UBC DIVISION OF PALLIATIVE CARE



Year of Added Competency in Palliative MedicineEnhanced Skills Residency ProgramDepartment of Family Practice | Faculty of MedicineHANDBOOK TABLE OF CONTENTS TOC \o "1-3" \h \z \u INTRODUCTION PAGEREF _Toc42554377 \h 4DIVISION MEMBERS & STAFF PAGEREF _Toc42554378 \h 5CLINICAL ROTATIONS PAGEREF _Toc42554379 \h 6Oncology: PAGEREF _Toc42554380 \h 7Ambulatory Palliative Care: PAGEREF _Toc42554381 \h 7Scholarly Activity: PAGEREF _Toc42554382 \h 7Electives: PAGEREF _Toc42554383 \h 8LEARNING OBJECTIVES AND OUTCOMES PAGEREF _Toc42554384 \h 9Family Medicine College Guidelines and Objectives PAGEREF _Toc42554385 \h 9Entrustable Professional Activities PAGEREF _Toc42554386 \h 14ACADEMIC CONTENT PAGEREF _Toc42554387 \h 17Academic Days, Case Review, Article Review and Journal Club PAGEREF _Toc42554388 \h 17Victoria Hospice Palliative Care Medical Intensive Course PAGEREF _Toc42554389 \h 17General Practice Oncologist (GPO) Didactic Course PAGEREF _Toc42554390 \h 17Resident as Teacher Day PAGEREF _Toc42554391 \h 18Scholarly Project PAGEREF _Toc42554392 \h 18Rounds PAGEREF _Toc42554393 \h 20Conferences PAGEREF _Toc42554394 \h 20Texts and Resources PAGEREF _Toc42554395 \h 20EVALUATIONS PAGEREF _Toc42554396 \h 22In-Training Evaluation Report (ITER) - Introductory Rotation PAGEREF _Toc42554397 \h 23In-Training Evaluation Report (ITER) - Community Hospice PAGEREF _Toc42554398 \h 27In- Training Evaluation Report (ITER) - Geriatrics PAGEREF _Toc42554399 \h 29In-Training Evaluation Report (ITER) –Advanced Palliative Care PAGEREF _Toc42554400 \h 31In-Training Evaluation Report (ITER) - Elective Rotation PAGEREF _Toc42554401 \h 33Academic Half-Day Feedback Form PAGEREF _Toc42554402 \h 38RESIDENCY PROGRAM COMMITTEE (RPC) PAGEREF _Toc42554403 \h 41COMPETENCY COMMITTEE (CC) PAGEREF _Toc42554404 \h 41WELLNESS, SAFETY, ACADEMIC AND PRACTICAL ISSUES PAGEREF _Toc42554405 \h 43Mentor and Faculty Advisor PAGEREF _Toc42554406 \h 43Resident Wellness and Wellness Faculty Member PAGEREF _Toc42554407 \h 43Palliative Medicine Resident Wellness Policy PAGEREF _Toc42554408 \h 43Resident Safety Policy PAGEREF _Toc42554409 \h 45Fatigue Risk Management Policy PAGEREF _Toc42554410 \h 49Housing PAGEREF _Toc42554411 \h 51Resident Mandated Travel and Reimbursement Support and Policy PAGEREF _Toc42554412 \h 51Pay and Benefits PAGEREF _Toc42554413 \h 51Expenses PAGEREF _Toc42554414 \h 51Resident Activity Fund PAGEREF _Toc42554415 \h 51Pagers PAGEREF _Toc42554416 \h 52Malpractice Insurance PAGEREF _Toc42554417 \h 52Prescription Writing PAGEREF _Toc42554418 \h 52Immunizations PAGEREF _Toc42554419 \h 52Vacation Scheduling PAGEREF _Toc42554420 \h 52Call Schedules PAGEREF _Toc42554421 \h 53Staying in Touch PAGEREF _Toc42554422 \h 53PRINCIPLES FOR THE LEARNER PAGEREF _Toc42554423 \h 54CHARACTERISTICS OF A SELF-DIRECTED LEARNER PAGEREF _Toc42554424 \h 55COMPLAINT MANAGEMENT SYSTEM PAGEREF _Toc42554425 \h 56INTRODUCTIONWelcome to Palliative Medicine at UBC!We hope that this guide will help you make the most of your palliative medicine education. It includes a framework for your clinical rotations, resources, policies, responsibilities and opportunities. Clinical rotations are designed to address the priority topics for competence in palliative care as outlined by the Standards of Accreditation for Residency Programs in Family Medicine. Rotations are scheduled to give you the opportunity to work across several health authorities and care environments, building on your skills from your family medicine training.Throughout the year, you will have an Academic Day educational series, article and case review presentations, as well as other structured learning opportunities.There are resident activity funds available to help fund conferences and elective rmation regarding the funds, the opportunities and the specifics of the program are found within this handbook and will be reviewed at the orientation session.Please connect with the Program Administrator for the Palliative Medicine Residency Programs at 604 806 9686 ext. 64941 for further assistance. Good luck with your year! We look forward to helping you become a palliative care consultant to your community. We celebrate your commitment to palliative care advocacy, teaching, research as well as your role as a lifelong learner.Sincerely,Anoo Tamber, MD, CCFP(PC) Program Director, Year of Added Competency in Palliative Medicine Julia Ridley MD, CCFP(PC) Program Director, Subspecialty Palliative Medicine Residency ProgramDIVISION MEMBERS & STAFFPositionDr. Pippa Hawley Head - UBC Division of Palliative CareDr. Anoo TamberProgram Director - Year of Added Competency in Palliative MedicineDr. Julia RidleyProgram Director – Subspecialty Palliative Medicine Residency ProgramDr. Tina WeberProgram Director – Family Medicine Enhanced SkillsDr. Rose HatalaResearch DirectorDr. Wai PhanWellness LeadKathryn InmanAdministrative Assistant –Division of Palliative Care – Subspecialty and YAC Residency ProgramsChloe YehAdministrative Assistant, Division of Palliative CareLindsay GowlandAdministrative Assistant – Dept Family Medicine, Enhanced SkillsA full list of clinical faculty members within the Division of Palliative Care can be found online at the division website.Further contacts for the Postgraduate Medical Education office (PGME) can be found on the PGME website, including contact information for Dr Ravi Sidhu, the PGME Associate Dean.CLINICAL ROTATIONSThere are 13 blocks (4 weeks each) per academic year. A typical schedule is reflected below, but may vary based on resident needs, rotation availability, etc.Content and Sequence of Rotations (4 week blocks)12345678910111213IntroductoryPalliative CareGeriatricsMedOncRad OncAmbulatoryPalliativeCareFlex/ResearchElectiveAdvancedPalliativeCareCommunityPalliativeCareElectivePalliative Care Introduction 8 weeksAmbulatory Palliative Care4 weeksOncology (2 week GPO course)8 weeksGeriatrics4 weeks Advanced Palliative Care8 weeksCommunity Palliative Care8 weeksElectives/ Flex Research8 weeksVacation4 weeks_______52 weeksPalliative Medicine Rotations Introductory blocks: Most residents will start their program with eight weeks with a palliative care service in the tertiary setting, including a palliative care unit. The resident is part of the interdisciplinary team, under the direct supervision of palliative physicians. This allows the resident to be well supported in his/her initial palliative care experiences, and also allows an assessment of the resident’s current knowledge, skills and vulnerabilities. During this foundational 8-week rotation, there is the opportunity to learn about basic principles of pain and symptom management, working with the interdisciplinary team and gaining some perspective on counseling and facilitating team meetings. Interventional anaesthesia approaches to pain management in palliative patients, palliative care for non-malignant conditions and care for patients with a history of substance use will also be introduced during this munity Palliative Care: This rotation allows the resident to provide palliative consultation services to patients in their homes as part of the Home Hospice Palliative Care Service. It may also involve palliative support for patients in long term care and hospice facilities including Canuck Place Children’s Hospice. During this 8-week period, the resident sees patients at home on a continuing basis. Attendance at community rounds, providing support and care for home deaths, and facilitating transitions of care from acute care to home, home to acute care, and hospice are key to the learning experience. The resident will also learn about other community resources that palliative patients and their families may use, such as visiting a funeral home, meeting with alternative care practitioners and attending grief support groups. This rotation stresses the Palliative Care Clinicians role as lead, support and educator to the Primary Care team and Physician. Access to a vehicle is required for most community rotation sites. If you do not have a vehicle for personal use please alert your program director.Advanced Palliative blocks: The resident works both on a tertiary palliative care unit and provides palliative consultation to other parts of the hospital throughout the rotation. The TPCU experience broadens the resident’s scope and solidifies the residents’ role as consultant. During the advanced rotation the resident will take on progressive responsibility. Some of the ways this progression may be demonstrated is through increased patient volume, participation in patient triage for admission to the PCU, and ownership of education for junior learners.Oncology: Oncology is primarily experienced in outpatient clinics, 3 weeks each of medical and radiation oncology, usually done at one of the provincial BC Cancer locations, plus the two-week General Practitioner in Oncology Course. More information on this course is in the Academic Content portion of this handbook.Ambulatory Palliative Care:These clinics give the resident the opportunity to participate in medical subspecialty non cancer clinics with a palliative focus, and provide symptom support to outpatients in the Pain and Symptom Palliative Care clinics at the BC Cancer Agency.Subspecialty areas are: Cardiology, Gastroenterology, Infectious Diseases/HIV, Nephrology, Neurology, Rheumatology and Respirology. Geriatrics:The resident gains insight into ethical decision making for patients with dementia, and assessing cognitive abilities and decision-making capacity. The resident learns how to effectively manage delirium in the frail elderly.Scholarly Activity: Completion of a scholarly project is a requirement of the residency program. To facilitate this, as well as other scholarly activity, dedicated time is part of the rotation schedule. Electives: Elective experience will be determined by resident learning needs and expressed areas of interest. They may be clinical or non-clinical and can include rotations out of province or out of country. These must be discussed and approved by the Program Director. Once electives have been scheduled please update the rotation schedule and inform the Program Administrator so One45 may be updated.Possible electives:Canuck Place Children’s Hospice or other Pediatric FacilityChronic Pain ServiceNeurology and neuromuscular diseases clinicPsychiatric issues in palliative carePalliative Care Community i.e. Kelowna, Richmond, FHA or Downtown East Side Vancouver.St. Paul’s Hospital with an emphasis on care for those with HIV/AIDSPastoral Care FellowshipInternational Electives in Clinical and/or Structural Programs Research Projects in Clinical, Economic and/or Operational Issues of Palliative Medicine.LEARNING OBJECTIVES AND OUTCOMESThe objectives of training are guided by the College of Family Physicians of Canada Priority Topics and Key Features for the Assessment of Competence in Palliative Care. It is strongly suggested that you review these objectives at regular intervals over the year.Palliative Medicine residency programs across Canada will be moving toward a competency based system, in the coming years. Entrustable Professional Activities (EPAs) are yet to be determined by the CFPC. However, a 2015 paper developed a set of 12 EPAs which were validated by a survey and focus group of palliative medicine physicians. These are a useful lens to use to determine progression through the residency program. Family Medicine College Guidelines and ObjectivesRATIONALEThe family physician is a skilled clinician.The doctor-patient relationship is central to the role of the family physician.The family physician is resource to a defined practice population.Family medicine is community based.OBJECTIVETo train palliative care specialists with the ability to apply the principles, philosophy, and core knowledge, skills and attitudes of the palliative medicine in their practice.LEARNING OUTCOMES(Knowledge, Attitude, Skills)Overview of palliative careReview the historical and current Canadian societal attitudes towards death and dying. (K) (A)Define Palliative care, outlining its basic principles and standards, and models of care. (K)Assess the current state of palliative care in Canada, including barriers to providing better care for the dying. (K)Describe the general framework for dealing with pain and symptom issues, psychosocial issues, and spiritual/ existential issues. (K) (A) (S)Consider various approaches to taking a palliative history. (K) (S)Pain ManagementAppraise prevalence of pain in cancer and other terminal illnesses. (K)Describe the etiology, pathophysiology, classification, and characteristics of pain and incorporate this knowledge into taking a pain history, assessing, and monitoring pain. (K) (S)Explain the basic principles of pain management and apply to using opioids for pain management. (K) (S)Demonstrate knowledge of opioid pharmacology, classification, dosing and titration, routes of administration, side effects and toxicities. (K) (S) Explain use of adjuvant agents in pain management. Consider various approaches and modify treatment to specific pain problems such as neuropathic pain, bony pain, incident pain, and complex pain syndromes. (K) (S)Consider and be able to prescribe non-pharmacological approaches to manage pain, including radiation, surgery, nerve blocks, neurosurgical procedures, and physical methods (e.g. relaxation training). (K) (S)Symptom ManagementManage symptoms and employ a preventive approach to symptom management. (K) (S)Utilize appropriate interventions for common symptoms, e.g. nausea/vomiting, constipation, bowel obstruction, dyspnea, sedation, fatigue, cord compression. (K) (S)Employ appropriate interventions for less common symptoms, e.g. cough, urinary obstruction, lymphedema, sleep disorders, sore mouth, wound care. (K) (S)Psychosocial and Spiritual IssuesReflect on the psychosocial and spiritual issues of dying patients and their families. In particular, consider the impact on quality of life, and the nature of suffering. (K) (A)Recognize the importance of a reflective practice by exploring personal experiences of death and dying and in caring for palliative patients. (K) (A) (S)Assess, diagnose and manage anxiety, delirium and depression in a palliative care context. (K) (S) Consider normal and complicated grief in patients and be able to manage grief and bereavement, including utilizing available community resources. (K) (S)Provide educational and supportive counseling for patients and their families. (K) (S)CommunicationDemonstrate effective communication skills in dealing with seriously ill patients and their families. (K) (S) (A)Demonstrate effective communication skills in specific scenarios, e.g. breaking bad news. (K) (S) (A)Identify barriers to effective communication, and modify approach to minimize these barriers. Realize that empathy and caring can be expressed through both verbal and non-verbal communication. (K) (S) (A)Demonstrate effective communication and collaboration among members of the interdisciplinary palliative care team, and other members of the health care team. (K) (S) (A)Appraise the elements of a comprehensive and practical palliative care consultation. (K) (S) Realize the importance of collaboration and assess the stages of team formation and development. Recognize the unique roles of members of the interdisciplinary palliative care team. (K) (A) Demonstrate effective conflict resolution skills, including the ability to identify the nature and causes of the conflict, and utilizing techniques to resolve or mediate the conflict. (K) (S) (A)Reflect on the importance of support for caregivers. (A)Describe the roles, regulatory frameworks, responsibilities and professional capabilities of members of other professions involved in palliative care. (K)The Last HoursRecognize the physiological changes associated with imminent death. (K) (S)Implement appropriate pain and symptom management interventions in the context of imminent death. (K) (S)Plan for the psychosocial and spiritual changes associated with the last hours and practice comfort measures for patients and their families to address needs and expectations. (K) (S) (A)Implement practical measures such as documentation (and whether a need to report), funeral arrangements, and bereavement counseling at the end of life. (K) (S)Cultural IssuesInterpret death and dying, and end of life care in the context of culture, e.g. religious, social, language or ethnic groups. (K) (S) (A) Describe framework for understanding cultural differences. (K) (A) Consider common differences between “western” and “non-western” cultural perspectives. (K) (A) Modify approach to care to reflect differing perspectives of patients and families. (K) (S) (A)Appraise ethical implications of different cultural perspectives. (K) (A)Palliative Care in Different SettingsProvide effective palliative care service in a variety of settings including: palliative care units, acute care hospitals, hospices, and community/home settings. (K) (S) Modify approach to care according to site and consider organizational arrangements for the seamless delivery of palliative care in specific settings, e.g. home visits. (K) (S)OncologyReview principles of management of common cancers. (K) Review various therapies in cancer treatment such as use of radiation therapy, chemotherapy/hormonal therapy, and surgery, including the side-effects resulting from such treatments. (K) Describe the role of radiation therapy in bony metastases, spinal cord compression, superior vena cava syndrome, intra-thoracic malignancy, brain metastases, and advanced pelvic malignancy. (K)Describe the role of chemotherapy/ hormonal therapy in breast cancer, non-small cell lung cancer, colorectal cancer, and prostate cancer. (K)Practice good communication skills and team work in managing cancer. (K) (S) GeriatricsNegotiate systems for the care of the frail elderly, including the interface of home, nursing home, and hospital. (K) (S)Recognize the role of formal and informal caregivers at home and the impact of hospitalization on the elderly. (K)Describe the effects of aging on organ systems and resulting effects on medication use and pharmacology. (K)Manage common disorders in the elderly, such as incontinence, dementia, delirium, depression, falls, including assessments and referrals as required. (K) (S)Perform functional assessments, both ADLs and IADLs and be able to provide support for failure of functions. (K) (S)ResearchDescribe the unique challenges?of palliative care research and strategies to?overcome?barriers. (K) (S)Explain the principles and techniques of?qualitative and quantitative?research methodologies and outcome evaluation, including?the statistical bases and limitations of?current methods to assess the validity of palliative care research. (K) (S)Identify current themes and trends in palliative care research. (K)Demonstrate knowledge of basic grant and proposal-writing techniques and funding sources nationally and provincially. (K) (S)Satisfactorily complete the Scholarly Project (K) (S)Entrustable Professional Activities EPA titleSummaryObservable and Measurable tasks1. Complete a palliativemedicine consultationMultidimensional assessment and synthesis of information to formulate an individualized management plan for a patient with serious life-limiting illnessand his or her family_ Assesses physical, social, psychological, spiritual, andfunctional domains (including appropriate use ofassessment tools)_ Communication skills used to develop a therapeuticrelationship_ Facilitates a goals-of-care discussion (includes illnessunderstanding)_ Decision-making processes are based on care goals_ Assesses caregiver distress and resiliency_ Selects and interprets tests and interventions_ Communicates effectively using oral, written, andelectronic methods2. Manage the care of a dying patient in the last days, and final hoursRecognize clinical signs and symptoms of patients approaching death. Bereavement practices, identifying caregivers at risk for pathologicalgrief, and when possible, advocacy for any cultural or spiritual practicesnear and at the time ofdeath_ Appropriately uses interventions as well as educatesaround the inappropriate use of other interventions(e.g., blood work, vital signs)_ Supports and effectively educates informal and formalcaregivers on common and expected clinical manifestationsof an imminently dying person_ Facilitates the diverse range of grief reactions andresponses3. Conduct a family conferenceor meetingLead a meeting with a family/caregivers and/or the patient and often includes colleagues and members of the interprofessional team_ Ensures perspective of all participants is heard_ Communicates using conflict resolution skills_ Facilitates a goals of care discussion (includes illnessunderstanding)_ Develops a plan of care4. Address difficult to managesymptoms throughpharmacological and nonpharmacologicalmodalitiesappropriate for the palliativemedicine settingComprehensive assessmentand formulation of asymptom management plan considering medications, routes of administration andtherapeutic and interventionalprocedures_ Symptoms to include (but not limited to):Pain, nausea, vomiting, breathlessness, cough, constipation, diarrhea, anorexia, cachexia, weakness,fatigue, edema, bleeding, thrombosis, anxiety, depression, spiritual or existential distress; at end-of-life:agitation, respiratory and oropharyngeal secretions,and the constellation of symptoms associated withdelirium_ Therapeutic symptom management procedures (e.g.,paracentesis)_ Clinical processes associated with palliative sedationtherapy (PST)5. Collaborate as a palliativemedicine physician withreferring health care teamsEffective working relationships with and education of members of referring health care teams when either direct or indirect consultationis being sought_ Negotiates to determine how the care of the patientwill be shared with the referring team_ Direct consultations represents direct involvement inassessing the patient/family_ Indirect consultations represents discussing clinicalissues with colleagues from a different service_ Educates referring team members with the aim ofbuilding capacity in the provision of quality primarylevel palliative care6. Educate about ‘‘palliativecare’’ as an approach orphilosophyEducate patients, family, informal caregivers, formalhealth care providers/teams, and the public_ Incorporates the principles of health literacy, adultlearning, and best practices in patient and familymember education_ Advocates for palliative care provision as appropriate7. Integrate into an interprofessionalspecializedpalliative care teamCommunicate with and advocate for interprofessionalteam members_ Advocates for the contribution of each professioncomprising an interprofessional palliative care team_ Active contributes to palliative care team function_ Appropriately participates in resolving team conflict(continued)8. Manage the palliativecare of a patient in thecommunity settingCollaborate with interprofessionalmembers of community-based palliative careteams_ Documents the care plan_ Informs caregivers of changes in status_ Identifies care needs for the patient as well as his or hercaregivers_ Appropriately utilizes community resources_ When appropriate facilitates decision making re:transfers in care setting9. Maintain resiliency inpractice as a palliativemedicine physicianMaintain an individualizedapproach to resiliency (i.e.,self-care) aimed at enhancingboth the well-being ofthe clinician him or herselfas well as the individualswith whom he/she interactswithin a professional context_ Applies continuously throughout training program_ Incorporates measures to attempt to achieve balancebetween the physical, emotional, intellectual, relational,and spiritual aspects_ Method should have a self-awareness-based approach(e.g., reflective writing and mindfulness meditation)_ Exposure to and experience with a variety of self-carepractices to facilitate determining which ones workbest for him or her for ongoing maintenance10. Provide palliative medicinetelephone advice andmanagementCommunicate by telephonewith patient, family member,caregiver, or clinicalcolleague for the purpose ofaddressing clinical issues,symptoms, or practicalconcerns_ Gathers relevant clinical information/history_ Provision of information/advice_ Arranges appropriate resources and follow-up_ Documents the encounter_ Communicates to other team members involved in thecare of the patient as required_ Telephone advice constitutes the clinical managementof the patient and equates to the provision of directpatient care11. Serve as Most ResponsiblePhysician for a patientadmitted to a designatedpalliative care bedMaintain overall responsibilityfor a patient admitted toa palliative care bed (forany setting) from the timeadmission until the time ofdeath, discharge, or transferof responsibility_ Manages the clinical, operational, and administrativeelements of the patient’s care_ Discharge or care transition planning_ Appropriately utilizes institutional resources_ Accountable for operational and clinical quality indicators12. Describe an approach tomanaging a controversialpalliative medicine ethicalissue for a patientArticulate how he/she‘‘should’’ proceed for agiven context, involvesconsideration of the relevantlaws, policies, andethical principles that governmedical practice in thejurisdiction‘‘Controversial’’ ethical issues include (but not limitedto):_ Nondisclosure (diagnoses, prognoses)_ Discordance or confusion about a patient’s autonomouswishes_ Withholding or withdrawing medical therapies orartificial nutrition/hydration_ Patient/family requests: euthanasia, assisted suicideMyers J, Krueger P, Webster F, et al. Development and validation of a set of palliative medicine entrustable professional activities: Findings from a mixed methods study. J of Pall Med. 2015; 18(8):682-690ACADEMIC CONTENT Academic Days, Case Review, Article Review and Journal ClubApproximately every 2 weeks, you have a full day of protected academic time. The Academic Days will alternate (mostly) every other Wednesday. Residents attend the academic seminars with the Adult Palliative Medicine Sub-specialty program residents, and these sessions will have designated topics you need to know in depth. These sessions will be led by a palliative care physician or clinician. Most Academic Days will have a Case Review in the morning, where each resident will take turns presenting an interesting case, and an Article Review in the afternoon, where one resident will be expected to present an article. The following 2-3 hours in each morning and afternoon will consist of small-group seminars. In person attendance is encouraged when possible, however, most will be available via video conferencing. These Academic Days will be set up with your learning needs prioritized, but rotating residents from other programs doing Palliative Care electives will be invited to attend some sessions. Your attendance and participation are required for all sessions unless you are on vacation. You should be prepared for each topic by reading relevant material. Please see the current Academic Day schedule for details. The Division of Palliative Care holds biweekly Education Rounds. These are also considered mandatory educational sessions. Residents are expected to present at one of these meetings during the year. The coordinator will be in touch with you at the beginning of the year to create a schedule.The Education Rounds not sponsored by pharmaceutical companies as per UBC policy.Victoria Hospice Palliative Care Medical Intensive CourseAs part of your core content, you are encouraged to take the one-week Victoria Hospice Palliative Care Medical Intensive Course (PCMI) unless taken in the prior 18 months of the date of the course. This inter-professional course covers basic and some advanced aspects of palliative care. There may be opportunity for you to teach parts of this course during your residency.A second course through Victoria Hospice, The Psychosocial Care of the Dying and Bereaved is also recommended. This 5-day course has 28 hours CME credits and is offered twice a year in Victoria. General Practice Oncologist (GPO) Didactic CourseWe have collaborated with the Family Practice Oncology Network of the BCCA and the GPO training and secured seats for palliative medicine residents to participate in the 2 week GPO didactic course in September of each year. This intensive lecture and workshop series is intended to familiarize you with common oncology chemotherapies and radiation therapies for various malignancies, as well as common side-effects of treatment. Novel approaches to cancer treatment will also be explored. This is an opportunity for you to liaise with oncological clinicians and develop relationships.Ultrasound Guided Palliative Care Procedures CourseThis is a half-day hands on workshop to learn and practice ultrasound guided palliative care procedures, such as thoracentesis, paracentesis, and DVT detection.Resident as Teacher DayThere will be several opportunities for you to teach during the residency. To assist you with your education duties, we will be offering a day long Resident as Teacher day to explore best practices and theories pertaining to medical education. The curriculum is based on the UBC PGME Resident as Teacher resources.Scholarly ProjectYou will be required to complete a scholarly project over the course of the residency program. There will be several academic sessions related to research. Scholarly projects can be collaborative, and qualitative or quantitative in nature. Each resident is expected to take on a primary role in development and implementation of a project, with the goal of publication or presentation if possible. Further information about the scope of the scholarly project will be provided during these sessions. In process and completed projects are presented at the annual research day in June. Purpose:The purpose of this mandatory project is for you to demonstrate competence in a scholarly activity relevant to palliative care. Activities engaged in during your scholarly project will demonstrate various CANMEDS competencies in the scholar, professional, health advocate, collaborator, communicator and expert role. It is hoped that this small endeavour will inspire you to continue similar academic pursuits during your career. There is a great need for good quality palliative care research, reflection, and innovation.***completion of the scholar project is required to complete your residency. The program director is obligated to withhold submitting your final evaluation (FITER) of palliative training until completion (i.e. submitted written report and presented at Resident Scholar Day). If you anticipate difficulties in completing on time, please ask for help from the faculty research advisor well before the end of the academic year. Types of scholarly projects:-Quantitative Research Studies (case-control, small prospective observational pilot study, small control trial, secondary analysis of data) -Survey-based studies (cross sectional study)-Qualitative Research Studies (focus groups, one-on-one interviews)-Systematic Review-Program Innovation (Pilot study of unique or new patient care program if includes outcomes) -Educational Intervention (if includes outcomes)-Quality Improvement initiativesKey Steps 1.Pick topic area and identify research supervisor 2.Form research question 3.Write research proposal4.Apply for ethics approval5.Collect data / implement project6. Analyze data7.Present project at research day8.Write manuscript Timeline There are at minimum four academic sessions devoted to the scholarly project:July-Aug: Introduction to research and brainstorm potential topics/supervisors/questionsMarch: Present work-in-progressJune: Submit written report and Present completed project at Resident Scholarship DaySupportOne faculty member in the Division of Palliative Care is responsible for facilitating the resident scholarly projects. This individual is not the project supervisor, but will meet regularly with the residents about their projects to ensure a suitable supervisor has been found and that the project is moving ahead.Research SupervisorYou are encouraged to seek out local palliative care physicians, UBC faculty or allied health professionals who share your interests to support your project as your research supervisor. Alternatively, you may approach someone who is already involved in research of their own. If, during your palliative care residency, you make a substantial contribution to an existing faculty/staff research project, such that you would be listed by them as an author, then you may write this up and present it as your Scholar Project. Your research supervisor can serve as the “Principal Applicant” (PI) on your ethics proposal, or if they do not meet requirements for this role then the Divisional representative can be the official PI.Research ProposalThis is a key document for your scholarly project (appendix 1). Every resident needs to fill out a research proposal for submission to their supervisor and the Divisional representative prior to commencing their project. This proposal will also be submitted as part of your ethics proposal.EthicsAll Projects involving humans must have UBC Ethics Board approval before starting. This includes educational interventions, interviews, photos, video and simple surveys. Projects using clinical data from patient charts also need Ethics Board approval. Ethics Board Application plete a research proposal.2.Submit the research proposal to your supervisor and the Divisional representative.3.Once proposal is finalized, go to Complete the relevant UBC Ethics Board application. There are many details on the website which will help you complete this.Statistical and Data Analysis If advanced statistical analysis is needed for quantitative projects and you are not experienced in doing this yourself, help is available. Contact the Divisional representative if you wish to enlist the help of a statistician. Written ReportThe written report should follow the ICMJE recommendations (). We strongly encourage you to submit your research to a journal for consideration for publication.Work In Progress PresentationThis is a chance for you to rehearse your oral presentation in front of your fellow residents and staff. It is a great opportunity to receive feedback on your work to date and suggestions for going forward.Resident Scholarship DayEach resident must present their scholarly project at palliative care resident research day held in June. You will have 20 minutes for your presentation. Your written work and presentation will be reviewed and evaluated by the Divisional representative prior to Scholarship day and your presentation will be evaluated on Scholarship day.RoundsAttending palliative care rounds is mandatory for residents at each site/rotation. Each palliative care unit holds weekly rounds. Recommended but not required rounds include:Vancouver Hospital - Research RoundsSt Paul’s Hospital - Research RoundsSt Paul’s Hospital – AIDS RoundsOther rounds as appropriate (Psychiatry, Oncology, and Geriatrics)ConferencesRecommended:Canadian Society Palliative Care Physicians Annual Meeting/Course Spring – Advanced Learning in Palliative MedicineSuggested:BC Hospice Palliative Care Association Annual Conference MayAnnual Forum on Death and Dying: Finding Comfort in Serious Illness October Canadian Pain Society Annual Meeting MayCanadian Hospice Palliative Care Association Annual Meeting SeptemberAmerican Academy of Hospice and Palliative Medicine Assembly SpringInternational Congress of Palliative Care FallTexts and Resources- Oxford Textbook of Palliative Medicine - Palliative Medicine: A Case based manual- Oxford Textbook of Palliative Care for Children- Care Beyond Cure: Management of Pain and Other Symptoms- Journal of Palliative Medicine- Journal of Pain and symptom Management- Textbook of Interdisciplinary Palliative Pediatric Care- Supportive care in Cancer Journal- UpToDate Other Resources:- Medical Care of the Dying. Fourth Edition. Victoria Hospice Society. 1900 Fort Street, Victoria, BC V8R 1J8. (This is included with course registration.)- Evidence –Based Practice of Palliative Medicine: Expert Consult: Online and Print N.E. Goldstein, R.S. Morrison- Demystifying Opioid Conversion Calculations: A Guide for Effective Dosing –M.L. McPherson Medicine: A case-based manual – D. Oneschuk, N. Hagen, N. MacDonald -Canadian Palliative Care Formualry (CPCF) –R. Twycross, A. Wilcock, M. Dean, B. Kennedy Online Resources1 Indigenous Cultural Competency Training Program Provincial Health Services Authority in BC 2 Ian Anderson Continuing Education Program in End-of-Life Care3 Canadian Virtual Hospice 4 Palliative Fast Facts and Concepts (Previously EPERC) 5 Fraser Health Palliative Symptom Guidelines 6. BC Centre for Palliative Care – includes symptom management guidelinesEVALUATIONSEvaluations are the primary tool for assessing your progress. Without proper documentation, providing a reference letter or letter of confirmation of training, especially a few years after the completion of training, becomes a much more onerous task and may result in less than desirable outcomes. Likewise, it is also important to document the educational objectives that demonstrate the effectiveness of the training, which in turn will help to ensure future government and university support of postgraduate palliative medicine education.Evaluations and progression of each resident through the program is now done by a competence committee, which will review evaluations and provide feedback to each resident twice a year in a summative Evaluation of the LearnerRotation In-Training Evaluation Reports These are specific to each rotation, and should be reviewed regularly on One45, UBC’s evaluation systemDirect/Indirect Observation Feedback forms These are completed on Qualtrix, UBC’s secure online survey tool, and are a core part of how each resident is assessed. Please ensure that you ask faculty to complete these on a regular basisArticle and Case ReviewsScholarly Project +/- Presentation/Survey/PosterJournal Club PresentationsJournal/Quarterly Personal Learning Plans (Optional)Examination Written/Oral (June)Minimum Requirements for Completion:Resident must pass all core rotations.Resident must have successfully completed his/her presentations.Resident must have successfully completed his/her scholarly project.Resident should have successfully completed the final examination.Evaluation of the ProgramEvaluation of each rotation and siteEvaluation of individual academic day seminarsEnd of residency evaluation of programExit interviewEVALUATIONSIn-Training Evaluation Report (ITER) - Introductory RotationResident Name: __________________________________________________________Rotation Dates: __________________________________________________________Rate the resident’s performance in the objectives listed below using the following scale:A – outstandingB – above averageC – meets expectationsD – below expectationE – unsatisfactoryN/A – not applicable/assessedRole #1 Medical ExpertDescribe current societal attitudes about death and dyingABCDEn/aDefine palliative care and describe its basic principlesABCDEn/aDescribe the elements of a comprehensive and practical palliative care consultation, including approaches to dealing with pain and other symptoms, psychosocial factors, and spiritual/ existential concernsABCDEn/aDemonstrate competency in taking a palliative history and performing a complete and appropriate physical examinationABCDEn/aIdentify issues in death and dying relevant to different cultures, spiritual beliefs and traditionsABCDEn/aDescribe the physical, psychological, and social issues of dying patients and their familiesABCDEn/aDemonstrate basic knowledge of the assessment and classification of pain, the neurophysiology of pain, the pharmacology of drugs used in pain and symptom management, and the pathophysiology of other symptomsABCDEn/aDescribe an approach to management of other physical symptoms and disorders, especially dyspnea, constipation, skin care, mouth care, terminal agitation, delirium, and nausea and vomitingABCDEn/aIdentify psychological issues associated with life-threatening illness and strategies that may be useful in addressing themABCDEn/aDescribe the process of normal griefABCDEn/aSeek appropriate consultations from other health care professionalsABCDEn/aRole #2 CommunicatorDemonstrate an ability to work with the patient and family to establish common, patient-centered goals of careABCDEn/aProduce clear and concise clinical notes, documenting patient assessments and interactionsABCDEn/aRole #3 CollaboratorDescribe the roles of other disciplines in providing palliative care and communicate effectively with other team members ABCDEn/aParticipate in interdisciplinary care of patients, including family conferencesABCDEn/aDemonstrate skills in learning from members of the interdisciplinary teamABCDEn/aUnderstand the role for the neurosurgeon and anesthetist in intractable pain managementABCDEn/aRole #4 ManagerDescribe the models of palliative care delivery and their utilizationABCDEn/aAssist the Palliative Care Unit staff in educating more junior medical trainees, and members of other professional disciplines on the care teamABCDEn/aRole #5 Health AdvocateDescribe current barriers to providing better care for the dying across different settingsABCDEn/aIdentify the special needs of people living with AIDS, and those who suffer from addictionABCDEn/aRole #6 ScholarAttend and participate actively in all academic sessions including academic day, journal club and roundsABCDEn/aAccess the relevant literature in helping to solve clinical problems in Palliative CareABCDEn/aApply critical appraisal skills to relevant literatureABCDEn/aDevelop ideas for research project ABCDEn/aAssist in supervision of junior residents and students on electives or rotations through the Palliative Care UnitABCDEn/aRole #7 ProfessionalDescribe his/her concerns about dealing with dying patients and their familiesABCDEn/aDemonstrate an awareness of how his/her own personal experiences of death and dying have influenced attitudes ABCDEn/aDescribe strategies for managing his/her stress in dealing with the dyingABCDEn/aDemonstrate integrity, honesty, and compassion in the care of patientsABCDEn/aMotivation: Shows enthusiasm, displays initiative, and works hardABCDEn/aInterpersonal Skills:Interacts effectively with staffABCDEn/aEmpathizes with patients and respects patient confidentialityABCDEn/aLearning:Self directs learning based on patient encountersABCDEn/aPresents thorough, organized, and well-researched roundsABCDEn/aThe following sources of information were used for this evaluation.Direct observationsYesNoDiscussion of consultationsYesNoReview of written consultationsYesNoChart reviewsYesNoFeedback from other physicians/health care professionalsYesNoStrengths:Weaknesses:Please rate this rotationFailPass Comments:Did you have the opportunity to meet with this trainee to discuss their performance:YesNo (For the evaluee to answer)Did you have an opportunity to discuss your performance with your preceptor/supervisorYesNo Date:Resident signature________________________________________________________Rotation supervisor:Supervisor signature: ______________________________________________________In-Training Evaluation Report (ITER) - Medical Oncology/Radiation OncologyResident Name: __________________________________________________________Rotation Dates: __________________________________________________________Rate the resident’s performance in the objectives listed below using the following scale:A – outstandingB – above averageC – meets expectationsD – below expectationE – unsatisfactoryN/A – not applicable/assessedRole #1 Medical ExpertDemonstrate a good knowledge of the current principles of cancer, its pathophysiology and managementABCDEn/aDemonstrate an ability to work with the patient and family to establish common, patient-centred goals of care, especially in transition from a curative to palliative situationABCDEn/aIdentify psychological issues associated with life-threatening illness, and strategies that may be useful in addressing themABCDEn/aIdentify sexuality issues related to surgery, cancer itself, and cancer treatmentsABCDEn/aManage cancer pain effectively, and demonstrate advanced knowledge of the assessment and classification of pain, the pharmacology of drugs used in pain and symptom management including methadoneABCDEn/aDemonstrate advanced knowledge of the assessment and management of other symptoms and disorders, especially dyspnea, constipation, skin care, mouth care, terminal agitation, delirium, and nausea and vomitingABCDEn/aRole #2 CommunicatorDemonstrate effective communications skills in dealing with terminally-ill patients and their families, including skills in delivering bad newsABCDEn/aCommunicate effectively with other care team membersABCDEn/aProduce clear, concise and useful dictated consultation notesABCDEn/aRole #3 CollaboratorDescribe the roles of other disciplines in providing palliative care in an oncology settingABCDEn/aRole #4 ManagerDemonstrate adequate skills in educating and in learning from members of the interdisciplinary teamABCDEn/aRole #5 Health AdvocateDescribe the barriers to delivery of effective care across settingsABCDEn/aRole #6 ScholarAccess the relevant literature in helping to solve clinical problems in oncologyABCDEn/aApply critical appraisal skills to literature in oncology and palliative medicine/supportive careABCDEn/aAttend and participate actively in all academic activities, including academic day, journal club and roundsABCDEn/aRole #7 ProfessionalDemonstrate effective consultation and communication skills in working with referring physiciansABCDEn/aDemonstrate integrity, honesty, and compassion in the care of patientsABCDEn/aMotivation: Shows enthusiasm, displays initiative, and works hardABCDEn/aInterpersonal Skills:Interacts effectively with staffABCDEn/aEmpathizes with patients and respects patient confidentialityABCDEn/aLearning:Self directs learning based on patient encountersABCDEn/aPresents thorough, organized, and well-researched roundsABCDEn/aThe following sources of information were used for this evaluation.Direct observationsYesNoDiscussion of consultationsYesNoReview of written consultationsYesNoChart reviewsYesNoFeedback from other physicians/health care professionalsYesNoStrengths:Weaknesses:Please rate this rotationFailPass Comments:Did you have the opportunity to meet with this trainee to discuss their performance:YesNo (for the evaluee to answer)Did you have an opportunity to discuss your performance with your preceptor/supervisorYesNo Date:Resident signature________________________________________________________Rotation supervisor:Supervisor signature: ______________________________________________________In-Training Evaluation Report (ITER) - Community Hospice Resident Name: __________________________________________________________Rotation Dates: __________________________________________________________Rate the resident’s performance in the objectives listed below using the following scale:A – outstandingB – above averageC – meets expectationsD – below expectationE – unsatisfactoryN/A – not applicable/assessedRole #1 Medical ExpertIdentify issues in death and dying relevant to different cultures, spiritual beliefs and traditionsABCDEn/aDemonstrate skills in working with the families of dying patients and understand the elements comprising good home care ABCDEn/aBe knowledgeable about and be able to provide home visits to dying patients ABCDEn/aDescribe the community resources available to support patients in their homesABCDEn/aDescribe an approach to the last hours of caring in the home and the responsibilities of the physician at the time of deathABCDEn/aDescribe the role of family physicians and specialists in the care of the terminally ill in their homesABCDEn/aDescribe the role of palliative care consultants in supporting the home care teamABCDEn/aRole #2 CommunicatorDemonstrate effective consultation and communication skills in working with general practitioners and other team members, particularly understand the role for a patient-held recordABCDEn/aRole #3 CollaboratorDemonstrate an ability to work with the patient and family to establish common, patient-centred goals of careABCDEn/aDescribe the roles of other disciplines in providing palliative careABCDEn/aDemonstrate adequate skills in educating and in learning from members of the interdisciplinary teamABCDEn/aRole #4 ManagerUnderstand how the home care program is funded and organized for most effective delivery of careABCDEn/aUnderstand the role for free-standing hospices and the need for a close working relationship between them and other health care settings, such as home and the Palliative Care UnitABCDEn/aRole #5 Health AdvocateAdvocate for the needs of home care patientsABCDEn/aDemonstrate an ongoing commitment to a patient and family from the time of palliative medicine consultation for a terminal illness until (and after) the patient diesABCDEn/aDescribe the barriers to effective care across different care settings, and various ways to overcome themABCDEn/aRole #6 ScholarAccess the relevant literature in helping to solve clinical problems in Home HospiceABCDEn/aApply critical appraisal skills to literature in palliative care in the homeABCDEn/aAssist with education of family doctors and home care nurses around the care issues of individual patientsABCDEn/aRole #7 ProfessionalDemonstrate integrity, honesty, and compassion in the care of patientsABCDEn/aDemonstrate an ability to manage boundary issues with patientsABCDEn/aBe aware of the need to maintain a safe working environment, particularly in terms of vulnerability when working alone, outside of a health care settingABCDEn/aDescribe the barriers to effective care across different care settings, and various ways to overcome themABCDEn/aMotivation:Shows enthusiasm, displays initiative, and works hardABCDEn/aInterpersonal Skills:Interacts effectively with staffABCDEn/aEmpathizes with patients and respects patient confidentialityABCDEn/aLearning:Self directs learning based on patient encountersABCDEn/aPresents thorough, organized, and well-researched roundsABCDEn/aThe following sources of information were used for this evaluation.Direct observationsYesNoDiscussion of consultationsYesNoReview of written consultationsYesNoChart reviewsYesNoFeedback from other physicians/health care professionalsYesNoStrengths:Weaknesses:Please rate this rotationFailPass Comments:Did you have the opportunity to meet with this trainee to discuss their performance:YesNo (for the evaluee to answer)Did you have an opportunity to discuss your performance with your preceptor/supervisorYesNo Date:Resident signature________________________________________________________Rotation supervisor:Supervisor signature: ______________________________________________________Please return to Garnette McCue, Program Assistant – Division of Palliative CareUBC Department of Family Practice, c/o 1081 Burrard Street, Vancouver, BC V6Z 1Y6Phone: 1.604.740.5711 Fax:1. 604.740-5737 Email: gmccue@familymed.ubc.caIn- Training Evaluation Report (ITER) - GeriatricsResident Name: __________________________________________________________Rotation Dates: __________________________________________________________Rate the resident’s performance in the objectives listed below using the following scale:A – outstandingB – above averageC – meets expectationsD – below expectationE – unsatisfactoryN/A – not applicable/assessedRole #1 Medical ExpertDescribe the effects of aging on organ systemsABCDEn/aDescribe the effects of aging on medication use and pharmacologyABCDEn/aDescribe the concept of frailtyABCDEn/aMedically manage illnesses commonly seen in the elderly, i.e. CHF, COPD, pneumoniaABCDEn/aRecognize the side effects of commonly used drugs, i.e. neuroleptics, cardiac meds, etc.ABCDEn/aRecognize the features of end-stage diseaseABCDEn/aRecognize and differentiate dementia, delirium and depressionABCDEn/aAdequately manage these syndromesABCDEn/aAssess and manage common geriatric syndromes, i.e. incontinence, fallsABCDEn/aRecognize when referral to a sub specialist is required for atypical presentations of geriatric syndromesABCDEn/aDemonstrate ability to make a functional assessment with respect to ADLs and iADLsABCDEn/aRecognize the contribution of medical diagnosis to evaluation of functional lossABCDEn/aDescribe the societal and environmental factors relevant to the care of the elderlyABCDEn/aAssess the role of advance directives and levels of interventionABCDEn/aRecognize the impact of dementia on decision makingABCDEn/aDescribe the fundamental concept of competency with regard to decision making on health care issuesABCDEn/aBe able to perform an assessment of competency in differing situationsABCDEn/aDescribe the concept of futile treatmentABCDEn/aBe able to manage ethical problems at the end of life, including withdrawing or withholding therapy, advance directives, euthanasia and assisted suicideABCDEn/aRole #2 CommunicatorDemonstrate an ability to work with the patient and family to establish common, patient-centered goals of care ABCDEn/aCommunicate effectively with other team membersABCDEn/aDemonstrate ability to write clear and concise consultation notesABCDEn/aRole #3 CollaboratorDescribe the roles of other disciplines in providing care of the elderlyABCDEn/aRecognize the roles of informal and formal caregiversABCDEn/aDemonstrate ability to put systems in place to support function failure, i.e. home care, home making, aidsABCDEn/aDemonstrate ability in working with a multi-disciplinary team to effectively manage functional lossesABCDEn/aRole #4 ManagerRecognize the changing demographics of our society, and its implications for future health care provision needsABCDEn/aDescribe the systems of care in place for the care of frail elderly, i.e. long term care, home care, etcABCDEn/aExplain the impact of hospitalization on the elderlyABCDEn/aDescribe the interface of nursing home, hospital and homeABCDEn/aRole #5 Health AdvocateRecognize the role of the physician as an advocate for care of the elderlyABCDEn/aRecognize the role of the physician in supporting family care giversABCDEn/aRole #6 ScholarAccess the relevant literature in helping to solve clinical problems in geriatricsABCDEn/aApply critical appraisal skills to literature in geriatrics and palliative careABCDEn/aRole #7 ProfessionalDemonstrate integrity, honesty, and compassion in the care of patientsABCDEn/aMotivation:Shows enthusiasm, displays initiative, and works hardABCDEn/aInterpersonal Skills:Interacts effectively with staffABCDEn/aEmpathizes with patients and respects patient confidentialityABCDEn/aLearning:Self directs learning based on patient encountersABCDEn/aPresents thorough, organized, and well-researched roundsABCDEn/aThe following sources of information were used for this evaluation.Direct observationsYesNoDiscussion of consultationsYesNoReview of written consultationsYesNoChart reviewsYesNoFeedback from other physicians/health care professionalsYesNoStrengths:Weaknesses:Please rate this rotationFailPass Comments:Did you have the opportunity to meet with this trainee to discuss their performance:YesNo (For the evaluee to answer)Did you have an opportunity to discuss your performance with your preceptor/supervisor?YesNo Date:Resident signature________________________________________________________Rotation supervisor:Supervisor signature: ______________________________________________________In-Training Evaluation Report (ITER) –Advanced Palliative CareResident Name: __________________________________________________________Rotation Dates: __________________________________________________________Rate the resident’s performance in the objectives listed below using the following scale:A – outstandingB – above averageC – meets expectationsD – below expectationE – unsatisfactoryN/A – not applicable/assessedRole #1 Medical ExpertDescribe issues in death and dying relevant to different cultures, spiritual beliefs and traditionsABCDEn/aDemonstrate consultant level diagnostic and therapeutic skills for ethical and effective patient care ABCDEn/aDemonstrate advanced knowledge of the assessment and classification of pain, the neurophysiology of pain, the pharmacology of drugs used in pain and symptom management, and the pathophysiology of other symptomsABCDEn/aDemonstrate competence in advanced pain management, including an understanding for the role of interventional techniques such as neuraxial infusion, neurolytic blocks and cementoplastyABCDEn/aManage other physical symptoms especially dyspnea, constipation, skin care, mouth care, terminal agitation, delirium, and nausea and vomitingABCDEn/aDescribe the process of normal and atypical grief, and a systematic approach to working with the families of dying patients including bereavement counselling ABCDEn/aIdentify the social and existential needs confronting patients and families, and strategies that may be useful in addressing themABCDEn/aRole #2 CommunicatorDemonstrate an ability to work with the patient and family to establish common, patient-centered goals of careABCDEn/aCommunicate effectively with other palliative care team membersABCDEn/aCommunicate effectively with referring physicians and care teams on the hospital wardsABCDEn/aDemonstrate ability to write clear and concise consultation notesABCDEn/aRole #3 CollaboratorDemonstrate the ability to work effectively in institutional multidisciplinary palliative care programABCDEn/aDemonstrate an understanding of the different perspectives of various medical specialties, and how to resolve inter-disciplinary conflict around goals of careABCDEn/aDescribe the roles of other disciplines in providing palliative careABCDEn/aParticipate in interdisciplinary care of patients, including family conferencesABCDEn/aRole #4 ManagerTeach junior trainees on Palliative Care rotations and electivesABCDEn/aAssist institutional and community palliative care programs in developing standards of careABCDEn/aRole #5 Health AdvocateDescribe the barriers to effective care across different settingsABCDEn/aAdvocate for the needs of dying patients in hospital but not in a Palliative Care bedABCDEn/aAct as an effective advocate for the rights of the patient and family in clinical situations involving serious ethical considerationsABCDEn/aUnderstand the issues related to provision of adequate bed availability in a general hospital, how to integrate with home care services, and the role for free standing hospices in resource managementABCDEn/aRole #6 ScholarDemonstrate skills in providing educational counselling to dying patients and their familiesABCDEn/aDemonstrate skills in educating and in learning from members of the interdisciplinary teamABCDEn/aRole #7 ProfessionalDescribe his/her concerns about dealing with dying patients and their familiesABCDEn/aDemonstrate an awareness of how his/her own personal experiences of death and dying have influenced attitudesDescribe strategies for managing his/her stress in dealing with the dyingABCDEn/aDemonstrate integrity, honesty, and compassion in the care of patientsABCDEn/aAct as a role model for other residents and physiciansABCDEn/aMotivation: Shows enthusiasm, displays initiative, and works hardABCDEn/aInterpersonal Skills:Interacts effectively with staffABCDEn/aEmpathizes with patients and respects patient confidentialityABCDEn/aLearning:Self directs learning based on patient encountersABCDEn/aPresents thorough, organized, and well-researched roundsABCDEn/aThe following sources of information were used for this evaluation.Direct observationsYesNoDiscussion of consultationsYesNoReview of written consultationsYesNoChart reviewsYesNoFeedback from other physicians/health care professionalsYesNoStrengths:Weaknesses:Please rate this rotationFailPass Comments:Did you have the opportunity to meet with this trainee to discuss their performance?YesNo (for the evaluee to answer)Did you have an opportunity to discuss your performance with your preceptor/supervisor?YesNo Date:Resident signature________________________________________________________Rotation supervisor:Supervisor signature: ______________________________________________________In-Training Evaluation Report (ITER) - Elective Rotation Resident Name: __________________________________________________________Rotation Dates: __________________________________________________________Rate the resident’s performance in the objectives listed below using the following scale:A – outstandingB – above averageC – meets expectationsD – below expectationE – unsatisfactoryN/A – not applicable/assessedResident Objectives ABCDEn/aABCDEn/aABCDEn/aABCDEn/aABCDEn/aABCDEn/aABCDEn/aABCDEn/aMotivation: Shows enthusiasm, displays initiative, and works hardABCDEn/aInterpersonal Skills:Interacts effectively with staffABCDEn/aEmpathizes with patients and respects patient confidentialityABCDEn/aLearning:Self directs learning based on patient encountersABCDEn/aPresents thorough, organized, and well-researched roundsABCDEn/aThe following sources of information were used for this evaluation.Direct observationsYesNoDiscussion of consultationsYesNoReview of written consultationsYesNoChart reviewsYesNoFeedback from other physicians/health care professionalsYesNoStrengths:Weaknesses:Please rate this rotationFailPass Comments:Did you have the opportunity to meet with this trainee to discuss their performance:YesNo (for the evaluee to answer)Did you have an opportunity to discuss your performance with your preceptor/supervisorYesNo Date:Resident signature________________________________________________________Rotation supervisor:Supervisor signature: ______________________________________________________SITE EVALUATION – Year of Added Competency in Palliative CareFor resident to complete. Date: Rotation SiteName of Resident"Date of Rotation"InstructionIn the spaces below, please write in the names of the instructor(s) with whom you have had the most contact during this experience. List only those faculty instructors for whom you can give a reliable assessment of their abilities as clinical teachers. 1. 4. 2. 5. 3. 6. BreadthThe instructor has a strong command of his or her area and discusses different approaches to patients and treatment.InstructorsStrongly DisagreeModerately AgreeStronglyAgree1. 12345672. 12345673. 12345674. 12345675. 12345676. 1234567ClarityThe instructor explains him/herself clearly and identifies the important aspect about patients and treatment.InstructorsStrongly DisagreeModerately AgreeStrongly Agree1. 12345672. 12345673. 12345674. 12345675. 12345676. 1234567Interaction The instructor is friendly towards the resident and encourages resident questions and discussion.InstructorsStrongly DisagreeModerately AgreeStrongly Agree1.12345672. 12345673. 12345674. 12345675. 12345676. 1234567SupervisionThe instructor provides suitable practice opportunities for the resident and objectively identifies strengths and deficiencies in resident performance.InstructorsStrongly DisagreeModerately AgreeStrong Agree1. 12345672. 12345673. 12345674. 12345675. 12345676. 1234567EnthusiasmThe instructor seems to enjoy teaching and stimulated interest for this field.InstructorsStrongly DisagreeModerately AgreeStrongly Agree1. 12345672. 12345673. 12345674. 12345675. 12345676. 1234567Summary AssessmentConsidering all aspects of instruction, how would you rate each instructor in terms of overall effectiveness as a teacher?InstructorsStrongly DisagreeModerately AgreeStrongly Agree1. 12345672. 12345673. 12345674. 12345675. 12345676. 1234567Rotation Organization and Content Please indicate your agreement or disagreement with each of the following statements as they apply to this rotation.StatementsStrongly DisagreeModerately AgreeStronglyAgreeA.The rotation was well organized with efficient use of time.1234567B.The opportunities for a resident to participate in patient care were meaningful and sufficient.1234567C.The major learning objectives were clearly described and followed.1234567D.A variety of patient problems representative of the discipline were seen.1234567E.The rotation yielded returns in proportion to its time allocation in the curriculum.1234567F.Were made to feel part of this experience, an integrated member of a team rather than a “fifth wheel”.1234567G.The assessments were a fair and valid evaluation of your competence.1234567H.The teaching was effectively delivered1234567IThe teaching content was useful and relevant1234567JConsidering all components, how would you rate the overall organization and content of this experience?1234567Overall Summary Assessment Considering all aspects of this experience, how would you rate its overall effectiveness as a learning experience?PoorSatisfactoryExcellent1234567CommentsPlease comment on strengths or weaknesses that particularly apply to this experience.Please return to UBC Division Of Palliative Care Program Administrative Assistant6389 Stadium Road, Vancouver BCFax (604) 806-9643; Email: ksinman@mail.ubc.caAcademic Half-Day Feedback Form************************************************************************6858004572000Date: 68580015240000Speaker:6858008382000Topic:Were learning objectives clearly stated? 685800000What did you learn from the session?45720012192000 Is there anything else that you could suggest to add to this session for next year (i.e. any specific additional learning objectives)?4572007683500Please comment re: the quality of the speaker.Positive feedback: 45720014541500Suggestions for improvement:457200000(Optional): Residency Training Program and Year:102870016827500RESIDENCY PROGRAM COMMITTEE (RPC)Residency Program Committees exist for both the Year of Added Competency in Palliative Medicine and Royal College Adult Palliative Medicine Programs. These committees are chaired by their respective Program Directors and meet four times a year. The committees are comprised of:Dr. Pippa Hawley Head - UBC Division of Palliative Care Dr. Anoo Tamber Program Director, Enhanced Skills Palliative MedicineDr. Julia RidleyProgram Director, Royal College Subspecialty Adult Pall Med Dr. Rose HatalaResearch Faculty LeadAs well as representatives from the distributed palliative medicine learning sites, oncology, geriatrics, and spiritual care. The chief resident also sits on this committee and serves as a voice and advocate for the residents. Purpose: The Residency Program Committee is responsible for all educational issues affecting the UBC postgraduate Palliative Medicine Program including but not limited to:Overall program directionsCurriculum planProgram objectivesPractice examsFinancial issuesResident selectionFaculty developmentOthers as deemed appropriate by the program director or raised by the committeeThe group will meet at least quarterly as required by the College, and may meet as often as monthly if agenda items are sufficient in number or urgency to warrant it. E-mail will facilitate information sharing but not decision making unless an urgent “vote” is needed.The Committee will function as the focus of academic policy discussion, development and setting for the Program. It will be advisory to the Program Director, but in virtually all situations it will expected that the Director will follow that advice unless he/she feels seriously in disagreement. Whenever possible, it will function in consensus mode, but any member or the Chair can call for a vote on any issue if desired. Simple majority will then decide the PETENCY COMMITTEE (CC)The Competency Committee provides regular, systematic and transparent review of each residents’ performance. As a move towards Competency based Education, the Competency Committee will be reviewing ITERs, direct and indirect observation forms, scholarly projects, and all other evaluations for each resident. The committee consists of 4 members who are not on the RPC, the Program Director attends the meetings, but it not an active/voting member.The competency committee will meet every 6 months, and will provide a summative report to each resident as well as the program director, after each meeting. These reports will advise on the residents progression through the program, identify areas requiring focused attention, and areas of strength. Reports are provided to the resident, RPC, and program director. WELLNESS, SAFETY, ACADEMIC AND PRACTICAL ISSUESPlease see the UBC Post Grad Website and Resident Doctors of BC for further information.For Policies and Procedures, please see UBC PGME policies and procedures. Mentor and Faculty AdvisorIt is encouraged that each resident establish a formal mentor for the year. The Program Director will provide names of appropriate individuals are the beginning of the program and will endeavour to make a good match for you. You will be encouraged to connect with the mentor on a regular basis. Some past residents have elected to work with multiple individuals as mentors. Whether you choose to engage with a mentor(s) is voluntary.A member of the Competency Committee will serve as your Faculty Advisor. You are expected to meet with your advisor a minimum of 3 times a year. During these meetings you may discuss challenges and successes from your recent rotations and formulate learning plans for upcoming blocks. Information from these meetings will inform the decisions of the Competency Committee as they determine progression of the resident through the program.Resident Wellness and Wellness Faculty MemberWellness is important for all residents, but particularly for Palliative Medicine residents, clinical and personal circumstances may lead to significant stress, distress and potential burnout. You are encouraged to talk to your mentor, program director, peers, faculty, whenever needed. Formal supports are also available, including a Wellness Faculty advisor. Academic Day sessions will also be devoted to resident wellness.UBC PGME office also has a Resident Wellness Centre which provides various resources, including counselling support. Please have a look at their webpage: Medicine Resident Wellness PolicyPreambleThe Postgraduate Medical Education (PGME) Office recognizes that residents require a safe, positive, and healthy learning environment to thrive. The Division of Palliative Care (DPC) aims to support this by creating, promoting, and sustaining a culture of wellness and resilience. Key responsibilities The UBC Faculty of Medicine PGME Office and all PGME Residency Programs, including the Year of Added Competency in Palliative Medicine and the Palliative Medicine Subspecialty Program, have a duty to promote the wellness of residents, provide resources to support physical, emotional and mental wellbeing, and to strive to assist residents in identifying and obtaining support at times that they are struggling in their physical, emotional and/or mental wellbeing. Residents are responsible for reporting fit for duty, and recognizing their own impairments, if present, and being familiar with the PGME Wellness Policy.PGME ResourcesUBC PGME provides several resources to support resident wellness. Palliative Medicine residents are encouraged to access the Resident Wellness Office (RWO) for support when needed, and utilize workshops and online resources offered by the RWO. Recommendations and resources provided by the RWO and Resident Wellness Advisory Group will be relayed to Palliative Medicine residents, and supported/enacted by the Program Director, RPC and clinical faculty. Division of Palliative Medicine ResourcesThe Division of Palliative Medicine and Palliative Medicine Residency Programs offer additional supports to their residents, in recognition of the specific emotional demands that training in palliative medicine can place on learners. These supports include:An annual Wellness Retreat, attended by Residents and FacultyWellness Workshops included in the academic curriculumBalint groups incorporated into the academic curriculumFormal Mentorship with a mentor in a non-evaluative role offered to each residentA Wellness Faculty Advisor to oversee the aboveProgram ResponsibilitiesThe Program Director will include wellness and address any concerns about mental, physical or emotional wellbeing of each resident at quarterly reviews. The Program Director is accessible by email and phone to clinical faculty and residents to discuss any concerns regarding resident wellness on a continual basis; when one Program Director is away, the Program Directors for the Year of Added Competency and Subspecialty Program provide cross coverage.ResourcesUBC resident wellness office ()Employee & Family Assistance Program ()Physician Health Program ()PGME Fatigue Risk Management PolicyResident Safety PolicyPREAMBLE The Postgraduate Medical Education (PGME) Office recognizes that residents have the right to a safe environment during their residency training. The responsibility for promoting a culture and environment of safety for residents rests with the Faculty of Medicine, regional health authorities, clinical departments, residency training programs and residents themselves. The concept of resident safety includes physical, emotional, and professional security. Key responsibilities Residents have a right to a safe and equitable workplace and learning environment. As such, residents have a professional duty to learn and to comply with the safety policies of the institution in which they are working, as outlined by the University of British Columbia Faculty of Medicine PGME Office. Furthermore, residents have a professional duty to communicate safety concerns and incidents to the residency programs The UBC Faculty of Medicine PGME Office and all PGME Residency Programs have a duty to ensure a safe and equitable environment for residents to work and to learn. This includes but is not limited to the following: Ensuring that the workplace is free of harassment or intimidation on the basis of gender, race, sexual orientation, physical (dis)abilities and level of training. ?Ensuring that residents are educated and informed with respect to the safety policies which govern the workplace and the learning environment. ?To record in writing and to act promptly on any safety concerns and incidents reported to its office by residents. ?Ensuring that every reasonable effort is made to record resident concerns in confidence and in good faith and that residents' rights to privacy and anonymity be ensured at all times. ?Strive to prevent workplace-related and learning environment-related personal retribution against residents in order to foster an open environment where genuine concerns can be raised freely and without fear of reprisal. ?Physical safety These policies apply only during postgraduate trainees’ activities that are related to the execution of postgraduate trainee duties: When postgraduate trainees are traveling for clinical or other academic assignments by private vehicle, it is expected that they maintain their vehicle adequately and travel with appropriate supplies and contact information. Provincial laws prohibit cell phone use and text messaging in the performance of residency duties while driving. For long distance travel for clinical or other academic assignments, postgraduate trainees should ensure that a colleague or the home residency office is aware of their itinerary. Postgraduate trainees should not be on call the day before long distance travel for clinical or other academic assignments by car. When long distance travel is required in order to begin a new rotation, the postgraduate trainee should request that they not be on call on the last day of the preceding rotation. If this cannot be arranged then there should be a designated travel day on the first day of the new rotation before the start of any clinical activities. Postgraduate trainees are not to be expected to travel long distances during inclement weather for clinical or other academic assignments. If such weather prevents travel, the resident is expected to contact the program office promptly. Assignment of an alternate activity is at the discretion of the Program Director. Postgraduate trainees should not work alone after hours in health care or academic facilities without adequate support from Security Services. Postgraduate trainees are not expected to work alone at after-hours clinics. Postgraduate trainees are not expected to make unaccompanied home visits. Postgraduate trainees should only telephone patients using caller blocking. Postgraduate trainees should not be expected to walk alone for any major or unsafe distances at night. Postgraduate trainees should not drive home after call if they have not had adequate rest. Postgraduate trainees should not assess violent or agitated and potentially violent patients without the backup of security and an awareness of accessible exits. The physical space requirements for management of violent patients must be provided where appropriate. Special training should be provided to postgraduate trainees who are expected to encounter aggressive patients. Site orientations should include a review of local safety procedures. Postgraduate trainees should familiarize themselves with the location and services offered by the occupational health office of each training site. This includes familiarity with policies and procedures for infection control and protocols following exposure to contaminated fluids, needle stick injuries, and reportable infectious diseases. Postgraduate trainees must observe universal precautions and isolation procedures when indicated. Postgraduate trainees should keep their immunizations up to date. Overseas travel immunizations and advice should be sought well in advance when traveling abroad for electives or meetings. Call rooms and lounges provided for postgraduate trainees must be clean, smoke free, located in safe locations, and have adequate lighting, a phone, fire alarms, and smoke detectors. Any appliances supplied are to be in good working order. There must be adequate locks on doors. Postgraduate trainees working in areas of high and long term exposure to radiation must follow radiation safety policies and minimize their exposure according to current guidelines. Radiation protective garments (aprons, gloves, neck shields) should be used by all postgraduate trainees using fluoroscopic techniques. Pregnant postgraduate trainees should be aware of specific risks to themselves and their fetus in the training environment and request accommodations where indicated. Postgraduate trainees should consult the Occupational Health Office for information. Psychological safety Learning environments must be free from intimidation, harassment, and discrimination. When a resident’s performance is affected or threatened by poor health or psychological?conditions, the resident should be granted a leave of absence and receive appropriate support. Such postgraduate trainees should not return to work until an appropriate assessor has declared them ready. All programs will appoint a faculty advisor and ensure that all postgraduate trainees in the program are informed as to the policies regarding the faculty advisor role and contact information. Residents will be supported by the program should an adverse event occur.?Residents in need of additional support will be free to approach the Program Director or appropriate coordinator for support, without fear of negative consequence or reprimand. Postgraduate trainees should be aware of and have easy access to the available sources of immediate and long-term help for psychological problems, substance abuse problems, harassment, and inequity issues. Resources include the UBC PGME and its Resident Wellness Office and Resident Doctors of BC. Professional safety Some physicians may experience conflicts between their ethical or religious beliefs and the training requirements and professional obligations of physicians. Resources should be made available to postgraduate trainees to deal with such conflicts. Examples include the College of Physicians and Surgeons of British Columbia, UBC Faculty of Medicine, and the regional health authority. Programs are bound by Resident Doctors of BC contract allowances for religious holidays. Residents should have adequate support from the program following an adverse event or critical incident. Programs should promote a culture of safety in which postgraduate trainees are able to report and discuss adverse events, critical incidents, ‘near misses’, and patient safety concerns without fear of punishment. Residency program committee members must not divulge information regarding postgraduate trainees. It is the responsibility of the residency Program Directors to make the decision and to disclose information regarding postgraduate trainees (e.g. personal information and evaluations) outside of the residency program committee and to do so only when there is reasonable cause. The resident file is confidential. With regard to resident files, programs must be aware of and comply with the Freedom of Information and Privacy (FOIPOP) Act. Programs can obtain guidance about FOIPOP issues from the UBC PGME office. Resident feedback and complaints must be handled in a manner that ensures resident anonymity, unless the resident explicitly consents otherwise. However, in the case of a complaint that must be dealt with due to its severity or threat to other postgraduate trainees, a Program Director may be obliged to proceed, against the complainant’s wishes. In that case the Associate Dean of Postgraduate Medical Education or the main campus Harassment Office should be consulted immediately. Depending on the nature of the complaint, the regional health authority and/or the College of Physicians and Surgeons of BC may need to be informed and involved. In general, the Program Director should serve as a resource and advocate for the resident in the complaints process. Postgraduate trainees must be members of the CMPA and follow CMPA recommendations in the case of real, threatened, or anticipated legal action. In addition to CMPA coverage for patient actions, postgraduate trainees are indemnified for actions or lawsuits arising from the actions or decisions made by committees (e.g. tenure, appeals, residency training) they may serve on, under the university insurance for lawsuits related to academic issues. Contact information CMPA: Doctors of BC:2399 – 650 West Georgia StreetVancouver, BC, Canada, V6B 4N7Phone: (604) 876-7636Toll-Free: 1-888-877-2722 PGME Resident Wellness Office: Risk Management PolicyPREAMBLE The Palliative Medicine Subspecialty Residency program recognizes that fatigue is a significant issue for trainees. Fatigue can be the result of the clinical and non-clinical work and expectations of training, commitments and requirements outside of residency, as well as the emotional fatigue of supporting patients, families and health care teams in a palliative care context. This policy, along with the resident wellness and health and safety policies are intended to support residents through their subspecialty training.This policy reflects University of British Columbia’s commitment to management of fatigue as part of supporting resident’s overall well-being. Fatigue risk management for residents is critical to maintain safe patient care, the integrity of physician liability, and personal safety and wellbeing. The PGME along with programs, faculty and the Resident Wellness Office (RWO) provides ongoing fatigue prevention strategies to monitor, assess and minimize the effects of fatigue for the health and safety of resident and the patients they care for.POLICY1. Definition of TermsFatigue - A symptom characterized by a difficulty in initiating or maintaining voluntary physical and/or mental task. It is usually accompanied by a feeling of weariness and tiredness and can be acute or chronic. Fatigue maybe the result of physical, emotional and/or social/cultural factors. Resident responsibilityResidents are responsible for reporting fit for duty and able to perform their clinical duties in a safe, appropriate and effective manner free from impairment due to fatigue. Residents have a professional responsibility to appear for duty appropriately rested and must manage their time before, during and after clinical assignments to prevent excessive fatigue.Residents are responsible for assessing and recognizing the signs of impairment due to fatigue in themselves. Residents experiencing such fatigue are to notify their Program Director or designate.If a resident experiencing fatigue anticipates it could impair their ability to perform their duties, he/she is encouraged to voluntarily seek assistance before clinical, educational and/or professional performance, interpersonal relationships or their health are adversely affected. Residents, who voluntarily seek assistance before their performance is adversely affected will not jeopardize their status as a resident.Residents who experience fatigue which they feel would impair their ability to drive related to work must arrange for alternative transportation arrangements to ensure safe travel. Residents who commute by other means must ensure they feel they can travel without increased risk to themselves or others.Residents who unable to rest more than 4 consecutive, uninterrupted hours at night while on shift of 24 hours or longer are to inform their clinical team the following day and are expected to be relieved of clinical duties by 10am unless exigent clinical circumstances exist or residents choose to stay for compelling reasons consistent with the terms set out in the HEABC Collective Agreement. In the event of a resident staying past 10am in the above situations, they are to be relieved of clinical duties if any impairment in performance is noted by the resident, peer or faculty.If a resident recognizes impairment due to excessive fatigue in another resident, that resident should immediately notify the program director or designate.Residency Program ResponsibilityIt is the responsibility of the Residency Program Committee to be aware of resident fatigue and the risk factors.If a program director or faculty member recognizes the effects of excessive fatigue adversely affecting the performance of a resident the member must take steps to ensure the safety and wellbeing of the resident and their patients. It is the responsibility of the program to have clinical duty and on-call schedules consistent with the HEABC Collective Agreement.ResourcesUBC resident wellness office ()Employee & Family Assistance Program ()Physician Health Program ()Current Sleep Science: The Fatigue Risk Management Toolkit, p.6-7Effective Self-Assessments on Fatigue: Epworth Sleepiness Scale and the Fatigue Severity Scale (with a score of 36 or higher to be problematic).National Steering Committee on Resident Duty Hours: Summary of Findings, Final Report 2013Resident Doctors of Canada, Fatigue Risk Management ToolkitHousingHousing is your responsibility to organize. To assist you we can provide some phone numbers that you may try that will give you opportunity to locate reasonable accommodation. For residents doing rotations outside of the Lower Mainland, e.g. Victoria, we will do our best to give you some assistance in finding accommodation, though we can’t provide you with any guarantees.Resident Mandated Travel and Reimbursement Support and PolicyMany expenses related to mandatory rotations and academic sessions are reimbursed. For current policy, and reimbursement forms, please see the UBC PGME Policies and Procedures Website.Pay and BenefitsAs a resident, you will receive a salary, plus benefits for you and your dependents, at the level of a third year resident (unless otherwise specified). This involves the completion of the required university forms and establishing precise start/stop dates of your training. It is strongly recommended that residents use the direct deposit method of payroll.Should you have any problems regarding your pay cheque, your queries may be directed PHSA payroll, the central paying agency for all residents. Please see the Resident Doctors of BC website for contact information regarding payroll. If you have any questions regarding benefits, please contact the Resident Benefits Coordinator, employeeRBsupport@phsa.ca; information regarding benefits can be found at the Resident Doctors of BC website.ExpensesPlease keep receipts for any expenses incurred due to participation in the YAC. Some expenses may be reimbursed through the Resident Activity Fund (see below). There is also an endowment resource which may be accessed through the Division of Palliative Care. This funding, however, varies year to year and is not guaranteed.Resident Activity FundAs a Palliative Medicine resident, you are entitled to some reimbursement for expenses related to course and conference registration fees. Please use the reimbursement of expenses form provided when submitting the original receipts to us for reimbursement.There are also funds available from Foundational Support for Palliative Medicine.These funds are variable and will be made available during the year for educational pursuits.Pagers Pagers are no longer used during the year. You are expected to provide your cell phone as contact information during each rotation.Malpractice InsuranceIn addition to the coverage provided by the University and affiliated hospitals, residents are required to obtain their own individual malpractice insurance through the Canadian Medical Protective Association, P.O. Box 8225, Ottawa, Ontario, K1G 3H7 (phone: 1-800-267-6522).Prescription WritingDuplicate pads are required in BC for opioid and controlled medications. Please ensure these are ordered for your use, as they are used on many palliative medicine rotations. Please liaise with the Program Administrator for details.ImmunizationsResidents are required to report immunization status prior to beginning of training, this will be/should have been part of your registration process. Vacation SchedulingPlease see the Resident Doctors of BC website for details beyond what is below.Residents are entitled to 20 working days vacation. This equates to four calendar weeks (a week is defined as seven consecutive days) Vacation scheduling is determined by the Program Director in accordance with operational and educational requirements. Every effort will be made to permit a Resident at least their third choice for a vacation period. Vacation requests must be made in writing to the Program Director. Once a vacation request is confirmed please inform the Program Administrator so that One45 may be updated.A minimum of two consecutive weeks’ vacation shall be granted to Residents so desiring.A Resident shall not be scheduled for on-call duty on the weekend immediately preceding or immediately following a block of vacation where the block starts on a Monday and continues uninterrupted ending on a Friday. Your days on service are also reduced for calculating the number of calls in a block. If both spouses (including common-law) are residents, subject to operational needs, they are entitled to take their vacation togetherEvery resident is entitled to 5 consecutive days off during the 12-day period that encompasses Christmas Day, Boxing Day and New Years Day and two full weekends. These 5 days will account for the three statutory holidays: Christmas Day, Boxing Day, New Years Day, and 2 weekend days. Residents who take the 5 days will not receive in-lieu days if they are scheduled to work on one of the statutory holidays, although they are still entitled stat pay. These 5 days can be taken at any mutually agreed upon (between the resident and the program) time during the specified period. For example, the 5 days could be Monday-Friday (meaning residents could be scheduled on the weekends for call), or the 5 days could be Wednesday-Sunday (with the resident working the beginning of the week).Vacation Requests: should ideally be submitted at the start of the year, so that rotations can be scheduled. Any change requests must be discussed with the Program Director a soon as possible. Due to the need to accommodate elective residents, and having limited training sites, we cannot always guarantee we can accommodate changes.Call SchedulesAs a resident, you will be expected to be on call on some, not all rotations. This is to enable you to gain experience in the working conditions you can expect to be moving to after you finish your program. You must honor the call schedule set up on your behalf. You should contact your preceptor for each rotation 6 weeks in advance of the rotation should there be any weekends or days that you do not wish to be on call. While in most cases call should be determined a month in advance, on many rotations residents do not provide coverage on a regular basis, therefore call days/weekends can be determined in discussion with the site faculty. Sick DaysResidents must inform the Program Office, Program Director and their rotation supervisor or supervising staff when taking sick days. Residents sick for longer than 5 consecutive days, must contact their Program Director to discuss their situation and, at the Program Director’s discretion, may be required to follow the procedures for medical leaves (short or long term). Additionally, the resident is required to update RMS.Staying in TouchIt is important that you keep your contact information with the Program up to date. The difficulty with a de-centralized program such as this is that when it is imperative to reach a resident immediately, it may take hours to track them down and may even be impossible. Please help in maintaining the point of contact throughout your training by notifying the Palliative Care Program Office and Residency program Director of any change in your mailing address, phone number or email. You will be given a UBC email address, and are strongly encouraged to use this address, or forward it to your regular email address, as it will be used routinely by the PGME office.PRINCIPLES FOR THE LEARNERLearning to be and remain competent as a physician is an ongoing developmental process if acquiring wise judgment, attentive compassion, precise skills, and accurate information. While change is constant, and uncertainty exists with every patient encounter, the principles of learning to become and be this effective physician remain constant. Reflection and self-assessment are fundamental to becoming such a self-directed learner. The following description addresses some of the principles:A.Principles for the learnerLearning is a consequence of clinical experience and that experience is not altered without altering the person;Learning is an experience which occurs inside the learner and is activated by the learner; thus no one directly teaches anyone anything of significance;Learning is the discovery of the personal meaning and relevance of ideas;Learning is a co-operative and collaborative process;Learning is an evolutionary process;Learning may be painful;One of the richest resources for learning is the learner him/herself;The process of learning is emotional as well as intellectual.B.Context of learning for the facultyEffective instruction of a learner occurs best if:The individuality of the resident is recognized;There is active participation of the learner(s);There is immediate and frequent feedback;Clinical preceptors/faculty are most effective facilitators of learning when in a professional relationship, where they might integrate five distinct educational roles as:An instructional designer (goals, plans, implementation, & evaluation);A role model;A resource;A supervisor;A mentor, a relationship that fosters professional and personal development by believing in the learner, helping them refine, support and attain their dream.“Imagination is more important than knowledge.”- A. EinsteinCHARACTERISTICS OF A SELF-DIRECTED LEARNERTakes the initiative, with or without the help of others, in diagnosing or assessing his/her own learning needs;Selects appropriate resources and, when necessary, temporarily surrenders some measure of independence for the sake of expedience in learning;Develops, through inquiry and reflection, appropriate criteria by which to evaluate specific learning goals;Asks for justification of rules, procedures, principles and assumptions which it might otherwise by natural to take for granted;Refuses to agree or comply with what others state or demand where this seems critically unacceptable;Is aware of alternative choices, both as to learning strategies and to interpretations or value position being expressed, and makes reasoned choices about a preferred course of action;Continually reviews his/her approach to learning and makes strategic and tactical adjustments in order to optimize learning;Conceives of goals, policies and plans independently of pressures from others to do so, or not to do so;Independently forms opinions and clarifies beliefs, yet is willing to relinquish beliefs or to alter opinions when relevant contrary evidence is presented, and does so irrespective of the presence or absence of external rewards or pressures;Clarifies what is of personal value or in one’s interests, as distinct from what may be expedient, or what may be convenient; and,Is willing and able to accept alternative points of view as legitimate and is able to deal with objections, obstacles, and criticisms or one’s point of view without becoming defensive, threatened or angry.- Daniel D. PrattCOMPLAINT MANAGEMENT SYSTEMWHERE CAN POSTGRADUATE STUDENTS GO TO DEAL WITH COMPLAINTS?1.Your Preceptor2.The Program Director3.The Department Head4.Resident Doctors of BC5.Associate Dean, Postgraduate Education6.Associate Dean, Equity7.College of Physicians and Surgeons of B.C.In turn any or all of these resources may contact the Associate Dean, Equity to coordinate the process. ................
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