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 Table of Contents  
GUEST EDITORIAL
Year : 2020  |  Volume : 8  |  Issue : 2  |  Page : 50-52

Developing the South Asian region's first head-and-neck surgical oncology multi-institutional program: Journey, milestones, challenges, and future


1 HCG Cancer Center, Ahmedabad, Gujarat, India
2 Department of Head and Neck Surgery, Patel Hospital, Jalandhar, Punjab, India
3 Department of Head and Neck Surgery, School of Medicine, Kochi, Kerala, India
4 Cytecare Cancer Hospital, Bengaluru, Karnataka, India
5 K.E.M Hospital and Seth G.S. Medical College, Mumbai, Maharashtra, India

Date of Submission12-Sep-2020
Date of Decision23-Sep-2020
Date of Acceptance29-Sep-2020
Date of Web Publication8-Dec-2020

Correspondence Address:
Dushyant S Mandlik
No. 205, OPD Building, HCG Cancer Centre, Science City, Ahmedabad - 380 060, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jhnps.jhnps_46_20

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How to cite this article:
Mandlik DS, Chopra S, Balasubramanian D, Kekatpure V, Iyer S, Dabholkar J, Patel K. Developing the South Asian region's first head-and-neck surgical oncology multi-institutional program: Journey, milestones, challenges, and future. J Head Neck Physicians Surg 2020;8:50-2

How to cite this URL:
Mandlik DS, Chopra S, Balasubramanian D, Kekatpure V, Iyer S, Dabholkar J, Patel K. Developing the South Asian region's first head-and-neck surgical oncology multi-institutional program: Journey, milestones, challenges, and future. J Head Neck Physicians Surg [serial online] 2020 [cited 2021 Jan 23];8:50-2. Available from: https://www.jhnps.org/text.asp?2020/8/2/50/302633




  Introduction Top


The Foundation for Head and Neck Oncology (FHNO) is the largest multidisciplinary organization in South Asia pertaining to head-and-neck oncology. The FHNO has always taken keen interest in establishing standard of care, research and education for head-and-neck oncology in the region. The FHNO felt a need for a structured head-and-neck surgical oncology program in the region due to various reasons. As a result of that, the FHNO Institutional Fellowship program was born.


  Understanding and Perceiving the Need of Structured Training Program for Head-and-Neck Surgical Oncology Top


Burden of head-and-neck cancer patients in the region

India, including the region of South Asia, has a high prevalence of head-and-neck cancer due to various epidemiological factors. India shares 33% of incidence burden of lip and oral cavity, 32.1% of hypopharynx cancer, and 19.2% of oropharynx cancer of the world. Lip-and-oral cavity cancers are second highest in incidence and mortality for India.[1] Majority of them are diagnosed at advanced stage, leading to poor outcome, with high morbidity and mortality.[2],[3]

Imbalance in numbers and training, reflecting in care and treatment outcomes

There is a huge deficit of health-care personnel in the region, especially of trained super-specialists.

India has approximately eight medical doctors/10,000 population.[4] We also lack severely in the number of specialist doctors compared to the rest of the world (6.82/100,000 specialist surgeons where n = 31 for the world).[5]

The current model of training and education has not been able to meet the demand as far as the quality and quantity of specialist is concerned. Innovative and efficient training models are the need of the day for efficient head-and-neck cancer prevention, management, and research.[6]

The region observes a variable pattern of background in the education of clinicians involved in the surgical care of head-and-neck patients, mainly: (a) from maxillofacial training background and (b) from other training routes such as general surgery, ear, nose, and throat surgery, plastic surgery, head-and-neck surgery, and surgical oncology. Both streams contribute significantly in the care of head-and-neck cancer patients. We needed a well-designed program incorporating and addressing the strengths and limitations of both.

We have many high-volume government, semi-government, and corporate institutes following evidence-based patient management, contributing significantly in academics, with significant clinical volume and eminent faculties. They were not able to start a training program due to many reasons, namely absence of a sturdy platform, inability to reach and capture right candidates, nonclarity about structure, and absence of recognition by a national body.

At the same time, many aspiring candidates were in search of the right institute and mentor. They were not clear about available institutes, institute credentials, structure and value of the program, and recognition. An initiative by the FHNO to start a structured institutional fellowship worked as a much-awaited bridge between these two.


  Beginning from Strong Foundation: Formation of a Fellowship Task Force and Development of Program Top


In order to meet the described challenges, the FHNO felt a need of a well-structured foundation before starting the course. It started with brainstorming by leaders from various institutes who were actively involved in teaching and practicing head-and-neck oncology for a significant time. It also included office bearers of the FHNO, representatives of academic institutes, technology experts, and thinkers. A ten-member task force was created in January 2018. The task force is an essential think tank to guide the fellowship on all important issues.

A fellowship document was designed keeping in mind all the key parameters. A detailed guideline was prepared regarding duration of the program; eligibility and selection criteria for candidates and institutes; core curriculum addressing clinical and academic standards; rotation to allied specialties; suggested syllabus and reading; code of conduct; and evaluation including entrance, interim, and exit examinations.

A dedicated website was created which helped sharing updated information, solving queries, and registering progress including an online logbook (https://fhnofellowship.org/). The curriculum is designed keeping in mind various documents (notably the Master of Chirurgiae curriculum in Head-and-Neck Oncology, the American Head and Neck Society program curriculum, and the Advanced Training Council guidelines) and balancing regional requirements.

A dedicated entrance exam committee comprises eminent academic members selected across India, which guides the process in ensuring its quality. The entrance exam comprises well-balanced modules of multiple-choice written examination and personal interview by the committee.

A unique matching selection process is adopted. Both the institutes and candidates are encouraged to interact with each other and are asked to prepare a confidential matching list individually, which they should submit to the examination board. Maximum pairs are matched with mutual selection from this list. We think that this process has helped to maximize right candidate–institute combination and minimize attrition.

According to the strengths and limitations of various educational backgrounds, the fellowship offers two heads, namely oral oncology fellowship and head-and-neck oncology fellowship.


  Outcomes of Current Endeavors Top


Application process, examination, and selection process were successfully conducted for first two batches (March 2019 and November 2019). Ninety-two candidates applied, with a majority of applicants from oral and maxillofacial surgery background (83.7%). Seventy (76.1%) candidates fulfilled all criteria to be eligible for the written examination, followed by oral examination. Seventeen and 19 fellows were matched to centers in the first and second fellowship cycles, respectively, with the program compliance of 88.2% and 84.2%, respectively.


  Hurdles and Challenges Top


Any educational endeavor constantly meets hurdles and challenges. Learning from them and optimizing the program ensures betterment and long-term success.

Despite the best of efforts, every teaching program has its own attrition rate. There are instances of fellows leaving the program for various reasons, mostly being personal. The FHNO has tried to minimize that by matching the process and introduction of path process, where an institute proposes a fellow, who needs to pass all the criteria of selection and clear the entrance examination process. Educating a candidate for the need of commitment for the fellowship, providing him/her with promised learning, and ensuring the quality of fellowship are going to be the top factors which can help limit attrition.

Ensuring minimum training is done by continuous evaluation, feedback, and interim analysis of both candidates and institutes. Grading of institutes objectively by various parameters is a desirable future process.

The COVID-19 pandemic has been a disrupting force in health care. It has changed clinical work scenarios in the form of more hands-on work done by senior faculties, limiting learning opportunities for the current fellows. We will have to evaluate its effects on the current fellows and take necessary steps to mitigate them. We are determined to go ahead with proceedings for the upcoming 2020 intake with online process.


  Future Scopes Top


The FHNO institutional fellowship program is a unique learning experience for FHNO also. By constant learning, adopting, and optimizing, the FHNO is committed for betterment of the program. We are looking forward to inclusion and enhancements such as surgical video repository, online training schedules, development of exit exam module, and expanding the umbrella of training to other countries of the world also. The FHNO fellowship committee is in discussion with government national bodies and universities to get them involved in formalizing and recognizing the training.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Disclosure

This material has never been published and is not currently under evaluation in any other peer reviewed publication.



 
  References Top

1.
Cancer Fact Sheets. International Agency for Research on Cancer WHO Website. Available from: https://www.gco.iarc.fr/today/fact-sheets-cancers. [Last accessed on 2020 Aug 31].  Back to cited text no. 1
    
2.
Kulkarni M. Head and neck cancer burden in India. Int J Head Neck Surg 2013;4:29-35.  Back to cited text no. 2
    
3.
Dandekar M, Tuljapurkar V, Dhar H, Panwar A, DCruz AK. Head and neck cancers in India. J Surg Oncol 2017;115:555-63.  Back to cited text no. 3
    
4.
Global Health Observatory Data. Density of Physicians. World Health Organization. Available from: https://www.who.int/gho/health_workforce/physicians_density/en. [Last accessed on 2020 Aug 31].  Back to cited text no. 4
    
5.
Specialist Surgical Workforce. Data Indicators. The World Bank IBRD-IDA Website. Available from: https://www.data.worldbank.org/indicator. [Last accessed on 2020 Aug 31].  Back to cited text no. 5
    
6.
Ahmed M, Raja A, Nundy S. Surgery in South Asia. BMJ 2004;328:782.  Back to cited text no. 6
    




 

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Introduction
Understanding an...
Beginning from S...
Outcomes of Curr...
Hurdles and Chal...
Future Scopes
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