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TrainingStandardsforClinicalFellowshipsinHead&NeckOncologicandReconstructiveSurgeryPreparedby:CanadianAssociationofHeadandNeckSurgicalOncology(CAHNSO)TrainingCommitteeFormallyRatifiedJune112016D.A.O’ConnellMDMScFRCS(C),P.GullaneCM,OOnt,MB,FRCSC,FACS,FRACS(Hon),FRCS(Hon),FRCSI(Hon)Reviewers:R.D.HartMDFRCS(C)R.GilbertMDFRCS(C)P.KerrMDFRCS(C)H.SeikalyMDMALFRCS(C)S.M.TaylorMDFRCS(C)
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TABLEOFCONTENTS PAGEIntoductionAdditionalGoalsandInformation 4Accreditationstatusdefinitions 5-6Preface 8Authorizedenrollment 9Definitionoftermsusedinadvancedspecialtyprogramaccreditation 10standardsREQUIREMENTSSECTION1:FELLOWELLIGIBILIGYANDSELECTION 11SECTION2:CanMEDSFRAMEWORK 12-24
1. MEDICALEXPERT2. MANAGER3. COMMUNICATOR4. COLLABORATOR5. HEALTHADVOCATE6. SCHOLAR7. PROFESSIONAL
SECTION3:PROGRAMSPECIFICREQUIREMENTS 26-331.PROGRAMEFFECTIVENESS 26-27 2.FELLOWSHIPDIRECTORANDAFFILIATEDTEACHINGSTAFF 283,FACILITIESANDRESOURCES 294.CURRICULUMANDPROGRAMDURATION 305.FELLOWS 31 ELIGIBILITYANDSELECTION EVALUATION DUEPROCESS RIGHTSANDRESPONSIBILITIES
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6.CLINCALACTIVITY/SURGICALTRAINING 31-32 7.SCHOLARLYACTIVITY 32-33
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INTRODUCTIONTheCanadianAssociationofHeadandNeckSurgicalOncology(CAHNSO)isanassociationofphysicianswithexpertiseandspecialinterestinheadandneckoncologythatstrivestoenhanceandenableknowledgeinCanadarelevanttothesurgicaltreatmentofcancersandotherneoplasticdiseasesoftheheadandneck,includingbothreconstructionandrehabilitation.CAHNSOwasestablishedinJuneof2013andformallyincorporatedasanotforprofitorganizationinMay2014.TheCAHNSOTrainingCommitteeisastandingcommitteewithinCAHNSOchargedwithcreatingtheinfrastructurerequiredtoset,maintainandadvancethehigheststandardsoftrainingforthesubspecialtyofHeadandNeckSurgicalOncologywithinCanada.Thisdocumentrepresentsthefirststepinthisprocess:settingstandardsofadvancedfellowshiptrainingbasedontheCanMEDSframework,andproposingaCanadiansystemforaccreditationofHeadandNeckSurgicalOncologyfellowships.TheCAHNSOTrainingCommitteewillstrivetoenhanceandencouragededicationtothehighestqualityofitsaccreditededucationalprograms.TheCAHNSOTrainingCommittee’svoluntaryaccreditationprogramwillstrivetoensurethatstandardizededucationofthehighestqualityisavailableforheadandnecksurgeons,andheadandneckreconstructivesurgeons.Thegoalofthisaccreditationprocessisvestedinthecommittee’sbeliefthathighqualityeducationultimatelyleadstohighqualitycareforheadandneckpatients.
ACCREDITATIONSTATUSDEFINITIONS
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ProgramsthatareinfullyoperationalAPPROVAL(withoutConditions):anaccreditationstatusgiventoaneducationalprogramthatachievesorexceedsthebasicrequirementsforaccreditation,andthathascompleteditsprobationary(“InitialAccreditation”)period.APPROVAL(withConditions):anaccreditationstatusgiventoaneducationalprogramthatmeetsmostaccreditationstandards,butinwhichtherearelimitedweaknessesordeficienciesinoneormoreareasoftheprogram.Evidenceofcompliancewiththecitedstandardsmustbedemonstratedwithin18months.IfthedeficienciesarenotcorrectedwithinthespecifiedtimeperiodaccreditationwillbewithdrawnunlesstheCAHNSOTrainingCommitteeextendstheperiodtoachievecomplianceforgoodcause.ProgramsthatarenotfullyoperationalAprogramthathasnotenrolledandgraduatedatleastonefellow,ANDhasnothadafelloworclassoffellowsregisteredinsequentialfellowshipperiodsisdefinedbytheCAHNSOTrainingCommitteeas“notfullyoperational”.TheaccreditationstatusgrantedtothistypeofprogrambytheCAHNSOTrainingCommitteeis“INITIALACCREDITATION”.When“PreliminaryAccreditation”statusisgrantedtoaprogramitisineffectthroughtheprojectedinitialenrollmentperiod.However,ifenrollmentisdelayedbytwoconsecutiveyearstheinstitutionmustreapplyfor“preliminaryaccreditation”andupdatepertinentinformationonprogramdevelopmentandevolution.Atthispointthereapplicationfor“initialaccreditation”willbeconsideredbytheCAHNSOTrainingCommittee.PRELIMINARYACCREDITATION:InitialaccreditationistheaccreditationstatusgrantedtoanyHeadandNeckOncologic/Reconstructiveadvancedtrainingprogramthatmeetstrainingstandards,buthasnotyetgraduatedatleastonefellow.Onceatleastonefellowhascompletedtraining,andwithevidenceofongoingsatisfactorytrainingconditionsbasedonadherencetostandardsoftrainingandfavorablereviewoftheprogrambythetrainee(s),thentheprogramiseligibleforpromotionto“Approval”status.Preliminaryaccreditationclassificationprovidesevidencetoeducationalinstitutions,accreditingandlicensingbodies,governmentorgrantingagenciesthatatrainingprogrammeetstrainingstandards,andthatprobationaryoperationscancommence.InitialaccreditationisgrantedbasedononeormoresiteevaluationsandisineffectuntiltheprogramisfullyoperationalandmeetscriteriatobeadvancedtoApproval(withoutconditions)status.MAJORCHANGESTOTRAININGPROGRAM:Majorchangestotrainingprogramaredefinedas(butnotlimitedto)reductioninsurgicaland/orclinicalvolumeor
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exposureforfellow(s)by25%ormore,removaloradditionofamajorsiteofpractice(hospital,surgicalfacilityetc.)fortrainingprogram,additionofanewaccreditedfellowperyearforthepurposesofadvancedpost-residencytraining.
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Preface
TheCAHNSOTrainingcommitteewasestablishedundertheauspicesoftheCanadianSocietyofOtolaryngology–HeadandNeckSurgerytoestablishtrainingguidelinesandcoordinatetheaccreditationsurveyprocess.ThisdocumentconstitutesthestandardsbywhichtheTheCAHNSOTrainingcommitteewillevaluatecandidatefellowshipprogramsforaccreditationpurposes.Generalandspecificstandardsregardingessentialeducationalcontent,instructionalactivities,patientcareresponsibilities,supervisionsandfacilitiesareincludedherein.Generalstandardsareidentifiedbynumericallisting(eg.1).Specificstandardsareidentifiedbymultiplenumericallisting(eg.1-2,1.2).MaintainingandimprovingthequalityofadvancededucationintheCanadianHeadandNeckOncologicandReconstructiveSurgeryFellowshipsistheprimaryaimoftheCAHNSOTrainingCommittee.TheCAHNSOTrainingCommitteeisrecognizedbytheCanadianAssociationofHeadandNeckSurgicalOncology(CAHNSO)asthenationalqualityassurancebodyforCanadianadvancedfellowshiptrainingprogramsinHeadandNeckOncologicandReconstructiveSurgery.Accreditationofadvancedtrainingfellowshipsisavoluntaryeffortofallpartiesinvolved.Theprocessofaccreditationensuresfellows,membersoftheCanadianSocietyofOtolaryngologyHeadandNeckSurgery,theRoyalCollegeofPhysiciansandSurgeonsofCanada,InstitutionalandProvincialgoverningbodiesaswellasthegeneralpublicthataccreditedtrainingprogramsareincompliancewithestablishedstandards.AfellowshipinHeadandNeckOncologicand/orReconstructiveSurgeryisaplannedpostresidencyprogramthatinvolvesadvancedtraininginthediagnosisandtreatment(bothsurgicalandadjuvant)ofheadandneckneoplasms(benignandmalignant)aswellasreconstructionofheadandneckdefectswithlocal,regionalandfreetissuetransfertechniques.AccreditationactionstakenbytheCAHNSOTrainingcommitteearebasedoninformationobtainedfromwrittensubmissions,includingapresurveyquestionnaire,completedbyfellowshipdirectorsandwhenrequiredevaluationsmadeonsitebyassignedCAHNSOconsultants.POLICYONMAJORCHANGESTOTRAININGPROGRAMMajorchangesasdefinedbytheCAHNSOTrainingCommitteearetobereportedpromptlytothetrainingcommittee.Majorchangeshaveadirectandsignificantimpactonaprogram’spotentialabilitytocomplywithtrainingstandards.Examplesofmajorchangesthatmustbereportedinclude(butarenotlimitedto)changesto
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fellowshipdirector,clinicalfacilities,programsponsorshiporcurriculumlength.Theprogrammustcommunicatethesechangesinwritingtothetrainingcommitteewithinsixty(60)days.AUTHORIZEDENROLLMENTHeadandNeckOncologicandReconstructiveSurgeryfellowshipprogramsareaccreditedforaspecificnumberoffellowsineachyear(s)oftheprogram.
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DefinitionofTermsUsedinTrainingStandardsforHeadandNeckOncologicandReconstructiveSurgeryFellowshipTrainingThetermsusedinthisdocument(ie.shall,must,should,canandmay)wereselectedcarefullyandindicatetherelativeweightthattheCAHNSOTrainingCommitteeattachestoeachstatement.MustorShall:Indicatesandimperativeneedand/orduty;anessentialorindispensableitem;mandatory.Examplesofevidencetodemonstratecomplianceincludebutarenotlimitedto:Desirablecondition,practiceordocumentationindicatingthefreedomorlibertytofollowasuggestedalternative.Should:Indicatesamethodormethodstoachievethestandards.MayorCould:Indicatesfreedomorlibertytofollowasuggestedalternative.LevelsofKnowledge:
KEYCOMPETENCIES:Athoroughknowledgeofconceptsandtheoriesforthepurposeofcriticalanalysisandsynthesisofamorecompleteunderstanding.
ENABLINGCOMPETENCIES:Adequateknowledgewiththeabilitytoapply.
FAMILIARITY:Asimplifiedknowledgeforthepurposeoforientationandrecognitionofgeneralprinciples.
LevelsofSkills:
PROFICIENT:Thelevelofskillbeyondcompetency.Itisthatlevelofskillacquiredthroughadvancedtrainingorthelevelofskillattainedwhenaparticularactivityisaccomplishedwithrepeatedqualityandamoreefficientutilizationoftime.COMPETENT:Thelevelofskilldisplayingspecialabilityorknowledgederivedfromtrainingandexperience.EXPOSED:Thelevelofskillattainedbyobservationoforparticipationinaparticularactivity.
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OtherTerms:
Head&NeckSurgeon:TheHeadandNeckSurgeon/ReconstructiveSurgeonwillbeaRoyalCollegeofPhysiciansandSurgeonsofCanada(orequivalent)withaspecialistcertificateinOtolaryngology–HeadandNeckSurgery,GeneralSurgery,orPlasticSurgery.AdvancedTraininginHeadandNeckOncologyisrequiredandisdefinedbyhavingcompletedanAdvancedTraininginHeadandNeckOncologicsurgeryfellowshipcomparabletothatwhichisdescribedinthisdocument.Tomaintaincompetency,aHeadandNeckSurgeonisexpectedtofunctionaspartofacomprehensivemultidisciplinaryteamandtoberegularlyperformingHeadandNeckoncologicassessmentsandproceduresasoutlinedintheOntarioguidelines1.Head&NeckReconstructiveSurgeon:Reconstructionexpertiseisrequiredforthesurgicalmanagementofpatientswithheadandnecktumoursandnecessitatesafellowship-trainedmicrovascularsurgeonwithspecifictraininginheadandneckreconstruction.Ahead&neckreconstructivesurgeonshouldperformatleast20microvascularfreetissuetransferproceduresinthehead&neckregionperyear.1
1. TheManagementofHeadandNeckCancerinOntario:OrganizationalandClinicalPracticeGuidelines.5-3PG,May2009.https://www.cancercare.on.ca/cms/One.aspx?portalId=1377&pageId=1025HeadandNeckSurgery:isasurgicalsubspecialtythatfocusesonthediagnosis,ablativesurgery,reconstructionandadjunctivetreatmentspertainingtomalignantandbenignneoplasticdiseasesoftheheadandneckregion..Headandneckmalignanciesarelife-threateningconditionsrequiringcomplexmanagement.Thesetumorsoftenhavedevastatingconsequencesonaperson’sabilitytobreathe,communicate,eat,andoftenaffectaperson’sappearance.Thepropertreatmentwillnotonlyofferthebestchanceofsurvivalbutwillhavelong-lastingimplicationsforthepatient’squality-of-life.Inordertoensuretheprovisionofthehighestqualityofcareforpatients,treatmentshouldbeprovidedinmultidisciplinarysettingbyqualifiedsubspecialistswithadvancedtraininginthetreatmentandmanagementofheadandneckcancer.ReconstructiveSurgery:involveslocal,regionalandfreetissuetransfertechniquestoreconstructandrehabilitatedefectsintheheadandneckregionsecondarytomalignantorbenigntumorextirpation,trauma,orcongenitalcauses.Reconstructivesurgeryinvolvestheidentificationoffunctionalandaestheticdeficitsintheheadandneckregions,aswellasthe
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appropriateapplicationofdifferentreconstructivemethodstoprovidethepatientwiththeoptimalfunctionalresult.FellowshipinHeadandNeckOncologic/ReconstructiveSurgery:Althoughcoresurgicaltraining(throughRCPSCsurgicalresidencyprograms)isfoundationaltothedevelopmentoftheheadandnecksurgeon,thecontemporarypracticeofheadandnecksurgeryisbeyondthescopeofstandardresidencytraining.Howeversuccessfulcompletionofaprerequisiteresidencyprogramisessentialpriortoembarkingonadvancedfellowshiptraining.Furthermore,advancedfellowshiptrainingshouldnotbeviewedasasubstituteforcoresurgicaltraining.AfellowshipinHead&NeckOncologicandReconstructiveSurgeryisaplannedpost-residencyadvancedtrainingprogramthatcontainseducationandtrainingindiagnosis,aswellassurgicalandadjuvanttreatmentsofdiseasesanddefectsoftheheadandneckregionscompletedinthecontextofahighvolumemulti-disciplinarytreatmentsetting.Institution(ororganizationalunit,divisionordepartmentwithinaninstitution):amedicalschoolandhealthcareprovidinginstitution,orhealthcarefacilitythatengagesinadvancedspecialtyeducation.SponsoringInstitution:primaryresponsibilityforadvancedspecialtyeducationprograms.AffiliatedInstitution:supportresponsibilityoradvancedspecialtyeducationprograms.Fellow:Individualformallyenrolledinfellowshipprogramundertakingadvancedtraininginheadandneckoncologicandreconstructivesurgery.CanMEDSFramework:aseriesofrolesandexpectationsoutlinedbytheRoyalCollegeofPhysiciansandSurgeonsofCanada.TheexpectationisthatHead&NeckSurgeonsintegrateallCanMEDSrolesincludingmedicalandsurgicalknowledge,clinicalskillsandprofessionalattitudesintheirprovisionofpatientcenteredcare.TheCanMEDSframeworkinitsapplicationtoHead&NeckOncologicandReconstructiveSurgeryisoutlinedinRequirementssection1ofthisdocument.
REQUIREMENTSSECTION1:FELLOWELIGIBILITYANDSELECTION
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1. ApplicantmusthavesuccessfullypassedthePrinciplesofSurgery
Examination(orequivalent).2. TheapplicantmusthavesuccessfullycompletedaRoyalCollegeof
PhysiciansandSurgeonsofCanada(RCPSC)5yearsurgicaltrainingprogram(orequivalent)andobtainedtheSpecialistCertificateinasurgicaldiscipline.*
3. Theapplicantmustbecredentialedbythelocalorregionallicensingbodyassociatedwiththetrainingprogram
4. Theapplicantmustmeetallrequirementstoobtainappropriateprivilegesatallinstitutionsaffiliatedwiththetrainingprogram.
5. TheapplicantmustbeamemberoftheCanadianMedicalProtectiveAgency(CMPA)orbeeligibleformembershipandprovideproofofapplicationtotheCMPAformembership.
6. Coretrainingofapplicantsbasespecialtymustincludethefollowingrotations:
a. Between40and52weeksofOtolaryngology–Head&NeckSurgery,PlasticSurgery,GeneralSurgeryorapplicablesurgicalbasespecialtytraining
b. Between12and18weeks,doing4–12weekrotationsinanyofthefollowing
i. PlasticSurgeryand/orFacialReconstructiveSurgeryii. Neurosurgeryiii. GeneralSurgery,PlasticSurgery,orOtolaryngology–Head
&NeckSurgeryc. Upto24weeksdoing4-8weekselectiverotationsinanyofthe
following:i. PediatricGeneralSurgeryii. Thoracicsurgeryiii. EmergencyMedicineiv. InternalMedicineandrelevantsub-specialitiesv. Pediatrics
d. Aminimumof4weeksonaservicethatprovidesinitialtraumamanagementsuchas:
i. Emergencymedicineii. GeneralSurgeryiii. TraumaTeam/TraumaSurgeryiv. PlasticSurgery
e. Aminimumof4weeksinCriticalCareMedicinef. Theremainderofthetraineesbase5yearsurgicalresidencymus
include156weeksofapprovedrotationsinthetraineesbasesurgicaldisciplineandincorporatetheprincipleofincreasinggradedresponsibilityandensurethatthetraineeisexposedtoallcoredomainsoftheirbasesurgicalspeciality
7. SelectioncriteriaandprocessmustadheretotheCharterofRightsandFreedomsofCanada
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*Justification:Priortobeginningadvancedtraininginheadandnecksurgery,theapplicantmustdemonstrateproficiencyinthegeneralsurgicalandmedicalmanagementofpatients.Thisincludesacuteandambulatorycareofsurgicalpatients.TheapplicantmusthaveastrongfoundationalknowledgeofmalignantandbenigndisordersoftheheadandneckAirway,nutritional,metabolic,psychosocialandpalliativemanagementofpatientswithheadandneckdisordersandmalignanciesmustbecontainedwithintheapplicantscoreresidencytraining.Acleardemonstrationoftheseattributesmustbeevidencedbyacompletecaselogfromtheirrespectivetrainingprogrambeingprovideduponrequestbythefellowshiptrainingprogram.TherigorousaccreditationprocessoutlinedbytheRCPSCforbasespecialtyprogramsprovidesassurancesthatapplicantswillhavetherequiredbackgroundfoundationalskills,knowledgeandexperiencetoenableadvancedtraininginheadandneckoncologicsurgery.
SECTION2:CanMEDSFRAMEWORKINHEAD&NECKONCOLOGICANDRECONSTRUCTIVESURGERYTRAININGTheCanMEDSframework©1wasdevelopedin2005bytheRoyalCollegeofPhysiciansandSurgeonsofCanadaasastandardofpost-graduatemedicaleducation.TheCHANTcommitteeaccreditationrequirementsarebasedontheCanMEDSframeworktostrivetotrainandeducatethehighestqualityhead&necksurgeons.TheCanMEDSframeworkinitsapplicationtoadvancedhead&neckoncologicandreconstructivesurgeryisoutlinedbelow.FellowssuccessfullycompletingCHANTcommitteeaccreditedfellowshipsinHead&NeckOncologicandReconstructiveSurgeryareexpectedtoshowexpertiseinallKeyCompetenciesandproficiencyinallEnablingCompetencieslistedintheRoledescriptions.
1.Frank, JR., Jabbour, M., et al. Eds. Report of the CanMEDS Phase IV Working Groups. Ottawa: The Royal College of Physicians and Surgeons of Canada. March, 2005.
ROLE:MEDICALEXPERT
Definition:AsMedicalExperts,Head&NeckSurgeonsintegratealloftheCanMEDSRoles,applyingmedicalknowledge,clinicalskills,andprofessionalattitudesintheirprovisionofpatient-centeredcare.MedicalExpertrepresentsthecentralroleoftheCanMEDSFramework.
Description:Head&NeckSurgeonspossessadefinedbodyofknowledge,clinicalskills,proceduralskillsandprofessionalattitudes,whicharedirectedtoeffectivepatient-centeredcare.Theyapplythesecompetenciestocollectandinterpretinformation,makeappropriateclinicaldecisions,andcarryoutdiagnosticand
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therapeuticinterventions.TheydosowithintheboundariesofthefieldofHead&NeckOncology,personalexpertise,thehealthcaresettingandthepatient’spreferencesandcontext.Theircareischaracterizedbyup-to-date,ethical,andresource-efficientclinicalpracticeaswellaswitheffectivecommunicationinpartnershipwithpatients,otherhealthcareprovidersandthecommunity.TheRoleofMedicalExpertiscentraltothefunctionofHead&NeckSurgeonsanddrawsonthecompetenciesincludedintheRolesofCommunicator,Collaborator,Manager,HealthAdvocate,ScholarandProfessional.
KEYCOMPETENCIES:Head&NeckSurgeonsareableto...
1. Functioneffectivelyasconsultants,integratingalloftheCanMEDSRolestoprovideoptimal,ethicalandpatient-centeredHead&NeckOncologiccare;
2. Establishandmaintainclinicalknowledge,skillsandattitudesappropriatetoHead&NeckOncologicSurgery;
3. Performacompleteandappropriateassessmentofapatient;
4. Usepreventiveandtherapeuticinterventionseffectively;
5. Demonstrateproficientandappropriateuseofproceduralandsurgicalskills,bothdiagnosticandtherapeutic;
6. Seekappropriateconsultationfromotherhealthprofessionals,recognizingthelimitsoftheirexpertise.
ENABLINGCOMPETENCIES:Head&NeckSurgeonsareableto...
1. Functioneffectivelyasconsultants,integratingalloftheCanMEDSRolestoprovideoptimal, ethicalandpatient-centeredmedicalcare
. 1.1.Effectivelyperformaconsultation,includingthepresentationofwell-documentedassessmentsandrecommendationsinwrittenand/orverbalforminresponsetoarequestfromanotherhealthcareprofessional
. 1.2.DemonstrateeffectiveuseofallCanMEDScompetenciesrelevanttothepracticeofhead&necksurgicaloncology
. 1.3.Identifyandappropriatelyrespondtorelevantethicalissuesarisinginpatientcare
. 1.4.Effectivelyandappropriatelyprioritizeprofessionaldutieswhenfacedwithmultiplepatientsandproblems
. 1.5.Demonstratecompassionateandpatient-centeredcare
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. 1.6.Recognizeandrespondtotheethicaldimensionsinmedicaldecision-making
. 1.7.Demonstratemedicalandsurgicalexpertiseinsituationsotherthanpatientcare,suchasprovidingexpertlegaltestimonyoradvisinggovernments,asneeded
2. Establishandmaintainclinicalknowledge,skillsandattitudesappropriatetotheirpractice
2.1.Applyknowledgeoftheclinical,socio-behavioural,andfundamentalbiomedicalsciencesrelevanttothephysician’sspecialty
. 2.2.DescribetheCAHNSOframeworkofcompetenciesrelevanttothepracticeof
Head&NeckOncologicSurgery
. 2.3.ApplylifelonglearningskillsoftheScholarRoletoimplementapersonalprogramtokeepup-to-date,andenhanceareasofprofessionalcompetence
. 2.4.Contributetotheenhancementofqualitycareandpatientsafetyintheirpractice,integratingtheavailablebestevidenceandbestpractices
3. Performacompleteandappropriateassessmentofapatient
. 3.1Effectivelyidentifyandexploreissuestobeaddressedinapatientencounter,includingthepatient’scontextandpreferences
. 3.2Forthepurposesofpreventionandhealthpromotion,diagnosisandormanagement,elicitahistorythatisrelevant,conciseandaccuratetocontextandpreferences
. 3.3Forthepurposesofpreventionandhealthpromotion,diagnosisand/ormanagement,performafocusedphysicalexaminationthatisrelevantandaccurate
. 3.4Selectmedicallyappropriateinvestigativemethodsinaresource-effectiveandethicalmanner
. 3.5Demonstrateeffectiveclinicalproblemsolvingandjudgmenttoaddresspatientproblems,includinginterpretingavailabledataandintegratinginformationtogeneratedifferentialdiagnosesandmanagementplans
4. Usepreventiveandtherapeuticinterventionseffectively
. 4.1Implementaneffectivemanagementplanincollaborationwithapatientandtheirfamily
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. 4.2Demonstrateeffective,appropriate,andtimelyapplicationofpreventiveandtherapeuticinterventionsrelevanttothephysician’spractice
. 4.3Ensureappropriateinformedconsentisobtainedfortherapies
. 4.4Ensurepatientsreceiveappropriateend-of-lifecare
5. Demonstrateproficientandappropriateuseofproceduralskills,bothdiagnosticandtherapeutic
. 5.1Demonstrateeffective,appropriate,andtimelyperformanceofdiagnosticproceduresrelevanttotheirpractice
. 5.2Demonstrateeffective,appropriate,andtimelyperformanceoftherapeuticproceduresrelevanttotheirpractice
. 5.3Ensureappropriateinformedconsentisobtainedforprocedures
. 5.4Appropriatelydocumentanddisseminateinformationrelatedtoproceduresperformedandtheiroutcomes
. 5.5Ensureadequatefollow-upisarrangedforproceduresperformed
6. Seekappropriateconsultationfromotherhealthprofessionals,recognizingthelimitsoftheirexpertise
. 6.1Demonstrateinsightintotheirownlimitationsofexpertiseviaself-assessment
. 6.2Demonstrateeffective,appropriate,andtimelyconsultationofanotherhealthprofessionalasneededforoptimalpatientcare
. 6.3Arrangeappropriatefollow-upcareservicesforapatientandtheirfamilies
.
ROLE:COMMUNICATOR
Definition:AsCommunicators,Head&NeckSurgeonseffectivelyfacilitatethedoctor-patientrelationshipandthedynamicexchangesthatoccurbefore,during,andafterthemedicalencounter.
Description:Head&NeckSurgeonsenablepatient-centeredtherapeuticcommunicationthroughshareddecision-makingandeffectivedynamicinteractionswithpatients,families,caregivers,otherprofessionals,andimportantother
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individuals.ThecompetenciesofthisRoleareessentialforestablishingrapportandtrust,formulatingadiagnosis,deliveringinformation,strivingformutualunderstanding,andfacilitatingasharedplanofcare.Poorcommunicationcanleadtoundesiredoutcomes,andeffectivecommunicationiscriticalforoptimalpatientoutcomes.Theapplicationofthesecommunicationcompetenciesandthenatureofthedoctor-patientrelationshipvaryfordifferentspecialtiesandformsofmedicalpractice.
KeyCompetencies:Head&NeckSurgeonsareableto...
1. Developrapport,trustandethicaltherapeuticrelationshipswithpatientsandfamilies;
2. Accuratelyelicitandsynthesizerelevantinformationandperspectivesofpatientsandfamilies,colleagues andotherprofessionals;
3. Accuratelyconveyrelevantinformationandexplanationstopatientsandfamilies,colleaguesandotherprofessionals;
4. Developacommonunderstandingonissues,problemsandplanswithpatientsandfamilies,colleaguesandotherprofessionalstodevelopasharedplanofcare;
5. Conveyeffectiveoralandwritteninformationaboutamedicalencounter.
EnablingCompetencies:Head&NeckSurgeonsareableto...
1. Developrapport,trust,andethicaltherapeuticrelationshipswithpatientsandfamilies
. 1.1.RecognizethatbeingagoodcommunicatorisacoreclinicalskillforHead&NeckSurgeons,andthateffectivephysician-patientcommunicationcanfosterpatientsatisfaction,physiciansatisfaction,adherenceandimprovedclinicaloutcomes
. 1.2.Establishpositivetherapeuticrelationshipswithpatientsandtheirfamiliesthatarecharacterizedbyunderstanding,trust,respect,honestyandempathy
. 1.3.Respectpatientconfidentiality,privacyandautonomy
. 1.4.Listeneffectively
. 1.5.Beawareandresponsivetononverbalcues
. 1.6.Effectivelyfacilitateastructuredclinicalencounter
2. Accuratelyelicitandsynthesizerelevantinformationandperspectivesofpatients
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andfamilies,colleagues,andotherprofessionals
. 2.1.Gatherinformationaboutadisease,butalsoaboutapatient’sbeliefs,concerns,expectationsandillnessexperience
. 2.2.Seekoutandsynthesizerelevantinformationfromothersources,suchasapatient’sfamily,caregiversandotherprofessionals
3. Accuratelyconveyrelevantinformationandexplanationstopatientsandfamilies,colleaguesandotherprofessionals
3.1.Deliverinformationtoapatientandfamily,colleaguesandotherprofessionalsinahumanemannerandinsuchawaythatitisunderstandable,encouragesdiscussionandparticipationindecision-making
4.Developacommonunderstandingonissues,problemsandplanswithpatients,families,andotherprofessionalstodevelopasharedplanofcare
. 4.1.Effectivelyidentifyandexploreproblemstobeaddressedfromapatientencounter,includingthepatient’scontext,responses,concerns,andpreferences
. 4.2.Respectdiversityanddifference,includingbutnotlimitedtotheimpactofgender,religionandculturalbeliefsondecision-making
. 4.3.Encouragediscussion,questions,andinteractionintheencounter
. 4.4.Engagepatients,families,andrelevanthealthprofessionalsinshareddecision-makingtodevelopaplanofcare
. 4.5.Effectivelyaddresschallengingcommunicationissuessuchasobtaininginformedconsent,deliveringbadnews,andaddressinganger,confusionandmisunderstanding
5.Conveyeffectiveoralandwritteninformationaboutamedicalencounter
. 5.1.Maintainclear,accurate,andappropriaterecords(e.g.,writtenorelectronic)ofclinicalencountersandplans
. 5.2.Effectivelypresentverbalreportsofclinicalencountersandplans
. 5.3.Whenappropriate,effectivelypresentmedicalinformationtothepublicormediaaboutamedicalissue
ROLE:COLLABORATOR
Definition:AsCollaborators,Head&NeckSurgeonseffectivelyworkwithinahealthcareteamtoachieveoptimalpatientcare.
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Description:Head&NeckSurgeonsworkinpartnershipwithotherswhoareappropriatelyinvolvedinthecareofindividualsorspecificgroupsofpatients.Thisisincreasinglyimportantinamodernmultiprofessionalenvironment,wherethegoalofpatient-centredcareiswidelyshared.Modernhealthcareteamsnotonlyincludeagroupofprofessionalsworkingcloselytogetheratonesite,suchasawardteam,butalsoextendedteamswithavarietyofperspectivesandskills,inmultiplelocations.ItisthereforeessentialforHead&NeckSurgeonstobeabletocollaborateeffectivelywithpatients,families,andaninterprofessionalteamofexperthealthprofessionalsfortheprovisionofoptimalcare,educationandscholarship.
KeyCompetencies:Head&NeckSurgeonsareableto...
1. Participateeffectivelyandappropriatelyinaninterprofessionalhealthcareteam;
2. Effectivelyworkwithotherhealthprofessionalstoprevent,negotiate,andresolveinterprofessional conflict.
EnablingCompetencies:Head&NeckSurgeonsareableto...
1.Participateeffectivelyandappropriatelyinaninterprofessionalhealthcareteam
. 1.1.Clearlydescribetheirrolesandresponsibilitiestootherprofessionals
. 1.2.Describetherolesandresponsibilitiesofotherprofessionalswithinthehealthcareteam
. 1.3.Recognizeandrespectthediversityofroles,responsibilitiesandcompetencesofotherprofessionalsinrelationtotheirown
. 1.4.Workwithotherstoassess,plan,provideandintegratecareforindividualpatients(orgroupsofpatients)
. 1.5.Whereappropriate,workwithotherstoassess,plan,provideandreviewothertasks,suchasresearchproblems,educationalwork,programrevieworadministrativeresponsibilities
. 1.6.Participateeffectivelyininterprofessionalteammeetings
. 1.7.Enterintointerdependentrelationshipswithotherprofessionsfortheprovisionofqualitycare
. 1.8.Describetheprinciplesofteamdynamics
. 1.9.Respectteamethics,includingconfidentiality,resourceallocationandprofessionalism
. 1.10.Whereappropriate,demonstrateleadershipinahealthcareteam(includingbutnotlimitedtomultidisciplinaryhead&neckoncologyclinicsand
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treatmentteams)
2.Effectivelyworkwithotherhealthprofessionalstoprevent,negotiate,andresolveinterprofessionalconflict
. 2.1.Demonstratearespectfulattitudetowardsothercolleaguesandmembersofaninterprofessionalteam
. 2.2.Workwithotherprofessionalstopreventconflicts
. 2.3.Employcollaborativenegotiationtoresolveconflicts
. 2.4.Respectdifferences,misunderstandingsandlimitationsinotherprofessionals
. 2.5.Recognizeone’sowndifferences,misunderstandingandlimitationsthatmaycontributetointerprofessionaltension
. 2.6.Reflectoninterprofessionalteamfunction
ROLE:LEADER
Definition:AsLeaders,Head&NeckSurgeonsareintegralparticipantsinhealthcareorganizations,organizingsustainablepractices,makingdecisionsaboutallocatingresources,andcontributingtotheeffectivenessofthehealthcaresystem.
Description:Head&NeckSurgeonsinteractwiththeirworkenvironmentasindividuals,asmembersofteamsorgroups,andasparticipantsinthehealthsystemlocally,regionallyornationally.Thebalanceintheemphasisamongthesethreelevelsvariesdependingonthenatureofthespecialty,butallspecialtieshaveexplicitlyidentifiedmanagementresponsibilitiesasacorerequirementforthepracticeofmedicineintheirdiscipline.Head&NeckSurgeonsfunctionasLeadersintheireverydaypracticeactivitiesinvolvingco-workers,resourcesandorganizationaltasks,suchascareprocesses,andpoliciesaswellasbalancingtheirpersonallives.Thus,Head&NeckSurgeonsrequiretheabilitytoprioritize,effectivelyexecutetaskscollaborativelywithcolleagues,andmakesystematicchoiceswhenallocatingscarcehealthcareresources.TheCanMEDSLeaderRoledescribestheactiveengagementofallHead&NeckSurgeonsasintegralparticipantsindecision-makingintheoperationandon-goingevolutionofthehealthcaresystem.
KeyCompetencies:Head&NeckSurgeonsareableto...
1. Participateinactivitiesthatcontributetotheeffectivenessoftheirhealthcareorganizationsand systems;
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2. Managetheirpracticeandcareereffectively;
3. Allocatefinitehealthcareresourcesappropriately;
4. Serveinadministrationandleadershiproles,asappropriate.
EnablingCompetencies:Head&NeckSurgeonsareableto...
1. Participateinactivitiesthatcontributetotheeffectivenessoftheirhealthcareorganizationsand systems
. 1.1.Workcollaborativelywithothersintheirorganizations
. 1.2.Participateinsystemicqualityprocessevaluationandimprovement,suchaspatientsafetyinitiatives
. 1.3.Describethestructureandfunctionofthehealthcaresystemasitrelatestotheirspecialty,includingtherolesofHead&NeckSurgeons
. 1.4.Describeprinciplesofhealthcarefinancing,includingphysicianremuneration,budgetingandorganizationalfunding
2. Managetheirpracticeandcareereffectively
. 2.1.Setprioritiesandmanagetimetobalancepatientcare,practicerequirements,outsideactivitiesandpersonallife
. 2.2.Manageapracticeincludingfinancesandhumanresources
. 2.3.Implementprocessestoensurepersonalpracticeimprovement
. 2.4.Employinformationtechnologyappropriatelyforpatientcare
3. Allocatefinitehealthcareresourcesappropriately
. 3.1.Recognizetheimportanceofjustallocationofhealthcareresources,balancingeffectiveness,efficiencyandaccesswithoptimalpatientcare
. 3.2.Applyevidenceandmanagementprocessesforcost-appropriatecare
4. Serveinadministrationandleadershiproles,asappropriate
. 4.1.Chairorparticipateeffectivelyincommitteesandmeetings
. 4.2.Leadorimplementachangeinhealthcare
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. 4.3.Planrelevantelementsofhealthcaredelivery(e.g.,workschedules)
ROLE:HEALTHADVOCATE
Definition:AsHealthAdvocates,Head&NeckSurgeonsresponsiblyusetheirexpertiseandinfluencetoadvancethehealthandwell-beingofindividualpatients,communities,andpopulations.
Description:Head&NeckSurgeonsrecognizetheirdutyandabilitytoimprovetheoverallhealthoftheirpatientsandthesocietytheyserve.Doctorsidentifyadvocacyactivitiesasimportantfortheindividualpatient,forpopulationsofpatientsandforcommunities.IndividualpatientsneedHead&NeckSurgeonstoassisttheminnavigatingthehealthcaresystemandaccessingtheappropriatehealthresourcesinatimelymanner.CommunitiesandsocietiesneedHead&NeckSurgeons’specialexpertisetoidentifyandcollaborativelyaddressbroadhealthissuesandthedeterminantsofhealth.Atthislevel,healthadvocacyinvolveseffortstochangespecificpracticesorpoliciesonbehalfofthoseserved.Framedinthismulti-levelway,healthadvocacyisanessentialandfundamentalcomponentofhealthpromotion.HealthadvocacyisappropriatelyexpressedbothbyindividualandcollectiveactionsofHead&NeckSurgeonsininfluencingpublichealthandpolicy.
KeyCompetencies:Head&NeckSurgeonsareableto...
1. Respondtoindividualpatienthealthneedsandissuesaspartofpatientcare;
2. Respondtothehealthneedsofthecommunitiesthattheyserve;
3. Identifythedeterminantsofhealthofthepopulationsthattheyserve;
4. Promotethehealthofindividualpatients,communitiesandpopulations.
EnablingCompetencies:Head&NeckSurgeonsareableto...
1. Respondtoindividualpatienthealthneedsandissuesaspartofpatientcare
. 1.1.Identifythehealthneedsofanindividualpatient
. 1.2.Identifyopportunitiesforadvocacy,healthpromotionanddiseasepreventionwithindividualstowhomtheyprovidecare
2. Respondtothehealthneedsofthecommunitiesthattheyserve
. 2.1.Describethepracticecommunitiesthattheyserve
. 2.2.Identifyopportunitiesforadvocacy,healthpromotionanddiseasepreventioninthecommunitiesthattheyserve,andrespondappropriately
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. 2.3.Appreciatethepossibilityofcompetinginterestsbetweenthecommunitiesservedandotherpopulations
3. Identifythedeterminantsofhealthforthepopulationsthattheyserve
. 3.1.Identifythedeterminantsofhealthofthepopulations,includingbarrierstoaccesstocareandresources
. 3.2.Identifyvulnerableormarginalizedpopulationswithinthoseservedandrespondappropriately
4.Promotethehealthofindividualpatients,communities,andpopulations
. 4.1.Describeanapproachtoimplementingachangeinadeterminantofhealthofthepopulationstheyserve
. 4.2.Describehowpublicpolicyimpactsonthehealthofthepopulationsserved
. 4.3.Identifypointsofinfluenceinthehealthcaresystemanditsstructure
. 4.4.Describetheethicalandprofessionalissuesinherentinhealthadvocacy,includingaltruism,socialjustice,autonomy,integrityandidealism
. 4.5.Appreciatethepossibilityofconflictinherentintheirroleasahealthadvocateforapatientorcommunitywiththatofmanagerorgatekeeper
. 4.6.Describetheroleofthemedicalprofessioninadvocatingcollectivelyforhealthandpatientsafety
ROLE:SCHOLAR
Definition:AsScholars,Head&NeckSurgeonsdemonstratealifelongcommitmenttoreflectivelearning,aswellasthecreation,dissemination,applicationandtranslationofmedicalknowledge.
Description:Head&NeckSurgeonsengageinalifelongpursuitofmasteringtheirdomainofexpertise.Aslearners,theyrecognizetheneedtobecontinuallylearningandmodelthisforothers.Throughtheirscholarlyactivities,theycontributetothecreation,dissemination,applicationandtranslationofmedicalknowledge.Asteachers,theyfacilitatetheeducationoftheirstudents,patients,colleagues,andothers.
KeyCompetencies:Head&NeckSurgeonsareableto...
1. Maintainandenhanceprofessionalactivitiesthroughongoinglearning;
2. Criticallyevaluateinformationanditssources,andapplythisappropriatelytopracticedecisions;
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3. Facilitatethelearningofpatients,families,students,residents,otherhealthprofessionals,thepublic, andothers,asappropriate;
4. Contributetothecreation,dissemination,application,andtranslationofnewmedicalknowledgeandpractices.
EnablingCompetencies:Head&NeckSurgeonsareableto...
1. Maintainandenhanceprofessionalactivitiesthroughongoinglearning.
. 1.1.Describetheprinciplesofmaintenanceofcompetence
. 1.2.Describetheprinciplesandstrategiesforimplementingapersonalknowledgemanagementsystem
. 1.3.Recognizeandreflectlearningissuesinpractice
. 1.4.Conductapersonalpracticeaudit
. 1.5.Poseanappropriatelearningquestion
. 1.6.Accessandinterprettherelevantevidence
. 1.7.Integratenewlearningintopractice
. 1.8Evaluatetheimpactofanychangeinpractice
. 1.9Documentthelearningprocess
2. Criticallyevaluatemedicalinformationanditssources,andapplythisappropriatelytopracticedecisions
. 2.1.Describetheprinciplesofcriticalappraisal
. 2.2.Criticallyappraiseretrievedevidenceinordertoaddressaclinicalquestion
. 2.3.Integratecriticalappraisalconclusionsintoclinicalcare
3. Facilitatethelearningofpatients,families,students,residents,otherhealth
professionals,thepublicandothers,asappropriate
. 3.1.Describeprinciplesoflearningrelevanttomedicaleducation
. 3.2.Collaborativelyidentifythelearningneedsanddesiredlearningoutcomesofothers
. 3.3.Selecteffectiveteachingstrategiesandcontenttofacilitateothers’
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learning
. 3.4.Demonstrateaneffectivelectureorpresentation
. 3.5.Assessandreflectonateachingencounter
. 3.6.Provideeffectivefeedback
. 3.7.Describetheprinciplesofethicswithrespecttoteaching
4. Contributetothedevelopment,dissemination,andtranslationofnewknowledgeandpractices
. 4.1.Describetheprinciplesofresearchandscholarlyinquiry
. 4.2.Describetheprinciplesofresearchethics
. 4.3.Poseascholarlyquestion
. 4.4.Conductasystematicsearchforevidence
. 4.5.Selectandapplyappropriatemethodstoaddressthequestion
. 4.6.Appropriatelydisseminatethefindingsofastudy
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ROLE:PROFESSIONAL
Definition:AsProfessionals,Head&NeckSurgeonsarecommittedtothehealthandwell-beingofindividualsandsocietythroughethicalpractice,profession-ledregulation,andhighpersonalstandardsofbehavior.
Description:Head&NeckSurgeonshaveauniquesocietalroleasprofessionalswhoarededicatedtothehealthandcaringofothers.Theirworkrequiresthemasteryofacomplexbodyofknowledgeandskills,aswellastheartofmedicine.Assuch,theProfessionalRoleisguidedbycodesofethicsandacommitmenttoclinicalcompetence,theembracingofappropriateattitudesandbehaviors,integrity,altruism,personalwell-being,andtothepromotionofthepublicgoodwithintheirdomain.Thesecommitmentsformthebasisofasocialcontractbetweenaphysicianandsociety.Society,inreturn,grantsHead&NeckSurgeonstheprivilegeofprofession-ledregulationwiththeunderstandingthattheyareaccountabletothoseserved.1
KeyCompetencies:Head&NeckSurgeonsareableto...
1.Demonstrateacommitmenttotheirpatients,profession,andsocietythroughethicalpractice;
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2.Demonstrateacommitmenttotheirpatients,profession,andsocietythroughparticipationinprofession-ledregulation;
3.Demonstrateacommitmenttophysicianhealthandsustainablepractice.
EnablingCompetencies:Head&NeckSurgeonsareableto...
1.Demonstrateacommitmenttotheirpatients,profession,andsocietythroughethicalpractice
. 1.1.Exhibitappropriateprofessionalbehaviorsinpractice,includinghonesty,integrity,commitment,compassion,respectandaltruism
. 1.2.Demonstrateacommitmenttodeliveringthehighestqualitycareandmaintenanceofcompetence
. 1.3.Recognizeandappropriatelyrespondtoethicalissuesencounteredinpractice
. 1.4.Appropriatelymanageconflictsofinterest
. 1.5.Recognizetheprinciplesandlimitsofpatientconfidentialityasdefinedby
professionalpractice standardsandthelaw
. 1.6.Maintainappropriaterelationswithpatients.
2. Demonstrateacommitmenttotheirpatients,professionandsocietythroughparticipationinprofession-ledregulation
. 2.1.Appreciatetheprofessional,legalandethicalcodesofpracticeofheadandnecksurgicaloncology
. 2.2.Fulfilltheregulatoryandlegalobligationsrequiredofcurrentpracticeofheadandnecksurgicaloncology
. 2.3.Demonstrateaccountabilitytoprofessionalregulatorybodies
. 2.4.Recognizeandrespondtoothers’unprofessionalbehavioursinpractice
. 2.5.Participateinpeerreview
3. Demonstrateacommitmenttophysicianhealthandsustainablepractice
. 3.1.Balancepersonalandprofessionalprioritiestoensurepersonalhealthandasustainablepractice
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. 3.2.Strivetoheightenpersonalandprofessionalawarenessandinsight
. 3.3.Recognizeotherprofessionalsinneedandrespondappropriately
SECTION3:ToupholditscommitmenttoutilizingtheCanMEDSframeworktotrainfellowsinthesub-specialityofhead&neckoncologicandreconstructivesurgerytheCHANTcommitteehasdevelopedaminimumlevelofrequirementsthatallprogramswishingtoobtainanylevelaccreditationfortheirrespectivefellowshipsmustmeet.Eachstandardincludingajustificationofrequirementarelistedinthesectionsbelow.REQUIREMENT1–PROGRAMEFFECTIVENESSANDINFRASTRUCTUREREQUIRMENTSTheprogrammustdevelopclearlystatedobjectivesoftrainingappropriateto
advancedspecialtytraininginheadandneckoncologicand/orreconstructivesurgery.TheseobjectivesandcurriculumshouldadheretoCanMEDSformatandaredescribedinsection1ofthesetrainingguidelines.
Theprogrammustdocumentitseffectivenessusingaformalandongoingoutcomes
assessmentprocesstoincludemeasuresoffellows’achievements.TheassessmentprocessshouldincludesummativeaswellasintervalassessmentscommentingonallcategorieslistedintheCanMEDSframework.
Justification:theCAHNSOTrainingCommitteeexpectseachprogramtoutilizethe
CanMEDSframeworktodevelopitsowngoalsandobjectivesforpreparingindividualsforthepracticeofheadandneckoncologicand/orreconstructivesurgeryandthatoneoftheprogramgoalsistocomprehensivelypreparecompetentindividualstoinitiallypracticethissurgicalsub-specialty.Theoutcomesprocessincludesstepsto:a)developclear,measurablegoalsandobjectiveconsistentwiththeprogram’spurpose/mission;b)developproceduresforevaluatingtheextenttowhichthegoalsandobjectivesaremet;c)collectandmaintaindatainanongoingandsystematicmanner;d)analyzethedatacollectedandsharetheresultswithappropriateaudiences;e)identifyandimplementcorrectiveactionstostrengthentheprogram;andf)reviewtheassessmentplan,reviseasappropriateandcontinuethiscyclicalprocess.
Themedicalandsurgicalresourcesmustbesufficienttosupporttheprogram’sstatedgoalsandobjectives.
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Justification:Theinstitutionshouldhavethemedicalandsurgicalresourcesrequiredtodevelopandsustaintheprogramonacontinuingbasis.Sponsoringinstitutionsshouldhavetheappropriatevolumeofannualoutpatientvisits,inpatientbeds,surgicalvolume,andemergencyroomvisitstoallowadequatesurgeryandpatientexposuretothefellows.Theprogrammustbeaffiliatedwitharegionalcancerprogramandshouldhaveaformalcollaborativerelationshipwithadepartment/divisionofoncologyand/ordepartments/divisionsofmedicalandradiationoncologytoensureadequateexposureofthefellow(s)tochemotherapyandradiationtherapyprotocolsTheprogramshouldhavetheabilitytoengageanadequatenumberoffull-timefaculty,secureprovincialorgovernmentalfundingtoallowadequateaccesstosurgicalresources,purchaseandmaintainequipment,procuresupplies,referencematerialandteachingaidsasreflectedinprovincialand/orinstitutionaland/ordepartmentaland/ordivisionaland/orsectionalannualbudgetallocations.
Institutions,HospitalsandotherFacilitiesthatsponsorfellowshipsmustbeaccreditedbyProvincialorNationallicensingbodiesortheirequivalent.Thebylaws,rulesandregulationsofhospitalsandinstitutionsthatsponsorfellowshipsmustensurethatincomingfellowscanobtaineducational,and/orfull,and/orconditionalprivilegesthatincludetheabilitytoprovidein-patient,out-patient,on-call,surgicalandclinicalpatientcareincludingbutnotlimitedtowritingin-patientcareorders,orderingdiagnosticstudies,writingin-patientandout-patientprescriptions,andprovidingdirectpatientcareinoperatingtheatres,surgicalwards,intensivecareunits,emergencydepartments,ambulatorycareclinicsandotherareasofthehospital(s)orinstitution(s).TheHeadandNeckOncologicprogrammustfunctionwithinanacutecarehospitalandbeaffiliatedwitharegionalcancerprogram.Theprogrammusthaveaccesstoregularambulatorycarefacilities,diagnosticimaging,stagingequipmentandexpertise,inpatientcarebedsandresourcesaswellasoperatingroomaccessandresourcesforcancersurgery.1.1:MinimumInfrastructureRequirements 1.1-1:AmbulatoryCareClinic
i. Rapidaccessclinicsshouldbeavailableforpatientsii. Fineneedaspiratecytologyiii. Directsurgicalbiopsyforfrozensectionpathological
analysisiv. Opentissueorlymphnodebiopsyv. Endoscopicevaluation(Pharyngolaryngoscopy)vi. Microscopyforevaluationoftemporalbone,middleear
orexternalauditorycanalpathology
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vii. Immediateaccesstoalliedhealthprofessionalsforpatientswithcomplexcommunication,swallowing,nutritional,psychological,orsocialneeds(includingbutnolimitedtospeechlanguagepathology,audiologysocialwork,dietician,nursespecialist/nursepractitioner)
viii. Thetrainee(fellow)isrequiredtoassesspatientspreoperativelyandmanagepostoperativepatientsintheambulatorycaresettingaminimumof1dayperweek(7.5hoursperweek)
1.1-2:DiagnosticImaging
i. Thefellow/treatmentteammustberesponsibleforcomprehensivestagingandinterpretationofresultsofinvestigationsfortheheadandneckpatient.Thisrequiresdirectandexpedientaccesstotestsanddiagnosticimagingincluding
a. CTorMRIofprimarytumourregionb. CTimgagingofthethoraxc. PET-CTorothernuclearmedicinemodalitiesin
appropriatesettingsd. Ultrasounde. Imageguidedfineneedleaspirationf. Ancillarytestingasrequiredsuchasgeneralized
metastaticsurvey,bonescan,abdominal/pelvicCT,centralnervoussystemimaging
1.1-3:OperatingRoomResources
ii. Thetrainee/fellowmustparticipateinthepreoperativeassessment,surgicalplanning,andpost-operativemanagementofthemajorityofthepatientswithintheheadandneckoncologyprogram
iii. Assesstorigidlaryngoscopy,rigidorflexibleesophagoscopy,flexiblebronchoscopymustbeavailable.
iv. Resourcestoenablemicrovascularreconstructions,laserandminiminallyinvasive(includingtransoralsurgery)surgerymustbeavailable
v. Immediateaccesstofrozensectionanalysisandsurgicalpathologymustbeavailable
vi. Trainees/fellowsmustspendaminimumof15hoursintheoperatingroomactivelyparticipatinginthesurgicaltreatmentofheadandneckcancerperweek(2workingdaysperweek,at7.5hoursperday).Thisminimumcanbeaveragedoverthecourseofthe
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trainingtimeframetoaccountforacademicleavestoconferences,aswellasvacationtime.
1.1-4:InpatientCare
i. Theheadandneckoncologyprogrammusthaveaminimumof7dedicatedinpatientbedsforthecareofheadandneckpatients.
ii. Accesstointensivecareunitresourcesmustbeavailable
iii. Perioperativemonitoringthatincludesspecializedsurgicalnursingunitswithavailable24hourcare,expertiseinairwaymanagement,andfreeflapmonitoringmustbeavailable
iv. Resourcestoallowforimmediateairwayinterventioninheadandneckcancerpatientsincludingintubation,fibreopticintubation,and/ortracheostomymustbeavailable.
v. Accesstointerventionalradiologymustbeavailablevi. Accesstoresourcestoenablefeedingtubeinsertion
mustbeavailablevii. Accesstoamultidisciplinaryteamincludingaspeech
languagepathologist,registereddietician,physiotherapistandoccupationaltherapistmustbeavailable
viii. Aheadandnecksurgeon(definedasanindividualwhohascompletedanaccreditedheadandnecksurgeryfellowshiporitsequivalentandhasprivilegesatthetrainingfacilitytoperformadvancedheadandneckoncologicsurgery)mustbeon-call24hoursperdayforpostoperativeissuesthatmayariseinheadandneckcancerpatients.
Theprogramorfellowshipdirectormusthavetheauthority,responsibility,andprivilegesnecessarytomanagetheprogrameffectively.
1.2:Fellowshipswhicharebasedininstitutionsorhospitalsthatalso
sponsorresidencyprogramsmustdemonstratethatthefellowshipandresidencyprogramsarenotinconflict.Thefellowshipexperiencemustnotcompetewiththeresidencytrainingprogramforsurgicalandclinicalcases.Separatestatisticsshouldbemaintainedforeachprogram.
1.3:Surgicalteachingstaffmustbeafellow(s)oftheRoyalCollegeof
SurgeonsofCanada(oritsequivalent)andhavefullprivilegesto
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practicetheirspecialtyand/orsub-specialtyatthesponsoringoraffiliatedinstitutionorhospital.
AFFILIATIONSTheFellowshipDirectormustacceptfullresponsibilityforthequalityofeducationprovidedinallaffiliatedinstitutions.Documentaryevidenceofagreements,approvedbythesponsoringandrelevantaffiliatedinstitutionsmustbeavailable.Thefollowingitemsmustbecoveredinsuchinter-institutionalagreements:
a. Designationofafellowshipdirector(s)b. Theteachingstaffc. Theeducationalobjectivesoftheprogram;d. Theeducationalobjectivesofthefellow(s);e. Eachinstitutionscommitmenttothefellowshipprogram
REQUIREMENT2–FELLOWSHIPDIRECTORANDTEACHINGSTAFFTheprogrammustbeadministeredbyadirectorwhoisafellowoftheRoyalCollegeofSurgeonsofCanada(oritsequivalent)inOtolaryngology–Head&NeckSurgery,GeneralSurgery,orPlasticSurgery.Thefellowshipdirectormustbeaheadandneckoncologicand/orreconstructivesurgeonandbeacorememberoftheheadandneckcancerteamattheaffiliatedregionalcancercentre.
2.1: Theresponsibilitiesofthefellowshipdirector(s)mustinclude: 2.1-1: Developmentofthegoalsandobjectivesoftheprogramanddefinitionofasystematicmethodofassessingthesegoalsbyappropriateoutcomemeasures. 2.1-2: Ensuringtheprovisionofadequatephysicalfacilitiesfortheeducationalprocess. 2.1-3: Participationinselectionandsupervisionoftheteachingstaff.Performperiodicevaluationsoftheteachingstaff. 2.1-4: Responsibilityforadequateeducationalresourcesfortheeducationoffellowsincludingaccesstoadequatelearningresources.
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2.1-5: Responsibilityforselectionoffellowsandensuringthatallappointedfellowsmeettheminimumeligibilityrequirements. 2.1-6: Maintenanceofappropriaterecordsoftheprogram,includingfellowandpatientstatistics,institutionalagreementsandfellowrecords.2.2: Teachingstaff:Teachingstaffmustbeofadequatesize,andincludeaminimumoftwofulltimeacademicsurgeonswhohaveachievedfellowshiptraininginHead&NeckOncologicSurgery(equivalenttothestandardsoutlinedinthisdocument)andmustprovideforthefollowing: 2.2-1:Providedirectsupervisionappropriatetoafellow’scompetenceandleveloftraininginallpatientcaresettings.2.3: ScholarlyActivityofTeachingStaff:Theremustbeevidenceofscholarlyactivityamongthefellowshipteachingstaff/faculty.Suchevidencemayinclude:
a. Participationinclinicaland/orbasicresearchstudiesincludingbutnotlimitedtoprojectsfundedfollowingpeerreview.b. Publicationoftheresultsoforiginalresearchprojectsandreviewsofexistingresearchtopicsinpeer-reviewedscientificmedia.c. Presentationatscientificmeetingsand/orcontinuingeducationcoursesandthelocal,provincialandnationallevel.d. Reviewersforjournalorsitoneditorialboard
REQUIREMENT3–FACILITIESANDRESOURCESFacilitiesandresourcesmustbeadequatetoprovidetheeducationalexperiencesandopportunitiesrequiredtofulfilltheneedsoftheeducationalprogramasspecifiedintheseStandards.Thefacilitiesandresourcesshouldpermittheattainmentofprogramobjectivesoftraining.Toensurehealthandsafetyforpatients,fellows,facultyandstaff,thephysicalfacilitiesshouldeffectivelyaccommodatetheclinicalschedule.Theprogrammustdocumentitscompliancewithanyapplicableregulationsoflocal,provincialandnationalagencies,includingbutnotlimitedtoradiationhygieneandprotection,ionizingradiation,hazardousmaterials,andbloodborneandinfectiousdiseases.Policiesmustbeprovidedtoallfellows,facultyandappropriatesupportstaffandcontinuouslybemonitoredforcompliance.Additionally,policiesonbloodborneandinfectiousdiseasesmustbemadeavailabletoapplicantsforadmissionandpatients.Fellows,facultyandappropriatesupportstaffshouldbeencouragedtobeimmunizedagainstand/ortestedforinfectiousdiseases,suchasmumps,measles,
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rubellaandhepatitisB,priortocontactwithpatientsand/orinfectiousobjectsormaterialsinanefforttominimizetherisktopatientsandpersonnel.REQUIREMENT4–CURRICULUMANDPROGRAMDURATIONThefellowshipprogrammustbedesignedtoprovidespecialknowledgeandskillsbeyondresidencytraining.Documentationofallprogramactivitiesmustbeensuredbythefellowshipdirectorandbeavailableforreview. 4.1 Thefellowshipprogramisastructuredpost-residencyprogramwhich
isdesignedtoprovidespecialknowledgeandskills.Thegoalsofthefellowshipmustbeclearlyidentifiedanddocumented.
4.2 Thedurationofthefellowshipshouldbeaminimumoftwelve
months. 4.2-1:AcademicandPersonalLeavesaredefinedasfollows:
i. Vacation:maximum15businessdaysper12monthperiod
ii. Conference:maximum10businessdaysiii. StatutoryHolidays:allrecognizedduring12month
periodiv. ItisunderstoodbytheCAHNSOTrainingCommittee
thatfellowsmayrequireleavesofabsencefromtraining.Thecircumstancesthatwouldqualifyfellowsforleavesofabsencearedeterminedbythehostuniversityofthefellowshipprogram.Itisanticipatedthatanytimelostduringaleavewillbemadeupuponthetrainee’sreturn.
v. Thepostgraduateofficeofthehostuniversitymayallowawaiveroftrainingfollowingaleaveofabsence,inaccordancewithuniversitypolicyandwithinthemaximumtimeforawaiverdeterminedbytheCAHNSOTrainingCommittee.Adecisiontograntawaiveroftrainingcanonlybetakeninthefinalyearoftheprogram.
vi. Eachuniversitywilldevelopitsownpolicyonwhetherornotitiswillingtograntawaiveroftrainingfortimetakenasaleaveofabsence;however,inthecasewherewaiversoftrainingareacceptabletotheuniversity,theymustbewithintheacceptabletimeslistedbelow.Inaddition,regardlessofanywaivedblocksoftraining,thedecisiontograntawaiveroftrainingmustbebasedontheassumptionsthatthefellowswillhaveachieved
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therequiredlevelofcompetencebytheendofthefinalyearoftraining.AwaiveroftrainingcanonlybegrantedbythePostgraduateDeanontherecommendationoftheresident’sProgramDirector.
a. Thefollowingarethemaximumallowabletimesforwaivers:1.Oneyearprogram–nowaiverallowed2.Twoyearprogram–sixweeks3.Threeyearprogram–sixweeks
4.3 Thefellowshipshouldincludeaformallystructuredcurriculumbased
ontheCanMEDSframework.Allfacetsoftrainingandexpectedkeyandenablingcompetenciesmustbereviewedwiththefellow(s)priortothestartoftheirtrainingperiod.
4.4 Thefellowshipprogrammustprovideacompletesequenceofpatientexperienceswhichinclude:
a. pre-operativeevaluation;b. advancedmulti-disciplinaryhead&neckcancerclinicsc. adequateoperatingexperience;d. diagnosisandmanagementofcomplications;e. post-operativeevaluation
4.5 Thefellowmustmaintainasurgicalcaselogofallproceduresandshouldincludeatleastthedateoftheprocedure,patientname,patientidentificationnumber,locationofwhereprocedurewasperformed,preoperativediagnosis,theoperativeprocedureperformed,andtheoutcomeoftheprocedure.
4.6 FellowswithSpecialNeeds,ConditionsorDisabilitiesPolicy
4.6-1:SupervisionandEvaluation
i. Thesupervisionofthefellowwithspecialneeds,conditionsordisabilitiesmustnotbelessthanthatoftheothercurrentorpreviousfellowsinthefellowshiptrainingprogram;thefellowwithspecialneeds,conditionsordisabilitiesmayrequiremoresupervisionthanthatoftheotherfellowsifrecommendedbytheUniversityPostGraduateOffice
ii. Allobjectivesconsideredessentialtopractice,asdefinedbythisdocument,mustbeachievedbythe
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fellowwithspecialneeds,conditionsordisabilitiesatthesamelevelofcompetenceasotherfellows.
iii. Theevaluationmethodsusedtoassessobjectivesinthedomains:
a. affectedbythespecialneed,conditionordisabilitymaybedifferentfromthatappliedtootherfellowsinthetrainingprogram,
b. notaffectedbythespecialneed,conditionordisabilitymustbeidenticaltoallotherfellowsinthetrainingprogram.
iv. TheCAHNSOTrainingCommitteemayconsulttheRoyalCollegeofPhysiciansandSurgeonsofCanadafortheirrecommendationsregardingevaluationmethodsandassessmentoftraineeswithspecialneeds,conditionsordisabilities.
v. Proceduresa. TheCAHNSOTrainingCommitteemustbe
notifiedinadvanceofanymodifiedfellowshiptraining.
b. Whereapplicable,theCAHNSOTrainingCommitteemayrequireawrittenverificationbythetreatingphysicianofaresident,describingthespecialneed,conditionordisability,orotherpersonalcharacteristicenumeratedunderapplicablehumanrightslegislation,anditspotentialimpactonfellowshiptrainingandevaluation.
c. Thespecialneed,conditionordisabilityorotherpersonalcharacteristicenumeratedunderapplicablehumanrightslegislation,mustbeverified,documentedandconsideredvalidbythefellowshipdirector,thepostgraduatedean,theCAHNSOTrainingCommittee
d. Themodifiedfellowshipprogrammustbeapprovedbythefellowshipprogramdirector,andtheCAHNSOTrainingCommittee.
e. Thefellowshipprogramdirectormustprovideasyllabusfortheapplicant’sentirefellowshipprogram.
REQUIREMENT5–FELLOWEVALUATION
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EVALUATIONAsystemofongoingevaluationandadvancementshouldensurethatthroughthefellowshipdirectorandfaculty,eachprogram:
a. Utilizingsummative(completionoftraining)includingperiodicintervalassessments(minimumquarterly)basedonallKeycompetenciesoutlinedbytheCanMEDSframework(section1)assessanddocumenttheperformanceoftheenrolledfellow(s);b. Providestofellowswrittenandface-to-facebidirectionalfeedbackbasedontheassessmentsoutlinedina.;c. Maintainsapersonalrecordofevaluationsforeachfellowthatisaccessibletothefellowandavailableforereviewduringsitevisits.
Attheendofthefellowshiptrainingperiod,thetraineemustsubmitacaselogthatconsistsof
a. Alistofnewpatientdiagnosisandevaluationsb. Detailedlistofsurgicalcasesincludingdiagnosis,descriptionof
procedure,complicationsandoutcomes.c. Participationineducationalactivities(asoutlinedinrequirement7)d. Researchprojectscompletedandinprogress.
Itshouldbenotedthatthecompletionof12monthsdoesnotautomaticallydeemthecandidatetohavecompletedadvancedtraininginheadandnecksurgery.Somefellowsandfellowshipsmayrequireadditionalclinicaltrainingbeyond12monthsinordertoensureappropriateminimalstandards.ItisonlywiththefinalapprovalofthefellowshipdirectorinconjunctionwiththeDepartmentPostgraduateprogramchairthatthefellowmaybedeemedtohavecompletedthefellowship.
RIGHTSANDRESPONSIBILITESAtthetimeofenrollment,thefellowsshouldbeapprisedinwritingoftheCanMEDSframeworkthatmakesupthekeyandenablingcompetencygoalsoftheirtrainingaswellasadescriptionoftheoftheeducationalexperiencetobeprovided,includingthenatureofassignmentstootherdepartments,divisions,orinstitutionsandteachingcommitments.Additionally,allfellowsmustbeprovidedwithwritteninformationthataffirmstheirobligationsandresponsibilitiestotheinstitution,theprogramandtheprogramfaculty.REQUIREMENT6–CLINICALANDSURGICALTRAINING
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ThoseenrolledinanaccreditedclinicalfellowshipinHeadandNeckOncologicandReconstructiveSurgerycompleteadvancedtraininginthissub-specialtyarea.
6.1 FellowshipProgram:Afellowshipisastructuredpost-residencyeducationalexperiencedevotedtoenhancementandacquisitionofskillsinafocusedareaandmustbetaughttoalevelofcompetence.
6.2 FellowshipGoals/Objectives:Toprovidecomprehensiveclinicalanddidactictrainingwhichallowthefellowtofunctionasaprimaryoncologicandreconstructivesurgeoninaheadandneckcancercareteamatthecompletionoftraining.6.3 SurgicalExperience:Surgicalexperiencemustincludethefollowingproceduresinsufficientnumberandvarietytoensurethatobjectivesofthetrainingaremet.Noabsolutenumberofcasescanensureadequatetraininghoweverevidencebaseddocumentstoensurequalitycareinheadandneckcancersurgeryhaveprovidedsomeguidance.1 Category1(Resection/AblativeCases)
Aminimumofonehundred(100)advancedtumourablationspertwelvetotwentyfourmonthtrainingperiod.ThearrayofcasesthefellowisexposedtoMUSTincludeprocedureswithALLofthefollowingelements:
• NeckDissection(minimumof40cases)• PartialLaryngectomy/TotalLaryngectomy/
Laryngopharyngectomy(minimumof10cases)• Oralcavitycancersurgery
o Mandibulectomyo Mandibulotomy
• Oropharyngealcancersurgeryo Mandibulotomy
• Majorskincancerresections• Salivaryglandcancersurgery
o Superficialparotidectomyo Totalparotidectomyo Facialnervedissectionwithpreservationo Facialnervesacrificewithappropriate
reconstruction/rehabilitativesurgery• Thyroidcancersurgery
o Totalthyroidectomyo Hemithyroidectomyo CentralCompartmentClearance
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• Parathyroidectomyo Primaryhyperparathyroidismsurgeryo MedicalandSurgicalmanagementofsecondary
hyperparathyroidismduetorenalfailure• Transoralsurgeryforupperaerodigestivetractcancer
o Lasermicrosurgeryand/orTORS• SkullBaseSurgery
o Traditionalskullbasesurgery(open)o Endoscopicskullbasesurgery
• Maxillectomy
*PleasenotethatfortheCaseLogtobeconsideredcompletetheFellowMUSTcompleteaminimumof40lateralneckdissectionsand10partialortotallaryngectomiesalongwithothercaseslistedabovetoachieveatotalof100majorcasesperformedduringtheirfellowshiptraining.Category2(ReconstructiveCases)
a. Directinvolvementinthepreoperativeevaluation,operation,andpostoperativecareofatleastforty(40)freetissuetransferproceduresforablativedefectsofthehead&neck.b. Casemixisatleastasimportantasoverallcasevolumeandthefellowshiptrainingmustincludereconstructionofsofttissueandbonydefectsofthehead&neckwithcombinationsoffasciocutaneous,myocutaneous,andosseocutaneousfreeflaps.c. Atleasttwenty(20)regional(basedonnamedaxialbloodsupply)and/orlocal(randombloodsupply)flapreconstructionsshouldcomplementthefreeflapexperiencebyensuringacomprehensiveapproachtothemanagementofhead&neckdefectstakingintoconsiderationthepatient-specificrequirements.
1. TheManagementofHeadandNeckCancerinOntario:OrganizationalandClinicalPracticeGuidelines.5-3PG,May2009.https://www.cancercare.on.ca/cms/One.aspx?portalId=1377&pageId=10252
6.5 ClinicalActivity
a. Clinicalexposuretoaminimumof150patientswithnewneoplasticdiseasesperyearincludingbutnotlimitedtointeractionstohospitalin-patients,out-patientclinicsandmultidisciplinaryclinics.
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b. Oppurtunitytobeexposedtoaminimumof250patientsdiagnosedwithneoplasticdiseasesofthehead&neck(newpatientsandfollow-up)includingbutnotlimitedtointeractionstohospitalin-patients,out-patientclinicsandmultidisciplinaryclinics.
c. Regularinteractionwithamultidisciplinaryhead&neckcancertreatmentteamincludinghealthcareprofessionalsfromradiationoncologyandmedicaloncology
d. Regularinteractionwithanhead&necksurgerycareteamincludingphysiotherapists,occupationaltherapists,speechpathologistsandnursingstaff
e. Pleaserefertosection1.1foramoreindepthdescriptionofthetrainingenviroment
REQUIREMENT7–SCHOLARLYACTIVITYFellowsmustengageinscholarlyactivity.Sucheffortsmayincludebutarenotlimitedto:
7.1 Participationinclinicaland/orbasicresearchparticularlyinprojectsfundedthroughpeerreview.7.2 Publicationoftheresultofinnovativethought,datagatheringresearchprojectsandthoroughreviewofpertinenttopicsinpeer-reviewedscientificmedia.7.3 Presentationatscientificmeetingsand/orcontinuingeducation
coursesatthelocal,regional,nationalorinternationallevels.7.4 Somefellowshipprogramsmayrequireasegregatedresearchblock
aspartoftheircoreexperience.Itshouldbenotedthatsegregatedresearchtimedoesnotconstituteclinicaltraining.
SUMMARY
TheultimategoalistoensurethehighestlevelofsurgicalcareforallCanadiansfacedwithcancersoftheheadandneck.Theinitialevaluationandmanagementbyqualifiedspecialistswithadvancedtrainingisthecornerstoneofbestpracticeandoptimalpatientoutcome.However,establishingCanadiantrainingstandardsforAdvancedHeadandNeckSurgeryFellowshiprepresentonlythefirststeptowardsthemaintenanceofthehighestqualityofcare.Optimalqualitycarerequiresproperlytrainedsurgeonsworkingwithintheframeworkofhighvolumeappropriatelyresourcedinstitutions,adoptingamultidisciplinaryteamapproach.
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