FELLOWSHIP PROGRAMME IN

PEDIATRIC OTOLARYNGOLOGY

& AIRWAY SURGERY

(TWO-YEAR FELLOWSHIP)

Department of Otorhinolaryngology

Postgraduate Center

College of Medicine, King Saud University

Riyadh, Saudi Arabia

Introduction

King Saud University, College of Medicine is situated in the heart of Riyadh, Kingdom of Saudi Arabia and it offers a continuing medical education in different fields of specialty for decades and that include Otorhinolaryngology and Head and Neck Surgery specialty.

The Graduates of the University have gone a long way and have proven their worth. Most of them are currently contributing their respective shares in extending training to the would-be fellows, as well as holding prestigious positions in different hospitals within and/or outside the kingdom.

Name of the Program

2-year Fellowship in Pediatric Otolaryngology & Airway Surgery

Objective

The objective of the program is to produce a specialist in pediatric otolaryngology who has achieved competencies in most of the pediatric otolaryngology and airway diseases.

Admission requirements / Prerequisites / Selection Criteria

To be admitted to Pediatric Otolaryngology subspecialty program, Candidate must:

1. Be a graduate of an approved school of Medicine.

2. Be a Board eligible/Board certified otolaryngologist to sit for the interview.

3. Be a  Board certified to be able to start the fellowship training.

4. Provide a letter of release and sponsorship as a full-time fellow for whole durations of the training.

5. Successfully complete the admission exam and/or the interview.

6. Provide (2) reference letters from consultants with whom the candidate is currently working or has recently worked with for a minimum period of six months.

GOALS AND OBJECTIVES OF THE TRAINING PROGRAM

General Guidelines

1. The duration of the sub-specialty training program is 2 years.

2. The fellow will be under the close supervision of the Pediatric Otolaryngology group.

3.  The start date of the fellowship program is the 1st working day in January of each year.  The application submission is from July to September of the academic year preceding the fellowship.

General Objectives: 

Pediatric otolaryngologist must possess a sound knowledge in the general principles of medicine and surgery. During the course of training, the fellow will acquire satisfactory knowledge of the principles common to all pediatric otolaryngology surgical practice. Pediatric otolaryngology embraces some components of neonatology, pediatric intensive care, head and neck, sleep medicine, plastic surgery, cardiothoracic, neurosurgery, pathology and other specialties. The candidate must have sufficient knowledge in these fields as it relates to the specialty. 

During the course of training, the fellow must develop clinical competence and detailed knowledge of the scientific rationale for the medical and surgical management of pediatric otolaryngology. This includes knowledge of the techniques of otology, rhinology, head and neck, and airway surgeries and. In addition, the fellow should be able to develop special expertise in the diagnosis and medical/surgical management of diseases and disorders related to disciplines within pediatric otolaryngology such as: auditory system and speech pathology. 

The fellow must demonstrate the knowledge, skills, and attitudes relating to gender, culture, and ethnicity pertinent to otolaryngology. In addition, they must demonstrate the ability to incorporate these matters in research methodology, data presentation, and analysis. 

Upon successful completion of the educational program, the graduate Physicians will be capable to function as a consultant pediatric otolaryngologist.

Program Certification:

The fellowship is an accredited program by the department of Otorhinolaryngology Head and Neck Surgery at College of Medicine, King Saud University. 

Resources and facilities

King Abdulaziz University Hospital (KAUH) is a tertiary care academic hospital attached to the College of Medicine, KSU, Riyadh.   It is located in the central area of Riyadh. The university hospital specializes in ORL-H. & N. surgery and ophthalmology with a capacity of 104 in-patient beds.  The total annual ambulatory visits to all departments are approximately 305340, and these include 101705 emergency visits.  There are about 300881 visits to the ENT clinic each year. The surgical case load is approximately 4459 surgeries/year. All procedures are performed in the main OR in KAUH with 3-4 rooms being in use each day in addition to one OR day per week at King Khalid University Hospital utilized by Pediatric Otolaryngologist as one of our staff based there.

1. Teaching staff:

At present, the Physicians staff consists of five committed, full time Pediatric Otolaryngologist with massive experience in teaching and training in the Pediatric Otolaryngologist subspecialty. 

1. Equipment

The ORL department at King Abdulaziz University Hospital is highly equipped center. All examination and operating rooms are equipped with the latest, top of the line instruments (CO2 laser, multiple sizes of endoscopes, different sizes of laryngeal stents and keels, micro drills, facial nerve monitor, etc.) and video documentation facilities in addition to excellent Radiology and Pathology services.

The scientific/academic computing center located in KKUH aids fellows, staff, and faculty in the scientific computing, including how to use the center’s computers, statistical analysis, data acquisition, analysis techniques, research methodology, and mathematical/analytical methods.

1. Surgery

Surgery includes a wide array of office procedure, routine Pediatric Otolaryngology surgery as well as complex cases. Recently, we expanded in complex and open airway surgeries and our Fellows will be exposed to these procedure.

1. Capacity:

The Pediatric Otolaryngologist fellowship program is very competitive and is limited to ONE candidate per year (this number is based on cases load).

1. Training Committee:

The training committee is comprised of the Pediatric Otolaryngology Consultants at the ORL, H and N Surgery Department of College of Medicine at King Saud University.  Participating Consultants in Pediatric Otolaryngology fellowship program are members at the program board committee and they will evaluate the program progress and candidates performance.

STRUCTURE AND CONTENT OF THE PROGRAM

1. Educational

2. Academic half day

The academic half day represents three hours of teaching time for the resident every Wednesday from 1:00 to 4:00 p.m.  Fellows will be excused from their clinic duties at this time to attend this half day if it is related to the sub-specialty. This day is structured with heavy resident input and includes didactic and interactive teaching sessions covering all of the major areas of general otolaryngology and the representative subspecialties of the field. In addition, special emphasis is placed on areas of perceived weakness such as pediatric otolaryngology.  It is also a forum for teaching the competencies, ethics, medical legal issues, and subjects in fields related to otolaryngology.  Attendance on these days is encouraged, and the fellow is expected to participate in this teaching.

1. Grand Round

The clinical meetings are every Wednesday from 1:00 to 2:00 pm. Most presentations are made by the attending staff and residents in the teaching program.  However, presentations are occasionally reserved visiting professors from around the world with international reputations, or invited clinicians from the KKUH milieu.  The meetings allow the fellows to critically review the literature pertaining to a specific case or small series of cases, and present that literature to their peers and staff in otolaryngology. Attendance for these meetings is mandatory.

1. Group Rounds

Each ORL group has pre-op and post-op rounds once a week. The rounds are designed with heavy fellow input as to the operative management of the patients.

1. Journal Club Meeting

Journal clubs are held 7 times a year on a Wednesday afternoon. Interesting cases are usually presented and are followed by a update on the topic presented.  The papers are presented in a PowerPoint format with the presenting resident/fellow highlighting key points.  The resident, the fellow, and the attending staff then critically review the paper.

1. Guest Speakers

Guest speakers are scheduled on a regular basis throughout the academic year. Speakers are usually asked to give a pre-selected lecture on a Tuesday afternoon.  The guests are invited well in advance, and the entire department is notified through ENT bulletin boards at each respective hospital.  Verbal announcements are also made at university rounds concerning guest speakers.

1. Examinations

There is one in-house training exam that is held once at the end of second year  (usually end of December).

1. Clinical

The fellow will participate “hands on” in all Pediatric Otolaryngology clinics and in the operating room.  The fellow’s clinical schedule mirrors that of the director of Pediatric Otolaryngology fellowship program.  Specifically, the fellow will receive clinical training during the weekly Pediatric Otolaryngology clinics and the surgical training in the operating room.  Additional clinical teaching takes place during hospital rounds on Pediatric Otolaryngology patients and during the course of the emergency Pediatric Otolaryngology cases only.  The fellow is clinically involved in call from home at the time of the rotation of the mentor of Pediatric Otolaryngology fellowship taking call (approximately 1 in 2).

1. Research

The fellowship program provides numerous opportunities for clinical and basic scientific research in the Pediatric Otolaryngology and airway disorder.  Fellows have to develop research proposals under the direction of the fellowship director with full departmental support to present the work at the major meetings in Saudi Arabia or abroad.  The fellow is also required to conduct at least two research experiments during his/her training, and this research part will be included in the final evaluation and the end of each year (refer to Fellow’s job description for research part requirements).

1. Elective Period

The fellowship provides opportunity to do elective training, courses, or gain more experience in a higher center worldwide as arranged by the university department or by the candidate himself after approval of the program board.

The Fellow will be given the opportunity to join any local pediatric otolaryngologist after being approved by the Committee of Fellowship for at least a month provided that 50% of the training is conducted at the University Hospitals.

FELLOW SUPERVISION AND PATIENT CARE RESPONSIBILITIES

Fellows are closely supervised during the first quarter of the Fellows clinical part in the fellowship.  As the Fellow matures, patient care independence is allowed, however, under the supervision of the Fellowship Director.  At the completion of the fellowship, the Fellow is able to evaluate and manage most of the diseases related to pediatric otolaryngology.

Patient care responsibilities

1. Examine and evaluate patients in the Pediatric Otolaryngology clinics.

2. Supervise the preparation process for patients requiring Pediatric Otolaryngology surgery.

3. Round on Pediatric Otolaryngology in-patients.

4. Supervise otolaryngology residents on the Pediatric Otolaryngology rotation.

5. Participate in the care of emergency Pediatric Otolaryngology patients.

6. Be involved in any Pediatric Otolaryngology emergency patients even belongs to general otolaryngologist. 

7. Be the primary physician of all Pediatric Otolaryngology cases referred by the department and others.

1. Procedural Requirements

The following procedures are performed during the fellowship:

Fellow and fellowship supervisors should be aware that the university hospital is a residency training hospital and fellows should not compete with the residents for their cases. The residents have the priority to any case that is classified as a "resident" case and the fellow should observe, train, and provide help as needed for the residents handling these cases.

1. Didactic Components

1. Attend all department conference pertaining to Pediatric Otolaryngology.

2. Assist in implementation of annual Pediatric Otolaryngology CME program.

3. Give 1 updated Pediatric Otolaryngology research in the department clinical presentation/year.

4. Give 6 lectures/year to otolaryngology residents.

5. Review a minimum of 4 journal articles per year.

6. Attend the otolaryngology journal club every month and proctor Pediatric Otolaryngology papers being discussed.

7. Supervise resident cadaver training dissection.

8. Attend all otolaryngology clinical meetings.

9. Provide one resident’s seminar every 2 months, whereby the residents select the topic and he/she supervise the discussion. Exam type discussion is encouraged. 

The fellow will be required to:

1. Attend minimum of one faculty development program held at postgraduate Department in the College Medicine KSU.

2. Complete the Bronchoesophagoscopy and Laser course.

3. Participate in preparation of all the Pediatric Otolaryngology division courses and is considered as a member in all Pediatric Otolaryngology Committees.

4. Attend at least one conference (national or international) related to Pediatric Otolaryngology per year.

5. Publish at least 2 peer review publications (refer to Fellow’s job description for research part requirements).

A suggested division of time and duties for the full two year period is as follows:

1. YEAR ONE

1. First three months:

2. Four (4) Research days in collaboration of research center, College of Medicine KSU (one day). 

3. One day Pediatric/Laryngology clinic.

4. One day operation room for gathering of data.

5. Second nine months:

6. One day research.

7. Audiology/Speech rotation.

8. One day clinic Pediatric Otolaryngology.

9. One day operation room.

10. One day pre & post operation round.

1. YEAR TWO

1. First three months:

2. Neonatal/ Pediatric Intensive Care Unit

3. Oncology/ Radiology

4. Cardiothoracic rotation

5. One day OR

6. One day research

1. Second nine months:

2. One day clinic 

3. One day pre and post operation round

4. One day OR

5. Two days research

Evaluation

The fellow will be evaluated on the following items using postgraduate evaluation scale from one to five; 1 being the lowest or very poor performance and 5 being the highest or excellent performance.

Final Exam 

Final exam will be at the end of second year (usually end of December).

Fellow Job Description

Title:                           Pediatric Otolaryngology Fellow

Department:              Department of ORL H & N Surgery, College of Medicine, KSU

Terms of Employment:

1. KAUH, Riyadh

2. ORL H& N Department, KSU, Pediatric Otolaryngology Division

Functions:

1. General:

1. For supporting ORL administrative patient care polices and protocols.

2. For ensuring exemplary Pediatric Otolaryngology patient care is provided to those Patient under his / her care.

3. For working cooperatively with all the other staff to ensure exemplary patient care.

4. Attends rounds promptly

1. Specific:

1. To help (with the resident) in looking after critically ill patients

2. Review, prepare and complete all the medical records of thePediatric Otolaryngology patients

1. Evaluation:

1. Assist in the evaluation of residents, medical students, and interns.

1. Research 

1. The first  3 months

2. Fellow(s) will have at least one research Proposal.

3. The two proposals have to be submitted to Institutional Review Board (IRB).

4. Attending Courses in research.

5. Minimal clinical works, to attend clinics only.

6. The Fellow has to fulfill all these so that they can start their full clinical duty at any point during the first 3 montths.

1. Requirements for promotion to F2 (year 2)

2. Fellow has to present in the update seminar at least one of his/her research.

3. At least one of the research has to be sent for publication

1. Requirements to sit for final exam

2. Fellow has to have  2 ISI publications or

3. One (1) ISI publication and one (1) Non ISI publication with two presentation in International conferences of his/her research project(s). 

4. Fellow must be the 1st Author on these research projects.

1. The Committee approved that case report is not acceptable and excluded in the research provision for fellows’ program structure.

1. Teaching:

2. Participate in the teaching of medical students, residents, interns, nurses and patients

1. Others:

2. Assume responsibilities for the development and maintenance of own professional competency.

1. At the end of his/her training, the fellow must:

2. Demonstrate competency of Pediatric Otolaryngology procedures and skills in the use of technology.

3. Demonstrate the ability to assess the Pediatric Otolaryngology patient by appropriate patient’s history documentation and physical examination.

4. Selecting appropriate investigations.

5. Interpreting investigations.

6. Make management plan for all Pediatric Otolaryngology problems.

7. Demonstrate effective communication skills.

8. Demonstrate academic qualities pertaining to Pediatric Otolaryngology.

9. Demonstrate effective teaching of the residents.

10. Participate in research work of the department.

11. Understand the relevant aspects of staff management and administration pertaining to high intensity of work.

1. At completion of two years Pediatric Otolaryngology program and passing all the exams and evaluation, Fellowship in Pediatric Otolaryngology willbe awarded to the candidate(s).

GENERAL RULES AND REGULATION:  ACCORDANCE TO THE RULES AND REGULATIONS OF KSU

1. Admission Processing     

The Postgraduate Medical Education (PGME), Medical Education Center will accept and perform the preliminary review of applicants and forward applications to the program director. The Committee will then conduct the interview and or selection exam and recommends candidates for acceptance using the special form for selection of candidates (Appendix IIIA of the KSU Policies and Procedures). Results will be forwarded to the Director of the Postgraduate Training Programs, who will forward the results to the Vice Dean of Postgraduate and Continuing Medical Education and the Dean of the College of Medicine. Upon approval of the results the PGME will write acceptance letters to the accepted candidates. 

The training will commence at the beginning of academic year – 1st working day of January.The accepted candidates will be registered with the Deanship of Admissions and Registrations. The submission of application will start July to September.

1. Rotations

Two years including pediatric otolaryngology, neonatology, pediatric intensive care, head and neck and cardiothoracic rotations.

1. Teaching commitments must be protected

1. Number of on call

The candidate will be assigned a shadow on-call with the fellowship staff for pediatric ORL cases (not more than 1 in 2).

1. Withdrawal

A valid reason for withdrawal must be given in writing to the Pediatric Otolaryngology program director. Submission of withdrawal should be made 3 months before the end of the training year to the Departmental Residency Committee (DRC) which will refer the request to the Postgraduate Training Board (PGTB) with recommendations.  The final decision will be made by the PGTB who will give their final reasons in writing.  In case the withdrawal was rejected by the PGTB and the resident left the program without permission, he will not be allowed to join any other programs for one year.

1. Disciplinary actions

Disciplinary actions will be in accordance with the KSU Residency Training Programs Policies and Procedures. Any resident exhibiting poor performance or misconduct will be thoroughly discussed in the (DRC) and the policies and procedures will be applied.  In case of dismissal from the program, the DRC has to refer the matter to the PGTB for appropriate decision.  The PGTB will then forward the matter to the Vice Dean of the Postgraduate and Continuing Medical Education.

1. Vacation

1. Must be according to the postgraduate guidelines, please refer to the KSU Residency Training Programs Policies and Procedures.

2. The fellow is entitled to a four (4) weeks’ vacation per year and should be approved by the director of Pediatric Otolaryngology Fellowship program and in accordance with the Department protocols.

3. The fellow should have one of the Eid Holidays.

4. Justified absence from the program such as sick and maternity/paternity leave should be compensated if more than 1 week/year.

5.  Educational leave will be granted to attend one hands-on course a year and one international conference a year. If the candidate is presenting his/her research, he /she can attend any additional number of meetings to present his / her work.

6. The elective training period for minifellowships are not to be part of the educational leaves.

SUGGESTED READINGS

It is highly recommended that each fellow read the following:

1. Pediatric Otolaryngology part of general textbooks of otolaryngology general reference (i.e.) Cummings, Scott-Brown, Bailey and Ballenger).

2. Pediatric Otolaryngology (Bluestone).

3. Practical Pediatric Otolaryngology (Cotton).

4. Surgical Pediatric Otolaryngology (Potsic).

5. Otolaryngology Clinics of North America series.

6. Computer applications SPSS: Data Management Program.

7. How to write and publish a scientific paper (Day).

8. Reference Manager Program.