In November and December 2023, I had the privilege of completing my Fellowship in Snoring and Sleep Apnea by the Indian Association of Surgeons for Sleep Apnea (IASSA CTP) under the guidance of Dr. Srinivas Kishore Sistla, the Director of ENT and Sleep Apnea Services at AIG Hospitals, Hyderabad. This fellowship wasn’t just a training program for me—it was a transformative journey, both professionally and personally.
Since then, several junior ENT colleagues have approached me with questions about how to enroll for this training program and about my experience. To make the process easier for anyone interested, I’ve outlined my experience and the steps you need to take.
The Application Process for IASSA CTP
The IASSA CTP is a two-month, non-stipendiary fellowship designed to enhance clinical skills, knowledge exchange, and expertise in managing obstructive sleep apnea (OSA). It offers hands-on training in patient evaluation, sleep studies, and various procedures like DISE. Trainees work closely with mentors in nine high-volume centers across India. The program includes a personal interview and requires candidates to submit a detailed logbook. For more details, visit IASSA CTP.
The process to apply for the IASSA CTP is straightforward but requires careful planning. The application form can be found on the IASSA website under the CTP link (https://www.iassa.in/iassa-ctp). While filling out the form, you need to list your priority of training centers.
While I trained under Dr. Srinivas Kishore Sistla, you can choose any faculty based on your convenience, the faculty’s availability, the distance to their center, and other factors. There are currently nine centers across India, each led by eminent faculties who are pioneers in the field of OSA and Sleep Apnea surgeries. The details of these centers and their mentors are available on the IASSA website.
Before selecting your mentor and training center, I strongly recommend getting in touch with the mentor personally. Discuss the timing of the fellowship and, if possible, arrange a visit to the center. This allows you to better understand the setup, the kind of cases handled, and the mentor’s teaching style. A preliminary visit helps set the right expectations and ensures a smooth fellowship experience.
Once the form is completed, you can submit it online or during the annual IASSA conferences. The allocation of training centers depends on your preferences, the availability of faculty, and your convenience. After submission, the IASSA team coordinates with the selected center to finalize your fellowship schedule.
Choosing My Mentor: A Stroke of Luck
I was fortunate to be referred to Dr. Srinivas Kishore by my guide, Dr. Seemab Shaikh, another renowned OSA and Sleep Apnea surgeon. Dr. Seemab Sir was the first to guide me through the complexities of sleep apnea and introduced me to the world of OSA surgery. I am fortunate that, I was able to finish my training under two eminent OSA surgeons.
Choosing the right mentor is crucial, as they not only shape your skills but also illuminate your future path. Opting to train under Dr. Srinivas was one of the best decisions I’ve made in my career. His passion for teaching, depth of knowledge, and relentless work ethic are unmatched.
The Early Days: A Guiding Hand
When I arrived at AIG Hospitals, I was fortunate to meet Dr. Shreya, the fellow who had just completed her training. She graciously took me under her wing during my early days, showing me around the department and introducing me to its routines. Her guidance helped me settle in quickly and gave me a solid foundation for the fellowship.
Overcoming Challenges: Financial and Emotional Hurdles
One of the biggest challenges of the fellowship was the emotional hurdle of leaving behind my established practice. The two months of absence were a source of concern for me—especially about losing my patient clientele. As a practicing surgeon, it’s difficult to step away from the comfort and continuity of your own practice. You worry about the potential impact on your patients, your reputation, and your revenue stream.
But I realized that in the medical field, where advancements are happening every second, keeping yourself updated is essential. The time you invest in learning and expanding your skill set will ultimately benefit your patients, leading to better care and more successful outcomes. It may feel like a sacrifice in the moment, but this training will empower you to return to your practice with greater expertise, ensuring more satisfied and happier patients. And in the long run, this will elevate your practice and help you stay at the forefront of your field.
However, another significant challenge was the financial and emotional investment required. The fellowship required ₹10,000 as a fee to IASSA, along with two months of living expenses in Hyderabad. I opted for accommodation at AIG Hospitals itself, which cost around ₹40,000–₹50,000. While there were other, more affordable options like paying guest facilities, as an outsider unfamiliar with the local place and language, I chose the convenience and security of staying at the hospital. If any of you are planning to opt for hospital accommodation, I recommend getting in touch with the hospital’s guest relations facility (Mr. Ashok Kumar Reddy) and pre-booking your rooms in advance to ensure a smooth stay.
Being away from home for two months also had its emotional challenges. As someone deeply connected to my roots in Kerala, I often missed the comfort of home-cooked meals and the familiarity of my native language. But the support from the team at AIG Hospitals made the transition easier. The kindness of my colleagues, their willingness to share both their professional knowledge and personal experiences, helped me feel less like an outsider. The emotional warmth of my mentors, the hospital staff, and the patients themselves reminded me of the greater purpose of this journey.
Learning and Growth: Diving Into the Ocean of Knowledge
Working with Dr. Srinivas was like exploring an ocean of treasures—you could collect as much as you could carry, and there was always more to learn. The exposure was vast and transformative:
- Clinical Evaluation and Decision-Making: I gained hands-on experience in evaluating OSA patients, deciding on surgical versus non-surgical interventions, and troubleshooting CPAP compliance issues.
- Advanced Surgeries: From BARB pharyngoplasty and Endoscopic DOME to genioplasty and nasal surgeries, I learned techniques that I had only read about before.
- Technology and Tools: The OR was equipped with cutting-edge technology, including the Tivato microscope, Storz endoscopes, VITOM, Warewolf system, and more. Working in such a resource-rich environment was inspiring.
- Holistic ENT Training: Working with Dr. Srinivas Kishore was a privilege. The exposure wasn’t limited to OSA surgeries—I was able to revisit and refine my skills across all ENT specialties, including otology, laryngology, and rhinology under his guidance. The hands-on surgical opportunities were invaluable. Srinivas Sir trusted me with free-hand surgeries, which boosted my confidence immensely.
- Academic Programs: Weekly academic sessions led by sir’s DNB students provided opportunities to stay updated on the latest advancements in ENT and sleep apnea surgery. These programs were instrumental in deepening my theoretical knowledge while complementing the hands-on training. Sir is incredibly up-to-date with the latest scientific advancements, despite his packed schedule from 8 a.m. to 9 p.m. I’ve always wondered how he finds the time to stay so well-read.
- Broader Skills: In addition to surgical expertise, I learned about CPAP compliance, troubleshooting CPAP failures, managing sleep labs, and conducting different levels of sleep studies.
- Working Hours: The working hours at AIG Hospitals were demanding—8 a.m. to 9 or 10 p.m., six days a week—but every minute spent there was worth it. Dr. Srinivas’s OPD and operating room were like a bustling university, and every patient interaction, surgery, and discussion were a lesson in itself.
- Cost: There’s no stipend or payments for fellows. You’ll need to pay ₹10,000 to IASSA, in addition to covering your travel, stay, and daily expenses.
Beyond the technical skills, I learned the importance of patient interaction. Dr. Srinivas’s friendly and empathetic approach left a lasting impression on me. He taught me that being a good surgeon isn’t just about technical precision—it’s about building trust and understanding with patients. I also learned the importance of outpatient decision-making, post-op follow-up care, and late-night patient rounds.
The Emotional Bond: A Team That Felt Like Home
From day one, the ENT team at AIG welcomed me with open arms. Other consultants like Dr. Amjad Khan, Dr. Chandrasekhar, and Dr. Santosh Kumar were incredibly supportive, always ready to share their insights and experiences. Senior resident Dr. Saba and sir’s student Dr. Arshia were equally helpful, making sure I never felt like an outsider.
Sir’s OR team members were just as wonderful. Sister Jomma, originally from Kerala, brought me traditional Kerala food, including her delicious veg kuruma and appam. These meals were like rain in the desert during my stay away from home. OR in-charge sister Philomina, the non-clinical office staff Vidya, Saif, and Sai—all made me feel like I was part of a larger family.
Dr. Srinivas himself was more than a mentor. His unwavering trust in my abilities, from letting me assist in surgeries to independently perform them even under his supervision, gave me immense confidence – from grommet insertion to BARB surgeries and even thyroidectomy. The late-night ward rounds, detailed post-operative discussions, and the encouragement to take on challenges were experiences that shaped me not just as a surgeon but as a person.
Expanding My Horizons: Collaborations with a Multidisciplinary Team
One of the unique aspects of my fellowship was the opportunity to collaborate closely with specialists from other disciplines. I had the privilege of working alongside Dr. Sukhvinder Bindra, Oral and Maxillofacial Surgeon (OMFS), and Dr. Gayathri, an orthodontist. Together, we performed innovative procedures, including Endoscopic DOME (Distraction Osteogenesis Maxillary Expansion) surgeries, combining our expertise to achieve outstanding results.
This collaboration underscored the importance of a multidisciplinary approach in managing complex OSA cases. Observing the synergy between ENT and Dental was an eye-opening experience, teaching me how various specialties can come together to deliver optimal patient care.
The Legacy of Mentorship
As the fellowship approached its end, I couldn’t help but feel a pang of sadness. Leaving behind the warmth of AIG Hospitals and the mentorship of Dr. Srinivas was bittersweet. But the lessons and relationships I built during those two months will stay with me forever.
Dr. Srinivas’s impact on my career didn’t end with the fellowship. He supported me in multiple publications, introduced me to leading OSA surgeons worldwide, and even gave me the opportunity to contribute a chapter to the upcoming OSA Handbook on the Role of Nose in OSA Patients. His dedication to his students is unparalleled, and I consider myself incredibly lucky to have learned from him.
A Message of Gratitude
I extend my heartfelt gratitude to Dr. Srinivas Kishore Sistla, Dr. Seemab Shaikh and the entire team for their guidance and support. I also thank the office bearers of IASSA for organizing this fellowship and providing aspiring surgeons with such an enriching opportunity. This would not be complete without expressing my special thanks to Dr. Rahul Modi, the IASSA CTP coordinator.
To those considering the IASSA CTP: it is not just a program—it’s an experience that will shape your career and perspective. Be prepared to work hard, learn relentlessly, and cherish every moment. For me, it was an opportunity to brush up on my entire ENT training while mastering OSA surgeries. It’s an experience that goes beyond the operating room, offering insights into patient interaction, teamwork, and the dedication required in this specialty.
And when you leave, don’t forget to thank the amazing people who made it possible—because behind every successful surgeon is a team of mentors and colleagues who believed in them.
A Word of Advice for Those New to OSA
If you are new to the domain of OSA, I highly recommend attending a few conferences dedicated to this field before applying for the fellowship. At least one national conference would be ideal to get a brief yet comprehensive understanding of the OSA domain, as this topic is often less covered during your post-graduation training.
Unlike other ENT fellowships like laryngology, rhinology, otology, or neurotology, a fellowship in OSA and sleep apnea surgeries is different. The surgical procedures involved are more complex, requiring substantial exposure to head and neck surgeries during your post-graduation. Without such exposure, your learning curve and ability to handle advanced OSA surgeries will be challenging.
It’s also wise not to rush into the fellowship immediately after finishing your post-graduation. Instead, I suggest you practice for 2–3 years before applying. During this period, you will identify the gaps in your knowledge and experience and realize the areas where you need further training. The fellowship will then serve as a powerful tool to help you bridge those gaps. While practicing, make it a point to attend as many conferences and events as possible to broaden your knowledge and network.
If you need any more information about the IASSA CTP course, please drop your comments below or feel free to get in touch with me.