PDF version available here:听AONA Spine Fellowship 2018

Overview of Program Information:听

The 91社区 Spine Fellowship offers a one year fellowship covering all aspects of spinal surgery. The candidates will spend one year training with the spine surgeons across the integrated spine service at 91社区. Fellows will meet before the beginning of the fellowship with the fellowship director and tailor their spinal fellowship based on their expectation and needs. The fellowship has a subspecialty training in which the fellows will choose to spend allotted blocks. The subspecialty training consists of 1) Minimal Invasive surgery focused at JGH, MNI 2) Adult Spinal Deformity at the MGH 3) Paediatric spinal & Scoliosis Surgery 4) Spinal Trauma and Spinal Oncology.

The 91社区 Spine Fellowship has also the possibility of offering a two year fellowship focused on Scoliosis surgery & Spinal Research. This two year fellowship can be a modified by combining a year focused on one of the spine subspecialty (trauma, MIS, Spinal Oncology) and a year focus on research.

Training distribution for the one year fellowship is expected to be divided and carried out as listed below:

• Montreal General Hospital (MGH): 25%
• Montreal Children Hospital (MCH) / Shriners Hospital: 25%
• Montreal Neurological Institute: 25%
• Jewish General Hospital: 25%

Training distribution for the two year fellowship, as an example - focused on Scoliosis is expected to be divided and carried out as listed below:

• Montreal Children Hospital (MCH) / Shriners Hospital: 50.0%
• Other sites: 50%

With 12 months working in one of the spine labs or clinical research units currently funded at 91社区.

听

91社区 Spine Fellowship

Objectives of the 91社区 Spine Fellowship

Trainees should master, in an incremental fashion over a 12 month period, the fundamentals sciences and the clinical and therapeutic knowledge required to treat patients with varying spinal disorders.

By spinal disorders we specifically expect the trainees to be able to initiate conservative management, assess if treatment is successful, and if not proceed, to surgical management for all the following pathologies:

1. Fractures: Occipital cervical, cervical, thoracic, lumbar, and sacral fracture with or without dislocation
2. Spinal deformities: Acquired or congenital of the scoliotic or kyphotic type: Spondy / lolysis / listhesis / loptosis
3. Degenerative disc disease: Cervical, thoracic, lumbar disc herniations, cervical or lumbar spinal stenosis
4. Spinal infections
5. Spinal tumors

The second role of the trainees is to supplement educational and research endeavors at 91社区. This includes teaching the residents basic science and clinical knowledge as well as surgical skills via daily clinical activities, daily OR, weekly spine rounds, and formal quarterly didactic talks. Trainees are expected to complete a research project, either clinical or basic science in our spine lab, which must lead to a publication.

Basic scientific knowledge to be acquired:

1. Detailed knowledge of anatomy, embryology and physiology of the spine
2. Congenital, developmental and acquired non-traumatic conditions of the spinal column
3. Musculo-skeletal anatomy of cervical, thoracic and lumbar spine, osseous ligamentous and neural elements including intervertebral disc morphology
4. Biomechanical and functional anatomy of the spine
5. Natural degeneration of the spine
6. Systemic inflammatory illness affecting the spine

Basic clinical knowledge:

1. Appreciation of classification (discal, degenerative disorders, mechanical instabilities, spinal deformities)
2. Display knowledge of appropriate investigative techniques
3. Interpretation of advanced investigative techniques:

• Computerized axial tomography
• CT myelography
• Magnetic resonance imaging

4. Display a detailed knowledge of operative approaches to the spinal column

History & physical examination:

1. Display clinical competence in the evaluation of spinal disorders:

• Relevant history taking to all spinal disorders

• Relevant physical exam assessing for spinal deformity and spinal instability

• Relevant neurological exam

This factor judges whether or not a trainee takes a complete medical history and performs an adequate physical examination to permit a valid formulation of the patient鈥檚 problem. The factor should also judge whether or not the information elicited and observed is recorded in an organized and sequential manner which permits a clear definition of the problem and a rational approach to differential diagnosis and management.

Interpretation and utilization of information:

1. Display competence in the non-operative management of spinal disorders
2. Display adequate knowledge in advanced non-operative management of spinal disorders, bracing techniques and physiotherapy
3. Appreciate indications for surgery for spinal disorders
4. Understand the principles of fusion levels in spinal deformity with their implication regarding complications and natural history
5. Recognize and manage postoperative complications
6. Recognize and evaluate vertebral sepsis: Osteomyelitis, discitis

These factors judge the trainee鈥檚 ability to effectively and efficiently establish a program of investigation and management adapted to the patient鈥檚 condition, all the while recognizing the limits of his/her ability, the hazards of drugs and other therapy and the need to modify therapy when indicated. The trainee should also demonstrate his/her appreciation for the total needs of the patient, recognizing factors that may limit compliance with prescribed therapy, as well as the non-medical (socio-economic and other) factors that may affect the patient鈥檚 health.

Clinical judgment & decision making:

1. Display competence in the non operative management of spinal disorders.
2. Display adequate knowledge in advanced non operative management of spinal disorders - bracing techniques, physiotherapy
3. Appreciate indications for surgery for spinal disorders
4. Understand principle of fusion levels in spinal deformity with their implication regarding complications, and natural history
5. Recognize and manage postoperative complications.
6. Recognize and evaluate vertebral sepsis: Osteomyelitis, Discitis.

Fellows are expected to apply their knowledge to make surgical decisions pending the clinical presentations for all the conditions mentioned above.

This factor judges the trainee鈥檚 ability to effectively and efficiently establish a program of investigation and management adapted to the patient鈥檚 condition, recognizing the limits of his/her ability, the hazards of drugs and other therapy and the need to modify therapy when indicated. The trainee should also demonstrate his/her appreciation for the total needs of the patient, recognizing factors that may limit compliance with prescribed therapy and the non-medical (socio-economic and other) factors that may affect the patient鈥檚 health.

Technical skills required in the specialty:听

1. Display surgical competence in the following areas:

• Laminectomy; lumbar fusion techniques - anterior versus posterior; discectomy - cervical, thoracic and lumbar; foraminotomy; spinal tumor debulking

2. Display surgical competence in complex spinal instrumentation:

• Transpedicular vertebral fixation; application of spinal hooks;
• Anterior and posterior vertebral instrumentation for the cervical, thoracic and lumbar spine (either with plates, screws, or rods); different pelvic fixations; interbody spacers, as well as vertebral body replacements

3. Display a detailed knowledge of the principles of internal fixation with regards to:

• Indications
• Complications
• Contraindications
• Limitations

These factors judge if the trainee can carry out professional techniques correctly and efficiently.

Inter-professional relationships with physicians:

This factor judges if the trainee can work effectively with other physicians in the healthcare team. It demonstrates if there is consideration respect and tact for junior members of the team.

Communications with other allied health professionals:

This factor judges the trainee鈥檚 ability to communicate and work effectively with the other members of the healthcare team.

Communications with patients:

This factor judges if the trainee is able to communicate easily with patients. It also demonstrates whether he/she shows respect for his/her patients and they can gain their patient鈥檚 cooperation and confidence.

Communications with families:

This factor judges if the trainee is able to communicate easily with patient鈥檚 families. It also demonstrates if he/she shows respect for his/her patient鈥檚 families and if they can gain the family鈥檚 cooperation and confidence.

Written communication and documentation:

This factor demonstrates if history, physical, diagnostic formulation, progress notes, plans, discharge summaries and consultation reports are complete and accurate with satisfactory organization and assessment.

Evaluation of Collaboration & Delegation Skills

Collaboration skills:
This factor demonstrates if the trainee interacts and consults effectively with all health professionals by recognizing and acknowledging their roles and expertise.

Delegation Abilities:
This factor judges that the trainee delegates effectively to other members of the healthcare team.

Evaluation of Management Skills:

Understands and uses information technology:
This factor judges if the trainee is able to use current information technology in the course of their professional life.

Uses health care resources cost-effectively:
This factor judges that the trainee has concern for the cost of unnecessary investigation and is sensitive to patient inconvenience and discomfort in the course of their professional duties.

Organization of work and time management:
This factor judges whether or not the trainee effectively organizes his/her work in such a way that priorities are established and that coordination occurs with the other members of the team ensuring total, acute, and continuing care of his/her patients.

Uses health care resources cost-effectively:
This factor judges that the trainee has concern for the cost of unnecessary investigation and is sensitive to patient inconvenience and discomfort in the course of their professional duties.

Organization of work and time management:
This factor judges whether or not the trainee effectively organizes his/her work in such a way that priorities are established and that coordination occurs with the other members of the team ensuring total, acute, and continuing care of his/her patients.

Health advocate

Advocates for the patient:
This factor judges the trainee鈥檚 ability to advocate for the patient.

Advocates for the community:
This factor judges the trainee鈥檚 ability to advocate for society and the community.

Scholar

Motivation to read and learn:
This factor judges the trainee鈥檚 knowledge of current scientific literature and his//her application of this knowledge of case presentation and daily patient management.

Critically appraises medical literature:
This factor judges the trainee鈥檚 ability to critically appraise research methodology and medical literature.

Teaching skills:
This factor judges whether the trainee takes the initiative and develops the ability to teach other health care professionals and/or patients about specific relevant health care issues.

Completion of research/project:
This factor judges that the trainee is able to organize and complete successfully a research study or a project.

Professionalism

Integrity & honesty:
This factor judges whether the trainee is dependable, reliable, honest and forthright in all information and facts.

Sensitivity & respect for diversity:
This factor judges that the trainee is able to understand and be sensitive to issues related to age, gender, culture and ethnicity.

Responsible and self-disciplined:
This factor judges whether the trainee adequately accepts professional responsibilities, placing the needs of the patients before the trainee鈥檚 own, ensuring that the trainee or his/her replacement are at all times available to the patients, recognizing the limits of competence, and seeking and giving assistance when necessary. The trainee is punctual, and respects local regulations relating to the performance of his/her duties.

Communicates with patients with compassion and empathy:
This factor judges whether the trainee is compassionate and empathetic towards the patient and their family.

Recognition of own limitations and seeks advice when needed:
This factor judges that the trainee is aware of his/her limits of competence, and is able to seek and give assistance when necessary.

Understands principles of ethics and applies them to clinical situations:
This factor judges the trainee鈥檚 ability to understand the principles and practice of biomedical ethics as it relates to the specific specialty or subspecialty, and to practice medicine in an ethically responsible manner.

Global evaluation of competence and progress

As per the 91社区 Faculty of Medicine鈥檚 guidelines, the Fellows must receive a formal [i.e. written] evaluation after 8 weeks (2 blocks) on a rotation. If a Fellow is doing a 4 block rotation, this means the Fellow will receive 2 formal evaluations, each bearing a Global Evaluation. Each evaluation will cover an 8 week period, and each is considered separate for promotions rules. If a Fellow is doing a 3 block rotation, the Fellow will receive 2 formal evaluations 鈥� one after 8 weeks, the second after 4 weeks. Each of these evaluations will be considered separate for promotions rules.

Explanation of Ratings:

The trainees鈥� assessment considers their overall clinical competence using the following ratings:

Superior: Far exceeds reasonable expectations.

Satisfactory: Meets reasonable expectations.

Borderline: Often falls short of reasonable expectations.

Unsatisfactory: Falls far short of reasonable expectations.

鈥淩easonable expectations鈥�: should be appropriate to the level of training of the candidate.

鈥淐ould not judge鈥�: in the global evaluation of competence and progress: This means that the trainee did not complete the rotation.

听