University Health Network – Toronto Western Hospital

• Horizontal program allows greater continuity of care and the opportunity for residents to build their own practice.
• Gain skills for the full scope family medicine — inpatient service, obstetrics, home visits, procedure clinic, emergency.
• Modern (designed for teaching) Family Health Team with brand new facilities built 2020
• Downtown, residential community with community businesses, arts and entertainment
• Our program is about leadership and responsibility. It is resident-centered, and the co-chief residents play a significant role in ensuring the program meets residents’ needs
• Flexible with eleven selective/elective blocks

Horizontal Family Medicine Component

One of the most popular aspects of the UHN Toronto Western Family Health Team’s program is its horizontal curriculum.

Family medicine clinics take place on three half days per week over most of the two years. This allows residents to cultivate their own practice (as opposed to seeing their supervisor’s patients during block rotations) and to develop continuing relationships with patients and their families. Teaching care reviews occur at the end of each clinical session. Half-days back are flexible, and reduced on the few rotations where service requirements are more demanding.

Flexible Training Experience

Complementary learning experiences are designed around this horizontal time back. While blocks of defined specialty experiences occur mainly in the first year, this program offers elective/selective experiences totaling 11 blocks in the two years.  However, residents who are mature, self-directed learners and who (with their preceptors) are able to clearly define their educational needs are preferred, as they take full advantage of the flexible nature of the program. Of the elective/selective blocks, five blocks of selective experiences are drawn from subspecialties within family medicine — these encourage residents to plan a career of delivering broad scope comprehensive family medicine, while facilitating the development of special interest areas. Commonly, residents also take opportunities to gain international experience and/or experience in the remote north. The academic half-day sessions are planned by the chief residents based on residents’ requests and a large menu of offerings that are modified from year to year based on previous feedback and expected competencies.

Special programs in which residents are involved: In-Patient Experience

The Family Inpatient Service (FIS) at UHN TWH is a team that provides care to up to twenty patients requiring medical care in the TWH, completely run by family doctors in our department. The patients have been admitted to the General Internal Medicine Service and thus have problems that are representative of the full range of inpatient medicine. The FIS affords the opportunity to directly and independently manage inpatient care (as opposed to being an off-service resident on a large internal medicine team), while simultaneously managing an outpatient clinical practice (i.e., you will maintain your half-day back time). There is no overnight in-hospital call on the rotation.

Family Medicine Enrichment Block

This block in first year offers a group of brief selective experiences that introduce you to opportunities inside and outside the office. This includes student health clinics, supervised home visits with the FHT Home-Based Care Program, LTC visits, Warfarin management training, a half-day with our Pediatrician, RT, PT and dietitian.

Obstetrical Care Program

You gain prenatal training through experience within a dedicated prenatal clinic at the Family Health Team (FHT), operated by our family physicians who do intrapartum obstetrics. This enables you to gain a comprehensive understanding of all issues in prenatal care, through a focused, high volume, team-based care model. In second year, this experience is combined with a full shift per week doing intrapartum obstetrics, as well as time for home visits on newborns in our maternal-newborn month. Out FHT takes care of and delivers about 300 women per year.

Home Visits

Part of a family physician's set of competencies is to provide care to patients in settings other than the ambulatory one, and this includes the home environment. As such, you will participate in the Family Health Team's Home-Based Care Program, which provides both routine and palliative care to patients who are functionally homebound. You will receive more detailed orientation to this program, but the expectation will be that you either "inherit" or identify from your own roster, one or two patients for whom you can provide home-based care.

Partners in Care Program (PIC) – PGY1

The Partners in Care Program introduces the PGY1 to the conceptual components of the patient-centered clinical method. The goal of this program is to develop clinical skills that will improve the quality of care and enhance the patient and physician’s satisfaction with the encounter. Residents enjoy a variety of learning modalities including small group discussions, observing clinical interviews, interviewing their own patients and evaluating videotapes of their patient interviews.

Partners in Care Program (PIC) – PGY2 (SOO Prep)

Partners in Care builds on the PGY2’s educational experiences in the PGY1 program. Your clinical interviewing skills are further refined in the second-year program. The focus is on assisting you in addressing difficult physician-patient interactions and patients with complex bio-psychosocial problems, within time limitations. The program also prepares you for the oral examination certification process at the end of their residency program, the CCFP exam.

The residents have various learning experiences in this program including videotaping their patient encounters, videotaping a simulated office oral of themselves and faculty as a standardized patient and participating in simulated office orals with trained standardized patients. The simulated office orals are evaluated with the residents using the patient-centered clinical method of interviewing.

1st Year

2nd Year

Selectives – 5 blocks

Residents are expected to select five blocks of rotations that support the comprehensive roles of family physicians (e.g., international health, rural medicine, community health, obstetrics, hospital medicine, palliative care, occupational medicine, rehabilitation, sports medicine, long-term care, home care, GP psychotherapy, emergency). There are two mandatory selectives: ER and delivery of care to a group of underserved communities.

Number of Family Medicine half-day back (continuity time) per week:

• PGY-1: 3 half-days/week clinical time
  • 1 half-day/week academic teaching (Wednesday a.m.)
• PGY-2: 3 half-days/week clinical
  • 1 evening/week clinical (with a daytime lieu half day granted each week)
  • 2 daytime half-days
  • 1 half-day/week academic teaching (Wednesday a.m.)