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Fellowship Position HSCM ARD Copie Fellowship position Acute care spine and spinal cord injury medicine 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 surgery 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 spinal cord injury/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 injuries. 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, wound 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, orthopedic surgery, 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 (mechanical ventilation, 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
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