Division of Respirology

Tuberculosis

St. Josephs's Healthcare
The resident will assess and treat patients with active and latent tuberculoisis during their second year rotation, Out-patient Subspecialty Clinics.  In-patients with tuberculosis issues are also seen in consultation on the Acute Care Service.

Medical Expert

  1. To gain knowledge of the clinical, diagnostic and pathological features of pulmonary and extra-pulmonary mycobacterial diseases, including Mycobacterium tuberculosis complex and non-tuberculous mycobacterial diseases.
  2. To understand the differences between tuberculosis infection and tuberculosis disease.
  3. To gain knowledge of the pharmacological management of tuberculosis disease and tuberculosis infection with demonstration of competence in the following areas:
    • Drug therapy for active tuberculosis, including DOT
    • Treatment of Latent Tuberculosis Infection (LTBI)
    • Treatment of multi-drug resistant tuberculosis (MDR-TB)
    • Tuberculosis in pregnancy, with appropriate consultation with Obstetrician
    • Tuberculosis in children, with appropriate consultation with Pediatrician
    • Tuberculosis in HIV infection, with appropriate consultation with Infection Disease specialist
    • Monitoring of persons on anti-tuberculous drug therapy for drug toxicity and clinical response
  4. To gain knowledge of the non-pharmacological management of tuberculosis disease:Infection control practices to be used within the hospital and the clinic:
    • Contact investigation
    • Reporting to Public Health Department
  5. To have awareness of epidemiological principles as applied to tuberculosis with knowledge of:
    • Incidence of tuberculosis disease in Hamilton, Ontario and Canada
    • Incidence of tuberculosis disease internationally
    • Canadian statistics identifying patterns of immigration
  6. To attain clinical skills in the following areas :
    • Administering and interpreting the TB skin test
    • Chest X-ray interpretation with ability to recognize patterns associated with active and latent tuberculosis
    • Interpretation of the laboratory tests for tuberculosis diagnosis – AFB smear, culture with susceptibility testing, AMTD, cytology, pathology
    • Appropriate use of procedures for diagnostic sampling - sputum collection, sputum induction, bronchoscopy, fine needle aspirate, excisional biopsy

Communicator

  1. To develop communication skills with consideration of ethnic, cultural, language and socio-economic differences.
  2. Recognize both the value and the limitations of communication facilitated by a partial or impartial translator
  3. Developing skills to communicate with persons for whom English is not their first language
  4. Establishing an alliance with professional translators – Settlement and Integration Services Organization (SISO)

Collaborator

To gain experience in collaborating with other heath care practitioners such as Tuberculosis Laboratory Staff, Infection Control Officer, Public Health Nurse and Medical Officer of Health, Citizenship and Immigration Canada

Manager

  1. To manage finite health care resources such as negative pressure isolation rooms, urgent consultation slots and supply of tuberculosis drugs.
  2. To enforce and to implement policy in the use of personal protective devices such as N95 masks and environmental control measures to protect oneself and others from the risk of acquiring tuberculosis infection and disease.

Health Advocate

To learn about the importance of being a health advocate for the individual patient and the community by:

    • Promotion of a safe community environment by minimizing risk of tuberculosis disease transmission
    • Screening high-risk populations for latent tuberculosis disease
    • Balancing the risks of drug preventative therapy for any given individual patient against the benefits that this therapy will provide for the population at large
    • Providing patient access to a reliable written and verbal source of information about his or her illness – pamphlets in appropriate language, translators
    • Being aware of the global initiatives to eliminate tuberculosis
    • Assisting immigrants with meeting the medical requirements for Immigration Surveillance for Tuberculosis as per Citizenship and Immigration Canada
    • Recognizing that the tuberculosis physician, who is one of the first health professionals to make contact with the immigrant or refugee, is in a unique position to offer supportive care or medical triage to persons new to Canada

Scholar

To contribute to the dissemination of knowledge of tuberculosis infection and disease to patients, colleagues, health care agencies and the general public.

Professional

To demonstrate professionalism by:

    • Being compassionate, empathetic and patient with others
    • Respecting cultural, social and religious differences
    • Practicing medicine with a high ethical standard