Clinical description

The cardiology service is one of the most recently developed subspecialty services at Royal Inland Hospital. It is currently being staffed by 6 full time equivalent Cardiologists and one ICU physician.  At present the service offers full time inpatient coverage consisting of a consultation service as well as an admission service.  Royal Inland Hospital has a newly expanded 16-bed Telemetry unit and a Coronary Care Unit is currently under development. The service also contributes to the Heart Function Clinic, Vascular Improvement Clinic, Device Clinic and a busy Rapid Access Cardiology Evaluation Clinic (RACE).  Other diagnostic services include ECG's, holters, exercise stress testing, nuclear medicine and echocardiography including stress echocardiography.   

Trainee expectations:

The rotation will be offered to resident trainees at all levels. A 2-4 week rotation is considered standard.  The trainee would alternate between weeks of inpatient and outpatient services. The inpatient service consists of consultations and care for ward and CCU patients.  Outpatient weeks consist of sessions at the heart function clinic and RACE clinic.  Depending on the level of training, the trainee will also be exposed to various cardiac diagnostics (ie. holters, stress testing, ECG's, echo etc).  An opportunity for community-based cardiology office practice also exists. Call frequency is 1:6.

Preceptors

Dr. Shawn Pun (Primary Contact)

Cardiologist, Royal Inland Hospital

Clinical description

The Intensive Care Unit is staffed by three RCPSC sub-specialty certified Intensivists and two general Internists with extensive experience and additional training in critical care. The ICU is a 10-bed, high acuity, multidisciplinary unit that is staffed using a closed model where the intensivist is the most responsible physician. There are approximately 650 adult admissions per year. Case-mix is approximately 50% medical and 50% surgical including neuro-trauma. A broad range of medical and surgical specialists and services supports the ICU team. Only patients requiring cardio-thoracic surgery, organ transplantation, and care in a dedicated major burn unit are routinely referred elsewhere. 

Trainee expectations

Trainees rotating in the ICU will be given graded responsibility based on level of training and experience. While the rotation may be offered to residents at all levels, it is usually recommended for residents in years 2 and higher. A four-week block is considered standard. The resident will be expected to attend daily ward rounds Monday through Friday and take primary responsibility for a selected number of patients. Call frequency is 1:4.

Preceptors

Timothy Schmidt MDCM, FRCPC (Primary contact)

Medical Director, Intensive Care Unit, Royal Inland Hospital

Clinical description

The general internal medicine service is staffed by five RCPSC certified internists and is further supported by two Respirologists who cross-cover on-call duties. The clinical activities of the general internal medicine service has two main components. The first is an inpatient internal medicine service that is staffed by an internist for a one-week block with other internists contributing to on-call. As only some sub-specialties admit patients at Royal Inland Hospital, the general internal medicine service manages a wide range of internal medicine problems. Typically patients are of high acuity. A large hospitalist service admits the majority of medical patients to Royal Inland Hospital and readily accepts patients in transfer from the general medicine service once acute issues have been addressed. The second component of the general internal medicine service is a hospital based weekly clinic schedule which includes a diabetes clinic, stress tests, myocardial perfusion imaging, vascular improvement clinic (risk reduction for vascular disease), and a preoperative clinic. ECGs performed at Royal Inland Hospital are interpreted by the general internal medicine service 5 days per week. 

Trainee expectations

Trainees rotating on the General Internal Medicine service will be given graded responsibility based on level of training and experience. The rotation will be offered to all trainees at levels ranging from medical students through to fellowship. A four-week block is considered standard and a minimum 2-week rotation is expected. A standard week of General Internal Medicine service runs Monday through Friday. For a four-week rotation trainees will typically spend three weeks on the inpatient service and one week attending outpatient clinics. Trainees are expected to do six nights of call, including one weekend day in a four-week rotation.

Preceptors

Dayne Ortved MD, FRCPC (Primary contact)

General Internist, Royal Inland Hospital

Clinical description

The Gastroenterology (GI) service is a busy service currently staffed by three RCPSC certified Gastroenterologists. The clinical activities of the GI service has three main components. The first is an inpatient and regional consultative service for ER and inpatients at the RIH, along with regional on call services for the Thompson/Caribou/Shuswap region. On any given day, the GI service typically follows between 10-25 patients in a consultative or admitting capacity. The GI service provides urgent and emergent therapeutic endoscopy services, including management of upper and lower GI bleeds including variceal hemorrhage, foreign body removal, ERCP and enteral stenting. Typically patients are of high acuity from the communities of Kamloops and surrounding areas. Common presentations include: GI bleeds, acute or chronic liver failure, Inflammatory bowel disease flare, pancreatobiliary conditions, and gastrointestinal malignancies.  A large hospitalist service admits the majority of medical patients to Royal Inland Hospital and readily co-manages a majority of the patients with the GI service. The second component of the GI service is a busy outpatient office practice, including a monthly hepatitis C clinic. A wide variety of patients with a wide range of gastrointestinal issues are assessed in the clinics/physician offices. The third component is an outpatient endoscopy services for the residents of Kamloops and the surrounding catchment area. The endoscopy unit at RIH currently has 3 endoscopy rooms, 2 of which run daily and are used by the GI specialists and general surgeons. 

Trainee expectations

Trainees rotating on the GI service will be given graded responsibility based on level of training and experience. The rotation will be offered to all trainees at levels ranging from medical students through to fellowship. A four-week block is considered standard and a minimum 2-week rotation is expected. A standard week of GI service runs Monday through Friday. For a four-week rotation trainees will typically assess inpatient and ER consults, formulate plans and review cases with their preceptor. There will be some expectations of the trainees taking ER and ward calls after hours, on the evenings when they are on call. There will be learning opportunities in an outpatient setting by joining the preceptor in their office. 

If there is interest on the part of the trainee and depending on their level of training, there will be opportunities for exposure to endoscopy techniques and development of endoscopy skills. 

Preceptors

Clinical description

The Infectious Diseases services is staffed by two RCPSC sub-specialty certified Infectious Diseases physicians who work in close collaboration with a team of highly trained pharmacists and specialized nurses. The Infectious Diseases service includes inpatient and outpatient consultations, prescription and monitoring of outpatient parenteral antibiotic therapy (OPAT), and HIV care. As a result of the high acuity of patients admitted to Royal Inland Hospital and referral area, the Infectious Diseases service sees a very broad range of patients as regards severity and etiology. With the exception of those co-infected with HIV who are managed by the service, patients with chronic viral hepatitis are referred to the liver clinic. All other patients with infectious diseases are accepted in referral otherwise. 

Trainee expectations

Trainees rotating on the Infectious Diseases service will be given graded responsibility based on level of training and experience. The rotation will be offered to all trainees at levels ranging from medical students through to fellowship. A four-week block is considered standard and a minimum 2-week rotation is expected. A standard week of Infectious Diseases service runs Monday through Friday and includes the following:  

• Five ½ day hospital-based OPAT/infectious diseases clinics

• One ½ day community-based HIV specialized clinic

• Inpatient consultation service at Royal Inland Hospital

• Telephone consultation service to regional physicians (Infectious Diseases sub-specialty trainees only)

After hours and weekend call is neither mandatory nor expected. 

Academic opportunities are available to interested trainees. These include participating in original research projects or authoring an Adult Infectious Disease Note to be published in the Canadian Journal of Infectious Diseases and Medical Microbiology. 

Preceptors

Dr. Kaveri Gupta MD, FRCPC (Primary Contact)

Infectious Diseases Consultant, Royal Inland Hospital

Clinical description

The nephrology program at Royal Inland Hospital is the largest community nephrology service in the interior.  We provided care for over 900 chronic kidney disease (CKD) patients through a multidisciplinary clinic with telehealth services within that group of patients including over 70 patients with inflammatory and vasculitic kidney disease.  In addition to having a large focus on prevention and management of CKD complications, we care for 150 dialysis patients in community dialysis centers, home hemodialysis, peritoneal dialysis and an in center dialysis unit running 6 days a week.  We provide SLED services in the ICU and insert our own temporary lines regularly.  Our program also provides post renal transplant care in the TCS region.  With a full service nephrology program we can provide an exciting experience focused on your learning and interest.   

Trainee expectations

Trainees will have an opportunity to rotate through all areas of the program with flexibility to focus on an area of interest if requested.  The rotation generally involves: 

• Half day clinic of peritoneal dialysis patient

• Half day of CKD telehealth services

• 3 full day clinics with various types and severity of chronic kidney

• 1 full day clinic of post transplant follow-up and assessment

• Dedicated time with a social worker and dietician who are part of the general program.

• Opportunity to observe and/or run multidisciplinary team meetings.

• Opportunity to learn to triage consults, bill for nephrology services and the skills involved in managing a large community nephrology program.

• Inpatient services with the option of accompanying us on call. Generally managing 8-15 patients with a variety of internal medicine issues who are on dialysis or diagnosing and managing those with new acute kidney disease or electrolyte abnormalities.

 After hours and weekend call is neither mandatory nor expected.

Preceptors

Joslyn Conley MD, MSc, FRCPC (Primary contact)

Nephrologist, Program Director Renal Services TCS

Clinical Professor, University of British Columbia

Clinical description

The Respirology service at Royal Inland Hospital has 3 full time respirologists who staff a daytime consultative service.  Typically we see patients with COPD, asthma, interstitial lung disease, lung cancer, atypical lung infections and sleep disordered breathing. All consultants have busy office practices where new referrals from the community are seen and followed up. Royal Inland Hospital has a fully functional pulmonary function testing laboratory with facilities to do full pulmonary function tests including dynamic and static lung volumes, carbon monoxide diffusion capacity, inspiratory and expiratory mouth pressures, methacholine challenge and exercise test for suspected exercise induced asthma. Every pulmonary function test is interpreted by a Respirologist. The home oxygen assessment program for the region is managed by a respiratory therapist. Approximately 4-5 fibreoptic bronchoscopies are done every week mostly for diagnostic purposes. Therapeutic bronchoscopies are also done frequently in ICU patients.

Trainee expectations

Trainees have opportunity, based on level of experience, to

• See Respiratory consults and follow up patients in hospital and office settings.

• Learn basic interpretation of lung function tests.

• Learn about indications of bronchoscopy and observe bronchoscopic techniques such as bronchial biopsies, bronchial brushing and bronchial washing.

• Learn the principles of home oxygen assessment

After hours and weekend call is negotiable.

Preceptors

DR. SURESH NAIR MD MRCP(UK) FRCPC  (PRIMARY CONTACT) 

Respirologist, Royal Inland Hospital

Dr. Ramesh Varma MD FRCP(Edinburgh) 

Respirologist, Royal Inland Hospital