Application Process 

Applicants interested in pursuing this fellowship must apply through the McGill University Faculty of Post-Graduate Medical Education website: http://www.mcgill.ca/pgme/admissions/prospective-fellows

They must also submit a letter of intent, curriculum vitae as well as 3 letters of reference before the appropriate deadlines.

Fellowship Information

Number of fellowship positions requested: 2 per year

Start date: July 1^st / November 1^st

Application deadline: September 1^st

Academic affiliation: McGill University

Background

This Division has developed an internationally recognized expertise in Thoracic and Upper G.I. Surgery. Performing on average 400 lung resections, 80 esophagectomies, and 70 gastrectomies annually.

The division is primarily an academic surgical unit; however, it has a strong commitment to research with half of the attending surgeons holding PhDs and all trainees involved in research with approximately 30-40 publications annually.

Mission:

The mission of the fellowship training is to provide the necessary experience in complex thoracic and upper G.I. cancers, and allow the candidate to practice at a consultant level upon completion of the fellowship. The goal is to launch trainees into a tailored academic practice with a strong foundation for their future clinical and academic careers.

Description:

The fellowship design is for the aspiring academic surgeon interested in obtaining advanced exposure to the treatment of complex thoracic and upper G.I. cancers. The exposure will include the comprehensive management of patients with lung, mediastinal, and esophageal/gastric malignancies including diagnosis and investigation, adjuvant and neo-adjuvant therapy planning, interventional endoscopy, minimally invasive and open surgery, and palliation of end-stage disease. At the completion of the 1-year advanced fellowship, the successful trainee will be well suited for an independent practice in Thoracic and Upper G.I. cancer surgery. Although there are operating room activities almost every day, it is expected that the trainee spend at least one day in clinic a week with protected time for academic and educational activities.

Curriculum

The fellowship is a 12-month curriculum that can be adapted to the interest of the individual trainee to increase lung/mediastinal or Upper GI surgery.

It includes 11 months of clinical rotation with exposure to:

1. Lung and Mediastinal Oncology Surgery Procedures:

• Interventional bronchoscopy –advanced bronchoscopy, EBUS, rigid bronchoscopy, airway stent
• Lung resection; (wedge, segmentectomy, lobectomy, pneumonectomy, sleeve and other complex resection and reconstruction) VATS, open and robotic
• Mediastinal tumor resection – VATS, open and robotic
• Other thoracic malignancy including chest wall, pleural and airway tumors

2. Upper G.I. Surgery Procedures:

• Endoscopic resection – endoscopic submucosal dissection and endoscopic mucosal resection
• Endoscopic palliation – esophageal stenting
• Advanced upper GI endoscopy – Dilation, EndoVac
• Gastrectomy – laparoscopic, open and robotic
• Esophagectomy – laparoscopic, open and robotic

3. Research project – 1 month

• The candidate will be required to participate in clinical or translational research during their 1-year fellowship.
• The expectation is for the trainee to present at least once at an international and/or national meeting, and publish at least one manuscript. To aid in this endeavour, the division has two full time clinical research coordinators and maintains several prospectively entered databases in Thoracic Oncology.

Research Year:

Our division offers the opportunity for clinical and translational research fellowships. Many trainees have decided to pursue research training with us upon completion of the clinical fellowship. Interested candidates must apply separately from this program. For more information in regards to the Thoracic Surgery Laboratory, please visit: https://www.mcgill.ca/thoracic/research-1

Academic Facilities 

The fellow will have access to a broad range of research facilities for academic pursuits extending from the broad McGill University research network to a comprehensive Thoracic and Upper G.I. Oncology prospectively entered institutional clinical databases and tissue banks. There is a clinical research coordinator with whom the fellow will be heavily involved to assist with ongoing academic projects.

Academic Responsibilities

From an educational standpoint, the fellow will be expected to prepare and facilitate tumor board rounds for the disease site on which he/she is rotating on a weekly basis. In addition, the fellow will be responsible for coordinating educational activities at our Friday divisional service rounds. The topics will span the breadth of thoracic surgical oncology and will be focused on areas of controversy in the field. In addition, areas of interest as dictate by our active “interesting patient” caseload will be explored. Mortality and morbidity rounds will remain the purview of the Chief Resident rotation on our service.

Furthermore, the fellow will be responsible for coordinating weekly teaching rounds independently with the resident house staff. The topics here will again be generated by case based problems arising from within the patient caseload and areas that are considered to be areas in need of improvement for the residents rotating on the service. The thoracic oncology fellow may be called upon to assist with Academic Half-Day teaching on occasion.

Finally, the fellow will be responsible for coordinating a monthly thoracic oncology journal club. The article to be discussed will be chosen in consultation with the fellowship director and will be chosen to reflect the fellow’s specific interests and the areas of focus on which they are rotating.

Fellow Duties/Responsibilities and protection of resident caseloads:

The fellow will share responsibilities with the senior and/or chief resident of the service with regards to on-call. The fellow will be directly supervised by the attending surgeon and will not be the senior supervisor of the senior or chief resident. In this respect, the senior and/or chief resident will continue to be primarily responsible for the conduct of daily rounds and will review patients directly with the appropriate faculty members. The fellow’s responsibility is to act as a mentor and consultant to the senior/chief resident and will still be expected to round on a daily basis to assist the house staff team.

From an operative standpoint, the fellow is expected to become a fully independent surgeon for all complex thoracic and upper G.I. cancer cases. While the fellow is welcome to scrub on benign cases, the priority for these cases will be given to residents to continue to assure a high volume of primary surgeon cases for rotating general surgery senior and chief residents.

Evaluations

The Thoracic and Upper G.I. Surgical Oncology Fellowship Training Program has a comprehensive evaluation system. Evaluations will be performed every two months. All attending physicians are required to evaluate the residents and fellows they are in contact with. These evaluations are summative evaluations addressing both knowledge and practical skills relating to the practice of thoracic and upper G.I. surgical oncology. All evaluations are reviewed with the fellow by the Program Director in consultation with the Training Program Committee. Mechanisms are in place for the assessment of grievances in accordance with guidelines from the McGill Faculty of Medicine. The fellow will be evaluated based on the McGill Faculty of Post-Graduate Medical Education Promotions Guidelines.

At the end of the fellowship, the trainee should have acquired the following competencies:

Medical Expert

• Able to formulate a comprehensive management plan for thoracic consultations
• Can perform a clinical assessment and interpret appropriate investigations for common presentations in thoracic patient including dysphagia, dyspnea and hemoptysis.
• Can discuss the principles and management of benign esophageal conditions including esophageal motility disorders, paraesophageal hernias, esophophageal diverticulae, gastroesophageal reflux disease and esophagitis.
• Can discuss the principles, staging and management of esophageal cancer.
• Can discuss the principles, staging and management of stomach cancer.
• Can discuss the principles, staging and management of lung cancer.
• Can discuss the principles, staging and management of mediastinal tumors.
• Can discuss the principles, staging and management of other common thoracic tumors from the chest wall, airway, pleura and diaphragm.
• Can discuss the management of empyema
• Can manage spontaneous pneumothorax and pleural effusion
• Is familiar with the management of chest trauma
• Identification of pertinent thoracic anatomy
• Appropriate tissue handling in the operating room
• Ability to surgically expose esophagus and stomach and lung

Communicator

• Establishes therapeutic relationship with patients and families
• Listens effectively
• Maintains clear, timely, accurate and appropriate records (e.g. written or electronic) of procedures and other clinical encounters

Collaborator

• Prevents and resolves interpersonal conflicts effectively
• Provides and receives feedback effectively
• Works effectively with multidisciplinary teams in and outside of the operating room

Health Advocate

• Identifies the health needs of an individual patient

Scholar

• Critically appraises medical information. Successfully integrates information from a variety of sources.
• Demonstrates effective presentation skills including use of appropriate media.
• Selects effective teaching strategies and content to facilitate learning of medical students and other health professionals.
• Successfully integrates information from a variety of sources

Professional

• Demonstrates awareness of personal limitations and seeks advice when necessary
• Exhibits appropriate professional behaviours in practice, including honesty, integrity, commitment, accountability, compassion, respect and altruism
• Respects patient and colleagues' confidentiality, privacy and autonomy

Leader

• Makes clinical decisions and judgments for the benefit of the individual patient based on sound clinical evidence and efficient use of the available resources
• Sets realistic priorities and uses time effectively in order to optimize professional and personal life