Medical Oncology Residency Program
Program Director: Dr. Ghazaleh Kazemi
Overview
The McMaster University Medical Oncology Training Program is a Royal College of Physician and Surgeons of Canada fully accredited two year program, providing training in all aspects of the CanMEDs competencies in medical oncology. The program provides a wealth of clinical experience in a setting of one-on-one interaction between residents and medical oncology teaching faculty.
The Juravinski Cancer Centre has one of the largest clinical trials programs in the country and a very active fellowship program with opportunities for further training following residency (PGY6 and/or PGY7). McMaster University has trained many clinical research fellows over the past decade in breast cancer, lung cancer, gastrointestinal cancers, genitourinary cancers and investigational new drugs, often combined with research and enrolment in McMaster University degree programs, such as master’s in health research methodology or master’s in education. Funded positions are available each year but fellows are encouraged to apply for outside sources of funding.
We have a comprehensive set of clinical, basic science and research rounds. The medical oncology program at McMaster University has a structured core teaching program, including academic half-day every Wednesday afternoon. A two year formal rotation of topics covers the spectrum of oncology from basic science, clinical epidemiology, cancer prevention and screening to treatment (systemic, radiation and supportive care). Topics are generally organized by tumour site with multidisciplinary teaching, as appropriate. A popular feature of our program is the clinical research curriculum, which is led by medical oncologist, Dr. J. Goffin and cancer statistician Dr. G. Pond. The research curriculum provides residents with practical training on clinical research methodology and an approach to critical appraisal of the oncology literature. Residents are paired up with a medical oncology faculty member who serves as their mentor to develop a research question, leading to the development of a research protocol and ultimately to a presentation at a meeting and/or publication in a peer review journal. Another unique feature of the McMaster University medical oncology program is that our residents have the opportunity to become co-investigators on national and international phase II and III clinical trials to gain valuable experience in this area prior to becoming staff. This became possible in 2018, thanks to the ground-breaking efforts of our clinical trials department head, Dr. Rosalyn Juergens.
Our program also offers a unique course that runs throughout the two year residency program called Molecular Oncology Rounds. This series of rounds is led every year by Dr. Hal Hirte and covers key molecular pathways in cancer pathogenesis, oncology drug development and the mechanisms of new targeted therapies, such as immunotherapies, novel kinase inhibitors, angiogenesis inhibitors and cell cycle inhibitors, to name a few. This program takes place every Friday morning, with the exception of the summer break. Additional teaching sessions include the McMaster ‘Bread and Butter’ rounds, which are resident led sessions that take place over the summer for the PGY4s new to medical oncology. This includes teaching from the PGY5 to PGY4 residents (with staff facilitators present) in breast, lung and gastrointestinal cancers, as well as accompanying review of key journals for each of the three disease sites and a review of common case scenarios that residents are likely to encounter in their first few months of training in medical oncology.
We transitioned to a Royal College of Physicians and Surgeons of Canada Competency Based Medical Education residency training program on July 1, 2018. Our faculty are highly motivated to provide frequent direct observation of their clinical skills with immediate feedback. We also have several assessments, including a communication skills Objective Structured Clinical Examination (OSCE), in-training written medical oncology examination, similar to the Royal College medical oncology board examination, and our residents participate in the American Society of Clinical Oncology in-training examination during both their PGY4 and PGY5 years. This ensures that skills are being learned at the appropriate stage of training from transition to discipline (TTD) to foundations (F) to core (C) to transition to practice (TTP).
Key Contacts
Ghazaleh Kazemi
Associate Professor
Director, Medical Oncology Residency Program
Ghazaleh Kazemi
Associate Professor
Director, Medical Oncology Residency Program
Ghazaleh Kazemi
Associate Professor
Director, Medical Oncology Residency Program
Ghazaleh Kazemi
Associate Professor
Director, Medical Oncology Residency Program
Current Medical Oncology Residents
Information Box Group
Zeba Siddiqui PGY5
Medical School: University of Limerick, Ireland
Year Graduated: 2019
Why I chose this field: For me, medical oncology offered me the opportunity to work with sick patients and make a meaningful difference in their lives. I was drawn to the rapid advances in care that have taken place in oncology, and also the breadth of pathology and therapeutics that this field offers.
Why I chose McMaster: I chose McMaster for various reasons, with the top one being the great sense of collegiality I experienced here. I noted that trainee experience was highly valued and they were treated as part of the family. I noticed that the focus on learning and growth was a priority. I found the environment to be very inclusive and everyone was treated with respect and these are values I hold close to my heart.
My Future Aspirations: Ideally, I see myself working closely with breast cancer patients and making early phase clinical trials an important element of my practice.
Favourite Pastime: Spending quality time with family and friends, whether it be watching a movie, playing board games or cards, being in the company of loved ones is key. I also enjoy going to amusement parks, skating and going on long drives.
AJ Aljameely PGY5
Medical School: King Abdulaziz University, Saudi Arabia
Year Graduated: 2017
Why I chose this field: Medical Oncology allows me to combine my passion for medicine with my desire to make a meaningful impact in patients’ lives by providing comprehensive care and innovative treatments for cancer.
Why I chose McMaster: I chose McMaster University for its renowned medical oncology program, which offers exceptional clinical training, research opportunities, and a supportive learning environment that aligns with my career goals and aspirations.
My Future Aspirations: To specialize in breast and genitourinary cancers as a medical oncologist, focusing on advancing treatments and improving patient care in both fields.
Hobbies: For fun, I enjoy playing video games and participating in soccer matches to unwind and stay active outside of work.
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Pooya Dibajnia PGY5
Medical School: The Temerty Faculty of Medicine, University of Toronto
Year Graduated: 2016
Why I chose this field: Mind-blowing molecular biology and the honour of being able to help people through a challenging journey in their lives.
Why I chose McMaster: McMaster boasts many renowned faculty in the field of oncology. It also fosters a supportive, learner-centred environment that is unparalleled. I could not have asked for a better place to undertake my subspecialty training.
My Future Aspirations: I have an interest in healthcare leadership. Currently I sit on the board of directors for Professional Association of Residents of Ontario where we address issues that are pertinent to resident training, working conditions and wellness. I hope to leverage this experience towards continually improving cancer care in Ontario.
Hobbies: Cycling, running, and cooking!
Nasser Al Majarafi PGY5
Medical School: Sultan Qaboos University, Oman
Year Graduated: 2013
Why I chose this field: I like to build long-term relationship with the patients, it’s a more emerging field.
Why I chose McMaster: More educational opportunities, great and friendly staff.
My Future Aspirations: To become a GI oncology specialist in my country.
Favourite Pastime: Playing with my kids, watching movies.
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Yazeed Alharbi PGY4
Medical School: King Abdulaziz University, Saudi Arabia
Year Graduated: 2016
Why I chose this field: I was drawn to the field of Medical Oncology due to its dynamic nature and profound impact on patient care. The complexity of oncology, coupled with the opportunity to alleviate suffering and improve quality of life for cancer patients, resonated deeply with me.
Why I chose McMaster: McMaster University’s esteemed reputation as a world-class institution, particularly renowned for its pioneering contributions to evidence-based medicine, made it a natural choice for me. Its legacy as the birthplace of evidence-based medicine; coupled with witnessing the exceptional skills and knowledge of two of my mentors who underwent medical oncology training at McMaster further solidified my decision.
My Future Aspirations: I aspire to excel in Medical Oncology, focusing on delivering compassionate patient care and actively engaging in medical education. My aim is to continuously enhance my skills to better serve cancer patients and their families.
Zainab Al Maqrashi PGY4
Medical School: Sultan Qaboos University, Oman
Year Graduated: 2019
Why I chose this field: It is where the real integration of all faces of medical care takes place. You are the physician who examines and treats, the surgeon in knowing the limitations of a scalpel, the radiologist in being aware of what you need to use, and the pathologist who decides what information to hunt for.
Why I chose McMaster: McMaster is a perfect blend of clinical, academic and research opportunities with an exceptionally supportive and resident-focused program.
My Future Aspirations: I would like to be involved in medical education, the development of local community services, including rural accessibility to specialized oncology care in my hometown.
Favourite Pastimes: Live sporting events, outdoor activities, travel, astrophotography, puzzles, comics & graphic novels.
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Samuel Chan PGY4
Medical School: The Temerty Faculty of Medicine, University of Toronto
Year Graduated: 2020
Why I chose this field: It is a unique specialty that takes the multi-systemic approach from internal medicine including both the diagnostic and treatment of complications skills with the molecular science of oncology. We care for a complex patient population and leverage both the science of medicine and the art of communication to provide compassionate and empathetic care.
Why I chose McMaster: The supportive program including our excellent program director and admin, opportunities for research and excellent teaching from all the oncology attendings
My Future Aspirations: To pursue a fellowship further specializing in a disease site such as thoracic oncology
Hobbies: Hiking, travelling and ramen.
Radiation Oncology Residency Program
Program Director: Dr. Justin Lee
Overview
Radiation oncology is a rewarding clinical specialty that includes hands-on multidisciplinary clinical care of cancer patients and mastery over sophisticated radiation treatment technology. It combines patient-oriented clinical skills with knowledge of the fascinating, ever-changing field of cancer biology, anatomy-based three-dimensional imaging competence and physics-based technical radiation treatment planning skills. Radiation oncology demands the development of competence in general medicine and palliative care, specifically in evidenced-based clinical oncology, it requires a commitment to excellent communication and collaboration skills and it provides an inclusive, supportive and inspiring multidisciplinary practice environment. Radiation oncology allows for a career focusing primarily on clinical practice or for a highly academic career combining practice with education, research and/or cancer control administration.
Radiation oncology training at McMaster University is a five year program, starting in PGY1, and mainly takes place at the Juravinski Hospital and Cancer Centre (JCC) in Hamilton. Clinical experiences also occur at the Hamilton General Hospital, McMaster Children’s Hospital and St. Joseph’s Hospital in Hamilton. Training includes general medical and surgical oncology training, training in diagnostic imaging, pathology, palliative medicine and emergency medicine, as well as extensive training in the evaluation and management of cancers in all body sites and specific radiation treatments related to those cancers. Training includes experience in adult and pediatric oncology. Trainees are required to do some training in a non-teaching Cancer Centre to experience the diversity of practice that exists in this specialty and have the opportunity to complete electives in centres in Ontario, elsewhere in Canada or beyond. Our trainees have completed electives in large and small centres all across Canada, in large US cancer centres, and in Uganda, Australia, Europe and the Middle East. Residents have dedicated training in applied medical physics, radiobiology and research methodology, and are required to complete and present a scholarly project. There are 25 radiation oncologists at the JCC and a large multidisciplinary group of physicians and allied health colleagues who make the atmosphere at McMaster collegial, motivating, inclusive and inspiring.
The Juravinski Cancer Centre houses contemporary radiotherapy technology, including an outpatient high dose-rate brachytherapy suite, a cyberknife unit, computerized tomography (CT) and magnetic resonance (MR)-simulators, an orthovoltage treatment unit, state-of-the-art linear accelerators with contemporary on-board imaging and sophisticated treatment planning technologies. Ours was the second centre in Canada to acquire a cyberknife unit, and our recently installed halcyon units are the first in Canada. Trainees are able to gain experience in all facets of established radiation treatment, as well as evolving technologies and techniques.
Hamilton has well-developed clinical multidisciplinary teams in gynecologic oncology, neuro-oncology, head and neck malignancies, hepatobiliary and gastrointestinal cancers, breast cancers, thoracic cancers, hematologic malignancies, skin cancers and genitourinary cancers, in addition to having one of Ontario’s few specialized sarcoma programs and the McMaster Children’s Hospital specialized pediatric oncology service. The Juravinski Hospital and Cancer Centre has dedicated inpatient and outpatient palliative care programs. Supportive care services at the Juravinski Cancer Centre include a regional genetics program with genetics counselling and testing, as well as social work, mental health and dietician support for patients. The JCC has an Indigenous patient navigator to service patients from the large local Indigenous populations living in Hamilton and within the region. Radiation oncologists at the JCC attend clinics in community hospitals in the region to bring care closer to patients in their own communities. Trainees attend such clinics, as well.
The academic Department of Oncology includes the clinical radiation oncology, medical oncology, malignant hematology and surgical oncology faculty, as well as non-clinical faculty in epidemiology and statistics. The Department of Oncology is very productive and collaborative with respect to clinical oncology research output. Faculty provide education, support, supervision and mentorship to trainees in research methods and the development and completion of scholarly projects.
Depending on research interests, other resources to support scholarship include:
- Supportive Cancer Care Research Unit (SCCRU)
- McMaster’s Department of Health Research Methods, Evidence and Impact (HEI)
- McMaster Education Research, Innovation and Theory (MERIT) Program
- Centre for Health Economics and Policy Analysis (CHEPA)
We are a full member of the Radiation Therapy Oncology Group (RTOG), an affiliate member of the Children’s Oncology Group (COG), an active participant in National Cancer Institute of Canada – Clinical Trials Group (NCIC-CTG) and are home to the Ontario Clinical Oncology Group (OCOG) and the Escarpment Cancer Research Institute (ECRI). The JCC has a large Clinical Trials Department, participating in intergroup trials, industry trials and in-house trials.
Residents are required to provide regular radiation oncology educational seminars to the inpatient Internal Medicine Housestaff, and to present at regular Journal Club meetings, morbidity and mortality rounds, clinical/pathology conferences and multidisciplinary case conferences. Many trainees also commit to longitudinal clinical skills teaching to undergraduate MD students and there are ad hoc opportunities to participate in education to undergraduate elective students. The collaborative atmosphere of the program results in frequent teaching of junior residents by senior trainees, both formally and informally. Many residents have identified opportunities for innovative educational initiatives, which have been adopted into the formal program.
Trainees in this program share a dedicated large, comfortable, bright space with ample computer resources for access to clinical and educational information and radiation treatment planning technology. Residents are financially supported to attend one Canadian Association of Radiation Oncology (CARO) annual scientific meeting and one American Society of Radiation Oncology (ASTRO) meeting during training, plus any North American meetings at which the trainee presents research. Trainees are also supported to attend the national prep course in PGY3, PGY4 and PGY5 to prepare for the Royal College exam and the London contouring boot camp once during training. Recommended physics and radiobiology texts are provided, as well as access to e-anatomy.
Wednesday afternoons are protected for education, which includes a weekly JCC-wide rounds followed by the academic half-day on a variety of relevant topics. Radiation physics is taught in a protected two week basics course in the fall followed by longitudinal sessions throughout the academic year, in the PGY2 and PGY3 years. A physics review week for senior residents is given annually. Radiobiology is taught through the University of Toronto annual radiobiology course in PGY2 and PGY4. An annual in-house written exam and semi-annual OSCE in PGY3, PGY4 and PGY5 help prepare senior residents for the Royal College fellowship exam, and dedicated one-on-one mock oral exams are given by faculty in the months leading up to the fellowship exam. Residents participate in, and lead, regular Journal Club meetings and JCC-wide morbidity and mortality rounds. Most importantly, resident work one-on-one with radiation oncologists throughout the PGY2-PGY5 years, acquiring the skills and knowledge required for a successful career in radiation oncology.
The division of radiation oncology is a collegial, diverse and inclusive group of 25 radiation oncologists who welcome our trainees into the specialty, supporting them educationally and personally through training. Residents each have a faculty mentor available for personal or professional support and additional mentoring relationships develop organically through training. The program director’s door is always open, physically and virtually. McMaster’s postgraduate medical education office has confidential support services for residents and access to a variety of supports to meet the needs of trainees. Most importantly, the resident group in the radiation oncology program creates a welcoming and mutually supportive training environment, supported by the program and the faculty to hold team-building and social events to ensure all residents thrive.
Transition to Discipline (PGY1)
Trainees will spend the first eight weeks of training in the Radiation Oncology Department in various clinical, treatment planning and delivery, and orientation environments.
Foundations (PGY1)
Trainees will spend the remainder of the PGY1 year in foundational training, including 12 weeks in general internal medicine and four weeks in each of thoracic surgical oncology, gynecology surgical oncology, emergency medicine, inpatient and outpatient palliative care, diagnostic imaging, neuro-oncology and inpatient oncology.
Core (PGY2 to PGY5):
Trainees will spend most of this stage of training working one-on-one with JCC radiation oncologists, gaining knowledge, experience and skill in each disease site, plus pediatric radiation oncology. There will also be protected time for focusing on learning the technical aspects of radiotherapy, applied radiation physics and radiobiology, protected time for scholarly work and dedicated clinical experiences in medical oncology, malignant hematology, community radiation oncology and clinical electives outside of the JCC.
Transition to Practice (latter PGY5):
This stage of training will comprise longitudinal clinical experience, practice management, completion of scholarly work and the development of independent decision-making and treatment planning to prepare for fellowship or independent practice.
Key Contacts
Justin Lee
Associate Professor
Interim Director, Radiation Oncology Residency Program
Justin Lee
Associate Professor
Interim Director, Radiation Oncology Residency Program
Justin Lee
Associate Professor
Interim Director, Radiation Oncology Residency Program
Justin Lee
Associate Professor
Interim Director, Radiation Oncology Residency Program
Current Radiation Oncology Residents
Information Box Group
Craig Beers PGY5
Medical School: University of Calgary
Graduation Year: 2019
Why I chose this field: I enjoy the integration of hands-on care for people diagnosed with cancer and medical imaging.
Why I chose McMaster: The residents and staff physicians I met at McMaster seemed genuinely happy to work and study there.
The Best Part about the Program: The collegial learning environment created at the Juravinski Cancer Centre.
My future aspirations: A fulfilling career with a mix of clinical duties, research, and education.
Favourite pastime: I have been an avid martial artist since starting at 7 years old, and I continue to regularly train today.
Stephan Tran PGY5
Medical School: University of Western Ontario, London, ON
Graduation Year: 2019
Why I chose this field: Radiation Oncology has a great mix of patient care and technology. I really enjoy making a difference in people’s lives, being able to talk to them and guide them through their cancer journey as well as getting to use state of the art technology to treat cancer with radiation.
Why I chose McMaster: I chose McMaster because of the people who work here, the standard of education offered by McMaster knowing that the volume of patients that go through the Juravinski Cancer Centre will allow me to see all things that I need to see to become a great radiation oncologist.
The best part about the program at Mac: The best part is the people that I work with. I know that I am well supported by a great group of people who care about each other. I really enjoy Head and Neck, CNS, SBRT and survivorship and hope to continue to learn more and lend my expertise in this field to help patients going forward.
Favourite Pastime: Feel free to talk to me about sports. Will always enjoy a good game, whether with friends or alone. Let’s Go Red Wings!
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Daniel Schep PGY4
Medical School: University of Western Ontario, London, ON
Graduation Year: 2020
Why I chose this field: I love working in oncology because I can help guide patients through a very difficult part of their lives – it is a field that provides a lot of support and time to our patients. We work very closely with many other medical specialties and allied health, so we always feel like we are working in a team, not alone. I chose radiation oncology specifically because it also has a strong focus on anatomy, physics and technology that is exciting and rapidly changing.
Why I chose McMaster: McMaster has such a supportive and friendly group – I know this sounds like a cliché but it is true! Every day I am at work I get to spend with my friends.
Best part about the program at Mac: The program is very flexible and responsive to resident concerns. Every year the program takes suggestions that we have made to change to curriculum to better suit our needs, and rotation scheduling is very flexible to help maximize exposure where you feel it is needed.
Future Aspirations: I hope to be working in an academic centre and find balance between clinical work, education, and scholarly pursuits. In particular, I want to pursue research in communication around end of life and palliative care in oncology.
Fun Fact & Favourite Pastime: When I was growing up, my siblings and I were obsessed with The Simpsons and quotes from that show have irrevocably made their way into my vocabulary. If something I say seems out of place or not quite cromulent, that is probably why. When I was in grad school, I used to compete in Simpsons trivia every week. Also, I like to hike.
Spencer Hu PGY4
Medical School: University of Western Ontario, London, ON
Graduation Year: 2020
Why I chose this field: Radiation Oncology is a unique field that applies technological advances to treat patients throughout their cancer journey, whether it is for treatment for cure or alleviate symptoms. After much search, this specialty was the one field that best combines my love for technology and my passion for longitudinal patient-physician relationships.
Why I chose McMaster: I chose McMaster as it offers the most welcoming environment to pursue my many interests in medicine, including learning the fundamentals to becoming a great radiation oncologist, the opportunities to teach and research, as well as being close to home and support network.
Best part about the program at Mac: The most collegial and collaborative environment with staff physicians, other residents, and other support staff.
Future aspirations: Establishing an excellent practice that serves the needs of the growing patient population.
Favourite Pastime: It’s never too late to find new interests and activities – I’ve solo backpacked and skydived before, and recently started to learn how to ski.
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Rawy Shaaban PGY3
Medical School: Queen’s University, Kingston, ON
Graduation Year: 2021
Why I chose Radiation Oncology: Oncology patients are incredible and our interactions are very rewarding for me whether the treatment is curative or palliative. We also get to work with cutting edge technology and there is lots of variety in our day-to-day duties including clinical, procedural, collaborative, and academic work.
Why I chose McMaster: Proximity to friends and family, very supportive program director and program (resident feedback gets taken seriously and implemented very quickly), diverse city and patient population,
The best part about the program at Mac: The people.
Future aspirations: I envision myself working in a diverse practice that encompasses a broad range of technical applications within radiation oncology, including Stereotactic Body Radiation Therapy (SBRT) and brachytherapy. I anticipate providing care for a wide range of patient populations across all stages of disease.
Favourite hobbies: Cooking & photography.
Isaac Kong PGY3
Medical School: McMaster University (Waterloo Regional Campus)
Graduation Year: 2021
Why I chose Radiation Oncology: Radiation oncology is the best mix of oncology, imaging, and technology. The patient interactions are very rewarding.
Why I chose McMaster: Hamilton is close to family and friends and the program has a good service to learning ratio.
Best part about the program at Mac: We have very supportive staff physicians and a close-knit resident group.
Future Aspirations: I hope to be able to teach and mentor the next generation of medical students and residents.
Favourite Pastime: Cycling, board games, FOOD
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Adam Gabara PGY2
Medical School: Queen’s University, Kingston, ON
Graduation Year: 2022
Why I chose this field: The mix of anatomy knowledge with the technological aspects of Rad Onc was appealing to me, while also having long term relationships with patients, and working within a large team of nurses, radiation therapists/planner, and other specialists to arrange care for the patients.
Why I chose McMaster: Proximity to family and friends, the fun resident culture, supportive program, and getting to cycle in the nearby countryside.
Future Aspirations: Still trying to figure out career goals, but being able to see where AI takes our field is exciting.
Hobbies: Cycling, anything active indoor or outdoor really, reading, checking out new cafes and the food scene in Hamilton (which is absolutely bumping), cheering for McLaren on F1 race weekends!
Francesco Fazzari PGY2
Medical School: University of Ottawa
Graduation Year: 2022
Why I chose Radiation Oncology: I chose McMaster because of the community environment and collegiality in the residency program. In addition, this specialty allows me to actively participate in the care of cancer patients during both the curative and palliative treatments we provide.
My favourite part about McMaster: How supportive the staff and residents are of each other.
Favourite hobbies: Cooking and cycling.
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Libby Ben-Zvi PGY1
Medical School: McGill, Montreal, QC
Graduation Year: 2023
Why I chose this field: As an oncologist, we get to provide impactful care and support in what is often the hardest time in a person’s life. Radiation Oncology provides the added bonus of lots of cool tech! Did you know that the Cyber Knife is an automotive robot?!
Why I chose McMaster: The strong focus on resident learning and wellness.
Future Aspirations: Writing code that streamlines medicine and enhances patient care.
Hobbies: Taking care of my 60+ house plants and going on nature adventures with my dog.
Zuhayr Yakub PGY1
Medical School: Michael DeGroote School of Medicine, McMaster University, Hamilton, ON
Graduation Year: 2023
Why I chose Radiation Oncology: Radiation oncologists are fierce patient advocates, expert communicators, and medical experts who uniquely combine the art of medicine with the science of cancer pathophysiology, medical physics, radiobiology. I really loved the mix of all these factors and spoke to the reason why I wanted to pursue medicine.
Why I chose McMaster: I’ve been in Hamilton since I started undergrad, my family is nearby, and the culture of McMaster is so supportive! I’ve put down roots here and I genuinely think it’s a great place to live and explore.
Best part about the program at Mac: Apart from the people, the best part of Mac’s program is how malleable it is to the needs and desires of residents! Even just in my first year, I had some conversations with other residents about curriculum changes during first and second year that would be helpful (physics and rad bio learning earlier). These ideas and conversations were taken seriously and changes were made for my PGY1 year.
Future Aspirations: In 5 years I will hopefully have passed the Royal College Exam and enjoying my life near a mountain and an ocean (or doing a fellowship).
Something interesting about me: When I was 5 I got asked in school to draw what I wanted to do when I was older. I didn’t know how to draw a firetruck so I drew a stethoscope.