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 16 week 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. 12 weeks of elective time is offered in the second year. International elective rotations are also encouraged. The second year finishes with a 4 week ‘Transition to Practice’ rotation.

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 Okanagan 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.  Jade Dittaro- Co-Site Director – jdittaro@nosm.ca

Dr. Gregory Handrigan -Co-Site Director –gregory.handrigan@familymed.ubc.ca
Dr. Robb Sebastian – Associate Rural Site Director – sebastianmary@hotmail.com

Chief Resident Message

The Rural Okanagan Family Medicine program offers nine positions available for incoming residents (6 CMG, 3 IMG). Our rural training program is unique in its flexibility, breadth of experience, and responsibility. This program provides training in the core aspects of medicine, while allowing residents to enhance their skills in areas of interest, as we are based out of a site with few other learners.

Our entire faculty and support staff are approachable, available and supportive to resident needs, and encourage communication and problem solving at multiple levels.

The first year of the Rural Okanagan program is completed at Kelowna General Hospital. This facility offers rotations in ICU, pediatrics, internal medicine, general and orthopaedic surgery, family medicine, obstetrics, psychiatry, and emergency medicine. Residents will have the opportunity to spend additional time throughout the year with family practice preceptors or specialists based on their interests (i.e. longitudinal elective). 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 3 x 16 week blocks. One of these blocks is dedicated to elective time, and many residents use this as an opportunity to travel across Canada and the globe for trauma and emergency medicine electives. The other two blocks place the resident in two rural training sites for four months each. These communities are distributed throughout British Columbia, with placements available in Inuvik as well. The learning experiences in your second year are plentiful, 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.

Typically, the Rural Okanagan residents are keen and ready for a bit of adventure. The first year provides an opportunity to 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 challenging.

The following courses are subsidized supplementary training courses within our program:  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, our residents are required to take the Essential Surgical Skills Course (ESSC) and the Comprehensive Approaches to Rural Emergencies (CARE) course in the R2 year. We have 10 conference days available over 2 years which may be used for conferences or additional coursework.

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

Looking forward to meeting you all, your co-Chiefs,

Sydney White – Sydney.white@alumni.ubc.ca

Lauren Galbraith- galbraithle@alumni.ubc.ca

Overview

Number of Residents: 6 CMG, 3 IMG
Location: Kelowna, BC
Community: 127,000
Hospital: Kelowna General

Curriculum Type: Block / Integrated
R2 Elective Time: 16 Weeks
Phone: 250-862-4014
Contacts: Co-Site Directors – Dr. Jade Dittaro– jdittaro@nosm.ca & Dr. Gregory Handrigan– gregory.handrigan@familymed.ubc.ca / Coordinator – Janice Demers –janice.demers@interiorhealth.ca
Chief Resident: Lauren Galbraith – galbraithle@alumni.ubc.ca / Sydney White – sydney.white@alumni.ubc.ca

Overview

The Rural Okanagan program takes place over two years and is well-suited to individuals who would like to work in a rural or small city setting. Individuals with personality traits of independence, self-direction, adventurousness and self-motivation 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 medicine and lots of ‘hands-on’ experiences.

The first year is designed to prepare Rural Okanagan residents for their more remote second-year experience. During R1, residents rotate through a variety of foundational specialties in both community- and hospital-based environments. All rotations incorporate the resident as a physician and you work as part of a team. Residents experience longitudinal family practice care with weekly half-days spent in community-based FP clinics in addition to an 8-week core family practice block. Additional longitudinal experiences may be sought in ER and obstetrics depending on a resident’s interests.

The R2 is spent primarily in rural communities throughout British Columbia. Residents complete two, 16-week blocks in two different rural communities, such as Bella Coola, Creston, Grand Forks, Lillooet, Masset, Port McNeill, Queen Charlotte, Revelstoke, 100 Mile House, Cranbrook, Gibsons, Inuvik, Powell River, Smithers, Golden & Vanderhoof. Four weeks of R2 are spent doing a trauma or an emergency rotation. Residents are allotted an additional 8 weeks in which they are encouraged to pursue elective experiences in areas of focused interest or meeting self-identified learning goals. The R2 year finishes back in Kelowna with a 4-week ‘Transition to Practice’ block.

During the second year, residents also travel to Vancouver and/or Kelowna for academic time (e.g., Essential Surgical Skills Course; HOUSE ultrasound) and for resident scholar day. This, along with travel for exams, conferences, and other commitments means that Rural Okanagan residents are on the road a lot more than in other programs.

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). In the R2 year, however, 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 monthly
  • CARE 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 Quality Improvement Project (QIP) and 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. Some training sites provide free or low-cost accommodation.
  • Funded ATLS, ACLS, ALARM, NRP, Essential Surgical Skills and special full-day ultrasound training (HOUSE course)

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 Haakon Lenes, Melissa Bryant and Joel Mohr (Current R2s)

What do you enjoy most about the Rural Okanagan program?

“The opportunity to gain experience in numerous specialties in year one in the beautiful city of Kelowna and then being able to bring all of the acquired information and skills into a rural setting for the majority of our second year!”

“Kelowna has a very close-knit medical community which is warm and welcoming.  One huge advantage is that you work very closely with staff and specialists, almost exclusively one-on-one, along with some opportunities to work with medical students.”

What does your typical day look like?

“This varies greatly depending on the rotation you are on, but it can be anywhere from being a 9-5 day working in a clinic based environment or a 24 hour call shift that could be either packed full of non-stop learning experiences, in a supportive environment, or a nice balance allowing for  information consolidation, sleep and a chance to lift your feet!”

Is there a large service component to your residency?

“Very little service.  The only 2 full-time residency programs at KGH are Family Medicine and Emergency.  As such, most staff are not relying on having residents around to assist with the workload, so the focus is generally much more about your learning rather than on dictating discharge summaries.”

“No I found there was a small component of service during our first year of residency. We rotate through many different specialties outside of family medicine. This creates huge flexibility in individual learning goals and what you want to get out of a rotation. The opportunities are endless, and you can be as involved as you wish. The specialists are all very accommodating and will reward enthusiastic learners.”

What kind of learning opportunities do you have?

“There is a vast number of learning opportunities but what I found most important is the ability to customize your own learning opportunities. This can be done by customizing what your work week looks like to get more time in specific interests. It can also be done by choosing which community you work in to gain experience in rural practice.”

“The opportunities are endless! From surgical assisting, to resuscitating a newborn, to being first call in the ICU, to performing intubations and central lines, to managing your own patient cohort in the hospital and community, to numerous procedural skills, there is everything for everyone. Gaining these learning opportunities often requires initiative and enthusiasm, but they are there, and definitely worth pursuing!”

Does it get fairly competitive with the other residents?

“I personally did not experience an ounce of competitiveness. We had a very fun, supportive group where we all recognized that everyone has their own strengths and weaknesses.”

“I never found this to be the case.  You’ll find that you become very good friends with your co-residents and that people look out for each other.  There are more than enough learning opportunities to go around and lots of one-on-one time with staff.”

How does the community react to having residents coming in every year?

“I felt very welcomed and I got the sense that it is an established process within the community.”

“The communities are happy to have residents, the physicians you work with really get to trust you and treat you almost like another staff.”

“Generally very positively.  Almost all staff are keen to have you around and to do some teaching.  Again, because staff are not relying on residents to be on service, your presence is an added “bonus” for people to make their work day a bit lighter and meant they could take some of the extra time to teach.”

Do both years of the Rural Okanagan residency take place in Kelowna?

“At present, the first year is exclusively in Kelowna and the second year is mostly in rural settings around the province.  You will have 4 months of elective time in 2nd year, of which as much or as little can be completed in Kelowna.  June in your second year will also be back in Kelowna.”

How does the program impact those residents with partners and/or families?

“You will be moving around the province, especially in the second year and having a partner or family can make this challenging. You and your partner or family will have to be up to the challenge of either being apart or following you around the Province.”

“The program here is definitely demanding.  The workload, pressure, and expectations can be difficult to manage at times and this can be tough on families and partners.  I think this can be expected in any residency program, and Kelowna is no different, but they also have a track record of graduating excellent residents.  You’ll be expected to work hard but you’ll also learn lots.  Having a supportive partner and family can be a huge help in getting you through the tough stretches.  There will be lots of evenings and nights where you can’t be home and it’s important that families are prepared for this.  It can also be hard to find the energy during residency to be your best for your family and partner, and it’s really important you take time for self-care and making family a priority.  Most staff and rotations are very understanding if family things come up that are diverting your attention or require you to leave.  People here are also very family-oriented and understand that you have a life outside of the hospital.”

“I think R2 will be a little challenging for residents with partners and families as the majority of the year is spent in rural communities outside of Kelowna. However, there are travel reimbursements opportunities and supports available for those having a difficult time. Depending on the rural site, and if the flexibility is there, a partner or family may join the resident in the rural community to which they are matched.”

 

Is it hard for residents to be stationed in Kelowna?

“Not at all.  Kelowna is a great city.  There are lots of good places to eat, great wine, and amazing outdoor adventure possibilities. You’ll have plenty of things to do and try in both summer and winter between water sports, hiking, riding, climbing, skiing, etc. It’s also a very friendly city and I had no trouble moving here and settling in.”

“Not at all, Kelowna is a great place to be for a year both for the great learning environment and the great climate.”

What do you think is the biggest strength of the Rural Okanagan program?

“The strength of the Rural Okanagan program is the combination of the first year in Kelowna working in various specialties and the second year working in some of the best rural communities in the Province.”

“I think there are 2 components that make Kelowna a great site.  One is the amount of time you spend in rural locations.  This is where you learn how to practice independently, how to manage and function efficiently in clinic, and where you are exposed to caring for acute complex patients in resource-limited settings.  This kind of training doesn’t exist elsewhere and really sets Kelowna apart.  The other piece is the amount of one-on-one time you’ll have with staff.  Being a learning-based rather than service-based site means the focus is your education, and I found that staff here enjoy being apart of mentoring and training new colleagues.”

“The 8 months of rural rotations that we have in our second year to gain rural experience and exposure in a very supportive learning environment!”