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Northern Remote Residency Orientation Binder 2015-2016 Table of Contents Chiefs’ Message to Northern Remote R1s:........................................................................................................................ 4 Contact Information .......................................................................................................................................................... 5 Northern Connection Medical Centre (NCMC) .............................................................................................................. 5 Winnipeg Hospitals / Sites ............................................................................................................................................. 6 PGY1 Rotation Contacts ................................................................................................................................................. 6 PGY2 Rotation Contacts ................................................................................................................................................. 7 Website Links ..................................................................................................................................................................... 8 NCMC Information ............................................................................................................................................................. 9 NCMC Pamphlet............................................................................................................................................................. 9 NCMC Discharge Form ................................................................................................................................................. 10 CareLink Project: After-hours Service Q&A and the Resident Role ............................................................................ 11 Curriculum Overview ....................................................................................................................................................... 13 Acronyms: Courses/Activities ......................................................................................................................................... 14 WRHA Aboriginal Culture Awareness Workshop (ACAW) ............................................................................................... 15 PGY1 Family Medicine Block Time Structure ................................................................................................................... 16 In-Unit Seminars ...................................................................................................................................................... 16 Psychiatry Seminars ................................................................................................................................................. 16 Guideline Review ..................................................................................................................................................... 16 Simulated Office Oral (SOO) .................................................................................................................................... 17 Practical Evidence Applied to Real Live Situations (PEARLS) ................................................................................... 17 Case Discussion Rounds ........................................................................................................................................... 18 On-Call Guidelines for NCMC ................................................................................................................................... 18 Enhanced Learning Opportunities during PGY1 FMBT ............................................................................................ 20 PGY2 Family Medicine Block Time Structure ................................................................................................................... 24 Simulated Office Oral (SOO) .................................................................................................................................... 24 Practical Evidence Applied to Real Live Situations (PEARLS) ................................................................................... 24 Clinical Audit Guidelines .......................................................................................................................................... 25 Community Bridging Project .................................................................................................................................... 25 Newborn Transports ................................................................................................................................................ 25 Addictions Rotation Preparation ............................................................................................................................. 25 PGY2 ON-CALL Procedures ...................................................................................................................................... 26 Aboriginal Health Rotation ...................................................................................................................................... 27 Reading ............................................................................................................................................................................ 29 Psychiatry Rotation .......................................................................................................................................................... 30 Evaluations ....................................................................................................................................................................... 31 Resident Evaluations ................................................................................................................................................ 31 Biannual Review....................................................................................................................................................... 32 Program Evaluations ................................................................................................................................................ 32 Resident Rotation Evaluation Survey....................................................................................................................... 32 Resident Rotation Evaluation Survey Form ............................................................................................................. 33 NR Policies ....................................................................................................................................................................... 35 Air & Ground Travel for Northern/Remote Stream ................................................................................................. 35 Self-Directed Learning & Scheduled Clinical Activities for Northern/Remote PGY2s ............................................. 38 MBTelehealth................................................................................................................................................................... 40 Tips For Success ............................................................................................................................................................... 47 Core Procedures .......................................................................................................................................................... 47 Dictation Tips ............................................................................................................................................................... 48 Northern Information ...................................................................................................................................................... 50 FMBT SITES .................................................................................................................................................................. 50 Northern Site Departure Airports ................................................................................................................................ 50 Travel Reimbursement ................................................................................................................................................ 51 Northern/Remote Resident Manual 2015-16 Page 2 PGY2 Technical Equipment .......................................................................................................................................... 52 Survival Items In A Can ................................................................................................................................................ 52 Wireless Modem for Rankin Inlet ................................................................................................................................ 54 Rogers service in the North ......................................................................................................................................... 55 Public Health Agency of Canada .................................................................................................................................. 55 J.A. Hildes Northern Medical Unit (NMU) ................................................................................................................... 58 General Information re: Churchill ............................................................................................................................... 60 Fly-in Trip Report ......................................................................................................................................................... 62 Northern Fly-in and Community Information.............................................................................................................. 63 Northern/Remote Resident Manual 2015-16 Page 3 Chiefs’ Message to Northern Remote R1s: It is our pleasure to welcome each of you to the Northern Remote (NR) Stream of Family Medicine at the University of Manitoba. The NR Stream is focused on training you to become competent and engaged Family Physicians who will provide the citizens of the North with excellent and culturally safe health care. You will be working in communities in northern Manitoba, Nunavut, and the Northwest Territories and serve their diverse populations of Canadian First Nations, Métis, and Inuit as well as new and established immigrants. The future of Medicine is in your hands. It is crucial to be proactive, flexible, and informed, to be able to serve with integrity and compassion. We call on you, our new colleagues, as the doctors of tomorrow, to champion the cause and accept the baton as it is handed to your generation, to labor for the best healthcare possible for all Canadians. ESSENTIALS TO REMEMBER THROUGHOUT YOUR TRAINING: CALL PAY: Keep track of your WRHA pay stubs and call pay (when in and out of the city). If you only receive partial payment, contact the PARIM office &/or the WRHA immediately. Keep track of on-call shifts in remote locations. (Ensure you fill out the appropriate forms and sign them, then fax or email to your PGY2 Program Assistant) Convert home call to “in-house call” on the PARIM website to be reimbursed appropriately. ALARM/ATLS/NRP/PALS/ACLS/Procedural Sedation: Enjoy! These courses are offered to NR Residents free of cost. Give proactive feedback to enhance positive changes. FLY-INS and R2 year: Network by phone/email/in person with other supportive healthcare providers. CONTRACT: Your Chiefs are responsible to represent the will and concerns of all NR Residents Your concerns and input are vital to due process of negotiation. Be aware and proactive in your feedback. BULLYING: If you are being targeted or discriminated against for any reason, contact your Chiefs, Drs. Lynch or Martin, or: Samantha Kelleher, M.D., FRCP Associate Dean, Professionalism & Diversity Ph: 204-789-3207 The University of Manitoba and all healthcare workers share a commitment to advance a safe working environment. If you witness bullying of patients, medical students, or residents in the workplace, you have the responsibility to contact your Chiefs, Drs. Lynch, or Martin. CANADA STUDENT LOANS: • If you have a loan from the government that has not been transferred to a bank and you are in repayment, you can qualify for $8000 to be deducted per year during your residency and practice, IF you work for 400 hrs or 50 days in a designated rural community. This means NR residents should qualify for two deductions, since with our Northern rotations we will accumulate more than the required amount (each WRHA pay period we get paid for 112 hrs) You can find the forms on CanLearn.ca or google Student Loan Forgiveness Canada and have our stream lead sign. Once again, the warmest welcome to the NR Stream of Family Medicine, NR Chief Residents Northern/Remote Resident Manual 2015-16 Page 4 Contact Information Northern Connection Medical Centre (NCMC) 425 Elgin Avenue, Lower Level Winnipeg MB R3A 1P2 Phone: 204-940-8202 / Fax: 204-940-4387 Staff LYNCH, Joanna CRAWFORD, Norma Title NCMC Unit Director/Physician Stream Lead PGY1 Education Director NCMC Office Manager Phone Email 940-1934 [email protected] 940-8208 [email protected] THIESSEN, Jacquie PGY1 Program Assistant 940-1927 Fx-940-4370 [email protected] ANDERSON, Donna T240 Bannatyne, HSC PGY2 Program Assistant 789-3831 Fx-789-3615 [email protected] Position vacant Northern Remote Office Assistant 272-3087 NCMC Senior Secretary 940-8227 [email protected] 940-8202 [email protected] 940-8202 [email protected] 940-8202 [email protected] ROMANEC, Jessica(mat leave) AHMO, Martha 940-8202 [email protected] [email protected] KENNEDY, Jelena (mat leave) WADE, Kristen 940-8207 [email protected] [email protected] 940-8203 [email protected] NCMC Child Psychologist 940-8202 [email protected] NCMC Dietician Research Coordinator 940-8210 [email protected] NCMC Shared Care Counselor 940-8202 NCMC Community Liaison Worker 940-4389 NCMC Pharmacist 940-8207 JUNIO, Karen Kaye CALO, Janice DUECK, Kara PETTIGREW, Amber NCMC Primary Care Assistant NCMC Registered Nurse ROBERT, Cecil BOW, Jane (Tu) CATTE, Daniel KLASSEN, Joanne (ed leave) ENS, Clarence KYDD, Gwen Position vacant DIAMOND-BURCHUK, Lisa BROWN, Cara NCMC Occupational Therapist [email protected] [email protected] [email protected] 940-8202 [email protected] 940-8202 [email protected] SCHORR, Rebecca NCMC Physiotherapist 940-8202 [email protected] BUSS, Mandy Physician/Preceptor Aboriginal Health Lead 940-8202 [email protected] CAVETT, Teresa Physician/Preceptor 940-8202 [email protected] CHEUNG, Paul Physician/Preceptor 940-8202 [email protected] HAHLWEG, Kenneth Physician/Preceptor 940-8202 [email protected] McFEE, Colin Physician/Preceptor 940-8202 [email protected] 940-8202 [email protected] 940-8202 [email protected] SUSS, Roger WHETTER, Ian Northern/Remote Resident Manual 2015-16 Physician/Preceptor Scholarly Lead Physician/Preceptor PGY2 Education Director Page 5 Winnipeg Hospitals / Sites Grace General Hospital (GGH) 300 Booth Drive Health Sciences Centre (HSC) T240, 770 Bannatyne Avenue (Northern Remote office) J.A. Hildes Northern Medical Unit (NMU) T162 - 770 Bannatyne Avenue Riverview Health Centre (RHC) 1 Morley Avenue St. Boniface General Hospital (SBGH) 409 Taché Avenue Seven Oaks General Hospital (SOGH) 2300 McPhillips Street Victoria General Hospital (VGH) 2340 Pembina Highway PGY1 Rotation Contacts PGY1 Core Adult ER HSC SBGH SOGH VGH Anita Bourgeois 204-787-2934 Lesley Roy 204-235-3006 Linda Codville 204-632-3558 Willie Hildebrand 204-477-3382 [email protected] [email protected] [email protected] [email protected] Seven Oaks CTU Audrey Golondrina 204-632-3207 [email protected] Palliative Dr. Fiona Crow Pamela Epp 204-237-2696 Chiefs Kristjana Wood 204-787-1676 Pediatric ER Obs [email protected] [email protected] [email protected] [email protected] HSC & SBGH Chiefs Kim Zeller 204-787-1988 Thompson Obs & Gyne Lynelle Zahayko 204-778-1436 [email protected] [email protected] [email protected] PGY1 Family Medicine Block Time (FMBT) BridgeCare Primary Care Clinic Dr. Afsaneh Oliver Dr. Cynthia Sawatzky Yessenia Hall 204-940-4384 Nine Circles Community Health Centre Dr. Laurie Ireland, Med Director Sonja Matthies 204-940-6000 Women’s Health Clinic Dr. Ken Hahlweg Samantha Bendell 204-947-2422 x202 Southeast Collegiate 1301 Lee Boulevard Northern/Remote Resident Manual 2015-16 [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] Page 6 PGY2 Rotation Contacts PGY2 Core General Surgery - Gold HSC Melissa Franzmann 204-787-8823 [email protected] ICU – GGH Erva Ritson 204-837-0588 [email protected] ICU - HSC Annette Lamy 204-787-1872 [email protected] Orthopedic Surgery - HSC Cidalia Hodnett 204-787-1219 [email protected] Chiefs [email protected] Pediatric Inpatient - HSC Rhonda Payne 204-787-2439 [email protected] PGY2 Family Medicine Block Time (FMBT) Sharon Shaydak 204-787-3843 [email protected] Addictions – HSC Dr. Marina Reinecke [email protected] HSC: Kalpana Bali 204-787-1825 [email protected] Newborn Care SBGH: Lynn Kaebe 204-237 2764 [email protected] Dr. Fabiana Postolow [email protected] Boundary Trails (Airway) Admin: Patti Rach 204-331-8987 [email protected] Agassiz Medical Ctr, 130-30 Stephen St, Morden Lead: Dr. Bob Menzies [email protected] Dr. C.W. Wiebe Medical Ctr, 385 Main St, Winkler The Pas (FMBT) The Pas Health Complex, 67 1st St. W. / 204-623-6431 The Pas Clinic, 4th Flr - 67 1st St. W. / 204-623-3334 The Pas (Airway) The Pas Health Complex, 67 1st St. W. / 204-623-6431 Lynelle Zahayko 204-778-1436 [email protected] Thompson: General Hospital (Airway) 871 Thompson Dr. S. / 204-677-2381 Thompson Clinic (FMBT) 50 Selkirk Ave / 204-677-1777 Yellowknife, NT Derek Orlaw 867-873-7257 [email protected] Dr. Sara Goulet [email protected] Rankin, NU Gloria Goulet [email protected] Inuvik, NT Leanne Goose 867-777-8108 [email protected] Hay River, NT Erin Griffiths 867-874-7115 Hay River Medical Clinic, 3 Gaetz Drive [email protected] NORTHERN MEDICAL UNIT (NMU) T162, 770 Bannatyne Ave Amanda Abele 204-789-3271 [email protected] Churchill Health Operating Division (Hosp) Dr. Deirdre O’Flaherty [email protected] 204-675-8881 Renee Collins, Clinic Manager [email protected] Norway House Hospital 204-359-8225 & 204-359-8253 Dr. Adrienne Morrow Carol Wass, Clinic Manager [email protected] [email protected] Percy E Moore Hospital (Hodgson) 204-372-8444 Dr. Mandy Buss Sandra Harrison, Clinic Manager Fly-in Nursing Stations: Kathy Risk 204-789-3598 [email protected] [email protected] [email protected] Berens River 382-2265 Pauingassi 397-2395 St. Theresa Point 462-2473 Pukatawagan 553-2271 Poplar River 244-2102 Bloodvein 395-2161 Red Sucker Lake 469-5321 Grand Rapids 639-2215 Little Grand Rapids 397-2115 Garden Hill 456-2343 Wasagamach 457-2189 Chemawawin (Easterville) 329-2212 Northern/Remote Resident Manual 2015-16 Page 7 Website Links University of Manitoba http://umanitoba.ca/ Dept of Family Medicine http://www.umanitoba.ca/faculties/medicine/units/family_medicine/ ITERS & Objectives http://umanitoba.ca/faculties/medicine/units/family_medicine/postgrad/6381.html Family Medicine Toolkit by NJML http://libguides.lib.umanitoba.ca/familymedicine Regional Health Authorities http://www.healthemployment.ca/pra_cont.html J.A. Hildes Northern Medical Unit (NMU) http://umanitoba.ca/faculties/medicine/units/community_health_sciences/departmental_units/north_medical/ National Aboriginal Health Organization Conference http://www.naho.ca/conference/english/index.php Society of Rural Physicians of Canada (SRPC) http://www.srpc.ca/ This support group has great national and provincial conferences and a great book on Procedure Canadian Association of Emergency Physicians (CAEP) www.caep.ca Have very good workshops The College of Family Physicians of Canada (CFPC) http://www.cfpc.ca/Home/ The Society of Obstetricians and Gynecologists of Canada (SOGC) http://sogc.org/ Canadian Pediatric Society (CPS) http://www.cps.ca/en/ Canadian Medical Association (CMA) http://www.cma.ca/clinicalresources/practiceguidelines A helpful resource for studying current and newly updated relevant Canadian practice guidelines Northern/Remote Resident Manual 2015-16 Page 8 NCMC Information NCMC Pamphlet Health Sciences Centre Northern Connection Medical Centre Northern Connection Medical Centre How can I contact the clinic? Northern Connection Medical Centre Radisson Hotel—Portage Ave. Northern/Remote Resident Manual 2015-16 Address: 425 Elgin Ave, Lower Level, Winnipeg, Manitoba R3A 1P2 Phone: (204) 940-8777 Fax: (204) 940-4387 Reception: 8:30 - 4:30 Page 9 NCMC Discharge Form Northern/Remote Resident Manual 2015-16 Page 10 CareLink Project: After-hours Service Q&A and the Resident Role Northern Connection Medical Centre was one of the first WRHA clinics to pilot the CareLink Project, an after-hours service that aims to provide enhanced continuity of care to patients with medical concerns outside of regular office hours. Both the on-call resident and attending physician carry a blackberry provided by the project. Emails from the nurserun call centre come through on both blackberrys simultaneously. Residents are responsible for calling back patients, or pharmacies if the nurse sends a call through, and should contact the on-call attending if there are any questions about the management of the call. Residents must also enter a note into the patient’s EMR the following work day. These emails are relatively infrequent, as most of the calls to the nurses are handled without involving the physician. Calls from labs with urgent results will come as phone calls directly to the resident blackberry. The emergency room, paging service, and family medicine ward at St. Boniface Hospital will contact the resident or attending physician on-call by phoning the blackberry. Please keep the blackberry charged and close at hand while on-call. Check with residents leaving the service for the voice-mail password. No system of reaching physicians after-hours is perfect. When starting on family medicine block, please contact St. Boniface Hospital paging and the family medicine ward and provide them with two other methods of reaching you, such as your personal cell phone number, pager, or home phone number. These numbers should also be shared with the Program Assistant at NCMC. Resident Blackberry: 204-803-2521 Physician Blackberry: 204-390-0231 Family Medicine Ward 6A South (temporary 4B): 204-237-2833 St. Boniface Hospital Paging: 204-237-2053 Northern/Remote Resident Manual 2015-16 Page 11 Northern/Remote Resident Manual 2015-16 Page 12 Curriculum Overview The curriculum satisfies all of the requirements of the College of Family Physicians of Canada. The residents participate in core specialty rotations in the first year primarily at Health Sciences Centre and St. Boniface Hospital in Winnipeg. They will also have a family medicine experience in Winnipeg at NCMC. During the second year of the program, the residents will complete a small number of core specialty rotations in Winnipeg, but will spend 7 months focused on family medicine training specifically designed to prepare them for remote practice. The rotations break down as follows: Year 1 Vacation Family Medicine Psychiatry Aboriginal Health Hospital Medicine Obstetrics Pediatrics ER Palliative Care or Geriatrics Adult ER 4 weeks 20 weeks horizontal during Family Medicine horizontal during Family Medicine 8 weeks 8 weeks 4 weeks 4 weeks (select one) 4 weeks Year 2 Vacation Trauma Surgery Orthopedic Surgery Pediatric Inpatient ICU Elective 4 weeks 4 weeks 4 weeks 4 weeks 4 weeks 4 weeks FMBT: Norway House or Hodgson Airway Management Fly-ins Addictions Neonatology Psychiatry Aboriginal Health Northern/Remote Resident Manual 2015-16 12 +/- weeks in: Churchill, Flin Flon, Norway House, Hodgson, The Pas, NU or NT +4 weeks minimum 2 weeks 4 +/- weeks (Mon-Thu or Tue-Fri if long weekend) 2-4 weeks 2 weeks horizontal during Family Medicine horizontal during Family Medicine Page 13 Acronyms: Courses/Activities Acronym ACAW ACLS ACSS ADs AHWC ALSO ATLS EBM EMR EPR FMEDECs Gold Trauma Activity Aboriginal Culture Awareness Workshop Advanced Cardiac Life Support Description During Provides relevant information about the contemporary, historical and cultural issues that influence stereotypical impressions of Aboriginal people. PGY1 FMBT Re-certification PGY2 Acute Care Surgery Service Academic Days PGY1: Last Monday-Tuesday of each Period PGY2: Last Tuesday-Wednesday of each Period Interactive seminars presented by physicians and allied health personnel with important topics relative to family physicians. Mandatory attendance (75%). Absence due to being post-call is still marked as absent. Attendance is taken so if you are late or absent you are responsible to advise Breanne Mitenko, Office Assistant by email. PGY-1/2 Aboriginal Health & Wellness Centre Advanced Life Support in Obstetrics Being replaced by ALARM course operated by the SOGC in 2014 PGY1 Advanced Trauma Life Support PGY-1 Evidence-based Medicine Electronic Medical Record Electronic Patient Record Family Medicine Distributed Education Centres HSC acute trauma NCMC St Boniface 4 sites – Steinbach, Boundary Trails, Brandon, Portage la Prairie 20 weeks @ 8 hrs/day, 5 days/week (Mon-Fri) Minus AD (Tue-Wed once a month), Thu pm (In-unit) and ½ day/week (SDL) Remaining time for clinic attendance & other FMBT activities To attend at least 2 weekend on-calls per block. PGY1 28 weeks: 16+/- weeks north 2 weeks Airway Management 4 +/- weeks Fly-ins 4 weeks Addictions 2 weeks Neonatology PGY2 Half-Days Back 8 Half day a week at your clinic during OSR (excluding Adult EM) PGY1 In-Unit Seminars Schedule emailed weekly and attendance is mandatory when on FMBT PGY1 FMBT NRP Neonatal Resuscitation Program Provided twice a year during AD NMU J.A. Hildes Northern Medical Unit http://umanitoba.ca/faculties/medicine/units/northern_medical_unit/index.shtml OSR Off-Service Rotation = Peds, ER, OBS, Surgery etc. Schedulers not to schedule you during AD, but may be on call in pm. HDB may be scheduled during OSR except adult ER If scheduled to be on call the night before a HDB, advise NCMC/Ed assistant of your absence as soon as you know your schedule Advise Program Assistant if scheduled during more than 2 clinic HDB or ADs/rotation. PALS Pediatric Advanced Life Support FMBT activities noted in green HDB In-units Family Medicine Block Time PGY1 FMBT PGY2 FMBT PGY-1/2 PGY2 Practical Evidence Applied to Real Live Situations 3 article evaluations in R1 and 2 in R2. A self-directed evidence-based reflection exercise taking clinical questions, deciding on a course of action supported by the literature, and then reflecting on the effectiveness of the process. Physician Management Institute Canadian Medical Association physician leadership courses PGY2 Procedural Sedation Emergency Medicine course PGY2 RoRP Review of Resident Progress Meet monthly w/ lead preceptor. AD attendance reviewed. Monthly phone or in-person update during OSR w/ lead preceptor, as needed. SAMP Short Answer Management Problem Practice exams PGY2 SCA Scheduled Clinical Activity Unscheduled time falls around Northern site rotations so SCAs may need to be scheduled for you to ensure you obtain adequate learning opportunities. PGY2 SDL Self-Directed Learning A ½ day per week allocated for your own learning needs. To be arranged by resident. SOO Simulated Office Oral PGY1 - 5 to 6 Mock exams PGY2 - 2 to 3 Mock exams Preparation for CCFP Exam, interactive component Practice based small group learning Format for journal club, which occurs during academic days PEARLS PMI PBSGL Northern/Remote Resident Manual 2015-16 PGY1/PG Y2 FMBT FMBT PGY-1/2 PGY-1/2 FMBT FMBT PGY-1-2 Page 14 MCCEE MCCQE1/2 Medical Council of Canada Evaluating Examination Medical Council of Canada Qualifying Examination 1 & 2 For eligibility to sit the Medical Council of Canada Qualifying Examination Part I, graduates of medical schools outside Canada and the United States, referred to on this site as International Medical Graduates (IMGs), as well as graduates from U.S. Schools of Osteopathic Medicine must first pass the Medical Council of Canada Evaluating Examination. IMGs with specialty certification in Canada or the U.S. may be granted an exemption from the Evaluating Examination. International medical graduates, international medical students in their final clinical year and U.S. osteopaths must take the MCCEE as a prerequisite for eligibility to the MCC Qualifying Examinations. This is a general assessment of the candidate's basic medical knowledge in the principal disciplines of medicine. It is also designed to assess the skills and knowledge required at the level of a new medical graduate who is about to enter the first year of supervised postgraduate training or practice. QE1 - One-day, computer-based test that assesses the competence of candidates who have obtained their medical degree, for entry into supervised clinical practice in postgraduate training programs. The MCCQE Part I assesses knowledge, clinical skills, and attitudes as outlined by the Medical Council of Canada’s Objectives. QE2 - assesses the competence of candidates, specifically the knowledge, skills, and attitudes essential for medical licensure in Canada prior to entry into independent clinical practice. No longer harmonized with CCFP exam. WRHA Aboriginal Culture Awareness Workshop (ACAW) “The Aboriginal Culture Awareness Workshop is a two-day workshop that provides relevant information about the contemporary, historical and cultural issues that influence stereotypical impressions of Aboriginal people. It assists in altering perceptions and dispelling stereotypes that may result in resistance to hiring Aboriginal employees or failure to provide culturally appropriate care, and promotes the development of an equitable work environment for all staff within the WRHA. The WRHA has developed this workshop to build understanding between all health care staff and the Aboriginal patients and families they care for, and to build culturally respectful workplaces within the Winnipeg health region. The Aboriginal population is the fastest growing population in the Winnipeg health region. By teaching the impact of Canadian history on the Aboriginal community and dispelling stereotypes about Aboriginal culture an increased understanding of Aboriginal peoples’ current cultural beliefs and traditions for well-being is obtained. This increased understanding may result in providing more appropriate care to the Aboriginal population and increase acceptance to hiring Aboriginal employees. In this two-day workshop, relevant information about contemporary, historical and cultural issues that influence perceptions of Aboriginal peoples is discussed in an open, non-judgmental environment. Participation by all health care staff working in the Winnipeg health region is encouraged.” Attendance at the workshop is mandatory for Northern Remote stream residents. Please be on time and plan to attend fully for both days. On-call responsibilities must be handed off to another resident if on off-service or to the attending if on family medicine block. The workshop will occur during academic days. Northern/Remote Resident Manual 2015-16 Page 15 PGY1 Family Medicine Block Time Structure Family Medicine Block Time (FMBT) consists of 5 blocks of clinical supervision at Northern Connection Medical Centre, plus 8 clinical Half-Days Back (HDB) at NCMC, when on specialty rotations. The PGY-1 Program Assistant schedules residents for HDB. Residents are not expected to attend HDB during their adult emergency rotations. If a resident happens to be post-call for a scheduled HDB, they are not required to attend. They are required to notify PCAs (204-940-8225) and Program Assistant (204-940-1927) that they will be unavailable to see patients during the post-call day. All rotations generally provide the schedule at least 4 weeks in advance, and therefore it is expected that residents let NCMC know at least 21 days in advance in order to avoid having to cancel booked patients. FMBT residents are not scheduled for clinic on Tuesday mornings. Some of the scholarly activity requirements of the residency program will be scheduled on Tuesday mornings. They are considered Self-Directed Learning (SDL) afternoons. These are opportunities for residents to catch up on charting, work on their chart audits, arrange specific learning experiences for themselves, or attend to personal matters. Activities during SDL are not tracked. If residents want help in finding good clinical experiences, they are encouraged to consult their preceptors, R2s, or the Program Assistants. A separate list of SDL and elective opportunities can also be found in the orientation binder. The PGY-1 Program Assistant will send out a weekly schedule near the end of every week via email. Residents are required to check their email accounts as this is the method used to communicate. All residents will be issued a University of Manitoba email account for this purpose. In-Unit Seminars In-unit seminars are held every Thursday afternoon at NCMC for residents on FMBT. Attendance is mandatory. Psychiatry Seminars Psychiatry seminars are provided by Dr. Kieran O’Keefe, via Telehealth at NCMC, or residents at St. Boniface for rounds can choose to attend in person. Some of these sessions will fall in the academic day schedule, and some will be scheduled separately for residents on FMBT. Attendance is mandatory. Guideline Review Guideline Review takes place over the lunch hour on Thursdays starting at 12:30. FMBT residents will take turns presenting guideline review, according to the schedule provided by the Program Assistant. In the first FMBT block, residents will be provided a “core” list of guidelines to choose from. In the second block, they can choose any guideline of interest. Please check with Dr. Suss regarding the choice of guideline prior to presenting. Here are some tips for how to present a review of an article or a clinical practice guideline: General tips: Choose your first guideline from the NCMC Guideline Review Core Curriculum below Your second guideline should address one of the 99 topics, and should be evidence based Your presentation should be about 20 minutes long. This will allow time for questions and discussions. Present a brief summary of the guideline in your first ten minutes. Highlight a few recommendations that you think will have the greatest impact on our patients. Spend your second ten minutes critiquing the guideline. Think of the exercise as a book review. At the end you want your colleagues to be able to decide whether to read the guideline and whether to take its recommendations seriously. Submit an electronic copy of your article to the Program Assistant for distribution before your presentation, and a copy of the powerpoint you present to the team. This is a list of things you should consider when analyzing the quality of an article or guideline: Source: Who are the authors? Why did they write this article? Was there any potential conflict of interest? Are the authors the best source of information on this topic? Applicability: Does it offer practical recommendations? Even in a remote practice location? Northern/Remote Resident Manual 2015-16 Page 16 What is the cost of the recommended interventions? Are they covered by pharmacare? FNIHB? How much benefit will the high impact interventions have for our patients? (The effectiveness of therapeutic interventions is generally measured as a Number Needed to Treat; screening interventions as a Number Needed to Screen; and diagnostic interventions as Likelihood Ratios.) Evidence: What kind of evidence is there to support the highlighted recommendations? If the evidence is weak then is there any reason we ought to follow them? NCMC Guideline Review Core Curriculum 1. Hypertension CHEP 2014 https://www.hypertension.ca/en/chep 2. Diabetes CDA 2013 http://guidelines.diabetes.ca/executivesummary 3. Breast Cancer Screening CTFPH 2011 http://canadiantaskforce.ca/ctfphc-guidelines/2011-breast-cancer/ 4. Cervical Cancer Screening CTFPH 2013 http://canadiantaskforce.ca/ctfphc-guidelines/2013-cervical-cancer/ 5. Colon Cancer Screening CAG 2010 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004442/ 6. Hyperlipidemia CCS 2012 http://www.onlinecjc.ca/article/S0828-282X%2812%2901510-3/fulltext 7. Osteoporosis, Osteoporosis Canada 2011 http://www.cmaj.ca/content/early/2010/10/12/cmaj.100771.full.pdf+html?ijkey=edc6c6048e7d4acdc41368 fe3f1e622bf5a2deac&keytype2=tf_ipsecsha 8. Asthma CTS 2012 http://www.respiratoryguidelines.ca/sites/all/files/2012_CTS_Guideline_Asthma.pdf 9. COPD CTS 2014 http://journal.publications.chestnet.org/data/journals/chest/0/chest.14-1676.pdf 10. CHF CCS 2012 http://www.onlinecjc.ca/article/S0828-282X%2812%2901379-7/pdf 11. Prostate Cancer Screening CTFPH 2014 http://www.cmaj.ca/content/186/16/1225.full.pdf+html Simulated Office Oral (SOO) Five to six mock exams will be scheduled for each resident. Further information is in the Department of Family Medicine Resident Manual. Practical Evidence Applied to Real Live Situations (PEARLS) Schedule to follow, information below. A series of evidence-based practice reflection exercises designed to enhance your understanding and application of critical appraisal skills. Evidence-Based Medicine (EBM), initially proposed by Dr. David Sackett and colleagues at McMaster University, is an important tool in the way physicians practice clinically, teach others, and do research. Dr. Sackett defines EBM as: “….the conscientious explicit and judicious use of current best evidence in making decisions about the care of individual patients.” Residents are required to complete 3 PEARLS exercises during your first academic year. Your Program Assistant will schedule your PEARLS sessions for you. Your preceptor will discuss your exercise with you and assign a pass/fail grade. PEARLS Exercise Reports (please use the report on your USB), Critical Appraisal Worksheets, and more information on PEARLS and the series of steps used in this reflection process can be found on the CFPC website at www.cfpc.ca/Pearls_for_Residents/. Northern/Remote Resident Manual 2015-16 Page 17 Case Discussion Rounds Case discussion rounds are held Wednesdays over the lunch hour starting at 12:30. On-Call Guidelines for NCMC Weekly Coverage: One attending physician is on-call per week, Monday at 8:30 to Friday at 5:00pm. Two residents at a time are assigned to hospital in-patient duties, alternating call days Monday-Thursday. When assigned to attend hospital in-patient duties, residents spend the morning at St Boniface Hospital on the family medicine ward at 6A South (temporarily 4B), and are expected at Northern Connection Medical Centre (NCMC) for afternoon clinic by 1:00pm. When not assigned to the hospital, residents should be at NCMC for clinic starting at 8:30 am. Mon. am rounds: The weekend and weekday attending physicians and hospital residents meet for sign-over at 8:30. Tue.-Fri.: Unless otherwise specified by the attending physician, ward rounds begin at 8:30 Tue-Fri. Residents are expected to assess their patients before rounds begin, begin to write notes, and read through the chart from the preceding day. Please come to rounds prepared to fully discuss the patients’ issues. The attending physician for the week determines the morning schedule. It may include attendance at Family Medicine Grand Rounds, which are scheduled once a month on a Tuesday, from 9-10 am (Grand Rounds schedule is posted on ward). When patient care activities are not expected to fill the morning, the attending physician may decide to provide a short teaching session on a relevant ward or hospital care topic. New admissions may occur in the morning or in the evening. The on-call resident may be required to go back to the hospital after completing his or her clinic duties. Generally, residents are not expected to return to the hospital after 10:00pm to admit stable patients. Only attending physicians should be accepting patients for admission. If called directly by the Emergency physician, residents should redirect the caller to the attending physician on call. Family medicine call is done from home. If there are concerns about a patient’s condition, residents are expected to return to assess the patient if the situation calls for it, regardless of the time. Once per rotation, academic days are held on the last Tuesday and Wednesday of the period. The hospital residents should meet the on-call physician at 8:00 am on the ward for a brief sign over before leaving to attend academic day which begins at 9. Newly admitted and active medical patients should be seen before rounds. Attending physicians will take care of hospital patients and will take calls on the blackberry throughout the day. The on-call resident may still be called in the evening for admissions or urgent patient care issues. Please update the shared NCMC drive daily. This is a shared drive accessible both from the hospital and the office where patient information can be securely stored. Please do not use patient names, only initials. It facilitates the care of patients as they are transferred from one team of residents to another. The file is password protected, consult your preceptor to get the code. Residents must enter discharge summaries for patients under their care within 24 hours of their discharge. It is helpful if the discharge summary is started early in the admission and is added to as the admission progresses. This facilitates handover to incoming residents. Weekend Coverage: Two residents will be on call each weekend; one resident from NCMC and one from Family Medical Centre (FMC). One attending physician from either NCMC or FMC will be on-call to support both residents. The NCMC residents and attending physician will sign-over to the weekend attending physician at 12:30pm in the conference room on the ward. After sign-over, FMC will meet in the conference room to conduct sign-over for their patients, while NCMC residents return to the clinic for the afternoon. The first patient for these two residents will be scheduled for 1:40. Northern/Remote Resident Manual 2015-16 Page 18 The attending physician will set the meeting time for the weekend. Weekend call is from Friday at 5:00 pm to Monday morning at 8:30 am. Occasionally, there will be a second year resident from FMC on-call in addition to the usual first year residents. In this case the R2 is in a supervisory and teaching role. The primary responsibility for the in-patients’ care and for any new admissions falls to the two R1 residents. When an R2 resident is available, he/she will review the patients with the other residents, and contact the attending for backup if needed. Weekend admissions are shared equally between the two R1s and are distributed by the attending physician. In general, the resident from each clinic will look after their own service’s patients, although if there is a marked discrepancy between the numbers of patients on the two services, the attending may ask one resident to help the other out. In the event that there is a medical student also taking a call shift over the weekend, they will participate in the daily care of the in-patients and may be asked to complete an admission. All of the orders will need to be co-signed by either a resident or an attending. Teaching Unit: FMC and NCMC share a 15-bed teaching unit, to which there will be unassigned patients admitted (patients with a family doctor who does not admit to the hospital) FMC accepts teaching unit admissions Monday and Tuesday while NCMC accepts teaching unit admissions Wednesday and Thursday. On Friday and over the weekend, the attending physician on-call accepts the teaching unit patients, and may reassign them on Monday to the other service so that each clinic carries approximately half of the patients. Private patients (those registered at NCMC or living in any of the communities served by NCMC) are accepted every day of the week, in addition to any teaching unit patients, and are not limited in number (other than by the number of open beds on the ward). Call Conversion: Home-call can convert to an in-house call if the resident has been present at the hospital for 4 hours after 5:00pm, as long as one of the hours is between midnight and 6:00am. The resident must have been directly involved with patient care for that period of time When a resident converts call to in-house, he or she is entitled to a post-call day the next day, but MUST call NCMC at 8:30 in the am to let the front desk staff know (204-940-8202), and notify the attending on call. Residents must attend sign-over rounds in the morning before they can leave for their post-call day. The attending physician and remaining resident(s) will take care of any remaining patient care issues. Residents are to go to the PARIM website for the forms needed to convert their call. There is a significant increase in the amount paid for in-house call compared to home-call. Residents are not expected to come in from home to do an admission after 10:00pm. If a resident is notified of an admission early in the evening but chooses to come in later to conduct the admission, the home- to in-house call conversion does not apply. Call Schedule: Northern Remote Chief Residents make up the call schedule for NCMC residents. Absence requests require a two-step process. Residents must email the Chiefs with any call requests before the schedule is sent out. They must also fill out a request for absence form, and submit it to Dr. Lynch or Norma Crawford, Office Manager. Request for Absence from Clinic forms are on the Department of Family Medicine website, and can also be found in the Resident Room at NCMC. Northern/Remote Resident Manual 2015-16 Page 19 Once the schedule is sent out, no further changes will be made by the Chiefs. Residents are welcome to switch evening or weekend call with each other at this point, but they are then responsible for notifying: o o o o o 6A South (4B) Paging at St Boniface ER NCMC physician on-call or FMC physician on weekend call Program Assistant, who will let the front desk know After residents switch call, it is their responsibility to ensure any necessary sign-over has occurred to ensure continuity of care and patient safety. There may be days when there are educational or other activities that conflict with the usual morning rounds. In that case, it is again the residents’ responsibility to ensure the patients are cared for. They can come in early to see patients, or ask the other resident(s) to cover the patients for the day. Attending physicians are also willing to cover. It is important to communicate the plan to the weekly attending physician. Sick Calls: When ill and unable to attend clinic or hospital rounds, residents must Call the front desk staff at NCMC, 204-940-8202, and the Program Assistant at 204-940-1927, advising them of their illness, at 8:30 am If on hospital duties, also call the attending physician advising him/her of the illness. NOT send a message with another resident, text a message or send emails, as these will not be checked in a timely manner. Enhanced Learning Opportunities during PGY1 FMBT Residents will be given a checklist of the enhanced learning experiences that are offered during PGY-1 FMBT. Residents will be scheduled into the activities by the NCMC primary care assistants and the Program Assistant, and will be able to see their daily schedules in Accuro. While every attempt is made to ensure all residents have opportunity to attend each activity, patient cancellations and resident/faculty illness can interfere with exposures. Residents are responsible to ensure the minimum number of exposures occur (see below) and are signed off by the preceptor. If the resident has not been scheduled or has had to cancel an activity, he or she should email the Program Assistant and ask that the experience be added to the schedule before the end of FMBT. Residents who desire more exposure, or who wish to attend an allied health appointment with a patient they have referred, can make requests to the front desk staff and attempts will be made to accommodate them. Field notes should be completed for all enhanced exposures. Allied Health Visits: All residents should spend one half day seeing patients with the dietitian, the occupational therapist, the physiotherapist, and the child psychologist. Residents are required to spend at least 2 half days with the psychiatrist. The shared care counselor is a resource for residents to learn community mental health resources and counseling skills from. When referring a patient to shared care, please send a message to Amber Pettigrew in Accuro asking her to schedule you to attend the session, in addition to filling out the Shared Care Mental Health Referral Form and tasking it to the preceptor. The counselor may follow-up with you to suggest alternate options for your patient or to discuss the case further prior to the appointment. The counselor on occasion will observe residents during medical appointments using the camera for feedback on interviewing and health behavior change in a primary care medical visit, together with your physician preceptor. If you would like more opportunity for direct observation please let your preceptor know. Nurses will work closely with new residents to help them get a feel for the clinic and for the nursing role. Northern/Remote Resident Manual 2015-16 Page 20 All staff of the clinic have a role in your education, including the support staff. Please feel free to ask lots of questions and get support when you need it. Lifeflight: Residents will be scheduled for one or two Lifeflight or STARS air ambulance shifts during FMBT. This will occur on the weeks the resident is not scheduled to cover hospital in-patients. The following day will be scheduled for SDL. Residents must attend an orientation prior to being scheduled for Lifeflight; orientation will occur during academic days. (A resident who misses the orientation because of vacation cannot be scheduled for Lifeflight). Call stipends do not apply to Lifeflight/STARS shifts. Newborn Care: Residents will be assigned at least one morning during FMBT to attend unassigned newborns with the NCMC physician on call for newborn care at Women’s Hospital. Newborn care takes place every second Tuesday. Please see reading list for newborn care. Teen Clinic: Teen clinic occurs once a week from 3-6 pm on Wednesday afternoons Sept-June at Southeast Collegiate, a private boarding school for Northern First Nations high school students. Each resident will be assigned to teen clinic at least once. Red Road Lodge: Each resident will be assigned to attend Red Road Lodge at least once. This is a temporary housing facility for homeless individuals who are awaiting treatment for addictions. House Calls: From time to time, residents will be asked to see patients in their home, if circumstances warrant it. Residents will be accompanied by a nurse, physician, or the Community Outreach worker. Many of these patients live in the residential complex at 425 Elgin Avenue (St. Andrew’s Place) or in the community within walking distance. BridgeCare Clinic: Each resident will have the opportunity to attend at least one full day at BridgeCare Clinic, located at the same desk as NCMC. The clinic sees new refugee families upon arrival in Winnipeg. Prenatal Clinic: Each resident must attend a minimum of 2 prenatal clinics, which occur on Wednesday afternoons at NCMC. Northern Exposure: R1 residents will be given the opportunity to spend two weeks in Norway House during FMBT, and/ or in Thompson for one block of obstetrics/gynecology. The goal is to expose first year residents to the challenges and rewards of northern work before spending the bulk of their FMBT in northern communities in second year. Women’s Health Clinic–Portage: (optional) A one day experience introducing the resident to Abortion Care, held at Women’s Health Clinic-Portage. See objectives below. Women’s Health Rotation Objectives: For all residents in the rotation: (including those who choose not to be present for an abortion procedure): 1. Understand pre-referral and follow up care of women who undergo an abortion. 2. Understand the experience of a women presenting for abortion through the process from counselling to discharge. 3. Understand issues of patient and staff confidentiality and security. Northern/Remote Resident Manual 2015-16 Page 21 4. Observe, and in some instances, participate in a counselling session including (depending on the resident comfort and preference) any or all of: pregnancy options, contraceptive options, or pre-abortion counselling. 5. Understand the opportunity for contraception counselling and provision when caring for any woman with an unwanted pregnancy, including the opportunity for provision of immediate long acting reversible contraception (LARC). For residents who also wish to observe (or learn portions of) the abortion procedure: 6. Perform early gestational dating pelvic examination, and receive immediate bedside ultrasound confirmation feedback. 7. Learn to perform a painless, effective, paracervical block (useful for IUD insertions, endometrial biopsies and D&C, etc) Nine Circles Community Health Centre: (optional) A two week experience at Nine Circles HIV care clinic is offered to all residents in the Northern Remote stream. See objectives below. Nine Circles Community Health Centre – HIV/Primary Care Selective Objectives Purpose: An Introduction to HIV Primary Care and overview of ST/BBI testing and prevention Objectives: 1. Review of HIV a. Risks b. Transmission c. Natural history d. Presentation 2. Overview of STI Screening 3. Review basics of initial assessment of new HIV diagnosis a. History b. Physical c. Investigations 4. Introduction to HIV Treatment a. Introduction to antiretroviral medications b. Review of treatment guidelines, prophylaxis for Opportunistic infections c. Review of common treatment side effects and interactions Resources: Articles: IDSA HIV primary care guidelines: 2013 update: http://cid.oxfordjournals.org/content/early/2013/11/12/cid.cit665.full.pdf+html IAS HIV treatment guidelines: 2014 update http://jama.jamanetwork.com/article.aspx?articleid=1889146 Other online resources: Northern/Remote Resident Manual 2015-16 Page 22 1. European HIV guidelines http://www.europeanaidsclinicalsociety.org/ 2. HIV primary Care guidelines out of BC Centre for Excellence http://www.cfenet.ubc.ca/therapeutic-guidelines/primary-care 3. US Department of Health and health Services Guidelines http://www.aidsinfo.nih.gov/guidelines/ 4. Sanford Guide on HIV/AIDS a good pocket reference Northern/Remote Resident Manual 2015-16 Page 23 PGY2 Family Medicine Block Time Structure In most northern locations, residents will be assigned to work with one primary preceptor, and the resident schedule will mirror that of the preceptor. It may entail some emergency shifts, obstetric call, PCH or hospitalist work, over and above the office based practice. Academic days will be held in Winnipeg on the last Monday and Tuesday of each rotation. Residents should be encouraged to attend any educational events including journal clubs or CME offered in the community. They are allowed one day to work on their chart audit in the community in which the audit will be conducted. Self-Directed Learning (SDL) As per the department’s Self-Directed Learning Time policy, second-year residents are allowed (12) half-days (or the equivalent) to engage in SDL to use to study/exam prep, learning opportunities etc. Scheduled Clinical Activity (SCA) Unscheduled time falls around Northern rotations so SCAs are scheduled to ensure residents obtain adequate learning opportunities. If requested SCA dates become unavailable then a SDL Half Day(s) may need to be scheduled as a SCA, and the SCA date that couldn’t be scheduled would become an SDL Half Day(s). Residents are expected to perform on-call duties. The exact nature and number of call shifts depend on the nature of the practice and generally mirror the practice of the lead preceptor. PARIM regulations are to be respected at every site, but residents are permitted to use their discretion if their best interest is served in extending duty hours in exceptional circumstances (eg: to be involved in a medevac or major medical intervention). Residents are under no obligation to do so and should not be coerced by preceptors to violate their rights to limited duty hours. If such coercion is felt to have occurred, please notify the stream lead or northern education director. Simulated Office Oral (SOO) Two to three mock exams will be scheduled for each resident. Further information is in Department of Family Medicine Resident Manual. Practical Evidence Applied to Real Live Situations (PEARLS) Schedule to follow, information below. A series of evidence-based practice reflection exercises designed to enhance your understanding and application of critical appraisal skills. Evidence-Based Medicine (EBM), initially proposed by Dr. David Sackett and colleagues at McMaster University, is an important tool in the way physicians practice clinically, teach others, and do research. Dr. Sackett defines EBM as “….the conscientious explicit and judicious use of current best evidence in making decisions about the care of individual patients.” Residents are required to complete 2 PEARLS exercises during your second academic year. Your Program Assistant will schedule your PEARLS sessions for you. Your preceptor will discuss your exercise with you and assign a pass/fail grade. PEARLS Exercise Reports, Critical Appraisal Worksheets, and more information on PEARLS and the series of steps used in this reflection process can be found on the CFPC website at www.cfpc.ca/Pearls_for_Residents/ . Northern/Remote Resident Manual 2015-16 Page 24 Clinical Audit Guidelines It's recommended that you do your Chart Audit while in Norway House, Churchill, Yellowknife, or Hodgson, and present it to the practice in which the audit was performed. If unable to complete the project in a community, it can be done at NCMC during SDL time. Projects will also be presented at the Department Research Day. Further information is in Department of Family Medicine Resident Manual. Community Bridging Project The Community Bridging Project is optional. You are given the opportunity to leave clinic, up to 2 half days in total, to participate in a community based, health-related activity of your choice. Permission must first be sought from your preceptor to ensure clinic coverage is secure. A field note should be reviewed with your preceptor and forwarded to the Program Assistant. The objectives of the Community Bridging Project are: 1) To raise the profile of the residency program in our partner communities and foster good relationship between our training program and community members. 2) To raise residents’ awareness of the wider determinants of health in northern communities. 3) To foster the residents’ sense of themselves as community members and leaders of change. 4) To allow residents to experience some of the richness of life in northern communities. Some examples of Community Bridging Projects include: Planting a community garden Participating in a radio call-in show (“Ask the Doctor...”) Participating in a cultural festival Participating in school health education sessions Learning a local craft from an elder Newborn Transports Interested PGY2 can take part in newborn transports while on Neonatology. The procedure: 1) Resident to call the transport nurse (in NICU 204-787-3567) just before their in-house call (resident's name and pager will then be placed on the NICU on-call board along with the primary transport physician's); 2) Resident (who could be in SBGH NICU or HSC IMCN) will be notified of impending transport by the transport nurse; 3) Transport team meets at HSC-Children's Emergency Room whilst waiting for ambulance; 4) After completion of transport, resident will present the primary transport physician "End of Shift Feedback Form" evaluation form (primary transport physician would be in a better position than the attending physician to evaluate as the primary transport physician was with the resident during transport). Any resident who is keen to be on call on the other weekend is welcome to go through the same steps (ideal mobilization time if they are coming from home is 30 minutes from the decision to transport & 45 minutes if there are extenuating circumstances like bad weather). Addictions Rotation Preparation Each Northern Remote family medicine resident will be scheduled for 4 weeks of Addictions Medicine at Health Sciences Centre. This is a hospital-based rotation that does not involve overnight call. There is, however, a requirement that residents are on call on a rota during the day, and for 2 weekends. If you have time off requests for weekdays or weekends, please advise the service of your request 4 weeks before starting the rotation. The Northern/Remote Resident Manual 2015-16 Page 25 administrative assistant from the service will contact you by email, using your University of Manitoba account, 6 weeks prior to the start of your rotation to prompt you. During the Addictions rotation there are no on-call stipends provided by the WRHA, due to the comparatively light duty hours required of learners on this service. Sharon Shaydak Administrative Assistant Addictions Program Health Sciences Centre TEL (204) 787-3843 FAX (204) 787-3996 [email protected] PGY2 ON-CALL Procedures NOTE: Follow procedures as below until otherwise notified of VENTIS instructions. Details regarding call can be found in the PARIM Collective Agreement. Please see Article 14 of the agreement. To get paid for call you must email, fax or drop off your completed Call Schedule Reports to your Program Assistant. A Resident who is scheduled for Home call on a weekend or a designated recognized holiday but is required to work in the hospital during the call for more than twelve (12) hours shall be remunerated at 75% of the rate applicable to the In-Hospital call. To be paid the appropriate amount, you must submit a call conversion form ONLINE for EACH call shift that qualifies. The PARIM Call Submission Form is available on: http://www.umanitoba.ca/faculties/medicine/units/family_medicine/postgrad/formsanddocuments.html WRHA will need to see the following on the template: 1) 2) 3) 4) 5) Rotation Site location and address Resident name Name, designation and signature of the preceptor State home or in-hospital call in each slot Residents are to follow the on-call requirements of the site. If, however, the site has put you on call in excess of the usual PARIM guidelines (1 in 3 for home call and 1 in 4 for in-hospital call), you are able to decline some of the call shifts, knowing that you may miss out on learning opportunities by doing so. If you prefer to participate in all scheduled shifts, PARIM will only pay stipends for up to the usual number. You are entitled to invoke the PARIM rule that if you are actively caring for patients for more than 4 hours in a row, one of which is after midnight, you are exempt from clinical duties the next day, after signing over your patients and ensuring continuity of care. You may not elect to take a call shift instead of working the usual clinic shift during the day. At remote sites, it may not be immediately obvious whether the call should be considered home call or in-hospital call. The location of the room that you live in is not the important factor, as they are often located in the hospital or hospital complex itself. If a call shift entails being up most of the night actively caring for patients, it should be Northern/Remote Resident Manual 2015-16 Page 26 considered in-hospital call, and the 1 in 4 limit would apply to the stipends offered by PARIM and to the maximum number of shifts you are obliged to attend. If you are primarily taking only phone calls, and are rarely needed to see a patient in person, it should be considered home call. This holds true for obstetric calls other than on core obstetric rotations. If you are called in and spend more than 4 hours involved in active patient care, one of which is after midnight, you can convert the call to hospital call, and request the higher stipend. To convert home-call to inhospital call you need to go to the PARIM home call conversion form online at http://www.parim.org/?page_id=256 Emergency shifts are not considered call shifts and stipends are not paid for these. Aboriginal Health Rotation Overview: The Aboriginal Health rotation is designed to promote among family medicine residents the knowledge, skills and attitude required to provide culturally competent and effective care to patients of aboriginal descent. It also aims to foster the development of leadership skills and an understanding of health policy as it pertains to aboriginal communities in Canada, particularly those in northern and remote areas of Manitoba. Goals: 1. Residents will develop an understanding of the determinants of health as they pertain to aboriginal people living in northern, remote, rural and urban environments. 2. Residents will develop an understanding of the political structures which oversee health delivery systems in Northern Manitoba and the Territories. 3. Residents will develop an understanding of the concept of cultural safety as it pertains to aboriginal populations. 4. Residents will gain an understanding of existing legislation and policies influencing healthcare services and the delivery of those services to aboriginal people and communities in northern and remote environments, and the ways in which these contribute to health equity. Activities: Participate in the WRHA Aboriginal Cultural Awareness workshop (2 days) Participate in Journal Club, and Academic Activities related to Northern Medicine and Aboriginal Health. Complete assigned readings Attend in-unit didactic sessions on topics relating to Aboriginal health, which may include: o FNIH presentation describing role of FNIH/NIHB in the funding and delivery of health care o Self-care o Effective distance communication o Effective use of interpreters o Jurisdictional issues vis a vis healthcare funding and service delivery (e.g., interfaces between relevant federal, provincial, regional health authority, band, community/municipality bodies) Traditional teachings with an aboriginal elder (available at HSC) Community Bridging Project Winter Retreat Exercises from Promoting Culturally Safe Care for First Nations, Inuit and Métis Patients: A Core Curriculum for Residents and Physicians (jointly developed by the Indigenous Physicians Association of Canada and The Royal College of Physicians and Surgeons of Canada) as well as the Family Medicine module that is part of the same set of documents. Northern/Remote Resident Manual 2015-16 Page 27 ABORIGINAL HEALTH OBJECTIVES It should be noted that objectives will be met over the course of the entire residency. Learning takes place during all rotations, during didactic seminars, and via independent study. GOAL: To enable residents to acquire the skills, knowledge and attitude needed to provide effective care to individuals of aboriginal descent and to aboriginal communities, particularly those which are located in northern and/or remote areas of Manitoba. The family physician is a skilled clinician. Can effectively provide and integrate acute and chronic care for individuals from various aboriginal populations in a culturally appropriate manner. Identifies issues and implements strategies for preventing illness and injury in aboriginal patients. Describes and assesses the cultural diversity of aboriginal patients that result in a variety of perspectives, attitudes, beliefs and behaviors. Describes aboriginal perceptions of health and wellbeing and understands the application of the medicine wheel to this concept. Describes the essential features of aboriginal traditional healing for local First Nations, Inuit and Métis communities and their implications for doctor-patient interactions. Demonstrates the ability to work collaboratively with the team of local health care professionals, heal care workers and traditional healers to provide optimal patient care. Recognizes the challenges in communicating with patients through interpreters and takes steps to optimize the effectiveness of communication and mitigate the associated risks. Demonstrates an awareness of itinerant, consultant and referral services available in aboriginal communities, and utilizes these services appropriately. Understands the challenges and risks associated with communicating with other health care professionals located in distant locations and implements strategies to reduce them. Is familiar with First Nations & Inuit Health Branch (FNIHB) benefits programs, including their scope and limitations and the processes involved in accessing them. Family Medicine is community based. Describes the determinants of health pertaining to aboriginal people living in northern, remote, rural and urban environments and recognizes the impact of these on the burden of illness in aboriginal populations. Describes the political structures which oversee health care delivery in Northern Manitoba and Nunavut and recognizes the jurisdictional issues (federal, provincial, health authority, band, community, municipality) which impact the delivery of health services. Describes existing legislation and policies influencing healthcare delivery and health equity for aboriginal people and communities. Recognizes and respects the diversity of roles, responsibilities and competencies of health professionals and health care workers in aboriginal communities. Collaborates with key aboriginal community contacts and support structures in the provision of patient care and in the development of community-based initiatives. Actively participates in community activities that relate to improvement of health and well-being. Applies evidence and manages care to provide cost appropriate care within aboriginal communities, taking socio-economic, geographic and cultural issues into account. Demonstrates partnership and appropriate ethics processes in developing research with aboriginal communities. Applies the concepts of community development, ownership, consultation, empowerment, capacity-building, reciprocity and respect in relation to health care delivery for aboriginal people and communities. Northern/Remote Resident Manual 2015-16 Page 28 The family physician is a resource to a defined practice population. Evaluates key health indicators for Canadian aboriginal people and understands and evaluates the limitations of available data. Advocates for equitable access to health care resources for aboriginal patients and communities. Understands the connection between history and health outcomes for aboriginal peoples. Assesses and evaluates the overt, subtle or structural discrimination occurring in interactions between aboriginal patients and the health care system. Identifies health public policy initiatives relevant to the aboriginal community(ies) being served and advocates for their adoption. Assesses the needs of aboriginal patients/communities with respect to health information and education and implements effective strategies to meet those needs. Acknowledges both positive and negative impacts of living in remote settings and implements effective strategies to balance professional, family and personal needs and demands in light of these impacts. The doctor-patient relationship is central to the role of the family physician. Defines the concepts of cultural sensitivity, cultural awareness and cultural safety and applies this understanding in interactions with patients. Acknowledges, identifies and analyzes the ways in which one’s own emotional reactions, cultural values and perspectives influences interpersonal interactions and the provision of care. Demonstrates the ability to establish a positive therapeutic relationship with aboriginal patients and their families which is characterized by understanding, trust, respect, honesty and empathy. Communicates with aboriginal patients and their families in a way that is understandable to them and encourages their participation in decision-making. Exhibits professional behavior in clinical encounters with aboriginal patients and other health providers. Upholds patient confidentiality, recognizing the challenges that may exist in aboriginal communities around this issue. Please see DFM Website for CanMeds-FM Updated version of Aboriginal Health Objectives as they apply to all residents in Family Medicine at the University of Manitoba Reading Required Reading (on your USB): Consult and Referral Request Letter Assessment Tool First Peoples, Second Class Treatment First Nations, Inuit, Métis Health Core Competencies Research Evidence / 5 Basic Tasks of the Medical Interview Resources – Certification Examination of the College of Family Physicians of Canada SOGC - A Guide for Health Professionals Working with Aboriginal Peoples – Executive Summary SOGC - A Guide for Health Professionals Working with Aboriginal Peoples – Health Issues Winter Driving Cultural Safety Fact Sheet Obstetrics Survival Guide Tips and Tricks for the EPR at St. Boniface BCG Vaccination of the Infant Care of the Late Preterm – HSC Policy Hepatitis B&C Management – HSC Policy BCG Information for Parents – HSC Policy Hypoglycemia in Infants – HSC Policy Infant at Risk of Chlamydia – HSC Policy Jaundice in the Newborn – HSC Policy Neonatal Substance Exposure in Utero – HSC Policy Normal Newborn Service – Goals and Teaching Package Ontario Directive on BCG Northern/Remote Resident Manual 2015-16 Page 29 Perinatal Sepsis 2011 – HSC Policy Preventing HIV Maternal Child Transmission – HSC Policy Selected Suggested Reading: CAIR Guidelines for Global Health Elective Placements (on USB) Chapter Two / The Principles of Family Medicine (on USB) Three Day Road, Through Black Spruce, The Orienda, Author Joseph Boyden (NCMC Library) Dancing with a Ghost, Author Rupert Ross (NCMC Library) Consumption, Author Kevin Patterson (NCMC Library) In Search of April Raintree, Author Beatrice Culleton Mosionier Night Spirits, Author Ila Bussidor (NCMC Library) Indian Horse, Author Richard Wagamese (NCMC Library) 2010 Inuit Cultural Competency Resources (on your USB) SOGC - Returning Birth to Aboriginal, Rural, and Remote Communities (on your USB) Cultural Safety in First Nations, Inuit and Métis Public Health (on your USB) Psychiatry Rotation Psychiatry experiences include: Seminars during FMBT in PGY1. Shared-care Psychiatry at NCMC – Residents will participate in comprehensive psychiatric assessments on patients at NCMC with the psychiatrist Monday afternoons on a rotating basis. Shared-care mental health counseling – Residents will work alongside a mental health counselor on a rotating basis participating in counseling sessions, as well as learning behavior change modification and Cognitive Behavior Therapy (CBT) in the office setting. Child Psychology – Residents will participate in clinical encounters with a Child Psychologist on Tuesday mornings during FMBT on a rotating basis Psychiatry experiences are found on the Off Service Rotations with frequency. The Addictions rotation is considered a significant component of the horizontal psychiatry/family medicine rotations in PGY2. Northern/Remote Resident Manual 2015-16 Page 30 Evaluations Resident Evaluations The process for completion and review of resident evaluation will be described by the Ventis team. Please check the DFM website for updates and instructions. In the event that the evaluations do not get implemented on VENTIS until a later date, please use the ITERS/Forms included on your USB. http://umanitoba.ca/faculties/medicine/units/family_medicine/postgrad/6381.html In-Training Evaluation Report (ITER) and Objectives will be linked to the rotation in Ventis. At the end of each Period, this comprehensive evaluation form is completed by the lead preceptor, which serves as the formal evaluation and determines whether or not the resident has passed the rotation. These forms are to be reviewed with the resident. Any horizontal exposure of two weeks or the equivalent will require an ITER (eg: airway rotation, newborn care rotation, Nine Circles exposure) End-of-Shift Trainee Feedback Form- For some rotations, the resident may be supervised by a large number of preceptors who are unable to complete a summary ITER due to insufficient exposure to the resident, such as during rotations that are less than 2 weeks in length, or those that are taking place in a shift‐work environment such as ER. In this case, End‐of‐Shift Trainee Feedback Forms should be filled out, with each exposure to the resident. End-of-shift forms should be used for SCA activities in PGY-2, airway rotations, and emergency or OB shifts which occur within a family medicine block in either year, and returned to the Program Assistant. Eventually these will also be linked to Ventis, but the interim plan will be to continue to use the version found on the website. Trip Reports- while travelling to fly-in communities in R2 with NMU preceptors, residents will complete trip reports (see section on fly-ins) and hand them in to the Program Assistant who will forward them to the NMU. End-of-shift reports therefore do not need to be filled in with presenting complaints, but the supervising physician should complete the evaluation portion of the form. Field Notes- brief encounter reflections will be required once a day on FMBT and every time a resident participates in an enhanced learning opportunity or works with an allied health team member. These are formative and not evaluative. The intent is for the residents to assess one aspect of their own performance, and reflect upon both their strengths and areas in need of improvement. Clinical Assessment Form - Can be completed whenever a resident is directly observed by a preceptor (FMBT only) and reviewed with the resident for feedback as soon as reasonably possible after the encounter. This may include office visits, observed directly or indirectly via a camera, procedures, encounters in the emergency room, etc. These forms are designed for immediate and specific feedback about performance and provision of constructive criticism. While the narrative content of the note is formative, there is also an evaluative assessment section at the bottom that needs to be completed (novice, advanced beginner, competent, proficient). If VENTIS procedures not implemented Please Fax ITERs/Evaluations to: Winnipeg: 204-977-6917 Toll Free: 1-866-238-2406 Or Mail to: Department of Family Medicine, Northern Remote Stream T158, 770 Bannatyne Ave. Winnipeg, MB R3E 0W3 OR email directly to the relevant Program Assistant Northern/Remote Resident Manual 2015-16 Page 31 Biannual Review The Stream Lead or Education Director will meet with each resident at the middle and end of each year to review his or her evaluations, scholarly activity, and Academic Day attendance for the year. At this time a summative ITER for Professionalism and Ethics will be completed, if required. Program Evaluations The Stream lead, Education Director, or delegate, will meet with each resident annually to gather individual feedback on the program as a whole. In addition, confidential preceptor evaluations and self-reflection forms will be collected through VENTIS for submission to the department head’s office. Chief residents meet annually with all residents in the stream to gather collective feedback on the strengths and weaknesses of the program, and convey their findings in their annual report. Resident Rotation Evaluation Survey To help improve on our program we request that an Evaluation Survey (following page) be completed, and anonymously mailed or faxed, following each rotation. They are kept until the end of the year at which time they are combined and given to the Stream Lead for review. These forms are anonymous. Additionally, the program will send out anonymous surveys to residents and graduates at intervals, to assess whether the curriculum is meeting its overall goals. Northern/Remote Resident Manual 2015-16 Page 32 Resident Rotation Evaluation Survey Form Academic Year: 1. Rotation PGY1 FMBT OBS: PGY2 HSC Addiction ICU FMBT: Adult ER Hospital Medicine Palliative SBGH Women’s Nine Circles Neonatology: SICU MICU Flin Flon HSC SBGH MSICU Gold Swan River NT: site NMU: Norway House Airway: The Pas Geriatric Peds ER Thompson Morden/Winkler Peds Gen Orthopedic Surgery The Pas Thompson Peds Inpatient NU: site Churchill Hodgson Fly-in: site 2. Lead Preceptor (if applicable): 3. Rotation orientation Poor Fair Good Excellent N/A 4. Frequency of feedback Poor Fair Good Excellent N/A 5. Use of specific, constructive feedback Poor Fair Good Excellent N/A 6. Frequency of formal teaching sessions (e.g. rounds guidelines, review, small group discussion or presentations) Poor Fair Good Excellent N/A 7. Effectiveness of clinical teaching overall Poor Fair Good Excellent N/A 8. Enthusiasm for teaching Poor Fair Excellent N/A 9. Interpersonal climate of rotation (patience, courtesy, respect) Poor Fair Good Excellent N/A Good 10. Degree of independence appropriate to resident’s level of comfort Not enough responsibility Appropriate Too much responsibility most of the time most of the time 11. Encouragement for resident to express his/her own ideas Poor Fair Good Excellent N/A 12. Use of evidence-based medicine in practice setting Poor Fair Good N/A 13. Presence of other learners Supported my learning Northern/Remote Resident Manual 2015-16 Excellent Interfered with my learning NA Page 33 14. Opportunity to teach Poor Fair Good Excellent N/A 15. Demonstration of participation in inter-professional practice High Moderate Low Not at all 16. Please comment on the accommodations provided with respect to: Location: Amenities, including internet connectivity: Cleanliness: Privacy: Other: Comments about the rotation not covered in the questionnaire, or any points that need further elaboration. Please Fax or Mail: Fax: 204-940-4370 Mail: Northern Connection Medical Centre, Rotation Survey, 425 Elgin Ave.,Wpg, MB R3A 1P2 Northern/Remote Resident Manual 2015-16 Page 34 The following Policies are specific to Northern Remote Stream. All policies are within the Family Medicine Resident Manual. NR Policies Air & Ground Travel for Northern/Remote Stream Title: Section: Approval By: Approval Date: Policy Air & Ground Travel for Northern/Remote Stream Postgraduate Education Postgraduate Education Committee Executive Management Committee PEC: June 19, 2013 EM: June 19, 2013 Effective Date: July 1, 2013 Scheduled Review: Policy Contact: Applies to: July, 2018 Postgraduate Education Coordinator Northern/Remote Residents only 1.0 Purpose: The purpose of this policy is to provide information and guidance to residents and staff with respect to the travel costs within the Northern/Remote stream that will be paid for by the Department. 2.0 Policy: 2.1 In order to make a travel expense claim, original receipts must be submitted within 90 days of the completion of travel. 2.2 The following costs will be borne by the Department of Family Medicine, Northern/Remote Stream: 2.2.1 Flights to and from northern communities when attending core rotations required by the program (i.e., one flight at the beginning and one flight at the end of the rotation). 2.2.1.1 Northern/Remote Resident Manual 2015-16 Should a resident choose to travel with their own vehicle instead of flying to a location where road travel is possible, the Department will reimburse for mileage for one roundtrip per block from Winnipeg to that location only if mileage costs are less than airfare. Parking expenses will be reimbursed up to a maximum of $100 per block, and original receipts must be submitted. 2.2.2 Mileage for residents driving to and from a community where air travel is not required, once at the beginning and once at the end of the rotation. 2.2.3 Cost of travel (round-trip airfare or mileage) to bring residents to Winnipeg for core educational activities where the program demands attendance in-person. 2.2.4 Cost of air travel within the Northwest Territories and the Territory of Nunavut, up to two (2) round trips outside Yellowknife or Rankin Inlet (respectively) per resident, if the trip comprises part of the core rotation. Page 35 2.3 2.4 Northern/Remote Resident Manual 2015-16 2.2.5 Cost of return travel to Winnipeg to write the CCFP exam as per the Preparation and Clinical Release for Certification Examination policy. 2.2.6 Change fees incurred as a result of flights having to be rescheduled when the rescheduling is at the request of the program. 2.2.7 Costs incurred as a result of flights being cancelled due to weather or a change in preceptor plans. 2.2.8 Change fees incurred as a result of resident health issues. A doctor’s note may be requested for residents deemed unable to fly due to medical reasons. 2.2.9 Ground transportation (generally by taxi) to and from airport (e.g., Winnipeg home to Richardson International Airport; northern airport to residence) up to a maximum of $100 per trip, upon submission of original receipts. Additional expenses may be incurred by residents who choose to travel beyond what is required for the program. The following costs will NOT be covered by the Department of Family Medicine, Northern/Remote Stream: 2.3.1 Travel on weekends during a rotation when the resident is not on call. 2.3.2 Return travel to Winnipeg during a vacation that is taken mid-rotation. 2.3.3 Cost of car rental, mileage, taxi fares, parking or other transportation costs incurred during the rotation itself (except as noted in 2.2.3 above). 2.3.4 Cost of travel or accommodations for elective rotations. 2.3.5 Cost of family and pet travel or accommodations. 2.3.6 Change fees incurred as a result of flights being rescheduled at the request of the resident. 2.3.7 Change fees for flights missed by residents. 2.3.7.1 A resident who misses a flight is responsible for notifying the education assistant, stream lead or education director immediately, and will receive instruction as to whether the flight should be rebooked. 2.3.7.2 If instructed, the resident must rebook the trip on the next available flight him/herself rather than booking through the University of Manitoba travel agent and account. The resident will be responsible for any charges related to this rebooking. At any time, if the resident feels that air travel is inadvisable due to adverse weather conditions or other factors, he or she may decline to board the aircraft. In such cases, the resident must immediately notify the education assistant, stream lead , or N/R education director of the decision not to travel. Alternate Page 36 arrangements will be made by the education assistant. 3.0 References 2.5 If a resident feels that road travel is unsafe due to weather conditions or other factors, he or she may decide not to travel on a particular day. In such cases, the resident must notify the education assistant, stream lead, or N/R education director immediately of the decision. Residents are encouraged to invest in CAA membership and to carry a cell phone and emergency/survival kit during the winter months. 2.6 The departmental expectation for attendance at academic sessions during any given rotation applies even in the case of missed or cancelled flights, or changes in driving plans. Any alternate clinical duties the resident undertakes due to missed or cancelled travel plans will be credited to the rotation. Alternate clinical duties will be assigned by the stream lead or education director. 3.1 Faculty Postgraduate Medical Education Resident Safety Policy, Faculty of Medicine, University of Manitoba 3.2 Preparation and Clinical Release for Certification Examination policy, Department of Family Medicine. Northern/Remote Resident Manual 2015-16 Page 37 Self-Directed Learning & Scheduled Clinical Activities for Northern/Remote PGY2s Northern/Remote Resident Manual 2015-16 Page 38 Northern/Remote Resident Manual 2015-16 Page 39 MBTelehealth If you are in a remote location and unable to attend Academic Days (ADs) in person, you may be able to connect via MBTelehealth. (see below for how to book telehealth in this situation) Occasionally, meetings may be set up with the Associate Program Director or Education Director via telehealth. Connecting To MBTelehealth: 1. Contact MBTelehealth at 204-975-7714 or 1-866-667-9891. 2. If you're unable to connect with the help of MBTelehealth, contact the Post-Graduate Secretary at 977-5663 to advise that you tried, but were unsuccessful. If you do not contact or leave a message, explaining that you were unable to connect with the ADs despite contacting MBTelehealth Service Desk, you may be considered absent. 3. Please announce your attendance to the moderator who can mark you as present from northern sites. MBTelehealth Service Desk: The MBTelehealth Service Desk provides real time support for MBTelehealth events. They can be contacted at 204-975-7714 or 1-866-667-9891 option 1 to provide assistance with anything related to your MBTelehealth event. Service Desk Hours are Monday to Thursday 0730-2100 and Friday 0730-1730. Training – Telehealth 101 An introduction to telehealth equipment and processes. This document will help you understand the following: What telehealth is What the high level benefits of telehealth are The services available at MBTelehealth The types of telehealth connections The scheduling process The service desk process The equipment involved in a telehealth event How to use the remote control to: o Turn the Microphone on or off o Change camera views o Change the screen layout and display o Connect to another site o Split the screen in a multi-site event and/or control the far end camera Best practices for participating in a telehealth event Northern/Remote Resident Manual 2015-16 Page 40 What is Telehealth? Telehealth is the use of information and communication technology to link people to health care expertise at a distance. A secure, high-speed video link is used to connect a patient to health care professionals at another site in the province, in the country or around the world. The patient and care provider are able to see, hear and talk to one another in real time on a television monitor within their local health care facility. Telehealth also encompasses health related education programs and administrative support for rural health authorities. Benefits of using Telehealth: Improved access to specialized services that may not be available in every community Saves the patient and the healthcare system the time, money and risks associated with travel Allows for access to care while remaining close to family, friends and community supports at a time when added emotional and physical help may be needed Reduces the hardship and inconvenience of being away from work and home Provides access to continuing education for health care professionals Reduces administrative costs in relation to travel for rural health authorities Types of Telehealth Events Clinical – Clinical events encompass a wide scope of activities. Generally, they refer to a range of client care. For example, clinical services may include the following: Specialist Consultations Follow-up appointments Client Teaching Case Conferencing Discharge Planning Education – Examples of education events include Continuing Medical Education (CME), Continuing Nursing Education (CNE), and weekly Grand Rounds offered by the University of Manitoba which allow rural based health professionals to remain in their communities while continuing their professional development. MBTelehealth can also link outside of Manitoba for National and International events however, additional charges will apply. Administrative - Administrative events are held for the purposes of conducting meetings and interviews. Holding these types of events using telehealth reduces travel time for regional administrators and increases their ability to participate in multiple meetings in the province regardless of distance. Some examples of administrative users for the network include regional, provincial and national health programs. Televisitation - A televisitation is an event where a patient, who is on an extended stay in hospital, connects to a family member(s) in their home community. Connection Types Point-to-Point – One site connecting to another Multi-Point – 3 or more sites connected via MBTelehealth’s multi-point control unit (MCU). Out-of-Province – Involves connecting to a site in another province or outside of the MBTelehealth network. These connections can be either point-to-point or multi-point * Note: Charges may apply, contact MBT scheduler with any questions. Northern/Remote Resident Manual 2015-16 Page 41 Scheduling a Telehealth Event: The majority of telehealth events are booked through a centralized scheduling desk. Requests are submitted using Clinical Booking Forms (CBF) for anything involving a patients and Non-Clinical Booking Forms (NCBF) for anything education or administration related. The CBF must be faxed (not emailed) because it contains patient information and can be sent to 204-975-7787. The NCBF can be faxed to the same number or emailed to [email protected]. Once submitted, the MBTelehealth Network Schedulers (schedulers) will respond to your request within 48 hours of receipt. To contact the schedulers regarding your request call 204-975-7714 or 1-866-667-9891 and select option 2. All requests must be received before noon on the day prior to the date requested however the earlier your request is submitted, the better the chances are that the requested site(s) will be available. iScheduler is a web-based telehealth scheduling application that allows MBTelehealth to give access to users to do their own scheduling of telehealth events. Through this application, identified users can schedule clinical and nonclinical events and receive an immediate response indicating that their event is confirmed. For more information on access contact your Regional Telehealth Coordinator. Contact the schedulers for all event modifications and cancellations unless they are same day changes. For same day changes, contact the MBTelehealth Service Desk to ensure that all participants are notified of the change to the event. MBTelehealth Service Desk The MBTelehealth Service Desk provides real time support for telehealth events. They can be contacted at 204-9757714 or 1-866-667-9891 option 1 to provide assistance with anything related to your telehealth event. Service Desk Hours are Monday to Thursday 0730-2100 and Friday 0730-1700. Telehealth Equipment Camera – A high-quality imaging device used to transmit near end images to the far end site Codec – The central part of the videoconferencing equipment. The main task of the codec is the compression of outgoing video, audio and data, the decompression of the incoming information and the transmission of this information between endpoints. Screen/Monitor – Displays images from the near and far end sites as determined by the codec Remote Control – Used to place calls, adjust the volume, navigate screens and select options. It controls all functions of the videoconference equipment Router – When connected to an MBTelehealth drop, the Router provides a secure connection back to the MBTelehealth network Cart – Allows the equipment to be mobile and therefore be utilized in multiple locations within a facility Microphone (not shown) – Is an input device used to send audio to the far end site through the codec Connecting the Equipment: Connecting telehealth equipment involves plugging in a power cable and an ethernet cable (see image below). The power cable is plugged into a standard power outlet and the ethernet cable is plugged into a computer drop that is configured for use on the MBTelehealth network. These drops will be identified by labels (often MBT or telehealth); once you have those two cables connected you can turn on your videoconference equipment. Ethernet cable Northern/Remote Resident Manual 2015-16 Page 42 Note: Some units are connected to a power bar and some have a power button that controls the entire unit. Make sure the router, codec and monitor are all turned on before trying to make a connection. The Remote Control Video Source Buttons The video source buttons on your remote control allow you to display images from video conference peripherals such as patient cameras, document cameras and laptops. The main camera button refers to the camera on top of the codec and is the default video source. You access the peripherals by pressing the corresponding video source buttons. For more information on video conference peripherals, see the Additional Telehealth Training opportunities listing on page 6. Mic Off The mic off button on the remote control is used to mute your microphone so that other sites cannot hear what is being said at your site. Most telehealth equipment is set to auto answer with the mic turned off; this means that your microphone will automatically turn off when someone connects to your equipment. This ensures that they are not able to dial in and listen to a conversation without a person at the near end site being aware. When your microphone is muted, you will see an icon on the monitor similar to this one: Pressing the mic off button will toggle the microphone on and off. Note: Make sure your site is on mute before making a call and while receiving presentations; turn the mute off when you are ready to be heard. Camera Controls/Presets The Camera Controls and Zoom +/- buttons are used to change the view of your camera. Use these to ensure you are on screen for the far end site to see. Camera presets are predetermined camera positions which are useful when images from different camera positions are to be viewed by the far end site. They are set up prior to the start of a telehealth event and are used to switch camera positions without having to manually move the camera. MBTelehealth has 3 standard presets: 1. Sign – The first preset is of a sign with the site name. This is an off screen camera view that allows users to move about the room without being on camera and identifies the sites that are connected. The equipment should always be set to the sign preset before connecting to an event. 2. Participant (Patient, Provider, Presenter) – This preset is a close up view of the person or persons involved in the event. Whether it is the patient, provider or a presenter, when setting this preset, you want to ensure that the far sites are able see the person clearly. 3. Room – Part of video conference etiquette includes making the sites you are connected to aware of everyone involved in the event. By setting a preset of the entire room, you can easily identify everyone in attendance and then switch back to preset number 2 as necessary. This preset is also helpful for question and answer periods. Northern/Remote Resident Manual 2015-16 Page 43 Note: See the cheat sheet included with your equipment for camera preset instructions specific to your videoconference unit. Cheat Sheets Cheat sheets are available for all types of MBTelehealth equipment. The cheat sheet provides site/equipment specific instructions regarding the following: Set Up Camera Presets Connecting to another site Layout changes Presentation display Etc Contact your Regional Telehealth Coordinator or email [email protected] for more information on Cheat Sheets Example Cheat Sheet Northern/Remote Resident Manual 2015-16 Page 44 Layout The layout button controls a picture in picture image of what you are sending to the far end site. There are five options for the location of the image; all four corners of monitor and turned off. You move through these options by pressing the layout button repeatedly. It is recommended that you always press the layout button after connecting to ensure you are constantly aware of what you are sending to the far end site. Selfview The selfview button is used to swap near end and far end images on your monitor. When you have a picture in picture view of yourself on screen and then press the selfview button, you will see that the near end image will appear in the big window and the far end image will appear in the smaller window. This is helpful for presentations where you have other people attending in the same room and also when using a patient camera so you can view the image you are sending to the far site more easily. Press the selfview button again to switch back to regular view. Connect/Disconnect Once you’ve booked your point-to-point event with scheduling, connecting to another MBTelehealth site is as simple as pressing the Phone Book button and then scrolling through the listing until you find the site you are scheduled to connect to. You can quickly skip to the site you are looking for using the corresponding number key on the remote control. For example, if you are looking for Pine Falls, press #7 on the remote to skip to the P section of the phone book. Once you find the site, press the green Connect button to place the call; press the red Disconnect button to end the call once your event is finished. For out of province connections, you will be given a dial in number which you enter by pressing the green Connect button and then typing in the number using the buttons on the remote control. You will need to enter the prefix 86 in front of the number in order for it to work. Note: Incoming calls will be automatically answered with the microphone turned off. Far End Taking Far End Camera Control allows you to move the camera at the far end site as well as control their video sources and presets during Point-to-Point connections. Before taking far end camera control, always request permission and explain why you are taking control. You may need to take far end camera control if: There is an unskilled operator at the far end. The operator requests that you take control. If the operator isn’t able to facilitate the event at their end. During Multi-Point events, Far End control allows you to change how the far end sites are displayed on your monitor. As discussed in Connection Types, Multi-Point events are set up using voice activation to control the display by default. Pressing the Far End button and then the up arrow allows you to toggle through the screen layouts shown below: Voice Activation 4 Site Split 10 Site Split 6 Site Split Pressing the Far End button again will turn off Far End control Northern/Remote Resident Manual 2015-16 Page 45 Tips for Participating in a Telehealth Event Once connected, use the layout button to see the image you are sending the other site(s). If you are not on screen clearly, use the arrow keys and zoom button to adjust the camera. Use the far end button and the up arrow to display multiple sites on screen Speak naturally as the microphone will automatically make adjustments so the other site(s) can hear you. Pause between speakers to accommodate slight audio delay Mute your microphone when you are not speaking to reduce background noise for other attendees Be aware of your scheduled start and end times. Ending late impacts other users who may be scheduled to use the equipment. Tips for Presenters/Facilitators Perform roll call/introductions at the start of the event. Include instructions for microphone muting and question and answer When asking questions direct them at each attending site individually to avoid multiple responses at the same time Use the far end button and the up arrow to display multiple sites on screen Use the selfview button to display presentations locally Additional Information For more information on additional training opportunities visit the Training Pages at: www.mbtelehealth.ca or contact the MBTelehealth Training Coordinator Jason Macdonald | Training Coordinator | MBTelehealth 772-715 McDermot Ave | Winnipeg | MB | R3E 3P4 Phone: 204.594.2030 ext 2016 | Email: [email protected] Northern/Remote Resident Manual 2015-16 Page 46 Tips For Success Core Procedures Integumentary Procedures Abscess incision and drainage; Wound debridement; Insertion of sutures - simple, mattress, and subcuticular; Laceration repair - suture and gluing; Skin biopsy - shave, punch, and excisional; Excision of dermal lesions, e.g., papilloma, nevus, or cyst; Cryotherapy of skin lesions; Electrocautery of skin lesions; Skin scraping for fungus determination; Use of Wood’s lamp; Release subungual hematoma; Drainage acute paronychia; Partial toenail removal; Wedge excision for ingrown toenail; Removal of foreign body, e.g., fish hook, splinter, or glass; Pare skin callus Local Anesthetic Procedures Infiltration of local anesthetic; Digital block in finger or toe Eye Procedures Instillation of fluorescein; Slit lamp examination; Removal of corneal or conjunctival foreign body; Application of eye patch Ear Procedures Removal of cerumen; Removal of foreign body Nose Procedures Removal of foreign body; Cautery for anterior epistaxis; Anterior nasal packing Gastrointestinal Procedures Nasogastric tube insertion; Fecal occult blood testing; Anoscopy/proctoscopy; Incise and drain thrombosed external hemorrhoid Genitourinary and Women’s Health Procedures Placement of transurethral catheter; Cryotherapy or chemical therapy genital warts; Aspirate breast cyst; Pap smear; Diaphragm fitting and insertion; Insertion of intrauterine device; Endometrial aspiration biopsy Obstetrical Procedures Normal vaginal delivery; Episiotomy and repair; Artificial rupture of membranes Musculoskeletal Procedures Splinting of injured extremities; Application of sling—upper extremity; Reduction of dislocated finger; Reduce dislocated radial head (pulled elbow); Reduce dislocated shoulder; Application of forearm cast; Application of ulnar gutter splint; Application of scaphoid cast; Application of below-knee cast; Aspiration and injection - knee joint; Aspiration and injection- shoulder joint; Injection of lateral epicondyle (tennis elbow); Aspiration and injection of bursae, e.g., patellar, subacromial Resuscitation Procedures Oral airway insertion; Bag-and-mask ventilation; Endotracheal intubation; Cardiac defibrillation Injections and Cannulations Intramuscular injection; Subcutaneous injection; Intradermal injection; Venipuncture; Peripheral intravenous line adult and child; Peripheral venous access—infant; Adult lumbar puncture Northern/Remote Resident Manual 2015-16 Page 47 Dictation Tips From your Friendly Transcriptionists that will make your and our lives easier 1. Test your machine periodically while dictating. If you can’t hear anything on playback or if it’s squeaking then something is wrong with the machine. Most often you just need to change the batteries. 2. Put your resident number on the encounter form in the space provided. This is used to track billing and is important. If you don’t know your resident number then please look at the day sheets on your door and it is the number beside your name. 3. At the beginning of every entry please state: i. your name ii. the date iii. patient name iv. chart number v. diagnosis(es) vi. nature of the problem as either major, minor or temporary 4. Please DO NOT speak in acronyms. We can’t always understand what you are saying. If they have HTN say “hypertension”. We will shorten where we can/know too. Dictation Etiquette 1. Dictation must be completed at the end of each day or chart filing and workload of stenos is hampered. 2. Short dictation and to the point. PHE should be the longest dictation – anything over ½ or ¾ page is too long. If you submit five charts and a full tape then your dictation is too long. 3. Always work your problems from the Problem List. If the problem is already listed then you use the corresponding problem # on the Problem List. 4. Use on 1 side of tape. 5. Speak clearly, and moderately slow (especially if you speak with an accent). Hold the Dictaphone close enough, but not too close to your lips. NEVER chew gum, eat while dictating or cough into the Dictaphone. 6. As you see patients write short notes on the Encounter Form to jog your memory for dictation. If a patient brings in a list of drugs, health foods, etc. attach this to the front of the chart to assist in transcription. 7. Where multiple problems are dealt with, only one set of SOAP notes with subheadings is appropriate. 8. Ensure that there is a chart for each dictated note and the “encounter form” is completed with: i. your resident number ii. the problem clearly written (or printed) iii. the diagnostic code for billing In addition, if you perform a minor procedure i.e., nevi removal, you must indicate on the “encounter form”: Whether a local was used – check off Whether an excision or closure was done – check off Why the procedure was done – MHSC pays for procedures of “medical necessity”. Criteria for medical necessity are met when nevi, warts and skin lesions show abnormal signs. I.E. – significant size &/or color changes which indicate malignancy or premalignacy, or symptoms such as pain, irritation, infection or bleeding. These are not considered cosmetic and are payable by MHSC. These abnormal signs or symptoms must be indicated on the claim in order to justify payment. The only exception to this rule is for persons 15 years of age and under in which case MHSC will pay for this service. Otherwise, you must bill for uninsurable services (ask for procedure for billing). Northern/Remote Resident Manual 2015-16 Page 48 9. If you see patient on-call, encounter forms and charts must accompany your dictation tape. On the morning after “on call” ask the receptionist to generate the necessary encounter forms (identify by name). Find the charts and attach your tape securely to the bundle of charts. (If you have difficulty finding the chart, ask the Medical Records Clerk for help.) You say this too but it is not typed Examples of how to dictate a note and approximately how it may appear Patient name/chart # #16257 – December 16, 2008 (although you say the pt name it may or may not be typed in depending on st whether it is the 1 note on the page etc. You also should have already dictated the date at the beginning of the tape) Heading Subjective or S Objective or O Assessment & Plan or A/P Low back pain – WCB Claim (S) 28 y/o male injured lower back in excess of 2 weeks ago. Pt works as a conductor for CN Rail. Injured his back while twisting rail. Was seen in clinic just with mechanical low back pain. Pt treated with Naprosyn and T3. Pt mentions that his low back has improved, has not returned to work as he was assigned modified duties, company not returning his calls. NO issues with BM or voiding. Pt notices morning stiffness and greater pain in the evening. Pt active, attends PT. (O) Reduced forward flexion of the lower back otherwise preserved ROM of lower back. Lt leg extension. Painful at 30-35 degrees suggesting radiculopathy and some form of sciatica. No saddle anesthesia. (A/P) 1) Mechanical low back pain improving. Recommended that pt continue with Naprosyn 375 mg t.i.d. x 2 weeks. As well pt given Rx for Tylenol #3 30 tabs q.6.h. PRN. Pt should continue with PT and chiropractor. 2) WCB form completed and general billing form completed as well. Alexander Singer, R2 Or for A/P you may choose to keep them separate and the above would then look like this: Assessment Plan (A) Mechanical low back pain. (P) Pain improving. Recommended that pt continue with Naprosyn 375 mg t.i.d. x 2 weeks. As well, pt given Rx for Tylenol #3 30 tabs q.6.h. PRN. Pt should continue with PT and chiropractor. WCB form completed and general billing form completed as well. Please let us know that you are finished dictating a note before proceeding to next note. Some examples of what others say are: 1) End note, 2) Thank you – your name, 3) Next note, 4) New pt. Letters to Consultants When dictating a letter, clearly indicate the following: Full name of the consultant, i.e., Dr. Hugh Smith Consultants “specialty, i.e., Cardiology The consultation letter is a brief summary of pertinent information about the patient, and the reason for referral. You may want a general opinion from the consultant, or a more focused inquiry about management and treatment. The letter should reflect this clearly, and in most cases should not exceed ½ to ¾ of a page. Northern/Remote Resident Manual 2015-16 Page 49 Northern Information FMBT SITES NWT NU Churchill Thompson OBS site option for R1s FMBT & Airway Mgmt site for R2s Flin Flon The Pas Norway House ____________ Fly-in sites in burgundy font Mon-Thu or Tue-Fri Exception: Hodgson is FMBT site Morden/Winkler Airway Mgmt site for R2s Northern/Remote Resident Manual 2015-16 Page 50 Northern Site Departure Airports Please ensure you arrive at the correct airport for departure. Flying To Airline/Airport Winnipeg Address Calm Air or Bearskin Airlines Winnipeg International Airport 2000 Wellington Avenue Northway Aviation-St Andrews Airport 501 Airline Road St. Andrews, MB Perimeter Aviation 626 Ferry Road Churchill Nunavut (Rankin, Iqaluit Baker Lake, Arviat) Thompson Flin Flon The Pas Pukatawagan Bloodvein Little Grand Rapids Pauingassi Poplar River Berens River Garden Hill Norway House Red Sucker Lake St. Teresa Point Wasagamack Grand Rapids and Easterville are drivable up Hwy 6. Hodgson is also reached by road. Driving to some northern communities is your option and you will be reimbursed at $0.43/km. There is a weight restriction for luggage on most flights. Additional charges are at the resident’s expense. Travel Reimbursement Per the Air & Ground Travel for Northern/Remote Stream policy, reimbursements will be processed for you for: Ground transportation (generally by taxi) to and from airport (e.g., Winnipeg home to Richardson International Airport; northern airport to residence) up to a maximum of $100 per trip, upon submission of original receipts. Mileage from Winnipeg to the northern location (payable at the current University of MB rate) and parking at the northern hospital for residents who choose to travel with their own vehicle instead of flying to a location where road travel is possible. Parking expenses will be reimbursed up to a maximum of $100, and original receipts must be submitted. Mileage for driving to and from a community where air travel is not an option, once at the beginning and once at the end of the rotation, and to return for Academic Days. You must submit an email to your Program Assistant to advise on KMs travelled and on what dates. Up to $50/day for per diem while on fly-ins only. Northern/Remote Resident Manual 2015-16 Page 51 PGY2 Technical Equipment Panasonic Toughbook ThinkTank Shapeshifter backpack w/ Drysac Ethernet cable & Two 16 GB SDHC memory cards Joby Gorillapod Magnetic Logitech Webcam Pro 9000 Olympus Stylus Tough-6020 digital camera LaCie “Itsakey” 4 GB memory stick LaCie “Itsakey” 4 GB memory stick Plantronics 470 foldable stereo headset w/ microphone & USB connector Northern/Remote Resident Manual 2015-16 Page 52 Survival Items In A Can o o o o o o o o o o o o o o o o o o o o o o Tin Can w/lid, any small coffee can (can flatten to make a digging tool) Water purification or Iodine Tabs MEC Duct Tape 6' Large garbage bags, orange x1, grocery store Ziploc Freezer, Bags small x 1, grocery store Whistle Fox 40, pea less orange, MEC Tin Foil 6' grocery store Snare Wire brass 20 gauge, Cdn Tire Match Case Coghlan's, orange/waterproof, MEC Bic Lighter, orange Knife folding Swiss Army, locking blade, MEC Wooden Matches Eddie Strike Signal Mirror Coghlan's Sight grid, MEC Emergency Blanket, Coghlan's, MEC Small Pencil, golfing pencil small note pad Button/wrist Compass Sunto MEC Flagging Tape, 10' orange, MEC Cordage/string, Para cord is best 12' min 400lb or better, online First Aid Kit, any basic first aid kit, size based on activity Cotton balls Small Sewing/Fishing kit, build a small fishing kit, should have a couple leaders, small sinkers, pickerel rig, extra hooks and add it to the sewing kit Carry on your person: o Emergency Food at least 1200 calorie trail mix o LED Headlamp, should have a blinking mode, MEC o 1 L Water David MacDonald CD1 President/Lead Survival Instructor ICSOS Inc. Northern/Remote Resident Manual 2015-16 Page 53 Wireless Modem for Rankin Inlet You MUST return this modem along with the two cables to the Program Assistant when your rotation in Rankin Inlet is finished. The Internet Service Provider is Qiniq. The Rankin Inlet office of Qiniq is located at the Sakku Investments Corp. The contact person there is Kelly, and her phone number is 867-645-2804. The plan we’ve arranged for will provide high-speed service up to 10G; after that you’ll experience significant slowdown (e.g., similar to dial-up). To arrange for a usage upgrade, you’ll need to see Kelly (as above) and pay a $17.50 charge. This charge is not reimbursable by the department. Our account number is 54013. Setting up your Wireless Modem The following will help you connect the Wireless Modem to your computer. If you follow these instructions closely you should not encounter any problems. If you have any trouble, please contact your CSP for technical support. Step 1. Connecting Cables to the Wireless Modem a. Remove your modem and cables from the box. b. Find and place the modem in a good spot near the computer. c. Plug the power cable into a wall outlet. d. Plug the power cable into the modem. e. Plug the Ethernet cable into the modem. f. Do not connect the Ethernet cable to your computer yet Step 2. Checking the Modem Lights The lights on the Modem blink to indicate the strength of the signal received by the Modem. The Modem is equipped with an internal antenna that receives this signal from your Internet service provider. The more lights that blink on the modem represents a stronger signal that the modem is receiving. If the modem is not able to receive any signal, the lights blink in sequence. Choose another location in the building in which to operate the modem. After the installation is completed, the lights will remain solid. This indicates the modem can provide you with high-speed Internet service. Step 3. Finding the Best Wireless Signal a. Place the modem on a table or shelf. b. Point the back of the modem (the side without a logo) toward a window. c. Remove your hands from the modem for a few seconds. d. Note the number of lights on the modem that blink. e. Point the modem to the left of the starting point, then to the right. At each point, note how many lights blink. f. Re-orient the back of the modem to the direction it was pointed when the most lights blinked. g. Make sure that the lights stay on after you release your hands from the modem. Step 4: Connecting the Ethernet Cable to the Computer a. Make sure the computer is powered off. b. Plug the Ethernet cable into the computer. c. Power on the computer. d. When the modem obtains Ethernet communication with your computer the lights stop blinking and become solid. e. Now you are ready to surf. Northern/Remote Resident Manual 2015-16 Page 54 Rogers service in the North Get a RogersOne account (free to sign up if you are already with Rogers) via the Rogers website www.rogersonenumber.ca . 1. Log-in to your account (using either your computer or iPad) once it's established; 2. Go to 'My Settings' and then 'Reach me rules'; 3. Enable 'Forward My Calls' and select 'Do Not Expire' under the duration option; enter the local phone number that you will have while away (either mobile or land line); 4. Select 'Activate'. You will now receive any calls going to your personal number through the local telephone that you have; 5. You should also be able to access and answer all text messages for free via your Rogers One main account page as well; and 6. When returning back to Winnipeg, simply 'Deactivate' the call-forwarding option (please see steps 4 & 5) so that you can receive calls via your own cell phone again. Public Health Agency of Canada Upon review of some information, listed below are but a few of common illnesses in Northern Remote communities. Diabetes 1 out of 4 indigenous adults living on reserves in Canada have type 2 diabetes. 2/3s of First Nations people living with Diabetes are Women. Nationwide - diabetes is highest in Ontario, Manitoba and Saskatchewan in aboriginal people Nearly ½ First Nations people over the age of 15, report diabetes as a health condition. Among Status Aboriginal People in Manitoba, 60% of hospitalization for heart disease and almost ½ hospitalizations for stroke are among people with diabetes. Type 2 diabetes is referred to as “adult onset”, in recent years Aboriginal children as young as 5 to 8 have been diagnosed. Tuberculosis Studies have shown that First Nation people are more at risk than other Canadians of getting TB infection. Some of the root causes are related to poor socio-economic conditions where they live. TB is more likely to occur in communities where people live in overcrowded housing and in remote areas, where access to health professionals is limited. o o o o Remote isolated (type 1): no scheduled flights, minimal telephone and radio, no road access Isolated (type 2): flights, good telephone service, no road access Semi-isolated (type 3): road access greater than 90 km to physician services Non-isolated (type 4): road access less than 90 km to physician services The fact that active TB occurs more often in remote communities puts a considerable strain on program resources, as treatment, contact tracing, and other control activities involve a great deal of traveling, and transport of equipment. Furthermore, health facilities in these communities are often more likely to experience a high rate of staff turnover, thereby increasing the probability of late diagnosis of TB, and predisposing the community to spread of the disease and an outbreak situation. HIV/Aids Northern/Remote Resident Manual 2015-16 Page 55 Although incidence (new HIV infections among the total population) has gone down in the Canadian population, it appears that HIV rates have been steadily increasing in First Nations and Inuit populations. They are at increased risk for HIV infections for several reasons. Social, economic, and behavioral factors such as poverty, substance use, including injection drug use, sexually transmitted diseases, and limited access to health services, have increased their vulnerability. AIDS is now as pre-eminent in the Aboriginal population as it is in the general population. 87.8 percent (16,986) of the total reported AIDS cases in Canada (19,344) have information on ethnicity (1979 to December 31, 2003); 520 of these cases were among Aboriginal peoples; According to this information, Aboriginal peoples make up 3.1 percent of reported AIDS cases; and According to the 2001 Census, Aboriginal peoples make up 3.3 percent of the Canadian population. Before 1992, out of the 6,203 reported AIDS cases with information on ethnicity, 80 cases or 1.3% were Aboriginal. This proportion steadily increased until it reached a high of 9.7% in 1999. In 2000 and 2001, the proportion decreased to 7.2% and 5.5% respectively. However, an increase was seen in 2002, when Aboriginal peoples accounted for 12.9% of the total reported AIDS cases for which ethnicity was known. Influenza "The overcrowding that exists on reserves, it's really quite high. It's a breeding ground for the virus to spread," he said. "It's an airborne virus — people cough and people are walking around in the house. When you've got as many as 11 people walking around the house, it really will spread to everybody." In one northern community though not a community that is served by NCMC, Mike Moose, health director for the Split Lake Cree First Nation, about 120 kilometers north of Winnipeg, said that community's clinics were packed and so many children are sick with flu that the school has had to be closed. Climate, Travel and Clothing Fly-in physicians face extraordinary challenges travelling to work and doing medical evacuations of sick patients from the small communities. Airports located on islands necessitate open-boat or skidoo travel even in inclement weather. Problems with weather or aircraft may pose risks of emergency landings/layovers. When travelling by boat, all physicians are urged to travel with a lifejacket. These are inconsistently available in boats up north. A floatation jacket is preferable for harsh fall and spring weather conditions. Remember that the temperature in northern communities may be colder during any season that the temperature you experience when you leave Winnipeg. Rubber boots are a must!!! The following articles of clothing are also recommended: Winter (travel by skidoo or vehicle on ice roads across the lakes): Parka: rated for very cold weather (-25 to -50°C), with a good hood and face-protecting ruff Parkas can be purchased through the Sears Catalogue, Mountain Equipment Co-op (MEC), and Mark's Work Warehouse Custom made parkas can sometimes be ordered locally, and are excellent Wind pants Long underwear: polypropylene (or silk on nice days) Sweaters: wool or fleece Boots: Buy heavy, warm boots rated for -50°C. Hiking boots are sufficient for early fall late spring travel periods. Mittens: Warm, wind-proof, fleece-lined mitts covering wrists. Gloves are too light and have too much area for cold exposure except in late spring. Locally made fur and leather mitts can be purchased Northern/Remote Resident Manual 2015-16 Page 56 Hat and scarf, neck-tube (MEC neck-gaiter) or balaclava are needed for protection on windy days in winter Ski goggles can be useful for eye protection during blizzards or cold windy days UV resistant sunglasses are recommended Spring and Fall (travel by open boat or helicopter) Fleece and jacket: Dressing in warm layers of windproof/floatation jackets and insulating fleece are recommended for this time of year, as it is often too cool for one jacket. Rubber Boots: Ordinary black boots are the most popular and functional, as the communities get quite wet in spring and fall. Consider buying them one size too big to allow room for duffel socks or thick woollen socks. Summer (travel by open boat) Raingear UV resistant sunglasses Hat with a brim Sun block with high SPF Northern/Remote Resident Manual 2015-16 Page 57 J.A. Hildes Northern Medical Unit (NMU) Section of First Nations, Métis & Inuit Health Department of Community Health Sciences Faculty of Medicine, University of Manitoba The J.A. Hildes Northern Medial Unit (NMU) provides family physicians to hospitals and nursing stations in communities throughout Northern Manitoba and consultant physicians in the Kivalliq Region of Nunavut. Family physicians work as part of an integrated University-based system which also includes regular medical specialist visits, allied health professionals, research and educational initiatives. The NMU is committed to the ongoing development of the First Nations and Inuit Communities we serve. The NMU offers: Excellent experience in primary and secondary care, community health and cross-cultural aspects of health care delivery. Ready access to a wide range of University-based consultants who provide community visits and telephone consultation. Unique cultural experiences and the opportunity to provide important services in areas where the needs are great. Kivalliq Region of Nunavut The Kivalliq Region of Nunavut spreads from the 60th parallel in the south to the Arctic Circle in the north. Inuktitut is the first language of the mainly Inuit inhabitants, and traditional culture is highly valued. The region is well known for its artisans, producing soapstone carvings, wall hangings and tapestries. The NMU provides consultant services to 8 Nunavut communities: Rankin Inlet, Arviat, Whale Cove, Chesterfield Inlet, Baker Lake, Repulse Bay, Coral Harbour, and Sanikiluaq. The total population numbers approximately 8000. Nurse Practitioners work in each of the Health Centres, along with Community Health Representatives, Interpreters and other support staff. Family physicians are based in Rankin Inlet and make regular visits to the other communities, seeing patients referred by the Nurse Practitioners. The full complement of physicians is 4.5. The Rankin Inlet Health Centre is equipped with x-ray and laboratory facilities, as well as a Birthing Centre staffed by Midwives. Winnipeg-based specialists flying in for regular visits as well as providing telephone support. Churchill Churchill is located on the shores of the Hudson Bay in northern Manitoba. Renowned for its polar bears, northern lights, and whale watching, Churchill depends on tourism as a major source of revenue. The Churchill Health Operating Division provides programs and services to the residents of Churchill and the communities of the Kivalliq Region of Nunavut, including: 25 acute and 6 extended care hospital beds, operation groom and delivery suite, laboratory, x-ray, and pharmacy. The family physicians enjoy fully modern support systems and equipment. The Fly-In Program Area The Fly-In area consists of ten First Nations communities in Northern Manitoba that do not have all-season road links to Winnipeg. The communities of Berens River, Bloodvein, Poplar River, Little Grand Rapids and Pauingassi are on the east side of Lake Winnipeg; Garden Hill, Red Sucker Lake, St. Theresa Point and Wasagamack are in the Island Lake Region and Pukatawagan is located 2 hours north of The Pas near the Manitoba-Saskatchewan border. The population served is approximately 10,000. Northern/Remote Resident Manual 2015-16 Page 58 Each community is served by a modern nursing station with well-equipped clinical facilities for primary care, staffed by nurses, nurse practitioners and community Health Representatives. Family physicians fly in weekly, working on a consultant basis, as well as providing educational support to the nurses and community. Grand Rapids and Chemawawin These communities lie 400km north of Winnipeg in the northwest shore of Lake Winnipeg, with a combined population of 2000. A physician drives in from Winnipeg on a weekly basis and provides consultant support to Nurse Practitioners staffing the local Nursing Stations. Norway House Norway House is a community of approximately 7500 people, located at the north end of Lake Winnipeg. It is connected to Winnipeg by daily flights and an all-weather road. The hospital has 16 beds, a laboratory, X-ray, pharmacy and social work services, providing an opportunity for multidisciplinary teamwork. A team of family physicians provide inpatient and outpatient services. On-call duties involve Emergency Room as well as obstetrical coverage. Hodgson The town of Hodgson is situated on the Peguis First Nation Reserve in the Interlake Region, 192 km north of Winnipeg. This is a culturally diverse area, including the Aboriginal First Nations of Cree and Ojibway/Saulteaux, as well as Hutterite colonies and the descendants of French and Ukrainian settlers. You will be part of a team of full time physicians at the Percy E. Moore Hospital, a 16 bed facility equipped with Laboratory, x-ray, pharmacy and outpatient departments. Outreach services are provided to the First Nations communities of Peguis, Fisher River and Jackhead, as well as the farming community of Fisher Branch. The total catchment population is about 15,000. J.A. Hildes Northern Medical Unit Section of First Nations, Métis & Inuit Health Department of Community Health Sciences Faculty of Medicine, University of Manitoba Hospital-Based Physician Coordinator Amanda Abele T162-770 Bannatyne Avenue Winnipeg, Manitoba R3E 0W3 204-789-3271 Fax: 204-774-8919 [email protected] Northern/Remote Resident Manual 2015-16 Inuit Health Program Dr. Anne Durcan T154-770 Bannatyne Avenue Winnipeg, Manitoba R3E 0W3 Toll Free (North America): 877-480-1999 Fax: 204-789-3959 [email protected] Page 59 General Information re: Churchill 1. Personal: Food of most sorts is readily available in Churchill. Difficult if you are non-meat eating, as not too much variety in the vegetarian sector, although not too hard to get by (fresh produce is more readily available in the summer as one might guess to meet the demands of the many tourists). It is suggested that you bring some of your favorite products in terms of dry goods, etc. However, remember you do not want to bring too much as there is a weight limit for your luggage. Remember, prices of food in Churchill are more expensive than here in Winnipeg but manageable. Clothing: As the date of your travel to Churchill approaches, please check the Environment Canada website at www.weatheroffice.gc.ca/canada for current weather conditions for Churchill. That will aid you somewhat in determining the type of clothing to bring. It will be winter there by the time you get there so layered clothing is your best bet as it allows you to prepare for any kind of weather. You will need a heavier jacket/parka, hiking/winter boots. If you pack with “layering” in mind, you should be fine. * Camera is essential if you want to remember your time up in Churchill. * There is a Recreation centre with a pool which is attached to the Churchill Health Centre. 2. Work related: Stethoscope, no need for diagnostic set, etc. Name tag is essential, particularly at the start of your elective. White coat is viewed as optional, and your choice. The dress code is business casual. You do not need to bring your own hospital scrubs. Texts are OK in the library in Churchill so no need to bring any unless you want to. 3. Accommodations in Churchill: You will be staying in an apartment in “A Block” which will mean more to you once you get there. All accommodations are located relatively close to the health centre. It is a fully furnished 1 bedroom apartment that you will be using at no cost to you, complete with microwave oven, fridge/stove (kitchen utensils, etc., all included), TV, cable and stereo (would need to bring own CDs). All standard needs...linens (i.e., towels, bed linens) and dishes, etc. are supplied so no need to bring sheets/pillows, etc. Laundry facilities are on site. You might want to bring a small container of laundry detergent that's convenient for travel as I'm not sure if that's supplied in the apartment. You can also buy laundry detergent there as well as there is the Northern Store which is like a grocery/department store all in one. 4. Travel Details (Flights, Baggage limit, etc). Travel to Churchill is with Calm Air located at the James A. Richardson International Airport (formerly Winnipeg International Airport). Your travel to Churchill is booked already, details to follow. When you check-in at the airport you will be provided a boarding pass. You will need identification (passport, etc.) as you would for any domestic/international flights. I will provide taxi slips for you to get to/from the airport here in Winnipeg. Baggage limit is 2 pieces not to exceed 70 lbs (32 kg) including one carry-on. Be aware sometimes personal baggage can get off-loaded more than once in a while, so carry essentials for one night, etc., in your carry-on if need be (and according to Airport Security guidelines). When you arrive in Churchill, there will be someone there to pick you up and take you to your apartment, same when you depart Churchill, someone will take you back to the airport then as well. 5. Banking: Local Royal Bank in town, Interac at most locations. Northern/Remote Resident Manual 2015-16 Page 60 6. Telephone (applicable only for NMU 1 bedroom apartment, #28 Tundra Block). The phone is for your use. The number is 204-675-2674. Local calls are free, however, if you make any long distance calls from the phone in the apartment, you will be accountable for any calls you make unless you use a calling card or call collect. A calling card would be best to avoid having to worry about keeping track of your long distance phone calls. NOTE: If you choose not to use either of the above methods, you will then have to keep track of your long distance calls and you will then owe the Northern Medical Unit for any calls you make upon completion of your elective. 7. Internet Access. There is Internet access but only at the Churchill Health Centre. EVALUATION FORMS: It is your responsibility to ensure that the preceptor you worked with the most complete your evaluation form(s) BEFORE you leave Churchill. Northern/Remote Resident Manual 2015-16 Page 61 Fly-in Trip Report Kathy Risk of the NMU will explain, and provide you with a Trip Report, when you meet with her prior to your Fly-in. Northern/Remote Resident Manual 2015-16 Page 62 Northern Fly-in and Community Information Berens River is located on the east shore of Lake Winnipeg at the mouth of the Berens River and is approximately 270 kilometers north of Winnipeg by Air and 391 kilometers by Provincial Road #304. Population: On reserve – 1,762 / Off-reserve – 1,003 Total Population – 2,765 (information was obtained from Southeast Community Futures Development Corporation) Demographics: Approximately 47% of the population is under the age of 19. Approximately 45% of the population is between the ages of 19 and 65. Approximately 3% of the population is over the age of 65. Language: Saulteaux/Ojibway Transportation: Berens River is accessible by a winter road that is open from January 15th to March 15th. For the rest of the year Berens River is accessible by air, utilizing a gravel airstrip the is maintained in the community Governance: The Chief of Berens River is George Kemp Councilors: Glen Boulanger, Stanford Boulanger, Hartley Everett, George Green and Gerald Kemp Health Director – Jackie Everette Commercial Businesses and or Services On reserve: Berens River Band Office Meemeesipii Inc. Berens River Logg Inn Berens River School (Frontier School Division: Nursery to Grad 9) Berens River Daycare Berens River Training & Employment Program Berens River Tug Boat/Barge Berens River Pumphouse (Water and Sewage Oshetoon Building Supplies Neil Disbrowe’s Woodworking Linda & Valerie’s Video Ship Christine’s Coffee Shop Berens River Store Northern Store Hubert Boyd (Store) Off Reserve: Barra Inn John Alex Enterprises Ltd. Communication: Radio Service is limited to Wpg stations. TX service is limited to stations received via satellite dish Important Numbers to know! Chief Jacob Berens Mino-Ayaawin Ctr-/ Berens River Nursing Station: ph (204) 382-2265, fax (204) 382-2005 o There are four nurses at the station Health Mgmt Berens River First Nations - Health Director: Jackie Everette, ph (204) 382-2813, fax (204) 3822260 Child and Family Services: o South East Child and Family Services 4th flr 360 Broadway Wpg MB, ph (204) 947-0011, fax (204) 9470007 Services Inc., Berens River, Ph (204) 382-2525, fax (204) 382-2130 o Berens River Field Office Southeast Child and Family Band Office – (204) 382-2161, fax (204) 382-2297 RCMP – The detachment that covers this community is the Selkirk community ph (204) 482-3322 24 – Hour Manitoba Suicide Line Toll Free 1- 877- 435-7170 24 - Hour Crisis Line Toll Free 1- 888- 322-3019 24 – Hour Sexual Assault Crisis Line Toll Free 1- 888 - 292-7565 Northern/Remote Resident Manual 2015-16 Page 63 Bloodvein First Nation is Located 210 kilometers north of Winnipeg on the east shore of Lake Winnipeg, directly north of the Bloodvein River. Bloodvein is situated along three kilometers of shoreline at the mouth of the river. Population: On reserve – 1006 / Off-reserve - 595 / Total Population – 1,601 Demographic: Approximately 47% of the population is between 0 and 19 years of age. Approximately 49% of the population is 19 and 65 years of age. Less than 1% of the population is over 65 years of age. Language: Saulteaux/Ojibway Transportation: There is a 3,000 foot gravel airstrip maintained in the community. Perimeter Aviation and Warm Air provide scheduled service. A ferry/barge service (39 passenger vehicle) is operated by the Marine Division of the Department of Highways. The ferry/barge is used during the summer month. Bloodvein is also accessible during the Winter Road Season during the summer months. Bloodvein is also accessible during the Winter Road Season (officially open around January 15th to March 15th) Governance: The Chief of Bloodvein First Nation is Roland J. Hamilton. The Councilors are, Lorraine Cook, Stella Keller, Oswald Ronald Turtle and Ellen Young Economic Base: Band office, Commercial, Fishing and Trapping Commercial Business and/or Services: Anishinabe Coffee Ship Bloodvein Arena Miskooseepi School (Nursery to Grade 9) Child & Family Services Bloodvein River Lodge Turtle’s Care Frank & Son Grocery Store/Video Rentals Mikisi Towing, Gas Bar & Convenience Store Keller & Son’s Grocery Store Communication: This community receives radio stations from both Winnipeg and the Interlake area. Important Numbers to Know Band Office - Phone: (204) 395-2148 / Fax: (204) 395-2099 Councilor with Health Portfolio Nursing Station – Nurse in Charge - Lionel Durisseau & Kathy Berens – 395-2161 RCMP Detachment (Patrol Cabin 204-395-2020) Child and Family Services o Southeast Child and Family Services Inc., Wpg – 4th Floor, 360 Broadway Ave. Ph 204-947-0011 / Fax 204-947-0009 o Bloodvein Field Office – Southeast Child and Family Services Inc., Bloodvein, MB Ph (204) 395-2476 / Fax (204) 395-2190 24 – Hour Manitoba Suicide Line Toll Free 1- 877- 435-7170 24 - Hour Crisis Line Toll Free 1- 888- 322-3019 24 – Hour Sexual Assault Crisis Line Toll Free 1- 888 - 292-7565 Northern/Remote Resident Manual 2015-16 Page 64 Little Grand Rapids First Nation is 268 air kilometers northeast of Winnipeg, on the shores of Family Lake near the Manitoba/ Ontario border. The reserve is spread out over an eight kilometer stretch along the lake shore. At Dusk Population: On-reserve - 1,129 / Off-reserve - 287 / Total Population - 1,416 (as of March 31, 2009) Demographic: Approximately 46% of the population is under the age of 19. Approximately 49% of the population is between the ages of 19 and 65. Approximately 6% of the population is over the age of 65. Language: Saulteaux/Ojibway Transportation: There is a 3,000 foot airstrip on provincial crown land across the lake from Little Grand Rapids. Access from the airport is restricted to boat or float plane during the summer months. During the freeze up and spring thaw the site is only accessible by helicopter. There is no permanent access road to Little Grand Rapids. Little Grand Rapids is accessible during the Winter Road Season (officially opens around January 15th to March 15th). Governance: The Chief of Little Grand Rapids First Nation is Martin Owen Councilors are: Hilda Crow, Diane Keeper, Wendy Keeper, Deon Lam, Howard Leveque and Robert Leveque Economic Base: Band Office, Commercial, Fishing, Trapping and Seasonal Rice Harvesting Commercial Businesses and/or Services: Clarence & Jemima's Family Lake Pool Hall/Canteen Owens Cash & Carry General Merchants Kitagas Group Home Northern Store Little Grand Rapids Airport Sanitation Service Water Treatment Plant Head Start Program Daycare Program Communication: This community receives AM radio from Wpg. CBC-TV and FM radio are rebroadcast in the community. Important Numbers to Know Nursing Station – Nurse in charge Jeff Hiltz (204) 397-2115 Little Grand Rapids Band Office Phone: (204) 397-2264 / Fax (204) 397-2340 Child and Family Services o Southeast Child & Family Services Inc. Wpg - 4th Flr, 360 Broadway, 204-946-0222 fax 204-947-0009 o Little Grand Rapids Field office: Phone# 204-397-2407 Fax – 204-397-2272 RCMP Detachment at Little Grand Rapids (204) 397-2133 24 – Hour Manitoba Suicide Line Toll Free 1- 877- 435-7170 24 - Hour Crisis Line Toll Free 1- 888- 322-3019 24 – Hour Sexual Assault Crisis Line Toll Free 1- 888 - 292-7565 Northern/Remote Resident Manual 2015-16 Page 65 Pauingassi First Nation is approximately 280 kilometers northeast of Winnipeg & 24 kilometers north of Little Grand Rapids, on a peninsula jutting southward into Fishing Lake, a tributary of Berens River. Population: On-reserve - 536 / Off-reserve - 37 Demographic: Approximately 35% of the population is under 19. Approximately 60% of the population is between the age of 19 and 65. Approximately 4.3% of the population is over 65 Language: Saulteaux/Ojibway Transportation: There is no permanent access road to the Pauingassi First Nation, although winter roads are constructed annually from Pine Dock and Bloodvein First Nation. Pauingassi is accessible during the Winter Road Season (officially opens around January 5th to March 15th). There is a 3000 foot airstrip approximately 24 kilometers south of Pauingassi at Little Grand Rapids First Nation. Access to the community via the airport is restricted to boat or float plane during the summer and by snowmobile during the winter. Governance: The Chief of Pauingassi is Harold Crow The Counselors are: Susanne Keeper, Michael Owens, James Owens Economic Base: Band Office, Phone: (204) 397-2371, Commercial, Trapping, Fishing and Seasonal Rice Harvesting Commercial Businesses and/or Services: Pauingassi Band Office Dojo's Store Northern Store Sanitation Service Communication: Sporadic radio reception depending on the type of receiver used. CBC-TV Northern/Remote Resident Manual 2015-16 Page 66 Important Numbers to Know Pauingassi Nursing Station 204-397-2395 Band Office: ph (204) 397-2371, fax (204) 397-2145 RCMP (Patrol Cabin) 204-397-2274 Child and Family Services o Southeast Child and Family Services Inc. Winnipeg – 4th fl. 360 Broadway, (204) 947-0011 o Pauingassi Field Office - (204) 397-2134, fax (204) 397-2273 Northern/Remote Resident Manual 2015-16 Page 67 Poplar River is located on the East side of Lake Winnipeg at the mouth of the Poplar River. Population: 1,195 – On reserve / 277 – Off-reserve Total Population - 1,472 (this information was obtained from the Southeast Community Futures Development Corporation as of March 31, 2009) Demographic Approximately 50% of the population of Poplar River is under the age of 19 Approximately 50% or the population of Poplar River is over the age of 19 Approximately 5% of the population of Poplar River is over the age of 65 Language: Saulteaux/Ojibway Transportation: No permanent road; however there is a winter road that is open from January 5th to March 15th. There is a gravel air strip as well as dock facilities for float planes and boats. Goods are also occasionally barged to the community from Selkirk. Governance The Chief of Poplar River is Clifford Bruce The Councilors are, Guy Doglas, Irvin Franklin, Emile Mason, Langford Mason, Frederick Mitchell and James Mitchell Businesses and/or Services: Poplar River Band Office – 244-2267, fax 244 2690 Sagaday Lodge Bunny’s Restaurant Sara’s Diner Negginan Hardware B&B Networking Poplar River Airport Sanitation Service Water Treatment Plan Headstart Program Daycare Program Northern Store Communication: This community receives radio from Winnipeg, Dauphin, and Native Communications Inc. (NCI) Winnipeg 96.9 CPOP FM. Important Numbers to Know Poplar River First Nation Negginan, MB (204) 244-2267, toll free: 1-888-542-1262, fax (204) 244-2690 Nursing Station: (204) 244-2102 fax (204) 244-2001 Child and Family Services Inc. o Southeast Child & Family Services Inc. 4th Flr. 360 Broadway Ave. Ph (204) 947-0011, fax (204) 947-0009 o Poplar River Field Office – Southeast Child and Family Services Inc. (204) 224-2267, fax (204) 244-2690 RCMP detachment - This community is serviced by the RCMP detachment in Selkirk: Ph (204) 482-3322 24 – Hour Manitoba Suicide Line Toll Free 1- 877- 435-7170 24 - Hour Crisis Line Toll Free 1- 888- 322-3019 24 – Hour Sexual Assault Crisis Line Toll Free 1- 888 -292-7565 Northern/Remote Resident Manual 2015-16 Page 68 Norway House Cree Nation is located 30 Km north of Lake Wpg on the bank of the eastern channel of Nelson River and is located 456 km by air north of Wpg, MB., 208 km by air east of the Pas and 190 km by air south of Thompson. The drive from Wpg is approximately 800 km. Population: On reserve 4,075 (2006) / Off-reserve 1,507 (2003) Demographics: Approximately 46.1% of the population is between the age of 0 and 19. Approximately 43.1% of the population is between the ages of 19 and 65. Approximately 3.5% of the population is over the age of 65. Language: Cree Transportation: Access can be obtained using an all-weather road through Jenpeg. Most of the roads in the community are paved with the exception of 4 kilometers. A ferry shuttle is used to cress the Nelson River in summer and a road over the ice is constructed in the winter. A 4,000 foot gravel airstrip is maintained in the community and serviced daily through scheduled flight. Dock facilities accommodate both float planes and boats. There are two taxi operations on a flat rate basis as well as one patient transportation operation. Governance: Nominations for the Chief Position will be held in June of 2011 with elections to follow in July of 2011 Chief and Council offices – (204) 359-6721 fax (204) 359-4189 Economic base: Trapping, fishing, mining. Commercial business and/or Service Anderson’s fuel and Confectionary Anderson’s Carwash and Convince Apetagon’s Parts and Accessories Apetagon’s small Motor Repairs Bernard and Lon’s Logging Canada Post Corporation Chicken Chef Community Council Cree Nation Design Inc. DJ Invader Music Services Duncan Taxi Florence Duncan – Dickie Dee Folster’s Trucking Fort Island Laundromat Frontier School Division Jack River Drilling and Blasting Manitoba Northern Airports Manitoba Hydro Manitoba Telephone Molson Lake Lodge Nor-Man Pharmacy Norway House Trapper Assoc. RCMP Detachment Susie’s Bakery Frontier School Division High School Kinosao Sipi Business Dev. Corp. Low’s Family Foods Multi Complex Manitoba Natural Resources Manitoba Community Services Manitoba Highways Muswagon’s Taxi Norway House Indian Hospital Perimeter Air Royal Bank York Boat Inn Communication: Norway House has a private radio station CJNC, and also receives signals from Thompson. (CJNC is affiliated with CBC radio). CBC-TV is rebroadcasted in the community. Important Numbers to Know: Norway House Cree Nation o Chief and Council - Ph (204) 359-6786, fax (204) 359-4186 o Administration – Ph (204) 359-6721, fax (204) 359-6080 Norway House Public Health Unit First Nations Inuit Health Branch (204) 359-4552 Norway House Hospital (204) 359-8223 Norway House Clinic (204) 359-8225 / Doctor’s Secretary (204) 359-8230 Child and Family Services o Wpg Sub-Office –Awasis Agency of Northern MB, 201-274 Smith St, ph (204) 987-9480, fax (204) 987-9489 o Kinosao Sipi Minisowin Agency, Norway House MB, ph (204) 359-4551, fax (204) 359-6013 The head office is located in Norway House with the Wpg office of Awasis Agency of Northern MB acting as a sub-office of the agency. RCMP detachment – This community has a local RCMP detachment (204) 359-6715 24 – Hour Manitoba Suicide Line Toll Free 1- 877- 435-7170 24 - Hour Crisis Line Toll Free 1- 888- 322-3019 24 – Hour Sexual Assault Crisis Line Toll Free 1- 888 - 292-7565 Northern/Remote Resident Manual 2015-16 Page 69
