Critical Care Medicine
The Department of Critical Care provides patient care and leadership in the hospitals affiliated with Dalhousie University. The Department is made up of a diverse group of physicians with varied specialty backgrounds, including anesthesia, internal medicine, emergency medicine and surgery, with subspecialty training in critical care medicine.
At the Queen Elizabeth II Health Sciences Centre, our clinical practice is to split among two sites, the Intensive Care Unit (ICU) at the Halifax Infirmary (HI) (5.2 Medical-Surgical-Neuro) and the Victoria General (VG) sites (3A Medical-Surgical ICU). The 9-bed 3A ICU primarily serves the needs of general surgery, thoracic surgery, otolaryngology (including head and neck cancers), oral surgery, urology and the Multi Organ Transplant Program (MOTP). Medical services based at the Victoria General Site include the Dialysis Unit as well as hematology, oncology and the Bone Marrow Transplant Unit. The 13-bed 5.2 ICU supports orthopaedic surgery, acute general surgery, Trauma Program, neurosurgery, vascular surgery and plastic surgery including the most severely burned patients. Medical services based at the Halifax Infirmary include general internal medicine, neurology, respirology and cardiology, although there is a separate Coronary Care Unit and a Cardiac Step-down Unit staffed by the Division of Cardiology, in addition to the cardiovascular surgery service, whose patients are cared for in 5.1 CVICU and staffed by a separate clinical team.
The Dartmouth General Hospital (DGH) ICU, is an 8 bed general medical-surgical ICU/Intermediate Care Unit (IMCU)/CCU that serves all of Dartmouth in addition to Musquodoboit and Eastern Passage.
The IWK Paediatric ICU (PICU) is the only Paediatric ICU in the Atlantic Provinces and cares for children who are critically ill, injured or who require high-level monitoring. Patients range in age from newborn to 16-years-old.
Undergrad and Postgrad Education
First and Second Year Med Students
Due to the high acuity and complex nature of critically ill patients, elective opportunities are limited for medical students in their first or second year of medical school. When offered, these electives are scheduled for either 8:00 am to noon, or noon to 4:00pm, one day per week for one full term.
Third Year Clerks
In their third year, students may choose to complete a combined ICU/Anesthesia selective rotation within the internal medicine block. Students will spend three weeks in the ICU, spending time at both the HI and VG sites, with one week spent in the operating room to gain or further exposure to anesthesia. While in the ICU, students will participate in all departmental academic activities including daily teaching sessions as well as weekly rounds and simulation sessions. Students can expect to work up to five ‘buddy call shifts’ paired with a senior resident.
Fourth Year Clerks
Students may choose two- or three-week electives in critical care to gain additional experience in the ICU and further their practical skills. Fourth year students will work three to four ‘buddy call shifts’ in conjunction with a more senior resident.
Residents
The Department of Critical Care provides a high quality educational program for postgraduate learners across the four major base specialties of Anesthesia, Emergency Medicine, Internal Medicine and Surgery. Over 100 residents rotate through the ICUs on an annual basis, fulfilling both compulsory and elective requirements of their training. In the ICU, residents are a crucial component of the health care team, helping to provide round the clock care for the most acutely ill patients. Residents can expect to work 24hr in hospital call shifts at an approximate frequency of one in four nights.
There is a well-developed educational curriculum with daily interactive educational sessions as well as weekly noon rounds, and bi-weekly simulation sessions. House staff are expected to attend all academic activities.
Subspecialty Training Program
Dalhousie’s two-year Critical Care Medicine (Adult) residency training program is accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC) and is the only critical care medicine training program east of Montreal, in the beautiful port city of Halifax, NS. In July 2019, the program successfully transitioned to competency based medical education (CBME), using the Royal College’s Competency by Design (CBD) platform.
Residency Training Site
Our trainees are based at the QEII Health Sciences Centre in Halifax, Nova Scotia, but may undertake elective rotations outside of Halifax at the discretion of the Program Director, and based on resident interest and training needs. The QEII Health Sciences Centre is a tertiary/quaternary referral hospital and the primary teaching hospital for Dalhousie University Faculty of Medicine. The 9-bed medical-surgical intensive care unit (ICU) at the Victoria General (VG) site has approximately 550 admissions per year, and the medical-surgical-neuro ICU at the Halifax Infirmary (HI) is a 13-bed ICU that sees approximately 800 admissions per year. Because of the large catchment areas of the QEII there is a widely diverse case mix yielding a broad educational experience.
Residency Rotations
The core critical care medicine curriculum is comprised of 15 blocks of intensive care, spread primarily over two critical care sites in Halifax: 4+ blocks at the VG ICU, 6+ blocks at HI ICU HI, and there are 2 “Flex” blocks that are taken at the local ICU most relevant to the trainees’ career goals. There is a mandatory cardiovascular ICU block in the Cardiovascular ICU (CVICU, HI) and 2 Community ICU blocks, which include a mandatory rotation in Sydney, Nova Scotia (Cape Breton Regional Hospital), and another elective Community block in the trainees’ community of choice (where an FRCPC trained intensivist is on staff).
Specific Electives rotations to augment the skill sets required to function as an Intensivist are undertaken as necessary based on the trainees’ base specialty and ongoing skills needs. For example, rotations of Anesthesia for Internal Medicine applicants, and Infectious Disease, Nephrology and other medical subspecialty rotations for those trainees coming from Anesthesia, Surgery, or Emergency backgrounds. There is ample time provided within the core training program for Selectives that can be used to pursue extra clinical training in areas of clinical or research interest; one scholarly project requirement must also be met over the course of the two -year program.
During their first two months of training, trainees can expect to provide in-house call coverage at a ratio of 1-in-4 nights, during the Transition to Discipline stage. In subsequent ICU blocks, trainees will cover one Saturday and a week of night call (Sunday to Thursday, similar to the call schedule of staff Intensivists), in order to optimize clinical exposure, maintain continuity of care, and ultimately to facilitate the transition to critical care practice. Night call is scheduled at the Halifax Infirmary (HI) site during all ICU rotations except for the trainee’s final rotation where they will function as Junior Attending, accepting managing outside calls and transfer requests, at the Victoria General (VG) site. As during previous months of training, the attending on call acts as backup to the trainee, ensuring there is a resource system in place should additional support be required. Travel to other provinces for training opportunities not provided here is encouraged and facilitated.
There is a well-developed educational curriculum with weekly Thursday afternoon teaching sessions (academic half days [AHD]) that encompass the full spectrum of critical care medicine, delivered on a 2- year rotating schedule. In addition to weekly AHDs, trainees participate in monthly Critical Care Grand Rounds, Journal Clubs, Morbidity & Mortality (M&M) Rounds, and scheduled simulation sessions. Our department has also partnered with the Department of Bioethics to develop and deliver a four-session Bioethics course over the two-year program. Opportunities also exist for various committee participation, strongly encouraged from a CanMEDS roles and Transition to Practice perspective. Generous conference and educational funding is also provided.
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