Fellowship position Acute care spine and spinal cord and rehabilitation

Program director Co-director Dr. Andréane Richard-Denis, MD, MSc. Dr Jean-Marc Mac-Thiong, MD., PhD. Associate Professor Full Professor Department of Medicine Department of Faculty of Medicine Faculty of medicine Université de Montréal Université de Montréal Physical medicine and rehabilitation (PM&R) Orthopaedic surgery SCI medicine Hôpital du Sacré-Cœur de Montréal Hôpital du Sacré-Cœur de Montréal CIUSSS du Nord-de-l’Île-de-Montréal CIUSSS du Nord-de-l’Île-de-Montréal

Program secretary: Virginie Gauthier University Education assistant CIUSSS du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal [email protected]

Program description Physiatry (physical and rehabilitation medicine) is a specific area of specialized medicine which is undergoing constant development. The goal of this specialized education program is to optimize functional recovery and minimize complications towards the improvement of quality of life, while promoting a multidisciplinary approach and collaborative work. Physiatry specializing in spinal care and /disease (SCI/D) medicine is interested in a wide range of pathologies such as degenerative, neoplastic, infectious and trauma spinal diseases, as well as lesions of the spinal cord (including cauda equina and spinal nerves) .

We offer a program of a minimum duration of 12 months (13 four-week periods) during which all adult spinal and spinal cord pathologies will be covered through specialized training in physical medicine and rehabilitation. The training will take place in a hospital affiliated with the University of Montreal, the Hôpital du Sacré-Cœur de Montreal, a Level-1 traumatology center specialized in spinal and spinal cord . Candidates will spend a year in PM&R medicine specializing in pathology of the spine and SCI/D. Multidisciplinary training will be given in collaboration with intensivists, orthopedic surgeons and neurosurgeons specializing in the acute management of spinal and SCI/D, as well as with health professionals actively involved in the care for these pathologies (physiotherapists, occupational therapists, nurses, etc.).

The fellowhip training will be twofold: 1) acute care spine and SCI/D medicine; 2) diagnosis and management of pathologies of the spine. Part 1 comprises the following 3 aspects: a) Medical and rehabilitation management of individuals with injury/disease of the spine and spinal cord during the acute care (traumatology) phase. b) Management and medical follow-up of this clientele in the community (outpatient clinic).

c) Work within the multidisciplinary acute rehabilitation team in coordination with subsequent rehabilitation teams.

All secondary conditions and medical complications pertaining to the early acute, acute and chronic phase will be assessed. Part 2 will comprise the following 2 aspects: a) Diagnosis and management of musculoskeletal spine pathologies during the acute care phase.

b) Diagnosis, management and some interventions of musculoskeletal spine pathologies during outpatient consultations (outpatient clinic).

During his/her training, the student will have to demonstrate that he(she) has the knowledge, skills, abilities and attitudes necessary for the care of patients suffering from spinal pathologies and SCI/D. spinal. As part of the first part of this fellowship (acute care spine and SCI/D medicine), he/she will have to master the concepts of prevention, diagnosis, treatment and management of SCI/D. During his training, the student will develop high expertise in clinical decision making and the management of complications associated with spinal cord and SCI/D (including cardiovascular, pulmonary, pressure injuries, urological, gastrointestinal, neurological, musculoskeletal, etc). The candidate will be an integral part of the multidisciplinary team specialized in acute SCI/D, including therapists (physical and occupational therapists, pharmacy, psychology, care, nutrition, speech therapist, nursing) and physicians (intensive care, trauma, neurosurgery, orthopaedic surgery, urology, neurology, psychiatry, geriatry). The candidate will also be involved in clinical research project(s), the program being notably led by experienced clinician-researchers in the field. As part of the second part of this fellowship, the student will have to master the diagnosis and indications for conservative treatment of musculoskeletal spine pathologies, indications for requesting surgical opinion, execute simple infiltration techniques, establish an appropriate rehabilitation postoperative and follow-up plan for patients who have undergone spinal surgery.

The program is open to applicants who have completed an approved residency program in a specialty relevant to the field, such as physiatry (physical medicine and rehabilitation), family medicine, neurosurgery, , neurology, geriatrics / medicine internal or intensive care. The student will have a teaching responsibility with residents of the physiatry program at the University of Montreal. He/she will have to deepen the human skills required to communicate with the patient/proxy, medical colleagues and members of the multidisciplinary team. The candidate will develop also its scientific skills and competences in research, with the aim of promoting innovative clinical research projects. The CanMEDS Competency Framework serves as the backdrop to the development of internship objectives. Throughout his/her training, and during regular assessments, the student must demonstrate a sustained interest in acquiring and developing his/her knowledge, skills and attitudes necessary for an exemplary and specialized medical practice.

The student of the program will be trained within a team comprising physiatry, spine surgery and intensivists whose academic expertise (clinical educational and research) is extensive and of international scope. The Hôpital du Sacré-Coeur de Montreal is one of the main traumatology center specializing in spine and SCI/D in Canada. This institution has a dedicated multidisciplinary spinal unit who assess more than 3,000 new patients with spinal disorders annually, of which approximately 1,000 require surgery and 150 sustain an acute SCI/D. All activities will take place in the Hôpital du Sacré-Coeur de Montreal, Québec.

Structure Duration: Minimum 12 months, with the possibility of extending for a period of 6 or 12 additional months

A. DIDACTIC TRAINING: 0.5 day / week

Academic teaching on the adult spine and rehabilitation following a spinal and / or spinal cord injury at the Hôpital du Sacré-Coeur de Montréal (HSCM) (or by videoconference):

Topics (Part 1: acute care spine and SCI/D medicine)

Epidemiology, pathophysiology, ISNCSCI classification and neurological/ functional prognosis

Acute medical management and stabilization, perioperative care and imaging

Neuroprotection, neurorehabilitation (activity-based therapy, electrical stimulation) and regenerative therapies Medical complications / secondary conditions and acute management: respiratory, cardiovascular and hematological system

Ventilatory support (, tracheostomy, etc.) after spinal cord injury

Medical complications / secondary conditions and management: neurogenic bladder and bowel

Medical complications / secondary conditions and management: pressure injuries

Medical complications / secondary conditions and management: neurogenic pain, bone health and autonomic dysreflexia

Quality of life, commitment, resilience process and associated peripheral neurological damage

Topics (diagnosis and management of pathologies of the spine)

Semiology of the spine

Spinal tumors and infectious pathologies

Degenerative diseases and spinal stenosis

Spinal radiculopathies and other peripheral neurotrauma

Scoliosis and spondylolisthesis in adults

Musculoskeletal spine rehabilitation

B. CLINICAL COURSES (3-4 days / week)

Ø The candidate will have to participate to 1 or 2 outpatient clinic (s) per week. Supervisors will be responsible for this distribution. Clinics will include: o The specialized interdisciplinary clinic for the follow-up of patients with SCI/D o The musculoskeletal spine clinic (outpatient consultations for spinal stenosis, radiculopathy, peripheral neurological trauma, cervical and lumbar pain) o Specialized clinics (spine surgery, urology, neurology, and others depending on availability and interests) Ø The candidate should actively participate in the clinical follow-up of hospitalized patients in collaboration with residents and other fellow-students of related programs (if applicable). Visiting hospitalized patients represents an educational opportunity for residents and will allow the candidate to familiarize themselves with the postoperative and rehabilitation development of the patient with acute spine and SCI/D as well as patients who have undergone spinal surgery. Ø The candidate will participate to the weekly multidisciplinary meetings in spinal trauma. Ø The candidate will be invited to follow and participate to the clinical and hospital activities of collaborating clinical professors within the program (intensive care, orthopedics, neurosurgery, trauma, neurology, urology, wound care, rehabilitation therapists, etc.) The student will be called upon to cover on call hours (for certain evenings, weekends and holidays) for pathologies of the spine and SCI/D. The student will be strongly advised to make himself available if complications arise or interesting cases related to his field must be dealt with during on-call hours. A financial bonus for on-calls will be offered (see salary section below).

C. TEACHING ACTIVITES: 0,5 day / week

The candidate should be available for a resident teaching session on the basics of SCI/D rehabilitation when a resident in physiatry and/or orthopedics is present. This session may take the form of a book club (journal club), a book chapter review, a workshop or a masterful presentation, according to an agreement with the residents and the physiatry program of the Université de Montréal.

D. RESEARCH: 1 day / week

The student must actively participate in setting up, development and/or finalizing one or more research projects in the field of SCI/D at the Hopital du Sacré-Coeur de Montréal (HSCM). Each project will lead to presentations in conferences and at least one scientific publication in a peer review journal. One day per week will be protected for research. The research project will be supervised by a clinician-scientist in physiatry from the HSCM.

Carrying out a research project normally involves the following steps (help of experienced research assistants can be provided): Ø Complete a critical review of the literature Ø If necessary, write the research protocol Ø Clinical assessment and monitor patients approached to participate in clinical studies Ø Carry out data collection and analysis Ø Prepare presentations Ø Write abstracts and at least one scientific manuscript Ø Present the results in scientific conference(s)

The candidate will be invited to participate and present his/her work at the following conferences: Research Day at the CIUSSS du Nord-de-Île de Montréal and Annual congress of the Association of physiatrists and the Édouard-Samson orthopedic program (if relevant) OR another relevant provincial, national or international conference at the choice of the student and his supervisor in the field of physiatry, rehabilitation, orthopedics, or trauma (eg ASIA, ISCOS, CAPMR, CSS). Registration fees will be covered by the physiatry department.

Hospital

• Hôpital du Sacré-Cœur de Montréal (CIUSSS du Nord-de-l’Île de Montréal), affiliated to Université de Montréal. Level-1 traumatology center specialized in SCI care.

Evaluation methods

Ø Formal assessment sheets (CanMEDs and Competence by Design) Ø Multi-source or 360 ° evaluation Ø Portfolio Ø Direct observation Ø Constructive feedback

Admission 1. ELIGIBILITY REQUIREMENTS

To be eligible as a regular student in this training program in specialized physiatry, the candidate must: Ø Meet the general eligibility conditions (section XI) of the Pedagogical Regulations for Graduate and Postdoctoral Studies Ø Hold a Doctorate in Medicine (M.D.) Ø Hold a specialist degree in physiatry or other related / relevant specialties. Canadian applicants must hold certification from the Royal College of Physicians of Canada, while foreign applicants must have certification issued by their country of origin.

1.1. Additional documents to provide when applying for admission Ø Submit a letter of intent in which the candidate describes their career pathway and reasons for undertaking graduate studies as well as their expectations regarding the program. He must comment on the relevance of his preparation, conditions favorable to his/her success and describe his/her fields of interest. Ø Submit a resume (curriculum vitae) Ø Submit three letters of recommendation from peers, including one from their residency program director. Ø Proof of United States Medical Licensing Examination (optional), if applicable.

1.2. Prior knowledge required Ø Master basic skills in physical medicine and rehabilitation (physiatry) Ø Have a good knowledge of French and English, and be able to communicate (spoken and written) in French.

1.3. Requirements and additional information Selection of candidates: Ø The application for admission must be submitted at least 12 months before the start of the desired training. Ø The request will be reviewed by the program committee. If the file is deemed admissible and meets requirements, the candidate will be invited to an interview. If necessary, the interview can be conducted by telephone or videoconference. Ø The training takes place at the Hôpital du Sacré-Coeur in Montreal. To practice in these establishments, the foreign candidate must obtain a temporary license to practice from the College of Physicians of Quebec as well as approval from the Department of Medicine of the Université de Montréal.

2. EDUCATION (minimum and maximum duration & student status) Ø This subspecialty program has a minimum duration of 12 months, or 13 four-week periods. Ø This program must be followed full time. Ø The student will benefit from vacation days, conference days, sick days and personal leaves for each year of training, according to the agreement in force between the Federation of Resident Physicians of Quebec (FMRQ) and the Ministry of Health and of Social Services (MSSS). Ø All application material should be emailed to: [email protected]

Program Number of fellowship positions: 1 Number of teachers: 6

Resources Clinical resources The training program is based on access to a spinal unit: Ø PM&R and surgery team, rehabilitation therapists and nursing team specialized in SCI/D management Ø specialized in SCI care, including ventilo-assistance Ø Medical imaging (including EMG and ultrasound) Ø > 15 acute spinal cord injury beds Ø > 15 spinal hospital beds and an outpatient clinic for assessing new patients and carry out follow- ups in the community. Ø An experienced research team in clinical resarch (SCI/D and spine)

Clinical research resources and facilities

Clinical research is integrated into the clinical activities of the physiatry department at the Hôpital du Sacré-Coeur de Montreal. Professors of the program lead or collaborate closely in research activities leading to conferences and scientific publications in the field of physiatry, rehabilitation and adult spinal surgery. Research activities include single or multi-center projects funded by internal funds, external grants or by industry. The student will therefore have access to established resources to carry out one or more research projects supported by a research team comprising 6 full-time research assistants (including a statistician) led by the directors of this program. The HSCM’s spine and SCI/D clinical research group is interdisciplinary and based on equity / diversity and inclusion principles. As part of his research activities, the candidate will be able to count on the support of master's and doctoral students, postdoctoral fellows, research associates, professionals and professors from in various clinical fields as well as engineering, electrophysiology, , medical imaging, computer science, neurosciences, etc.

Salary and lump sum premium

Compensation is offered. Total compensation includes salary (contract), holidays, liability insurance costs and covers tuition fees. A lump sum premium may be offered for on-call services.

List of the main teaching professors at the Hôpital du Sacré-Cœur de Montreal

Dre Andréane Richard-Denis, MD, MSc Associate Professor, Faculty of Medicine, Université de Montréal Director, PM&R and SCI Medicine unit

Dr Jean-Marc Mac-Thiong, MD, PhD Full Professor, Faculty of Medicine, Université de Montréal Senior clinician-scientist Spinal surgery

Dr Étienne Bourassa-Moreau Assistant Professor, Faculty of Medicine, Université de Montréal Spinal surgery

Dr Francis Bernard Full Professor, Faculty of Medicine, Université de Montréal , neuro-intensivist Director, neurological intensive care unit