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Fellowships
in Sunnybrook
and Women’s College |
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The Department of Anaesthesia at Sunnybrook and Women’s
College Health Sciences Centre (Sunnybrook campus) in Toronto, Ontario, Canada
offers one-year clinical fellowships in Critical Care Medicine which involve
provision of primary patient care to a total of 32 beds. The service also provides daily consultant
care to a 10-bed burn unit and a 10-bed neurosurgical unit. There are no other areas in the hospital which
admit intubated patients.
Medical-Surgical
This 18-bed unit admits approximately
1000 patients annually, divided equally between trauma, medical and surgical
populations.
This group includes
all ventilated patients from the largest trauma program in Canada.
Acuity is fairly high, as a separate stepdown unit takes many short-stay
postoperative admissions. Critical Care physicians covering the Medical-Surgical
unit also provide consultative coverage for the 10-bed Neurosurgical Intensive
Care unit. Several clinical research
protocols are ongoing, including outcomes research and novel ventilatory techniques
in acute lung disease, pharmacologic interventions in sepsis, and investigations
in sleep pathology in critical care patients.
Cardiovascular
This 14-bed unit admits approximately 1400 postoperative cardiac
and major vascular surgery patients annually. The cardiac population includes 70% coronary revascularization,
25% valvular, and 5% congenital. The
vascular population includes a substantial volume of thoracoabdominal aneurysm
repairs. An active transesophageal
echocardiography service is primarily provided by Critical Care attending
staff.
Burn
This
10-bed unit handles approximately 200 acute burn admissions annually, which
is the largest adult volume in Canada. Critical
Care physicians covering this unit provide daily consultant service on all
critically ill patients.
Role
Critical
Care staff physicians attend for a week at a time in each of these units. We assign fellows for one unit at a time, and
(after orientation) no more than one fellow per unit at a time. The fellow is an integral part of the critical
care team, and has the opportunity to assume a position of considerable responsibility.
Fellows are involved in all levels of patient care, including primary
assessment and management, procedural work, coordination of admissions and
discharges, liaison with referring services, and external consultations. Through graded assignment of responsibility during the year, the
fellow will optimally assume the role of a junior staff physician.
Education
Program
We
also train more junior housestaff. Over
30 University of Toronto residents will rotate through our service during
1999-2000. We
run a very active teaching program for the residents, with bedside teaching
rounds and one hour daily of didactic seminars.
Performance feedback is provided monthly. Fellows are expected to participate in instruction of junior housestaff
in both the seminar program and bedside teaching, as well as teaching the
nursing staff and respiratory therapists where requested. The opinions of the fellows are regularly sought
in our evaluation of junior trainees.
The
fellows attend a seminar series at the University of Toronto every Tuesday
afternoon, and the staff physicians are involved in individual instruction
with the fellows daily.
Fellows
are also involved in continuing education in our department. Every six weeks, the critical care team presents
at a weekly hospital-wide Trauma round; our involvement is coordinated by
the fellow staff. The fellows are
responsible for organizing departmental Morbidity and Mortality rounds, which
are run every two months. Fellows
attend and participate in a monthly Critical Care Ethics rounds, where individuals
from a variety of disciplines discuss morally controversial cases.
Finally, the fellows attend and participate in a weekly
one hour Continuing Education round, involving guest speakers and analysis
of journal articles.
Electives
Up
to eight weeks is available for elective rotations relevant to critical care
during the fellowship, contingent upon adequate staffing of the critical care
units. A mutually acceptable plan
for elective activities must be composed prior to beginning this component
of the fellowship. Night call to the
critical care unit continues during the elective block.
On-Call Duty
The
fellows’ on-call schedule for clinical critical care is up to 1 night in 3
(including weekends); this call responsibility is taken in house or as home
call, depending on the fellow’s abilities, distance of the fellow’s home from
the hospital, and the competence of the resident on first call. Four weeks of vacation are provided.
Information
For
further information, contact
Dr. Cameron Guest
E-mail
cameron.guest@utoronto.ca
Fax (416) 480
6039