Number of Residents: 7
Locations: Distributed training sites include Victoria – 2 residents, Vancouver Mainland – 3 residents, and Rural Vancouver Island – 2 residents
Community: various, as above
Hospitals: Royal Jubilee, Victoria General Hospital, St. Paul’s, Cowichan District Hospital, Nanaimo General Hospital, Saanich Peninsula Hospital, BC Women’s Hospital, and Ladysmith Urgent Care

Curriculum Type: Partial Horizontal
R2 Elective Time: 10-14 Weeks

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 Indigenous Family Medicine Victoria site is a unique blend of urban and rural medicine. I get all the amenities of city life, while having ample rural opportunities to practice more resource-restricted medicine. During my family medicine blocks, I work with a general family practitioner twice a week where I have the chance to build my bread and butter family medicine knowledge and skills. On Tuesdays, I am downtown, seeing a complex inner city population. This placement has helped me to understand the mammoth barriers facing people experiencing homelessness, substance use, and mental health challenges in an urban context. In contrast, I regularly get to serve more rural populations on reserve at Pacheedaht or Tsartlip. I then finish up my week at the Wellness Clinic at the Victoria Native Friendship Centre, where I work with the local, urban Indigenous folks. While this variety of placements felt daunting at first, I have come to really enjoy having so many different learning opportunities with so many knowledgeable, compassionate, and kind preceptors.

During my family medicine rotations, I also do house and labour & delivery overnight call shifts at the local hospitals, which allow me to improve my inpatient and perinatal care. My main Academic Half Days and off-service rotations are completed alongside the Victoria Family Medicine residents, many of whom have become close friends.

Every two months, our program has Indigenous Academic Half Days, during which we have had the opportunity to visit a variety of local communities on the island and in the lower mainland, and learn about each communities’ special health programs and needs, and how we might fit in as doctors. These retreats allow for bonding with my co-residents (including the bestowing of much-needed support and advice), as well as spending time in ceremony with our much beloved program elders.

These opportunities for cultural immersion encourage extensive reflection. They have strengthened our grasp of history and how it applies to today, including the interaction between western people, politics, and medicine, and Indigenous populations over the past 300 years 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 majority Indigenous population, have given me the skills and cultural competency I need to feel confident working as a doctor with Indigenous 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

A Day in the Life of a Ladysmith Resident:

“I am the current 2022-2024 resident at the Ladysmith site and having a wonderful experience!

When you are on your Family Practice blocks you will spend most of your days at the Hillside Clinic in Ladysmith, but there are opportunities to participate in care at either the Stz’uminus Health Centre with one of the Nurse Practitioners, or Snuneymuxw Hulit Lelum with one of the physicians who works there. Outside of your time at Hillside Clinic you have the opportunity to spend time at the Ladysmith Urgent Care Centre. Here you manage a variety of undifferentiated patients with full work up and management. It is an excellent place for learning, and you see everything from kiddos with ear infections, dislocated shoulders, to chest pain. You commonly see your patients from Hillside clinic in the Urgent care setting, allowing for increased continuity of care during your Family Practice blocks. My two preceptors, Dr. Swamy and Dr. Steeves are incredible teachers and keen to provide learning experiences wherever possible. I’ve listed an example of a typical week on family practice below:

Monday – Hillside Clinic Day (9 -5 PM)

Tuesday – Hillside Clinic Day (9 -5 PM)

Wednesday – Urgent Care (8-3 PM or 3-10 PM)

Thursday – Hillside Clinic Day (9 -5 PM)

Friday – Snuneymuxw Hulit Lelum (9 -5 PM)

Your rotations outside of your Family Practice blocks are located primarily in Nanaimo, Duncan and Victoria. Where you are depends on preference, but also preceptor and site related availability, as there are lots of wonderful learners on Vancouver Island. Depending on which site you work at you may be with other resident learners, or on your own with preceptors getting one on one teaching. For some of my off service I was located at the following sites:

Obstetrics – Victoria (other resident learners and medical students)

Pediatrics – Victoria (other resident learners and medical students)

Internal Medicine – Duncan (one on one with preceptor)

Emergency Medicine – Nanaimo (one on one with preceptor)

Addictions Medicine – Nanaimo (one on one with preceptor)

Another amazing aspect of the Ladysmith site is the involvement with the Nanaimo program and their residents. The Nanaimo program schedules their structured learning sessions into academic weeks instead of academic half days. It is nice to have connections to other learners close by and have learning weeks to connect and take a break from clinical work. The Indigenous Program meets 4 times each year for our own academic days (typically a Thursday and Friday) where we receive cultural teachings, spend time on the land and in community and connect with co-residents. We are a tight knit group despite the distance between each of our learning sites.

The Ladysmith site would be particularly well suited for a resident that is self-directed, comfortable with some movement for off-service rotations, wants to develop a wide scope of practice and enjoys working in a variety of settings.