The fellowship training program ensures that fellows gain experience in all major areas of paediatric orthopaedics. Each fellow rotates with two surgeons every three months. There is some flexibility regarding the roster which is established in consultation with each fellow. Our goal is for fellows to develop highly competent skills and sound clinical judgment to be leading academic paediatric orthopaedic surgeons. Fellow responsibilities include preparation and surgical treatment for elective cases, operative fracture treatment, outpatient clinics and research. A typical fellow weekly assignment includes two operating room days, two clinic days, and at least one half day for research.
The Hospital for Sick Children is a level I paediatric trauma centre and has a broad referral base for emergent conditions. Becoming confident with the acute management of fractures, complex trauma and bone and joint infections is an essential aspect of paediatric orthopaedic training. Principles and experience gained from these areas translate broadly to elective scenarios. Clinical fellows take call on a hierarchical roster together with residents and faculty. Primary calls to the emergency department, the ward and from other institutions are fielded by the residents. Fellows assume duties that are transitional on their way to becoming faculty themselves. They are called mostly for advice and to take cases to the operating room, not usually to visit the emergency department or the wards. Fellows have privileges to take cases to the operating room independently. Faculty usually allow the fellow to supervise operative management.
|Monday||7:00 A.M.||Post-Operative Weekly Review||Rotating Staff|
|4:30 P.M.||Chairman's Rounds'||Howard|
|Tuesday||7:00 A.M.||Resident Rounds||Rotating Staff|
|4:00 P.M.||Hip/Fellow Rounds||Rotating Staff|
|Wednesday||7:00 A.M.||Week 1: Journal Club||Narayanan|
|Week 2: Indication Rounds||Howard|
|Week 3: Research Rounds||Howard|
|Week 4: Morbidity & Mortality||Hopyan|
|Thursday||7:00 A.M.||Pre-Operative Weekly Review||Rotating Staff|
|Friday||7:30 A.M.||University Wide Rounds||Rotating Staff|
Curriculum for Orthopaedic Rounds
- Ankle Fractures: Distal Tibia
- Assessment in Management with Ambulatory CP
- Back Pain in Children: Spondylolysis, Spondylolisthesis, Miscellaneous
- Benign Tumours of Bone
- Bone Dysplasia and Metabolic Bone Disease
- Brachial Plexus and Birth Palsies
- Cavus Foot, Adolescent Bunions, Tarsal Coalition, Skew Foot
- CBC Journal Club
- Cerebral Palsy
- Club Foot, Congenital Vertical Talus
- Combined Sessions with Plastics on Hand Fractures
- Congenital Hand Anomalies (Radial Club Hand, Syndactyly)-with Plastic Surgery
- Developmental Hip Dysplasia (DDH)
- Elbow Dislocations, Lateral Condyle, Medial Condyle, Radial Neck & other Elbow Fractures
- Evidence Based Teaching
- Femoral Shaft Fractures
- Forearm Fractures, Wrist Fractures, Monteggia Injuries
- Growth Plate Injuries and Sequelae
- Hip & Pelvic Fractures
- Juvenile Arthritis, Haemophilia
- Knee Fractures: Distal Femur, Proximal Tibia, Patella
- Kyphosis-Idiopathic and Congenital
- Leg Length Discrepancy and Congenital Limb Deficiencies
- Legg-Perthes’ Disease, Slipped Capital Femoral Epiphysis
- Limping Child, Osteomyelitis and Septic Arthritis
- Malignant Tumours
- Muscular Dystrophy, SMA, Arthrogryposis, Neurofibromatosis
- Neuromuscular Spinal Deformity
- Paediatric Knee Disorders, Recurrent Dislocation of Patella, OCD, Discoid Meniscus
- Paediatric Multiple Trauma, Open Fractures, Compartment Syndrome
- Patellar Instability and Dislocation
- Pathological Fracture and Child Abuse
- Pre-operative Planning and Lower Extremity Deformity
- Proximal Humeral and Humeral Shaft Fractures, Clavicle Fractures
- Scoliosis-Idiopathic, Congenital & Neuromuscular
- Spina Bifida
- Spine Bracing
- Sprengels Deformity, Torticollis, Klippel Feil Syndrome, Erb’s Palsy
- Supracondylar Fractures
- The Young Overhead Throwing Athlete
- Thoracic and Lumbar Spine Fractures, C-Spine Fractures
Interview with staff surgeon Dr. Unni Narayanan
As newly appointed Fellowship Director, what is your vision for the SickKids orthopaedic fellowship program?
To become the premier pediatric orthopaedic fellowship program in the world, providing the best possible educational experience that will prepare our fellows to assume the mantle of a pediatric orthopaedic practice, and to be future leaders in the field.
You have trained in a number of diverse countries and cultures, how has this experience shaped your career? India provided me with a strong medical school foundation and my first taste of orthopaedics, then in the UK my interest in orthopaedics was cemented and I was exposed to the benefits and downsides of a publically funded health care system running in parallel with private health care. In the USA I was exposed to structured residency training that is par excellence, bar none! Finally, Canada gave me my clinical fellowship followed by my Masters degree in clinical epidemiology; (one of the smartest investments of my time) followed by first and only job within an academic practice model that is hard to beat.
Who were the biggest influences in your surgical career, and why?
I had fantastic role models in medical school and during my residency and fellowships. These included Jim Gage, Tom Novacheck and Steve Koop who sparked my interest in cerebral palsy; were fantastic teachers and role models in every sense of the word. Mark Dahl taught me the value of pre-operative planning, attention to details and technical excellence. Mercer Rang opened my eyes to the value of the big picture. Jim Wright: taught me about the value of evidence and the science of measurement. John Wedge is responsible in more ways than one for where I am today.
You have won awards for your teaching, what do you think makes you a successful surgical teacher?
First of all I enjoy it and therefore I make the time to do it. I really try to focus on principles and teach trainees how to deconstruct the problem, understand the natural history to define the ultimate goals, weigh options (which are seldom black or white), determine what is feasible; and one’s own experience/expertise. I try to keep an open mind and welcome being challenged. Teaching is the best way of learning.
What are you looking for in a potential fellow for the program?
Our ideal candidate seeks a career in full time academic paediatric orthopaedic and aspires to be a leader in the field. We are looking for fellows who are open minded, energetic, enthusiastic and fun to work with.
How should a fellow decide on which paediatric orthopaedic fellowship to do?
The fellowship year has the potential for being one of the most rewarding experiences of one’s life. It is a time when one is finally focusing on what they really want to pursue for their career; with neither the chores associated with being a resident nor the stresses associated with the responsibilities of independent practice. The fellowship experience ought to be sufficiently different from what one has already been exposed to as a resident, to broaden one’s horizons not only in pediatric orthopaedics, but life in general. The fellowship has to be an enjoyable experience; an opportunity for new friendships that will last a lifetime; experiencing life in a new city or country; and an unforgettable adventure.
How do we best train the next generation of surgeons?
Advances in the field and the inevitable sub-specialization that comes with it makes it a growing challenge to provide a comprehensive experience that is broad as well sufficiently deep, within the time limited framework of a conventional one year fellowship. Competency based curricula, which are appropriate for training at the resident level, are unlikely to satisfy fellows who are seeking experiences that will take them past basic competence to more advanced levels of expertise. That means customizing the fellowship experience based on individual fellow’s needs and interests. The field is never static, so learning is a lifelong commitment. What will remain a constant is the importance of learning sound principles and being exposed to the nuances about decision making which will equip the practicing surgeon the tools to grow with the specialty and to handle unfamiliar situations.
How do you find time to manage a busy clinical practice be an enthusiastic teacher and a successful researcher?
I love all aspects of what I do: the clinical work that is so gratifying; the research that is rewarding and the teaching that is just fun. I am fortunate that I have been able to integrate my clinical interests closely with my research interests. There are more efficient ways to do all this than I have done, so I have my family to thank for putting up with this.
Peter studied philosophy at the University of Michigan and medicine at Loyola University Chicago. He completed his orthopaedic surgery training at Wake Forest University in North Carolina where he also obtained a PhD in Neuroscience. Peter has several clinical interests including complex limb deformity, hip dysplasia, trauma, infections, and hand & upper extremity surgery. Outside of the hospital, Peter is dedicated to his wife and family. He also enjoys spending time with his English bulldog and watching American football.
Scott completed his orthopaedic surgery residency at University of California, San Francisco, in 2013. He was born in San Francisco, obtained his BS from Georgetown University in international affairs, worked in international business, then returned to Johns Hopkins University for post baccalaureate premedical training. He met his wife, Sunitha in medical school at Washington University in St. Louis. They plan to return to San Francisco next year with their one year old son and join the staff at UCSF. Scott’s interests include trauma, disorders of gait, deformity and international research collaboration.
Elaine is from the Glens of Antrim on the North East coast of Northern Ireland. She graduated from The Queen’s University of Belfast and completed basic surgical training in Northern Ireland. Thereafter she undertook two years of clinical research in Newcastle Upon Tyne winning the Kreibich Memorial research prize and the British Trauma Society best paper prize during that period. She completed higher surgical training in orthopaedics in Northern Ireland in 2012 and following fellowship at Sick Kids intends to return to the UK to a general paediatric orthopaedic practice. In her spare time Elaine walks, plays the piano and collects Irish art.
Matthew completed his Bachelor of Medicine & Bachelor of Surgery at The University of Adelaide, Australia, followed by 2 years of general training at The Royal Adelaide Hospital, South Australia. He also completed his advanced training in orthopaedic surgery in South Australia and undertook a Fellowship at the Shriner’s Hospital for Children, Portland, Oregon, USA. Matthew works as an attending paediatric orthopaedic surgeon at the Women’s & Children’s Hospital, Adelaide and also in adult trauma & arthroplasty at the Flinders Medical Centre, Adelaide. Matthew enjoys cycling, fishing and spending time with his wife, Annie and young son, Oliver.
Barry Danino grew up in Haifa, Israel. Following 5 years of military service he attended medical school at the Tel Aviv University. He then joined the orthopaedic residency program at the Tel-Aviv Sourasky Medical Center. Prior to arriving to the Hospital for Sick Children in Toronto he completed a year of paediatric orthopaedic fellowship in Dana Children’s Hospital in Tel Aviv. On completion of his clinical fellowship, Barry is planning to stay for a research year and then join the paediatric orthopaedic department in Dana Children’s Hospital in Tel Aviv, Israel as a staff surgeon. Barry is a proud father to his three kids. The family spends the weekends hiking, and bicycle riding.
Select Fellow Publications in 2012–2013
Popkin CA, Murnaghan ML. Knee injuries in growing athletes. Orthopaedics and Trauma. 2012 Feb;26(1): 12-19.
Moktassi A, Popkin CA, White LM, Murnaghan ML. Imaging of osteochondritis dissecans. Orthop Clin North Am. 2012 Apr;43(2):201-11, v-vi.
Alves C, Steele M, Narayanan U, Howard AW, Alman BA, Wright J. Open reduction and internal fixation of unstable slipped capital femoral epiphysis by means of surgical dislocation does not decrease the rate of avascular necrosis: a preliminary study. J Child Orthop. 2012 Jun 6:277-283.
Truong W, Murnaghan ML, Hopyan S, Kelley SP. Ischioplasty for Femoroischial Impingement: A Case Report. JBJS Case Connector, 2012 Sep 26;2(3):e51 1-5.
Dodwell E, Snyder B, Wright J. Off-label use of bone morphogenetic proteins in pediatric spinal arthrodesis. J Am Med Assoc. 2012 Oct 10;308(14):1429-32.
Cuomo AV, Howard A, Hsueh S, Boutis K. Gartland type I supracondylar humerus fractures in children: is splint immobilization enough? Pediatr Emerg Care. 2012 Nov;28(11):1150-3.
Dodwell E, O’Callaghan J, Anthony A, Jellicoe P, Shah M, Curtis C, Clarke H, Hopyan S. Combined glenoid anteversion osteotomy and tendon transfers for brachial plexus birth palsy: early outcomes. J Bone Joint Surg Am. 2012 Dec 5;94(23):2145-52.
Ibrahim T, Howard AW, Murnaghan ML, Hopyan S. Percutaneous curettage and suction for pediatric extremity aneurysmal bone cysts: is it adequate? J Pediatr Orthop. 2012 Dec;32(8):842-7.
Al-Aubaidi Z, Lebel D, Oudjhane K, Zeller R. Three-dimensional imaging of the spine using the EOS system: is it reliable? A comparative study using computed tomography imaging. J Pediatr Orthop B. 2013 May 4. In press.
Lebel DE, Corston JA, McAdam LC, Biggar WD, Alman BA. Glucocorticoid Treatment for the Prevention of Scoliosis in Children with Duchenne Muscular Dystrophy: Long-Term Follow-up. J Bone Joint Surg Am. 2013 Jun 19;95(12):1057-61.
SickKids Paediatric Orthopaedic Fellowship
Five clinical fellowship positions in paediatric orthopaedics are available at The Hospital for Sick Children each year. Two fellowship positions are available for eligible candidates through the San Francisco matching scheme for paediatric orthopaedics. These fellowships commence in August each year. Three further fellowship positions are available through a direct application to The Hospital for Sick Children and can commence in either February or August depending on availability. The duration of the fellowship is for one year. Six month fellowships are not encouraged.
The Division of Orthopaedic Surgery is seeking candidates with a strong clinical and academic background that demonstrates proficiency in orthopaedic surgery and related subjects. Candidates will be pursuing a clearly defined path in paediatric orthopaedic surgery. International Medical Graduates who have obtained their medical education and training from non-Canadian, American, British or Australian systems, are encouraged to obtain several years experience as a paediatric orthopaedic surgeon before applying to the program.
Trans-Canada Paediatric Orthopaedic Fellowship
Three children’s hospitals across Canada offer a combined fellowship program in paediatric orthopaedics, and is awarded to applicants who show an exceptional level of scholarship. Fellows have an opportunity to work at The Hospital for Sick Children, Toronto; BC Children’s Hospital, Vancouver; and Shriners Hospital for Children, Montreal for a period of 6 months at each institution. The program is designed to provide a comprehensive and diverse fellowship experience in paediatric orthopaedic surgery, to engage fellows in collaborative and multidisciplinary clinical care, deepen their research experience and expand their professional network. As each institution specializes in different types of musculoskeletal problems, training in these specialized areas is available.
From an administrative standpoint the fellow’s primary educational institution will be the University of Toronto with elective periods at the University of British Columbia (for BC Children’s Hospital) and McGill University (for Shriners Hospitals for Children); as such, The Hospital for Sick Children will be the first rotation. Trans-Canada fellows must rotate at all three institutions. It is not mandatory to be fluent in French to be considered for this program. Fellows will be required to apply for separate work visas and educational licenses from each province. Each institutions responsible for providing a stipend.
Interested applicants should visit each institution’s website to find out more about their individual programs.
SickKids Spine Fellowship
The Hospital for Sick Children also offers an advanced fellowship in paediatric spinal deformities. This single-specialty fellowship provides comprehensive training in the surgical and conservative treatment of paediatric spinal disorders, however the focus of this fellowship is on the surgical reconstruction of complex deformities. Substantial previous experience in spinal surgery is a prerequisite to applying for this fellowship. Fellows are mentored by the two paediatric orthopaedic spine surgeons; Dr Zeller and Dr Lewis. The spine fellow also participates in the paediatric orthopaedic on-call schedule for trauma. The training period can range from six months to one year.
Numerous ongoing or new research projects can be chosen by fellows. The faculty include bona-fide clinical epidemiologists as well as basic scientists with a wide range of clinical and research interests for guidance. A highly qualified clinical research assistant is dedicated entirely to facilitating fellow research projects, with the ability to help with study design, obtain ethical board approval and in data analysis.
Professional and Personal Leave
Fellows are encouraged to attend North American and international paediatric orthopaedic meetings, including POSNA and IPOS. Each fellow is provided with a stipend for travel expenses in addition to their salary. Fellows have four weeks a year of paid vacation leave, plus one week of conference leave.
Cadaver Surgical Skills Labs
Fellows participate in hands on cadaver skills labs to learn specific surgical approaches and more complex procedures including:
- Hip: surgical dislocation, advanced pelvic osteotomies
- Foot: soft tissue reconstruction and foot osteotomies
- Spine: instrumentation and osteotomies
- Upper Extremity: brachial plexus dissection and shoulder reconstruction
- Extensile Exposures: upper/lower limb and pelvis for tumour reconstruction
- Arthroscopy: knee, hip, shoulder
Where Are They Now?
“The Paediatric Orthopaedic Fellowship at The Hospital for Sick Children brings together fellows from all over the globe. One rapidly becomes a member of larger international family, with the common goal of improving the orthopedic care that our patients receive. The skills, the knowledge, and more importantly the wonderful memories will follow us throughout the rest of our careers. I am confident that I will be faced with clinical dilemmas that will bring to light some of the discussions and debates we have had with our mentors at SickKids. And, if I forget, I am reassured that they will only be a phone call away.”
—Michael Bensimon (Alumnus 2013)