The Ontario Ministry of Health announced in March 2023 additional funding for medical student positions, including at the University of Ottawa.  We anticipate this will modestly increase the number of MS3 clinical clerks by 2025 or 2026.  The number of MS3 clerkship should remain stable until then.

Anesthesia remains an extremely popular speciality amongst medical students locally, resulting in high demand for MS4 anesthesia elective spots.  For 2022-2023, there was exceptionally high demand in Ottawa and we were challenged to create enough elective opportunities for our students.  The University of Ottawa did not accept any outside medical students but our students were likewise restricted from travelling to other schools for electives.  Without enough elective time for everyone, students were concerned that they would be disadvantaged applying to anesthesia residency during CARMS compared to students at other centers who were not similarly restricted.  Through collaboration with local partners, we were able to eventually offer all students interested in anesthesia at least 4 weeks of anesthesia elective time.  Dr. Hicks, the anesthesia residency program director in Ottawa, also communicated our local restriction to the anesthesia program directors throughout Canada so that our students would be represented fairly during CARMS.  This solution, although not perfect, was well received by the MD class of 2023 and the University.

The relative shortage of anesthesia elective spots for MS4 students in Ottawa is a longstanding problem, highlighted by the unique circumstances of 2022-2023.  We would like to eventually increase the number of elective spots especially during the pre-CARMS period between September to January to sixty to accommodate the need both locally and for students from other Universities.  Students will be able to travel for electives beginning in 2023-2024.

Aside from clinical teaching in the operating room, our department continues to provide both staff and resident tutors for many didactic learning sessions.  During the anesthesia clerkship rotations, resident tutors lead students through case based learning sessions, called Anesthesia Learning Cases.  This is complemented by practical Anesthesia clinical skills workshops, also resident led, which give the students hands on practice with airway management and a simulation based OR learning session.  These sessions are very well received by the students, provide formal teaching of the rotation learning objectives and help to consolidate knowledge and skills from their clinical rotation. 

Staff physicians and felllows continue to participate in pre-clerkship teaching including the organization and delivery of the pre-clerkship pain curriculum, case-based learning tutorials and e-portfolio.  Due to human resource constraints, it has become more challenging in recent years to consistently and reliably provide staff for these sessions, which often take place at times and locations less compatible with an anesthesiologist’s typical practice.  This will continue to be a challenge and innovative solutions will be required to allow the demands of clinical care provision and undergraduate medical education to co-exist.

On the administrative side, we continue to expand our examination bank, doubling the number of exams from 2 to 4 in the past year.  The University UGME renewal incorporating Entrustable Professional Activities has been delayed until at least 2025.  Dr. Mohamed Eissa has taken up the role of UGME Site Coordinator at the Civic starting May 2023, taking over from Dr. Dina Aboutouk who served in this role since October 2020.  Ms. Amber Devlin regrettably resigned her position as UGME Hospital Coordinator in Feburary 2023 after many, many years to take on a position at the Royal College of Physicians and Surgeons of Canada.  The Hospital Coordinator position has been taken by Ms. Kelsey Rice.  Thank you to Dina and Amber for their contributions to the UGME program and a warm welcome to Mo and Kelsey!

We are still amazed by the breath and degree of undergraduate teaching our department performs.  The most obvious example of this is the one-on-one teaching offered by every staff member in the operating rooms.  This exposure during early medical training provides practical knowledge and skills to our future doctors.  It also increases the profile of the speciality as a whole allowing us to inspire and educate the next generation about what anesthesiologist can do.  Equally impressive are the many staff and residents who engage with students in various activities out of the operating rooms.    

Thank you to all our members who contribute to undergraduate teaching!

Here are some important highlights: 

1. 5-year curriculum: Since 2021, our program has implemented a 5-year curriculum aligned with the Royal College of Physicians and Surgeons of Canada (RCPSC) Competence by Design (CBD) framework. This transition was influenced by the insights gained from our Fundamental Innovations in Residency Education (FIRE) pilot CBD project. Eligible residents also have the option to pursue an enrichment training pathway  to allow residents the flexibility to seek out further professional opportunities or deviate from the standard curriculum while still achieving the residency program requirements set out by the Royal College of Physicians and Surgeons of Canada 

2. Academic half days update: We have revised the schedule for academic half days to ensure consistency and accommodate the flipped classroom model of the CBD framework. PGY1 residents have sessions on Tuesday afternoons, while PGY2-4 residents have sessions on Thursday afternoons. Residents preparing for the RCPSC exam meet on Monday afternoons. These updates align the curriculum with national standards and enhance RCPSC exam preparation.
3. Transition to Practice: The final six months of residency are critical to gaining both competence and confidence.   Resident Independent Practice Evaluation (RIPE) days remain a crucial element of this stage and have been expanded to include out-of-OR activities.   Additionally, residents will be booked with a variety of cases and faculty on non-RIPE days, providing them with opportunities to demonstrate increased independence in a controlled environment. To better prepare our graduating residents, they now have a pediatric rotation during this stage as well.   Finally, we have introduced academic half day sessions focusing on non-medical expert skills such as financial management and continuing professional development. POCUS curriculum: Our faculty have successfully implemented a Point-of-Care Ultrasound (POCUS) elective for residents, which has now become a stable part of our core rotation curriculum. This addition allows residents to develop expertise in POCUS, a valuable skill in anesthesiology practice.
4. Airway rotation at Civic campus: To enhance our trainees' learning experiences, we have introduced a new airway rotation at Civic campus. Dr. Laura Duggan, with her expertise in this area, will lead the rotation. This addition provides our residents with exposure to diverse clinical settings and ensures continued exposure to highly trained airway experts and cases throughout residency.
5. CanNASC sessions: We deliver all 5 CanNASC simulation scenarios to each senior resident. This initiative is a requirement of training for Royal College certification and ensures our residents are well-prepared for their future practice.
6. Royal College Examination preparation: Our dedicated faculty members consistently contribute to preparing our residents for the RC exam. We conduct regular preparation sessions, including biannual mock oral exams, Monday afternoon Academic Half Day (AHD) sessions, and the evening Bell Ringer session. Dr. Chris Harty, our new Director of Oral Exams, has made significant efforts to improve oral exam preparation. A new longitudinal preparation initiative has been introduced, incorporating oral practice sessions into PGY 2-4 AHD.
7. Residency program accreditation: We have received valuable feedback from our trainees during the internal review in March 2023. The Residency Program leadership and committee have actively addressed many of the identified areas for improvement. We are preparing the necessary documentation for the upcoming external accreditation review by the Royal College in May 2024.
8. COVID Workarounds: The COVID-19 pandemic presented numerous challenges, especially in clinical scheduling. However, our residents have demonstrated exceptional commitment and professionalism, stepping up to care for patients in the ICU and filling gaps in the call schedule. We have adapted by hosting educational sessions virtually to comply with public health guidelines.
9. Residency Leadership roles: Dr. Asad Mirghassemi assumed the role of the new Program Director in 2023, succeeding Dr. Shawn Hicks, who made significant contributions to the residency program from 2016-2023. Welcome to Dr. Dina Aboutouk as the new Resident Coordinator at Civic campus (April 2023) and Dr. Sophie Breton as the interim CHEO Resident Coordinator (April 2023). We would also like to express our gratitude to Dr. Asad Mirghassemi and Dr. Heather O'Reilly for their contributions these roles previously. The program director will work closely with educational leads, including interim Vice Chair of Education Dr. Crooks, CBD Director Dr. Curtis Nickel, Competency Committee Chair Dr. Stephane Moffett and resident coordinators (Dr Dina Aboutouk, Dr Sophie Breton, Dr. Kristen Gadbois and Dr Chidam Yegappan) to further enrich the residency program training.
10. Residents are of course the most important part of our program. We have several residents that occupy leadership roles within the RPC:

2021-2022

2022-2023

Their dedication and contribution to the academic mission is invaluable. They serve as strong voices and advocate for their 50+ colleague residents

11. Competence Committee: The Competence Committee plays a crucial role in reviewing and making decisions regarding residents' progress. Its primary objective is to ensure that residents completing the program possess the necessary skills, knowledge, and attitudes to provide safe and competent patient care.  (CCC member names under section break)

12. Education Committee: The Education Committee, led by Dr. Curtis Nickel, consists of module leads responsible for monitoring resident progress, establishing assessment strategies, and developing educational requirements aligned with the national curriculum. The committee aims to foster a supportive learning environment. (member’s  names under section break)

We appreciate the support and dedication of our residents and faculty during these challenging times. Through ongoing efforts and teamwork, our Anesthesiology Residency Training Program will continue to evolve and remain at the forefront of anesthesiology education in Canada.

• Asad Mirghassemi, MD, MScHQ, FRCPC
  Program Director, Anesthesiology Residency  
  Department of Anesthesiology and Pain Medicine 
  Staff Anesthesiologist, The Ottawa Hospital 
  Assistant Professor, University of Ottawa

• Stephane Moffett, MD, MEd, FRCPC 
  Competency Committee Chair - CCC 
  Department of Anesthesiology and Pain Medicine  
  Staff Anesthesiologist, The Ottawa Hospital 
  Assistant, University of Ottawa

• Curtis Nickel, MD, FRCPC
  CBD Curriculum Director 
  Department of Anesthesiology and Pain Medicine 
  Staff Anesthesiologist, The Ottawa Hospital 
  Assistant Professor, University of Ottawa

Simulation education for residents

Simulation education continues to be the cornerstone of our residency program. 

Our PGY 1 residents engage in bootcamp, during which they develop their knowledge, skills and attitudes towards crisis management. They engage in over 30 high fidelity simulation scenarios and develop their approach towards common and uncommon perioperative complications. The implementation of self- and peer-debriefing allows for the development of critical reflection skills that are the cornerstone of adult learning. The added benefit of bootcamp is the support and friendships that develop over the 3 bootcamp blocks between our junior residents.

Bootcamp 2022

Bootcamp 2021

High fidelity simulation continues throughout residency, with emphasis on the importance of interprofessional and multidisciplinary training: we learn together so we can work together. During the past 2 years we have conducted scenarios with Obstetrics & gynecology, Neurosurgery, General surgery, Emergency medicine, OR nursing, OB nursing and anesthesia assistants.  Working with our surgical colleagues means that we develop surgical models. In the last 2 years, we made bleeding livers, ectopic pregnancies, spinal instrumentation, etc.

Pediatric specific simulation education occurs yearly for our residents in the form of the

Managing Emergencies in Paediatric Anaesthesia (MEPA) course. This consists of 5 evidence based crisis scenarios that are evidence based and peer reviewed.

What’s inside the mannequin.

Simulation education is used for both formative and summative learning. The OSCE and CRM OSCE for PGY1s, ACLS milestones and CanNASC are formal assessments that allow our residents to demonstrate their ability to manage common and uncommon issues. In 2021 we introduced EPA assessments that could be requested with specific simulation assessments (ACLS milestone, CRM OSCE). This enables our residents to acquire the EPA evidence of their capabilities in management of these uncommon critical events.

ACLS milestone assessment is unique in that it is a resident-driven, in-situ, “surprise” simulated assessment that allows residents to demonstrate their skills in an intraoperative resuscitation.  Resident leaders are identified and are responsible for implementing the scenario, rating and delivering feedback (with instructor assistance).

The Canadian National Anesthesiology Simulation Curriculum (CanNASC) assessment is a RCPSC required element for certification. Residents must demonstrate competence in the management of all 5 scenarios prior to graduation. This rigorous, standardized assessment is done nationally. We have been completing these CanNASC assessments yearly: in April 2023, we delivered 60 scenarios to 12 residents! This is an enormous undertaking that we couldn’t do without our CHEO, Montfort and Military colleagues: Heather O’Reilly, Meghan Andrews and Dan Power.

Simulation education resident elective

In 2022, Dr Curtis Nickel joined the simulation faculty and was instrumental in introducing a simulation education elective offered to our senior anesthesia residents. Raman Sohi was our first resident to partake in this. During this elective she actively participated and debriefed sessions, created a simulation scenario, developed an interdisciplinary scenario with vascular surgery and attended FEAST lectures offered to our simulation fellows through DIME.  Dr Sohi also starred in the Sim Trek plenary at the International Conference in Medical Education and met with Justin Trudeau at uOSSC.  This was a very successful education elective that we look forward to continuing.

Simulation education: local and international

Simulation education was the plenary presentation at the International Conference for Residency Education in Montreal 2022.  Drs Simone Crooks and Adam Garber were able to showcase how simulation could be used for the teaching of CanMEDS competencies, with the assistance of Dr Raman Sohi.  The plenary was a huge success with plans for SimTrek at ICRE 2023 already underway.

The importance of simulation education continues to be recognized within and without medicine. The Prime Minister Justin Trudeau, visited the uOSSC in February 2023, meeting with learners, including our very own Raman Sohi. 

Simulation Faculty

Our simulator instructors are a diverse group and are engaged in many different aspects of education and scholarship. Their presentations, publication and grant activity are captured in the research update. 

Highlights:  in 2023, Dr Dan Power became the Chief of Anesthesia for the Canadian Armed Forces and advisor to the Surgeon General for Anesthesia matters. In the past 2 years his military simulation activities have included Medical Director Advanced Military Trauma Resuscitation Program AMTRP- East. (Nov 2015-Aug 2022). Dr Power is also part of the Mobile Surgical Resuscitation Team (MSRT): a high-readiness, rapidly deployable, mobile damage control surgery team. This team provides damage control surgery in austere and mobile platforms (vehicles, aircraft) and undergo simulation based training 1-3 times annually.  Dr Power deployed with this team to Mauritania Africa in March 2020, and for an exercise to Texas in Sept 2022.  Dr Power share his military expertise with the PGY1s during bootcamp.

Dr Michelle Chiu was 1 of 25 invited faculty (and the only Canadian) to Copenhagen working on the development of a curriculum for simulation-based education and training for anaesthesiology trainees.

Dr Purnima Rao spent the past year and a half doing a palliative care medicine fellowship. She will be returning to anesthesia Simulation education in 2024. Dr Amy Fraser had her last year doing anesthesia simulation education in 2022. Dr Curtis Nickel joined the simulation education group in 2023 after having completed HESP and FEAST through DIME. We welcome his educational expertise and scholarly vision.

On behalf of the simulation faculty (Drs. Andrews, Chiu, Gu, Nickel, O’Reilly, Power, Rao), I would like to sincerely thank you for your continued support.  I look forward to updating you next year on our ongoing endeavours!

Simone Crooks, MD FRCPC
Director, Simulation Education
Department of Anesthesiology and Pain Medicine