We provide advanced training for family physicians, either immediately following the first two years of family medicine residency or to physicians who are already in practice. Our program is accredited by the College of Family Physicians of Canada (CFPC). Once successfully completed, residents will be eligible to receive a Certificate of Added Competence (CAC) in Family Practice Anesthesia from the CFPC.

We enjoy close ties with our colleagues in Anesthesiology as well as with many community-based family physicians with focused practices in anesthesia in the communities around Ottawa. This balance of tertiary and community settings is something we are proud to offer and we believe this will contribute to your understanding of what it truly means to be a Family Practice Anesthetist.

The FPA program aims to develop core competencies in the following areas:

• Pre-anesthetic assessment;
• Anesthetic equipment;
• Vascular access;
• Airway management;
• Pharmacology of drugs used in anesthesia;
• Procedural sedation;
• General Anesthesia;
• Spinal and Epidural anesthesia;
• Regional anesthesia;
• Obstetrical anesthesia;
• Pediatric anesthesia;
• Postoperative care;
• Acutely ill and injured patients;
• OR emergencies and complications;
• Acute and Chronic pain; and,
• Crisis Resource Management (CRM).

Self-directed learning is the cornerstone of our program and continues to be critical in independent practice. In order to enhance your daily learning experience, we expect you to come prepared each day with a list of 3 separate learning objectives for the day. Your goal will be to discuss these objectives with your staff and to seek out experiences that reflect your objectives.

The year is divided into 13 blocks, each of which is 4 weeks in length:

Community Anesthesia (3 blocks):

Location(s):

Communities in the Ottawa area including Perth, Smiths Falls, Winchester and Almonte.

Purpose:

• Introduce the FPA resident to the practice and FP-anesthesia;
• Develop mentorship from local FPAs, maintain a connection to family practice;
• Learn the foundational aspects of FPA practice (e.g. perioperative assessment, perioperative management, procedural skills, etc);
• Develop a sense of limits to the complexity of cases that can be done depending on the resources within a community setting;
• Later community rotations in community anesthesia will assist the FPA resident in transition to independent practice.

Clinical Environment:

• One-on-one with attending FPAs throughout these rotations. Examples of ORs you will be placed in include: General surgery, Orthopedics, OBGYN, Urology, ENT, Plastics, Endoscopy, Ophthalmology;

• Opportunities to work in various other settings including family practice offices, pain clinics, pre-operative clinics as well as the Emergency Room;

• 1:3 home-call where you will shadow your attending FPA who will provide you with graduated responsibilities that are safe for patients and reflect your level of training. Examples of on-call experiences in the community include trauma, ICU crises management, ER crises management, OB epidurals, and various emergency surgeries.

Adult Anesthesia (7 blocks):

Location:

The Ottawa Hospital

Purpose:

• One-on-one training with FRCPC anesthesiologists who are both expert clinicians and educators, experience more complex elective and emergency cases and experience a large volume of cases (e.g. epidurals);

• Variety of rich experiences to develop your skills. Examples include managing patients in the PACU, providing anesthetics for emergency operations, performing labour epidurals, completing consults on the ward, responding to code blues and trauma codes, etc.

Clinical Environment:

• The FPA residents are typically assigned a “home” campus at either the General campus or the Civic Campus for all of their adult anesthesia rotations. However, there may be opportunities to work at the other campus;

• Assigned to ORs that an FPA would be exposed to in the community setting. Examples of these include: Obstetrics, Urology, Gynecology, General Surgery, ENT, Orthopedics, Ophthalmology, Endoscopy, Dental and Plastic surgery. One of your adult anesthesia rotations will be dedicated to OB anesthesia. In addition, you will be exposed to difficult airway cases and regional anesthesia;

• In addition to working in the operating room, you will have opportunities to work in various other settings including pain clinics, pre-operative clinics and acute pain rounds on the wards;

• 1:4 in-house call during their adult anesthesia rotations. During your first exposure to anesthesia call at TOH, you will shadow a more senior anesthesia resident for 1-2 blocks prior to transitioning to solo call responsibilities.

Pediatric Anesthesia (2 blocks):

Location:

The Children’s Hospital of Eastern Ontario (CHEO).

Purpose:

• Gain confidence and competence in managing healthy children for scheduled minor surgeries;

• Become familiar with the differences in anatomy and physiology in children compared to adults with regards to anesthesia;

• Become familiar with anesthesia management of pediatric emergencies in the community setting (e.g. epiglottitis, status asthmaticus, foreign body in airway, etc).

Clinical Environment:

• One-on-one with FRCPC pediatric anesthesiologists who are both expert clinicians and educators in pediatric anesthesia;

• You will typically be assigned to ORs that a practicing FPA would commonly encounter. Examples of these include electives lists from the following surgical specialties: ENT, General Surgery, Orthopedics, Dentistry and Urology. In addition, the FPA resident will be exposed to a variety of emergency cases while on-call.

• 1:4 in-house call during the pediatric anesthesia rotations

Adult ICU (1 block):

Location:

The Ottawa Hospital.

Purpose:

• Exposure to a variety of critically ill patients, with each patient often having multi-organ system dysfunction.

Clinical Environment:

• Work with in a team that is composed of many people including a staff intensivist, an ICU fellow, multiple residents from various specialties, as well as medical students, pharmacists, dieticians and nurses;

• The team typically rounds on 16 or more patients per day, with 4-6 patients typically being assigned to the FPA resident;

• 1:4 in-house call during their adult ICU rotation where you will function as the senior resident and will be responsible for managing patients in the ICU, assisting the junior resident with RACE calls, performing and supervising procedures (e.g. arterial lines, central lines, intubations) as well as accepting and working up new admissions.

The academic curriculum includes learning opportunities from multiple sources:

NOSM FPA Summer Lecture series:

From July to September, you will participate, through videoconferencing, in the NOSM FPA summer lecture series. These lectures are given by a variety of anesthesiologists and FPAs from around the province. The lectures topics are specifically designed for FPAs and cover a wide variety of areas (e.g. pre-operative assessment, pharmacology, monitoring, physiology, trauma, etc). There are typically 2-3 lectures per week that take place from 4-6PM. You will have protected academic time to attend these lectures

NOSM FPA Boot Camp:

Designed specifically for FPA residents, you will have the opportunity to attend the NOSM FPA Boot Camp at the end of Block 1 and are strongly encouraged to attend. The boot camp takes place in Sudbury, Ontario and is 5 days in duration. FPA residents from around the country attend this course, which is taught by a dedicated team of FRCPC anesthesiologists, FPAs, RTs, RNs and residents who all recognize the need to properly train FPAs for critical events. The course is divided into simulation, workshops, and lectures:

• 18 unique simulation mega code cases, each with a 45 minute structured debrief;
• Workshops on central lines, arterial lines, ventilator modes, airway devices, etc; and,
• CRM principle based lectures throughout the week.

Lecture Bank:

There is a bank of lectures that reflect the goals and objectives of this program. Residents are expected to access to these lectures that you are expected to read on your own time. Your staff will also have access to your list of lectures and may discuss aspects of these topics with you while you are working together.

FRCPC CBD Cases:

There may be opportunities to participate with the Royal College residents on lecture topics that are relevant to the FPA.

Rounds:

Once per week during the adult anesthesia rotations, you will attend and participate in resident rounds, called morning report. Morning report consists of a case discussion, led by an attending anesthesiologist, whereby the residents work through a case in an oral examination format and must determine the anesthetic considerations and appropriate plan for the particular case.

You will also attend Anesthesia Grand Rounds through the Department of Anesthesiology. The Grand Rounds lectures typically occur on a monthly basis from September to June each year. Grand Rounds will also be made available through live webcasting when the FPA resident is on a community rotation. You are expected to present a topic at one of the Anesthesia Grand Rounds.

Simulation:

At least twice throughout the year, you will have hands-on sessions in the simulation centre with the anesthesiology residents in addition to the NOSM FPA Boot Camp. During these sessions, you will receive direct observation and feedback from attending anesthesiologists on your leadership and code running skills.

Research Activities:

The Department of Anesthesiology holds its Journal Club approximately once per month. You are expected to present a brief summary and critical appraisal of a previously circulated article at one of the Journal Club Rounds.

You are also required to participate in a small scholarly project (academic, research, chart audit), which you will present at the Department of Family Medicine Research Inquiry and Opinion (RIO) Day in June.

Interested candidates are strongly encouraged to complete an adult ICU rotation prior to starting the FPA program, and to have up to date Advanced Cardiovascular Life Support (ACLS) certification prior to starting the program. As well, we highly recommend completing the following resuscitation courses (either before or during your FPA training year):

• Acute Critical Events Simulation (ACES);
• Acute Trauma Life Support (ATLS);
• Neonatal Resuscitation Program (NRP); and,
• Pediatric Acute Life Support (PALS).