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Leadership development facilitated by the “sandwich” and related glaucoma fellowship programs

Victoria Liu (McMaster University, Hamilton, Canada)
Rita Whitford (Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada)
Karim F. Damji (Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada)

Leadership in Health Services

ISSN: 1751-1879

Article publication date: 10 June 2021

Issue publication date: 31 August 2021




The purpose of this paper is to evaluate leadership training in the Sandwich Glaucoma Fellowship (SGF), a program in which fellows learn skills in a developed world institution and their home country to become leaders in glaucoma care.


This paper is a retrospective, qualitative and quantitative evaluation. Participants of the SGF between 2007 and 2019 were provided a survey eliciting demographic information, leadership training exposure, development of leadership competencies and feedback for the fellowship program.


Seven of nine alumni responded. The fellowship strongly impacted leadership competencies including integrity (8.8, 95% CI 7.8–9.8), work ethic (8.64, 95% CI 7.7–9.6) and empathy (8.6, 95% CI 7.7–9.5). A total of 85% of alumni indicated positive changes in their professional status and described an increasing role in mentorship of colleagues or residents as a result of new skills. Lack of formal leadership training was noted by three respondents. Informal mentorship equipped fellows practicing in regions of Sub Saharan Africa with competencies to rise in their own leadership and mentoring roles related to enhancing glaucoma management. Suggested higher-order learning objectives and a formal curriculum can be included to optimize leadership training catered to the individual fellow experience.


Leadership is necessary in health care and specifically in the context of low- and middle-income countries to bring about sustainable developments. The SGF contains a unique “Sandwich” design, focusing on the acquisition of medical and leadership skills. This evaluation outlines successes and challenges of this, and similar fellowship programs. Other programs can use a similar model to promote the development of skills in partnership with the fellows’ home country to strengthen health-care leaders.



This evaluation of the SGF was made possible by many alumni who participated in this survey and who are leaders in glaucoma care. Thanks are due to Drs. Faith Masila, Dan Kiage, Jeremie Agre, Girum W. Gebreal, Sheila Marco, Testfaye Tadesse and others. This project would not have been possible without them.

This project has received no funding or sponsorship. Karim F. Damji has received funded grants from Alberta Innovates and Neurosciences, Rehabilitation and Vision SCN Seed Grant Competition for projects titled: Degenerative Eye Condition VR Experience and The Burden of Vision Loss in Stroke: Barriers to Care Experienced by Stroke Survivors in Alberta.


Liu, V., Whitford, R. and Damji, K.F. (2021), "Leadership development facilitated by the “sandwich” and related glaucoma fellowship programs", Leadership in Health Services, Vol. 34 No. 3, pp. 280-295.



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