During the Core Adult and Pediatric Clinical Immunology and Allergy rotations, the resident will achieve the following in their role as:

Medical Expert

1. Perform histories and physical examinations that are complete, accurate and well-organized.
2. Demonstrate proficiency in the formulation of differential diagnoses.
3. Demonstrate the ability to accurately interpret the results of appropriate diagnostic investigations relating to patient care in Clinical Immunology & Allergy.
4. Synthesize all of the pertinent information to arrive at complete and accurate clinical decisions.
5. Use preventive and therapeutic interventions effectively and independently.
6. Recognize the limits of their own expertise and seeks appropriate consultations from other health professionals.

Communicator

1. Establish a therapeutic relationship with pediatric and adult patients and/or their caregivers and demonstrates an understanding of and recognize the emotional and personal needs of patients and families.
2. Provide clear and thorough explanations of diagnosis, investigations and management to patients and families.
3. Give appropriate advice (including but not limited to allergen avoidance, pharmacologic/immunologic treatment) which considers patient characteristics such as age, gender, religion, sexual orientation, age, culture and ethnicity.
4. Develop a common understanding of issues, problems and plans with patients, families and other professionals to develop a shared plan of care.
5. Prepare written documentation (including patient notes, and patient letters) that is accurate, organized and timely.
6. Demonstrate the ability to verbally present cases in an accurate, concise, and organized fashion.

Collaborator

1. Interact effectively with health professionals by recognizing and acknowledging their roles and expertise.
2. Provide effective consultation relevant to Clinical Immunology and Allergy
   Consult and delegate effectively.
3. Establish good relationships with peers and other health professionals.
4. Collaborate effectively and constructively with other members of the health care team.
5. Demonstrate leadership in a health care team as appropriate.
6. Demonstrate understanding of issues involving disabilities, gender, race and culture when working with other team members.
7. Work with other health professionals effectively to prevent, negotiate, and resolve interprofessional conflict.

Manager

1. Demonstrate awareness and makes cost-effective use of all forms of Clinical Immunology and Allergy healthcare resources based on sound judgment, and where possible evidence-based medicine.
2. Demonstrate knowledge of and willingness to be involved in, cost-containment and quality assurance programs.
3. Set realistic priorities and uses time effectively in order to optimize professional performance.
4. Balances professional, personal and institutional commitments.
5. Demonstrate knowledge of the Canadian health care system and an awareness of the role of allergists/clinical immunologists in societal and governmental aspects of health care provision.
6. Demonstrate ability to manage clinic schedules and manage patient care priorities independently.

Health Advocate

1. Advocate for and intervene on behalf of patients including appropriate preventive care and health surveillance strategies.
2. Promote active involvement of the patients and families in medical decision-making.
3. Advocate for both the patient and family by working with the family to obtain needed services for care and ongoing family support.
4. Recognize that the health care needs of children/adolescents are different from adults, and change throughout the developmental continuum.
5. Participate in efforts to increase public awareness of the medical conditions relevant to Clinical Immunology and Allergy.
6. Identify the determinants of health for the populations that they serve.

Scholar

1. Demonstrate an understanding of and a commitment to the need for continuous learning.
2. Develop and implement an ongoing and effective personal learning strategy with an analysis and evaluation of the relevant medical literature.
3. Give constructive feedback to both teacher and students.
4. Seek to learn from errors and aspires to excellence through self-evaluation and acceptance of the critiques of others.
5. Demonstrate the ability to critically appraise medical information.
6. Successfully integrate information from a variety of sources.
7. Describe the principles of adult learning and helps others learn by providing guidance, teaching and by giving constructive feedback.
8. Receive feedback well.

Professional

1. Demonstrate honesty and integrity (including being fair, truthful and keeping one’s word; meeting commitments; being forthright in interactions with patients, peers, and in all professional work whether through documentation, personal communication, presentations, research or other aspects of interaction).
2. Demonstrate compassion and empathy (including listening attentively, responding humanely to the concerns of patients and family members).
3. Demonstrate respect for others and diversity (including extends to all spheres of contact, including but not limited to patients, families, other physicians, and professional colleagues; treats all persons with respect and regard for their individual worth and dignity; is fair and non-discriminatory; aware of emotional, personal, family, and cultural influences on patient well-being and patients’ rights and choices of medical care; respects confidentiality).
4. Demonstrate reliability, responsibility and conscientiousness (including meets deadlines, is punctual, complete assigned duties and fulfills commitments; accountable to one’s patients and also to their families, accountable to society to ensure the public’s needs are addressed; willingness to accept responsibility for errors).
5. Demonstrate an understanding of ethical practice and applies this to one’s work (including accountable to one’s profession to ensure that the ethical precepts of practice are upheld).
6. Demonstrate self-awareness/knowledge (including awareness of one’s own limitations and seeks advice when necessary; accept advice graciously; insightful as to the impact of one’s behaviour on others and cognizant of appropriate professional boundaries).
7. Demonstrate altruism (including unselfish regard for and devotion to the welfare of others; self-interest or the interests of other parties should not interfere with the care of one’s patients and families).
8. Demonstrate a commitment to physician health and sustainable practice, including balancing personal and professional priorities.

During the Community rotation, the resident will achieve the following in their role as:

Medical Expert

1. Become proficient in gathering appropriate and timely information on patients (history, physical exam, investigations) and independently formulating a management plan.
2. Gain experience with administering and supervising food and drug oral challenges.
3. Gain experience in preparing and performing patch testing.
4. Become proficient in immunotherapy (SLIT and SCIT), including patient selection, dosing adjustment, mixing venom immunotherapy, and recognizing contraindications.
5. Gain experience with biologic therapies including mixing and administration (e.g. Xolair, Nucala).
6. Obtain knowledge regarding establishing and managing a practice including sources and cost of extracts, spirometry, patch testing, other clinic supplies and human resource management.

Communicator

1. Establish a therapeutic relationship between patients and/or their caregivers.
2. Provide clear and thorough explanations of diagnosis, investigations and management to patients and families.
3. Give appropriate advice considering patient characteristics such as age, gender, religion, sexual orientation, age, culture and ethnicity.
4. Develop a common understanding of issues, problems and plans with patients, families and other professionals to develop a shared plan of care.
5. Prepare written documentation (including patient notes, and patient letters) that is accurate, organized and timely.
6. Demonstrate the ability to verbally present cases in an accurate, concise, and organized fashion.

Collaborator

1. Demonstrate adjustment to a new team and work well with assistants, nurses and other clinic staff.
2. Seek referrals appropriately from other consultants.

Leader

1. Function with the appropriate level of autonomy for their training level with assigned patients.
2. Practice effective time management.
3. Guide allied health staff effectively and appropriately with shared patients.
4. Acquire knowledge on operating a clinic in a cost-effective manner, including developing proficiency in billing OHIP codes for allergy services rendered.

Health Advocate

1. Advocate for and intervene on behalf of patients, including encouraging proper environmental control, assisting with access to medications and smoking cessation resources, and providing action plans for asthma and anaphylaxis.
2. Manage daily schedule so patients are seen in a timely manner.

Scholar

1. Demonstrate evidence-based management strategies.
2. Actively seek information from the literature to address knowledge gaps.

Professional

1. Seek help appropriately and respectfully from a consultant and other staff in the clinic when needed.
2. Demonstrate respect for all team members.
3. Accept and act on feedback appropriately.

Trainees will be expected to acquire a working knowledge of the diagnosis and management of common dermatologic conditions relevant to the practice of Clinical Immunology and Allergy.

The following sections outline the rotation expectations in CanMEDS roles within the domains of medical expert, communicator, collaborator, manager, health advocate, scholar and professional.

Medical Expert

Key Competencies. Physicians are able to:

1. Function effectively as consultants, integrating all the CanMEDS roles to provide optimal, ethical and patient-centred medical care.
2. Perform a consultation, with recommendations that are organized and well documented in written and /or verbal form.
3. Demonstrate the use of all CanMEDS competencies relevant to dermatology.
4. Demonstrate ability to prioritize professional duties when faced with multiple patients and problems.

Apply fundamental knowledge, skills and attitudes to the practice of dermatology:

1. Basic Science
2. Overview of the immune system pertaining to the skin
3. Therapeutics

• Topical steroids, topical immune modulators (i.e. tacrolimus)
• Biologics including monoclonal antibody technology (cytokine, cytokine receptor) mediated therapy pertaining to skin conditions relevant to the practice of Clinical Immunology and Allergy
• Monitoring of therapeutics agents and management of complications

Principles and Methodology of relevant laboratory tests:

1. Laboratory tests for the diagnosis of autoimmune skin conditions diseases, including measurement of inflammatory markers, autoantibodies, and complement.
2. Diagnostic techniques relevant to skin conditions, punch biopsy, with H&E and immunofluorescence.

Clinical Sciences:
Demonstrate knowledge of etiology, pathophysiology, diagnostic methods, assessment and practical management of the following:

1. Dermatitis (contact and atopic)
2. Autoimmune (bullous pemphigoid, pemphigus, lichen planus, cutaneous lupus)
3. Chronic urticaria
4. Other (mastocytosis)

Communicator

Key Competencies:

1. Develop rapport, trust, and ethical therapeutic relationships with patients.
2. Accurately elicit and synthesize relevant information and perspectives of patients, colleagues and other professionals.
3. Accurately convey relevant information and explanations to patients, colleagues and other professionals.
4. Develop a common understanding of issues, problems, and plans with patients and families, colleagues, and other professionals to develop a shared plan of care.
5. Convey effective oral and written information about the dermatologic condition and the associated medical encounter.

Specific Requirements:

1. Communicate effectively with all staff, allied health professionals and discuss appropriate information with patients and team.
2. Establish effective relationships with patients, family members and caregivers to obtain meaningful history, conduct relevant physical exams and properly manage a patient’s medical problem.
3. Demonstrate effective communication skills by presenting concise, informative overviews on topics related to relevant dermatologic disorders.

Collaborator

Key Competencies:

1. Participate effectively and appropriately in an interprofessional healthcare team.
2. Effectively work with other health care professionals to prevent, negotiate and resolve interprofessional conflict.

Specific Requirements:

1. Contribute clinically appropriate dermatological opinions on patients referred for consultation, including arranging for specific testing, administering required therapy, and conveying clinically relevant results to referring physicians. Contribute effectively to interdisciplinary team activities held within the hospital (rounds, journal clubs, etc.).

Manager

Key Competencies:

1. Participate in activities that contribute to the effectiveness of healthcare organizations and systems.
2. Allocate finite healthcare resources appropriately.

Specific Requirements:

1. Appropriate use of IVIgG
2. Appropriate use of biologics given in hospital and outpatient settings

Health Advocate

Key Competencies:

1. Respond to individual patient healthcare needs and issues as part of patient care.
2. Respond to the healthcare needs of the communities that they serve.
3. Identify the determinants of health of the populations that they serve.
4. Promote the health of individual patients, communities and populations.

Specific Requirements:

1. Demonstrate an appreciation of the healthcare needs of patients with all serious dermatological conditions that necessitate admission to hospital.
2. Encourage active family involvement in decision-making and ongoing management.
3. Understand how effective laboratory support is important in the management of patients with dermatological and medical problems.
4. Advocate for patients if there are obstacles in diagnosis and management as a result of limited resources.

Scholar

Key Competencies:

1. Maintain and enhance professional activities through ongoing learning.
2. Critically evaluate information and apply this appropriately to practice decisions.
3. Facilitate the learning of patients, families, trainees, other health professionals, and the public as appropriate.
4. Contribute to the creation, dissemination, application, and translation of new medical knowledge and practices.

Specific Requirements:

1. Provide evidence during their case presentations to dermatology attendings, that they are acquiring an appropriate depth of knowledge of the particular dermatologic disorder. To develop critical appraisal skills specific to the dermatological literature, particularly as it applies to patient management.

Professional

Key Competencies:

1. Demonstrate a commitment to their patients, profession and society through ethical practice.
2. Demonstrate commitment to their patients, profession, and society through participation in profession-led regulation.
3. Demonstrate a commitment to physician health and sustainable practice.

Specific Requirements:

1. Deliver the highest quality care with integrity, honesty and compassion.
2. Exhibit appropriate personal and interpersonal professional behaviour including civility and punctuality.
3. Practice medicine ethically consistent with the obligations of a physician.

During the ENT rotation, the resident will achieve the following in their role as:

Medical Expert

1. Build a strong knowledge base of the basic science and clinical information relevant to diseases of the nose, sinuses, middle ear, upper-airway-associated lymphoid tissue and larynx, particularly those associated with allergic sensitization, environmental exposures and immunological abnormalities.
2. Develop specific diagnostic and investigative skills including radiological examinations appropriate to the assessment of diseases in the ears, nose and throat.
3. Acquire competence in the medical treatment modalities used in ENT diseases and become knowledgeable of surgical therapies in ENT conditions.

Communicator

1. Develop a therapeutic relationship with patients with ears, nose and throat problems and with their families.
2. Collect relevant information and synthesize the significant history from patients and families with regards to otolaryngological conditions particularly in those with a significant allergic and immunological component.
3. Assess the influence of environmental cultural, social and economic factors on the illness.
4. Listen effectively to information provided by patients, their families and other health professionals involved in the care of individual patients with otolaryngological diseases.
5. Deliver adequate information to patients with otolaryngological conditions, specifically those with an allergic and immunological basis.
6. Provide appropriate and comprehensive advice as well as instructions for environmental control, and other therapies related to ENT conditions.

Collaborator

1. In consultation with the ENT specialist and other health care professionals involved in the care of the patients with otolaryngological diseases, develop a comprehensive care plan for the patient. While demonstrating the ability to incorporate the opinions of the ENT team, to enhance and contribute allergy/clinical immunology-specific expertise to the team.

Manager

1. Understand the functioning of the ENT department as part of a health care organization, utilizing its resources to the effect of balancing patient care, learning needs and outside activities.
2. Make appropriate decisions when allocating finite health care resources.
3. Prioritize and execute tasks related to ENT care in an efficient manner.
4. Utilize information technology to optimize patient care, maintain life-long learning.

Health Advocate

1. Identify the important determinants of health affecting patients suffering from otolaryngological diseases, in particular, those with allergic components.
2. Contribute effectively to improve the health of patients and communities by adapting the management according to the patient’s medical history, social circumstances, work environment, exposure to allergens or irritants.

Scholar

1. Critically appraise sources of medical information with regards to otolaryngological problems particularly those with an allergic/immunologic basis.

Professional

1. Deliver the highest quality care with integrity, honesty and compassion.
2. Exhibit appropriate personal and interpersonal professional behaviours.
3. Respect diversity of age, gender, disability, intelligence and socioeconomic status.
4. Practice medicine ethically, consistent with the obligations of a physician.
5. Exhibits punctuality.

During the HIV medicine rotation, the resident will achieve the following in their role as:

Medical Expert

1. Build a strong knowledge base regarding T cell structure and function.
2. Review the mechanism of HIV infection/transmission.
3. Develop an understanding of HIV testing methodologies.
4. Develop a strong knowledge of the clinical information relevant to the diagnosis and management of HIV.
5. Acquire competence in the medical treatment modalities for HIV, their mechanisms of action, their indications and contraindications, common side effects and management of these side effects.
6. Develop strong knowledge of the common complications of HIV including the clinical circumstances in which these typically occur.

Communicator

1. Develop therapeutic relationships with patients infected with HIV and their families.
2. Collect relevant information and synthesize the significant history from patients and families with regard to their diagnosis of HIV, complications of their disease and treatment.
3. Listen effectively to information provided by patients, their families and other health professionals involved in the care of the individual patients.
4. Deliver adequate information to the patients regarding their diagnosis and treatment.

Collaborator

1. In consultation with the Infectious Disease specialist and other health care professionals, develop a comprehensive care plan for the patient.

Leader

1. Understand the function of the HIV clinic as part of a health care organization.
2. Understand the role of different health care practitioners and allied health within the HIV clinic.
3. Make appropriate decisions when allocating finite health care resources.
4. Prioritize and execute tasks related to patient care in an efficient manner.
5. Utilize information technology to optimize patient care, maintain life-long learning.

Health Advocate

1. Identify the important determinants of health including environmental, cultural, social and economic factors affecting patients with HIVContribute effectively to improve the health of patients and communities.

Scholar

1. Critically appraise sources of medical information with regard to HIV medicine.

Professional

1. Deliver the highest quality care with integrity, honesty and compassion.
2. Exhibit appropriate personal and interpersonal professional behaviours.
3. Respect diversity of age, gender, disability, intelligence and socioeconomic status.
4. Practice medicine ethically, consistent with the obligations of a physician.
5. Exhibit punctuality.

During the immunodeficiency rotation, the resident will achieve the following in their role as:

Medical Expert

1. Acquire an appropriate knowledge of basic science and clinical principles of immunodeficiency diseases both primary and secondary.
2. Become proficient in the diagnosis, investigation and management of immunodeficiency conditions.
3. Learn the principles and practical considerations of therapeutic modalities utilized in immunodeficiency diseases.

Communicator

1. Form therapeutic relationships with patients/families with immunodeficiency conditions.
2. Obtain and synthesize relevant information from patients/families/health care professionals with regards to immunodeficiency conditions.
3. Discuss appropriate information with the patient/family/health care professionals.
4. Provide appropriate advice and instruction for therapies related to immunodeficiency conditions including infection treatment and control, bone marrow transplantation, and other immunomodulatory therapies.
5. Conveys effective oral and written information about the medical encounter.

Collaborator

1. Work effectively with members of the Immunodeficiency Diseases healthcare team to develop a comprehensive care plan for the patient.

Manager

1. Manages time and sets priorities to balance patient care, learning needs and personal life.
2. Allocate finite health care resources.
3. Utilize information technology to optimize patient care, maintain life-long learning.

Health Advocate

1. Identify situations in the immunodeficiency population where patient advocacy is required.
2. Acts as a patient advocate where appropriate.

Scholar

1. Develops, implements and monitors a personal continuing education strategy with regards to relevant immunodeficiency diseases.
2. Critically evaluates medical information and its sources with regards to immunodeficiency problems, and applies it appropriately to practice decisions.
3. Facilitates the learning of patients/families/health care professionals with regard to immunodeficiency problems.
4. Attends and contributes to learning events where appropriate.

Professional

1. Deliver the highest quality care with integrity, honesty and compassion.
2. Exhibit appropriate personal and interpersonal professional behaviours.
3. Respect diversity of age, gender, disability, intelligence and socioeconomic status.
4. Practice medicine ethically, consistent with the obligations of a physician.
5. Exhibits punctuality.

The overall objective of this period of training is to provide the resident with the necessary skills, competence and confidence to be aware of the issues that occur in biochemical laboratory analysis that may impact the utility of laboratory results.

Medical Expert

1. Operation of automated immunoassay analyzers:
   • Understand the principles of the operation of automated analyzers.
   • Interpret the generated results.
2. Basic laboratory techniques and centrifugation:
   • Methods of standardization and calibration
   • Identify common method interferences.
   • Detect errors and sources of error.
3. Knowledge of the terminology used to evaluate an Analytical Method:
   • Bias
   • Imprecision
   • Sensitivity
   • Specificity
   • Investigation of common interferences
   • Range
   • Criteria for acceptability
4. Describe the laboratory techniques used in Clinical Immunology and Allergy, including determination of normal values, indications and limitations, availability:
   • Flow cytometry (cell surface markers & receptors)
     • lymphocyte enumeration (immunophenotyping)
     • cytokines
     • dihydro-rhodamine oxidation
     • total and specific-IgE
     • ELISA (EIA)
     • Bioplex ANA
     • AntiTTG (IgA)
     • Thyroid peroxidase (replacing thyroglobulin and microsomal Abs)
     • Indirect Immunofluorescent Assay (IFA)
     • ANCA
     • Mitochondrial AB, Smooth muscle Ab, Parietal cell Ab, Endomysial Ab
     • Nephelometry
     • Rheumatoid factor
     • Radial immunodiffusion (quantitative precipitin reaction)
     • C1 Inhibitor
   • CH50
   • Isohemagglutinins
   • Functional Antibodies
     • Serum IgG to tetanus, diphtheria
     • Measles, mumps, rubella serology
   • Precipitating IgG antibodies (Precipitins)
   • Functional Lymphocyte Assay (sent out)
     • Mitogen proliferation
     • Antigen proliferation
   • Immunoglobulin levels
   • Complement assays (C3, C4, CH100)
   • Immune complex assays (e.g. C1q binding)

Communicator

1. Demonstrate an ability to listen effectively to laboratory staff, colleagues and patients and their families.

Manager

1. Describe the utility of diagnostic tests used in Clinical Immunology Allergy to balance costs and availability in optimizing patient care.

Professional

1. Exhibit appropriate personal and interpersonal professional behaviours.

During the Occupational Medicine rotation, the resident will achieve the following in their role as:

Medical Expert

1. Demonstrate knowledge of the etiology, pathophysiology, assessment and practical management of occupational rhinitis and occupational asthma.
2. Demonstrate knowledge of the etiology, pathophysiology, assessment and practical management of allergic contact dermatitis as it relates to workplace exposures.
3. Develop specific diagnostic and investigative skills including radiological examinations appropriate to the assessment of diseases related to occupational exposures.
4. Understand the role of patch testing in the diagnosis of allergic contact dermatitis as it relates to occupational exposures.
5. Become proficient in technical aspects of patch testing for allergic contact dermatitis.
6. Understand the role of Occupational Medicine physicians in the prevention of occupational and environmental injury.
7. Acquire competence in the medical treatment modalities used for common occupational illnesses/injuries.

Communicator

1. Develop a therapeutic relationship with patients with occupation-related illnesses.
2. Collect relevant information and synthesize the significant history of patients and families.
3. Listen effectively to information provided by patients, their families and other health professionals involved in the care of individual patients with occupation-related illnesses.
4. Deliver adequate information to patients with occupation-related conditions.
5. Provide appropriate and comprehensive advice as well as instructions for environmental control, and other therapies.

Collaborator

1. In consultation with the Occupational health specialist and other health care professionals involved, develop a comprehensive care plan for the patient.
2. While demonstrating the ability to incorporate the opinions of the Occupational Medicine team, to enhance and contribute allergy/clinical immunology-specific expertise to the team.

Leader

1. Understand the functioning of the Occupational Medicine department as part of a healthcare organization.
2. Understand the roles of different healthcare practitioners/allied health within the Occupational Medicine clinic.
3. Understand the economic impact associated with occupational health issues.
4. Make appropriate decisions when allocating finite health care resources.
5. Prioritize and execute tasks related to care of occupation-related illness in an efficient manner.
6. Utilize information technology to optimize patient care, maintain life-long learning.

Health Advocate

1. Identify the important determinants of health including environmental, cultural, social and economic factors affecting patients suffering from occupation-related diseases, in particular, those with allergic components.
2. Contribute effectively to improve the health of patients and communities by adapting the management according to the patient’s medical history, social circumstances, work environment, exposure to allergens or irritants.

Scholar

1. Critically appraise sources of medical information with regards to occupational medicine problems particularly those with an allergic/immunologic basis.

Professional

1. Deliver the highest quality care with integrity, honesty and compassion.
2. Exhibit appropriate personal and interpersonal professional behaviours.
3. Respect diversity of age, gender, disability, intelligence and socioeconomic status.
4. Practice medicine ethically, consistent with the obligations of a physician.
5. Exhibit punctuality.

During the Respirology rotation, the resident will achieve the following in their role as:

Medical Expert

1. Develop a solid knowledge base of the basic science and clinical information related to respiratory diseases particularly asthma, lung involvement in hypersensitivity and occupational diseases, auto-immune/rheumatological and vasculitic conditions.
2. Gain proficiency in clinical diagnosis, investigational procedures and their interpretation relative to lower airway function and disease.
3. Specific skills and interpretative strategies to be acquired: chest exam, pulmonary function testing, principles of bronchial challenges, sputum and exhaled, and gross interpretation of imaging studies.
4. Acquire the principles and practical considerations of the management of respiratory diseases including the pharmacology of utilized treatment modalities.

Communicator

1. Establish a therapeutic relationship with patients with respiratory problems and with their families.
2. Obtain appropriate information and synthesize the relevant history from patients and families with regards to respiratory conditions particularly in those with a significant allergic and immunological component.
3. Assess the influence of environmental, cultural, and economic factors on respiratory illness.
4. Listen effectively to the information provided by patients and families and other health professionals involved in the care of the individual patients with respiratory diseases, particularly those with an allergic, autoimmune basis.
5. Provide appropriate information to patients with respiratory conditions, specifically those with an allergic/immunologic basis.
6. Provide appropriate advice for environmental control, occupational exposures, asthma action plans, and problems related to respiratory conditions.
7. Discuss appropriate information with the health care team when necessary.

Collaborator

1. In consultation with the respirologist and other health care professionals involved in the care of the patients with respiratory diseases, develop a comprehensive care plan for the patient assessed.
2. While demonstrating the ability to incorporate the opinions of respiratory team members to enhance and contribute clinical allergy/immunology specific expertise to the respiratory team.

Manager

1. Understand the function of the Respiratory Department as part of a health care organization, utilize its resources to the effect of balancing patient care, learning needs and outside activities.
2. Make appropriate decisions when allocating finite health care resources.
3. Prioritize and execute tasks related to respiratory care in an efficient manner.
4. Utilize information technology to optimize patient care, maintain life-long learning.

Health Advocate

1. Identify the important determinants of health affecting patients suffering from respiratory diseases, in particular those with allergic/immunologic basis.
2. Contribute effectively to improve the health of patients by adapting the management according to the patients’ medical history, social circumstances, work environment, exposure to allergens or airway irritants.
3. Recognize and respond to those issues where advocacy is appropriate to indicate how relevant allergens and airway irritants may be avoided in workplaces, homes, schools, etc.

Scholar

1. Develop, implement and monitor a personal continuing education strategy with regards to respiratory diseases.
2. Critically appraise sources of medical information with regards to respiratory problems particularly those with an allergic/immunological component.
3. Participate in the process of learning of patients, house staff, and other health professionals with regard to respiratory problems.

Professional

1. Deliver the highest quality care with integrity, honesty and compassion.
2. Exhibit appropriate personal and interpersonal professional behaviours.
3. Respect diversity of age, gender, disability, intelligence and socioeconomic status.
4. Practice medicine ethically, consistent with the obligations of a physician.
5. Exhibits punctuality.

The following sections outline the rotation expectations in CanMEDS roles within the domains as a medical expert, communicator, collaborator, manager, health advocate, scholar and professional.

Medical Expert

As Medical Experts, Clinical Immunologists and Allergists integrate all of the CanMEDS roles, applying medical knowledge, clinical skills and professional attitudes in their provision of patient-centred care.

Key Competencies
Physicians are able to:

1. Function effectively as consultants, integrating all the CanMEDS roles to provide optimal, ethical and patient-centred medical care.
2. Perform a consultation, including the presentation of well-documented assessments and recommendations in written and/or verbal form in response to a request from another healthcare professional.
3. Demonstrate the use of all CanMEDS competencies relevant to Rheumatology.
4. Demonstrate the ability to prioritize professional duties when faced with multiple patients and problems.
5. Apply fundamental knowledge, skills and attitudes:

Basic Science

• Overview of the immune system as pertaining to rheumatology
• Effector mechanisms (chemokines/ cytokines/ adhesion molecules)
• B cell-mediated immunity
• T cell-mediated immunity
• Immune functions of cellular elements of the immune system (platelets, T cells, B cells, granulocytes)

Pharmacology

• Steroids, IVIG, DMARDs, biologics

Therapeutics

• Cytokine, cytokine receptor-mediated therapy
• Recombinant molecules and humanized monoclonal antibodies
• Monitoring for therapeutic agents and managing complications

Specific Diagnostics

• Laboratory tests for inflammation and autoimmune diseases
• Autoantibody testing
• Diagnostic imaging techniques in the assessment of rheumatic diseases that overlap immunological conditions

Clinical Sciences – demonstrate knowledge of etiology, pathophysiology, diagnostic methods, assessment and practical management of the following:

• Vasculitides (small, medium, large vessels)
• SarcoidosisImmune rheumatic disorders (including but not limited to SLE, Sjogren’s)
• Inflammatory myositis

Principles and Methodology of lab techniques in Rheumatology related to Allergy

• Measurement of immunoglobulins
• Serum protein electrophoresis and immunoelectrophoresis
• Measurement of immune complexes, cryoprecipitable proteins, complement
• Monoclonal antibody technology

Communicator

Key Competencies

1. Develop rapport, trust, and ethical therapeutic relationships with patients.
2. Accurately elicit and synthesize relevant information and perspectives of patients, colleagues and other professionals.
3. Accurately convey relevant information and explanations to patients, colleagues and other professionals.
4. Develop a common understanding of issues, problems, and plans with patients and families, colleagues, and other professionals to develop a shared plan of care.
5. Convey effective oral and written information about the medical encounter.

Specific Requirements

1. Communicate effectively with all staff, allied health professionals and discuss appropriate information with patients and team.
2. Establish effective relationships with patients, family members and caregivers to obtain meaningful history, conduct relevant physical exams and properly manage a patient’s medical problem.
3. Understand the psychosocial aspects of caring for patients with acute, chronic and life-threatening disorders.
4. Understand the biomedical ethics involved in the investigation and care of patients with rheumatological disorders.
5. Demonstrate effective communication skills by presenting concise, informative overviews on topics in the diagnosis of rheumatologic disorders.

Collaborator

Key Competencies

1. Participate effectively and appropriately in an interprofessional healthcare team.
2. Effectively work with other health care professionals to prevent, negotiate and resolve interprofessional conflict.

Specific Requirements

1. Contribute clinically useful rheumatological opinions on patients referred for consultation, including ordering and arranging for specific testing, administering required therapy, and conveying results of the rheumatological opinion to referring physicians. This may require integrating results of clinical, laboratory, EMG, and radiological data.
2. Consult and collaborate with physicians, lab staff, clinic staff and other health care professionals and contribute effectively to interdisciplinary team activities held within the hospital (rounds, journal clubs, etc.).

Manager

Key Competencies

1. Participate in activities that contribute to the effectiveness of their healthcare organizations and systems.
2. Allocate finite healthcare resources appropriately

Specific Requirements

1. Appropriate use of IVIG.
2. Appropriate use of biologics given in a hospital setting.

Health Advocate

Key Competencies

1. Respond to individual patient health needs and issues as part of patient care.
2. Respond to the health needs of the communities that they serve.
3. Identify the determinants of health of the populations that they serve.
4. Promote the health of individual patients, communities and populations.

Specific Requirements

1. Demonstrate an appreciation of the health care needs of patients with all serious rheumatological conditions that necessitate admission to the hospital.
2. Encourage the promotion of active family involvement in decision-making and continuing management.
3. Understand the ways effective laboratory support is important to patients with rheumatological and medical problems.
4. Advocate for patients if there are delays in diagnosis and management as a result of limited resources.

Scholar

Key Competencies

1. Maintain and enhance professional activities through ongoing learning.
2. Critically evaluate information and its sources and apply this appropriately to practice decisions.
3. Facilitate the learning of patients, families, students, residents and other health professionals, the public and others as appropriate.
4. Contribute to the creation, dissemination, application, and translation of new medical knowledge and practices.

Specific Requirements

1. Provide evidence in the material that they present during their presentations of cases to rheumatology attendings that they are acquiring an appropriate level of in-depth knowledge pertaining to rheumatology diagnostics and a current understanding of the pathophysiology of the disorder.
2. Develop critical appraisal skills specific to rheumatological literature, especially as it applies to the physiology and pathophysiology of the particular rheumatological disorder being treated.

Professional

Key Competencies

1. Demonstrate a commitment to their patients, profession and society through ethical practice.
2. Demonstrate commitment to their patients, profession, and society through participation in profession-led regulation.
3. Demonstrate a commitment to physician health and sustainable practice.

Specific Requirements

1. Deliver the highest quality care with integrity, honesty and compassion.
2. Exhibit appropriate personal and interpersonal professional behaviour.
3. Practice medicine ethically consistent with the obligations of a physician.
4. Be courteous and punctual.
5. Follow up on patients evaluated.
6. Arrange additional laboratory investigations as appropriate.

During the second year of training, the resident will attend and run the Senior Resident Clinic longitudinally. The resident will achieve the following in their role as:

Medical Expert

1. Demonstrate proficiency in the formulation of differential diagnoses.
2. Demonstrate the ability to accurately interpret and follow up on appropriate diagnostic investigations relating to patient care in Clinical Immunology & Allergy.
3. Synthesize all of the pertinent information to arrive at complete and accurate clinical decisions.
4. Use preventive and therapeutic interventions effectively and independently.
5. Recognize the limits of their own expertise and seeks appropriate consultations from other health professionals.

Communicator

1. Establish a therapeutic relationship with pediatric and adult patients and/or their caregivers.
2. Provide clear and thorough explanations of diagnosis, investigations and management to patients and families.
3. Give appropriate advice in the clinic and on the phone if necessary.
4. Prepare written documentation (including patient notes and patient letters) that is accurate, organized and timely.
5. Demonstrate the ability to verbally present cases in an accurate, concise, and organized fashion.

Collaborator

1. Interact effectively with health professionals by recognizing and acknowledging their roles and expertise including nurses, clinic clerks, and administrative assistants.
2. Provide effective consultation relevant to Clinical Immunology and Allergy.
3. Establish good relationships with peers and other health professionals.
4. Collaborate effectively and constructively with other members of the healthcare team.
5. Demonstrate leadership in a health care team as appropriate.
6. Demonstrate understanding of issues involving disabilities, age, gender, race and culture when working with other team members.
7. Work with other health professionals effectively to prevent, negotiate, and resolve interprofessional conflict.

Manager

1. Demonstrate awareness and makes cost-effective use of all forms of Clinical Immunology and Allergy healthcare resources based on sound judgment, and where possible evidence-based medicine.
2. Demonstrate knowledge of and willingness to be involved in, cost-containment and quality assurance programs.
3. Set realistic priorities and uses time effectively in order to optimize professional performance. Balances professional, personal and institutional commitments.
4. Demonstrate knowledge of the Canadian healthcare system and an awareness of the role of allergists/clinical immunologists in societal and governmental aspects of healthcare provision.
5. Demonstrates the ability to manage clinic schedules and manage patient care priorities independently.

Health Advocate

1. Advocate for and intervene on behalf of patients including appropriate preventive care and health surveillance strategies.
2. Advocate for both the patient and family by working with the family to obtain the needed services for care and ongoing family support.
3. Recognize that the healthcare needs of children/adolescents are different from adults, and change throughout the developmental continuum.
4. Participate in efforts to increase public awareness of the medical conditions relevant to Clinical Immunology and Allergy.

Scholar

1. Demonstrate an understanding of and a commitment to the need for continuous learning.
2. Develop and implement an ongoing and effective personal learning strategy with an analysis and evaluation of the relevant medical literature.
3. Seek to learn from errors and aspires to excellence through self-evaluation and acceptance of the critiques of others.
4. Demonstrate the ability to critically appraise medical information. Successfully integrate information from a variety of sources.
5. Describe the principles of adult learning and helps others learn by providing guidance, teaching and by giving constructive feedback.
6. Receive feedback well.

Professional

1. Demonstrate honesty and integrity (including being fair, truthful and keeping one’s word; meeting commitments; being forthright in interactions with patients, peers, and in all professional work whether through documentation, personal communication, presentations, research or other aspects of interaction).
2. Demonstrate compassion and empathy (including listening attentively, and responding humanely to the concerns of patients and family members).
3. Demonstrate respect for others and diversity.
4. Demonstrate reliability, responsibility and conscientiousness.
5. Demonstrate an understanding of the ethical practice and applies this to one’s work (including accountability to one’s profession to ensure that the ethical precepts of practice are upheld).
6. Demonstrate self-awareness/knowledge (including awareness of one’s own limitations and seeks advice when necessary; accept advice graciously; insightful as to the impact of one’s behaviour on others and cognizant of appropriate professional boundaries).
7. Demonstrate altruism (including unselfish regard for and devotion to the welfare of others; self-interest or the interests of other parties should not interfere with the care of one’s patients and families).
8. Demonstrate a commitment to physician health and sustainable practice, including balancing personal and professional priorities.

1. Introduction

Resident education must occur in a physically safe environment (Royal College of Physicians and Surgeons of Canada, standard A.2.5; College of Family Physicians of Canada). The university also recognizes that a safe working environment for trainees is beneficial to resident education and patient care and that there are ethical and moral reasons for maintaining such a working environment.
The purpose of this document is to provide a policy regarding workplace safety for postgraduate trainees in Clinical Immunology and Allergy at McMaster University and to demonstrate the commitment of the residency training program in providing and maintaining healthy and safe working and learning environment for all postgraduate trainees. This is achieved by observing best practices that meet or exceed the standards to comply with legislative requirements as contained in the Ontario Occupational Health and Safety Act, Environmental Protection Act, their regulations, and the policy and procedures established by the University.
It is expected that the postgraduate trainee, the residency training program, the Postgraduate Medical Education (PGME) Office will work together with the affiliated teaching hospitals and community training sites to ensure the personal safety of all postgraduate trainees.
This policy complies with the Royal College accreditation standards A2.5 and B1.3.9 and does not supersede any University-wide or PGME Policy that is already established. In this policy, “Safety” relates to the residents’ physical, emotional and professional wellbeing. See: //fhs.mcmaster.ca/postgrad/policies.html

2. Scope

This policy covers resident safety in the areas of travel, patient encounters, including house calls, after-hours consultations in isolated departments (Royal College Standard B1.3.9). This policy should allow residents’ discretion and judgment regarding their personal safety and ensure residents are appropriately supervised during all clinical encounters.
These policies apply only during residents’ activities that are related to the execution of residency duties.

3. Program Specific Policies

3.1 The Resident Safety Policy needs input and acceptance from the residents through the residency education committee.
3.2 Residents need to provide rotation and faculty evaluations to help direct or establish concerns about resident safety.
3.3 The residency program administration and the Program Director need to act promptly to verify safety issues and take due action to rectify the problem.
3.4 Critical incidents involving residents must be recorded, and appropriate debriefing should occur in a timely fashion.

4. Responsibility of the Resident

Travel

4.1 Residents travelling for clinical or other academic duties by private vehicles should maintain their vehicles adequately and travel with appropriate supplies and contact information. Residents should not use cell phone use or text messaging while driving.
4.2 If the resident has determined that it is unsafe to travel (i.e. due to extreme weather concerns), the resident may elect not to attend the clinic, see a consult, or academic half-day. However, they must inform their clinical supervisors as soon as possible in a professional manner.
4.3 Residents should ensure adequate rest after call duties before travelling home from the site of clinical duties. Call rooms are available at each training site to accommodate residents for rest before travel. Residents should discuss such arrangements with the on-call supervisor or program director.
4.4 Residents who are called in for clinical duties after 6 pm and before 6 am, and feel unsafe to drive post-call should opt to take a taxi for transportation. Reimbursement for taxi charges will be provided upon the presentation of appropriate receipts.
4.5 Residents are not required to attend academic half-day if they are greater than 50 km away from the academic half-day location nor are they required to attend on post-call days. Should residents feel well-rested despite being post-call, they are encouraged and welcome to attend academic sessions. If not attending due to post-call, residents must inform the Program Assistant (Ann-Marie) of this reason for absence.

Physical Safety

4.6 Residents must participate in required safety sessions including Workplace Hazardous Materials Information and Safety (WHMIS), Fire Safety, and abide by the Safety Codes of the designated area where s/he is training.
4.7 Residents must observe universal precautions and isolation procedures. If necessary, a refresher or literature will be provided on universal precaution procedures.
4.8 Residents should familiarize themselves with the occupational and safety office. This includes familiarity with policies and procedures in reporting contact with contaminated fluids, needles, TB exposure or risk, etc.
4.9 Residents should keep their immunizations and TB skin testing up to date. Overseas travel immunizations and advice should be organized well in advance when travelling abroad for electives or meetings. Since the residency training program does not mandate overseas electives, the resident is expected to coordinate and finance these services.
4.10 Residents should not assess violent or psychotic patients without the backup of security or a supervisor and also an awareness of accessible exits.
4.11 Residents should not work alone at after-hours clinics, make unaccompanied home visits, perform air transport, or arrange to meet patients after hours without on-site support. This does not apply if a patient is being seen in the emergency room or in a hospital ward. A supervisor must always be present if the resident is assessing a patient in an ambulatory setting after hours.
4.12 If the resident feels that his/her own personal safety is threatened, s/he should seek immediate assistance and remove themselves from the situation in a professional manner. The resident should be aware of the contact for security at participating training sites. The resident should ensure that their immediate supervisor and/or Program Director, has been notified, as appropriate. The resident can also bring their safety concerns to the attention of the PGME office (905 525 9140 Ext. 22118) during regular work hours, particularly if the Program Director is not available. If an issue arises after regular office hours, where the clinical supervisor and/or Program Director may not be available, contact Security of the institution where the trainee is based.
4.13 Residents doing home calls and arriving after hours should be aware of their environment before leaving their car and have a cellphone available to contact security if it is deemed an escort is required. If residents feel a potential threat to their safety, residents should not exit their cars and leave accordingly. In the rare event this occurs, residents should notify the clinical supervisors on call.
4.14 Residents must get approval from the program director when planning to do an elective outside of North America to ensure compliance with standards and best practices for the safety of all trainees. International electives must occur in a stable political environment with a qualified preceptor to provide appropriate supervision. Additionally, there must be a Canadian Consulate in that country.
4.15 Residents must use caution with respect to confidential personal and patient information, and exercise good judgment and professional behaviour when using social media.
4.16 If an injury occurs while working, the injury must be reported as follows:

• During daytime hours, while working at one of the Hamilton teaching hospitals, the trainee should go to the Employee Health Office at any of the teaching hospitals. An incident form will be provided by the Employee Health Office to the trainee. Trainees are encouraged to submit a copy of the incident form to the Program Director and the PGME Office for records.
• During after hours, while working at one of the Hamilton teaching hospitals or if working at a training site outside of the Hamilton area, the trainee should go to the nearest emergency room and identify themselves as a resident and request to be seen on an urgent basis. The trainee must complete, within 24 hours, an Injury/Incident Report available in the local emergency room. The form should be submitted to the hospital where the injury took place, the Program Director and the PGME office for records.

Psychological Safety

4.17 Residents are encouraged to report incidents of intimidation, harassment and discrimination to the Program Director. Any incidents or issues brought forth to the Program Director will remain confidential and residents have the right to confidential psychological and counselling services.
4.18 Residents are encouraged to comment on the rotation evaluations of any professional issues encountered by staff and residents.

Professional Safety

4.19 Residents must not be expected to participate in any situation that would go against their professional responsibilities, ethics, or moral beliefs.
4.20 Residents must have adequate contact with their clinical supervisors for help during critical incidents.
4.21 CMPA provides legal advice and insurance for residents who have acquired coverage.

5. Responsibility of the Program

5.1 It is the responsibility of the residency training program and the PGME to ensure that appropriate safety sessions are available to all trainees. In addition to WHMIS, the residency training program must ensure that there is an initial, specialty, site-specific orientation available to the trainee.
5.2 It is the responsibility of the residency training program to ensure that individual clinics or practice settings develop a site-specific protocol in the event that personal safety is breached. The protocol should include the following:

• Identify potential risks to the trainee.
• Include how the trainee would alert the supervisor if they felt at risk during an encounter, identification of potentially problematic patients at the beginning of the encounter, so they could be monitored.
• A supervisor or co-worker must be present:
  • While the trainee is seeing a patient after hours in the clinic. This would not apply if the patient is being seen in an emergency room.
  • At the end of office hours if the trainee is still with patients.

5.3 It is the responsibility of the residency training program that each training site remains compliant with the program policy.
5.4 It is the responsibility of the residency training program to ensure a safe learning environment that is free from intimidation, harassment and discrimination. The residency training program will not tolerate such behaviours.

Resources Available

Postgraduate Medical Education Office
905-525-9140 X22118
905-527-2707

Faculty of Health Sciences Safety Office
Health Sciences Centre, Room 3N1C1200
Main Street West, Hamilton, ON L8N 3Z5
905-525-9140 X24956
905-528-8539

Hamilton Health Sciences
Human Resources – Employee Health
Telus Sourcing Solutions
120 King Street West, Suite 200
Hamilton, ON
905-387-9495 X63900

St. Joseph’s Healthcare
Occupational Health and Safety Services
50 Charlton Avenue East
Hamilton, ON L8N 4A6
905 522 1155 X33344

During the Bone Marrow Transplantation rotation, the resident will achieve the following in their role as:

Medical Expert

1. Understand major histocompatibility complex structure and functions.
2. Develop knowledge regarding the basic science principles of graft rejection and tolerance.
   • Understand alloreactive T cell activity and recognition of alloantigens.
3. Demonstrate knowledge of indications for bone marrow. transplantation, both autologous and allogeneic.
4. Demonstrate knowledge of the management of complications of transplant, including rejection and infection.
5. Understand the principles of prevention, recognition and treatment of allograft rejection.
6. Understand the pathophysiology, presentation, prevention and management of graft vs host reactions (acute and chronic).
7. Demonstrate knowledge of conditioning regimens used in bone marrow transplant for different indications.
8. Become familiar with immunomodulatory medication commonly used in transplantation.
9. Describe the principles and methodology of histocompatibility typing.

Communicator

1. Develop a therapeutic relationship with bone marrow transplant recipients and donors.
2. Collect relevant information and synthesize the significant history from patients and families.
3. Listen effectively to information provided by patients, their families and other health professionals involved in the care of the individual patients.
4. Deliver adequate information to the patients regarding their disease and treatment.
5. Provide appropriate and comprehensive advice, as well as instructions for therapies.

Collaborator

1. In consultation with the hematology team and other health care professionals involved, develop a comprehensive care plan for the patient. While demonstrating the ability to incorporate the opinions of the hematology team, enhance and contribute allergy/clinical immunology-specific expertise to the team.

Leader

1. Understand the function of the bone marrow transplantation team as part of a health care organization.
2. Understand the role of different health care practitioners and allied health members within the bone marrow transplantation team.
3. Understand the economic impact associated with bone marrow transplantation for different indications.
4. Make appropriate decisions when allocating finite health care resources.
5. Prioritize and execute tasks in an efficient manner.
6. Utilize information technology to optimize patient care, maintain life-long learning.

Health Advocate

1. Identify the important determinants of health including environmental cultural, social and economic factors on bone marrow transplant donors and recipients.
2. Contribute effectively to improve the health of patients and communities by adapting the management according to the patient’s medical history and social circumstances.

Scholar

1. Critically appraise sources of medical information with regards to bone marrow transplantation, particularly those related to bone marrow transplant in immunodeficiency.

Professional

1. Deliver the highest quality care with integrity, honesty and compassion.
2. Exhibit appropriate personal and interpersonal professional behaviours.
3. Respect diversity of age, gender, disability, intelligence and socioeconomic status.
4. Practice medicine ethically, consistent with the obligations of a physician.
5. Exhibit punctuality.

During the Solid Organ Transplantation rotation, the resident will achieve the following in their role as:

Medical Expert

1. Understand major histocompatibility complex structure and function.
2. Develop knowledge regarding the basic science principles of transplant rejection and tolerance.
3. Understand alloreactive T cell activity and recognition of alloantigens.
4. Demonstrate knowledge of indications for transplant (organ site-specific).
5. Demonstrate knowledge of the management of complications of transplant, including rejection and infection.
6. Understand the principles of prevention, recognition and treatment of transplant rejection.
7. Understand the pathophysiology, presentation, prevention and management of graft vs host reactions.
8. Demonstrate knowledge of peri-transplant immunomodulatory regimens used in solid organ transplantation and their indications.
9. Describe the principles and methodology of histocompatibility typing.

Communicator

1. Develop a therapeutic relationship with transplant recipients and donors.
2. Collect relevant information and synthesize the significant history of patients and families.
3. Listen effectively to information provided by patients, their families and other health professionals involved in the care of the individual patients.
4. Deliver adequate information to the patients regarding their disease and treatment.
5. Provide appropriate and comprehensive advice as well as for instructions for therapies.

Collaborator

1. In consultation with the transplant team and other health care professionals involved, develop a comprehensive care plan for the patient.
2. While demonstrating the ability to incorporate the opinions of the transplant team, enhance and contribute allergy/clinical immunology-specific expertise to the team.

Leader

1. Understand the function of the transplant team as part of a health care organization.
2. Understand the role of different health care practitioners and allied health members within the transplant team.
3. Understand the economic impact associated with organ transplantation for different indications.
4. Make appropriate decisions when allocating finite health care resources.
5. Prioritize and execute tasks in an efficient manner.
6. Utilize information technology to optimize patient care, maintain life-long learning.

Health Advocate

1. Identify the important determinants of health including environmental cultural, social and economic factors on transplant donors and recipients.
2. Contribute effectively to improve the health of patients and communities by adapting the management according to the patient’s medical history and social circumstances.

Scholar

1. Critically appraise sources of medical information with regards to organ transplantation, particularly those related to immunologic mechanisms and immunomodulatory treatments.

Professional

1. Deliver the highest quality care with integrity, honesty and compassion.
2. Exhibit appropriate personal and interpersonal professional behaviours.
3. Respect diversity of age, gender, disability, intelligence and socioeconomic status.
4. Practice medicine ethically, consistent with the obligations of a physician.
5. Exhibit punctuality.

Clinical Immunology and Allergy Resident Handbook 2020 (PDF)