FELLOWSHIP PROGRAMME IN OTOLOGY AND NEUROTOLOGY FELLOWSHIP

(TWO-YEAR FELLOWSHIP)

Department of Otorhinolaryngology

Medical EducationCenter

College ofMedicine

King SaudUniversity

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

As a saying goes, education is a continuing process, hence, the College of Medicine kept on bringing and/or extending an intensive training in a particular field of specialty.

Thus, the Division of Otology/Neurotology initiated the Otology/Neurotology Fellowship program (May 2009) to offer an in-depth, high quality, 2 years subspecialty program aiming to graduate highly qualified and well trained fellows in the field of Otology/Neurotology.

Objective

This two-year program is designed to develop special expertise in the diagnosis and medical/surgical management of diseases and disorders relating to the following areas within otology/neurotology, auditory system, vestibular system, facial nerve, in addition to temporal bone and related skull base structures and other lesions of the cerebellopontine angle and lateral skull base.

Admission requirements / Prerequisites / Selection Criteria

To be admitted to Otology/Neurotology subspecialty program, Candidate must:

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

2. Be a Board eligible/Board certified otolaryngologist.

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

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

5. 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 Otology/ Neurotology group.

3. The start date of the fellowship program is 1^st working day of January each year. Acceptance of application is from July to September of the academic year preceding the fellowship.   While the selection interview will be either September to December.

General Objectives:

Otologist and Neurotologist 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 ear surgical practice. Otology and neurotology embraces some components of neurology, neurosurgery, plastic surgery, dermatology, 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 ear disorders in patients of all ages. This includes knowledge of the techniques of otology, neurotologic, neuro, and cosmetic surgeries and radiation. 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 otology/neurotology such as: auditory system, vestibular system, facial nerve, temporal bones and related skull base structures, tumors, and other lesions of the cerebellopontine angle and lateral skull base.

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 graduates physicians will be capable to function as a consultant otologist and neurotologist.

Program Certification:

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

Resources and facilities

King Abdullaziz University Hospital (KAUH) is a tertiary care academic hospital attached to theCollegeofMedicine, KSU, Riyadh.  It is located in the central area ofRiyadh. The university hospital specializes in ORL H and 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 (approximately 25% are otology and neurotology related). All procedures are performed in the main OR in KAUH with 3 rooms being in use each day. Moreover, some neurotology and lateral skull base cases will be performed at King Khalid University Hospital (KKUH).

1. Teaching staff:

At present, the physicians staff consists of six, committed, full time Otologists with massive experience in teaching and training in the Otology/Neurotology subspecialty aside from the collaboration with the Otologist/Neurotologist in the affiliated hospital(s) of the fellowship.

FELLOWSHIP TEACHING STAFF AND CONSULTANTS

1. Prof. Abdulrahman Alsanosi          Professor, Consultant,

Otologist, Neurotologist &

Skull Base Surgeon

KAUH, King Saud University

King Abdullah Ear Specialist Center

1. Prof. Abdulrahman Hagr               Professor, Consultant,

KAUH, King Saud University

King Abdullah Ear Specialist Center

President of Saudi ORL Society

Director of Prince Sultan Research Chair for Hearing Disability & Implantable Devices

1. Prof. Farid Alzhrani                      Med. Director, Prof., Consultant

KAUH, King Saud University

King Abdullah Ear Specialist Center

1. Dr. Fida Almuhawas                     Associate Professor, Consultant,

KAUH, King Saud University

Head, King Abdullah Ear Specialist Center

1. Dr. Salman Alhabib                      Associate Professor, Consultant,

KAUH, King Saud University

King Abdullah Ear Specialist Center

1. Dr. Adulaziz Alballaa                   Assistant Professor, Consultant,

KAUH, King Saud University

King Abdullah Ear Specialist Center

1. Dr. Maryam Alamro                     Consultant,

KAUH, King Saud University

King Abdullah Ear Specialist Center

1. Dr. Nezar Alhamed                       Demonstrator

KAUH, King Saud University

King Abdullah Ear Specialist Center

1. Equipment:

The ORL department at KAUH is a highly equipped center. All examination and operating rooms are equipped with the latest, top of the line instruments (neuro-navigator, stapes set and prosthesis, 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 Otology/Neurotology surgery as well as complex and revision surgery. The temporal bone lab is used to carry out experiments on human biological material.

1. Capacity:

    The Otology/Neurotology fellowship program is very competitive and is two per year (this number is based on cases load).

(5)    Training Committee:

    The training committee is comprised of the Otology/Neurotology      consultants at the ORL, H and N Surgery Department of College of Medicine at KSU and participating consultants from the affiliated hospitals in Otology/Neurotology fellowship program are members at the program board committee.

The committee will manage, supervise and oversee all aspects of the sub-specialty fellowships-training, research and performance of the fellows and be sure that it is updated and meet the required (national/international) standards.

Structure and content of the program

I- Educational

1. Academic half day

The academic day represents three hours of teaching time for the resident every Wednesday from 1:00 to 4:30 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 fellows’ 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 otology and neuro-otology.  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 Rounds

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. Journals and/or ENT Club Meeting

Journal clubs are held 7 times a year on a Wednesdays 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 Wednesday  afternoon or  in the Department’s ENT update Seminar.  The guests are invited  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. Promotion Exams (F1 to F2)

1. Fellows must present in the ENT Updates seminar at least one of his/her research.

1. At least one of his/her research has to be sent for publication.

1. Final Exam Requirements (F2)

1. Fellow has to have two  (2) ISI publications

1.  or  one (1) ISI publication and one (1) Non ISI publication with 2 presentations in International conferences of  his/her research project(s)

1. Fellow must be the 1^st Author on the research projects

2. Case report is not acceptable

There will be no exceptions to those who cannot fulfill the requirements cannot sit for the exam at the end of the year.

II- Clinical

The fellow will participate “hands on” in all Otology/Neurotology clinics and in the operating room.  The fellow’s clinical schedule mirrors that of the director of Otology/Neurotology fellowship program.  Specifically, the fellow will receive clinical training during the two, weekly Otology/Neurotology clinics and the surgical training in the operating room twice per week.  Additional clinical teaching takes place during hospital rounds on Otology/Neurotology patients and during the course of the emergency Otology/Neurotology cases only. The fellow is clinically involved in call from home at the time of the rotation of the mentor of Otology/Neurotology fellowship taking call (approximately1 in2).

III- Research

The fellowship program provides numerous opportunities for clinical and basic scientific research in the areas of ear infection, hearing loss, and balance 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.

    At the recently approved policies with regards to the Fellow’s research

    (2018);   below is the program structure

1. The first  3 months

1.  Fellow(s) will have at least one or two  research Proposal(s)

      1.2. The two proposals have to be submitted to Institutional Review

            Board (IRB)

      1.3. Attending Courses in research

      1.4. Minimal clinical works, to attend clinic only

              The Fellow has to fulfill all these so that he can start his full clinical

             duty.

IV- Elective period

       The fellowship provides opportunity to do elective training, courses, or        gain more experience in a higher center local or 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 otologist/ neurotologist after being approved by the Committee of Fellowship for at least 3 months per year if local program and 1 month if outside the Kingdom and/or abroad 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 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 the ear and lateral skull base.

Patient care responsibilities

1. Examine and evaluate patients in the Otology/Neurotology clinics.

2. Supervise the preparation process for patients requiring Otology/Neurotology surgery.

3. Round on Otology/Neurotology in-patients.

4. Supervise otolaryngology residents on the Otology/Neurotology rotation.

5. Participate in the care of emergency Otology/Neurotology patients.

6. Be involoved in any Otology/Neurotology emergerncy patients even belongs to general otolaryngologist.

7. Be the primary physician of all Otology/Neurotology cases referred by the department and others.

1. Procedural Requirements

1.1.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 Otology/Neurotology.

2. Assist in implementation of annual Otology/Neurotology CME program

3. Give 1 updated Otology/Neurotology 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 Otology/Neurotology papers being discussed.

7. Supervise resident cadaver training dissection.

8. Supervise the usage of Otology/Neurotology laboratory dissection materials.

1. Attend all otolaryngology clinical meetings.

2. Attend all tumor board conferences where lesions of the ear and lateral skull base are presented.

3. 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 basic and advanced Temporal bone lateral and skull base courses.

3. Participate in preparation of all the Otology/Neurotology division courses and is considered as a member in all Otology/Neurotology Committees.

4. Attend at least one conference (national or international) related to Otology/Neurotology per year.

5. Research requirements to comply (see Fellow’s job description

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

Year one

    * First three months:

         - Research – 2 proposals and for submission to IRB

         - Audiology

         - Vestibular Physiology

         - Minimal clinical tasks      

         - Operating Room for data gathering

* Second nine months:

         - One day research

         - One day Otology/Neurotology clinic

         - One day operation room

         - One day pre & post operation round

Year Two:

    * First three months: Skull base rotation

1. Neurosurgey

2. Radiation

3. Oncology

4. Radiology

5. One day research

    * Second nine months:

1. One day clinic                 

2. One day pre & post operation round

3. Two days operating room

4. 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. The exam includes

40% - Written -   Format - Short answer questions

     = 20 questions carrying 2 mark     

                             30% - Oral   

                            30% - Evaluation

Fellow Job Description:

Title:               Otology/Neurotology and Lateral Skull Base Program

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

Terms of Employment:

1. KAUH, Riyadh

2. ORL H & N Department, KSU,

Otology/Neurotology division

1. King Abdullah Ear Specialist Center

1. For supporting ORL administrative patient care polices and protocols

Functions:

1. General:

1. For ensuring exemplary Otology/Neurotology patient care is provided to those Patient under his / her care

    1.3.   For working cooperatively with all the other staff to ensure exemplary

             patient care

    1.4  Attends rounds promptly

1. Specific:

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

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

2.2 Review, prepare and complete all the medical records of the Otology/Neurotology patients

3. Evaluation:

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

4. Teaching:

6. Others:

6.1. Assume responsibilities for the development and maintenance of own

      professional competency.

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

7.1 Demonstrate competency of Otology/Neurotology Procedures and skills in the use of technology.

1.  Demonstrate the ability to assess the Otology/Neurotology patient by

  7.2.1. Appropriate patient’s history documentation and physical

            Examination

  7.2.2. Selecting appropriate investigations

   7.2.3. Interpreting investigations

    7.3. Make management plan for all Otology/Neurotology problems

    7.4. Demonstrate effective communication skills

    7.5. Demonstrate academic qualities pertaining to Otology/Neurotology

    7.6. Demonstrate effective teaching of the residents

    7.7. Participate in research work of the department

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

8. At completion of two years Otology/Neurotology program and passing all    the exams and evaluation, the King Saud University fellowship in    Otology/Neurotology will be awarded to the candidate from postgraduate of     medicine in K.S.U.

General Rules and Regulation:  Accordance to the rules and regulations of KSU

1. Admission Processing     

The Postgraduate Medical Education (PGME),MedicalEducationCenterwill accept and perform the preliminary review of applicants and forward applications to the program director. The Departmental Residency 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 theCollegeofMedicine. Upon approval of the results, the PGME will write acceptance letters to the accepted candidates.

All incomplete requirements (2 months before the start of training) cannot be processed their registration and may lead to candidate’s replacement.

2.  Rotations

Two years including otology/ neurotology, neurosurgery, radiology, neurology, audiology and vestibular rotations.

3.  Teaching commitments must be protected

4.  Number of on call

The candidate will be assigned in on-call with the fellowship staff for otology and neurotology cases (no more than1 in2).

5.  Withdrawal

A valid reason for withdrawal must be given in writing to the Otology/Neurotology 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.

6. 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.

7. Vacation

   7.1. Must be according to the postgraduate guidelines, please refer to the

          KSU Residency Training Programs Policies and Procedures.

   7.2. The fellow is entitled to a four (4) weeks vacation per year and should

          be approved by the director of Otology/Neurotology Fellowship

         program and in accordance with the Department protocols.

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

  7.4 . Justified absence from the program such as sick and maternity/paternity

          leave should be compensated if more than 1 week/year.

  7.5  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.

  7.6. The elective training period for mini fellowships are not to be part of the  

         educational leaves.

Suggested Readings

It is highly recommended that each fellow read the following:

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

2. Otology/Neurotology set of SIPAC’s (self-instructional packets from AAO-HNS)

3. Otolaryngology Clinics ofNorth Americaseries

4. Computer applications SPSS:Data management program

5. Otologic surgery (Brackman)

6. Imaging of the temporal bone (Swartz)

7. Middle ear and mastoid microsurgery (Sanna)

8. Vestibular disorders A case-Study Approach (Furman)

9. Handbook of Balance function testing (Jacobson)

10.  Clinical neurophysiology of the vestibular system ( Baloh)

11.  Dizziness, hearing loss and tinnitus (Baloh)

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

13.  Reference Manager program.

Graduate Fellows Awarded Fellowship Certificate: