Residency Program

Introduction:

The educational efforts of the Department of Otolaryngology-Head and Neck Surgery at King Fahd Hospital of the University began in 1405 AH/1985 CE and was pioneered with our first residency class of King Faisal University (old name of Imam Abdulrahman bin Faisal University) Residency Training Program fellowship in Otolaryngology Head and Neck Surgery (ORL-H&N) which was the first clinical fellowship in the kingdom of Saudi Arabia that has been accredited by the Saudi Commission for Health Specialties and Arab Board for Medical Specialization. From then, the residency training program has been modified to provide residents with strong foundations in all aspects of otolaryngology- head and neck surgery. Hence, to evolve and develop a competent ENT graduates to serve our community.
Recently in 2019, Upon the guidance of His Excellency the president of the university Prof. Abdullah AlRubaish, the Vice President for Postgraduate studies and Scientific Research Prof. Fahad AlHarbi and The Dean of the Medical College Prof. Ali AlSultan to resume and re-establish the IAU-ORL-H&N Fellowship program along the with agreement of the Otolaryngology department. The program underwent a dramatic restructuring, keeping into consideration the rapid changes in the basic concepts of medical education, and benchmarking with local and international residency training programs. It was also important for us to follow the major concept on CanMEDS framework during the creation of the new curriculum.
In addition to our residency program, the Department honours its commitment to medical education in otolaryngology at all levels, under-graduate teaching, post-graduate training, medical education, and internships.

Program Objectives

•  Aims to graduate outstanding, safe otolaryngologist by providing specialized training to medical graduates that focus on solid academic and research background to provide better service to the society necessity and the medical scientific field.
• Gain an appreciation for the role of basic and clinical research for the further development of the otolaryngology Head and Neck surgery specialty, to enhance areas of professional competence.
• Our residency program offers a unique educational experience that provides exposure to all facets of otolaryngology. We offer a full-time faculty member in every subspecialty. Aided by valuable resources, such as our state-of-the-art otolaryngology surgical and clinical training procedures. Our faculty work together to provide trainees with a strong, broad foundation in the field.

Program Strategy

IAU fellowship in Otorhinolaryngology-Head and Neck Surgery is a five-year training program, emphasising on residents’ competencies in the field of basic knowledge, physical examination, communication, and surgical skills.
Training will be reinforced, and will be conducted under the direct supervision of general and subspecialized otolaryngologist faculties, maintaining high level of competencies at regular intervals. The program offers the expertise of world-renowned faculty representing the full range of subspecialty areas, including: general and pediatric otolaryngology, facial plastic, head and neck oncology, laryngology, otology and neurotology, rhinology and skull base surgery. It is also worth noting that we are strongly committed to research in our residency curriculum and to supervise the progress of residents’ research projects throughout the residency program.
In addition, many scientific meetings and courses are conducted for our residents such as dissection courses that offer advanced, hands-on instruction using anatomic and cadaveric specimens including:

• Temporal Bone Dissection Course.
• Endoscopic Sinus Surgery Dissection Course.
• Rhinoplasty Course.
• Head & Neck Dissection course.
• Annual Proposal and Research day.

The foremost objective of the (IAU-ORL-H&N) fellowship program is to graduate competent, well-trained residents who are capable of functioning independently and able to provide the highest level of care to their ear, nose, and throat (ENT) patients.

Dr. Salma Alsharhan

Otolaryngology Training Program

Vision

The vision of the Otorhinolaryngology - Head and Neck surgery residency program is twofold: to comprehensively train medical graduates as medical experts, health advocates, scholars, professionals, collaborators, efficient managers, and effective communicators in order to serve the community at large, and to be one of the world's foremost otorhinolaryngology - head and neck surgery residency training programs.

Mission

To provide specialized training to medical graduates to gather knowledge and skills in the domain of otorhinolaryngology - head and neck surgery through advanced teaching and training methodologies.

Program Goals and Objectives

Upon completion of the residency training program, graduating residents will be able to function as independent otolaryngologists - head and neck surgeons, enabling them to successfully pursue careers in general otolaryngology or to proceed with subspecialty fellowship training. They will be responsible individuals with the highest commitment to their patients, fulfilling all CanMEDS domains as consultant surgeons while demonstrating a commitment to their profession, to lifelong learning, and to the society in general.

General Objectives

• Graduate residents who are able to integrate all of the CanMEDS Roles to provide optimal, ethical, patient-centered medical care. They will know how to apply their medical knowledge, clinical skills, and professional attitudes to provide effective patient-centered care.
• Graduate residents who can function effectively as communicators who can facilitate the doctor-patient relationship and the dynamic exchanges that occur before, during and after the medical encounter.
• Graduate residents who can function effectively as collaborators who can work within an interdisciplinary health care team to achieve optimal patient care.
• Graduate residents who can function effectively as managers who are able to organize sustainable practices, make decisions about allocating resources, and contribute to the effectiveness of the health care system.
• Graduate residents who can function effectively as health advocates who use their expertise and influence responsibly to advance the health and well-being of individual patients, communities, and populations.
• Graduate residents who can function effectively as scholars who demonstrate a lifelong commitment to receive learning as well as to the creation, dissemination, application, and translation of medical knowledge.
•  Graduate residents who can function effectively as professionals who are committed to the health and well-being of individuals and society through ethical practice, profession-led regulation, and high personal standards of behavior.

Specific Objectives

• To provide adequate infrastructure for teaching the basic sciences and the clinical and surgical aspects of otorhinolaryngology.
• To provide an optimal science milieu essential to understanding otorhinolaryngologic diseases through a structured and organized academic program of seminars, clinical rounds, and journal clubs.
• To develop the abilities of the residents, who, by the end of the course, should be able to elicit medical histories and conduct physical examinations of patients with otorhinolaryngologic - head and neck surgery diseases, formulate reasonable and comprehensive differential diagnoses, and manage patients with common and rare otorhinolaryngologic disorders.
•  To provide proper training in otorhinolaryngologic disorders through patient care and management by means of ward rounds, outpatient clinics, emergency room rotations, and intensive care unit postings.
• To create a learning environment by inviting discussions, guest lectures, grand rounds, workshops & seminars, and journal clubs.
• To provide the means to develop technical proficiency and surgical skills in otorhinolaryngologic surgery through supervised exposure in the operating room, minor surgery in the clinics, and cadaver surgery in the anatomy and temporal bone laboratories.
• To provide adequate basic and clinical research opportunities to the residents.
• To encourage a multidisciplinary approach to patent management in such areas as neurotology, head and neck surgical oncology, communication, and swallowing disorders.

General Training Requirements

• Applicants should fulfill all admission requirements set by the Saudi Commission for Health Specialties.
• Trainees should abide by the training regulations and obligations set by the Saudi Commission for Health Specialties.
• Training is a full-time commitment. Residents should be enrolled in full-time, continuous training for the duration of the program.
• Training is conducted in institutions accredited for training by the Saudi Board of Otolaryngology.
• Applicants should fulfill all the requirements set by the Saudi Commission for Health Specialties and the Scientific council of otolaryngology.
• Trainees should be actively involved in patient care, with a gradual progression of responsibility.

Structure and Organization of the Program

Program Framework:
As a Saudi Board of Otolaryngology training program, we follow and fulfill all requirements set by the Saudi Commission for Health Specialties and the Scientific council of otolaryngology. Candidates start with general surgical rotations (R1-otolaryngology) and then commence their formal otolaryngology training for four years (R2-5). The program includes eight domains: Otology and Neuro-otology, Rhinology and skull base surgery, Laryngology and voice, Pediatric Otolaryngology, Head and Neck Surgery, General Otolaryngology.

Year 1 Resident (R1):
The first year of training in otolaryngology is a surgical foundation year, in which the residents acquire knowledge and experience in the basic principles of general surgery and develop an ability to apply these. The year composed of different rotations in several surgical subspecialties include general surgery, pediatric surgery, neurosurgery, plastic surgery, thoracic surgery and oral & maxillofacial surgery. In addition, the residents do rotations in the intensive care unit and the emergency room, join two months of Otolaryngology, and attend the basic science course, and a research methodology course.

Year 2-5 Resident (R2-5):
Residents engage in formal otolaryngology training over four years. The last year R5 is the senior year where residents acquire most of their advanced surgical expertise. Rotations are distributed into three-months periods, each rotation is with a subspecialty team. Over the duration of the training program, residents are expected to develop proficiency in:
• Obtaining the otolaryngological history and performing physical examination.
• Interpretation of audiological and vestibular tests.
• Interpretation of medical imaging techniques.

•  Gain experience and proficiency in common clinical procedures like:

1.  Flexible nasolaryngoscopy.
2. Rigid nasal endoscopy.
3.  Functional Endoscopic Evaluation of Swallowing.
4.  Fine needle aspiration biopsy.
5.  Microscopic examination and management of the ear disease.
6.  Intra-tympanic injection.
7. Percutaneous tracheostomy.

•  Management of common otolaryngological emergencies:

1. Epistaxis (cautery, anterior and posterior packing).
2.  Airway problems (evaluation of patient with stridor, management of airway obstruction, airway foreign body, tracheostomy complications).
3. Perform open and percutaneous tracheostomy.
4.  Esophageal emergencies (foreign body, caustic ingestion).
5. Peritonsillar and deep neck infection.
6. Acute complications of rhinosinusitis.
7. Otitis media, otitis externa and sudden sensory neural hearing loss.

•  Acquire experience in the common otolaryngologic procedures.

1. Tympanoplasty and tympanomastoidectomy.
2. Basic endoscopic sinus surgery.
3.  Septoplasty and turbinoplasty.
4.  Laryngoscopy, bronchoscopy and esophagoscopy.
5.  Endoscopic airway surgery.
6.  Adenoidectomy, tonsillectomy and management of intra-oral lesion.
7.  Neck dissection.
8.  Management of head and neck soft tissue lesions

• Matters of ethical and responsible behavior, ability to work as a part medical team, and fulfill all CanMEDS domains.

Administrative Structure

Program director

Dr.Ahmed Alkhateeb, MBBS, MSc, FRCSC
Consultant Pediatric Otolaryngology
Assistant Professor of Otolaryngology Head and Neck Surgery
Imam Abdulrahman Bin Faisal University
Dammam, Saudi Arabia
E-Mail: aaalkhateeb@iau.edu.sa

Program Coordinator
Miss. Zahra Alsadah
Location: ENT department at KFHU
Email: Zasadah@iau.edu.sa
Email: cm-dent@iau.edu.sa
Phone: 013 895 7999 ext: 1684

Residency Program Committee

The Residency Program Committee (RPC) assists the Program Director in the planning, organization, and supervision of all aspects of the residency training program. The committee meets every three months to discuss and re-evaluate three main domains:

• Resident Education and Academic Performance
• Research
• Resident wellness

Resident Education and Academic Performance:
The committee constantly works on maintaining a high level of education in all aspect of otolaryngology, and head and neck surgery through academic half days, grand rounds, hospital rounds, journal clubs and hands-on courses and workshops.

Research:
The committee advocates and assists residents to integrate in research by joining one or more of the research teams in the department. We hold annual resident research day where all residents are expected to deliver a ten-minute research presentation.

Resident wellness:
The committee works to promote a healthy work-life balance, provide physical, psychological and professional wellness education, and support to optimize the clinical learning environment and, in turn, patient care, the psychological, emotional, and physical well-being of our residents.

RPC Members:

Members	Subspecialty	Role
Ahmed Alkhateeb	Pediatric Otolaryngology	Program director - Head
Salma Alsharhan	Rhinology	Deputy program director
Abdulmalik Alsaed	Laryngology	Member
Redha Alrumaih	Otology	Member
Sarah Alqurian	General	Member
Abdulaziz Alenzi	General	Member
Senior resident	Resident	Senior resident representative
Junior resident	Resident	Junior resident representative

 
Otolaryngology Staff

Otolaryngology Consultants
Prof. Laila Telmesani	Otology and cochlear implant
Dr. Abdulaziz Alshaiji	Otology, Neuro-otology and cochlear implant
Dr. Redha Alrumaih	Otology and cochlear implant
Dr. Mohammed Albar	Rhinology, skull base surgery & Laryngology
Dr. Salma Alsharhan	Rhinology
Dr. Nada Albahrani	Rhinology and Allergy
Dr. Mona Ashoor	Rhinology and Facial Plastics
Dr. Hani Almuslim	Facial Plastics
Dr. Naser Aljazan	Head and Neck Surgery
Dr. Abdulmalik Alsaed	Laryngology
Dr. Ahmed Alkhateeb	Pediatric Otolaryngology
Dr. Adhra Alhumaidan	General Otolaryngology
Dr. Mona Alramah	General Otolaryngology
Otolaryngology Specialists
Dr. Hani Alsayed	ENT specialist
Dr. Khalid Aboshama	ENT specialist
Dr. Fahad Alzahrani	ENT specialist
Dr. Saad Alshummari	ENT specialist
Dr. Norah Almulhim	ENT specialist
Dr. Sarah Alquorain	ENT specialist
Dr. Abdulaziz Alenzi	ENT specialist
Audiology
Dr.Nithreen Mohammed	Audiology consultant - Assistant Prof
Dr.Mahmoud Mahrous	Audiology Consultant
Dr.Amal Al-Shaik	Consultant  - Assistant Prof
Dr. Ibrahim Abosaud	Audiology Doctor
Rasha Al-Safar	Audiologist-Non Doctor
Mrs.Samar Alaswad	Audiologist- Non Doctor
Mrs.Hala Alruwaili	Audiology Technician
Speech and Language Pathology
Dr.Ahmed Abdelhamid	Consultant- Assistant Prof
Samera Ashoor	Speech language pathologist-Non Doctor
Fatima Al-shaikh	Speech language pathologist-Non Doctor
Maria Al- Sunbul	Speech language pathologist-Non Doctor
Khalil Al-Adarba	Speech language pathologist-Non Doctor

ENT Team Distributions at KFHU

Otolaryngology at KFHU is divided into 3 general teams:

Team 1	Team 2	Team 3
Dr. Abdulmalik Alsaed Dr. Abdulaziz Alshaiji Dr. Salma Alsharhan Dr. Ahmed Alkhateeb	Dr. Naser Aljaizan Dr. Albar Albar Dr. Nada Albahrani Dr.Lina Telmisani	Prof. Laila Telmisani Dr. MonavAshoor Dr. Hani Almuslim Dr. Redha Alrumaih Dr. Mona Alrummah

Weekly Resident Schedule

	Sunday	Monday	Tuesday	Wednesday	Thursday
7:30-8:00	Morning round	Morning round	Morning round	Morning round	Morning round
08:00 - 09:00	Didactic	Resident clinic	Resident clinic		Departmental Grand Round
09:00 - 10:00	Daily Duties (clinics, OR, in-patient care, consultations)				Weekly audit
10:00 - 14:00					Screening clinic & Day surgery
14:00 - 15:00		Academic lecture
15:00 - 16:00		Self-directed teaching

Annual ORL Service

Out-patient service:
We have daily specialized ENT clinics, with an average of 13 out-patient clinics per week, seeing around 24,000 patients annually. There is daily audiology and SLP clinics.

Sunday	Monday	Tuesday	Wednesday	Thursday
Otology & CI Otology & CI Neuro-otology & Vestibular	Rhinology Facioplasty Head & Neck Pediatric ENT	Rhinology & Skull base Laryngology Rhinology	Rhinology and Allergy General	Screening
Audiology	Audiology	Audiology	Audiology	Audiology
SLP	SLP	SLP	SLP	SLP

ENT Surgical Procedures:

We have a minimum of 6 OR rooms per week, plus add-on rooms. All adenotonsillectomies are done on Thursday in 1-2 operating rooms. We do all major and minor ENT procedures except major head and neck reconstruction procedures. That includes, but not limited to:

• All types of mastoidectomy
• Tympanoplasty and ossiculoplasty
• Cochlear implant
•  Endoscopic ear surgery
• Functional Endoscopic Sinus Surgery (FESS)
• Endoscopic skull base surgery
• Endoscopic and Open Epistaxis procedures
• Endoscopic airway surgery (pediatrics and adults)
• Open airway surgery (pediatrics and adults)
• Phonosurgery
• Thyroplasty
• Head and neck tumor resections
•  Neck dissection
• Velopharyngeal reconstruction (speech surgery)

Academic Half Days

•  Weekly academic half days, distributed over subspecialty blocks.
• Two hours of academic protected time includes didactic and interactive teaching sessions covering all of the major areas of general otolaryngology and the representative subspecialties of the field.
• The first hour is a lecture presented by an otolaryngology consultant and the second hour is a self-directed teaching session presented by a senior resident.
• This time is protected time i.e. the trainees will be exempted from all clinical duties including: ORs, clinics, and calls.
• The academic schedule is arranged in blocks. Each block covers a subspecialty, follows the index of Baily’s textbook, and concluded by an OSCE exam. The program is distributed over two year period.
• The subspecialty blocks are distributed as the following:

Subspecialty block	Number of sessions
Otology and neurotology	13
Rhinology and allergy	11
Pediatric otolaryngology	11
Laryngology	8
Head and neck oncology and reconstruction	15
General otolaryngology	7

Hands-on Seminars and Workshops:

• Four seminars per year as the following:

Temporal bone dissection course

•  Includes lectures and hands-on dissection
•  The dissection is intended primarily for the R3-R5

1. Functional sinus surgery workshop
2. Endoscopic airway surgery seminar
3. Facial plastic review day

•  Covers all topics of aesthetic and reconstructive facial plastics

Teaching Rounds

Teaching rounds are conducted in several ways:

•  ORL Audit:

 It is a weekly session on every Thursday morning, attended by all ORL consultants, specialists, and residents where all ENT consultations and referral for the corresponding week are discussed. Occasionally, a short power point presentation is presented on a specific interesting case.

• Sunday Morning Didactics:

It is an hour weekly teaching session, presented by an ORL specialist. It covers clinical scenarios, topics review, exam questions.

• Bedside Case Discussion:

Case by case discussion with the consultant.

• Virtual Surgery Lectures
• An initiative to alleviate the deficiency in OR exposure for our trainee residents during COVID-19 pandemic, through lectures presented by KFHU ORL staff. These lectures cover:
• Surgical indications
•  Pre-operative evaluation
•  Informed consent
•  Surgical instruments and OR preparation
•  Operative technique
•  Post-operative care

The procedures included in the series are:

Block	Procedure
Otology	Tympanoplasty
	Mastoidectomy
Rhinology	FESS
	Septoplasty
Laryngology	Tracheostomy
Pediatric	Direct laryngoscopy and bronchoscopy Pediatric
Head and Neck	Neck dissection

OR Template:

The OR template was invented to maximize the learning from each surgical procedure. It is completed by the resident assigned to each OR procedure and emailed to the consultant surgeon, the day before the procedure.

Otolaryngology Head and Neck Surgery
OR template

Patient’s name:                                        Date of Surgery:
Age:                                                             MRN:
Diagnosis:                                                 Surgery:

History:
Brief history summarizes the indication for the surgery, and the expected outcome

Physical Examination:
Relative examination that might indicates some intra operative adjustment

Investigation:
Positive findings that might indicates some intra operative adjustment

Indication for Surgery:
Clear statement of indication for surgery

Pre-Operative preparation:
Any intra operative supplies might be needed for the surgery, e.g. tracheostomy tube, hyaluronic acid, mitomycin C, prosthesis etc. Checked and confirm available.

Surgical Steps:

Level of Confidence:
1. Uncomfortable doing the key steps of the surgery by myself
2. Comfortable doing following key steps of the surgery by myself:
3. Capable of doing the key steps of the surgery with assistance
4. Capable of doing the key steps of the surgery with confidence
5. Capable of teaching the key steps of the surgery to another resident

Resident who scores level 5 of confidence for the key surgeries of his/her rotation, during the second half of the rotation, will honored superior evaluation for his/her surgical skills

Grand Rounds

• Weekly departmental grand rounds, total of 40 rounds per year.

Grand Round	Number of rounds per year
Otology Round	4
Rhinology Round	4
Pediatric OTL Round	4
Laryngology Round	4
Head and Neck Surgery Round	4
Innovations in OTL	4
M&M	4
Visiting Professor round	4
Journal club	3
Ask professor round	2
Facial Plastics and reconstruction surgery	1
Medical education	1
Resident Research day	1

Research Unit:

• Headed by Dr.Mona Alrammah, ENT consultant.
•  Helps attach each resident in a research team.
• Facilitates ENT residents in research.
• Organize the Annual Resident Research Day.

Resident Research Day

•  The last grand round in the academic year.
•  ALL R2-4 residents are expected to present in the research day. Failure of presenting will affect the research domain in their evaluation.
•  Top 3 researches will be honored.

On-line References

IAU library E-Resources include a large range of electronic resources in order to support teaching, learning and research. Currently, there are more than 319 databases on different subjects and more than 70,000 full-text e-journals, along with over 500,000 e-books available at IAU’s libraries.

Evaluation of Resident Performance

• Residents meet with the program directory every 6 months for evaluation, career counseling and setting general objectives for the next rotation.
• Residents meet the training consultants, at the beginning of the rotation for discussing rotation’s objectives, at mid rotation for feedback, and at the end of rotation for evaluation.
• Minimum of two consultants evaluate each resident at the end of each rotation, using the one-45 evolution form, and discuss the evaluation with the resident.
• At the end of each rotation, residents should evaluate the rotation using the one-45 evaluation form.