It will be a two years (twenty-four months) program incorporating supervised and independent operating responsibilities pertinent to head and neck extirpation, reconstruction and surgical rehabilitation; outpatient clinics; inpatient care; teaching activities including Tumor Boards and academic Grand Rounds; research projects, and presentations at regional/national/international meetings.
At the completion of the fellowship program, the fellow, if so inclined, should have the option to request i) additional subspecialty training pertinent to his/her specialty at another participating centre; or ii) a period of additional research responsibility at the same or other participating centres. There will also be an option of a similar expression of interest at the time of the periodic 6-monthly reviews. The grant of such a request will be subject to institutional discretion and availability at participating centres.
At the end of 18 months (third review), the fellows are expected to be competent in all ablative head and neck surgery. At the end of 24 months (fellowship completion), the fellow is expected to be proficient in reconstructive surgery.
Formal training in patient and grief counselling should be incorporated wherever possible.
(Even though the presence of all of the below mentioned allied specialists at the training centre is ideal, trainees should be scheduled for rotations at outside affiliated centres if the above is not practicable)
This recommendation should be for 1-2 days each month, or a 15-day continuous rotation. This will allow the trainees to interact with the dental oncologist regarding preradiation prophylaxis, post radiation conservative dental management and prevention/management of osteoradionecrosis.
Maxillofacial prosthesis training is important, as dental and prosthetic rehabilitation is integral for patients to return to their premorbid state.
Basic implantology training for timing and technique of implants, and surgical modifications to increase rates of dental rehabilitation, are essential.
This recommendation should be for 1-2 days each month, or a 15-day continuous rotation.
Trainees will be instructed by the SLP/equivalent in alaryngeal speech/dysphagia rehabilitation following management of laryngeal/hypopharyngeal cancer, speech articulation/dysphagia management post glossectomy, and dysphagia rehabilitation post organ preservation treatment in pharyngeal cancer.
The fellow is expected to become proficient in TEP troubleshooting, compensatory manoeuvres/rehabilitation, interpretation of tests (VFS, FEES) and other aspects of voice and dysphagia management.
A week-long interactive rotation between the trainee and a radiologist experienced in head and neck imaging is recommended. This allows for discussion of a wide variety of cases by the trainee to allow understanding of radiological staging and subsequent surgical planning wherever indicated. The trainee should be able to understand the decision making as regards choice of investigation modality, and also understand the indications of therapeutic nuclear medicine.
A week-long interactive rotation with an experienced pathologist is recommended. Training will include essential aspects as cytopathology, processing of diagnostic biopsy, surgical specimen orientation, margin assessment, and a basic overview of routine as well as intraoperative pathology.
The recommendation is for 2 weeks of rotation each year. At the completion of this rotation, the trainee should be able to understand the interplay between the two specialties in guiding decision-making, understand the indications of radiation therapy in head and neck cancers, and understand the sequelae and toxicities of radiation therapy and their management/ mitigation.
The recommendation will be for 2 weeks of training. At the completion of this rotation, the trainee should be able to understand the rationale of decision making as regards cytotoxic and biological agents including immunotherapy, and regimen choice based on treatment setting and performance status. He/she should also be able to understand and recognize toxicities of common chemotherapeutic agents and their basic management.
This is recommended as a monthly interaction with the pain/palliative care specialist to understand cancer-associated pain and the pharmacological/ interventional modalities utilized to manage the same. This interaction will be aimed at gaining further perspective on end-of-life issues.
It will be integrated with the outpatient clinic experience as abovementioned.
This constitutes an essential recommendation, and will incorporate strategies of tobacco cessation, community and physician initiatives, current role of HPV and the appropriate counselling, management of leucoplakia and other premalignant lesions, trismus rehabilitation, among others. Fellow is expected to have conducted at least one screening camp & one public education activity.