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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

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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

.

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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