Rhinology

Objective

To develop specialized knowledge of medical and surgical management of nasal and paranasal sinus disease in individuals wishing to pursue a career in academic rhinology.

Justification:

The McGill University rhinology group is well known for its expertise in sino-nasal disorders. The McGill Rhinology group offers a unique training opportunity for advanced training by the grouping of its three recognised experts in a common workgroup, the variety and number of procedures performed yearly, and the structured teaching.

Eligibility:

Candidates will be individuals having successfully completed an accredited otolaryngology residency who are interested in pursuing a career in academic rhinology.

Candidate selection will be via a process of application, with selection based on letters of recommendation, academic achievements, and personal interview.

Candidates will have to be eligible for a training card from the College des médecins.

Specific objectives:

At the end of training, the individual will have acquired skills and knowledge allowing him/her to develop and sustain an academic position in rhinology. This will be via the following means:

1. Medical rhinology:

   Investigation and medical management of nasal and sinus disorders

   Teaching will be through exposure to common nasal and sinus problems presenting for care in tertiary level rhinology clinics in the McGill University hospital network. Drs. Desrosiers, Frenkiel, and Samaha will act as preceptors. Exposure to multiple preceptors will maximize exposure and allow the candidate to see different approaches. Having the fellow staff a clinic in rhinology will foster his/her professional development.

   The fellow will attend specialized rhinology clinics at least two-half days per week. As well, he/she will be expected to staff one-half day clinic him/herself, with attending supervision/consultation. This regular training will be complemented by exposures to allergy, radiology, and migraine clinics over the course of the year.

   If possible, the fellow will attend specialized pediatric rhinology clinics at the MCH site.

2. Surgical Rhinology:

   The candidate will participate in pre, per, and post operative management of patients presenting for surgery. The candidate's exposure will be tailored to ensure exposure to a broad selection of cases, with a focus on tertiary procedures. Surgery will be performed at the MGH, JGH, and RVH sites. It is understood that priority will be given to residents and that for uncomplicated cases the fellow will primarily assist and teach the residents, rather than perform the cases.

   It is expected that the candidate will be exposed to sufficient volume of the following cases to develop a facility with them:

   • ESS for anatomic anomalies
   • ESS for chronic rhinosinusitis
   • ESS for sino nasal polyposis
   • Frontal sinus outflow tract surgery
   • Revision ESS
   • ESS for benign tumours of the sinus and skull base

   Endoscopic approaches to the skull base:

   • Pterygopalatine fossa
   • Sphenoid sinus
   • Mucoceles

   Orbital procedures:

   • Optic nerve decompression
   • Orbital decompression
   • Dacryocystorhinostomy (DCR)

   Combined / Open approaches to the sinuses

   • Osteoplastic flap
   • Lateral rhinotomy
   • External rhinoplasty
   • Caldwell-Luc
   • Mid facial degloving

   Image guided surgery for ESS

   Complementing the above will be:

3. Selected readings program:

   The fellow will be furnished a list of selected readings, which will be maintained and kept up to date by the members of the rhinology group. Additional resources and access to the medical literature is available via the internet from the McGill University libraries free of charge.

4. Attendance at a national meeting

   The rhinology group will arrange to send the fellow to at least one major medical meeting during the fellowship year. This may be to present a paper or to attend a specialized conference.

5. Teaching:

   The candidate will attend all normal activities of the Department, including evaluation/follow up of hopsitalized patients as required. He/she will also:

   • Supervise residents in the OR
   • Organise and supervise Grand Rounds when the subject is rhinology.
   • Prepare and deliver lectures for rhinology day
   • Teach medical students/residents/community ENTs during organised teaching activities held by the department

6. Research:

   While the primary objective of the experience is not to develop researchers, development of academic skills is important in this fellowship. To this end the fellow will:

   • write a review paper (on a topic to be determined with the preceptors) early in the training period to develop research/writing skills
   • undertake and complete one clinical research project, which he/she will present at a national meeting, and prepare the resulting article for publication

   Participation in a collaborative project with a basic science effort will be according to the orientation of the rhinology group at that time.

March 2, 2007