Head and Neck Surgery Fellowship

The Head and Neck Fellowship at WayneStateUniversity, which is accredited by The American Joint Council for Advanced Training, was established in 1991. Although the program encourages 2 year applicants, a 1 year experience is also offered.  Those seeking 2 years of training will have opportunities to be involved in various research opportunities.  The program is clinically based at the Karmanos Cancer Institute.  This is one of the first designated comprehensive centers in the National Cancer Institute program, and has held this prestigious designation since 1978.  The institute supports over 200 physician scientists, 300 researchers, 5 research programs and 10 core facilities.  Fifteen multidisciplinary medical teams treat more than 5,500 new patients annually, of which roughly 400 are head and neck cancer patients.  The Karmanos Cancer Institute operates as a free-standing cancer-only inpatient hospital with 123 beds.  This is the only free-standing cancer hospital in the State of Michigan.  Roughly 6,000 patients a year are placed in clinical trials.

Having a carefully structured evaluation system, these programs are site-visited, reviewed, and approved by the Executive Council of the American Head and Neck Society. A diploma is awarded by the Society to those candidates who follow the rigid criteria and successfully complete the fellowship. An additional diploma is issued by the Wayne State University School of Medicine.

Appointment Requirements
For applicants from the United States and Canada, the fellow must be board-certified or board eligible in Otolaryngology, General Surgery or Plastic Surgery by the ACGME or Royal College of Surgeons.  International candidates who are not Board eligible are also welcome and should apply directly to our program director below.  Completion of USMLE Steps 1, 2 and 3 is required.  Competitive international applicants are usually already serving as junior faculty at their academic institutions. 

Clinical Experience
The scope of clinical practice involves the entire head and neck from skull base down into the chest.  Training is provided in classic extirpation, minimally invasive surgery, endoscopic skull base and salivary surgery, transoral laser microsurgery, transoral robotic surgery, endocrine surgery, and microvascular reconstructive surgery.  Outpatient experience is limited to the evaluation/management of the head and neck cancer patient in surgical oncology.  Outpatient experience in ultrasound techniques and procedures is available. Familiarity with medical oncology, radiation oncology, and rehabilitation techniques will also be provided.  This occurs in the outpatient clinical area of the Karmanos Cancer Institute.  The fellow does not see patients independently nor participate on the call schedule with the house staff.  It is, however, anticipated that he/she will be available for emergency procedures in the head and neck cancer population. 

The fellow also participates at the multidisciplinary conference which occurs weekly.  At this conference all new oncology patients are presented and evaluated as a group.  The departments of Radiation Oncology, Medical Oncology, Endocrinology, Prosthodontia, Speech Therapy, Nursing, Pathology and Radiology participate.  Following that conference a smaller group representing the primary treatment modalities and other services as required meet with the patient and family on an individual basis to discuss the recommended treatment program and the alternatives.

The fellow will play an important role in teaching and training residents in the management of head and neck cancer patients both clinically and surgically.  The fellow will serve as an Associate Director to Courses in Advanced Surgical Dissection in Head & Neck Oncology and Craniofacial Reconstruction, which involve fresh cadaveric dissections throughout the year. 

Research Opportunities
This fellowship will provide advanced training in head and neck oncology including not only patient management, but also appreciation of the research foundation upon which the specialty exists. This program is directed toward the development of future academic leaders in the field.  There are multiple opportunities for both basic science and clinical research.

It is anticipated that the fellow will develop and publish clinical manuscripts.  For those fellows who are interested and have the appropriate background in the basic sciences, opportunities are available in a wide variety of fields.  This included but are not limited to: areas of biomarkers, molecular biology of the tumor cell, theraputic trials, gene therapy and biomedical engineering. Block time is available upon the interests and type of project selected.  There is an opportunity for mentorship outside of the department, once again depending upon the fellow's interests and background.  It is anticipated that the fellow will present at the annual department research day held in the spring of each year.  Past fellows have presented their work nationally and internationally.  The fellow will also participate in the quarterly research protocol meetings.  At these meetings the status of ongoing trials are reviewed, and new potential trials are presented for approval and prioritization by the group.

If interested, the fellow will have an opportunity to gain exposure to all aspects of drug development from phase I to phase III trials.   There is a long-standing interest in rehabilitation of the head and neck cancer patient with possible funding for the interested fellow to participate in.

Strengths of the Program
There are strong interdisciplinary clinical activities between members of Radiation Oncology, Medical Oncology, Thoracic Surgery, Neurological Surgery, Endocrinology and Dermatology.  The fellow will have an opportunity to be trained in all aspects of head and neck cancer management including endoscopic skull base surgery, sialendoscopy, TLM, TORS, endocrine surgery, craniofacial reconstruction, cutaneous oncologic surgery and sentinel lymph node biopsies, Mohs reconstruction, and a diverse array of microvascular reconstructive techniques.  Outpatient ultrasound training and exposure is also available. Clinical time with Medical Oncology and Radiation Oncology is also included.

Goals of the Program
To provide advanced training in head and neck oncology including not only patient management, but also appreciation of the research foundation upon which the specialty exists. The surgical experience will include exposure to all current techniques including microvascular and skull base resection. Familiarity with medical oncology, radiation therapy, and rehabilitation techniques will also be provided.
This program is directed toward the development of future academic leaders in the field. In addition to instruction in the latest techniques in the management of the head and neck cancer patient, an appreciation of the research foundation upon which future developments depend will be established.

Program Experience
Given the fellowship is built around a residency training program, it is anticipated that the fellow will add to, rather than detract from, the existing residency program experience. This requires that the fellow be prepared to act more as an instructor as opposed to solely being a student. This is critical to the training of our residents at all levels.  

Teaching
The fellow will function as a junior faculty member in this role. There will be active interaction with the medical students and residents. The fellow will have a major role in the Wednesday morning multidisciplinary clinic. In addition to case presentations, the fellow will participate by presenting didactic material during this and other departmental conferences. It is anticipated that in the operating room the fellow will function as a junior attending "taking" a resident through the case where appropriate.  

Fellows will also be appointed as the Associate Director for fresh cadaveric courses in Advanced Head and Neck and Craniofacial Surgical Techniques.  These courses occur periodically during the year and are organized by Dr. Raza.

Friday afternoon didactic teaching sessions will be held that are case-based. Fellows will be expected to guide residents through the cases that they present, and also prepare cases for teaching certain topics at times. These cases will range from topics of oncology and reconstruction for all levels of training, including fellowship level discussions.

Clinical Experience
Surgical Activities
Training is provided in classic extirpation, endoscopic skull base surgery, sialendoscopy, TLM, TORS, endocrine surgery, cutaneous oncology, Mohs reconstructive surgery and a diverse array of free tissue transfer and microvascular reconstructive surgery techniques. Collaborative cases are performed with Neurosurgery, Vascular Surgery and Thoracic Surgery.

Outpatient Activities
Fellows will not be responsible for their own outpatient office.  Instead, they will participate in the existing outpatient clinics along with the residents and faculty.  

External Rotations  
Rotation experience will be available in medical oncology, radiation oncology and endocrinology.  It is anticipated that the fellow will become familiar with currently utilized drugs in the head and neck cancer population and their associated toxicities. Time with radiation oncology would include clinics involving treatment planning.  Endocrinology clinic at Karmanos would be focused on thyroid cancer and management.

Head & Neck Multidisciplinary Tumor Board
Fellows will be required to attend and participate in the weekly head and neck multidisciplinary tumor board. 

Melanoma Multidisciplinary Tumor Board
Fellows will be required to attend and participate in the weekly melanoma multidisciplinary tumor board.

Benefits 
The fellow will be provided the benefit package associated with the applicable post-graduate year of training.  

Evaluations  
The participant is evaluated every 6 months following completion of forms by the program faculty.  The participant meets with the program director for a one-on-one conference. During this conference the participant is given an opportunity to critique the program. Current performance as judged by the program faculty is reviewed with the participant. Goals for the next 6 month time period are then set. In addition there is a blinded evaluation submitted by the participant to The American Joint Council. This occurs every 12 months.

Research
It is anticipated that the fellow will develop and publish clinical manuscripts.  For those fellows who are interested and have the appropriate background in the basic sciences, opportunities are available in a wide variety of fields.  This included but are not limited to: areas of biomarkers, molecular biology of the tumor cell, theraputic trials, gene therapy and biomedical engineering. Block time is available upon the interests and type of project selected.  There is an opportunity for mentorship outside of the department, once again depending upon the fellow's interests and background.  It is anticipated that the fellow will present at the annual department research day held in the spring of each year.  Past fellows have presented their work nationally and internationally.  The fellow will also participate in the quarterly research protocol meetings.  At these meetings the status of ongoing trials are reviewed, and new potential trials are presented for approval and prioritization by the group.

If interested, the fellow will have an opportunity to gain exposure to all aspects of drug development from phase I to phase III trials.   There is a long-standing interest in rehabilitation of the head and neck cancer patient with possible funding for the interested fellow to participate in.

Facilities  
The program is clinically based in the Detroit Medical Center.  This is a consortium of ten hospitals operating over 2,600 licensed beds throughout the Detroit metropolitan area.  The primary geographic focus for the fellowship is at the Karmanos Cancer Center on the downtown campus of the Detroit Medical Center.  The Karmanos Cancer Institute was one of the first programs designated comprehensive by the National Cancer Institute.  With the addition of a new research tower, there is approximately 350,000 sq. ft. of research space.  There are 135 Ph.D. level investigators, and the center sees approximately 6,000 newly diagnosed cancer patients per year. 

APPLICATION INFORMATION

Application Process:  Applications and appointments for fellowships are processed through a central matching program.  Fellowship match information and application forms may be downloaded from the Fellow's Corner of the AHNS website https://www.ahns.info/residentfellow/fellowships/ .  You will need to send one application; along with the required letters of reference, to the Advanced Training Council for the appropriate match. Select which programs you would like to receive your application, and the central office will forward your application to the appropriate program directors and send you a ranking list. Keep in mind that some programs hire fellows each year, while others hire on a biennial basis. No applications will be forwarded to program directors until all materials have been supplied. If a program director wishes to invite you to interview, you will be contacted by the program directly. Submission of your application materials and fee does not guarantee an interview, but does guarantee consideration by each program you select.  

Qualifications:  United States and Canadian candidates - we participate with the American Joint Council for Advanced Training.  Please see the following link regarding applications: https://www.ahns.info/residentfellow/fellowships/uscanadian-applicants/ 

International candidates who don't participate in the American Joint Council should apply directly to our Program Director. USMLE Steps 1, 2 and 3 must be completed. Please see the following link regarding applications: https://www.ahns.info/residentfellow/fellowships/international/

S. Naweed Raza, M.D., FRCS(C)
Wayne State University
Department of Otolaryngology-Head and Neck Surgery
540 E. Canfield Avenue, 5E-UHC
Detroit, MI 48201
Ph: 313-577-0804
Fax: 313-577-8555
snraza@med.wayne.edu

Deadline for Application & Ranking:  Please review deadlines on the AHNS website at https://www.ahns.info/residentfellow/fellowships/ . The match results will be announced to candidates annually on July 1.   Please make sure all your application materials have been sent to the ATC office well before the program interview dates.  

Please contact AHNS Associate Executive Director JJ Jackman (jj@ahns.info)  or 310.437.0559, x154) for any questions regarding the Fellowship match.