McMaster University

McMaster University

The First Trainees

"The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head." ~ Sir William Osler, Dundas-raised Physician and Icon of Modern Medicine (1849 - 1919)

Dr. Vivian Rambihar
Dr. Vivian Rambihar

The years 1975-1978 allowed the McMaster Department of Cardiology the chance to grow and develop competency in all domains necessary for an accredited Royal College of Physicians and Surgeons of Canada Cardiology Fellowship program.  This seemed only natural, says Dr. Fallen, identifying three levels of education within the tertiary-level academic institution: the undergraduate MD level, addressed by McMaster Medical School, post-professional Continuing Medical Education, addressed by Dr. Tanser’s faculty retreat curriculum, leaving Postgraduate Education as the last stone unturned.  McMaster sought far and wide for the best possible candidates to reflect the philosophy of their center.  The inaugural Cardiology Fellows in 1978 were Dr. Vivian Rambihar and Dr. Eric Stanton.

From the cardiology fellows’ standpoint, the tremendous flexibility offered was one of the highlights of the program at its inception.  They were able to pursue individual interests such as dropping by the cardiac catheterization laboratory after hours for extra training, while achieving Royal College competency in all aspects of clinical cardiology.  Theyworked city-wide and covered different cardiology subspecialties independently, allowing for enhanced personal interaction with staff, surgeons, and other fellows.  They had exposure to burgeoning fields such as exercise stress testing, congenital heart disease and echocardiography, cardiac catheterization and interventional cardiology. The four different hospital systems each had its own different flavour of learning and teaching.  Small group sessions such as Friday afternoonphysical diagnosis rounds at St. Joseph's session, offered solid clinical training taught by the most seasoned consultants, although anecdotally, five individuals might hear five totally different sounds!  More than anything, the small size of the program allowed the development of strong collegial bonds, which continue to this day.

In addition to solid clinical training, research in the first two years flourished. The paper entitled, Pulmonary veno-occlusive disease: antemortem diagnosis from roentgenographic and hemodynamic finding by Drs. Rambihar, Fallen and Cairns [Can Med Assoc J. 1979 Jun 23;120(12):1519-22] prompted an editorial in the Lancet and continues to be cited today. Intracoronary nitroglycerin reversal of life-threatening ergonovine maleate-induced coronary artery spasm by Drs. Stanton and Tanser [Angiology. 1982 Mar;33(3):206-11] contributed to the growing catheterization literature. Pulmonary edema associated with isoxsuprine therapy by Drs. Rambihar, Fallen, Cairns, and Nimrod (future head of the SOGC) [Am J Obstet Gynecol. 1984 Mar 1;148(5):625-9] was presented at the InterAmerican Congress of Cardiology in 1981, attracting attention to a fledgling program and presaging later global leadership in research. Following their fellowships, Dr. Rambihar pursued a fellowship in echocardiography in the early days at Toronto General Hospital. Dr. Stanton obtained a Heart and Stroke Foundation Research Grant and pursued a fellowship in Nuclear Medicine.

The fellowship program continues to enjoy an excellent reputation, with all McMaster Cardiology fellows to date successful in the Royal College Cardiology Examinations.  The current program director is Dr. Alison Montgomery.


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