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
Elective Rotations
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 8:00 am to noon, 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 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 training program in Adult Critical Care Medicine is fully accredited with the Royal College and is the only critical care training east of Montreal. It successfully transitioned to Competency Based Medical Education (CBME) in July of 2019.
The core critical care medicine curriculum has each trainee spend five rotations in 3A ICU (VG Site) and six rotations at the busier 5.2 ICU (HI Site) over the course of their two year training. Additional compulsory ICU rotations include one month in the Cardiovascular Intensive Care Unit (CVICU) and one month in a community ICU setting (Dartmouth, Kentville, Sydney, or Saint John). Specific rotations to augment the skill sets required to function as an Intensivist are undertaken as necessary based on base specialty training and ongoing skills needs (For example, but not limited to, anesthesia rotation for internal medicine applicants, infectious disease, nephrology and other medical subspecialty rotations for anesthesia and surgical applicants). There is ample time provided within the core training for electives which can be used to pursue extra clinical training in areas of clinical or research interest; a scholarly project requirement must also be met over the course of the 2 year program.
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 into the discipline as a practicing Critical Care Attending. Night call is scheduled at the Halifax Infirmary site during all ICU rotations except for the trainee’s final rotation at the Victoria General site when they function as Junior Attending, including accepting managing outside calls and transfer requests. As during previous months of training, the attending on call act as backup to the trainee, ensuring there is a resource system in place should additional support be required.
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, on a 24 month rotating schedule. In addition to these academic half days, Critical Care Grand Rounds, Journal Club, Morbidity & Mortality (M&M) Rounds, and scheduled simulation sessions occur monthly, changing on a weekly basis. Additionally, 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. Opportunities exist for committee participation as well and is encouraged from a transition to discipline perspective.
Residency Training Sites
Our trainees are based at the Queen Elizabeth II (QEII) Health Sciences Centre, but may undertake elective rotations outside of Halifax at the discretion of the Program Director, based on training needs. 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 9-bed medical-surgical Intensive Care Unit (ICU) at the Victoria General site has approximately 550 admissions per year, and the medical-surgical-neuro ICU at the Halifax Infirmary is a 13-bed ICU that sees approximately 800 admissions per year. Because of the large catchment areas of QEII Health Sciences, there is a widely diverse case mix yielding a broad educational experience.