Developing South Asia’s first structured head and neck surgery multicenter fellowship initiative.

Abstract

11037 Background: Despite high head neck cancer incidence in South Asia, there exist few fellowship programs, which are limited by lack of structure, review processes and standard curricula. Our aim was a regionwide multicenter head and neck fellowship initiative to address the above limitations. Methods: A 10-member task force was constituted in January 2018 under the aegis of the Foundation for Head and Neck Oncology. First phase: Initial curriculum drafted by incorporating region-specific perspectives, aided by multiple source documents. Candidate eligibility criteria outlined, accommodating multiple pertinent disciplines and an international applicant base. Format for a structured entrance examination, and a mandatory/desirable rotation schedule were developed. Second Subcommittee(SC) phase: Creation of a web portal ( www.fhnofellowship.org ) by Outreach SC, approval of applicant centers by Accreditation SC, layout of exam structure by the Examination SC, and defining a rank order list-driven match process by the Match SC. Third phase: Development of standard documentation including suggested bibliography, log book format, recommended grand rounds topics, common minimum criteria for fellowship graduation. A common entrance exam was conducted in Feb 2019, which incorporated written screening, center-candidate interactions, objective interview, and the merit-based institution-fellow match. Results: Total number of applicants: 92, the majority Oral Maxillofacial Surgeons(83.7%). Seventeen fellows matched in the first cycle, the initial and 6-month program compliance 94.1% and 88.2% respectively. More eligible institutions accredited(36.8% increase) prior to the second cycle in Nov 2019, during which 19 fellows(11.8% increase) were matched. An interim review was done in Oct 2019, and periodic reviewing set at 6-month intervals. Planned fourth phase: Objective center/candidate feedback, surgical video repository, online training schedule, develop the fellowship exit examination, and expand outreach to other countries. Conclusions: Owing to high head neck cancer incidence in the subcontinent, anatomic complexity, need to balance outcomes/toxicities and requirement of expert multidisciplinary care; structured head neck fellowship training is imperative. Despite inherent challenges of concept and implementation in a diverse multicultural resource-limited setting, we foresee the application of region-relevant perspectives helping us achieve the objective of furthering subspecialty head neck training in South Asia.