Pain Management and Anesthesia

The Advanced Clinical Practice Fellowship at St. Michael’s Hospital Department of Anesthesia is a program designed to offer trainees an opportunity to gain more experience in the overall context of anesthesia practice, including anesthesia for high-risk procedures.

As the adult trauma centre for downtown Toronto, St. Michael’s is a hub for trauma, neurosurgery, complex cardiac and cardiovascular care, minimally invasive surgery and care of the homeless and disadvantaged. St. Michael’s is also one of the province’s major sites of care for critically ill patients. This combination of factors makes St. Michael’s a host for critically ill patients who need surgery and clinical care, and offers learning opportunities for physicians and other health-care workers in a high quality multidisciplinary environment. St. Michael’s is a fully-affiliated hospital with the University of Toronto.

ACP Fellows in this program will provide anesthesia services for of all types of surgery carried out at St. Michael’s Hospital, except cardiac anesthesia and critical care (please see other programs offered in our department for details about fellowship opportunities in these areas).

With 16 rooms in the main OR complex and six additional rooms in the ambulatory OR, St. Michael’s Hospital provides services for a variety of surgical specialties. These include General Surgery, Trauma Surgery, Urology, Orthopedics, Plastics, Gynecology &, Obstetrics, Minimally Invasive and Robotic Surgery, Ophthalmology, Vascular surgery, Neurosurgery, and a Spine Surgery program. We also cover 18 acute care beds in the Main Post-Anesthesia Care Unit (PACU) and in the Ambulatory PACU. ACP Clinical Fellows will have the opportunity to work in the main OR and in the ancillary anesthetic locations for elective and urgent procedures. Fellows might also be involved in providing care in the pre-assessment clinic.

Ancillary anesthetic locations include:

• three cardiac catheterization and electrophysiology labs for angiography, stenting, implantable defibrillator insertion, MAZE, ablation procedures and more
• A neuro-angiography suite providing care for patients requiring complex neuro interventional procedures
• Multiple endoscopy suites
• Magnetic Resonance Imaging suites
• A dedicated floor for labor & delivery, including two ORs and multiple L&D patient rooms

ACP fellows will also be included in the on-call roster and will be required to also work nights, weekends and holidays on a rotation basis. We are proud to offer pre- and post-call time off for our fellows and limit the number of on-call to a monthly average of eight night and/or weekend calls, although the actual number is usually well below the limit. All our fellows receive a competitive salary and extended health benefits.

Additional information

Positions offered

• two positions starting each January
• two additional positions starting January.

Duration

Programs are 6-12 months in length, according to the trainee’s goals and objectives. Fellows usually work full-time (100 per cent, five days per week), but a reduced workload (60-80 per cent, 3-4 days/week) can be considered upon request (include details and information on application and letter of interest).

English proficiency

Applications will only be analyzed if proof of English proficiency is provided. Each hospital site of the University of Toronto can request different minimum scores or grant waivers at their discretion. Therefore, you must inquire the minimum score for each site if applying for multiple sites/programs. Review general guidelines for applying to Fellowship programs.

English proficiency requirements for St. Michael’s Hospital Department of Anesthesia Fellowships

• If your medical school was taken in English but English is not the official language of your country, you must still provide proof of English proficiency.
• Minimum scores for English proficiency tests:
  • Anesthesia Education and Simulation Fellowship:
    • TOEFL-IBT minimum score of 100 (minimum 25 in each section) OR
    • IELTS ACADEMIC minimum overall score of 7.5 or higher (minimum of 7.5 in each section)
  • All Other Fellowship Programs:
    • TOEFL-IBT minimum score of 93 (including a minimum score of 24 on the speaking section and minimum of 23 on all other sections) OR
    • IELTS ACADEMIC minimum overall score > 7.0 (minimum score of 7.0 in each section)

Applications

To apply online for this program, please select it from the link on the U of T Anesthesia Fellowships Offered page.

Contact

Filipe Nadir Caparica Santos, MD, PhD, MScCH (HPTE), FRCPC
ACP Fellowship Program Director| Department of Anesthesiology and Pain Medicine, University of Toronto
Director Fellows Program| Department of Anesthesia, St. Michael’s Hospital
Staff Physician | Department of Anesthesia, St. Michael’s Hospital
Assistant Professor | Department of Anesthesia, University of Toronto
416. 864.5071 | filipe.caparicasantos@unityhealth.to
30 Bond St., 6th Floor Donnelly Wing, Toronto, ON M5B 1W8

The Anesthesia Education and Simulation Fellow will have clinical responsibilities within the Department of Anesthesia and have exposure to a broad spectrum of anesthetic practice in an inner-city tertiary care and trauma centre, aside from the specific subspecialty content in the field of education.

This fellowship is designed for anesthesiologists who wish to gain experience in simulation education and pursue an academic career as a clinician educator. The overarching goal is to provide a foundational overview of simulation and medical education, and to incorporate these concepts into current practice. Fellows will be introduced to these concepts through multiple activities, such as weekly journal club sessions and simulation sessions at The Allan Waters Family Simulation Centre at Unity Health Toronto.

Fellows will be directly involved in the Anesthesia Crisis Resource Management (ACRM) course of the anesthesiology residency program at the University of Toronto. They will have an opportunity to learn and practice how to design simulation scenarios, coordinate a simulation and apply different debriefing techniques. Identifying gaps in performance and teaching non-technical skills are part of the core skills that fellows will develop during their fellowship program.

Fellows will also be expected to engage in teaching activities inside and outside of the operating room, for learners of different health professions and levels. There will also be opportunities to engage in innovative research in medical education.

By the end of the academic year, fellows should be able to apply simulation as a learning tool, describe essential concepts required to facilitate a simulation session, and identify opportunities to apply simulation to current practice. Additionally, fellows should have a robust teaching dossier and teaching experience that will enable them to apply for faculty positions as an educational leader.

Duration

Program is 12 months in duration. Fellows usually work full-time (100 per cent, five days per week), including two educational days in which they are expected to be involved in Simulation Sessions with UofT anesthesia residents and other Medical Education and teaching activities with medical students and residents.

English proficiency

Applications will only be analyzed if proof of English proficiency is provided. Each hospital site of the University of Toronto can request different minimum scores or grant waivers at their discretion. Therefore, you must inquire the minimum score for each site if applying for multiple sites/programs. Review general guidelines for applying to Fellowship programs.

English proficiency requirements for St. Michael’s Hospital Department of Anesthesia Fellowships

• If your medical school was taken in English but English is not the official language of your country, you must still provide proof of English proficiency.
• Minimum scores for English proficiency tests:
  • Anesthesia Education and Simulation Fellowship:
    • TOEFL-IBT minimum score of 100 (minimum 25 in each section) OR
    • IELTS ACADEMIC minimum overall score of 7.5 or higher (minimum of 7.5 in each section)
  • All Other Fellowship Programs:
    • TOEFL-IBT minimum score of 93 (including a minimum score of 24 on the speaking section and minimum of 23 on all other sections) OR
    • IELTS ACADEMIC minimum overall score > 7.0 (minimum score of 7.0 in each section)

Applications

To apply online for this program, please select it from the link on the U of T Anesthesia Fellowships Offered page.

Contact

Filipe Nadir Caparica Santos, MD, PhD, MScCH (HPTE), FRCPC
Anesthesia Education and Simulation Fellowship Program Director| Department of Anesthesiology and Pain Medicine, University of Toronto
Director Fellows Program| Department of Anesthesia, St. Michael’s Hospital
Staff Physician | Department of Anesthesia, St. Michael’s Hospital
Assistant Professor | Department of Anesthesia, University of Toronto
416. 864.5071 | filipe.caparicasantos@unityhealth.to
30 Bond St., 6th Floor Donnelly Wing, Toronto, ON M5B 1W8

The Cardiovascular Anesthesia and Critical Care (CV) Fellowship Program at St. Michael’s Hospital Department of Anesthesia is a program designed to offer its trainees the opportunity to become a cardiovascular anesthesia specialist.

St. Michael’s Hospital is a tertiary care cardiac centre with a case load of 1200 cardiopulmonary bypass surgeries per year, including valve and aortic surgeries. Besides offering outstanding anesthesia management training for our trainees, our CV fellowship program has a strong training focus in TAVRs and transesophageal echocardiography, with a goal of 150 per year.

The CV anesthesia fellowship program is divided in three main rotations: OR, Cardiovascular Intensive Care Unit (CVICU), and Transesophageal Echocardiogram.

OR rotation

The OR rotation is seven months in duration and an opportunity to provide anesthesia for all types of cardiovascular surgeries that happen in our hospital. In order to maintain the trainee’s general skills, CV fellows will also be scheduled in non-cardiac rooms in a ratio of 50 per cent of the OR days.

Cardiovascular Intensive Care Unit (CVICU)

The CVICU rotation is two months in duration and continuously spent in the CVICU, providing intensive care for cardiac patients.

Transesophageal Echocardiogram (TEE)

The TEE rotation is three months in duration, and a period when the CV fellow will only perform and report TEEs.  From our experience, most fellows can do anywhere between three to isx full exams (pre- and post-CPB) per day.  There will be two fellows on TEE. However, the start of the blocks will be staggered so both fellows can work in partnership. Fellows will also receive supervision/teaching on TEE skills from our CV staff members booked in the respective OR for the day.

Our department is also proud of offering an echo textbook for each CV fellow. This book is annually chosen by the CV staff team.

On-call

CVA Fellows only take calls in the CVICU following the CVICU routine and schedule. While on call, if a cardiac case comes in (such as a dissection), CVA fellows are expected to help in the OR, when possible, as these cases happen infrequently and offer excellent learning opportunities with emergency cardiac cases.

There is a CV on-call team to bring extra people to the OR, should emergency cardiac surgeries need to be performed. Therefore, the CVICU Fellow helps in the OR only when possible.

Cardiovascular Rounds

The CV rounds are designed to review and discuss TTE/TEE cases, and will also include special topics throughout the year. CV Fellows may also be expected to prepare a topic and bring for discussion.

These rounds usually happen once a week. Fellows will be excused from clinical duties to attend these rounds and are not expected to attend if they are post-call. There are also monthly CV Surgery M&M rounds where complex cases and some challenging managements are discussed.

Additional information

All our fellows receive a competitive salary and extended health benefits.

Positions offered

• Start dates in January and July
• Total of six positions per year

Duration

• This is a full-time program, with 12 months in duration.

Past trainee testimonials

“The cardiovascular anesthesia fellowship at St. Michael’s Hospital was a great experience. I could learn more about the anesthesia and post-operation management of patients who underwent a cardiac surgery. I also could learn and practice Transesophageal echocardiogram (TEE).” — Dr. Carolina Barbosa, MD (2018-2019)

” I had the experience of being a CV anesthesia fellow at St. Mikes for 3 years. It was an amazing time and it really shaped how my career developed afterwards. The CV anesthesia fellowship  had a really robust program of training and helped me to feel comfortable doing cardiac cases and performing TEE after I finished it.
I strongly recommend this program at St. Michael’s Hospital.” — Fabio de V Papa, MD, FASE

English proficiency

Applications will only be analyzed if proof of English proficiency is provided. Each hospital site of the University of Toronto can request different minimum scores or grant waivers at their discretion. Therefore, you must inquire the minimum score for each site if applying for multiple sites/programs. Review general guidelines for applying to Fellowship programs.

English proficiency requirements for St. Michael’s Hospital Department of Anesthesia Fellowships

• If your medical school was taken in English but English is not the official language of your country, you must still provide proof of English proficiency.
• Minimum scores for English proficiency tests:
  • Anesthesia Education and Simulation Fellowship:
    • TOEFL-IBT minimum score of 100 (minimum 25 in each section) OR
    • IELTS ACADEMIC minimum overall score of 7.5 or higher (minimum of 7.5 in each section)
  • All Other Fellowship Programs:
    • TOEFL-IBT minimum score of 93 (including a minimum score of 24 on the speaking section and minimum of 23 on all other sections) OR
    • IELTS ACADEMIC minimum overall score > 7.0 (minimum score of 7.0 in each section)

Applications

To apply online for this program, please select it from the link on the U of T Anesthesia Fellowships Offered page.

Director of the CV Fellowship Program

Fabio Papa, MD, MSsCH, FASE
Cardiocascular & Critical Care Fellowship Program Director| Department of Anesthesiology and Pain Medicine, University of Toronto
Staff Physician | Department of Anesthesia, St. Michael’s Hospital
Assistant Professor | Department of Anesthesia, University of Toronto
416. 864.5071 | Fabio.Papa@unityhealth.to
30 Bond St., 6th Floor Donnelly Wing, Toronto, ON M5B 1W8

The Chronic Pain Fellowship at St. Michael’s Hospital Department of Anesthesia is a program designed to cultivate and foster your development as an adept clinician, and a skilled interventionist. We are part of a greater collaborative partnership as an academic pain management group and encourage you to pursue opportunities to build your interprofessional skills, develop scholarly projects, and be mentored by experts in unique fields of chronic pain.

According to several large population-based surveys, it is estimated that one in five Canadians lives with chronic pain. Within this context, the Chronic Pain Fellowship program will prepare trainees to work with this population while developing their anesthesia skills in one of North America’s largest trauma centres.

Our Chronic Pain team includes seven Anesthesiologists who each run clinics and perform procedures. They have developed special interests within their respective programs, including comprehensive mindfulness-based management, neuromodulation, and complex opioid management.

The Pain Management Program is currently run by Dr. David Sussman. It was founded by Drs. Peter Leung and Bokman Chan, who together have trained hundreds of residents and fellows, and have really put pain medicine on the map in Toronto. Dr. John Hanlon is the Program Director for the Royal College certified Pain Medicine Residency FRCPC program. Dr. Mary McLoone on top of interventional pain has a focus on adolescent pain medicine, and alternative treatments, including but not limited to acupuncture. Dr. Aaron Hong is the director of Neuromodulation and implants around 70 to 100 spinal cord stimulators per year. Dr. Karim Ladha is recognized as a world expert in pain research and clinical epidemiology, with a focus on pharmacological management, cannabis, and interventional psychiatry.

We benefit from a full-time administrative assistant as well as full nursing and imaging support (ultrasound and fluoroscopy with an X-ray tech) for procedures. Blocks are performed two days a week and clinics run three days a week.

We also have clinical activities that are performed at Women’s College hospital.

We see approximately 250 new patients per year and perform 600 follow-up consults per year.

Pharmacological management and interventional pain management are the cornerstones of our pain management program. We perform approximately 1300 procedures a year with the bulk of these being epidural steroid injections and trigger point injections.  We also perform the most commonly used blocks and techniques including Radiofrequency Ablation (RFA) and neuromodulation program, which is led by Dr. Aaron Hong.

Fellows spend 1-2 days per week performing procedures and 1-2 days per week seeing patients in the Pain Management Consult Clinic (Outpatient).  The other two days a week are spent providing anesthetic services in the main operating room and ancillary anesthetic locations (cardiac catheterization and related services, neuro interventional procedures, multiple endoscopy suites, Magnetic Resonance Imaging suites, and a dedicated floor for labor & delivery, including two ORs and multiple L&D patient rooms).

The Pain Fellows will also be expected to work on the Acute Pain Service a couple times per year to gain comprehensive experience.

Additional information

Duration and workload

• Programs are 12 months in duration and full-time (five days per week), although shorter training may be considered on a case by case basis.
• Chronic Pain Fellows will also be included in the on-call roster and will be required to also work nights, weekends and holidays on a rotation basis. We are proud to offer pre- and post- call time off for our Fellows and limit the number of on-call to a monthly average of eight night and/or weekend calls, although the actual number is usually well below the limit. All our Fellows receive a competitive salary and extended health benefits.

English proficiency

Applications will only be analyzed if proof of English proficiency is provided. Each hospital site of the University of Toronto can request different minimum scores or grant waivers at their discretion. Therefore, you must inquire the minimum score for each site if applying for multiple sites/programs. Review general guidelines for applying to Fellowship programs.

English proficiency requirements for St. Michael’s Hospital Department of Anesthesia Fellowships

• If your medical school was taken in English but English is not the official language of your country, you must still provide proof of English proficiency.
• Minimum scores for English proficiency tests:
  • Anesthesia Education and Simulation Fellowship:
    • TOEFL-IBT minimum score of 100 (minimum 25 in each section) OR
    • IELTS ACADEMIC minimum overall score of 7.5 or higher (minimum of 7.5 in each section)
  • All Other Fellowship Programs:
    • TOEFL-IBT minimum score of 93 (including a minimum score of 24 on the speaking section and minimum of 23 on all other sections) OR
    • IELTS ACADEMIC minimum overall score > 7.0 (minimum score of 7.0 in each section)

Applications

To apply online for this program, please select it from the link on the U of T Anesthesia Fellowships Offered page.

Director of the Chronic Pain Fellowship Program

David Sussman, BMSc, MD, FRCPC
Chronic Pain Fellowship Program Director| Department of Anesthesiology and Pain Medicine, University of Toronto
Staff Physician | Department of Anesthesia, St. Michael’s Hospital
Lecturer | Department of Anesthesia, University of Toronto
416. 864.5071 | david.sussman@unityhealth.to
30 Bond St., 6th Floor Donnelly Wing, Toronto, ON M5B 1W8

The Perioperative Medicine Fellowship is a new program, aiming to prepare the trainee for a patient-centered multidisciplinary medical care program during the perioperative period, which includes the time of contemplation of surgery through the operative period to full recovery (but excluding the operation or procedure itself).

The Fellow will build expertise and experience in the preoperative evaluation, preoperative optimization and postoperative follow-up of high-risk surgical patients (e.g., frail, multi-comorbidity).

Fellows spend one full day per week providing anesthetic care in the main operating room, two half-days per week performing preoperative consultations in the pre-admission facility, and two half-days per week performing postoperative follow-up (in the setting of the post-anesthesia care unit, surgical wards and critical care units) in select high-risk surgical patients.

Fellows will also have one day per week with protected non-clinical time, which will be used to undertake a research project during their training and also to prepare for education rounds (including presenting at departmental grand rounds once during the year).

The remaining day per week will alternate between a full day in the main operating room and a full day on specific elective activities pertaining to perioperative medicine. This elective activity, which will be selected following discussion between the fellow and supervisor, might include training in specific clinical techniques (e.g., focused cardiac ultrasound), quality improvement projects, or research. Fellows might also be involved in providing care in the pre-assessment clinic.

Perioperative Medicine Fellows will be included in the on-call roster and will be required to also work nights, weekends and holidays on a rotation basis. We are proud to offer pre- and post-call time off for our fellows, and limit the number of on-call to a monthly average of eight night and/or weekend calls, although the actual number is usually well below the limit. All our fellows receive a competitive salary and extended health benefits.

Additional information

• The program is 12 months in duration in a full time position (five days per week).

English proficiency

Applications will only be analyzed if proof of English proficiency is provided. Each hospital site of the University of Toronto can request different minimum scores or grant waivers at their discretion. Therefore, you must inquire the minimum score for each site if applying for multiple sites/programs. Review general guidelines for applying to Fellowship programs.

English proficiency requirements for St. Michael’s Hospital Department of Anesthesia Fellowships

• If your medical school was taken in English but English is not the official language of your country, you must still provide proof of English proficiency.
• Minimum scores for English proficiency tests:
  • Anesthesia Education and Simulation Fellowship:
    • TOEFL-IBT minimum score of 100 (minimum 25 in each section) OR
    • IELTS ACADEMIC minimum overall score of 7.5 or higher (minimum of 7.5 in each section)
  • All Other Fellowship Programs:
    • TOEFL-IBT minimum score of 93 (including a minimum score of 24 on the speaking section and minimum of 23 on all other sections) OR
    • IELTS ACADEMIC minimum overall score > 7.0 (minimum score of 7.0 in each section)

Applications

To apply online for this program, please select it from the link on the U of T Anesthesia Fellowships Offered page.

Director of the Perioperative Fellowship Program

Duminda Wijeysundera, MD, PhD, FRCPC, FAHA
Perioperative Medicine Fellowship Program Director| Department of Anesthesiology and Pain Medicine, University of Toronto
Professor, Institute of Health Policy Management and Evaluation, University of Toronto

Scientist, Li Ka Shing Knowledge Institute of St. Michael’s Hospital
Adjunct Scientist, Institute for Clinical Evaluative Sciences
Endowed Chair in Translational Anesthesiology Research, St. Michael’s Hospital and University of Toronto
416-864-5071 | Duminda.Wijeysundera@unityhealth.to
30 Bond St., 6th Floor Donnelly Wing, Toronto, ON M5B 1W8

St. Michael’s Hospital is a Level 1 Trauma Centre serving downtown Toronto and central Ontario, and a major referral centre for neurological and neurosurgical diseases in the province with more than 1000 admissions per year that included acute traumatic brain and spinal cord injury, multi-system trauma, stroke and subarachnoid hemorrhage.

Clinical curriculum

Fellows gain experience both in anesthetic management of wide spectrum of neurosurgical procedures consisting of neuro-oncological surgery (trans-sphenoidal pituitary surgery, awake craniotomy, malignant brain tumor), major spine surgery, cerebrovascular surgery (AVMs, aneurysms), and interventional neuroradiology (endovascular aneurysm repair, embolization, mechanical thrombectomy, carotid revascularization, kyphoplasty). In addition, fellows have a rotation in Trauma-Neuro Intensive Care Unit, a 19-bed closed unit for trauma and neurosurgical patients.

In addition, experience in multimodal neuromonitoring (EEG, TCD, intraoperative neuoromonitoring, PbtO2 monitoring, ICP monitoring) in the perioperative and critical care setting will be a part of the clinical learning.

Call duties

Fellows will participate in general on-call duties at a frequency of approximately 4-5 calls per month.

Research

Research opportunities include clinical neuroanesthesia outcome studies, pain management after major spine surgery, effects of anesthesia on neuro-electrophysiology, traumatic brain injury. Fellows are encouraged to discuss with our research faculty if interested in pursuing research opportunities.

Education

Neuroanesthesia Fellow Rounds are held biweekly. These seminars will be led by Anesthesiologists, Neurosurgeons, Neuroradiologists and Neurologists. Neuroanesthesia trouble rounds are held monthly to discuss challenging cases and complications, and journal clubs are held bi-monthly to explore latest literature in trauma and neuro anesthesia. Trauma rounds will be held weekly. Fellows will also have hands-on sessions where they will acquire skills for neuromonitoring, POCUS, and regional anesthesia for neurosurgical procedures.

Licensing

Once in receipt of the required documents, a temporary license is issued by the College of Physicians and Surgeons of Ontario (CPSO). This enables the fellow to practice under direct supervision in a teaching hospital. After successful completion of a 1 to 3 month assessment period, the CPSO issues an educational license and the fellow may continue the fellowship. This assessment period is mandated by the CPSO and failure of this assessment will preclude licensure and the fellowship will be immediately terminated.

Applications and inquiries

• if you are interested in applying for 2024-2025, please complete this online application form.

Direct inquiries to:

Dr. Kan Ma
St. Michael’s Hospital
30 Bond Street, 6F-501 Donnelly South
Toronto, ON Canada M5B 1W8
Kan.Ma@unityhealth.to

• University of Toronto Anesthesia Program