The Heart Institute is the site of mandatory cardiac anesthesia rotations for all University of Ottawa anesthesiology residents. During their introductory rotation, residents are exposed to routine cardiac surgery cases in order to develop their base knowledge of physiological and pharmacological. During subsequent rotations, residents are exposed to more complex surgeries which expand their knowledge of physiological principles and further emphasize the use of advanced monitoring techniques, including transesophageal echocardiography (TEE).
A Fellowship in Cardiac Anesthesiology is a highly specific one or two year program of specialty skills in cardiac anesthesia and transesophageal echocardiography for physicians who are already specialists in Anesthesiology.
The Division of Cardiac Anesthesiology offers a structured one year post-specialty Fellowship in Cardiac Anesthesiology. The Fellowship offers training in Adult Cardiac Anesthesiology, Transesophageal Echocardiography, and Cardiac Surgical Critical Care. Anesthesiologists from around the world have completed a Fellowship at the Heart Institute and many have gone on to academic positions in Canada, the United States, England, Ireland, Saudi Arabia, India and Nepal.
The program accommodates two Fellows a year, starting each July and lasting one year for a clinical Fellowship.
Training is organized around a personalized core program which can be conformed to fit the objectives of individual trainees (e.g. private practice, academic career as clinical teacher and/or independent research investigator). Each Fellow can develop competence in the following areas:
- Adult cardiac anesthesia
- Perioperative transesophageal echocardiography (TEE)
- Cardiac surgery intensive care unit (CSICU)
- Pre-admission unit and cardiac anesthesia consultation service
- Clinical research
- Clinical epidemiology
Fellows are assigned to a variety of surgical cases. Non-clinical activities include twice weekly didactic teaching sessions with staff anesthesiologists, 1 month of dedicated perioperative transesophageal echocardiography (TEE) training and development of academic skills (research, teaching and administrative).
During the one-year period, a Fellow will be involved in the management of at least 150 cardiac surgical cases in the operating room (OR). The case distribution should be close to the following:
- 40% coronary artery bypass graft surgery (first time CABG or redo)
- 20% isolated valve surgery
- 20% combined procedures (multi-valve and/or CABG + valve)
- 10% others: adult congenital heart surgery, heart transplantation, thoracic aortic surgery, pulmonary thromboendarterectomy
- 10% catheter based interventions (TAVI, ASD closures, Mitraclip, renal artery ablations for hypertension)
At least one third of all cases managed by the Fellows in the OR are high-risk cases (based on the Cardiac Anesthesia Risk Evaluation score developed at the Heart Institute). This objective is meant to improve the Fellows’ability to manage perioperative complications.
Fellows spend a minimum of eight weeks in total in the Cardiac Surgery Intensive Care Unit (CSISU), participating in the critical care of at least 200 patients per year. They have the opportunity to use TEE, various methods of invasive cardiovascular monitoring, and various modes of ventilation in the management of those patients.
Fellows are also involved in managing cardiology patients undergoing electrophysiology (EP) procedures such as ablation of abnormal conduction pathways, implantation of pacemakers and internal cardiac defibrillators, and laser lead extractions for pacemaker wires. Fellows must also develop consulting skills by participating in the preoperative evaluation and management of cardiac surgical patients at the pre-admission unit (PAU). They should assess at least 50 patients in the PAU over a one-year period.
Perioperative Transesophageal Echocardiography (TEE)
The use of transesophageal echocardiography (TEE) is an important aspect of cardiac anesthesia practice. Fellows will acquire knowledge and expertise in perioperative TEE through didactic sessions, review of various TEE images and videos, clinical management of individual patients in the OR and in the CSICU, mandatory reading of recognized textbooks and an optional month rotation in the cardiology echocardiography laboratory. Finally, all Fellows are given the opportunity to attend the Annual Comprehensive Review and TEE Update organized by the Society of Cardiovascular Anesthesiologists and held in San Diego in mid-February.
All Fellows are strongly encouraged to write the Examination of Special Competence in Perioperative Transesophageal Echocardiography (PTEeXAM). This examination is held once a year, usually just after the Annual Meeting of the Society of Cardiovascular Anesthesiologists.
We have full 3D echocardiography capabilities in all of our cardiac operating rooms. This has allowed us to remain near the forefront of the ever evolving field of 3D echocardiography.
Each Fellow is assigned the responsibility of completing a clinical research project. Participation in more than one research project is possible. Non-clinical time is available for these activities. Allocation of non-clinical time durig the fellowship is proportional to the nature and complexity of the research endeavours. The didactic objectives sought through participation in research projects are the following:
- Learn how to set up and design a project
- Learn about research funding opportunities
- Learn about basic statistical software and statistical analyses
- Prepare an effective presentation for the Gary Johnson Day (our Annual Research Day for the whole University Department of Anesthesiology) or for a national or international scientific meeting
- Develop writing skills
- Develop links with other academic departments (Epidemiology, Physiology, others)
- Learn how to prepare a peer-reviewed grant application to a recognized national or international funding agency (mandatory only for Fellows doing a two-year combined clinical-research Fellowship)
All candidates must speak English fluently, and must have completed a full anesthesia residency program in Canada, the United States, a country from the European Union, New Zealand or Australia.
Interested applicants must send the following:
- A formal letter of application for a Cardiac Anesthesiology Fellowship at the Heart Institute. The letter must state the desired Fellowship starting date and its duration (12 or 24 months). This information can be sent by e-mail or FAX.
- An up-to-date curriculum vitae (CV), which can be sent by e-mail or FAX.
- Three letters of reference addressed to the Fellowship Coordinator and sent by regular mail. Only original reference letters with official letterhead signed by independent referees are accepted. Each letter must be sent separately by the individual referees. Reference letters sent by the applicant personally will be rejected. Electronic (e-mail) or FAX copies will also be rejected.
Sean Dickie, MD
Division of Cardiac Anesthesiology
40 Ruskin Street, Room H2410
Ottawa, Ontario, Canada, K1Y 4W7