Mentorship Opportunities

Fellowship In Respiratory Medicine (Clinical and Research)

Eligibility

Three years of approved residence training in general internal medicine. To be eligible for the Royal College Accreditation Examination in Respiratory Medicine at the completion of the program, the candidate must be certified in Internal Medicine by the Royal College of Physicians and Surgeons of Canada. Objectives are available on the Royal College of Physicians and Surgeons of Canada website. Graduates of medical schools other than those in Canada and the United States must have passed the Medical Council of Canada Evaluating Examination (MCCEE). To receive funding through the Province of British Columbia, either Canadian citizenship or landed immigrant status is required.

Remuneration

Salary is according to the P.A.R.I. (Professional Association of Residents and Interns of B.C.) scale for the clinical years, and is variable, depending on the source of support, for the research year.

Structure of the Training program

The program is approved by the Royal College of Physicians and Surgeons of Canada. There are provisions for 2-3 trainees in Clinical Respiratory Disease, and for at least two training positions as Research Fellow in Respiratory Disease.

The program consists of two years of clinical training followed by one optional year of research. The two years of clinical training in Respiratory Disease consist of rotations at the Vancouver Hospital and St. Paul’s Hospital. This will include 9-12 months of general in-patient respiratory medicine plus a minimum of two months intensive care, one month of pulmonary function laboratory and rotations in ambulatory respirology, tuberculosis, lung cancer, sleep disorders, and radiology. Two- 3 months of elective training will be available in the second year. The year of research training can be basic laboratory, clinical or epidemiologic investigation and is available at both hospitals. It includes training in clinical respiratory physiology.

The Respiratory Training Program at UBC is unique because it is an integrated program of faculty and resources from two different hospitals: Vancouver Hospital and St. Paul’s Hospital.

Clinical Program

In-patient Care

During the clinical training, the respiratory fellow is responsible for the management of patients in the Respiratory Service in any of the hospitals he/she is rotating through under the supervision of the attending staff. He/she acts in a supervisory capacity for the general medical resident(s) and medical student interns rotating through the Respiratory Service.

There are usually about 20-30 patients on the Respiratory Service in both St. Paul’s Hospital and Vancouver Hospital at any one time. Daily working ward rounds with attending staff are held as well as formal teaching rounds once or twice weekly. In both hospitals there is a close liaison with the thoracic surgery units.

Procedures

The respiratory fellows are expected to perform the following procedures under the supervision of the attending staff when necessary: thoracocentesis, pleural biopsy, percutaneous needle biopsy of the lung, insertion of chest tubes, fiber optic bronchoscopy with bronchial biopsy and brushings. Trainees are expected to perform more than 100 fiber optic bronchoscopies during the clinical year.

Lung Function Laboratories

Both hospitals have well equipped laboratories for pulmonary function tests. Both St. Paul’s Hospital and Vancouver Hospital have pulmonary mechanics and exercise testing equipment. Vancouver Hospital also has an inhalation challenge laboratory for assessment of patients with occupational asthma. Trainees spend one month in the pulmonary function laboratories learning how to measure and interpret pulmonary function studies.

Intensive Care

Intensive care training is available at St. Paul’s Hospital and Vancouver Hospital, and scheduling is flexible to accommodate those with or without special interest in intensive care.

Tuberculosis

Vancouver Hospital has the only tuberculosis ward in British Columbia. It has 18 beds and 2-3 admissions per week.

Ambulatory Care

At Vancouver Hospital there is an outpatient clinic where approximately 800 new respiratory patients are seen annually. Similar numbers attend respiratory physicians’ outpatient clinics at St. Paul’s. The trainees are expected to attend one half-day longitudinal outpatient clinic per week during the second year of clinical training. Specialty clinics are available in tuberculosis, sleep disorders, lung cancer and occupational lung disease during a 2- 3 month ambulatory rotation. Rehabilitation program for patients with chronic obstructive lung disease are available at St. Paul’s Hospital.

Respiratory Sleep and Neuromuscular Disorders

There is a multi-disciplinary sleep disorders clinic and a six bed sleep laboratory at the UBC site of Vancouver Hospital. 21 overnight sleep studies are performed weekly. Over 4,000 patients with respiratory sleep and neuromuscular disorders are currently being followed. Expertise exists to treat these patients with nasal CPAP, nasal ventilation, oral appliances and surgery. A rotation in Sleep Disorders is incorporated in to the training program.

Laser Therapy

Photodynamic therapy and YAG laser therapy for endobronchial tumours are being carried out regularly at Vancouver Hospital.

Cystic Fibrosis

The adult cystic fibrosis clinic is located at St. Paul’s Hospital. Approximately 100 patients are followed as out-patients with 5 in-patient beds dedicated to the care of cystic fibrosis patients.

Spinal Cord Program

The spinal cord program is located at Vancouver Hospital. Trainees are involved in the management of the respiratory complications of approximately 100 spinal cord injured patients/year.

Organized Teaching

During the course of two years, trainees are expected to participate in organized teaching. This consists of:

•Pulmonary pathophysiology course

•Clinical lung function testing seminars

•Chest radiography review series

•Clinical lecture series

•Research seminar series

•Scientific writing course

•Molecular biology seminar

In addition, trainees are expected to attend organized teaching in the individual hospitals where they are rotating, eg. combined medical-thoracic surgical rounds, respiratory rounds, clinical-radiology-pathology rounds. The applicants should note that to satisfy requirements of the Royal College of Physicians and Surgeons of Canada, they are required to be registered with UBC as trainees, and if accepted, will be required to pay UBC a registration fee of $332.00.

Research Program

The research program is hospital-based.

St. Paul’s Hospital

A multi-disciplinary Pulmonary Research Laboratory exists at St. Paul’s Hospital. The group consists of members from the Departments of Pathology, Medicine and Surgery, and is dedicated to the investigation of pathophysiologic relationships in various lung diseases. This laboratory contains extensive equipment for measurement of pulmonary function and mechanics in animals, and includes a well-equipped surgical laboratory containing an x-ray table for fluoroscopy unit. In addition, facilities are available for protein chemistry and immunology, and for detailed pathological studies, including light and electron microscopy. Studies presently being conducted in this laboratory include:

•Lung mechanics and mediator release in allergic animals and asthmatics.

•Non-cardiogenic pulmonary edema in the dog, pig and rabbit. These studies involve the use of electron microscopic tracer substances, indicator dilution methods, along with measurement of gas exchange and lung mechanics.

•Function-structure correlations in chronic obstructive lung disease. Studies of pulmonary function are correlated with pathologic abnormalities in patients going to thoracic surgery.

•Studies of the possible role of latent viral infections in the pathogenesis of airway and interstitial lung disease. In situ hybridisation polymerase chain reaction and other molecular biology techniques are used.

•In vitro studies of human tracheal-bronchial smooth muscle.

•Cell culture of animal and human pulmonary endothelial cells, investigation of the effects of neutrophils, complement and free radicals on endothelial cell integrity.

•In vivo, in vitro and morphologic studies of the role of airway smooth muscle mechanics in bronchial hyper reactivity.

•Clinical studies in the ICU involving measurements by radio nuclear techniques of cardiac function and influence of cardiovascular drugs in acute lung injury, respiratory muscle function, and white blood cell transit in the lung.

•Studies of WBC kinetics in normal and diseased lungs.

•Cystic fibrosis – epidemiology, microbiological and therapeutic trials.

Vancouver Hospital

Vancouver Hospital encompasses both the former Vancouver General Hospital and UBC Hospital which merged in 1993. The Vancouver Hospital has an active research laboratory where studies involving measurements of detailed lung mechanics are conducted, as well as facilities for studies of gas exchange, exercise tolerance and ventilatory responses to CO2 and hypoxia. In addition, there is an active immunology laboratory with provisions for testing for serum precipitins, preparation of antigens, measurement of plasma histamine, leukotriene and prostaglandin radio immunnoassays and another laboratory with facilities for studies on neutrophil elastase, alveolar macrophage cultures, serum and bronchial protease inhibitors. The respiratory sleep disorders program at the UBC site has extensive non-invasive equipment and computer facilities for on-line analysis of overnight sleep studies and the detailed examination of breathing patterns. There is also an animal laboratory which includes biplane fluoroscopy for measurement of respiratory mechanics, hemodynamics and muscle activity. The group at the Vancouver Hospital has expertise in asthma, occupational asthma and occupational lung diseases, epidemiology, environmental lung disease, respiratory sleep and neuromuscular disorders, lung cancer, transplantation and tuberculosis. Among the projects which are currently being pursued at the Vancouver Hospital are the following:

Tuberculosis

•Evaluation of tuberculosis problems and anti tuberculosis program in Canada

•Clinical studies related to tuberculosis

Asthma Research

•Pathogenic mechanisms in asthma

•Epidemiology of asthma, prevalence and determinants in Canada

•Environmental, indoor and outdoor, risk factors in asthma

•Evaluation of asthma educational program

•Study of secondary messengers in signal transduction and development of novel drugs in the treatment of asthma

•Clinical trials of new modalities of treatment

Occupational and Environmental Studies

•Epidemiological surveys and clinical evaluation of respiratory and non-respiratory diseases in various industries in British Columbia

•Clinical studies of types of occupational asthma

•Studies of genetic determinants of occupational asthma

•Studies on the pathogenesis of occupational asthma

•Studies on the adverse respiratory health effects of indoor and outdoor air pollution

Lung Cancer Research

•Population studies on pathogenesis, prevention and treatment of lung cancer

•Early detection of lung cancer using laser bronchoscopy

•Photodynamic therapy of lung cancer

Chronic Obstructive Lung Research

•Effects of smoking on functional activity of protease inhibitors in the lung and on the release of neutrophil elastase. These studies include determinations of bronchoalveolar lavage obtained before and after smoking in volunteers, and comparison with lavage findings in patients undergoing bronchoscopy

•Interaction between smoking and oxidant production by neutrophils and pulmonary alveolar macrophages and their relationship to functional activity of antitrypsin

Respiratory Muscle Disorders

•Diaphragmatic function and fatigue in animal studies. These studies involve the technique of sonomicrometry along with measurement of trans-diaphragmatic pressure and diaphragm EMG

•Neuromuscular function and phrenic nerve afferents

•Respiratory muscle function in acute spinal cord injury

Applications

Respiratory Medicine Fellowship

•Three-Four positions (Clinical)

Applications for clinical programs are through CaRMS www.carms.ca

Frank Ryan, MB, FRCPI, FRCPC, FCCP
Director, Post Graduate Training Program

C/O Margie Bell
UBC Respiratory Medicine
The Lung Centre, 7th Floor
2775 Laurel Street
Vancouver, B.C. V5Z 1M9 Canada
Phone: (604) 875-4327
Fax: (604) 875-4695
E-mail: Margie.Bell@vch.ca

The applicants should note that to satisfy requirements of the Royal College of Physicians and Surgeons of Canada, they are required to be registered with UBC as trainees, and if accepted, will be required to pay UBC a registration fee of $332.00.