NOSM Internal Medicine
NOSM's Internal Medicine residency offers comprehensive training combining learning in the larger urban centres with rotations in Northern Ontario. Based out of both Northeastern and Northwestern Ontario, this hands-on program provides for a unique residency opportunity that will expose you to the most expansive variety in learning opportunities.
The program includes core rotations in Internal Medicine
and subspecialty rotations selected to incorporate a diversity of experience
and proficiency in subspecialty areas integral to community based practice but
less commonly emphasized in traditional Internal Medicine residency programs.
Based on the resident's personal learning plan, the
content, sequence of training and schedule of movement between teaching sites
may vary. Residents are required to provide
their own vehicle and it is strongly recommended that residents have a laptop
Core Program Clinical Rotation
TB - Thunder Bay
SUD - Sudbury
SSM - Sault Ste. Marie
- MCTU (TB and SUD) – 4 blocks
- Cardiology TB and SUD – 1 block
- Community Cardiology SSM – 1 block
- ICU (only available in SSM) – 1 block
- Nephrology – 1 block
- Emergency Medicine (TB and SUD) – 1 block
- Subspecialty Selectives – 4 blocks
- MCTU – 4 blocks
- CCU (Ottawa) or ICU (SUD and TB) - 2 blocks
- Community GIM – 1 block
- Subspecialty Selectives – 3 blocks
- Electives – 3 blocks
- MCTU – 4 blocks
- CCU or ICU (whichever not done in PGY-2) – 2
- Community GIM – 2 blocks
- Subspecialty Selectives – 3 blocks
- Electives – 2 blocks
ICU in PGY-2 or PGY-3 must
be done as a two block rotation
Community GIM is offered in
Huntsville, North Bay, Parry Sound, Sudbury, Thunder Bay and Timmins
Residents are strongly
encouraged to do one rotation in each of the following subspecialties in
addition to the required rotations listed above. Program approval is required
if any specific subspecialty rotations are NOT going to be completed.
- Endocrinology TB and SUD
- Gastroenterology TB and SUD
- Geriatrics TB and SUD
- Hematology SSM and TB
- Infectious Disease SUD and TB
- Medical Oncology SSM and TB and SUD
- Nephrology TB and SUD
- Neurology TB
- Respirology TB and Ottawa
- Rheumatology SUD and TB
- Electives can be done in any
subspecialty at any academic institution. The resident is responsible for
arranging these rotations.
- 1 and in some cases 2
elective blocks can be used for research. There must be a deliverable at the
end of each of these blocks.
- With program approval, up to
2 elective blocks can be converted to do a second rotation in a subspecialty
All residents MUST complete a scholarly
activity. It may be done longitudinally or during elective research blocks as
After completing the three core years of Internal Medicine,
residents may choose to continue in a 4th year of NOSM General Internal
Medicine. Previous residents have been
successful in either route - completing 4th year NOSM General Internal
Medicine, as well as applying to subspecialty fellowships at other institutions.
The fourth year NOSM General Internal Medicine program will
be designed to meet the particular interests of applicants.
The fourth year of training in Internal Medicine consists
of 13 blocks of four weeks duration. There are five mandatory blocks. Elective
rotations should be balanced and tailored to the individual resident’s needs
and future practice. Rotations can be set up at centers outside of NOSM, with
approval of the program. The final rotation schedule must be approved by the
site and/or program director.
- MCTU – 2 blocks as junior attending; Residents
are encouraged to do one rotation in Sudbury and one rotation in Thunder Bay
- Community GIM – 2 blocks; to be done in two
different NOSM communities
- ICU -1; Must be completed in a closed ICU;
Suggested that it is completed in a NOSM community
– strongly recommended to complete one or two blocks
– Strongly recommended to complete a second block
rotations can be completed with program approval.
Responsibilities & On-Call:
The PGY-4 is generally
expected to function at the level of a junior consultant not at the level of a
senior medical resident.
Call for core rotations
should be 1 in 4 to 1 in 5 (5-7 calls per 28 day block)
Specific rotation objectives
are defined for all core and strongly recommended rotations.
all elective rotations, the resident is expected to develop objectives based on
their own learning goals. These require preceptor and program approval.
Objectives must be received by the program 4 weeks prior to the start of the rotation.
In addition to the resident developed objectives, there are also general
objectives that will apply to elective rotations.
Training in the following
procedures can be arranged. The resident must identify this goal prior to the
beginning of their academic year.
- Exercise stress testing
- Ambulatory ECG monitoring (e.g. Holter monitors)
- Pulmonary Function Testing
- Bone marrow biopsy and aspiration
If the resident requires
training in other procedures due to a need in their expected community of
practice, the program may be able to accommodate.
Procedures requiring more
extensive training (e.g. echocardiography, endoscopy) are now included in the
scope of a subspecialty GIM fellowship and cannot be accommodated in our PGY-4
Academic half day sessions occur weekly,
on Wednesdays, throughout the year during protected time from clinical duties.
Academic half days are on a 2 year topic rotation. During blocks 1-3 of each
year academic half days focus on Internal Medicine emergencies to provide an
overview for new residents. Residents will also have the opportunity to
participate in educational rounds, presentations, journal clubs and rounds
through the Ontario Telemedicine Network.
Residents from both sites meet a minimum
of 1 time each year for OSCE and other teaching sessions.
Simulation – Each year, NOSM residents
gather for a weekend course designed to teach an approach to various clinical
scenarios, including code leadership and core procedure skills with the help of
new simulation lab and other modern technologies.
OSCE – Residents are given the
opportunity each year to participate in a formative OSCE delivered in the same
format as standard national certification and licensing examinations for the
purpose of exam preparation and structured feedback on clinical skills by
practicing physicians (including several certified Royal College examiners) in
a non-intimidating setting.
Purpose of American Boards – Each year,
all NOSM Internal Med residents write the American Board of Internal Medicine
(ABIM) Qualifying Exam with the goal of promoting self-awareness of strengths
and weaknesses within the wide spectrum of Internal Medicine. This test also offers
residents an excellent opportunity to witness their own progress on a yearly
basis as they progress from PGY1 through PGY3 and helps them prepare for the
Royal College examination written in PGY4.
Residents will participate in an
evolving research curriculum. They will also have access to a Physician
research advisor dedicated to Internal Medicine Residents, a research
assistant, and a Research Librarian. All
residents will do two four-week rotations in research or scholarly activity.
Residents are expected to complete a research project and present their
research at the Resident Research Day.
Expert guidance and funding is available to provide high quality
research experiences. In consultation
with the Program Director, elective time can also be arranged for research.
residents will be offered the option of ATLS during the fourth year. The
anticipated outcome is of a well-rounded generalist trained to provide a broad
range of services which are in high demand in community based General Internal
Medicine. The program will give the resident additional skill sets that might
not typically be available to General Internal Medicine residents. Versatility
and flexibility are the hall marks of true generalists and will be the basis of
NOSM’s fourth year program.
Internal Medicine Resident Handbook 2015-2016
Please note that an updated handbook will be provided to incoming residents upon commending the program.
How to Apply
To apply to NOSM's Internal Medicine program, visit the Canadian Resident Matching Service (CaRMS) website at www.carms.ca and select the Northern Ontario School of Medicine's Internal Medicine residency program description.
Dr. Kim Tilbe
NOSM Internal Medicine Residency Program
Coordinator, Postgraduate Specialty Medicine
Tel: (705) 662-7103