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 over 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 in anesthetic management of a wide spectrum of neurosurgical procedures consisting of neuro-oncological surgery (trans-sphenoidal pituitary surgery, awake craniotomy, malignant brain tumour), 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 the 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, and ICP monitoring) in the perioperative and critical care settings 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, and 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 the latest literature in trauma and neuroanesthesia. 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 1–3 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.
