Dr. Divya D’s Path from Dental Surgery to Advanced Head & Neck Oncology Fellowship
Conversation with Dr. Divya D, Fellow in Head and Neck Oncology
In this edition of DocScopy, Dr. Theresa Lily Thomas interviews Dr. Divya D, an oral and maxillofacial surgeon. Dr. Divya completed her BDS from Century International Institute of Dental Sciences and Research Center, Kasaragod, Kerala, India, and went on to specialize in Oral and Maxillo-Facial Surgery (MDS) from Azeezia Dental College, Kollam, Kerala. Later, she worked as a surgical intern in head and neck oncosurgery in multiple private hospitals under Karkinos healthcare in Kochi.
In this conversation, Dr. Divya shares her journey, insights into OMFS, and her experiences in the field of oncosurgery.
Dr. Theresa Lily Thomas: Where do you currently work?
Dr. Divya D: I am a Fellow in Head and Neck Oncology (FHNO) at ASTER MIMS Hospital, Calicut, Kerala. This fellowship is conducted by Indus University, Ahmedabad, under the organization Federation of Head and Neck Oncology.
Dr. Theresa Lily Thomas: How would you describe your daily routine as an FHNO and your working hours? What is the benefit of this fellowship program as a surgeon?
Dr. Divya D: My working hours are 24x7. I have pre-rounds, main rounds, a few hours in the OT for surgeries, and I see patients in the OPD. I stay quite close to the hospital since I have to be available during any emergency involving the head and neck area. This fellowship provides major surgical training required in H&N oncology. I am also doing a thesis along with the fellowship.
Dr. Theresa Lily Thomas: Can you describe what the fellowship training involves?
Dr. Divya D: The fellowship focuses on both surgical training and clinical exposure. Even though I was performing surgeries in the head and neck area after my post-graduation, I couldn’t do independent surgeries. This fellowship or an MCh program gives you more surgical skills and experience required for it. Detailed study with more years of dedication is available during this program, which is its benefit. The fellowship includes learning surgeries such as mandibulectomies, maxillectomies, skull base surgeries, different types of neck dissections, thyroidectomies, glossectomies—more exposure in the head and neck area than being restricted to the oral area. Neck dissections in tumor management.
Scopy procedures like laryngoscopy and bronchoscopy.
Multidisciplinary tumor board discussions and management of tracheal carcinoma in collaboration with cardiothoracic surgeons.
National and state-level presentations with weekly webinars and interaction with leaders in this field.
Management of patients with cancer is also entirely different.
Dr. Theresa Lily Thomas: What is the current focus of your research work? How does it contribute to the advancements in H&N oncology?
Dr. Divya D: My thesis is on Assessing risk factors for complications in head and neck surgery: A comparative analysis of comorbidity indices at a tertiary center in north Kerala on comparing comorbidity indices used in head and neck surgery with the modified Clavien - Dindo scale to assess their accuracy in predicting postoperative complications. Many global indices exist, such as the Washington University Head and Neck Comorbidity Index (WUHNCI), but they are not always applicable in all situations. I am trying to make it easy to predict the comorbidities that may develop after a head and neck surgery. Post surgical assessment will be made easier.
My second ongoing study is to develop a comorbidity index tailored to the Indian population. It will bring a new perspective and am hoping patient management can be improved through this.
Dr. Theresa Lily Thomas: What exams are required to pass the program or to enter this fellowship?
Dr. Divya D: There are both entrance and exit exams (FHNO entrance examination). After my post-graduation, I worked in the Head and Neck department in Kochi, where I met my mentor, Dr. Moni Abraham Kuriakose, a renowned maxillofacial head and neck surgeon. I had always dreamed of pursuing a fellowship in oncology. After PG, I initially tried in Malabar Cancer Centre but couldn’t get in. I later found out about the FHNO exam. It is very competitive and requires a referral letter to the federation, after which they allow us to appear for the entrance examination. At the end of the program, we have to appear for an exit exam.
Dr. Theresa Lily Thomas: What excites you most in this fellowship?
Dr. Divya D: It gives me more exposure in oncology and career growth in this field. I like doing neck dissections, tracheostomies, and thyroidectomies. So altogether, it's a win-win.
Dr. Theresa Lily Thomas: How long is the fellowship?
Dr. Divya D: It is a 2-year program.
Dr. Theresa Lily Thomas: What are your future goals—short and long term?
Dr. Divya D: In the short term, I plan to do a travel fellowship at Tata Memorial Cancer Centre, Mumbai, immediately after this. In the long term, I hope to pursue another clinical fellowship in head and neck oncology in the United Kingdom.
Dr. Theresa Lily Thomas: How would you differentiate between a fellowship and a PhD?
Dr. Divya D: A PhD mandates research submission, while a fellowship focuses more on clinical training, though research can still be a part of it.
Dr. Theresa Lily Thomas: What advice would you give to future fellows in this field?
Dr. Divya D: Be mentally and physically prepared for anything and everything. Whether it's surgical or medical oncology, mental strength is crucial.
Dr. Theresa Lily Thomas: Would you say the mortality rate in your area of study is high? Is that why you said this needs mental strength?
Dr. Divya D: No, the mortality rate is comparatively lower in Kerala since we are able to diagnose it at an early stage. But advanced stages do appear as well.
Dr. Theresa Lily Thomas: How important is mentorship in this field?
Dr. Divya D: Without the right mentor, you won't learn effectively. I was lucky to have excellent mentors. It’s a team effort, and when mentors treat students as colleagues, it creates the best learning environment.
Dr. Theresa Lily Thomas: What stipend do you receive as a fellow?
Dr. Divya D: I receive a stipend of ₹80,000 per month.
Dr. Theresa Lily Thomas: How would you describe your journey so far? What was the most difficult part?
Dr. Divya D: The journey has been challenging. It's never easy—our minds work 24/7, its hectic, but I love what I do. I am blessed to be doing it. That mental load is the hardest part. But the work environment has been fair. In my department, despite being the only woman among three male surgeons, I've never faced gender discrimination.
Dr. Theresa Lily Thomas: Any final thoughts you’d like to share?
Dr. Divya D: Always keep upgrading yourself.
MedBound Times expresses sincere gratitude to Dr. Divya D for sharing her valuable insights on our platform.
