Division of Respirology

Ambulatory Respirology Care Clinic

St. Joseph’s Healthcare
This rotation is a half day clinic per week that will extend across the 2 years of training. In the first year, the experience will be supervised by the resident’s mentor. In the second year, a community component will be encouraged. This clinic will allow the resident to acquire and follow his or her own patient population in order to meet learning objectives around providing continuity of care in ambulatory patients.

Medical Expert

  1. To develop an understanding of the natural history of both treated and non-treated respiratory diseases.
  2. To learn of the concept of continuity-of-care based on familiarity with the normal evolution of disease entities outside the hospital.
  3. To assess the positive and negative outcomes arising from the medical and surgical interventions of respiratory diseases which occur over time.
  4. To learn to reassess and modify strategies in patients who pose a dilemma in terms of diagnosis, or who fail to respond to first line treatment measures.
  5. To learn to effectively assess, diagnose and treat acute respiratory presenting complaints and diseases in the out patient setting including conditions such as:
    • Pulmonary infections
    • Acute exacerbation of COPD
    • Acute asthma/bronchospasm
    • Cough
    • DyspneaGastro-esophageal reflux and aspiration syndromes
    • Lung malignancy
    • Pleural effusion
    • Pulmonary embolus
    • Pulmonary edemaPulmonary hemorrhage
  6. To learn to effectively assess, diagnose and manage chronic respiratory presenting complaints and diseases in the out patient setting including conditions such as:
    • COPD
    • Cor pulmonale and pulmonary heart disease
    • Asthma
    • Bronchiectesis
    • Cough
    • Dyspnea
    • Laryngeal dysfunction
    • Cystic fibrosis
    • Pulmonary fibrosis and interstitial lung disease
    • Sarcoidosis
    • Pneumoconiosis
    • Neuromuscular disease
    • Pleural disease
    • Lung malignancy
    • Sleep disorder


  1. To develop rapport, trust and ethical therapeutic relationships with patients and families.
  2. To convey effective oral and written information about a medical encounter in a timely fashion.
  3. To provide consultation notes contain appropriate information including headings, reason for consultation, history and physical, opinion and recommendations.
  4. To lead a discussion with the patient and family about long term goals and parameters of care such as advanced directives and end of life care (when appropriate).
  5. To communicate with the patient to establish the parameters and terms of your professional relationship, such as after-hour care, availability or lack of availability via telephone correspondence, group practice/clinic policies.
  6. To arrange for appropriate follow up.
  7. To learn when and how to sign off an office patient back to the care of the primary care physician.


  1. To be aware of the benefit of informal consultation or of requesting a second opinion from a respirology colleague in managing a challenging office case.
  2. To recognize and respect the diversity of roles, responsibilities and competencies of the office administrators, nursing, clerical and technical staff within the office respiratory practice.
  3. To develop professional relationships with the primary care physician and other consultants within the shared patient care model.


  1. To gain insight into the organizational skills required by the office physician in his or her role as manager of non-medical issues such as staffing, booking, billing, financial planning, accounts payable and accounts receivable.
  2. To learn time management skills in running a busy office clinic.
  3. To improve awareness of health economic issues in ambulatory care:
    • in order to apply evaluative science to diagnostic and treatment modalities
    • cost benefit analysis of treatment in the ambulatory vs. hospital setting
    • decision making re: optimal venues for car

Health Advocate

  1. To learn to shift one’s clinical focus towards health promotion and disease prevention, when appropriate.
  2. To develop an understanding of population health and the epidemiology of respiratory disease.
  3. To serve as health advocate to assist the patient with social issues arising from their respiratory disease such as conflict about health issues in the workplace, WSIB claims, unsafe housing, disability assessment, need for financial assistance for drugs or medical devices, home care assistance.
  4. To recognize the broad determinants of health, including an appreciation for the importance of social and physical environment.


  1. Identify that competence in office practice may involve new skills not mastered in hospital practice, and to reflect upon these skills in formulating a personal learning plan.
  2. To foster research appropriate to the appropriate to the optimal delivery of care in ambulatory settings.


To learn to set appropriate boundaries in the doctor-patient office relationship while still conveying compassion and empathy