PROGRAM DESCRIPTION

Overview: The head and neck fellowship at Ohio State is a comprehensive, high-volume head and neck microvascular fellowship that aims to train the future leaders of our field.  Fellows are trained in microvascular reconstructive surgery, transoral robotic surgery, and the entire array of ablative head and neck oncologic surgery.  Fellows receive a tremendous surgical volume to major head and neck surgery and currently perform greater than 175 free flaps during the fellowship.  The fellow is trained within a very collaborative surgical environment that embraces two-team surgery.  The fellow also leads multidisciplinary tumor board conference along with an attending head and neck radiologist

Objectives: To train highly skilled surgeons and mentor future leaders and educators in our field.

Strengths:

• Tremendous clinical volume (ablative and reconstructive)
• Entire breadth of microvascular reconstruction, including significant exposure to perforator based flaps, lateral arm, rectus, and scapula donor sites
• Unique open and endoscopic skull base experience
• Multidisciplinary oncology program supports primary surgical management of oropharyngeal and laryngeal cancer when appropriate
• Extensive TORS experience

Eligibility: All candidates who have completed ACGME accredited Otolaryngology, General Surgery or Plastic Surgery residency programs and whom are currently board eligible in those specialties.

Fellows’ Duties/Responsibilities: The fellow’s primary relationship is with Drs. James Rocco, Amit Agrawal, Matthew Old, Enver Ozer, Stephen Kang, and Ricardo Carrau. The overall majority of operative and clinical patient interactions for the fellow for head and neck oncology patients (clinic and operating room) are done in conjunction with Drs. Rocco, Agrawal, Old, Ozer, Kang, Carrau, and other teaching faculty. The AHNS fellow partipates in the OR engaged in all aspects of head and neck ablative surgical cases (open, transoral laser/robotic, open skull base) as well as the full spectrum of surgical reconstruction including locoregional flaps as well as microvascular free tissue transfer (approximately 175‐200 microvascular cases/year). Graduating fellows are trained to harvest radial fasciocutaneous/osseocutaneous forearm, scapula, rectus, fibula, lateral arm, and anterolateral thigh free flaps. Microvascular reconstructive surgery is performed by four faculty within the Department of Otolaryngology‐Head and Neck Surgery (Agrawal, Kang, Old, and Ozer). Fellows are also trained to harvest supraclavicular and submental regional flaps.  During procedures where free flaps are utilized, the AHNS fellow often works with both the ablative and the reconstructive team serving as operating surgeon with faculty supervision. During these cases, a “two team” surgical approach for the large majority of surgical cases requiring free tissue transfer. Because many free flaps are not harvested until the resection is complete, the fellowship includes a large experience of ablative oncologic cases. The fellow is also primary surgeon for all advanced ablative cases, such as conservational laryngeal surgery. For the large majority of cases, the fellow acts as operating surgeon with direct teaching faculty supervision as well as in a supervisory faculty role for surgery in which residents are involved commensurate with experience as well as assistant to the other teaching faculty.

As credentialed clinical faculty, the AHNS fellow may operate as well as see patients in the Head and Neck Oncology Clinic or other ambulatory clinics independent of teaching faculty, however the fellow is not assigned or responsible for an independent clinic and does not have independent OR block time assigned. The overwhelming majority of clinical activity carried out be the fellow occurs in concert with

teaching faculty supervision both in the outpatient as well as OR setting. The Head and Neck Oncology Fellow participates in no general otolaryngology clinics, trauma clinics, and is not involved with on‐call faculty responsibility. It is, however, expected that the fellow will be involved in all emergencies involving the head and neck cancer patient population.

Research Opportunities: It has always been the policy of the Division leadership and fellowship director to give the head and neck fellows the opportunity to select particular area(s) of research within the Head and Neck Oncology program that holds the greatest interest for them rather than assigning them to particular projects. All of the head and neck fellows are provided with the opportunity to become involved with ongoing clinical and/or laboratory research. Fellows meet with clinical and basic investigators whose primary focus of research relates to head and neck oncology at the outset of fellowship not only to explore and identify avenues for research endeavors, but also to establish mentorship. The fellows also participate in the writing of clinical protocols as well as the registration of patients to local/national protocols and their subsequent continued follow‐up. Fellows are also provided with the opportunity to travel to national cooperative group meetings as a means of becoming more familiar with workings of a large national cancer cooperative group. The fellowship time for research can be expanded depending on his/her needs. As the majority of current fellows elect to spend one year at our institution, a dedicated laboratory block/rotation is not assigned at the outset. Nonetheless, the fellow is provided with one day/week of protected time for pursuit of academic research which includes the opportunity to engage in both clinical and/or laboratory research (see block schedule) . Although it is anticipated that the head and neck fellow will spend a significant proportion of their time engaged in clinical activity, the schedule can be further modified and adapted accordingly depending upon the individual needs of the head and neck fellow to meet the research needs of the fellow.

Supervision, Teaching & Call:  The fellow assists faculty with resident and medical student surgical teaching and with patient care in the Head and Neck Oncology Clinic, rounds, and in the operating room. In the operating room, the fellow acts as supervising surgeon for residents for standard head and neck oncologic procedures (i.e. endoscopy, airway management, tumor resection/neck dissection, regional flap reconstruction, etc). As clinical attending faculty, the head and neck fellow also may serve as primary staff for the surgical care and/or coordination or multidisciplinary care of patients referred to The Ohio State University from the Ohio Correctional System requiring head an neck oncologic care as well as for cases which derive and are staffed by the fellow arising from inpatient consultation at the Ohio State University Wexner Medical Center and James Cancer Hospital. The head and neck fellow also serves as course director and coordinator for the 3rd/4th year medical student elective DOC‐3 curriculum course entitled “Contemporary Care of the Cancer Patient.” This is a 4 week course designed to provide an overview of the multidisciplinary care of the cancer patient. In addition to these teaching responsibilities, the fellow is asked to give lectures throughout the medical center to other faculty or staff as well as participates as a lecturer during the annual Head and Neck Oncology Course for residents and medical students.

PAST FELLOWS
Amit Agrawal, M.D., Associate Professor, The Ohio State University
Carol M. Bier-Laning, M.D., Assistant Professor, Loyola University
Jeffrey R. Haller, M.D., Private practice
James P. Malone, M.D., Assistant Professor, University of Southern Illinois-Springfield
Ernest C. Manders, M.D., Assistant Professor, University of Cincinnati
Rodney E. Mountain, M.B., Ch.B, Consultant ENT Surgeon, University of Dundee Scotland
Roy E. Nicholson, M.B., Ch.B., Royal Melbourne Hospital Australia
Enver Ozer, M.D., Professor, The Ohio State University
Pramod K. Sharma, M.D., Private practice
Norbert Viallet, M.D., Faculty, University of Manitoba, Canada
Keith M. Wilson, M.D., Associate Professor, University of Cincinnati
Matthew Miller, M.D., Associate Professor, University of Rochester
Hassan Arshaud, M.D., Assistant Professor, University of Buffalo
Kiran Kakarala, M.D., Assistant Professor, University of Kansas
Peter Dziegelewski, M.D., Assistant Professor, University of Florida
Jon Chan, M.D., Assistant Professor, Virginia Commonwealth University
Stephen Kang, M.D., Assistant Professor, The Ohio State University
James Bekeny, M.D., Florida Hospital Cancer Institute, Orlando, FL
Antoine Eskander, M.D., Assistant Professor, University of Toronto
Krupal Patel, MD, Assistant Professor, Moffitt Cancer Center