We are unable to consider trainees who do not meet the eligibility criteria outlined in the following section: http://www.medicine.mcgill.ca/postgrad/admission_fellowships.htm or whose file is incomplete. Applicants must ensure that they meet the eligibility criteria for postgraduate training in the province of Quebec prior to application: http://www.medicine.mcgill.ca/postgrad/admission_fellowships.htm
Overview of Program Information:
There are (2) two 1 year Spine Fellowship positions available and 1 (one) 2 year position available in the Orthopedic Department of McGill University Health Centre. Training will be divided and carried out as listed below:
Montreal General Hospital (MGH): 33.3%
Montreal Children Hospital (MCH) / Shriners Hospital: 33.3%
Jewish General Hospital (JGH): 33.3%
For the complete description please check the following link: Orthopedic Scoliosis and Spine 1 and 2 year Fellowships
McGill’s Combined Spine Fellowship Goals & Objectives
Trainees should master in an incremental fashion over a 12 month period: the fundamentals sciences, clinical and therapeutic knowledge required to treat, patients with any 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:
- Occipital Cervical, Cervical, thoracic, lumbar, and sacral fracture with or with out dislocation
- Spinal Deformities: Acquired or congenital of the Scoliotic or Kyphotic type. Spondy / lolysis / lesthesis / loptosis
- Degenerative disc disease: cervical, thoracic, lumbar disc herniations; cervical or lumbar spinal stenosis
- Spinal infections
- Spinal tumors
The second role of the trainees is to supplement educational and research endeavors at McGill. This includes teaching resident’s basic science and clinical knowledge as well as surgical skill via daily clinical activities, daily OR, bi weekly spine rounds, and formal quarterly didactic talks. We expect the trainees to complete a research project either clinical or of basic science in our spine lab which will lead to a publication.
Basic scientific knowledge to be acquired:
- Detailed knowledge of anatomy, embryology and physiology of the spine
- Congenital, developmental and acquired non-traumatic conditions of the spinal column and its impact on management of these
- Musculo-skeletal anatomy of Cervical, thoracic, lumbar spine; osseous ligamentous and neural elements including Inter vertebral disc morphology
- Biomechanical and functional anatomy of the spine
- Natural degeneration of the spine
- Systemic inflammatory illness affecting the spine
Basic clinical knowledge:
- Appreciation of Classification (discal, degenerative disorders, mechanical instabilities, spinal deformities).
- Display knowledge of appropriate investigative techniques
- Interpretation of advanced investigative techniques:
Computerized axial tomography.
Magnetic resonance imaging.
- Display a detailed knowledge of operative approaches to the spinal column.
These factors are judged using standardized rating system described below.
A low rating indicates the trainee shows serious gaps in his/her knowledge of clinical sciences or that he/she does not apply this knowledge correctly. A satisfactory rating indicates that the trainee has a good knowledge of clinical sciences that he/she applies well in problem- solving and other aspects of patient care. This factor should also consider the trainee’s knowledge of current scientific literature and his/her application of this knowledge to case presentation and daily patient management.
History & physical examination:
- Display clinical competence in evaluation spinal disorders:
Relevant history taking to all spinal disorders
Relevant physical exam assessing for spinal deformity, 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’s 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:
The trainee must master:
- Role of physiotherapy and occupational therapy in the management of spinal disorders - acute and chronic
- Display competence in operative and non operative management of spinal disorders in respect to indications, contraindications and complications related to surgical intervention
This factor judges whether or not the trainee is able to interpret correctly the information gathered and shows discrimination in identifying the important and less important information that will allow the identification of the problems affecting the health of the patient. The trainee’s concern for the cost of unnecessary investigation and sensitivity to patient inconvenience and discomfort should also be considered.
Clinical judgment & decision making:
- Display competence in the non operative management of spinal disorders.
- Display adequate knowledge in advanced non operative management of spinal disorders - bracing techniques, physiotherapy
- Appreciate indications for surgery for spinal disorders
- Understand principle of fusion levels in spinal deformity with their implication regarding complications, and natural history
- Recognize and manage postoperative complications.
- 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’s ability to effectively and efficiently establish a program of investigation and management adapted to the patient’s 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’s health.
Technical skills required in the specialty:
- Display surgical competence in the following areas:
Laminectomy, Lumbar fusion techniques anterior vs posterior, discectomy cervical, thoracic and lumbar, foraminotomy, spinal tumor debulking
- 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
fixation, Interbody spacers as well as vertebral body replacements
- Display a detailed knowledge of the principles of internal fixation with regards to:
indications, complication, contraindications, and limitations.
This factor judges if the trainee can carry out professional techniques correctly and efficiently.
Interprofessional relationships with physicians:
This factor judges if the trainee can work effectively with other physicians in the healthcare team, shows consideration and tact for junior members of the team and is respectful of team members.
Communications with other allied health professionals:
This factor judges the trainee’s 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, showing respect for his/her patients and gaining their cooperation and confidence.
Communications with families:
This factor judges if the trainee is able to communicate easily with patients’ families, showing respect for his/her patients and gaining their cooperation and confidence.
Written communication and documentation:
History, physical, diagnostic formulation, progress notes, plans, discharge summaries and consultation reports are complete and accurate with satisfactory organization and assessment.
Interacts and consults effectively with all health professionals by recognizing and acknowledging their roles and expertise.
Delegates effectively: This factor judges that the trainee delegates effectively to other members of the healthcare team. Manager
Understands & 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 sensitivity to patient inconvenience and discomfort in the course of their professional duties.
Organization of work & 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.
Advocates for the patient:
This factor judges the trainee’s ability to advocate for the patient.
Advocates for the community:
This factor judges the trainee’s ability to advocate for society and the community.
Motivation to read and learn:
This factor judges the trainee’s knowledge of current scientific literature and his//her application of this knowledge to case presentation and daily patient management.
Critically appraises medical literature:
This factor judges the trainee’s ability to critically-appraise research methodology and medical literature.
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, or a project.
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’s 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
Recognition of own limitations, seeking advice when needed:
This factor judges that the trainee is able to acknowledge his/her limits of competence, and is able to seek and give assistance when necessary.
Understands principles of ethics; applies to clinical situations:
This factor judges the trainee’s 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
The trainee will be evaluated quarterly in a informal fashion. At mid rotation and at the termination of his fellowship a formal written evaluation will be completed judging his performance and on completion of his objectives. This factor judges the total professional competence and progress of the trainee in consideration of his/her stage of training in his/her specialty. This judgment synthesizes the assessments given in the above criteria, keeping in mind their relative importance and indicating the degree to which the trainee has shown progress and diligence during his/her rotation.
Explanation of Ratings:
Please assess the trainee’s 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.
“Reasonable expectations” should be appropriate to the level of training of the candidate.
“Could not judge” in the global evaluation of competence and progress: This means that the trainee did not complete the rotation.