Scientilic Council
Dr. Abdulmonem Hassan
Alshaikh"""""""""Chairman
of the Council'
Dr. Sateh Fahad Al Dhahry ...........Chairman, Training and Accreditation
Committee.
Prof. Nabil Nizam Aldeen zahet.........chairman, Examination committee.
Daghistani.............."'
""""""""Member'
"""""""",Member'
Prof. Khalid Abdulrahman Al Mazroa....
"""'Member'
Prof. Khatid lbrahim Al Noury.....
""""""""Member'
Prof. Abdulrahman Abdallah llagr........
""'Member'
Prof. Laila Mohammed Telmesani....
"Member'
Dr. Osama Abdulrahman Marglani.....
................'"""""'Member'
Dr. Hafa Sulaiman Al Naser......
"'Member'
Dr. Bandar Mohammed Al Qahtani...
"Member'
Dr. Khatid Ali Alshehri..
Dr. Ali Saeed At Qahtani.......
"""""""Member'
"Member'
Dr. Mohammed Abdallah Alsayaeri.....
Prof. Kamal Jalal
lntroduction
The Saudi Board of Otorhinolaryngology and Head and Neck Surgery (ORL-H&NS) programme
consists of a five years period. The trainee at the end of the programme will have a sound base of
knowledge in the principles of the diseases of the specialty and their methods of management.
The trainies will acquire clinical and technical experience that will qualify them to practice the
specialty in a professional and competent safe manner particularly in relation to common
diseases and emergencies of the specialty
Obiectives:
a- General Objectives:
The main objective is to graduate practitioners in the specialty of Otorhinolaryngology and
Head Neck Surgery, competent in the specialty and able to practice independently.
b- Specific Objectives:
Atihe end oflhe programme the trainees will gain the following skills and capabilities:
l- Possess sound background knowledge in the principles of ORL-HNS.
2- Ableto obtain a good history of the disease and conduct efficient physical
examination.
3- Formulate a reasonable and comprehensive differential diagnosis. The trainees will
also be able to recognize common and rare otorhinolaryngology disorders specially
those cases that are amenable to treatment.
4- Recognize emergency situations and manage them effectively.
5- Able io chose reievant investigations in each case and offer accurate interpretation of
the results.
6-Able to treat common cases of otorhinolaryngology with a sound knowledge of other
forms of treatment.
7-Possess essential skills in performing therapeutic and diagnostic surgical procedures.
8- Be able to communicate well with patients, relatives, and colleagues.
9-Be able to keep orderly and proper medical records.
l0- Participate in Continuous Medical Education and keep abreast of latest development
in the field of the sPecialtY.
I I - Offers advise about the specialty to colleagues from other disciplines.
12-Enjoy high professional and ethical standards.
Admission Requirements
In order to join the programme the candidate has to fulfill the following requirements:
1-Holds a degree from a recognized university.
2- Successfully completed a rotating internship in recognized hospitals.
3- Pass an admission examination and an interview.
4- provides three recommendation letters from consultants confirming the suitability of the
candidate for training in the field of the specialty.
join a full
5- provides a letter from a sponsoring organization approving that the candidate can
time training programme for the whole period of the programme ( 5 years).
6-Signs a contract .tutirg that he/she will abide by all the rules of the Saudi Commission for
Health Specialties.
7-Has to register with the Saudi Commission for Health Specialties.
6. Should pass a medical fitness check up.
Training Requirements
l- Training is a full time programme ( 5 years). Residents shall be enrolled in continuous full
time training for the whole of the five years period. The candidate will abide by the rules of
the commission and scientific board. ( Please see index).
2-The training will be conducted in an institution accredited by the Saudi Board.
3- Training shall be comprehensive and includes all aspects of hospital activities i.e.
inpatients, outpatients, emergency room, operating theatre, rounds, scientific
activities within the departments.
4- The trainee shall be involved in direct patient care with gradual progression of
responsibilities.
Programme Structure
The training programme is of five years which consists of:
1- One year in general surgery.
2- Four years of ORL-HNS training
I- One vear surgery training
a. General
as
surgery.
b- lCU.
c--Plastic surgery.
d-Neurosurgery.
e- Paediatric Surger.
follows:
..Three months.
......Three months.
....Two months.
......One month.
..One month.
e- Emergency Medicine.................One month.
e- Annual
holiday.
.......One month.
Objectives of the General Surgery Rotation:
By the end of the rotation the trainee shall be able to:
1- Keenly appreciate the need for pre-operative evaluation and postoperative care ofthe surgical patient and conduct them professionally
and properly.
2-Manage initially common surgical emergencies and seek further help
and guidance.
3- Be aware of the importance of conditions like bleeding, shock,
infections ...etc in the in the diagnosis and management of general
surgical conditions.
4- Observe surgical procedures and gradually assist and then perform
them.
5-Understand the principles of plastic and reconstructive surgery.
6- Be aware of the concept of combined team work.
7- Be aware of the surgical concepts in sorting out patients problems.
8- Be aware of the basic concept of surgical ICU and its utilization.
General rule: The evaluation should be directed to serve the principles of surgery as outlined
above.
II- Four vears ORL residencv ( R2-R5).
Objectives of the four years residency training programme:
A- Junior Residencv Phase ( R2 :12 months and R3: 12 months):
Junior residents will spend 2 years training in ORL HNS in different
hospitals recognized by the SCHS.
The resident is expected to acquire sound knowledge and clinical experience in the specialty.
The resident will be attached to a senior member of staff in the department.
Responsibilities;
1- Be able to obtain proper history and perform physical examination
This includes ( but not limited to):
* Use of proper illumination sources for examination e.g.
head light,otoscope.
* Use of flexible and rigid nasopharyngoscope
* Using the mirror to perform indirect laryngosocpy.
* Use of the microscope
* Evaluation of cranial nerves functions.
2- Perform and interpret audiological and vestibular tests. The R2 resident will attend the
Audiology clinic for at least four weeks under the supervision of a senior audiologist.
3- Management of common ORL HN emergencies under supervision (epistaxis;airway
conditions e.g. emergency tracheotomy, epiglottitis, croup; deep neck infections; the dizzy
patients; ORL HN trauma...etc.
4- The interpretation of ancillary radiological tests
5- Attendance of temporal bone dissection and endoscopic sinus surgery training courses.
6- Attendance of basic sciences course.
years of training.
7 - Participation in the educational activities is compulsory during the first 2
8- Attendance of local scientific activities is mandatory.
Operative objectives:
i- Cuin experience and proficiency in tonsillectomy, adenoidectomy, myringotomy, insertion
of ventilation tubes, microscopic examination of ears and suctioning, tracheotomy, and
draining an abscess...etc.
ii- Acquire some experience in other procedures e.g. septoplasty, sinus surgery, biopsies. These
will be performed at the end of second and third years of training.
Operative Experience:
i- During these two years the resident has to acquire proper experience
in the following surgical procedures ( Number of cases required in
brackets):
-
Adenotonsillectomy(50).
-
Myringotomy and insertion of ventilation tubes (30).
Microscopic ear examination and suctioning (50).
Septoplasty (30).
Tracheotomy (10).
Abscess incision and drainage (10).
ii- The candidate will acquire experience in the following procedures under adequate
supervision near the end of third year:
1- Rhinology:
The trainee will assist in the following operation:
Rhinoplasty (5).
FESS (5) ( Only after having attended a hands on recognized training courses.
External ethmoidectomY (4).
Caldwell Luc (3).
2- Otology:
The trainee will assist in the following operation
- Myringoplasty ( 5).
-Tympanoplasty (5)
- Mastoidectomy ( 5)
3- Endoscopies ( Excluding FESS)
-
MicrolaryngoscoPY(5)
Bronchoscopy ( 5)
Eosophagoscopy (5)
4-Head & Neck Surgery
-Thyroglossal duct cyst excision (5)
- Sunandibular salivary gland excision ( 5)
B- Senior Residencv Phase ( R4:12 months and R5:12 months:
Senior residents will spend 2 years training in ORL HNS in different
hospitals recognized by the SCHS. The resident will be responsible for managing emergencies
andelective admissions, organizing seminars, journal clubs and clinical meetings.
Participation in the educational activities is compulsory during the last 2 years of training.
Objectives:
phase of the training involves preparing the candidate to start acting independently,
taking on more responsibilities and gaining the experience necessary to achieve these
objective. The clinical judgment and surgical skills attained in the previous years will be fine
t- tris
tuned now.
2-By the end of this period of training the trainee should possess sufficient basic and clinical
knowledge , and technical skills to undertake the management of patients under the
supervision of appropriate staff.
will be responsible for the supervision and teaching ofjunior residents, intems,
and medical students.
3- The trainee
Responsibilities:
o Managing the outpatients clinics.
o Taking care of the in-patients responsibilities which include clerking, completion of
history, physical examination and taking care of the necessary investigations and the
results.
Adhering to the ethics of the profession and guarding the confidentiality of the patients.
Supervising junior residents.
Performing administrative tasks such as the on call rota, , residents holidays schedule,
preparation for the examination, progress notes and case summaries as well as discharge
notes. These activities should not hinder the resident's training.
o Enhancing the surgical skills needed by perfuming most of the standard ORLHNS
procedures.
o The senior trainee should be exposed to all ORL HNS surgical procedures.
o The trainee should attend at least 60 teaching rounds and journal club per year.
o The trainee should perform at least 20 pure tone and tympanometry procedures as well as
5 speech audiometry.
o The trainee should have enough exposure to Speech Pathology and Phoniatrics.
o The trainee should attend at least 10 Mortality and Morbidity meetings in the department
or hospital.
Operative Skills and experience:
The candidate will obtain proficiency in the following:
- Otology:
. Myringoplasty (10)
o Tympanoplasty (10)
o Mastoidectomy(10)
o Stapedectomy (5)
o Assist in Vestibular system conditions
- Head and Neck Surgery:
o Neck Dissection (10)
o Laryngectomy (5)
o Maxillectomy (5)
o Thyroid Surgery (10)
o parotid Surgery (5)
o Submandibular Surgery (10).
o Regional flaps and grafts.
o Zenke r's diverticulum.
o
o
o
- Rhinology
o
o
o
FESS. (20)
External frontoethmoidectomy.
Trephine of frontal the sinus.
-
o
.
Internal maxillary artery ligation.
Sphenopalatine artery ligation.
Facial plastic surgery
:ffi,x#t!'o'
-
-
paediatric
oRL
o
o
o
o
o
Management of scars' (10)
Oesophagoscopy. (20)
Bronchoscopy.(10)
Laryngotracheoplasty (20).
Supraglofficplasty.
Laser Surgery
Departmental Periodic Reports
The training coordinator in the hospital is responsible for providing the department with three
monthly evaluation reports about each trainee. This should include the attendance of all hospital
activities e.g. ward rounds, scientific meetings, tutorials and other activities.
Loe Book
All surgical procedures
attended, assisted and performed by the trainee should be listed in the
log book.
2- All procedures in the log book should be countersigned by the supervisors.
3- The attendance of symposia, conferences, workshops and training courses should be entered
in the log book with copies of certificate of attendance.
4- The trainee should receive this log book at the beginning of the first year of trainiSng.
5- The local Training Committee should revise this book yearly before the promotion
examination to oversee its completion.
6- The Central Committee will not allow the trainee to sit for the final examination if the log
book is not complete and countersigned by all the consultants that the trainee has worked with.
1-
Courses and Scientific Activities
All
trainees
will have to attend the following courses:
l- Basic Sciences
Course at the beginning of the first month of the second year ( R2) of the
programme..
2- Temporal Bone Dissection Course during the first two years of the programme (R2-R3).
3- Endoscopic Sinus Surgery Course during the last two years of the programme (R4-R5).
4- Attendance of the local scientific activities.
o- Revisiuon course in ther last year of the programme.
6- The trainee has to produce certificates of attendance of the above mentioned activities in
1,2,3,4.
7- No trainee shall enter the final written examination unless he/she has produced these
certifi cates of attendance mention ed in 1,2,3,4.
8- The time given for these courses and activities is not included in the yearly study leave See
below).
Vacations. Holidavs and On-Call
l- Trainees are entitled to thirty days vacation annually and one of the Eid Holidays.
2- Trainees are entitled seven days study leave annually.
3- Sick, emergency and maternity leaves should be compensated for during or at the end of
training.
4- On call duty should be on average one out of 4 nights ( minimum of 7 calls per month,24
hours per call except when working in the emergency room).
5- lt is not permitted to link the annual holidays or part of it with the sick leave or scientific or
emergency leaves.
6- The trainee should obtain the leave form from the department of ORL at the hospital. The
leave should be approved by the head of the department and then authenticated by the
chairman of the local training committee. The trainee can start his/her leave only after
completion of this procedure as mentioned above. ( copy of form is included).
N.B.
Trainees are to perform resular duties the dav after 6(on call'n and ensure the continuitv of
patients care.
r- End of rotation evaruation,
'valuation
At the end of each rotation, the supervising consultant/team shall
submit to the training committee a written evaluation of the
resident's performance for that rotation.
2- In training examination:
The programme incorporates an annual written examination as part
of the evaluation process of residents for promotion from one
level to another except for the final year.
3- Annual overall training evaluation:
This includes:
i- Summation of end of 4 rotation evaluations includingquiz,
attendance, presentations for the year (50% of total marks).
ii- Results of annual end of year written examination(50% of total
marks).
50 Marks for the written paper.
50 marks for yearly evaluation.
l-
Promotion
To be promoted from one level to the next, the candidate need to score not less
than 50%o of each of i and ii of item 3 of Evaluation. The total passing mark is
60%.
2- Promotion to senior residency ( from R3 to R4) depends on annual overall
evaluations and passing the first board examination.
3- Rl promotion examination will be held by the ORLHNS Board concentrating
on principles of general surgery.
First year marks are allocated as follow:
Written examination.................50
Yearly evaIuation.....................50
Local training committees will be responsible for supervision of first year trainees.
Board Examinations
The Board examinations consist of two parts.
a- Part
I Board Examination:
1- The examination is held at least once ayear in all training centres.
lied basic sciences and
2- It is written examination consistine of mainl
solrle
3- Candidates are allowed to sit the examination after successful completion
of the second (R2) year of training.
4- Passing Part I of the board examination is a prerequisite for promotion to
senior residency.
5- Candidates are allowed atotal of 3 (three) affempts. Candidates failing
the 3'd attempt will be expelled from the programme unless the local
training committee support a 4th attempt.
b- Part
II Board Examination:
1- Candidates can sit Part II examination after successful completion of
training , as evidenced by an acceptable final-in-training report from the
Central Residency Committee ( CRTC) and passing the promotion
examination.
2- The examination will be held once a year in one or more of the training
centres.
3- No trainee can appear in part II of the board examination till the
completion of two research papers.
3- Part II Examination consists of two parts:
a- Written Examination
1- designed to evaluate knowledge and
clinical judgement. Only successful candidates will proceed to the
clinical/oral examination.
2- The date for this examination is the 4'h Tuesday of October very
year.
3-The candidate can sit the examination after successful completion
of the training period as evidenced by the Central Training
Committee's report and passing the promotion examination.
4-The examination consists of two papers of hundred question
each ( best answer type). Each paper shall cover all aspects of
basic and clinical sciences.
b- ClinicaUOral Examination
1- Designed to test clinical proficiency and judgement in the field
of ORL-HNS.
Z-The date for this examination is the 2nd Saturday of December
every year.
3- The examination consists of many committees that covers all
aspects of the speciality.
Research
It is important to encourage scientific research and publication. It is the duty of the
trainers to guide the trainees in the methodology of scientific research and
choosing the topics. The trainers are also requires to guide the trainees in the
methods of writing a scientific paper.
1- The research should be conducted in three training years ( R2,R3 and R4).
2- The trainees has to produce two scientific researches; an original research paper
and the second may be a case report.
3- An advisor should be appointed for each trainee.
4- No trainee should be allowed to sit the Part II Examination unless he/she has
complied with the above conditions.
( The suggestions from the scientific committee of the Board should be included
here.)
General Resulations:
1- Passing the written examination is a pre-requisite to appear in the
ClinicaV Oral.
2- A candidate who does not successfully compete the Clinical /Oral examination
in the allowed period, has to apply to the Central Training Committee (CTR)for
renewal of his / her eligibility to sit the examination he/she wishes to by at least
six months. The CTC may accept or deny hisftrer application for ayear and will
require the candidates to complete an extra period of training satisfactorily.
3- If the candidate fails to pass the ClinicaVOral Examination during the
appointed period after renewal of eligibility he/she can apply againfor renewal
for another year and his/trer application is treated the same as before.
4- If the candidate cannot pass the ClinicaUOral Examination after the second
renewal ( i.e. a total if five years) he/she cannot apply for renewal again and in
this case has to resit the second written part hence repeat the same time period
following the passing of the second written examination.
Readins
Suggested References Books
1- Bailey Head and Neck Surgery
Otolaryngology
2- Scott-Brown' s Otorhinolaryngology
3-Cummings Otolaryngology Head and Neck Surgery
4 - P apar ella Otolaryngology.
-
N.B.
Latest editions are recorlmended.
The candidate need also to read national and international journals
Certification
Candidates passing the Part
II Board examination will
be awarded the
Neck Sureerv.(SSC ORL).
N.B.
The contents of this booklet of information are guidelines and are to be
considered within the contest General Rules and Regulations of the Saudi
Board as shown in the booklet of Training Regulation and Examination Rules
and Regulation of the Saudi Commission of Health Specialities.
Appendix I:
See the model forms in the
Arabic section
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