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Division of Orthopaedics

Orthopaedics at the U of T has a long tradition of developing innovative treatment approaches, performing research of the highest quality, developing new education programs, and providing clinical care of the highest quality possible. We are leaders in the field, and our faculty members play leadership roles nationally, and internationally. Read more »

Division Chairs for Orthopaedics - University of Toronto Orthopaedic Chairs 1976 - Today.
From left to right - Ben Alman (2006-Today), James Waddell (1996-2006), Robert Salter (1976-1986), Allan Gross (1986-1996).

Sunnybrook - Saint Michael's - Sick Kids

SUNNYBROOK HEALTH SCIENCES CENTRE
ST. MICHAEL’S HOSPITAL
HOSPITAL FOR SICK CHILDREN

DIVISIONS OF ORTHOPAEDIC AND NEUROSURGERY
Combined Spine Fellowship Program

OVERVIEW
The Combined Spine Program, Divisions of Orthopaedic and Neurosurgery, Sunnybrook Health Sciences Centre, Divisions of Orthopaedic Surgery and Neurosurgery, St. Michael’s Hospital and the Division of Orthopaedic Surgery, The Hospital for Sick Children offers Clinical Fellowships 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.

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.

St. Michael’s Hospital is also a designated Level-I Trauma Centre and includes a total of approximately 500 instrumented spine cases per year. The Division of Neurosurgery at St. Michael’s Hospital is the most active in Canada, performing procedures in cerebrovascular, neuro-oncology, skull base, pituitary, spinal, peripheral nerve, microvascular, trauma and cranial nerves.

The Division of Orthopaedic Surgery at The Hospital for Sick Children offers advanced training paediatric spinal deformities. This fellowship provides comprehensive training the surgical and conservative treatment of pediatric spinal disorders, encompassing a broad range of cases from the standard to the most complex deformities.

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

SUPERVISORS
Dr. Leo da Costa (Neurosurgery, Sunnybrook Hospital)
Dr. Mahmood Fazl (Neurosurgery, Sunnybrook Hospital)
Dr. Joel Finkelstein (Orthopaedic Surgery, Sunnybrook Hospital)
Dr. Michael Ford (Orthopaedic Surgery, Sunnybrook Hospital)
Dr. Todd Mainprize (Neurosurgery, Sunnybrook Hospital)
Dr. Farhad Pirouzmand (Neurosurgery, Sunnybrook Hospital)
Dr. Michael Schwartz (Neurosurgery, Sunnybrook Hospital)
Dr. Albert Yee (Orthopaedic Surgery, Sunnybrook Hospital)
Dr. Henry Ahn (St. Michael’s Hospital)
Dr. Howard Ginsberg (St. Michael’s Hospital)
Dr. Steve Lewis (Hospital for Sick Children)

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.
• Odontoid screws and occipital-cervical fusions
• Retropleural/retroperitoneal/transthoracic spine exposure, decompression and fusion with anterior plates, strut grafts, posterior pedicle screws
• 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 TOEFLibt 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 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
Fellows with Orthopaedic training are anticipated to contribute towards both spinal call and general Orthopaedic trauma call. Fellows with Neurosurgical training are anticipated to contribute towards spinal call and general Neurosurgical call. Call coverage will not be more than 1:4.

Spine Rounds
Combined spine rounds are held on a weekly basis and comprise the Divisions of Orthopedic and Neurosurgery (at the SB Campus). Attendance is expected and a topic for presentation may be assigned. While at a specific campus, general Orthopaedic and Neurosurgical 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 spine interest group. At the Sunnybrook Campus, Fellows may also be requested to assist the in 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 surgeons on the spine service. 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 $51,065.00 CDN per annum are available. 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 and used to support the Fellowship Program. 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. 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.

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

Attn: Ms. Carolyn Gimera, Administrative Coordinator
The Combined Spine Program, Divisions of Orthopaedic and Neurosurgery
Sunnybrook Health Sciences Centre
2075 Bayview Ave., Rm MG 317
Toronto, Ontario M4N 3M5
T: (416) 480-4884 F: (416) 480-5886
E-mail: carolyn.gimera@sunnybrook.ca