Introduction to the Rhinology Training Council and the Application Process

Background

The American Rhinologic Society (ARS) was created in 1954 to advance education and research in the care of patients with rhinologic disorders. Throughout its history, the ARS has placed training of the next generation of rhinologists as a high priority. Fellowships play an important role in that training, particularly training related to the most advanced rhinologic procedures. To assist the next generation of rhinologists assess the available fellowships, and to assist fellowship providers assess their own programs, the ARS is embarking on this program that will, on a voluntary basis, review available fellowships and offer affirmation of their quality.

The Rhinology Training Council (RTC) was created in the spring of 2016 by the Board of Directors (BOD) of the ARS to advance the ARS educational mission. The impetus for creation was the quickly evolving landscape of rhinology fellowships and the growing field of endoscopic skull base surgery. The RTC is to advise the ARS Board on key criteria that secure the needs of trainees, programs and patient care. Programs that meet criteria for a NeuroRhinology – Advanced Rhinology fellowship will be approved by the ARS Board.

The RTC was tasked with researching and developing a model of oversight for the rhinology fellowship programs. The RTC reviewed various oversight models before deciding to pursue a model similar to that used by the American Head and Neck Society in oversight of the head and neck surgery fellowships.

The RTC concluded that the need for oversight is not directed toward training in “routine” rhinological surgery but rather procedures that are communally understood to be “advanced”, which may require dedicated fellowship training. One of the natural differentiations between the two was the surgery involving or beyond the dura. Other procedures that are communally recognized as technically challenging (“Advanced Rhinology”) may merit additional training. As such, the focus of the RTC will be on "neurorhinology" procedures and advanced rhinological surgery.

The rationale for this was several-fold. First, many of the ARS sister societies have fellowship oversight. Second, there is currently no “home” for endoscopic skull base fellowships and it was felt to be in the best interests of the ARS to provide leadership in this regard. Third, there is precedent with neuro-otology and the skull base is a natural break point between inflammatory disease and skull base procedures. Finally, this, in no way, would impact resident training in “routine” rhinologic disease, nor would it preclude an institution from having a basic “rhinology” fellowship. By overseeing only the NeuroRhinology – Advanced Rhinology, no changes would be necessary for programs that wish to continue with a “Rhinology” fellowship outside of this structure. All programs would remain in the San Francisco match. The only difference is the NeuroRhinology – Advanced Rhinology programs would be able to offer graduates an ARS affirmation for performing neurorhinologic (skull base) and advanced rhinological surgery procedures. This would allow fellowship programs the choice to pursue additional criteria and oversight.

It is important to note that fellowships are educational programs. Fellowship providers will be asked as part of the application process to affirm that their fellowship is being offered for purely educational purposes and not to advance the business purpose of the provider’s medical practice. Failure to offer this affirmation will disqualify a fellowship from participating in this program.

Protocol for establishing RTC members

The Rhinology Training Council is an ARS select committee made up of ten ARS members, five that are fellowship trained but are not affiliated with rhinology fellowship programs and five that are affiliated with rhinology fellowship programs. There is a chairperson, not affiliated with a fellowship program, that is appointed by the ARS BOD. The ARS President as well as the ARS Fellowship Committee chair are ex officio, non-voting members.

The fellowship program representatives are elected by the Fellowship Committee. The non-fellowship affiliated representatives on the committee are nominated by the ARS president and approved by the ARS BOD.

RTC members will serve a three-year term with the potential for one renewal. When an individual’s term is about to end, the chair of the RTC will confirm their willingness to serve a second term. If they are willing, then the RTC chair will re-nominate them to the BOD or to the fellowship committee for non-fellowship affiliated and fellowship affiliated members, respectively.

If a non-fellowship affiliated RTC member becomes affiliated with a fellowship during that individual’s RTC term, said individual must resign their position on the RTC and the BOD must nominate a new member to finish out that person’s term.

Organizational Structure and Reporting

The RTC reports to the BOD of the ARS. Final authority and responsibility for all training issues is retained by the BOD of the ARS. The RTC will review the applications, oversee the Interviews of the fellowship programs, and make recommendations to the ARS BOD. The BOD will make the final decisions on the standing of a program.

Program Application Process

Interested programs will complete an application. The application will include a written application form, program goals and objectives, evaluation templates, a nonrefundable application fee of $2000, and affirmation that the program will be compliant with common program requirements and agree to stipulated terms as outlined in the application. The application fee will be used to help offset the administrative costs of overseeing the fellowships.

Every program must apply and must pay the application fee (i.e. no “grandfathering” of programs).

The initial application and approval process will be a 2-year process. This will allow all programs to complete an application and all program personnel to be interviewed. All programs granted full approval will formally begin their NeuroRhinology-Advanced Rhinology fellowships no later than July 1, 2020.

The application will be reviewed, discussed and the RTC will vote on the program. RTC members must recuse themselves from reviewing and voting on their own programs, or programs with which they have been affiliated with in the past (i.e. for training). Programs will require a 2/3 majority “yes” vote to be forwarded to the ARS BOD for a vote. All programs that receive a majority vote in their favor by the BOD will be granted “Provisional Approval Contingent Upon Program Interview” (hereinafter “Provisional Approval”).

Those programs that do not get Provisional Approval will be given a written report outlining their strengths and weaknesses and areas of concern.

Programs not attaining Provisional Approval will be allowed to appeal the decision directly to the BOD.

Provisional Approval will last until a Program Interview has been completed. Please see section A6 for details on the Program Interview.

Following the Program Interview, the RTC will vote on the program. As previously noted, RTC members must recuse themselves from voting on their own programs or programs with which they have been affiliated with in the past. Programs will require a 2/3 majority “yes” vote to be forwarded to the ARS BOD for a vote. All programs that receive a majority vote in their favor by the BOD will be granted “Full Approval”.

Programs that do not get Full Approval will be given a written report outlining their strengths and weaknesses and areas of concern.

Programs not obtaining Full Approval will be allowed to appeal the decision directly to the BOD.

Upon failure to obtain Full Approval, programs will lose their Provisional Approval and be required to begin the process anew with a new application, application fee, etc. if they desire an ARS Approved NeuroRhinology – Advanced Rhinology fellowship.

All programs that have passed the Program Interview will receive “Full Approval” status. Upon receiving Full Approval, all graduates will be from an “ARS Approved NeuroRhinology – Advanced Rhinology Fellowship”. There will be no retrospective “ARS Approved” fellowship status to programs or graduates.

Programs will then be granted approval for up to 5 years in duration based on any citations stemming from the Program Interview.

Programs will pay $500 with every renewal to maintain approval. This fee will be used to help offset the administrative costs of assessing and overseeing the fellowships.

Yearly Applications

Applications will be due yearly on July 1. Applications received after July 1 will be included in the following year’s application cycle deadline. The RTC will have up to two years review the application, grant Provisional Approval Contingent Upon Program Interview, schedule a Program Interview, and grant or deny Full Approval.

  • Example: If a Program Application is received July 15, 2018 or thereafter, that application will fall under the July 1, 2019 application cycle deadline and the RTC will have until July 1, 2021 to review the application, grant Provisional Approval Contingent Upon Program Interview, schedule a Program Interview and grant or deny Full Approval, provided the program meets the criteria for each.

Common Program Requirements

Program Director

All fellowship programs must have a single, dedicated fellowship program director (PD) with authority and accountability for the operation of the program. The PD must be a fellow of the ARS and be in good standing with the ARS. The PD must have a valid, unrestricted, medical license and appropriate hospital privileges. The PD must have at least 5 years of clinical experience beyond their final year of training at the time of application submission. The PD must administer and maintain an educational environment conducive to educating fellows. The PD must ensure availability of all personnel for effective fellowship administration. They must also ensure adequate resources are available for the fellows. The PD is responsible for ensuring the requirements of the RTC are met and for providing the required, as well as any additional requested, documentation to the RTC.

Case Logs

Fellowships will be required to submit two years’ worth of case logs for past fellows, OR two years of faculty case logs in the setting of new fellowships, to ensure an adequate number of neurorhinologic and advanced rhinological procedures. See section C6 for an example of a case log. Programs are mandated to use the attached Case Log form. No PHI is to be included in case logs. Please note section D.3 asks for total faculty numbers for the past 12 months. This is cases done by ALL faculty members, not just the fellows. These are a separate set of data and may be used to cross reference fellow case numbers.

Curriculum and Goals and Objectives

All fellowships must develop a written curriculum as well as written goals and objectives for the trainees. The curriculum must contain overall goals for the program, regularly scheduled didactics/conferences and delineation of fellow responsibilities for patient care and management. See section C1 for an example. Programs are not mandated to use the attached examples. These are provided for their use if so desired.

Evaluation of faculty, programs and trainees

All fellowships must develop written evaluations for twice yearly evaluation of the trainees by faculty. The timing of these evaluations is at the discretion of the programs, however, must be done at least twice during the fellowship year. Faculty must evaluate fellow performance in a timely manner, providing objective assessment of competence in patient care and surgical skills. Evaluations of the trainees must be made available during the Program Interview as well as for any renewal applications. See section C4 for a fellow evaluation example. Programs are not mandated to use the attached examples. These are provided for their use if so desired.

All fellowships must develop written evaluations for yearly evaluation of the program and faculty by the trainees. Fellows must have the opportunity to evaluate the faculty as well as the program confidentially and in writing at least once annually. This evaluation must be sent directly and confidentially to the RTC. This has 3 components: Evaluation of the Program, evaluation of the Faculty, and a record of Operative Case logs. See section C2 for an example of a faculty evaluation form and section C3 for a program evaluation form. Programs are not mandated to use the attached examples. These are provided for their use if so desired. A specific Case Log forms is, however, mandated. See section C6 for the case log template.

The evaluations completed by the trainees must be submitted directly to the RTC to maintain confidentiality. They should be sent to: The Chair of the RTC, care of [email protected]can-rhinologic.org or via U.S. Mail to:

Chair of the RTC
c/o Wendi Perez
Executive Administrator of the ARS
PO Box 269
Oak Ridge, NJ 07438

Program Self-Evaluation

All programs must complete self-evaluations on a yearly basis. These must be made available for program renewal applications and Program Interviews. These require documented evidence of periodic self-evaluation of the program in relation to the educational goals, the needs of the trainees and the teaching responsibilities of the faculty. This evaluation should include an assessment of the balance between the educational and service components of the program. We encourage all programs to complete a Self-Evaluation prior to the initial application. Please see section C5 for an example of the Program Self-Evaluation. Programs are not mandated to use the attached examples. These are provided for their use if so desired.

Program Interviews

All programs will be evaluated by Program Interviews following receipt of Provisional Approval Contingent Upon Program Interview.

As mentioned, Provisional Approval will be based on the Program Application. If Provisional Approval Contingent Upon Program Interview is granted, the program will be invited to schedule a Program Interview. Following a Program Interview that results in a favorable vote, Full Approval will be granted. Full Approval may last for up to 5 years pending citations issued stemming from the Program Interview.

Program Interviews may be completed by a web interview or as an in-person interview. These will be decided on a case by case basis at the discretion of the RTC.

During the initial Program Interviews and any subsequent Interviews, the RTC analyzes the program’s strengths and weaknesses to ensure that adherence to the core curriculum, adequate faculty participation, caseload, and overall quality are all maintained.

Interviews will last approximately one hour and will require the presence of the Fellowship Director, any fellowship faculty that are able to participate, and the current fellow (if applicable).

Programs must provide to the RTC all fellowship related documents including, but not limited to, fellow evaluations by faculty, case logs, didactic/conference schedules, fellowship self-evaluations, fellowship goals and objectives. Failure to produce requested fellowship documents will result in a citation for the program.

Program Interviews will be structured per the attached document (RTC Program Interview Outline).

Standardized Forms (section C) are completed by the program in advance and the RTC is responsible for completing and submitting a structured report following the Program Interview.

Additional Program Interviews may occur with significant program changes or upon recommendation of the RTC. Potential Triggers for a Program Interview include but are not limited to: a change in Program Director, a change in the number of fellows, a significant change in the associate faculty, insufficient case logs, program complaints, failure to address previous citations, and conflicts with the residency program (where applicable).

Please note, Program Interviews are designed to be for verification purposes only, not for punitive reasons.

Program Interviewers

Program Interviewers will be made up of RTC members. All interviewers will be educated on conducting a Program Interview by a learning module outlining the goals and objectives of a Program Interview.

Application

Download the application