Paediatric Ophthalmology

Fellowship in Paediatric Ophthalmology & Adult Strabismus


This fellowship is designed to promote subspecialty competence, confidence, and efficiency in managing the full range of medical and surgical cases in paediatric ophthalmology and adult strabismus. An  innovative teaching environment with carefully graduated responsibility is a hallmark of this program. While competition between fellows and residents can be a concern in many fellowship programs, this program is designed to synergize learning for both the resident and fellow, maximizing the intensity and quality of the learning experience for each.


Interested and qualified applicants should submit a personal statement, curriculum vitae, medical school/residency transcripts, and three confidential reference letters through Ginette Snook, Departmental Education Program Coordinator at the University of Ottawa Eye Institute. American/foreign medical graduates must contact Ginette Snook regarding the application process in advance of submitting an application, as the application process involves the Postgraduate Medical Education Office. Applications are due September 1st in the year preceding the fellowship, with candidates notified by December 1st regarding the success of their application.


Fellowship Director and Preceptor: Michael D. O'Connor, MD, FRCSC

Duration: One year fellowship starting July 1st.

Upcoming Positions:
• 2020-2021 – No fellowship offered
• 2021-2022 – Full
• 2022-2023 – One position available

Minimum educational and clinical requirements

  1. A degree of medical doctor (MD) or equivalent from an approved medical school.
  2. Successful completion of an approved ophthalmology post-graduate residency training program or equivalent prior to starting the fellowship.
  3. Documented experience in the following areas:a. Clinical examination, diagnosis, and formulation of a. treatment plan of pediatric ophthalmology patients.
    b. Clinical examination, diagnosis, and formulation of a treatment plan of adult ophthalmology patients.
    c. Horizontal muscle strabismus surgery as the primary surgeon in first operation cases.
  4. Priority will be given to graduates of Canadian residency programs who plan to practice in Canada following completion of the fellowship. Additional priority will be given to those who are planning a career in academic medicine. Special consideration will also be given to international candidates who will be practicing in regions that are lacking in pediatric ophthalmology resources.

 

Training sites

  1. CHEO is the primary training centre for the fellowship, which is centred around paediatric ophthalmology.
  2. iCare Surgical and Optical Centre for adult strabismus and comprehensive ophthalmology.
  3. The Ottawa Hospital (The University of Ottawa Eye Institute at the Ottawa Hospital – General Campus) for adult on-call duties and ophthalmic ultrasound.
  4. Off-site observerships at other designated sites (for example, CNIB). Funding $60,000/year for an applicant without external funding support. Funding for research (including associated conference leave) is available on a competitive process through the University Medical Research Fund. Qualifications obtained in training Candidates who successfully complete the training program will be awarded a certificate at the end of the fellowship.


Fellowship Goals
This fellowship is intended to prepare candidates for a career as a comprehensive ophthalmologist with a strong emphasis on pediatric ophthalmology and strabismus, and for candidates who envision a career as a full-time pediatric ophthalmologist and strabismus surgeon, in an academic or community setting.

 

  1. Clinical:
    a. Appropriately evaluate, diagnose, and treat paediatric and adult in patients in an adult and pediatric ophthalmology outpatient setting.
  2. Surgical
    a. Appropriately evaluate, diagnose, and treat the spectrum of paediatric surgical eye conditions, particularly strabismus, pediatric cataract, and glaucoma, and obtain subspecialty-level skill in the management of adult strabismus.
  3. Education
    a. Develop a more organized, effective, and efficient approach to the basic clinical training of medical students and residents in the clinic and operating theatre.
    b. Become a more effective oral and visual communicator in a didactic teaching setting, including medical student and resident teaching sessions, as well as Department of Ophthalmology Grand Rounds.
  4. Scholarship
    a. Develop an appreciation for pursuit of knowledge and advancement of medicine and surgery through scientific enquiry, including clinical research project design and completion, along with publication and presentation.
  5. Personal Development
    a. Employ techniques to maximize personal growth and career and life satisfaction.
    b. Incorporate volunteerism into a life plan.

 

Specific objectives
At the end of the fellowship, the successful candidate will be able to perform the following:

 

  1. Pediatric ophthalmology and adult strabismus
    a. Medical expert
      i. Effectively triage consultations.
      ii. Evaluate, diagnose, and manage the following conditions:
          1. Congenital eye abnormalities
          2. Retinopathy of prematurity
          3. Pediatric cataracts
          4. Retinoblastoma
          5. Nystagmus
          6. Hemangioma
          7. Hyphema​​​​​​​
          8. Cellulitis​​​​​​​
          9. Uveitis​​​​​​​
          10. Amblyopia​​​​​​​
          11. Strabismus
          12. Abnormal head position
    b. Medical skills
      i. Perform visual acuity testing confidently and reliably in the appropriate scenarios using the following techniques
          1. Bruckner test
          2. Central/steady/maintained fixation testing
          3. Age-appropriate optotypes​​​​​​​
          4. Fixation preference with Teller/Cardiff cards
          5. Special techniques for the visually impaired child
          6. Special techniques for the child with functional visual loss
      ii. Perform ocular motility and sensory testing confidently and reliably in the appropriate scenarios using the following techniques
          1. Worth four dot
          2. Stereo tests (including Lang, Randot, and Frisby)
          3. Cover testing for phorias, tropias​​​​​​​
      iii. Identify the following on examination
          1. Common patterns of childhood strabismus
          2. Monofixation syndromes/microtropias​​​​​​​
          3. Paralytic strabismus and secondary deviations
          4. Oblique muscle dysfunction
          5. Monocular elevation deficiency
          6. Incomitancy​​​​​​​
      iv. Perform refractions confidently and reliably in the appropriate scenarios using the following techniques
          1. Loose lens refractions​​​​​​​
          2. Manifest and cycloplegic refractions​​​​​​​
          3. Aphakic refractions​​​​​​​
    ​​​​​​​       4. Over-refractions​​​​​​​
          5. Bifocal assessment
  2. Comprehensive adult ophthalmology
    a. Appropriately diagnose, manage, and treat adult patients with
      i. Glaucoma and suspicion of glaucoma
      ii. Cataract, including performing a pre-operative assessment
      iii. Uveitis​​​​​​​
      iv. Refractive error
      v. Macular degeneration
      vi. Urgent complaints in an emergency outpatient ophthalmology clinic setting
  3. Pediatric and comprehensive ophthalmology
    a. Surgical skills
      i. Understand the indications, create a surgical plan, anticipate surgical complication, and perform surgery safely and independently for surgical correction of
          1. Strabismus, including vertical muscles, oblique muscles, reoperations, and adjustable sutures
          2. Nystagmus​​​​​​​
          3. Nasolacrimal duct obstruction
          4. Pediatric cataract
          5. Pediatric glaucoma
          6. Hemangioma​​​​​​​
          7. Hyphema​​​​​​​
          8. Retinopathy of prematurity
          9. Examination under anaesthesia​​​​​​​
    b. Communicator
      i. Establish therapeutic relationships with patients
      ii. Establish therapeutic relationships with families
    c. Collaborator
      i. Establish effective working relationships with other members of the patient’s circle of care
    d. Manager
      i. Utilize the resources of the clinic effectively
    e. Scholar
      i. Perform independent study with respect to clinical cases
    f. Health Advocate
      i. Facilitate patient access to hospital and community resources appropriately
    g. Health Professional
      i. Exhibit exemplary interpersonal interactions with colleagues and co-workers
      ii. Demonstrate empathy, compassion, and honesty in dealing with patients and families 

 

Expectations and minimum requirements for completion

  1. The Department of Ophthalmology Administrative Assistant will make the Clinic and Operating Theatre schedules available at least one month in advance.
  2. Unless other clinical duties have been specified, the Fellow will work in clinic and in the operating theatre with Dr. O’Connor on weekdays. Typical workday hours are 0730-1730.
  3. The Fellow will participate in weekly retinopathy of prematurity screening at the neonatal intensive care unit with Dr. O’Connor.
  4. The Fellow will supervise the resident(s) covering daytime emergencies and inpatient consults at CHEO, under the guidance of Dr. O’Connor.
  5. The Fellow will make regular presentations/small group teaching sessions to the residents, and will participate in Department Grand Rounds and Journal Club.
  6. The Fellow will spend dedicated time each week on reading for personal learning.
  7. The Fellow will spend dedicated time in the Ophthalmic Surgical Skills Centre, including with the cataract surgical simulator (EyeSi).
  8. Participation in research project(s) during the fellowship is encouraged but not mandatory.
  9. A minimum of one half-day should be spent observing strabismus surgery by other surgeons in the Department. Ideally this will be arranged on a day when no other clinical duties are scheduled.
  10. If possible, a minimum of one half-day will be spent at each of the following:
    a. CNIB Ottawa
    b. The OCTC Low Vision Early Intervention Program
    c. The Ottawa Public School Board Itinerant Low Vision Teachers
    d. The “i-screen” Kindergarten Vision Screening Program
    e. The electrophysiology lab at the Eye Institute
    f. Other learning opportunities of this nature can be discussed upon request.


Performance evaluation
Formal performance evaluations will be completed at 3-month intervals. Informal feedback will be provided on a day-to-day basis. Evaluations will be based on performance in clinic, operating theatre, teaching sessions and rounds, and from feedback from other members of the health care team.

 

On-Call Duties

  1. In the event that the resident assigned to CHEO is unavailable (for example in the event of a vacation or conference leave), the Fellow will take first call for CHEO outpatient and inpatient consults from 0800-1700 hrs, excluding weekends and holidays.
  2. The Fellow will cover on-call responsibilities when the residents are relieved of their on-call duties, for example the night before the Oral Exams and OKAP Examination. This responsibility will be shared between the Fellows, and the call schedule will be organized in conjunction with the Fellowship Preceptor and Program Director.
  3. The Fellow will be responsible for and will attend to weekend and evening clinical responsibilities as per Dr. O’Connor’s staff on-call schedule and as clinical responsibilities demand. The Fellow is expected to be available, unless otherwise planned, to receive telephone queries from surgical patients.


Vacation and Education Leave
Provided in compliance with PARO guidelines.


Reading requirements
At a minimum during the Fellowship, the Fellow should complete reading of the following during the fellowship:
1. Pediatric Ophthalmology and Strabismus by Hoyt and Taylor
2. Color Atlas of Strabismus Surgery by Kenneth Wright
3. Crucial Conversations by Kerry Patterson et al.


Contacts:
Michael D. O’Connor, Fellowship Director and Preceptor
Department of Ophthalmology
Children's Hospital of Eastern Ontario​​​​​​​
Email: micoconnor@toh.ca

Ginette Snook, Departmental Education Program Coordinator
Department of Ophthalmology
The Ottawa Hospital
Email: gsnook@toh.ca

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