Endocrine Fellowship

Thyroid composite

1. History

Augusta University has a rich tradition of robust thyroid surgery, dating back to the era of Arlie Mansberger. The Thyroid program was revitalized in 2004 with the inauguration of the Augusta University Thyroid Center, which is a collaborative effort between Otolaryngology-Head and Neck Surgery, Endocrinology, and Nuclear Medicine.

The past five years have seen the advent of intra-operative laryngeal nerve monitoring, endoscopic thyroid and parathyroid surgery, outpatient thyroidectomy and parathyroidectomy, and introduction of novel technologies like the Harmonic scalpel. Augusta University has quickly moved to the forefront of academic health centers in pioneering new surgical techniques and perfecting old ones.

Coincident with the development of a first-class endocrine surgery program, the comprehensive Head and Neck Tumor Board took shape (starting in the fall of 2002), and has become an acknowledged leader in the Southeast for the treatment of head and neck cancers. The Tumor Board is now directed by Michael Groves, J. Kenneth Byrd, and Jimmy J. Brown and more than 300 patients are prospectively evaluated each year. This is done in a multidisciplinary fashion with involvement of plastic surgery, oral surgery, radiation oncology, medical oncology, pathology, radiology, and speech-language pathology. With the emergence of chemoradiotherapy treatments, the surgical emphasis is on salvage surgery, endoscopic surgical techniques, conservation laryngeal surgery, and salivary gland surgery. State-of-the-art techniques are practiced, and a robust clinical research program has been developed.

With the amalgamation of the medical and surgical experiences in endocrine and head and neck surgery, it was natural that an advanced fellowship in endocrine-head and neck surgery should be developed.

2. Duration

The Endocrine Head and Neck Surgery fellowship is a one-year fellowship with an anticipated start date of July 1st each year.

3. Prerequisite Training/Selection Criteria

Applicants with one of the following qualifications are eligible for appointment to Augusta University Endocrine Head and Neck Surgery Fellowship:

  • Board eligible/Board certified Otolaryngologists trained in the United States or Canada.
  • Graduates of Otolaryngology Residency Programs outside the United States and Canada who meet the following qualification: Have received a current valid certificate from the Educational Commission for Foreign Medical Graduates.

Fellows will be selected based on their ability and knowledge within the field of Otolaryngology and Thyroid Diseases. There is specifically no discrimination on the basis of age, gender, ethnic background, religious beliefs, or sexual orientation. Recognizing the superb academic opportunities available within the department, and the institution at large, Augusta University particularly encourages applications from individuals with an interest and a proven track record of excellence in scholarly pursuits. All applications received by Augusta University are independently reviewed by at least two faculty members, and decisions regarding interviews are made by consensus.

Interested applicants should contact:

David J. Terris, M.D., F.A.C.S.
Regents Professor
Department of Otolaryngology-Head and Neck Surgery
Augusta University
1120 Fifteenth Street, BP-4109
Augusta, Georgia 30912-4060
Phone: (706) 721-6100
Fax: (706) 721-0112
Email: dterris@augusta.edu

4. Goals and Objectives of Training

The objective of this one-year fellowship is to provide a broad experience in the clinical and basic science aspects of thyroid and parathyroid diseases (and to a lesser extent head and neck cancers) to interested and qualified applicants. Through our fellowship training we will develop leaders in the field who will help to improve current standards of patient care, educate others, and conduct cutting-edge research. This program is carried out in such a way as not to adversely affect the current resident training experience.

The fellowship is designed to provide excellent training in the recognition, diagnosis, and medical and surgical management of thyroid and parathyroid diseases, salivary gland diseases, and head and neck cancers, with particular emphasis on minimally invasive and function-sparing techniques. Fellows will have exposure to ultrasound techniques and fine needle aspiration biopsies. The specific surgical techniques that will be included in the program are conventional thyroidectomy, minimally invasive thyroidectomy, endoscopic thyroidectomy, conventional and endoscopic parathyroidectomy, parotid surgery (including use of the facelift incision), use of intra-operative laryngeal nerve monitoring and Harmonic technology, and performance of composite resections and neck dissections. The Fellows will also have exposure to in-office transnasal esophagoscopy with training by Gregory Postma, one of the pioneers of this technique.

5. Program Certifications

The Endocrine Head and Neck Surgery Fellowship is a non-accredited program affiliated with the Department of Otolaryngology-Head and Neck Surgery at Augusta University and its accredited residency program. As of today, there are no ACGME-accredited Endocrine Head and Neck Surgery fellowship programs in the United States.

6. Resources

1. Teaching Staff

  • David Terris, MD, Regents Professor, Department of Otolaryngology-Head and Neck Surgery, Augusta University.
  • Gregory N. Postma, MD, Professor and Vice Chairman, Department of Otolaryngology-Head and Neck Surgery, Augusta University.
  • Edward Chin, MD, Associate Professor, Division of Endocrine and Nutrition, Augusta University.
  • Anthony Mulloy, DO, Section Chief, Division of Endocrine and Nutrition, Augusta University.
  • Laura Mulloy, MD, Section Chief, Division of Nephrology, Augusta University.
  • William Paulson, MD, Professor, Division of Nephrology, Augusta University.
  • Jason White, MD, Assistant Professor, Division of Nephrology, Augusta University.

2. Facilities

The fellow spends time in three hospitals:

  • Augusta University Health

As the teaching hospital of Augusta University, the Augusta University Medical Center includes a 520-bed hospital, Ambulatory Care Center with over 80 outpatient clinics in one convenient setting, Specialized Care Center housing a 13-county regional trauma center, Comprehensive Cancer Program, Emergency and Express Care Services.

The Children's Hospital of Georgia has 149-beds, including one of five Neonatal Intensive Care Units in the state.

  • Veterans Administration Medical Center

The Augusta VAMC primary service area includes 17 counties in Georgia and seven counties in South Carolina; but as a member of the Atlanta Veterans Integrated Service Network (VISN7), veterans who live as far away as Alabama may be cared for in the Augusta VAMC. The Downtown Division adjacent to Augusta University has 155 beds (52 medicine, 37 surgery, six neurology, and 60 spinal cord injury).

7. Educational Program Basic Curriculum

  • Clinical

The fellow participates “hands on” in all endocrine surgery office hours, Head and Neck Tumor Board, and in the operating room. The Fellow's clinical schedule mirrors that of Dr. Terris. Specifically, the fellow receives clinical training during two endocrine surgery half-day clinics per week, in the half-day Head and Neck Tumor Board once per week, and in the operating room three days per week. Additional clinical teaching takes place during hospital rounds on endocrine and head and neck surgery patients, and during the care of emergency endocrine surgery cases. Time will be allocated approximately one half-day per week to work with the Endocrinology Team in their offices. The fellow is clinically involved in call from home in the rotation of the faculty call.

  • Research

The fellowship provides numerous opportunities for clinical research in the areas of minimally invasive thyroid surgical techniques, endoscopic and robotic thyroid surgery, thyroid and parathyroid proteomics, outpatient thyroid and parathyroid surgery, management of thyroid cancer, and novel techniques for the diagnosis and management of patients with thyroid and parathyroid diseases. Fellows are encouraged to develop research proposals under the direction of the Fellowship Director with department funding available to support travel to present work at the major meetings of the American Thyroid Association, the American Academy of Otolaryngology-Head and Neck Surgery and the Triological Society.

  • Fellow Supervision and Patient Care Responsibilities

Fellows are closely supervised during the first quarter of the Fellowship. As the Fellow matures, patient care independence is allowed, still under the supervision of the Fellowship Director. At the completion of the Fellowship, the Fellow is able to independently evaluate and diagnose patients with thyroid and parathyroid diseases and head and neck cancer.

Fellow patient care responsibilities:

  • See and evaluate endocrine surgery patients in the endocrine surgery clinics.
  • See and evaluate head and neck cancer patients in the Head and Neck Tumor Board.
  • Supervise the preparation process for patients requiring endocrine or head and neck surgery.
  • Participate in endocrine and head and neck surgery cases in the operating room.
  • Round on in-hospital endocrine and head and neck surgery patients twice daily.
  • Supervise otolaryngology residents on the endocrine and head and neck surgery rotation.
  • Participate in the care of emergency endocrine and head and neck surgery patients.
  • Procedural Requirements

The following procedures are performed during the fellowship:

  • Thyroidectomy: 225
  • Parathyroidectomy: 60
  • Neck Dissection: 25
  • Composite Resection: 10
  • Endoscopies: 100

Didactic Components

  • Attend all department conferences pertaining to Endocrine and Head and Neck Surgery.
  • Assist in implementation of annual CME programs.
  • Give two otolaryngology resident lectures per year. Lecture topics may include: Introduction to Thyroid and Parathyroid Disorders, Thyroid Surgical Techniques, and Parathyroid Surgical Techniques.
  • Serve as a peer reviewer of a minimum of four journal articles per year.
  • Attend otolaryngology journal club every month and proctor endocrine and head and neck surgery papers being discussed.
  • Supervise resident cadaver training dissection.
  • Attend all otolaryngology grand rounds.

8. Evaluations

  • Fellow Evaluation

The Fellow will be evaluated on the following items using a scale from 1 to 5, 1 being the lowest or very poor performance and 5 being the highest or excellent performance:

Patient care - compassionate, appropriate, and effective for the treatment of health problems and the promotion of health

Medical knowledge - established and evolving biomedical, clinical, and cognate (e.g., epidemiological and social-behavioral) sciences and the application of this knowledge to patient care

Practice-based learning and improvement - involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care

Interpersonal and communication skills - that result in effective information exchange and teaming with patients, their families, and other health professionals

Professionalism - as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population

Systems-based practice - as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value

  • Faculty Evaluation

The Fellow provides verbal and/or written meaningful feedback to the Director of the Fellowship regarding ways of improving the quality and effectiveness of the Fellowship (PDF available as a link).