Rural Okanagan

Site Director Message

In this carefully designed program, residents spend their first year based in the Okanagan Valley. The majority of rotations occur at Kelowna General Hospital. Some rotations, such as first year family practice, are completed in practicing physicians’ offices in Kelowna or close to. During this time, residents are given the option of living together in one of two cost-effective resident houses located near the hospital. This gives residents a unique opportunity to share both their learning and their living experiences with one another, as well as build strong, lasting friendships with future colleagues.

During the second year of training, residents complete two four-month rotations in rural/remote communities in BC and the Northwest Territories. In these communities, residents work alongside experienced rural preceptors who provide teaching and role modeling of remote and rural practice. Four months of elective time is offered in the second year. International elective rotations are also encouraged.

We will prepare you to practice in non-urban settings while stressing the importance of balancing personal needs with professional commitment.

Research has demonstrated that the best candidates for our program are those who are looking for adventure and exciting medicine in a non-urban full spectrum family practice community. Candidates usually have an interest in the recreational and outdoor potential of rural communities. Such “rational risk takers” stand out from the average resident based on their activities, experiences, and attitudes.

Students interested in rural-based training should seriously consider applying to the Rural Kelowna Site. The best promoters for the Rural program are the current residents and grads. We would be happy to put you in touch with these colleagues if you wish to communicate with them directly. Otherwise have a serious look at our website and feel free to contact us with any questions you may have.

Dr. Maureen Sharko
Site Director – Rural Okanagan Site
msharko@me.com
Dr. Robb Sebastian
Associate Rural Site Director – Rural Okanagan Site
sebastianmary@hotmail.com

Chief Resident Message

With thirteen positions available for incoming residents, the Rural Kelowna Site attracts friendly candidates with many diverse interests. The Rural training program is unique in its amount of flexibility, adaptability, breadth of experience, and responsibility. The program provides training in the core aspects of medicine, while allowing residents to enhance their skills in areas of interest by offering a training program with few other residents and learners. Our entire faculty and support staff are approachable, available, supportive, and encourage communication and problem solving at multiple levels.

The first year is based out of Kelowna, and offers excellent rotations in ICU, pediatrics, internal medicine, general and orthopaedic surgery, family medicine, obstetrics, psychiatry, and emergency medicine. Residents also have the opportunity to spend time throughout the year with family practice preceptors or specialists based on their interests. Our academic half days are well structured, interactive, and relevant to rural family medicine topics. The learning in this program is largely self-directed, which allows residents to tailor their schedule to suit their learning needs.

The second year is divided into three blocks of sixteen weeks. One of these blocks is dedicated to elective time, and many residents use this as an opportunity to travel across Canada and the globe (e.g. South Africa) for trauma and emergency medicine electives. Residents are also encouraged to pursue individual interests including initiatives in international health, women’s health, and wilderness medicine to name a few. The other two blocks place the resident in their choice of two rural training sites. These communities are distributed throughout British Columbia, with placements available in Inuvik, NWT as well. The learning experiences in your second year are endless, and residents are trained to develop sophisticated management plans for their patients with considerations that are unique to the rural and remote physician. Many of the rural family physicians with whom we train have full spectrum family practices, and provide excellent learning in all areas of medicine (including flight medicine in more isolated communities).

Typically, the Rural Kelowna residents are keen and ready for a bit of adventure. The first year provides an opportunity to really get to know your fellow residents and faculty. Residents are generally able to enjoy extracurricular activities together in their spare time, including skiing, biking, wakeboarding, kite boarding, running, paddling, and more. Each year strong friendships are formed within the resident group, which continue into practice in rural and remote areas. When in rural communities during the second year, we network with each other through monthly teleconferences and attend an annual retreat at Big White, near Kelowna. This program demands residents who can entertain themselves when in 2nd year rural rotation communities, as the isolation can prove potentially challenging.

Subsidized supplementary training courses are offered in our program. These include Advanced Trauma Life Support (ATLS), Advanced Cardiac Life Support (ACLS), Advances in Labour and Risk Management (ALARM), and Neonatal Resuscitation Program (NRP) certifications, in addition to an Essential Surgical Skills Course (ESSC) and the Comprehensive Approaches to Rural Emergencies (CARE) course for our rural training group. There are also conference days and resident funding which can be put towards additional courses such as Pediatric Advanced Life Support (PALS), Point of Care Ultrasound (POCUS), and Airway Management in Emergencies (AIME), and conferences like the Rural Emergency Continuum of Care (RECC).

From air-evacuating medical emergencies above the Arctic Circle to perfecting fish hook removal techniques in the Queen Charlotte Islands, the adventures abound and we’d love the opportunity to welcome you to the rural family!

Drs. Jim Huang & Kurt Deschner

jimhuang@alumni.ubc.ca
deschk@alumni.ubc.ca

Number of Residents: 9 CMG, 4 IMG
Location: Kelowna, BC
Community: 180,000+
Hospital: Kelowna General

Curriculum Type: Block / Integrated
R2 Elective Time: 16 Weeks
Phone: 250-862-4014
Contacts: Director – Dr. Maureen Sharko – msharko@me.com / Coordinator – Janice Demers –janice.demers@interiorhealth.ca
Chief Resident: Kurt Deschner – deschk@alumni.ubc.ca / Jim Huang – jimhuang@alumni.ubc.ca

Overview

The Rural Okanagan program takes place over two years and is well suited for individuals who would like to work in a rural or small city setting. Individuals with personality traits such as independent, self-directed, adventurous and motivated will thrive in this environment. Also, if you are willing to travel throughout BC and the territories and experience medical training at various locations with limited resources then this opportunity is for you. The benefits include a wide exposure to acute and chronic patients and lots of ‘hands-on’ experiences

The first year helps prepare Residents for their more remote second year experience. The Residents rotate through a variety of specialties in partnership with the undergraduate Southern Medical Program (as of 2012). All rotations incorporate the Resident as a physician and you work as part of a team.

The second year is spent all over BC. Residents complete two, 16 week blocks in rural communities (e.g. Bella Coola, Creston, Grand Forks, Lillooet, Masset, Port McNeill, QCC, Revelstoke, 100 Mile House, Cranbrook, Gibsons, Inuvik, Powell River, Smithers, Golden & Vanderhoof). Four weeks are spent doing a trauma or an emergency rotation. Another 12 weeks consists of elective time; residents choose what and where they want to learn.   There is also an option to spend four months in Kelowna and surrounding region for a four month block if there is interest to spend more time locally or possibly work in the region after training. During the second year, residents also travel to Vancouver and/or Kelowna for academic time and for resident research day. This, along with travel for exams, conferences, etc. means our residents are on the road a lot more than in other programs…but they get to see lots of BC (and beyond if they decide to do an international elective!)

Residents who do well in our program enjoy self-directed learning – meaning they are comfortable working in a hospital where they need to take the initiative to get involved with patient care to meet their personal learning needs. In the R1 year, because we are not a fully service based hospital, the level of responsibility may be less on some rotations (compared to other programs) …but in the R2 year, responsibility is close to the level of a practicing rural physician (with support of course).

 

Program Highlights

  • Highly evaluated academic half day program in the R1 year; teleconferences and web learning in the R2 year
  • Simulation sessions on a variety of adult and pediatric scenarios are done monthlyCARE Course for second year Residents (REAP funded)
  • 32 weeks or more spent in rural communities to enhance confidence in procedures and management of acute and chronic medical problems
  • Second year academic exam prep week
  • Experience in continuity of care to appreciate how a patient’s life experience affects the presentation and course of illness. Practice of preventative medicine and health promotion Education in health economics and consideration of local communities, costs of investigations, and referrals are highlighted
  • Critical appraisal of publications and thorough review of EBM guidelines and assistance with Practice Improvement Project (PIP) and opportunity for second year scholarly project.
  • Chance to experience the lifestyle of living and working in rural communities with preceptors who effectively balance their work and personal lives
  • Funding for travel and subsidy for accommodations during mandatory R2 rotations
    Funded ATLS, ACLS, ALARM, NRP, Essential Surgical Skills and special full day ultrasound training
  • 16 weeks of rural accommodation is funded up to a maximum of $1300/month. Some training sites provide free or low-cost accommodation.

Sample Rotation

Block 1 Block 2 Block 3 Block 4 Block 5 Block 6 Block 7 Block 8 Block 9 Block 10 Block 11 Block 12 Block 13
PGY1

Ortho

Peds

Psych

ICU

Obs

Obs

Hospitalist

CTU

Peds

FM

FM

ER

Surg

PGY2

Rural1
FM

Rural1
FM

Rural1
FM

Rural1
FM

Elec

Elec

Trauma
Emerg

Elec

Rural2
FM

Rural2
FM

Rural2
FM

Rural2
FM

Transition to Practice

Interview with Michael Slatnik (previous R2)

What do you enjoy most about the Rural program?
The independence that comes with rural training. Being a resident in a small town, you feel like an integral part of the medical community and are able to become involved in all aspects of medical care. You get the training you need to become an effective rural family physician.

What does your typical day look like?
It’s different for Year 1 residents (R1s) than Year 2 residents (R2s). Right now, I’m on a rural rotation in Grand Forks. In the mornings, I usually work Emergency and then spend my afternoons at the community clinic. My Fridays are call-protected.

Is there a large service component to your residency?
We do some service, but staff and preceptors are very respectful of the fact that residents are here to learn and they protect that. They prioritize our education and allow us to structure our schedules to maximize our learning opportunities.In R1 you’re less service-based, and in R2, as you develop the need to see large volumes of patients, your service component increases appropriately.

What kind of learning opportunities do you have?
I interact with a lot of GP specialists and I’m often invited to observe or participate in procedures that would normally be snapped-up by specialist residents. Otherwise, I pretty much decide what interests me and then approach preceptors to set up the learning opportunity. You’re pretty much a self-directed learner at the Rural site.

Does it get fairly competitive with the other residents?

No, not at all. Our R1s are the only residents in Kelowna General Hopsital [there are actually now two Emergency Medicine residents based out of Kelowna as well.] So you have first chance to participate with procedures that you wouldn’t see in other Family Practice training programs. For example, I’ve learned how to insert an IUD, which is something that would normally be done by a gyn resident.

There isn’t a resident hierarchy at the rural sites. In fact, you can have two residents on-call at night and both will be invited to participate with the patients. It’s very learning-focused.

It sounds like you’re all pretty friendly.
Our group is definitely close. We regularly go camping and hiking together. We even organized a week-long canoeing vacation as a group! Even though we’re all spread out over the province during our rural rotations, we still travel to visit each other.

How does the community react to having residents coming in every year?
The physicians and staff are very welcoming and supportive of us – it doesn’t take long to feel like you’re part of the community. In fact, our resident and faculty social group participates in the “Adopt-a-Highway” program, as well as the local “Ski to Sea” race. It’s pretty easy to feel accepted here.

Do both years of the Rural residency take place in Kelowna?
Not really. R1s spend the year in Kelowna. R2s are based in Kelowna but participate in two four-month rotations – one in a ‘smaller’ rural community and one in a ‘larger’ rural community – so there is a lot of travel during your second year. The long rotations give you the chance to really experience life and medicine in these rural communities. If you choose electives that takes you out of Kelowna, you could be traveling even more.

Do R2s find the traveling stressful? 
It really helps if you’re independent, flexible and open to change. The benefits you received from learning in the smaller communities are really worth all the travel.

How does the program impact those residents with partners and/or families?
About 50 per cent of our residents have partners, and all of them in our group have found work in Kelowna. It is important to realize that in R2 you will be required to travel to smaller communities, and couples may not be placed together (although all attempts are made to do so). Residents with families really appreciate the rural lifestyle for their children, so there hasn’t really been any negative impacts.

Is it hard for residents to be stationed in Kelowna?
Kelowna has everything you could want – wineries, excellent restaurants, UBC Okanagan, great access to outdoor activities. It’s a city, really.

What do you think is the biggest strength of the Rural program?
You get to see what’s out there and are encouraged to participate in whatever opportunities come your way. You also get to really know your patients and your community. This program allows you to develop an independence and a breadth of practice that you wouldn’t find anywhere else.