Overview

The University of Toronto Foot/Ankle Fellowship Program consists of academic hospitals affiliated with the University of Toronto, and a program director at each hospital with a University of Toronto appointment in the Faculty of Medicine. These hospitals include St. Michael’s hospital, University Health Network – Toronto Western hospital, William Osler Health Care System –Brampton Civic hospital and Scarborough Grace hospital. These Clinical Fellowships are offered to graduates of accredited Residency Programs to pursue further subspecialty training in foot/ankle surgery. Although the Clinical Fellowship Program has a predominantly surgical focus, Fellows are involved in all aspects of patient care. Foot and ankle fellows will be exposed to a broad scope of adult foot and ankle surgery encompassing traumatic and non-traumatic (degenerative, deformity, neoplastic, and infectious) conditions. The fellowship will train 5 fellows (4 clinical and 1 research). Each fellow will rotate through all hospitals comprising of 12 months clinical/research training. Each fellow will rotate through each hospital for 3 months.

The Fellow will have the opportunity to rotate through each hospital, and rotations are generally divided into 3-month intervals.

• University of Toronto Foot/Ankle fellows training will not interfere with medical student and/or resident training. The fellowship committee will help coordinate manpower to ensure that a rotation is adequately balanced between resident and fellow trainees. With the current requested numbers there will be one fellow per staff person at each academic hospital. 
• There will be a minimum of four citywide foot and ankle rounds yearly to promote discussion of interesting cases amongst the academic and community foot and ankle surgeons in the Toronto area.

Supervisors

• Dr. Tim Daniels
  Associate Professor (St. Michael’s hospital)
• Dr. Johnny Lau
  Assistant Professor (University Health network – Toronto Western hospital)

Fellowship Objectives

At the completion of this Fellowship, the trainee will be able to:

A. Cognitive

• Understand the biomechanics of the foot and ankle and how this is related to the overall gait mechanics of the lower extremity.
  Experience in the management of acute trauma of the lower extremity, in particular the foot and ankle.
• Experience in the assessment and management of various foot pathologies. In particular, how to relate the knowledge acquired on gait and foot mechanics to the physical exam.
• Understand the natural development of the foot and to be able to differentiate between normal variations in foot mechanics and those that are pathologic.
• Experience in the evaluation of the neuropathic (diabetic) foot and to understand the stages of managing various problems related to this disease entity.
• Understand the deformities in the forefoot and the importance and application of both conservative and surgical modes of treatment.
• Understand the disease processes, which benefit from surgical management and to become comfortable with the principles, and
• Experience in the interpretation of the radiographs and other investigations pertinent to the foot and ankle.

B. Attitudinal

• Experience in approaching and attending to patients with various foot pathology in both children and adults.
• Learn the skills required to be a successful sub-specialist in foot and ankle surgery and contributing member of a team of physicians, nurses and paramedical personnel providing total foot care.
• Learn the skills required to be a successful provider of foot and ankle expertise and advice to various health professionals.

C. Technical

• Acquire surgical skills for handling and repair of both soft tissues and bone.
• Acquire skills required in correcting foot and ankle deformities and methods by which to obtain reconstructive surgery.
• Acquire arthroscopic skills necessary in the assessment and treatment of foot and ankle pathology.
• Acquire expertise on orthotics, prosthetics and other devices that aid in the conservative and surgical management of foot and ankle pathology.

Job Description

A. Clinical

• Attend the orthopaedic foot and ankle clinics and become competent and autonomous in the evaluation of various foot and ankle pathologies.
• Assist in the pre-operative, intra-operative and post-operative care of the supervisor’s patients.
• Assist in the evaluation of in-patient, outpatient and Emergency Department consults referred to the supervisor.
• Assist in the clinic ward and didactic teaching responsibilities of the Division of Orthopaedics at each hospital.
• Work in a timely fashion with other house staff attending to patients in the Emergency Department.

*** It is clearly understood that none of the above responsibilities will in any way interfere with the Orthopaedic Residency Training Program of the University of Toronto but will, rather, complement and reinforce the teaching of residents. Fellows may often add an international perspective to teaching at each hospital.

B. Research

• Generate a minimum of one clinical research paper and one basic science research paper during the fellowship year. It is expected that these contributions will qualify for presentation at the Canadian and American Orthopaedic meetings. It is also expected that they will be submitted for publication in peer-reviewed journal(s).

Requirements for Appointment

• Candidates must have successfully completed an Orthopaedic Residency Program in an accepted, accredited Training Program in North America. Foreign fellows are accepted if they have completed comparable Orthopaedic training, as determined by the College of Physicians and Surgeons of Ontario.
• The Attending Surgeon (s) of the foot and ankle service, the Heads of the Divisions of Orthopaedic Surgery, the hospital surgeon-in-chief, and the University divisional fellowship coordinator, must approve candidates.
• All Fellows must be approved by the University of Toronto and must qualify for licensure with the College of Physicians and Surgeons of Ontario. Foreign Fellows will require a work visa. This will be processed by the University of Toronto and requires at least six months lead-time.
• Foreign Fellows must provide evidence that their medical training was completed in English or must successfully pass the TOEFL with a minimum overall score of 93, as well as a minimum score of 24 on the speaking portion.

Length of Fellowship

The Fellowship Program is usually of twelve months duration commencing in July of one year and ending in June of the following year. Occasionally, six month Fellowships are permitted. The opportunity for a two-year masters or PhD research fellowship encompassing both a clinical and fundamental research year is available upon request.

Duties

Patient Care

• Fellows are expected to be in attendance at surgery to assist the Surgeon.
• Fellows are to attend the Surgeon’s Outpatient Clinics, inpatient wards and the Foot and Ankle Clinics.
  Outpatient clinics will also include fracture clinics, which encompass foot and ankle and community-level trauma.
• The Fellows are expected to provide backup and be a resource to the surgical residents-in-training in the management of in-patient consultations and peri-operative patient care.

On-Call Responsibilities

Fellows are anticipated to contribute towards both call and general Orthopaedic trauma call. Call coverage will not be more than 1:4.

Foot and Ankle Rounds

While at a specific campus, general Orthopaedic Rounds are held weekly and again attendance is encouraged. The Fellow is to assist in the preparation of the quarterly meetings of the University of Toronto/Greater Toronto Area foot and ankle interest group. Fellows may also be requested to assist the in preparation of topics for hospital based medical and trauma rounds.

University Rounds

Fellows are encouraged to make themselves available for many Orthopaedic, and city-wide foot/ankle surgical educational opportunities offered through the University of Toronto.

Teaching

Fellows participate in the educational endeavours throughout the rotation. They are expected to participate in the teaching activities for medical students, residents and allied health professionals.

Research

Generate a minimum of one clinical research paper and one basic science research paper during the fellowship year. It is expected that these contributions will qualify for presentation at the Canadian and American Orthopaedic meetings. It is also expected that they will be submitted for publication in peer-reviewed journal(s).

Remuneration

Canadian Fellows will be self funded through assist fees and call fees billed to OHIP. Furthermore, the billing fellows will contribute 25% of total billings to the Academic Enrichment Funds of St. Michael’s Hospital and UHN – Toronto Western Division. For Foreign trained fellows that do not have OHIP billing numbers, the University of Toronto Foot/Ankle Fellowship Program will guarantee a minimum salary of the PARO PGY1 rate for the year attending.

Vacation and Meeting Time

Fellows are granted four weeks vacation per year. One week of Professional leave is given to attend a conference. The Division may reimburse academic conference/registration fees as well as travel/hotel expenses up to $1,500 maximum.

ALL REQUESTS FOR LEAVE MUST BE SUBMITTED IN WRITING AT LEAST FOUR WEEKS IN ADVANCE.

Program Evaluation

An in-training evaluation will be undertaken by the Supervisor for each Fellow every six months and on completion of their program. Fellows also need to complete an evaluation of their Supervisor. Upon successful evaluation and program completion, fellows will receive a hospital-based certificate of completion and be eligible for a University Faculty of Medicine fellowship certificate.

Further Information

For further information on any of this University of Toronto Foot/Ankle Fellowship opportunity, please contact:

orthofellowships@uhn.ca