Program overview and Rotation Description

The two-year residency training program fulfills the specialty training requirements in Adult Palliative Medicine as defined by the Royal College of Physician and Surgeons of Canada. The program is committed to provide opportunities for residents to hone their skills by offering a complementary three-pronged approach through clinical exposure, didactic teaching and interactive workshops.

Mandatory rotations in Community Palliative Care are provided under the supervision of a palliative care physician lead in Indigenous Health with Six Nations of the Grand River (6N). Residents will be exposed to the needs of the structurally vulnerably, housed through the Palliative Education and Care for the Homeless (PEACH) program at McMaster University. A unique Integrative Psychosocial Block offers longitudinal work in psychiatry, grief counselling, spiritual care, and infectious disease / addictions medicine. Medical Discipline Selectives are spread throughout the two years. There will be a mandatory of 6, including Infectious Disease (incorporated in the Integrative Psychosocial Block), and 5 others of the resident’s choosing from: Cardiology, Critical Care Medicine, Gastroenterology, Geriatric medicine, Nephrology, Neurology, and Respirology. Later in their residency, residents will have a 4-week block to consolidate their understanding of a mandatory scholarly project and bring it to completion. This dedicated time with access to mentors and supervisors will allow for preparation for dissemination through presentations, written papers or implementation / spread of QI projects. A sample resident rotation schedule is provided below. The Program Director will work with the resident to identify areas of interest and help arrange rotations and educational experiences, whether at McMaster-affiliated sites or at external sites in other catchment areas.

b. Objectives/Competencies

McMaster University’s Royal College Subspecialty training in Palliative Medicine will be committed to provide its residents the skills needed to address the physical, psychological, social and spiritual symptoms of patients with all life-threatening conditions, and lead palliative medicine in the future to serve the Canadian population’s health needs.

Objectives of the program are to provide support for the development of academic research and professional competencies within the framework of the CanMEDS roles. The specific objectives are tailored to meet the requirements of the Royal College of Physician and Surgeons of Canada for certification in Palliative Medicine.

The program has been designed to support resident achievement of increasing responsibility to independence through a logical sequence of clinical experiences. Beginning in the transition to discipline stage, Palliative Medicine residents will gain a firm understanding of the foundations of the discipline. The bulk of the rotations will serve to refine knowledge and skills, and tailor towards residents’ individual learning needs and goals. Near the end of the program, residents will be expected to function as junior attending staff during palliative medicine rotations, preparing them for independent practice.

Palliative Medicine – McMaster University Two-Year Program

Clinical Rotations Sample:

Description of training rotations

The first two rotations are on inpatient palliative care services. This will include daily patient rounds with an attending physician, which allows for residents to be more closely supervised initially with increased independence and responsibility as the resident’s knowledge/skills develop. The purpose of these rotations is to transition the resident to the discipline and provide the necessary foundations.

Residents will then move into core rotations, including an Integrative Oncology Block, providing comprehensive and longitudinal experience in Medical Oncology, Radiation Oncology and the Pain and Symptom Management Outpatient Palliative Care Clinic. This allows the resident to thoroughly immerse in the care of a patient with a malignancy and follow their journey.

Community setting rotations are split evenly over the two years, giving a broad exposure to multiple settings, including Six Nations and Joseph Brant Hospital.

An Integrative Psychosocial Block provides comprehensive and longitudinal experience in Psychiatry, Infectious Disease / Addictions Medicine, and additional relevant selectives such as Spiritual Care and/or Grief Counselling. Academic Half—Days tailored around communication skills will predominantly occur during this time.

Mid-way in their training, residents return to inpatient consultations to begin to consolidate their first year of training and focus on teaching skills of junior learners.

Medical Discipline Selectives are spread throughout the two years. There will be a mandatory of 6, including Infectious Disease (incorporated in the Integrative Psychosocial Block), and 5 others of the resident’s choosing from: Cardiology, Critical Care Medicine, Gastroenterology, Geriatric medicine, Nephrology, Neurology, and Respirology.

Scholarly activity is largely done on a longitudinal basis throughout the two-year training program with a protected block in the second year to consolidate the scholarly work in preparation for dissemination and presentation.

The final two months of training will be done back in inpatient palliative care to consolidate learning and concepts of “transition to practice”. During this time, the trainee will be acting effectively as a junior attending with responsibility for patient care as well as teaching and supervision of more junior trainees, as appropriate. The supervising staff physician will be available for advice and to ensure that the trainee is ready for independent practice.

c. Educational ActivitiesProgram-Wide Educational Activities

• Academic Half-Days

Residents are excused from their clinical duties to attend Palliative Medicine academic half days on a weekly basis. Occasional, additional protected time is allotted in the afternoon after the weekly AHD for residents to complete scholarly work.

• Medicine Specialties

Academic Half Days The Medicine Specialties programs combine efforts to provide half-days addressing the intrinsic CanMEDS roles that are common among all specialties. Separate subspecialty half days are organized for the PGY-4 and PGY-5 residents with some common sessions. A committee with resident representation from all the medicine subspecialties allows for topics that are selected by the residents to ensure relevance and interest. Topics may include financial planning, career planning, leadership, resident stress, and harassment.

Academic Rounds

• Medical Grand Rounds
• Case Rounds
• Division of Palliative Care Journal Club

Research and Scholarly Activities

Residents will be required to complete a scholarly project on a self-selected topic or patient population. The Division of Palliative Care at McMaster University is a recognized leader nationally in the development and production of scholarly work and research. Given that McMaster hosts several large and well recognized research institutes in Population Health (PHRI), Geriatric research (GERAS), Oncology research (ECRI) and the more recently established Juravinski Research Institute, there is an abundance of opportunities for residents to participate with world class academics and researchers. In particular, the Division of Palliative Care has academics pursuing work in Public Health, vulnerable populations, whole patient care, end-of-life in critical care, and the development of educational programs in Palliative Care. Scholarly activity in the program is a longitudinal experience beginning early in the first year of the program, with the support and guidance of a Palliative Medicine Research Advisor.

Mentorship

The residency mentorship program will offer a space for residents to receive support and guidance regarding wellness, stress, personal and professional challenges. Residents will be assisted in finding a mentor and encouraged to engage with their chosen mentors who may have knowledge and experience to help them navigate career opportunities.

Leadership

In addition to expected clinical leadership roles (i.e. junior attending roles, team management), residents will be encouraged to develop their leadership, administrative, and academic skills through various opportunities in the division, and the broader university community. Leadership opportunities are encouraged such as quality improvement initiatives, research initiatives, committee representation, and educational opportunities.

Career Counseling

Residents regularly meet individually with the Residency Program Director to self-reflect and discuss career goals, research plans, and resident performance. Resident schedules will also be reviewed and adjusted to tailor towards the resident’s career goals, while still adhering to the mandatory curriculum.

Clinical Investigator Program

Health Research Methodology

Master of Health Science Education

Master of Science in Global Health

Medical Sciences Graduate Program

Master of Biomedical Discovery and Commercialization

The Department of Family Medicine