Introduction:

Majority of the prominent graduates of King Saud University (KSU) Fellowship training program have molded their own distinct identity in their chosen fields particularly in the specialty of Otorhinolaryngology Head and Neck Surgery (ORL, H and N surgery). These graduates have gone a long way and have proven their worth. Most of them are currently contributing with 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.

Each fellowship program is closely scrutinized and reviewed periodically by the Postgraduate Committee of the ORL, H and N surgery Department. There are now two subspecialty clinical experience programs at the Department of ORL. One of these is Rhinology. It complies with the standard of the equivalent internationally certified programs.

History

The Department of ORL College of Medicine, KSU has great history in training Graduates and Fellows in ORL in Saudi Arabia. Initially the postgraduate training program was started with diploma program in 1982, this was followed by a four year K.S.U. fellowship 1988 which in early 2000 was combined with Saudi Board training program comprising a well-established five years program. This program graduates will be well qualified general ORL H and N surgeons with good knowledge and training.

In 2003 the division of Rhinology started the Rhinology Fellowship program to offer a 2-year subspecialty program aiming to graduate highly qualified, safe and well-trained fellows in the field of Rhinology.

2-YEAR KSU FELLOWSHIP IN RHINOLOGY AND SKULL BASE SURGERY

Goals and objectives of training:

To provide a broad experience in the surgical, clinical and basicscience aspects of Rhinology and Skull Base Surgery and by the end of the two-year period, the Candidate shall:

Have a good exposure to all diagnostic, surgical and medical therapeutic cares of nose and paranasal sinuses disorders.

Have adequate exposures to advanced imaging techniques related to the field of rhinology such as CT and MRI and be able to identify the radiological sinonasal pathology at a clinician level.

Assess the role of imagingguided surgery, its application in sinonasal disorders.

Be trained in the extended uses of FESS and endoscopic managements of anterior skull base defect and tumors.

Managing allergic disorders

Learn the pathology and treatment of olfactory disorders.

Be trained on self-updated learningand identify the available resources.

Develop the skills of conducting and supervising research related to basic science and clinical aspects of Rhinology and Skull Base Surgery.

Having teaching responsibility in the field of Rhinology and be able to promote the Science of Rhinology. Develop leadership in the field of Rhinology by which the Candidate will help to improve the current standard of care and educated others

PREREQUISITE/SELECTION CRITERIA:

To be admitted to Rhinology and Skull Base Surgery subspecialty program, Candidate must:

Be a Board eligible/Board certified Otolaryngologist or equivalent.

Provide a letter of release and sponsorship as full time commitment for the whole period of training.

Pass the admission examination and/or interview.

Provide 2 references letters from Consultants with whom the Candidate is currently working or has recently worked with, for a minimum period of six months.

General Guidelines

The duration of sub-specialty trainingwill be two (2) years.

The fellow will be under the close supervision of the Rhinology group.

The start of the fellowship 1st working day inJanuary in each academic year.

The application deadlinewill be in November of the academic year preceding the Fellowship.

This training includes didactic sessions, clinical care, research opportunities and medical and surgical experience.

Program Certification:

The fellowship will be an affiliated program affiliated to the Department of Otorhinolaryngology Head and Neck Surgery at College of Medicine, King Saud University (KSU) and it will be accredited by KSU as King Saud University Fellowship in Rhinology and Skull Base Surgery.

Resources and facilities

King Abdulaziz University Hospital (KAUH) and King Khalid University Hospital (KKUH) are a tertiary care academic hospital attached to the College of Medicine, King Saud University, Riyadh. King Fahad Medical City (KFMC) is an affiliated hospital where the fellows will have arotation period in Otorhinolaryngoloy Head & Neck Department. It is located in central area of Riyadh. The University Hospital is a specialized hospitalfor Otorhinolaryngology Head & Neck surgery and ophthalmology with a capacity of 104 inpatient beds. Total ambulatory visits to all departments are approximately 305340 annually including 101705 emergency visits. There are about 300881 visits to ENT clinic each year.

King Fahad Medical City, a tertiary care hospital in Riyadh, is located 5.9 km away from KAUH.

The department’s surgical case load is approximately 4459 per year. Out of this number, 240 average rhinology cases have done every year. All procedures are performed in the OR in KAUH, KKUH and KFMC.

Teaching staff

At present physician staff consists of eight full time Rhinologists with experience in teaching and training in the Rhinology and Skull Base Surgery subspecialty. In addition the other teaching Staff of the Department will also help in accomplishing the program objectives as well as the consultants in the affiliated hospitals.

Equipment

The ORL department in KAUH, KKUH and KFMC are a highly equipped center. All examination rooms and operating roomsare equipped with updated and latest instruments and video documentation facilities in addition to excellent Laboratory, Radiology and Pathology services.

Surgery

Surgery includes a wide array of office procedure, routine rhinology surgery as well as complex and revision surgery using imaging-guided techniques. Rhinology laboratory dissections will be carried out on human biological material using advanced instrumentation.

A variety of research opportunities are offered in collaboration with research department of College of Medicine, KSU to perform basic and clinically orientated research projects.

The scientific/academic computing center located in K.K.U.H., aids fellows, staff, and faculty in the scientific computing, including how to  use the Center’s computers and other facilities, statistical analysis, data acquisition, analysis techniques, research methodology, andmathematical/analytical methods.

Capacity

The number of Candidate in the programgoing to be accepted in the Rhinology and Skull Base Surgery fellowship is two Candidates per year.

In addition,there are other teaching staffsfrom other department such as Allergy Ophthalmology and Neurosurgery.

STRUCTURE AND CONTENTOF THE PROGRAM

Clinical

The fellow will participate “hands on” in all Rhinology and Skull Base Surgery clinics and in the operating room.The fellow will receive clinicaltraining during Rhinology full- day clinics per week and surgical training in the operating room twice per week. Additional clinical teaching takes place during hospital rounds on rhinology patients and during the care of emergency rhinology cases. The fellow is clinically involved in call from home in the rotation of the mentor of Rhinology fellowship taking call (approximately 1-2 in 7).

Additionally, the Fellow will be involved in trans nasal endoscopic approach for intracranial tumor resection & reconstruction with neurosurgical team at least once per week.

Research

The fellowship providesnumerous opportunities for clinical and basic scienceresearch in the areas of allergic fungal rhino sinusitis, hyperplastic sinusitis-nasal polyposis, molecular biology of chronic sinusitis, microbiology of sinus infections and clinical/surgical outcomes. Fellows are encouraged to develop research proposals under the direction of the fellowship director with full Department support to present the work at the major meetings in Saudi Arabia or abroad

Policy with regards to the Fellow(s)’ research aspects will be as follows

The first3 months

Fellow(s) will have at least two research Proposal(s)

The two proposals have to be submitted to Institutional ReviewBoard (IRB)

Attending Coursesin research

Minimal clinical works, to attend clinic only

The Fellow has to fulfill all these so that he can starthis full clinicalduty.

Requirements for promotion to F2 (year 2)

Fellow has to presentin the update seminar at least one of his/her research.

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

Requirements to sit for final exam

Fellow has to have two (2) ISI publications or

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

Fellowmust be the 1st Author on the research projects.

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

Elective period

The fellowship provides opportunity to attend Mini fellowship, courses or get more experience in higher center worldwide as arranged by university department or by candidate himself after approval of the program board.

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, still under the supervision of the fellowship director. At the completion of fellowship, the fellow is able to evaluate and manage all medical disease related to the nasal cavity and paranasal sinuses.

Patientcare responsibilities

Manage Rhinology patients in the Rhinology clinics.

Be fully in-charge (in coordination with his senior) of all inpatients and out-patients in Rhinology service.

Supervise otolaryngology residents on the Rhinology rotation.

Participatein the care of emergency Rhinology patients.

Receive consultations of all Rhinology cases referred from the department or from others.