UNIVERSITY OF MIAMI

Neurorhinology and Advanced Endoscopic Skull Base Surgery Fellowship Program
(ACGME Accredited Residency Required)

INSTITUTION & ADDRESS

University of Miami Miller School of Medicine
Department of Otolaryngology
1120 NW 14th Street, 5th Floor
Miami, Florida 33136
Phone: (305) 243-4756
FAX: (305) 243-2009

SF MATCH PROGRAM ID#

2864

FELLOWSHIP DIRECTOR

Roy R.Casiano, M.D., F.A.C.S
Professor and Vice Chairman
1120 NW 14th Street, 5th Floor
Miami, Florida 33136
Phone: (305) 243-4756
FAX: (305) 243-2009
[email protected]

DEPARTMENTAL MISSION STATEMENT

To educate and nurture medical students, residents and fellows, to create knowledge, and to provide service to our community and beyond. Committed to excellence and proud of the diversity of our University family, we strive to develop future leaders of our nation and the world.

OVERVIEW OF FELLOWSHIP

The University of Miami/Jackson Health System Rhinology and Endoscopic Skull Base Surgery Fellowship is a 12 month training program. It is designed for otololaryngologists that have completed their ACGME accredited residency and desire to advance their fund of knowledge and surgical skills in the otolaryngology subspecialty area of advanced rhinology as well as endoscopic skull base surgery.

FELLOWSHIP DESCRIPTION

Fellowship Duration

1 Year

Fellowship Term

July 1 through June 30th every year

Goals and Objectives for Training:

• To further develop the fellow’s surgical skills, required for the performance of advanced endoscopic surgical procedures in the nose and adjacent paranasal sinuses, orbit, and skull base, in a multidisciplinary approach.
• To develop the fellow’s expertise in the multidisciplinary treatment of common ailments afflicting the upper and lower respiratory system (asthma, chronic rhinosinusitis, allergies, and other common airway disorders).
• To enhance the fellow's understanding about the multidisciplinary management and treatment of common inflammatory and neoplastic disorders of the nose and paranasal sinuses
• To develop the fellow’s expertise in the diagnosis and management of allergies and immunologic disorders affecting the upper airway.
• To enhance the fellow understanding about the appropriate workup, indications and potential adverse side-affects of pharmacotherapy versus immunotherapy, for patients with allergies (optional)
• To develop important clinical teaching skills and experience that will prepare fellows if they choose to continue in academic practice.
• To enable the fellow to establish a strong foundation in the use of clinical quality improvement databases, which they can choose to incorporate into their own practice in the future.

Faculty (Rhinology and Endoscopic Skull Base Team)

• Dr. Roy R. Casiano (rhinologist with special interest in advanced sinonasal procedures and endoscopic skull base surgery)
• Dr. Corinna G. Levine (rhinologist with special interest in advanced sinonasal procedures and endoscopic skull base surgery)
• Dr. Aura Acosta (rhinologist with special interest in allergies and office-based procedures); OPTIONAL
• Dr. Zoukaa B. Sargi (Head and Neck Surgery/microvascular reconstruction, endoscopic skull base surgery)
• Dr. David K. Lerner (rhinologist with special interest in advanced sinonasal procedures and endoscopic skull base surgery)
• Dr. Ricardo J. Komotar (neurosurgeon with special interest in endoscopic skull base surgery)
• Dr. Michael E. Ivan (neurosurgeon with special interest in endoscopic skull base surgery)
• Dr. Carolina G. Benjamin (neurosurgeon with special interest in endoscopic skull base surgery)
• Dr. Ashish H. Shah (neurosurgeon with special interest in endoscopic skull base surgery)

Hospital and Clinic Facilities:

• UHealth Clinical Research Building (CRB): main outpatient clinic facility for UM rhinology, neurosurgery, on the medical center campus
• University of Miami Hospital and Clinics/Sylvester Comprehensive Cancer Center (UMHC/SCCC) on the medical center campus
• UHealth Tower (UHT; University Hospital) on the medical center campus
• Sethi Medical Center Bldg on the medical center campus
• Jackson Memorial Hospital (JMH) on the medical center campus
• Plantation UHealth Outpatient Facility, Plantation Florida in Broward County north of the medical campus
• Lennar UHealth Outpatient Facility in Coral Gables, Florida in the undergraduate campus south of the medical campus
• SolaMia UHealth Outpatient Facility in North Miami Beach, Florida

Clinical/Surgical Rotations:

Rotations in the operating room are primarily with Drs Casiano, Levine, Lerner, Sargi, Komotar, Morcos, Ivan, Benjamin, and Shah (see weekly schedule). Clinic rotations are primarily with Drs Casiano, Levine, or Lerner (at CRB, UHealth Plantation, UHealth Lennar or UHealth Doral). Optional allergy rotations with Dr Acosta at the Sethi Center next to the CRB bldg.   

Weekly Schedule:

 * Schedule subject to adjustments depending on rhinology team needs 

CURRICULUM

Didactics and Teaching Responsibilities:

The fellow will actively participate with the residents and faculty in the department’s weekly departmental grand rounds and pertinent monthly journal clubs. He/she participates as faculty in our annual University of Miami International Endoscopic Sinonasal and Skull Base Anatomy Course (meeting held in South Florida in the winter), as well as our annual endoscopic surgical anatomy course for the residents and fellows in the summer (All-Florida Residents/Fellows Endoscopic Surgical Anatomy Course with University of South Florida and University of Florida Residents and Fellows). Also, the fellow will be responsible for weekly presentation of future surgical skull base cases at Tuesday's Multidisciplinary Skull Base Conference and/or Thursday's H&N Tumor Conference, for discussion of the best surgical and/or nonsurgical treatment strategies. In addition, he/she practices advanced procedures, and helps teach our international “minifellows”, in our state-of-the-art endoscopic sinus surgery lab at the medical examiner’s office on campus.

The fellow will have access to the latest endoscopic skull base equipment in our C.A.N.E.S microsurgical cadaveric simulation lab at the medical school on the medical center campus to practice advanced endoscopic skull base surgical techniques on cadaveric specimens. It is here where the fellows practice their skull base drilling technique for middle cranial fossa/clival/infratemporal fossa resections on formalin-fixed or fresh specimens, further refining their understanding of the complex skull base anatomy.

Supervisory and Patient Care Responsibilities:

The degree of faculty supervision is dependent on the fellow’s previous surgical experience as a resident and skill level.  It is expected that the fellow has completed the minimal requirements for practicing Otolaryngology in the U.S. This includes having a fundamental grasp of basic endoscopic surgical skills to perform uncomplicated endoscopic ethmoidectomies, maxillary, sphenoid, and frontal sinusotomies.  To this end, the fellow is required to assist the faculty in the training of residents on basic sinus cases. He/she will help attend and supervise the residents for rhinology consults and associated operative cases. Patient care is restricted to the hospitals and outpatient clinics listed above.  As part of the rhinology and skull base team, the fellow will assist the rhinology and neurosurgery faculty on their private rhinology, endoscopic skull base, as well as pituitary cases. Fellows will be trained on the use of EPIC and CERNER electronic health records and REDCap Database entry. 

Diversity of Cases:

Advanced endoscopic rhinologic and orbital/skull base cases and management are the focus of this fellowship. This includes, but is not limited to, the care of complicated rhinologic cases and performing advanced endoscopic sinus plus endoscopic skull base procedures. This includes: extended sinusotomies (frontal, sphenoid, or maxillary), sphenopalatine and internal maxillary artery cauterizations/ligations for the control of epistaxis, orbital and/or optic nerve decompression, meningoencephalocele resection and/or CSF leak repair, resection of sellar and suprasellar lesions (craniopharyngiomas, adenomas, Rathke’s cysts, etc.), resection of benign and malignant sinonasal neoplasms of the skull base (clival chordomas, petrous apex cholesterol granulomas, infratemporal fossa,  and anterior skull base lesions),  and other endoscopic skull base procedures. 

The fellow is also actively involved in resident supervision and teaching. He/she helps the faculty in assisting the residents on a number of rhinologic procedures at our county facility on campus (Jackson Memorial Hospital). The fellow will also take 2-3 weeks of paid general ENT call with the rest of the otolaryngology faculty and other “clinical instructor” fellows in the department to maintain their general ENT skill set during the course of the year.  Opportunities to pick up additional paid ENT general call may be available.

2021-2022 Fellow's Case Log

Surgical Case Load:

Every year the fellow is expected to perform as surgeon of record on a minimum of 150-200 patients (300-400 sinonasal surgical procedures). Approximately 60% of these are advanced revision inflammatory cases, and 20% are sinonasal and/or skull base neoplasms (in addition to pituitaries). South Florida is very endemic for destructive advanced CRS polyps cases (example: AERD, AFS, eosinophilic mucin CRSwNP) in over 60% of polyp cases. This provides the fellow ample opportunity to perform advanced procedures (extended sinusotomies, etc.) even on primary chronic inflammatory surgical cases. 

Research Responsibilities:

Research projects, appropriate for presentation at one of several national otolaryngologic meetings and suitable for publication in peer-reviewed journals, are mandated. A variety of anatomic, clinical, and basic science research projects are available under faculty supervision. There will be a yearly travel stipend to meetings, where the fellow is presenting. Historically, the fellow has completed a minimum of 2 clinical research projects during his/her 12-month rotation, suitable for publication in one of the Otolaryngology peer review journals.  Opportunities for publication of book chapters, monographs, and other forms of media, will also be available. All fellows are required to take appropriate IRB mandated online courses including CITI, in order to participate in human research projects.

Administrative Responsibility:

The fellow will hold the position of the chief administrative fellow. He/she will work closely with the rhinology faculty in developing the weekly clinic and OR case assignments. The administrative fellow has the right of first refusal for all endoscopic skull base cases. He/she gets first priority.  

CURRENT AND PAST FELLOWS

*International fellows

Salary and Fringe Benefits:

The fellow’s salary and benefits commensurate with the University of Miami/Jackson Health System PGY-6 level. They must obtain a Florida license and meet all requirements for hospital privileging and credentialing as an adjunct faculty member of the University of Miami Medical Group. As clinical instructors, fellows may qualify for pre-tax loan repayment paycheck deductions during their employment. Fellows are allowed 4 weeks of vacation per year. Housing and transportation are not provided.

REQUIREMENTS FOR APPOINTMENT

• Board-eligible/Board-certified otolaryngologist
• Valid Florida State medical license or be elibible to obtain one
• Interest in rhinology and rhinologic research, as demonstrated by prior experience

APPLICATION INFORMATION

\Applications are reviewed in the winter/spring for a position beginning July 1 of the subsequent (see SF Match timelines for application submission, interviews, and ranking list). Selected applicants are invited to travel to Miami for an individual interview with the faculty, and spend time with our current fellow, observing his/her surgical skills, reviewing the fellow’s case log, and interactions with the faculty, staff, and residents. The interview is a 2-day commitment . There will be ample time to address all questions the applicant may have, one on one, with the fellow and faculty. There are options for virtual interviews as well. 

DEADLINE FOR APPLICATION

February 1 (see SF Match for timelines for application submission, interviews, and ranking list)

CONTACT INFORMATION

Fellowship Program Administrator:
Danierys Font
[email protected]
Phone: (305) 243-4932
Fax: (305) 243-1651
Department website: www.otolaryngology.med.miami.edu
Residency/Fellowship Program website: https://graduate.jacksonhealth.org/program/otolaryngology-head-and-neck-surgery/