Safety

McMaster Emergency Medicine Safety Policy

Preamble

The Royal College of Physicians and Surgeons accreditation standards (B1.3.9) requires that every residency program have specific policies with respect to resident safety. The policy should allow residents discretion and judgment regarding their personal safety and ensure residents are appropriately supervised during all clinical encounters.

The document, Postgraduate Medical Education Health and Safety Policy available at: https://pgme.mcmaster.ca/app/uploads/2019/02/Health-Personal-Safety-Policy-PGEC-2011.pdf provides procedures for reporting and responding to specific circumstances contained in that document. The Emergency Medicine residency program formally acknowledges, endorses, and agrees to adhere to these guidelines.

Residents have the right to a safe environment during their residency training. The responsibility for promoting a culture and safe environment is shared between the University, the faculty of medicine, the hospitals/clinical departments, residency training programs and the residents themselves.

Key Responsibilities 

FOR RESIDENTS

• To provide information and communicate safety concerns to the program and to comply with safety policies.

FOR RESIDENCY TRAINING PROGRAMS

• To act promptly to address identified safety concerns and incidents and to be proactive in providing a safe learning environment.

Physical Safety 

These guidelines apply only during residents’ activities that are related to the execution of residency duties:

Travel Safety 

• When residents are travelling for clinical or other academic assignments by private vehicle, it is expected that they maintain their vehicle adequately and travel with appropriate supplies and contact information. Provincial laws prohibit non-hands-free cell For phone use and text messaging in the performance of residency duties while driving.
• For long-distance travel for clinical or other academic assignments, residents should ensure that a colleague or the home residency office is aware of their itinerary.
• Residents should not be on call the day before long-distance travel for clinical or other academic assignments by car. When long-distance travel is required in order to begin a new rotation, the resident should request that they not be on call on the last day of the preceding rotation. If this cannot be arranged then there should be a designated travel day on the first day of the new rotation before the start of any clinical activities.
• Residents are not to be expected to travel long distances during inclement weather for clinical or other academic assignments. If such weather prevents travel, the resident is expected to contact the program office promptly. Assignment of an alternate activity is at the discretion of the Program Director.

Hospital Safety 

• Residents are not expected to walk alone for any major or unsafe distances at night. This includes walking on the hospital premises and parking lots. The residents are expected to request security escorts if such circumstances occur. Residents should not drive home after call if they have not had adequate rest.
• Residents should not assess violent or psychotic patients without the backup of security and an awareness of accessible exits. When interacting with patients with a potential for violence, residents should ascertain that there is a backup from security staff and that the patients are seen in an area, which allows for safe and easy exit
• The physical space requirements for the management of violent patients must be provided where appropriate.
• Site orientations should include a review of local safety procedures.

Personal Safety 

• Residents should only telephone patients using caller blocking.
• Residents should familiarize themselves with the location and services offered by the Employee Health and Safety/Occupational Health Office.
  • HGH 4 North Room 415, ext. 46307
  • JHCC Section A – Level 0 – Room 60, ext. 42314
  • MUMC 1F11 (behind red elevators), ext. 75573
  • SJHH Charlton (Martha Wing 4th Floor), ext. 33344
• This includes familiarity with policies and procedures for infection control and protocols following exposure to contaminated fluids, needle stick injuries, and reportable infectious diseases.
• Residents must observe universal precautions and isolation procedures when indicated.
• Residents should keep their immunizations up to date. Overseas travel immunizations and advice should be sought well in advance when travelling abroad for electives or meetings.
• Pregnant residents should be aware of specific risks to themselves and their fetus in the training environment and request accommodations where indicated. Residents should consult the Occupational Health Office for information.

Psychological Safety 

• Learning environments must be free from intimidation, harassment, and discrimination. Where there are situations where there are concerns regarding Intimidation, harassment or discrimination residents are strongly encouraged to discuss this with the Program Director, Associate Program Director or Program Assistant. Residents may also contact the Post Grad Office directly.
• When a resident’s performance is affected or threatened by poor health or psychological conditions, (physical or mental) the resident should be granted a leave of absence and receive appropriate support. Such residents should not return to work until an appropriate assessor has declared them ready.
• Residents should be aware of and have easy access to the available sources of immediate and long-term help for psychological problems, substance abuse problems, harassment, and inequity issues.

Professional Safety

• Residents may experience conflicts between their ethical or religious beliefs and the training requirements and professional obligations of physicians. Resources should be made available to residents to deal with such conflicts. Examples include the Program Director, the Canadian Medical Protective Association and the College of Physicians and Surgeons of Ontario.
• Residents must be appropriately supervised recognizing that part of residency training is graded responsibility. Details regarding specific standards of supervision may be found on the CPSO Policy Professional Responsibilities in Postgraduate Medical Education – https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Professional-Responsibilities-in-Postgraduate-Medi
• Where there is a disagreement between a resident and a faculty member with respect to the management of a patient, there is a process endorsed by McMaster University and the Council of Ontario Faculties of Medicine – https://cou.ca/wp-content/uploads/2017/10/Resolution-of-Resident-Conflict-with-Attending-Physician-or-Supervisor-on-an-Issue-of-Patient-Care.pdf
• The Program will adhere to the PARO-CAHO Collective Agreement.
• Where possible the Program will accommodate religious holidays having regard for professional and patient care responsibilities.
• Residents should have adequate support from the program following an adverse event or critical incident.
• Programs should promote a culture of safety in which residents are able to report and discuss adverse events, critical incidents, ‘near misses’, and patient safety concerns without fear of punishment.
• Residency program committee members must not divulge information regarding residents. It is the responsibility of the residency Program Directors to make the decision and to disclose information regarding residents (e.g. personal information and evaluations) outside of the residency program committee and to do so only when there is reasonable cause. The resident file is confidential.
• Resident feedback and complaints must be handled in a manner that ensures resident anonymity unless the resident explicitly consents otherwise.
• Residents must be members of the CMPA and follow CMPA recommendations in the case of real, threatened, or anticipated legal action.

The Role Of Residents in Ambulance Transports 

PGE:COFM Dec. 9, 1999, Educational Principles

• In many programs, participation in patient transport is a valuable learning experience for residents.
• There must be clear educational objectives underlying the resident’s participation in patient transport.
• Residents must have appropriate training with demonstrated competency in the circumstances relevant to the transport experience.
• Communication and supervision between the resident and his/her designated supervising physician must be available at all times.
• Resident well-being should be considered in all transports.

Note: On occasion residents/fellows may be confronted with a situation for which they are not sufficiently trained. It is expected that they, like other physicians, will deal with such situations as practicing professionals to the best of their ability. The Program Director is always available to provide support and guidance.

Shift Reduction

PGY5 EM Shift Reductions Prior to Exams

In order to provide them with additional time to study for their Royal College Exams, FRCPCP EM Residents in PGY5 are provided with a shift reduction for the 3 blocks leading up to the exam until the exam is complete. As this shift reduction is intended to provide residents with additional time to study, it is understood that if a resident chooses to use the shift reduction, they will not pick up any additional clinical work during this period.

Shift Requirements

For the 3 Blocks leading up to the written exam, the shift requirement for PGY5 Residents is 11 shifts per block.

Starting in the block following the oral exam the shift requirement returns to 15 shifts per block.

Vacation Adjustments during the period of the shift reduction:

• 3 shift reduction for every 1 week of vacation
• Less than 1 week of vacation – 1 shift reduction for every 2 vacation/PL days
• Absolute minimum of 8 shifts in a block

Exam Blocks

The Block of the Written Exam:

• 2 Exam Days
• If Resident takes a week off – 8 Shifts Minimum
• If not – 10 shifts

The Block of the Oral Exam:

• 1 Exam Day + Travel time to and from Ottawa
• If Resident takes a week off – 9 shifts Minimum
• If Not – 11 Shifts

If both the Written and Oral Exams are in the Same Block:

• 3 Exam Days + Travel time to and from Ottawa for the Oral Exam
• If a Resident Takes a Week off – 6 Shifts Minimum
• If a Resident Takes 2 weeks off – 4 shift minimum
• If not – 8 shifts

If there is a full block between the Written and Oral Exam:

• 13 Shifts in that block
• 3 shift reduction for every 1 week of vacation
• Less than 1 week of vacation – 1 shift reduction for every 2 vacation/PL days
• Absolute minimum of 8 shifts in a block

Night shifts will not be required during the shift reduction period, however, residents may choose to work them if they so desire.

Residents need not have a preceptor for any block where they have 8 or fewer shits, however, will require one in any block with more than 8 shifts.

Any resident doing longitudinal PEM Shifts may only do 1 PEM Shift per block during the shift reduction period.

PGY5s are entitled to an additional week (7 days) of Professional Leave in the 4 weeks leading up to the Royal College exam. Residents may choose to split the 7 days between the written and oral components of the certification exam or take all 7 days consecutively.

Academic Requirements 

Given the multiple roles of PGY5 residents at rounds, journal club and other academic events, it is expected that they will attend all academic events until 4 weeks in advance of the written exam and 1 week prior to the oral exam. This requirement does not apply if on a formal vacation or PL.

In the 4 weeks prior to the written exam (and 1 week prior to oral exam) PGY5 Residents are encouraged to come to academic events however it will not be required. Following the exams the attendance requirements return to normal.

Any unique circumstances not outlined above will be considered on a case-by-case basis by the program director.

Restricted Registration

The McMaster Emergency Medicine program is a participant in the provincial Restricted Registration (RR) program. The following is a summary of the yearly requirements that should be met by residents seeking RR licensing.

Please note that though you are eligible, you must independently apply for a special RR license through the CPSO registration committee. Please see the RR website for more information (http://restrictedregistrationontario.ca/).

Fees & deadlines: It is important to note that there are required fees and strict deadlines. Fees for an RR license must be paid on a yearly basis for each job site regardless of how much of the year is spent working.

Current eligible sites for eligible McMaster FRCPC ER Residents 

• HGH ICU
• JH ICU
• SJH ICU
• MCH PCCU

Requirements for participation

• Attendance at AHD/JC meets expectations for good standing
• Adequate performance for CITE and Block Exams
• On Track for EPAs and other evaluations

Guidelines

• Can apply during PGY3 following Critical Care Rotations
• Limited to 1 additional shift per week
• Work hours can NOT exceed the maximum/time off between shifts as outlined in the PARO-CAHO Collective Agreement
• May not interfere with Residency Program Requirements (clinical or academic)
• May not be done during shift reduction period leading up to Royal College exam.

Equity, Diversity and Inclusion

McMaster University Emergency Medicine EDI Statement

McMaster University is located on the traditional territories of the Haudenosaunee and Mississauga Nations and, within the lands protected by the “Dish with One Spoon” wampum agreement.

In keeping with its Statement on Building an Inclusive Community with a Shared Purpose, McMaster University strives to embody the values of respect, collaboration and diversity, and has a strong commitment to employment equity. The diversity of our workforce is at the core of our innovation and creativity and strengthens our research and teaching excellence. The University seeks qualified candidates who share our commitment to equity, diversity and inclusion. All qualified candidates are invited to apply and we particularly welcome applications from women, persons with disabilities, First Nations, Métis and Inuit peoples, members of visible minorities, and LGBTQ+ persons.

The McMaster FRCPC Emergency Medicine Program in particular aims to build a community that is safe, inclusive, and respectful for all. We unequivocally condemn racism in all forms, and recognize that Black, Indigenous, and people of colour suffer disproportionate acts of hatred and discrimination. We stand in solidarity with our patients and colleagues who experience injustice and commit to creating a more tolerant reality.

As current and future Emergency Medicine practitioners we recognize the power and privilege we hold when caring for patients, often at their most vulnerable. We see the result of social inequality on a daily basis manifested as poor health outcomes. Advocacy should be a foundational component of our academic, research, and clinical work.

Our program pledges to embed this in the work that we do. We commit to continually reflecting, listening, learning, and, where needed, changing our systems. The Inclusion, Diversity, Equity, and Anti-racism (IDEA) committee is a group of McMaster EM residents with a dual focus on academic programming and on increasing representation in emergency medicine.