Internal Medicine

Program Director
Dr. Jeffrey Schaefer
Room 933, North Tower
Foothills Medical Centre
1403 - 29 Street NW
Calgary  AB  T2N 2T9
Phone: (403) 944-1525
Fax: (403) 944-1666
e-mail: jeffrey.schaefer@albertahealthservices.ca

Program Administrator
Jennifer Glow / Charlene Brass
e-mail: jennifer.glow@albertahealthservices.ca
e-mail: charlene.brass@albertahealthservices.ca

For further information see also:
http://www.carms.ca
http://www.departmentofmedicine.com/education/

The Department of Medicine at the University of Calgary offers fully accredited training in internal medicine and its subspecialties including cardiology, critical care, endocrinology and metabolism, gastroenterology, geriatric medicine, hematology, infectious diseases, nephrology, oncology, respirology, and rheumatology. The department has about 60 full time and 110 part-time faculty representing a broad range of clinical and research interests. The Department of Clinical Neurosciences is also fully accredited and interacts closely with Medicine.

Residents may progress to subspecialty training following the three "core" years (such individuals tend to apply to programs across the country as well as to our own). For those physicians seeking careers as generalists, a two year General Internal Medicine program is available.

Program Outline
The program is based on a thirteen block "lunar calendar," the majority of rotations being one block (four weeks) in duration. During the first year, six blocks are spent on general internal medicine (GIM) medical teaching units (MTU's) and the remainder on subspecialty electives. In the second year, two blocks are spent in critical care and the remainder on subspecialty electives.

The third year consists of three blocks as MTU leader, one block of critical care and eight blocks of subspecialties or electives. Each of the four MTU teams is comprised of three to four PGY-1 residents from internal medicine, family medicine and other disciplines, one or two senior residents, two to three clinical clerks and a general internist preceptor. Each team has a home-base ward and a director. Night and weekend call on the MTUs is usually one in four or less.

Critical Care at FMC offers a segregated experience of one month each in the coronary care unit and ICU/Trauma, while at the Peter Lougheed Centre the Coronary and ICU experiences are integrated. Residents from a wide spectrum of programs serve in the critical care units.

Electives include the subspecialties of internal medicine (which are predominantly consultation services), neurology, the general internal medicine consultation service, community internal medicine (in Lethbridge or Yellowknife), geriatrics, emergency medicine and research. Night and weekend coverage on subspecialties is usually "out-of-house" at a frequency of one in three or less. Up to three months training may be taken outside of the program.

Attendance in ambulatory care clinics is mandatory on subspecialty rotations and is a major component of all subspecialty programs. MTU seniors attend a weekly clinic which includes follow-up of patients discharged from the MTUs as well as GIM referrals from the hospital emergency departments.

The program is designed so there is a continuous evolution from a predominantly primary care role to that of a junior consultant. Responsibility for independent patient care and for teaching of other members of the team increases progressively in a manner suited to the ability and mastery of clinical skills demonstrated by the individual resident.

A philosophy of independent self-directed learning underlines the program. Since it is impossible for any individual to master all of the knowledge in internal medicine, it is essential that skills be developed which allow the physician to access pertinent current literature easily, to analyze this critically and to adopt a pattern of self-directed learning which wil continue beyond the completion of the program.

Seminars and Rounds
Grand rounds are held in each institution weekly as are subspecialty noon rounds. A Clinical Pathological Conference occurs weekly at the Health Sciences Centre. The emphasis is on the active discussion of cases presented and faculty representing a broad spectrum of backgrounds in internal medicine and pathology attend. Most subspecialty divisions hold inter-hospital rounds weekly as well as journal clubs on a regular basis. The Foothills Hospital MTUs also organize Case of the Week Rounds and monthly Morbidity and Mortality Rounds. First year residents attend a weekly academic seminar.

"Club Medicine" is a monthly event held at a Calgary restaurant. Dinner is followed by both a journal club and an informal seminar. The latter provides a forum for discussion and teaching of communication skills, bioethics, statistics, critical appraisal and career planning. Opportunities for learning medical audit occur in the context of patient care and are also included in some of the formal rounds. In addition, during the third year, residents serve one month on the FH Audit Committee, when they have a primary responsibility for case evaluation.

A weekly "academic half-day" is offered on subspecialty and elective rotations during the first year and on all rotations thereafter. The academic half-day is meant to be quite flexible in order to accommodate the interests and needs of each individual resident. It may be employed to undertake a research project, a medical audit or quality assurance/utilization review, a project in medical writing, or a formal university course.

Research
It is the goal of the program that all residents be exposed to research to the extent that each develops a deep understanding of the principles of science and an ability to analyze the medical literature comprehensively. Extensive opportunities exist for residents to undertake clinical or laboratory-based research projects concurrently with clinical training or as a year or more interrupting or following the clinical program. An Associate Director, Clinical Education - Research is available as a resource for residents seeking such experience and a broad range of faculty interests and experience exists to support research endeavours. Annual Departmental and Faculty resident research days are high profile events during the academic year.

Conference leave is allowed in each year. An allowance of nine hundred to eleven hundred dollars is available annually for residents to attend a medical conference. Additional funding and opportunities exist for trainees presenting at scientific meetings.

Evaluation
The evaluation program is the responsibility of the Associate Director, Clinical Education Evaluation and the emphasis is on continuous constructive feedback for the individual. An in-training evaluation occurs at the conclusion of each rotation and is reviewed with each resident. Also all three years take the American College of Physicians knowledge examination which provides feedback to the individual while group performance data are useful for the Department in refining its educational program. As well, an objective structured clinical examination (OSCE) to test clinical skills is held annually in the first year, and second and third year residents are given two oral examinations.

Residents completing the University of Calgary program have had a very high success rate on the Royal College of Physicians and Surgeons written and oral examinations.

Resources
The Foothills Medical Centre

• Number of beds: 700
• Number of emergency visits/year: 60,000

The Foothills Medical Centre is a major referral centre for southern Alberta and southeastern British Columbia. It functions predominantly as a secondary and tertiary level care institution but community and family physicians play an important role. It is adjacent to the Tom Baker Cancer Centre (TBCC) and the Health Sciences Centre (HSC), which houses the Faculty of Medicine of the University of Calgary.

Strengths of the Program
The program has a collegial philosophy which is noncompetitive and mutually supportive. Residents participate actively in the conduct and evolution of the program in a variety of ways: through five resident representatives to the Graduate Education Committee, regular group meetings with the chief resident and program director, annual educational retreats and the "open door" approach that characterizes the faculty in general and the program administration in particular.

We believe our two greatest strengths have been the dedication and ability of our teaching faculty and the tremendous contributions and hard work of so many outstanding former and current residents.

Selection Criteria
All selection to the residency program is through the Canadian Resident Matching Service. The ranking and selection of residents is based on academic and clinical performance, letters of reference and personal interviews. It is strongly recommended that at least one letter of reference be from a general internist and/or medical subspecialist. Equal consideration is given to external candidates and those from the University of Calgary.