Hepatobiliary & Surgical Oncology Anesthesia Fellowship

Medical expert

The fellow should be able to perform preoperative assessments and discuss a comprehensive anesthetic management plan with the patient taking into account existing morbidity and perform a risk assessment based on history, physical examination and investigations.

• should be able to safely provide an anesthetic taking into account the preoperative evaluation including decision of invasive monitoring, advanced vascular access, advanced airway management, regional anesthesia and analgesia and blood product management.
• demonstrate understanding of chemotherapy and radiation therapy around the perioperative period and understand its implications for anesthesia.
• demonstrate an understanding of preoperative embolization techniques and implications for anesthesia.
• demonstrate the ability to identify of intraoperative considerations required for specific surgeries and anticipate possible intraoperative events pertinent to pathophysiology related to the surgical procedure itself.
• understand the anesthetic considerations for non-operative room anesthesia and be able to provide good-quality and safe patient care for a population with severe comorbidities in a remote location
• demonstrate the ability to use and interpret non-invasive cardiac output monitoring for high-risk patients and surgeries.
• make decisions regarding postoperative management and disposition.

Communicator

Demonstrate the ability to discuss the perioperative anesthetic management plan with the patient and their family including but not limited to invasive monitoring, informed consent for regional techniques and blood products and post-operative disposition including the need for step down and intensive care.

Demonstrate the ability to communicate plans with the attending anesthesiologist and operating room team when present.

To actively be involved in the WHO preoperative check list and to voice anticipated concerns to both surgical and nursing staff.

To communicate effectively with the operating room team if a critical event were to occur

To perform a thorough handover to the post-operative care unit staff

To maintain clear, accurate and appropriate records of procedures and plans ensuring that records are organized and structured.

Collaborator

Demonstrate the ability to optimize patient preoperatively along with other members of the perioperative team.

Demonstrate the ability to liase with perioperative team members including physicians and other health care providers to ensure patient care and safety

Demonstrate the ability to effectively transfer and handover patients over to nursing staff either in the post anesthesia care unit or intensive care unit.

Leader

The fellow should demonstrate the ability to engage in shared decision making and collaborative leadership.

• demonstrate the ability to engage perioperative physicians in the management and decision making with regards to perioperative care of the patient.
• demonstrate the ability to understand resource management within the healthcare system

Health Advocate

The fellow should demonstrate the ability to share their expertise by promoting health in the perioperative period.

• demonstrate the ability to ensure preoperative optimization of patients before complex, high risk surgery using evidence-based medicine
• demonstrate the ability to discuss risks and benefits of the anesthetic and procedure and help the patient and their families make informed decisions.
• ability to convey anesthetic concerns and rationale to surgeons and proceduralists.

Scholar

The fellow should demonstrate a commitment to learning and teaching.

• should take part in continuing medical education by reviewing literature pertinent to the fellowship and making evidence-based decisions.
• should play a role in departmental presentations and academic teaching sessions.
• should demonstrate the ability to effectively supervise and teach both medical students and residents.

Professional

The fellow should be able to demonstrate clinical competence, commitment to professional development and integrity in their interactions with both patient and other healthcare professionals.

• demonstrate a commitment to providing safe care that is of the highest standard for patients undergoing complex, high risk surgery with complex medical and surgical comorbidities.
• demonstrate the ability to work with teams and be respectful of physicians and healthcare professionals involved in the perioperative care of the patient.
• demonstrate insight into personal limitations and the ability to call for assistance when need be, keeping patient safety first and foremost.

Weekly assignment schedule split (unevenly) into:

1. Subspeciality days [2 – 3 days] in specialty anesthesia. Fellows are assigned one- to- one with specialty anesthesia staff.
2. Service days [2 days] in the operating room performing adult anesthesia lists. Fellows are assigned to an OR list and operate independently while being covered by anesthesia staff operating in another adjacent OR
3. Non-clinical days (NCDs) or academic days [1 day]: This granted according to the fellow’s academic engagement (research, teaching, journal clubs etc..).

On call duty:  

• 2 weekdays and 1 weekend per month. 
• Fellows are assigned on-call at the Juravinski hospital from 17:00 pm- 8:00 am. 
• Fellows are assigned with anesthesia staff working in the OR. 
• The next day is post-call