> Home Page > International Fellowship Programs > University Health Network & Mount Sinai Hospital

University Health Network & Mount Sinai Hospital

Welcome from the Program Director

dr_steel2The Critical Care Medicine International Fellowship at the University Health Network (UHN) and Mount Sinai Hospitals is truly an international program. Our alumni, with whom we continue to collaborate, include former fellows from countries all over the World including: the United States, Italy, Japan, Switzerland, United Kingdom, Singapore, Argentina, Ireland, Spain, and Israel.

The Critical Care Medicine program provides our fellows with exceptional clinical, educational, and research experience. Our aim is to train the leaders in critical care for the future and to help improve the quality and delivery of patient care throughout the World. Our program is recognised by the University of Toronto, Faculty of Medicine, and upon completion fellows are awarded a certificate from the University that attests to their achievement. Many of our fellows will sit the European Diploma of Intensive Care Medicine (EDIC) and American Board of Internal Medicine Critical Care examinations during their time with us. They have found our academic program to be invaluable for exam preparation.

The clinical experience offered by the program spans the breadth of critical care. Each fellow will spend time at our three university hospitals: Toronto General Hospital, Toronto Western Hospital, and Mount Sinai Hospital. In addition to affording patients the highest standard of general adult intensive care, each is a tertiary referral centre for subspecialty critical care, as detailed below.
To further broaden the educational opportunities for our fellows we provide elective clinical training periods in areas such as: cardiovascular ICU, burns, transfusion medicine, anaesthesiology, transplant medicine, and trauma. The list has yet to be exhausted.

The University of Toronto is renowned as a global leader in critical care research and many of its stars are based at the hospitals of UHN and Mount Sinai. UHN is a leader in patient safety initiatives and the development of Rapid Response Systems; the Critical Care Response Team. Mount Sinai is a leading clinical training centre, boasting a state of the art hi-fidelity simulation centre for crisis resource management in ICU.

The fellowship program is initially a one year program but can be extended to two or three years. This would be at the discretion of the Program Director and Department Chief, and subject to the performance of applicants and their educational goals. Details of the application process are available through the link (application process). The minimum requirement for application is a specialty certificate in Internal Medicine, Emergency Medicine, Critical Care, Surgery, or Anaesthesia (such as the MRCP(UK) or FANZCA (Australia and New Zealand). Applications are always highly competitive and so please ensure that you apply early and that all paperwork submitted is in good order.

Thank you for your interest,

Dr. Andrew Steel BSc MBBS MRCP FRCA EDIC
Assistant Professor
Department of Anesthesiology
Interdepartmental Division of Critical Care Medicine
Toronto General Hospital
University of Toronto

 

University Health Network

Toronto General Hospital (TGH)
 
Tgh.jpgToronto General Hospital is the largest of three institutions that together form the University Health Network. It is a 404-bed hospital located on University Avenue in Downtown Toronto. It is a global leader in solid organ transplantation, cardiovascular medicine and surgery, and surgical oncology.

The hospital has three formal critical care areas: a 20-bed Medical Surgical Intensive Care Unit, a 18-bed Cardiovascular Intensive Care Unit, and a 13-bed Coronary Intensive Care Unit. In addition to this it has 5 sub-specialty high dependency units.

The Medical Surgical Intensive Care Unit is a busy unit, admitting more than 800 patients per year with a high acuity. Clinical coverage is divided into two intensivist-led teams: nominally Team A and Team B. Team A, is the larger of the two and therefore comprises the majority of resident house staff and is responsible for approximately two-thirds of the MSICU patients.

The second ICU team, Team B, is traditionally staffed by an Attending Intensivist, Critical Care Fellow and, when available, a resident. The team is responsible for the Critical Care Response Team (CCRT) at Toronto General and one-third of the inpatients on the unit.

 

Sub-specialty fellowship training afforded at the TGH site includes:

  • High Frequency Ventilation (Jet and Oscillation Ventilation)
  • Extracorporeal Membrane Oxygenation (ECMO) and Ventilation (NovalungÒ)
  • Heart-Lung, Lung, and Liver Transplantation Critical Care
  • Cardiovascular Intensive Care, including Heart Transplant and VAD management

 

Fellows’ roles and responsibilities:

There are generally 3 – 4 fellows scheduled to be at TGH during any one month. Fellows 1 and 2 are assigned to Team A and Fellow 3 to the Critical Care Response Team / Team B.

Fellow 1 – Junior Attending role for Team A
Thus is expected to: direct patient care, lead daily rounds, assign patients to residents, help manage patient flow and review all consults. As Fellow 1 you will be honing both your clinical and teaching skills; at the same time as developing your administrative and leadership skills.

Fellow 2 – Resource to the team.
Is available within the ICU during rounds to trouble shoot problems and respond to patient needs in order that morning multidisciplinary rounds be completed efficiently. This will often entail direct supervision of residents during procedures and consults.

Fellow 3 - Junior Attending role for Team B
Functioning as the Junior Attending for all Team B patients and responsible for attending all ICU follow up visits and Critical Care Response Team consultations with the nursing staff and respiratory therapists.

Additional fellows to the staff will collaborate with Fellow 3 to ensure appropriate coverage of Team B inpatients and CCRT. This fellow will also be responsible for daily resident teaching over and above that of the teaching schedule. On weeks with low demand they should also anticipate working on a quality improvement project, research or other academic activities.


[back to top]


Toronto Western Hospital (TWH)

twh.jpgThe Toronto Western Hospital is not only a world-renowned centre for neurosciences, but is also a vital and busy provider of acute secondary care to the Greater Toronto Area. The hospital has approximately 240 acute medical and surgical beds.

The combined Medical-Surgical and Neuroscience Intensive Care Unit recently underwent complete refurbishment and now has 20 state of the art ICU beds and 12 Neurosurgical “Step-Down” monitored beds.

The clinical workload of the MSNICU is approximately 60% neurosurgical and is therefore offers an excellent opportunity to learn about the management and invasive monitoring of the variety of neurological pathology, especially neurovascular injuries.

As with its sister hospital, TGH, clinical coverage is divided into two intensivist-led teams: nominally Team A and Team B as well. The design of the new ICU lends itself to this staffing model as it is divided into “pods” with 4-6 beds. Therefore Team A, the larger of the two, will be responsible for the majority of the MSICU patients and will cover all but 2 “pods” of the unit. Team B, also staffed by an attending intensivist, critical care fellow and resident, will be responsible for the Critical Care Response Team (CCRT) and two inpatient pods on the unit.

 

Sub-specialty fellowship training afforded at the TWH site includes:

  • Neurosurgical and Neurological Critical Care
  • High Frequency Ventilation (Jet and Oscillation Ventilation)
  • Neuroradiology

 

Fellows’ roles and responsibilities:

Staffing at TWH and TGH are similar. There are generally 3 – 4 fellows scheduled during any one month. Fellows 1 and 2 are assigned to Team A and Fellow 3 to the Critical Care Response Team / Team B.

Fellow 1 – Junior Attending role for Team A
Thus is expected to: direct patient care, lead daily rounds, assign patients to residents, manage patient flow and consults. As Fellow 1 you will be honing both your clinical and teaching skills; at the same time as developing your administrative and leadership skills.

Fellow 2 – Resource to the team.
Is available within the ICU during rounds to trouble shoot problems and respond to patient needs in order that morning multidisciplinary rounds be completed efficiently. This will often entail direct supervision of residents during procedures and consults.

Fellow 3 - Junior Attending role for Team B
Functioning as the Junior Attending for all Team B patients and responsible for attending all ICU follow up visits and Critical Care Response Team consultations with the nursing staff and respiratory therapists.

Additional fellows to the staff will collaborate with Fellow 3 to ensure appropriate coverage of Team B inpatients and CCRT. This fellow will also be responsible for daily resident teaching over and above that of the teaching schedule. On weeks with low demand they should also anticipate working on a quality improvement project, research or reading.


Mount Sinai Hospital

msh.jpg Mount Sinai Hospital is a busy University Hospital with 460 beds that provides secondary and tertiary care for the Greater Toronto Area. As its name suggests it has strong links with the large Jewish community in the city.

The hospital has world-renowned Obstetric Medicine and High-risk Pregnancy departments and performs more than 1600 high-risk deliveries per year. The Department of Surgery at the University of Toronto has an international reputation for sarcoma surgery, which is performed at this hospital.

Mount Sinai Hospital has a 16 bed Medical-Surgical Intensive Care Unit and three additional high dependency units for medical, surgical, and coronary care patients respectively. Like Toronto General and Toronto Western Hospitals, Mount Sinai has a multidisciplinary team for the provision of critical care outside of the MSICU. Here it is called the ACCESS team – Acute Critical Care Emergency Support Service. It covers not only the Mount Sinai facility but also the adjacent oncology centre, Princess Margaret Hospital.

Two intensivist-led teams provide clinical coverage. One attending intensivist, together with two fellows and all the resident house staff, is responsible for the MSICU patients, and the second intensivist and fellow responsible for the ACCESS team.

 

Sub-specialty fellowship training afforded at Mount Sinai Hospital includes:

  • High Frequency Ventilation (Jet and Oscillation Ventilation)
  • Hematology-Oncology and Bone Marrow Transplantation Critical Care
  • Obstetric Critical Care

 

Fellows’ roles and responsibilities:

There are usually only three fellows scheduled at Mount Sinai Hospital during any one month. Fellows 1 and 2 are assigned to work on the MSICU itself and Fellow 3 to the ACCESS team.

Fellow 1 – Junior Attending role for Team A
Thus is expected to: direct patient care, lead daily rounds, assign patients to residents, manage patient flow and consults. As Fellow 1 you will be honing both your clinical and teaching skills; at the same time as developing your administrative and leadership skills.

Fellow 2 – Resource to the team.
Is available within the ICU during rounds to support Fellow 1, trouble shoot problems, resuscitate new admissions, and coordinate discharges. Fellow 2 provides supervision of residents during procedures, family meetings, and consults. During the weekly teaching timetable Fellow 2 would be expected to provide the formal presentation at Monday lunchtime teaching rounds.

Fellow 3  - ACCESS Team Leader
Functions as the Junior Attending for the ACCESS team. As such is responsible for attending all ICU follow up visits and emergency consultations with the nursing staff and respiratory therapists.

Shared responsibilities that are divided between fellows:

  • Morbidity and mortality rounds
  • Scheduling the provision of backup call for the residents

 

[back to top]

Application

Further Information

More information about Critical Care training in Toronto can be found in the following document (originally prepared for the Intensive Care Society website in the UK).

 

[back to top]


logo Department of Medicine