Egyptian curriculum and assessment protocol for postgraduate study in otorhinolaryngology, head and neck surgery advanced training

Postgraduate medical education worldwide is now governed by academic standards that describe the qualities and abilities of graduates. We fi rst defi ned these standards for the general and professional competencies expected from our graduates in otolaryngology upon successful completion of training. Th ese expectations are clearly refl ected in the otolaryngology curriculum. Th e curriculum describes what trainees will know and be able to do upon completion of training.

Th e primary aim of our work is to develop an Egyptian program to produce competent postgraduate ENT doctors.
Postgraduate medical education worldwide is now governed by academic standards that describe the qualities and abilities of graduates. We fi rst defi ned these standards for the general and professional competencies expected from our graduates in otolaryngology upon successful completion of training. Th ese expectations are clearly refl ected in the otolaryngology curriculum. Th e curriculum describes what trainees will know and be able to do upon completion of training.
All topics covered during practical and theoretical studies are outlined in a simplifi ed manner that will aid candidates of postgraduate otorhinolaryngological practice. Th is will help guide trainees in their readings and their choice of learning activities. In addition, all required clinical cases and procedures are listed, together with expected performance at various stages of training.
Th is curriculum will be constantly revised and updated. Th e examination will not normally test areas that are not clearly or implicitly included in the curriculum, but it should be noted that research and changes in the medical environment might sometimes lead to changes in scientifi c theory and clinical practice before the curriculum is updated to refl ect them.
We divided the curriculum into seven main themes: Applied basic science, Pediatric otolaryngology, Head and neck surgery, Otology, Rhinology, Skull base and neuro-otology, and miscellaneous topics in otorhinolaryngology.
Each theme has three pillars of competence: Knowledge (information stored in a learner's mind; they either have it or not); Clinical skills (these are actions that a person performs in a competent way to achieve a goal; skills range from none to mastery); and Attitude (a feeling about a situation based on knowledge and experience that results in an action toward that situation). All of them together defi ne the main objective for each Intended Learning Outcome (ILO).
Th en we assigned a weight for every ILO using an action verb, as action verbs defi ne the depth of knowledge required for each ILO -for example, for an imperative subject about which the trainee must know all details we use the action verb 'discuss', and for others about which the candidate needs to know only a little we use 'enumerate' or 'outline'. We used other suitable action verbs for clinical skills and attitude.
Our work has been assessed and used by the Egyptian Board (fellowship) of ENT and has been used for the accreditation of the Egyptian Board (fellowship) of ENT program by the Royal College of Surgeons in Ireland (RCSI) since 11 July 2011 to date.

Otolaryngology, head and neck surgery curriculum
Th e Egyptian Fellowship Board and the Otolaryngology Scientifi c Council worked collaboratively and closely to make this curriculum available for trainees' guidance and support.
Postgraduate medical education worldwide is now governed by academic standards that describe the qualities and abilities of graduates. In addition, there are standards for the training processes, trainers' selection, and methods of assessment to ensure transparency and clarify expectations.
Th e Egyptian Fellowship Board has already defi ned and published its standards for the general and professional competencies expected from our graduates in diff erent specialties upon successful completion of training. Th ese expectations are clearly refl ected in the otolaryngology curriculum.
Th e curriculum describes what trainees will know and be able to do upon completion of training. In addition, methods of teaching and learning needed to deliver the curriculum are outlined. Th e curriculum also describes in detail, in 'Th e training rules and regulations section', expectations from trainees during their rotations. Methods of assessment and examination regulations are also available in the last section of the curriculum.
All topics covered during practical and theoretical studies are outlined. Th is will help guide trainees in their readings and their choice of learning activities. In addition, all required clinical cases and procedures are listed, together with expected performance at various stages of training.
To help our trainers and supervisors and maximize benefi ts, we provided a guide for required lectures at various training stages. Mandatory courses are also mentioned, and the Egyptian Fellowship Board will work closely with otolaryngology scientifi c council to ensure proper organization of courses at appropriate training stages.
We hope that all our trainees, trainers, and educational supervisors will follow the guides provided in the curriculum and cooperate with Th e Egyptian Fellowship Board and Otolaryngology Scientifi c Council to implement the curriculum in the best way.

Secretary General Higher Committee of Medical Specialties
References Th e committees consulted international and regional curricula in otolaryngology. Th e external references for the development of this curriculum are as follows: (1)

Oncology Objective
To understand pathological processes as they present in common oncological pathologies.
Demonstrate an understanding of cancer staging in relation to otorhinolaryngology. K1.4.2 List the principles of chemotherapy and radiotherapy in relation to otorhinolaryngology.

Pediatric otolaryngology Objective
To understand the etiology, presenting signs, symptoms, and management of common pediatric ORL conditions. Th is module gives some indication of the breadth and depth of required knowledge and surgical skills. Th e list should not be considered fully inclusive or exhaustive. Advise the patient/parents or caregivers of the treatment options, discuss risks, potential benefi ts, and potential complications, and obtain informed consent. Advise the patient/parents or caregivers of the treatment options. A2.8. 3 Discuss risks, potential benefi ts, and potential complications. A2.8.4

Acute otitis media in children
Obtain informed consent. A2.8. 5 Defi ne the role of extended teamwork.
Attitude (A2.14) A2.14.1 Advise the patient of the treatment options and risks. Perform independently, but may need help with, the excision of branchial cyst. SS2.14 Perform independently, but may need help with, endoscopic laser surgery for airway diseases.

Head and neck Objective
To understand the etiology, presenting signs, symptoms, and management of common head and neck conditions. Th is module gives some indication of the breadth and depth of required knowledge and surgical skills. Th e list should not be considered fully inclusive or exhaustive. Assess the patients with critical airways. CS3.8. 3 Competently perform endoscopic assessment of the airway and intubation.

Salivary gland disease
Advise the patient of the treatment options. A3.8. 2 Work with anesthetists in the 'shared airway'. A3.8. 3 Discuss risks, potential benefi ts, and potential complications and obtain informed consent. Assist in fi ne needle aspiration cytology. SS3.20

Objective
To understand the etiology, presenting signs, symptoms, and management of common ORL conditions. Th is module gives some indication of the breadth and depth of required knowledge and clinical and surgical skills. Th e list should not be considered fully inclusive or exhaustive. Discuss potential complications, risks, and potential benefi ts and obtain informed consent. Describe surgical approaches to the inner ear (see also K2.8.1). K4.9. 4 Describe the principles of osseointegration (see also K2.8.1). K4.9.5

Acute otitis media in adults
Explain speech-processing strategies.

K4.10.5
Outline the principles of management and rehabilitation for facial paralysis in adults. Discuss risks, potential benefi ts, and potential complications and obtain informed consent. A4.12. 4 Refer appropriately to other specialties when needed.

Objective
To understand the etiology, presenting signs, symptoms, and management of common rhinological conditions. Th is module gives some indication of the breadth and depth of required knowledge and surgical skills. Th e list should not be considered fully inclusive or exhaustive. Outline the anatomy and physiology of the nose (in relation to smell). K5.14. 2 Describe the classifi cation of olfactory disorder and causes of smell disturbance. K5.14. 3 Describe the clinical evaluation of smell function and diff erent lines of management.
Attitude (A5.14) A5.14.1 Demonstrate communication skills and empathy, including teamwork and issues relating to practice. A5.14. 2 Advise the patient/parents or caregivers of the prognosis. A5.14. 3 Discuss risks, potential benefi ts, and potential complications and obtain informed consent. Perform independently surgical removal of foreign bodies from the nose and sinuses. SS5. 5 Perform independently endoscopic sinus surgery. SS5. 6 Manage complications of sinus disease (e.g. orbital cellulites). SS5. 7 Assist in repair of CSF leaks and other complications. SS5.8

Orbital and optic nerve decompression
Assist in rhinoplasty and septorhinoplasty (reduction, augmentation, including harvesting of grafts). SS5.9 Observe and assist in surgery for choanal atresia. SS5.10 Observe surgical interventions for nasal and paranasal sinus tumor surgery.

Skull base and neuro-otology Objective
To understand the etiology, presenting signs, symptoms, and management of common skull base conditions. Th is module gives some indication of the breadth and depth of required knowledge and clinical and surgical skills. Th e list should not be considered fully inclusive or exhaustive. Discuss risks, potential benefi ts, and potential complications and obtain informed consent. Analyze fMRI.

Positron emission tomography (PET) Objective
To understand the basics of PET scanning and integrated PET/CT scanning and interpret their fi ndings in relation to the practice of head and neck oncology that surgeons will encounter during the management of both adult and pediatric cancer patients. Outline nononcological applications of PET scanning with special emphasis in cochlear implantation procedures. K7.2.5 Understand the concept and benefi ts of using integrated PET/CT.