Obstetric Anesthesia

Fellowship Program Director – Dr. Ilana Sebbag

The Department of Anesthesia and Perioperative Medicine at the Schulich School of Medicine and Dentistry, Western University offers a one-year, Clinical Obstetric Anesthesia Fellowship based at Victoria Hospital, London Health Sciences Centre in London Ontario Canada.

Victoria Hospital is an academic tertiary care hospital which provides obstetrical anesthesia services for almost 6000 deliveries per year. The cases are interesting and challenging as almost 30% of the obstetric patients are considered high risk. There is an approximately 80% epidural user rate and a 23% cesarean delivery rate.

 The Obstetrical Anesthesia Fellowship places emphasis on advanced clinical expertise, through clinical exposure, regular education/teaching opportunities, research and quality improvement activities, and leadership opportunities.

The fellowship offers a variety of clinical experiences such as a 24 hour epidural labor analgesia service, cesarean deliveries and other obstetric surgeries, an acute postcesarean pain service, and an Obstetric Anesthesia clinic for consultation of high risk obstetric patients. The fellow will also gain experience in the use of ultrasound for neuraxial anesthesia. These activities are supported by weekly Obstetric Anesthesia rounds.

As well, there is an expectation that the fellow will regularly teach residents, medical students, and other health care personnel. The fellow is also expected to perform with direct supervision at least one research project during the fellowship. Other research activities include online modules, grant, REB and abstract submissions, as well as presentations at meetings. The fellow will also, with supervision review manuscripts for anesthesia journals.

London Health Sciences Centre’s Women’s Care Program at Victoria Hospital is the first in Canada to be designated as a Centre of Excellence by the Society for Obstetric Anesthesia and Perinatology (SOAP) for providing safe, effective, and evidence-based Obstetric Anesthesia care. Read more on the LHSC website.

Fellowship Structure

  • Duration: The Fellowship Training Program will be undertaken over twelve (12) consecutive months and includes four (4) weeks of holiday time. The remaining forty eight (48) weeks will be comprised of general clinical, subspeciality training and research (if approved in advance).
  • Number of fellowship positions: 2
  • Location: Fellowship training will take place at Victoria (Children’s Hospital).
  • Service commitment: 100 days per year (subject to change according to department fellowship policies). This service commitment may be in subspecialties unrelated to Obstetric Anesthesia. The remainder of the weekdays is subspecialty time. Academic time may be granted depending on the academic productivity of the fellow.

"I’m completing my obstetric anesthesia fellowship at Western University and the clinical experience has been excellent, with many complex cases and opportunities for inter specialty collaboration. There are numerous research opportunities as well, and excellent researchers in the department for guidance. I've enjoyed working with and teaching the residents and medical students, and these interactions have made my fellowship truly memorable. " - Dr. Tammy Symons, Canada

Eligibility Requirements for Canadian and Foreign Medical Graduates

  • Candidates must possess a medical degree from a University recognized by the Medical Council of Canada (MCC)
  • Candidates must have completed an anesthesia residency that is recognized by the College of Physicians and Surgeons of Ontario (CPSO)
  • International Medical Graduates do not need to write additional exams, but must be approved by the PGE Office at Western University
  • English Language Requirement for IMGs: TOEFL-iBT required to achieve an overall score of no less than 93 with a minimum score of 24 in speaking; IELTS required to achieve a minimum score of 7 in each category. 
  • All non-Canadian trained anesthesiologists will be required to pass an assessment period taking place over the first 4 - 8 weeks in order to continue with the fellowship (‘PEAP’ – Pre-entry assessment period).
  • Please refer to the Application and Requirements page for a more detailed description

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Goals and Objectives

Medical Expert

  • Integrate all the CanMEDs roles to provide optimal, ethical, and patient and family centred obstetric anesthesia care.
  • Establish and maintain clinical knowledge, skills, and attitudes appropriate to provide safe obstetric anesthesia care.
  • Perform a patient-centred clinical assessment and establish an appropriate obstetric anesthesia care plan.
  • Plan and perform procedures and therapies for the purpose of assessment and/or management of the obstetric patient.
  • Establish plans for ongoing care and, when appropriate, timely consultation of the obstetric patient.
  • Actively contribute, as an individual and as a member of a team providing obstetrical care, to the continuous improvement of health care quality and obstetric anesthesia patient safety.

The fellow will demonstrate detailed knowledge of the following:

  • Normal maternal physiology of pregnancy
  • Fetal and placental physiology
  • Intrapartum and postpartum neonatal resuscitation

Medical diseases during pregnancy and their peripartum management including but not limited to how the disease impacts the pregnancy, how the pregnancy impacts the disease and the obstetric implications and management of the disease:

  • Hypertensive disorders of pregnancy
    • Respiratory disease
    • Cardiac disease
    • Morbid obesity
    • Endocrine disease
    • Hematological and coagulation disorders
  • Labour analgesia including but not limited to anatomy and physiology of labour pain, and strategies for analgesia
  • Anesthesia for obstetric surgery:
    • Regional anesthesia for cesarean delivery
    • General anesthesia for cesarean delivery
    • Other obstetric surgery
    • Postoperative analgesia
  • Management of obstetrical complications
  • Anesthetic management of non-obstetric surgery during pregnancy
  • Anesthesia related morbidity and mortality in pregnant patients
  • Ethical principles of obstetric anesthesia

Communicator

  • Establish professional therapeutic relationships with patients and their partners and families.
  • Elicit and synthesize accurate and relevant information, incorporating the perspectives of patients, partners and their families.
  • Share health care information and plans with patients and their families
  • Engage patients and their partners and families in developing plans that reflect the patient’s health care needs and goals
  • Document and share written and electronic information about the medical encounter to optimize clinical decision-making, patient safety, confidentiality, and privacy

Collaborator

  • Work effectively with physicians and other colleagues in the obstetric care profession
  • Work with physicians and other colleagues in the health care professions to promote understanding, manage differences, and resolve conflicts.
  • Hand over the care of an obstetric patient to another health care professional to facilitate continuity of safe patient care

Leader

  • Contribute to the improvement of obstetrical care delivery in teams, organizations, and systems
  • Engage in the stewardship of health care resources
  • Demonstrate leadership in obstetrical anesthesia practice
  • Emphasize patient safety and quality improvement processes through incorporation of obstetric anesthesia patient safety standards.
  • Manage their clinical work, career planning, and personal life.
  • Demonstrate competence in health care informatics.

Health Advocate

  • Respond to an individual obstetric patient’s health needs by advocating with the patient within and beyond the clinical environment
  • Respond to the needs of the obstetric populations they serve by advocating with them for system-level change in a socially accountable manner

Scholar

  • Engage in the continuous enhancement of their professional activities through ongoing learning
  • Teach students, residents, and other health care professionals in a safe learning environment.
  • Integrate best available evidence, contextualized to specific situations in obstetric anesthesia, and integrate it into real-time decision-making.
  • Contribute to the creation and dissemination of knowledge and practices applicable to obstetric anesthesia.

Professional

  • Demonstrate a commitment to obstetric patients by applying best practices and adhering to high ethical standards
  • Demonstrate a commitment to society by recognizing and responding to societal expectations in obstetrical health care
  • Demonstrate a commitment to the profession by adhering to standards and participating in physician-based regulation
  • Demonstrate a commitment to physician health and well-being to foster optimal patient care

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