Residency Program

Otolaryngology Training Program

Vision

The vision of the Otorhinolaryngology - Head and Neck surgery residency program is twofold: to comprehensively train medical graduates as medical experts, health advocates, scholars, professionals, collaborators, efficient managers, and effective communicators in order to serve the community at large, and to be one of the world's foremost otorhinolaryngology - head and neck surgery residency training programs.

Mission

To provide specialized training to medical graduates to gather knowledge and skills in the domain of otorhinolaryngology - head and neck surgery through advanced teaching and training methodologies.

Program Goals and Objectives

Upon completion of the residency training program, graduating residents will be able to function as independent otolaryngologists - head and neck surgeons, enabling them to successfully pursue careers in general otolaryngology or to proceed with subspecialty fellowship training. They will be responsible individuals with the highest commitment to their patients, fulfilling all CanMEDS domains as consultant surgeons while demonstrating a commitment to their profession, to lifelong learning, and to the society in general.

General Objectives

• Graduate residents who are able to integrate all of the CanMEDS Roles to provide optimal, ethical, patient-centered medical care. They will know how to apply their medical knowledge, clinical skills, and professional attitudes to provide effective patient-centered care.
• Graduate residents who can function effectively as communicators who can facilitate the doctor-patient relationship and the dynamic exchanges that occur before, during and after the medical encounter.
• Graduate residents who can function effectively as collaborators who can work within an interdisciplinary health care team to achieve optimal patient care.
• Graduate residents who can function effectively as managers who are able to organize sustainable practices, make decisions about allocating resources, and contribute to the effectiveness of the health care system.
• Graduate residents who can function effectively as health advocates who use their expertise and influence responsibly to advance the health and well-being of individual patients, communities, and populations.
• Graduate residents who can function effectively as scholars who demonstrate a lifelong commitment to receive learning as well as to the creation, dissemination, application, and translation of medical knowledge.
•  Graduate residents who can function effectively as professionals who are committed to the health and well-being of individuals and society through ethical practice, profession-led regulation, and high personal standards of behavior.

Specific Objectives

• To provide adequate infrastructure for teaching the basic sciences and the clinical and surgical aspects of otorhinolaryngology.
• To provide an optimal science milieu essential to understanding otorhinolaryngologic diseases through a structured and organized academic program of seminars, clinical rounds, and journal clubs.
• To develop the abilities of the residents, who, by the end of the course, should be able to elicit medical histories and conduct physical examinations of patients with otorhinolaryngologic - head and neck surgery diseases, formulate reasonable and comprehensive differential diagnoses, and manage patients with common and rare otorhinolaryngologic disorders.
•  To provide proper training in otorhinolaryngologic disorders through patient care and management by means of ward rounds, outpatient clinics, emergency room rotations, and intensive care unit postings.
• To create a learning environment by inviting discussions, guest lectures, grand rounds, workshops & seminars, and journal clubs.
• To provide the means to develop technical proficiency and surgical skills in otorhinolaryngologic surgery through supervised exposure in the operating room, minor surgery in the clinics, and cadaver surgery in the anatomy and temporal bone laboratories.
• To provide adequate basic and clinical research opportunities to the residents.
• To encourage a multidisciplinary approach to patent management in such areas as neurotology, head and neck surgical oncology, communication, and swallowing disorders.

General Training Requirements

• Applicants should fulfill all admission requirements set by the Saudi Commission for Health Specialties.
• Trainees should abide by the training regulations and obligations set by the Saudi Commission for Health Specialties.
• Training is a full-time commitment. Residents should be enrolled in full-time, continuous training for the duration of the program.
• Training is conducted in institutions accredited for training by the Saudi Board of Otolaryngology.
• Applicants should fulfill all the requirements set by the Saudi Commission for Health Specialties and the Scientific council of otolaryngology.
• Trainees should be actively involved in patient care, with a gradual progression of responsibility.

Structure and Organization of the Program

Program Framework:
As a Saudi Board of Otolaryngology training program, we follow and fulfill all requirements set by the Saudi Commission for Health Specialties and the Scientific council of otolaryngology. Candidates start with general surgical rotations (R1-otolaryngology) and then commence their formal otolaryngology training for four years (R2-5). The program includes eight domains: Otology and Neuro-otology, Rhinology and skull base surgery, Laryngology and voice, Pediatric Otolaryngology, Head and Neck Surgery, General Otolaryngology.

Year 1 Resident (R1):
The first year of training in otolaryngology is a surgical foundation year, in which the residents acquire knowledge and experience in the basic principles of general surgery and develop an ability to apply these. The year composed of different rotations in several surgical subspecialties include general surgery, pediatric surgery, neurosurgery, plastic surgery, thoracic surgery and oral & maxillofacial surgery. In addition, the residents do rotations in the intensive care unit and the emergency room, join two months of Otolaryngology, and attend the basic science course, and a research methodology course.

Year 2-5 Resident (R2-5):
Residents engage in formal otolaryngology training over four years. The last year R5 is the senior year where residents acquire most of their advanced surgical expertise. Rotations are distributed into three-months periods, each rotation is with a subspecialty team. Over the duration of the training program, residents are expected to develop proficiency in:
• Obtaining the otolaryngological history and performing physical examination.
• Interpretation of audiological and vestibular tests.
• Interpretation of medical imaging techniques.

•  Gain experience and proficiency in common clinical procedures like:

1.  Flexible nasolaryngoscopy.
2. Rigid nasal endoscopy.
3.  Functional Endoscopic Evaluation of Swallowing.
4.  Fine needle aspiration biopsy.
5.  Microscopic examination and management of the ear disease.
6.  Intra-tympanic injection.
7. Percutaneous tracheostomy.

•  Management of common otolaryngological emergencies:

1. Epistaxis (cautery, anterior and posterior packing).
2.  Airway problems (evaluation of patient with stridor, management of airway obstruction, airway foreign body, tracheostomy complications).
3. Perform open and percutaneous tracheostomy.
4.  Esophageal emergencies (foreign body, caustic ingestion).
5. Peritonsillar and deep neck infection.
6. Acute complications of rhinosinusitis.
7. Otitis media, otitis externa and sudden sensory neural hearing loss.

•  Acquire experience in the common otolaryngologic procedures.

1. Tympanoplasty and tympanomastoidectomy.
2. Basic endoscopic sinus surgery.
3.  Septoplasty and turbinoplasty.
4.  Laryngoscopy, bronchoscopy and esophagoscopy.
5.  Endoscopic airway surgery.
6.  Adenoidectomy, tonsillectomy and management of intra-oral lesion.
7.  Neck dissection.
8.  Management of head and neck soft tissue lesions

• Matters of ethical and responsible behavior, ability to work as a part medical team, and fulfill all CanMEDS domains.

Administrative Structure

Program director

Dr.Ahmed Alkhateeb, MBBS, MSc, FRCSC
Consultant Pediatric Otolaryngology
Assistant Professor of Otolaryngology Head and Neck Surgery
Imam Abdulrahman Bin Faisal University
Dammam, Saudi Arabia
E-Mail: aaalkhateeb@iau.edu.sa

Program Coordinator
Miss. Zahra Alsadah
Location: ENT department at KFHU
Email: Zasadah@iau.edu.sa
Email: cm-dent@iau.edu.sa
Phone: 013 895 7999 ext: 1684

Residency Program Committee

The Residency Program Committee (RPC) assists the Program Director in the planning, organization, and supervision of all aspects of the residency training program. The committee meets every three months to discuss and re-evaluate three main domains:

• Resident Education and Academic Performance
• Research
• Resident wellness

Resident Education and Academic Performance:
The committee constantly works on maintaining a high level of education in all aspect of otolaryngology, and head and neck surgery through academic half days, grand rounds, hospital rounds, journal clubs and hands-on courses and workshops.

Research:
The committee advocates and assists residents to integrate in research by joining one or more of the research teams in the department. We hold annual resident research day where all residents are expected to deliver a ten-minute research presentation.

Resident wellness:
The committee works to promote a healthy work-life balance, provide physical, psychological and professional wellness education, and support to optimize the clinical learning environment and, in turn, patient care, the psychological, emotional, and physical well-being of our residents.

RPC Members:

 
Otolaryngology Staff

ENT Team Distributions at KFHU

Otolaryngology at KFHU is divided into 3 general teams:

Weekly Resident Schedule

Annual ORL Service

Out-patient service:
We have daily specialized ENT clinics, with an average of 13 out-patient clinics per week, seeing around 24,000 patients annually. There is daily audiology and SLP clinics.

ENT Surgical Procedures:

We have a minimum of 6 OR rooms per week, plus add-on rooms. All adenotonsillectomies are done on Thursday in 1-2 operating rooms. We do all major and minor ENT procedures except major head and neck reconstruction procedures. That includes, but not limited to:

• All types of mastoidectomy
• Tympanoplasty and ossiculoplasty
• Cochlear implant
•  Endoscopic ear surgery
• Functional Endoscopic Sinus Surgery (FESS)
• Endoscopic skull base surgery
• Endoscopic and Open Epistaxis procedures
• Endoscopic airway surgery (pediatrics and adults)
• Open airway surgery (pediatrics and adults)
• Phonosurgery
• Thyroplasty
• Head and neck tumor resections
•  Neck dissection
• Velopharyngeal reconstruction (speech surgery)

Academic Half Days

•  Weekly academic half days, distributed over subspecialty blocks.
• Two hours of academic protected time includes didactic and interactive teaching sessions covering all of the major areas of general otolaryngology and the representative subspecialties of the field.
• The first hour is a lecture presented by an otolaryngology consultant and the second hour is a self-directed teaching session presented by a senior resident.
• This time is protected time i.e. the trainees will be exempted from all clinical duties including: ORs, clinics, and calls.
• The academic schedule is arranged in blocks. Each block covers a subspecialty, follows the index of Baily’s textbook, and concluded by an OSCE exam. The program is distributed over two year period.
• The subspecialty blocks are distributed as the following:

Hands-on Seminars and Workshops:

• Four seminars per year as the following:

Temporal bone dissection course

•  Includes lectures and hands-on dissection
•  The dissection is intended primarily for the R3-R5

1. Functional sinus surgery workshop
2. Endoscopic airway surgery seminar
3. Facial plastic review day

•  Covers all topics of aesthetic and reconstructive facial plastics

Teaching Rounds

Teaching rounds are conducted in several ways:

•  ORL Audit:

 It is a weekly session on every Thursday morning, attended by all ORL consultants, specialists, and residents where all ENT consultations and referral for the corresponding week are discussed. Occasionally, a short power point presentation is presented on a specific interesting case.

• Sunday Morning Didactics:

It is an hour weekly teaching session, presented by an ORL specialist. It covers clinical scenarios, topics review, exam questions.

• Bedside Case Discussion:

Case by case discussion with the consultant.

• Virtual Surgery Lectures
• An initiative to alleviate the deficiency in OR exposure for our trainee residents during COVID-19 pandemic, through lectures presented by KFHU ORL staff. These lectures cover:
• Surgical indications
•  Pre-operative evaluation
•  Informed consent
•  Surgical instruments and OR preparation
•  Operative technique
•  Post-operative care

The procedures included in the series are:

OR Template:

The OR template was invented to maximize the learning from each surgical procedure. It is completed by the resident assigned to each OR procedure and emailed to the consultant surgeon, the day before the procedure.

Otolaryngology Head and Neck Surgery
OR template

Patient’s name:                                        Date of Surgery:
Age:                                                             MRN:
Diagnosis:                                                 Surgery:

History:
Brief history summarizes the indication for the surgery, and the expected outcome

Physical Examination:
Relative examination that might indicates some intra operative adjustment

Investigation:
Positive findings that might indicates some intra operative adjustment

Indication for Surgery:
Clear statement of indication for surgery

Pre-Operative preparation:
Any intra operative supplies might be needed for the surgery, e.g. tracheostomy tube, hyaluronic acid, mitomycin C, prosthesis etc. Checked and confirm available.

Surgical Steps:

Level of Confidence:
1. Uncomfortable doing the key steps of the surgery by myself
2. Comfortable doing following key steps of the surgery by myself:
3. Capable of doing the key steps of the surgery with assistance
4. Capable of doing the key steps of the surgery with confidence
5. Capable of teaching the key steps of the surgery to another resident

Resident who scores level 5 of confidence for the key surgeries of his/her rotation, during the second half of the rotation, will honored superior evaluation for his/her surgical skills

Grand Rounds

• Weekly departmental grand rounds, total of 40 rounds per year.

Research Unit:

• Headed by Dr.Mona Alrammah, ENT consultant.
•  Helps attach each resident in a research team.
• Facilitates ENT residents in research.
• Organize the Annual Resident Research Day.

Resident Research Day

•  The last grand round in the academic year.
•  ALL R2-4 residents are expected to present in the research day. Failure of presenting will affect the research domain in their evaluation.
•  Top 3 researches will be honored.

On-line References

IAU library E-Resources include a large range of electronic resources in order to support teaching, learning and research. Currently, there are more than 319 databases on different subjects and more than 70,000 full-text e-journals, along with over 500,000 e-books available at IAU’s libraries.

Evaluation of Resident Performance

• Residents meet with the program directory every 6 months for evaluation, career counseling and setting general objectives for the next rotation.
• Residents meet the training consultants, at the beginning of the rotation for discussing rotation’s objectives, at mid rotation for feedback, and at the end of rotation for evaluation.
• Minimum of two consultants evaluate each resident at the end of each rotation, using the one-45 evolution form, and discuss the evaluation with the resident.
• At the end of each rotation, residents should evaluate the rotation using the one-45 evaluation form.