Clinical Fellowship

Cornea/External Disease, Anterior Segment, and Refractive Surgery

Duration:

2 years: July 1 –June 30

Positions:

One

Supervisors:

Setareh Ziai, MD, FRCSC (Clinical Fellowship Director); Mona, Koaik, MD, FRCSC; Kashif Baig, MD, MBA, 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 Departmental Education Program Coordinator ([email protected]) regarding the application process, which involves the Postgraduate Medical Education Office. Applications for the are due in October. Interview notifications will be made by the end of October. Interviews will be held virtually in November. The Match takes place December.

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:

$70,000/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: [email protected]
• Ginette Snook, Departmental Education Program Coordinator
  University of Ottawa Eye Institute
  Email: [email protected]

Fellowship Objectives:

• To acquire experience beyond that of the normal residency in the diagnosis and treatment of medical and surgical retinal disorders by working closely with fellowship trained retinal surgeons at the University of Ottawa Eye Institute, the Riverside Eye Care Centre and the Children’s Hospital of Eastern Ontario.

• To become familiar with the use of diagnostic equipment for the diagnosis of retinal detachments, retinal tears and retinal disease including ultrasonography, fluorescein angiography, indocyanine green angiography and electrodiagnostics.
• To acquire experience reading computerized optical coherence tomography scans, ultrasonography scans, fluorescein and indocyanine green images and electrodiagnostic scans.
• To acquire experience in the surgical management of retinal tears and detachments, vitreous hemorrhage, macular disease, intraocular tumors, retinopathy of prematurity and traumatic ocular injury.
• To acquire experience in the management and treatment of macular degeneration.
• To become familiar with the management and operation of clinical trials related to retinal disease.
• Participate in at least one clinical or basic research project during the twenty-four months and present the data at a national or international meeting. Participate in writing several scientific reports or case reports during the fellowship year.
• Play a role in the teaching of medical students and residents.

This position is offered through the SF Match 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 the Departmental Education Program Coordinator ([email protected]). All Foreign Trainee applications to our program must go through the PGME office. Foreign Trainee candidates must apply on-line through the Fellowship application system. The application site for Foreign Trainees opens in July/August and the deadline for applications is September 30th for the next academic year. All Foreign Trainee candidates are expected to apply to both the SF Match and the PGME Foreign applications. Applications are due in the fall. Interview notifications will be made in October. Interviews will be held at the end of October/November. The Match takes place in December.

The objectives in Neuro-Ophthalmology are:

Clinical

• obtain direct hands-on clinical experience and training in the evaluation and management of afferent and efferent neuro-ophthalmic conditions.

• To be able to perform and master the art of a comprehensive neuro-ophthalmologic examination
• To develop and master a diagnostic and therapeutic approach to difficult neuro-ophthalmic case presentations.
• Develop facility and mastery in the evaluation and management of patients with optic neuropathies.
• Develop facility and mastery in the evaluation and management of patients with optic nerve head swelling including papilledema and pseudopapilledema
• Develop facility and mastery in the evaluation and management of patients with central nervous system disorders such as stroke, neuromuscular junction disease, and degenerative diseases (eg. Neuro-ophthalmic manifestations of Parkinson’s disease)
• Develop facility and mastery in the evaluation and management of patients with facial pain syndromes
• Develop facility and mastery in the evaluation and management of patients with orbital fissure, cavernous sinus, and chiasmal disorders
• Develop facility and mastery in the evaluation and management of patients with trigeminal pain syndromes, and migraine
• Develop facility and mastery in the evaluation and management of patients with visual field disturbances
• Develop facility and mastery in the evaluation and management of patients with neuro-ophthalmic features of multiple sclerosis
• Develop facility and mastery in the evaluation and management of patients with diplopia
• Develop facility and mastery in the evaluation and management of patients with anisocoria
• Develop facility and mastery in the evaluation and management of patients with cranial neuropathies

For more information on the Neuro-Ophthalmology fellowship program, please contact Departmental Education Coordinator at [email protected], Departmental Education Program Coordinator. All Foreign Trainee applications to our program must go through the PGME office. Foreign Trainee candidates must apply on-line through the Fellowship application system. The application site for Foreign Trainees opens in July/August and the deadline for applications is September 30th for the next academic year. All Foreign Trainee candidates are expected to apply to the PGME Foreign applications.

Surgical

• Develop an understanding of which clinical scenarios and presentations require or warrant surgical intervention.

• Develop an understanding of when optic nerve sheath fenestrations are warranted in the management of intracranial hypertension. The trainee should obtain the necessary skills and experience in the hands-on performance of optic nerve sheath fenestrations.
• Develop skills and strategies to independently plan and execute a variety of adult strabismus surgeries including but not limited to:
  • Adjustable suture techniques
  • Fixed suture techniques
  • Horizontal rectus muscles
  • Cyclovertical muscles
  • Sensory deviations
  • Thyroid-related dysmotility
  • Re-operations
  • Congenital or longstanding deviations
  • Congenital Nystagmus surgery
• Develop mastery of temporal artery biopsies
• To be able to assess the need for and independently perform suture tarsorrhaphies, ectropion and entropion repairs
• To develop an approach to the prevention (whenever possible) and management of peri-operative, intra-operative and post-operative complications.

For more information on the Neuro-Ophthalmology fellowship program, please contact the Departmental Education Program Coordinator at [email protected], Departmental Education Program Coordinator. All Foreign Trainee applications to our program must go through the PGME office. Foreign Trainee candidates must apply on-line through the Fellowship application system. The application site for Foreign Trainees opens in July/August and the deadline for applications is September 30th for the next academic year. All Foreign Trainee candidates are expected to apply to the PGME Foreign applications.

Academic

• To develop a broad and in-depth fund of knowledge of neuro-ophthalmology and relevant aspects in related fields such as Neurology and Neurosurgery.

• To be able of teach clinical, academic, and surgical concepts to residents and medical students.
• To participate in on-going neuro-ophthalmology research projects, as well as take primary initiative on at least one project of particular interest to the trainee. This may lead to presentation of his/her work at a national or international conference, and/or to publication in a peer-reviewed academic journal.
• The trainee will be expected to provide guidance, leadership, and assistance to residents in their pursuit of academic proficiency in neuro-ophthalmology.

For more information on the Neuro-Ophthalmology fellowship program, please contact the Departmental Education Program Coordinator at [email protected], Departmental Education Program Coordinator. All Foreign Trainee applications to our program must go through the PGME office. Foreign Trainee candidates must apply on-line through the Fellowship application system. The application site for Foreign Trainees opens in July/August and the deadline for applications is September 30th for the next academic year. All Foreign Trainee candidates are expected to apply to the PGME Foreign applications.

Fellowship in Pediatric 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 pediatric 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 the Departmental Education Program Coordintor at [email protected], Departmental Education Program Coordinator at the University of Ottawa Eye Institute. American/foreign medical graduates must contact the Departmental Education Program Coordinator at [email protected] regarding the application process in advance of submitting an application, as the application process involves the Postgraduate Medical Education Office. Applications are due September 30th 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.

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 pediatric and adult in patients in an adult and pediatric ophthalmology outpatient setting.

2. Surgical
   a. Appropriately evaluate, diagnose, and treat the spectrum of pediatric 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

   1. Medical expert

      1. Effectively triage consultations.

      2. 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

   2. Medical skills

      1. 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

      2. 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

      3. 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

      4. 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

   1. Appropriately diagnose, manage, and treat adult patients with

      1. Glaucoma and suspicion of glaucoma

      2. Cataract, including performing a pre-operative assessment

      3. Uveitis

      4. Refractive error

      5. Macular degeneration

      6. Urgent complaints in an emergency outpatient ophthalmology clinic setting

3. Pediatric and comprehensive ophthalmology

   1. Surgical skills

      1. 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

   2. Communicator

      1. Establish therapeutic relationships with patients

      2. Establish therapeutic relationships with families

   3. Collaborator

      1. Establish effective working relationships with other members of the patient’s circle of care

   4. Manager

      1. Utilize the resources of the clinic effectively

   5. Scholar

      1. Perform independent study with respect to clinical cases

   6. Health Advocate

      1. Facilitate patient access to hospital and community resources appropriately

   7. Health Professional

      1. Exhibit exemplary interpersonal interactions with colleagues and co-workers

      2. 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:
    1. CNIB Ottawa
    2. The OCTC Low Vision Early Intervention Program
    3. The Ottawa Public School Board Itinerant Low Vision Teachers
    4. The “i-screen” Kindergarten Vision Screening Program
    5. The electrophysiology lab at the Eye Institute
    6. 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: [email protected]

• Ginette Snook, Departmental Education Program Coordinator
  Department of Ophthalmology
  The Ottawa Hospital
  Email: [email protected]

Introduction

The Fellowship program in uveitis at the university of Ottawa (uOttawa) takes place in the Department of Ophthalmology spanning 3 clinical centres, the Ottawa Hospital General Campus (University of Ottawa Eye Institute), the Ottawa Hospital Riverside Campus (Riverside Eye Care Centre), and the Children’s Hospital of Eastern Ontario.

The objective of the uOttawa Fellowship program in uveitis is to train ophthalmologists who have completed a Canadian or US residency (or international clinical and surgical training program in ophthalmology) in the sub-specialty management of patients with inflammatory diseases of the eye and orbit. The Fellowship is for one year. The Fellow will have the opportunity to work with two uveitis specialists in the clinic and in the operating room. The Fellow will have the opportunity to participate in uveitis clinics, operating room, research, teaching, Grand Rounds, Journal Clubs, as well as regional, national and international conferences. Resident teaching, on-call coverage and a research project in the field of uveitis are required.

Training Overview

A wide variety of exposure to uveitis cases in a tertiary care centre allows for the development of an approach to all types of cases, both adult and pediatric. A high volume of clinical exposure to patients with common, rare, severe, and complex inflammatory ocular and systemic diseases challenges the Fellow to gain competence and mastery of a wide variety of diagnostic testing and knowledge of the therapies, both medical and surgical, for uveitis. A Fellow will develop a solid grasp of the indications for immunosuppression, therapeutic options, the knowledge to prescribe immunosuppressive agents, and coordinate care with co-managing rheumatologists, respirologists, gastroenterologists, infectious disease specialists and other ophthalmologists involved in the care of patients with uveitis and inflammatory eye/orbital diseases. Long-term medication monitoring and follow up planning are essential in the care of uveitis patients, and Fellows will learn to care for the patient with uveitis using a patient-centered model to optimize vision and the overall function and well-being of the patient.

Selection Criteria

The applicant will have:

• Completed training in a university ophthalmology program that meets the criteria for a physician-trainee at the university of Ottawa.
• Can obtain an educational license through the College of Physicians and Surgeons of Ontario.
• Can converse comfortably with patients in the English language.
• Presents an up-to-date curriculum vitae and 2 letters of recommendation, one of which is from the Program Director of the residency program where the trainee completed their ophthalmology training.
• Interview with the professors co-supervising the Fellow and other department members or Fellows.

Educational Components

The Fellowship program in uveitis at the university of Ottawa (uOttawa) involves participation in department educational, research and teaching activities, as follows:

• Participation in uveitis clinics and operating rooms
• Participation in other related subspecialty clinics, such as rheumatology and pediatric ophthalmology, for exposure to a wide variety of patients with uveitis and to gain a deeper knowledge of treatment approaches.
• Participation in teaching to medical students, residents and other allied professionals in teaching sessions, meetings, conferences or clinics.
• Carry out to completion a scientific research project with publication of results as a journal article, as well as present a project at the Department’s Annual Research Day.
• Present at uveitis Grand Rounds and Journal Clubs
• Present at one regional, national or international uveitis conference each year.
• Protected research time during the week will be provided for scholarly activities and research.

Schedule

A monthly schedule will be developed in advance and reviewed with the Fellow and approved by the Uveitis Fellowship Director, to be released monthly. An example is as follows:

Goals and Objectives

The educational competencies of the uveitis Fellowship are as follows.

Medical Expert:

Academic Knowledge:

Ocular inflammatory disease, orbital inflammation, corneal and conjunctival inflammation

1. Understand the elements of the immune system and scientific concepts of intraocular inflammation pathogenesis, orbital inflammation, and inflammation of the conjunctiva and cornea
2. Understand the anatomic classification of uveitis
3. Understand classification of uveitis by standardized definitions of acute/chronic, granulomatous/non-granulomatous, recurrent/persistent/chronic
4. Understand the pathology, diagnosis and treatment of ocular infections, including
   1. Bacterial and fungal diseases
   2. Spirochetal diseases
   3. Acquired immunodeficiency syndrome (AIDS)
   4. Acute retinal necrosis and progressive outer retinal necrosis
   5. Other viral diseases (causing anterior uveitis and retinitis)
   6. Ocular Toxoplasmosis
   7. Ocular Histoplasmosis
   8. Toxocara canis
   9. Onchocerciasis and other parasitic diseases
   10. Post-surgical uveitis: Endophthalmitis vs. TASS
   11. Scleritis caused by infectious agents
   12. Keratitis associated with uveitis
5. Understand the pathology, diagnosis and treatment of non-infectious ocular inflammatory disease, orbital inflammation, including
   1. Anterior uveitis
   2. Scleritis and episcleritis
   3. Intermediate uveitis
   4. Sarcoidosis
   5. Sympathetic ophthalmia
   6. Vogt-Koyanagi-Harada syndrome
   7. Birdshot retinochoroidopathy
   8. Behçet’s disease
   9. Retinal vasculitis
   10. Serpiginous choroidopathy
   11. “White-dot syndromes” or inflammatory chorioretinopathies
   12. Masquerade syndromes including autoimmune retinopathy, lymphoproliferative disease, and leukemia
   13. Drug-induced ocular inflammation, including topical therapies, oral medications, and IV therapies, including checkpoint inhibitors and cancer therapies
6. Understand the philosophy, goals, management, and co-management of medical therapy of uveitis using NSAIDs, corticosteroids, immunosuppressive medications, biologics and non-biologic response modifiers
7. Understand the common presentations of uveitis in children vs. adults
8. Interpret results of laboratory tests and imaging
9. Counsel patients on non-medical therapies for uveitis and the co-management of uveitis other practitioners, such as naturopathic doctors and pharmacists

Medical Skills:

Uveitis and ocular inflammatory disease, orbital inflammation

1. Take a proper and concise uveitis oriented ophthalmic history
2. Examine a patient with emphasis on uveitis-related signs and anatomic complications of inflammatory disease
3. Grade anterior chamber and vitreous cells, flare, and haze according to standardized grading scales
4. Assess orbital, corneal, and conjunctival inflammation according to standardized grading scales

Medical Judgement:

Uveitis and ocular inflammatory disease, orbital inflammation

1. Appropriately apply diagnostic testing for patients with uveitis
2. Appropriately determine management of the ocular inflammatory diseases listed above
3. Understand the frequency of follow-up required for different uveitis
4. Refers to subspecialists for surgical management of glaucoma, retinal complications, orbital disease and corneal/scleral complications of uveitis, or biopsies

Surgical Skills:

Uveitis and ocular inflammatory disease, orbital inflammation

1. Perform a periocular and intravitreal steroid injection (orbital or sub-Tenon’s, intravitreal)
2. Perform anterior chamber and posterior chamber tap for diagnosis
3. Applies principles and techniques of cataract surgery in patients with uveitis (iris maintaining devices such as hooks or rings, use of capsular-staining dyes, division of iris from cornea or anterior capsule synechiae)

Surgical Judgement: Uveitis

1. Understand the principles of managing OID in the perioperative period (use of topical, oral and intraocular or periocular corticosteroids and intravitreal implants)
2. Understand the role of diagnostic and therapeutic vitrectomy surgery in patients with uveitis
3. Understand the role of B-scan ultrasound, UBM, anterior chamber paracentesis, vitreous biopsy and chorioretinal biopsy in patients with uveitis

Consultancy Skills

1. Be able to see a patient referred to the uveitis service and do a full work-up determining necessary ancillary tests and investigations, treatments and referrals

Patient-Centered Care:

1. Can demonstrate patient-centered care and collaborate with the patient in determining an appropriate care plan (“goals of care”) involving medical treatments and long-term drug therapies (immunosuppressive and biologic therapy), surgical treatments and other treatments in collaboration with the patient’s views, beliefs and wishes

Communicator:

1. Establishes therapeutic relationships with patients seen in the uveitis clinics
2. Can listen effectively to the patient and families met in the uveitis clinics
3. Can obtain and synthesize a relevant history, specifically pertaining to uveitis-related systemic symptoms (history of arthritis or joint pain, past medical & family history, exposure to key infections, high-risk behaviours, current or past cancer therapies, etc.) from patients and their families in uveitis clinics
4. Can effectively summarize & communicate a patient’s ocular problem to other subspecialties often in the circle of care of patients with uveitis (adult & pediatric rheumatology, radiology, infectious disease specialists, pathology and laboratory medicine)
5. Provides hand-over and follow up information to other health care professionals often in the circle of care of uveitis patients, including other resident doctors, staff physicians, rheumatologists and optometrists
6. Takes a “best possible medication history” and allergy history, communicates with pharmacies when needed to verify drugs and doses taken
7. Provides hand-outs and/or information/discussion on prescribed or recommended drug therapies for uveitis. Provides a communication tool or drug list to patients to help them understand new prescriptions or changes to eye drops and medications.

Collaborator:

1. Can consult effectively with the surgical retina service, glaucoma service, or cornea and external disease service, adult rheumatology, pediatric rheumatology, pathology and laboratory medicine to coordinate care for uveitis patients
2. Can effectively interact with the staff physician in determining the diagnosis and management of patients seen in clinic
3. Collaborates with pharmacists, optometrists, and opticians to establish follow up care and maximize patient safety
4. Collaborates with the patient’s local health provider (nurse practitioner or family physician) to coordinate testing when needed and establish follow up care

Leader:

1. Is able to utilize the resources of the clinic wisely in the management of the spectrum of patients seen in clinic
2. Applies evidence-based treatments for uveitis and ocular inflammatory diseases and cost-appropriate care plans

Scholar:

1. Has shown the ability to do independent study with respect to uveitis cases seen in clinic
2. Teaches students, residents, the patient, and other health care professionals
3. Integrates best available evidence into care of patients with uveitis and ocular inflammation
4. Can discuss best available evidence with patients when formulating a care plan for treating uveitis, specifically with immunomodulatory and biologic treatments

Health advocate:

1. Facilitates access to low vision assessments, Vision Rehabilitation Canada, and other resources for visually impaired patients
2. Facilitates access to rheumatology, internal medicine, respirology, infectious disease, neurology, neurosurgery, oncology, pathology, laboratory medicine, radiology and medical imaging in urgent situations
3. Communicates lifestyle modifications (smoking cessation, reduced alcohol consumption, healthy eating) to improve effectiveness of medical therapy for uveitis and maximize safety of medications administered to treat uveitis

Health professional:

1. Exhibits professional personal and interpersonal behavior with staff and residents in clinic
2. Is an honest, ethical, and compassionate physician
3. Respects patient diversity and cultural differences

Rules and Regulations

The Fellow is subject to the rules and regulations of the College of Physicians and Surgeons of Ontario, the Ottawa Hospital, the Children’s Hospital of Eastern Ontario and the university of Ottawa. A monthly schedule of clinics, ORs, teaching and protected research time will be organized via the Uveitis Fellowship Director. The presence of the Fellow in clinics, operating rooms and educational/teaching activities cannot be modified without the agreement of the Uveitis Fellowship Director.

Evaluation: Although daily feedback is common in the program, a formal evaluation will be completed and discussed with the Fellow quarterly. The educational competencies and the Fellow’s specific educational goals will be reviewed at the start of the fellowship, with an informal review at 2 months and a mid-fellowship evaluation at 6 months. Feedback from the Fellow to the Fellowship Director or Department Chair will be sought at 6 and 12 months.

Vacation: 2 weeks

Conference: 1 regional, national or international conference with $1,000 sponsorship from the Program.

Although no on-call system exists for the uveitis service, the Fellow is expected to courteously provide occasional clinical care in the evenings or weekends for patients with urgent, emergent or postoperative care.

Completion of 12 months of training will allow the Fellow to be granted a certificate of clinical training in uveitis from the university of Ottawa. Failure to comply with the Educational Components or Rules and Regulations may result in no certificate being granted at the discretion of the Fellowship Director. Early termination criteria are in accordance with the University of Ottawa.

Funding

Funding in the form of a salary of $70,000 CAD is provided.

How to Apply

Send your application (curriculum vitae and 2 letters of recommendation, one of which is from the Program Director of the residency program where you completed ophthalmology training) by the deadline to:

Dr. Chloe Gottlieb
Director, Postgraduate Medical Education
University of Ottawa Eye Institute, The Ottawa Hospital, General Campus
501 Smyth Road
Critical Care Wing, Box 307
Ottawa, Ontario
Canada
K1H 8L6
Tel: 613-739-6845
E-mail: [email protected]

Questions about the application? Please contact:

Ginette Snook, Department Educational Coordinator
Departmental Education Program Coordinator
Department of Ophthalmology
University of Ottawa Eye Institute, The Ottawa Hospital, General Campus
501 Smyth, Suite W6255 (Box 307)
Ottawa, Ontario
Canada
K1H 8L6
Tel: (613) 737-8899 x79422
E-mail: [email protected]

Deadlines

Application Deadline: September 30