Fellowship Programs

Program Entry Requirement

Candidates to this program are required to have completed a fourth year of training in General Pediatrics, which will have been preferably tailored to the candidate's further training plans in Academic Pediatrics. In addition, it is strongly recommended that candidates have planned or initiated a scholarly project, which will be completed as a requirement to this program. Ease in spoken French and English, and in written English are essential for maximal educational experience, due to the demographics of the Montreal Children's Hospital's (MCH) patient population (~40% French, ~30% English, ~30% Other languages). Candidates unfamiliar with the MCH are encouraged to complete a clinical rotation at our institution to become familiar with its learning and clinical environment.

Curriculum

Sample Rotation Training Grid (12 month / 12 training blocks)

Types of Electives:

• Complex Care Service
• Medical Day Hospital
• Junior ward attending
• Night float senior
• Child Protection
• Other subspecialty rotations, based on fellow’s clinical interests

Educational Opportunities:

• Weekly one-to-one session with program director
• Bi-monthly continuity clinic adapted to trainees' clinical interests
• Participation in CCHSCP sessions with other subspecialty trainees
• Yellow Belt (one-day course) Lean Six Sigma methodology (free registration)
• Protected time to undertake graduate level courses (e.g. MPH, MBA, MSc)
• Possibility to register for Pediatrics Advanced Life Support (PALS) and Neonatal Resuscitation Program (NRP) courses at resident rate
• Regular opportunities to teach pediatric residents

There is also a possibility to undertake research or specialized academic training (e.g. MSc, MBA, MPH).

Innovations

The advanced pediatric trainee will be prepared to play a builder role in academic center-type practice, including some training in:

• Health Administration and Leadership
• Medical Education
• Quality Assurance/Risk Management

Training Sites

Montreal Children's Hospital

Training Requirements

To successfully complete the Academic Pediatrics Fellowship Program, the fellow will have to demonstrate:

• satisfactory completion of all clinical rotations, including core rotations
• completion of a scholarly project
• regular attendance and active participation at fellows’ protected teaching
• regular attendance and active participation at CCHCSP
• fulfilment of yearly call responsibilities
• participation in at least one hospital or university-based committee

All General Pediatrics fellows are expected to assume on-call duties. The types of calls and their frequency will depend on the fellowship stream and may be individualized by the fellowship director, taking into account the fellow's previous experience, their personal training objectives, and their future career scope.

Training Requirements

The desired goal of the Complex Clinical Care Fellowship Program is to equip the senior pediatrics trainee with a specific set of skills required to pursue a career in the care of the child with complex medical needs, similar to the pediatric “hospitalist” model. This fellowship program aims to train ‘’builders’’, who will develop Complex Care Pediatrics at the regional and national levels in the creation and evaluation of clinical care, curriculum, and research domains. Training components, described below, may be tailored to the unique needs of each candidate.

All General Pediatrics fellows are expected to assume on-call duties. The types of calls and their frequency will depend on the fellowship stream and may be individualized by the fellowship director, taking into account the fellow's previous experience, their personal training objectives, and their future career scope.

A maximum of 2 in-house calls per block on the General Pediatrics inpatient unit may be required.

Clinical Component

The clinical experiences are geared towards broad exposure to children with complex care needs and the health care infrastructure that supports or is required to support the needs of this growing subsegment of the pediatric population. Exposures will be concentrated in the Complex Care Service (previously known as the Intensive Ambulatory Care Service/Homecare) and include inpatient, outpatient, home-based and community-based care.

Fellows will develop the knowledge, skills and attitudes required to provide high quality collaborative care. Specifically, the infrastructure of multidisciplinary teams, care coordination and communication will be emphasized. Children with complex care needs include vulnerable and fragile populations such as post-solid-organ transplant recipients, technology dependent children, those with progressive neuromuscular conditions and those at high risk of frequent and recurrent hospitalization. Clinical training is expected to comprise approximately 10 of the 12 months of advanced pediatrics training, with the remaining two months allocated to the completion of a scholarly project such as a small-scale research project or a quality improvement project.

Specific training activities include:

• Complex Care Service rotations (10-11 blocks):

1. Longitudinal exposure to children with complex conditions, focused in the Complex Care Service, formerly known as the Intensive Ambulatory Care Service
2. Complex care consultations
3. Participation in multidisciplinary clinics and weekly Complex Care teaching rounds
4. Home and community (CLSC, Rehab Centre) visits

• Scholarly project (2-3 blocks)
• Call duties: Complex care service (one week of “home call” per block when on CCS service)
• Attendance at a national/international conference which focuses on the care needs of medically fragile/complex children.

Academic Component

Specific to this fellowship program is the expectation that trainees will develop, implement, and complete a scholarly project, suitable for presentation at a national/international conference on the care of children with complex medical needs. This project may take the form of a research project (chart review, retrospective case-control, or prospective survey, for example), a quality assurance or advocacy project.

In addition, all Complex Clinical Care Fellows will also be expected to join the Pediatric Health Research Epidemiology Statistics CurriculA (PHRESCA)
Course Director: Dr. Evelyn Constantin MD
Associate Course Directors: Dr. Elise Mok PhD
Course Coordinator: Ms. Sofia Bamboulas

Which includes the following curriculum of interactive teaching sessions:

1. Introduction to Epidemiology and study design
2. Searching and managing medical literature
3. Developing a research questions/designing a study
4. Introduction to statistics
5. Randomized controlled trails
6. Cohort studies
7. Case control studies
8. Cross-sectional studies
9. Research writing skills
10. Presentation skills
11. Research ethics
12. Curriculum vitae preparation (common CV)
13. Time management workshop
14. Career planning

General Principles

• Clinical exposures to pediatric complex care will be the focus of the fellowship
• Fellows will be expected to have call duties in a variety of settings where the issues and needs of children with complex care are emphasized
• Fellows will be expected to complete a scholarly project, as described above.

Mission and Vision

Mission
To advance the field of Social Pediatrics through the support of Advanced Pediatric Training for pediatricians who will act as champions of positive change for the health of vulnerable populations.

Vision
All graduates will have the medical expertise, advocacy, and research skills to engage, collaborate and help empower socially vulnerable populations. These graduates will also possess skills in lobbying for health policy change, health promotion, and will contribute to the knowledge growth of socially disadvantaged children.

Background
The Department of Pediatrics has a long history of participating in the care of disadvantaged populations. There has been a core pediatrics rotation in social pediatrics for second year residents since 2002. A number of pediatricians affiliated with the Department practice with socially disadvantaged populations, have links to community-based health organizations and are involved in community-based advocacy. There are long established programs in multiculturalism, Aboriginal health, and children under youth protection. Finally, there is a long tradition in Global Health within the department. Thus, the fellow interested in focusing on training in social pediatrics and models of care that are community based and sensitive to social context will have excellent opportunities to do so within the Department of Pediatrics.

The evolution of pediatric practice has made the time ripe to develop the idea of a social medicine focus in the training of professionals in child health. Over the last 60 years, pediatrics has evolved from a specialty dealing with largely acute diseases to one with a significant population of children affected by the social determinants of health, with chronic diseases and special needs. In the 21st century, pediatric practice continues to evolve, and research demonstrates that social factors clearly have long lasting effects on the health of children, and later as adults.

Training Requirements

Medical Training

Having stated that an understanding of the social determinants of health and the effect of social context on health is integral to the training of all child health professionals, we recognize the need to enrich the community of pediatricians with individuals who possess the requisite knowledge, skills, and sensitivity to act as champions of positive change for the health of disadvantaged populations. Such a person must possess sound medical expertise in the specific health problems of socially vulnerable populations, the skills to appropriately engage and collaborate with communities, and the attitudes that have social justice as a core value. Clinical rotations are tailored to this training philosophy and are mostly community-based.

Clinical exposures generally run in a longitudinal fashion (e.g., one day/week over several months, mixed in with other similar exposures), and take place in a variety of community organizations in and around Montreal. These organizations have in common that they are rooted in the communities that they serve (providing community empowering models of care among socially vulnerable populations), with clinical supervisors committed to advocacy within the specific populations. A list of organizations is in the Annex.

To round out clinical experiences, fellows are able to undertake longitudinal electives in specific clinical areas (tailored to their needs and future career) in selected specialty and general pediatrics clinics at the Montreal Children’s Hospital. Fellows also undertake one mandatory month on the pediatric inpatient consult service (includes Child Protection), with significant teaching duties within the Division of General Pediatrics at the Montreal Children’s Hospital. Ultimately, we seek to encourage the development of a diverse next generation of pediatricians, who are prepared as a group to respond to the needs of the children of Quebec, Canada, and the World.

Advanced Academic Skills

Experts in social pediatrics must not only gain complex medical expertise; they must also develop academic skills (including research and/or advocacy skills) in order to contribute to the improvement of the health of disadvantaged populations at the population health level. We see the social pediatrician as a physician who is able to undertake community-based medical research, who has the skills in community activism and lobbying for health policy change, and who views health promotion as a core value. Such an individual will incorporate this practice within an ethos that seeks to empower the communities that he or she serves.

Academic training, then, for the advanced trainee in social pediatrics will make use of the many links that have been made with the leadership in other faculties at McGill University, notably Social Work, Law, Epidemiology and Anthropology. The leadership in these faculties is very open to the idea of pediatric trainees receiving training with them in order to develop the academic skills needed to function as a positive agent of social change, fellows are expected to undertake a major scholarly project in a domain pertinent to social pediatrics. Such projects might include: community-based clinical research (e.g., “epidemiology of Hepatitis C among street youth in Montreal”), advocacy (e.g., “improving access to health care for new refugees to Montreal”), or in other scholarly fields such as Medical Ethics, or Medical Education. Projects are assessed for suitability based upon relevance to the care of vulnerable pediatric and youth populations.

General Principles

• Fellows continue (or start if they are new to the program) the Residents’ Continuity Clinic or a similar community-based clinic throughout the 12 months of fellowship.
• Many of the exposures can be arranged to run longitudinally, rather than block by block.
• All fellows are expected to contribute to the development of the protected teaching curriculum for advanced trainees.
• All fellows will participate in the Canadian Child Health Clinician Scientist Program (CCHCSP).
• All fellows are expected to complete and present the results of a scholarly project. The topic (e.g., advocacy, policy promotion, research), scale and presentation will depend on the fellow’s training and career goals.
• On call duties.
• All fellows will have teaching duties within the Division of General Pediatrics, as a scholar role expectation, e.g. in-training OSCE for pediatrics residents, Chief of Service rounds, teaching to medical students and junior pediatrics residents on the wards, Pediatric Consultation Center (PCC) or Residency Continuity Clinic (RCC) outreach education or other teaching.

All General Pediatrics fellows are expected to assume on-call duties. The types of calls and their frequency will depend on the fellowship stream and may be individualized by the fellowship director, taking into account the fellow's previous experience, their personal training objectives, and their future career scope.

A maximum of 2 in-house calls per block on the General Pediatrics inpatient unit may be required.

Sample Rotation Training Grid

Eligibility and Funding

Eligibility
Candidates for this fellowship are required to have completed a fourth year of General Pediatrics residency in a Canadian program and should be expecting completion of their FRCPC Pediatrics certification prior to entry. They must also meet the eligibility requirements of McGill University.

Capacity in conversational French would be a strong asset due to the demographics of the Montreal Children’s Hospital’s (MCH) patient population (~40% French, ~30% English, ~30% Other languages). Candidates unfamiliar with the MCH may consider completing a clinical rotation at the institution in order to become familiar with its learning and clinical environment.

Please note that pediatric residents who have obtained their MD in Quebec and/or who did residency training in Quebec in a contingent régulier or contingent particulier position are eligible to apply to this fellowship only via the “formation complementaire” program.

Funding
Funding and tuition support for accepted candidates is available. Details can be found on the McGill Department of Pediatrics website: https://mcgill.ca/peds/education-training/pgme/funding

Curriculum

The fellow will be exposed to the full range of tertiary hospital pediatrics, along with opportunities in community settings. The majority of the clinical rotations will take place at the Montreal Children’ Hospital. Elective clinical rotations may take place at McGill-affiliated centres such as the Royal Victoria Hospital/Glen (Newborn Nursery), Jewish General Hospital (Newborn Nursery), LaSalle Hospital (Newborn Nursery), and Cite de la Sante Hospital (Pediatric Unit).

During clinical rotations, the supervisory role of the fellow towards more junior trainees will vary depending on the nature of the rotation. However, it is expected that the fellow will be directly responsible for resident and medical student supervision in some capacity while on clinical rotations.

All General Pediatrics fellows are expected to assume on-call duties. The types of calls and their frequency will depend on the fellowship stream and may be individualized by the fellowship director, taking into account the fellow's previous experience, their personal training objectives, and their future career scope.

Assessment

In order to successfully complete the Pediatric Hospital Medicine Fellowship Program, the fellow must demonstrate:

• Satisfactory completion of all clinical rotations, including core and elective rotations
• Completion of a scholarly project
• Regular attendance and active participation at fellows’ protected teaching
• Regular attendance and active participation at CCHCSP
• Fulfilment of yearly call responsibilities
• Regular participation in department meetings (e.g. QUIPS rounds) and teaching activities (e.g. Evidence-based Rounds)

During each clinical rotation, fellows will receive regular feedback on their performance in order to guide their formative trajectory. Mid-way feedback, as well as final feedback at the end of the rotation, will be expected of supervising staff members.

Written evaluations will be provided for clinical and academic rotations using McGill University’s online One45 evaluation platform. In the cases where the fellow will have worked with multiple supervising staff over the course of a rotation, the final evaluation will be reflective of cumulative input. The One 45 system will also permit the fellows to complete formal evaluations of their rotations and of the teaching faculty.

Regular meetings every three months with the Fellowship Program Director will allow fellows to remain cognizant of their performance. This will facilitate an open dialogue to enhance the learning experience while providing tailored feedback. Since the General Pediatrics Fellowship Committee supervises and coordinates the training of fellows in the various General Pediatrics Fellowship Programs, it will also review trainee progress and performance throughout the year as well as at the end of the fellowship.

Upon successful completion of the fellowship, candidates will receive a certificate of completion from McGill University.

Training Sites

• Montreal Children’s Hospital: 70 - 90%
• Jewish General Hospital (NICU, Newborn Nursery): 0 - 10%
• Royal Victoria Hospital (NICU, Newborn Nursery): 0 - 10%
• LaSalle Hospital (NICU, Newborn Nursery): 0 - 10%
• Hopital Cite de la Sante (Pediatric unit): 0 - 10%

Academic Facilities:

• Office space in the Montreal Children’s Hospital General Pediatrics area (General Pediatrics Fellows’ Office BRC. 6154)
• Electronic access to the McGill Health Sciences Library from computers in all training sites and to “Uptodate” from computers at the Glen site
• In person access to the Glen Site McConnell Resource Centre/Medical Library and McGill Health Sciences Library
• Simulation sessions at the Shriners Hospital Simulation Centre and the McGill Steinberg Centre for Simulation and Interactive Learning

Contacts

Fellowship Director: Dr. Catherine Nolin (Montreal Children’s Hospital)
Fellowship Coordinator: Ms. Bobbie Carin (Montreal Children’s Hospital)
Oversight Committee: General Pediatrics Fellowship Committee (which reports to the General Pediatrics Residency Training Committee):

• Chair: Administrative Director of the General Pediatrics fellowships
• Members: Directors of each of the General Pediatrics fellowships, Director of the General Pediatrics Residency Program, 1 - 2 General Pediatrics fellow representatives

Teaching Faculty:

• Inpatient Wards: Dr. H. Agostino , Dr. L. Auger, Dr. R. Benkelfat, Dr. V. Clavel, Dr. M. Dandavino, Dr. M. Donlan, Dr. G. Dougherty, Dr. T. Giannone, Dr. J. Hebert, Dr. S. Hum, Dr. C. Karatzios, Dr. L. Kimoff, Dr. N. Korah, Dr. P. Li, Dr. S. Liben, Dr. C. Millar, Dr. G. Morantz, Dr. C. Nolin, Dr. E. Rubin, Dr. E. Ruano Cea, Dr. R. Sterszus

• Complex Care Service: Dr. C. Henin, Dr. A. Lafontaine, Dr. S. Long- Gagne, Dr. H. Patel, Dr. AM. Sbrocchi
• Medical Day Hospital: Dr. M. Berry, Dr. E. Constantin, Dr. MP. Guilbault, Dr. J. Morel, Dr. A. O'Gorman, Dr. J. Ortenberg, Dr. C. Phi, Dr. K. Saylor, Dr. O. Tse
• Newborn Nursery: Dr. Beaumier, Dr. A. Gorgos, Dr. D. Leduc, Dr. K.Nguyen
• Pediatric Intensive Care Unit: Dr. F. Bhanji, Dr. T. Di Genova, Dr. P. Fontela, Dr. R. Gottesman, Dr. P. Puligandla, Dr. S. Shemie, Dr. S. Zavalkoff, Dr. D. Withington
• Neonatal Intensive Care Unit: Dr. G. Altit, Dr. J. Bartholomew, Dr. M. BelTempo, Dr. R. Gosselin, Dr. E. Hailu, Dr. F. Olivier, Dr. T. Perreault, Dr. G. Sant’Ana, Dr. W. Shalish
• Pediatric Emergency Department: Dr. R. Paquin, Dr. L. Plotnick, Dr. S. Vaillancourt
• Community Hospitals: Dr. S. El Tarazi, Dr. T. Giannone, Dr. MP. Guilbault