Program Structure

The Critical Care Program is generally a two-year program divided into 26 four-week blocks. This includes thirteen blocks of general adult Critical Care, one block of Cardiac Echo training, one block of Toxicology and one block of Cardiac Surgery ICU. Ten blocks are available for electives and other recommended rotations, allowing residents to customize their training to suit their personal career goals. For some residents, Critical Care training may overlap with the final one or two years of base specialty training; for these trainees the program with generally span three years.

ICU:              Intensive Care Unit, Kingston General Hospital
ELEC:           Elective
CSU:             Cardiac Intensive Care, Kingston
ICU-LHO:     Community ICU, Lakeridge Health, Oshawa
BASE:           Rotations in base specialty
TOX:             Toxicology
 

Recently, Queen’s University has embarked on an innovative program to transition all training programs to a competency based curriculum by 2017. The competency-based curriculum is formalizing an approach of graded responsibility and focus on practical acquisition of skills and knowledge that has long been a tenant of our training program. We feel this philosophy will continue to be one of the true strengths of the program as residents continue to achieve a high level of comfort in independent patient care, while enjoying close, collegial relationships with the attending staff.

The curriculum is divided into four phases of training. The “Transition to Discipline” is a short, early introduction to the speciality focused on ensuring comfort with basic concepts, procedures and roles within the ICU. The “Foundations of Discipline” stage occurs in the first large block of rotations and is focused on the development of knowledge of physiology and key critical care concepts. During this stage, trainees supervise patient care by junior trainees with close supervision from attending staff. They assess all consults, admissions and discharges in close collaboration with attending staff.

During the “Core of Discipline” stage, trainees develop competence in advanced technical skills such as bronchoscopy and percutaneous tracheostomy insertion. They take a leadership role in daily team rounds, and participate in the teaching program for junior learners. Supervision by attending physicians gradually evolves into a coaching relationship during this phase.

The final stage is “Transition to Practice” during which residents take on all the roles of an attending physician, including resource allocation and management decision-making. They will supervise and lead patient care in the ICU with the supervising attending physician always available to provide coaching, consultation and discussion.

Research

Research and scholarly activity have been long- identified strengths of the Critical Care Program at Queen’s. There is a strong research infrastructure and expertise in the Program, with approximately $1.5 million of annual operating grants and research support provided to Critical Care research projects.

All residents are provided with one week per block of ICU to dedicate towards independent scholarly activity, which may take the form of a clinical research, education, or a quality assurance project. Faculty play an important role in this process, helping residents to establish and complete their scholarly project. Residents receive funding to attend a national or international meeting at which their research is presented.

Critical Care Trainees who wish to pursue a long- term career as a Clinician Scientist may also be eligible to enrol in an advanced academic degree in conjunction with their clinical CCM training, through the Queen’s Clinician Investigator Program.

Educational Activities

Residents are excused from clinical responsibilities for one afternoon per week. During these academic half-days, facilitated by faculty members, trainees examine a range of Critical Care topics in-depth, and gain a familiarity with the evidence base behind Critical Care practice. Some half-days are spent in the patient simulation laboratory, where trainees have the opportunity to enhance their Crisis Resource Management skills. Practice written exams also help residents to consolidate their knowledge base. During the academic year, trainees also attend and present at weekly Critical Care Grand Rounds, Morbidity and Mortality reviews, and at monthly Journal Club.

Critical Care trainees at Queen’s are provided with a number of resources during their training, including a copy of a recent textbook of critical care and a subscription to“Up-To-Date”. Funding is provided for each trainee to attend ACES, ATLS, and ACLS courses, in addition to an annual allowance of $2000 to attend national or international Critical Care conferences.

Training Sites

Kingston General Hospital (KGH)

is southeastern Ontario’s leading centre for complex-acute and specialty care, and is home to the Cancer Centre of Southeastern Ontario. An accredited Level 1 Trauma Centre, KGH is also the major referral centre for injured patients in the region, and is home to the regional Stroke and Primary Cardiac Revascularization programs. KGH serves almost 500,000 people through its Kingston facility and 24 regional affiliate and satellite sites. It was ranked in 2011 as one of Canada’s Top 40 Research Hospitals by Research Infosource. The intensivist-directed 33 bed ICU at KGH is located in a new, modern space. In addition, the hospital has a 14-bed Cardiac Sciences Unit and an 18-bed open-medical-model “stepdown” ICU.

Lakeridge Health is a large community hospital corporation serving approximately 600,000 people in the Durham Region at its 5 hospitals in Bowmanville, Oshawa, Ajax Pickering, Port Perry and Whitby. A regional education hub affiliated with Queen’s University, Lakeridge Health, Oshawa, has a 25-bed Critical Care Unit and active clinical teaching unit. It is the regional high-volume thoracic surgery center and stroke centre. Lakeridge provides our trainees with unique opportunities and clinical exposures including exposure to transport medicine.

How to Apply

Application to the two-year subspecialty program in Critical Care at Queen’s is coordinated through the Medicine Subspecialty Match (MSM) offered by the Canadian Residency Matching Service (CaRMS). Applicants to the match must generally be in their be in their final year of Canadian residency training in Anesthesiology, Emergency Medicine, Cardiac Surgery, or General Surgery, or must be in their third year of a Core Internal Medicine residency. For complete details on eligibility and on applying to the Queen’s CCM Program through the MSM, visit www.carms.ca.

Candidates wishing to apply for CCM training overlapping with their base specialty training in Anesthesiology, Emergency Medicine or General Surgery must have completed at least three years of residency prior to entry into Critical Care. Overlap training is usually restricted to trainees from Queen’s University residency programs, but applicants from other centres may be considered in some circumstances. Overlap training requires the consent and recommendation of the base specialty training program director, and interested applicants should contact the Critical Care program director directly to discuss application requirements and procedures.

Entrance to Critical Care training from other specialty programs is possible, but must follow completion of primary specialty training and candidates must meet the eligibility requirements set by the Royal College of Physicians and Surgeons of Canada Specialty Committee in Critical Care. Such applications are considered on a case-by-case basis, and generally require significant advance planning on the part of the trainee to ensure that entrance requirements are met during base specialty training.

International physicians wishing to pursue Critical Care training at Queen’s University must be fully sponsored and funded for such training by their home government. Interested applicants should contact the Queen’s University Postgraduate Medical Education office for information on eligibility and application procedures