Co-Site Directors Message

So you want to be a rural family doc? The pursuit of becoming a rural, family practice physician at our Terrace site includes the opportunity for optimum learning experiences in a community-based, longitudinal and integrated program. As one of our residents, you will have unfettered access to clinical encounters in numerous fields of medicine. Furthermore, you can take advantage of a large pool of services, while receiving individualized teaching to ensure your growth as a confident and competent physician. You can also take heed in knowing that our success can be measured, at least in part, by the majority of our graduates who now serve in rural locations. If this sounds like the type of learning experience and practice you are looking for, please reach out to tell us more about yourself and your professional goals.

Program Structure

From Houston to Haida Gwaii, the Terrace site consists of a diverse population with a high degree of exposure to Indigenous patients. We skillfully serve a core population of greater than twenty thousand people, which expands to nearly eighty thousand people, regionally.

We have built a program that emphasizes continuity, and learning within the context of a rural environment, as well as a program that provides stability to our learners. Most of your time is spent in the Northwest region of British Columbia, however, 16-weeks of your residency will take you to other parts of the province, and potentially even internationally, on your elective and selective rotations. As such, this program is designed to maximize your opportunities for small, rural learning practices in BC and elsewhere. This residency site also offers an intensified pediatric training experience in a larger BC facility. Correspondingly, our enhanced curriculum includes the following courses: ACLS, ATLS (or equivalent), ALARM, NRP, HOUSE, and an Enhanced Surgical Skills course. These curriculum components are designed to help you build your foundational skills in rural medicine. In addition, you may also have an opportunity to participate in the Society of Rural Physicians of Canada conference. This event will help you to consolidate your network of like-minded professional contacts and participate in the largest rural conference of its kind in Canada.

Moreover, our Terrace site prides itself on the community-responsive component of our program as your work will take place in a variety of clinical and community settings. You will discover and appreciate how your efforts in medicine can carry an even larger impact within a rural setting. You may also be interested to learn that the call schedules at our site are flexible and resident-driven. Our residents work with a dedicated group of family physicians and specialists that cover a significant scope of service, thus allowing our residents to have exceptional exposure to the many facets of medicine. In addition, the Mills Memorial Hospital in Terrace functions as a Regional Intensive Care Unit as well as a Regional Acute Psychiatric Unit. In September 2024, we will also be entreated to a brand new, state-of-the-art hospital at the center of our teaching and learning program. Accordingly, as the Northern Medical Program teaching site, you will also serve as instructors to our 3^rd year, Integrated Community Clerkship (ICC) medical students.

Lifestyle

This area best serves outdoor enthusiasts and adventurers. Here we boast easy access to world-class fishing, boating, hiking, road and mountain cycling, skiing, and sledding. We encourage you to breathe the fresh air and enjoy our breathtaking mountain views; both of which we share with our abundant wildlife.

In terms of lifestyle, the financial advantages of practicing in a rural setting are undeniably considerable. As we operate in a smaller city, the cost of living is more affordable, thus allowing your earnings to go further. If you are carrying a student loan, we encourage you to investigate the government student loan forgiveness programs for healthcare professionals working in rural areas. These BC Provincial and Federal Student Loans are forgiven at different rates starting in your first year of residency. It is important to note that the Rural Northwest Program is one of only a few sites in the province where this loan forgiveness program applies.

Let me share that the doctors who do best in our setting are adventurous, adaptable, independent, and reliable. If you are genuinely considering us, please do reach out as contacting us is required for your CaRMS application to be seriously considered at this site. As such, we encourage you to contact us by email with any questions you may have. Also, feel free to reach out to our residents so that you may gain from their perspective. We would also welcome hosting you for a site visit. Alternatively, since we understand that financial constraints can make visiting our site difficult, we could also meet with you at the UBC CaRMS open house event that takes place in January.

Wishing you continued success,

Dr. Sasha Langille-Rowe and Dr. Ariane Mundhenk

Lead Resident Message

Thank you for your interest in Terrace! We are UBC’s Northwestern Family Practice residency training site. Terrace is a rural community in the heart of the Coast mountains with a local population of approximately 15000, and a hospital that serves as a regional referral centre for approximately 31000 people. Our program is situated in Gitxsan and Tsimshian territory and we serve a population with a large Indigenous component. Mills Memorial Hospital supports a range of specialists and full-service family physicians as well as a contingent of family medicine residents and third year medical students. There is a new hospital currently under construction that is estimated to open early 2025. There are opportunities to visit and practice in some of the smaller surrounding communities, including Kitimat, Prince Rupert, Smithers, Hazelton, and the Nass Valley.

A typical week here consists of 3 half days in Family Practice with the rest of the time filled with specialists and interdisciplinary care. Each resident is assigned with one preceptor for an entire year, the other components of our program are integrated throughout our remaining time. In-patient round responsibilities are typically shared between preceptors in one-week rotations. During your first year you can expect your family medicine preceptor to have a week of rounds about every five weeks. There is ample opportunity for continuity of care as you may see your in-patients during clinic follow ups. Likewise, your family medicine preceptor may work emergency department shifts and/or obstetrics call which you are welcome to join in on. Call requirements are currently one weekend per month and one day per week. Call shifts usually consist of either a 24 hour obstetrics call or an evening emergency medicine shift (5pm to midnight or midnight-8am), but can also include internal medicine call, general surgery call, or hospitalist call depending on your interests. If you have any further questions about scheduling and call requirements I invite you to attend our open house in early 2024!

We are a small site with 2 residents per year and are joined by 2 to 4 third-year medical students. This allows learners to be involved in interesting cases. Preceptors get to know learners well, allowing us to gain independence and responsibility to match our level of training. Our academic sessions are grouped together into “academic weeks” which are call protected and happen twice per year; these weeks include sessions on a wide range of topics that help prepare us for the CCFP exam. In addition to academic weeks, we have emergency SIM sessions, MOREOB sessions, and practice sessions for both the oral and written component of the family medicine exam (SOO/SAMP). The program also provides financial support for ACLS, ATLS (or equivalent), NRP, ALARM and ESS courses.

Terrace and its surrounding area are an outdoor enthusiast’s dream. Skiing, fishing, hiking, biking and many other outdoor activities are easily accessible. There is also an active arts and theatre community in town. The people of Terrace are generous and happy not only to welcome resident to work, but also play in their area of the Northwest. If you’re worried you might miss out on your favourite hobby or pastime in Terrace, just ask us and we’ll see what we can find out about it for you.

As residents, we believe that the program in Terrace provides us with the training necessary to succeed in a full-service family practice in any environment in British Columbia or Canada. If you have any questions or require more information, please contact us.

Kevin Krysiak

Number of Residents: 2 CMG
Location: Terrace, BC
Community: 15,500
Hospital: Mills Memorial
Distance from Vancouver: 1,351 km

Curriculum Type: Integrated
R2 Elective Time: 16 Weeks
Phone: 250-638-4023
Contact: Co-Site Director – Dr. Sasha Langille-Rowe / Co-Site Director – Dr. Ariane Mundhenk / Site Coordinator – Cara-Lee Malange
Lead Resident: Dr. Kevin Krysiak

Overview

This program is centrally located in Terrace, British Columbia. The city is situated in the Northwestern part of the province, alongside highway16 and the mighty Skeena River. Terrace is a vibrant community with a population of approximately fifteen thousand five hundred people. Further to its’ world-class outdoor recreational activities including but not limited to fishing, hiking, cycling, skiing, and sledding; it boasts a strong community filled with culture. With a diverse population including many Indigenous peoples throughout the area, you are bound to enjoy the art, music, dance, and overall rich cultural experiences Terrace has to offer.

Program Highlights

About 19 family physicians working in outpatient clinics and more than 30 specialists providing services in: General Surgery, Pediatrics, Obstetrics, Gynecology, Otorhinolaryngology, Ophthalmology, Psychiatry, Urology, Radiology, Internal Medicine, and Anesthesiology.
Visiting specialists’ services are provided in the areas of Psychiatry, Internal Medicine, Neurology, Rheumatology, Dermatology, Endocrinology and Pediatrics. Including: Pediatric Neurology, Pediatric Cardiology, Pediatric Rheumatology and Pediatric Endocrinology.
Orthopedic rotations will occur in nearby Smithers and Psychiatric rotations will be held in Prince Rupert.
Mills Memorial Hospital, in Terrace, has approximately 32 acute care beds, 5 ICU beds and 10 regional Psych beds and provides, per annum, greater than 28 thousand ER visits, approximately 300 deliveries, 17,000 inpatient days (including Psychiatry) and greater than 4 thousand surgeries including endoscopy and cataracts.
In Terrace, there are about 500 GP visits per day with opportunities to practice in other centers
Instead of participating in the Rural Match, residents in their second year, will be placed in Haida Gwaii for one month.
Academic weeks will be covered in Nanaimo and includes a Behavioral Medicine component.

While family practice residents will be based in one community for the majority of their time they will need to travel to the other communities for some rotations, so a vehicle is required.

Sample Rotation

This program is longitudinally integrated beginning with one month in family practice followed by wide range specialty services as well as ongoing longitudinally integrated Family Medicine.

Interview with Ashley Nicholson (previous R2)

The Northwest site is based in the city of Terrace, BC which is fairly remote. What made you choose this site for your postgraduate training?
I wanted a training program that would allow me to practice family medicine in a rural or semi-rural setting. Terrace seemed to fit the bill as it is not very large (18,000 people) but when you factor in the population of the surrounding region, that number increases to 80,000 people, so there is a lot of rural and semi-rural medicine being practiced at this site.

The Northwest program allows me to work in the family medicine clinic and train with specialists at the hospital in Terrace, but I also get to travel monthly to more remote areas for a true rural experience. I feel that I’ve gotten a balanced view of family practice at this site.

What do you enjoy most about the Northwest program?
The community up here is small, so you really get to know your patients and the other physicians on a personal level. Knowing the lifestyles and occupations of my patients helps me provide better care, which benefits them in the long term.

I really appreciate that the physicians and staff at the site are very collegial and treat the residents as peers. They’re very supportive about lending us a hand when we need one, answering questions and teaching. I feel comfortable and confident in this environment because I know that if I need help, it’s readily available.

What kind of learning opportunities are available at the Northwest site?
There are amazing learning opportunities here – with only two residents per year and three medical students from UNBC, there is no competition for procedures so you get a wide range of hands-on experiences. For example, it’s very easy to be included in the surgeries and more often then not, you’ll be the First Assist. In this program, you quickly become used to doing procedures which in turn helps you feel more confident and capable, especially in rural settings.

The specialties here are well represented. There are general surgeons, OB/GYNs, anaesthesiologists, ENTs, a urologist and even an ophthalmologist. There are internal medicine specialists who make regular trips to Terrace so we have access to that skill set as well. The only specialty that’s not immediately available is orthopedics – this specialty is however available in Kitimat and Prince Rupert and is included in our residency training.

Is there a large service component to your residency?
Terrace Hospital is not service driven and thus doesn’t rely on residents to function routinely. If our preceptor is on call in the ER, we’ll take the call with them. Generally though, we’re on-call about 1 in 3 to 1 in 4. On the weekends, residents are on-call about 1 in 5 or 1 in 6. The only exception to that schedule is the inclusion of obstetrics call which is in addition to regular call.

Is the community very welcoming of residents?
The community of health professionals is very supportive of residents. There aren’t a lot of other residents so you get to know your colleagues very well – not just as preceptors but as people. Several of the physicians provide mentoring that goes beyond medicine – they provide a lot of advice and coaching about life and career, which I really appreciate.

What kind of facilities are available in Terrace?
Terrace Hospital is an older facility but it has a newly renovated ER/Trauma and the Radiology department has been upgraded with new equipment including a CT machine and fluoroscopy.

All of the clinicians and specialists have their offices in one building with the exception of the urologist. This is really convenient, especially if you have a patient who needs a specialist emergency consult – you can just send him/her down the hall for an appointment and reduce the wait time for a specialist consult.

Are there any recreational and/or cultural opportunities in Terrace?
There are many opportunities for sports and outdoor activities in Terrace. You can go hiking, wildlife viewing, backcountry skiing, cross-country skiing, mountain biking, and road riding. The local ski hill is within a 30-minute drive of Terrace and it boasts an average of 40 feet of snow each year. There are several indoor sports facilities for adult recreational hockey, soccer, tennis, and badminton.

Culturally, you can tour the ancient lava beds in the Nass Valley, visit the local historical sites and tour native villages in the region. There are also some small galleries featuring local artists.

What are the living conditions like in Terrace?
Housing and accommodation are actually quite reasonably priced, although the availability of rentals varies depending on the time of year. You don’t need to have a car for daily activities/errands in Terrace – I found accommodations within walking distance of the hospital – but it is convenient, especially on the days when you travel back and forth a lot between the clinic and the hospital. A car is definitely a necessity when it comes to traveling to nearby communities for clinical consults. Because there is often snow and black ice on the roads in the area during the winters, it’s best to have a vehicle with four-wheel drive and winter tires.