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:
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
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