Division of Respirology

Mandatory Rotations

Acute Care Service

St. Joseph’s Healthcare Hamilton (SJHH)
During this 2 month rotation, you will gain experience in functioning as an Junior Consultant on a busy tertiary care Respirology service. SJHH hospital has been established as the Center of Excellence for Respiratory Medicine and Thoracic Surgery, thus there is a wide variety of cases to see. There are 4 in-patient Respirology beds for which our service acts as Most Responsible Physician. A variety of consultations are requested by Internal Medicine and its subspecialties, Intensive Care Unit, Emergency Room and the surgical services. Two to four rotating residents are assigned to this service during any given month. There will be much opportunity for supervision and teaching of the junior house staff. Skills to acquire during this rotation include fiber-optic bronchoscopy, management of invasive and non-invasive ventilated patients, intubation, thoracentesis, and radiological interpretation and clinical correlation. Follow-up of in-patients post hospital discharge in the resident’s longitudinal out patient clinic is a rewarding and valuable component of the resident’s education.

Juravinski Hospital and Cancer Centre
The Juravinski Hospital and Cancer Centre is associated with the Juravinski Oncology Centre. In addition to providing inpatient consultation for the Respirology service, the resident will have the opportunity to attend a half-day lung cancer clinic. A high volume of fiber-optic bronchoscopies are performed at this site, including transbronchial biopsy, transbronchial needle aspiration and brachytherapy. Because of the Henderson’s association with the cancer centre, the resident will gain experience in the inpatient management of patients with lung cancer, including complications of chemotherapy and radiation therapy.

Thoracic Surgery

St. Joseph’s Healthcare
As a Center of Excellence, there is the opportunity to assess and treat a large number and variety of thoracic surgical patients. The resident will learn to insert and manage chest tubes, and will be responsible for following the patients on the Thoracic Surgery ward. Skills to acquire during this rotation include fiber-optic and rigid bronchoscopy, pleuradesis and providing surgical assistance in the operating room. In the Thoracic Surgical clinic, new consults and post-operative patients will be assessed. The above activities will provide learning opportunities for diagnosis, staging and management of thoracic neoplasm. On the Thoracic rotation, the resident will take call for the Thoracic Surgery Service under the supervision of one of the Thoracic surgeons.

Diagnostics and Chest Radiology

St. Joseph’s Healthcare and HHSC
McMaster University Medical Center: During the diagnostics rotation, the resident will develop expertise in theory, performance and interpretation of pulmonary function testing including cardio pulmonary exercise testing. There will also be exposure to thoracic imaging (both plain film and CT scanning) with access to a large volume of radiographic material on the PACS digital imaging and data storage system.

Critical Care

Juravinski Hospital and Cancer Centre
A 2 month critical care rotation will provide the resident with experience in managing a busy tertiary care Intensive Care Unit. Several of the supervisory staff members at the Juravinski site are dual trained in both Critical Care and Respirology. Skills in managing multi-system organ failure, respiratory failure with mechanical ventilation, and knowledge in applied respiratory physiology will be enhanced.

Respiratory Rehabilitation

St. Joseph’s Healthcare
There is a new respiratory inpatient and outpatient rehab program recently established in the new tower at St. Joseph’s. It is a marvelous facility staffed with an enthusiastic multidisciplinary team. During this rotation, the resident will become familiar with the rationale for and the components of respiratory rehabilitation. There will be an opportunity to refine skills in management of chronic respiratory disease, chronic respiratory failure, and of patients on long term or home ventilation.

Scholarly Activity / Research Block

St. Joseph’s Healthcare
There are many opportunities to develop an academic career at the Firestone Institute for Respiratory Health, a facility recognized as an international leader in respiratory research. There is time allotted for scholarly activities during both years of training. Residents are encouraged to participate in either clinical or lab based research during their training program, and the resident will be expected to complete a Quality Assurance project during the two-year period.

Cystic Fibrosis

McMaster University Medical Center
During this ambulatory rotation, the resident will see patients with cystic fibrosis (including adults) in a multidisciplinary regional clinic. You will develop an understanding of issues regarding both the pulmonary and extrapulmonary manifestations of cystic fibrosis. Activities such as genetic counseling and selection of patients for lung transplantation will be available. Sub-specialty clinics, such as immunology or pediatric asthma may be combined with this experience.

Lung Transplantation Rotation

University of Toronto
The Lung Transplantation rotation is an external elective at the University of Toronto. You will assess both inpatients and out patients before and after transplantation. Resident skills with bronchoscopy and transbronchial biopsy will be enhanced during this rotation.

Out Patient Sub-specialty Clinic Rotation

St. Joseph’s Healthcare, HHSC, Community, Other Academic Centers
In the resident’s PGY5 year, several clinic rotations will be chosen to gain exposure to specialized areas in Respirology, essential to residency training. Some important areas are alveolits, tuberculosis, thoracic oncology, steroid resistant asthma, allergy, occupational. The selection of the clinics will be mutually agreed upon by the resident and the Program Director.

Longitudinal Outpatient Clinic Experience

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.

Sleep Medicine

St. Joseph’s Healthcare / Private Clinic
The sleep medicine rotation is based at two sites. The majority of clinical exposure to patients being investigated for sleep disordered breathing will be at a busy private practice which includes a high volume sleep lab. There is also opportunity to obtain grounding in the basic theory and practice of interpretation of sleep studies working with the sleep physicians and technicians based at St. Joseph's Healthcare.