Surgical training posts requirements

• The patient load must be such that the Board of Otolaryngology Head and Neck Surgery is satisfied that the trainee is exposed to a wide range of otolaryngology head and neck surgery patients.
• There should be access to audiological services and the ability to participate actively in the testing of hearing. The audiological services should be comprehensive and include all aspects of pure tone audiometry and masking, impedance audiometry and evoked potentials. There should be adequate access for the registrar to staff trained in all of the above.
• In addition to the supervisor of surgical training, at least two other active otolaryngologists must be available to the trainee in the accredited post except in special circumstances. Each of these consultants should spend regular time at the hospital practicing the specialty. For a second accredited position, there should be a minimum of five active otolaryngologists in the unit.
• There should be adequate access to beds to allow a suitable number of elective surgical procedures.
• There should be a minimum of three half-day operating sessions per week per Trainee.

The Board would expect the following to be available:

• full radiological services with CT and access to MRI scanning
• fully equipped operating theatres including, but not limited to, a modern operating microscope, FESS equipment, a full range of otologic instrumentation
• a well-equipped outpatient clinic, including access to an operating microscope as well as flexible and rigid endoscopes
• audiological facilities.

The Board would expect the following support services to be available:

• radiology
• histopathology
• accident and emergency
• intensive care unit
• adequate office space and internet access
• secretarial support for the department.

Hospitals that may be considered as offering head and neck or paediatric training in Otolaryngology Head and Neck Surgery must satisfy the above requirements.

A hospital designated as providing adequate training in Head and Neck Surgery should have the following:

• two members of the consultancy staff adequately trained in head and neck surgery
• facilities and personnel to conduct all major head and neck procedures, including some skull base procedures
• adequately trained dietitian and speech pathologists in the management of head and neck surgery and the aftercare of total laryngectomy type patients
• access to laser surgery and/or robotic surgery, particularly in the endoscopic and trans-oral treatment of head and neck cancer
• access to a multidisciplinary head and neck meeting with the presence of a consultant radiologist, pathologist, medical oncologist, radiation oncologist, and allied health
• access to an outpatient clinic where comprehensive discussion is given to the management plans of cancer patients with the presence of a consultant head and neck oncology surgeon in attendance
  • There should preferably be a reconstructive surgeon in attendance for the discussion of reconstructive surgery

A hospital designated as providing adequate training in paediatrics in Otolaryngology Head and Neck Surgery should have the following:

• adequate access to in-patient and day procedure beds to allow the performance of adequate numbers of basic ENT procedures such as adenotonsillectomy and ventilating tube insertion
• a member of the consultancy staff adequately trained in paediatric otolaryngology
• the performance of paediatric airway investigation and management which would:
  • involve the ability of the hospital to perform paediatric airway endoscopy and foreign body removal
  • likely necessitate access to paediatric intensive care unit beds
• a full range of paediatric audiological services.

Each hospital with an accredited Otolaryngology Head and Neck Surgery training post must have a supervisor of training who for the most part will be the head of the unit. The supervisor of surgical training should be:

• an experienced otolaryngology head and neck surgeon with appropriate clinical, administrative and teaching skills to conduct the training program
• a current Fellow of the Royal Australasian College of Surgeons in Otolaryngology Head and Neck Surgery
• a member of either the Australian Society of Otolaryngology Head and Neck Surgery or the New Zealand Society of Otolaryngology, Head and Neck Surgery
• familiar with his/her responsibilities to the Board of Otolaryngology Head and Neck Surgery and to the Trainee
• their hospital's representative on the regional training subcommittee
• spend an adequate amount of time in the hospital of the accredited post and participate in elective surgery, outpatients clinics and by way of the on-call roster, management of ENT emergencies (a minimum would be two to three half-days per week and participation in the on-call roster).

The accredited Otolaryngology Head and Neck Surgery training post should provide a balanced and diversified training experience in otolaryngology head and neck surgery and audiology. There should be:

• an opportunity for research to satisfy the Board of Otolaryngology Head and Neck Surgery requirements for completion of a research project before registrars are eligible to sit for the Fellowship Examination
• education (particularly in an outpatient setting to elicit various signs and symptoms), ward rounds with an emphasis on postoperative care case presentations, and personal tutorials
• active encouragement to attend the Australian Society of Otolaryngology Head and Neck Surgery annual general meeting each year
• adequate time allocated for the registrar to attend the regular weekly evening tutorial sessions.

The Board will also require the following:

• some histopathology sessions
• regular radiology sessions
• regular surgical audit of diagnosis and outcome of patients treated by the unit
• access to a temporal bone laboratory for the dissection of temporal bones if the hospital does not have its own temporal bone lab.