Head & neck oncological surgery fellowship program

Background

Sunnybrook, Mount Sinai Hospital, and the University Health Network (Toronto General Hospital/Princess Margaret Hospital) are all teaching hospitals within the University of Toronto (UofT) health sciences complex. Over the past 15 years, the department of otolaryngology—head and neck surgery at UoftT has developed a highly integrated, multidisciplinary head and neck fellowship program incorporating these three campuses. The Toronto Western Hospital, where neurosurgical expertise is concentrated, serves as the site for any surgery involving the skull base.

About the program

There are four 1-2 year head and neck oncological surgery fellowship positions available each year. 

The fellowship program is recognized internationally for patient care, research and education, principally involving the disciplines of radiation, medical and surgical oncology. The program interfaces with medical imaging, pathology, dentistry, speech, nutrition, nursing, social work, psychiatry, and research scientists.

The program provides well-balanced exposure to all areas including:

• skull base surgery
• microvascular surgery
• endocrine surgery
• innovative head and neck research

More recently, head and neck oncology has been selected as one of the programs of excellence within the Ontario Cancer Institute/Princess Margaret Hospital. Similarly, head and neck oncology is designated at the Mount Sinai Hospital as a high-priority program within the strategic focus of the hospital.

About the hospitals

At Sunnybrook, approximately 400 new cases of head and neck squamous cell carcinoma (scc) are seen each year. Yearly, approximately 100 free tissue transfers are performed at Sunnybrook, in addition to 200 endocrine cases. 

Within Mount Sinai/UHN, 700 new cases of scc are evaluated in the program per annum at the Princess Margaret Hospital. One thousand major procedures are performed each year within this head and neck site group. Two hundred free tissue transfers are carried out by the service to reconstruct defects about the head and neck. In addition to the above, 750 thyroid procedures are carried out by the staff.

The fellowship expereince

A head and neck oncological surgery fellow is exposed to a large volume of head and neck related cases. The experience is tailored to the desires and ultimate career goals of the fellow. The fellow is also expected to integrate with residents in the teaching program and act as mentor to them.

Fellows are given incremental responsibility according to performance. Supervision is available at all time. Fellows are not required to manage patients outside the scope of head and neck oncology or related diagnoses.

Throughout the academic year there are a large number of teaching rounds, tumor boards, continuing medical education events, courses, and visiting professorship to which the fellow is invited to participate.

The majority of head and neck cases in the Toronto region are seen in the multidisciplinary facilities of Sunnybrook, UHN, and Mount Sinai Hospital. Head and neck is considered a tertiary referral program by most community-based physicians and surgeons.

Duties and responsibilites of trainees

The head and neck oncological surgery fellowship program broadly encompasses a wide variety of neoplastic head and neck diagnoses.

The major subsites include all head and neck mucosal malignancies.

Other subsites include:

• salivary glands
• thyroid
• complex head and neck skin malignancies
• head and neck sarcoma that are managed by the head and neck surgical group in collaboration with the respective radiation oncology and medical oncology site group members

During the one or two-year fellowship program, the clinical rotations include Sunnybrook, UHN, or Mount Sinai Hospital. There are four fellowship positions available per year.

The duties of the head and neck oncology fellow are as follows within the respective institutions:

1. Participate in outpatient clinics pertaining to the head and neck.
   
   
2. Participate in surgical procedures pertaining to the head and neck.
   
   
3. The core teaching curriculum requires that a topic be researched monthly within the head and neck program.
   
   
4. Completion of at least three clinical-oriented research projects that results in peer-reviewed publications. Opportunity is available for basic science projects. Support is available for presentation of the fellow’s work at scholarly meetings.
   
   
5. Attend weekly interdisciplinary Tumor Board Rounds at Sunnybrook, UHN or Mount Sinai Hospital 
   
   
6. Present at least one Grand Rounds per year related to the head and neck program and participate at all tumor board related rounds at Sunnybrook, UHN or Mount Sinai Hospital.
   
   
7. Prepare a topic for the fellows’ monthly Education Seminar that takes place on the first Monday of each month.

Program faculty