to pay a $15 deductible per year for health claims. In order to make a
claim, fill in the Maritime Life claim form and send it in. For claim forms, go to:
www.manulife.ca/groupbenefits/SecureServe
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Life insurance: You are covered for 2 times your annual earnings
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Extended health: You are covered under Maritime Life Insurance Company (aka
Manulife Financial) which covers medications, physiotherapy (up to $500 per year)
Dental: You are covered for 85% of costs
Vision: You are covered up to $250 every 24 months
Scheduling Tips
We are a unique program in that we spend a lot of our time off-service. For this reason, it
is important to be organized and plan your scheduling well ahead of time. At least four weeks
before your new rotation starts, it is a good idea to email the contact person for that rotation and
let them know that you are coming on service. In addition, this is a good time to let them know
about any scheduling requests. You should try to request not to be on call Monday nights as
this makes it difficult to stay awake during Tuesday academic day! You should list your call
requests and remind them of any vacation time that you have previously arranged.
Book and Conference Fund
You will receive a gifted copy of the new Rosen’s Emergency Medicine (7th edition)
when it is published later this year. Starting in PGY2, there will be a $500/year for use towards
academic related purchases. For example, these funds may be used to build your emergency
medicine library, to attend conferences (travel, conference fees, etc.). This also includes medical
software purchases for your PDA/Smartphone but not for the purchase of hardware. You must
keep receipts of your purchases and fill out a reimbursement sheet. This reimbursement request
is found on the website under: EducationFRCP (EM) Resident's PageResources for
Residents.
Resident Travel Awards
In order to encourage residents to prepare and present scientific abstracts at national and
international conferences, the Division of Emergency Medicine is providing limited financial
support to residents whose work has been accepted for presentation. Awards will be for up to
$1000 for oral presentations and up to $750 for poster presentations. More information about
these awards can be found on the website under: EducationFRCP (EM) Resident's
PageResources for Residents.
Medical Courses
There are several extra courses that you should be aware of:
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ACLS Provider: This is a must for emergency residents. As a first-year resident, this
course is paid for by the hospital. You should contact Terry Smith at
TerryG.Smith@sunnybrook.ca to enroll in a course.
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ACLS Instructor: This is a useful course if you plan to join the growing number of
emergency residents teaching ACLS! Teaching ACLS not only is a good way to make
money, but it also dramatically improves your cardiac arrest skills. Contact Terry Smith
or the Heart and Stroke Foundation at resuscitation@hsf.on.ca
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ATLS: This course is a useful introduction to trauma care. It is not essential to take this
course as most of the material will be covered in Group A lectures. However, it does
serve as a good introduction to trauma and would be most valuable if taken before doing
your trauma rotation. Contact Terry Smith for more information.
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Emergency Ultrasound: Dr. Woolfrey is planning to implement an Emergency
Department Echography (EDE) course into the residency curriculum this year. Details
will follow later this year. Some useful websites that pertain to the EDE course are
CEUS (ceus.ca) and EDE (www.the-ede-course.com). .
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PALS/NRP: Sunnybrook has just started to run a PALS course four times annually.
Terry Smith will have more information if you’re interested. North York General offers
a Neonatal Resuscitation Course that is valuable to take prior to starting your Pediatric
rotation there. Contact the NYGH Education Chair Dr. Stephen Moss
(smoss@utoronto.ca) for more information.
Office of Resident Wellness
The PGME office at the University of Toronto provides services for residents:
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Counselling: Residents are frequently seen for stress management, mental health
concerns, challenges with work-life balance, academic problems, career uncertainty, and
other issues. We offer the following options for support: PGME Wellness Advisor,
Christopher Hurst; and referrals to external counselors are coordinated by the Director of
Resident Wellness;
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Family doctor registry;
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Links to Faculty of Medicine, University of Toronto, and community-based resources;
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Half-day and longitudinal workshops that teach you resiliency skills aimed at optimizing
your coping skills and resources to combat life’s stressors. You can always check out the
PGME Web Site at www.pgme.utoronto.ca and click on the Resident Wellness tab for
up-to-date information on current workshops being offered.
That’s a lot of information so far. If you have any questions, do not hesitate to ask one of your
fellow residents or our friendly staff. We’re here to help you succeed in residency.
Cheers
The FRCP (EM) residents group
and
The Royal College Emergency Medicine Residency Training Program