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:
1. Burrholes for:
  1. Biopsy
  2. Removal of hematoma
  3. Intracranial pressure monitoring
2. Supratenotrial Craniotomies for:
  1. Removal of intracranial hematomas
  2. Removal of intrinsic and extrinsic tumors
  3. Treatment of intracranial infections
  4. Brain Biopsy
  5. Decompression for Cerebral Swelling
  6. Simple Aneurysms
3. Infratentorial Craniotomies for:
  1. Removal of intracranial hematomas
  2. Removal of Intrinsic and extrinsic tumors
  3. Treatment of intracranial infections
  4. Brain Biopsy
  5. Cerebellar decompression
4. Endonasal transsphenoidal surgery
  1. Simple pituitary adenomas
5. Treatment of simple and compound depressed skull fractures
6. Carotid endarterectomy
7. Spinal decompression and fusion
  1. Cervical
    1. Anterior (ACDF)
      1. Discectomy
      2. Vertebrectomy
    2. Posterior
      1. Laminectomy
      2. Foramenotomy
      3. Lateral mass screws
      4. C1/C2 fusion
  2. Thoracic
    1. Posterior
      1. Laminectomy
      2. Posterolateral decompression
      3. Pedicle screw fixation
  3. Lumbosacral
    1. Posterior
      1. Discectomy
      2. Laminectomy
      3. Posterolateral decompression
      4. Pedicle screw fixation
8. Closed reduction and external immobilization
9. Resection of intradural extramedullary spinal tumors
10. Peripheral nerve
  1. Carpal Tunnel decompression

1. 1. Ulnar nerve decompression and transposition
  2. Nerve and muscle biopsy
  3. Sural nerve harvest
  4. Resection of simple nerve tumors
2. CSF management
  1. Shunt tap

1. 1. CSF leak repair
  2. EVD
  3. ETV
2. Release of tethered cord
3. Skull
  1. Tumor removal/biopsy

1. 1. Cranioplasty
  2. Treatment of simple sagittal synostosis
2. Ventricular endoscopy for tumor biopsy or excision
3. Cranial nerve disorders
  1. Microvascular decompression

1. 1. Percutaneous techniques

Residents may assist Fellows/Staff in the following cases:
1. Supratentorial craniotomies for:
  1. AVMS
  2. Vascular reconstruction and bypass
  3. Complex intrinsic and extrinsic tumors
2. Infratentorial Craniotomies for:
  1. Aneurysms
  2. Vascular malformations
  3. Complex intrinsic and extrinsic Tumors
3. Stereotactic and functional Procedures:
  1. Surgical treatment of epilepsy
  2. DBS
  3. Spinal stimulation
  4. Intrathecal pump insertion
  5. Selective Dorsal Rhizotomy
4. Expanded endonasal skull base approaches
5. SRS
6. Endovascular procedures
  1. Carotid stenting
  2. Aneurysm/AVM management
  3. Tumor embolization
7. Spinal decompression and/or fusion
  1. Cervical
    1. Anterior
      1. Transoral
      2. Odontoid screw
      3. Multilevel complex reconstruction
    2. Posterior
      1. Craniocervical fixation
  2. Thoracic
    1. Anterior Extracavitary
  3. Lumbosacral
    1. Transabdominal or retroperitoneal
  4. Vertebral augmentation (kypho/vertebra plasty)
8. Spinal cord tumors or vascular malformations
9. Complex spinal dysraphic states
10. Peripheral nerve
  1. Brachial Plexus

1. 1. Other nerve entrapments
  2. Nerve grafting
  3. Complex nerve tumors
  4. Sympathectomy

Pay

Minimum salary of $51,000 per year

Holidays

4 weeks of paid holiday per year

Conferences

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