Education and learning
The Hospital for Sick Children (SickKids) was founded in 1875. It is the prime paediatric referral centre in the Greater Toronto Area (population 4 million) and, it enjoys a unique agreement with the other teaching hospitals and the Faculty of Medicine at the University of Toronto (UofT). All children with paediatric neurosurgical disorders are admitted to the SickKids neurosurgical service.
The Division of Neurosurgery at SickKids is one of the largest such paediatric neurosurgical facilities in North America. Each year, an average of 1,200 children are admitted to the neurosurgical division, where a total of 800 operative procedures are performed. The neurosurgical division at SickKids not only looks after patients from the metropolitan area, but also caters to the rest of the Province of Ontario as well as other parts of Canada. In addition patients with difficult pediatric neurosurgical problems are referred from the United States, South America, Europe and Asia.
The four attending neurosurgeons - Drs Peter B. Dirks, James M. Drake, Robin P. Humphreys and James T. Rutka - all hold positions within the Department of Surgery of the Faculty of Medicine at the University of Toronto. They practice full time and are based in offices within SickKids.
The Division of Neurosurgery at SickKids has 25 beds in a neurosurgical unit which admits patients up to 18 years of age. In addition, paediatric neurosurgical patients are looked after in the specialized neonatal intensive care unit as well as a paediatric critical care unit and the trauma unit. The neurosurgical service is actively supported by skilled neuroanaesthetists, neuroradiologists, neuro-ophthalmologists, neuropathologists, intensivists and neonatologists as well as social workers and physiotherapists assigned to the neurosurgical service.
The neurosurgical operating room in the Atrium (opened in 1993) is equipped with the latest technological devices which are necessary to perform sophisticated neurosurgery. In addition to this dedicated theatre there is a craniofacial operating room where techniques are combined with a craniofacial surgeon. Elective operative procedures are carried out 5 days each week. Approximately 100 children with brain tumors are operated upon annually, 75 with various forms of spinal dysraphism, 60 with craniofacial and synostotic abnormalities and 400 for CSF diversionary shunts. There are 4 out-patients clinics weekly, in which 3,000 children are reviewed each year. The spina bifida clinic is held twice monthly at an associated children's rehabilitation facility.
The Division of Neurosurgery at SickKids is one of several such units associated with the neurosurgical training program at the University of Toronto. In addition to the informality of bedside and theatre teaching, the neurosurgical fellow is exposed to the didactic instruction of weekly clinical rounds and a residents' seminar based on techniques for passage of the examination of the Royal College of Physicians and Surgeons of Ontario and the American Board of Neurological Surgery. Each week there are neurosurgical rounds, including morbidity and mortality sessions, combined neurology/neurosurgery rounds, tumor board and epilepsy rounds.
The Division of Neurosurgery has a computerized data retrieval system which provides the opportunity for one to prepare and publish reviews on paediatric neurosurgical topics. The Hospital for Sick Children has an affiliated Research Institute where neuroscientists are actively involved in a variety of projects. The Arthur & Sonia Labatt Research Centre has a laboratory devoted to neurosurgical projects on neuro-oncology.
The University of Toronto provides for several visiting professorships including one devoted to paediatric neurosurgery. In addition, visitors from around the world spend time as observers on the neurosurgical unit and take part in various teaching sessions.
The University of Toronto neurosurgical training program provides two residents on six-monthly rotations to the Division of Neurosurgery at SickKids. These residents who are at varying levels of their training have only had adult clinical experience before arriving at SickKids for their exposure to paediatric neurosurgery. In addition to the University of Toronto residents, self-funded residents from other training programs come for periods of three to six months to gain exposure in paediatric neurosurgery. Medical students also spend elective time on paediatric neurosurgery.
The clinical fellow in paediatric neurosurgery at SickKids is an individual who has completed his or her neurosurgical training and is interested in an academic career in paediatric neurosurgery. He or she will be exposed to a wide variety of clinical material and is provided with ample time for clinical research. The neurosurgical laboratory is available for specific research projects.
The neurosurgical fellow at The Hospital for Sick Children is responsible for the entire neurosurgical service. The fellow makes rounds with all the residents and students each morning before the day begins. This activity is carried out during the week and on the weekends as well. The fellow has independent operating privileges although surgery is booked under the name of the surgeon who is primarily responsible for the care of the patient. The fellow assigns and supervises the residents, and can choose which cases he/she wishes to scrub on. It is expected that the fellow will provide second call for the emergency room and come in at night or on weekends to assist the resident with trauma or emergency procedures at night and weekends. A supervising staff neurosurgeon is always available.
Neurosurgical outpatient clinics are held four days a week and the neurosurgical fellow has the choice of attending a clinic run by one of the staff neurosurgeons.
The neurosurgical fellow organizes the neurosurgical teaching rounds. In collaboration with the chief resident in neurology the fellow organizes the Combined Neurology-Neurosurgery Conference each week, and in collaboration with the neuro-oncologists structures the Neuro-oncology Rounds. The fellow is also in charge of the monthly journal club which is held in the home of one of the staff neurosurgeons.
In past years men and women from across Canada, the United States, Argentina, Australia, Brazil, Great Britain, Ireland, Germany, Israel, Japan, Thailand, Taiwan, South Korea, the Philippines, Saudi Arabia, France, Italy and South Africa, have received fellowship training in the Division of Neurosurgery at The Hospital for Sick Children.