Residents do call at each of the four clinical sites. At the JHCC, they cover daytime weekends only (8 am- 8 pm) and none of the weeknights. At all the other sites, (HGH, McMaster and SJH), residents do 24 hour call during the week and do “split call” on the weekends (8 am- 5 pm shift and a 5 pm-8 am shift). On average, residents do 3 weekend shifts a month (no more than 2 weekends) and 2 weekday shifts, totaling 5 calls overall for the month. Anesthesia residents are always off at 8 am post-call. At the end of PGY1, when you return to Anesthesia rotations in May, you will do several buddied calls prior to doing solo call. At the HGH, residents do not do solo call until they are halfway through the PGY2 year, again, after several buddy calls. The reason for this is the higher-level demands of the airway management of the trauma patient.

Most programs have eliminated 24-hour call entirely. However, most staff positions involve 24-hour call. At McMaster, we feel it is important that residency prepare you for practice. We also feel that there is more to wellness than the length of the call shift, such as the amount of call in total, the length of the non-call days and the amount of academic time that is given. It is interesting to note that in the US, 24-hour call has been “re-approved” again and a recent (March 17, 2017) NEJM article explores that topic. It’s not a simple issue and it impacts on patient care in some paradoxical ways.

We track all the residents’ call while on Anesthesia on a spreadsheet in real time, that is shared amongst all the residents and used to ensure equity in call distribution.

Call during off-service rotations is specific to the service. During several of the “medicine year” rotations, Anesthesia residents do Anesthesia “fly-in” call, thus maintaining a connection with their home program.

Anesthesia is not a “lifestyle specialty”. We work unsociable hours and sometimes our days are unpredictable in terms of when they will end. As a resident, you will be involved in lists of all durations. We have lists that end at 3:30 pm, 4:00, 4:30, 5:00 and 6:00 pm. The cardiac rooms are booked until 7 pm. You will be assigned to all types of lists during your residency and during the PGY4 year (subspecialty rotations), the frequency of long days is greater. Unless on call or on subspecialty, it would be unusual not to be finished by 5 pm and often quite a bit earlier.

At McMaster Anesthesia, the assigning of residents to lists is done by the “admin resident” at each site, who is usually a PGY4. The admin resident also constructs the call schedule. Part of the admin resident’s role is to be in dialogue with the other residents at the site to ensure that their learning needs are being met. PGY5’s have more input into their list selection as they are keen to round out their residency and ensure a balanced exposure to all types of patients and cases. We have a fair, transparent online process where residents can make their requests for vacation time or days off.

There are many other ways in which residents have control over their learning. Our academic curriculum is very interactive and is optimized through self-directed learning. Research opportunities are myriad such that almost any interest can be explored. There are many optional rotations to explore in the off-service years as well as while in Anesthesia, including the Uganda elective.

Finally, many of our residents explore alternative learning programs towards the end of their residencies, through the Critical Care Medicine Program or Chronic Pain residency program (both are two year programs which can overlap for one year with the PGY5 year of Anesthesia) or through the Clinical Investigator Program.

Absolutely! Residents are involved in teaching clerks throughout residency. Residents participate in the clerkship curriculum, where they teach didactic sessions and facilitate sessions with task trainers and our standardized simulation scenarios. On average, each resident would spend approximately 2 days per year teaching within the clerkship program. As well, the clerks spend one night “on call” and are attached to the anesthesia resident for that experience.

Some residents chose to participate in teaching “Clinical Skills” to Undergraduate medical students. Finally, the McMaster Medical School (Undergrad) has an active “Anesthesia Interest Group” which organizes weekend workshops with volunteer Anesthesia residents and faculty as facilitators.

Residents also have the opportunity to develop their presentation skills through their Journal Club presentations, Research Exchange Day presentation and mandatory presentations at academic half days and rounds. For example, PGY4 residents “teach” the PGY3 summer academic half-day curriculum along with a faculty facilitator.

Yes! Each PGY year has a resident representative on the resident advisory council, which sits on the Residency Program Committee. There are also many other committee opportunities through the postgrad office. Amongst our residents we have the PARO past-president and several PARO board members.

Yes, you will be assigned a faculty mentor when you arrive. You will have a mentor for the full five years of your program; during the early stages of residency, they will help you get oriented, and as you progress through the program they will be there to provide advice in areas such as exam preparation, electives, fellowships, and career decisions. We will also you assign you a more senior resident “buddy”. Many residents naturally find many other “informal mentors” as they move through the program. One thing to be aware of is that each resident also has an academic advisor (AA). The AA fulfills a different role than the mentor. The AA tracks your academic progress and ensures that you are on track regarding the achievement of your EPA’s.

I suppose, “We’ve always done it this way” is not a satisfying answer? OK, well, we think there are several benefits to the way we have ordered our rotations. For one, once you finish that PGY3 medicine year, you are on Anesthesia rotations for the rest of your residency, so you can focus exclusively on your core material as you hit the home stretch of exam preparation. Also, as a PGY4, you encounter all your Anesthesia subspecialty rotations, so you have the equivalent “medicine” background experience in order to optimize your rotation. For example, when you do Cardiac Anesthesia, you have already done CV-ICU; When you do Thoracic Anesthesia, you have already done Respirology and gained experience in bronchoscopy; when you do High-Risk Peds, you have already done your NICU (or PICU) rotation) etc. etc. Finally, because we offer a FULL ACADEMIC DAY to our residents (which doesn’t apply when they are off-service), by keeping the off-service rotations bunched into one year, it allows us to plan the academic time more coherently for each PGY cohort. (If some of your group was getting a full day, and some a half day, it would be difficult to avoid having some residents miss part of the day). Other programs who only offer an academic half-day throughout the entire residency (or until the end of PGY4) do not have these logistical considerations of where to place the off-service rotations.

Like all aspects of our program, this issue is on the table for discussion and we are constantly seeking input from our residents. Recently, when I asked the PGY4’s if we should look at deconstructing the “medicine year” to intersperse the rotations rather than having them occur as a one-year block, they were unanimous in saying that the block of rotations is preferable. As it stands, most residents have one or two Anesthesia rotations during their PGY3 year and that, as well as the buddy call, helps them stay in touch with their home base.