Â鶹AV

Fellowship director

Fellowship Director: Dr. Karen M Kost, MD, FRCSC, Professor of Otolaryngology-Head and Neck Surgery and Director of the Â鶹AV Voice and Dysphagia Laboratory.

Preamble

Currently, otolaryngology residents are not eligible to write the certification exams for the American Board of Otolaryngology. As a direct consequence, American fellowships are largely unavailable to Canadian otolaryngology graduates wishing to pursue additional training. This situation has generated a demand, and need, to provide Canadian fellowships. At the present time, there is only one half-time laryngology fellowship available in Canada. Â鶹AV is uniquely positioned to offer a fellowship in laryngology.

Duration:

1 year

Capacity:

1 per year

Eligibility Criteria

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The Â鶹AV voice and swallowing laboratory

The Voice and Swallowing Laboratory at the Â鶹AV Health Center (MUHC) is widely recognized as a center of excellence and provides services to over 3000 referred patients annually. The clinical activities are conducted by 3 fellowship-trained laryngologists: Dr Jon Young, Dr Francoise Chagnon and Dr Karen Kost The Â鶹AV Voice and Dysphagia Lab is known to the entertainment industry and is closely tied to the Â鶹AV Schulich School of music and the University of Montreal school of music, providing advice and care to a range of professionals and young singers. The Lab contains state of the art equipment complete with an integrated database and digitized recording system. There are clinics five days/week and one to three laryngology OR days per week. There are also voice clinics and ORs at the Montreal Children’s Hospital. Neurolaryngology clinics are held once monthly with a neurologist. The volume of clinics and ORs is such that the residents have ample exposure to laryngology throughout their training and cannot attend more than a maximum of 2-3 halfday clinics/week. As a result, the majority of the clinics are run by the staff alone. Similarly, complex surgical cases are performed by the attending staff. As such, there is ample clinical material to provide excellent training for the residents and one fellow.

Terms

The fellowship will last one year and consist of clinical, teaching and research responsibilities. The division of activities will be roughly 60% clinical and 40% research.

Goals and objectives

1. Exposure to a large and varied number of clinical and operative voice and dysphagia cases. Development of expertise and acquisition of advanced diagnostic and operative skills (see below). This exposure will occur in the Voice and Dysphagia Laboratory, at specialized neurolaryngology clinics, in the OR and on the ward. The fellow is expected to assume increasing autonomy and teaching responsibilities throughout the year.
2. Clinical and research conferences as well as journal clubs are, and will continue to be conducted regularly. These include laryngology rounds and research conferences in collaboration with two Â鶹AV basic scientists, Dr Luc Mongeau (Â鶹AV School of Engineering), and Dr Nicole Li-Jensen (Â鶹AV School of Communication Disorders). In addition, the fellow is expected to run the twice weekly multidisciplinary Tracheostomy Care Rounds with the Junior otolaryngology resident, Speech-Language Pathologist, Respiratory therapist, Nurses from the ICU and Intensive care, and the nurse clinician. The fellow will participate in the planning and conducting of these conferences.
3. The fellow will have supervised opportunities to develop skills in clinical examinations, office-based procedures and microlaryngeal surgery. In addition, the fellow will work in a multidisciplinary setting, with colleagues and referring physicians. The fellow is expected to participate in teaching medical students, residents, and other healthcare professionals. Teaching will occur at the bedside, in the Voice and Dysphagia Lab, as well as in the OR. Furthermore, the fellow will provide both interactive and didactic laryngology lectures to the Otolaryngology residents and Master’s students. The fellow will also participate in the planning and execution of a ‘Hands-on’ Voice and/or Dysphagia Course for residents at the Â鶹AV Simulation centre, and World Voice Day.
4. The fellow will interact with related disciplines and engage in educational activities to further his/her role as an educator and communicator in the Karen M Kost, MD, FRCSC Professor of Otolaryngology-Head and Neck Surgery Director of the Voice and Dysphagia Laboratory, Â鶹AV ROYAL VICTORIA HOSPITAL AT GLEN SITE 1001 Decarie Blvd., Montréal (Québec) Canada H4A3J1, Tél : (514) 934-1934 EXT.31951 Page 3 subspecialty of laryngology. There are ample such opportunities at Â鶹AV with the multidisciplinary clinics in Dysphagia (run with the occupational therapist and speech-language pathologist), Neurolaryngology (run with a neurologist) and the trach care team (made up of SLP, nurse clinician, respiratory therapist, ICU nurse and Otolaryngologists).
5. The fellow will participate in research with one clinical and one basic science project, collaborating with Dr Luc Mongeau and/or Dr Nicole LiJensen.

Clinical

1. The fellowship will provide structured clinical opportunities for fellows to develop advanced diagnostic, therapeutic and phonosurgical skills.
2. A sufficient number and variety of cases will be available for each fellow to assure adequate exposure to the broad range of conditions associated with the management of voice disorders and dysphagia.
3. At the end of the fellowship, the fellow will have had a cumulative experience as the operating surgeon in at least 150 phonosurgery cases performed in the operating room and over 500 outpatient procedures.
4. Lines of responsibility will be clearly delineated for trainees and other residents as related to areas of training and clinical duties.

Research

1. An active research component will enhance and compliment the educational experience. Although the clinical experience is essential, a supervised research experience is expected. The integrated databaseÌýallows for almost unlimited clinical research possibilities. In addition, collaboration between Dr. Luc Mongeau’s and Dr. Nicole Li-Jensen’s labs and the voice lab provides opportunities for basic science research. The fellow will participate in a minimum of one clinical and one basic science research project. These will be presented at a minimum of one scientific meeting and submitted for publication.

Fundamental components of the fellowship

1. The fellow must participate in the evaluation, management, and care of a minimum of 3000 cases of voice disorders/dysphagia. This includes management of the performing artist and care of the sick singer.
2. Participation in at least 150 surgical procedures, representing the full scope of phonosurgery in voice and swallowing.
3. Participation in at least 500 outpatient phonosurgery procedures performed in the clinic. These include biopsies, therapeutic injections, vocal fold augmentations, botulinum toxin injections, esophagoscopies, and outpatient KTP laser procedures.
4. Intensive exposure to the interdisciplinary management of patients with voice disorders/dysphagia.
   1. Multi-disciplinary clinic participation with Speech-Language Pathologists
   2. Dysphagia management team
   3. Tracheostomy care rounds and management team
   4. Neurolaryngology team
5. Participation in the development and implementation of research in Laryngology.
6. Participation in World Voice Day (April)
7. The above objectives will be attained in the context of the seven CanMeds roles: medical expert, communicator, collaborator, manager, health advocate, scholar, professional.

Fellowship clinical curriculum

The fellowship will provide clinical and/or didactic exposure to:

1. Videostrobolaryngoscopy
2. Full range of voice disorders
3. Vocal nodules, cysts, polyps
4. Laryngopharyngeal reflux
5. Functional voice disorders
6. Muscle tension dysphonias
7. Speech-Language vocal rehabilitation
8. Neurologic voice disorders, including dystonias
9. Benign neoplasms, including papillomatosis
10. Malignant neoplasms, including squamous cell carcinoma
11. Vocal fold paresis/paralysis
12. Vocal fold bowing/presbylarynx
13. Sulcus Vocalis
14. Vocal fold granulomas/ulcers
15. Vocal fold scarring
16. Glottic/Tracheal stenosis and reconstruction
17. Laryngeal manifestations of systemic disease
18. Vocal fold injection/augmentation/thyroplasty
19. Polypoidal degeneration
20. Laryngeal electromyography
21. Botulinum toxin injection
22. Applications of CO2 laser
23. Applications of the KTP laser
24. Application and uses of microdebriders
25. Microflap techniques
26. Endoscopic resection of early glottic cancers
27. Dysphagia in the context of neurologic disease
28. Dysphagia in Head and Neck Cancer patients
29. Functional Endoscopic Evaluation of Swallowing
30. Surgical Management of Dysphagia
31. Morbidity and mortality conferences
32. Journal clubs
33. Clinical research protocols

Sample Outline of Weekly schedule

Monday: Tracheostomy Care Rounds, Voice Lab 1/2 day or OR, research
Tuesday: Voice Lab all day
Wednesday: Tracheostomy Care Team Rounds, Dysphagia Lab, Voice Lab ½ day or OR, research
Thursday: Clinical hospital Rounds, Voice/Dysphagia Lab ½ day, research, University Grand Rounds, or OR
Friday: Voice Lab am, research pm

Note: The fellow will attend all ORs and participate in voice and dysphagia clinics. The fellow may also participate in voice clinics and OR at the Montreal Children’s Hospital as is relevant. This schedule is an outline only. Time will be provided for research.
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Evaluation of the fellow and of the staff

The fellow will be formally evaluated every 3 months. ‘Mini feedback’ sessions pertaining to a specific skill or clinical case will be provided 2-3x/week. An early informal assessment will be provided in the first 6 weeks. Evaluations will be based on the current CanMeds roles and modified as appropriate to Laryngology. The fellow will be evaluated on clinical, surgical, teaching and research activities as set out in the fellowship curriculum. Evaluations will be performed online and reviewed with the fellow.

Summary

The Â鶹AV Voice and Dysphagia Laboratory, with its large and varied clinical volume, is uniquely positioned to provide a high-quality laryngology fellowship to Canadians and appropriately qualified physicians from abroad.