Welcome
Overview of the program and key components (i.e. clinical care, education and research)
Certification Outcome
The successful completion of the fellowship will grant a Fellowship McMaster Certification.
Entry Requirements
- Must have completed Cardiology Residency training prior to the start of the fellowship
- Recent graduates are required to submit an application form and comply with McMaster University Postgraduate Medical Education requirements for residents and fellows.
Application Deadline
A general deadline of November 30 each year. The program will accept a January 1 or July 1 start date
Goals of Training
- Cardiac or coronary care units, staffed by cardiologists, have been in existence for over 50 years. Since their advent, there has been a substantial fall in patient mortality. In the past 10 years, the cardiac care unit patient population has changed with more patients having complex co-morbid conditions and some requiring advanced life support therapies such as mechanical ventilation, non-invasive ventilation, inotropic and vasopressor agents, renal replacement therapies and mechanical circulatory support. As a result, cardiac care units in many tertiary hospitals have acuity and patient complexity levels similar to many general intensive care units. Therefore, the traditional skill set of the cardiologist working in a more acute cardiac care unit has shifted to one requiring familiarity with a wide range of chronic diseases, acute non-cardiovascular complications and life-supporting measures and technologies.
- The Canadian Cardiac Intensive Care Unit (CICU) Director working group, the American Heart Association, and the European Society of Cardiology have all published position papers advocating for dedicated critical care training for cardiologists attending in more advanced cardiac intensive care units. They advocate for cardiologists to increase their skill set in order to provide quality care to this patient population.
- Fellows will function as integral members of the ICU team, leading daily bedside rounds, performing initial assessments, plans and follow-ups of all patients. Fellows will also be immersed in educational and leadership activities similar to Royal College Critical Care Medicine Residents. Faculty will foster and support the refinement of the fellow’s scientific, academic, and clinical career goals.
- Develop a robust clinical skill set to enable comprehensive management of critically ill cardiac patients in the Cardiac Care Unit.
- Demonstrate expertise in managing critically ill patients with multiorgan dysfunction.
- Gain experience and proficiency in technical and procedural skills required to manage critically ill cardiac and non-cardiac patients.
- Develop an appreciation for different methods of discussing goals of care, withdrawal of life support and end-of-life issues by attending and participating in family conferences with different critical care medicine attending physicians.
Length of Training
1 year
Curriculum Highlights
The curriculum for training is designed to meet the competencies specified by the Heart Rhythm Society (HRS), the Canadian Heart rhythm society (CHRS) and the European Heart rhythm Association (EHRA). The curriculum is delivered in different methods which include training in the EP lab and device implant lab, formal rounds, journal club, bedside teaching and supervised clinics as well as consult services.
Clinical Rotations
Based on the recommendations from the Canadian CICU directors working group and the American Heart Association, the training includes:
- MSICU at HHS and SJH sites (4 blocks)
- CVICU at HGH (2 blocks)
- CCU Junior Attending at HGH (2 blocks)
- Anesthesiology at HHS (1 block)
- Respirology at HHS (1 block)
- Advanced Heart Failure and Transplantation (Toronto General Hospital/UHN) (2 blocks)
- Elective time for research or additional clinical block to facilitate clinical or academic career goals (i.e., Trauma, Nephrology, Infectious Diseases, etc.) (1 block)
4 weeks of vacation will also be granted over the year.
Learning Objectives for Rotations
Medical Expert
- Understand the pathophysiology, clinical presentation, investigation, differential diagnosis, treatment options and complications for critically ill patients with shock.
- Understand the pathophysiology, clinical presentation, investigation, differential diagnosis, treatment options and complications of non-cardiac respiratory distress.
- Manage patients with severe non-cardiac illness requiring intensive care therapies including continuous renal replacement therapy (CRRT), inotropes and vasopressors, invasive hemodynamic monitoring, advanced respiratory support and mechanical ventilation, antimicrobial agents.
- Safely perform procedures required in critically ill patients including chest tube insertion and management, central venous cannulation, arterial cannulation, bronchoscopy and bronchoalveolar lavage, paracentesis of abdominal or pleural fluid, lumbar puncture, endotracheal intubation and point-of-care ultrasonography.
Leader
- Manage a clinical team made of trainees, nurses and other allied healthcare providers as well as interacting with various consultant services assisting with aspects of patient care.
- Display appropriate use of ICU resources to maintain patient flow and bed availability for new patients.
Communicator
- Demonstrate the ability to succinctly, coherently and accurately communicate information to the members of the entire health care team, patients and their families via both written (chart/consult notes) and verbal (daily rounds, patient presentations and family meetings) methods.
- Develop an appreciation for different methods of discussing goals of care, withdrawal of life support and end-of-life issues by attending and participating in family conferences with different critical care medicine attending physicians.
- Demonstrate appropriate communication and ability to establish therapeutic relationships with patients and family members.
Health Advocate
- Recognize opportunities for advocacy, health promotion and disease prevention in ICU patients.
Scholar
- Contribute to the development of new knowledge by educating junior medical staff and other health professionals.
Professional
- Exhibit professional behaviours in practice, including ability to deliver quality care to patients with integrity, honesty and compassion.
- Understand and apply basic principles of medical ethics including informed consent, advanced directives, research ethics, patient autonomy and justice.
Collaborator
- Demonstrate an ability to deal effectively and constructively with differences of opinion and conflict situations arising in the interdisciplinary ICU environment.
- Interact effectively (by note, verbal communication, team meetings) with other health care providers to ensure optimal patient care is provided.
Medical Expert
- Understand the clinical evolution, possible complications and treatment of patients post-cardiac surgery, including valve and aortic surgery, coronary bypass surgery, tumor resection, pericardiectomy, etc.
- Learn the indications, pathophysiology, complications and management of ECLS (extracorporeal life support), including being part of ECLS triage team.
- Enhance procedure skills required in critically ill cardiac patients including chest tube insertion and management, central venous cannulation and pulmonary artery catheter placement, arterial cannulation, endotracheal intubation, point-of-care echocardiography, temporary transvenous pacemaker insertion, electrical cardioversion and insertion of mechanical circulatory support devices (i.e., intra-aortic balloon pump, ECMO cannulae, etc.).
- Demonstrate effective management of actively bleeding post-cardiac surgical patients, including massive transfusion, fluid resuscitation and emergency re-sternotomy.
Leader
- Manage a clinical team made of trainees, nurses and other allied healthcare providers as well as interact with various consultant services assisting with aspects of patient care.
- Display appropriate use of ICU resources to maintain patient flow and bed availability for new patients.
- Demonstrate ability to captain a team during cardiac arrest in the post-cardiac surgery patient, including running CSU-ALS protocols and initiating emergency re-sternotomy if clinically indicated.
Communicator
- Demonstrate the ability to succinctly, coherently and accurately communicate information to the members of the entire health care team, patients and their families via both written (chart/consult notes) and verbal (daily rounds, patient presentations and family meetings) methods.
- Develop an appreciation for different methods of discussing goals of care, withdrawal of life support and end-of-life issues by attending and participating in family conferences with different critical care medicine attending physicians.
- Demonstrate appropriate communication and ability to establish therapeutic relationships with patients and family members.
Health Advocate
- Recognize opportunities for advocacy, health promotion and disease prevention in ICU patients.
Scholar
- Contribute to the development of new knowledge by educating junior medical staff and other health professionals.
Professional
- Exhibit appropriate professional behaviours in practice, including the ability to deliver quality care to patients with integrity, honesty and compassion.
- Understand and apply basic principles of medical ethics including: informed consent, advanced directives, research ethics, patient autonomy and justice.
Collaborator
- Demonstrate an ability to deal effectively and constructively with differences of opinion and conflict situations arising in the interdisciplinary ICU environment.
- Interact effectively (by note, verbal communication, team meetings) with other health care providers to ensure optimal patient care is provided.
Medical Expert
- Demonstrate proficiency in managing patients with acute cardiac disease requiring cardiac intensive care, including: acute coronary syndromes, decompensated heart failure, myocarditis, pericardial effusion and cardiac tamponade, severe valvular heart disease, diseases of the aorta, respiratory failure, arrhythmias, pulmonary embolism, and pulmonary hypertension.
- Become comfortable with administering procedural sedation.
- Gain experience in management of critically ill cardiac patients based on clinical assessment, invasive hemodynamic information and point-of-care echocardiographic data.
Leader
- Effectively lead the Cardiac Care Unit team as Junior Attending for daily rounds, participating in all major decisions involving patient care, triaging patient transfer requests from outside hospitals and bed management in concert with the CCU Attending Physician.
Communicator
- Demonstrate the ability to succinctly, coherently and accurately communicate information to the members of the entire health care team, patients and their families via both written (chart/consult notes) and verbal (daily rounds, patient presentations and family meetings) methods.
- Develop an appreciation for different methods of discussing goals of care, withdrawal of life support and end-of-life issues by attending and participating in family conferences with different critical care medicine attending physicians.
- Demonstrates appropriate communication and ability to establish therapeutic relationships with patients and family members.
Health Advocate
- Identify patient groups at risk of cardiovascular disease and its complications and apply available knowledge regarding primary and secondary prevention.
Scholar
- Demonstrate effective teaching ability to junior medical staff, cardiology residents and other health professionals.
Professional
- Exhibit appropriate professional behaviours in practice, including ability to deliver quality care to patients with integrity, honesty and compassion.
- Understand and apply basic principles of medical ethics including: informed consent, advanced directives, research ethics, patient autonomy and justice.
Collaborator
- Demonstrate an ability to deal effectively and constructively with differences of opinion and conflict situations arising in the interdisciplinary ICU environment.
- Interact effectively (by note, verbal communication, team meetings) with other health care providers to ensure optimal patient care is provided.
Medical Expert
- Effectively perform clinical preoperative assessment, including risk assessment and comprehensive anesthetic planning.
- Demonstrate an understanding of the physical principles relating to anesthesia equipment and the safety aspects pertaining to this equipment, including equipment checking.
- Displays proficiency in airway management, demonstrating competence with mask ventilation, endotracheal tube insertion using direct laryngoscopy and video laryngoscopy and use of laryngeal mask airway devices.
- Understand the pharmacology of commonly used drugs in the perioperative period including analgesia and sedation medications, as well as drugs used during peri-procedural resuscitation.
- Assess and manage, with appropriate intervention, the respiratory and hemodynamic status of the patient during the perioperative period.
Leader
- Demonstrate ability to assist supervising Anesthesiologist in effectively and efficiently managing operating room patient lists.
Communicator
- Effectively communicate the risks and benefits of the anesthetic options available for the patient’s surgery for the purpose of informing the patient and including them in the decision-making process.
- Thoroughly communicate with all colleagues and members of the team involved in caring for the patient.
Health Advocate
- Demonstrate ability to promote the health of each patient and appropriately utilize finite healthcare resources.
Scholar
- Demonstrates self-directed learning, focused on career learning objectives.
- Effectively applies the principles of evidence-based practice toward clinical decision-making.
Professional
- Consistently displays professional behaviours in terms of reliability and punctuality.
Collaborator
- Interact effectively with other health care providers (i.e., surgeons, residents, nurses and other allied health professionals) to ensure optimal patient care is provided.
Medical Expert
- Understand the pathophysiology, clinical presentation, investigation, differential diagnosis, treatment options and complications of patients with acute and chronic respiratory problems.
- Review respiratory physiology.
- Understand the indications and contra-indications to bronchoscopy and bronchoalveolar lavage.
- Displays proficiency in bronchoscopy and bronchoalveolar lavage
Leader
- Demonstrates the ability to prioritize when juggling with consultations, follow-ups, and procedures.
Communicator
- Effectively communicate the risks and benefits of bronchoscopy, broncho-alveolar lavage and procedural sedation.
Health Advocate
- Demonstrate ability to promote the health of each patient and appropriately utilize finite healthcare resources.
Scholar
- Demonstrates self-directed learning, focused on career learning objectives.
- Effectively applies the principles of evidence-based practice towards clinical decision making
Professional
- Consistently displays professional behaviours in terms of reliability and punctuality.
Collaborator
- Interact effectively with other health care providers (i.e., physicians, residents, nurses and other allied health professionals) to ensure optimal patient care is provided.
Medical Expert
- Understand the pathophysiology, clinical presentation, investigation, differential diagnosis, treatment options and complications of patients with acute and chronic heart failure.
- Learn the indications, pathophysiology, complications and management of ECLS (extracorporeal life support), including being part of the ECLS triage team.
- Become comfortable with the advantages, disadvantages and troubleshooting of various temporary and durable mechanical circulatory support options.
- Develop a familiarity with the indications and contraindications for cardiac transplantation
- Become familiar with palliative care discussions and plans.
- Gain experience in management of advanced heart failure patients based on clinical assessment, invasive hemodynamic information and point-of-care echocardiographic data.
Leader
- Demonstrates the ability to prioritize when juggling with consultations, follow-ups, and procedures.
Communicator
- Demonstrate the ability to communicate information to the members of the entire health care team, patients and their families via both written (chart/consult notes) and verbal (daily rounds, patient presentations and family meetings) methods.
- Develop an appreciation for different methods of discussing goals of care, withdrawal of life support and end-of-life issues by attending and participating in family conferences with different critical care medicine attending physicians.
Health Advocate
- Demonstrate ability to promote the health of each patient and appropriately utilize finite healthcare resources.
Scholar
- Demonstrates self-directed learning, focused on career learning objectives.
- Effectively applies the principles of evidence-based practice toward clinical decision making
- Able to discuss the ethical controversies relevant to organ transplant.
Professional
- Consistently displays professional behaviours in terms of reliability and punctuality.
Collaborator
- Interact effectively with other health care providers (i.e., physicians, residents, nurses and other allied health professionals) to ensure optimal patient care is provided.
Supervision & Feedback
Trainees will be assessed by formal written evaluation every 3 months along with daily verbal feedback