Anesthesia, Pain Management and Perioperative Medicine

Location:	QEII - Health Sciences Centre 10 West Victoria 1276 South Park Street P.O. Box 15000 Halifax, NS B3H 2Y9
Telephone:	(902) 473-2331

The Department of Anesthesia, Pain Management and Perioperative Medicine is a clinical and academic Department affiliated with Dalhousie University’s Faculty of Medicine and two health authorities: Nova Scotia Health (NSH) and IWK Health in Nova Scotia. The academic mandate supporting education is also offered in conjunction with Horizon Health in New Brunswick.

Our faculty is well equipped to teach all aspects of medicine related to anesthesia and acute care medicine. As a part of our clinical services, our anesthesiologists administer leading-edge programs and services in perioperative medicine, perioperative blood management and chronic and acute pain management. They provide general, neuraxial, regional and monitored anesthesia care to patients undergoing surgery, such as general surgery, obstetrics/gynecology, orthopedics, ophthalmology, oral and maxillofacial, cardiac, vascular, ENT, plastic, neuro, thoracic, transplantation and urology. Our anesthesia staff also manage adult and pediatric trauma cases and administer epidural analgesia to mothers in labour.

 We welcome various types of learners annually who receive on-the-job clinical teaching from our faculty. The department is actively involved in the undergraduate medical education program through the Case Based Learning (CBL) tutorials, electives, lectures, and clerkship. The Department hosts more than 30 postgraduate anesthesia residents (anesthesiologists in training) in the five-year Anesthesia Residency Program; with six new entry spots a year through the Canadian Residency Matching System (CaRMS). We also accommodate eight one-year fellows - anesthesiologists seeking additional sub-specialty training. As well, the Department assists in the education of other health professions such as nurses, paramedics, anesthesia assistants and respiratory therapists, through established agreements. Whether you are a student, resident, or fellow, you can be sure that you will experience the highest quality anesthesia education.

Electives

First and second-year medical students

Students attend one-half day per week during their elective in anesthesia acquiring intravenous and airway management skills.  They learn to assess and optimize patients, an important aspect of perioperative medicine.  During this elective, the students also work on a project of interest.

Third year medical students

Students may choose to complete a combined ICU/Anesthesia selective rotation within the Internal Medicine block. During this four-week rotation, they will complete one week of anesthesia, which will allow them the opportunity to gain some insight into anesthesia.

Fourth year medical students

Students may choose a two-week anesthesia elective to further improve skills associated with airway management.  During this elective apart from intravenous skills, they have more hands-on experience with procedures and practice patient-centered anesthesia care. These rotations can be completed in various areas of general adult anesthesia, Pain Management, or Women’s Anesthesia. Various elective options are available at our teaching sites throughout the Maritimes.

Program Curriculum

This anesthesia residency program is for 5 years.

Program length of training does not exceed the Royal College or College of Family Physicians of Canada standard.

Stages of Training

The Anesthesia Program contains four levels of training: [Note: one block is 4 weeks]

1. Transition to Discipline - 2 blocks of orientation in non-subspecialty anesthesia
2. Foundations - 22 blocks of fundamental anesthesia, medicine, surgery, pediatrics, obstetrics, critical care, pain/regional, and elective or formal enhanced learning plan
3. Core - 28 blocks of subspecialty anesthesia, medicine, critical care, and elective or formal enhanced learning plan
4. Transition to Practice - 13 blocks allocated but may be completed in a minimum of 5 blocks; includes complex anesthesia, obstetric anesthesia, pediatric anesthesia, critical care, teaching, and elective

Transition to Discipline

This 8-week stage emphasizes the orientation and assessment of new trainees arriving from different medical schools and programs. It includes orientation to academic, administrative and clinical components required to succeed early in the Dalhousie Anesthesia Program. New residents are matched with 3 clinical mentors who they will work with over the 8 weeks, one of whom will become the residents’ academic advisor for their residency program. The clinical orientation also includes basic teaching sessions and an intensive simulation curriculum on the management of common intraoperative problems.

Foundations

This 22 block stage covers broad-based competencies that every trainee must acquire before moving on to more advanced, discipline-specific competencies.  The stage is comprised of 9 modules including:  Airway and ENT, Perioperative Medicine, Surgery, Obstetrics, Pediatrics, Cardiovascular, Pain and Regional, Emergency and Critical Care.  Each module helps the resident to focus on basic assessment and knowledge of anatomy, physiology, and pharmacology combined with their application to anesthesia.  For example, the ENT and Airway module includes one block on ENT surgery and one block of Airway anesthesia.  The Obstetrics module includes one block of obstetrics and one block of obstetrical anesthesia.  The rotation designated as "PLB (Personal Learning Block)" can be used for research, elective or a formal enhanced learning plan and allows for flexibility within the Program.

Core

This stage includes all the major subspecialty areas that make up the discipline. Residents rotate though 13 modules over 28 blocks.  Modules include Pediatrics, Neuro, Obstetrics, Cardiovascular, Thoracic, Complex Surgery, Community and Out of OR anesthesia, as well as Perioperative Medicine, Pain and Regional, Emergency and Critical Care Medicine and PLB.

Transition to Practice

This stage of residency is designed to promote independent practice.  Residents will complete a minimum of 5 blocks including Pediatrics, Obstetrics, Complex Surgery, and Community anesthesia as well as Critical Care.  The other 8 blocks can be used for electives or research. 

Research 

There is a formal course on research methodology and critical appraisal. There are active journal and research clubs. Completion of a scholarly project during training is required. Major areas of research activity in the department include pediatric and adult pain, airway management, obstetrics, cardiovascular and ambulatory anesthesia.

Academic Curriculum

Residents are released from clinical duties on Wednesday afternoons to attend the academic program.  The academic curriculum is offered in parallel sessions, and then all the residents come together for weekly resident led case-based discussions. The curriculum was reviewed in the fall of 2020 for content updates and scheduling changes to accommodate the date change for the Royal College examination period.

Junior residents participate in the Foundations Program which concentrates on basic principles of anesthesia including preoperative assessment, pharmacology and physiology, anesthesia equipment and anesthesia practice.  Teaching is mostly case based, simulation, and small group learning.

Senior residents attend the Core Program which runs over 2 years and covers all subspecialties. Again, teaching is mostly case based and simulation.   The Transition to Practice year will concentrate on exam preparation and independent practice.

Residents in 2^nd year and above participate in biannual mock oral examinations for practice and experience. There is a mid-training OSCE to monitor learning in these academic programs. All residents complete the AKT examinations at the specified intervals.

Community 

Community rotation sites throughout the Maritimes are available for rotations, and a minimum of 10% (approximately equal to 6 blocks) of the program will take place in the community.

Continuing Professional Development

The Department of Anesthesia, Pain Management and Perioperative Medicine’s Continuing Professional Development program is designed to provide education opportunities for members of the department, our community partners and the broader anesthesia community. Opportunities provided through the Office of Education are of the highest quality, are timely in their development and are available to all members of the department and its community at large. Regular activities within the department include grand rounds, subspecialty and critical appraisal journal clubs, workshops and seminars. Recent initiatives include Staff Simulation sessions, POCUS training and ACLS recertification. Physicians and allied health professionals from other departments may also partake in many of our continuing professional development activities.

Fellowships

The department offers fellowship programs in many specialized anesthesia areas including pediatric anesthesia, women's and obstetrics anesthesia, airway management, cardiac anesthesia, regional anesthesia and acute pain, and global health. These programs ensure optimal patient care while offering plentiful opportunities for the fellows to develop skills in clinical care and judgment, teaching and research.

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