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Paediatrics
Paediatrics

Core paediatrics residency program

Philosophy

The University of Toronto’s Core Paediatric Resident Program is dedicated to providing excellence in patient care, education, and scientific investigation. Similarly, it is hoped that all trainees will emerge from the program with first class clinical skills, the ability and desire to continue to learn throughout their career, and the ability to ask appropriate questions and contribute to understanding and knowledge in their field of interest.

The training takes place at The Hospital for Sick Children (SickKids), Mount Sinai Hospital, St. Michael’s Hospital, North York General Hospital, St. Joseph’s Health Centre and Holland Bloorview Rehabilitation Hospital. In addition, residents participate in elective opportunities at other hospitals within the Greater Toronto Area and beyond.

Objectives of the Paediatric Training Program

  1. To provide broad-based clinical and academic training in paediatrics with the goal of creating the foundation required for the academically rigorous practice of general and subspecialty paediatrics.
  2. To focus on clinical experiences of a secondary and tertiary nature in general and subspecialty paediatrics as seen in both a large academic health science centre for children and in community practice.
  3. To ensure training in critical appraisal, research methodology, and the application of evidence-based medicine to practice.
  4. To emphasize development of teaching and research skills.
  5. To provide graded responsibility in the acquisition of leadership skills.
  6. To fulfill all the objectives of specialty training required in Paediatrics by the Royal College of Physicians and Surgeons of Canada including the seven CanMeds roles.
  7. To provide the environment, mentorship and experience which will allow each resident to achieve the goals outlined above.

Timeline: The academic year for all programs is July 1 to June 30. Most trainees complete one of two training paths:

  • Three years of general (core) paediatrics, followed by two or three years of training in a paediatric subspecialty
  • Four years of general paediatrics leading to a career as a consultant and/or primary care paediatrician

It is expected that all candidates will proceed to the Fellowship Examinations of the Royal College of Physicians and Surgeons of Canada.

Site

The Hospital for Sick Children (SickKids) provides primary, secondary and tertiary care to the local community and tertiary-level care to the rest of Ontario and beyond, when required. There is a very busy emergency room and general paediatric unit where common paediatric problems are seen in large numbers. In addition, all paediatric subspecialties exist at SickKids, which ensures exceptional patient volume and variety. The SickKids Atrium provides spacious modern facilities for a family-centered-care approach to our paediatric patients. Residents have access to electronic medical resources. The majority of the residency training time is spent at SickKids, but other hospitals or facilities used include:

  • Mount Sinai Hospital (MSH): Located across the street from SickKids. Mount Sinai has an active perinatal unit through which residents rotate. Perinatology subspecialty training is also available.
  • Holland Bloorview Kids Rehabilitation Hospital: A chronic and rehabilitative care facility for children, Holland Bloorview Kids Rehabilitation Hospital serves as an excellent resource for experience with problems such as long-term management of arthritis, chronic asthma, birth defects, and brain injury. It is located in Toronto, accessible by TTC (subway), or about a 25-minute drive from SickKids.
  • North York General Hospital (NYGH) and St. Joseph’s Health Centre (SJHC): Both are full-service community hospitals that provide primary and secondary level paediatric care in their retrospective communities. PGY1 paediatric resident’s rotate through either NYGH or SHHC for one month of general inpatient and outpatient paediatrics in a community hospital setting.
  • St. Michael’s Hospital (SMH): A major downtown hospital with expertise in diverse areas of health care, SMH is located in the downtown core of Toronto. PGY3 paediatric residents rotate to SMH for one month of level two community neonatology.
  • Sunnybrook and Women’s Health Sciences Centre (SWHSC): The Women & Babies Program offers expert, personalized care for women and their families before, during and after pregnancy. Each year they deliver approximately 4,000 babies, one quarter of which are high-risk deliveries and require specialized care for mother and baby. PGY4 residents spend one month rotating through SWHSC.
  • Orillia Soldiers Memorial Hospital (OSMH): A 230-bed facility located in Orillia, Ontario, OSM is a community hospital providing regional programs, as well as surgical and medical services to the residents of Simcoe County and Muskoka. PGY4 residents spend one month in Orillia, gaining experience in general Community Paediatrics in a more rural setting.

Eligibility

Residency positions are available to Canadian citizens or landed immigrants of Canada who are in their final year of medical school in North America. Residency positions are also available to Canadian Citizens or landed immigrants of Canada who trained outside North American through the International Medical Graduate Stream (IMG). All applications are handled centrally by the Canadian Resident Matching Service (CaRMS),  51 Slater Street, Suite 1004, Ottawa, Ontario, K1P 5N1.

All other applications for residency training need to be sponsored by an agency approved by the Postgraduate Education Office of the Faculty of Medicine, University of Toronto.

Program Content

First Year (PGY1): This year is designed to provide a broad exposure to General Paediatrics. Under careful supervision by senior residents and staff, trainees will have ample opportunity to learn and refine the clinical skills considered fundamental to paediatrics, and to begin to build a sound paediatric knowledge base.

Included in the first year are the following experiences:

  • General Inpatient Paediatrics
  • Ambulatory Paediatrics
  • Emergency Paediatrics
  • Infectious Diseases/Immunology
  • Perinatology
  • Paediatric Surgery
  • Adolescent Medicine
  • Community Paediatrics
  • Research

Second Year (PGY2): This year is comprised mostly of paediatric subspecialty experiences.  Elective time is also provided.

Experiences include:

  • Developmental Paediatrics
  • Paediatric Neurology
  • Paediatric Cardiology
  • Paediatric Nephrology
  • Paediatric Haematology/Oncology
  • Paediatric Respiratory Medicine
  • Neonatology
  • Paediatric Gastroenterology
  • Paediatric Endocrinology
  • Paediatric Rheumatology
  • Elective
  • Selective / Research

Third Year (PGY3): This is a year in which the senior resident is expected to function in a supervisory role. He or she will have overall responsibility for a team of junior trainees on inpatient wards, in Emergency, and neonatal or perinatal units. The year is designed so that residents may choose from a number of electives / selectives in order to focus their training on individual areas of interest. All senior residents do a rotation in ambulatory paediatrics.

Experiences available to the PGY3 include:

  • Inpatient General Paediatrics
  • Ambulatory Paediatrics
  • Emergency Paediatrics
  • Neonatology/Perinatology
  • Paediatric Intensive Care
  • Genetics-Metabolics
  • Level II neonatology (St. Michael’s Hospital)
  • Critical Care Response Team/General Paediatric Consult Service
    Elective

Fourth Year (PGY4): For the fourth year of training, two options are offered:

  1. Core Paediatrics: The year is largely self-designed, and provides an opportunity for the resident to create a series of training experiences that will meet his or her objectives. PGY4s spend a rotation on the General Paediatric Consultation Service - Paediatric psychiatry, Rural Community Paediatrics in Orillia, Level III neonatology at SWCHC, Suspected Child Abuse and neglect, three blocks of community paediatrics and the rest of the year is elective time. A key element of the PGY4 year is the teaching and supervisory role. Two of the PGY4s are designated as Chief Residents.
  2. Subspecialty Paediatrics: Credit for a fourth year of paediatric training may also be obtained by entering a paediatric subspecialty program. The year can count towards core paediatric and subspecialty certification.

Electives for Core Paediatric Residents: Elective time in the second, third, and fourth years provides an opportunity to focus on specific areas of interest. A multitude of elective opportunities exist at SickKids. In addition, electives at other institutions can be arranged. All elective experiences must be approved in advance by the Program Director, and all such experiences are evaluated in the same manner as other rotations.

Evaluation

  • The PGY1, PGY2 and PGY3 paediatric residents are required to write the In-Training Examination of the American Board of Pediatrics at the beginning of each academic year. The feedback from this examination provides candidates with an assessment of their knowledge compared with individuals at the same level of training, and with information on areas of strength and weakness. Changes in the absolute score from one year to the next are informative. The exam is also helpful in pointing out problems that may exist in the teaching program.
  • Electronic In-Training Evaluation Reports (ITERs) are automatically sent to the supervisor near the end of each rotation. After the supervisor completes the electronic evaluation form, it is forwarded to the trainees who will review and sign it on-line. Staff are expected to discuss the evaluations with the trainees face-to-face before completing them.
  • Clinical skills assessments are done at least twice a year for all residents and are a mandatory part of the program. During these sessions, residents do a complete history and physical examination while being observed by a faculty member, and subsequently discuss their approach to the problem. The faculty member completes a written evaluation of this process, and feedback is provided to the trainee.
  • Evaluation works both ways, and residents are asked to evaluate each rotation and each clinical teacher. In addition, members of the Postgraduate Residency Program Committee support reviews of each rotation through Resident Retreat Reports annually. This information has an important role in the implementation of changes/improvements in the program.

Residency Program Committee (PGME - Postgraduate Medical Education): This Committee has overall responsibility for the quality and function of the residency training program. It meets monthly, and generally has a very full agenda. In addition to the faculty members, resident membership includes the two Chief Residents and two incoming Chief Residents and two elected residents from each year of training. The Resident Selection Committee is a subcommittee of this group.

UNIVERSITY OF TORONTO PAEDIATRIC RESIDENCY TRAINING PROGRAM RESIDENCY PROGRAM COMMITTEE TERMS OF REFERENCE
The Residency Program Committee is charged with:

  • Developing, operating, evaluating, and reviewing the paedaitric training program including educational objectives, resource allocation, curriculum and teachers
  • Maintaining a mechanism for the evaluation and promotion of Residents throughout the program and maintaining an appeal mechanism for Residents with referral to the University of Toronto Appeals Committee as required
  • Developing and reviewing issues related to career counseling
  • Developing and reviewing issues related to stress in residency
  • Selecting candidates for the program (via the Resident Selection Subcommittees)

The committee meets monthly each year with the exception of July and August. It reviews all matters pertaining to the Paediatric Training Program including curriculum, rotation specific objectives, review of teaching and teachers and review of Resident evaluation and promotion. Any member of the committee can table an issue for discussion. Resident representatives are asked to bring forward any items for discussion arising from their colleagues. Issues which arise pertaining to the training program raised by non-committee members are tabled by the Program Director.

The agenda for the residency training committee meetings is circulated electronically prior to the meeting. Agenda items are requested. After the meeting, minutes are distributed electronically and a hard copy is maintained in the Postgraduate Director’s office.

Recommendations are made by this Committee to the Chairman of the Department of Paediatrics. In turn the Chairman uses this Committee as a sounding board on all matters related to the education of Residents.

The membership of this committee includes: Program Director (Chair), 2 members of each of the first 3 academic years – voted by their peers, current Chief Residents, incoming Chief Residents, one faculty site representative from each mandatory site, broad faculty representation from the Department of Paediatrics.

Subcommittees

1. The Resident Selection Committee is charged each year with the selection of candidates for the paediatric training program and for the evaluation and promotion of Residents to the next level of training. The Resident Selection Committee meets from September to February, at least once a month, and often more frequently, to deal with the large numbers of applications to the program. This committee has broad faculty representation and resident representation.

2. The Resident Selection Committee – International is charged each year with the selection of candidates for the paediatric training program through the International Medical Graduate route (IMG). This committee meets from September to February reviewing applications, making decisions about interviewing and ranking candidates. This committee has broad faculty representation including faculty who are International Medical Graduates.

3. Resident Promotions and Remediation Committee – Is charged with ensuring that all residents meet the requirements of each year of the program and designing a plan for residents in difficulty with the help and support of the office of the Vice Dean.

4. The PeRLS committee (Academic Half-Day committee) is chaired by the Program Director and is made up of Residents and one other faculty representative (since July 2010). This committee is charged with the oversight of the AHD curriculum, responding to Resident feedback, ensuring compliance with the RCPSC goals and objectives of training and planning the blueprint for the upcoming academic year.

5. International Health Oversight Committee (started 2011) – is charged with the task of providing mentorship, guidance and expertise in the area of international electives. This involves involvement with the creation of the goals and objectives for the rotation, recommendations to the program director around approval of the proposed elective, pre-departure training and post-elective debriefing. This committee is currently chaired by Dr. Julie Johnstone, and the membership includes faculty with expertise in international health as well as residents from each year of the program.

6. CaRMS committee (started 2011) – is charged with monitoring, reviewing and designing the CaRMS process for prospective candidates applying to the University of Toronto Program. This committee is chaired by a PGY-3 resident, and includes residents from all years in the program. This committee was the brainchild of the resident group who wanted to ensure that the program was described well to potential candidates, and to ensure that the candidates enjoyed their visit to the program.

7. Resident Wellness Committee (started 2012) – This committee is chaired by the Chief Residents. This committee was the idea of the current Chief Residents who wanted to ensure that the wellness aspect of the program had oversight and was meeting the needs of the residents. This committee is made up of residents from each year in the program and 2 faculty from the RPC.

8. Advocacy Committee – This committee is chaired by two residents, with faculty oversight. There is broad resident representation across the 4 years of the program. The mandate of this committee is to provide leadership and organization around the advocacy projects taking place in the program. New ideas for advocacy initiatives/projects are brought to this committee and support is provided.

Research

SickKids has long played an international role in paediatric research. The SickKids Research Institute is located on-site, and many faculty members have cross-appointments. There are ample opportunities for residents to collaborate with SickKids investigators, or indeed to begin projects of their own under appropriate supervision. While time is always short during residency training, all SickKids residents participate in projects, often resulting in presentations at scientific meetings and/or publications in peer-reviewed journals. All residents are expected to complete at least one scholarly project during their three core years. Elective time may be spent on a supervised research project.

Each year, residents are invited to submit abstracts for the resident research competition. The research awards are given to those Core and Subspecialty Paediatric residents ranked highest at the annual Resident Research Day. Residents whose papers are accepted for presentation at scientific meetings receive substantial financial assistance to cover travel expenses.

Educational Leave

All residents are entitled to educational leave annually, and this may be used to attend an approved scientific meeting or course. Financial assistance to help defray travel expenses is provided by the Department of Paediatrics. Satisfactory arrangements for coverage must be made before conference leave is approved.

Vacation, Statutory Holidays, Pregnancy and Parental Leave

These matters are governed by an agreement between the Professional Association of Interns and Residents of Ontario (PAIRO) and the Ontario Council of Teaching Hospitals (OCATH). In order to obtain the current information on vacation, statutory holidays and pregnancy and parental leave, please go to http://www.pairo.org/

On-call Duty

The PAIRO agreement allows for a frequency of 1-in-4 night call. Most rotations in the program are on a 1-in-4 schedule, and some rotations have no night call. High intensity units such as Emergency Services and the Neonatal ICU operate on a shift basis. The 11th floor of The Hospital for Sick Children provides modern, comfortable, and clean on-call rooms, as well as a lounge.

Rounds and Seminars

Clinical training in paediatrics is complemented by an extensive schedule of rounds, seminars, guest lectures, and journal clubs. There is a three-hour block of protected teaching time per week. In addition to weekly Grand Rounds, Chair’s Rounds, noon reports, subspecialty noon report, and each Division has its own teaching conference schedule. Distinguished visiting professors are regularly invited to The Hospital for Sick Children, often as Grand Rounds speakers.

Faculty

Within the Department of Paediatrics, there are approximately 251 full-time and 211 part-time faculty. Most part-time faculty are paediatricians in the community who have dedicated themselves to an ongoing role in resident education. They form a valuable part of the clinical teaching staff, and serve as excellent role models for many of the trainees. There are 359 members of the active medical staff at The Hospital for Sick Children. The Department of Paediatrics is comprised of 18 Divisions, encompassing virtually all of the subspecialties of paediatrics. The availability of superb paediatric subspecialty expertise adds great depth to the training program. Subspecialty training is balanced by a strong emphasis on general and ambulatory paediatrics. These latter areas have recently been reviewed and strengthened in order to improve the quality and quantity of this experience.

About Toronto

Toronto is Canada's largest city, with a metropolitan population of more than five million, and a richly diverse cultural and ethnic make-up. It has abundant facilities and resources to satisfy a wide variety of cultural and recreational interests.

For more information, please contact:

Adelle Atkinson
Program Director - Core Paediatric Residency
Paediatrics
The Hospital for Sick Children
555 University Avenue, Room 1447
Toronto, ON
M5G 1X8
Canada
Phone: 416-813-5310
Fax: 416-813-5230
email: adelle.atkinson@sickkids.ca

Victoria Snell (Interim support to Medical Education)
Business Operations Manager, Divisions of Adolescent Medicine, Clinical Pharmacology & Toxicology,
Nephrology & Respiratory Medicine
Department of Paediatrics
The Hospital for Sick Children
Med Ed Phone: 416-813-6230
email: victoria.snell@sickkids.ca

Sandra Layno
Program Coordinator
Paediatrics
The Hospital for Sick Children
Phone: 416-813-5310
email: sandra.layno@sickkids.ca

Natalie Rees (Interim Support)
Administrative Assistant
Paediatrics
The Hospital for Sick Children
Phone: 416-831-7654 Ext. 228349
email:natalie.rees@sickkids.ca

updated: September 21, 2017