Queen’s University offers an outstanding, fully accredited five-year residency program in Anesthesiology and Perioperative Medicine that produces excellent clinicians, researchers, and educators who will be the leaders of tomorrow. We have over 30 attending anesthesiologists on our staff. All are appointed through Queen’s University, and are dedicated to providing the highest standard of education to our residents. Most of our attending staff members are fellowship trained in the various subspecialties within anesthesiology, and all take pride in providing quality care to our patients. In addition, there are two non-clinical PhD researchers, and a strong clinical research infrastructure. Research is strongly supported at Queen’s, and members of the department have produced numerous publications in highly respected peer-reviewed journals. Residents are major players in a lot of our research, contributing to many of these papers.
After three years of planning and preparing, we are very excited to be implementing our Competence by Design (CBD) curriculum for our Anesthesia Residency program for the cohort starting in July 2017. This is a competency based medical educational design, where the final desired product is determined, and the program is structured around achievement of the competencies required for success. In other words, we determine what are the defining characteristics of a skilled and successful anesthesiologist, and we then design a program to allow the learners to get there. The emphasis shifts to the learner to demonstrate that they can do a task, as the goals are now knowledge application rather than knowledge acquisition. Working with all Anesthesiology training programs across the country and the Royal College of Physicians and Surgeons of Canada, we developed consistent standards, expectations and assessment strategies for residents. The residents currently in our program will continue with the traditional curriculum as delineated by the Royal College. These two programs will be integrated over the years to capitalize on the strengths and make novel learning opportunities available to all of our residents.
The academic program will be delivered during a protected half day weekly. There will be 3 separate programs; an introductory Transition to Discipline orientation in the first two months of the program, one at the Foundations level, which will have a one-year cycle, and a separate one at the Core level on a two-year cycle. The academic program may not necessarily coincide with the clinical rotation that the resident is doing at that particular time, but rather will be done as a group for feasibility as well as to foster teamwork and collegiality.
Our university hospitals, Kingston General Hospital, Hotel Dieu Hospital and Providence Care, provide ample clinical opportunities for our residency program. Our hospitals see a wide variety of interesting cases, as we are the referral center for a population of approximately 750,000, and the regional trauma center. We provide services for all major surgical subspecialties including orthopedic, cardiac, thoracic, vascular, neuro, pediatric, urologic, gynecologic, plastic, ENT and general surgery. We provide training in transesophageal echocardiography, transthoracic echocardiography, and ultrasound-guided regional anesthesia. The residents are also trained in a state of the art high-fidelity Anesthesia Simulator. Both preoperative assessment and perioperative acute pain management are stressed, and training is provided in the Chronic Pain clinic. Our residents are exposed to a wide variety of cases, and become very proficient in managing complicated patients both electively and on an emergency basis. We have a tertiary care obstetrical service with ~ 2000 deliveries per year and a level 3 Neonatal ICU. Rotations in our 35 bed ICU and 10 bed Cardiac Sciences ICU round out the experience. In addition to the rotations here, all residents get a chance to work in a major pediatric hospital (usually the Children’s Hospital of Eastern Ontario) and two community hospitals (Peterborough General Hospital and Lakeridge Health Centre (Oshawa)). Elective time of up to 6 months can be spent anywhere in Canada or internationally. A number of our attending anesthesiologists are involved with medical care and training in developing countries, and opportunities to accompany the physicians on these missions are available to our residents.
Residents are continuously exposed to all areas of anesthesia and have input into their room assignments through the Resident Manager. More than 50% of our surgical cases are ASA 3-5, as one would expect in a tertiary centre with a large catchment area. Graduating residents feel extremely confident in managing the most complex traumas or patients with multiple medical comorbidities.
While on call, our residents are available to provide anesthetic management for all surgical procedures from obstetrics to cardiac to neonatal surgery, as well as trauma in the Emergency Department (as members of the Trauma Team) or cardiac arrests throughout the hospital (as members of the Code Team). On account of the wide variety of clinical problems encountered during a typical night on call, our residents are paired with a more senior resident for their first four months of call. This allows the junior resident to seek advice and assistance at any time. Clinical duties while on call begin at 1600h until 0800h the following morning. The pre-call time is used for academic requirements, such as research, preparing rounds, independent study, and attending academic events. The resident call schedule mirrors that of our staff.
Our residency program is one of the smaller ones in the country, and we see that as one of our major strengths. Our residents learn to handle responsibility quickly and earn the respect of the staff early in the program. This allows them to be directly involved in complicated cases right from the start, and to manage these cases with a graded amount of independence. The small number of fellows ensures that residents get ample experience to all types of cases. The experience thus gained has produced an exceptional pass rate on the Royal College exams for our residents.
Kingston is a small, friendly and historical city located on the shores of Lake Ontario and the St Lawrence River, at the beginning of the picturesque Thousand Islands recreational area. It is an easy drive to Ottawa, Toronto and Montreal, and close to U.S. Border. Despite the small-town feel, Kingston possesses all of the amenities of bigger cities, including three centers of higher learning: Queen's University, St Lawrence College and the Royal Military College. Recreational activities abound, including an abundance of sporting, arts, music and recreational opportunities, and one of the best sailing and boating venues in the world. There is an impressive number and variety of shopping and restaurant options. A well-rounded experience is encouraged in all residents and Faculty. The attending staff at the three Queen's affiliated hospitals enjoy a collegial atmosphere with our residents, who earn the trust of the staff to assume responsibility and independence early in their training.
Melinda Fleming, MD, FRCPC