Enhanced Skills Program: FP-Anesthesia
The Family Practice Anesthesia (FPA) Program is a 52 week intensive residency program supported jointly by the Departments of Family and Community Medicine and Anesthesiology and Pain Medicine. It is designed to provide family physicians with the knowledge and skills to be able to provide safe anesthesia care for low-risk patients undergoing relatively uncomplicated procedures, particularly in smaller rural communities.
The FPA residency program is of interest to recent graduates from family medicine training programs as well as family physicians who have been in independent practice who wish to acquire the knowledge, skills and judgement necessary for independent FP anesthetic practice. Our program is accredited by the College of Family Physicians of Canada (CFPC) and residents who have successfully completed the program are eligible to receive a Certificate of Added Competence (CAC) in Family Practice Anesthesia from the CFPC.
Dr. Vaibhav Kamble MD CCFP FRCPC
Department of Anesthesia, Michael Garron Hospital
825 Coxwell Avenue, Toronto ON M4C 3E7
(416) 469-6580 ext.6212
Length of Program: One Year (52 Weeks) - Full Time
Program and Application Eligibility
Family Medicine/Enhanced Skills Match:
- Trainees currently enrolled in a CFPC accredited program, who hold a postgraduate education certificate of registration or equivalent in their province are eligible for the Match. N.B.: Those enrolled in a PGY3 Enhanced Skills Program at the time of application are NOT eligible to apply to another PGY3 Enhanced Skills position.
- Off-cycle applicants: PGY2 residents with completion dates between July 1 and December 31, 2023 are also eligible but must declare their completion date on the application form and request a late start. You may only apply to the match one time. While some programs are able to admit residents' off-cycle, others are not. Off-cycle applicants will remain eligible to apply to the following year's match recognizing that they may have obtained an independent practice license in the interim period.
- Residents currently enrolled in ACGME accredited Family Medicine residency programs in the U.S. who are Canadian citizens or Permanent Residents may apply to the PGY3 FP Anesthesia Match if they meet the CFPC requirements outlined on the College of Family Physicians of Canada website at: http://www.cfpc.ca/Home/. Further information is available on the CaRMS Provincial Eligibility site. Information regarding licensure requirements is available at the College of Physicians and Surgeons of Ontario site.
Not eligible to apply through CaRMS:
- Practicing Family Physicians are not eligible for the PGY3 FP Anesthesia Match but may access PGY3 FP Anesthesia training via the Ontario Ministry of Health and Long-Term Care's Re-Entry program. Re-Entry Program information is available at the following website: MOHLTC Re-Entry Program Information
Core Competencies and Core Professional Activities
The FPA Residency Program adheres to CanMEDS-FM roles (Medical Expert, Communicator, Collaborator, Leader, Scholar, Health Advocate and Professional) and is planned around 181 core competencies in the following Priority Topics:
Pre-Anesthetic Assessment of the Patient
Acutely Ill or Injured
OR Emergencies and Complications
Acute Pain Management
Know and Apply Limits of Capacity
Resuscitation and Crisis Management
Self-directed Learning and Scholarly Project
Neuraxial and Regional Anesthesia
Communication, Collaboration and Team Work
See Curriculum Map for more details regarding core competencies.
Program Structure: Clinical Experiences
Rotational Goals & Objectives
The program is divided into 13 blocks. Each block is 4 weeks in length:
Adult Anesthesia (6 blocks)
Location: Michael Garron Hospital
Residents begin the first 2-3 blocks of residency at Michael Garron Hospital (MGH) which is a community hospital based in the east end of Toronto with a diverse patient population. MGH is also the home site for the FPA program and residents will spend half their residency at this teaching site.
One block at MGH will be devoted to pediatric anesthesia.
Goal: Residents will experience one-on-one training and supervision with FRCPC anesthesiologists who are expert clinicians and teachers experienced in training FPA residents. Learners will be exposed to a variety and high volume of cases including complex elective and emergency cases and epidurals.
Objectives: FPA residents will be exposed to OR cases that include Dentistry, Endoscopy, ENT, General Surgery, Gynecology, Obstetrics, Ophthalmology, Orthopedics, Pediatric Surgery, Plastic Surgery and Urology. During rotations at MGH residents will develop their skills and knowledge in general anesthesia, vascular access, management of difficult and complex airways, OR emergencies and complications, acute pain management, procedural sedation, anesthesia consultations, post-operative care, crisis management and procedural skills. Developing awareness about the limitation of the FPA’s scope of practice and its relationship to a community’s capacity and resource limitations including the knowledge and skills to stabilize and transfer patients are part of the clinical experience and knowledge gained during these rotations.
Through learning experiences in the PACU, Labour and Delivery Unit, ward consultations, and the pre-op clinic residents will continue to develop and improve their technical, clinical, professional and communication skills as well as collaborative team skills and anesthesia knowledge.
In addition to working in the operating room, residents will experience working in other settings such as pre-operative clinics, endoscopy room and pain clinics.
Obstetrical Anesthesia (2 blocks)
Location: Mount Sinai Hospital (MSH)
Residents will complete 2 blocks of their obstetrical anesthesia training at one of Canada’s largest perinatal centres that houses a renowned high-risk pregnancy program and has the largest Neonatal Intensive Care Unit.
Goal: One-on-one training and supervision with FRCPC anesthesiologists who are expert clinicians and teachers in obstetrical anesthesia will give residents the confidence, competence and skills to manage obstetrical anesthesia cases, emergencies and complications.
Objectives: During these 2 blocks, residents will have exposure to cases in Obstetrical Anesthesia that are commonly encountered in FPA practice. Residents will further develop their skills in troubleshooting obstetrical analgesia, recognizing and managing intraoperative complications, and identifying high-risk situations to be able to apply limits of capacity.
Pediatric Anesthesia (2 blocks)
Location: The Hospital for Sick Children (HSC)
HSC is Canada’s leading and largest children’s hospitals dedicated to improving the health of children and providing the best pediatric care.
Goal: Residents will receive one-on-one training and supervision with FRCPC expert clinicians and teachers in pediatric anesthesiology. Through their training at HSC, residents will become familiar with pediatric anatomy and physiology with regard to anesthesia.
Objectives: Residents will also be exposed to anesthesia management of pediatric emergencies such as difficult airway and participate in OR pediatric cases seen in community settings such as Dentistry, ENT, General Surgery, Ophthalmology, Orthopedics and Urology.
ICU (1 block)
Goal: Residents will be exposed to a variety of critically ill patients and improve their technical skills and knowledge in the management of the critically ill patient.
Objectives: Residents will also have an opportunity to participate in team care of patients with both physicians and non-physicians (pharmacists, dieticians, nurses) in order to continue their development of interdisciplinary team activities and learn how to allocate finite health care resources wisely. During this rotation, residents will have many opportunities to improve their skills in communication with patients, staff and families.
Family Practice Anesthesia (1 block)
Location: Communities north of the Greater Toronto Area including Port Perry, Orangeville, Orillia and Midland
Goal: During the community practice rotation, residents will be introduced to the practice of FP-Anesthesia through one-on-one training with attending FPAs. Residents will experience typical OR lists common to smaller communities in Ontario such as General Surgery, Orthopedics, ENT, OBGYN, Plastics, Endoscopy, Ophthalmology and Dentistry.
Objectives: While out in a community setting, residents will maintain a connection to family practice and learn the foundational aspects of FPA practice such as perioperative assessment, perioperative management, procedural skills, and balancing hospital and community practice work. Dependent upon the FPA practice within a given community, residents may have opportunities to work in various settings such as family practice offices, pain clinics, long-term care, pre-operative clinics and emergency room.
This rotation will help residents develop a sense of limits to the complexity of cases dependent upon community resources and setting. It will also provide residents with the necessary skills to transition to independent practice.
At the University of Toronto FPA program residents complete rotations through the following hospitals:
- Community Hospital Rotation (Anesthesia) - Michael Garron Hospital: 28 Weeks (includes 4 weeks of Pediatric focused Anesthesia)
- Pediatric Anesthesia - Hospital for Sick Children: 8 Weeks
- Tertiary Care & High-Risk OB - Mount Sinai Hospital: 8 Weeks
- Rural Community Hospital (Orillia Soldiers Memorial Hospital, Georgian Bay General Hospital, Port Perry Hospital or Orangeville Hospital): 4 Weeks
- Intensive Care (Goals and Objectives)- Site TBD: 4 Weeks
Our program also provides interested residents an opportunity to apply for a 4 week selective in Nunavut or 2 week Acute on Chronic Pain selective at Wasserman Pain Clinic/Mount Sinai.
Clinical Duties and On-Call Expectations
Residents will rotate through at least 4 different hospital sites. Call will vary by site and will not exceed the guidelines indicated by PARO. At present, call will not exceed 1 in 4. Residents in the Royal College Anesthesia Program will share call duties when both types of trainees are present. At present, PARO states that residents are entitled to 4 weeks of holiday per 12 months of training.
Program Structure: Curriculum Experiences
Morning Didactic Teaching and Wednesday afternoon Teaching Series
From September to June each year, FPA residents are given dedicated time to attend their rotation’s morning didactic teaching provided by each teaching site’s Department of Anesthesia as well as those lectures relevant to FPA practice given by the University of Toronto’s Department of Anesthesiology and Pain Medicine’s Wednesday afternoon seminar series.
Self-directed Learning and Reading
Residents are expected to engage in self-directed learning throughout the course of their residency. Residents are given a reading guide of priority topics in anesthesia, physiology and pharmacology that are essential for the successful completion of the program. Continued reading and self-directed learning are central to the development of clinical knowledge necessary for FPA practice.
NOSM Boot Camp
In September of each year FPA residents have the opportunity to participate in NOSM’s 5 day BootCamp in Sudbury, Ontario. Attendees will participate in simulator sessions, lectures and workshops.
AKT Knowledge Test
In August, FPA residents write the AKT(1) exam to test their baseline anesthesia knowledge. The results of this exam will help guide each residents’ independent education plan. In December, FPA residents write the AKT (6) exam alongside the Royal College Anesthesia residents. Results from this exam are used to continue each residents’ independent education plan and serve as a guide to self-directed learning.
FPA residents will have the opportunity to participate in 2-3 high fidelity simulator sessions. The Patient Simulator sessions are designed to expose the FPA residents to rare but life-threatening events that occur in the peri-operative period.
Each resident is responsible for one Grand Round presentation and participation in one of the monthly Journal Club meetings held by the Department of Anesthesiology & Pain Medicine at MGH. Designated faculty are assigned for guidance and support. Residents are also expected to participate in any one of the following scholarly projects: E-modules, Infographics or Resident Handbook.
Indigenous Safety Training Modules
Residents are provided protected time to complete this mandatory online module.
Your Connection to Family Medicine
Residents are provided with the choice of either a half-day back in family medicine or following a group of patients from pre-op through to post-op care.