Critical Care Program

Critical Care Medicine (Adult) Residency Program

Overview

The Critical Care Medicine (Adult) Residency Program at McMaster University is a vibrant, collegial and academic group within the Department of Anesthesia. The CCM Residency Program is an accredited program that strives to create an environment that is conducive for the development of critical care specialists who place an emphasis on patient-centred care, clinical expertise, communication and professionalism. The Program office and teaching facilities are based out of the McMaster Campus of Hamilton Health Sciences (HHS) but all CCM trainees rotate through St. Joseph’s Healthcare as well as the Juravinski and General sites of HHS.

We accept trainees from various base specialties including 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 are eligible to through CaRMS if all requisite rotations are completed. We accept 3-4 CaRMS applicants and approximately 2 international medical graduates per year. Please feel free to contact us regarding Program itself or the application process.

Dr. John Centofanti, MD, MHM, FRCPC

Assistant Professor
Anesthesiology & Critical Care Medicine
Program Director, Critical Care Medicine Residency Program McMaster University
RM. 2V15 c/o Dept. of Anesthesia
1280 Main St. W.
Hamilton, ON L8S 4K1
Tel: 905.521.2100 Ext. 75180
Fax: 905.523.1224
Email: john.centofanti@medportal.ca

Mrs. Sarah Richardson, BA

Program Assistant

Critical Care Medicine Residency Program McMaster University

RM. 2V15 c/o Dept. of Anesthesia

1280 Main St. W.

Hamilton, ON L8S 4K1

Tel: 905.521.2100 Ext. 75180

Fax: 905.523.1224

Email: srichar@mcmaster.ca

Residency Program

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.

The Program is administered by the Residency Program Committee (RPC), headed by the Program Director, within the Department of Anesthesia at McMaster University. This committee is composed of faculty representatives from each participating institution as well as elected and appointed resident representatives. The RPC meets at least 4 times per year to discuss and review issues that may impact residency training and education. Consequently, our program has been successful in working with our community partners in order to better provide trainees with a community experience. Dr. Sameer Shaikh, from Joseph Brant Hospital in Burlington, is currently the community representative helping to achieve this goal.

RPC Membership 2020/2021

Chair – Dr. John Centofanti, Program Director
Program Administrator – Mrs. Sarah Richardson (ex officio) Postgraduate Dean – Dr. Parveen Wasi (ex officio)
Academic Department Chair – Dr. James Paul (ex officio)

Site Educational Coordinator (HGH West) – Dr. Julian Owen
Site Educational Coordinator (HGH East/South) – Dr. Sunjay Sharma Site Educational Coordinator (JHCC) – Dr. Timothy Karachi
Community ICU Representative – Dr. Sameer Shaikh (ex officio)

Competence Committee Chair – Dr. Jill Rudkowski
Academic Curriculum Lead – Dr. Heather Whittingham
Research Lead – Dr. Bram Rochwerg
Member at Large (HHS) – Dr. Paul Engels
Member at Large (SJH) – Dr. Waleed Alhazzani

Appointed Resident Representative – Chief Resident – Dr. Michael Mikhaeil
Elected Resident Representatives –
- Year 1 – Dr. Natasha Ovtcharenko
- IMG – Dr. Mohammed Alfawaz

Ombudsperson – Dr. Craig Ainsworth (ex officio)

Education Program

The Critical Care Medicine Residency Program has a very diverse educational curriculum with training being delivered in several different formats. Each aspect is intended to complement the others and fulfill the Objectives of Training in Adult Critical Care Medicine as set by the RCPSC.

Academic Half-Day Curriculum - This weekly teaching session occurs each Tuesday afternoon from 1:00 pm until 4:00 pm in Room 2V3 (Department Resident Room) at the McMaster Campus, or currently, via Zoom. The topics and the expert lecturers are organized by the Program Director as well as the CCM residents. Also included in this series is a knowledge review session that is resident-driven. This component is also specifically intended to better prepare the residents for the critical care certification examination.

ACES Course -

Bedside Teaching Experience - Each resident spends a minimum of 15 months in the McMaster teaching hospitals. CCM residents are expected to function in the capacity of both learner and educator simultaneously. This provides the opportunity to develop, expand and solidify your skills in patient management, supervision of housestaff & on-site physicians, administration of a multidisciplinary ICU and to interact with the many health care professionals essential to the functioning of such an ICU.

We continue to provide a robust academic curriculum to our trainees. 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).

Conferences - Each resident is expected to attend the Canada Critical Care Forum each year in Toronto (registration is paid for by the Program). As well, each resident is encouraged and provided with limited funding to attend another major critical care conference. Additional funding is provided if a resident is presenting original research at a conference.

Formal Junior Resident Education - CCM residents are expected to take part in the formal education of the junior residents rotating in the ICU. A weekly rotating resident round occurs each Tuesday following the academic half-day. It is teleconferenced to the rotating residents at each site. These rounds are attended and evaluated by faculty.

Journal Club - This event is held approximately every second month at a hospital site. These sessions provide an opportunity to discuss important literature and to practice methods of critical appraisal with the participation of all CCM residents as well as faculty. Guest experts are invited to provide editorial on the discussed topics.

Regional Rounds

This event is also held approximately every second month. The format varies between topic- oriented presentations, patient management problems, and research topics relevant to critical care. Guest speakers are often invited to present topics of interest for these rounds.

Simulation Program -

Simulation training has become an integral part training in critical care. Several CCM faculty are trained simulation instructors. The Clinical Learning Centre at the McMaster Campus enables simulation training with various activities: course in Acute Critical Events Simulation (ACES), Crisis Resource Management, advance airway skills, as well as other sessions that strengthen leadership and communication skills.

Workshop Series (new)
These series of sessions provides residents with more “hands-on” learning in the technical skills that have become the cornerstone of critical care. Topics to be scheduled are:

i) Ultrasonography in the ICU
ii) CRRT management & operation
iii) Mechanical ventilation

Throughout each academic year, the program provides the trainees with

high-fidelity simulation sessions to enhance and assess their skill set.

Competency Based Medical Education – CBME is a framework of education which focuses on both the process & outcomes of training.

An outcomes-based approach to the design, implementation, assessment, and evaluation of a

medical education program using an organizing framework of competencies. Competency by

Design (CBD) is the Royal College’s version of CBME.

Stages of CBD

Stage 1: Transition to Discipline (TTD): emphasizes orientation and assessment of new trainees

arriving from various schools and programs.

Stage 2: Foundations of Discipline (FOD): broad-based competencies that every trainee must acquire before moving on to advanced, discipline-specific competencies. This stage covers essential competencies that make up the majority of a discipline.

Stage 3: Core of Discipline (COD): covers the core competencies that majority of a discipline

Stage 4: Transition to Practice (TTP): senior trainee demonstrates readiness for autonomous practice.

Clinical Rotations

Our Program at McMaster University provides its clinical experience at the teaching hospitals in the city of Hamilton, Ontario. Hamilton Health Sciences (HHS) and St. Joseph’s Healthcare represent the affiliated teaching hospitals. HHS has 3 acute care institutions: General Campus, Juravinski Campus, and McMaster Campus.

HHS – General Campus

The General Site was founded in 1848 as the first hospital in Hamilton as the Hamilton General Hospital. It is a regional centre of excellence in cardiovascular care, neurosciences, trauma and burn treatment. It is also a research centre, home to the Population Health Research Institute and the development of the future David Braley Cardiac, Vascular and Stroke Research Institute.

The General Site is a regional centre of excellence for several clinical services including the following types of care:

General medical care
General surgical care
Trauma
Neurosciences (Neurology/Stroke Unit, Spine Surgery and Neurosurgery) Cardiovascular medicine (Heart Investigation Unit)

Cardiovascular surgery Vascular surgery
Burn unit

This site has more than 300 acute care beds. There is a 16-bed ICU (ICU East) and a 10-bed ICU (ICU South) which accommodate the care of most critically ill patients at this site. These two units have expertise in the care of neurosurgical, vascular and trauma patients as well as general medical-surgical experience. The Regional Burn Unit is associated with ICU South. This

site is also the regional referral centre for cardiovascular medicine and surgical care. The Heart Investigation Unit consists of 4 catheterization laboratories and a 32-bed recovery unit. There are 9 interventional cardiologists and 6 cardiac surgeons. The cardiovascular ICU (ICU West) is an 18-bed unit caring for such patients.

The attending ICU staff include faculty from Anesthesia, Medicine and Surgery. The intensivists rotate on a weekly basis, from Thursday to Thursday. The Site Director of ICU East and ICU South is Dr. Sunjay Sharma and the Site Director of ICU West is Dr. Julian Owen.

HHS – Juravinski Campus

The Henderson Site began as the Mount Hamilton Hospital in 1911 and served the veterans of the first war. In 1954, the Henderson General Hospital opened as a 322-bed hospital. Through the years the Henderson has become an integral part of the mountain community and supports the Juravinski Cancer Centre. As of 2011, the newly constructed Juravinski Hospital with a state-of-the-art ICU has been fully functional.

The Juravinski Site has more than 300 beds and a 19-bed ICU. This site provides acute inpatient and palliative care, diagnostic services and an educational environment to support the needs of patients requiring the following types of care:

General medical care
General surgical care
Advanced digestive diseases care (including regional gastroenterology program) Hepatobiliary surgery
Colorectal surgery
Hematology and hematologic oncology (including BMT program)
Regional plasmapheresis program
Medical oncology
Radiation oncology
Major gynecologic surgery
Orthopedic surgery

The attending ICU staff include faculty from Respiratory Medicine, Anesthesiology, Gastroenterology, and General Medicine. The intensivists rotate on a weekly basis, from Friday to Friday. The Site Director is Dr. Tim Karachi.

HHS - McMaster Campus

Located next to McMaster University in west Hamilton, McMaster University Medical Centre (MUMC) opened in 1972. This site is home to Women’s Health services including high-risk obstetrics and gynecology. This site also houses the McMaster Children’s Hospital.

Despite limited adult services, this site continues to maintain a 3-bed ICU/Stepdown unit. The attending ICU staff include faculty from Respiratory Medicine and Internal Medicine. The intensivists rotate on a weekly basis, from Friday to Friday. The Site Director is Dr. Simon Oczkowski.

Mandatory Content of Training (16 Blocks of ICU rotations)

Rotation Description	Duration	Sites in which this training may be taken
Neuro/Trauma/Vasc ICU	4 Blocks	ICU East – General Campus, HHS
Cardiovascular ICU	2 Blocks	ICU West – General Campus, HHS
Regional Burn Unit	2 Blocks	ICU South – General Campus, HHS
Medical/Surgical ICU	5 Blocks	St. Joseph’s Healthcare (SJH)
Medical/Surgical ICU	4 Blocks	Juravinski Campus, HHS
ICU Electives	10 Blocks	- Any ICU within Hamilton - Approved Community ICU Sites
Critical Care Transport Unit (CCTU)	During ICU on-call weeks

Elective Content of Training (10 Blocks of rotations)
Electives are an essential component of the Program with great flexibility to accommodate the individual needs of each resident. Depending on one’s background and base specialty, electives enable each trainee to round out and/or build on their skill set. Electives both in and outside of Hamilton are possible depending on one’s learning needs and career goals. Electives include:

Anesthesia	Palliative Care
ECHO	Radiology
ECMO/MSICU	Research
Ethics/End of Life	Respirology
Infectious Disease	Thoracic Surgery
Nephrology	Toxicology
Neuro Critical Care	Trauma
Trillium Gift of Life	Ultrasound

Community ICU electives are encouraged for those residents planning for such a career. Many options are available in nearby cities or with alumni from our Program. Examples of such locations are:

Brantford General Hospital (Brantford, Ontario)
Credit Valley Hospital (Mississauga, Ontario)
Grand River Hospital (Kitchener, Ontario)
Joseph Brant Memorial Hospital (Burlington, Ontario)
Oakville-Trafalgar Memorial Hospital (Oakville, Ontario)
Peterborough Regional Health Centre (Peterborough, Ontario)
Royal Victoria Hospital (Barrie, Ontario)
St. Catharines General Hospital (St. Catharines, Ontario)
St. Mike’s Hospital (Toronto, Ontario)
Toronto General Hospital (Toronto, Ontario)
Trillium Health Centre (Mississauga, Ontario)

Program Structure

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.

CCM Research

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 Alhazzani 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. This friendly competition began over 25 years ago and is an event the trainees look forward to yearly.

CCM Exchange Day Results

Proton Pump Inhibitor vs. Histamine 2 Receptor Antagonist for Stress Ulcer Prophylaxis: a meta-analysis

CCM Trainee Research

CCM_Trainee_Research_Application_Upated_Sept._10_2020 (pdf)

703 KB

CCM Resident/Fellow Research Grant Application

Applications are due to Sarah Richardson by October 15th, 2021. As the RPC's Research Lead, the application and selection process will be led by Dr. Bram Rochwerg. The maximum you can receive an award is for 2 years, with a maximum of $5000 annually. Funding allocation and selection will be determined by a selection committee. Please forward any questions to Dr. John Centofanti and Dr. Bram Rochwerg.

McMaster Fundamentals of Health Research Methodology Course

This is an optional online course I would like to offer all of our trainees if they are interested; prepared from McMaster University and Department of Anesthesia. This course is an online 10-week certification course. It is certainly not as detailed as an HRM Masters, but does provide an introductory approach to Research principles, applicable to all healthcare professionals. It will cover topics including research methodology, outcome measures, statistics, appraisal, KT, and proposal/manuscript development.

Faculty

Our faculty include many national and international leaders in critical care. Faculty are dedicated to world class research, education, and continuous quality improvement. We have an active research program that supports both basic science and clinical trials research. Many of us are actively involved in the Canadian Critical Care Trials Group, Canadian Intensive Care Foundation and the Critical Care Canada Forum. Consequently, several of our residents (past & present) have also become active in the CCCTG.

Clinically, we have a very diverse faculty with backgrounds in medicine, surgery, anaesthesia, cardiac surgery, neurosurgery and pediatrics.

Local Faculty by Site

ICU East/South	ICU West	ICU Juravinski	ICU St. Joseph's
Dr. Paul Engels	Dr. Craig Ainsworth+	Dr. John Centofanti*	Dr. Waleed Alhazzani*+
Dr. Andy Freitag*+	Dr. Faizan Amin (CS)+	Dr. Joanna Dionne (CS)	Dr. Deborah Cook*+
Dr. Cindy Hamielec+	Dr. Emile Belley-Côté (CS)+	Dr. Graham Jones*+	Dr. Erick Duan*+
Dr. Draga Jichici+	Dr. Alison Fox- Robichaud*+	Dr. Tim Karachi*	Dr. Roman Jaeschke+
Dr. Maureen Meade*	Dr. Kam Kahnamoui*+	Dr. Simon Oczkowski*+	Dr. Kim Lewis (CS)
Dr. Sunjay Sharma*	Dr. Peter Kraus	Dr. Bram Rochwerg*+	Dr. Tania Ligori
Dr. Heather Whittingham*+	Dr. Julian Owen	Dr. Farzin Visram+	Dr. Dan Perri*
	Dr. Corey Sawchuk		Dr. Jill Rudkowski*
			Dr. Mark Soth *+

Legend:

* Denotes GFT (geographic full-time)

+ Denotes Division of Critical Care (with DOM)

CS Denotes Clinical Scholar

Regional Faculty by Site

St. Catharines/ Niagara	Grand River Hospital, Kitchener	Joseph Brant Hospital, Burlington
Dr. Han-Oh Chung*+	Dr. Paul Hosek	Dr. Joseph Berlingieri
Dr. Erick Duan*+	Dr. Rebeccca Kruisselbrink	Dr. Paul Lysecki
Dr. Ryan D’Sa	Dr. Christine Nethercott	Dr. Derek Prodger
Dr. Melanie Hollidge	Dr. Bill Plaxton	Dr. Jim Rogers
Dr. Jennifer Tsang*+		Dr. Sameer Shaikh*
		Dr. Steven Skitch

Legend:

* Denotes GFT (geographic full-time)

+ Denotes Division of Critical Care (with DOM)

CS Denotes Clinical Scholar

Critical Care Medicine (Adult) Residency Program

Overview

Residency Program

RPC Membership 2020/2021

Education Program

Clinical Rotations

Program Structure

CCM Research

CCM Exchange Day Results

2020 Results

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2019 Results

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2018 Results

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2017 Results

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2016 Results

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2015 Results

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2014 Results

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2013 Results

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2012 Results

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2011 Results

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CCM Trainee Research

CCM Resident/Fellow Research Grant Application

McMaster Fundamentals of Health Research Methodology Course

Faculty

Local Faculty by Site

Regional Faculty by Site

Health Sciences

Department of Anesthesia

Location

Office Hours

Contact Information