Postgraduate Curriculum

Background

The residency training program at the University of Toronto prepares residents with the knowledge, judgment, and critical skills necessary for independent anesthetic management across a wide range of surgical procedures and pain management scenarios. Our residents benefit from unparalleled clinical experiences in quaternary care centers, complemented by a robust academic curriculum.

Simulation Training

Simulation plays a vital role in our anesthesia training. Residents engage in high-fidelity simulation training at St. Michael's Hospital and Sunnybrook Health Sciences Centre, participating in multiple simulation sessions as part of the core curriculum. Additionally, residents supervise and teach medical students, enhancing their leadership skills throughout their training.

Diverse Clinical Experiences

Residents gain broad clinical exposure to develop competencies in various areas, including high-risk obstetrical anesthesia, trauma (with experiences at Toronto's Trauma Centers), transplantation, thoracic, cardiovascular, and neuroanesthesia. Specialized rotations in high-risk obstetrical anesthesia, regional anesthesia, and chronic pain management are integral to the program. Pediatric anesthesia training occurs through clinical rotations at the Hospital for Sick Children.

Residents also complete internal medicine and critical care medicine rotations at several quaternary care facilities across the city. Internal medicine training includes rotations in respirology and cardiac care units, as well as exposure to diverse medical subspecialties. Critical care rotations offer exceptional learning opportunities in various intensive care settings, including medical/surgical, neurosurgical, trauma, cardiac, and cardiovascular ICUs. There are also opportunities for experience in pediatric and neonatal intensive care.

Toronto’s diverse clinical environment provides residents with abundant patient resources and unique learning opportunities. Training occurs in both quaternary care and academic community hospitals, ensuring unparalleled clinical case exposure. Residents also have access to a wealth of academic, research, and teaching resources, along with a variety of electives, including community and rural electives. All residents are required to complete a community hospital experience, typically taken as a one-block elective, with options for out-of-province and international electives.

Competency-Based Medical Education (CBME)

To enhance patient care and align medical education with evolving healthcare needs, the Royal College of Physicians and Surgeons of Canada has introduced a competency-based medical education (CBME) initiative called Competence by Design (CBD). This initiative empowers learners to engage more fully in their education process by using time as a framework for progression rather than a strict measure.

In CBD programs, residency training is organized into stages, each with specific milestones based on required competencies. These milestones enable targeted learning outcomes and involve frequent formative assessments to ensure residents develop the necessary skills.

Since July 2017, anesthesiology programs in Canada, including our residency program, have adopted CBD-based learning and assessment. Residents will continue to undergo rigorous accreditation processes and will receive Royal College-approved certification upon completion, which includes passing a Royal College examination alongside milestone assessments documented in an electronic portfolio.

The University of Toronto's Department of Anesthesia Residency Program has fully implemented a CBD curriculum in alignment with the Royal College of Physicians and Surgeons of Canada. Our program features highly functioning CBD and Competence Committees, with resident representation involved in planning and implementation.

Curriculum Stages

Transition to Discipline Stage: This initial three-block training period equips residents with core skills and competencies essential for early success. It includes real and simulated training experiences, alongside a structured academic curriculum that features didactic sessions, case-based learning, e-modules, and simulation training.
Foundations Stage: Lasting approximately 20 months, this stage allows residents to gain broad-based competencies through clinical rotations, preparing them for advanced anesthesia training. It corresponds with Junior Resident status in traditional models, promoting graduated independence and clinical responsibility.
Core Training Stage: Expected to span about 24 months, this stage covers core competencies essential for perioperative medical and subspecialty anesthesia training. Residents engage in high-complexity cases and assume greater clinical responsibility, corresponding to Senior Resident status in traditional training models.
Transition to Practice Stage: In this final stage, senior trainees focus on clinical experiences that prepare them for independent practice.

Academic Program

Our rich academic curriculum spans all five years of residency and includes:

Morning rounds
Academic half-days
Resident educational retreats
Simulation training (part-task and high-fidelity)
Journal Club
POCUS educational curriculum (bootcamps and longitudinal sessions)
Transfusion medicine series
Research training curriculum
Senior Revision Tutorial

Morning teaching sessions occur 4-5 times weekly across all training sites, led by faculty members. The city-wide curriculum integrates didactic teaching, case discussions, simulation sessions, and Grand Rounds.

Additional weekly academic sessions during the Academic Half-Day cover a wide range of anesthesia topics, including wellness and stress management. The curriculum aligns with the National Curriculum and emphasizes communication skills, biostatistics, airway management, critical care, and perioperative medicine, among other areas.

In the final year, weekly "Senior Revision Tutorials" help residents consolidate their knowledge and prepare for examinations.

Portfolio and Mentorship

Residents participate in a collaborative learning process facilitated by faculty, sharing narratives and reflections to underpin the CanMEDS competencies in clinical practice. This process promotes introspection and encourages the development of new knowledge, skills, and perspectives.

Each resident is assigned to a Mentorship Group, providing guidance and support throughout their residency. The benefits of this relationship include:

Access to advice and expertise from experienced mentors
A supportive work environment
Career development guidance
Role modeling and advocacy for residents

Mentorship fosters professional and personal development, contributing to the strength of our medical community.