Toronto – Canada

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Interventional Cardiology Fellowship, Toronto General Hospital, Toronto, Canada

BCIS-Boston Scientific Interventional Fellowship

START DATE 1st JULY 2018

Supervisors: Dr M Osten (Toronto) & Dr R Kharbanda (UK) on behalf of the BCIS Training and Education Group

This successful fellowship programme is now in its tenth year. It has been developed to provide interventional experience in an internationally prominent high volume Canadian centre. The successful candidate will take up an interventional cardiology fellow post for 12 months at the Toronto General Hospital, University Health Network in association with The University of Toronto. This centre has a high international profile and a well developed and well established fellowship programme, co-ordinated and supervised by Dr Mark Osten. Access to the fellowship will be limited to UK specialist registrars in the final 2 years of training who are BCIS members and intend to specialise in Interventional Cardiology.

Prof Rajesh Kharbanda
Consultant Cardiologist
Oxford University Hospital
On behalf of BCIS Training and Education Group

Link to official BCIS website: http://www.bcis.org.uk/pages/page_box_contents.asp?pageid=709&navcatid=233

fellowship overview

The Toronto General Hospital, Peter Munk Cardiac Centre is associated with the University of Toronto. This is a large university quarternary care centre with a high volume interventional cardiology department performing more than 1600 PCIs per year. It has a well established fellowship programme with very experienced and internationally renowned interventionalists as trainers. It has a well established interventional educational programme and an active research output primarily focused on clinical outcomes and multicentre trials.

The department has 6 cath labs (3 dedicated coronary labs) with a new suite of labs. The local set up involves simple and complex cases referred to Toronto General Hospital. Transradial access is used for the majority of the PCI procedures. The case mix is varied and complex with exposure to the full range of interventional techniques.

Interventional fellowship programme
Interventional fellows can expect to perform a high volume of procedures (300-500 as first or solo operator) using a full range of interventional devices for managing complex patients. Multiple interventional research projects are underway including single and multi-centre projects. The interventional fellow will be expected to develop research projects during his time in Toronto leading to presentation and publication.

There is a well organised formal interventional training scheme developed by Dr Peter Seidelin who himself came to Toronto originally as a visiting UK interventional fellow more than 15 years ago. The educational programme involves: (1) a weekly journal club and research meeting; (2) monthly half day PTCA Fellows seminar run by the University of Toronto including a comprehensive set of seminar topics; (3) a two day interventional fellows course composed of practical, hands-on workshops run by the University of Toronto at the annual Canadian Cardiovascular Congress and (4) the opportunity to go to one or more of TCT, CRF North American Fellows course, or other meetings.

The fellowship programme has attracted several UK specialist registrars who have gone on to tertiary centre interventional posts. Examples include Clare Appleby, Keith Oldroyd, Doug Fraser, Pitt Lim, Dan Blackman, Saqib Chowdhary, Vaikom Mahadevan and Jonas Eichhöfer highlighting a first class interventional fellowship programme.

Application process
Access to the fellowship will be limited to UK trainees in their last two years of Specialist Registrar training who intend to specialise in Interventional Cardiology and are BCIS members. The supervising consultants act on behalf of the BCIS Training and Education Group.

The successful candidate will be identified by means of formal interview. The interview panel will be made up of several independent consultant cardiologists from multiple centres.

The fellowship will be awarded based upon the candidate’s career development, interventional experience and performance at interview.

If you would like to register your interest in this opportunity, please submit by email (bcis@bcs.com) a detailed curriculum vitae (this should include a personal statement and procedural numbers) AND letters of support from two supervisory consultants to Azeem Ahmad, BCIS Secretariat, Tel: +44 (0)20 7380 1918.

Please clearly indicate in your application whether you would like to be considered for a post in Toronto, Vancouver Island or both.

The deadline for applications is 12pm, 16 March 2017. Shortlisted candidates will be informed by 24 March 2017.

N.B Interviews will take place on 9 May 2017, British Cardiovascular Society, 9 Fitzroy Square, London W1T 5HW. The successful candidates will be required to enter into a contract to take up their posts in Toronto and Vancouver island on 1st July 2018.

The fellowship bursary will be paid to the institution and not to an individual. The salary support provided will be equivalent to that of a senior SpR. The fund in question will be at the receiving institution in Canada and the candidate will be paid a regular salary in Canadian Dollars from that fund. The selected fellow is in no way considered to be an employee of Boston Scientific.


Testimonials

Author: Dr Shazia Hussain (shaziathussain@icloud.com) – fellow 2016 – 2017

The BCIS/Boston Scientific fellowship at Toronto General Hospital provides an excellent opportunity for senior interventional trainees to further advance their interventional skills within a well established fellowship programme.

One of the real strengths of this fellowship is the quality of the teaching. In addition to the well established educational programme, the technical teaching during cases is exemplary. The fellows benefit from being taught by highly experienced operators who are comfortable with the fellows taking the lead both in the decision making and during the procedure, even in the most high-risk cases.

TGH is a regional referral centre for complex cases therefore the case mix is diverse providing invaluable experience in multivessel PCI, bifurcation stenting, CTO (antegrade and retrograde), LMS PCI and graft intervention, all supported with adjunctive imaging ie IVUS and OCT. In addition, fellows will gain experience in inserting mechanical support devices such as the Impella.

Personally, I have benefitted greatly from my time at TGH, with enhanced interventional skills, a greater understanding of the bio-mechanics underpinning coronary angioplasty, and increased confidence to work under stress in an unfamiliar environment. Essential qualities that will help bridge the gap between a trainee and a Consultant.

Outside the lab, Toronto is a vibrant, cosmopolitan and diverse city with lots on offer for everyone. There is a large community of clinical fellows from around the world ensuring that you will make lifelong friends and remain busy.

TGH is in downtown Toronto close to the Harbour and so enjoys easy access to the arts, cultural activities and a dining experience more diverse than you can imagine.

For the outdoor types, the lakes in Muskoka and Algonquin park are just a short drive away and offer great opportunities for hiking, fishing and camping.

I would thoroughly recommend this fellowship for the experience that I have gained in the lab, the people that I have met and for the opportunity to explore the cosmopolitan hub that is Toronto.

I would be happy to answer any questions on shaziathussain@icloud.com


Author: Dr Javaid Iqbal (javaid@doctors.net.uk) – fellow 2015-2016

Peter Munk Cardiac Centre at the Toronto General Hospital is an internationally renowned, tertiary-care cardiac centre in Toronto. It is a high-volume centre for coronary interventions, especially complex cases including CTOs and cases requiring circulatory support with Impella.

The prestigious BCIS/Boston Scientific fellowship provides an excellent opportunity to consolidate training in coronary intervention within a well-established fellowship programme. Fellows can expect to perform ~300 cases as first/solo operator. The numbers may be slightly less than other fellowships but the majority of these cases are complex providing good experience in multivessel revascularisation, bifurcation stenting, unprotected LMS PCI, graft PCI and circulatory support with Impella. The majority of cases are performed via trans-radial approach. There is also an active CTO programme offering both antegrade and retrograde approaches. There is a supra-regional structural intervention programme but this fellowship is predominantly for coronary intervention.

There are usually 3-4 fellows in total from UK, Australia, New Zealand and Middle East. Each fellow can get 6-7 cath lab sessions per week and remaining time for research projects. There are no out-patient commitments and ward duties are limited to looking after your own PCI patients pre- and post-procedure. You will be on-call for STEMI (1:3 to 1:4); however, number of STEMI cases are rather small (<200 cases per year), so unlikely to affect your next day lists. You may also be asked to do 1-2 days/month of general cardiology on-call.

There is a well organised teaching programme including weekly interventional rounds and a fortnightly journal club. There is a formal half-day interventional teaching session every 6-weeks, organised by the University of Toronto for fellows at all 3 PCI centres in Toronto. You will also attend a two day interventional fellows’ course providing practical, hands-on workshops at the annual Canadian Cardiovascular Congress. You may also be given the opportunity to attend one of the North American Fellows Course (SCAI, CRF, TCT etc); I attended the SCAI course in Las Vegas.

Fellows are encouraged to participate in interventional research projects including single and multi-centre trials. Abstract submission for national and international meetings is also encouraged and support to attend the meetings is generally available.

My family also enjoyed living in the cosmopolitan city of Toronto, visiting tourist attractions like CN Tower and Niagara Falls, summer sailing at Toronto Island and Manitoulin Island, watching colours of fall at Algonquin Park, and visiting USA for couple of short trips.

I fully recommend this fellowship to any interventional trainee who wants to get further training into complex PCI procedures. I am happy to be contacted for any further information.

Javaid Iqbal
javaid@doctors.net.uk


Author: Dr Ross McGeoch (rossmcgeoch@doctors.net.uk) – fellow 2014-2015

The Boston Scientific Interventional Fellowship based at Toronto General Hospital provides an excellent opportunity to train in complex coronary intervention within a well-established fellowship programme in an internationally renowned centre.

The majority of PCI cases undertaken are complex providing excellent experience in multivessel revascularisation, bifurcation stenting, CTO (antegrade and retrograde), LMS PCI, graft intervention and rotational arthrectomy.

My own experience is that the fellows are given the opportunity to take the lead in all cases, both technically and intellectually, with excellent support and guidance from the consultant staff. The educational element of the fellowship is excellent..

This fellowship offers an experienced interventional trainee opportunity to gain further high quality training in a prestigious unit, gain insight of a different healthcare system and work with fellows from around the world. I would highly recommend it.

I would be happy to answer any questions: rossmcgeoch@doctors.net.uk


Author (Fellow 2010-2011): Dr Sohail Khan (sohailkhan@doctors.org.uk)

Supervisors: Dr Vladimír Džavik (vlad.dzavik@uhn.on.ca) & Dr Peter Seidelin (peter.seidelin@uhn.on.ca)

Toronto General Hospital is a large tertiary centre based in the heart of Toronto. Over 1800 PCI procedures are carried out per year and there is an active primary PCI service covering the city. It is also a supra-regional centre for transplantation, alcohol septal ablation, aortic valvuloplasties and TAVI (both CoreValve and Edwards).

There are usually 5 fellows in total from around the world who provide a day-to-day service and you will be allocated to new, state-of-the-art labs on an average of 4 days per week, with 1 day set aside for research. There is on average 1 outpatient clinic every 2 weeks (pre-PCI clinic) and the only ward commitment is limited towards the care for your own PCI patients. The case mix is varied and there is ample opportunity to use adjunctive coronary devices such as rotablation, distal and proximal vein graft protection devices and the Impella circulatory support device. FFR and IVUS are actively encouraged and carried out in a high proportion of cases. There is also an active CTO program with opportunity for both antegrade and retrograde approaches. The majority of cases are carried out via the transradial approach.

There is opportunity for clinical research with a well-supported database. Abstract submission for national and international meetings is strongly encouraged and support to attend the meetings is available.

Due to its international reputation there are many ongoing multicentre trials and a dedicated trial nurse. During my time I was also involved in recruiting patients for the recently published RIVAL and PROTECT 2 international trials.

There is a formal monthly interventional teaching programme, coordinated through the University of Toronto where you will get to meet interventional fellows from Sunnybrook and St Michael’s (the other 2 PCI centres in Toronto). The teaching programme is very comprehensive and consists of both lecture and practical components including a “wet lab day”.

Funding for this fellowship is provided by Boston Scientific through a competitive interview process. The salary is equivalent to a UK SpR salary. There are however opportunities for fellows to apply directly to the programme but due to its popularity I would advise making enquiries at least 18 months in advance.

Outside of work I found Toronto to be a great city and very family friendly. The schools are exceptional with plenty of family recreational activities for the evenings and weekends.

Sohail