Cardiovascular Anesthesia and Critical Care (TGH)

(8-10 positions per year)

Clinical Curriculum 

The 12-month fellowship consist of 9 months spent in the OR’s and 3 months in the CVICU. About 6 weeks are dedication TEE training which is considered a core clinical skill. Up to 8 weeks of academic time can be allocated. The goal is for fellows to be able to complete approximately 120 open chest cardiac cases per year involving CPB of which about 50% will be valve repair or replacement, complex adult congenital repairs, root repair or replacement, LVAD insertion, heart transplants, TEVAR’s and TAAA’s. Off Pump Coronary Artery Bypass (OPCAB) and minimally invasive CABG and valve surgeries are also done on a regular basis.

An elective cardioversion list is scheduled weekly. Arrhythmia ablation as well as pacemaker insertion, including biventricular and epicardial systems, insertion of aortic stents (coarctation), device closure of ASD’s, VSD’s, LAA’s and perivalvular leaks, percutaneous valve repair (including MitraClips) and replacement (including TAVI’s) have become an integral part of the cardiovascular anaesthesiologist duties.

Heart transplant and ventricular assist devices are managed under the heart failure program. The centre performs an average of 30-40 heart transplants and 30-40 ventricular assist devices per year.

The CVICU is a 20-bed unit that is managed by the department of cardiovascular anaesthesia in conjunction with the department of cardiovascular surgery. The anaesthesia fellow weekday coverage is from Monday to Saturdays and the evening and overnight call alternates with the cardiac surgical fellows. During the time in the CVICU, the fellow will become proficient in the management of post-operative cardiac surgical patients, including heart transplants and ventricular assist devises.

Call duties

Currently Cardiac OR call is done from home on a rotational basis. The Cardiac OR call will include on average 2 weekends per month with week day calls as well. Cardiac anesthesia fellows can expect to be scheduled for call 4-7 times per month. The anesthesia CVICU fellows do a week of day time call, Monday to Saturday followed by a week of night call on Monday, Wednesday, Friday and Sunday. This arrangement can change. During the 12 month fellowship, fellows will complete 12 weeks of CVICU. Due to scheduling, some fellows will complete more CVICU in the first half of their fellowship.

Education Curriculum

TEE reading sessions are mandatory for fellows. Wednesdays comprise formal didactic TEE topic followed by relevant clinical cases. Thursdays have a formal reading session where challenging or illustrative cases from the previous week are reviewed.

There are several multi-disciplinary rounds in the hospital that are weekly and which fellows are strongly encouraged to attend if there is no conflict with their clinical duties. These rounds include cardiovascular didactic and triage rounds, congenital heart rounds, and heart transplant rounds.

Weekly teaching sessions are held Tuesday’s at 17:00 covering various and TGH practice specific topics. Monthly professor rounds are organized on Mondays at 17:00. Departmental rounds are scheduled for Friday mornings at 07:30. Monthly cardiac-fellows directed rounds are organized by the cardiac-fellows group around core topics related to cardiac anesthesia, normally held on Mondays at 17:00.

Research

Participation in research and education is expected. Research is integrated into the fellowship with academic time provided to those involved in projects, with a goal of one non-clinical day per week up to a maximum of 40 days over a 12-month fellowship period. There are ongoing trials in which you may participate, or you may embark on their own individual research projects.

Participation and presentation in academic conferences is encouraged. Travel grants are available for research presentations at eligible North American meetings.

Application requirements and process

The fellowship is aimed at anesthesiologists in their early professional career. Interested applicants need to have successfully completed all the required anesthesia examinations, be registered with the official regulatory authorities and have at least 5 years of anesthesia training and experience at an academic centre. (1 of the 5 years may include a rotational year, also known as an internship, houseman year and medical officer year)

A current and valid ACLS certification is a requirement.

Applicants need to apply by using the online platform.

Shortlisted candidates will be contacted 12-18 months before the tentative start date for reference letters and to further the application. Please do not send any reference letters until requested to do so.

Successful candidates will be notified about 9-15 months ahead of a potential start date. An interview might be required.

If you are interested in applying for January 2025, please complete this online application form.

If you are interested in applying for July 2025, please complete this online application form.

Direct inquiries to

Dr. Adam Snyman
Coordinator, Fellowship Program
Toronto General Hospital 200 Elizabeth Street, EN3-438
Toronto, ON Canada M5G 2C4
adam.snyman@uhn.ca