Throughout residency training, residents can be expected to gain the knowledge, judgement and critical skills required for independence in the anesthetic management of patients for all types of surgical procedures and in the management of pain. Unparalleled clinical experiences in quaternary care centers are aligned with a robust academic curriculum.
Simulation is an important part of anesthesia training at the University of Toronto. All residents participate in the High-Fidelity Anesthesia simulation training situated at St. Michael's Hospital and Sunnybrook Health Sciences Centre. Residents attend multiple simulation opportunities as part of the core teaching program and residents supervise and teach medical students throughout their residency.
Broad and diverse clinical experiences to obtain competencies in clinical anesthesia, including high-risk obstetrical anesthesia, trauma (including experience at both of Toronto's Trauma Centers), transplantation, thoracic, cardiovascular and neuroanesthesia. Special rotations in high-risk obstetrical anesthesia and regional anesthesia and chronic pain management will be completed. Pediatric anesthesia training includes clinical rotations at the Hospital for Sick Children.
Internal medicine and critical care medicine rotations occur at several quaternary care facilities across the city. The internal medicine training includes rotations in respirology and CCU as well as opportunities to experience a wide varies of medical subspecialty training. The critical care rotations occur at several potential sites with exceptional learning opportunities including potential experience in medical/surgical, neurosurgical, neurotrauma, trauma, cardiac and cardiovascular Intensive Care Units. During the program there is also opportunity for experience in pediatric and neonatal intensive care.
Toronto offers a wealth of clinical experiences and abundant patient resources. Our residents routinely train in quaternary care hospitals as well as academic community hospitals. The clinical case exposure is unparalleled. Our residents enjoy a wealth of resources which span the clinical, academic, research and teaching faculty arenas. A wide variety of electives are also available and residents may propose their own. There are also options for community and rural electives. All residents must do a community hospital experiences. This is usually taken as a one block elective. Out-of-province and international electives are permitted.
To contribute to the success of Canadian physicians and the delivery of high-quality patient care, the Royal College of Physicians and Surgeons of Canada has embarked upon an initiative to introduce competency-based medical education (CBME) in Canadian postgraduate specialty training and in professional practice in Canada. This initiative, called Competence by Design (CBD), aims to enhance patient care by aligning medical education and lifelong learning with evolving patient needs and empowering learners to more fully engage in their education process.
CBD will use time as a framework rather than the main basis for progression. It is not anticipated that the duration of training will change for the majority of trainees. Residency programs will be broken down into stages, and each stage will have a series of milestones based on required competencies. These milestones will create more targeted learning outcomes and involve more frequent, formative assessments within the clinical workplace to ensure residents are developing and receiving feedback on the skills they need.
Anesthesiology programs in Canada have adopted CBD in July 2017. Thus, Residents entering Anesthesiology will experience CBD-based learning and assessment.
All programs implementing CBD will continue to undergo the same rigorous accreditation processes as traditional programs. All CBD programs (and traditional programs) will continue to lead to Royal College approved certification. Certification for trainees in both CBD and traditional programs will include the completion of a Royal College examination; however, residents in CBD programs will also be assessed against program milestones throughout their training. Within a CBD program, all milestones (documented within an electronic portfolio) and the Royal College examination must be successfully completed to achieve certification.
The University of Toronto, Department of Anesthesia Residency Program, implemented a complete CBD curriculum July 2017. The program is in full alignment with the Royal College of Physicians and Surgeons of Canada. The program as highly functioning CBD and Competence Committees. Resident representation is present at all planning and implementation committees.
The program has implemented a full set of competence-based assessment tools and criteria for current trainees. This includes stage appropriate Entrustable Professional Activities and other workplace-based assessments. All residents receive detailed orientation and ongoing information sessions regarding CBD expectations. Regular reviews of resident performance by the Anesthesia Resident Competence Committee is completed and forwarded to each resident for feedback regarding their individual performance and progress. Residents meet with their Academic Coaches on a regular basis to discuss their learning trajectory and receive advice and support regarding academic progress.
Our Program’s Competency Based Education and follows the Royal College Competency By Design framework:
Transition to Discipline Stage: This is a robust 3 block training period which includes core skills and competencies needed for early residency success. These include real and simulated training experiences designed to support technical skills, patient assessment and perioperative patient management. There are several weeks of highly structured academic curriculum incorporating didactic, case-based, e-module, simulation, and interactive learning. This is paired with clinical experience including buddy-call exposure.
Foundations Stage: This training period spans roughly 20 months of residency. Residents experience clinical rotations designed to support educational opportunities which allow achievement of broad-based competencies that every trainee must acquire before moving on to more advanced competencies in their anesthesia training. This stage corresponds with Junior Resident status in the traditional model of training and supports graduated independence and clinical responsibility. Residents rotate through several hospitals and experience a level appropriate, broad exposure of anesthesia sub-specialty training.
Core Training Stage: This training period is expected to span roughly 24 months of training. This stage covers the core competencies that make up the majority perioperative medical training and subspecialty anesthesia training. This stage corresponds to the Senior Resident status currently used within the traditional education model. The clinical rotations support advanced patient management experiences and clinical responsibility. Residents experience high case complexity exposure to all anesthesia sub-specialty training.
Transition to Practice stage: During this time, the senior trainee will obtain clinical experiences designed to support readiness for independent practice.
There is a rich academic curriculum which spans all 5 years of residency training. This includes morning rounds, academic half-days, resident educational retreats, simulation training (part-task, high-fidelity, and specific crisis resource management), Journal Club, POCUS educational curriculum (bootcamps, block rotations and longitudinal educational sessions), transfusion medicine educational series, portfolio sessions, research training curriculum and "Senior Revision Tutorial".
There is a robust morning academic teaching curriculum across the city at every training site. The morning teaching is mapped to align with the clinical and educational focus of the hospital. There are sessions 4-5 mornings each week, led by faculty. The city-wide curriculum includes didactic teaching, trouble round discussions, case-based questions, simulation sessions, hands-on tutorials, and Grand Rounds.
Additional resident academic and education sessions are held weekly during the Academic Half-Day and include an introduction to a wide range of anesthesia topics and related subjects. This includes resident wellness and stress management. The curriculum is based on extensive knowledge objectives and the National Curriculum [hyperlink]. Topics include communication skills, biostatistics and critical appraisal, airway management, monitoring and equipment, obstetrical anesthesia, regional anesthesia, pain management, critical care, perioperative medicine and the individual areas of operative subspecialty anesthesia. There is also focus on education of the CanMEDs competencies. This curriculum includes session with expanded education in ethics, critical appraisal, teaching and communication skills, leadership, and the skills of practice management. Simulation sessions and sessions on advanced airway management, regional anesthesia and vascular access in an anesthesia skills lab and with full and part-task simulation are also part of the curriculum, as is a full Crisis Resource Management Simulation experience.
In the final year of training, weekly small group sessions called "Senior Revision Tutorial" allow residents to consolidate their knowledge, build judgement and critical thinking for clinical practice and assist in preparation for examinations.
Our residents participate in a group learning process, facilitated by Faculty Leads. The process involves sharing narratives and reflections with one another which underpin the CanMEDs competencies in clinical practice. One of the goals is to develop new knowledge, perspective, skills and attitudes in the intrinsic roles and to promote introspection and to challenge ourselves, our ideas and our behaviors.
All residents are assigned a Mentorship Group of peers and faculty to provide guidance and support throughout the residency journey.
A successful mentoring relationship has a number of benefits:
- The resident gains from advice and expertise from those who have “already been there.”
- A mentor can help provide a supportive work environment, offer advice on career development, function as an advocate for the resident, and be a role model.
- From the mentor’s perspective, they have a unique opportunity to encourage the professional and personal development of an individual in training, and help contribute to the strengths of our medical community. This includes faculty and the residents themselves - who act as neat-peer mentors to their colleagues.