Auris Nasus Larynx 41 (2014) 327–330
Contents lists available at ScienceDirect
Auris Nasus Larynx journal homepage: www.elsevier.com/locate/anl
Japanese Board Certification System for head and neck surgeons§ Seiichi Yoshimoto a,*, Torahiko Nakashima b, Takashi Fujii c, Kazuto Matsuura d, Naoki Otsuki e, Takahiro Asakage f, Yasushi Fujimoto g, Nobuhiro Hanai h, Akihiro Homma i, Nobuya Monden j, Kenji Okami k, Masashi Sugasawa l, Yasuhisa Hasegawa h, Ken-ichi Nibu e, Shin-etsu Kamata m, Seiji Kishimoto n, Naoyuki Kohno o, Satoshi Fukuda i, Yasuo Hisa p a
Department of Head and Neck Oncology, National Cancer Center Hospital, Japan Department of Otorhinolaryngology, Kyushu University, Japan Department of Otolaryngology – Head and Neck Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan d Department of Head and Neck Surgery, Miyagi Cancer Center, Japan e Department of Otolaryngology – Head and Neck Surgery, Kobe University, Japan f Department of Otolaryngology – Head and Neck Surgery, University of Tokyo, Japan g Department of Otorhinolaryngology, Nagoya University, Japan h Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Japan i Department of Otolaryngology – Head and Neck Surgery, Hokkaido University, Japan j Department of Otorhinolaryngology – Head and Neck Surgery, Shikoku Cancer Center, Japan k Department of Otolaryngology, Tokai University, Japan l Department of Head and Neck Surgery, Saitama Medical University International Medical Center, Japan m Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, Japan n Department of Head and Neck Surgery, Tokyo Medical and Dental University, Japan o Department of Otolaryngology – Head and Neck Surgery, Kyorin University, Japan p Department of Otolaryngology – Head and Neck Surgery, Kyoto Prefectural University of Medicine, Japan b c
A R T I C L E I N F O
A B S T R A C T
Article history: Received 26 September 2013 Accepted 25 November 2013 Available online 26 February 2014
The Japan Society for Head and Neck Surgery (JSHNS) started a board certification system for head and neck surgeons in 2010. To become certified, the following qualification and experiences are required: (1) board certification as otorhinolaryngologist, (2) 2 years of clinical experience in a board-certified training facility, (3) clinical care of 100 patients with head and neck cancer under the supervision of board-certified faculty and (4) surgical experience in 50 major head and neck surgical procedures, including 20 neck dissections, under the supervision of board-certified faculty. The following scientific activities are also required during the preceding 5 years: (1) two clinical papers on head and neck cancers presented at major scientific meetings, (2) one clinical paper on head and neck cancer published in a major journal, (3) attendance at two annual meetings of JSHNS and (4) enrolment in three educational programs approved by JSHNS. The qualifying examination consists of multiple choice tests and oral examinations. A total of 151 head and neck surgeons were certified in 2010 followed by 43 in 2011 and 34 in 2012, while the membership of JSHNS dramatically increased from 1201 in 2007 to 1748 in 2013. Although the board certification system for head and neck surgeons was started only recently, it has encouraged many residents and fellows as well as established head and neck surgeons. We believe that this system will contribute to further advancement in the clinical practice for head and neck cancers in Japan. ß 2014 Elsevier Ireland Ltd. All rights reserved.
Keywords: Board certification Training facility Curriculum Examination
1. Introduction §
This work was presented at the 8th International Conference on Head and Neck Cancer, on July 22–24, 2012, at Toronto, ON, Canada and the 3rd Congress of the Asian Society of Head and Neck Oncology on March 20–22, 2013, at Cebu, Philippines. * Corresponding author at: Department of Head and Neck Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. Tel.: +81 3 3542 2511; fax: +81 3 3542 3815. E-mail address: [email protected] (S. Yoshimoto). 0385-8146/$ – see front matter ß 2014 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.anl.2013.10.019
The average life span was 86.4 years for women and 79.9 years for men in Japan in 2012 (the longest and the fifth longest in the world, respectively) [1]. Mostly due to this increase in life expectancy, cancer is now the leading cause of death in Japan, with around 700,000 people diagnosed with cancer [2] and 350,000 people dying of cancer annually [3]. Currently, one in two
328
S. Yoshimoto et al. / Auris Nasus Larynx 41 (2014) 327–330
Japanese gets cancer during his or her lifetime, and one in three dies of cancer. In accordance with the ‘‘Cancer Control Act’’ [4], the Basic Plan to Promote Cancer Control Programs was formulated by the Cancer Control Promotion Council and approved by the Japanese cabinet in June 2007 [5]. Certification by the Japanese Board of Cancer Therapy (JBCT), which was established in 2006, is recommended for all doctors engaging in cancer treatment. Broad knowledge and basic skills related to clinical oncology are required for certification, and multiple choice questions (MCQs) are used for qualifying examinations for both certification and re-certification [6]. The number of patients with head and neck cancer in Japan in 2007 was estimated at about 18,000 (14 per 100,000), excluding nasal cavity and paranasal sinus cancers, thyroid cancer, and malignant lymphoma [2], and has been increasing annually [7]. Consequently, the demand for treatment of head and neck cancers has been expanding in this society with its unprecedented aging. However, a surveillance conducted by the Japan Society for Head and Neck Cancer (JSHNC) in 2006 reported a decrease in new head and neck surgeons due to long working hours and insufficient income [8]. The report concluded that there is an urgent need for the establishment of a highly attractive and challenging training system in order to ensure a sufficient supply of human resources to this field and to enhance the status of head and neck surgeons. In line with this recommendation, the Japan Society for Head and Neck Surgery (JSHNS) prepared a board certification system for head and neck surgeons in collaboration with the Oto-RhinoLaryngological Society of Japan and introduced the new system in 2010 [9]. 2. Definition of ‘‘Board-Certified Head and Neck Surgeon’’ A ‘‘Board-Certified Head and Neck Surgeon’’ is defined by JSHNS as ‘‘a surgeon with advanced skills and expertise of otolaryngology – head and neck surgery as well as basic knowledge, skills and medical ethics of cancer treatment who has an ability to provide multimodal therapy to the patients with head and neck cancer.’’ The qualification criteria for a ‘‘Board-Certified Provisional Educator’’ are as follows: (1) 10 years of clinical experience in the treatment of patients with head and neck cancer; (2) 100 major head and neck surgical operations including 100 neck dissections performed during the preceding 5 years; and (3) publication of five clinical papers on head and neck cancer. The term of validity is 10 years. As of 2013, there were 301 board-certified provisional educators. The requirements for a ‘‘Board-Certified Training Facility’’ are as follows: (1) employment of at least one full-time ‘‘Board-Certified Provisional Educator’’ or ‘‘Board-Certified Head and Neck Surgeon’’; (2) availability of radiotherapy facilities; and (3) treatment of 100 new cases with head and neck cancer per year. As of 2013, 139 facilities, including 17 cancer centers (with an average of 240 new cases/year), 77 university hospitals (131 new cases/year), and 45 general hospitals (109 new cases/year), have been certified as ‘‘Training Facility’’ by the Board (Fig. 1). 3. Curriculum for ‘‘Board-Certified Head and Neck Surgeon’’ The curriculum for ‘‘Board-Certified Head and Neck Surgeon’’ covers diagnosis and staging, cytology and pathology, general management, assessment and planning, surgery, radiation, chemotherapy and supportive care and psycho-oncology, and other topics comprising professionalism, informed consent, rehabilitation, team approach, and clinical research. In terms of operative experience, fellows are expected to gain competence in Category A procedures such as partial glossectomy and thyroid lobectomy in the first year, and Category B procedures, such as total
Fig. 1. As of 2013, 139 facilities, including 17 cancer centers (with an average of 240 new cases/year), 77 university hospitals (131 new cases/year), and 45 general hospitals (109 new cases/year) have been certified as ‘‘Training Facility’’ by the Board.
Table 1 Surgery. Category A (1st year) Partial glossectomy, resection of SMG, superficial parotidectomy, thyroid lobectomy Category B (2nd year) Total laryngectomy, total pharyngolaryngectomy, total parotidectomy, parital maxillectomy, neck dissection, resection of parapharyngeal tumor, harvesting a pedicle flap Category C (3rd year) Resection of advanced oral cancer, resection of advanced oropharyngeal cancer, partial laryngectomy, total maxillectomy, segmental mandibulectomy, reconstruction using a pedicle flap
laryngectomy and neck dissection, in the second year. In the third year, they should become skilled in Category C procedures, that is, resection of advanced oral cancer, resection of advanced oropharyngeal cancer, partial laryngectomy, total maxillectomy, segmental mandibulectomy, and reconstruction using a pedicle flap (Table 1). 4. Requirements for becoming ‘‘Board-Certified Head and Neck Surgeon’’ To become board certified as a head and neck surgeon, the following qualifications and experience are required: (1) 3 years of clinical experience following board certification by the Oto-RhinoLaryngological Society of Japan; (2) 2 years of clinical experience in a board-certified training facility; (3) clinical care of 100 patients with head and neck cancer under the supervision of board-certified faculty; (4) surgical experience in 50 major head and neck surgical procedures including 20 neck dissections under the supervision of board-certified faculty. The following scientific activities are also required during the preceding 5 years: (1) two clinical papers on head and neck cancers presented at major scientific meetings; (2) one clinical paper on head and neck cancer published in a major journal; (3) attendance at two annual meetings of JSHNS; and (4) enrolment in three educational programs approved by JSHNS (Table 2). The certification expires after 5 years. The following academic activities are required during the 5 years preceding re-certification: (1) attendance at five major Japanese scientific meetings on head and neck cancers; (2) attendance at two annual meetings of
S. Yoshimoto et al. / Auris Nasus Larynx 41 (2014) 327–330 Table 2 Requirements for becoming a ‘‘Board-Certified Head and Neck Surgeon’’. Clinical experience (under the supervision of board-certified faculty) 1. Three years of clinical experience following board certification by the Oto-Rhino-Laryngological Society of Japan 2. Five years of experience in head and neck cancer treatment of which 2 years of experience in a board-certified training facility 3. Clinical care of 100 patients with head and neck cancer 4. Surgical experience in 50 major head and neck surgical procedures including 20 neck dissections Scientific activities (during the preceding 5 years) 5. Two clinical papers on head and neck cancers presented at major scientific meetings 6. One clinical paper on head and neck cancer published in a major journal 7. Attendance at two annual meetings of the Japan Society of Head and Neck Surgery (JSHNS) 8. Enrolment in three educational programs approved by JSHNS
JSHNS; and (3) enrolment in three educational programs approved by JSHNS. 5. Examination The qualifying examination consists of MCQs and an oral examination. MCQs were prepared by a committee consisting of head and neck surgeons, medical oncologists, radiologists, radiation oncologists and plastic surgeons. MCQs consist of 60 questions, with 20 questions each on general clinical oncology, general head and neck oncology and clinical cases with head and neck cancer. For the oral examination, the candidates are asked to answer several clinical questions about the surgical records presented during the examination. Attitudes regarding team approach, holistic medicine and professionalism are also evaluated. A total of 165 head and neck surgeons applied for the first examination, 151 of whom were certified by the Board for a passing rate of 91.5%. As of 2012, there were 228 board-certified head and neck surgeons in Japan, while the number of membership of JSHNS dramatically increased from 1201 in 2007 to 1748 in 2013.
329
dealt with, the effect of the board certificate system was almost certainly to bring together patients with head and neck cancer at the main referral centers. However, the average annual numbers of new cases vary considerably among cancer centers, university hospitals and general hospitals. In the fellowship program of American Head and Neck Surgery (AHNS), fellows are supposed to participate for 1 or 2 years in the clinical care of at least 200 cases with head and neck neoplastic lesions and a minimum of 100 major surgical procedures within the broad range of head and neck surgical oncology [10]. To catch up with the AHNS fellowship program, we should develop a nationwide cross-university matching system for fellowship programs to rectify the disparity among training facilities. The review by JBMS recommended improvements in the assessment method for candidates’ operative skills. In response to this recommendation, since 2012, we have extended the interview time from 10 min to 20 min to assess the surgical skills by asking several questions related to the surgical records presented during the examination, by referring to the procedures for board certification by the American Board of Otolaryngology (ABOto). Maintaining the diplomates’ competence is another important issue associated with the board certification system. To this end, we have recently started annual educational seminars for boardcertified head and neck surgeons and are currently considering using web-based seminars for medical ethics and medical care safety. In addition, JBMS recommends re-evaluation of clinical skills for re-certification. Finally, in terms of lifelong learning, we are thinking about establishing a Maintenance of Certification System by referring to the ABOto’s Maintenance of Certification for ABOto-certified otolaryngologists-head and neck surgeons [11]. 7. Conclusions Board certification for head and neck surgeons has just started in Japan. Although there is still much room for improvement, we believe that this system will result in providing state-of-the-art care for patients with head and neck cancer and contributing to advances in the treatment of head and neck cancers in Japan.
6. Comments The most important goal for the establishment of the board certification system is to recruit promising fellows to this field and to improve the status of head and neck surgeons. We are happy to report that not only established head and neck surgeons but also many fellows and residents have shown interest in this board certification. Since its establishment 6 years ago, more than 500 head and neck surgeons, fellows and residents have become members of JSHNS. ‘‘Head and Neck’’ as a field of medical specialization has not gained much public recognition in Japan until now. However, the formal approval in 2013 by the Japanese Board of Medical Specialties (JBMS) of the board certification system for head and neck surgeons as the first subspecialty in the field of otolaryngology – head and neck surgery will undoubtedly enhance the status of head and neck surgeons and also raise public awareness of head and neck cancers, and can be expected to result in the early diagnosis and prevention of head and neck cancer. Another important objective of the board certification system is to establish centers of excellence for head and neck cancers to provide better medical care for patients with head and neck cancer, and better training for head and neck surgeons. In 2008, only 64 facilities in Japan dealt with 100 or more new cases with head and neck cancer per year, but as of 2013, there are 139 board-certified facilities. Since at least 100 new cases per year are required to be
Acknowledgments The authors express their sincere thanks to Prof. Robert H. Miller, Executive Director of ABOto, and all the staff members of ABOto for their kind support. References [1] Ministry of Health, Labour and Welfare, editor. Life expectancies at birth in some countries. Abridged Life Tables for Japan 2012. 2013. Available from http://www.mhlw.go.jp/english/database/db-hw/lifetb12/dl/lifetb12-03.pdf. [2] Matsuda A, Matsuda T, Shibata A, Katanoda K, Sobue T, Nishimoto H, et al. Cancer incidence and incidence rates in Japan in 2007: a study of 21 population-based cancer registries for the Monitoring of Cancer Incidence in Japan (MCIJ) Project. Jpn J Clin Oncol 2013;43:328–36. [3] Center for Cancer Control and Information Services, National Cancer Center, Japan, editor. Cancer mortality (1958–2011). 2013. Available from http:// ganjoho.jp/professional/statistics/statistics.html [in Japanese]. [4] Ministry of Health, Labour and Welfare, editor. Overview of the ‘‘Cancer Control Act’’. 2010. Available from http://www.mhlw.go.jp/english/wp/wphw3/dl/2-077.pdf. [5] Ministry of Health, Labour and Welfare, editor. Overview of the basic plan to promote cancer control programs. 2011. Available from http:// www.mhlw.go.jp/english/wp/wp-hw3/dl/2-078.pdf#search=’Basic+plan+to+ Promote+Cancer+Control+program. [6] Mori T. The system of Japanese Board of Cancer Therapy. Nihon Geka Gakkai Zasshi 2008;109:105–8 [in Japanese]. [7] Center for Cancer Control and Information Services, National Cancer Center, Japan, editor. Cancer incidence (1975–2008). 2013. Available from http:// ganjoho.jp/professional/statistics/statistics.html [in Japanese].
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[8] Matsuura K, Fujimoto Y, Onitsuka T, Kano M, Kitano H, Kitamura M, et al. Round table discussion – how should we recruit young otolaryngologists to the field of head and neck cancer? Toukeibu Gan 2006;32:391–403 [in Japanese]. [9] Nibu K. Designing of head and neck cancer management in Japan – expectation on the system of head and neck cancer specialists. Nihon Jibiinkoka Gakkai Kaiho 2011;114:7–14 [in Japanese].
[10] Shaha AR. Training in head and neck surgery and oncology. J Surg Oncol 2008;97:717–20. [11] Medina JE, Miller RH. Maintenance of Certification for American Board of Otolaryngology-certified otolaryngologists-head and neck surgeons. Arch Otolaryngol Head Neck Surg 2007;133:318–9.
Contents lists available at ScienceDirect
Auris Nasus Larynx journal homepage: www.elsevier.com/locate/anl
Japanese Board Certification System for head and neck surgeons§ Seiichi Yoshimoto a,*, Torahiko Nakashima b, Takashi Fujii c, Kazuto Matsuura d, Naoki Otsuki e, Takahiro Asakage f, Yasushi Fujimoto g, Nobuhiro Hanai h, Akihiro Homma i, Nobuya Monden j, Kenji Okami k, Masashi Sugasawa l, Yasuhisa Hasegawa h, Ken-ichi Nibu e, Shin-etsu Kamata m, Seiji Kishimoto n, Naoyuki Kohno o, Satoshi Fukuda i, Yasuo Hisa p a
Department of Head and Neck Oncology, National Cancer Center Hospital, Japan Department of Otorhinolaryngology, Kyushu University, Japan Department of Otolaryngology – Head and Neck Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan d Department of Head and Neck Surgery, Miyagi Cancer Center, Japan e Department of Otolaryngology – Head and Neck Surgery, Kobe University, Japan f Department of Otolaryngology – Head and Neck Surgery, University of Tokyo, Japan g Department of Otorhinolaryngology, Nagoya University, Japan h Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Japan i Department of Otolaryngology – Head and Neck Surgery, Hokkaido University, Japan j Department of Otorhinolaryngology – Head and Neck Surgery, Shikoku Cancer Center, Japan k Department of Otolaryngology, Tokai University, Japan l Department of Head and Neck Surgery, Saitama Medical University International Medical Center, Japan m Department of Head and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, Japan n Department of Head and Neck Surgery, Tokyo Medical and Dental University, Japan o Department of Otolaryngology – Head and Neck Surgery, Kyorin University, Japan p Department of Otolaryngology – Head and Neck Surgery, Kyoto Prefectural University of Medicine, Japan b c
A R T I C L E I N F O
A B S T R A C T
Article history: Received 26 September 2013 Accepted 25 November 2013 Available online 26 February 2014
The Japan Society for Head and Neck Surgery (JSHNS) started a board certification system for head and neck surgeons in 2010. To become certified, the following qualification and experiences are required: (1) board certification as otorhinolaryngologist, (2) 2 years of clinical experience in a board-certified training facility, (3) clinical care of 100 patients with head and neck cancer under the supervision of board-certified faculty and (4) surgical experience in 50 major head and neck surgical procedures, including 20 neck dissections, under the supervision of board-certified faculty. The following scientific activities are also required during the preceding 5 years: (1) two clinical papers on head and neck cancers presented at major scientific meetings, (2) one clinical paper on head and neck cancer published in a major journal, (3) attendance at two annual meetings of JSHNS and (4) enrolment in three educational programs approved by JSHNS. The qualifying examination consists of multiple choice tests and oral examinations. A total of 151 head and neck surgeons were certified in 2010 followed by 43 in 2011 and 34 in 2012, while the membership of JSHNS dramatically increased from 1201 in 2007 to 1748 in 2013. Although the board certification system for head and neck surgeons was started only recently, it has encouraged many residents and fellows as well as established head and neck surgeons. We believe that this system will contribute to further advancement in the clinical practice for head and neck cancers in Japan. ß 2014 Elsevier Ireland Ltd. All rights reserved.
Keywords: Board certification Training facility Curriculum Examination
1. Introduction §
This work was presented at the 8th International Conference on Head and Neck Cancer, on July 22–24, 2012, at Toronto, ON, Canada and the 3rd Congress of the Asian Society of Head and Neck Oncology on March 20–22, 2013, at Cebu, Philippines. * Corresponding author at: Department of Head and Neck Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. Tel.: +81 3 3542 2511; fax: +81 3 3542 3815. E-mail address: [email protected] (S. Yoshimoto). 0385-8146/$ – see front matter ß 2014 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.anl.2013.10.019
The average life span was 86.4 years for women and 79.9 years for men in Japan in 2012 (the longest and the fifth longest in the world, respectively) [1]. Mostly due to this increase in life expectancy, cancer is now the leading cause of death in Japan, with around 700,000 people diagnosed with cancer [2] and 350,000 people dying of cancer annually [3]. Currently, one in two
328
S. Yoshimoto et al. / Auris Nasus Larynx 41 (2014) 327–330
Japanese gets cancer during his or her lifetime, and one in three dies of cancer. In accordance with the ‘‘Cancer Control Act’’ [4], the Basic Plan to Promote Cancer Control Programs was formulated by the Cancer Control Promotion Council and approved by the Japanese cabinet in June 2007 [5]. Certification by the Japanese Board of Cancer Therapy (JBCT), which was established in 2006, is recommended for all doctors engaging in cancer treatment. Broad knowledge and basic skills related to clinical oncology are required for certification, and multiple choice questions (MCQs) are used for qualifying examinations for both certification and re-certification [6]. The number of patients with head and neck cancer in Japan in 2007 was estimated at about 18,000 (14 per 100,000), excluding nasal cavity and paranasal sinus cancers, thyroid cancer, and malignant lymphoma [2], and has been increasing annually [7]. Consequently, the demand for treatment of head and neck cancers has been expanding in this society with its unprecedented aging. However, a surveillance conducted by the Japan Society for Head and Neck Cancer (JSHNC) in 2006 reported a decrease in new head and neck surgeons due to long working hours and insufficient income [8]. The report concluded that there is an urgent need for the establishment of a highly attractive and challenging training system in order to ensure a sufficient supply of human resources to this field and to enhance the status of head and neck surgeons. In line with this recommendation, the Japan Society for Head and Neck Surgery (JSHNS) prepared a board certification system for head and neck surgeons in collaboration with the Oto-RhinoLaryngological Society of Japan and introduced the new system in 2010 [9]. 2. Definition of ‘‘Board-Certified Head and Neck Surgeon’’ A ‘‘Board-Certified Head and Neck Surgeon’’ is defined by JSHNS as ‘‘a surgeon with advanced skills and expertise of otolaryngology – head and neck surgery as well as basic knowledge, skills and medical ethics of cancer treatment who has an ability to provide multimodal therapy to the patients with head and neck cancer.’’ The qualification criteria for a ‘‘Board-Certified Provisional Educator’’ are as follows: (1) 10 years of clinical experience in the treatment of patients with head and neck cancer; (2) 100 major head and neck surgical operations including 100 neck dissections performed during the preceding 5 years; and (3) publication of five clinical papers on head and neck cancer. The term of validity is 10 years. As of 2013, there were 301 board-certified provisional educators. The requirements for a ‘‘Board-Certified Training Facility’’ are as follows: (1) employment of at least one full-time ‘‘Board-Certified Provisional Educator’’ or ‘‘Board-Certified Head and Neck Surgeon’’; (2) availability of radiotherapy facilities; and (3) treatment of 100 new cases with head and neck cancer per year. As of 2013, 139 facilities, including 17 cancer centers (with an average of 240 new cases/year), 77 university hospitals (131 new cases/year), and 45 general hospitals (109 new cases/year), have been certified as ‘‘Training Facility’’ by the Board (Fig. 1). 3. Curriculum for ‘‘Board-Certified Head and Neck Surgeon’’ The curriculum for ‘‘Board-Certified Head and Neck Surgeon’’ covers diagnosis and staging, cytology and pathology, general management, assessment and planning, surgery, radiation, chemotherapy and supportive care and psycho-oncology, and other topics comprising professionalism, informed consent, rehabilitation, team approach, and clinical research. In terms of operative experience, fellows are expected to gain competence in Category A procedures such as partial glossectomy and thyroid lobectomy in the first year, and Category B procedures, such as total
Fig. 1. As of 2013, 139 facilities, including 17 cancer centers (with an average of 240 new cases/year), 77 university hospitals (131 new cases/year), and 45 general hospitals (109 new cases/year) have been certified as ‘‘Training Facility’’ by the Board.
Table 1 Surgery. Category A (1st year) Partial glossectomy, resection of SMG, superficial parotidectomy, thyroid lobectomy Category B (2nd year) Total laryngectomy, total pharyngolaryngectomy, total parotidectomy, parital maxillectomy, neck dissection, resection of parapharyngeal tumor, harvesting a pedicle flap Category C (3rd year) Resection of advanced oral cancer, resection of advanced oropharyngeal cancer, partial laryngectomy, total maxillectomy, segmental mandibulectomy, reconstruction using a pedicle flap
laryngectomy and neck dissection, in the second year. In the third year, they should become skilled in Category C procedures, that is, resection of advanced oral cancer, resection of advanced oropharyngeal cancer, partial laryngectomy, total maxillectomy, segmental mandibulectomy, and reconstruction using a pedicle flap (Table 1). 4. Requirements for becoming ‘‘Board-Certified Head and Neck Surgeon’’ To become board certified as a head and neck surgeon, the following qualifications and experience are required: (1) 3 years of clinical experience following board certification by the Oto-RhinoLaryngological Society of Japan; (2) 2 years of clinical experience in a board-certified training facility; (3) clinical care of 100 patients with head and neck cancer under the supervision of board-certified faculty; (4) surgical experience in 50 major head and neck surgical procedures including 20 neck dissections under the supervision of board-certified faculty. The following scientific activities are also required during the preceding 5 years: (1) two clinical papers on head and neck cancers presented at major scientific meetings; (2) one clinical paper on head and neck cancer published in a major journal; (3) attendance at two annual meetings of JSHNS; and (4) enrolment in three educational programs approved by JSHNS (Table 2). The certification expires after 5 years. The following academic activities are required during the 5 years preceding re-certification: (1) attendance at five major Japanese scientific meetings on head and neck cancers; (2) attendance at two annual meetings of
S. Yoshimoto et al. / Auris Nasus Larynx 41 (2014) 327–330 Table 2 Requirements for becoming a ‘‘Board-Certified Head and Neck Surgeon’’. Clinical experience (under the supervision of board-certified faculty) 1. Three years of clinical experience following board certification by the Oto-Rhino-Laryngological Society of Japan 2. Five years of experience in head and neck cancer treatment of which 2 years of experience in a board-certified training facility 3. Clinical care of 100 patients with head and neck cancer 4. Surgical experience in 50 major head and neck surgical procedures including 20 neck dissections Scientific activities (during the preceding 5 years) 5. Two clinical papers on head and neck cancers presented at major scientific meetings 6. One clinical paper on head and neck cancer published in a major journal 7. Attendance at two annual meetings of the Japan Society of Head and Neck Surgery (JSHNS) 8. Enrolment in three educational programs approved by JSHNS
JSHNS; and (3) enrolment in three educational programs approved by JSHNS. 5. Examination The qualifying examination consists of MCQs and an oral examination. MCQs were prepared by a committee consisting of head and neck surgeons, medical oncologists, radiologists, radiation oncologists and plastic surgeons. MCQs consist of 60 questions, with 20 questions each on general clinical oncology, general head and neck oncology and clinical cases with head and neck cancer. For the oral examination, the candidates are asked to answer several clinical questions about the surgical records presented during the examination. Attitudes regarding team approach, holistic medicine and professionalism are also evaluated. A total of 165 head and neck surgeons applied for the first examination, 151 of whom were certified by the Board for a passing rate of 91.5%. As of 2012, there were 228 board-certified head and neck surgeons in Japan, while the number of membership of JSHNS dramatically increased from 1201 in 2007 to 1748 in 2013.
329
dealt with, the effect of the board certificate system was almost certainly to bring together patients with head and neck cancer at the main referral centers. However, the average annual numbers of new cases vary considerably among cancer centers, university hospitals and general hospitals. In the fellowship program of American Head and Neck Surgery (AHNS), fellows are supposed to participate for 1 or 2 years in the clinical care of at least 200 cases with head and neck neoplastic lesions and a minimum of 100 major surgical procedures within the broad range of head and neck surgical oncology [10]. To catch up with the AHNS fellowship program, we should develop a nationwide cross-university matching system for fellowship programs to rectify the disparity among training facilities. The review by JBMS recommended improvements in the assessment method for candidates’ operative skills. In response to this recommendation, since 2012, we have extended the interview time from 10 min to 20 min to assess the surgical skills by asking several questions related to the surgical records presented during the examination, by referring to the procedures for board certification by the American Board of Otolaryngology (ABOto). Maintaining the diplomates’ competence is another important issue associated with the board certification system. To this end, we have recently started annual educational seminars for boardcertified head and neck surgeons and are currently considering using web-based seminars for medical ethics and medical care safety. In addition, JBMS recommends re-evaluation of clinical skills for re-certification. Finally, in terms of lifelong learning, we are thinking about establishing a Maintenance of Certification System by referring to the ABOto’s Maintenance of Certification for ABOto-certified otolaryngologists-head and neck surgeons [11]. 7. Conclusions Board certification for head and neck surgeons has just started in Japan. Although there is still much room for improvement, we believe that this system will result in providing state-of-the-art care for patients with head and neck cancer and contributing to advances in the treatment of head and neck cancers in Japan.
6. Comments The most important goal for the establishment of the board certification system is to recruit promising fellows to this field and to improve the status of head and neck surgeons. We are happy to report that not only established head and neck surgeons but also many fellows and residents have shown interest in this board certification. Since its establishment 6 years ago, more than 500 head and neck surgeons, fellows and residents have become members of JSHNS. ‘‘Head and Neck’’ as a field of medical specialization has not gained much public recognition in Japan until now. However, the formal approval in 2013 by the Japanese Board of Medical Specialties (JBMS) of the board certification system for head and neck surgeons as the first subspecialty in the field of otolaryngology – head and neck surgery will undoubtedly enhance the status of head and neck surgeons and also raise public awareness of head and neck cancers, and can be expected to result in the early diagnosis and prevention of head and neck cancer. Another important objective of the board certification system is to establish centers of excellence for head and neck cancers to provide better medical care for patients with head and neck cancer, and better training for head and neck surgeons. In 2008, only 64 facilities in Japan dealt with 100 or more new cases with head and neck cancer per year, but as of 2013, there are 139 board-certified facilities. Since at least 100 new cases per year are required to be
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