Number of Positions

5 per year

Duration

1 year clinical; 2 year clinical/research available upon request

Site

Toronto Western Hospital, University Health Network

Supervisors

• Dr. Michael Fehlings
• Dr. Stephen Lewis
• Dr. Eric Massicotte
• Dr. Christopher Nielsen
• Dr. Raja Rampersaud

The Toronto Western Hospital Spine Program is a combined Orthopaedic and Neurosurgical program. There are three Orthopaedic and two Neurosurgical trained attending spine surgeons, each with different clinical and research focus. The main areas of research include spinal cord injuries, deformity, education, minimally invasive spine surgery as well as clinical outcomes in all aspects of surgical spine care. We offer Clinical Fellowships to graduates of accredited Orthopaedic or Neurosurgical Residency Programs to pursue further subspecialty training in spinal surgery. Although the Clinical Fellowship Program has a predominantly surgical focus, Fellows are involved in all aspects of patient care.

Spinal fellows will be exposed to a broad scope of adult spine surgery encompassing traumatic and non-traumatic (degenerative, deformity, neoplastic, and infectious) conditions. The Toronto Western Hospital is home to the largest Neurosurgical program in Canada and attracts complex spinal cases of all types of diagnoses. The Toronto Western Hospital is affiliated with the University Health Network which includes Princess Margaret Hospital and the Toronto General Hospital. This attracts complex tumour cases to the Spine program as well as collaboration with other surgical services in complex resections and reconstructions. Up to five fellows per year are accepted and are supervised by five fellowship trained academic spinal surgeons.

Fellowship Objectives

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

Clinical Skills

• Demonstrate the ability to take a relevant history;
• Perform a complete musculoskeletal and neurological examination of the spine;
• Arrive at an appropriate differential diagnosis
• Order and interpret appropriate laboratory, radiological and other diagnostic procedures; Produce an acceptable management plan;
• Display knowledge of and competence in treating surgical and medical complications;
• Provide a plan for patient follow-up.

Technical Skills

• Exhibit proficiency in non-operative management of spinal pain and disability;
• Demonstrate technical competence in surgical decompression and spinal arthrodesis for degenerative, traumatic and neoplastic conditions of the cervical, thoracic ando lumbar spine;
• Show capacity for the correct use of instrumentation for spinal disorders.

Cognitive Knowledge

• Demonstrate a fundamental knowledge and understanding of the incidence, etiology, pathophysiology, natural history, diagnosis, investigation, management, prognosis, and complications of the disease processes affecting the spine;
• Participate in clinical spine research;
• Exhibit skills in the design and implementation of a research project
• Exhibit skills in the critical appraisal of scientific literature specifically in the design, methodology and evaluation of clinical studies.

Length of the Fellowship

The Fellowship Program is usually of twelve months duration commencing in July of one year and ending in June of the following year. The opportunity for a two-year fellowship encompassing both a clinical and fundamental research year is available upon request.

Patient Care Duties

• Fellows are expected to be in attendance at surgery to assist the Surgeon.
• Fellows are to attend the Surgeon’s Outpatient Clinics and the Spine Clinics.
• The Fellows are expected to provide backup and be a resource to the surgical residents-in-training in the management of in-patient spinal consultations and peri-operative patient care.

On-Call Responsibilities

Call at the Toronto Western Hospital is out of house coverage. Fellows are anticipated to contribute towards spine call. Call coverage will not be more than 1:4.

Spine Rounds

Spine rounds are held on a weekly basis in conjunction with the Division of Neurosurgery. Fellow participation and attendance in case/topic presentations are expected. Fellows are invited to attend weekly Spine rounds for the Orthopaedic residents. In addition, the Fellow is encouraged to assist in the preparation of the quarterly meetings of the University of Toronto/Greater Toronto Area spine interest group, and in quarterly Mortality and Morbidity rounds.

University Rounds

Fellows are encouraged to make themselves available for many Divisional educational opportunities offered through the University of Toronto Program.

Teaching

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

Research

As part of their program, Fellows will participate actively in research and academic activities and be expected to complete two research projects during their fellowship year. Research projects will be supervised by one of the surgeons on the spine service. Projects should be formalized during the early part of the Fellowship. All research proposals must be prepared and approved according to defined guidelines. Research opportunities exist in basic science, Epidemiology, and clinical studies. Opportunities exist for fellows that may be interested in a two year combined clinical and research fellowship with a goal towards obtaining a Masters level graduate degree with the University School of Graduate Studies.

Vacation and Meeting Time

Fellows are entitled to four weeks of vacation per year and two weeks to attend academic meetings. All requests for leave must be submitted in writing at least four weeks in advance.

Contact

Christopher J Nielsen MD, FRCSC 
Spine Fellowship DirectorAssistant Professor University of Toronto Staff

Anoushka Singh
Fellowship Coordinator

Send inquiries and application(s) to:
SpineFellowship.Application@uhn.on.ca

Divisions of Orthopaedic and Neurosurgery Combined Spine Fellowship Program

• Sunnybrook Health Sciences Centre
• St. Michael’s Hospital
• Toronto Western Hospital

Overview

Sunnybrook Health Sciences Centre offers a University of Toronto approved Clinical Spine Surgery Fellowship.  A 1 or 2 year experience is offered based on interest and availability. Although based at Sunnybrook, there is opportunity for a combined experience with St. Michael’s Hospital and the Toronto Western Hospital.  Our fellows will work with spine surgeons from both Divisions of Orthopaedic Surgery and Neurosurgery at respective hospitals, including Sunnybrook’s Division of Spine Surgery service activity.  Clinical Fellowships are offered to graduates of accredited Residency Programs to pursue further subspecialty training in spinal surgery.

Although the Clinical Fellowship Program has a predominantly surgical focus, Fellows are involved in all aspects of patient care. Spinal fellows will be exposed to a broad scope of adult and paediatric spine surgery encompassing traumatic and non-traumatic (degenerative, deformity, neoplastic, and infectious) conditions. Up to four fellows per year are accepted.  Fellows will also benefit from academic events and city-wide teaching available through the University of Toronto Department of Spine Surgery.

As a designated Level-I Trauma Centre, spine surgery at the Sunnybrook Campus reflects a complex traumatic spinal focus. Surgery plays a major role in this Fellowship, which includes a total of approximately 600 traumatic and non-traumatic cases per year.  Sunnybrook is also 1 of 2 regional Cancer Centres in Toronto with our Odette Cancer Centre.

Formal Supervisors

• Dr. Joel Finkelstein
  Orthopaedic Surgery, Sunnybrook Hospital
• Dr. Jeremie Larouche
  Orthopaedic Surgery, Sunnybrook Hospital
• Dr. Farhad Pirouzmand
  Neurosurgery, Sunnybrook Hospital
• Dr. Albert Yee
  Orthopaedic Surgery, Sunnybrook Hospital
• Dr. Jetan Badhiwala
  Neurosurgery, Sunnybrook Hospital
• Dr. Leodante da Costa
  Neurosurgery, Sunnybrook Hospital

Fellowship Objectives

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

Clinical Skills

• Demonstrate the ability to take a relevant history;
• Perform a complete musculoskeletal and neurological examination of the spine;
• Arrive at an appropriate differential diagnosis;
• Order and interpret appropriate laboratory, radiological and other diagnostic procedures;
• Produce an acceptable management plan;
• Display knowledge of and competence in treating surgical and medical complications;
• Provide a plan for patient follow-up.

Technical Skills

• Exhibit proficiency in non-operative management of spinal pain and disability;

• Demonstrate technical competence in surgical decompression and spinal arthrodesis for degenerative, traumatic and neoplastic conditions of the cervical, thoracic and lumbar spine;

• Show capacity for the correct use of instrumentation for spinal disorders.

• C1-C2 and occipital-cervical fusions, subaxial cervical decompression and instrumentation

• Anterior and Posterior thoracolumbar decompression and instrumentation

  TLIF;

  Intra and extradural spinal tumours, Chiari decompression and treatment of syringomyelia;

  Spinal vascular lesions.

Cognitive Knowledge

• Demonstrate a fundamental knowledge and understanding of the incidence, etiology, pathophysiology, natural history, diagnosis, investigation, management, prognosis, and complications of the disease processes affecting the spine;
• Participate in clinical orthopaedic research;
• Exhibit skills in the critical appraisal of scientific literature specifically in the design, methodology and evaluation of clinical studies;
• Master the techniques of research a problem developing a research methodology, carrying this through to completion, and demonstrate the ability to express his or her findings in spoken and written form.

Requirements for Appointment

Candidates must have successfully completed an Orthopaedic or Neurosurgical Residency Program in an accepted, accredited Training Program in North America. Foreign fellows are accepted if they have completed comparable Orthopaedic or Neurosurgical training, as determined by the College of Physicians and Surgeons of Ontario.

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 August of one year and ending in July of the following year. Occasionally, six month Fellowships are permitted. The opportunity for a two-year 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 Spine Clinics. For fellows with Orthopaedic training, outpatient clinics may also include fracture clinics, which encompasses both spinal and non-spinal trauma.

The Fellows are expected to provide backup and be a resource to the surgical residents-in-training in the management of in-patient spinal consultations and peri-operative patient care. On call responsibilities will provide back up to residents.  Call coverage is usually 1:3 or 1:4.

Spine Rounds

Combined spine rounds are held on a weekly basis and comprise the Divisions of Orthopedic, Neurosurgery and Spine Surgery (at the Sunnybrook Bayview Campus). Attendance is expected and a topic for presentation may be assigned. While at a specific campus, general Orthopaedic and Neurosurgical Rounds are also 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 spine interest group. At Sunnybrook, Fellows may also be requested to assist in the preparation of spinal topics for hospital based medical and trauma rounds.

University Rounds

Fellows are encouraged to make themselves available for many Orthopaedic and/or Neurosurgical, and city-wide spinal 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. Fellows will participate in a structure two-day Spinal Instrumentation Learning Centre held quarterly.

Research

As part of their program, Fellows will participate actively in research and academic activities. Two half days per week are set aside specifically for clinical or fundamental research. Research projects will be supervised by one of the spine surgeons. The particular project should be formalized during the early part of the Fellowship.

All research proposals must be prepared and approved according to defined guidelines. Research opportunities exist in biomechanics, basic science, Epidemiology, and clinical studies.

Remuneration

Four funded Fellowships of $71,635.24 CDN per annum are available (annual rate is based on University Departmental guidelines which increase on an annual basis so please check with contact below regarding most current salary figure). Unfunded Fellowships are also available. Fellows are responsible for obtaining licensure with the College of Physicians and Surgeons, and liability insurance with the Canadian Medical Protective Association. Please note applicants will be reimbursed the registration fees for these applications upon presentation of receipts. Applicants will also be reimbursed for fees associated with registration with the University of Toronto. Individual billing to OHIP is not permitted. Income derived from surgical assistant’s fees and clinic services will be pooled, distributed as per the Sunnybrook Orthopaedic Associate practice plan including individual overage and that used to support Fellowship Program activities. Partial remuneration will be paid for attendance at a spine meeting where the Fellow is presenting research conducted as part of the Fellowship.

Vacation and Meeting Time

Fellows are granted four weeks vacation per year. The Division will pay your salary during vacation.

One week of Professional leave is given to attend a conference. The Division may pay conference registration, travel, and expenses.

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 as per current University Department process.  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 of Toronto Department of Surgery Spine Program and University Faculty of Medicine Fellowship Certificate.

Contact

For further information on the combined spine fellowship opportunities please contact:

Attn: Ms. Eva Lee, Academic Program Coordinator
The Combined Spine Fellowship Program
Sunnybrook Health Sciences Centre
2075 Bayview Ave., Rm MG 317
Toronto, Ontario M4N 3M5

T: (437) 551-3624
F: (416) 480-5886

E-mail: spinefellowship@sunnybrook.ca