Critical Care Medicine
Location: Bethune Building, Victoria General Site
QEII Health Sciences Centre
3rd Floor, Room 377
Halifax, NS
B3H 2Y9
Telephone: (902) 473-3486
Fax: (902) 473-3610
Website: medicine.dal.ca/departments/critical-care.html
Email: Critical.Care@nshealth.ca


The Department of Critical Care Medicine provides patient care and leadership in the hospitals affiliated with Dalhousie University. The Critical Care Department at Dalhousie University is made up of 13 clinicians at the QEII, 9 at the Dartmouth General Hospital and 4 at the IWK. They all come from varied professional backgrounds. Each member has training in Anesthesia, Internal Medicine, Emergency Medicine or Surgery, and the additional Critical Care training qualifies those at the QEII and IWK as Intensive Care specialists.

At the Queen Elizabeth II Health Sciences Centre, our clinical practice is to support the two Intensive Care Units. The 9-bed 3A Med/Surg ICU at the Victoria General Site primarily serves the needs of General Surgery, Thoracic Surgery, Otolaryngology including Head and Neck Cancer, Oral Surgery, Urology and the Multi Organ Transplant Program. Medical services based at the Victoria General Site include the Dialysis Unit as well as Hematology Oncology and the Bone Marrow Transplant Unit. Occasionally, General Medicine patients from the Halifax Infirmary Site or patients from services based at the Halifax Infirmary Site are transferred to this unit when appropriate. Supporting the management of acutely ill patients at the Victoria General Site are two, four-bed Intermediate Care Units that provide a transition unit for our most acutely ill patients from the ICU to the wards. We are frequently consulted to the Intermediate Care Units but are not responsible for their management.

The 13-bed 5.2 Med/Surg/Neuro ICU at the Halifax Infirmary 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. Cardiovascular Surgery is also at the Halifax Infirmary site however these patients are cared for in 5.1 CVICU and staffed by a separate clinical team.

At the Dartmouth General Hospital ICU, we provide support for medical, surgical and coronary care patients in the Dartmouth are as well as some patients referred from smaller hospitals across the Halifax region.

The IWK PICU is the only Pediatric ICU in the Atlantic provinces and cares for children who are critically ill, injured or need constant observation. Patients range from newborn to 16-years-old.

Education Highlights

Three of our members have dedicated research interest related to Critical Care Pharmacology, Resuscitation and Sepsis and a basic science laboratory in Acute Lung Injury and Mechanical Ventilation.

There is a well developed educational curriculum with weekly Tuesday afternoon teaching sessions that encompass the full spectrum of Critical Care Medicine using a 24 month rotating curriculum. In addition to these scheduled teaching sessions, Critical Care Grand Rounds, M & M Rounds, Journal Club, and scheduled Simulation sessions are scheduled monthly. Our Department has partnered with the Department of Bioethics to develop a four-session Bioethics course open to the rotating house staff as well as all members of the Department.

Our trainees are supported to attend at least one medical meeting per year and are expected to complete a QA/QI or research project of sufficient quality to be presented at a national meeting.

Elective Rotations

First and Second Year Med Students

Due to the high acuity and complex nature of critically ill patients, elective opportunities are typically not offered to medical students in their first or second year of schooling.

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 at either the HI or VG site, with one week spent in the Operating Room to gain or further knowledge in anesthesia techniques. 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 five ‘buddy call shifts’ paired with a senior resident for added support overnight.

Fourth Year Clerks

Students may choose two or three week electives in Critical Care to gain additional experience in the Intensive Care Unit and further their practical skills. Fourth year students will work three to four ‘buddy call shifts’ in conjunction with a more senior resident for backup overnight.

Residents

The Department of Critical Care Medicine 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 ratio of one in four nights.

House staff attend all academic activities including daily case-based, interactive educational sessions as well as weekly noon rounds. Simulation sessions are also held weekly and focus on topics such as crisis resource management, airway management and advanced cardiac life support and resuscitation.

Subspecialty Training Program

Dalhousie’s training program in Adult Critical Care Medicine is fully accredited with the Royal College and is the only training program in this discipline east of Montreal.

Core rotations in Critical Care Medicine will see each trainee spend five rotations in the Med/Surg ICU based at the Victoria General site and six rotations at the Med/Surg/Neuro ICU at the Halifax Infirmary site at the Queen Elizabeth II Health Sciences Centre over the course of their two year training. Additional rotations through the Cardiovascular Intensive Care Unit and a compulsory rotation in a community Intensive Care Unit (Dartmouth, Kentville, or Saint John) are considered core and therefore mandatory components of training. Specific rotations to augment the skill sets required to function as an Intensivist will be required as necessary (e.g. Anesthesia rotation for Internal Medicine applicants, Infectious Disease rotation for Anesthesia applicants). There is ample time provided within the core training for electives which can be used to pursue extra clinical training for specific research objectives.

During their first three months of training, trainees can expect to provide in house call coverage at a ratio of one in four nights. In their remaining ICU months, trainees will cover a week of night call, Sunday to Thursday, to mimic the call schedule of staff Intensivists and facilitate the transition to an attending physician. Night call is scheduled at the Halifax Infirmary site during all ICU rotations except the trainee’s final rotation at the Victoria General site. Night call is scheduled from 4:00pm to 7:00am the following morning, at which point the trainee is relieved of their duties by 9:00 am on the post call day as per the Maritime Resident Doctors collective agreement.  The attending on call serves as backup to the trainee, ensuring there is a resource system in place should additional support be required.

Residency Training Sites

Our trainees are based at the Queen Elizabeth II Health Sciences Centre but can do elective rotations outside of Halifax at the discretion of the Program Director. The Queen Elizabeth II Health Sciences Centre is a tertiary/quaternary referral hospital and is the primary teaching hospital for Dalhousie University School of Medicine. The MED/SURG ICU, an 9-bed ICU at the Victoria General site has approximately 550 admissions per year with the MED/SURG/Neuro ICU is a 13-bed ICU at the Halifax Infirmary site having approximately 800 admissions per year.