Fellow Policy

University of Toronto
Neurosurgery Residency Program
Fellow Policy 

A vibrant and successful Fellowship program at the University of Toronto is an important component to fulfilling our vision of training the best neurosurgeons and pushing forward the frontiers of neurosurgery. It is recognized, however, that there is the potential for conflicting roles between residents and fellows. The Program expects that all teaching sites will adhere to the following Fellow Policy in order to avoid such conflicts and to allow fellows to achieve their individual objectives while also serving as an overall benefit to resident training.

Selection of Fellows:

•    Each teaching site will be responsible for the recruitment of its own fellows

•    Each teaching site should have at least one designated Fellowship Coordinator

•    It is expected that all fellows will be of high-quality with training that would allow them to function at the level of a newly graduated Canadian-trained neurosurgeon, at minimum

•    The objectives of each fellowship should be made clear and should not conflict with the objectives of residency training

•    All fellows and their contracts must be approved in advance by the site Division Chief, the Chairman of Neurosurgery, and the Neurosurgery Fellowship Program Director, with appropriate input sought from the Residency Program Committee (RPC)

Clinical Activities:

•    Must be outlined in the contract with the specific teaching site and Fellowship Coordinator

•    Generally responsibilities will include:

•    Attend all clinics of primary supervisor

•    Attend OR of primary supervisor

•    Participate in scholarly activities of the division such as paper production, presentations and     teaching.

•    Call Responsibilities

•    May perform first or second call up to 1:4 (or as outlined in contract)

•    Operating Room Activities

•    Residents will have lead in following cases, commensurate with their level of training:
    a.    Burrholes for:
        i.    Biopsy
        ii.    Removal of hematoma
        iii.    Intracranial pressure monitoring
    b.    Supratenotrial Craniotomies for:
        i.    Removal of intracranial hematomas
        ii.    Removal of intrinsic and extrinsic tumors
        iii.    Treatment of intracranial infections
        iv.    Brain Biopsy
        v.    Decompression for Cerebral Swelling
        vi.    Simple Aneurysms
    c.    Infratentorial Craniotomies for:
        i.    Removal of intracranial hematomas
        ii.    Removal of Intrinsic and extrinsic tumors
        iii.    Treatment of intracranial infections
        iv.    Brain Biopsy
        v.    Cerebellar decompression
    d.    Endonasal transsphenoidal surgery
        i.    Simple pituitary adenomas
    e.    Treatment of simple and compound depressed skull fractures
    f.    Carotid endarterectomy
    g.    Spinal decompression and fusion
        i.    Cervical
            1.    Anterior (ACDF)
                a.    Discectomy
                b.    Vertebrectomy
            2.    Posterior
                a.    Laminectomy
                b.    Foramenotomy
                c.    Lateral mass screws
                d.    C1/C2 fusion
        ii.    Thoracic
            1.    Posterior
                a.    Laminectomy
                b.    Posterolateral decompression
                c.    Pedicle screw fixation
        iii.    Lumbosacral
            1.    Posterior
                a.    Discectomy
                b.    Laminectomy
                c.    Posterolateral decompression
                d.    Pedicle screw fixation
    h.    Closed reduction and external immobilization
    i.    Resection of intradural extramedullary spinal tumors
    j.    Peripheral nerve
        i.    Carpal Tunnel decompression
        ii.    Ulnar nerve decompression and transposition
        iii.    Nerve and muscle biopsy
        iv.    Sural nerve harvest
        v.    Resection of simple nerve tumors
    k.    CSF management
        i.    Shunt tap
        ii.    CSF leak repair
        iii.    EVD
        iv.    ETV
    l.    Release of tethered cord
    m.    Skull
        i.    Tumor removal/biopsy
        ii.    Cranioplasty
        iii.    Treatment of simple sagittal synostosis
    n.    Ventricular endoscopy for tumor biopsy or excision
    o.    Cranial nerve disorders
        i.    Microvascular decompression
        ii.    Percutaneous techniques

•    Residents may assist Fellows/Staff in the following cases:
    a.    Supratentorial craniotomies for:
        i.    AVMS
        ii.    Vascular reconstruction and bypass
        iii.    Complex intrinsic and extrinsic tumors
    b.    Infratentorial Craniotomies for:
        i.    Aneurysms
        ii.    Vascular malformations
        iii.    Complex intrinsic and extrinsic Tumors
    c.    Stereotactic and functional Procedures:
        i.    Surgical treatment of epilepsy
        ii.    DBS
        iii.    Spinal stimulation
        iv.    Intrathecal pump insertion
        v.    Selective Dorsal Rhizotomy
    d.    Expanded endonasal skull base approaches
    e.    SRS
    f.    Endovascular procedures
        i.    Carotid stenting
        ii.    Aneurysm/AVM management
        iii.    Tumor embolization
    g.    Spinal decompression and/or fusion
        i.    Cervical
            1.    Anterior
                a.    Transoral
                b.    Odontoid screw
                c.    Multilevel complex reconstruction
            2.    Posterior
                a.    Craniocervical fixation
        ii.    Thoracic
            1.    Anterior Extracavitary
        iii.    Lumbosacral
            1.    Transabdominal or retroperitoneal
        iv.    Vertebral augmentation (kypho/vertebra plasty)
    h.    Spinal cord tumors or vascular malformations
    i.    Complex spinal dysraphic states
    j.    Peripheral nerve
        i.    Brachial Plexus
        ii.    Other nerve entrapments
        iii.    Nerve grafting
        iv.    Complex nerve tumors
        v.    Sympathectomy


•    Minimum salary of $51,000 per year


•    4 weeks of paid holiday per year


•    1 week of Conference leave per year

•    Hospital Division will support up to $2000tod

Licensures and Insurance (not covered by division unless specified)

•    CPSO license

•    CMPA

•    UHIP

•    Consider disability insurance

Conflict Resolution

•    Concerns regarding the role of fellows at any teaching site can be brought forward by any resident, fellow, or faculty 

•    Concerns should first be made to the local teaching site Division Chief, Fellowship Coordinator and Residency Site Director

•    If this does not result  in successful resolution, then the concerns can be brought forward for discussion at the RPC through any of the RPC members

•    Although fellows are not routinely represented on the Neurosurgery RPC, a fellow may chose to present their grievance or defence in writing to the RPC or, at the request of the RPC, in person