Standardization of Head

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Standardization of Head Neck Training Worldwide
Core Curriculum
KC Soo National Cancer Centre Singapore
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Standardization of Head and Neck Training
Worldwide

• Should the training be identical worldwide?
• Should the training be post residency?
• What are the critical skills to be acquired?

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Differing Practice of Head and Neck Surgery

• Specialty dominance
• Advanced disease
• Lack / abundance of supporting specialties

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? Identical Training

• Skills development tailored to individuals
  background
• Greater emphasis on simpler reconstruction for
  developing countries
• Sophisticated subspecialties in developed
  countries e.g. skull based, laryngology,
  endocrine hn, hn reconstruction

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Should training be post residency?

• Complex surgical skills
• Multidisciplinary relationships
• Clinical judgement
• Leadership in rehabilitation

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What are the critical skills?

• Diagnostic
• Analytical / judgement
• Surgical / technical

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Diagnostic Skills (1)

• Anatomy - head neck
• - superior
• mediastinum
• - regional flaps
• Physiology - speech /
• voice
• - swallowing
• - occlusion /
• mastication
• - vision / hearing /
  olfaction

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Diagnostic Skills (2)

• Direct / Mirror / Endoscopic Visualisation

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Diagnostic Skills (3)

• Head Neck Radiology
• - CT, MRI, CT-PET

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Diagnostic Skills (4)

• TNM staging
• ? Molecular staging

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Analytical / Judgement Skills

• Tumour biology and pathology transformation
  from technical specialist to surgical oncologist
• Critical / statistical analysis of publications
• Multidisciplinary tumour boards and audit
• Clinical trials /- basic research
• IT skills to maintain currency

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Rates of Laryngeal Preservation According to the
Treatment Group
Concurrent Chemotherapy and Radiotherapy for
Organ Preservation in Advanced Laryngeal
Cancer AA Forastiere et al NEJM 2003, 349 (22)
2091-8
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Kaplan-Meier Estimates of Progression-Free
Survival
Postoperative Irradiation with or without
Concomitant Chemotherapy for Locally Advanced
Head and Neck Cancer J Bernier, et al NEJM 2004,
350 (19) 1945-52
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Analytical / Judgement Skills

• Tumour biology and pathology transformation
  from technical specialist to surgical oncologist
• Critical / statistical analysis of publications
• Multidisciplinary tumour boards and audit
• Clinical trials /- basic research
• IT skills to maintain currency

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Surgery and Adjuvant Radiotherapy vs Concurrent
Chemoradiotherapy in Stage III/IV Nonmetastatic
Squamous Cell Head and Neck Cancer A Radomised
Comparison KC Soo, EH Tan, J Wee, et al BJC 2005,
1-8
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Surgical Skills

• Airway management
• Tumour ablation
• Osteotomies for access
• Vascular techniques
• Nerve repair
• Temporal bone
• Median sternotomy / thoracotomy
• Local / regional flaps ? microvascular
• Abdominal surgery

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