Canada

Education and training

-program and examination for specialization Otolaryngologists who wish to sub-specialize in laryngology and voice disorders take a fellowship, usually one year in length, some time after completion of their residency. The fellowships will usually consist of a combination of clinical and research experience. Similarly, graduate speech pathologists wishing to pursue a career in voice will receive extra training within a multi-disciplinary academic voice clinic, usually as part of a Ph.D. program.

I enclose here a copy of our own fellowship description.

-University of British Columbia/Pacific Voice Clinic Fellowship
in Laryngology - 1999
Murray Morrison M.D. FRCSC & Linda Rammage Ph.D.

Laryngology is a subspecialty of Otolaryngology-Head & Neck Surgery that encompasses the diagnosis and treatment of those laryngo-pharyngo-esophageal disorders that cause problems with voice production, swallowing, and the laryngeal airway. A broad spectrum of benign and malignant disease affects this part of the aerodigestive tract and a rapidly enlarging armamentarium of technological advances permits a clearer understanding of the complexity of interconnected processes. New treatments such as botulinum toxin injections for laryngeal dystonia, thyroplasty techniques for altering position or tension of the vocal folds, and microscopic and laser procedures for managing laryngotrachael stenosis and laryngeal malignancies have become common, but are not familiar to a large proportion of practicing otolaryngologists. The goals of this training program are 1) to provide the fellow with advanced experience in diagnosis and treatment of laryngeal disorders, 2) to provide basic clinical research experience with a specific focus on neurolaryngology, and 3) to create an environment that will stimulate the participant to pursue a career in academic Otolaryngology.

This one year fellowship will provide broad clinical experience in
laryngology and voice disorders, basic and clinical research in laryngology, and didactic teaching. The fellow will take an active role in all multidisciplinary voice assessments including regular interaction with the Pacific Voice Clinic staff including laryngologist Dr Murray Morrison and speech pathologist Dr Linda Rammage; and frequent interaction with
psychiatrist Dr. Hamish Nichol and singing teacher Bruce Pullan. The fellow will have ample opportunity to act in the role of primary care giver, but always with advice and support close at hand.

In order to satisfactorily complete this fellowship the
fellow will:
- acquire competence in the diagnosis of laryngeal and related disorders and in a variety of surgical procedures including use of botulinum toxin for laryngeal and craniocervical dystonias; thyroplasty techniques for the management of laryngeal paralysis; and microscopic, laser, and open techniques for management of benign and malignant diseases of the larynx
- develop a firm understanding of laryngeal anatomy and physiology, necessary for high quality clinical practice and as a platform for
investigative ideas, acquire an in-depth knowledge of the principles and practice of voice therapy and rehabilitation
- become familiar with the basics of vocal pedagogy to the level required for effective communication with the community of singing teachers and singer patients
- develop skill in basic laryngological research techniques such as acoustic analysis, phonatory airflow and pressure studies, esophageal manometry/pH testing, laryngeal EMG, and EGG among others
- become a highly skillful video-laryngo-stroboscopist
- attend weekly conferences including Otolaryngology Grand Rounds, BCCA, tumor conferences and coordinate the weekly difficult-case-of-the-week conference

- Teaching and resident training:
The laryngology fellow will not negatively impact on the training of UBC residents in Otolaryngology. Rather s/he will augment the training of residents since the increased volume of laryngeal cases will result in more exposure to, and discussion of, laryngeal disorders for residents and other students. The fellow will be expected to play a „casual“ teaching role as a part of all activities.

Associations
-Canadian society of Otolaryngology Head & Neck Surgery.
-Canadian Voice Care Foundation Based in Calgary, Alberta. Director is Katharine Ardo.

Literature
Morrison and Rammage: The management of voice disorders.
Singular Press 1994 - second edition in preparation.
Koschkee and Rammage: Voice care in the medical setting.
Singular Press 1997
Rammage: Vocalizing with ease: a self improvement guide - see the pvcrp
website (http://www.pvcrp.com) for details.