PROGRAM DESCRIPTION

Overview: The University of Texas Southwestern Medical Center is the leading medical center and only medical school in Dallas. The Dallas Fort Worth (DFW) Metroplex is an 11-county metropolitan area with a population of 7.5 million – the fourth largest in the US. The medical center and the Department of Otolaryngology serve the Metroplex and a referral catchment area extending from New Mexico to Arkansas as a part of Southwestern Health Resources; a network of 27 hospitals and 300 clinics. It is also home to the only NCI designated comprehensive cancer center in North Texas. UT Southwestern has a research budget of 450 million dollars and includes as faculty, 22 members of the National Academy of Sciences, 17 members of the National Academy of Medicine, 15 members of the American Academy of Arts and Sciences, 15 current members of the Howard Hughes Medical Institute and 3 Nobel Laureates.

Being integrated into this very large ecosystem as the tertiary/quaternary care center provides exceptional training to future leaders in head and neck oncologic surgery. The experience is based at the main UT Southwestern campus which includes Parkland Memorial Hospital, Clements University Hospital, and Children’s Medical Center. This integrated campus provides fellows with a wide breadth of experiences including the full spectrum of mucosal ablative surgery, endocrine surgery, salivary surgery, transoral laser surgery (TLMS), transoral robotic surgery (TORS), advanced cutaneous surgery with sentinel lymph node mapping, and ultrasound-guided procedures. Fellows are also trained in advanced reconstructive techniques including local, regional, and microvascular free tissue reconstruction. The fellowship program is incorporated into multidisciplinary management for head and neck cancer patients which requires working closely with medical oncology, radiation oncology, and a wide variety of other clinical and non-clinical services.

Objectives: The goal of the program is to train outstanding head and neck surgeons by providing advanced training in all aspects of care for the head and neck cancer patient. The program will cultivate a wide range of operative skills used in the management of head and neck cancer and reconstruction. The fellowship will provide a thorough grounding in the knowledge base required for independent practice as a subspecialist in head and neck oncology. The fellow will also work within a multidisciplinary team to understand that the contemporary management of head and neck cancer requires a comprehensive approach to care.

Strengths: The fellowship emphasizes clinical skill and knowledge, with the goal of graduating trainees with outstanding technical operative skills as well as a clinical fount of knowledge. We see over 1,000 new head and neck patients a year as well as over 3,000 patients yearly after treatment. The training program includes all aspects of head and neck ablative surgery, microvascular and reconstructive surgery, transoral laser microsurgery (TLMS) and transoral robotic surgery (TORS) with the da Vinci Surgical Robotic systems (Si and Sp). The training further includes procedures such as complex airway reconstruction, advanced benign tumor resections for schwannoma/paraganglioma, facial nerve re-animation, resection and reconstruction of advanced cutaneous malignancies, techniques in sentinel lymph node biopsy, ultrasound-guided procedures, as well as a large volume of endocrine and salivary gland operations. The division performs approximately 50 transoral robotic surgery (TORS) cases and over 100 microvascular free flap procedures yearly. We currently have 4 faculty that perform
free flap surgery in addition to 5 faculty that perform TORS. The TORS training program includes hands-on cadaver training in the state of the art simulation center in the new West Campus Building. Microvascular training will also include a microvascular rat lab and course.

This is a new program leveraging the unique strengths of UT Southwestern Medical Center and the tremendous volume and diversity of head and neck oncologic cases treated within our department.

Eligibility: All applicants must demonstrate completion of an ACGME-accredited residency in Otolaryngology-Head and Neck Surgery, General Surgery, or Plastic Surgery and qualification to sit for the American Board of Otolaryngology, Surgery, or Plastic Surgery. Canadian applicants must have passed or be eligible to sit for the Royal College of Surgeons of Canada Exam. Applicants must be eligible to apply for a Texas Medical license which should be obtained by the start of Fellowship. It is preferred that applicants have prior exposure to head and neck surgery.

Fellows’ Duties/Responsibilities: The head and neck fellow will participate in all major head and neck cases including TORS, TLMS, and microvascular reconstruction. The Fellow will work closely with the supervising attending surgeons on major surgical cases. For more basic head and neck procedures, the fellow will serve as an instructor and teaching surgeon for the UTSW Otolaryngology residents. Continuity of oncologic care and complete management of the patients will be emphasized with the Fellow being involved in the initial consults, preoperative visits, postoperative care, and tumor surveillance of the patients.

The program is rotation based, with the fellow being assigned to specific teams of faculty for rotating blocks of time. Given the volume of surgery, the fellow will have the opportunity to select cases best aligned with their training goals. Fellows will be in clinic approximately 2-3 half days per week. They will participate in the weekly head and neck multidisciplinary tumor conference, weekly head and neck didactic sessions, all head and neck grand rounds and journal clubs, and the monthly head and neck prospective clinical trial planning meeting.

Research Opportunities: The fellow is expected to complete a clinical project during the year and submit it for presentation at a national meeting and for the project to be submitted for publication in an impactful peer-reviewed journal. The fellow will also participate in prospective clinical trials being conducted at UT Southwestern by the Head and Neck Oncology Team. Basic science research opportunities are available in the immune landscape and metabolism of tumors, population health research and bioinformatics, cancer imaging, genomics and proteomics through longstanding collaborations with well-established investigators. With over $11 million in direct funding for head and neck cancer research from the NIH and the Cancer Prevention and Research Institute of Texas (CPRIT), ample opportunities for translational collaborations exists.

Supervision, Teaching & Call: The Fellow will be supervised by faculty for complex head and neck cases, with greater independence and responsibility over the course of the year. The Fellow will supervise and teach residents in clinic at Parkland and in the operating room for appropriate cases. The Fellow will share faculty call on a rotating weekly basis, averaging 1 week/7-9 weeks.