The Critical Care Medicine (Adult) Residency Program at McMaster University is a fully-accredited program accepting trainees from various base specialties: Internal Medicine, General Surgery, Anesthesia, Emergency Medicine, and Cardiac Surgery. Trainees from other specialties are also eligible to apply if all requisite rotations are completed. Canadian medical graduates apply if all requisite rotations are completed. Canadian medical graduates apply through CaRMS with 3 to 4 applicants accepted per year. The program also accepts approximately 2 international medical graduates per year. These individuals that seek additional training in specific areas of expertise in critical care, such as neurocritical care, cardiovascular critical care, or clinical research in critical care. Currently, we are able to accept 1 to 2 individuals per year in each of these areas of sub-specialization.
Oversight of the program is provided by the Residency Program Committee (RPC). This committee meets at least 4 times per year to discuss and review all issues that may impact residency training and education. This committee is comprised of several faculty members that represent each of the roles within the program. Resident representation is provided by the Chief Resident (appointed position) and the elected representatives from each year of training, as well as from the IMG member of the RPC. Consequently, our program has been successful in working with our community partners in order to better provide trainees with a community experience. Dr. Paul Hosek, from Grand River Hospital, is currently the community representative helping to achieve this goal.
We continue to provide a robust academic curriculum to our trainees. Each Tuesday afternoon is a dedicated academic half-day provided by both our faculty as well as lecturers from all departments about divisions of the Faculty of Health Sciences. This educational series serves to cover most topics included in the RCPSC Objectives of Training in the Subspecialty of Adult Critical Care Medicine. In addition, all trainees enrolled in the program must complete the Acute Critical Events Simulation (ACES) course, as well as attend the national conference (CCCF) and Canadian Critical Care Review (CCCR). Throughout each academic year, the program provides the trainees with high-fidelity simulation sessions to enhance and assess their skill set. The program has enjoyed great success with invited speakers providing Regional Critical Care Rounds and Journal Club on a monthly basis. These events have excellent attendance with lively debates.
All trainees complete their clinical rotations in the ICU at the teaching hospitals at McMaster University Medical Centre (MUMC), Hamilton General Hospital (HGH), Juravinski Hospital (JH), and St. Joseph's Healthcare (SJH). The Hamilton General Hospital site has three intensive care units and 45 level 3 critical care beds, providing service for cardiovascular care, neurosurgical and trauma care, and burn management. The Juravinski Hospital site has one intensive care unit with 19 level 3 critical care beds, providing service for surgical, medical, and radiation oncology, regional orthopedic surgery, and the regional GI program. The St. Joseph's Healthcare site has 1 intensive care unit with 24 level 3 beds. This site is the location of regional dialysis and renal transplant programs, thoracic surgery, and respiratory medicine. All sites also have rapid response teams as well as busy acute care surgery and respiratory medicine. All sites have rapid response teams as well as busy acute care surgery and medicine services. CCM trainees rotate through each site as well as various other elective rotations within these hospitals as well as with our community partners.
Our program is uniquely structured to achieve all the requirements of training. During ICU rotations, the trainees follow a 3-week cycle. This cycle includes one week of clinical duty in critical care followed by a week of on-call responsibility. This week has been structured to mimic the typical work week of intensivists in practice throughout much of Canada. Upon completion of this call week, the trainees complete a week of non-clinical duties whereby most trainees accomplish their studying, teaching of other individuals, as well as maintaining their competency in their base specialty. Trainees have applauded this structure as a major strength of our program since it prepares individuals very well for entrance into independent practice in the specialty.
The Critical Care Medicine (Adult) Residency Program at McMaster University is a two-year program. Applicants must have base specialty training from Internal Medicine, General Surgery, Emergency Medicine, Anesthesia, or Cardiac Surgery. Applications will be considered if the candidate is already certified in one of these specialty programs or will be eligible for certification prior to the end of the two-year program. The number of residents accepted to the program varies each year.
The program, while utilizing the regional resources of both McMaster University and its affiliated teaching hospitals, is centrally coordinated in a multidisciplinary fashion, thus reflecting the cross-specialty horizontal nature of Critical Care Medicine in Canada. Recognizing the varied backgrounds of the Critical Care trainees, the program is set up to enable a great deal of flexibility with regards to the details of training. This will ensure that - regardless of background - each individual, whether emanating from Medicine, Surgery, or Anesthesia, will be able to function as an ICU consultant on any type of patient. As a result, rotations will vary according to an assessment of the individual's strengths and weaknesses.
The trainee functions at a progressive level of responsibility, assuming the role of ICU coordinator as soon as it is appropriate to do so, although always with direct faculty support. On-call for the ICU coordinator is typically out of hospital as support to the in-house physicians. The ICUs are staffed by residents from medicine, surgery, anesthesia, and emergency medicine, as well as by independently-licensed physicians. Therefore, our trainees function in a role that oversees, acting as a supervisor and teacher for junior residents.
During the two-year program, our trainees are required to complete 16 block rotations in the ICU at Hamilton Health Sciences and St. Joseph's Healthcare Hamilton. These rotations are designed to provide a broad clinical experience in several busy, multidisciplinary intensive care units. These core rotations are distributed throughout the program and ensure that the trainee is exposed to a large variety of medical and surgical patients. Given the vast referral population, trainees will have a great opportunity to care for patients of specialty care programs, such as Trauma, Burns, Oncology, and all surgical subspecialties, including Neurosurgery and Cardiovascular Surgery.
The remaining 10 blocks are available for elective rotations. These rotations are provided to strengthen and diversify one's skills and abilities. Electives are available in virtually every discipline. They must have clearly-described learning objectives for critical care. The educational curriculum includes academic half-day seminars, journal clubs, regional rounds, as well as other sessions which all round out a full academic experience.
The Critical Care Medicine (Adult) Residency Program at McMaster University offers a wide-ranging and full clinical experience complemented by an enthusiastic faculty that support the academic objectives of adult learners dedicated toward a fulfilling career in critical care medicine.
The program structure is well-suited for trainees that are self-directed in their learning as well as those that are motivated to complete scholarly projects during the course of their training. This may be original research or a quality assurance project. Research mentors, Dr. Waleed Al-Hazzani and Dr. Bram Rochwerg, currently oversee the Research-in-Progress meetings on a quarterly basis to monitor their progress and provide guidance on their research process. Our trainees present their projects at a joint McMaster-Western Research Exchange Day held each spring.
Sameer Shariff, McMaster University
Neuromuscular blocking agents in acute respiratory distress syndrome: updated systematic review and meta-analysis of randomized trials
John Landau, Western University
The AORTUS trial: Ultrasound guided resuscitation after open abdominal aortic surgery
Wadiah Alfilfil & Reham AlHarbi, McMaster University
The proportion & characteristics of positive & negative trials in adult critical care from 2013-2019, a systematic review/meta epidemiological study.
Kimberley Lewis, McMaster University
Cuff Leak Test and Airway Obstruction in Mechanically Ventilated ICU Patients (COMIC): A Pilot Randomized Controlled Trial Interim Analysis
Jessica Spence, McMaster University
Benzodiazepine-free Cardiac Anesthesia for Reduction of Delirium (B-Free): A Pilot Study to Determine the Feasibility of a Multi-Centre, Randomized Cluster Crossover Trial
Zainab Al Duhailib, Western University
The Use of Central Venous to Arterial Carbon Dioxide Tension Gap for Outcome Prediction in Critically Ill Patients. A Systematic Review and Meta-Analaysis
John Basmaji, University of Western Ontario
Randomized point of care ultrasound guided resuscitation and usual care comparison in the management of undifferentiated shock: The CRiXUS study
Joanna Dionne, McMaster University
Diarrhea: Interventions, Consequences and Epidemiology in the Intensive Care Unit (ICE-ICU Study): A Prospective Multicenter Cohort Study
Faizan Amin, McMaster University
Predicting survival after VA-ECMO for refractory cardiogenic shock: validating the SAVE-score
Greigh McCreery, University of Western Ontario
Early Rescue from Severe Clostridium difficile Colitis: A Pilot RCT of Intestinal Lavage for the Treatment of Severe-Complicated CDI
Yousef AlMubarak, McMaster University
MetaClinician - Clinical Practice: Its Variability and Consistency with SSC Guidelines
Faizan Amin and Ayed Asiri, McMaster University
Dexemedetomindine vs. Propofol for Sedation in Patients after Cardiac Surgery: Systematic Review and Meta Analysis
Vincent Lau, University of Western Ontario
Directly from ICU Sent to Home: Factors Associations with Increasing Rates of Discharges Directly Home from ICU (DISH Study)
Brian Buchanon, McMaster University
Comprehensive Ultrasound Evaluation of the Failure-to-Wean Patient: a Pilot Study
John Centofanti, McMaster University
Resident Reflections on End-of-Life Education: a Mixed-Methods Study of the 3 Wishes Project
Erick Duan, McMaster University
OSCILLATE Knowledge Translation - An Audit of ARDS Management
Asher Meldelson, University of Western Ontario
Design of Headrest for Patients Undergoing Prone Ventilation in the ICU
Andrew Gibson and Rohin Malhotra, McMaster University
The Development of a Critical Care Ultrasound Curriculum for Faculty and Fellows
Erick Duan, McMaster University
Use of a Daily Goals Checklist on Morning Rounds: A Mixed Methods Study
Bram Rochwerg, McMaster University
Fluid Resuscitation in Sepsis: A Network Meta-Analysis
Phil Andros, University of Western Ontario
The Physical Exam in Critical Illness
Rebecca Kruisselbrink, McMaster University
Monitoring of Medical and Surgical Patients in Mulago Hospital, Uganda: A Pilot Observational Study Using the Modified Early Warning Score
Robert Lepeer, University of Western Ontario
A 12 Year Review of the Beneficial Effects of a Non-Operative Management Algorithm for Splenic Trauma
Ian Mazetti and Simon Oczkowski, McMaster University
Han-Oh Chung and Damien Medina, McMaster University
Sepsis Module - An Educational Tool for the Management of Sepsis
Waleed Al-Hazzani, McMaster University
Neuromuscular Blocking Agents in Acute Respiratory Distress Syndrome: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Craig Ainsworth, McMaster University
Dave Nagpal, University of Western Ontario
Starch or Saline after Cardiac Surgery: Results of a Pilot Randomized Controlled Trial
Robert Lepeer, University of Western Ontario
Resuscitative Outcomes for Surgeon vs. Non-Surgeon Trauma Team Leaders - 10 Year Experience at a Canadian Trauma Centre
Waleed Al-Hazzani, McMaster University
Proton Pump Inhibitor vs. Histamine 2 Receptor Antagonist for Stress Ulcer Prophylaxis: a meta-analysis