Cornea, External Diseases and Refractive Surgery - Clinical

Clinical Fellowship

Cornea/External Disease, Anterior Segment, and Refractive Surgery
 

2021-2023

Duration: 2 years: July 1, 2021 –June 30, 2023

Positions: One

Supervisors:
Setarah Ziai, MD, FRCSC; Kashif Baig, MD, MBA, FRCSC (Clinical Fellowship Director), George Mintsioulis, MD, FRCSC; Saama Sabeti, MD, MPH, FRCSC


Application:
This position is offered through the SF Match (Program #4733) and uses its Central Application Service (CAS). Interested and qualified applicants should submit a personal statement, curriculum vitae, and three confidential reference letters through CAS. Non-CAS documents include medical school/residency transcripts and should be submitted to Ginette Snook, Departmental Education Program Coordinator. American/foreign medical graduates must contact Ginette Snook, Departmental Education Program Coordinator regarding the application process, which involves the Postgraduate Medical Education Office. Applications for the 2021-2023 cycle are due on Friday, October 16, 2020. Interview notifications will be made by Friday, October 23, 2020. Interviews will be held virtually on Thursday, November 26, 2020. The Match takes place on Thursday, December 17, 2020.


Description:
The University of Ottawa Eye Institute offers a two-year post-residency fellowship in Cornea/External Disease, Anterior Segment, and Refractive Surgery. This is a demanding, hands-on, clinical/surgical fellowship with research and teaching obligations. Medical, surgical, and research activities take place at the Eye Institute, a 60,000-square-foot facility that spans two floors of the General Campus of the Ottawa Hospital. Overall, about 15,000 surgical eye cases and a total of 120,000 patient encounters occur every year at the Eye Institute (General Campus) and the Eye Care Centre (Riverside Campus). Training also takes place at Precision Cornea Centre (PCC), a subspecialty clinic located 2.5 km from the Eye Institute. PCC is a referral centre for corneal and anterior segment pathology exclusively. Finally, training also takes place at the adjacent Children’s Hospital of Eastern Ontario (CHEO) for pediatric cornea and anterior segment surgical cases. The fellowship produces a well-rounded subspecialist comfortable in managing complex cases using clinical acumen and surgical versatility acquired in an innovative teaching environment.

Competition between fellows and residents is a concern in many programs. This fellowship has been crafted to mesh with the residency program so that both the resident and Fellow experience superb medical and surgical training.


Objectives:
To develop expertise in medical/surgical management of disorders in Cornea, Anterior Segment. and Refractive Surgery.
To further develop medical teaching skills.
To develop a habit of constant learning and innovation.
To develop an understanding of the research process from design to publication.
To develop practice management knowledge (EMR, billing, scheduling, etc.).

Surgery:
Cornea/Anterior Segment: The Fellow will assist, perform, and later teach the following partial list of surgeries in both adult and pediatric settings: full-thickness penetrating keratoplasty (PK), endothelial keratoplasty (EK: DSAEK, DMEK, DWEK/DSO), deep anterior lamellar keratoplasty (DALK), superficial anterior lamellar keratoplasty (SALK), lamellar and full-thickness keratoprostheses (KPros), iris reconstruction, dislocated lenses/IOLs, IOL exchange, secondary IOLs (iris-sutured, scleral-sutured, glued, anterior chamber supported, iris-claw, transconjunctival intrascleral haptic fixation), piggyback IOLs, artificial iris implants, ocular surface reconstruction with amniotic membrane, simple limbal epithelial transplantation, anterior segment trauma, and limbal/pars plana approaches to anterior vitrectomy. Each surgical case is recorded digitally in high definition for teaching and presentation purposes. An advanced wet lab facility is available for the Fellow to enhance surgical skills and is used by the Attendings to investigate new and experimental surgical techniques. The wet lab is well equipped with surgical microscopes with video cameras, phacoemulsification machines, corneal instruments, an EyeSi Surgical Simulator, and dedicated personnel to run the facility.


Cataract:
This is not a fellowship in developing cataract skills as it is expected that the Fellow has mastered basic and intermediate phacoemulsification skills during their residency training. Residents on the Anterior Segment Rotation usually get priority to assist/perform cataract surgery and must achieve the objectives that have been set up for the Rotation. However, the Fellow is expected to be fully involved with the pre-operative assessment and post-operative follow-up of cataract patients to gain familiarity with issues surrounding advanced technology IOLs.


Refractive:
The Fellow will actively participate in the evaluation of patients seeking femtosecond LASIK, PRK, PTK, and CXL. The VISX Star S4 IR excimer laser and IntraLase femtosecond laser are used in the refractive suite. Training on the use of these two laser platforms will occur early in the first fellowship year. A dedicated Refractive Surgery team is in place to coordinate clinical trials, patient interactions, and the clinic/surgery schedule. Furthermore, PCC is partnered with a private refractive surgery centre, Herzig Eye Institute, located adjacent to PCC. This centre offers advanced diagnostics and the full spectrum of refractive surgery (cornea-based: SMILE, both WG- and TG-LASIK/PRK, PTK, ISRS, CXL; lens-based: ICL, RLE, FLACS, cataract surgery) using ORA and the VisuMax, Mel90, iFS, VISX, and Catalys lasers.

Schedule:
Year 1: The Fellow will work with the 4 attending surgeons and be involved with clinics, all surgical consults, ocular surface surgery (minor operating room), and laser vision correction.
Year 2: In addition to Year 1 responsibilities, the Fellow will perform intraocular surgery 3 times a week.

Clinics:
The Fellow is expected to be present at the Eye Institute or PCC, regardless of scheduled clinical activities, between 8:00am and 4:30pm, Monday to Friday. All absences must be approved in advance. When not involved in clinical or surgical duties, time must be used to further academic pursuits such as research and teaching. When a Supervisor is away on vacation or conference leave, the Fellow can participate in another Supervisor’s clinic/OR, do research, teach, take vacation, and/or perform another pre-approved academic activity.

Teaching:
The Fellow is expected to teach residents and medical students informally in clinics and the operating room, and more formally in lectures. The Fellow plays an active role in teaching residents by reviewing suturing techniques in the wet lab at the beginning of an Anterior Segment Rotation and helping to ensure resident teaching objectives are met during the rotation. The Fellow is responsible for organizing journal clubs throughout the year and presenting interesting cases during PCC International Rounds. In addition, the Fellow is expected to do an informal, five-minute presentation once a month to the Cornea Service on a recent article or a chapter from a Cornea text.

Research:
The Cornea and Refractive Surgery Faculty is involved with multiple clinical trials on an ongoing basis at the Eye Institute as well as the PCC Research Centre. The Fellow will be expected to be first author on at least one major research project. The Fellow is encouraged to present at a major Ophthalmology meeting (AAO, ASCRS, ESCRS, EuCornea, Asia Cornea, COS, etc.) and to submit a manuscript for publication in an ophthalmology journal. The Fellow will also present at the Department of Ophthalmology Annual Research Day. Access to the latest Ophthalmology journals will be available online.

Conference:
Conference leave may be taken if the Fellow is presenting at a meeting and must be approved by the Fellowship Director.

Call:
The Fellow is expected to carry a pager/cell phone at all times. Throughout the year, the Fellow is the first point of contact for residents and clinics wishing to discuss an urgent Cornea consult. The Fellow is also expected to be available for weekend/closure clinics, resident calls, and emergency procedures that take place when a supervisor is on call (about 8-9 weeks total). The Fellow will share first call duties with other clinical fellows when residents are not able to take call (mock orals, OKAP, etc.). Finally, the Fellow is expected to be available for weekend follow-ups of post-operative and complex Cornea patients.

Vacation: Two weeks

Evaluations:
Formal evaluations of the Fellow’s progress in the fellowship will be performed by the Supervisors every four months.

Funding:
$60,000/year for a Fellow without funding support. Funding for research (including associated conference leave) is available on a competitive process through the University Medical Research Fund.

Contacts:
Setareh Ziai, MD, FRCSC; Cornea Fellowship Director
Email: sziai@toh.ca
 

Ginette Snook, Departmental Education Program Coordinator
University of Ottawa Eye Institute
Email: gsnook@toh.ca

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