FNB Head and Neck Oncology: Admissions, medical colleges, fees, eligibility criteria details

FNB Head and Neck Oncology or Fellow of National Board (FNB) in Head and Neck Oncology also known as FNB in Head and Neck Oncology is a doctoral fellowship program for doctors in India that is done by them after completion of their postgraduate medical degree course. The duration of the FNB course is for 2 years.

FNB Head and Neck Oncology training includes all aspects relevant to research, prevention, diagnosis, treatment, and rehabilitation of head and neck cancers, with specific emphasis on hands-on surgical training in head and neck oncology and contemporary reconstruction.

The course is a full-time course pursued at various accredited institutes/hospitals across the country the top institutions Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Atal Bihari Vajpayee Regional Cancer Centre, Agartala Tripura, and more.

Candidates can get admission to 2 years FNB course after successfully qualifying for the FET (Fellowship Entrance Test) examination which NBEMS conducts. FET is conducted annually as per the prescribed schedule. The merit-based counselling for admissions to the FNB Programme after the conduct of FET is administered by NBEMS.

The fee for pursuing FNB Head and Neck Oncology varies from accredited institutes/hospital to hospital and is around Rs.1,25,000 per year.

After completion of their respective course, doctors can either join the job market. Candidates can take reputed jobs at positions as research fellows, Senior residents, Consultants, etc. with an approximate salary range of Rs. 26 lakhs to Rs. 90 lakhs per year.

The Nomenclature of the FNB qualification awarded by the National Board of Examinations in Medical Sciences is “Fellow of National Board”. The FNB qualifications are recognized qualifications in terms of the Gazette notification dated 10th August 2016.

What is FNB in Head and Neck Oncology?

FNB in Head and Neck Oncology is a two-year doctoral fellowship program that candidates can pursue after completing a postgraduate degree.

Head and neck Oncology is the branch of Oncology. The stress is on the multimodality treatment of these tumors as well as on providing good quality of life along with the cure to these patients. Training includes all aspects relevant to research, prevention, diagnosis, treatment, and rehabilitation of head and neck cancers, with specific emphasis on hands-on surgical training in head and neck oncology and contemporary reconstruction.

Three main goals of the course:

• establishing uniform and internationally accepted standards of care for head and neck cancers in the country.
• Promote research programs in basic sciences as well as clinical areas.
• Initiating educational activities like structured oncology training programs.

The curriculum governs the education and training of FNB Head and Neck Oncology.

Course Highlights

Here are some of the course highlights of FNB Head and Neck Oncology

Name of Course	FNB Head and Neck Oncology
Level	Fellowship
Duration of Course	Two years
Course Mode	Full Time
Minimum Academic Requirement	Candidates must have a postgraduate medical Degree in MS/DNB General Surgery or MD/DNB Otorhinolaryngology or MCh/DNB/DrNB Surgical Oncology or MCh Head and Neck Oncology obtained from any college/university recognized by the Medical Council of India (Now NMC)/NBE. The feeder qualification mentioned here is as of 2022. For any further changes to the prerequisite requirement please refer to the NBE website.
Admission Process / Entrance Process / Entrance Modalities	Entrance Exam (FET) Merit-based counselling administered by NBEMS
Course Fees	Rs.1,25,000 per year
Average Salary	Rs. 26 lakhs to Rs.90 lakhs per year

Eligibility Criteria

The eligibility criteria for FNB in Head and Neck Oncology are defined as the set of rules or minimum prerequisites that aspirants must meet in order to be eligible for admission, which includes:

Name of Fellowship course	Course Type	Prior Eligibility Requirement
Head and Neck Oncology	FNB	MS/DNB General Surgery MD/DNB Otorhinolaryngology MCh/DNB/DrNB Surgical Oncology MCh Head and Neck Oncology.

Note:

Admission Process

The admission process contains a few steps to be followed for the candidates for admission to FNB. Candidates can view the complete admission process for FNB Head and Neck Oncology mentioned below:

• FET is a qualifying-cum-ranking examination for admission to Fellow of National Board (FNB)/Fellow of National Board - Post Doctoral (FNB-PD) courses.
• The selection of a student will be through an MCQ-based examination namely Fellowship Entrance Test.
• A student can apply for the fellowship courses for which his/her broad or super specialty qualification/ equivalent qualification is eligible, at the time of online submission of the application form.
• The total duration of the question paper will be 105 minutes (Part A - 45 minutes and Part B - 60 minutes).
• QUALIFYING CRITERIA: Students who obtain a minimum of 50th Percentile in their respective question paper/specialty shall be declared as “Qualified”.
• NBEMS shall declare a specialty-wise merit list i.e., there will be a separate merit list for each fellowship course. There shall not be any equating/scaling and normalization. The merit shall be generated strictly based on marks obtained by the student and the application of the prescribed tie-breaking criteria.
• The admission to Fellowship courses in the accredited hospitals shall be undertaken solely based on merit-based counseling conducted by NBEMS.
• Documents required to be produced at the time of counseling: MBBS Degree Certificate and MD/MS/DNB/DM/MCh/DrNB Degree Certificate/Provisional Pass Certificate of eligible Post Graduate Medical Qualification issued.

Fees Structure

The fee structure for FNB Head and neck Oncology varies from accredited institute/hospital to hospital. The fee is generally less for Government Institutes and more for private institutes. The average fee structure for FNB Head and neck Oncology is around Rs.1,25,000 per year.

Colleges offering FNB Head and Neck Oncology

FNB in Head and Neck Oncology is a two years specialization course that provides training in the stream of Head and Neck Oncology.

The course content for FNB Head and Neck Oncology is given in the NBE Curriculum released by the National Board of Examinations, which can be assessed through the link mentioned below:

FNB Head and Neck Oncology: Check Out NBE Released Curriculum

1. Surgical training

a) During his/her training, the fellow is expected to have seen, evaluated, and participated in the treatment of at least 200 patients with head and neck cancer.

b) The fellow is expected to have participated in at least 200 major and minor head and neck surgical procedures over the 2-year fellowship period.

c) A minimum of two full operative days per workweek (equivalent to 16 hours of operating room time) are recommended.

d) The fulfillment of the recommended number of site-wise surgical procedures will be considered an essential requirement for fellowship completion- this will be maintained as a surgical case log in the standard format.

e) It is recommended that the scope of the procedures should be expanded to include surgically amenable benign thyroid/parathyroid disease, benign salivary gland, and skull base tumors, etc.

f) Other subspecialty training requiring head/neck expertise pertinent to Otolaryngology-Head and Neck Surgery (CO2 laser surgery or endoscopic

skull base or Plastic Maxillofacial Surgery craniofacial surgery) can be allowed to be incorporated into training.

g) The fellow will be required to maintain a surgical case log with a comprehensive list of all cases participated in. Submission of a completed

operative case log will be an essential requirement for the issuance of the fellowship completion certificate.

h) The log book will be countersigned by the Program Director each month, and case log review will form an essential component of the periodic fellowship review (to be performed every 12 months till the completion of the fellowship).

2. Clinics

a) The number of hours spent in the outpatient clinic and patient numbers seen will be documented and standardized. These may be variable across multiple training institutions.

b) A minimum of two full clinic days (at least one of them directly supervised by the Program Director or the Assistant Program Director) is recommended.

c) Clinic case presentations should be at least one per full clinic day per fellow. There should also be the provision of incorporating case presentations into the weekly Multidisciplinary Tumor Board Conference.

d) There should be a recommendation and provision for periodic interaction with the social worker/s and the psychological counsellor/s.

e) Formal training in patient and grief counseling should be incorporated wherever possible.

3. Academic program and Tumor Board

a) As part of the academic program, the trainee will help organize and attend a weekly Multidisciplinary Tumor Board Conference, to be attended by all disciplines present in the institution and pertinent to the practice of head and neck oncology, including but not limited to Head and Neck Surgery,

Reconstructive Surgery, Radiation Oncology, Medical Oncology, Pathology, Radiology, Nuclear Medicine, Dietetics, Speech/ Swallowing Therapy,

Psychological Counselling, Nursing Supervisors, social workers, etc. As many cases as possible should be presented by the trainees. The tumor board format and consensus recommendations will prepare the trainees to make well-informed decisions and prepare them for a future team-leading position.

b) Wherever feasible, a Head and Neck Board should be encouraged with participation by Head and Neck Surgery, Plastic/ Reconstructive Surgery,

Psychological Counselling, Dietetics, Physical therapy, etc. The frequency of this meeting will be at the discretion of the participating institution.

c) There should be a provision for didactic training in a Grand Rounds format. The series of lectures should be delivered at least once weekly. The

recommended format may include a minimum of (alternating) one trainee lecture and one lecture by program faculty and should encourage extensive interaction. All topics about the management of head and neck oncology

should be incorporated into the lecture schedule. The list of topics will be proposed by NBE.

d) Morbidity/mortality meetings, journal club, and guest faculty presentations in a standard format are recommended to occur every month for each activity.

e) The creation of an online training forum under the aegis of the NBE will be encouraged, where the trainees can share their perspectives via discussion threads. The registered users will have login privileges for accessing uploaded relevant course materials and recent literature.

4. Training in allied specialties (Even though the presence of all of the below-mentioned allied specialists at the training center is ideal, trainees should be scheduled for rotations at outside affiliated centers if the above is not practicable)

a) Dental oncology

FNB trainees may interact with the dental surgeon regarding pre-radiation prophylaxis, post-radiation conservative dental management, and

prevention/management of osteoradionecrosis. Maxillofacial prosthesis training is important, as dental and prosthetic rehabilitation is integral for patients to return to their premorbid state.

b) Speech and swallowing rehabilitation:

Trainees will be encouraged to participate in rehabilitation following management of laryngeal/hypopharyngeal cancer, speech articulation/dysphagia management post glossectomy, and dysphagia rehabilitation post organ preservation treatment. The fellow is expected to become proficient in TEP troubleshooting, compensatory maneuvers/rehabilitation, and other aspects of voice and dysphagia management.

c) Diagnostic anatomical and functional imaging/nuclear medicine: A week-long interactive rotation between the trainee and a radiologist experienced in head and neck imaging is suggested. This allows for discussion of a wide variety of cases by the trainee to allow understanding of radiological staging and subsequent surgical planning wherever indicated. The trainee should be able to understand the decision-making as regards the choice of investigation modality, and also understand the indications of therapeutic nuclear medicine.

d) Pathology:

A week-long interactive rotation with an experienced pathologist is recommended. Training will include essential aspects such as cytopathology,

processing of diagnostic biopsy, surgical specimen orientation, margin assessment, and a basic overview of routine as well as intraoperative pathology.

e) Radiation oncology:

The recommendation is for 2 weeks of rotation each year. After this rotation, the trainee should be able to understand the interplay

between the two specialties in guiding decision-making, understand the indications of radiation therapy in head and neck cancers, and understand

the sequelae and toxicities of radiation therapy and their management/mitigation.

f) Medical Oncology:

The recommendation will be for 2 weeks of training. After this rotation, the trainee should be able to understand the rationale of decision-making as regards cytotoxic and biological agents including immunotherapy, and regimen choice based on treatment setting and performance status. He/she should also be able to understand and recognize the toxicities of common chemotherapeutic agents and their basic management.

g) Pain management and palliative care:

This is recommended as ongoing interaction with the pain/palliative care specialist to understand cancer-associated pain and the pharmacological/

interventional modalities utilized to manage the same. This interaction will be aimed at gaining further perspective on end-of-life issues.

h) Preventive Oncology:

This constitutes an essential recommendation and will incorporate strategies of tobacco cessation, community and physician initiatives,

the current role of HPV and the appropriate counseling, management of leucoplakia and other premalignant lesions, and trismus rehabilitation, among others. The fellow is expected to have conducted at least one screening camp & one public education activity.

5. Research experience

a) Candidate should fulfill the minimum following requirements in 2 years to be eligible for examination.

b) One paper publication as lead author in PubMed indexed journal/One conference presentation per year.

c) Candidate should attend at least two HN conferences (national/international or equivalent) in tenure.

d) The institution will provide infrastructural support, provision for maintenance of electronic or file data, IRB support, and biostatistics support (in-house or

outsourced as applicable) and permission for the trainee to present or publish on behalf of the institution.

e) The decision on the provision of protected research time will rest on a mutual decision made together by the trainee, program faculty, and the institution.

6. Rotations at outside centers:

a) External rotation (outside the institute) is recommended if the institute doesn’t have necessary allied departments suggested for internal rotation. (especially for Rotations are preferred for dysphagia, dental rehab, and reconstruction, pain palliative, and psychology)

b) It needs to be done under an External Mentor.

c) The external mentor will have the following responsibilities: ensuring a beneficial supplemental training period by providing perspectives of

management practiced by another institution, signing off on the operative log book at the end of the rotation, and ensuring that the trainee gets adequate operating room experience during the rotation.

d) Trainees need to log their observations and participation during these external postings. The trainee also has to submit a written report on their experience.

e) Upon the fulfillment of the above prerequisites, a certificate signifying the satisfactory completion of the external rotation will be issued. This will be an essential document at the time of completion of the fellowship.

7. Meetings/Conferences:

a) The trainee is encouraged to participate and present papers (at least 2 in tenure of 2 years) at regional, national and international meetings, which will inspire confidence, bolster awareness and enhance study patterns.

b) The institution may, at its discretion, choose to reimburse the registration cost of the meeting attended.

c) Candidate must attend at least one meeting every year.

d) Candidate must present one paper every year in the head neck or allied meetings

8. Suggested syllabus

a) A selected collection of textbooks including basic science texts, operative and lab manuals, and compendia will be suggested for reading during the training period.

b) By no means should these lists be considered all-encompassing. The trainee will be encouraged to read other standard texts and journals as per his/her discretion under the supervision of the program faculty.

9. Surgical Curriculum

The FNB curriculum mandates a minimum of twice weekly OR with details mentioned in the log book. The following numbers suggest the minimum required

surgical exposure of the candidate.

For head neck oncology - Surgical curriculum year one

	Procedure		Seen		Assisted		Performed under Supervision
	Lymph node biopsy + Minor Procedure						25
DL Scope biopsy		5		5		10
Neck dissection		10		10		5
Glossectomy		5		5		2
Mandibulotomy*		2		2		1
Parotidectomy		2		2		1
Thyroidectomy		5		5		2
Mandibulectomy -segmental		5		5		2
Mandibulectony – marginal		5		5		2
Laryngectomy - total		5		3		0
Maxillectomy		5		3		0
Pectoralis major		3		3		2
Other local flaps		3		3		2

For head neck oncology - Surgical curriculum year two

Procedure	Performed under Supervision
DL Scopy biopsy	20
Neck dissection	10
Glossectomy	5
Parotidectomy	2
Thyroidectomy	2
Mandibulectomy	10
Laryngectomy - total	2
Maxillectomy	2
Pectoralis major	5
Other local flaps	5

(May vary according to institutional practice, Candidate may undergo a microvascular course before commencement of free flap training Free flaps – Outside rotation at a high volume center is desirable if the Institute is not performing free flaps)

1. Academic curriculum
2. Weekly presentations – 30 / year.
3. The following topics are recommended to be covered in the curriculum over 2 years. The academic curriculum must include one case presentation and one seminar presentation per week along with journal club and grand rounds
• Cancer Biology
• Chromosome-related technology (Karyotyping, Comparative genomic hybridization, Fluorescence in Situ Hybridization)
• DNA and RNA-related technology (Isolation and quantitation of DNA/RNA, Mutation analysis, PCR, RT PCR, Real-Time PCR, sequencing, arrays)
• Protein-related technology (Immunohistochemistry and Western blotting)
• Tumor Immunology
• Cell cycle
• Programmed cell death/apoptosis
• Angiogenesis

i. Basic science

· Cancer stem cells

· Apoptosis and its significance in cancer

· Biomarkers in the head and neck cancer

ii. Carcinogenesis

• Etiology of cancer

· Environmental factors in carcinogenesis

· Genetic factors in carcinogenesis

· Human Papilloma Virus and cancer

• Other tumor viruses

· Tobacco carcinogenesis

iii. Principles of cancer screening

1. Radiology Clinics

v. Principles of Radiation Oncology

• Physical and biologic basis of radiation oncology
• Fractionation techniques
• Brachytherapy

· Newer techniques in radiation Oncology

• Hypoxia in head neck cancers and hypoxic cell sensitizers

· Radiotherapy planning

· IMRT and evidence to support its use in HN cancer

vi. Principles of medical oncology

• Mechanism of action of cytotoxic agents
• Management of febrile neutropenia
• Targeted therapy
• Assessment of response (clinical and RECIST)
• Biology of drug resistance
• Immunotherapy

1. Clinical Research Methodology
• Making a database
• Study designs – case-control, cohort, and RCTs
• Writing a research protocol
• Writing a paper for publication
• Survival analysis
• Randomized controlled trials
• Systematic reviews and meta-analysis
• Evaluating screening tests and biases
• Evaluating /critique a published paper

1. Quality of Life:
• Measuring QOL – instruments (EORTC, site-specific QOL)
• QOL as an outcome measure.
• End-of-life care issues
• Principles of palliative management
• Medical ethics in Oncology

1. Others
• Biotherapeutics
• Interferons
• Cancer vaccines

• Case discussions:
• Carcinoma of the Thyroid with/without neck node
• Unknown Primary Carcinoma with cervical node
• Early-stage cancer of the oral tongue
• Advanced-stage cancer of the oral tongue
• Cancer Gingivobuccal complex
• Maxillary mass
• Salivary gland neoplasms
• Osteoradionecrosis
• Laryngeal/hypopharyngeal cancers
• premalignant lesions of the oral cavity

• Lectures and seminars:

LIP AND ORAL CAVITY

• Imaging the mandible
• Infratemporal fossa – anatomy, imaging, and relevance to resectability
• Muscles of mastication and technique of composite resections videos)
• Management of early oral cancer (stage I & II)
• Imaging of the neck and management of the neck in early oral cancer
• Types of neck dissection
• Reconstruction options after surgery for early oral cancer (buccal mucosa and tongue)
• Resection margins in surgery for oral cancer- evidence
• Role of neoadjuvant chemotherapy in oral cancers
• Adjuvant therapy for oral cancers
• Brachytherapy for lip cancers
• Principles of reconstruction and local flaps after lip resections
• Role of sentinel node biopsy
• Dental evaluation (pre and post-op) and prosthetics after oral cancer surgery

OROPHARYNX

• Staging and Imaging for oropharyngeal cancers
• HPV and oropharyngeal cancers
• Methods of detection of HPV
• Discuss surgery vs. radiotherapy as primary treatment for oropharyngeal cancers
• Role of robotic surgery in oropharyngeal cancers
• Approaches to surgery for oropharyngeal tumors (techniques with videos)

THYROID

• Surgical anatomy of the thyroid, parathyroids, and nerves about thyroid
• Physiology of TSH and its importance in thyroid cancer
• Thyroglobulin in thyroid cancer
• Epidemiology and changing trends in patterns of thyroid cancer
• Aetio-pathology, prognostic, and staging systems of DTC
• Molecular biology of thyroid carcinogenesis (DTC, PDTC, and MTC)
• Management of a solitary thyroid nodule
• Hemithyroidectomy vs. total thyroidectomy for early thyroid cancers
• The technique of total thyroidectomy and central neck dissection (videos/pictures)
• Management of neck nodes in thyroid cancer (central and lateral)
• Management of postoperative hypocalcemia
• Locally advanced thyroid cancer- management of the recurrent laryngeal nerve
• Preparation for RAI therapy
• RAI therapy
• Follow-up of patients after thyroid cancer treatment.
• TENIS and alternative therapies for non-radio-iodine avid cancers
• Staging and management of MTC
• Familial MTC
• Management of metastatic MTC
• Management of anaplastic thyroid cancer

PARATHYROID

• Clinical features and workup of patients of hyperparathyroidism
• Surgery for parathyroid adenoma
• Parathyroid carcinoma

HYPOPHARYNX

• Relevant surgical anatomy and staging of hypopharyngeal cancers
• Work up for a patient with hypopharyngeal cancer
• Management of stage I/II hypopharyngeal cancer
• Management of stage III/IV (non-metastatic) hypopharyngeal cancer
• Reconstruction of defects after surgery for hypopharyngeal cancer- when and how?

• Stage-wise prognosis and outcomes after treatment for hypopharyngeal cancer

• Technique of total laryngectomy (videos/pictures)

• Speech rehabilitation after total laryngectomy

• Speech and swallowing dysfunction after organ preservation strategies

LARYNX

• Surgical anatomy of the larynx

• Histological variants of laryngeal cancer

• Workup of a patient with suspected laryngeal cancer

• Options for treatment of early laryngeal cancers

• Physics and principles of laser surgery

• Speech therapy after laser resections

• Organ preservation strategies for advanced laryngeal cancer

• Role of conservative salvage surgery for recurrence

• Technique of supra cricoid laryngectomy (videos/pictures)

SALIVARY GLANDS

• Surgical anatomy of the parotid gland and facial nerve

• Pathology of salivary gland neoplasms with discussion on treatment and prognostic significance

• Staging and workup of a parotid tumor

• Techniques of superficial, total, and radical parotidectomy (videos/pictures)

• Assessment of facial nerve dysfunction postoperatively

• Facial nerve reanimation procedures

• Adjuvant therapy in salivary gland tumors

EAR AND TEMPORAL BONE

• Surgical anatomy of the temporal bone

• Natural history and mechanisms of spread of temporal bone tumors

• Imaging of temporal bone tumors

• Various surgical procedures and indications for temporal bone tumors

• Indications for adjuvant therapy

NOSE AND PARANASAL SINUSES

• Imaging of a maxillary mass
• Pathology of sinonasal tumors
• Maxillary defects and reconstructions
• Types of maxillary resections
• Indications for craniofacial resections
• Indications for endoscopic sinonasal resections
• Role of neo-adjuvant therapy in sinonasal malignancy

GENERAL HEAD NECK

• Management of unresectable HN cancer
• Nutritional support for HN cancer patients (peri-operative and during radiation therapy)
• Role of re-irradiation in HN cancer
• Parapharyngeal anatomy and tumors of the parapharyngeal space
• Sarcomas of the head and neck
• Mucosal melanomas
• Skin cancer
• Palliative chemotherapy
• Targeted therapy in HN cancer

RECONSTRUCTION

• Principles of Reconstruction in Head Neck Cancer
• Pedicled flaps -PMMC, Deltopectoral, submental,
• Local flaps: Nasolabial, palatal
• reconstruction of the lip
• Hypopharyngeal reconstruction

2. Journal club: Journal club presentations may be conducted by the candidate every week. Institute is encouraged, over and above suggested articles, to discuss appropriate articles in Journal Club.

Career Options

After completing FNB Head and Neck Oncology, candidates will get employment opportunities in Government and the Private sector.

In the Government sector, candidates have various options to choose from, including Junior research fellow, Teaching at academic medical centers, and Consultants.

While in the Private sector, the options include Fellow (Head and Neck Oncology), Junior research fellow, Senior Research fellow (Head and Neck Oncology), and Consultants.

Frequently Asked Questions (FAQs) –FNB Head and Neck Oncology Course/ FNB in Head and Neck Oncology Course

• Question: What is the full form of FNB?

Answer: The full form of FNB is Fellow of National Board.

• Question: What is FNB Head and neck Oncology?

Answer: FNB in Head and Neck Oncology or Fellow of National Board in Head and Neck Oncology is a doctoral fellowship course for doctors in India that is done by them after completion of their postgraduate medical degree course.

• Question: What is the duration of FNB in Head and Neck Oncology?

Answer: FNB in Head and Neck Oncology is a postdoctoral program of two years.

• Question: What is the eligibility of FNB in Head and Neck Oncology?

Answer: Candidates must have a postgraduate medical Degree in MS/DNB General Surgery or MD/DNB Otorhinolaryngology or MCh/DNB/DrNB Surgical Oncology or MCh Head and Neck Oncology obtained from any college/university recognized by the Medical Council of India (Now NMC)/NBE. The feeder qualification mentioned here is as of 2022. For any further changes to the prerequisite requirement please refer to the NBE website.

• Question: What is the scope of FNB Head and Neck Oncology?

Answer: FNB Head and Neck Oncology offer candidates various employment opportunities and career prospects.

• Question: What is the average salary for FNB Head and neck Oncology candidate?

Answer: The FNB Head and neck Oncology candidate’s average salary is between Rs.26 lakhs to Rs. 90 lakh per annum depending on the experience.

• Question: Can you teach after completing FNB Head and Neck Oncology Course?

Answer: Yes, the candidate can teach in a medical college/hospital after completing the fellowship.