Fellowship | Transoral Laser Microsurgery/Microvascular Head & Neck Reconstruction/Oncology

Program Demographics

Host:

Washington University School of Medicine

Program:

Head & Neck Oncology/Transoral Laser Microsurgery/Microvascular Reconstruction

Mailing address:

Jose Zevallos, MD, MPH
Department of Otolaryngology
660 S. Euclid Ave.
Campus Box 8115
St. Louis, MO 63110

Program address:

517 S. Euclid Ave
St. Louis, MO 63110
Phone (314) 362-0365
Fax (314) 362-7522

Program email:

richardsonj@wustl.edu

Program Director:

Jose Zevallos, MD, MPH

Alternate Program Contact:

Jana Richardson


History The fellowship in Head & Neck Oncology/Transoral Laser Microsurgery/Microvascular Reconstruction Fellowship in the Department of Otolaryngology at Washington University is a longstanding feature of the educational curriculum offered within this academic medical center. Since 1984, 31 fellows have continuously occupied this position. Prior to this the Department offered a Head and Neck surgery fellowship, which concentrated mainly upon resectional techniques, under the direction of Dr. Joseph Ogura.

Our intention is to continue the program on into the future in this vital subspecialty of Otolaryngology-Head and Neck surgery. Candidates have come from a variety of quality residencies around the USA, Canada, Germany, and India and have included graduates from Washington University’s own ACGME approved Otolaryngology resident training program. The large majority of candidates have graduated from this program to faculty positions in other academic institutions, where in turn they practice and teach the techniques they have learned.

Duration This is a ONE YEAR program, July 1st to June 30th.

Prerequisite Training/Selection Criteria The applicants, to be eligible to start full duties on July 1, must have:

  • A verified, bona fide degree in medicine.
  • Obtained a physician’s license from the Missouri State Board of Healing Arts.
  • Completed, and graduated in good standing from a bona fide, ACGME accredited Otolaryngology residency program, if training was in the United States. This corresponds with the training prerequisites for the American Board of Otolaryngology’s certification examination.
  • Completed, and graduated in good standing from a bona fide, equivalent of United States Otolaryngology residency program in their country of training, if same was not in the United States. Such overseas programs must also be officially approved by that country’s own national accrediting organization.
  • Provided the preceptors of the fellowship with three letters of reference, at least two from faculty members of the training program of origin, one of whom is the program chairman.
  • Visited the program site, completed the interview process, and been approved by the interviewers in the Department of Otolaryngology at Washington University.

Preference is given to those applicants who have performed exceptionally in their residency program and excelled in the six core competencies. We place an emphasis on 1) a high level of technical proficiency in head and neck and microsurgery of all types (microvascular reconstructive surgery is technically demanding), 2) a keen interest in academic otolaryngology as a future career and 3) a strong track record in teaching and working well with other trainees and faculty. We prefer graduates from otolaryngology programs with above average exposure to reconstructive techniques.

Goals and Objectives for Training The broad educational purpose of this fellowship program is to graduate Otolaryngology-Head and Neck surgeons who have superior proficiency in head and neck reconstruction, with independent skills in microvascular free tissue transfer. Competence in choice and execution of flaps from all relevant donor sites for reconstruction of a full range of recipient sites is attained. Specific objectives include mastery of:

  • Diagnosis and office management/work up of patients with neoplastic and benign diseases of the head and neck.
  • Participation in management/leadership of a multidisciplinary Head and Neck Oncology Tumor Board within an NCI Comprehensive (Siteman) Cancer Center.
  • Treatment planning and coordination with radiation and medical oncology.
  • Surgery for head and neck cancer and other benign tumors of the head and neck, transoral laser microsurgery, reconstruction for defects of the head and neck with a special emphasis on microvascular free tissue transfer techniques.
  • Post-operative management and rehabilitation of patients with head and neck oncologic conditions and reconstructions.
  • Participation in presentation of a head and neck reconstructive core curriculum lecture program for residents and medical students.

Additional Certification/Recognition Our program qualifies for publication in the American Academy of Otolaryngology- Head and Neck Surgery’s (our specialty’s largest member, and principal CME organization) Fellowship Training Program booklet.


Resources

Teaching staff Dr. Jose Zevallos, fellowship trained in microvascular surgery (University of Michigan) and transoral laser microsurgery, is co-preceptor of the fellowship. His supervisory responsibilities include recruitment, and selection of the fellow and design of the schedule. Daily observation and mentoring of the fellow’s skill set and competency (the fellow operates with Dr. Zevallos or is in clinic with him most days) is incorporated. As the year progresses, Dr. Zevallos ensures that appropriate progress is being made in skill acquisition, advising the fellow on what aspects may need strengthening. Dr. Zevallos also tracks the numbers of procedures performed with or by the fellow to ensure he/she gains adequate experience as the year proceeds.

Dr. Jay Piccirillo, Professor of Otolaryngology, acts as an advisor in any clinical or outcomes research projects, within the Division of Outcomes research.

Facilities Training occurs at the Washington University Medical Center in St. Louis and includes rotation to the Barnes–Jewish Hospital, and the Center for Advanced Medicine, where the NCI-Comprehensive Siteman Cancer Center is housed.


Educational Program -- Basic Curriculum

Clinical and Research Components The fellow will see and plan treatment for advanced head neck oncologic cases including transoral laser microsurgery, skull base malignancy cases, and cases requiring reconstruction of the facial structures: jaws, mouth, tongue, pharynx, larynx, and external facial and neck skin and facial skeletal structures. All clinical care is done in collaboration with the Otolaryngology residents. The fellow is also responsible for supervision of postoperative care of the patients in close consultation with the residents from our ACGME approved Residency Program. He/she will handle elective cases, emergencies and complications.

The fellow is required to allocate approximately 10% of his/her time to research. This involves designing a research project, acquisition and analysis of data. For clinical research, data is acquired from either computerized databases or patient charts. One written abstract/manuscript is required to be submitted for either a peer-reviewed scientific program or for publication in a peer-reviewed journal. Projects undertaken by fellows have included detailed measurements of flap dimensions for precise planning of head and neck reconstructions as well as clinical research projects involving large numbers of patients and analysis of how preoperative variables correlate with postoperative outcomes. Data analysis and outcomes of transoral laser microsurgery cases has produced several publications and data is collected on a regular basis for future studies.

The average hours worked in this fellowship are approximately 70 hours per week. The maximum work hours do not exceed 80.

Supervisory and Patient Care Responsibilities The fellow supervises the work of residents, nurses and allied health professionals. He/she is responsible for supervision of post operative care of the patients in close consultation with the residents of the ACGME approved residency program. All surgery is done in collaboration with the same residents, often teaching and mentoring “hands on” with technical aspects. In consultation and cooperation with the four nursing staff, the fellow attends in the head and neck nursing office. The fellow also supervises patient rehabilitation affairs in cooperation with the head and oncologic residents and oversees the work of speech pathologists, physical and occupational therapists.

The patient care responsibilities of the fellow include assisting the professorial staff with evaluation and management of patients in the Head and Neck Division. This involves interviewing patients, performing their physical examination reaching a diagnosis and then formulating management plans. This is in direct consultation with the fellowship mentors at all times and includes 3 half-day clinics per week. The fellow is required to attend a weekly Multidisciplinary Head and Neck Tumor Board where patient cases are presented and treatment plans are discussed with otolaryngologists, medical oncologists, pathologists, radiologists, and prosthodontists.

The fellow is also required to perform daily ward rounds with the residents and attend/assist with or perform surgery under supervision of the relevant faculty.

Procedural requirements The fellow must achieve proficiency in advanced head and neck oncologic resections (e.g. the full range of partial laryngectomies, minimally invasive endoscopic resections and skull base work) as well as a full repertoire of free flaps used to treat head and neck defects e.g. fore-and lateral arm, fibula, scapula, iliac crest, rectus, lateral and anterolateral thigh, latissimus dorsi, gracilis. The fellow must learn how to adapt and mold this tissue to complicated defects to preserve function of the special senses of the head and neck and maintain airway, swallowing and voice. He/she must also know when and when not to use other reconstructive approaches such as local and regional flaps.

Didactic Components The fellow is required to attend (and participate in teaching of) the Head and Neck Reconstructive Course, which is given biannually within our Core Curriculum and also taught to the residents by the fellowship supervisors. In addition, the fellow attends weekly Grand Rounds, Head and Neck Tumor Board, and the monthly Morbidity and Mortality and also Journal Club Conferences.

Evaluation Due to his/her relatively short appointment, the fellow has to date been formally evaluated only by the supervising faculty at a mid-year interview, and then an end of year interview. A log of cases is reviewed. From July 1 2003, however, we will use the core competencies method of organizing this evaluation, with an initial “360 degrees” method, which we shall also be using with our residents. Since the other core competencies have been mastered during residency, we shall place greater weight on Patient care, Medical Knowledge and Systems-based practice. All clinical care is done in collaboration with the same residents.