Citywide Spine Fellowship Program

The University of Toronto Spine Program offers  a combined (neurosurgery and Orthopaedic surgery) clinical citywide spine fellowship program supervised by our spine faculty (surgeons) through its affiliated hospitals (Toronto Western Hospital, Sunnybrook Health Sciences Centre, St. Michael's Hospital and Hospital for Sick Children/SickKids Hospital). The program also offers a spine research fellowship supervised by our spine faculty (surgeon scientists) at the affiliated spine research programs/units.

Vision:  To provide the future generation of spine surgeons the best exposure to academic spine surgery and research at U of T and its fully affiliated citywide hospitals

Mission:  To facilitate the coordination of citywide fellowship program activities providing fellows the best opportunity to benefit from both university and hospital based educational resources.

Model: The U of T Department of Surgery & its fully affiliated citywide hospitals will offer fellowship opportunities that align with one of two primary objectives:

1. General fellowship year with focus on the spectrum of adult spine disorders

2. Specialized fellowship year with subspecialty focus on:

• paediatrics
• adult trauma
• adult spine deformity
• adult spine oncology
• adult MIS surgery
• adult chronic pain
• complex cervical
• complex Intradural spine pathology

3. Two year fellowship (1 adult general year, 2nd year subspecialty)

4. Research fellowship year(s) for fellows interested in pursuing graduate degree as postdoctoral research fellows in basic, translational or clinical research

For general fellowships – fellows will continue to apply to a primary hospital base.

• Toronto Western Hospital - University Health Network (TWH- UHN)
• Sunnybrook Health Sciences Centre (SHSC)
• Saint Michaels's Hospital - Unity Health Toronto (SMH - UHT)
• Hospital for Sick Children (HSC)

The U of T Spine Program & the affiliated hospitals continue to coordinate elective/selective rotations for sub-specialties inc: Oncology, Minimal Invasive Spine Surgery (MIS), Deformity, Trauma, Complex cervical, Complex Intradural spine pathology, and Paeds.

The nationally based fellowship curriculum (Larouche et al 2015) is  the model used for guiding fellowships – ‘general curriculum’ for general fellowship competencies with ‘advanced competencies’ guiding specialty fellowships.  Fellows will be offered educational opportunities at the university level and hospital level. Offerings including Surgical Skills Course, Journal Club, Hospital-Based Visiting Professorships, Hospital Rounds, Case-based Discussion Forums, and Research activities

Dr. Yee and Dr. Jeremie Larouche spearheaded the development of a new national competency-based spine fellowship training syllabus containing a general, advanced focus, and paediatric curricula through our key national spine society, the Canadian Spine Society (CSS). The curricula developed high level learning objectives and competency-based cognitive and procedural standards of training expectations for spine surgery in Canada. Several academic manuscripts have arisen further disseminating this initiative with publications in important journals in the field of spine surgery: Spine (Malempati et al., 2013), (Larouche et al., 2016), the European Spine Journal (Kumaria et al., 2019) and the Global Spine Journal (Bateman et al., 2019).

Link to Binder

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 and 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

Spine Fellowship Director

Christopher J Nielsen MD, FRCSC
 

Fellowship Coordinator

Anoushka Singh

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

UHN Spine Fellowship Application - fillable PDF.pdf

Sunnybrook Health Sciences Centre
St. Michael's Hospital
Hospital for Sick Children (SickKids)


Overview: 
The Spine fellowship Programs at Sunnybrook Health Sciences Centre, St. Michael’s Hospital, and SickKids offer 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. Spine 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 at each of Sunnybrook and St Michaels, and 1 fellow at SickKids.

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 in 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 the four hospitals,  and rotations are generally divided into 3-month intervals.

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.
• 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 $71.635.24 CDN per annum are available. Fellows are responsible for obtaining licensure with the College of Physicians and Surgeons, and liability insurance with the Canadian Medical Protective Association. 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 Meetings 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.

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

Attn: Ms. Eva Lee, Academic Program Coordinator
The Combined Spine 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

The University of Toronto has  established a case-log for citywide spine fellows to log their surgical activities.

Log your cases HERE

Case log Tutorial 

Current Fellows:

• Maria Pia Monjardino - Portugal
• Motti Zucker - Israel
• Rajesh Kumar - Pakistan
• Luke Reda - Canada
• Colton Kennedy - Canada
• Aditya Raj - India (extension)
• Ariel Zohar - Israel
• Prarthan Amin - India
• Peyton Lawrence - West Indies
• Yousef Al-Jamaan - Saudi Arabia
• Francois Dantas - Brazil
• Karlo Pedro - Philippines
• Hiroyuki Kato - Japan
• Fahad Alotaibi - Saudi Arabia
• Zsolt Zador - Canada
• Shun Hayasaka

2022/2023

• Doron Edelman - Israel
• Fahmi Abduljalil - Australia
• Shadi Hayek - Israel
• Fabio von Faber-Castell - Switzerland
• Mohammad Alshardan - Saudi Arabia
• Jay Toor - Canada
• Ali Eren - Turky
• Rajesh Kumar - Pakistan
• Motti Zucker - Israel
• Ahmed Cherry - Canada
• Nisaharan Srikandarajah - United Kingdom
• Ragavan Manoharan - Australia
• Aditya Raj - India
• Mark Chu Xu - Canada
• Rajendra Sakhrekar - India

2021/2022

• Carlo Iorio - Italy
• Johann Hofereiter – Germany
• Martin Gagliardi - Argentina
• Sho Akahori – Japan
• Hasaan Chaudhry – Canada
• James Wu – Canada
• Nader Hejrati – Switzerland
• Karlo Pedro - Philippines 
• Nasser Alenezi - Saudi Arabia
• Ohad Einav - Israel  
• Doron Edelman - Israel
• Fahmi Abduljalil - Australia

2020/2021

• Eric Crawford - Canada
• Hari Ramakonar - Australia
• Nandan Marathe - India
• Brett Rocos - United Kingdom
• Dora Pelletier - Canada
• Hananel  Shear Yashuv - Israel
• Jeremie Nallet - France
• Julia Bowes - Canada
• Einav Ohad - Israel
• Isaac Aguirre Carreno - Mexico
• Laura-Nanna Lohkamp - Germany
• Manuel Fuetsch - Germany
• Peter Proemmel - Switzerland
• Dhawi Al-Otaibi - Saudi Arabia
• Kelechi Eseonu - United Kingdom

2019/2020

• Carolyn Lai - Canada
• Tan Chen - Canada
• Dora Pelletier - Canada
• Isaac Aguirre Carreno - Mexico
• Kaoru Eguchi  - Japan
• Kunal Bhanot - Canada
• Brett Rocos - United Kingdom
• Allan Martin - Canada
• Colby Oitment - Canada
• Anna Reinmuller - Austria
• Thorsten Jentzsch - Switzerland
• Hananel  Shear Yashuv - Israel

2018/2019     

• Rami Khalaf  Alshamrani - Saudi Arabia
•  Alexander Romagna - Italy
•  Anastasios Charalampidis - Sweden
•  Pratipal Singh Kalsi - United Kingdom
•  Francis Gerard Lyons - Ireland
•  Vasudev Hannant Navalgund - Australia
•  Christopher Alfred Small - Canada
•  Jamie Russell Wilson - United Kingdom
•  Wu  Pang Hung - Singapore
•  Hananel Yashuv - Israel
• Michel Schneider - Switzeland
• Fan Jiang - Canada

2017/2018     

• Jean-Christophe Murray - Canada
• Mohammed Obeidat - Jordan
• Dror Ofir - Israel
• Zachary Tan - Canada
• Stephanie de Vere - Canada
• Mario Ganau - United Kingdom
• Robert Ravinsky - Canada
• Vinay Kulkarni - Australia
• Christopher Nielsen - Canada
• Fan Jiang - Canada
• Ralph Schaer - Switzerland
• Jamie Wislon - Canada

2016/2017     

• Amit Keren - Israel
• Jean Christophe Murray - Canada
• Mohammed Obeidat - Jordan
• So Kato - Japan
• Kyle Stampe - Canada
• Gary Rosenberg - USA
• Dror Ofir - Israel
• Shoichi Haimoto - Japan
• Amit Sigal - Israel
• Yi Yang - Australia

2015/2016     

• David Bellut - Switzerland
• Kachinga Sichizia - Zambia
• Mohammad Zarrabian - Canada
• Amit Keren - Israel
• So Kato - Japan
• Mohammed Safraz - Trinidad
• Cliff Lin - Canada
• Mark Pahuta - Canada
• Mark Kotter - United Kingdom
• Carlo Santaguida - Canada
• Michael Dodds - Irland
• Kevin Koo - Canada
• Nizar Moayer - Netherlands