Indigenous

Number of Residents: 7
Locations: Distributed training sites include Vancouver’s Downtown East Side – 3 Residents, Vancouver Island (Ladysmith, Victoria and Cowichan) – 4 Residents
Community: various, as above
Hospitals: Royal Jubilee, Victoria General Hospital, St. Paul’s, Cowichan District Hospital, Nanaimo General Hospital, and Saanich Peninsula Hospital
Distance from Vancouver to Vancouver Island- Victoria: 116 KM

Curriculum Type: Partial Horizontal
R2 Elective Time: 10-14 Weeks
Contacts: Co-Site Director – Dr. Terri Aldred, Co-Site Director- Dr. Cassandra Felske Durksen, Coordinator – Carlea Remodo
Lead Resident: Lead Resident Vancouver Mainland-  Dr. Chelsea Monnell & Lead Resident Vancouver Island- Dr. Domique Seper

Overview

A main objective of our site is to have graduates be aware of the specific needs of Indigenous peoples and to be a resource for anyone working with this community. We offer a small family feel site with a focus on resident well-being through sharing circles, Elder support and community engagement.

In order to enhance the amount of time spent in Indigenous communities, our site transitioned to a distributed site in July 2013 and in 2015 we will be offering 2 separate match sites: Vancouver Island and Vancouver Urban. As each site offers unique educational opportunities, a sample curriculum follows; however specific curricula vary slightly from site to site. Both sites offer educational experiences to meet accreditation standards.

Additional Curricula
Due to our small size (i.e. 2 – 4 residents per geographic site), our sites collaborate with other UBC Family Practice Residency Program sites to deliver academic curricula. Indigenous site residents participate in the local academic curriculum of their partner UBC Family Practice site.

Indigenous Educational Experiences
In addition to the variety of experiences residents have within their home base community, the full complement of Indigenous Site residents meet bi-monthly for Indigenous academic days. We gather face to face in our Indigenous home base communities to learn from Elders and participate in local activities for 1.5 days. The first half-day will focus on site governance and the second day is to honor and celebrate Indigenous approaches to health and healing. Indigenous academic days also offer an opportunity to reconnect and share stories about the successes and challenges in working in the area of Indigenous health and also to consolidate teachings about cultural safety.

Matches
Successful applicants are matched to an Indigenous community site in either Vancouver or on Vancouver Island. Due to the unique nature of our site, we encourage you to contact Dr. Cassandra Felske-Durksen – Interim Site Director (cassandra.felske@gmail.com) or Carlea Remodo – Site Coordinator (cremodo@uvic.ca) for up to date information regarding Indigenous site specifics.

Program Highlights

• The mission of the UBC Indigenous Program is to improve the health of Indigenous people of British Columbia by training Indigenous and other family physicians sensitive to and empowered with skills and knowledge of Indigenous health issues.
• You do not need to be Indigenous to be selected but you need to have a desire to work with the Indigenous population
• Focus on Indigenous patients in Family Medicine and elective rotations with 1 month Family Medicine rotation in Alert Bay during R1 for Vancouver Island-based learners and several one week rural fly-in opportunities for Vancouver based learners
• Opportunities for interaction with Elders and Elder support, Indigenous physicians and community visits are incorporated into academic sessions
• Attend Indigenous conferences and workshops where registration fee may be covered
• Understanding health in the context of the medicine wheel as well as other Indigenous paradigms for health
• Incorporate traditional healing practices and beliefs as well as an understanding of the importance of these practices to many First Nations
• Program is evolving, and residents can help shape its future as we build further opportunities to train with Indigenous patient populations
• Family feel – small flexible and supportive training site.

Sample Rotation

Program Curriculum – Vancouver Island

This site provides opportunities to develop special expertise in Indigenous health for both Indigenous and non-Indigenous physicians. Please note that this site also includes residents based at Indigenous – Mainland Vancouver however it is included in a separate CaRMS match.

Our program is relationship-based and engaged with Indigenous communities. We work in collaboration with a number of Indigenous communities and their health care teams to provide educational experiences whereby residents are connected with an Indigenous community for the duration of their training. Over the course of their training residents develop relationships with specific Indigenous individuals, families and their community and see these same clients and their extended family networks in a variety of care settings (ie. primary care clinic, in-hospital etc.). The residents are welcomed and encouraged to participate in community activities and gatherings in order to help them develop trust with the community they are serving. Our program focuses on supporting residents to engage with communities in a respectful way in order to learn about health and healing with and from Indigenous peoples.

In order to enhance the amount of time spent in Indigenous communities, our site has adopted a distributed model. We have residents placed in Victoria, Duncan and Ladysmith and we are looking to expand to other communities. All of our residents also gain experience in remote Indigenous health in either one month community based rotations or one week a month fly-in experiences. Each site offers unique educational opportunities, and as such specific curricula vary slightly from site to site. Our sites have embraced longitudinal curricula that maximize residents’ continuity of care. All sites offer educational experiences to meet accreditation standards.

Curriculum Sample – *Please note that these vary site to site

Training Sites

**In-hospital educational experiences will occur in the following hospitals depending on a resident’s home-base; Victoria – Royal Jubilee Hospital, Duncan – Cowichan District Hospital & Nanaimo Regional General Hospital, Ladysmith – Nanaimo Regional General Hospital.

Internal matches
Successful applicants are internally matched to a community on Vancouver Island – Victoria, Duncan or Ladysmith. Every effort is made to accommodate the candidate’s first choice community. Due to the unique nature of our site we encourage you to contact either Cassandra Felske-Durksen  – Interim Site Director (cassandra.felske@gmail.com) or Carlea Remodo – Site Coordinator (cremodo@uvic.ca) for up to date information regarding Indigenous site specifics.

Program Curriculum – Mainland Vancouver

This site provides opportunities to develop special expertise in Indigenous health for both Indigenous and non-Indigenous physicians. Please note that this site also includes residents based at Indigenous – Vancouver Island. Information regarding Indigenous – Vancouver Island can be found under a separate CaRMS description.

Our program is relationship-based and engaged with Indigenous communities. We work in collaboration with a number of Indigenous communities and their health care teams to provide educational experiences whereby residents are connected within an Indigenous community for the duration of their training. Over the course of their training residents develop relationships with specific Indigenous individuals, families and their community and see these same clients and their extended family networks in a variety of care settings (ie. primary care clinic, in-hospital etc.). The residents are welcomed and encouraged to participate in community activities and gatherings in order to help them develop trust with the community they are serving. Our program focuses on supporting residents to engage with communities in a respectful way in order to learn about health and healing with and from Indigenous peoples.

In order to enhance the amount of time spent in Indigenous communities, our site has adopted a distributed model. We have residents placed across BC, including Vancouver’s Downtown Eastside in the Indigenous – Mainland Vancouver site. The primary clinical sites for our Indigenous – Mainland Vancouver residents are Vancouver Native Health Society, Urban Indigenous Health and Healing Cooperative, Lu’Ma Medical Clinic and Sheway. All of our residents also gain experience in remote First Nations health which is unique to our site. Our clinical sites incorporate longitudinal curriculums that maximize residents’ continuity of care. All sites offer educational experiences to meet accreditation standards.

Curriculum Sample

Training Sites

Vancouver Native Health Society – Vancouver Native Health Society (VNHS) was established in 1991 with a mission to improve and promote the health of individuals with a focus on the Aboriginal community residing in Greater Vancouver. Today, Vancouver Native Health Society delivers comprehensive medical, counselling and social services generally to Vancouver’s Downtown Eastside Aboriginal community. The majority of VNHS clients struggle with overlapping issues and concurrent health issues such as substance abuse, mental health, chronic disease, homelessness and poverty.

Sheway – Sheway is a Pregnancy Outreach Program (P.O.P.) located in the Downtown Eastside of Vancouver. The program provides health and social service supports to pregnant women and women with infants under eighteen months who are dealing with drug and alcohol issues. The focus of the program is to help the women have healthy pregnancies and positive early parenting experiences.

Lu’Ma Medical Centre – Located within Lu’Ma Native Housing Society. The Lu’Ma clinic provides safe, culturally integrated health care that is accessible to families to increase positive health outcomes and remove disparities. The clinic offers a smudging area and medicine bag making materials as well as access to traditional healers and Elders.

Urban Indigenous Health and Healing Cooperative (UIHHC) – a collaboration between Indigenous Elders, physicians and allied health professionals to provide a safe and healing space for the Indigenous and non-Indigenous community in Vancouver’s Downtown Eastside. This centre will be opening in the fall of 2018, to provide care to over 3000 individuals of all nations who face the challenges of inner-city living.

St. Paul’s Hospital – Home of one of only two active Family Practice teaching wards in Canada, modeling comprehensive and continuous care in a metropolitan setting. Majority of primary care inpatient and specialist training takes place at St. Paul’s Hospital, a tertiary referral hospital of 480 beds including Family Practice Ward, Obstetrics, and a very busy Emergency Department. St. Paul’s has been a teaching hospital for residents and interns for over 70 years and has a proud reputation for the quality of its teaching programs.

A day in the life of a Vancouver Indigenous Site Resident

R1
The R1 curriculum has been adapted over the past year based on resident input, and because this is still a new site, it may change further. The residency starts off with the “Foundations of Family Medicine” block with our St. Paul’s Hospital sister site. This is an entire month free of call (!) with an emphasis on getting oriented to residency, as well as a focus on Behavioral Medicine. It is a lovely time to get to know the SPH residents who, in addition to the Aboriginal Site residents, will become your resident family.

Next, residents spend 3 months doing longitudinal Family Medicine, either based at Vancouver Native Health Society clinic/Urban Indigenous Health and Healing Cooperative/Lu’Ma Medical Clinic or at Sheway. The resident based at VNHS/UIHHC/Lu’Ma whereas the resident based at Sheway does rounds on FIR square and on-call with the Family Practice obstetrics call group at BC Women’s Hospital. After 3 months, the residents switch primary sites. These 3 month longitudinal sessions have provided a level of continuity with patients and clinics that is difficult to attain within a residency program, and which is beneficial both for the resident and the clients. In addition to the above longitudinal experiences, residents at VNHS/UIHHC/Lu’Ma will join Dr. John Pawlovich in monthly visits to five small reserve communities in north central BC, where residents get valuable in-community experience and practice full-scope remote family medicine.

The second half of R1 is spent doing core rotations in Internal Medicine, Obstetrics (with Family Practice Call group at BCWH), Family Medicine Ward, Emergency, Pediatrics and Electives. Most rotations, with the exception of Pediatrics and Obstetrics are done at St. Paul’s Hospital.

R2
The R2 curriculum is very resident driven. The required block rotations include a 2 week Palliative Care rotation, which is highly sought after and completed at SPH or St John’s hospice. There is also a mandatory Surgery rotation, which residents generally choose to complete in Sidney (just north of Victoria) because of the fantastic preceptor with whom we have established a relationship. While Surgery is considered to be a “problem” rotation in many Family Medicine Residency programs, we are proud to say that our residents have been consistently enthusiastic about completing their surgical rotations, and have ranked the surgical attending as one of the best teachers in the program for several years running. As with all residencies, there is a mandatory 2 month Rural rotation, which can be extended to 4 months at the residents request. However, for anyone interested, the opportunities to arrange rural electives are limitless and funding is available to cover transportation and accommodation through the Rural Education Action Plan (REAP). The remainder of R2 is made up of block and longitudinal electives, as well as longitudinal Family Medicine at our clinic sites. We as residents are able to reflect on our learning professional goals, and adjust our activities accordingly, both to fill in gaps in our learning, and to continue to grow professionally in a highly supportive environment.

A day in the life of a Victoria Resident

The Aboriginal Program has provided me with fantastic training in family medicine, both as it applies to community at large as well as BC’s Aboriginal population. The program team is fun and supportive, and seek out invaluable field and learning experiences for the residents. During special monthly Aboriginal Academic Half Days we have had the opportunity to visit a variety of Aboriginal communities, from Sooke to Duncan and beyond, learn about each Bands’ special health programs and needs, and how we might fit in as doctors. These opportunities for cultural immersion encourage extensive reflection. They have also strengthened our grasp of history and how it applies to today, more specifically, the interaction of western people, our politics and medicine, with aboriginal populations over the past 300 years, the good and the bad (sadly, it was mostly bad), and how we can move forward together with respect, understanding and collaboration. This teaching, coupled with an excellent rural placement in Alert Bay, with a greater than 50% Native population, have given me the skills and cultural competency I need to feel confident working as a doctor with aboriginal populations in remote or urban settings. If I had to do residency over again (hopefully that won’t happen!), I would not change a thing.

A day in the life of a Ladysmith Resident

As the first resident at the Ladysmith site, I’m more than happy to provide a brief overview of the experiences it has to offer.

When on Family Practice block, depending on the day, I will either start off in the morning at the Hillside Clinic or head out to the Stz’uminus Health Centre to see patients there. In addition, other days are spent at the Ladysmith urgent care centre. The urgent care work offers you a wide range of undifferentiated patients to work up and manage. Often the patients that present there are members of the Stz’uminus First Nation as well. My two preceptors, Dr. Swamy and Dr. Steeves are great teachers and keen to provide learning experiences wherever possible.

Rotations other the Family Medicine, take place at the Nanaimo hospital for the most part. On these rotations you are generally the only learner present, which provides you a lot of face time and teaching from the specialists. One of the amazing aspects of the Ladysmith site is the involvement with Nanaimo program and their residents. The Nanaimo program schedules their structured learning sessions into academic weeks, which I also attend. I feel very fortunate to be in this position, as I have the support of both Dr. Behn-Smith and Dr. Beerman who are extremely encouraging and approachable site directors.

The Ladysmith site would be particularly well suited for a resident that is self-directed, wants to develop a wide scope of practice and enjoys working in a variety of settings. Feel free to contact me if you have any questions about the site or the program in general.

Dr. Randal Mason
drmason@live.ca

A day in the life of a Duncan FM Resident

The Aboriginal FM program in Duncan is largely a choose your own adventure book. It is well suited for individuals who are self-directed and motivated to seek out the learning opportunities they are interested in or want more exposure to. It is a mix of longitudinal and block time with the start of residency focused on establishing yourself in the community and getting comfortable with your family medicine clinic. The amazing people involved in the logistics of the program are very welcoming and open; everyone becomes a part of your little residency family. They will go out of your way to make sure your experience is well-rounded while helping you find ways to achieve a balanced lifestyle amidst the challenges and demands of residency.

A “typical” day for me begins with a brisk bike ride to the hospital (rain or shine) where I work with one of the GP preceptors and round on inpatients. There is flexibility to pick and choose the cases you will follow based on their learning potential. A quick 5 minute bike ride down the hill takes me to the clinic where I will work with 1 of 3 preceptors and an excellent cohort of office staff. This clinic is high volume with a wide variety of ages and cultural backgrounds. There is also the opportunity for minor procedures such as IUDs, lumps and bumps, and vaccinations. Most evenings are yours to do as you please but occasionally you will be invited to CME events or clinic QI meetings, or you will be on call for the Maternity Clinic. The best parts about the call schedule are that you get to choose when you are on call and who you work with, and that it is home call. You are also free join an interesting case with the OB if you happen hear of it during your call night.

On the “not typical” days, I am doing longitudinal pediatrics (+/- call if you want) and psychiatry, as well as the freedom to join public health for youth clinic or breastfeeding clinics, or to help out with diabetes education sessions, or to get extra practice with casting.

Being on the island you get to go to Alert Bay in your first year, which is easily the highlight of the year. It is ridiculously beautiful, you are surrounded by eagles, ocean and trees and the people and town are amazing. It really is an once-in-a-lifetime experience that you will never forget. For your in-hospital rotations (IM, Peds, Surg, ER, etc.) you may spend time in Victoria, Nanaimo or Duncan. Travel to the bigger sites can be tough due to either a commute or staying in the city itself, it is nice because it is a chance to spend some time with other residents. In Duncan, you are 90% of the time the only learner on, so you are first in-line for procedures (paracentesis, thoracocentesis, intubations, etc). For the most part, the specialist preceptors are great teachers and want you to learn. They will allow you to see the interesting cases and not make you do scut work which is a nice change from clerkship. We have quite a few specialists so there are quite a few choices for electives within your home-site but you also have the advantage of being connected to Victoria/Nanaimo and learning opportunities there as well. If you are planning on staying on the island after you are done residency (which you likely will because it is amazing) getting to know the docs/specialists in all three different sites makes it easier for planning locums as you already know the cities/hospitals.

Another perk about being in Duncan is that there is a small cohort of 3rd year medical students that spend an entire year here. This creates an excellent opportunity to try your hand at medical teaching if so inclined, and also gives you a social group. Academics are combined with the Nanaimo program so I will spend the odd week with the friendly Nanaimo residents with more structured lectures and interactive assignments. Our affiliation with Nanaimo means that there are extra opportunities to do some sessions that are unique to Nanaimo with that group, but certainly not required (such as going to a local middle school to teach classes about healthy lifestyle choices!). Being the only resident in your year can be challenging at times, but the Site administration is aware of this and will work with you to find ways to help you feel connected.

The Aboriginal Site also holds its own academic days which often have their own cultural twist; we recently visited Ahousaht First Nation and participated in their local health conference, traditional dancing, and we even ended up helping prepare breakfast for the participants. In addition, there are local sessions available to join such as visiting with elders at the Elder’s Lunches, or participating in a plant walk to learn about traditional medicines, or learning how to cook traditional foods using a bentwood box.

In terms of the community activities, there is an abundance of hiking, mountain biking, swimming, and many other outdoor activities in the beautiful Cowichan Valley. There are opportunities to join sports teams such as hockey, ultimate frisbee, and soccer as well. The Rec Centre is a bustling hub, the downtown area has some neat shops and food services, and all the necessities you would need are a quick 10-15 minute drive away. Duncan is also conveniently located between Victoria and Nanaimo so it is a quick hour drive maximum if you are craving the big city.