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 CVICU. About 6 weeks are dedicated 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), 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 / defibrillator 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 transplants and ventricular assist devices are managed under the heart failure program. The centre performs an average of 30-40 heart transplants and 10-20 ventricular assist devices per year.

The CVICU is a 27-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 devices.

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 weekday 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 about 12 weeks of CVICU.

Potential applicants from countries with limits of working hours should note that no such legislation exists in Canada. It would be impossible to gain the level of experience for which we are known if there were. However, we aim to make sure no-one works >24h unless they have had sufficient rest and wish to finish their overnight cases.

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 they may participate, or they may embark on their own individual research projects.

The increasing complexity of medical research makes designing, getting approval, funding and completing a research project unrealistic within a single fellowship year. However, many of our fellows have started projects while here, and completed them after having left, and we are happy to facilitate this. Alternatively, you may work on a specific part of an ongoing research effort (study design, grant proposal, REB, data analysis, write-up), hand it over to the next fellow and still receive credit.

Review publications are quite achievable within the year, provided you start early and manage your time effectively. We have a departmental librarian to construct professional search strategies for systematic reviews, and other narrative reviews, book chapters, editorials etc. come up frequently.

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)

Experience as a staff anesthesiologist based in the operating room in an academic setting for 1-2 years is strongly advised. Your clinical anesthesia practice should be current and exposure during the preceding three years of a fellowship should have a strong operating room component.

You will need to have significant experience managing life-threatening situations such as massive transfusion, cardiac failure, critical vasoplegia, hemodynamically unstable arrythmias and profound fluid shifts before you start this fellowship. This is not the opportunity to acquire this experience – you will need to be comfortable and able to manage independently in such situations when you arrive. We are here to teach you the technically demanding subspecialty of cardiac anesthesia, preferably so that you go on to do cardiac anesthesia in your consultant life, not give you an opportunity to gain “big case experience”.

It is very hard to come to a new country, with a completely different medical system and culture, possibly in a second language, and jump straight into doing some of the most complex anesthesia there is. We often offer people a 6–12-month placement in our Advanced Clinical Practice (ACP) fellowship, which offers excellent experience in non-cardiac cases in its own right, as a way into our program with a “softer landing”. It’s an opportunity to get used to our department and Canadian practice, without the intensity of the cardiac fellowship, and for us to get to know you with a view to offering you a cardiac fellowship if all goes well.

A current and valid ACLS certification is a requirement.

Fellowship start dates are normally beginning February and beginning August each year. Applicants need to apply by using the online platform under the UofT website. Applications open 24 months and close 12 months ahead of a possible fellowship start date. A language pro-efficiency test result of adequate score is a requirement with the online application if English is not your first/home language. Certain exemptions may apply. Please review the UofT English language and English language pro-efficiency test requirements.

Shortlisted candidates will be contacted 10-16 months before a tentative start date for reference letters and to further the application. An interview will be required. Please do not send any reference letters until requested to do so.

Successful candidates will be notified about 8-14 months ahead of a potential start date.

Begin Your Application

Applicants must apply using the online platform.

• Applications for July 2026 have closed.
• If you are interested in applying for January 2027, please complete this online application form.
• If you are interested in applying for July 2027, please complete this online application form.

Please Note: The online application form will close 12 months before the start date.

Send 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