Regional Anesthesia
Program Director, Dr. Javier Cubillos, MD
Welcome to the Regional Anesthesia Fellowship at the Department of Anesthesia and Perioperative Medicine of Schulich School of Medicine & Dentistry of Western University!
Prepare to embark on an exhilarating journey that will transform you into a top-tier regional anesthesiologist. Our fellowship is meticulously designed to empower you with unparalleled skills and knowledge, ensuring you excel in all aspects of perioperative management for patients receiving neuraxial or peripheral nerve blocks.
In this page: Program highlights Eligibility Requirements Fellowship Structure Goals and Objectives Assessment
Here’s what awaits you:
Mastering Ultrasound-Guided Techniques
Dive into the world of regional anesthesia and become an expert in performing common upper and lower limb, truncal, and neuraxial blocks for a wide variety of surgical procedures and subspecialties. Immerse yourself in the detailed anatomy and sono-anatomy relevant to regional anesthesia and analgesia.
Gain hands-on experience in our four state-of-the-art block rooms across the city. With our capacity to perform over 8,000 blocks annually, your training will be comprehensive and robust.
By the end of your fellowship, you will be proficient and precise in providing safe and effective single-shot and catheter techniques, ready to excel in your career as a regional anesthesiologist.
Comprehensive and Complex Pain Management
Elevate your expertise in conducting thorough, personalized perioperative pain management assessments to ensure that every patient receives the highest standard of care, reflecting the cutting-edge philosophy of precision medicine. Learn to tailor multimodal analgesia to each individual patient.
Master the use of parenteral opioid techniques, including infusions of lidocaine and ketamine, and expertly select the most appropriate blocks for each patient.
Develop resourceful troubleshooting skills for continuous peripheral and neuraxial nerve blocks, ensuring seamless postoperative care.
Rise to the challenge of assessing and managing opioid-dependent patients and those with complex pain issues.
Collaborate with our acute and chronic pain management teams, who will provide unwavering support in demanding cases requiring optimal solutions.
Shine as a consultant to anesthesiologists, surgeons, nurses, and physiotherapists, offering your invaluable expertise and support.
Block Room Administration
Take charge and efficiently manage a block room, fostering effective communication with surgical and nursing staff. Gain the ability to establish a new Regional Anesthesiology and Acute Pain Medicine program in your future practice.
Research Opportunities
This fellowship not only aims to enhance your clinical skills but also to foster a strong foundation in academic and research excellence. If you have any specific research interests, the faculty will support you in exploring those to further their knowledge and contribute to the field of regional anesthesia and acute pain medicine.
You will have the chance to participate in ongoing research projects, develop your own research initiatives under the guidance of experienced mentors, present your findings at national and international conferences, and publish your research in reputable medical journals.
Leadership in Education
Lead the way in training future generations of generalists and subspecialists in Regional Anesthesiology and Acute Pain Medicine.
Provide visionary leadership in organizing and managing an acute pain medicine service within a hospital setting.
Develop your teaching skills by becoming a stellar educator, sharing this knowledge with other staff, residents, and medical students.
Become a beacon of knowledge, educating patients, family members, surgeons, PACU, and floor nurses about the management of nerve blocks.
Join us and become a trailblazer in the field of Regional Anesthesiology and Acute Pain Medicine!
In their words
“I recently completed my regional anesthesia and acute pain fellowship and this fellowship gave me a multi-layered experience both clinically and academically. The varied patient population between the three hospitals made sure the exposure to the different blocks and cases was vast and complete. It was a pleasure to work and learn with all the consultants who are approachable and proactive in teaching and who enable effective clinical and academic work. It was a constructive fellowship both professionally and personally.” - Dr. Niveditha Karuppiah, India
"I have recently completed my Regional Anesthesia Fellowship and I have learned a wide variety of traditional and novel truncal, upper limb and lower limb blocks, with excellent teaching from the staff anesthesiologists. I was also able to participate in cadaveric and ultrasound workshops for regional anesthesia. In addition to the large clinical volume of regional anesthesia, I maintained my skills in general anesthesia with a broad range of surgical lists. I also appreciated the opportunity to complete research during my fellowship." - Dr. Georgina Mahony, Australia
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
Fellowship Structure
- Duration: The fellowship training program will be undertaken over twelve consecutive months and includes four weeks of vacation time.
- Number of fellowship positions: 2 to 4 per year
- Location: Fellowship training will take place at St Joseph’s Healthcare London and London Health Sciences Center which includes University Hospital, Victoria Hospital and the LHSC Surgicenter. Subspecialty training will be roughly divided evenly between those locations, although this is flexible depending on clinical exposure attained.
- Service commitment: 100 days per year (subject to change according to department fellowship policies). This service commitment may be in subspecialties unrelated to regional anesthesia. The remainder of the weekdays is subspecialty time. Academic time may be granted depending on the academic productivity of the fellow.
- Call Commitment: Fellows will be expected to be available out of hours (evenings, nights and weekends) to troubleshoot blocks, and follow up blocks sited. Coverage will vary dependent on number of fellows. On most of the occasions, troubleshooting would be possible via telephone. The fellow would also be expected to run the acute pain service rounds at weekends once in every 4 weeks.
- Regional technique exposure: You will have the opportunity to learn and practice across four different block rooms in the city, allowing fellows to gain proficiency in a diverse array of ultrasound-guided procedures. These include neuraxial techniques (such as spinal, epidural, and combined spinal-epidural procedures of varying complexity), as well as single-shot blocks and peripheral nerve catheters for the upper limb, lower limb, and trunk.
Research
- Research is an important and expected component of the fellowship. Fellows are expected to spearhead at least one original research project, including protocol creation, research grant application, ethics approval submission, and participant recruitment.
- Attendance of at least one major conference (CAS, ASRA or ASA) is highly encouraged with presentation of an abstract if available.
Education
Regional anesthesia specific education will be ongoing throughout the subspecialty and take the following forms:
- Clinical education: During subspecialty training days, fellows will work under the direct supervision of an experienced regional anesthetist. They will have the opportunity to enhance their recognition of sonoanatomy, refine their block selection and needling skills, and perform both single-shot and catheter blocks. An essential focus of this training component will be the follow-up and post-procedure management of nerve blocks.
- Regional Anesthesia Journal club: Journal club will be held between 2 and 4 times per month for the duration of the fellowship. Relevant articles will be presented and analysed. Fellows will be expected to present regularly (at least monthly) at these rounds and supervise presenting residents.
- Anatomy lab: The anatomy lab will be held one to two times per year and will be attended by both residents and fellows. Initially, fellows will participate as students, gaining valuable insights from cadaveric models. They will have the opportunity to correlate 3D anatomy with ultrasound imaging and understand spatial relationships through needle handling in cadaveric specimens. As the fellowship progresses, fellows will transition to the roles of teachers and demonstrators in subsequent labs.
Resources
Fellows will have access to the following resources:
- Department Anesthesia Library
- The Western University Library online resources, providing access to the majority of significant anesthesia journals
- Department librarian assistance
Goals and Objectives
Assessment
- 360-degree appraisal from staff anesthetists, residents, medical students, surgeons, nurses (block and PACU nurses) after each block room rotation.
- 3 times yearly (post PEAP, mid fellowship, end fellowship) meeting with fellowship director.
- Personal feedback as anatomy lab tutor.
- Fellows are required to keep an up-to-date logbook of procedures performed.