McMaster University - Anesthesiology - Hamilton
The Anesthesia residency program at McMaster is unique in its ability to offer a wide range of clinical activity at four acute care hospitals within the setting of a relatively small and intimate residency program. We have approximately 40 residents, 95 Hamilton-based faculty and 95 faculty with adjunct appointments. Residents and faculty have the opportunity to get to know each other very well over the course of 5 years. This "family" feel does not come at the expense of clinical exposure, however, with a full range of busy surgical services servicing Hamilton and the regions from Niagara Falls up to Owen Sound. Our residents are a tight-knit group who are highly collegial and supportive of each other.
The other strengths of our program include:
- a strong simulation program, where residents have frequent opportunities to learn in this environment (not just as "observers")
- the opportunity to be involved in clerkship teaching, in didactic sessions, simulation and the clinical setting
- strong research infrastructure to support success, both for the resident who is highly interested in research as well as for the resident who is research-phobic
- a finely-tuned academic (curriculum) program, which is tailored to each clinic year; each session is led by expert faculty member with usual ratio 6 learners:1 faculty. Our Curriculum Chair is Dr. DeTina and she works to ensure a balanced curriculum that is responsive to resident feedback.
- call schedule that addresses fatigue-management and is tracked closely to ensure fairness and transparency for all residents. Average call per month is 3 weekend split-call shifts (encompassing no more than 2 weekends) and 2 weekday call for a total of 5 call shifts/month (3 of them being half-shifts)
- clinical exposure to obstetrics and pediatric anesthesia throughout the residency program, rather than just during specific limited rotations
- strong support of exam preparation with biannual program oral exams as well as ample MCQ practice through in-house exams and National in-training examinations. In addition, weekly practice oral session are offered to the PGY 5 group a few months prior to the exams. We have had an excellent pass rate at the Royal College exams over the past few years for both CMG and IMG residents.
- PGY5 residents have a full academic day each week, with formal, organized oral exam training
- full academic day for PGY2's and PGY4's (September-June), in addition to the full day that our PGY5's have throughout the year. This allows for a lot more independent study time for residents throughout residency, not just during the PGY5 year. PGY 1’s have a full academic day in the summer, and subsequent AHD. PGY 3, which is an off-service year, have an AHD (academic half day)
- the opportunity to be involved in international health through our liaison with Uganda- this elective is a 4 week opportunity which is funded by St. Joseph's Healthcare; as well, a similar collaboration is beginning with the Anesthesia residency program in Guyana.
- superb administrative support from program coordinator, Candice Stroud-Grundy
- experienced, dedicated, and accessible Program Director and Assistant Program Director (Dr’s Reddy and Parrish).
- a dynamic group of dedicated, enthusiastic, and skilled clinical teachers
- highly engaged residency program committee with ample resident representation, that meets monthly. As part of the CBD infrastructure, the Clinical Competence Committee is comprised of strong clinicians with an interest in Residency Education.
- the opportunity to apply to and complete the "Clinical Investigator Program" at McMaster during the Anesthesia residency.
- resident wellness, well-being and support are a serious consideration of the program. We have resident buddies, faculty mentors, a Wellness Director, and an Ombudsman that functions independently of the program, as well as a host of resources offered by the Post Graduate Office.
Hamilton is a "best kept secret" in Southern Ontario, set on the shores of Lake Ontario. A vibrant arts scene as well as abundant hiking and biking trails at your doorstep will help you keep a balanced lifestyle during your residency program. As a city, it has a small town feel and is easy to navigate, while Toronto and its amenities are a short drive or train-ride away. While you are living here, you will get to know the Farmer's markets (indoor and outdoor); the fabulous concerts at Hamilton Place; the Locke street stores, restaurants and bars; the Dundas Conservation area with its forests, trails and wildlife; and all those waterfalls and more waterfalls!
What is the call like?
Residents do call at each of the four clinical sites. At the JHCC, they cover daytime weekends only (8 am- 8 pm) and none of the weeknights. At all the other sites, (HGH, McMaster and SJH), residents do 24 hour call during the week and do "split call" on the weekends (8 am- 5 pm shift and a 5 pm-8 am shift). On average, residents do 3 weekend shifts a month (no more than 2 weekends) and 2 weekday shifts, totaling 5 calls overall for the month. Anesthesia residents are always off at 8 am post-call. At the end of PGY1, when you return to Anesthesia rotations in May, you will do several buddied calls prior to doing solo call. At the HGH, residents do not do solo call until they are halfway through the PGY2 year, again, after several buddy calls. The reason for this is the higher-level demands of the airway management of the trauma patient.
Most programs have eliminated 24-hour call entirely. However, most staff positions involve 24-hour call. At McMaster, we feel it is important that residency prepare you for practice. We also feel that there is more to wellness than the length of the call shift, such as the amount of call in total, the length of the non-call days and the amount of academic time that is given. It is interesting to note that in the US, 24-hour call has been "re-approved" again and a recent (March 17, 2017) NEJM article explores that topic. It's not a simple issue and it impacts on patient care in some paradoxical ways.
We track all the residents' call while on Anesthesia on a spreadsheet in real time, that is shared amongst all the residents and used to ensure equity in call distribution.
Call during off-service rotations is specific to the service. During several of the "medicine year" rotations, Anesthesia residents do Anesthesia "fly-in" call, thus maintaining a connection with their home program.
How long are the workdays?
Anesthesia is not a "lifestyle specialty". We work unsociable hours and sometimes our days are unpredictable in terms of when they will end. As a resident, you will be involved in lists of all durations. We have lists that end at 3:30 pm, 4:00, 4:30, 5:00 and 6:00 pm. The cardiac rooms are booked until 7 pm. You will be assigned to all types of lists during your residency and during the PGY4 year (subspecialty rotations), the frequency of long days is greater. Unless on call or on subspecialty, it would be unusual not to be finished by 5 pm and often quite a bit earlier.
How much do I get to control my learning, as a resident?
At McMaster Anesthesia, the assigning of residents to lists is done by the "admin resident" at each site, who is usually a PGY4. The admin resident also constructs the call schedule. Part of the admin resident's role is to be in dialogue with the other residents at the site to ensure that their learning needs are being met. PGY5's have more input into their list selection as they are keen to round out their residency and ensure a balanced exposure to all types of patients and cases. We have a fair, transparent online process where residents can make their requests for vacation time or days off.
There are many other ways in which residents have control over their learning. Our academic curriculum is very interactive and is optimized through self-directed learning. Research opportunities are myriad such that almost any interest can be explored. There are many optional rotations to explore in the off-service years as well as while in Anesthesia, including the Uganda elective.
Finally, many of our residents explore alternative learning programs towards the end of their residencies, through the Critical Care Medicine Program or Chronic Pain residency program (both are two year programs which can overlap for one year with the PGY5 year of Anesthesia) or through the Clinical Investigator Program.
Are there opportunities to teach as a resident?
Absolutely! Residents are involved in teaching clerks throughout residency. Residents participate in the clerkship curriculum, where they teach didactic sessions and facilitate sessions with task trainers and our standardized simulation scenarios. On average, each resident would spend approximately 2 days per year teaching within the clerkship program. As well, the clerks spend one night "on call" and are attached to the anesthesia resident for that experience.
Some residents chose to participate in teaching "Clinical Skills" to Undergraduate medical students. Finally, the McMaster Medical School (Undergrad) has an active "Anesthesia Interest Group" which organizes weekend workshops with volunteer Anesthesia residents and faculty as facilitators.
Residents also have the opportunity to develop their presentation skills through their Journal Club presentations, Research Exchange Day presentation and mandatory presentations at academic half days and rounds. For example, PGY4 residents "teach" the PGY3 summer academic half-day curriculum along with a faculty facilitator.
Are there opportunities to be involved in committees?
Yes! Each PGY year has a resident representative on the resident advisory council, which sits on the Residency Program Committee. There are also many other committee opportunities through the postgrad office. Amongst our residents we have the PARO past-president and several PARO board members.
Do you have a Mentorship Program?
Yes, you will be assigned a faculty mentor when you arrive. You will have a mentor for the full five years of your program; during the early stages of residency, they will help you get oriented, and as you progress through the program they will be there to provide advice in areas such as exam preparation, electives, fellowships, and career decisions. We will also you assign you a more senior resident "buddy". Many residents naturally find many other "informal mentors" as they move through the program. One thing to be aware of is that each resident also has an academic advisor (AA). The AA fulfills a different role than the mentor. The AA tracks your academic progress and ensures that you are on track regarding the achievement of your EPA’s.
Why do your residents do all their "medicine" rotations during one year, rather than breaking it up a bit?
I suppose, "We've always done it this way" is not a satisfying answer? OK, well, we think there are several benefits to the way we have ordered our rotations. For one, once you finish that PGY3 medicine year, you are on Anesthesia rotations for the rest of your residency, so you can focus exclusively on your core material as you hit the home stretch of exam preparation. Also, as a PGY4, you encounter all your Anesthesia subspecialty rotations, so you have the equivalent "medicine" background experience in order to optimize your rotation. For example, when you do Cardiac Anesthesia, you have already done CV-ICU; When you do Thoracic Anesthesia, you have already done Respirology and gained experience in bronchoscopy; when you do High-Risk Peds, you have already done your NICU (or PICU) rotation) etc. etc. Finally, because we offer a FULL ACADEMIC DAY to our residents (which doesn't apply when they are off-service), by keeping the off-service rotations bunched into one year, it allows us to plan the academic time more coherently for each PGY cohort. (If some of your group was getting a full day, and some a half day, it would be difficult to avoid having some residents miss part of the day). Other programs who only offer an academic half-day throughout the entire residency (or until the end of PGY4) do not have these logistical considerations of where to place the off-service rotations.
Like all aspects of our program, this issue is on the table for discussion and we are constantly seeking input from our residents. Recently, when I asked the PGY4's if we should look at deconstructing the "medicine year" to intersperse the rotations rather than having them occur as a one-year block, they were unanimous in saying that the block of rotations is preferable. As it stands, most residents have one or two Anesthesia rotations during their PGY3 year and that, as well as the buddy call, helps them stay in touch with their home base.