Emergency Medicine

The goal of the program is to produce an individual who is:

Clinically proficient in the practice of pediatric emergency medicine, particularly in the management of the acutely ill and injured child
Competent in teaching pediatric emergency medicine
Capable of conducting research
Familiar with flow management and administrative issues

The core requirements for Royal College certification are completed in two years. Consideration for funding our trainees for a three-year program is also available. This qualifies them to write the Pediatric Emergency Medicine Subspecialty Certifying Examination offered by the American Board of Pediatrics, but must be identified upon entry into the program.

Program structure

The first year of training includes 7 blocks of clinical emergency medicine and 1 block of research. Other core rotations for the first year include the following: orthopedics, plastic surgery, anaesthesia, radiology/ultrasound and 1 elective block.

In the second year, there are 6 core blocks of emergency medicine and 1 block of research. Completion of the remaining core rotations includes the following: toxicology, trauma, adult emergency medicine, EMS and administration. There is time for a further elective slot in the senior year. At the end of the two years, trainees are expected to produce at least one completed research project during their program to be presented at a scientific meeting and are encouraged to have one peer-reviewed journal publication by the end of their training.

The third year, if chosen, consists of research or education scholarship, trauma fellowship or a Master’s program as approved by the program director. Ongoing emergency department clinical work and teaching would continue to be part of the responsibilities in the third year.

There are weekly protected academic education days which include pediatric emergency medicine Grand Rounds, journal scanning club, fellow seminar series and simulation training. At least twice a year, trainees are expected to participate in the teaching of the Pediatric Advanced Life Support course. Other activities include undergraduate and postgraduate-level bedside and simulation teaching.

Remuneration and benefits applicable for this position will be stipulated by the guidelines and agreements already in place between the Professional Association of Residents of Ontario (PARO), the University of Ottawa (uOttawa) and the Children's Hospital of Eastern Ontario (CHEO).

Stipends are in accordance with the resident's level of seniority and correspond to the schedule paid throughout Ontario, as do benefits. Support for attendance at educational meetings, start-up research and other requirements are available.

Curriculum

The two years of the core program follow the Royal College of Physicians and Surgeons of Canada requirements.

The first year of the program includes 7 blocks in the emergency department and 1 block each of research, anaesthesia, orthopedics, plastic surgery and radiology/ultrasound.

In the second year, the PEM resident must complete 6 blocks of emergency and 1 block each of research, adult emergency medicine, toxicology, trauma, emergency medical services and pediatric critical care. There is also a mandatory administration component to the program as per Royal College requirements. There are no mandatory electives.

We also offer an option of a third year which may consist of research/education scholarship, trauma fellowship or may be used to complete a Master’s program.

Rounds and teaching

There are weekly education rounds including the following: emergency rounds, academic fellow seminars which address the core objectives of training from the Royal College and simulation and debriefing training.

The PEM subspecialty residents participate in teaching off-service residents and students at the bedside in simulation and skill lab sessions. They are also involved in the teaching of Pediatric Advanced Life Support courses for residents, nursing and community-based physicians.

Clinical programs

The emergency department at the Children's Hospital of Eastern Ontario (CHEO) serves as the tertiary care referral centre for Eastern Ontario and Western Quebec. CHEO treats more than 65,000 patients per year and is the referral trauma centre for the region; over 800 cases per year require acute resuscitation, both trauma and non-trauma.

Because it is the only children's hospital within a catchment area of approximately 1.5 million people, CHEO has a unique place in serving acutely ill and injured children in the Ottawa region. CHEO is also the referral centre for parts of Northern Ontario and Nunavut.

Inpatient and outpatient care

To respond to the extremely varied needs of over 70,000 patients per year, with an average of over 1,300 per week, CHEO’s Emergency Department is staffed 24 hours a day by pediatric emergency medicine specialists and experienced pediatric emergency nurses, who are supported by nurse practitioners, crisis intervention workers, child life specialists, patient service clerks and patient service assistants. Services also include the Regional Pediatric Trauma Program and Regional Pediatric Sexual Assault Program.

The Emergency Department is comprised of a number of specialized areas, including trauma and resuscitation, acute zone, ambulatory zone, mental health and procedure rooms. Our division has an active point of care ultrasound program with a dedicated ultrasound machine in the department.

Our clinical programs extend beyond our walls in many ways. CHEO is the tertiary care pediatric referral centre for Eastern Ontario, Western Quebec, parts of Northern Ontario and Nunavut. As such, the department receives referral calls and advice calls every day where our specialists help to stabilize and manage acutely ill and injured patients before they arrive at CHEO.

Our department also has an active outreach program that delivers training and information to community hospital emergency departments in our area. This includes sharing our clinical care pathways, order sets and patient information sheets so that CHEO-level care can be provided to patients at their local hospital. Recently, the outreach program has expanded to include simulation-based training opportunities in partnership with our regional pediatric trauma program.

Clinical problems and diseases evaluated and followed

The Emergency Department assesses the full spectrum of acute pediatric illness and injury, as well as exacerbations of chronic disease as the main gateway into CHEO. This spectrum includes everything from neonatal problems in newborns rushed in from home deliveries through to adolescent health concerns including mental health crisis, addiction and homelessness. This dynamic variety is challenging but also exciting.

Overall, between 6 to 7 per cent of patients seen in the Emergency Department are admitted to hospital. The high proportion of patients who are able to be managed and discharged reflects the acute but minor and self-limited nature of most pediatric illnesses and injuries. In most interactions, addressing the concerns of the parents and family is as important as addressing the child or youth’s medical concerns.

Sites

The Pediatric Emergency Medicine fellowship is based primarily at the Children’s Hospital of Eastern Ontario (CHEO), with rotations in trauma and toxicology time spent at alternate sites with inter-university agreements in place in Toronto and New York. Adult emergency medicine and EMS are completed at The Ottawa Hospital.

Research opportunities

Research is a strong component of the Division of Emergency Medicine, with a sizeable number of externally funded projects. There is a close affiliation with the CHEO Research Institute where funding and expertise is available to aid in the completion of a research project.

Major research interests within the division include randomized controlled trials evaluating new therapies for acute respiratory diseases such as asthma, croup and bronchiolitis. In addition, there is ongoing work on childhood injuries and interventions for their prevention. Research is facilitated by a specialized volunteer program known as SUPPORT (Students Undertaking a Pediatric Program of Research Training).

Faculty

Application process

Application to the Division of Emergency Medicine Fellowship program is completed through CaRMS. Deadlines for applications are due the year preceding (i.e. for July 1, 2015 entry, applications are due March, 2014) as per the CaRMS subspecialty match.

To be eligible for admission to the program, applicants must have completed three years of core training in either pediatrics or adult emergency medicine. In the case of the latter, the curriculum content may be adjusted to reflect the candidate's adult emergency experience.

Applicants are evaluated with respect to their residency record, recommendations from former program directors and mentors as well as their apparent commitment to achieving excellence in training towards a career in pediatric emergency medicine.