Report for International Observership in Paediatric Otolaryngology and Airway Surgery at Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio – August 2014

May I take this opportunity to thank the HCA International Foundation for your generous support of my two-week international observership in the Department of Pediatric Otolaryngology at Cincinnati Children’s Hospital Medical Center in Ohio, US, which I completed between 11th - 22nd August 2014. The HCA International Foundation grant of £1000 has been of immeasurable benefit, being utilised to support both the high costs of travel and accommodation to undertake this educational opportunity in the US, as well as my own professional development.

I aspire to pursue a career in tertiary paediatric ENT and have a keen interest in airway surgery. I am currently in my final year of ENT surgical training (ST8) on the North Thames training programme and have completed a year of tertiary paediatric airway experience at ST7 with Mr Yogesh Bajaj, Consultant ENT Surgeon, at St Bartholomew’s and The Royal London. I have also completed a six-month ST5 ENT training post at Great Ormond Street Hospital for Children previously.

My decision to visit Cincinnati Children's Hospital Medical Center (CCHMC) owes to its position in the top 3 of paediatric hospitals in the US and as it is recognised as the leading centre in the US for paediatric airway surgery. CCHMC has a globally renowned reputation and I had the privilege of meeting some of the world's most prolific paediatric airway surgeons, including Dr Robin Cotton and Dr Michael Rutter, with the aim of experiencing their current practice in the field of airway surgery.

The ENT team at CCHMC is lead by 10 attending surgeons (consultants) performing procedures in up to 10 theatres daily. In two weeks I was able to see 73 procedures performed by the ENT surgeons and their trainee fellows. Airway surgery I experienced included diagnostic laryngotracheobronchscopy, laryngotracheal reconstruction, tracheoplasty, balloon laryngotracheoplasty, laryngoplasty including aryepiglottoplasty, thyroplasty, tracheal stenting, tracheostomy, and airway laser techniques. I saw how the ENT team worked together with pulmonologists (respiratory physicians) and cardiothoracic surgeons in some of these cases. I also observed other advanced tertiary paediatric otolaryngology surgery including cochlear implantation, paediatric head and neck surgery, and endoscopic sinus surgery. During this period it was interesting to see how higher surgical training in the US is based predominantly in theatre as opposed to the UK mix of training theatres and clinics.

I gained further experience in multidisciplinary team work through attending specialist clinics at CCHMC including the voice clinic, as well as multidisciplinary paediatric aerodigestive surgical committee meetings and paediatric upper airway and obstructive sleep apnoea meetings. I joined ward rounds and had the opportunity to meet some of the children and their families and carers who were being treated at CCHMC, some of whom had travelled many hours nationally and internationally to seek the services offered by such a prestigious hospital.

Overall, the experience I gained was tremendous both educationally and professionally, and enabled me to surpass the objectives I had set myself for the visit. Not only did I enrich my own knowledge of airway surgery and meet an inspiring team of surgeons, nurses and allied health professionals, but I was able to share my experience from our tertiary centre in the UK with our colleagues in a US tertiary centre, for a mutual benefit to improve our learning for patients’ care – something I have not had the opportunity or experience to do before. Furthermore, on returning to the UK, I have been able to bring back knowledge and discuss with my peers and seniors, the techniques and nuances that the team used in managing their cases in the US. This has given me inspiration to develop fresh ideas to improve our practice further in the UK, for example with combined assessment of the lower tracheobronchial tree with flexible bronchoscopy as an adjunct to our normal rigid laryngotracheobronchoscopy, to more fully assess the airway of children with complex respiratory issues in a single general anaesthetic. This is not yet typically done in the UK and would be an exciting improvement to the services we offer at our institution. In addition I will be able to use my experience to offer ideas for efficiency savings, reducing complications and improve patient care overall.

I will use this experience as a springboard to obtaining a tertiary paediatric ENT fellowship, for which I am in the process of application, and that I aim to complete in the UK by October 2016, in the run up to becoming a consultant. The placement at CCHMC has enriched me as a surgeon and I am certain this will help to demonstrate that I would be an asset to any paediatric ENT department I join as a consultant. My patients will directly benefit from better care by a surgeon who has gained worldwide experience of management of paediatric ENT and airway problems, and where I have used these experiences to inform my decision making to offer more efficient and safe and therefore the best possible care to children, their families and carers.