|Host:||Washington University School of Medicine|
|Program:||Head & Neck Oncology/Transoral Laser Microsurgery/Microvascular Reconstruction|
|Mailing address:||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 Duration:||This is a one year program, July 1 – June 30.|
Prerequisite Training/Selection Criteria
Our Advanced Head and Neck Surgical Oncology and Microvascular Reconstruction fellows hold dual titles: First as Clinical Fellow, and second as Instructor of Otolaryngology.
In order to participate in our head and neck fellowship program, it will be necessary for you to qualify for an H1B Visa. Therefore, you must have taken all three steps of the USMLE’s to become licensed and eligible.
Applicants, to be eligible to start full duties on July 1, must have:
- A medical degree from an accredited institution
- Graduation from a US ACGME-accredited otolaryngology residency program
- A physician’s license from the Missouri State Board of Healing Arts, BNDD, and DEA.
- Three letters of reference — at least two from faculty members of the training program of origin, one of whom is the program chair — provided to the preceptors of the fellowship
- Attain hospital privileges at Barnes-Jewish Hospital and the John Cochran VA Medical Center.
- Participation in the AHNS centralized application process and match
- 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 l) a high level of technical proficiency, 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. Salary is commensurate with PGY level.
The Fellowship in Advanced Head & Neck Surgical Oncology and Microvascular Reconstruction within the Department of Otolaryngology at Washington University is a longstanding feature of the educational curriculum offered within this academic medical center. Since 1984, 33 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 carry on this strong legacy of surgical innovation within the multidisciplinary context of modern head and neck cancer care.
The fellowship takes place primarily at Barnes-Jewish Hospital. Rotations at the John Cochran V.A. Hospital are also possible, and provide the fellow with graduated autonomy in both head and neck cancer ablation and complex reconstruction.
The large majority of fellows have graduated from this program to faculty positions in other academic institutions, where they practice and teach the techniques they have learned.
Goals and Objectives for Training
- Diagnosis and office management/work up of patients with neoplastic (benign and malignant) diseases of the head and neck.
- Surgery for head and neck cancer and other benign tumors of the head and neck, transoral surgery, skull base surgery, and 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 Multidisciplinary Head and Neck Cancer Clinic.
- Participation in management of a multidisciplinary Head and Neck Oncology Tumor Board within an NCI Comprehensive Cancer Center.
- Multidisciplinary treatment planning and coordination with radiation oncology, medical oncology, other surgical-medical services (i.e. thoracic surgery, neurosurgery, ophthalmology, dermatology, etc.), pathology, radiology, speech pathology, and prosthodontics for patients with head and neck neoplastic diseases. This includes neoplastic diseases of the upper aerodigestive tract, skull base, thyroid gland, parathyroid glands, salivary glands and skin.
- Participation in presentation of a head and neck reconstructive core curriculum lecture program for residents and medical students.
The broad educational purpose of this fellowship program is directed to graduating fellows who develop and have superior proficiency in head and neck surgical oncology. An important strength of this program is exposure to the full depth and breadth of transoral techniques for upper aerodigestive tract malignancies, including both transoral laser microsurgery (TLM) and transoral robotic surgery (TORS).
Our fellows graduate with an expert level of confidence with complex head and neck reconstruction and 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 (free tissue transfer, regional flaps, and local flaps).
Another important feature of the fellowship is a broad experience in open and endoscopic skull base resection and reconstruction with dedicated skull base surgeons within our group.
Randy C. Paniello, MD, PhD, MPH
Wade L. Thorstad, MD, Associate Professor of Radiation Oncology
Hiram A. Gay, MD, Associate Professor of Radiation Oncology
Mackenzie Daly, MD, Assistant Professor of Radiation Oncology
Douglas R. Adkins, MD, Professor of Medicine, Division of Medical Oncology
Peter Oppelt, MD, Assistant Professor of Medicine, Division of Medical Oncology
Samir El-Mofty, DMD, MS, PhD, Professor of Pathology & Immunology
Rebecca Chernock, MD, Associate Professor of Pathology & Immunology
Duties and Responsibilities of Fellows
Clinical responsibilities are divided amongst 6 head and neck surgeons and 2 endoscopic skull base surgeons. These clinical responsibilities are divided between the clinic, the operating room, and postoperative care. In a typical week, the fellow’s time is divided by approximately 1.5 days per week in the clinic, 3 days in the operating room and 0.5 days for research. The fellow evaluates and manages patients with advanced head and neck oncologic conditions, including those undergoing transoral surgeries (transoral laser microsurgery or transoral robotic), open partial laryngectomies, surgery for paragangliomas, surgery for skull base malignancies (endoscopic and open), and complex reconstructive surgeries requiring free tissue transfer. All clinical care is done in close collaboration with the otolaryngology residents and under the supervision of the faculty. The fellow has an Instructor position with the medical school and is expected to function at this level. As such, for other head and neck case (including laryngectomies, thyroidectomies, parotidectomies, neck dissections, and sentinel lymph node biopsies, etc.) the fellow supervises the work of the residents and takes more of a teaching physician role, particularly in the operating room.
The fellow is required to formally allocate approximately 10% of their time to research. This includes designing a research project and acquisition and analysis of data. A large tissue repository is available for molecular/translational research projects within an established laboratory. For clinical research, data is acquired from epidemiologic databases or patient charts. There are tremendous opportunities available for research projects, with an impressive infrastructure within the department and institution for support.
One written abstract/manuscript is expected 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
- Analysis of how preoperative variables correlate with postoperative outcomes
- Defining quality metrics for patients undergoing surgery for head and neck malignancies
Data analysis and outcomes of transoral laser microsurgery cases has produced several publications and data is collected on a regular basis for future studies.
Supervision, Teaching and Call
The fellows work in a teaching and supervisory role to the otolaryngology residents. He/she provides oversight and support to the residents in pre-operative, operative, and post-operative care of the head and neck patient, including regular ward rounds with the residents. During resident-level operative procedures, the fellow acts in a teaching surgeon role to the residents and helps them develop their technical skills. The fellow is also available to provide assistance and supervision to residents for inpatient consultations.
The fellows are required to take department otolaryngology call 1 weekday per month, and 1 weekend approximately every 4 months. This is equitable with the call responsibilities with the other faculty members in the department. The fellows also take call for the patients that they directly take part in surgical or non-surgical management of their neoplastic disease.
Fellows are evaluated informally on an ongoing basis with regular feedback. Residents are formally evaluated at 6 months and at the completion of the fellowship.