Rhinology and Skull Base Surgery Fellowship
The Vanderbilt Rhinology and Skull Base Surgery Fellowship is a intensive one-year program that combines clinical and surgical duties at a busy tertiary medical center. One position is offered annually, beginning in July. The Vanderbilt Rhinology and Skull Base Surgery Fellowship is offered through the San Francisco (SF) Match Program and the American Rhinologic Society.
The goal of the fellowship is to equip each fellow with the skill set to be a leader in rhinology and endoscopic skull base surgery, and offers a ternary experience of clinical care, research and teaching.
Surgical cases include primary and revision sinus surgery, skull base and orbital pathology, and treatment of CSF leaks and encephaloceles. A broad anterior skull base and pituitary experience includes the use of extended endoscopic approaches and complex reconstruction techniques. Endoscopic approaches to orbital pathology are also emphasized as part of a close collaborative effort with ophthalmology. Moreover, the fellow will gain experience in performing office-based rhinology procedures.
This fellowship offers a unique opportunity to build strong collegial relationships across multiple Vanderbilt specialties, including allergy/immunology, neurosurgery, occuloplastic surgery, and pulmonology. Multidisciplinary conferences include head and neck tumor board, neurosurgical tumor board, and a pituitary planning conference.
The Rhinology and Endoscopic Skull Base Surgery Service is also integrated with the Vanderbilt Allergy, Sinus and Asthma Partnership (VASAP), providing multidisciplinary medical and surgical care, in conjunction with allergy/immunology and pulmonary, for patients with complex airway inflammatory disease, including ASA triad and AFRS. Vanderbilt rhinologists also provide care in the Vanderbilt Smell and Taste Clinic and are leaders in research in the Vanderbilt Smell and Taste Center.
The Vanderbilt Rhinology and Skull Base program also provides fellows with a diversity of cases, with more than 20% of the patient population coming to Vanderbilt from out of state.
Rakesh K. Chandra, MD, MMHC
Professor of Otolaryngology-HNS
Endowed Directorship in Otolaryngology for Leadership and Educational Development
Service Chief, Rhinology and Skull Base Surgery, and Fellowship Program Director
Naweed I. Chowdhury, MD
Assistant Professor of Otolaryngology-HNS
David T. Kent, MD
Assistant Professor of Otolaryngology-HNS
Director of Sleep Surgery
Paul T. Russell III, MD
Associate Professor of Otolaryngology-HNS
Timothy H. Trone, MD
Assistant Professor of Otolaryngology-HNS
Justin H. Turner, MD, PhD
Associate Professor of Otolaryngology-HNS
Associate Professor of Biomedical Engineering
Associate Director of Research, Otolaryngology-HNS
Director, Vanderbilt Smell and Taste Center
Holly Budnick, MSN, APRN, FNP-BC
Nurse Practitioner for Sleep Surgery
The Vanderbilt Rhinology and Skull Base Surgery Fellowship curriculum provides extensive training in the medical-surgical management of sinonasal disorders and a comprehensive skull base experience. The program also works closely with the Vanderbilt Sinus and Allergy Program (VASAP) to offer a unified airway approach to chronic rhinosinusitis and the Vanderbilt Smell and Taste Center further enriches the clinical and academic experience.
In addition, fellows are clinical instructors at Vanderbilt University School of Medicine, giving them experience and leadership in the academic setting. Fellows are also given surgical privileges at Vanderbilt University Medical Center, Vanderbilt Children's Hospital, and the VA Hospital.
The Department of Otolaryngology-Head and Neck Surgery is housed in five levels, totaling 150,000 square feet, in the Vanderbilt Bill Wilkerson Center. In addition to clinical space, there are several "dry lab" research facilities. Less than a 5-minute walk away are several "wet lab" facilities in proximal buildings on the grounds of the Vanderbilt University Medical Center. These facilities include equipment for molecular and cell biology, tissue storage, cell culture and microscopy. Appropriate standard laboratory tools (e.g. water baths, mass balances, and vortexes) and bench space is available. Computers and software resources for statistical analysis, graphing, plotting and the full suite of Microsoft Office applications are provided.
The Vanderbilt Institute for Surgery and Engineering (VISE) provides an environment in which engineering teams and practitioners can interact and exchange ideas on a regular basis to develop, realize and evaluate novel solutions to identified needs in current practices. Vanderbilt University has a strong history of and commitment to interdisciplinary work and the close proximity of its Medical and Engineering Schools not only eliminates traditional boundaries, but provides a structure to facilitate world-class research.
The Medical Engineering and Discovery Lab is another research space available to fellows where doctors and engineers work side by side to create new lifesaving medical technologies by designing and constructing devices to make interventional medicine more accurate, less invasive, and more effective.
A host of basic science, translational, and clinical research projects are available for the fellow’s participation. Many fellows have also traditionally developed unique projects that have spawned off of existing research lines. A devoted rhinology lab is available for translational and basic science pursuits. These studies are primarily funded under NIH grants totaling over $4 million, for which Dr. Justin Turner is the primary investigator. Additional grants and industry sponsorship round out the funding portfolio. Fellows also have opportunities to engage in studies involving surgical robotics, stereotaxis, and surgical outcomes. The fellowship is designed to provide adequate time for academic pursuits, and fellows are strongly encouraged to present at national meetings. The minimum requirement is to present one abstract at a national meeting during the fellow's Vanderbilt tenure. Fellows typically exceed these minimums just by being engaged in the department and division over the year. This includes multiple opportunities for writing review articles and chapters, which appear in high-visibility, high-impact sources. Statistical analysis and clinical research coordinator support are available in the division and department, respectively.
Fellows attend weekly department Grand Rounds, giving one lecture annually. There is also a weekly rhinology and skull base case conference where resident case presentations are moderated by the fellow and senior faculty. The department also participates in a weekly multidisciplinary Head and Neck Tumor Board as well a Pituitary Planning Meeting, in which fellows participate periodically. Fellows are mentors to residents for rhinology case presentations at the quarterly departmental M&M Conference and also proctor the annual Cadaver Endoscopic Skills Dissection Lab. Fellows also have an active role in training residents at various levels in the clinic and OR.
Fellows rotate in two-month segments with senior rhinology attendings to receive both clinic and OR experience.
In the OR, fellow guides PGY-3 resident through the approach and lower sinuses before taking the role of the primary training surgeon for more complicated steps suck as the skull base, frontal, drilling, tumor removal, skull base reconstruction, etc.
The fellow rounds with the rhinology service residents and communicates with appropriate attendings. The fellow is the primary point of contact for impatient rhinology consultations and, in many instances, is the primary surgeon on the resulting operative cases with backup by more senior faculty of the division. Once monthly, the fellow staffs the residents' continuity clinic. Call as an attending is one weekend out of six.
The Rhinology fellow works collaboratively with the facial plastic and reconstructive surgery fellow (in O-HNS), the occuloplastic surgery fellow, and the neurosurgical team for preop planning, surgery, and postop care. Opportunities also exist to collaborate with the sleep surgery section for exposure to advanced aspects of that discipline.
International Forum of Allergy & Rhinology
American Journal of Rhinology & Allergy
GENERAL COGNITIVE GOALS AND OBJECTIVES
- Develop an expanded and deeper knowledge of the basic sciences, particularly as it pertains to clinical applications and to research in Rhinology.
- Demonstrate an effective, lifelong methodology for maintaining current knowledge and competency in the practice of Rhinology.
- Continue regular surveillance and reading of new literature and information pertinent to the “cutting edge” practice of Rhinology.
- Be frank and realistic regarding procedures and operations you feel confident in performing independently, and knowing when you need to refer or ask for help.
NON‐COGNITIVE GOALS AND OBJECTIVES
- Develop leadership skills and decision‐making capabilities
- Delegate responsibilities to junior residents and medical students, commensurate with their abilities to accept those responsibilities.
- Serve as a role model for residents and medical students.
- Serve as a resource for residents and medical students, providing advice, information and guidance.
- Monitor the progress of residents and provide constructive criticism and feedback on their performance.
- Master and become proficient in advanced clinical examination techniques and procedures.
- Demonstrate independence in surgical judgment, carrying an operative procedure to completion, and
- instructing junior residents in proper surgical technique.
- Have a method to record operative experience.
- Implement a personal operative recording database for operative log recording.
- Prepare for practice opportunities post‐fellowship.
- Develop the habit of intermediate and long‐term planning by having one- and five-year goals.
- Master the orchestration of running a busy service, taking into consideration all the details that go into providing excellent clinical care and meeting the responsibilities incumbent upon the fellow.
COMPETENCY BASED GOALS AND OBJECTIVES
I. Medical Knowledge
- Hone ability to diagnose of a broad spectrum of patients presenting to the clinic, emergency room and inpatient consultations.
- Fully understand and teach the use and interpretation of diagnostic radiology.
- Demonstrate proficient knowledge of nasal and skull base anatomy.
- Gain experience in advanced procedures and surgical skills needed in a Rhinologist.
- Begin to develop a working knowledge of immunotherapy for allergic disease.
- Describe and perform various approaches for treating malignant sinonasal neoplasms, including multidisciplinary procedures and the criteria for selecting each approach.
- Describe and perform the various approaches to managing chronic frontal sinusitis including endoscopic and open procedures.
- Describe and perform various approaches for managing cerebrospinal fluid leaks.
- Outline the expected course of Rhinologic procedures and describe in detail common and unusual complications that can arise in operative and postoperative periods.
- Understand the limitations of Rhinologic surgery and what constitutes realistic expectations on the part of the patient.
II. Patient Care
- Hone the management skills of a broad spectrum of patients with various problems.
- Know and be able to teach the indications, contraindications and risks of surgery.
- Thoroughly understand the perioperative management of patients.
- Independently order and interpret diagnostic tests and understand their role in patient care.
- Perform a broad range of surgical procedures with oversight.
- Makes correct diagnosis and formulates appropriate treatment plan for sinonasal tumors.
- Recognize common complications and obtain appropriate consultations.
- Formulate treatment plans for sinusitis based on understanding of the pathophysiology.
III. Interpersonal Communication
- Communicate effectively with patients presenting to the clinic, emergency room and inpatient consultations.
- Communicate effectively with other healthcare providers both verbally and with written documentation.
- Develop working relationships across specialties.
- Demonstrate respect for patients and their families.
- Demonstrate respect for other healthcare providers.
- Exhibit cultural sensitivity with patients or providers of varying ethnicities and backgrounds.
- Respect patient privacy and personal health information.
- Maintain an appearance befitting of a physician.
- Analyze and manage complex ethical situations.
V. Practice Based Learning and Improvement
- Hone skills of critical self‐evaluation regarding patient care and based on patient outcomes.
- Participate in self‐evaluation exercises such as discussions with faculty and conferences (M&M) that critically review patient care.
- Identify gaps in knowledge and methods to address those gaps.
- Identify quality sources of information locally and on the internet to improve self‐learning and patient care.
- Engage in the education of medical students, residents and patients.
- Demonstrate consistent behavior of incorporating evidence‐based information in practice.
VI. Systems Based Practice
- Effectively navigate affiliated hospital(s).
- Effectively utilize the electronic medical records.
- Appreciate the cost of various interventions and learn to practice cost‐effective medicine.
- Advocate for quality patient care and optimal patient care systems.
- Analyze M&M findings and provide feedback to improve patient safety.
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