University of Florida MSB M2-228 1345 Center Drive Gainesville, Florida  32608 (352) 273-5199 Peter T. Dziegielewski, MD, FRCSC, FACS – Fellowship Director Deepa Danan MD, MBA, MHA, FACS – Associate Fellowship Director Program Website

Number of Fellowships: 1 Duration (in years) / Type: 1 year / 1 Year Clinical Faculty: Peter Dziegielewski MD, FRCSC, FACS Deepa Danan MD, MBA, MHA, FACS Brian Hughley, MD, FACS Dustin Conrad MD, MSc, FRCSC Neil Chheda, MD Bill Mendenhall MD Bob Amdur MD Kathryn Hitchcock MD, PhD Freddy Kaye MD Tony Mancuso, MD Danny DeJesus, MD Marino Leon, MD Kristianna Fredenberg, MD John Hardeman DMD

 PROGRAM DESCRIPTION

Overview: The University of Florida Head and Neck Surgical Oncology program sees more than 3500 outpatient cancer visits per year with 400-550 patients treated surgically. This consists of the majority of head and neck oncology patients referred in North Central Florida as well as numerous from all over the state. The head neck surgery team performs over 150 major head and neck ablative – free flap cases per year in addition to a robust number of endocrine, salivary gland and trans-oral cases.

The fellowship focuses on advanced head and neck cancer ablation and defect-oriented reconstruction, with an emphasis on a variety of free flaps. Fellows will be given responsibilities to maximize clinical skill and knowledge for advanced tertiary surgical treatment of head and neck cancer patients. Additional skills will be developed in research and teaching to produce well-rounded academic surgeons. The fellow will operate with the head and neck surgical oncology and microvascular surgery faculty on advanced ablative and reconstructive cases. For basic cases, the fellow may act as the supervising/teaching physician to the chief and junior residents.

Objectives: The Fellowship is designed to train Otolaryngology-Head and Neck Surgery graduates in the art and science of head and neck surgical oncology and microvascular reconstruction. The goal is to provide well-rounded, multidisciplinary training for a career in academic surgery.  The trained fellow will gain expertise in:

1. Multidisciplinary management of head and neck cancer patients
2. Head and neck mucosal tumor ablation
3. Head and neck skin cancer ablation
4. Skull base surgery
5. Endocrine surgery
6. Trans-oral surgery
7. Regional flaps
8. Microvascular free flap reconstruction

Strengths: The University of Florida Head and Neck Surgical Oncology/ Microvascular Surgery fellowship will provide fellows with thorough and diverse training in tumor ablation, endocrine surgery, transoral techniques, regional flaps as well as a high volume of free flap reconstructions. Fellows can expect to graduate with over 120 free flaps with comfort in multiple types of soft tissue and bony flaps.

Eligibility:

1. Applicant must have passed USMLE Step 1, 2CK, 2CS and 3.
2. Applicant must be eligible for a Florida State Medical License
3. Applicant ideally will have completed an ACGME or RCPSC accredited residency in
   Otolaryngology-Head and Neck Surgery including:
4. 24-52 weeks of surgical base specialty training (PGY 1-2). This may include 4-8 week
   blocks of: emergency medicine, general surgery or relevant subspecialties, internal
   medicine of relevant subspecialties, plastic surgery, critical care, anesthesiology, or
   neurosurgery.
5. 208 – 236 weeks of Otolaryngology-Head and Neck Surgery including at least 36 weeks
   of Head and Neck Surgery.
6. Applicants completing residency training in other specialties approved for the AHNS
   match may also be considered.
7. Applicant must demonstrate proficiency in general medical and surgical management of
   patients in acute and ambulatory settings.
8. Applicant will have a robust foundation of knowledge of benign and malignant diseases
   of the head and neck, as well as head and neck reconstruction.
9. Applicant will have a strong base of training in head and neck and surgery gained
   thorough residency. A case log may be requested.

Fellows’ Duties/Responsibilities:

Surgery: Major Head and Neck Cancer cases: The fellow will participate in cases requiring a free flap if possible. The fellow will be responsible for:
1. Assisting with and performing tumor ablation and neck dissection.
2. Assisting with and performing free flap raising and insetting.
3. Assisting with and performing microvascular anastomosis

Tumor Ablation (non-flap cases):
1. The fellow may assist with, perform or teach residents tumor ablative cases.
2. The fellow will have the opportunity to participate in transoral laser (TLM) or TORS cases.

Laryngologic Oncology:
1.The fellow will have the opportunity to perform secondary tracheoesophageal punctures & speech valve insertion, stomaplasty, esophageal dilation, laser laryngoscopy, vocal fold injection, thyroplasty, tracheal resection/anastomosis as well as other procedures to enhance the speech and swallowing of head and neck cancer survivors.

Trauma:
1. The fellow will participate in complex head and neck trauma cases managed by our
service if possible.

NB: Surgical independence will be commensurate with skill level and experience. It is expected
that the fellow will develop increasing independence as the fellowship progresses.

Inpatient Care:

1. The fellow will work with the inpatient team to manage and coordinate post-op care in head and neck surgical patients.

Clinic:

1. The fellow will do at least ½ a day of clinic per week. The fellow will have an independent clinic that runs parallel to a faculty clinic.
2. The fellow will gain experience with in-office head and neck ultrasound as well as ultrasound-guided FNA biopsies.

Head and Neck Tumor Board:

1. The fellow will attend the weekly head and neck multidisciplinary tumor board. The
   conference is attended by head and neck surgical oncologists, radiation oncologists,
   medical oncologists, radiologists, pathologists as well as ancillary staff.
2. The fellow will be assigned to present patients at the conference to be actively involved
   in staging tumors, planning treatment and coordinating the care of patients.

Research:

1. The fellow is expected to complete 2 projects for publication and presentation at national conferences.
2. Research time will be allotted to the fellow

Vacation:

1. The fellow will be given 15 business days of vacation / conference leave per year.

Courses:

1. UF Head and Neck Lecture Series: the fellow will attend the residents’ head and neck
   lecture series. The fellow may give some lectures to residents and will be expected to
   take the final exam with the residents.
2. UF Head and Neck Anatomy Course: the fellow will attend the residents’ head and neck
   anatomy course. The occurs over a 4-week span in the winter on a yearly basis and
   consists of lectures and cadaver dissections.
3. Florida Advanced Bony Reconstructive Course: the fellow will attend the advanced bony
   reconstructive cadaver course.

The fellow’s training may be supplemented by other formal courses:

1. Microvascular Free Flap Bootcamp
2. Robotic Surgery Course
3. AO-CMF Courses

Research Opportunities:  The fellow will have opportunities to pursue clinical and basic science research projects.

1. Clinical: multiple project options in the realms of quality of care, survival, functional and quality of life outcomes are available.

Research projects can be tailored to the fellow’s interests and multi-departmental collaborations are possible.

Supervision, Teaching & Call:

Supervision:

1. The fellow will have appropriate faculty level supervision, which is expected to decrease as the fellow’s competence increases. The fellow will receive appropriate independence in cases as their skills progress with the idea to developing independent operative decision making.

Teaching Responsibilities:

1. To work with and teach residents on ablative and reconstructive cases. It is expect that as the fellow’s skill increases, they will be able to take residents through cases.
2. To attend weekly head and neck oncology lectures (20-26) during the resident’s 10 week head and neck oncology lectures series.
3. To attend the resident’s yearly 4 week head and neck anatomy course. The fellow will supervise and teach residents in the head and neck anatomy lab on cadavers and may give anatomy lectures to the residents as well. The fellow will participate in the hands-on final exam at the end of the course.
4. To perform didactic teaching with the residents on head and neck oncologic and reconstructive surgery.

Call:

1. The fellow will take faculty level call at a similar frequency as other faculty members.