TGH - Thoracic Anesthesia

(3-4 positions annually)

Clinical Curriculum

Surgical oncology procedures makes up the bulk of thoracic surgery at the Toronto General Hospital. Interventions for lung cancer vary from diagnostic procedures, minimally invasive resection (video assisted and robotic thoracic surgery) to major incision and resection.  There is an active caseload of esophageal surgery, both resection and reconstruction for cancer and functional surgery for benign disease (anti-reflux surgery, etc). It’s a referral center for major airway surgery, airway stenting, resection and reconstruction are frequent. Thymectomy is also routinely performed, both for malignancy and for the treatment of myasthenia gravis. A comprehensive approach to acute perioperative pain practice in thoracic surgery patients includes multimodal systemic analgesia, the use of truncal blocks and epidural placement.

There is emphasis for fellows to become proficient at the care of patients with end-stage lung disease undergoing high-risk surgery: lung transplantation (approximately 200 cases per year), pulmonary endartectomy (60-70 cases annually) and lung volume reduction (10-15 cases per year). The anesthesia department plays an active role in the assessment, selection and perioperative management of these cases. Thoracic anesthesia fellows gain extensive experience in a number of extracorporeal life supporting technologies.  ECMO, both veno-venous and veno-arterial are used as a treatment for acute lung injury and hemodynamic failure respectively. Intra-operative ECMO support is common during lung transplant surgery, and less commonly used for bridge to transplant or bridge to recovery scenarios.

The fellowship aims to offer 2 thoracic days per week, factoring in on call duties and case availability.

Call duties

At this time call is done from home for lung transplant and pulmonary endarterectomies, in a one in three to four rotation, including approximately 2-weekends per month.

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

Weekly teaching sessions are held Tuesdays at 17:00 covering various and TGH practice specific topics. Echocardiography lectures and case discussion rounds are done Wednesdays and Thursdays at 17:00 and attendance and participation is encouraged. Monthly professor rounds are organized on Mondays at 17:00. Departmental rounds are scheduled for Friday mornings at 07:30.

A fellow-lead journal club/topic discussion rounds focusing specifically on thoracic topics has recently been initiated, running every 4-6 weeks.

Multidisciplinary meetings for discussion and selection of patients for lung transplant listing and pulmonary endarterectomy surgery are also weekly, and thoracic anesthesia fellows are welcome to participate.

Research

Participation in research and education is encouraged. Research opportunities can be 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.  Frequently there are ongoing trials in which fellows may participate or they may embark on their own individual research projects. Recent study opportunities include transfusion management during ECMO supported lung transplantation, and coagulation profiles in pulmonary endarterectomy patients. Quality improvement and assurance projects are also an area of interest.

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.

Applications 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 or 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 comfortable independently in such situations when you arrive. We are here to teach you the technically demanding subspecialty of thoracic anesthesia, preferably so that you go on to do thoracic 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-thoracic anesthesia 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 thoracic fellowship, and for us to get to know you with a view to offering you athoracic 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 the 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 can apply using the online platform:

• The July 2026 application process has 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