Under Construction: Phase 2 - Interviews

IM Subspecialities:

    Allergy and Immunology

    Cardiology

    Endocrinology

    Gastroenterology

    Geriatrics

    Hematology

    Oncology

    Infectious Diseases

    Nephrology

    Respirology

    Rheumatology

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Respirology

Introduction

Respirology (also known as Pulmonology in some countries) is a subspecialty of internal medicine that mainly deals with disorders of the lower respiratory tract (lungs and bronchial tubes) but also involves disorders of the upper respiratory tract (throat, pharynx and nose) and heart. Respirologists are experts when it comes to both chronic and acute diseases of the chest; often encountering genetic disorders, infections, and malignancies on a daily basis. Respirology training is attained through 3 years of foundational internal medicine, followed by 2 years of an adult respirology program. Pediatric respirology requires a 3 year pediatric program, followed by 2 years of pediatric respirology.

Respirologists boast a wide variety of skills and duties when it comes to assessing and treating the pulmonary system. Managing chronic illnesses such as COPD, asthma, or lung cancer is a hallmark of respirology. In order to optimize a chronically ill patient’s quality of life, respirologists must have an in-depth knowledge of antibiotics and steroids. They must also be adept at initiating and discussing lifestyle modifications such as smoking cessation. Another large aspect of this specialty is pulmonary function testing, the results of which need to be interpreted into accurate diagnoses. Pulmonary testing also plays a big role in the perioperative management of patients with lung disease. It is up to the respirologist to decide if a patient’s lungs can handle surgery or not. More invasive diagnostic tests involving bronchoscopies and lung biopsies also fall under the umbrella of respirology. In fact, interventional respirology is a budding specialty that has respirologists implanting airway stents and cryogenically freezing lung tumours in addition to performing their standard diagnostic interventions.

Common Disease and Disorders

Tuberculosis (TB)
Mycobacterium Tuberculosis is the second most lethal infectious agent on the planet (behind HIV) and currently infects over one third of the world’s population. While the rates of infection are much lower in developed countries, the few cases that are found are always managed by respirologists. Hallmarks of the disease include formation of hard grayish nodules, or tubercles, along with cough, hemoptysis and dyspnea. Treatment involves a lengthy course of potent antibiotics and pulmonary testing to monitor lung function.

Chronic Obstructive Pulmonary Disease (COPD)
This disease is characterized by abnormalities in the lungs that make it difficult to exhale. COPD involves two distinct types of airway narrowing; emphysema and chronic bronchitis, both of which are usually caused by cigarette smoking. Management involves the use of steroids, lifestyle modifications and intermittent pulmonary testing to assess function and prognosis.

Cystic Fibrosis (CF)
This autosomal recessive genetic disorder is the most commonly inherited disease in North America. CF causes the body to produce abnormally thick mucus in several different parts of the body, most prominently in the lungs. This sticky secretion generates consistent airway obstruction and predisposes patients to pulmonary infections. CF also affects the pancreas, which causes patients very serious digestive symptoms. Management involves pulmonary function testing, targeted genetic therapies, and symptom management through steroids and other medications.

Lung Cancer
Lung malignancies are the rapid growth and division of cells within the lung tissue. This form of cancer is the highest in terms of incidence and mortality among men, and second in women (behind breast cancer). 80–90% of lung cancers are due to long-term exposure to tobacco smoke, while the remaining 10-20% are caused by a combination of genetic factors and exposure to other irritants like asbestos and air pollution. Respirological management of lung cancer includes pulmonary function testing, symptom management and surveillance.

Further Advanced Training Opportunities

There are many fellowship opportunities that provide even more specialized training in the management of specific chronic pulmonary illnesses. Examples include adult cystic fibrosis fellowships, asthma and airway disease fellowships, and interstitial lung disease fellowships. Other opportunities include programs in sleep medicine, lung injury and complex critical illness, and medical lung transplant management to name a few.

Gender Breakdown
87 responses (2014 National Survey Results)

Age Breakdown
87 responses (2014 National Survey Results)
Hours Breakdown (Excluding on-call activities)
50 responses (2014 National Survey Results)

Activity Hours Worked (mean)
Direct patient care without a teaching component 18.24
Direct patient care with a teaching component 11.30
Teaching/ educating without direct patient care 2.52
Indirect patient care 5.63
Health facility committees 1.39
Administration 3.31
Research 3.79
Managing your practice 1.27
CME/ CPD (Continuing Professional Development) 2.96
Other actvities .16
Total Hours 50.56

Average number of on-call work hours per month: 103.21
70 responses; reported as mean (2014 National Survey Results)


Adult Respirology Residency Programs in Canada

Contact information for Program Directors can be accessed on the Royal College’s website here: Open in new tab

University of British Columbia
Vancouver, British Columbia

Queen’s University
Kingston, Ontario

University of Calgary
Calgary, Alberta

University of Ottawa
Ottawa, Ontario

University of Alberta
Edmonton, Alberta

McGill University
Montréal, Quebec

University of Saskatchewan
Saskatoon, Saskatchewan

Université de Montréal
Montréal, Quebec

University of Manitoba
Manitoba, Winnipeg

Université de Sherbrooke
Sherbrooke, Quebec

Université Laval
Laval, Québec

Western University
London, Ontario

Dalhousie University
Halifax, Nova Scotia

McMaster University
Hamilton, Ontario

University of Toronto
Toronto, Ontario

Page Author(s): Jake Yeoman (2018)
© 2017 Internal Medicine Interest Group (IMIG) - Schulich School of Medicine and Dentistry