Thrombosis AFC

Fellowship Program at McMaster

Welcome to the Adult Thrombosis Medicine Area of Focused Competence Training Program at McMaster University. McMaster is a leader in the field of thrombosis, with internationally renowned clinicians and researchers among our faculty. The goal of our training program is to develop the next generation of Thrombosis experts, who will be leaders in clinical service, research, and policy.

Dr. Vinai Bhagirath, Program Director
Dr. Vinai Bhagirath, Program Director


There are 6 Core Clinical Rotations in McMaster’s Thrombosis AFC training program – a Part I and Part II at each of 3 clinical sites (St. Joseph’s Healthcare Hamilton, Hamilton General Hospital, and the Juravinski Hospital). The Part I rotations are meant to establish fundamental competencies, while Part II rotations allow consolidation of the competencies acquired in Part I. There is a gradation of responsibility and independence, with development of more advanced competencies in Part II rotations.

Each Core Clinical Rotation involves both inpatient and outpatient clinical activities, in addition to teaching responsibilities, seminars, and protected academic time. Each site has a somewhat different clinical focus - renal, rheumatological, and obstetrical patients are more common at St. Joseph’s; cancer-associated thrombosis is more common at the Juravinski; and trauma and arterial thrombosis most common at the Hamilton General - but core thrombosis issues are encountered at all sites.

In addition, there are biweekly longitudinal clinics which allow trainees to follow-up patients and develop consultant-level skills in clinic management, including a mandatory 6-month longitudinal clinic experience focusing on women’s thrombosis issues. An ambulatory block and a scholarly block complete the mandatory experiences. Two flexible elective blocks allow trainees to explore experiences to best prepare them for their future career.

Outside of clinical work, a robust and protected academic half-day schedule allows the trainees to interact with world experts among our faculty. In addition, several national academic half-days allow interaction with experts from other Canadian institutions. A scholarly project is mandated in the curriculum, facilitated by protected time and access to mentors and resources, and may include research or quality improvement activities.

Certification Outcome

Upon successful completion of training, the trainee will be granted a Fellowship Certification from McMaster University and a Diploma in the Adult Thrombosis Area of Focused Competence from the Royal College of Physicians and Surgeons of Canada.

Entry Requirements

Trainees must be certified in Internal Medicine or Emergency Medicine, or be eligible to receive such certification during the course of AFC training, in order to be accepted into the program.

Recent graduates are required to submit an application form and comply with McMaster University Postgraduate Medical Education requirements for residents and fellows.

Application Deadline

Applications are due October 1st for the training period beginning July 1st of the subsequent year.

Call for Applications

Please see the Call for applications 2022 for all the details.

Goals of Training

After completion of training, the trainee is expected to be ready for independent practice as a Thrombosis physician. They will be able to diagnose, prevent, and treat venous thromboembolism or complications of antithrombotic therapy in complex patients in the in- and out-patient settings. They will provide excellent communication and education to patients and colleagues. They will be familiar with laboratory testing pertinent to thrombophilia and coagulation. The trainee will demonstrate readiness to lead a clinical Thrombosis service. They will contribute to Thrombosis' scholarly activity. Finally, they will show a commitment to life-long learning in this field. 

The competencies, spanning the CanMEDS roles, that define a diplomate in Adult Thrombosis Medicine are summarized by the Royal College in the Adult Thrombosis Medicine Competencies.

Length of Training

The Thrombosis AFC fellowship program is 12 months, with the possibility of extending over 24 months if the trainee is concomitantly pursuing a graduate degree.

Curriculum Highlights

Patient Care

Outpatient Clinics: for the 6 Core Clinical Rotations, the trainee will attend Thrombosis half-day clinics daily, acting as a junior consultant with graded responsibility. The trainee will be expected to assess both new consults and follow-up patients, developing and implementing a management plan which will be reviewed with the attending Faculty member.

Inpatient: during the 6 Core Clinical Rotations, the trainee will participate daily in the inpatient Thrombosis consultation service. The trainee will be expected to appropriately triage and assess their inpatient consults, developing and implementing a management plan which will be reviewed with the Faculty member on call. Thrombosis nurses are key members of the Inpatient Thrombosis services, and clear communication with the Thrombosis nurses is vital.

On Call: the trainee will be first call for the Thrombosis service approximately one week for each of the 6 core clinical rotations. Thrombosis call does not require remaining on site overnight, and very rarely requires return to hospital after hours. Calls come from both the hospital and from outside community physicians. The trainee is expected to review the questions raised and advice given with the Faculty member, with graded responsibility.


Academic Half-Day: One half-day per week will be reserved for academic development, and the trainee will not be expected to participate in clinical work. The timing of the half-day will be co-ordinated with the Hematology Residency half-day to allow the AFC trainees to attend pertinent Hematology Residency half-day sessions. Time management and ability to triage tasks is an important consultant skill, and the AFC trainees are expected to ensure appropriate handover and patient safety during academic half-days.

Teaching: the trainee will hold teaching sessions with residents, medical students, and others. Trainees will generally also present at Hematology Regional Grand Rounds. The trainee should distribute assessment forms for each session, and the assessments can be forwarded to the AFC director, who will collate assessments from several teaching sessions, anonymize them, and review with the trainee.


The trainee is required to participate in a Scholarly Project, which could involve research or a quality improvement initiative. A six-week dedicated block is provided to focus on the Scholarly Project, but work on the project is expected to continue throughout the training program. Many opportunities are available through our academically productive faculty.

Full program curriculum Curriculum of the Program Thrombosis AFC

Supervision & Feedback

An orientation session will take place either prior to or during the first week of the rotation to discuss the goals and description of the rotation with the trainee. The specific objectives of the trainee will be discussed, and an attempt made to integrate these objectives into the overall objectives of the rotation. The program-wide educational contract will be signed.

Trainees are provided with feedback during the rotation concerning their proficiency in managing clinical problems and their performance in informal and formal teaching sessions. Feedback for on-call duties is provided by the faculty member working with the trainee, particularly when they share weekend on-call duties.

A scheduled assessment session with the trainee will take place at the mid-point in the rotation as well as at the end of the rotation. At the mid-point meeting there will be two-way feedback on the rotation and discussion of the goals for the remainder of the rotation. Both the mid unit and final assessment sessions will be used to summarize the trainee’s progress in meeting the goals of this rotation and the AFC Program Portfolio Milestones. Input is sought from all attending Faculty members, as well as members of the team who have worked with the trainee, including Thrombosis nurses and ward staff nurses (using a Multisource Feedback Form).

A written mid-unit assessment form will be completed and discussed with the trainee who will be asked to sign the form. On completion of the rotation, a formal web-based CanMEDS compliant assessment is completed by the rotation supervisor, with feedback from the other individuals, including allied health professionals. Final assessments are discussed with the trainee.

Vinai Bhagirath

Medicine; Hematology & Thromboembolism
Vinai Bhagirath
Associate Professor
Thrombosis AFC Program Director

Sue Lambier

Medicine; Hematology & Thromboembolism
Placeholder portrait image for Sue Lambier
Fellowship Administrator

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