MedStar Union Memorial Spine Fellowship

Updated

Contact Information

Contact name
Trish Koehler
Address
3333 N. Calvert St, Ste, 400 JPB
City
Baltimore
State/Province
MD
Zip/Postal code
21218
Email
This email address is being protected from spambots. You need JavaScript enabled to view it.
Phone
410-554-6865
Fax
410-261-8105

Program Information

Fellows per year
1
Accredited
Yes
Specialty
Spine

One year Spine Fellowship

Starts July 24, 2108 - July 31, 2019

Must have USMLE Steps 1-3

MedStar Union Memorial Spine Fellowship

Overview

This one year ACGME accredited Spine program follows the program requirements for Graduate Medical Education in Orthopaedic Surgery of the Spine. One fellow will be trained for all spinal diseases and conditions of the cervical, thoracic, and lumbar spine: both degenerative and deformity; trauma and tumor; pediatric and adult. Fellows will learn minimally invasive techniques, where surgeons make a small incision and use advanced computer technology and specialized instruments to repair back and spine conditions. Also, learned is microscopic spine surgery, where combine minimally invasive techniques with highly sensitive, cutting-edge surgical microscopes to access even the most delicate areas with precision. Individuals completing the fellowship will be well-suited for either a career in academics or in private practice. This fellowship will have an intellectual environment for acquiring the knowledge, skills, clinical judgment, and attitudes essential to practice spine surgery. The aspects that will be covered include cervical thoracic and lumbar spine disease, deformity of the spine, cervical, thoracic, and lumbar degenerative disease, cervical, thoracic, and lumbar tumors of the spine, fractures of the spine cervical, thoracic, and lumbar infections of the spine, anterior and posterior approaches to the cervical, thoracic, lumbar, and sacral spine, anterior and posterior segmental instrumentation, and several forms of segmental fixation (screws, hooks and wires)

Drs. P. Justin Tortolani, Paul Asdourian, and Mesfin Lemma spine attending physicians, perform approximately 600 cases per year. The overall case load profile is 24% deformity, 75% degenerative, and 1% tumor/fracture. 50% of cases are cervical, while 6% are thoracic/lumbar in nature. Age distribution equates to 99% adult and 1% pediatric.

Faculty:

  1. P. Justin Tortolani: Spine Fellowship program director has 12 years experience in the field of Spine Surgery. Medical School, Cornell University, Residency, Johns Hopkins Medical Institution, Fellowship Emory University Spine Center. On the Board of Directors for MedStar Union Memorial Hospital, Committee member for the residency credentialing committee, and member of the Orthopaedic Surgical Policy Committee.

 

Paul Asdourian: Regional Director of Spine Surgery for MedStar Orthopaedics. Medical School SUNY at Stony Brook School on Medicine, Residency, Boston University Medical Center, and Fellowship at Rush Medical College. Clinical instructor Orthopaedic Surgery, Johns Hopkins University School of Medicine, and Member of the Orthopaedic Surgical Policy committee MedStar Union Memorial Hospital.  

 

Mesfin Lemma: Director Spine Surgery & Director of Minimally Invasive Spine Surgery, MedStar Good Samaritan Hospital/Union Memorial Hospital. Medical School, Case Western Reserve, Residency, Johns Hopkins Hospital, Fellowship, Johns Hopkins Hospital. Former Assistant Professor & Division Chief, Johns Hopkins University, Department of Orthopaedic Surgery.

 

Zeena Dorai: Chief of Neurosurgery MedStar Union Memorial Hospital, Medical School, Jefferson Medical College, Residency, The University of Texas Southwestern Medical Center/Parkland Memorial Hospital, Fellowship, The University of Texas MD Anderson Cancer Center.

Bradley Moatz: Attending Spine Surgery, MedStar Union Memorial Hospital. Medical School, Penn Hershey College of Medicine, Residency, MedStar Union Memorial Hospital, Fellowship Emory University Hospital.

Fellow Requirements:

  • Fellow must be able to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health.
  • Fellow will be responsible for documenting (generally by dictation) the portion of the evaluation and management that they personally provided.
  • Fellow must be able to competently perform all medical, diagnostic and surgical procedures considered for the area of Spine surgery.
  • The fellow will be expected to round on all inpatient surgical and non-operative patients and then will report to the attending that will then round on the same patients.   In concert with the attending, the fellow will develop a daily treatment plan for each patient.
  • Fellow must demonstrate knowledge of established and evolving biomedical, clinical epidemiological and social behavior sciences, as well as the application of this knowledge to patients.
  • Fellow is expected to develop skills and habits to meet the following goals:
  • Systematically analyze practice using quality improvement methods and implement changes with the goal of practice improvement
  • Locate , appraise, and assimilate evidence from scientific studies related to their patients health problem
  • Fellow must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families and health professionals.
  • Fellow must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
  • Fellow must demonstrate an awareness of and responsiveness to the larger context and system of health care as well as the ability to call effectively on other resources in the system to provide optimal care.
  • Clinical and basic science research projects the fellow is encouraged to participate and complete at least two projects/papers.
  • Surgical, out-patient and in-hospital care of the spinal patient is stressed.
  • Attend all in house conferences
  • Complete reading list (Up-to-date review articles, Meta-analyses, outcomes studies, and Cochrane reviews will be provided as part of a balanced and thorough reading curriculum)
  • Teach residents
  • New Innovations: Enter all duty hours weekly and Scholarly Activities.
  • Attend Spine related courses and annual meeting
  • Attend Orthopaedic Research meeting
  • Submit research project to Maryland Orthopaedic Society
  • Enter case logs in the ACGME case log system
  • End of year evaluate program and faculty
  • Attend Lab sessions
  • Present research project at annual Visiting Professor Lectureship
  • Participate in a patient safety project
  • Attend Orthopaedic committee meetings: OPIC and OSPC
  • Attend Journal Club
  • Participate in the ACGME Resident Survey and MedStar Union Memorial Survey

The GME of MedStar Union Memorial Hospital is committed to maintaining a safe, healthful and efficient environment which enhances the welfare of health care practitioners by MedStar Union Memorial Hospital, employees, patients, visitors, and the community. This policy is intended as a guide when health care providers appear to have performance problems that could be attributed to impairment.

All faculty members and fellows are educated to recognize the signs of fatigue and sleep deprivation. Duty Hours are monitored by the GMEC and the program director. Fellows are given SITEL modules during orientation on the signs of fatigue and sleep deprivation. Counseling and psychological support is provided for all fellows through the MedStar Employee Assistance Program (EAP).

Sleep, Alertness & Fatigue Education (SAFER) is given to every fellow in the residency program. Each fellow completes this module on line in SiTEL training before they start the program. This module discusses important aspects of sleep, alertness and fatigue education in a residency.

 

Resources

MedStar Union Memorial Hospital Medical Library

The Library is located on the first floor of the 33rd street building. The library is staffed weekdays from 8:00 a.m. to 4:30 p.m. and can be accessed 24/7 with a hospital ID badge. Along with the computers, copiers, and print materials available in the library, many resources are also available online.

The Online Clinical Library within the MedStar network can be accessed through the intranet, http://starport.medstar.net or http://library.medstar.net. Contact the library staff for remote access to the library resources. MedStar UMH offerings include PubMed with LinkOuts, Ovid, Access Surgery, Access Medicine, MDConsult, Cochrane Library, STATRef texts, Micromedex drug information, ePocrates Diseases Up-to-date (within the network only), and over 400 e-journals

The library staff can assist in literature searches and providing document delivery for those journal articles/book chapters that they do not own. This outside service can take a few days so please try to plan accordingly. Consumer Health information geared towards patients and their family is also available.

 

Orthopedic Library at MedStar Union Memorial

 

The Orthopedic Library is located on the 4th Floor of the Johnston Professional Building has a selection of orthopedic textbooks and is located in the Johnston Professional Building within the orthopedic offices. A compilation of publications by Department staff are maintained.

Facilities:

Outpatient

MedStar Spine Surgeons and fellow see patients in six clinics.   Locations are as follows:

MedStar Union Memorial Hospital, Lutherville, Harbor Hospital, Westminster, Ellicott City, and Belair. Each facility has its own imaging center. Four faculty members will supervise each fellow. Patients are drawn from the city of Baltimore as well as all of the surrounding counties of Maryland and additionally, from neighboring states including Delaware, Pennsylvania, and Virginia. Following surgery, patients are generally continually followed at an outpatient satellite center closer to their home. At our institution, there is no distinction between outpatient clinics and private physician offices. In this setting, the fellow will be working side-by-side with their supervising attending. The fellow will be given the opportunity to see all new and returning patients and then presenting the case to the attending that then will visit with each patient and provide the ultimate clinical decisions.

Inpatient

Patients stay at MedStar Union Memorial Hospital. State-of-the-art operating rooms, imaging capabilities, and expert nursing care as well as rehabilitative services are available at each Hospital. Plans for the future include MedStar Harbor Hospital Center, Franklin Square and Good Samaritan Hospitals.  

Emergency Department

The fellow will be expected to see emergent spine consultations in the ED, with direct communication with the attending on call to develop a timely evaluation and management plan.

Imaging

The following imaging is   available to help support fellow education:

§ X-ray - This imaging technique is used to show the alignment of your bones, whether you have degenerative joint disease or possible tumors.

§ Magnetic Resonance Imaging (MRI) or Computerized Tomography (CT) Scans -These scans can show more than bone. These images may reveal herniated disks or problems with muscles, cartilage, ligaments, tendons or blood vessels.

§ Myelography - This X-ray test uses dye directly injected into your spinal canal to help show places where your spinal cord may be getting pinched by the vertebrae in your back.

§ Bone Scan - A bone scan uses a special camera to help detect bone tumors or compression fractures caused by osteoporosis. The test is performed to identify abnormal processes involving the bone, such as tumor, infection or fracture.

§Electrodiagnostic Studies - These studies investigate the signals your nerves produce. They can confirm nerve compression caused by herniated disks or spinal stenosis.

§ An electrocardiogram (ECG) - Evaluates your heart function

§ Discogram - Dye is injected directly into a disk to determine any damage

§ Myelogram​ - Shows pressure on the spinal cord caused by ruptured disks, bone spurs or tumors

§ Electromyography (EMG) - Assesses nerve or muscle damage

Laboratory

Lab work for patients is available at each facility. (MedStar Union Memorial Hospital, Lutherville, Harbor Hospital, Westminster, Ellicott City, and Belair.)

Rehabilitation

Our exercise physiologists work with patients to offer rehabilitation following surgical and medical procedures. They meet daily with patients to provide assessments, develop exercise prescriptions in conjunction with the attending physician, and offer educational materials to prepare patients for discharge.

Rehabilitation facilities are located on our specialty care wards and the fellow is encouraged to observe patients’ rehabilitation sessions and directly communicate with physical and occupational therapists.

 

Research

A total of 10,000 square feet of well-equipped research space is dedicated to orthopedic research and surgical skills training. Two separate areas provide a wide array of research and training opportunities ranging from biomechanical studies to tendon cell biology. These facilities support resident and fellow projects and education, company sponsored grants, and NIH and foundation funded research. The fellow will have 1 day/week for research and self-directed studies.

Biomechanical Research and Surgical Techniques and Technology Laboratory

The Biomechanical Research and Surgical Techniques and Technology (STAT) Laboratory is a state-of-the-art laboratory that offers multistation facilities for surgical techniques training and separate areas dedicated to biomechanical research studies. Funding for projects provided through Orthopaedic Research Department. There is a medical editor to help with publications.

Osteoporosis Center

Houses a GE Lunar densitometer for assessing bone mineral density by dual x-ray absorptiometry. This equipment can be used for clinical studies, analysis of the density of excised cadaver material, small animal studies, and measurement of body composition.

Operating Rooms

Each operating room at MedStar Union Memorial Hospital is equipped with state-of-the-art equipment including OSI Spine Frame operating tables, Multi-planar fluoroscopy, Large Screen over-head monitors, Anesthesia machines, intra-operative electrophysiological monitoring, and Head-cam video technology. Operating room Teams allow for highly specialized patient-centered intra- and peri-operative care that should maximize fellow education. One-on-one instruction and supervision will be provided to the fellow on every surgical case at our institution. Fellows will not perform surgery without an attending present and scrubbed during the procedure. A graduated responsibility paradigm will be established such that the fellow will be allowed to perform greater amounts of each surgical procedure after completing appropriate milestones. One-on-one instruction and supervision will be provided to the fellow on every surgical case at our institution. Fellows will not perform surgery without an attending present and scrubbed during the procedure. A graduated responsibility paradigm will be established such that the fellow will be allowed to perform greater amounts of each surgical procedure after completing appropriate milestones.

The fellow will be provided clinical instruction on how to perform a comprehensive neurologic exam. Performance of such exams will be constantly monitored by the faculty and feedback provided in an ongoing and repetitive fashion throughout the fellowship. Our spine service works seamlessly with our neurosurgery and neurology colleagues to ensure comprehensive instruction in developing a differential diagnosis and neurologic evaluation and management.

Each patient evaluated in the clinical setting or prior to surgery (in indications conference) will be discussed with regard to the most appropriate diagnostic laboratory tests to order including the use of electrophysiological monitoring. Instruction on what specific laboratory and/or imaging tests will be provided to fellow on case by case basis.

Operative skills will be taught to each fellow via hands-on learning in the operating room under direct instruction and supervision as well as via cadaver-based teaching modules that are readily accessible in our STAT (see previous) lab. Graduated skill development will enable surgeons-in-training to perform increased percentages of each case based on demonstrated competency. Appropriate surgical atlas and/or technique guides will be made available when appropriate.

Teaching skills will be acquired during instruction to our resident surgeons during didactic spine conferences, pre-admission conferences, as well as during surgery and on the wards.   Fellows will also be encouraged to speak at medical and surgical Grand Rounds at our institution.

 

Conferences Schedule:

Case Based Spine Didactic Conference: Meets twice/month. All Spine faculty & fellows are in attendance in addition to Interventional radiology.

Pre-admission Conference (“Indications”): Meets every Friday. All spine faculty & fellows are in attendance in addition to Case Management, Nursing, Pharmacy, Equipment vendors, OR personnel.

Spine Journal Club: Meets once every 2-3 months. All spine faculty & fellows are in attendance in addition to Physiatry, Physical Therapy, and Nurses

Orthopaedic Research Conference: Meets Quarterly

Morbidity and Mortality: Meets Quarterly

Consults: In-hospital spine consultations will be available to the fellow on a case-by-case basis. Fellows will be given the opportunity to perform a thorough, independent history and physical exam and develop a management plan. This will be presented to the faculty who will then examine the patient and develop an ultimate treatment plan after providing feedback to the fellow. Fellows will be encouraged to assist in the teaching of our orthopaedic surgery residents, rotating medical students, and physician assistants. Based on experiences with other fellowships at our institution, this experience is particularly rewarding for the fellow.

In order to ensure the fellow has adequate experiences on both the outpatient and inpatient arenas, we plan on limiting the number of fellows in our program and allowing him/her access to all of our patients. Given the number of patients visiting our center (both inpatient and outpatient) as well as the wide demographic and clinical variability inherent to our spine service, we would expect the clinical experience to not be lacking in any key aspect of spine care.

There will be a close mentor-mentee relationship that evolves daily with constant feedback and graduated responsibility that can only occur with careful supervision. Fellows will have quarterly meetings with their faculty in order to ensure that they are meeting necessary milestones for both operative and non-operative care of spine patients from the faculty perspective, but furthermore to ensure that the fellow is receiving what he/she believes to be the best possible experiences in whi

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Category: Spine
One year Spine Fellowship Starts July 24, 2108 - July 31, 2019 Must have USMLE Steps 1-3

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