McMaster Combined Spine Surgery fellowship

OVERVIEW OF PROGRAM

The Combined Spine Program, Divisions of Neurosurgery and Orthopaedic Surgery, at McMaster University offers a one-year Clinical Fellowships to graduates of accredited Residency Programs to pursue further subspecialty training in spinal surgery. The fellowship is based at the Hamilton General Hospital (HGH) site of Hamilton Health Sciences (HHS) which is a busy academic tertiary center for Neurosciences serving a catchment population of over 2.75 million Ontarians.

 

Institution

Hamilton Health Science Centre

237 Barton St. East

Hamilton, Ontario, Canada

L8L 2X2

Division of Neurosurgery

Division of Orthopaedic Surgery

Departments:

Aleksa Cenic, MD MSc FRCSC and Mark Pahuta, MD PhD FRCSC

Directors:

Overview:

Number of Positions: 2 per year
Duration: 1 year

Percentage of Fellowship devoted to Operative Care: 60%
Non-Operative Care: 40%
* Research/Publication Obligation: Yes

Approximate percentage of Fellowship exposure to the Spine by region:
Cervical: 33%
Thoracic: 33%
Lumbar: 34% >

Approximate percentage of Fellowship exposure to the Spine by diagnostic category:
Degenerative: 45%
 Trauma: 25%
Deformity: 10%
 Tumor: 20%

*Annual surgical volume: >1000 cases

Requirements:

 

Candidates must have successfully completed an Orthopaedic or Neurosurgical residency and qualify for licensure with the College of Physicians and Surgeons of Ontario.

 

All Fellows must be approved by McMaster University. Foreign Fellows will require a work visa. This will be processed by McMaster University and requires at least six months lead-time.

Fellowship applications must be processed through the McMaster University Department of Post Graduate Medical Education.

Application:

Objectives:

Fellows will master, in an incremental fashion, the cognitive and technical skills required to treat patients with the full spectrum of spinal disorders. The Fellowship is designed to refine skills gained during residency.

Fellows may choose to pursue electives in

  1. Minimal invasive surgery,

  2. Adult spinal deformity,

  3. Trauma,

  4. Oncology, and (v) paediatric spine & scoliosis.

The fellowship follows a preceptor model. The expectation is that fellows will attend two ORs per week and attend one clinic per week. Two half-days per week will be dedicated to research.

Six months of the Fellowship will be spent on the Neurosurgical spine service and six months will be spent on the Orthopaedic spine service.

Schedule:

Local faculty will provide a cadaveric “crash course” on spinal techniques in the first two months of the fellowship year.

Skills Lab:

Fellows will participate actively in research and academic activities and will be expected to complete two research projects during their fellowship year resulting in publication. 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. Research opportunities exist in basic science, epidemiology, and clinical studies.

 It is expected that the Fellow will present a project at the Annual Neurosurgery and Orthopaedics Visiting Professor Days and/or Research Day during the fellowship year. Fellows are expected to, and will be supported to, present at least at one national conference such as the Canadian Spine Society.

Opportunities exists for fellows that may be interested in a two (2) year combined clinical and research fellowship with a goal towards obtaining a Masters level graduate degree in the Health Research Methodology Program through the Faculty of Health Sciences at McMaster University.

Research Activities:

DUTIES

Fellows are in the OR twice per week. They will have the opportunity to share their knowledge and experience with staff and residents, in addition to gaining new knowledge and surgical skills.

Fellows attend clinic once per week. Clinic serves as a great resource for learning about both spine pathology and practice management. The fellows will be expected to help train residents in a clinic setting.

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.

Fellows may cover first call in conjunction with the other clinical fellows during the weekly academic resident teaching sessions. This may include 08:00-17:00 0n any day where there are full academic activities/conferences.

Patient Care:

Fellows are expected to take dedicated spine call. Responsibilities include:

  • Coordinating urgent OR cases and attending the OR

  • CritiCall Ontario phone consultations from physicians at peripheral hospitals requesting patient transfers for escalation of care

  • Supervising residents who are responsible for covering the wards and seeing consults

On Call Responsibilities:

Indication rounds are held on a weekly basis with members of the Divisions of Neurosurgery and Orthopedics. Attendance and participation is expected and a topic for presentation may be assigned.  

Resident teaching rounds are held on a weekly basis. Fellows will share in teaching responsibilities with the attending surgeons.

Journal clubs will be held six timers per year. Fellows will be responsible for organizing and moderating these meetings.

Fellow maybe requested to present at Grand Neurosciences or Orthopaedics Rounds.

Academics:

Fellows will take the role of junior staff. Fellows will coordinate inpatient care, in collaboration with residents, to ensure that patients are seen daily and that daily notes and orders are done according to patients’ clinical needs. Fellows will support residents in the management of emergency cases, emergency consults, and first line screening clinics.

Supervisory Responsibilities:

There will be regular feedback on performance every three (3) months; this will be done formally through Websis and one-on-one discussion.  The Fellow will have an opportunity to discuss their experience as well.  This will also be used as an opportunity for career counseling.

 Evaluation will be based upon the three performance parameters and will be done in a consultative manner with all of the faculty members:

  • Clinical Ability

  • Academics/Teaching

  • Research Progress

Performance Evaluations:

Remuneration will consist of a minimum of $50,000 annually.  This amount will be funded through your clinical earnings processed through Regional Medical Associates (RMA) if you have OHIP billing capabilities. Gross clinical earnings will be tithed by 30%; remaining clinical earnings, after deducting base salary, RMA fees, and Administrative fee, will be paid to you as self-employment (T4A) earnings; T4A earnings are also subject to taxes and fringe.

 

If the Fellow cannot acquire remuneration through Surgical Assist Billings, then he/she MUST secure their own funding (e.g., government or institution -sponsored from country of origin) with respect to his/her annual salary as a Clinical/Academic Fellow.

 

Fellows are responsible to cover the costs of CMPA membership, CPSO dues, trainee registration fees, RMA fees, McMaster University fees, and all other ancillary costs pertaining to the performance of the clinical Fellowship.

REMUNERATION:

Salary is inclusive of 4 weeks’ paid vacation per academic year (July – June) or a pro-rated equivalent for any part of your appointment that is less 12 months. All requests for leave must be submitted in writing at least four weeks in advance.

VACATION AND MEETING TIME:

APPENDIX 1: FELLOWSHIP OBJECTIVES

Contact

Please contact Vanessa Kastrati (kastratv@mcmaster.ca) for information and procedure of applications.