Fellowship Review by Dr Margot Den Hondt (Fellow August 2018 – July 2019)

Facial surgical oncology and reconstructive surgery fellowship at Chris O’Brien Lifehouse in Sydney, Australia
Prepared by Dr Margot Den Hondt, Fellow August 2018 – July 2019

THE FELLOWSHIP

The Facial Surgical Oncology and Reconstructive Surgery Fellowship is supervised by A/Prof Sydney Ch’ng. The fellowship is designed for ambitious candidates who intend to pursue a career in reconstructive microsurgery. The position provides excellent surgical experience in reconstructive head and neck surgery, especially following management of advanced skin cancers. Complex resection of facial cancers, free flap and complex non-microsurgery reconstruction, facial nerve surgery, management of regional nodal basin in the head and neck, i.e., sentinel node biopsy, parotidectomies, and neck dissections form the majority of the caseload.

After completing her Plastic and Reconstructive Surgery training (FRACS), A/Prof Sydney Ch’ng undertook 12 months of Fellowship training in Head and Neck Surgical Oncology at the Sydney Head and Neck Cancer Institute (SHNCI). Following that, she was a Fellow at Chang Gung Memorial Hospital, Taiwan in Maxillofacial Trauma for 6 months, before embarking on yet another 12-month American Society of Reconstructive Microsurgery Fellowship at The University of Texas MD Anderson Cancer Center in Houston.

CHRIS O’BRIEN LIFEHOUSE CANCER CENTRE – OUTSTANDING TEAMWORK

The Chris O’Brien Lifehouse (COBL) Cancer Centre is a unique state-of-the-art comprehensive cancer centre. COBL is a teaching hospital affiliated with the University of Sydney and the Royal Prince Alfred Hospital (RPA), located across the road.

Based on major Head and Neck caseload, the Head and Neck department of COBL is the busiest in Australia. Focusing on integrative care, it brings together over forty highly skilled medical and allied health professionals including surgeons, radiation and medical oncologists, dental specialists, speech therapists, specialist nurses and dieticians, along with research scientists and a data manager. The department has a prospectively maintained database dating back to 1980’s. It has a robust weekly multidisciplinary team meeting.

The department is composed of eight Head and Neck Surgeons; A/Prof Carsten Palme (Head of Department), A/Prof Sydney Ch’ng, Prof Jonathan Clark, Dr Anthony Clifford, A/Prof Michael Elliott, Dr Hubert Low, Dr Kerwin Shannon and Dr James Wykes, all working together in close partnership – committed to providing patients with the best possible care. A/Prof Ch’ng is the only combined Plastic and Reconstructive, and Head and Neck Surgeon in the team. In 2018, the department performed 238 free flaps, and approximately the same number of major Head and Neck resections with complex non-microsurgical reconstruction. Each consultant has a different sub-specialty interest and expertise, A/Prof Ch’ng’s primary focus is management of cutaneous malignancies, ranging from small facial lesions on cosmetically sensitive subsites to advanced lesions that require major craniofacial resection and complex reconstruction including facial reanimation, and metastatic disease that require parotidectomy and neck dissection.

Four Fellows are active at the department. The three other Fellows are selected via the SHNCI. Because of the high operating volume, every fellow has a dedicated roster with specific consultants, and little to no competition exists.

A/Prof Sydney Ch’ng is also affiliated with the Melanoma Institute Australia (MIA). MIA is a world-class, integrated facility for treatment and research of melanoma, housing the largest melanoma patient database in the world. MIA is integral in many of the international multicenter clinical trials, which have shaped melanoma management as we know it today.

At Royal Prince Alfred Hospital (RPA), a tertiary referral centre and a trauma centre, A/Prof Ch’ng is often consulted for complex reconstruction needs outside the head and neck region, including for the torso and extremity, either following oncological resection or trauma.

APPLICATION PROCESS: START EARLY

The pathway to be accredited in order to treat patients for International Medical Graduates (IMG) can be lengthy. If English is not the primary language of the applicant, successful completion of an English language competency test such as IELTS Academic Module at the start of the application is a prerequisite. It is highly recommended to complete this early (1 year in advance), as the test results will be needed throughout the application process for visa nomination, endorsement by the Royal Australasian College of Surgeons (RACS) and approval by the Australian Health Practitioner Regulation Agency (AHPRA).

Ambitious applicants for the fellowship will be evaluated based on their clinical experience, research and academic background. A personal interview can be conducted via Skype or FaceTime. Additionally, a visit to the unit as an observer is encouraged.

Application is sought from candidates who have completed their surgical training or those who intend to integrate the Fellowship into their surgical training (final year), especially if they have had considerable exposure to microvascular reconstruction. At the start of the program, all Fellows complete a microsurgical course at the Institute of Academic Surgery (IAS). There is access to a wet laboratory at IAS, where microsurgical skills can be practiced if required.

DAYTIME AND ON CALL DUTIES

The Fellow is responsible for the daily inpatient ward rounds, starting at 7 AM. He/she is supervised directly by A/Prof Sydney Ch’ng, but will also work under some of the other surgeons (to a lesser extent). The Fellow actively participates in the preoperative planning, surgery and postoperative care of patients. Outpatient clinics and operating sessions are mainly located at COBL. On Friday mornings, melanoma-related cases are discussed at the MDT meeting at MIA. A Resident and a Registrar at COBL are primarily responsible for daily administrative work on the ward so that the Fellow can focus on his/her own learning experience.

The on-calls, organized on a weekly basis, are divided among the four fellows. Starting on Friday, they include ward rounds on the weekend and public holidays, and being available for inpatient and outpatient queries, and unexpected revisional surgeries. Patient progress and potential problems are discussed with the treating surgeon. The Fellow on call also organizes the weekly Head and Neck MDT meeting held on Monday mornings. Furthermore, the department has three-monthly Morbidity and Mortality meetings, where critical learning points are discussed in a blame-free environment.

The Fellow participates in the management of both public and private patients. The Fellow is expected to scrub in on every case and is actively involved, as a true part of the team. The responsibility of the Fellow increases stepwise with experience. Initially, he/she may only perform part of a procedure but will work towards operating independently. The Fellowship provides an excellent opportunity to upgrade microsurgical skills.

Despite the heavy workload, supervision and guidance are provided at all times. No matter what time of the day or night, A/Prof Ch’ng is committed to share her knowledge, discuss potential issues and support the Fellow’s growth.

RESEARCH

Access to databases affords opportunities for research. The Fellow updates A/Prof Ch’ng’s individual database and the Head and Neck database on a regular basis. He/she is expected to undertake at least one research project during the Fellowship. There is rostered protected research time.

SOCIAL LIFE

Chris O’Brien Lifehouse is located in Camperdown, an inner suburb of Sydney. Bars and restaurants are located just around the corner. Transfer to other hospitals is feasible by public transport. It is strongly recommended to find accommodation close to COBL. Rental prices are fairly high in Sydney; the mean rent for a non-furnished one-bedroom apartment in Camperdown is around AUD 600 per week.

Australia is a magnificent country; the warm-hearted people, enjoyable climate and pristine nature will leave no one unimpressed.

CONCLUSION

My experience this year has exceeded my expectations in every possible way. The Fellowship was excellent because of exposure to the high level of surgical expertise, the level of structured teaching, the hands-on experience with incremental responsibility, and the research opportunities. This all took place in a very collegial atmosphere amongst colleagues and patients. It is difficult to not fall in love with this place.

Prof Ch’ng’s motto is that we have to keep challenging ourselves to strive for excellence. Her professional background, emotional intelligence, anatomical knowledge, technical expertise, and involvement in multiple world-class organizations ensure the quality of this fellowship.

For more information about the formal aspects of the Fellowship, please contact A/Prof Sydney Ch’ng at sydney.chng@sydney.edu.au

If you are after a more informal discussion about my personal experience, feel free to contact me at margot_dh@hotmail.com