university of toronto department of otolaryngology head and neck surgery

1. University of TorontoDepartment of Otolaryngology Head and Neck Surgery�State of the Union Address� Dr. Patrick Gullane Chair, Department of Otolaryngology Head and Neck Surgery Dr. Ian Witterick, Director Post-Graduate Education January 11, 2008

2. The Department of Otolaryngology at the University of Toronto has a long and honourable heritage. It has trained many notable leaders in our Specialty that continue to enhance and further expand our Specialty.

3. The Vision The activities should be compatible with thepriorities of the: Department of Otolaryngology � Head & Neck Surgery Priorized Programs of each Individual Hospitals� Mission

4. University of Toronto - Vision Read the slide This Vision is being realized by our President, David Naylor ( the former Dean of Medicine) and Vice President and Provost, Vivek Goel who you will meet tomorrow. Vivek is a previous Chair of our Department of Health Policy Management and Evaluation in the Faculty of Medicine, a population health researcher and family physician. As you can appreciate, the relationship between the Faculty of Medicine and the senior administration of the University of Toronto is very strong. Read the slide This Vision is being realized by our President, David Naylor ( the former Dean of Medicine) and Vice President and Provost, Vivek Goel who you will meet tomorrow. Vivek is a previous Chair of our Department of Health Policy Management and Evaluation in the Faculty of Medicine, a population health researcher and family physician. As you can appreciate, the relationship between the Faculty of Medicine and the senior administration of the University of Toronto is very strong.

5. Department of Otolaryngology � Head and Neck Surgery University of Toronto Largest Program in Canada Largest Residency Training Program in Canada Largest # of Fellowship Programs Largest # of Research Programs Largest # of Endowed Chairs �Head & Neck Surgery, Cochlear and Research Largest # of CME events Largest # of Visiting Professorships

6. Department of Otolaryngology � Head and Neck Surgery University of Toronto 98 Faculty appointments 49 MDs � Otolarynoglogists 23 MD Cross appointments 26 Others - PhD Scientists, Audiologists, Speech Language Pathologists etc. 22 Residents (5 per year) 16+ Fellows (clinical and research)

7. The Faculty � July 2007 Professor and Chair P.J. Gullane Professores Emeriti P.W. Alberti B.D. Birt T.D.R. Briant D.P. Bryce P. Cole W.S. Crysdale W.S. Goodman J.S. McGrail Professors S.M. Abel P.A. Adamson D.H. Brown D.A.F. Ellis V. Forte J.L. Freeman J. Friedberg R.W. Gilbert J. Haight R.V. Harrison. W.M. Hawke M.L. Hyde J.C. Irish J.M. Nedzelski A.M. Noyek J.A. Rutka Associate Professors J.S. Chapnik J.M. Chen K. Conrad M.J. Davidson R.S. Fenton B.C. Papsin K. Riko A.J. Smitheringale I.J. Witterick Assistant Professors J. Anderson P. Campisi M. Cashman A. Chiodo K.Y. Chow F. DeSouza W. El Masri D. Enepekides A.M. Gantous D. Goldfarb K. Gordon J. Halik K. Higgins A. James W.S. Middleton

8. Chairs Dr. Percy Ireland - 1946-1966 Dr. Douglas Bryce - 1967-1982 Dr. Peter Alberti - 1982-1992 Dr. Julian Nedzelski - 1992-2002 Dr. Patrick Gullane - 2002-2012

9. Program Directors Dr.W.F. Goodman 1967-1988 Dr. Derek Birt 1988-1998 Dr. Dale Brown 1998-2001 Dr. Joe Chen 2001-2004 Dr. Ian Witterick 2004-Present

10. Department Hospital Chiefs Sunnybrook Joe Chen St. Michael�s Ron Fenton Mt. Sinai Jeremy Freeman HSC Vito Forte UHN Patrick Gullane, R. Gilbert � (Deputy Chief) UHN/Mt.SinaiChief Surgical Oncology Jon Irish U of T Division ofHead & Neck Oncology Ralph Gilbert TEGH Oakley Smith SJH Ian Witterick

11. University - Staff Business Officer: Audrea Martin Department Secretary: Zoila Huezo Postgraduate Secretary: Ursula Stephenson

12. University of Toronto - Organizational Structure

13. Funding The principal source of funding is from the combination of Ministry of Training, Colleges and Universities (MTCU) and Teaching & Research funds (T&R). Others sources � AFP�s, repair funds from Cancer Care Ontario, and on call stipends. Full AFP at HSC helped significantly to recruit clinician-scientists and clinician-educators. Hospital departments have through the leadership of their chiefs and faculty received substantial donations which are used to support research endeavors, clinical and research fellows. Over the past five years we have seen significant expansion in the research grants obtained by members of the Department.

14. Clinical Program Over the past five years we have seen a significant change in clinical services. Major focus in head and neck oncology and reconstruction, endocrine oncology, neurotology, reconstructive and plastic surgery, complex otology and skull base surgery. With this shift and increased academic expansion, the fully affiliated hospitals have obtained an increase in the capital equipment and funding necessary and also volume based funding resulting from the government need to reduce wait times. However with the expansion of the complex clinical programs, it was necessary to evaluate the mix of cases and operative experiences obtained by the residents. Review of the PGY5 resident case logs who graduated in 2005 demonstrated that the average resident performed 1862 otolaryngology procedures during their training and despite the concerns that they were not obtaining basic otolaryngology training, we found that 26.4% of the procedures fell under the category of �General Otolaryngology�.

15. Research Program Over the past five years we have witnessed a significant increase in the research activities within the Department. This has been a major focus of mine, having identified the research weakness on my appointment. Furthermore, our residents needed to have greater exposure to clinical and basic research, especially the opportunity to pursue a �Master�s degree�. The research covers all aspects of our specialty from head and neck oncology, vestibular research, otology, neurotology, ear and acoustics research, audiology and cochlear implantation research and basic science applied both to oncology, otology and upper airway sciences.

16. Research Program Dr. Robert Harrison, Director of Research and Chair of the Research committee, has annually held a Research Evening since my appointment to highlight the research activities ongoing within the Department and to expose and stimulate resident interest in pursuing a Master�s thesis. This has had a profound effect on the Department with ten individuals having completed a Master�s thesis. I am extremely proud of this accomplishment which had been identified as a weakness. I am indebted to many of the researchers and mentors including: Drs. Robert Harrison, Blake Papsin, Karen Gordon, Sharon Abel, Suzanne Kamel-Reid, Fei-Fei Liu, Jonathan Irish, Paolo Campisi, Jeremy Freeman, Vito Forte, Jim Haight and many others for their leadership.

18. Master�s Thesis Dr. Vance Tsai, Master�s thesis in International Health at theLondon School of Hygiene. Dr. Evan Propst two-year Master�s thesis in the Genetics of Hearing Loss (Surgeon-Scientist Program) Dr. Molly Zirkle Master�s thesis in Education. Dr. Kevin Higgins Master�s thesis in Clinical Epidemiology Dr. David Goldstein Master�s thesis in Clinical Epidemiology Dr. Manish Shah Master�s thesis in Clinical Epidemiology atCambridge University in England. Dr. Sharon Cushing Master�s thesis as part of the Surgeon Scientist Program Dr. Ian Witterick completed his Master�s in Clinical Epidemiology Dr. Allan Vescan � presently in progress Dr. Vincent Lin � presently in progress

19. Research Program The Basic Science Laboratories in Head and Neck Oncology within the Princess Margaret Hospital; Directors Drs. Suzanne Kamel-Reid and Fei-Fei Liu have helped to further enhance our research profile nationally and internationally. I am grateful to Fei-Fei and Suzanne for their enormous contributions. A combination of the endowment of Chairs, successful competitive research grants obtained through private donations and corporate support have helped enormously to further enhance this activity. I am indebted to Drs. Robert Harrison, Blake Papsin and Karen Gordon for their leadership, support and guidance in cochlear and basic auditory research. The recent successful CIHR (one million) grant obtained by Dr. Harrison demonstrates his prominence in the research arena of auditory science.Dr. Blake Papsin�s contributions in cochlear implant research was recognized with an endowed chair, �Cochlear Corporation Chair in Auditory Development� in 2005 with recent publication in NEJM November 2007.

20. Research Program The Department has in addition increased interaction with other cognate departments in the clinical and academic arenas. Clinical interactions have expanded in head and neck oncology, with more cross appointments in activities with the Department of Radiation and Medical Oncology at the Princess Margaret Hospital. Collaborative clinical and educational programs have also expanded within the Department of Endocrinology, Plastic Surgery, and basic research. The goal of the Department is to allow the research program to integrate in the core activity of another department. Over the past five years, the Department has developed significant programmatic excellence with a number of its faculty known nationally and internationally for their programmatic excellence. The advent of image guided surgery and the development of the GTX program lead by Drs. Jonathan Irish, Jeffrey Siewerdsen and Walter Kucharczyk remains a very exciting focus.

21. Research Program Currently their are four endowed Chairs in the Department of Otolaryngology � Head & Neck Surgery which for a smaller department is unprecedented. These include: The Temmy Latner/Dynacare Chair in Head and Neck Oncology at Mt. Sinai Hospital held by Dr. Jeremy Freeman. The Wharton Chair in Head and Neck Surgery at the University Health Network held by Dr. Patrick Gullane The Mariano Elia Chair in Head and Neck Research at the Princess Margaret Hospital held by Dr. Fei-Fei Liu The Cochlear Corporation Chair in Auditory Development at the Hospital for Sick Children held by Dr. Blake Papsin.

22. Wharton/Latner/Elia/CochlearChairs in Otolaryngology � Head and Neck Surgery Chair in Head and Neck Surgery$2,000,0000 - Dr. Patrick Gullane Bartley-Smith/Wharton Chair in Radiation Oncology$2,000,000 - Dr. Brian O�Sullivan Elia Chair in Head and Neck Research$2,500,000 - Dr. Fei-Fei Liu Temmy Latner/Dynacare Chair in Head and Neck Oncology$3,000,000 - Dr. Jeremy Freeman Cochlear Americas Chair$2,000,000 - Dr. Blake Papsin Two future Chairs pending.

23. Research Support, Grants and Publications 2002 � 2007 Endowment interest from Chairs, peer-reviewed grants, industry and pharmaceutical support, group practice plans, resulted in $5.7 million in research support from July 2002 � June 2007. Publications: 2002-2005 217 peer-reviewed papers 56 chapters 3 text books 2005-2006 108 peer-reviewed papers 14 chapters 3 text books 2006-2007 92 peer-reviewed papers 4 chapters

24. Publications Over the past five years, the research �academic output� and peer-reviewed publications have significantly increased from 2002-2006 when compared with the previous publication numbers from 1996-2001 as is documented in the Departmental Annual Report and from the submission of the Research report by Dr. Harrison. A written communication from Dean David Naylor (now President of the University of Toronto) in reference to the Annual Report of 2006, states: As I expressed to you some time ago, the greatest difference in performance measures on a per capita basis-when comparing the University of Toronto to similar institutions is in your department- followed closely by a number of others such as Law & Chemistry.

26. Education Programs The Education Programs have been a major focus of my activities over the past five years and have received significant attention. The Undergraduate and Postgraduate Directors, and their committees are to be complimented for their enormous contributions to this most important area within our Department.

27. Undergraduate Education Dr. Paolo Campisi has taken over the leadership of this program from Dr. Julian Nedzelski who lead the program previously. The course content has been updated by Dr. Campisi and his committee and is now available on-line for students to review. The Undergraduate Medical Education is conducted through three academies: The Peter-Boyd Academy The Wightman-Berris Academy The Fitzgerald Academy. Our Department is committed to provide over 900 hoursof undergraduate medical education per annum.Evaluations from the medical students from all threeacademies are excellent.

28. Undergraduate Medical Education Activity per Annum960 hours

29. Undergraduate Education During the past five years we have increased exposure to Otolaryngology � Head & Neck Surgery which includes the PBL Foundations of Medical Practice, taught by Dr. Alma Smitheringale, the Year III clerkship experience in Otolaryngology � Head and Neck Surgery shared with the Department of Ophthalmology and spread through a two week block interval. Teaching is carried out within the context of the academies with a half day interval at the Hospital for Sick Children as part of the experience during each of these teaching blocks.

30. Undergraduate Education The Undergraduate Education Committee chaired byDr. Paolo Campisi has ensured that a standardized curriculum has been struck and maintained. An evaluation tool for students and teachers has been developed. Plans are in place to implement on-line scheduling, including faculty and student evaluation forms, and patient encounter logs. An upcoming challenge to the committee is the expansion of the undergraduate program and a new clerkship academy at the Mississauga campus. A site visit has already taken place jointly by both Dr. Campisi and the Chair.

31. Undergraduate Education Over the past five years we have seen a significant number of �elective rotations� with an increased number of medical students interested in spending more time in our department and as a result an increased interest in pursuing Otolaryngology � Head & Neck Surgery as a specialty career. The main weakness is the regret by the students of not having more allocated time to our specialty in the Pre-clerkship year. This will be a focus of my attention in the next five years.

32. Postgraduate Education Dr. Ian Witterick was appointed as Director of the Postgraduate Program September 2004 . During the Royal College Site Survey in 2001 some areas of weaknesses were identified and in the mandate of the Internal Review of September 2002 (3 months after I was appointed as Chair) all of these weaknesses were identified and corrected.

33. Postgraduate Education During the past three years under the superior leadership of Dr. Ian Witterick we have experienced significant changes that have included: Enhancement of general otolaryngology A mandatory 4 month research block for residents Established goals and objectives for the residency (Red and Yellow books) Implementation of a 360 degree evaluation tool The establishment of a chief resident category

34. Postgraduate Education During the same time we also have expanded the core teaching lectures, improved resident-faculty evaluations (POWER) online case log tracking system; PGY1 skills course, oral examinations, practice written examinations, addition of anesthesia rotation in PGY1; increased CMGs from 3 to 4 (as of 2008 increased to 5), significant number of invited visiting professors and continuing education courses, Master�s degrees, six over the past five years and finally a mentorship program for PGY1 residents. Increased social interactions to improve the morale of the residents and make them feel like they are �Partners in the Department�.

35. PostgraduateEducation A combination of a large, dynamic and dedicated faculty with high satisfaction ratings, a comprehensive curriculum with re-structuring of the program to adhere to the CanMeds Guidelines have resulted in the recent successful Royal Collegeon-site Survey, April 18th, 2007.

36. University of TorontoDepartment of Otolaryngology � Head and Neck Surgery Percy Ireland16th Annual Academic Day and Dinner May 3-4th, 2007 Dr. Patrick Gullane � Chair Dr. Ian Witterick � Post Graduate Director Guest Speaker � Dr. David Eisele Honoured Guest � Dr. Hugh Barber (posthumous)

37. Percy Ireland Day 18 Guest Professors1990-2007 1990 Charles Cummings 1991 Eugene Myers 1992 Bob Ruben 1993 Noel Cohen 1994 Howard Lampe 1995 Lauren Hollinger 1996 Derald Oldring 1997 Clarence Sasaki 1998 Murray Morrison 1999 Stephen Harner 2000 Dominique Dorion 2001 Richard Mabry 2002 Melvin Schloss 2003 Jonas Johnson 2004 P. Ashley Wackym 2005 Lanny Garth Close 2006 Richard Chole 2007 David W. Eisele

38. Postgraduate Education Our congratulations to Dr. Witterick on his receipt of the Faculty of Medicine Award for Excellence in Postgraduate Medical Education under the Category of Development/Innovation in Postgraduate Education � October 2007.

39. Major Accomplishment Reversed the reciprocity of Canadian graduates to take the American Board of Otolaryngology accrediting examination.

40. Fellowship Program The Fellowship Programs within the University of Toronto(approx. 17 fellows per year) have continued to flourish & include the American Head and Neck Fellowship Program accredited by the advanced training council of the American Head Neck Society, the American Academy of Facial Plastic and Reconstructive Program accredited by the AAFPRS and the Pediatric Program accredited through the American matching system. Our Department has a long standing history of post-residency fellowship training with many of our postgraduate trainees having come from 42 countries over the past 40 years. These fellow graduates have therefore added significantly to the academic output and productivity of the Department. The Fellowships within the Department all have specific Job Descriptions with terms of reference to ensure that the fellowship experience complements rather than interferes with resident training.

41. Fellowship Program Head and Neck Oncology, including (6) microvascular surgery � intergrationof UHN/Mt.Sinai/Sunnybrook Approval of 3rd accredited position July 1, 2005 in Head and Neck by ATC of AHNS Pediatric Otolaryngology (1-2) Neurotology � approval of 2nd (2-3) fellowship by TWJ Otologic Research (2) Rhinology (2) Facial Plastic Surgery � AAFPS (2)

42. Continuing Medical Education The Continuing Education Committee, Chaired by Dr. Ian Witterick, has revolutionized and redesigned the focus of CME. The CME has become a priority of the Department. Emphasis has been placed on high quality, interactive activities intended to stimulate both community and academic otolaryngologists. Guest Professors and Lecturers over the past five years include some of the most prominent individuals in our specialty. The activities of the CME have been further enhanced with the interest in minimally invasive surgery resulting in an increased number of endoscopic Skull Base Dissection and Temporal Bone courses hosted by our Department within the Surgical Skills Laboratory.

43. Continuing Medical Education Drs. Al Chiodo and Richard Rival (representative on our Executive Committee of community academic faculty) have continued to successfully coordinate with the University Department, the annual �Otolaryngology Update� atToronto East General Hospital. This event attracts over half of the otolaryngologists in the province of Ontario on an annual basis. This again is further evidence of improved relationships with our community colleagues. Many other events during the past five years have included the �Current Concepts on the Management of Thyroid Nodular Disease and Cancer� organized by Dr. Jeremy Freeman. The annual Wharton/Elia Day coordinated by Drs. Ralph Gilbert and Gullane Numerous endoscopic & Temporal bone courses etc. coordinated byDrs. Witterick, Rutka, Papsin, Chen, Nedzelski etc.

44. Continuing Medical Education Finally, on the international scene, the Canada International Scientific Exchange Program in Otolaryngology (CISEPO) under the directorship ofDr. Arnold Noyek has been incredibly active on numerous fronts including the organization of international scientific meetings in the Middle East. Dr. Noyek�s innovations have helped to build bridges in the Middle East where no other government or agency had been able to be successful.

45. Accredited CME Courses 2002 � 2005 2002-2003 A series of visiting professors was planned for the academic year but many had to be cancelled secondary to the SARS outbreak. February 8, 2003Otolaryngology Update 2003Course Director: Dr. Albino Chiodo June 20-21, 2003Advanced Endoscopic Sinus SurgeryCourse Director: Dr. Ian Witterick 2003-2004 October 23-25, 20033rd Practical Otology/Neurotology Update 2003Course Directors: Drs. John Rutka, Manohar Bance, Jerry Halik February 7, 2004Otolaryngology Update 2004Course Directors: Drs. Albino Chiodo, Richard Rival April 16-17, 2004The Toronto Voice Course featuring Laryngeal Disorders, Stroboscopy, Thyroplasty and Percutaneous TracheotomyCourse Directors: Drs. Jennifer Anderson, Ian Witterick

46. Accredited CME Courses 2003 � 2005 2003-2004 June 11-12, 20045th Biennial Course on the Management of Thyroid Nodular Disease and CancerCourse Coordinator: Dr. Jeremy L. Freeman June 18-20, 2004Temporal Bone Dissection CourseCourse Directors: Drs. John Rutka, Jerry Halik June 26, 2004Otolaryngology Saturday at the University Course Director: Dr. Ian Witterick 2004-2005 October 28-30, 2004Endoscopic Sinus Surgery and Rhinoplasty CourseCourse Directors: Drs. Ian Witterick, Peter Adamson November 11, 2004Practical Course in Mystagmus, Vestibular Testing and the Management of the Dizzy PatientCourse Directors: Drs. David Tomlinson, Paul Ranalli, Heather Desroches, John Rutka

47. Accredited CME Courses 2003 � 2005 2004-2005 November 12, 2004The Toronto Paediatric Endoscopy CourseCourse Directors: Drs. Vito Forte, Ian Witterick December 11, 2004Otolaryngology Saturday at the UniversityCourse Director: Dr. Ian Witterick February 11, 2005Treatment of Head and Neck Cancer by Transoral Laser SurgeryCourse Organizers: Drs. Ian Witterick, Ralph Gilbert February 12, 2005Otolaryngology Update 2005Course Directors: Drs. Albino Chiodo, Richard Rival, Ian Witterick June 9-11, 2005Temporal Bone Dissection CourseCourse Directors: Drs. John Rutka, Jerry Halik June 11, 2005One Day Course on Functional and Structural Diseases of the ThyroidCourse Coordinators: Drs. Jeremy L. Freeman, Michael Odell

48. Accredited CME Courses 2005 � 2008 2007-2008 September 27-29, 2007Temporal Bone Dissection CourseCourse Directors: Drs. John Rutka, Jerry Halik November 16-17, 2007Endoscopic Surgery of the Pituitary Fossa and Cranial BaseCourse Directors: Drs. Fred Gentili, Ian Witterick February 9, 20086th Annual Otolaryngology UpdateCourse Organizers: Drs. Al Chiodo, Richard Rival, Ian Witterick

49. Visiting Professorships 2002-2007 Wharton Lectureship Morley Binstock Lectureship Bulhose Lectureship Leibinger Lectureships Abbott Lectureship Elia Lectureship How have we done?

50. Department of Otolaryngology/Head and Neck SurgeryVisiting Professors/Observers 2002 Dr. Robin Blair Oct Visiting Professor Scotland UK Dr. Patrick Bradley Oct Visiting Professor Nottingham England Dr. Noel Cohen Feb Visiting Professor New York Dr. Fadel Ishak June Visiting Surgeon Sudbury Dr. Bernard Lyons Feb Visiting Professor Australia Dr. James McGillivray Aug Visiting Surgeon Collingwood Dr. Shahed Quraishi Jul-Aug Observer Nottingham Dr. Ali Safavi Naini Sept-Dec Observer Iran Dr. Patrick Sheahan Apr Observer Dublin Dr. David Schuller June Visiting Professor Columbus Ohio Dr. David Sidransky June Visiting Professor Baltimore Maryland Dr. Salvatore Singarelli July Observer Milan Italy Dr. Sandro Stoeckli Sept-Oct Observer Switzerland Dr. Ibrahim Wedyan Oct-Nov Observer Jordan Dr. Ernest Weymuller Apr Visiting Professor Seattle Washington

51. Department of Otolaryngology/Head and Neck SurgeryVisiting Professors/Observers 2003 Dr. Martin Desrosiers February Visiting Professor Montreal Quebec Dr. Patricia Chute Feb Visiting Professor New York Dr. Eduardo Manuel Casal Feb-Mar Visiting Professor Argentina Dr. Jack Coleman Mar Visiting Professor Indianapolis, Indiana Dr. David Lam Mar Observer Oxford Dr. Ian Jackson March Visiting Professor Michigan Dr. Jose Maria Galan Fajardo Mar-May Observer Madrid Spain SARS Mar-July Dr. Jonas Johnson May Visiting Professor Pittsburgh Dr. Essam Aizimaiti July/Aug Visiting Observer Saudi Arabia Dr. Sinnathurai Selvaratnam Aug Visiting Observer Singapore Dr. Robert Takes Aug Visiting Observer The Netherlands Dr. Peter Lohuis Aug Visiting Observer Amsterdam Dr. Marcel Cooper Aug Visiting Observer The Netherlands Mr Brent Elliott September Visitor Tech Consultant � Baxter Dr Prema P Samy Sept-Dec Observer Malaysia Dr. Richard Smith Oct Visiting Professor University of Iowa Dr. David Parsons Oct Visiting Professor South Carolina Dr. Paul Levine Oct Visiting Professor Virginia Dr. Fons Balm Nov Visiting Professor The Netherlands Dr. Lorne Parnes Dec Visiting Professor Univ of Western Ont

52. Department of Otolaryngology/Head and Neck SurgeryVisiting Professors/Observers 2004 Dr. Prema P Samy Jan-Sept Observer Malaysia Dr. Francois Lavigne Jan Visiting Professor Univ of Montreal Dr. Manohar Bance Feb Visiting Professor Dalhousie Univ, NS Dr. Natalie Narango Feb-Dec Observer Univ of UACA, San Jose, Costa Rica Dr. Peter J Wormald March Visiting Prof U of Adelaide � S Australia Dr. Mark Rafferty March Observer Dublin Ireland Dr. Antti Makitie Mar-Apr Visiting Prof Helsinki Finland Dr. Lance Oxford Apr Observer U of Texas Dr. Gerry Funk Apr Visiting Prof Iowa College of Medicine, Iowa Dr. Syed Farhan Ahsan Apr Observer Aberdeen Scotland Dr. Anthony Jahn Apr Visiting Prof Columbia University, New York Dr. Yi Deng Apr-May Observer Hubei Medical CollegeChina Dr. Hiroyuki Itoh Apr-June Observer, Tokyo Medical Hospital � Japan Dr. Steve Cohen May-July Observer Rouge Valley Health Care System Dr. Colm Fahy May Observer Belfast Ireland Prof Jean Bourhis June Visiting Professor Villejuif, France Dr. Bert O�Malley June Visiting Professor Philadelphia, PA Dr. Vincent Clarke June Observer Queen Eliz Hospital, Barbados Dr. Hendrik Verschuur July Visiting The Netherlands Dr. Samer Alnajjar July Observer Wayne State Univ, Michigan Dr. Ernest Mazzaferri September Visiting Prof Univ of Florida, Gainesville Dr. Karim Nazarali September Visiting Surgeon Mississauga On Dr. Michiel van den Brekel Nov Visiting Prog Amsterdam Dr. John C Muthusami Nov-Dec Observer Chris Med College, Nadu India

53. Department of Otolaryngology/Head and Neck SurgeryVisiting Professors/Observers 2005 Dr. Stefanos Naxakis Jan-Apr Visiting Observer Patras Greece Dr. Masoud Zarandy Jan-Dec Visiting Observer Iran Dr. Natalie Naranjo Jan � Dec Visiting Professor Costa Rico Alex Drossos Jan 14 Visiting Observer Cancer Care Ontario Dr. Maya Sardesai Feb 16 Visiting Observer Univ of Western Ont Dr. Blake Wilson Feb 18 Visiting Professor Duke University Dr. Paul Kessler Feb � Dec Visiting Observer Switzerland Dr. Rajan Patel Mar 14-16 Visiting Observer North Bristol Hosp - England Dr. Charles Minett Mar 30 Visiting Professor Guelph, Ontario Dr. Bernard Hoffmann Apr 18-30 Visiting Observer Charite University - Berlin Dr. Nabil Abdel-Hamid May 4 Visiting Professor Thunder Bay Dr. Lanny Close May 6-7 Visiting Professor Columbia University Dr. Arnold Cheung May Visiting Observer Hong Kong Dr. Konstantina Tzifa June � July Visiting Observer Birmingham England Dr. Wytske Fokkens June 3 Visiting Professor Univ of Amsterdam Dr. Kian Ang June 16-18 Visiting Professor MD Anderson Dr. Low Wong Kein July 6 Visiting Professor Singapore Gen Hospital Dr. Antti Makitie Aug 2-12 Visiting Professor Helsinki Finland

54. Special Visiting Professors 2002-2003 October 2002 Dr. Patrick J. Bradley Consultant, OtorhinolaryngologyHead & Neck SurgeonUniversity HospitalQueens Medical Centre, Nottingham, England2nd Morley Binstock � Mt. Sinai Hospital LecturerUniversity of Toronto Visiting Professor February 2003 Dr. Martin Desrosiers Associate ProfessorDepartment of Otolaryngology,Universit� de Montr�al1st Annual Bayer Healthcare � University of Toronto � Mount Sinai Hospital Lecture in Rhinology Dr. Patricia M. Chute Associate Professor, Department ofCommunication DisordersMercy College, NY

55. October 2003 Dr. Richard Smith ProfessorDepartment of Otolaryngology, � Head & Neck Surgery University of Iowa Dr. David Parsons Clinical Professor, University of South Carolina1st GlaxoSmithKline LecturerUniversity of Toronto Visiting Professor Dr. Paul A. Levine Robert W. Cantrell � Professor and ChairmanDirector, Head and Neck Surgical OncologyUniversity of Virginia Health System13th Annual Abbott - Mt. Sinai Hospital LecturerUniversity of Toronto Visiting Professor Special Visiting Professors 2003

56. Special Visiting Professors 2003-2004 December 2003 Dr. Lorne S. Parnes Professor and Program DirectorDepartment of OtolaryngologyUniversity of Western OntarioLondon, Ontario1st Solvay Pharma LecturerUniversity of Toronto Visiting Professor January 2004 Dr. Francois Lavigne ProfessorInstitut ORL de Montreal1st Bristol Myers Squibb LecturerUniversity of Toronto Visiting Professor February 2004 Dr. Manohar Bance Associate ProfessorDepartment of OtolaryngologyDalhousie UniversityHalifax, Nova Scotia

57. Special Visiting Professors 2004 April 2004 Dr. Anthony F. Jahn ProfessorColumbia University College of Physiciansand SurgeonsNew York, NYThe Michael Hawke Commemorative LectureUniversity of Toronto Visiting Professor Dr. Karen Kost Director of the Voice Lab, McGill UniversityDirector of Otolaryngology,Montreal General Hospital Dr. Murray Morrison Professor of OtolaryngologyUniversity of British Columbia

58. Special Visiting Professors 2004 June 2004 Dr. Joseph Dohar Pediatric OtolaryngologistPittsburgh Children�s Hospital Dr. Bruce Freeman Wasser Pain Management CentreMt. Sinai Hospital, Toronto Mr. W.M. Armstrong Manager, MD Management LimitedToronto September 2004 Dr. Ernest L. Mazzaferri Professor of MedicineUniversity of Florida Gainesville Dr. Ross Davidson Associate Director, MicrobiologyQueen Elizabeth II Health Sciences CentreHalifax, Nova Scotia

59. Special Visiting Professors 2005 February 2005 Dr. Petra Ambrosch Professor of Otorhinolaryngology � Head and Neck SurgeryUniversity of Kiel, Kiel, Germany Dr. Shan R. Baker Professor and DirectorCentre for Facial Cosmetic SurgeryUniversity of MichiganAnn Arbor, Michigan Dr. David W. Kennedy Vice Dean for Professional ServicesUniversity of Pennsylvania School of MedicinePhiladelphia, Pennsylvania Dr. Blake S. Wilson Senior Fellow at the Research Triangle InstituteDuke University Medical Center

60. Special Visiting Professors 2005-2006 October 2005 Dr. John A. Ridge Chief, Head and Neck Surgery SectionFox Chase Cancer CenterPhiladelphia, PA4th Annual Morley Binstock Lecturer Dr. Eric D. Blom Blom-Singer�Voice Restoration SystemsCarpinteria, California November 2005 Dr. Manohar Bance Professor, Division of Otolaryngology,Department of SurgeryDalhousie University

61. Special Visiting Professors 2006 February 2006 Dr. Robert CowanAssociate ProfessorDepartment of OtolaryngologyUniversity of Melbourne, AustraliaNalli Day Lecturer Dr. Paul Gardner Minimally Invasive Skull Base FellowDepartment of Neurological SurgeryUniversity of Pittsburgh School of MedicinePittsburgh, Pennsylvania Dr. David Howard Institute of Laryngology and OtologyLondon, England Dr. Amin Kassam Associate Professor of Neurological SurgeryUniversity of Pittsburgh School of MedicinePittsburgh, Pennsylvania

62. Special Visiting Professors 2006 April 2006 Dr. Jesus Medina Chair, Department of OtolaryngologyPaul and Ruth Jonas Chair in CancerTreatment and ResearchUniversity of Oklahoma May 2006 Dr. Richard Chole Chair, Department of OtolaryngologyWashington University School of MedicineSaint Louis, Missouri15th Percy Ireland Visiting Professor June 2006 Dr. Randall Gaz Harvard Medical SchoolMassachusetts General HospitalBoston, Massachusetts Dr. Bryan McIver Mayo Clinic College of MedicineRochester, Minnesota

63. Special Visiting Professors 2006-2007 June 2006 Dr. Gerry Funk Department of Otolaryngology � Head & Neck SurgeryUniversity of Iowa, Iowa Dr. Merrill Kies MD Anderson Cancer CenterHouston, Texas December 2006 Dr. Karen Kost Associate ProfessorDirector of the Voice Lab,McGill University Richard C. Seewald, Ph.D. Professor and Canada Research Chair in Childhood Hearing,National Centre for Audiology,Faculty of Health Sciences,University of Western Ontario,London, ON

64. Special Visiting Professors 2007 February 2007 Dr. Emily A. Tobey Professor and Nelle C. Johnston Chair in Communication Disorders, School of Behavioral and Brain Sciences, Human DevelopmentDepartment of OtolaryngologyUniversity of Texas Southwestern Medical Center at DallasNalli Day Lecturer May 2007 Dr. David W. Eisele 16th Percy Ireland Visiting Professor Dr. John Charles O�Brien Jr. Attending Surgeon both in the Department Of General Surgery and Sammons Cancer CenterDallas, Texas5th Annual Binstock � University of Toronto � Mt. Sinai Hospital Lecturer

65. Special Visiting Professors 2007-2008 October 2007 Dr. John Yoo Associate ProfessorChair, Department of Otolaryngology,Schulich School of Medicine & Dentistry,The University of Western Ontario,London, Ontario November 2007 Dr. Fran�ois Lavigne Associate Professor of OtolaryngologyUniversit� de Montr�al Dr. Michel Bojanowski Professor of Neurosurgery Universit� de Montr�al Dr. Ricardo Carrau Professor of Otolaryngology � Head & Neck SurgeryUniversity of Pittsburgh School of Medicine

66. Faculty Recruitment A considerable expansion of the Department has occurred over the past five years. This is crucial to maintain the academic department status in North America. Since 2002, there have been nine full-time and eight adjunct academic faculty added to the Department. This number is significantly greater than the combined number of retirements and resignations. We have been successful in recruiting talented individuals with advanced training in head and neck oncology, microvascular reconstruction, pediatric otolaryngology, plastic and reconstructive surgery, skull base surgery.

70. How Do We Cope? Baby-boomer Retirement: Shortage of Talent - a recent surveyof 208 Otolaryngologists � Head and Neck Surgeons in Ontario showed a mean average age of 58 years, similarly in General Surgerya mean age of 61 years. We will experience a crisis in Canada within 5 years! Other countries potentially will lure our talent away from North America.

71. How to Fix It �The leaders and followers are emerging now� says Mitch Leventhal, an American Consultantin International Education. In 10 years the landscape will be unrecognizable. We as the Department of Otolaryngology � Head & Neck Surgery have to change or we will be condemned to the educational backwater.

72. Future of Otolaryngology - Head and Neck Surgery Must engage �Champions� to resolve this flight of the Creative Class especially as it impacts on our educational mission. Dr. Richard Florida author of �Flight of the Creative Class� just recruited to the University of Toronto, Rothman School of Business. We must evaluate our manpower needs. Provide exposure to our medical students andResidents during training. Increase the number of job fairs and exhibits at AAO-HNS, ACS and ASPRS. We must engage and educate our politicians and provide them with a menu of solutions.

73. Challenges in Otolaryngology � Head and Neck Surgery education at U of T and in Canada:How can we make it better?

74. Faculty Development We have continued to stimulate and encourage our junior faculty to take additional training in a variety of disciplines over the past five years. A number of faculty have obtained Master�s degrees (Drs. Kevin Higgins, David Goldstein, Molly Zirkle, Paolo Campisi). A yearly academic interview is held with all of the full-time faculty as well as many of the adjunct appointees. This interview process provides the Chair with the opportunity to further stimulate the faculty�s interest in such endeavors as the �Triological thesis.� (Campisi, James, Higgins)

75. Academic Promotions The faculty have been encouraged to seek academic promotions and in accordance with University policy. The Promotions Committee reviews yearly curriculum vitae of faculty and recommendations made to the Chair as to their suitability for consideration of academic promotion. In the past five years, 5 individuals have been promoted to Full Professor, 1 to the rank of Associate Professor,5 to the rank of Assistant Professor and 2 to Lecturer.

77. Faculty Communications With the advent of email, communication with the faculty, residents, fellows and undergraduates has been greatly facilitated. The recent updated website, completed March 2007, has helped to further increase the awareness of opportunities within the Department and enhance the communications and profile. http://www.otolaryngology.utoronto.ca

78. Accomplishments Over the Past Five Years

79. Accomplishments Over the Past Five Years Reversed the reciprocity of Canadian graduates to take the American Board of Otolaryngology accrediting examination. Name change of our Department from �Otolaryngology� to �Otolaryngology � Head and Neck Surgery�. Established a University of Toronto, Department of Otolaryngology � Head and Neck Surgery Nucleus Committee for Fundraising Chaired by Dr. Peter Adamson. Endowment of a $2 million Chair in Otolaryngology � Head and Neck Surgery (presently ongoing negotiations).

80. The Next Five Years Secure additional Alternate Funding for all faculty. Rationalize resources across teaching hospitals developing further foci of excellence in Otolaryngology � Head and Neck Surgery. This may also include an �Ear Institute� at one of our hospitals. Increase the number of faculty educators(negotiate financial support for teachers). Further promote and encourage Master�s thesis within theSurgeon Scientist Program. Stimulate increased participation in basic research(molecular, genetics, education and health policy). Enhance research funding.

81. The Next Five Years Promote enhanced collaboration in joint research opportunities (neurosciences, surgery, radiation oncology, education, radiology, medical oncology and endocrinology). Further explore and develop �Simulation Models� within the Surgical Skills Centre that would enhance resident training and diminish the impact of residency training on our resources within the operating room. Review the future role of robotics, tissue engineering, nanotechnology and minimal access surgical approaches within our specialty. Pursue further funding opportunities to explore new technologies. Work closely with University and affiliated Hospitals in enhancing the Faculty of Medicines� strategic plan. (White paper draft)

82. Can we predictthe future?

83. The Next Five Years It is clear that many of the accomplishments that have occurred over the past five years would not have been possible without the dedication, passion and support of my most vital ingredient (faculty). Some thirty years ago I was told by a very prominent head and neck oncologist in the United States that to be successful one has to �surround themselves� with people that are better than you are, empower them and let them provide the leadership. Well, I think I have done that and believe that we have all benefited from this approach.

84. It is a time to take pride of our past accomplishments, reflect on our strengths and anticipate a future fullof promise.

85. Thank You for Your Support Did the Pub Night which was the brainchild of Drs. Witterick, Forte, Harrison and Chen make the difference? Resident graduation dinner. Following slides tend to tell me that it did.

86. Graduating Residents 2006

88. Pub Night Winners

92. The Seven C�s of Leadership

93. The Molecular Biology RevolutionThe Past 50 Years Historical Landmarks: 1953 Structure of DNA determined 1965 The genetic code determined 1968 Restriction endonucleases discovered 1973 Gene transfer techniques described 1983 Polymerase chain reaction (PCR) described 1986 Tumor suppressor genes identified 1995 More than 1000 gene therapy patients 1999 cDNA Microarray analysis 2001 Human Genome Project Completed 2005 Regenerative Medicine - Stem Cell Therapeutics, Gene Therapy - emerging developments

94. Transplantation Robotics Tissue Engineering Image Guided Targeted Surgery

95. Future However, from a quote by Lord Byron �the good old times� - all times when old are good have disappeared with a medical-health care environment in turmoil and perception by our trainees of loss of career flexibility that previously characterized our specialty. Many adjustments will have to be made in order for this program to continue to be the best and most attractive in Canada and one of the best in North America.

97. Finally, thanks to our Dean, President and Hospital CEO�s who have been remarkably supportive of the goals, visions and objectives of our department.