Department of Otolaryngology
And Communicative Sciences
University of Mississippi Medical Center
2012-2013
Resident Manual
2
TABLE OF CONTENTS
I.
INTRODUCTION ...................................................................................................................... 1
II.
EDUCATIONAL QUOTATIONS ........................................................................................... 1
III.
EDUCATIONAL GOALS AND OBJECTIVES ..................................................................... 3
A.
Philosophy and Overall Goals..........................................................................................................3
B.
General Objectives for All Rotations ..............................................................................................4
C.
Goals and Objectives for the PGY-1 Year. .....................................................................................4
D.
University Head and Neck Service ..................................................................................................6
E.
University Pediatrics/Laryngology Service................................................................................... 38
F.
University Facial Plastics/Otology/Rhinology Service ................................................................. 43
G.
Research/Diagnostics Rotation ...................................................................................................... 49
H.
VA Medical Center ......................................................................................................................... 58
I.
General Knowledge Base and Skill Sets ........................................................................................ 64
J.
Monitoring of Effectiveness ........................................................................................................... 66
IV.
CURRICULUM .................................................................................................................... 66
A.
Purpose and Overview.................................................................................................................... 66
B.
Cycle of Assessment and Improvement ........................................................................................ 67
C.
Methodology .................................................................................................................................... 68
V.
CURRICULAR OUTLINE ................................................................................................... 71
A.
Patient Care and Medical Knowledge ............................................... Error! Bookmark not defined.
B.
Practice Based Learning and Improvement (Stringer, Monico, faculty) ..... Error! Bookmark not
defined.
C.
Interpersonal and Communication Skills (Stringer/faculty) .......... Error! Bookmark not defined.
D.
Professionalism (Stringer, faculty) .................................................... Error! Bookmark not defined.
E.
Systems Based Practice (Stringer, all faculty) .................................. Error! Bookmark not defined.
VI.
RESEARCH PROGRAM .................................................................................................. 152
3
A.
Director .......................................................................................................................................... 152
B.
Statistics ......................................................................................................................................... 152
C.
Project Requirements ................................................................................................................... 152
D.
Project Selection............................................................................................................................ 152
E.
Guidelines ...................................................................................................................................... 153
F.
Research Proposal Format ........................................................................................................... 154
G.
Submissions and Awards .............................................................................................................. 155
H.
Funding .......................................................................................................................................... 155
I.
Submission of Proposals and Presentations .............................................................................. 155
J.
Failure to Comply ........................................................................................................................ 155
VII.
ADDITIONAL EDUCATIONAL PROGRAMS .................................................................. 155
A.
Communicative Sciences .............................................................................................................. 155
B.
Journal Club.................................................................................................................................. 155
C.
Reading Assignments .................................................................................................................... 157
D.
Temporal Bone Lab ...................................................................................................................... 157
E.
Conferences ................................................................................................................................... 157
F.
Sinus Surgery Course ................................................................................................................... 158
G.
Soft Tissue Surgery and Flap Course .......................................................................................... 106
H.
Anatomic Dissections .................................................................................................................... 158
VIII.
RESIDENT EVALUATION PROCESS ............................................................................. 160
A.
Expectations .................................................................................................................................. 160
B.
Evaluation Criteria ....................................................................................................................... 162
C.
Feedback of Results ...................................................................................................................... 171
D.
Promotion of Residents ................................................................................................................ 171
E.
Probationary Status, Suspension, and Dismissal ....................................................................... 171
F.
Procedure for Appeal and Grievance.......................................................................................... 174
IX.
PROGRAM EVALUATION ............................................................................................... 177
4
X.
POLICIES .......................................................................................................................... 177
A.
Duty Hours .................................................................................................................................... 177
B.
Lab Coats....................................................................................................................................... 179
C.
Professional Attire ........................................................................................................................ 179
D.
Benefits (A complete description is available from Human Resources) ................................... 179
E.
Meals .............................................................................................................................................. 180
F.
Work Environment ....................................................................................................................... 180
G.
Sexual Harassment ....................................................................................................................... 180
H.
Substance Abuse and Mental Health .......................................................................................... 181
I.
Counseling ..................................................................................................................................... 181
J.
Emergency Loans .......................................................................................................................... 181
K.
Library ........................................................................................................................................... 181
L.
Non-programmatic Activities (Moonlighting) ............................................................................ 182
M.
Licensure, Credentials, and Memberships ................................................................................. 183
N.
Subscriptions ................................................................................................................................. 183
O.
Research Studies ........................................................................................................................... 183
P.
Leave .............................................................................................................................................. 183
Q.
Educational Fund .......................................................................................................................... 186
R.
Presentation Travel....................................................................................................................... 187
S.
Resident Selection ......................................................................................................................... 188
T.
Conflict of Interest ......................................................................................................................... 189
XI.
CLINICAL ISSUES ........................................................................................................... 190
A.
Resident Duties.............................................................................................................................. 190
B.
Resident Distribution .................................................................................................................... 191
C.
Continuity of Care ........................................................................................................................ 193
D.
Record Completion ....................................................................................................................... 194
E.
Appointment Scheduling and ER Follow-ups ............................................................................ 194
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F.
Surgery Scheduling ....................................................................................................................... 194
G.
Dictations ....................................................................................................................................... 194
H.
Identification ................................................................................................................................. 196
I.
Hand Cleansing ............................................................................................................................. 196
J.
Billing issues .................................................................................................................................. 196
K.
Follow-up issues ............................................................................................................................ 196
L.
Employee counseling..................................................................................................................... 196
M.
Phone message return ................................................................................................................... 196
N.
New patients .................................................................................................................................. 196
O.
Sample pharmaceuticals ............................................................................................................... 196
P.
Consult Protocol............................................................................................................................ 196
Q.
Supervision of Patient Care ......................................................................................................... 198
R.
Call Schedule ................................................................................................................................. 200
S.
ICU Bed Requests ......................................................................................................................... 200
T.
Communications with Outside Physicians .................................................................................. 200
U.
Compliance .................................................................................................................................... 201
V.
Resident Case Distribution........................................................................................................... 201
W.
Criteria for Advancement and Graduation
211
1
I.
Introduction
This manual is meant to provide guidelines to assist you during your residency. Read and
familiarize yourself with these guidelines; you are responsible for all material in this manual and
will be held accountable for this information. These requirements are necessary to allow us to
run an orderly and effective residency program.
Christine B. Franzese, M.D., F.A.A.O.A.
Residency Program Director
Associate Professor
Scott P. Stringer, M.D., M.S.
Professor and Chairman
II.
Educational Quotations
“Follow your heart. That’s what I do.”
Napoleon Dynamite
“Learn as if you will live forever; live as if there is no tomorrow!”
Unknown
“The measure of a person’s worth is the degree to which they strive for excellence no matter what their
chosen pursuit.”
Vince Lombardi
“Learning is not attained by chance; it must be sought for with ardor and attended to with diligence.”
Abigail Adams 1780
“The significant problems we face cannot be solved at the same level of thinking we were at when we
created them.”
Albert Einstein
“Nothing can stop the man with the right mental attitude from achieving his goal; nothing on earth can
help the man with the wrong mental attitude.”
Thomas Jefferson
“No whining. Keep your head up, and your lip buttoned.”
Unknown
“Stop trying to change reality by attempting to eliminate complexity.”
David Whyte
“When in doubt, always follow your nose.”
Gandalf
2
The Fellowship of the Ring, J.R.R. Tolkien
“Follow your nose, it always knows!”
Toucan Sam
3
I.
Educational Goals and Objectives
A. Philosophy and Overall Goals
The Accreditation Council for Graduate Medical Education via its Outcome Project has
increased its emphasis on educational outcome assessment in the accreditation process. This
increased emphasis is reflected in changes to Program and Institutional Requirements that
require programs to:

Identify learning objectives related to the ACGME's general competencies

Use increasingly more dependable (i.e. objective) methods of assessing residents'
attainment of these competency-based objectives; and,

Use outcome data to facilitate continuous improvement of both resident and residency
program performance.
The core competencies were developed via research and a collaborative review process with
broad representation. They reflect among other things an increasing recognition of our
responsibility as educators of physicians to ensure the public that we are training residents in a
consistent and logical manner to be adequately prepared to practice in a rapidly changing
healthcare environment. The core competencies are meant to represent what residents should
know and be able to do. Programs are expected to determine the objectives that should guide
progress toward achievement of the competencies. Subsequently, outcomes assessment will be
expected to follow to assess effectiveness in meeting the objectives.
The final evaluation of graduating residents is to reflect that the resident has “demonstrated
sufficient professional ability to practice competently and independently.” Given the emphasis
on educational outcomes assessment, it is our viewpoint that the structure of the core
competencies is the best framework for achieving this landmark. Goals, objectives, assessment,
and improvement can all readily be framed within the competencies.
Therefore, the overall goal of the residency program is to develop in our graduating residents a
proficiency level appropriate for a new and independent practitioner in the core competencies as
outlined by the ACGME:
1. Patient care that is compassionate, appropriate and effective for the treatment of
health problems and the promotion of health.
2. Medical knowledge about established and evolving biomedical, clinical and cognate
sciences and the application of this knowledge to patient care.
3. Practice based learning and improvement that involves investigation and evaluation
of patient care, the appraisal and assimilation of scientific evidence followed by
improvement in patient care.
4. Interpersonal and communication skills that result in effective information exchange
4
with patients, their families and other health professionals.
5. Professionalism as manifested through a commitment to carry out professional
responsibilities, adherence to ethical principles and sensitivity to a diverse patient
population.
6. Systems based practice as manifested by actions that demonstrate an awareness
of and responsiveness to the larger context in system of healthcare and the ability to
effectively call on system resources to provide care that is of optimum value.
Each rotation is designed to contribute to the achievement of the overall goal and therefore
shares the common goal. In order to direct progress toward goal achievement, general and
specific objectives are identified. General objectives are purposefully common to all rotations
and listed separately. Unique aspects of each rotation are outlined and specific objectives are
listed under each rotation. In order to achieve our stated goal, we have purposefully mirrored the
goals and objectives of the ACGME’s Outcome Project. Our assessment tools are designed to
demonstrate progress towards these objectives by direct linking via a common format.
Residents are responsible for reviewing all general and specific goals and objectives prior to
beginning each rotation.
Note: Interns are specifically PGY1 residents, Junior residents are PGY 1 to PGY 3 residents,
and senior residents are PGY 4 and PGY 5 residents.
B. General Objectives for All Rotations
1. Patient Care
a)
communicate effectively and demonstrate caring and respectful behaviors when
interacting with patients and their families
b)
gather essential and accurate information about their patients
c)
make informed decisions about diagnostic and therapeutic interventions based
on patient information and preferences, up-to-date scientific evidence, and
clinical judgment
d)
develop and carry out patient management plans
e)
counsel and educate patients and their families
f)
use information technology to support patient care decisions and patient
education
g)
perform competently all medical and invasive procedures considered essential
5
for the area of practice
h)
provide health care services aimed at preventing health problems or maintaining
health
i)
work with health care professionals, including those from other disciplines, to
provide patient-focused care
2. Medical Knowledge
a)
demonstrate a logical, thoughtful and analytical approach to clinical situations
b)
know and apply the basic and clinically supportive sciences which are
appropriate to their discipline
3. Practice-Based Learning and Improvement
a)
analyze practice experience and perform practice-based improvement activities
using a systematic methodology
b)
locate, appraise, and assimilate evidence from scientific studies related to their
patients’ health problems
c)
obtain and use information about their own population of patients and the larger
population from which their patients are drawn
d)
apply knowledge of study designs and statistical methods to the appraisal of
clinical studies and other information on diagnostic and therapeutic effectiveness
e)
use information technology to manage information, access on-line medical
information; and support their own education
f)
facilitate the learning of students and other health care professionals
4. Interpersonal and Communication Skills
a)
create and sustain a therapeutic and ethically sound relationship with patients
b)
use effective listening skills and elicit and provide information using effective
nonverbal, explanatory, questioning, and writing skills
c)
work effectively with others as a member or leader of a health care team or other
professional group
5. Professionalism
6
a)
demonstrate respect, compassion, and integrity; a responsiveness to the needs
of patients and society that supersedes self-interest; accountability to patients,
society, and the profession; and a commitment to excellence and on-going
professional development
b)
demonstrate a commitment to ethical principles pertaining to provision or
withholding of clinical care, confidentiality of patient information, informed
consent, and business practices
c)
demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and
disabilities
6. Systems-Based Practice
a)
understand how their patient care and other professional practices affect other
health care professionals, the health care organization, and the larger society
and how these elements of the system affect their own practice
b)
know how types of medical practice and delivery systems differ from one
another, including methods of controlling health care costs and allocating
resources
c)
practice cost-effective health care and resource allocation that does not
compromise quality of care
d)
advocate for quality patient care and assist patients in dealing with system
complexities
e)
know how to partner with health care managers and health care providers to
assess, coordinate, and improve health care and know how these activities can
affect system performance
C. Goals and Objectives for the PGY-1 Otolaryngology Year
The following sections outline the goals and objectives for the Otolaryngology Intern year that
have been established both locally and nationally, in that order. The Department of
Otolaryngology and Communicative Sciences has incorporated the nationally recognized PGY-1
Otolaryngology Resident goals and objectives advocated by the Otolaryngology Residency
Review Committee. In addition, The UMMC Otolaryngology Department has locally
established PGY-1 Otolaryngology Resident educational goals, objectives, and rotation
descriptions for each rotation that supplement and enhance the RRC recommendations.
Otolaryngology Interns rotating on the ENT service follow the Junior level goals and objectives
for the Pediatric Service. The particular rotations each PGY-1 is assigned to may vary slightly,
but will meet all criteria set forth by the ACGME under the specific specialty Program
Requirements for Otolaryngology for completion of the PGY-1 year. Each year, the
Otolaryngology Program Director confirms with the Program Director of General Surgery that
7
the rotation schedule of each intern fulfills these criteria.
University General Surgery Intern Rotation
1. Educational Goal
Interns rotate on this service in order to obtain a balanced experience in the preoperative,
operative, and postoperative care for both outpatients and inpatients with conditions falling
within the principal components of General Surgery which will enhance the attainment of the
overall competencies desired with particular emphasis on this specialty.
2. Rotation Description
An intern is assigned to this service. Overall supervision for the rotation is by the faculty in the
Division of General Surgery assigned to the service. Supervision of junior residents and interns
is also performed by the PGY 5 resident assigned to the service.
Residents see patients in the Surgery A or B service clinic and, work hours permitting, at the
UMMC Pavilion faculty direct referral clinic during this rotation. These clinics meet at least
weekly, giving the resident the opportunity to participate in the preoperative and postoperative
care of patients upon whom the residents have operated or patients with similar problems. The
Surgery A clinic/Colorectal Surgery clinic offers special opportunities in the outpatient
management of anal/colorectal disease evaluation and treatment. Residents see patients in the
Surgery B service clinics during this rotation, one each of which emphasizes surgical disease of
the breast and surgical endocrine diseases. One or more residents attend Transplant Clinic, work
hours permitting. Each of these clinics meets weekly, giving the resident the opportunity to
participate in the preoperative and postoperative care of patients upon whom the residents have
operated or patients with similar problems.
Primary components of this rotation include evaluation and treatment of diseases of the Head &
Neck, Breast, Skin & Soft Tissues, Alimentary Tract, Abdomen, Vascular System, Endocrine
System, Comprehensive Management of Trauma and Emergency Operations, and Surgical
Critical Care. Special emphasis is given to Bariatric surgical procedures upon the alimentary
tract; Advanced laparoscopic procedures on the alimentary tract, spleen, and abdominal wall;
Complex anorectal/colorectal procedures; Endocrine surgical procedures including targeted
treatment of hyperparathyroidism and outpatient laryngoscopy; Outpatient, ambulatory, and
inpatient breast disease surgical management including needle localized biopsy and sentinel node
biopsy; Melanoma management including sentinel node biopsy; Renal transplantation and
management of immunosuppression; Peritoneal and angioaccess for renal dialysis; Gastric
dysmotility syndromes.
Interns are expected to learn to perform appropriate history and physical examinations for this
group of patients. Appropriate management of the postoperative patient is emphasized. In
addition, they are expected to make basic diagnoses and formulate appropriate treatment plans.
A resident at this level should receive a basic understanding of the pathophysiology of these
disease processes. An understanding of basic surgical techniques is promoted.
8
Residents will attend the core conferences of the Division of General Surgery during the course
of this rotation. Formal attending rounds are made regularly. All residents are expected to be
actively involved in the teaching of their fellow residents and medical students.
3. Specific Objectives
a)
Patient Care
(1)
(2)
become proficient in:
(i)
Patient interview
(ii)
Comprehensive physical examination
Describe indications, contraindications, perioperative management, complications, and
surgical sequence for and perform pertinent portions of:
(i)
Laryngoscopy
(ii)
Bronchoscopy
(iii)
Upper and lower gastrointestinal endoscopy
(iv)
Ultrasonography of the abdomen and pericardium
(v)
Immunomodulation of sepsis
(vi)
Conditions falling within the scope of the Trauma and Emergency
Operation component of General Surgery include:
Trauma at all sites
Sepsis
Peritonitis
Hemorrhage
Obstruction
Fistula
b)
Medical Knowledge
(1)
be able to discuss and describe:
(i)
Shock of all types
(ii)
Sepsis
(iii)
Coma
(iv)
Single or Multisystem Organ Failure
(v)
Systemic Inflammatory Response Syndrome
9
(vi)
Coagulopathy
(vii)
Invasive and noninvasive monitoring
(viii)
Mechanical ventilation
(ix)
Vasoactive drugs
(x)
Pacemakers and ventricular assist devices
(xi)
Dialysis of all types
(xii)
Fluid and electrolyte imbalance
(xiii)
Shock and circulatory physiology
(xiv)
Genitourinary physiology
(xv)
Respiratory physiology
(xvi)
Immunobiology and transplantation
(xvii)
Noninvasive vascular diagnosis and invasive vascular interventional techniques
(xviii)
Ultrasonography of the abdomen
VA General Surgery Intern Rotation
4. Educational Goal
Interns rotate on this service in order to obtain experience in the preoperative, operative, and
postoperative care for both outpatients and inpatients with conditions falling within the principal
components of General Surgery which will enhance the attainment of the overall competencies
desired with particular emphasis on this specialty. This service provides more focus on geriatrics
experience and is complementary to the University General Surgery Rotation
5. Rotation Description
An intern is assigned to this service. Overall supervision for the rotation is by the faculty in the
Division of General Surgery assigned to the service. Supervision of junior residents and interns
is also performed by the PGY 5 resident assigned to the service.
Residents see patients in the VAMC General Surgery clinic, and intermittently in the Thoracic
Surgery clinic, during this rotation. These clinics meet at least weekly, giving the resident the
opportunity to participate in the preoperative and postoperative care of patients upon whom the
residents have operated or patients with similar problems.
10
Primary components of this rotation include evaluation and treatment of diseases of the Head &
Neck, Breast, Skin & Soft Tissues, Alimentary Tract, Abdomen, Vascular System, Endocrine
System, Comprehensive Management of Trauma and Emergency Operations, Surgical Critical
Care. Special emphasis is given to Geriatric surgical patients; Advanced laparoscopic procedures
on the alimentary tract and abdomen; Gastrointestinal endoscopy; Noncardiac thoracic surgical
diseases.
Interns are expected to learn to perform appropriate history and physical examinations for this
group of patients. Appropriate management of the postoperative patient is emphasized. In
addition, they are expected to make basic diagnoses and formulate appropriate treatment plans.
A resident at this level should receive a basic understanding of the pathophysiology of these
disease processes. An understanding of basic surgical techniques is promoted.
Residents will attend the core conferences of the Division of General Surgery during the course
of this rotation. Residents will also attend VAMC-based Morbidity and Mortality conferences
during this rotation. Formal attending rounds are made regularly. All residents are expected to
be actively involved in the teaching of their fellow residents and medical students.
6. Specific Objectives
a)
Patient Care
(1)
(2)
become proficient in:
(i)
Patient interview
(ii)
Comprehensive physical examination
Describe indications, contraindications, perioperative management, complications, and
surgical sequence for and perform pertinent portions of:
(i)
Laryngoscopy
(ii)
Bronchoscopy
(iii)
Upper and lower gastrointestinal endoscopy
(iv)
Ultrasonography of the abdomen and pericardium
(v)
Conditions falling within the scope of the Trauma and Emergency Operation
component of General Surgery include:
Trauma at all sites
Sepsis
Peritonitis
Hemorrhage
Obstruction
Fistula
11
b)
Medical Knowledge
(1)
be able to discuss and describe:
(i)
Infectious and inflammatory conditions
(ii)
Neoplasms and premalignant conditions
(iii)
Gastrointestinal hemorrhage
(iv)
Motility disorders
(v)
Strictures and obstruction
(vi)
GERD and hiatus hernia
(vii)
Invasive and noninvasive monitoring
(viii)
Mechanical ventilation
(ix)
Vasoactive drugs
(x)
Lymphadenopathy at all sites
(xi)
Wound infection and dehiscence
(xii)
Fluid and electrolyte imbalance
(xiii)
Shock and circulatory physiology
(xiv)
Genitourinary physiology
(xv)
Respiratory physiology
(xvi)
Neck masses
(xvii)
Noninvasive vascular diagnosis and invasive vascular interventional techniques
(xviii)
Ultrasonography of the abdomen
Pediatric General Surgery Intern Rotation
7. Educational Goal
The intent of this rotation is to provide the intern with exposure to the care of pediatric patients
requiring general surgical procedures and to the nonoperative management of general surgical
diseases in pediatric patients, which will enhance the attainment of the overall competencies
desired with particular emphasis on this subspecialty.
8. Rotation Description
12
The environment of the State’s only children’s hospital offers an experience in the
multidisciplinary management of patients and the working relationships among surgeons and
pediatricians. The high volume of surgery performed at this institution gives the resident an
opportunity to participate in all facets of the perioperative management of patients requiring
pediatric general surgical care. Residents participate in the management of patients in the
Pediatric Intensive Care Unit and the Newborn Intensive Care Unit.
An intern is assigned to this service. Overall supervision for the rotation is by the faculty of the
Division of Pediatric Surgery. Supervision of junior residents and interns is also performed by
the PGY 4 resident assigned to the service.
Residents see patients at least weekly in the Pediatric Surgery service clinics during this rotation.
These clinics give the resident the opportunity to participate in the preoperative evaluation and
work-up of patients as well as the postoperative follow-up of patients upon whom the residents
have operated or similar patients.
Interns are expected to learn to perform appropriate history and physical examinations for this
group of patients. Appropriate management of the postoperative patient is emphasized. In
addition, they are expected to make basic diagnoses and formulate appropriate treatment plans.
A resident at this level should receive a basic understanding of the pathophysiology of pediatric
disease processes. An understanding of basic surgical techniques is promoted.
Residents will attend the core conferences of the Division of General Surgery during the course
of this rotation. Formal attending rounds are made regularly. All residents are expected to be
actively involved in the teaching of their fellow residents and medical students.
9. Specific Objectives
a)
Patient Care
(1)
(2)
become proficient in:
(i)
Patient interview
(ii)
Comprehensive physical examination
Describe indications, contraindications, perioperative management, complications, and
surgical sequence for and perform pertinent portions of:
(i)
Laryngoscopy and tracheobronchoscopy
(ii)
Upper and lower gastrointestinal endoscopy
(iii)
Laparoscopy
(iv)
Thoracoscopy
(v)
Investigation and manipulation of the distal common bile duct
13
(vi)
b)
Physiologic testing of the gastrointestinal tract
Medical Knowledge
(1)
be able to discuss and describe:
(i)
Anomalies of the head & neck, thorax, and abdomen, and their
contents
(ii)
Breast and soft tissue anomalies
(iii)
Childhood neoplasms of the head & neck, thorax, mediastinum, and abdomen,
and their contents
(iv)
Childhood neoplasms of the breast and soft tissues
(v)
Childhood neoplasms of the genitalia
(vi)
Childhood burn injuries and injuries of child abuse
(vii)
Neonatal enterocolitis
(viii)
Foreign bodies
(ix)
Inflammatory conditions of the respiratory and gastrointestinal tracts
(x)
Testicular torsion
(xi)
Hernia
(xii)
Childhood diseases of the endocrine system
(xiii)
Liver, kidney, and intestinal transplantation
(xiv)
Conditions requiring central or prolonged vascular access
(xv)
Anomalies of the genitalia
(xvi)
Gastrointestinal physiology
(xvii)
Musculoskeletal biomechanics and physiology
Trauma Surgery Intern Rotation
10. Educational Goal
Interns rotate on this service in order to obtain experience in the multidisciplinary management
of polytrauma patients throughout all phases of care from pre-hospital through rehabilitation,
which will enhance the attainment of the overall competencies desired with particular emphasis
on this subspecialty.
14
11. Rotation Description
An intern is assigned to this service. Overall supervision for the rotation is by the faculty in the
Division of General Surgery, Section of Trauma and Critical Care, with acute/emergent patient
supervision by faculty of the Division of General Surgery. Supervision of junior residents and
interns is also performed by the PGY-4 resident assigned to the service.
Residents see patients in the Trauma Surgery clinic during this rotation. This clinic meets at
least weekly, giving the resident the opportunity to participate in the postoperative care of
patients upon whom the residents have operated or patients with similar problems.
Primary components of this rotation include evaluation and treatment of diseases of the Head &
Neck, Skin & Soft Tissues, Alimentary Tract, Abdomen, Vascular System, Surgical Critical
Care, Cardiothoracic Surgery, Plastic Surgery, Pediatric Surgery, Transplant Surgery. Special
emphasis is given to Trauma Systems organization and implementation; Potential organ donor
management; Integration of mid-level practitioners into patient care.
Interns are expected to learn to perform appropriate history and physical examinations for this
group of patients. Appropriate management of the surgical trauma patient is emphasized. In
addition, they are expected to make basic diagnoses and formulate appropriate treatment plans.
An understanding of basic surgical techniques is promoted.
Residents will attend the core conferences of the Division of General Surgery during the course
of this rotation. Residents will also attend the monthly Trauma Morbidity and Mortality
Conference and the weekly Multidisciplinary Trauma Rounds. All residents are expected to be
actively involved in the teaching of their fellow residents and medical students.
12. Specific Objectives
a)
Patient Care
(1)
(2)
become proficient in:
(i)
Trauma assessment
(ii)
Comprehensive physical examination of the Trauma patient
Describe indications, contraindications, perioperative management, complications, and
surgical sequence for and perform pertinent portions of:
(i)
Laryngoscopy
(ii)
Bronchoscopy
(iii)
Upper and lower gastrointestinal endoscopy
15
(iv)
Ultrasonography of the abdomen and pericardium
(v)
Immunomodulation of sepsis
(vi)
Conditions falling within the scope of the Trauma and Emergency Operation
component of General Surgery include:
Trauma at all sites
Sepsis
Peritonitis
Hemorrhage
Obstruction
Fistula
b)
Medical Knowledge
(1)
be able to discuss and describe:
(i)
Shock of all types
(ii)
Sepsis
(iii)
Coma
(iv)
Single or Multisystem Organ Failure
(v)
Systemic Inflammatory Response Syndrome
(vi)
Coagulopathy
(vii)
Invasive and noninvasive monitoring
(viii)
Mechanical ventilation
(ix)
Vasoactive drugs
(x)
Pacemakers and ventricular assist devices
(xi)
Dialysis of all types
(xii)
Fluid and electrolyte imbalance
(xiii)
Shock and circulatory physiology
(xiv)
Genitourinary physiology
(xv)
Respiratory physiology
(xvi)
Immunobiology and transplantation
(xvii)
(xviii)
Noninvasive vascular diagnosis and invasive vascular interventional techniques
Ultrasonography of the abdomen
16
Cardiothoracic Surgery Intern Rotation
13. Educational Goal
Interns rotate on this service in order to obtain initial exposure to the care of adults and children
requiring cardiothoracic surgical procedures which will enhance the attainment of the overall
competencies desired with particular emphasis on this particular subspecialty specialty.
14. Rotation Description
An intern is assigned to this service. Overall supervision for the rotation is by the faculty of the
Division of Cardiothoracic Surgery. The chief resident in cardiothoracic surgery assigned to the
service also performs supervision of residents, interns, and medical students.
Residents see patients at least weekly in the UHC Cardiothoracic Surgery clinic during this
rotation. These clinics give the resident the opportunity to participate in the preoperative
evaluation and work-up of patients as well as the postoperative follow-up of patients in whose
care the residents have participated or similar patients.
Interns are expected to learn to perform appropriate history and physical examinations for this
group of patients. Appropriate management of the postoperative patient is emphasized. In
addition, they are expected to make basic diagnoses and formulate appropriate treatment plans.
A resident at this level should receive a basic understanding of the pathophysiology of these
disease processes. An understanding of basic surgical techniques is promoted.
Residents will attend the core conferences of the Division of Cardiothoracic Surgery during the
course of this rotation. Formal attending rounds are made regularly. All residents are expected to
be actively involved in the teaching of their fellow residents and medical students.
15. Specific Objectives
a)
Patient Care
(1)
(2)
become proficient in:
(i)
Patient interview
(ii)
Comprehensive physical examination
Describe indications, contraindications, perioperative management, complications, and
surgical sequence for and perform pertinent portions of:
(i)
Tracheobronchoscopy
(ii)
Thoracic esophagoscopy
17
b)
(iii)
Thoracoscopy
(iv)
Off-pump cardiopulmonary operative techniques
(v)
Transesophageal echocardiography
(vi)
Noninvasive vascular diagnosis and invasive vascular interventional techniques
Medical Knowledge
(1)
be able to discuss and describe:
(i)
Coronary artery disease
(ii)
Valvular heart disease
(iii)
Neoplasms of the heart, great vessels, and pericardium
(iv)
Cardiogenic shock including pharmacologic and mechanical support
(v)
Cardiac transplantation
(vi)
Anomalies of the heart, great vessels, and pericardium
(vii)
Foreign bodies
(viii)
Cardiac conduction abnormalities
(ix)
Aneurysms and dissections of the great vessels
(x)
Respiratory failure and lung transplantation
(xi)
Anomalies of the trachea, lungs, pleura, and thoracic esophagus
(xii)
Hemorrhage from the thoracic airways or esophagus
(xiii)
Mediastinal masses and fluid collections, including the pericardium
(xiv)
Diseases of the diaphragm and chest wall
(xv)
Trauma to the thorax, pleura, lungs, heart, great vessels, diaphragm and
mediastinum
(xvi)
Physiologic consequences of cardiopulmonary bypass
(xvii)
Fistulas and acquired diverticula
Neurosurgery Intern Rotation
16. Educational Goal
18
Interns rotate on this service in order to obtain a balanced experience in the preoperative,
operative, and postoperative care of patients requiring neurosurgical procedures and to the
nonoperative management of patients with neurologic diseases.
17. Rotation Description
An intern is assigned to this service. Overall supervision for the rotation is by the faculty in the
Department of Neurosurgery. The service chief resident also performs supervision of junior
residents and interns.
Residents see patients in the Neurosurgery clinics at least weekly during this rotation. These
clinics give the resident the opportunity to participate in the preoperative evaluation and work-up
of patients as well as the postoperative follow-up of patients in whose care the residents have
participated or similar patients.
Interns are expected to learn to perform appropriate history and physical examinations for this
group of patients. Appropriate management of the postoperative patient is emphasized. In
addition, they are expected to make basic diagnoses and formulate appropriate treatment plans.
A resident at this level should receive a basic understanding of the pathophysiology of these
disease processes. An understanding of basic surgical techniques is promoted.
Residents will attend the core conferences of the Department of Neurosurgery during the course
of this rotation. Formal attending rounds are made regularly. All residents are expected to be
actively involved in the teaching of their fellow residents and medical students.
18. Specific Objectives
a)
Patient Care
(1)
(2)
b)
become proficient in:
(i)
Patient interview
(ii)
Comprehensive physical examination
Describe indications, contraindications, perioperative management, complications, and
surgical sequence for and perform pertinent portions of:
(i)
Lumbar puncture
(ii)
Ventriculostomy
(iii)
Minimally invasive approaches to the spine
Medical Knowledge
(1)
be able to discuss and describe:
19
(i)
Trauma to the central and peripheral nervous systems
(ii)
Fractures of the skull and spine
(iii)
Cranial and spinal cord metastases
(iv)
Cushing's disease and syndrome
(v)
Intervertebral disc disease and its operative approaches
(vi)
CSF shunting and its operative approaches
(vii)
Cerebrovascular disease
(viii)
Chronic pain and its palliation
(ix)
Musculoskeletal biomechanics and physiology
(x)
Shock and circulatory physiology
(xi)
Fluid and electrolyte imbalance
Vascular Surgery Intern Rotation
19. Educational Goal
Interns rotate on this service in order to obtain initial exposure to the care of adults requiring
vascular surgical procedures which will enhance the attainment of the overall competencies
desired with particular emphasis on this particular subspecialty.
20. Rotation Description
An intern is assigned to this service. Overall supervision for the rotation is by the faculty of the
Division of Vascular Surgery. The chief resident in Vascular surgery assigned to the service also
performs supervision of residents, interns, and medical students.
Residents see patients at least weekly in the UHC Vascular Surgery clinic during this rotation.
These clinics give the resident the opportunity to participate in the preoperative evaluation and
work-up of patients as well as the postoperative follow-up of patients in whose care the residents
have participated or similar patients.
Interns are expected to learn and to perform appropriate history and physical examinations for
this group of patients. Appropriate management of the postoperative patient is emphasized. In
addition, they are expected to make basic diagnoses and formulate appropriate treatment plans.
A resident at this level should receive a basic understanding of the pathophysiology of these
disease processes. An understanding of basic surgical techniques is promoted.
20
Residents will attend the core conferences of the Division of Vascular Surgery during the course
of this rotation. Formal attending rounds are made regularly. All residents are expected to be
actively involved in the teaching of their fellow residents and medical students.
21. Specific Objectives
(a)
Patient Care
(1)
become proficient in:
(i)
Patient interview
(ii)
Comprehensive physical examination
(iii)
Describe indications, contraindications, perioperative management,
complications, and surgical sequence for and perform pertinent portions
of:
Central line placement with ultrasound guidance
Tunnel Catheter placement
Arteriovenous fistula creation
(b)
Medical Knowledge
21
(1)
Be able to discuss and describe:
(i)
Shock of all types
(ii)
Sepsis
(iii)
Coma
(iv)
Single or Multisystem Organ Failure
(v)
Systemic Inflammatory Response Syndrome
(vi)
Coagulopathy
(vii)
Invasive and noninvasive monitoring
(viii)
Mechanical ventilation
(ix)
Vasoactive drugs
(x)
Pacemakers and ventricular assist devices
(xi)
Dialysis of all types
(xii)
Fluid and electrolyte imbalance
(xii)
Shock and circulatory physiology
Anesthesiology Intern Rotation
22. Educational Goal
Interns rotate on this service in order to obtain exposure to the care of patients requiring
anesthesia services for surgical procedures. Services will include airway management, general
anesthesia, regional anesthesia, monitored local anesthesia care and peripheral nerve blocks. The
resident will also be exposed to the principles and techniques of management of chronic pain,
including palliative therapy. Through collaborative care provision, the resident will gain an
understanding of the roles of nonphysician anesthesia healthcare providers including Certified
Registered Nurse Anesthetists.
23. Rotation Description
An intern is assigned to this service. Overall supervision for the rotation is by the faculty in the
Department of Anesthesiology. Anesthesiology chief residents also perform supervision of
junior residents and interns assigned to the service.
22
Residents will see patients preoperatively in the Ambulatory Surgery Unit and in the
Preoperative Holding Area. Postoperative patients will be seen in the Post-Anesthesia Care Unit,
the Ambulatory Surgery Unit, and/or the UHC nursing units as appropriate to the patient and the
anesthetic service provided. These encounters will give the resident the opportunity to
participate in the pre-anesthetic evaluation and work-up of patients as well as the post-anesthetic
follow-up of patients in whose care the residents have participated or similar patients.
Interns are expected to learn to perform appropriate history and physical examinations for this
group of patients. Appropriate management of the anesthetized patient is emphasized. In
addition, they are expected to make basic diagnoses. A resident at this level should receive a
basic understanding of the pathophysiology of these disease processes. An understanding of
basic anesthetic techniques is promoted.
Residents will attend the core conferences of the Department of Anesthesiology during the
course of this rotation. All residents are expected to be actively involved in the teaching of their
fellow residents and medical students.
24. Specific Objectives
a)
Patient Care
(1)
(2)
b)
become proficient in:
(i)
Patient interview
(ii)
Comprehensive physical examination
Describe indications, contraindications, perioperative management, complications, and
surgical sequence for and perform pertinent portions of:
(i)
Laryngoscopy
(ii)
Tracheobronchoscopy
(iii)
Oral and nasal endotracheal intubation
(iv)
Rapid sequence intubation
(v)
Central line placement
Medical Knowledge
(1)
be able to discuss and describe:
(i)
Acute pain and its prophylaxis and management
(ii)
Palliation of chronic pain
23
(iii)
Airway access and management
(iv)
Intraoperative pulmonary or cardiovascular instability
(v)
Anesthetic monitoring
(vi)
Anesthetic agents and techniques
(vii)
Conditions requiring intraoperative transfusion
(viii)
Fluid and electrolyte imbalance
(ix)
Shock and circulatory physiology
(x)
Respiratory physiology
Surgical Intensive Care Unit (SICU) Intern Rotation
25. Educational Goal
Interns rotate on this service in order to obtain experience in the preoperative, operative, and
postoperative care for critically ill surgical intensive care inpatients with conditions falling
within the principal components of General Surgery which will enhance the attainment of the
overall competencies desired with particular emphasis on this specialty.
26. Rotation Description
An intern is assigned to this service. Supervision for the rotation is by the faculty of the Section
of Trauma/Critical Care in the Division of General Surgery. Supervision of junior residents and
interns is also performed by the senior resident assigned to the service.
No outpatient clinics are involved in this rotation. Each resident follows specific patients
throughout their SICU stays.
Primary components of this rotation include evaluation and treatment of diseases of the Head &
Neck, Skin & Soft Tissues, Alimentary Tract, Abdomen, Vascular System, Endocrine System,
Surgical Critical Care, Cardiothoracic Surgery, Plastic Surgery, Transplant Surgery. Special
emphasis is given to Invasive monitoring; Vasoactive, sedative-hypnotic-analgesic, and
neuromuscular blocker drug pharmacology; Surgical microbiology; Mechanical ventilation and
airway management; Surgical nutrition; Metabolic response to injury.
Interns are expected to learn to perform appropriate history and physical examinations for this
group of patients. Appropriate management of the critically ill patient is emphasized. In
addition, they are expected to make basic diagnoses and formulate appropriate treatment plans.
A resident at this level should receive a basic understanding of the pathophysiology of these
disease processes. An understanding of basic surgical and invasive monitoring techniques is
promoted.
24
Residents will attend the core conferences of the Division of General Surgery during the course
of this rotation. Formal attending rounds are made daily every weekday. All residents are
expected to be actively involved in the teaching of their fellow residents and medical students.
27. Specific Objectives
a)
Patient Care
(1)
(2)
b)
become proficient in:
(i)
Patient interview
(ii)
Comprehensive physical examination
Describe indications, contraindications, perioperative management, complications, and
surgical sequence for and perform pertinent portions of:
(i)
Laryngoscopy
(ii)
Bronchoscopy
(iii)
Upper and lower gastrointestinal endoscopy
(iv)
Ultrasonography of the abdomen and pericardium
(v)
Immunomodulation of sepsis
Medical Knowledge
(1)
be able to discuss and describe:
(i)
Shock of all types
(ii)
Sepsis
(iii)
Coma
(iv)
Single or Multisystem Organ Failure
(v)
Systemic Inflammatory Response Syndrome
(vi)
Coagulopathy
(vii)
Invasive and noninvasive monitoring
(viii)
Mechanical ventilation
(ix)
Vasoactive drugs
25
(x)
Pacemakers and ventricular assist devices
(xi)
Dialysis of all types
(xii)
Fluid and electrolyte imbalance
(xii)
Shock and circulatory physiology
(xiii)
Genitourinary physiology
(xiv)
Respiratory physiology
(xv)
Immunobiology and transplantation
Emergency Medicine Intern Rotation
28. Educational Goal
Interns rotate on this service in order to obtain experience in the evaluation and management of
patients presenting to the University of Mississippi Emergency Department for treatment. The
rotation with provide exposure to a spectrum of patient situations, ranging from acute, lifethreatening emergencies, to multisystem trauma, to patients requiring inpatient admission, to
straightforward outpatient treatment scenarios, all of which will enhance the attainment of the
overall competencies desired with particular emphasis on this specialty.
29. Rotation Description
An intern is assigned to this service. Overall supervision for the rotation is by the faculty in the
Department of Emergency Medicine assigned for each shift. Supervision of junior residents and
interns is also performed by the senior residents assigned to the Emergency Department for each
shift.
Interns will evaluate and manage patients presenting to the Adult or Pediatric Emergency Room
by walk-in, ambulance, or airlift. Residents will be responsible for each patient they have
evaluated until the patient is discharged from the Emergency Room, admitted to the hospital as
an inpatient or observation patient, or the residents’ shift is completed. When a resident’s shift is
completed, appropriate and thorough sign-out will be given regarding all patients the resident is
responsible for to the oncoming shift resident or intern. The rotation has no separate outpatient
clinic.
Interns are expected to learn to perform appropriate history and physical examinations for this
group of patients. Appropriate management of the acutely ill patient is emphasized. In addition,
they are expected to make basic diagnoses and formulate appropriate treatment plans. A resident
at this level should receive a basic understanding of the pathophysiology of these disease
processes. An understanding of basic emergency care and skills is promoted.
Residents will attend the core conferences of the Department of Emergency Medicine during the
26
course of this rotation. All residents are expected to be actively involved in the teaching of their
fellow residents and medical students.
30. Specific Objectives
a)
Patient Care
(1)
(2)
b)
become proficient in:
(i)
Problem oriented history
(ii)
Problem oriented physical examination
(iii)
appropriate prioritization of active problems for multiple emergency
patients
(iv)
the team concept of medical care by prehospital providers, nurses,
technicians, emergency physicians, consultants, and ancillary staff
(v)
identification, evaluation, and treatment acutely ill patients
Describe indications, contraindications, perioperative management, complications, and
sequence for and perform pertinent portions of:
(i)
venipuncture
(ii)
intravenous catheter placement
(iii)
airway management
(iv)
nasogastric tube placement
(v)
arterial puncture
(vi)
Foley catheter insertion
Medical Knowledge
(1)
be able to discuss and describe:
(i)
Airway management
(ii)
Trauma to all sites
(iii)
Coma
(iv)
Upper Respiratory Tract Infections
(v)
COPD
(vi)
Coagulopathy
27
(vii)
Pancreatitis/Cholecystitis
(viii)
Acute Abdomen
(ix)
Mental Status Changes
(x)
Toxicology
(xi)
Abscess of all sites
(xii)
Shock and circulatory physiology
(xiv)
Dehydration
(xv)
Management of the difficult/combative patient
ENT Specialty Diagnostic Testing Intern Rotation
31. Educational Goal
Interns rotate on this service in order to obtain experience in the evaluation of patients,
performance of specialty testing, and reading and interpreting test results on patients who have
been referred to the Division of Communicative Sciences in the Department of Otolaryngology
and Communicative Sciences for evaluation. The rotation will provide exposure and experience
in audiology, vestibular testing, and speech and swallowing evaluation.
32. Rotation Description
An intern is assigned to this service. Overall supervision for the rotation is by the faculty in the
Division of Communicative Sciences in the Department of Otolaryngology and Communicative
Sciences.
Interns will spend approximately two weeks [10 business days] with Audiology and
approximately two weeks [10 business days] with Speech and Language Pathology. These days
may be consecutive or nonconsecutive. During time scheduled with audiology, interns will be
exposed to and trained in the performance and basic interpretation of various audiologic and
vestibular testing techniques on both adult and pediatric patients, including (but not limited to)
audiograms—for adults and pediatric patients, including play audiometry, word recognition
scoring, stapedial reflex testing, Auditory Brainstem Response testing, OAEs, tests for
nonorganic hearing loss (Stenger Testing, etc.), ENG and Dix-Hallpike maneuvers, and
computerized posturography. Evaluations will be performed on both inpatients and outpatients.
During time scheduled with speech and language pathology, interns will be exposed to and
trained in the performance and basic interpretation of various speech pathology testing
techniques on adult patients, including (but not limited to) speech and voice evaluation, speech
therapy techniques, bedside swallowing evaluation, videostroboscopy, FEESS, and FEESST.
Evaluations will be performed on inpatients and outpatients.
28
Interns will attend the core conferences of the Department of Otolaryngology and
Communicative Sciences during the course of this rotation.
33. Specific Objectives
a)
Patient Care
(1)
b)
become proficient in:
(i)
Performance of audiograms, including play audiometry
(ii)
Performance of specialty audiometric testing, including stapedial
reflexes, acoustic decay, ABR, and tests for nonorganic hearing loss
(iii)
Performance of vestibular testing, including ENG, Dix-Hallpike
maneuvers, and computerized posturography
(iv)
Performance of speech and voice evaluation, including videostroboscopy
and speech therapy techniques
(v)
Performance of swallowing evaluation, including beside swallowing
evaluation, FEESS, and FEESST
(vi)
Basic interpretation of all of the above diagnostic testing methods
Medical Knowledge
(1)
be able to discuss and describe:
(i)
Basic anatomy and cranial nerve anatomy involved in hearing, balance, speech,
and swallowing, including involuntary reflexes
(ii)
Evaluation and testing for nonorganic hearing loss
(iii)
Antiquated audiometric testing
(iv)
Common audiologic and vestibular diseases and pathology
(v)
Common voice complaints, and speech and swallowing disorders
RRC Established PGY-1 Otolaryngology Rotation Goals and Objectives
The Goals and Objectives for these rotations are adapted from the “Prerequisites for Graduate
Surgical Education. A Guide for Medical Students and PGY1 Surgical Residents” published by
the American College of Surgeons. This document was produced a few years ago, after the
Graduate Education Committee of the American College of Surgeons convened a group of
surgeons representing all of the surgical specialties (General Surgery, Neurological Surgery,
Obstetrics & Gynecology, Ophthalmology, Orthopaedic Surgery, Otolaryngology, Plastic
Surgery, Urology, Thoracic Surgery, Pediatric Surgery, Vascular Surgery, and Colon & Rectal
Surgery). The purpose of the meeting was to “brain-storm” about what a PGY-1 surgical resident
29
should learn before continuing in specialty surgical education. The lists of knowledge and skills
were then circulated to 400 surgeons who ranked the lists according to priority: essential,
desirable, or supplementary. Those areas of knowledge and skills that are pertinent to the
formation of residents beginning their Otolaryngology residency have been selected and
supplemented as deemed appropriate by the Residency Review Committee.
PATIENT EVALUATION, ASSESSMENT, AND MANAGEMENT
By the completion of PGY 1, the resident should be knowledgeable in the following areas and be
able to do:
History and Physical Examination, Documentation
• Obtain a detailed surgical history and obtain and review relevant medical records and reports
• Perform a detailed physical examination.
• Develop a complete differential diagnosis.
• Maintain a personal patient log.
• Write a succinct H&P, including a risk assessment evaluation.
• Obtain a written informed consent.
• Document the treatment plan in the medical record, including the indications for treatment.
• Dictate an operative note and discharge summary.
Patient Assessment and Perioperative Management
• Order and interpret basic laboratory tests and screening X-Rays, and evaluate the patient’s cardiac, pulmonary,
renal, and neurological status.
• Develop a preoperative assessment of risk factors.
• Review, prioritize, and order medications the patient is currently taking, as appropriate.
• Use and understand the nursing notes and patient data.
• Prescribe activity level, management of medications, pain management, follow up appointments, and obtain
urgent contact information.
Assessment of Basic Diagnostic Tests and X-Rays
• Recognize abnormalities in basic radiologic and laboratory tests and learn normal values and ranges.
• Choose the optimal imaging technique.
• Recognize:
pleural effusion on CXR
chest mass on CXR
pneumonitis on CXR
bowel gas patterns on flat plate abdomen
diaphragm abnormalities on CXR
spinal column fractures
cervical spine radiographs
• Interpret basic EKG findings
• Recognize ischemia & arrhythmia patterns on EKG.
Management of Fluid/Electrolyte and Acid Base Balance
• Understand acid-base balance and the applications of body composition to fluid, electrolyte, and acid-base
balance in health and disease.
• Give fluid resuscitation, manage postoperative fluid requirements, and recognize and correctly manage acidbase disorders.
• Make adjustments in fluid administration for comorbid conditions, e.g. renal or cardiac insufficiency, diabetes,
hypovolemia.
• Use CVP and urine flow rates for adjustments of fluid administration.
• Perform a saphenous cutdown.
• Recognize and treat calcium and magnesium imbalance.
Fever, Microbiology, and Surgical Infection
30
• Know the mediators of fever, differential diagnosis, evaluation and management of the febrile patient in order
to initiate appropriate workup of fever and provide supportive treatment.
• Initiate definitive treatment with appropriate antibiotics.
• Be able to monitor antibiotic levels and recognize drug-related complications. Know the antibiotic of choice.
• Know and apply the principles of prevention of nosocomial infections, sterile technique and universal
precautions.
• Order and interpret the appropriate imaging studies for localization of an infected focus.
• Know and apply the principles of incision and drainage.
• Know the proper use of prophylactic antibiotics.
• Know the classification of wounds (clean, clean-contaminated, contaminated, and infected).
• Recognize the septic syndrome and initiate appropriate supportive treatment. Be familiar with the current
literature concerning the causes and mediators of the sepsis syndrome and its pathophysiology.
Epidemiology and Public Health
• Be knowledgeable in AIDS diagnosis and prevention of HIV infection.
• Understand the epidemiology and treatment of sexually transmitted diseases and other communicable
diseases.
Nutrition
• Perform a metabolic assessment of the surgical patient.
• Understand the metabolic implications of trauma and operation.
• Know the indications for nutritional support of the surgical patient.
• Know the methods of calculation of nutritional requirements in health and disease using the Harris-Benedict
or similar formulae.
• Know the composition of various enteral and parenteral formulas and adjust appropriately.
• Calculate and order basic enteral or parenteral formulas.
• Recognize complications of enteral and parenteral feedings.
• Manage central IV lines.
• Manage gastrostomy or jejunostomy feeding tubes.
• Assess when a postoperative patient can be fed and assess adequacy of intake.
• Know and utilize comparative costs of nutritional support methods.
Perioperative Preparation
• Complete, document, and assess appropriate workup, write preoperative orders, and obtain required
consultation from other specialists.
Surgical Skills
• Learn surgical site positioning, preparation and draping.
• Perform as first assistant. Know how to obtain hemostasis of small vessels and exposure of the operative field.
• Be familiar with common surgical instruments (scalpel, forceps, scissors, needle holders, hemostats, retractors,
electrocautery) and suture materials and their proper uses.
• Perform basic maneuvers, e.g. suture of skin, soft tissues, fascia; tie knots; obtain simple hemostasis.
• Learn basic techniques of dissection and handling of tissues.
• Under supervision:
excise benign lesions of skin and subcutaneous tissues.
perform lymph node biopsy.
remove superficial foreign bodies.
incise and drain an abscess.
repair simple lacerations.
repair umbilical and type I and II inguinal hernias.
perform appendectomy.
Sterile Technique
• Understand indications for and utilize appropriate methods of routine and reverse isolation procedures.
• Maintain appropriate sterile technique in the ER, at the bedside, in the ICU, and in the office.
31
Wound Management
• Differentiate between wound infection, hematoma, and seroma, and initiate therapy.
• Perform extensive debridement with supervision.
• Debride and pack wounds and apply dressings.
• Recognize and differentiate between wound infection and necrotizing fasciitis, and detect crepitus.
• Identify wound dehiscence and evisceration.
• Know and apply the specific recommendations for tetanus immunization (active and passive).
• Know the clinical manifestations of rabies in carrier and patient, and agents available to prevent development
of the disease.
• Obtain proper wound specimen and perform and interpret Gram stain.
Prioritize and Manage Complications
• Assess and manage complications or change in health status, such as:
altered mental status.
fever.
hypotension.
hypovolemia, oliguria.
hypoxia.
pain .
vomiting, distention, nausea.
bleeding at the bedside & coagulopathy.
atelectasis, pneumonia, aspiration.
fecal impaction, constipation
chest pain,
dyspnea
pneumothorax
congestive heart failure, pulmonary edema
superficial phlebitis
pulmonary embolus
urinary retention
diabetic ketoacidosis or hyperosmolar coma
peripheral ischemia or cyanosis
seizures, alcohol or drug withdrawal
ANESTHESIA ROTATION
The main goal of this rotation is to provide the PGY1 resident an organized experience to enable
him/her to acquire the basic knowledge and skills in preoperative care including preanesthetic
evaluation, anesthetic risk assessment, airway evaluation and immediate postoperative care.
At the completion of this rotation the PGY 1resident should be knowledgeable in the following
areas and be able to do:
• Basic laryngeal anatomy and physiology.
• Appropriate indications for general vs local anesthesia.
• Appropriate preoperative evaluation including when to order a pre-operative chest x-ray, EKG, and laboratory
tests based on the patient’s age, past medical history and social habits.
• Write pre-anesthetic orders
• Obtain oropharyngeal control of airway and provide Ambu ventilation
• Be able to perform:
orotracheal intubation
nasotracheal intubation
laryngeal mask ventilation
jet ventilation
• Interpret the anesthesia record
32
• Position the patient properly for operative exposure, temperature control, and protection from
pressure/traction.
• Be familiar with intraoperative monitoring.
• Insert arterial and venous lines.
• Know the dose range and complications (including pulmonary edema and malignant hyperthermia) of the
following agents:
barbiturates
local anesthetics
paralyzing agents
reversing agents
inhalant anesthetics
• Know when and how to use epinephrine, hyaluronidase, in local anesthesia
• Under supervision:
administer a local block
administer general anesthesia
• Understand and use conscious sedation
• ACLS certification
THORACIC SURGERY ROTATION
The main goal of this rotation is to provide the PGY1 resident an organized experience to enable
him/her to acquire the basic knowledge and skills in the evaluation and management of patients
with common cardiac and pulmonary surgical problems.
At the completion of this rotation the PGY1 resident should be knowledgeable in the following
areas and be able to do:
• Review applied cardiac physiology and applied pulmonary physiology
• Critical care and management of shock
• Basic surgical skills.
• Evaluation and management of chest masses
• Care for at least 15 ICU patients/month
CRITICAL CARE ROTATION (ICU)
The main goal of this rotation is to provide the PGY1 resident an organized experience to enable
him/her to acquire the basic knowledge and skills in the evaluation and management of patients
in the intensive care setting.
At the completion of this rotation the PGY1 resident should be knowledgeable in the following
areas and be able to do:
Critical Care and Management of Shock
• Differentiate types of shock (hemorrhagic, cardiogenic, septic, and neurologic) and initiate appropriate
therapy.
• Insert central venous and arterial catheters and obtain hemodynamic data; interpret data and initiate therapy.
• Recognize clinic presentation of a pneumothorax and insert chest tube
• Understand and utilize basic principles of mechanical ventilation.
• Recognize the indications for blood component therapy and initiate therapy.
• Recognize a transfusion reaction and initiate management.
• Institute measures to prevent upper GI bleeding in critically ill patients.
Coagulation and Anticoagulation
• Choose the appropriate tests for diagnosis of a coagulopathy, and have a working knowledge of factor
analysis.
• Apply effective preventive measures for DVT and PE.
• Initiate and monitor therapeutic anticoagulation and its complications.
33
• Diagnose and manage acute deep venous thrombosis.
• Acutely manage a patient with a suspected acute pulmonary embolus, and provide a differential diagnosis.
Applied Cardiac Physiology
• Recognize rhythm disturbances, myocardial ischemia on EKG.
• Assess, formulate a differential diagnosis and initiate therapy for hypotension.
• Know and apply appropriate treatment for supraventricular tachycardia.
• Treat congestive failure and acute pulmonary edema.
• Manage hypertension in a surgical patient. Understand multidrug therapy and the toxic and side effects of
antihypertensive drugs.
Applied Renal Physiology
• Know the pathophysiology of the development of acute renal failure; the differentiation of prerenal, renal,
obstructive types of renal failure; and the general concepts of prevention and treatment of ARF.
• Recognize and treat simple electrolyte disturbances.
• Understand appropriate fluid replacement and balance.
Applied Pulmonary Physiology
• Know the manifestations—clinical and by laboratory testing—of obstructive pulmonary disease and
pulmonary insufficiency, and their surgical perioperative management.
• Recognize bronchoconstrictive disorders and their perioperative management.
Applied Nutrition
• Learn to manage the nutritional needs of a critically ill patient.
• Placement of nasogastric tube and dophoff tube.
Surgical Skills
• Develop surgical skills in CPR, CVC placement, arterial catheter placement, and chest tube placement.
• Perform first assistant in bedside bronchoscopy, pulmonary lavage, and tracheotomy.
• Obtain oropharyngeal control of airway, provide Ambu ventilation and perform orotracheal intubation.
EMERGENCY MEDICINE ROTATION
The main goal of this rotation is to provide the PGY1 resident an organized experience to enable
him/her to acquire the basic knowledge and skills in the evaluation and management of patients
presenting to the emergency room with emphasis on patients presenting with head and neck
complaints. The PGY1 resident should also gain a better appreciation of medical conditions often
seen as co-morbidities in head and neck patients including diabetes mellitus, hypertension,
stroke, congestive heart disease, respiratory distress and myocardial infarction.
At the completion of this rotation the PGY1 resident should be knowledgeable in the following
areas and be able to do:
• Conduct primary assessment and take appropriate steps to stabilize and treat patients with trauma (penetrating
and blunt), respiratory distress, congestive heart failure, metabolic imbalances, myocardial infarction, and
chronic pain.
• Establish the acuity level of patients in the ER, establish priorities and define the tasks necessary to manage
the patients successfully.
• Monitor, observe, manage, and maintain the stability of one or more patients who are at different stages in
their work-ups including fundamental lab tests and radiological studies.
• Recognize and initiate treatment for an acute anaphylactic reaction.
• Collaborate with physicians and other professionals to evaluate and treat patients, arrange appropriate
placement and transfer if necessary, formulate a follow-up plan, and communicate effectively with patients,
family, and involved health care members.
• Closure of simple and complex lacerations.
• Develop some familiarity with disaster management.
34
NEUROSURGERY ROTATION
The main goal of this rotation is to provide the PGY1 resident an organized experience to enable
him/her to acquire the basic knowledge and skills in the evaluation and management of patients
presenting with neurosurgical complaints. The resident should gain an appreciation for the
collaborative efforts between the ORL and NES specialties.
At the completion of this rotation the PGY 1resident should be knowledgeable in the following
areas and be able to do:
• Review basic cranial anatomy including cranial nerve origin and function.
• Perform neurosurgical patient evaluation, assessment and management.
• Learn evaluation and treatment of neurological trauma, critical care and emergencies.
• The indications for and basic interpretation of diagnostic tests and X-rays including basic head CT and MRI
imaging studies.
• Basic neurosurgical skills, technique, and wound management including simple craniotomy, dural suturing
and craniotomy closure.
• Recognition, diagnosis, and basic management of CSF leaks.
• Insertion and management of a lumbar drain.
• Management of common neurosurgical complications.
• Differentiate between stroke, TIA, and non-cerebrovascular events causing neurological symptoms and know
the diagnostic techniques.
• Participate in at least 5 major procedures (cranial decompression, craniotomy, removal of pituitary adenoma).
D. University Head and Neck Service
1. Educational Goal
Residents rotate on this service in order to obtain an intensive clinical exposure to head and neck
oncology, other head and neck disorders, and microvascular free flap reconstruction techniques,
which will enhance the attainment of the overall competencies desired with particular emphasis
on this subspecialty area.
2. Rotation Description
Both junior and senior residents are assigned to this service. This experience is attained in the
clinic, on the wards, on the consulting service, and in the operating room. Residents work
directly with the faculty members with subspecialty training and experience in these areas.
Exposure to the patients and faculty is provided in all clinical settings and as such, provides an
excellent continuity of care experience. The rotation seeks to facilitate an orderly progression
from the more basic knowledge and skills to complex clinical and surgical problems.
The junior residents are expected to learn to perform appropriate history and physical
examinations for this group of patients. Appropriate management of the postoperative patient is
emphasized. In addition, they are expected to make basic diagnoses and formulate appropriate
treatment plans. A resident at this level should receive a basic understanding of the
pathophysiology of these disease processes. An understanding of basic surgical techniques is
promoted.
Senior level residents are expected to progress in their ability to arrive at appropriate diagnoses
35
and institute treatment plans to the point that they could be expected to practice independently at
the end of their residency. The resident at this level is afforded the opportunity to improve their
administrative and teaching skills as they take an active role in the administration of the service
and education of junior residents and medical students. The senior resident is expected to gain
proficiency with all surgical techniques utilized in the clinical areas outlined for this service.
The resident is involved in progressively more difficult and sophisticated diagnostic and surgical
procedures as their skills and knowledge grow. They have progressively greater responsibilities
in decision making as well. Emphasis is placed on functioning as a consultant and
communicating effectively with referring physicians and parents. A major goal is to allow
enough exposure to all aspects of this service so that at a chief resident level they could function
independently even with most complex problems in this area.
We will attempt to identify any inequities in the experience of similar level residents. If any level
resident has had less experience with certain categories of procedures, we will try to supplement
the resident’s experience in this area to allow progression at what we consider to be a normal
pace for this level of resident. We also try to progress the junior residents according to their
individual capabilities.
All residents are expected to be actively involved in the teaching of their fellow residents and
medical students.
3. Specific Objectives
a)
Patient Care
(1)
Junior
(a)
(b)
Become proficient in:
(i)
Patient interview
(ii)
Comprehensive head and neck examination
(iii)
Procedures such as flexible laryngoscopy and biopsy of suspicious
lesions
Describe indications, contraindications, perioperative management,
complications, and surgical sequence for and perform pertinent portions of:
(i)
Nasal endoscopy
(ii)
Flexible and rigid laryngoscopy and rhinoscopy
(iii)
Direct laryngoscopy/microlaryngoscopy
(iv)
Esophagoscopy
36
(2)
(v)
Tracheotomy
(vi)
Fine needle aspiration of neck masses
(vii)
Excision of neck mass
(viii)
Deep Neck Space abscess drainage
(ix)
Lymph node biopsy/excision
(x)
Excision of facial skin tumors
(xi)
Submandibular gland excision
Senior
(a)
Describe indications, contraindications, perioperative management,
complications, and surgical sequence for and perform pertinent portions of:
(i)
Complete and partial maxillectomy
(ii)
Wide local excision of aerodigestive tract mucosal lesions
(iii)
Split thickness skin graft reconstruction
(iv)
Regional and microvascular flap reconstruction
(v)
Marginal and segmental mandibulectomy
(vi)
Pharyngotomy
(vii)
Partial laryngectomy surgical procedures (less than total laryngectomy)
(viii)
Total laryngectomy, laryngopharyngectomy and
laryngopharyngoesophagectomy
(ix)
Surgical voice restoration
(x)
All forms of elective and therapeutic neck dissections
(xi)
Thyroidectomy/parathyroidectomy
(xii)
Parotidectomy and other salivary gland procedures
(xiii)
Tracheal resection
(xiv)
Reconstruction of cutaneous surgical defects
37
b)
(xv)
Management of the difficult airway
(xvi)
Transoral endoscopic laser excision techniques
(xvii)
Bicoronal incision and orbitozygomatic osteotomy
(xviii)
Approaches to the parapharyngeal space
(xix)
Arterial ligation
(xx)
Repair of laryngeal fractures and penetrating neck injuries
(xxi)
Repair of Zenker’s diverticulum
(xxii)
Endoscopic and external approach cranial base surgery
(xxiii)
Sentinel lymph node biopsy
(xxiv)
Brachytherapy
(xxv)
Glossectomy, partial and total
(xxvi)
Microvascular free flap reconstruction
Medical Knowledge
(1)
Junior
(a)
(b)
Be able to discuss and describe the:
(i)
Staging of HNSCC
(ii)
Neck zone anatomy
(iii)
Epidemiology of HNSCC
(iv)
Anatomy of the nose and paranasal sinuses
(v)
Anatomy of the oral cavity, pharynx, larynx, and cranial nerves
Be able to describe the clinical presentation, diagnosis and management of:
(i)
Neck mass
(ii)
Stridor
38
(iii)
(2)
Oral cavity, pharyngeal, laryngeal neoplasms
Senior
(a)
(b)
Be able to discuss and describe:
(i)
Use of modern imaging for evaluation of head and neck lesions including
CT, MRI, PET, ultrasound, and nuclear imaging
(ii)
Indications and different applications of chemotherapy and radiation
therapy, including external beam, IMRT, and brachytherapy
(iii)
Anatomy and utilization of various reconstructive procedures for head
and neck procedures
(iv)
Appropriate use of prosthetic devices
(v)
Psychologic, social and occupational functioning particularly as it relates
to head and neck cancer
(vi)
Laser safety and basic laser surgery principles
(vii)
Histopathology of head and neck malignancies
(viii)
Indications for sentinel lymph node biopsy
(ix)
Pre-operative work-up and testing for microvascular free flaps
Be able to discuss indications, contraindications, risks and alternatives for the
management of:
(i)
Neoplasms of the oral cavity, pharynx and larynx
(ii)
Thyroid neoplasms
(iii)
Cutaneous malignancies
(iv)
Salivary neoplasms and benign salivary disorders
E. University Pediatrics Service
1. Educational Goal
Residents rotate on this service in order to obtain an intensive clinical exposure to pediatric
otolaryngology, pediatric airway disorders, and general otolaryngology, which will enhance the
attainment of the overall competencies desired with particular emphasis on these subspecialty
areas.
39
2. Rotation Description
Residents on this service are exposed to pediatric otolaryngology. Also, there is additional
otologic exposure provided on this rotation due to the expertise of the primary faculty members.
Both junior and senior residents are assigned to this service. This experience is attained in the
clinic, on the wards, on the consulting service, and in the operating room. Residents work
directly with the faculty members with subspecialty training and experience in these areas.
Exposure to the patients and faculty is provided in all clinical settings and as such provides an
excellent continuity of care experience. The rotation seeks to facilitate an orderly progression
from the more basic knowledge and skills to complex clinical and surgical problems.
The junior residents are expected to learn to perform appropriate history and physical
examinations for this group of patients. Appropriate management of the postoperative patient is
emphasized. In addition, they are expected to make basic diagnoses and formulate appropriate
treatment plans. A resident at this level should receive a basic understanding of the
pathophysiology of these disease processes. An understanding of basic surgical techniques is
promoted.
Senior level residents are expected to progress in their ability to arrive at appropriate diagnoses
and institute treatment plans to the point that they could be expected to practice independently at
the end of their residency. The resident at this level is afforded the opportunity to improve their
administrative and teaching skills as they take an active role in the administration of the service
and education of junior residents and medical students. The senior resident is expected to gain
proficiency with all surgical techniques utilized in the clinical areas outlined for this service.
The resident is involved in progressively more difficult and sophisticated diagnostic and surgical
procedures as their skills and knowledge grow. They have progressively greater responsibilities
in decision making as well. Emphasis is placed on functioning as a consultant and
communicating effectively with referring physicians and parents. A major goal is to allow
enough exposure to all aspects of this service so that at a chief resident level they could function
independently even with most complex problems in this area.
We will attempt to identify any inequities in the experience of similar level residents. If any level
resident has had less experience with certain categories of procedures, we will try to supplement
the resident’s experience in this area to allow progression at what we consider to be a normal
pace for this level of resident. We also try to progress the junior residents according to their
individual capabilities. Residents on this rotation will be expected to augment their surgical
experience with temporal bone dissections.
All residents are expected to be actively involved in the teaching of their fellow residents and
medical students.
3. Specific Objectives
a)
Patient Care
40
(1)
Junior
(a)
(b)
Become proficient in:
(i)
Patient interview
(ii)
Comprehensive head and neck examination in infants and children
(iii)
Appropriate history for patient care area
(iv)
Airway assessment and management
Describe indications, contraindications, perioperative management,
complications, and surgical sequence for and perform pertinent portions of:
(i)
Pneumatic and microscopic otoscopy
(ii)
Removal of foreign bodies from ears
(iii)
Perform tuning fork tests
(iv)
Tracheotomy, greater than 4 years of age
(v)
Tracheotomy change in infants and children
(vi)
Flexible fiberoptic laryngoscopy
(vii)
Direct Laryngoscopy, with or without intervention
(viii)
Bilateral myringotomy and tube insertion
(ix)
Myringoplasty
(x)
Tonsillectomy and adenoidectomy
(xi)
I & D Peritonsillar abscess and neck abscess
(xii)
Cerumen removal
(xiii)
Placement ear canal wick
(xiv)
Excision of skin lesions
(xv)
Removal of uncomplicated upper aerodigestive tract foreign bodies
(xvi)
Biopsy neck mass
(xvii)
Oral biopsy
41
(2)
(xviii)
Bronchoscopy
(xix)
Branchial cleft excision
(xx)
Thyroglossal duct excision
Senior
(a)
Describe indications, contraindications, perioperative management,
complications, and surgical sequence for and perform pertinent portions of:
(i)
Reconstruction of cleft lip and palate deformities
(ii)
Laryngotracheal reconstruction
(iii)
Epiglottoplasty
(iv)
Microtia repair
(v)
Mastoidectomy
(vi)
Tympanoplasty/myringoplasty
(vii)
Stapedectomy/Ossiculoplasty
(viii)
Cochlear implant
(ix)
Facial recess approach
(x)
Pediatric laryngobronchoesophagoscopy and foreign body removal
(xi)
Repair of caustic ingestion and thermal injuries
(xii)
Excision of congenital cysts and sinuses
(xiii)
Treatment of laryngeal clefts and TE fistulas
(xiv)
Resection of vascular malformations
(xv)
Reduction/fixation fractures of bony facial skeleton
(xvi)
Tracheal resection
(xvii)
Esophagoscopy, with or without foreign body removal
(xviii)
Tracheostomy, age less than 4 years
(xix)
Removal of upper airway foreign body
42
b)
Medical Knowledge
(1)
Junior
(a)
(b)
(2)
Be able to discuss and describe:
(i)
Congenital disorders in care of pediatric patient
(ii)
Disorders of the head and neck specific to the pediatric patient
Be able to describe the clinical presentation, diagnosis and management of:
(i)
Recurrent tonsillitis
(ii)
Hypertrophic adenotonsillar disease
(iii)
Postoperative bleeding and airway obstruction
(iv)
Otitis media (acute and chronic)
(v)
Complications of otitis media
(vi)
Foreign bodies in upper aerodigestive tract
(vii)
Pediatric airway emergency
(viii)
Pediatric sinusitis
(ix)
Complications of sinusitis
(x)
Congenital head and neck anomalies
Senior
(a)
Be able to describe the clinical presentation, diagnosis and management of:
(i)
Pediatric head and neck tumors
(ii)
Airway obstruction
(iii)
Obstructing laryngotracheal masses
(iv)
Laryngotracheal and esophageal foreign bodies
(v)
Systemic diseases affecting the larynx
43
(b)
(vi)
GERD
(vii)
Airway obstruction
(viii)
Congenital, inherited, and acquired pediatric hearing loss
(ix)
Repair of caustic ingestions
(x)
Laryngotracheoplasty
Be able to discuss and describe:
(i)
Surgical management of epistaxis in children
(ii)
Surgical options for acute/chronic otitis media
(iii)
Management of complications otitis media
F. University Facial Plastics/Otology/Laryngology Service
1. Educational Goal
Residents rotate on this service in order to obtain an intensive clinical exposure to facial plastic
and reconstructive surgery, otology, adult and pediatric voice and swallowing disorders, adult
airway disorders, as well as general otolaryngology, which will enhance the attainment of the
overall competencies desired with particular emphasis on these subspecialty areas.
2. Rotation Description
Both junior and senior residents are assigned to this service. This experience is attained in the
clinic, on the wards, on the consulting service, and in the operating room. Residents work
directly with the faculty members with subspecialty training and experience in these areas.
Exposure to the patients and faculty is provided in all clinical settings and as such provides an
excellent continuity of care experience. The rotation seeks to facilitate an orderly progression
from the more basic knowledge and skills to complex clinical and surgical problems.
The junior residents are expected to learn to perform appropriate history and physical
examinations for this group of patients. Appropriate management of the postoperative patient is
emphasized. In addition, they are expected to make basic diagnoses and formulate appropriate
treatment plans. A resident at this level should receive a basic understanding of the
pathophysiology of these disease processes. An understanding of basic surgical techniques is
promoted.
Senior level residents are expected to progress in their ability to arrive at appropriate diagnoses
and institute treatment plans to the point that they could be expected to practice independently at
the end of their residency. The resident at this level is afforded the opportunity to improve their
administrative and teaching skills as they take an active role in the administration of the service
44
and education of junior residents and medical students. The senior resident is expected to gain
proficiency with all surgical techniques utilized in the clinical areas outlined for this service.
The resident is involved in progressively more difficult and sophisticated diagnostic and surgical
procedures as their skills and knowledge grow. They have progressively greater responsibilities
in decision making as well. Emphasis is placed on functioning as a consultant and
communicating effectively with referring physicians and parents. A major goal is to allow
enough exposure to all aspects of this service so that at a chief resident level they could function
independently even with most complex problems in this area.
We will attempt to identify any inequities in the experience of similar level residents. If any level
resident has had less experience with certain categories of procedures, we will try to supplement
the resident’s experience in this area to allow progression at what we consider to be a normal
pace for this level of resident. We also try to progress the junior residents according to their
individual capabilities. Residents on this rotation will be expected to augment their surgical
experience with temporal bone dissections.
All residents are expected to be actively involved in the teaching of their fellow residents and
medical students.
3. Specific objectives
a)
Patient Care
(1)
Junior Resident
(a)
Become proficient in:
(i)
Patient interview
(ii)
Cosmetic interview and exam
(iii)
Otologic interview and exam
(iv)
Evaluation of the head and neck trauma patient
(v)
Perform and interpret audiograms and various vestibular tests, including
ENG
(vi)
Dynamic voice assessment using flexible laryngoscopy
(vii)
Rigid, per-oral laryngoscopy with stroboscopy
(viii)
Endoscopic evaluation of swallowing.
(ix)
Interpretation of swallowing studies.
(x)
Performing comprehensive speech and swallowing assessment at
bedside
45
(xi)
(b)
(2)
Interpretation of laryngovideostroboscopy
Describe indications, contraindications, perioperative management,
complications, and surgical sequence for and perform pertinent portions of:
(i)
Tonsillectomy
(ii)
Local and regional anesthetic techniques
(iii)
Complex facial lacerations
(iv)
Cerumen removal
(v)
Placement ear canal wick
(vi)
Perform Dix-Hallpike test and particle repositioning procedure
(vii)
Split Thickness and Full Thickness Skin Grafts
(viii)
Basic soft tissue skills, including closure of simple lacerations
(ix)
Oral biopsy
(x)
Closed reduction of nasal fracture
(xi)
Myringotomy and tube placement
(xii)
Tympanoplasty
(xiii)
Repair of complex lacerations of the face and neck
(xiv)
Direct Laryngoscopy, with or without intervention
(xv)
Basic microlaryngeal procedures, including use of laser
Senior Resident
(a)
Describe indications, contraindications, perioperative management,
complications, and surgical sequence for and perform pertinent portions of:
(i)
Septoplasty/Rhinoplasty
(ii)
Dacrocystorhinostomy
(iii)
Mastoidectomy, all types
(iv)
Tympanoplasty/myringoplasty
46
(v)
Stapedectomy/Ossiculoplasty
(vi)
Cochlear implant
(vii)
Facial recess approach
(viii)
Perilymphatic fistula exploration
(ix)
Acoustic neuroma resection
(x)
Canalplasty
(xi)
Meatoplasty
(xii)
Endolymphatic sac surgery
(xiii)
Transtympanic installation of ototoxic drugs
(xiv)
Middle ear exploration
(xv)
Vestibular nerve section
(xvi)
Labyrinthectomy
(xvii)
Glomus tumor removal
(xviii)
Congenital middle ear reconstruction
(xix)
Otoplasty
(xx)
Blepharoplasty
(xxi)
Brow/Facelift
(xxii)
Surgery for alopecia
(xxiii)
Surgical use of facial implants and expanders
(xxiv)
Soft tissue surgery and reconstruction
(xxv)
Skin resurfacing techniques
(xxvi)
Neck lift and cervical liposuction
(xxvii)
Cosmetic botulinum toxin application
(xxviii) Snoring and sleep apnea surgery
(xxix)
Basic rhinoplasty techniques
47
(xxx)
Operative microlaryngoscopy
(xxxi)
Laser laryngeal surgery
(xxxii) Bronchoscopy
b)
Medical Knowledge
(1)
Junior Resident
(a)
(b)
Be able to discuss and describe:
(i)
Embryology of the ear and temporal bone
(ii)
Anatomy and physiology for auditory and vestibular function
(iii)
Eustachian tube dysfunction and its consequences
(iv)
Temporal bone anatomy
(v)
Interpretation of audiogram and tympanograms
(vi)
Classification for facial nerve paralysis
(vii)
Tympanoplasty classification
(viii)
Standard method for facial analysis
(ix)
Snoring and sleep disorders
(x)
Wound management principles
(xi)
Laryngeal physiology and anatomy
(xii)
Principles and indications of behavioral management of patients with
voice disorders
(xiii)
Method of multi-disciplinary evaluation and care of voice disorders
(xiv)
Methods for diagnosis and management of swallowing disorder
(xv)
Specialized history evaluation of singers
Be able to describe the clinical presentation, diagnosis and management of:
(i)
Lacrimal system disorders
48
(2)
(ii)
The facial trauma patient
(iii)
Nasal and facial cosmetic conditions
(iv)
Cholesteatoma
(v)
Hearing loss
Senior Resident
(a)
(b)
Be able to discuss and describe:
(i)
Interpretation of temporal bone imaging
(ii)
Facial reanimation
(iii)
Surgical options for external nasal surgery
(iv)
Surgical options for acute/chronic otitis media
(v)
Management of complications otitis media
(vi)
Proper ordering and interpretation of standard vestibular testing, ECOG,
ENOG, OE, facial EMG
(vii)
A detailed differential diagnosis for otologic and neurologic complaints
(viii)
Phonatory surgery
(ix)
Laryngeal framework surgery
(x)
Medialization laryngoplasty
(xi)
Arytenoidectomy/arytenoidpexy
(xii)
Cricopharyngeal myotomy
(xiii)
Zenker’s diverticulectomy
(xiv)
Management of laryngeal fractures
(xv)
Botulinum toxin injection for speech/swallowing disorders
(xvi)
Endoscopic management of glottic, subglottic, and tracheal stenosis
(xvii)
Vocal cord injection
Be able to describe the clinical presentation, diagnosis and management of:
49
(i)
Acute/chronic facial paralysis
(ii)
Anatomy/physiology of aging face
(iii)
Analysis nasal relationships
(iv)
Facial paralysis including management of eye closure
(v)
Cranial nerve VII/VIII neoplasms
(vi)
Soft tissue injuries
(vii)
Facial and mandibular fractures
(viii)
Pediatric and adult obstructive sleep apnea
(ix)
Immobile vocal fold(s)
(x)
Paradoxical vocal fold motion disorder
(xi)
Laryngeal dystonias
G. Rhinology/Head and Neck Endocrine Surgery Rotation
1. Educational Goal
Residents rotate on this service in order to obtain an intensive clinical exposure to head and neck
oncology, endocrine head and neck disorders, rhinology, and medical aspects of otolaryngic
allergy, as well as general otolaryngology which will enhance the attainment of the overall
competencies desired with particular emphasis on this subspecialty area.
2. Rotation Description
Both junior and senior residents are assigned to this service. This experience is attained in the
clinic, on the wards, on the consulting service, and in the operating room. Residents work
directly with the faculty members with subspecialty training and experience in these areas.
Exposure to the patients and faculty is provided in all clinical settings and as such, provides an
excellent continuity of care experience. The rotation seeks to facilitate an orderly progression
from the more basic knowledge and skills to complex clinical and surgical problems.
The junior residents are expected to learn to perform appropriate history and physical
examinations for this group of patients. Appropriate management of the postoperative patient is
emphasized. In addition, they are expected to make basic diagnoses and formulate appropriate
treatment plans. A resident at this level should receive a basic understanding of the
pathophysiology of these disease processes. An understanding of basic surgical techniques is
promoted.
50
Senior level residents are expected to progress in their ability to arrive at appropriate diagnoses
and institute treatment plans to the point that they could be expected to practice independently at
the end of their residency. The resident at this level is afforded the opportunity to improve their
administrative and teaching skills as they take an active role in the administration of the service
and education of junior residents and medical students. The senior resident is expected to gain
proficiency with all surgical techniques utilized in the clinical areas outlined for this service.
The resident is involved in progressively more difficult and sophisticated diagnostic and surgical
procedures as their skills and knowledge grow. They have progressively greater responsibilities
in decision making as well. Emphasis is placed on functioning as a consultant and
communicating effectively with referring physicians and parents. A major goal is to allow
enough exposure to all aspects of this service so that at a chief resident level they could function
independently even with most complex problems in this area.
We will attempt to identify any inequities in the experience of similar level residents. If any level
resident has had less experience with certain categories of procedures, we will try to supplement
the resident’s experience in this area to allow progression at what we consider to be a normal
pace for this level of resident. We also try to progress the junior residents according to their
individual capabilities.
All residents are expected to be actively involved in the teaching of their fellow residents and
medical students.
3. Specific Objectives
a)
Patient Care
(1)
Junior
(a)
(b)
Become proficient in:
(i)
Patient interview
(ii)
Comprehensive head and neck examination
(iii)
Rhinologic patient interview
(iv)
Procedures such as flexible laryngoscopy and biopsy of suspicious
lesions
Describe indications, contraindications, perioperative management,
complications, and surgical sequence for and perform pertinent portions of:
(i)
Nasal endoscopy
(ii)
Flexible and rigid laryngoscopy and rhinoscopy
51
(2)
(iii)
Direct laryngoscopy/microlaryngoscopy
(iv)
Esophagoscopy
(v)
Tracheotomy
(vi)
Fine needle aspiration of neck masses
(vii)
Excision of neck mass
(viii)
Deep Neck Space abscess drainage
(ix)
Lymph node biopsy/excision
(x)
Excision of facial skin tumors
(xi)
Submandibular gland excision Septoplasty and turbinoplasty
(xii)
Nasal packing
(xiii)
Antral irrigation
(xiv)
Endoscopic ethmoidectomy, anterior/posterior/total
(xv)
Endoscopic maxillary antrostomy
(xvi)
Nasal polypectomy
Senior
(a)
Describe indications, contraindications, perioperative management,
complications, and surgical sequence for and perform pertinent portions of:
(i)
Endoscopic sphenoid sinusotomy
(ii)
Image guided surgery
(iii)
External sinusotomies
(iv)
Endoscopic and external approaches to epistaxis management
(v)
CSF leak repairs
(vi)
Orbital decompression
(vii)
Endoscopic frontal sinusotomy
(viii)
Lateral rhinotomy approach
52
(ix)
Endoscopic and transseptal hypophysectomy
(x)
Complete and partial maxillectomy
(xi)
Wide local excision of aerodigestive tract mucosal lesions
(xii)
Split thickness skin graft reconstruction
(xiii)
Regional flap reconstruction
(xiv)
Marginal and segmental mandibulectomy
(xv)
Pharyngotomy
(xvi)
Partial laryngectomy surgical procedures (less than total laryngectomy)
(xvii)
Total laryngectomy, laryngopharyngectomy and
laryngopharyngoesophagectomy
(xviii)
Surgical voice restoration
(xix)
All forms of elective and therapeutic neck dissections
(xx)
Thyroidectomy/parathyroidectomy
(xxi)
Parotidectomy and other salivary gland procedures
(xxii)
Tracheal resection
(xxiii)
Reconstruction of cutaneous surgical defects
(xxiv)
Management of the difficult airway
(xxv)
Transoral endoscopic laser excision techniques
(xxvi)
Bicoronal incision and orbitozygomatic osteotomy
(xxvii)
Approaches to the parapharyngeal space
(xxviii) Arterial ligation
(xxix)
Repair of laryngeal fractures and penetrating neck injuries
(xxx)
Repair of Zenker’s diverticulum
(xxxi)
Endoscopic and external approach cranial base surgery
(xxxii) Sentinel lymph node biopsy
53
(xxxiii) Brachytherapy
(xxxiv) Glossectomy, partial and total
b)
Medical Knowledge
(1)
Junior
(a)
(b)
Be able to discuss and describe the:
(i)
Staging of HNSCC
(ii)
Neck zone anatomy
(iii)
Epidemiology of HNSCC
(iv)
Anatomy of the nose and paranasal sinuses
(v)
Anatomy of the oral cavity, pharynx, larynx, and cranial nerves
(vi)
Nasal obstruction
(vii)
Epidemiology of acute/chronic sinusitis
(viii)
Infectious, inflammatory and neoplastic sinonasal conditions
(ix)
Basic science and immunology of otolaryngic allergy
(x)
Clinical diagnosis of otolaryngic allergy
Be able to describe the clinical presentation, diagnosis and management of:
(i)
Neck mass
(ii)
Stridor
(iii)
Oral cavity, pharyngeal, laryngeal neoplasms
(iv)
Acute vs. chronic sinusitis
(a)
Be able to differentiate among different causes of sinusitis: viral,
bacterial, allergy, fungal, structural, impaired mucociliary
transport
(b)
Display an understanding of non-sinus etiologies affecting sinonasal disorders: GERD, migraine, CSF leak, psychological
issues
54
(2)
(v)
Allergic fungal sinusitis
(vi)
Epistaxis
(vii)
Medical aspects of otolaryngic allergy including RAST testing, and
pharmacotherapy, and immunotherapy
(viii)
Olfactory and gustatory disturbances
(ix)
CSF leaks
Senior
(a)
Be able to discuss and describe:
(i)
Use of modern imaging for evaluation of head and neck lesions including
CT, MRI, PET, ultrasound, and nuclear imaging
(ii)
Indications and different applications of chemotherapy and radiation
therapy, including external beam, IMRT, and brachytherapy
(iii)
Anatomy and utilization of various reconstructive procedures for head
and neck procedures
(iv)
Appropriate use of prosthetic devices
(v)
Psychologic, social and occupational functioning particularly as it relates
to head and neck cancer
(vi)
Laser safety and basic laser surgery principles
(vii)
Histopathology of head and neck malignancies
(viii)
Indications for sentinel lymph node biopsy
(ix)
Pre-operative work-up and testing for microvascular free flaps
(x)
Interpretation of sinus CT
(xi)
Appropriate use of antimicrobial therapy
(xii)
Advanced medical aspects of otolaryngic allergy including RAST and
alternative testing and pharmacotherapy
(xiii)
Proper management of CSF leaks
(xiv)
Management of complications sinusitis
55
(b)
Be able to discuss indications, contraindications, risks and alternatives for the
management of:
(i)
Neoplasms of the oral cavity, pharynx and larynx
(ii)
Thyroid neoplasms
(iii)
Cutaneous malignancies
(iv)
Salivary neoplasms and benign salivary disorders
(v)
Sinonasal neoplasms
(vi)
Chronic bacterial and inflammatory sinusitis
(vii)
Otolaryngic allergy
(a)
Understands and can implement appropriate diagnostic testing
and pharmacotherapy
(viii)
Non-allergic rhinitis
(ix)
Exophthalmos
(x)
Fungal rhinosinusitis
H. Research/Diagnostics Rotation
RESEARCH PORTION
1. Educational Goal
The intent of this rotation is to acquaint residents with the protocols used to create, plan,
implement, and collect data relative to a hypothesis being tested. This experience will
particularly enhance the competency of practice based learning and improvement.
2. Rotation Description
Residents enter into a research rotation during their PGY-3 and PGY-4 year. Each resident
selects a research mentor to assist him/her with development and completion of two research
projects. The resident has no daytime clinical duties during this time. The resident also is
assigned readings in statistical methods and study design. The monthly research meeting
enhances this rotation. To ensure the greatest utilization of time during this rotation, each
resident is given guidelines, outlined in great detail in the research guidelines section, to facilitate
attainment of the following objectives.
56
3. Specific Objectives
a)
b)
c)
Patient Care
(1)
The trainee is expected to become familiar with good clinical research practices
including regulatory guidelines, criteria for informed consent, and the role of the IRB.
(2)
Trainees who participate in clinical research should be properly trained and ideally
designated as co-investigators on the protocol materials.
(3)
All research projects involving patients and/or patient-related materials must have IRB
approval or approved exemption.
(4)
Recording and reporting of patient data must observe guidelines set forth to protect
patient confidentiality.
Medical Knowledge
(1)
Critically appraise research literature and understand research process.
(2)
Develop knowledge of research design, biostatistics, and epidemiology.
(3)
The research project identified and developed should build on relevant medical
knowledge of otolaryngology (basic or clinical).
(4)
The research mentor should demonstrate expertise in the defined area of research.
(5)
Develop research questions to be addressed during the rotation.
(6)
Generate a proposal to study the topic chosen (ideally, a NIH-style grant proposal).
(7)
Devise methods for collecting and analyzing data.
(8)
Demonstrate the ability to initiate and complete a research project.
(9)
Recognize the importance of the literature review, be familiar with internet-based
search engines and on line retrieval of relevant manuscripts.
(10)
Prepare a research report/manuscript including familiarity with reference manager
programs to readily incorporate the referenced sources.
Practice-Based Learning and Improvement
(1)
Apply knowledge of study design and statistical methods to evaluate studies.
(2)
Use information technology appropriately with respect for patient confidentially.
57
d)
e)
f)
Interpersonal and Communication Skills
(1)
Work towards a constructive relationship with patients and staff.
(2)
Elicit the help of senior co-investigators, the PI and/or mentor if any questions or
concerns arise.
Professionalism
(1)
Receive instruction in obtaining informed consent from study subjects.
(2)
Receive appropriate training to perform study-related procedures.
(3)
Demonstrate respect and compassion for all study patients with special attention to
sensitivity to patients’ age, gender, culture, and disabilities.
Systems-Based Practice
(1)
Understand how the care provided by the study relates to the patient’s total healthcare
status.
(2)
Understand costs of studies and how those costs are covered.
DIAGNOSTICS PORTION
1. Educational Goal
The overall goal of this rotation is to allow the resident to develop an appreciation for and
improved skills in the major ancillary diagnostic tests associated with the specialty of
otolaryngology.
2. Rotation Description
The rotation will consist of a multidisciplinary experience in the key ancillary areas associated
with the diagnosis of head and neck pathology. The PGY-3 resident will attend regular sessions
with the neuroradiology service reading head and neck images. The resident will have dedicated
sessions with faculty audiologists and speech language pathologists to participate in the
performance of standard audiologic and speech language pathology procedures. Finally, the
resident will have dedicated time to spend with faculty head and neck pathologists to review
frozen, gross, and permanent pathologic specimens from head and neck services.
The key faculty members staffing this rotation will be Drs. Buciuc, Bigler, and Windmill.
Coordination of the scheduling and hours will be performed by the Otolaryngology Program
Director.
58
3. Specific Objectives
The resident will:
a)
Gain an understanding of the appropriate selection of radiologic procedures used
for diagnosis of head and neck pathology.
b)
Learn to systematically review radiologic images and formulate a working
diagnosis.
c)
Develop an appreciation of the process for preparing and analyzing frozen
section and permanent pathologic specimens.
d)
Obtain skills in reading pathologic slides.
e)
Be able to appropriately order audiologic and speech language pathology tests
and learn basics of performing these tests
f)
Learn to interpret audiologic and speech language pathology tests.
g)
Become more aware of the critical working relationship between otolaryngology
and pathology, radiology, and audiology.
h)
Develop an enhanced understanding of head and neck differential diagnosis.
I. VA Medical Center
1. Educational Goal
The goal of this rotation is to provide experience in all aspects of adult otolaryngology, including
otolaryngic allergy and immunotherapy, in a setting that mirrors an adult general otolaryngology
practice. Experience in geriatric care and sensorineural hearing loss are particular benefits of the
population. Therefore, the rotation is additive to University rotations and provides a different
practice setting than the University. It is intended that this service will better prepare the senior
resident for independent practice.
2. Rotation Description
Both junior and senior residents are assigned to this service. The service is a broad-based
secondary and occasionally tertiary care practice. This experience is attained in the clinic, on the
wards, on the consulting service, and in the operating room. Residents work directly with the
faculty members with training and experience in these areas. Exposure to the patients and
faculty is provided in all clinical settings and as such provides an excellent continuity of care
experience. The rotation seeks to facilitate an orderly progression from the more basic
knowledge and skills to complex clinical and surgical problems
59
The junior residents are expected to learn to perform appropriate history and physical
examinations for this group of patients. Appropriate management of the postoperative patient is
emphasized. In addition, they are expected to make basic diagnoses and formulate appropriate
treatment plans. A resident at this level should receive a basic understanding of the
pathophysiology of these disease processes. An understanding of basic surgical techniques is
promoted. A resident at this level is also expected to perform basic prick testing and allergy
evaluation and screening.
Senior level residents are expected to progress in their ability to arrive at appropriate diagnoses
and institute treatment plans to the point that they could be expected to practice independently at
the end of their residency. The resident at this level is afforded the opportunity to improve their
administrative and teaching skills as they take an active role in the administration of the service
and education of junior residents. The senior resident is also expected to be able to decide which
candidates are appropriate for intradermal testing, and perform intradermal testing, vial
preparation, and immunotherapy, including sublingual immunotherapy. Finally, the senior
resident is expected to gain proficiency with all surgical techniques utilized in the clinical areas
relevant to this population.
We will attempt to identify any inequities in the experience of similar level residents. If any level
resident has had less experience with certain categories of procedures, we will try to supplement
the resident’s experience in this area to allow progression at what we consider to be a normal
pace for this level of resident. We also try to progress the junior residents according to their
individual capabilities.
All residents are expected to be actively involved in the teaching of their fellow residents and
medical students.
3. Specific Objectives:
a)
Patient Care
(1)
Junior
(a)
Become proficient in:
(i)
Patient interview
(ii)
Head and neck physical examination
(iii)
Interpretation of sinus CT
(iv)
Interpretation of temporal bone CT
(v)
Interpretation of neck CT
60
(b)
(2)
(vi)
Appropriate use of MR, US, Angiography for evaluation of head and neck
disorders
(vii)
Performance of fine needle aspiration
(viii)
Performance of allergy evaluation
(ix)
Allergy screening via prick testing and intradermal testing
Describe indications, contraindications, perioperative management,
complications, and surgical sequence for and perform pertinent portions of:
(i)
Pneumatic and microscopic otoscopy
(ii)
Removal of foreign bodies from ears
(iii)
Perform tuning fork tests
(iv)
Tonsillectomy
(v)
Facial laceration repair
(vi)
Septoplasty
(vii)
Epistaxis control
(viii)
Skin cancer excision and reconstruction
(ix)
Direct laryngoscopy
(x)
Vocal cord injection
(xi)
Direct bronchoscopy
(xii)
Direct esophagoscopy
(xiii)
Foreign body removal
(xiv)
skin testing techniques, including prick and intradermal
Senior
(a)
Perform complete head and neck exam
61
(b)
Perform instrumented physical examination, flexible laryngoscopy, diagnostic
nasal endoscopy, videostrobolaryngoscopy, FEES examination
(c)
Interpret radiographs: Axial CT of the neck, axial and coronal CT of sinuses,
fine cut CT of temporal bone, barium esophagram and video fluoroscopic
examination, MRI of head and skull bone.
(d)
Interpret diagnostic studies: Vestibular testing, audiometry, auditory evoked
response
(e)
Describe indications, contraindications, perioperative management,
complications, and surgical sequence for and perform pertinent portions of:
(i)
Neck dissection
(ii)
Laryngectomy (total, supra, vertical hemi)
(iii)
Mandibulotomy/Mandibulectomy
(iv)
Endoscopic sinus surgery
(v)
Tracheotomy
(vi)
Direct laryngoscopy
(vii)
Rigid esophagoscopy
(viii)
Wound closure
(ix)
Parotidectomy
(x)
Mastoidectomy
(xi)
Tympanoplasty
(xii)
Endoscopic and external management of epistaxis
(xiii)
Vocal cord injection
(xiv)
Septorhinoplasty, intranasal or external approaches
(xv)
Bronchoscopy with/out biopsy
(xvi)
Medialization thyroplasty
(xvii)
Blepharoplasty
(xviii)
Browlift/facelift
62
(xix)
Facial resurfacing techniques
(xx)
Submandibular gland excision
(xxi)
Endoscopic laser surgery of the upper aerodigestive tract
(xxii)
Laser safety and laser surgery techniques
(xxiii)
Gold weight and facial paralysis surgery
(xxiv)
Canthopexy/plasty
(xxv)
Vagal Nerve Stimulator Implantation
(xxvi)
Intradermal testing/skin endpoint titration
(xxvii)
Immunotherapy, including sublingual immunotherapy
(xxviii) UPPP
(xxix)
b)
Radiofrequency ablation of tongue base
Medical Knowledge
(1)
Junior
(a)
Understand head and neck manifestations of systemic diseases
(b)
Recognize head and neck congenital conditions
(c)
Gain knowledge of anatomy and embryology of the oral cavity, pharyngeal
structures, neck, orbit, temporal bone, cranial base and cranial nerves
(d)
Understand the VA medical and computer systems
(e)
Be able to describe the clinical presentation, diagnosis and management of:
(i)
Epistaxis
(ii)
Acute/Chronic Sinusitis
(iii)
Temporal bone trauma
(iv)
Acute/Chronic otitis media
(v)
Facial trauma
(vi)
Neck mass
63
(2)
(vii)
Pharyngitis
(viii)
Airway distress
(ix)
Otolaryngic allergy including in vivo and in vitro testing,
pharmacotherapy, and immunotherapy
Senior
(a)
Be able to describe the clinical presentation, diagnosis and management of:
(i)
Dizziness and Dysequilibrium
(ii)
Hearing loss
(iii)
Otalgia
(iv)
Aural drainage
(v)
Facial nerve paralysis
(vi)
Rhinosinusitis
(vii)
Nasal obstruction
(viii)
Nasal polyposis
(ix)
Atypical facial pain
(x)
Dysphagia
(xi)
Neck mass
(xii)
Odynophagia
(xiii)
Voice change
(xiv)
Otolaryngic allergic emergencies
(xv)
Otolaryngic allergy including in vivo and in vitro testing,
pharmacotherapy, and immunotherapy
(b)
Know staging systems for head and neck cancer
(c)
Know definitions for rhinosinusitis
(d)
Know indications for surgical management for rhinosinusitis
64
(e)
Know indications/contraindications for surgical management of head and neck
cancer
(f)
Know indications/techniques for chemo/radiotherapy
(i)
Primary tumor
(ii)
Adjuvant therapy
J. Elective Rotation
1. Educational Goal
During the fourth and final year of otolaryngology training, the resident may choose to perform a
2 week block rotation in a relevant medical subspecialty to enhance his/her otolaryngology
training. Appropriate rotations include but are not limited to rotations on Neuroradiology,
Radiation Oncology, Pathology, etc. The resident is required to develop at least 3 learning
objectives for the elective which require approval by both the sponsoring physician and the
residency program director. All parties will sign written documentation of these objectives which
will be placed in the resident educational file. The rotation may take place at an outside facility
in accordance with the University of Mississippi policy regarding outside rotations.
2. Rotation Description
For a resident that needs remediation in one or more areas or has had an inequity in experience
previously identified, or who requires further research time due to the extended or complicated
nature of basic science research project schedules, the Program Director will meet with the
resident to define his/her individual elective rotation schedule. The program director will closely
monitor the residents experience and the experience of those residents already assigned to a
particular service(s) so that the addition of another senior resident does not negatively impact the
experience of the previously assigned residents.
For a resident that does not require remediation in any area or additional research time, elective
rotations can be arranged with Endocrinology, Sleep Medicine, Allergy and Immunology, Head
and Neck Radiology, Head and Neck Pathology, Oral Oncology, Oro-Maxillofacial Surgery,
Dentistry, Oncology, Radiation Therapy, Plastic Surgery, Neurosurgery, Anesthesia, and the
Business of Otolaryngology [Otolaryngology Clinic Office Management]. If a two month time
period is approved for the elective rotation, the resident may choose to take one or more electives
during that two month block time. The resident may also choose to undertake a humanitarian
mission trip during that time. As these electives will be arranged on an individual basis, rotation
descriptions and competency-based Goals and Objectives will be constructed at the time the
elective rotation is defined and placed in the individual resident’s permanent folder.
K. General Knowledge Base and Skill Sets
65
This area will cover outline objectives for the acquisition of a knowledge base and skill sets
desired in all residents that are not specific to one particular rotation.
1. Knowledge Base
a)
b)
Junior
(1)
Learn the embryology, anatomy, physiology, histology and pathology of the head and
neck structures
(2)
Become familiar with basic science concepts as related to otolaryngology from
immunology/allergy, microbiology/virology, endocrinology, neurology, molecular
biology, genetics, and epidemiology
(3)
Be able to appropriately select and interpret radiologic and laboratory tests
(4)
Develop a practical knowledge of principles of pharmacology for common medication
classes used in otolaryngology
(5)
Display a functional knowledge of proper preoperative, intraoperative and
postoperative care including patient selection, site of surgery selection, universal
precautions, correct surgical site procedures, anesthetic principles, fluid management,
airway management, wound management, and management of postoperative
complications
(6)
Become facile with the concept of disease prevention
Senior
The senior resident is expected to continue to develop a broader and deeper knowledge base in
these areas and to assist with the teaching of this knowledge to junior residents and medical
students.
2. Skill Sets
a)
Junior
(1)
Taking a complete medical history appropriate for otolaryngology
(2)
Diagnostic exam procedures including normal and pathologic findings for the head and
neck structures
(3)
Discuss the evaluation and management of postoperative fever
(4)
Describe the proper recognition and management of nutritional deficiency in the
perioperative period
66
b)
Senior
The senior resident is expected to continue to develop a broader and deeper knowledge base in
these areas and to assist with the teaching of this knowledge to junior residents and medical
students.
L. Monitoring of Effectiveness
The goals and objectives are achieved through resident participation in clinical and research
rotations, didactic lectures, clinical conferences, journal reading, and independent assigned
reading. The success of goal and objective achievement is monitored by semi-annual resident
evaluation by all clinical faculty, results of the home study course testing, performance in any
simulated examinations, results of the annual otolaryngology examination, monitoring of
resident placement, resident evaluation of the program and success with the American Board of
Otolaryngology certification examination. The semi-annual resident evaluation is compiled from
a variety of sources including observation, 360 evaluation instruments, patient questionnaires,
role playing, case scenario discussions, and medical record audits, and performance on various
portfolio projects. Each resident has a portfolio collection of projects which assess each of the
six competencies and complement the goals and objects of all resident rotations. The portfolio
matures over each resident’s five years as more and different projects are completed as he/she
progresses.
In addition, surveys are mailed or emailed to former graduates annually to determine what
aspects of the program were most helpful, what aspects could be improved, added, or eliminated,
and an overall assessment of whether the program adequately prepared them for independent
practice.
II.
Curriculum
A. Purpose and Overview
The purpose of the curriculum is to provide an organized and rational approach to the
achievement of the goals and objectives of the educational program.
The Accreditation Council for Graduate Medical Education via its Outcome Project has
increased its emphasis on educational outcome assessment in the accreditation process. This
increased emphasis is reflected in changes to Program and Institutional Requirements that
require programs to:

Identify learning objectives related to the ACGME's general competencies

Use increasingly more dependable (i.e. objective) methods of assessing residents'
attainment of these competency-based objectives; and,

Use outcome data to facilitate continuous improvement of both resident and residency
program performance.
The core competencies were developed via research and a collaborative review process with
broad representation. They reflect among other things an increasing recognition of our
67
responsibility as educators of physicians to ensure the public that we are training residents in a
consistent and logical manner to be adequately prepared to practice in a rapidly changing
healthcare environment. The core competencies are meant to represent what residents should
know and be able to do. Programs are expected to determine the objectives that should guide
progress toward achievement of the competencies. Subsequently, outcomes assessment will be
expected to follow to assess effectiveness in meeting the objectives.
The final evaluation of graduating residents is to reflect that the resident has “demonstrated
sufficient professional ability to practice competently and independently.” Given the emphasis
on educational outcomes assessment, it is our viewpoint that the structure of the core
competencies is the best framework for achieving this landmark. Goals, objectives, assessment,
and improvement can all readily be framed within the competencies.
Therefore, the overall goal of the residency program is to develop in our graduating residents a
proficiency level appropriate for a new and independent practitioner in the core competencies as
outlined by the ACGME. In order to best achieve this goal and the relevant objectives, the
curriculum will be framed to the greatest degree possible within the core competencies.
B. Cycle of Assessment and Improvement
The goals, objectives and curriculum are developed by the faculty members with resident input
and participation. The framework for this curriculum is based on the ACGME Common
Program Requirements, the Program Requirements for Resident Education in Otolaryngology,
and the American Board of Otolaryngology Scope of Knowledge Report.
The curriculum is assessed in a variety of ways:
1. Education issues are discussed informally at every monthly faculty meeting which includes
resident representation and participation.
2. Every lecture and lab session is evaluated contemporaneously by the residents. These
results are collated and presented to the faculty member. In addition, these results are used
globally in framing the curriculum.
3. The residents meet quarterly with the program director on an individual basis to share
concerns and offer suggestions for improvement. Meetings in January and June will be formal
evaluation reviews and discussion of educational progress. Meetings in September and
March/April will be informal discussions of any problems, future work plans, or potential areas
of program improvement. The Chairman is available to meet with residents, especially PGY-2
and PGY-3 residents, regarding future work plans or fellowship at any time at their request.
4. The curriculum, the faculty, and the rotations are evaluated confidentially by the residents
annually. The results are collated and presented to the residents for further input and
clarification. Then the results are presented to the faculty as a whole, with resident
representation, and used to adjust the curriculum for the upcoming year.
5. Each faculty member is encouraged to constantly participate in self-evaluation with regard
68
to their assigned portion of the curriculum.
6. Results of resident performance on the Annual Otolaryngology Examination, the American
Board of Otolaryngology exams, and Home Study Course Self Assessments are considered.
7. Success of resident placement in fellowships and private or academic practice is considered.
8. Results of external, faculty and self-assessment of the resident’s success in meeting the core
competency standards are assessed semi-annually. Assessment methods for each competency
are outlined specifically in the resident evaluation document. Tools used include 360 global
and modified evaluations, direct observation, medical record audits, case scenario discussions,
patient simulations, patient questionnaires, hospital reports, case log reviews, surgical
checklists, conference attendance records, travel records, examination scores, conference
discussions, resident presentations, journal club discussions, and resident publications.
All of the above information is considered on a formal basis annually by the faculty with resident
representation. Adjustments and improvements are made on the basis of this data. In this
manner, a constant cycle of assessment and improvement is maintained.
C. Methodology
Each faculty member or group is assigned a primary area of responsibility in the curriculum.
The material is most commonly actually conveyed as a group effort, but the responsibility rests
with the assigned faculty member and ultimately the program director/chair. The responsible
faculty member or group can deliver this information in a variety of ways as appropriate for the
subject matter. The teaching occurs across all rotations, and therefore the curriculum is
presented in a global fashion. However, particular areas are emphasized on each rotation as
outlined in our departmental goals and objectives outline. Methods of delivering the curriculum
include:
1. Teaching in clinical settings
a)
Ward rounds
b)
Consultations
c)
Surgical suites
d)
Outpatient clinics
2. Hands on instruction in audiologic, vestibular, and speech language pathology
assessment
3. Hands on instruction in physical examination skills
4. Hands on instruction in use of instrumentation
69
5. Assigned and Independent Reading Program
a)
b)
Assigned
(1)
Home Study Course
(2)
Bailey’s Otolaryngology Text
Independent
(1)
Surgical atlases
(2)
Pediatric texts
(3)
Otology texts
(4)
Head and neck texts
(5)
Laryngology texts
(6)
Facial plastics texts
6. Conferences
a)
Didactic lectures by faculty and invited speakers
b)
Visiting professor lectures and discussions
c)
Case discussions
d)
Case scenario discussions
e)
Performance Improvement Conference
f)
Head and Neck Tumor Conference
g)
Pathology Review Conference
h)
Research Meeting
i)
Journal Clubs
j)
Resident presentations
7. Laboratories
70
a)
Anatomic dissections
b)
Sinus surgery cadaver lab
c)
Temporal bone dissections
d)
Soft tissue surgery dissections
e)
Facial plating lab
f)
Flap anatomical dissections
8. Research Program Participation
9. Attendance at Outside Meetings
a)
Trauma Courses
b)
Facial Plastic Courses
c)
Allergy Courses
d)
Temporal Bone Courses
e)
Skull Base Courses
f)
American Academy of Otolaryngology Annual Meetings
g)
h)
(1)
Scientific sessions
(2)
Poster sessions
(3)
Research sessions
(4)
Instructional Courses
Combined Otolaryngologic Spring and Sectional Meetings
(1)
Scientific sessions
(2)
Poster sessions
Regional (state) otolaryngology meetings
71
III.
Curricular Outline
The Otolaryngology—Head and Neck Surgery Comprehensive Core Curriculum outlined below
is a compendium of topics, diseases and disorders that is included in the scope of knowledge for
Otolaryngology—Head and Neck Surgery. The Curriculum outlines and provides an operational
structure for the body of knowledge that is available in Otolaryngology—Head and Neck
Surgery Residency training programs. This Curriculum is the foundation for the written and oral
certification examinations developed by the American Board of Otolaryngology. This document
was developed by the Education Council, a committee established by the American Board of
Otolaryngology, which is composed of representatives from the American Board of
Otolaryngology, the ACGME Otolaryngology-Residency Review Committee, Society of
University Otolaryngologists-Head and Neck Surgeons, and the Association of Academic
Departments of Otolaryngology-Head and Neck Surgery.
Contributors:
Bruce Gantz, MD-Chair
Patrick Brookhouser, MD
Richard Chole, MD, PhD
Dean Toriumi, MD
Paul Lambert, MD
Michael Stewart, MD, MPH
Brad Marple, MD
Robert Ossoff, MD
James Hadley, MD
Ed Weaver, MD, MPH
Jay Piccirillo, MD, PhD
Mark Richardson, MD
Clough Shelton, MD
Steven Telian, MD
Lanny Close, MD
Randy Weber, MD
Wayne Larrabee, MD
General Otolaryngology Curriculum
I. Fundamental Knowledge
1. General Head and Neck Anatomy
A. Unit objective
i. At the completion of this unit, the resident understands the basic anatomy
of the head and neck, including surface and internal anatomy.
B. Learner objectives
i. Upon completion of this unit the resident:
1. understands the anatomy of the head and neck, including
interrelationships between neural structures, aerodigestive tract,
ear, facial skeleton, skull, etc.
2. knows the surgical anatomy of the head and neck
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3. understands radiologic imaging of the head and neck
C. Contents
i. Ear
ii. Face
iii. Nose
iv. Paranasal sinuses
v. Facial skeleton
vi. Skull
vii. Teeth
viii. Neck
ix. Aerodigestive tract
x. Cranial nerves
xi. Vascular anatomy
xii. Radiologic evaluation and anatomy
2. General Head and Neck Embryology
A. Unit objective
a. At the completion of this unit, the resident understands the basic concepts
and importance of embryology of the head and neck, including the ear
and temporal bone, pharynx, endocrine structures, nerves and
vasculature.
B. Learner objectives
a. Upon completion of this unit the resident:
i. understands the embryology of all structures of the head and
neck, including interrelationships between adjacent and related
structures.
ii. understands the surgical implications of embryology, for example:
1. location of parathyroid glands
2. tracts for congenital fistulas and sinuses
C. Contents
a. Found in individual sections – Otology, Pediatric Otolaryngology, Head
and Neck, Laryngology, etc.
3. Physiology in General Otolaryngology
A. Unit objective
a. At the completion of this unit, the resident understands the physiology of
olfaction and taste, and of the aerodigestive tract – humidification,
respiration, phonation, and swallowing.
B. Learner objectives
a. Upon completion of this unit the resident understands the functions of
smell and taste, and the multiple related functions of the aerodigestive
tract.
C. Contents
a. Olfaction – found in Rhinology section
b. Taste
c. Nasal physiology – found in Rhinology section
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d. Respiration & phonation in the larynx – found in Laryngology section
e. Swallowing
i. Dysphagia
ii. Aspiration
iii. Odynophagia
f. Laryngopharyngeal reflux
4. Physical Examination in General Otolaryngology
A. Unit objective
a. At the completion of this unit, the resident understands how to perform a
physical examination of the head and neck, including internal and
external structures.
B. Learner objectives
a. Upon completion of this unit the resident:
i. understands the evaluation of anatomy of the head and neck.
ii. understands the techniques for physical examination
C. Contents
Inspection
Palpation
Otoscopy
Tuning fork testing
Rhinoscopy
Indirect (mirror) laryngoscopy and pharyngoscopy
Fiberoptic endoscopy
Neurologic examination
Dental occlusion
Anatomic zones of the neck
D. Clinical Skills
During the training period the resident:
Recognizes the normal and abnormal anatomy of the head and neck
Utilizes instruments and techniques to perform complete physical
examination of the head and neck
II. Diseases and Disorders in General Otolaryngology
1. most diseases are found within subspecialty curricula (Otology, Rhinology,
etc.)
A. Unit objective
i. At the completion of this unit, the resident will be able to recognize,
assess, diagnose, and manage diseases and disorders within general
otolaryngology.
B. Learner objectives
i. Recognize the signs, symptoms and physical findings of diseases and
disorders within general otolaryngology
1. use appropriate diagnostic tests
2. be able to perform physical examination of the head and neck
ii. Understand medical and surgical management of diseases and disorders
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with general otolaryngology
C. Contents
i. Ear disease – see Otology section
ii. Nasal disease – see Rhinology section
iii. Sinus disease – see Rhinology section
iv. Allergy – see Allergy section
v. Oral cavity
1. cheilitis
2. stomatitis
a. bacterial
b. fungal
c. viral
d. ulceration
3. pharyngitis/tonsillitis
4. peritonsillar abscess
5. sialadenitis/sialolithiasis
6. neurologic
a. palate weakness
b. tongue weakness/paralysis
c. dysarthria
vi. Larynx and voice – see Laryngology section
vii. Swallowing – see Laryngology section
viii. Head and neck mass
1. Congenital – see Pediatric section
2. Neoplasm – see Head & Neck section
3. Inflammatory
a. Lymphadenitis
b. Nontuberculous mycobacteria
c. Scrofula
d. Sarcoid
4. Rare diseases (sinus histiocytosis with massive lymphadopathy,
etc.)
ix. Trauma
1. soft tissue injury
2. soft tissue loss
3. facial fracture
a. frontal sinus
b. maxilla and midface
c. orbital fractures
d. mandible
e. surgical approaches
f. closed reduction vs. open reduction
4. penetrating trauma
a. airway management
b. neck zones
c. imaging and evaluation
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d. vascular injuries
e. surgical management
5. larynx trauma
a. airway management
b. endoscopic evaluation
c. radiologic evaluation
d. repair
x. Sleep-disordered breathing – see Sleep Disorders section
1. snoring
2. sleep apnea
3. other sleep disorders
xi. Systemic diseases with head and neck manifestations
1. Wegener’s granulomatosis
2. Sarcoidosis
3. Behcet’s disease
4. Pemphigus
5. Rheumatoid arthritis
6. etc.
xii. Syndromes
1. Osler-Weber-Rendu
2. Basal cell nevoid syndrome
3. etc.
D. Clinical skills
i. Upon the completion of this unit, the resident can perform a
comprehensive history and physical examination, order appropriate
laboratory and diagnostic testing, develop a differential diagnosis, and
arrive at a diagnosis of diseases and disorders in general otolaryngology.
ii. The resident can discuss the nonsurgical and surgical management of
diseases and disorders in general otolaryngology.
iii. The resident can integrate the embryology, genetics, anatomy and
physiology, in the understanding of diseases and disorders of general
otolaryngology.
Rhinology Curriculum
I. Fundamental Knowledge
1. Anatomy and Physiology of the Nose and Paranasal Sinuses
A. Unit Objective
1. At the completion of this unit the resident understands the
anatomy of the nose and paranasal sinuses, along with pertinent
neural structures of the anterior skull base, vascular supply, and
adjacent anatomic areas.
B. Learner Objectives
1. Upon completion of this unit the resident
a. Understands the bony and soft tissue anatomy of the nose
and paranasal sinuses and their relationship to related
vascular, neural, orbital, and intracranial structures of the
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anterior and lateral skull base.
b. Knows the surgical anatomy, neural, vascular, and
osseous components of the nose and paranasal sinuses
c. Understands the surgical relationship of the neural,
vascular, and osseous components of the nose and
paranasal sinuses to the anterior and lateral skull base.
d. Knows operative approaches to the nose and paranasal
sinuses.
C. Contents
1. Structural surface anatomy
a. External nasal anatomy
b. Septum
i. Quadrangular cartilage
ii. Perpendicular plate of the ethmoid
iii. Vomer
iv. Sphenoid rostrum
v. Maxillary crest
c. Lateral nasal wall structures
d. Choana
e. Olfactory cleft
2. Bony anatomy
a. Maxillary bone
i. Anatomic Subunits
ii. Relationship to pertinent anatomy
1. Infraorbital nerve
2. Orbit
3. Alveolus
4. Pterygomaxillary space
b. Ethmoid bone
i. Anatomic subunits
1. Uncinate process
2. Ethmoidal bulla
3. Basal lamella
4. Lamina papyracea
5. Cribriform
a. lateral lamella
b. lamina cribrosa
c. Middle turbinate
6. Perpendicular plate
7. Crista galli
ii. Extramural ethmoid cells
1. Agger nasi
2. etc.
c. Sphenoid bone
i. Anatomic subunits
1. Rostrum
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2. Greater wing
3. Lesser wing
4. Planum sphenoidale
5. Clivus
6. Pterygoid plates
ii. Intra-sphenoid surface topography
iii. Relationship to surrounding structures
1. Optic nerve
2. Carotid artery
3. Cavernous sinus
4. etc.
d. Palatine Bone
i. Anatomic subunits
ii. Relationship to surrounding structures
1. Pterygopalatine fissure
2. Foramina
3. Functional anatomy
a. Nasal valve
4. Vascular relationships
a. External Carotid
i. Superior labial artery
ii. Internal maxillary artery
b. Internal Carotid
i. Anterior ethmoidal artery
ii. Posterior ethmoidal artery
5. Neural relationships
a. Olfactory Nerve
b. Trigeminal Nerve
i. Ophthalmic division
1. Nasociliary nerve
a. Anterior ethmoidal nerve
b. Posterior ethmoidal nerve
ii. Maxillary division
1. Infraorbital nerve
2. Nasopalatine nerve
c. Parasympathetic innervation
i. Sphenopalatine ganglion
ii. Vidian nerve
d. Optic nerve
6. Diagnostic skills
a. Radiology
i. CT
ii. MR
iii. Cisternogram
b. Endoscopy
D. Clinical Skills
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1. During the training period the resident:
a. Recognizes the normal and abnormal anatomy of the nose
and the paranasal sinuses.
b. Interprets tests to diagnose anatomic abnormalities of the
nose and paranasal sinuses
c. Performs surgical procedures that utilize anatomic
knowledge of the nose and paranasal sinuses.
2. Embryology of the Nose
A. Unit Objective
a. At the completion of this unit the resident understand the
embryology of the nose and paranasal sinuses
B. Learner Objectives
a. Knows the normal embryological development of the nose and
paranasal sinuses
b. Understands how embryological development impacts the
anatomy of the nose and paranasal sinuses
C. Content
a. Development of the nasal cavity and paranasal sinuses
i. Nasal development
ii. Olfactory placode
iii. Maxillary
iv. Ethmoid
1. Ethmoturbinals
2. Primary furrows – form recesses and meati
v. Sphenoid
vi. Frontal
b. Patterns of pneumatization
i. Ethmoid
1. Anterior ethmoid cells
2. Posterior ethmoid cells
3. Variant patterns of pneumatization
ii. Frontal
iii. Maxillary
iv. Sphenoid
c. Cleft palate
d. Encephalocele
e. Dermoid
D. Clinical Skills
a. During the training period the resident:
i. Recognizes the normal embryologic develop of the nose
and paranasal sinuses and its impact upon the fixed and
variable anatomy of the paranasal sinuses
ii. Recognizes how variations in paranasal sinus
pneumatization contribute to subtle variations in surgical
anatomy in a predictable fashion
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iii. Interprets imaging and endoscopic studies that
demonstrate variations and disorders of the embryologic
development of the nose and paranasal sinuses
iv. Performs surgical procedures that utilize the embryologic
knowledge of the nose and paranasal sinuses.
3. Physiology of the Nose and Paranasal Sinuses
A. Unit Objective
a. At the completion of this unit the resident understands the normal
physiology of the nose
B. Learner objectives
a. Understand how normal function of the nasal mucosa contributes
to the homeostasis of the nose and paranasal sinus
b. Understand the role of nasal airflow in the function of the nose
C. Content
a. Mucosa and mucociliary function
i. Mucosa
1. Respiratory epithelium
2. Pseudostratified columnar epithelium
3. Cilia structure
a. Ciliary ultrastructure
ii. Vascular dynamics
1. Autonomic control
2. Nasal cycle
iii. Glandular anatomy
1. Goblet Cells
2. Seromucinous glands
iv. Mucus
1. Composition
2. Motility
3. Immune function
v. Mucociliary flow
1. Function
2. Flow pathways
b. Air flow
i. Air flow characteristics
ii. Nasal air processing
D. Clinical Skills
a. During the training period the resident:
i. Uses knowledge of nasal physiology to interpret causes of
nasal disease.
ii. Performs surgical procedures understanding their potential
impact upon nasal and paranasal sinus physiology.
4. Olfaction
A. Unit Objective
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a. At the completion of this unit the resident understands nasal
contribution to olfaction
B. Learner Objectives
a. Understand the relationship between normal function of the nasal
mucosa and olfactory function
b. Understand the role of nasal airflow contributes to olfaction
c. Understand neural pathways of olfaction
C. Content
a. Neuroanatomy
i. Olfactory neuroepithelium
1. Histology
2. Diffusion of odorants
a. Role of mucus
ii. Olfactory tract neuroanatomy
1. Peripheral
2. Central
b. Dynamics of olfaction
i. Odorants
ii. Airflow dynamics at olfactory mucosa
iii. Odorant diffusion
iv. Olfactory transduction and coding
v. Central processing
c. Olfactory testing
i. Sensorineural tests
ii. Imaging
iii. Lab
D. Clinical Skills
a. During the training period the resident:
i. Demonstrates ability to evaluate and treat causes of
olfactory dysfunction
ii. Demonstrates understanding of potential impact of various
treatments upon olfactory function.
5. Nasal and Paranasal Sinus Immunology/Inflammation
A. Unit Objectives
a. At the completion of this unit the resident understands the role of
immune system in maintaining nasal and paranasal sinus
homeostasis
B. Learner objectives
a. Understand the role of the immune system in maintenance of
nasal and paranasal sinus homeostasis
b. Recognize the role of inflammation in common diseases of the
nose and paranasal sinuses
C. Content
a. Immunology
i. General aspects
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ii. Triggers of the immune response
iii. Components
a. Inflammatory cells
b. Immunoglobulins
c. Inflammatory mediators
b. Microbiology
c. Endocrinology
d. Neurology
e. Diagnostic Interpretation
D. Clinical Skills
a. During the training period the resident:
i. Demonstrates the ability to recognize the role of
inflammation plays in chronic and acute disorders of the
nose and paranasal sinuses
ii. Demonstrates the ability to evaluate for underlying causes
of inflammation
iii. Demonstrates the ability to maximize medical evaluation
as a component of the management of patients with nonemergent
inflammatory paranasal sinus disease
iv. Appropriately selects surgical candidates based upon
knowledge of underlying inflammatory disorders
6. Physical Examination
A. Unit Objectives
a. At the completion of this unit the resident demonstrates the
components of a thorough physical examination as it relates to the
nose and paranasal sinuses
B. Learner Objectives
a. Understand the individual components of the physical examination
as it relates to the nose and paranasal sinus
b. Ability to perform a comprehensive physical examination as it
relates to the nose and paranasal sinuses
c. Ability to interpret physical findings accurately
C. Content
a. External nasal examination
b. Evaluation of nasal valve function
c. Anterior rhinoscopy
d. Indirect nasopharyngoscopy
e. Nasal endoscopy
i. Rigid
ii. Flexible
f. Olfactory testing
g. Nasopharyngeal culture
h. Sinonasal aspirate/culture
i. Antral puncture
ii. Endoscopic middle meatal culture
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i. Evaluation for CSF fistula
j. Interpretation of findings
D. Clinical Skills
a. During the training period the resident:
i. Develop the ability of perform a comprehensive physical
examination directed to the nose and paranasal sinuses.
ii. Accurately interpret results of the physical examination
iii. Use information gathered during physical examination to
develop diagnostic/treatment plans for diseases of the
nose and paranasal sinuses
II. Diseases, Disorders, and Conditions
A. Unit Objective
a. At the completion of this unit the resident will be able to recognize, assess,
diagnose, and manage disease and disorders of the nose and paranasal
sinuses, and anterior skull base.
B. Learner Objective
a. Recognize the signs and symptoms of diseases and disorders of the nose,
paranasal sinuses, and anterior skull base
b. Use the appropriate diagnostic tests to assess diseases and disorders of the
nose, paranasal sinuses, and anterior skull base
c. Be able to develop a diagnosis of diseases and disorders of the nose, paranasal
sinuses, and anterior skull base
d. Understand the surgical and non-surgical management of diseases and
disorders of the nose, paranasal sinuses, and anterior skull base
C. Content
a. Olfactory Disorders
i. Neurosensory olfactory disorders
1. Viral
2. Trauma
3. Neoplasm
4. Demyelinating or degenerative CNS disorder
ii. Conductive disorders
1. Inflammatory rhinosinusitis
b. Nose
i. Congenital Malformations
ii. Genetic disorders
1. HHT
iii. Trauma
iv. Foreign body
v. Anatomic obstruction
1. Nasal valve collapse
2. Inferior turbinate hypertrophy
3. Septal deviation
vi. Infections
1. Vestibulitis
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2. Rhinitis
vii. Inflammation
1. Allergic rhinitis
2. Non-allergic rhinitis
viii. Epistaxis
ix. Neoplasms
c. Paranasal sinuses
i. Congenital malformations
ii. Trauma/foreign body
iii. Developmental
1. Mucocele
iv. Inflammatory
1. Chronic inflammatory rhinosinusitis with polyposis
2. Chronic inflammatory rhinosinusitis without polyposis
3. Allergic fungal rhinosinusitis
4. Relationship between rhinosinusitis and asthma
v. Infectious
1. Acute rhinosinusitis
2. Chronic infectious rhinosinusitis
3. Invasive fungal
4. Infectious complications of CRS or ABRS
a. Orbital
b. Intracranial
c. Facial soft tissue
vi. Granulomatous
vii. Cystic fibrosis
viii. Autoimmune
ix. Complications of paranasal sinus surgery
1. Intracranial
2. CSF fistula
3. Orbital
4. Recurrence/persistence of disease
x. Neoplasms
d. Skull base
i. Congenital
ii. Developmental
iii. Trauma
iv. Neoplasm
e. Pathology of regions adjacent to the paranasal sinuses
i. Orbital/Lacrimal
1. Dacryocystitis
2. Grave’s exophthalmia
ii. Intracranial
1. Pituitary adenoma, etc.
D. Clinical Skills
a. Upon the completion of this unit the resident can:
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i. perform a comprehensive history, focused physical examination, order
appropriate laboratory and diagnostic studies to develop a thorough
differential diagnosis, and arrive at a definitive diagnosis of the above
diseases nose, paranasal sinuses and adjacent structures
ii. can discuss the non surgical as well as surgical management of the
diseases and disorders of the nose, paranasal sinuses and adjacent
structures
iii. discuss the procedures and strategies necessary to treat the diseases
and disorders of the nose, paranasal sinuses, skull base, and adjacent
structures
III. Surgical Concepts
A. Unit Objective
a. At the completion of this unit the resident will understand the treatment strategies and
procedure for the surgical management of diseases of the nose, paranasal sinuses, skull
base, and adjacent structures
B. Learner Objectives
a. The resident will be exposed to the surgical strategies necessary to treat
diseases and disorders of the nose, paranasal sinuses, skull base, and adjacent
structures
b. The resident will be able to perform surgical strategies to treat diseases and
disorders of the nose, paranasal sinuses, skull base, and adjacent structures
C. Content
a. General
i. Basic principles
1. Local anesthesia
2. Principles of hemostasis
ii. Open approaches to the paranasal sinuses and anterior skull base
iii. Laser principles
iv. Equipment/instruments
v. Intra-operative image guidance
vi. Graft materials
b. Specific Surgical Procedures
i. Endoscopic
1. Nasal endoscopy
2. Inferior turbinoplasty
3. Endoscopic septoplasty
4. Maxillary antrostomy
5. Ethmoidectomy
6. Sphenoidotomy
7. Frontal sinusotomy
a. Draf I
b. Draf II
c. Draf III
8. Trans-pterygoid approach to:
a. Pterygomaxillary fissure
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b. Sphenoid sinus
9. Repair of CSF fistula (access to encephalocele/meningocele)
a. Ethmoid
b. Sphenoid
10. Concha bullosa
11. Orbital decompression
12. Dacryocystorhinotomy
13. Medial maxillectomy
14. Hypophysectomy
15. Laser ablation of telangiectasia (HHT)
ii. Non-endoscopic
1. Septoplasty
2. Inferior turbinoplasty
3. Anterior antrostomy
4. External ethmoidectomy
5. Frontal
a. Trephine
b. Osteoplastic flap
c. Obliteration
d. Cranialization
e. Ablation
6. Transeptal sphenoid sinusotomy
7. Medial maxillectomy
8. Septal dermaplasty
D. Clinical Skills
a. At the completion of this unit the resident will:
i. Understand the surgical strategies and procedures to manage disease
and disorders of the nose, paranasal sinuses, skull base, and adjacent
structures
ii. Be able to select the most appropriate surgical procedure in order to
treat diseases and disorders of the nose, paranasal sinuses, skull base, and
adjacent structures
Allergy Curriculum
I. Fundamental Knowledge
1. Immunology of Allergic Ear Nose and Throat Disorders
A. Unit objectives:
1. At the completion of this unit, the resident understands the
structure and function of the immune system with its related
cellular and humoral functions as it relates to allergic respiratory
disorders.
B. Learner objectives
1. Upon completion of this unit, the resident:
a. Understands the complex structure and function of the
immune system as it relates to cellular and humoral
function along with the cells and related cytokines that are
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produced during the allergic reaction
b. Understands the structural anatomy of the respiratory tract
and related functions of conjunctiva, middle ear, tracheal
and bronchial mucosa and sinus and nasal mucosa.
C. Contents
1. Definition of immunity, anaphylaxis, allergy, atopy
2. Role of innate and adaptive immunity
a. Non-specific responses
b. Specific responses
i. Specificity
ii. Memory
iii. Self-limitation
iv. Self-recognition (non-reaction to self)
v. Amplification
vi. Feedback control
vii. Recruitment of secondary defense mechanisms
3. Components of the immune system
a. Cells of the immune system
i. Classes of lymphocytes including T cells, B cells,
null cells
1. TH-1 and TH-2 cells
2. Suppressor T-Cells
ii. Mononuclear phagocytes and macrophages,
1. Role of antigen-presenting cells
iii. Mast cells and basophils
iv. Eosinophils
v. Neutrophils and platelets
b. Antibodies and antigens
i. Immunoglobulins
ii. Antibodies
iii. Antibody response to antigen challenge
c. Nonspecific mediators: Cytokines and lymphokines
i. Role of interferon, GM-CSF, TNF-alpha, TNF-beta,
role of interleukins
d. Complement
i. Classic and alternate pathway activation in the
complement cascade
e. Hypersensitivity reactions: Gell and Coombs reactions
i. Type I: Immediate (anaphylactic) hypersensitivity
reaction along with early and late phase reactions
ii. Type II: Antibody-dependent cytotoxicity
iii. Type III: Immune complex-mediated
hypersensitivity reactions
iv. Type IV: Cell-mediated hypersensitivity
v. Other hypersensitivity reactions
D. Clinical Skills
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1. At the completion of this unit the resident will:
a. Understand the clinical impact of immunologic
disorders of the head and neck
2. Inhalant Allergic Disorders
A. Unit objectives:
1. At the completion of this unit, the resident understands the nature
of inhalant allergens and their impact on the patient with allergic
disorders respiratory disorders.
B. Learner objectives
2. upon completion of this unit, the resident:
a. Understands the relevant inhalant allergens giving rise to
allergic disorders and the cross reactivity of these allergens.
b. Understands the nature of food allergy, types of food
allergens and different food allergy reactions.
c. Understands the categories of antibodies, their
production stimulation and secretion.
C. Contents: nature of allergic antigens
3. Categories of inhalant allergens
a. Pollens
vi. Tree, grass, weed pollens
vii. Thommen’s postulates
b. Fungi
c. Bacteria
d. House dust mite
e. Animal danders
4. Nature of food allergens and food allergy
a. Immunologic reactions to foods
b. Cyclic food Allergy
i. various stages of cyclic food sensitivity
ii. masked sensitization and food addiction
iii. diagnostic techniques for cyclic food allergy
1. oral challenge test
2. skin testing techniques
a. intradermal testing technique
b. in vitro food tests
c. Fixed food allergy
d. Signs and symptoms of food allergy
e. Theory of action of neutralization treatment of food sensitivity
5. Development of antibodies
a. Immunoglobulins: Development of 5 different classes of
the immunoglobulins distinguished by antigenic and
structural characteristics
b. Production of immunoglobulins by transformation of B cells
into plasma cells
D. Clinical Skills
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1. At the completion of this unit the resident:
a. understands the pathophysiology behind
immunotherapy treatment of inhalant allergy
2. Hypersensitivity Disorders
A. Unit objectives:
1. At the completion of this unit, the resident understands the
development of different types of hypersensitivity reactions
and their impact on the patient with allergic disorders
respiratory disorders.
B. Learner objectives
2. Upon completion of this unit, the resident:
a. Understands the different types of hypersensitivity
reactions that give rise to allergic disorders.
b. Understands the nature of mechanisms of control of
hypersensitivity reactions.
C. Contents
1. Gell and Coombs hypersensitivity reactions
a. Type I: Immediate hypersensitivity reaction
b. Type II: Antibody-dependent cytotoxicity
c. Type III: Immune complex-mediated hypersensitivity
d. Type IV: Cell-mediated hypersensitivity
2. Additional hypersensitivity reactions
D. Clinical Skills
1. At the completion of this unit the resident will:
a. Understand the pathophysiology behind hypersensitivity
reactions.
3. Diagnosis of Allergic Ear Nose and Throat Disorders
A. Unit objectives:
1. At the completion of this unit, the resident understands the
diagnostic methods to determine the presence of an allergic
disorder in the ear, nose and throat patient.
B. Learner objectives
1. Upon completion of this unit, the resident:
a. Understands the relevant history, chief complaints and past
medical history that demonstrates a diagnosis of upper
respiratory allergy
b. Understands the physical examination characteristics of a
patient with respiratory allergy including the conjunctiva,
middle ear, tracheal and bronchial mucosa and sinus and
nasal mucosa.
c. Understands the rational diagnostic methodologies and
physical examination of the patient with allergic disorders
d. Is able to formulate a plan of management of a patient with
ear nose and throat allergic disorders.
C. Contents
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1. History, pertinent past medical history, review of systems.
2. Family history: Awareness of the possibility of familial
involvement of inhalant respiratory allergies.
3. Specific physical examination and physical findings
a. General
i. Observation
b. Skin
i. urticaria, eczema
c. Eyes
i. allergic shiners
ii. acute allergic conjunctivitis
iii. atopic keratoconjunctivitis
d. Ears
i. external ear: Id reaction
ii. middle ear: Recurrent serous otitis media and
eustachian tube dysfunction
e. Nose
i. chronic nasal congestion
ii. allergic hypertrophic inferior turbinates
iii. nasal crease
iv. nasal polyposis
f. Oral cavity/oropharynx
i. chronic mouth breathing
ii. high arched palate
iii. posterior oropharyngeal cobblestone formation
g. Larynx
i. edema of larynx
h. Chest and pulmonary tract
i. asthma and classic expiratory wheezes
D. Clinical Skills
1. At the completion of this unit the resident will:
a. Be able to diagnose allergic disorders from
history.
b. Be able to diagnose allergic disorders from
physical examination.
4. Diagnostic Testing for Allergic Ear Nose and Throat Disorders
A. Unit objectives:
1. At the completion of this unit, the resident understands the
methods of inhalant and in vitro testing techniques for the proper
diagnosis of allergic respiratory disorders.
B. Learner objectives
1. upon completion of this unit, the resident:
i. Understands the different methods of skin testing and their
results
j. Understands the methods of In Vitro testing for respiratory
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and food allergens and the results
k. Is able to formulate a plan of management of a patient with
ear nose and throat allergic disorders.
C. Contents
1. Skin testing techniques:
2. Role of scratch testing
3. Skin prick testing
a. single prick techniques
i. wheal and flare response
ii. method of measurement
b. multiple prick testing technique
i. different types of multiple prick testing methods
4. Intradermal testing
a. placement of a known quantity of antigen into the dermis
b. Skin endpoint titration (SET)
c. Screening for allergies using skin testing
5. In vitro testing techniques
6. RAST testing
7. Enzymatic in vitro techniques
8. Indications for in vitro testing
9. Allergy screening using in vitro techniques
10. Immunotherapy based on in vitro test results
11. Combining in vitro and skin testing techniques.
12. Diagnostic techniques for food Allergy
a. History of food allergy reactions of patient
b. In vitro testing
c. Skin testing techniques
D. Clinical Skills
1. At the completion of this unit the resident will:
a. Be able to diagnose allergic disorders using different diagnostic tests.
II. Diseases Disorders and Conditions
A. Unit objectives:
1. At the completion of this unit, the resident understands the
different conditions of upper respiratory tract disorders and how
allergy may relate to the disease and to symptoms.
B. Learner objectives
1. Upon completion of this unit, the resident:
a. Understands the problem of the patient and should be able
to make a diagnosis of common allergy problems in the patient.
b. Is able to formulate a plan of management of a patient with
ear nose and throat allergic disorders.
C. Contents
1. Allergic Rhinitis
A. Unit objectives:
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a. At the completion of this unit, the resident understands the nature and etiology
of common allergic rhinitis as well as the mechanisms of management.
B. Learner objectives
a. Upon completion of this unit, the resident:
understands the development of allergic
rhinitis and signs and symptoms of the problem.
b. Understands the nasal anatomy and physiology and its relation to allergic
disease.
c. Is able to formulate a plan of management of a patient with symptoms of
allergic rhinitis.
d. Understands the differential diagnosis of allergic rhinitis and other types
of rhinitis.
C. Contents
a. Seasonal Intermittent Rhinitis
b. Springtime allergy and related pollens
c. Fall allergy and related pollens
d. Perennial Persistent Rhinitis
1. Relative allergens causing the perennial symptoms
e. Persistent Rhinitis
d. Rhinitis medicamentosa
e. Rhinitis of pregnancy
f. Vasomotor rhinitis
D. Clinical Skills
1. At the completion of this unit the resident will:
a. Be able to diagnose and treat common rhinologic problems
related to allergy and inflammation.
2. Allergic Ocular Disease and Conjunctivitis
A. Unit objectives:
a. At the completion of this unit, the resident understands the
manifestations of ocular disorders and inhalant allergies.
B. Learner objectives
a. Upon completion of this unit, the resident:
i. Understands the signs and symptoms of allergic ocular disease.
ii. Is able to formulate a plan of management of a patient with allergic
ocular disorders.
iii. Pathophysiology of the allergic reaction in the eye
iv. Classification of ocular allergy
C. Contents
a. Seasonal/perennial allergic conjunctivitis
b. Vernal keratoconjunctivitis
c. Atopic keratoconjunctivitis
d. Giant papillary conjunctivitis
e. Drug-induced allergic conjunctivitis
f. Therapy for allergic ocular disease
i. Topical antihistamines
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ii. Topical mast cell stabilizers
iii. Nonsteroidal anti-inflammatory medications
iv. Corticosteroid therapy
D. Clinical Skills
1. At the completion of this unit the resident will:
a. Be able to diagnose and treat common ophthalmologic disorders related
to allergy and inflammation.
3. Allergic Disease and Middle Ear Dysfunction
A. Unit objectives:
a. At the completion of this unit, the resident understands the different
manifestations of middle ear disease as it relates to inhalant allergy.
B. Learner Objectives:
a. Upon completion of this unit, the resident:
Understands the role of IgE reactions and development of middle ear problems in
the allergic patient
b. Is able to formulate a plan of management of a patient with ear nose and throat
allergic disorders.
C. Contents
a. Mucous membrane and the middle ear
b. Manifestations of serous otitis media
c. Eustachian tube dysfunction
D. Clinical Skills
1. At the completion of this unit the resident will:
a. Be able to diagnose and treat common middle ear disorders related to
allergy and inflammation.
4. Allergic Disease and Inner Ear Dysfunction
A. Unit objectives:
a. At the completion of this unit, the resident understands the different
manifestations of inner ear disorders and how they relate to symptoms of patients.
B. Learner objectives
a. Upon completion of this unit, the resident:
i. Understands the rationale of the development of signs and symptoms of
inner ear dysfunction with allergic symptoms.
ii. Is able to formulate a plan of management of a patient with inner ear
allergic disorders.
C. Contents
a. Meniere’s syndrome and indications for allergy testing.
b. Vertigo induced from hypersensitivity
D. Clinical Skills
1. At the completion of this unit the resident will:
a. Be able to diagnose and treat common inner ear disorders related to
allergy and inflammation
5. Allergic Disorders and Rhinosinusitis
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A. Unit objectives:
a. At the completion of this unit, the resident understands the mechanism of the
development of rhinosinusitis in the patient with allergic symptomatology.
B. Learner objectives
a. Upon completion of this unit, the resident:
i. Understands the relationship of allergies and subsequent development of
inflammatory and possible bacterial rhinosinusitis.
ii. Is able to formulate a plan of management of a patient with
rhinosinusitis.
C. Contents:
a. Pathophysiology of paranasal sinus disorders
b. Acute rhinosinusitis
c. Recurrent acute rhinosinusitis
d. Chronic rhinosinusitis
e. Allergic Fungal Rhinosinusitis
i. Diagnostic criteria of allergic fungal rhinosinusitis
ii. Pathophysiology of allergic fungal rhinosinusitis
iii. Role of fungal antigens in evaluation
iv. Testing for fungal allergy
v. Therapy for AFRS
vi. Immunotherapy in the patient with AFRS
D. Clinical Skills
1. At the completion of this unit the resident will:
a. Understand the association between allergy and rhinosinusitis
and be able to treat accordingly.
6. Allergic Disease and Laryngeal Dysfunction
A. Unit objectives:
1. At the completion of this unit, the resident understands the different conditions
of laryngeal and pharyngeal disorders and how they relate to symptoms of patients
with allergy.
B. Learner objectives
1. Upon completion of this unit, the resident:
i. Understands the anatomy and physiology of the larynx and pharynx and
the signs and symptoms of allergic laryngeal disorders.
ii. Is able to formulate a plan of management of a patient with laryngeal
and pharyngeal allergic disorders.
C. Contents
1. Laryngopharyngeal anatomy
2. Acute laryngopharyngitis: Anaphylaxis
3. Allergic angioedema and laryngitis
4. Angioedema and urticaria of the larynx
5. Role of ACE inhibitors
6. Oral allergy syndrome
7. LPR and GERD
D. Clinical Skills
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1. At the completion of this unit the resident will:
a. Understand the association between allergy and laryngeal dysfunction
and be able to treat accordingly.
7. Allergic Disease and Asthma
A. Unit objectives:
1. At the completion of this unit, the resident understands the different symptoms
of asthma in allergic patients.
B. Learner objectives
1. Upon completion of this unit, the resident:
a. Understands the mechanisms of asthma and pathophysiology of this
problem
b. Is able to formulate a plan of management of a patient with asthma and
understands the pertinent medications to control symptoms.
C. Content
1. Asthma diagnosis
2. Auscultation
3. Pulmonary function testing
c. Role of flow-volume loop
d. Peak flow measurements
4. Pathophysiology of asthma
5. Asthma severity
6. Pharmacotherapy of asthma
D. Clinical skills
1. At the completion of this unit the resident will:
a. Understand the association between allergy and asthma
8. Latex Hypersensitivity
A. Unit objectives:
1. At the completion of this unit, the resident understands the nature of latex
hypersensitivity.
B. Learner objectives
1. Upon completion of this unit, the resident:
a. Understands the role of latex reactions and crossreactivity.
b. Is able to formulate a plan of management of a patient with latex
hypersensitivity.
C. Content
1. Latex hypersensitivity
2. Cross reactions and latex hypersensitivity
3. Mechanism of management of the patient with latex hypersensitivity
D. Clinical Skills
1. At the completion of this unit the resident will:
a. Understand and be able to treat latex hypersensitivity reactions.
9. Allergic Manifestations of Chemical Sensitivity
A. Unit objectives:
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1. At the completion of this unit, the resident understands the different
manifestations of chemical sensitivity.
B. Learner objectives
1. Upon completion of this unit, the resident:
i. Understands the symptoms of possible chemical sensitivity in the
allergic patient.
ii. Is able to formulate a plan of management of a patient with e chemical
sensitivity and other allergic disorders.
C. Content
1. Nature of chemical sensitivity
2. Mechanisms of chemical injury
i. Acute poisoning
ii. Chronic poisoning
3. Total allergic load
4. Chemical hypersensitivity tests
5. Treatment of chemical sensitivity
D. Clinical Skills
1. At the completion of this unit the resident will:
a. Understand and be able to treat chemical sensitivity disorders.
10. Non-Allergic Rhinitis
A. Unit objectives:
1. At the completion of this unit, the resident understands the signs
and symptoms of a patient with rhinitis not due to any allergic
sensitivities.
B. Learner objectives
1. Upon completion of this unit, the resident:
i. Understands the manifestations of symptoms of non-allergic rhinitis
ii. Is able to formulate a plan of management of a patient with symptoms of nonallergic disorders.
C. Content
1. Vasomotor Rhinitis
2. Management of symptoms of non-allergic rhinitis
D. Clinical Skills
1. At the completion of this unit the resident will:
a. Understand and be able to treat non-allergic rhinitis.
III. Habilitation/rehabilitation
A. Unit objectives:
1. At the completion of this unit, the resident understands the
methods to improve a patient symptoms of allergic rhinitis with
development of avoidance techniques, and environmental
controls, pharmacotherapy and potential immunotherapy
B. Learner objectives
2. Upon completion of this unit, the resident:
a. Understands the rationale for the use of environmental controls
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b. Is able to utilize appropriate pharmacotherapy to help control symptoms
of inhalant allergy
c. Is able to formulate a plan of management using appropriate allergen
immunotherapy.
d. Understands the potential reactions that may occur in the patient
undergoing treatment with immunotherapy
C. Content
1. Environmental controls and avoidance techniques
ii. Prevention of allergy
iii. Specific environmental controls
1. Pollen controls
2. Mold controls
3. Dust mite control
4. Epidermal avoidance
5. Other allergens and their controls
6. Role of use of air filters and air conditioning
2. Pharmacotherapy
i. First and second generation antihistamines
1. Uses of classic antihistamines
2. Benefits of second generation antihistamines
3. Combination decongestant and antihistamine therapy
ii. Decongestant therapy
iii. Mast cell stabilizers
iv. Corticosteroids
1. Topical
a. Different topical medications
b. Adverse reactions to topical intranasal steroids
2. Systemic
iv. Anti-leukotrienes
v. Mucolytic agents
vi. Monoclonal antibody therapy
3. Allergen immunotherapy
i. Indications for immunotherapy
ii. Contraindications to immunotherapy
iii. Interpretation of Allergy tests
iv. Mixing immunotherapy vials
v. Immunotherapy escalation schedules
vi. Maintenance immunotherapy
1. Symptom-relieving dose of treatment
2. Maximally tolerated dose treatment
3. Optimal-dose treatment
vii. Immunotherapy safety
D. Clinical Skills
1. At the completion of this unit the resident will:
a. Understand and be able to recommend environmental controls and avoidance
techniques.
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b. Understand and be able to treat with pharmacotherapy.
c. Understand treatment of allergic disorders with immunotherapy.
Laryngology, Voice and Swallowing Curriculum
I. Fundamental Knowledge
1. General Larynx Anatomy
A. Unit objective
a. At the completion of this unit, the resident understands the basic
anatomy of the larynx, including surface and internal anatomy
B. Learner objectives
a. Upon completion of this unit the resident:
i. Understands the anatomy of the larynx, including relationships between
framework, muscles, and nerves
ii. Knows the surgical anatomy of the larynx
C. Contents
a. Cartilage
i. Thyroid
ii. Cricoid
iii. Arytenoid, with emphasis on cricoarytenoid motion
iv. Cuneiform and corniculate
b. Muscles, including actions
c. Vascular supply and lymphatic drainage
d. Nerves
i. Sensory
ii. Motor
e. Mucosa, including layered histology
i. Epithelium
ii. Basement membrane
iii. Superficial, middle and deep layers of lamina propria
1. Vocal ligament
f. Membranes
i. Thyrohyoid
ii. Cricothyroid
iii. Conus elasticus
iv. Quadrangular membrane
D. Clinical skills
a. Upon the completion of this unit the resident will
i. understand the anatomy of the larynx.
2. General Larynx Embryology
A. Unit objective
a. At the completion of this unit, the resident understands the basic
concepts and importance of embryology of the larynx.
B. Learner objectives
a. Upon completion of this unit the resident:
i. Understands the embryology of the larynx, including
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interrelationships
ii. Understands the surgical implications of embryology
C. Contents
a. Embryologic fusion planes
b. Branchial arches, pouches, etc.
D. Clinical Skills
1. At the completion of this unit the resident will:
a. Understand embryology and its relationship to anatomy of the larynx.
3. Laryngeal and Pharyngeal Physiology
A. Unit objective
a. At the completion of this unit, the resident understands the physiology
of respiration, phonation and swallowing.
B. Learner objectives
a. Upon completion of this unit, the resident understands the functions of
the larynx and pharynx.
C. Contents
a. Respiration
b. Phonation
i. Cover-body theory of phonation, including meaning and
significance of “mucosal wave”
ii. Mechanism of pitch control
iii. Anatomic and physiologic correlates of voice quality
c. Swallowing
d. Airway protection
D. Clinical skills
a. Upon the completion of this unit the resident:
i. Understands the physiology of different functions of the larynx
ii. Understands the impact of laryngeal dysfunction on different
aspects of normal physiology
4. Physical Examination in Laryngology
A. Unit objective
a. At the completion of this unit, the resident understands how to perform a
physical examination of the larynx
B. Learner objectives
a. Upon completion of this unit the resident
i. Understands the evaluation of the anatomy of the head and neck
ii. Understands the techniques for physical examination
C. Contents
a. Inspection
b. Palpation
c. Indirect (mirror) examination
d. Fiberoptic examination
i. Flexible
ii. Hopkins rod
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e. Stroboscopy
f. Direct (operative) laryngoscopy
g. Other evaluations
i. Voice analysis (jitter, shimmer, etc.)
ii. EMG
iii. Perceptual analysis
D. Clinical skills
a. Upon the completion of this unit the resident can:
i. Perform a comprehensive physical examination and evaluation of the larynx and
laryngeal function.
ii. Perform appropriate evaluation of the larynx.
II. Diseases, Disorders, and Conditions in Laryngology
A. Unit objective
a. At the completion of this unit, the resident will be able to recognize, assess,
diagnose and manage diseases and disorders within laryngology
B. Learner objectives
a. Recognize the signs, symptoms, and physical findings of diseases and
disorders in laryngology
i. Use appropriate diagnostic tests
ii. Perform physical examination
b. Understand medical and surgical management of diseases and disorders
with general otolaryngology
C. Contents
a. Infectious
i. Laryngitis
1. bacterial
2. viral
3. fungal
ii. Pharyngitis
1. bacterial
2. viral
3. fungal
b. Inflammatory/traumatic
i. Laryngitis
ii. Laryngopharyngeal reflux
iii. Hemorrhage
iv. Polyp
v. Cyst
vi. Nodule
vii. Granuloma
viii. Reinke’s edema
ix. Scar
c. Neoplasm
i. Benign
1. papilloma
2. other
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ii. Malignant
1. squamous cell carcinoma
2. other
d. Structural
i. Sulcus vocalis
ii. Voice changes of aging
iii. Saccular cyst
iv. Laryngocele
1. internal
2. external
3. mixed
e. Neurologic
i. Vocal fold paralysis or paresis
1. unilateral
2. bilateral
ii. Sensory deficit
iii. Spasmodic dysphonia
f. Syndromes and diseases with laryngeal involvement
i. Sarcoid
ii. Amyloid
iii. Wegener’s
iv. Tuberculosis
v. Other granulomatous disease
D. Clinical skills
a. Upon the completion of this unit the resident can:
i. Develop a thorough differential diagnosis, and arrive at a definitive
diagnosis of the above diseases and disorders of the larynx.
ii. Discuss the different etiologies, manifestations, and patterns of
laryngeal diseases and disorders.
III. Therapeutic and surgical concepts
A. Unit objective
a. At the completion of this unit, the resident will understand the
treatment strategies and procedures for the medical, surgical and behavioral
management of diseases of the larynx and pharynx
B. Learner objectives
a. The resident will be exposed to the medical, surgical and behavioral
strategies necessary to treat diseases and disorders of the larynx and
pharynx
b. The resident will be able to perform surgical strategies to treat diseases and
disorders of the larynx and pharynx
C. Contents
a. Behavioral management
i. Voice rest
ii. Voice therapy
b. Medical management
i. Steroids
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ii. Reflux medication
iii. Botulinum toxin
iv. Other
c. Surgical management
i. External surgical approaches
1. Laryngofissure
2. Laryngeal framework surgery
a. Thyroplasty types 1 to 4
b. Arytenoid repositioning surgery
3. ORIF of larynx
ii. Internal/endoscopic approaches
1. Fiberoptic flexible laryngoscopy
a. Therapeutic
i. injection
ii. foreign body removal
iii. other
2. Direct laryngoscopy
a. Suspension surgical laryngoscopy
b. Micro-suspension surgical laryngoscopy
3. Vocal fold surgery
a. Injection
b. Injection augmentation
c. Botox
d. Incisional biopsy
e. Excisional biopsy
f. Stripping
g. Marsupialization
h. Mucosal microflap
4. Laser surgery
a. CO2
b. Angiolytic lasers
5. Microdebrider surgery
D. Clinical Skills
a. At the completion of this unit the resident will:
i. Understand and be able to perform endoscopic and open surgical
procedures on the larynx.
ii. Be able to select the most appropriate surgical procedure in order to
treat diseases and disorders of the larynx.
Adult Sleep Medicine Curriculum
I. Fundamental knowledge
1. Sleep Physiology
A. Unit objective
i. At the completion of this unit, the resident understands the physiology of
sleep, including sleep stages, and sleep disorders
B. Learner objectives
i. Upon completion of this unit, the resident:
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1. understands sleep physiology
2. understands sleep disorders
3. understands sleep evaluation techniques
C. Contents
i. Sleep stages
ii. Sleep latency
iii. Neural centers
iv. Neural connections
v. Electroencephalogram changes
vi. Circadian features related to sleep
vii. Sleep disorders
1. Sleep stage dysfunction
2. Sleep timing disorders: delayed sleep phase, advanced sleep phase, shift
work/jet lag
3. Inadequate sleep/sleep deprivation
4. Restless limb syndrome/periodic limb movement disorder/bruxism
5. Insomnia
6. Narcolepsy
7. Sleep disordered breathing
a. Central sleep apnea
b. Obstructive sleep apnea/snoring/upper airway resistance
syndrome
i. Sites of obstruction
ii. Severity staging
iii. Associated comorbidity
1. Medical: hypertension, etc.
2. Sequelae: sleepiness, performance
D. Clinical skills
i. Understand normal and abnormal sleep physiology
ii. Understand anatomic mechanisms of obstructive apnea
iii. Understand the evaluation of normal and abnormal sleep
iv. Understand medical and functional consequences of sleep apnea
2. Physical examination in sleep disordered breathing
A. Unit objective
a. At the completion of this unit, the resident understands the examination of
the patient with a sleep disorder
B. Learner objectives
a. Upon completion of this unit, the resident can perform an appropriate
physical examination of a patient with sleep disorder
C. Contents
a. Nasal anatomy
b. Soft palate
c. Oropharynx and retrolingual airway
d. Tonsil and adenoid tissue
e. Tongue
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i. Oral
ii. Tongue base
f. Craniofacial (mandible, maxilla)
g. Neck soft tissue
h. Hyoid position
i. Laryngeal anatomy
j. Body habitus
k. Body mass index
D. Clinical skill
a. Be able to perform a comprehensive physical examination of the patient
with a sleep disorder.
3. Diagnostic evaluation in sleep disorders, including apnea
A. Unit objective
a. At the completion of this unit, the resident understands the diagnostic
evaluation of the patient with a sleep disorder
B. Learner objectives
a. Upon completion of this unit, the resident can perform an appropriate
diagnostic evaluation of a patient with a sleep disorder
C. Content
a. Sleep study (polysomnography, ambulatory cardiorespiratory studies,
actigraphy)
i. Data measured (apnea index, etc.)
1. Normal ranges
ii. Sleep architecture
iii. Ventilation/respiration parameters
iv. Oxygenation parameters
v. Position, sleep stage
b. History: symptoms, comorbidities
c. Physical examination
d. Fiberoptic examination
i. Sedated
ii. Awake
e. Occlusion
f. Cephalometric evaluation
g. Multiplanar radiologic evaluation
i. CT
ii. MRI
D. Clinical skills
a. Understand indications for further evaluation of sleep dysfunction.
b. Be able to interpret an overnight polysomnogram
c. Be able to use diagnostic tools for anatomic evaluation
II. Diseases and Disorders
A. Unit Objective
a. At the completion of this unit, the resident understands sleep diseases
and disorders
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B. Learner Objective
a. Upon completion of this unit:
i. the resident knows the differential diagnosis of sleep disorders.
ii. the resident can diagnose sleep disorders including sleep disordered
breathing.
C. Content
1. Sleep stage dysfunction
2. Sleep timing disorders: delayed sleep phase, advanced sleep
phase, shift work/jet lag
3. Inadequate sleep/sleep deprivation
4. Restless limb syndrome/periodic limb movement disorder/bruxism
5. Insomnia
6. Narcolepsy
7. Sleep disordered breathing
a. Central sleep apnea
b. Obstructive sleep apnea/snoring/upper airway resistance
syndrome
i. Sites of obstruction
ii. Severity staging
iii. Associated comorbidity
1. Medical: hypertension, etc.
2. Sequelae: sleepiness, performance
D. Clinical Skills
1. At the completion of this unit the resident will:
a. Understand the differential diagnosis of sleep disorders.
III. Surgical concepts
B. Unit objective
a. At the completion of this unit, the resident understands the surgical
treatment of some sleep disorders
C. Learner objective
a. Upon completion of this unit the resident:
i. Can perform surgical correction of anatomic deformities causing
sleep apnea
ii. Understands the roles of surgery, realistic goals of surgery, and
staging of surgical procedures
iii. Understands indications for surgical intervention and expected
outcomes
iv. Understands risks and complications of surgery
D. Content
a. Roles of surgery
i. Adjunctive (i.e. facilitate CPAP)
ii. Salvage treatment for failure of nonsurgical treatment
iii. Primary treatment
b. Surgery staging
i. Primary level of obstruction
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ii. Multi-level strategies
iii. Global airway strategies
c. Nasal surgery
i. Septum
ii. Turbinate
1. partial resection
2. tissue reduction (radiofrequency, cold ablation, etc.)
iii. Nasal valve
d. Tonsillectomy
e. Adenoidectomy
f. Palate surgery
i. Uvulopalatopharyngoplasty
1. multiple modifications
ii. Tissue reduction (radiofrequency, etc.)
iii. Stiffening procedures
g. Tongue surgery
i. Volume reduction
ii. Tongue suspension
1. suture
2. genioglossus advancement
h. Mandible with or without tongue and maxilla
i. Genioglossus advancement
ii. Sagittal split osteotomy with advancement
1. maxillo-mandibular advancement
i. Neck
i. Lipectomy
ii. Hyoid suspension
j. Tracheotomy
k. Role of bariatric surgery
l. Outcomes of surgical interventions
i. Facilitation of nonsurgical therapies
ii. Polysomnography outcomes
iii. Clinical outcomes: symptoms, quality of life, function, medical risk,
mortality risk
iv. Risks and complications of procedures
E. Clinical skills
a. Understand and be able to perform surgical procedures for obstructive
sleep apnea
b. Understand the staging and combination of multiple level surgeries
c. Understand success rates, and complication rates of different surgical
techniques.
IV. Non-surgical treatments
A. Unit objective
a. At the completion of this unit, the resident understands the non-surgical
treatment of some sleep disorders
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B. Learner objective
a. Upon completion of this unit the resident:
i. Understands non-surgical treatment
ii. Understands indications for surgical and non-surgical intervention
C. Content
a. Treatment of related disorders
i. Obesity: Weight loss
ii. Rhinitis: medication, allergy testing/treatment
iii. GERD: medication, lifestyle changes
b. Sleep positioning
c. Avoiding or changing medications
d. Sleep hygiene
e. Dental appliances, including tongue appliances
f. Positive airway pressure devices (CPAP, BiPAP, autoPAP)
g. Address related sleep disorders
D. Clinical skill
a. Understand the non-surgical treatment of sleep apnea, including success
rates, and compliance rates.
Pediatric Otolaryngology Curriculum
I. Fundamental knowledge
1. Embryology and anatomy
A. Unit objective
At the completion of this unit the resident will have comprehension of the
basic embryology of the head and neck and abnormalities of development
including genetic, environmental, and spontaneous mutations. He/she will
also understand relative differences between adult and pediatric anatomy.
B. Learner objective
Understands the significance of differences between adult and pediatric
anatomy as it relates to the temporal bone, nasal cavity and sinuses,
pharynx and esophagus, larynx and trachea, cranial nerves, boney and
soft tissues of the head and neck. Also including the salivary glands and
endocrine structures.
Understands the normal and abnormal embryologic derivations of these
structures.
Knows the various conditions and circumstances that lead to abnormal
embryologic development as well as normal variances in anatomy.
Knows the operative corrections/approaches for these disorders.
C. Contents
External ear/ auricle
Facial bones /cranium
Nose//paranasal sinuses
Larynx and trachea/pharynx and esophagus
Lips teeth tongue and pharynx
Salivary glands and endocrine structures
D. Clinical skills
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Perform an accurate physical examination using advanced techniques
and equipment, including fiberoptics, video, otomicroscopy etc. and utilize
and synthesize laboratory and imaging data for evaluation and planning.
Educate and train parents and other family members of the significance,
etiology, impact, origin of the abnormalities and the options for correction
including the timing, and staging of surgery.
2. Child development and parent/child interaction
A. Unit objective
At the completion of this unit the resident will have comprehension of the
normal and abnormal development of children’s language, gross and fine
motor skills, growth, psychology, etc. They will understand pharmacology
and fluid management and growth charts as they relate to children.
They will also comprehend normal and abnormal parenting skills and will
be able to advocate for children. They will be able to identify potential
child abuse. They will be able to achieve informed consent.
B. Learner objective
Understand the normal and abnormal physiology and psychologic
aspects of child development. Accurately assess good poor and harmful
parenting skills and advocate for children in need.
C. Contents
Normal growth and development
Pharmacology/dosing, special metabolic profiles of children versus adults.
Fluid management.
Parenting skills, cultural norms
Psychiatric stages of identity for children
Children’s rights ethics, informed consent
Team approaches to children’s care
D. Clinical skills
Interviewing parents and children for history
Application of appropriate developmental testing; motor, sensory,
psychologic
Appropriate prescribing of drugs, fluids etc., based on weight/height or
meter squared area
Achievement of informed consent, experimental study entry
Interdisciplinary team care delivery for complex conditions.
3. Ears: Otology, Hearing and hearing loss
A. Unit objective
Understands the etiology of sensorineural and conductive hearing loss as
well as the evaluation and management of those conditions.
Understands infectious and inflammatory diseases of the ear, their
significance, etiology and treatment.
Understands and assesses balance disorders in childhood.
Understands the causation and staging of microtia and aural
atresia.
B. Learner Objective
Understands congenital, acquired and genetic aspects of sensorineural
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and conductive hearing loss.
Interprets and recognizes appropriate audiologic testing for infants
and children including OAEs, ABRs, VRAs, play audiometry, etc,
Interprets and obtains appropriate imaging for the ear.
Comprehends basic microbiology and immunology as it relates to otitis,
understands pathways of disease spread, complications and treatment
Understands the basic physiology of hearing and balance including
mechanotransduction, psycho-acoustics and central
C. Contents
Hearing and balance physiology
Diagnostic testing
Audiology
Imaging
Genetics
Laboratory
Acute and chronic otitis media, Eustachian tube function, normal and
abnormal, otitis externa, cholesteatoma, aural dysplasia and atresia,
pediatric disorders of the facial nerve and the temporal bone.
Congenital and acquired hearing loss, genetic and non genetic.
D. Clinical skills
History taking and physical assessment of the ears, use of the otoscope,
otomicroscope
Balance evaluation
Interpretation of testing, including imaging and genetics.
Management of complications in children.
4. Nose and paranasal sinuses
A. Unit objective
Understands specific aspects of developmental nasal disorders.
Understands infectious and inflammatory disorders of the nose and
paranasal sinuses.
Understands the basics of olfaction.
B. Learner objectives
Understands allergy and its expression in the pediatric nasal cavity.
Understands microbiology and immunology of pediatric rhinologic
infection including pathways of spread and complications.
Understands anatomy and physiology of the nose and differences
between children and adults.
Correctly interprets testing data, imaging, cultures and smears.
Understands basics of olfaction, airflow dynamics, turbinate function.
C. Contents
Nose septum external skeleton
Lateral superior and inferior nasal cavity
Paranasal sinuses and relationships to optic, intracranial, and
pterygomaxillary spaces, nasopharynx, especially differences between
pediatric and adult.
Vascular supply, neurogenic control, anatomy and physiology
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Imaging: CT, MRI
Microanatomy of respiratory epithelium, olfactory neurons
Microbiology of infection, pathways of spread of complications,
treatment.
D. Clinical skills
History taking and physical examination of the pediatric patient including
fiberoptic visualization of the nasal cavity.
Imaging interpretation in pediatric patients
Surgical correction of septal deformity, treatment of infectious
complications, congenital abnormalities, epistaxis
5. Pharynx and Esophagus
A. Unit objective
Understands dynamic anatomy and contributions to speech, airway
maintenance, and swallowing and feeding
Understands infectious and inflammatory disorders, and complications in
pediatrics, including gastroesophageal reflux
Understands the effects of sleep disordered breathing in children.
Knowledge of congenital and acquired disorders of the esophagus.
B. Learner objective
Knows the elements of proper speech production and speech pathology
Knows how to evaluate and treat various sleep disorders in pediatrics.
Understands microbiology, infections and complications related to tonsils
adenoids and dentition in children
Understands surgical indications and techniques.
C. Content
Oropharynx/pharynx and esophagus anatomy, development and function.
Tonsils and adenoids
Microbiology of the oral cavity
Tongue, palate and other structures contributing to speech swallowing
and airway maintenance
Atresia, caustic ingestion, stenosis, reflux, trauma, foreign body
Neurovascular supply and its development
Imaging and other diagnostic testing (CT, MRI, polysomnography)
D. Clinical skills
History taking and physical examination of the pediatric patient including
fiberoptic and video exams of swallowing and speech.
Interpretation of imaging, PSN, VPI evaluation, video swallow.
Surgical and non surgical management of sleep disordered breathing,
speech disorders, infections and inflammatory disorders. Complications
related to tonsil, adenoid and oral infections.
6. Larynx, Trachea and Bronchi
A. Unit objective
Understands the functional aspects of the larynx and trachea as it relates
to air exchange, speech production and airway protection and
maintenance in the pediatric patient.
Understands the traumatic, infectious and inflammatory disorders that can
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affect the larynx and trachea and their effects on the pediatric airway.
Knows congenital abnormalities that can result in stridor in the infant and
their natural history
B. Learner objectives
Knows the embryologic derivation of laryngeal functional development,
neurovascular anatomy, and central control pathways.
Uses multiple strategies for management of airway distress.
C. Content
Embryologic development of larynx and trachea.
Physics of air passage through the larynx and trachea.
Normal voice production
Neurovascular physiology of the larynx
Laryngeal closure and protection, (Laryngospasm)
Vocal fold mobility impairment
Origins of infectious and inflammatory disorders of the pediatric larynx
and trachea.
Papilloma, laryngotracheobronchitis, epiglottitis, bacterial tracheitis
Aspiration protection strategies
Imaging and other evaluation techniques including EMG, video
endoscopy, FEESST
D. Clinical skills
History taking and physical examinations including fiberoptic flexible
examinations. Ordering and obtaining appropriate additional information.
Interpretation of testing, exams and prior assessments.
II. Diseases Disorders and Conditions
A. Unit objective
At the conclusion of this unit the resident will be able to recognize,
assess, diagnose, and manage diseases and disorders of the pediatric
patients ear, nose, sinus, pharynx, esophagus, larynx, trachea, face,
salivary glands, endocrine glands. They will also note deviations from
normal psychologic and physiologic development and be able to help
correct these problems.
B. Learner objective
Recognize signs and symptoms of pediatric otolaryngologic disorders
Use appropriate tests and evaluation methods for pediatric otolaryngologic
disorders.
Develop a diagnosis for pediatric otolaryngologic disorders
Understand the surgical and non surgical management of
pediatric otolaryngologic disorders.
D. Content
External ear
Congenital malformations
Trauma (Hematomas, foreign bodies)
Infections/inflammatory disorders
Middle ear and mastoid
Congenital malformations
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Trauma
Infection
Acute Suppurative and non suppurative
Chronic Suppurative and non suppurative
Cholesteatoma Congenital and Acquired
Mastoiditis
Coalescent-acute
Chronic
Complications
Tympanic membrane perforations
Ossicular erosion, discontinuity
Abscesses
Meningitis
Neoplasm
Inner ear
Neurosensory loss
Genetic
Acquired
Congenital (Mondini, vestibular aqueduct, etc.)
Vertigo
Migraine
Inflammatory
Nose/paranasal sinus
Congenital disorders
Dermoid cyst
Glioma
Encephalocele
Choanal atresia/stenosis
Hemangioma
Pyriform aperture stenosis
Cystic fibrosis
Nasolacrimal duct cyst
Infections
Acute
Chronic
Bacterial
Fungal
Allergy and inflammation
Complications
Abscess
Orbital
Epidural
Intracranial
Neoplasms
Benign
Antro-choanal polyp
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Angiofibroma, etc.
Malignant
Esthesioneuroblastoma
Hemangioendothelioma, etc
Pharynx/esophagus
Congenital
Atresia, stenosis
Beckwith syndrome
Cleft palate
Infection/inflammation/allergy
Tonsillitis
Acute and chronic
Adenoiditis
Reflux esophagitis
Eosinophilic esophagitis
Angioedema
Stomatitis
Glossitis
Complications
Peritonsillar abscess
Retropharyngeal abscess
Parapharyngeal abscess
Neoplasms
Benign
Lymphangioma
Dermoid, etc.
Malignant
Hypertrophy/obstruction tonsils and/or adenoids
Sleep disorders
Facial growth
Speech disorders
Hyponasality
Hypernasality (VPI)
Delayed speech acquisition
Larynx/Trachea
Congenital
Subglottic stenosis
Saccular cyst, laryngocele
Laryngeal cleft
Laryngomalacia
Hemangioma
Tracheal stenosis
Extrinsic compression of the trachea
Innominate, Subclavian, Aortic, Pulmonary artery, Cardiac
Bronchial stenosis, malacia
Tracheomalacia
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Infections/Inflammation
Croup
Epiglottitis
Bacterial tracheitis
Trauma
Laryngeal fracture
Laryngeal hematoma
Laryngotracheal separation
Foreign body
Larynx
Trachea
Neurologic
Vocal cord paralysis
Unilateral
Bilateral
Neoplasms
Benign
Papillomas
Granular cell myoblastoma, etc.
Malignant
Dysmorphology
Craniosynostoses
Crouzons
Sathre Chotzen
Aperts
Pfeiffers
Mandibulofacial dysostosis
Robin sequence
Stickler’s syndrome
Velo cardio facial (VCF) syndrome
Cleft lip
Craniofacial microsomia
CHARGE association
Head and Neck
Embryologic
Thyroglossal cyst/ lingual thyroid
Thymic cysts
Branchial cysts, clefts fistulae
Lympho-venous malformation/cystic hygroma
Vascular lesions
Hemangioma
Arterio-venous malformations
Venous malformations
Tumors
Rhabdomyosarcoma
Lymphomas
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Langerhans cell histiocytoses, etc.
Infections
Abscess
Immune deficiency
Adenopathy
Viral (Kawasaki)
D. Clinical skills
Upon completion of this unit the resident will complete a
comprehensive history physical exam and order appropriate laboratory
and diagnostic studies to develop a differential diagnosis and arrive at a
definitive diagnosis of the above noted pediatric otolaryngologic
disorders.
The resident will be able to discuss surgical and non-surgical
management of pediatric otolaryngologic disorders
The resident will be able to discuss the strategies and procedures
necessary to treat pediatric otolaryngologic disorders.
III. Surgical concepts
A. Unit objectives
At the end of this unit the resident will understand treatment
strategies and procedures for surgical management of pediatric
otolaryngologic disorders.
B. Learner objectives
The resident will be exposed to surgical strategies needed to treat
pediatric otolaryngologic disorders. The resident will be able to perform
surgical procedures used to treat pediatric otolaryngologic disorders.
C. Content
Specific surgical procedures
Otologic
Tympanocentesis
Tympanostomy
Tympanoplasty
Mastoidectomy
Cochlear implantation
BAHA and implantable hearing aids
Nose and Sinus
Polypectomy
Endoscopic procedures of the lateral sinus wall
Drainage of peri-orbital abscess
Pharynx
Tonsillectomy
Partial vs. total
Cold instruments
Powered instruments, etc.
Adenoidectomy
Incision and drainage of abscess
Pharyngoplasty
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Esophagoscopy
Larynx/trachea
Endoscopic
Diagnostic
Therapeutic (i.e., foreign body removal)
Stent placement
Tracheostomy
Infant
Pediatric
Suspension microlaryngoscopy
Epiglottiplasty
Removal of papilloma
Laser
Shaver
Open surgical procedures
Cartilage graft
Excision, reanastomosis
Intubation and airway management
Head and Neck
Removal of branchial cysts and fistulae
Thyroglossal cyst excision (Sistrunk)
Lymph node biopsy
Sclerotherapy, intralesional injection
Neck abscess, incision and drainage
IV. Habilitation/Rehabilitation
Hearing assistive devices
Non implantable hearing aids
Implantable
Cochlear implants
Bone anchored hearing aids
Speech rehabilitation
Surgical
Prosthetic
Other therapy
Swallowing rehabilitation
Otology/Audiology Curriculum
I. Fundamental Knowledge
1. Temporal Bone and Skull Base Anatomy
A. Unit Objective
1. At the completion of this unit the resident understands the anatomy of
the temporal bone, cranial nerves, vascular and neural structures of the
lateral skull base, the peripheral and central anatomy of the cochlea and
vestibular systems.
B. Learner Objectives
1. Upon completion of this unit the resident:
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i) understands the bony and soft tissue anatomy of the
temporal bone and its relationship to related
vascular, neural, muscular, and bony structures of
the lateral skull base.
ii) knows the surgical anatomy, neural, vascular, and
skeletal components of the temporal bone and
lateral skull base.
iii) knows the operative approaches to the temporal bone and
lateral skull base.
iv) knows the microscopic anatomy of the auditory and
vestibular systems.
C. Contents
1. Auricle
2. External Ear
3. Tympanic Membrane
4. Ossicles
5. Tympanum
6. Eustachian Tube
7. Attic
8. Mastoid
9. Petrous Apex
10. Jugular Foramen
11. Cochlear and Central auditory pathways
i) osseous labyrinth, membranous labyrinth
ii) Reissner’s membrane, spiral ligament, stria vascularis, basilar
membrane, Boettcher’s cells, Claudius’ cells, tectorial
membrane, osseous spiral lamina
iii) Organ of Corti (Hansen’s cells, Dieters’ cells, pillar cells,
stereocilia, outer hair cells, inner hair cells)
iv) Neural anatomy of cochlea, and central auditory
pathways
12. Vestibular End Organs and neural pathways
i) vestibule, semicircular canals, saccule, utricle
ii) crista ampullaris, macula sacculi, macula utriculi,
kinocilium, stereocilia, type I hair cells, type II hair
cells
iii) vascular supply
iv) peripheral and central neural anatomy (VOR,
vestibulospinal tract, vestibulocerebellar tract)
13. Cranial Nerves
i) III, IV, V, VI, VII, VIII, IX, X, XI, XII
14. Associated Vascular, Neural, and Muscular Structures of the Lateral
Skull Base
15. Diagnostic imaging: CT scanning, MRI imaging, plain film
x-rays
D. Clinical Skills
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1. During the training period the resident:
i) Recognizes the normal and abnormal anatomy of the
temporal bone, lateral skull base, and auditory and
vestibular systems.
ii) Interprets tests to diagnose anatomical abnormalities of the
temporal bone, lateral skull base, and auditory and vestibular
systems.
iii) Performs surgical procedures that utilizes anatomical
knowledge of the temporal bone, lateral skull base,
auditory and vestibular systems.
2. Embryology of the Ear
A. Unit Objective
1. At the completion of this unit the resident understands the
embryology of the temporal bone, inner ear, and lateral skull
base.
B. Learner Objectives
1. Knows the normal embryological development and common
embryological development disorders that affect the temporal
bone, auditory and vestibular systems
2. Understands how embryological development disorders impact
treatment of these disorders
C. Contents
1. Development of the external ear
i) auricular hillocks of His- 5th week gestation
a) 1-3: 1st pharyngeal arch
b) 3-6: 2nd pharyngeal arch
ii) Microtia
2. Complete membranous labyrinthine dysplasia (SiebenmannBing)
3. Cochleosaccular dysplasia (Scheibe)
4. Complete labyrinthine dysplasia (Michel)
5. Incomplete partition (Mondini)
6. Common cavity
7. Semicircular canal dysplasia
8. Enlargement of the vestibular and/or cochlear aqueducts
9. Narrow internal auditory canal
D. Clinical Skills
1. During the training period the resident:
i) Recognizes the normal and abnormal embryological
development of the ear and how it influences management of disorders
such atresia of the ear canal, and inner ear deformities related
to hearing loss.
ii) Interprets imaging studies and other diagnostic tests
that demonstrate disorders of embryological development of the ear and
temporal bone.
iii) Performs surgical procedures that utilizes the embryological
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knowledge of the temporal bone, ear, and lateral skull base.
3. Physiology of the Eustachian Tube/Middle Ear/Mastoid
A. Unit Objective
1. At the completion of this unit the resident understands the normal
ventilation system of the eustachian tube, middle ear and mastoid.
2. The resident also understands the pathophysiology of
abnormal conditions of the same structures.
B. Learner Objectives:
1. Understands how ventilation occurs in the middle ear and
mastoid via the eustachian tube.
2. Understands the consequences of poor ventilatory function.
C. Contents:
1. Anatomy and physiology of the eustachian tube/middle ear and
mastoid.
2. Acute otitis media.
3..Chronic otitis media with effusion
4. Idiopathic hemotympanum
5. Chronic serous mastoiditis.
6. Cholesteatoma pathophysiology
D. Clinical Skills:
1. Uses knowledge of physiology of eustachian tube ventilation to
explain the causes of the above pathologic conditions.
2. Understands the rationale for the medical and surgical approaches
for the treatment of the above pathophysiological conditions.
4. Physiology of the Auditory System
A. Unit Objective
1. At the completion of this unit the resident understands the
normal physiology of the auditory system
B. Learner Objectives
1. Understands how sound is amplified by the middle ear,
transduction in the cochlea, and routes of transmission in
the brainstem to the brain
2. Understands how pitch and intensity of sound is coded in the
cochlea
C. Contents
1. Definitions of Sound
2. Middle Ear Mechanics
3. Cochlear Mechanics
4. Hair Cell Transduction
5. Auditory Nerve Action Potentials
6. Efferent Auditory System
7. Pitch Perception (temporal and place)
8. Intensity
D. Clinical Skills
1. Uses knowledge of middle ear mechanics to interpret causes of
conductive hearing loss
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2. Uses knowledge of cochlear mechanics and physiology of
auditory system to understand sensorineural hearing loss
5. Audiology
A. Unit Objective
1. At the completion of this unit the resident has the knowledge
the testing procedures used to evaluate hearing
B. Learner Objectives
1. Understands common audiologic testing procedures
2. Understands use of masking, methods of performing
audiogram and speech testing
3. Knows the indications for performing auditory diagnostic tests
C. Contents
1. Audiogram
2. Pure-tone Air Conduction
3. Pure-tone Bone Conduction
4. Speech Testing
5. Masking
6. Acoustic Impedance
7. Otoacoustic Emissions
8. Electrocochleography
9. Auditory Brainstem Response
10. Steady State Evoked Potentials (ASSR)
11. Play Audiometry
12. Visual Response Audiometry
13. Intraoperative Monitoring
D. Clinical Skills
1. Can perform routine audiometric testing such as air conduction
and bone conduction audiogram, speech testing, acoustic
impedance, otoacoustic emissions, auditory brainstem
response and intraoperative auditory monitoring
2. Can interpret standard audiogram, ABR, acoustic impedance,
and OAE, testing to diagnose hearing loss
6..Physiology of the Vestibular System
A. Unit Objective
At the completion of this unit, the resident understands the physiology of
the vestibular system sufficiently to make wise diagnoses, properly
interpret vestibular testing in its clinical context, and plan appropriate
medical, rehabilitative, or surgical treatment.
B. Learner Objectives
1. Understands the peripheral and central vestibular system and its
neural projections.
2. Understands sensory integration essential to human equilibrium, and
its implications for vestibular diagnosis and treatment.
3. Understands vestibular compensation and its treatment implications.
C. Contents
1. Semicircular canals
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2. Otolithic organs (Saccule, Utricle)
3. VestibuloOcular Reflex (VOR)
4. Vestibulo-Spinal Reflex and output responses
5. Nystagmus and Ewald’s laws
6. The rationale for vestibular rehabilitation therapy
7. The rationale for vestibular ablation procedures
D. Clinical Skills
1. Able to take an organized medical history from a dizzy patient
2. Able to determine appropriate testing and treatment
3. Able to distinguish the surgical candidate from the non-surgical patient
7. Vestibular Testing
A. Unit Objective
At the completion of this unit, the resident understands the clinical
measures that may be used to assess the balance disorder patient,
including simple bedside testing and the testing modalities employed in a
sophisticated modern vestibular testing facility.
B. Learner Objectives
1. Understand the physical exam findings that indicate a unilateral
peripheral vestibular lesion or a bilateral peripheral vestibulopathy.
2. Understand the vestibular testing environment and basic principles for
interpretation of test results, including potential pitfalls and false positive
results.
C. Contents
1. Electro- or videonystagmography
a. Oculomotor testing: saccade latency, accuracy, velocity;
smooth pursuit and optokinetic testing
b. Spontaneous and positional nystagmus
c. Caloric irrigations
2. Rotary Chair
3. VEMP
4. Posturography
5. Bedside testing in vestibular disorders (See Physical Exam below)
D. Clinical Skills
1. Perform a suitable bedside exam for the balance disorder patient.
2. Be able to identify physiological and pathological nystagmus that is
present in a computerized eye movement tracing, and interpret its
significance.
3. Recognize central abnormalities in oculomotor test results.
4. Perform calculations of unilateral weakness and directional
preponderance from caloric results.
5. Properly interpret rotary chair and posturography response results
6. Articulate a summary evaluation of vestibular abnormalities and how
they relate to clinical diagnosis and treatment.
8. Facial Nerve Testing
A. Unit Objectives:
At the completion of this unit the resident understands the
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pathophysiology of nerve injury and the utility of facial nerve testing.
B. Learner Objectives:
a. Understands the Sunderland classification of neural injury.
b. Understands the use of nerve excitability testing, maximal stimulation
testing, electroneuronography and electromyography.
C. Contents:
a. Pathophysiology of neural injury.
b. Clinical examples of neural injuries (Bells Palsy, facial nerve
trauma).
a. Nerve excitability testing
b. Maximal stimulation testing.
c. Electroneuronography
d. Electromyography
D. Clinical Skills:
e. Can order and interpret appropriate facial nerve testing for a
given clinical lesions.
9. Surgical Monitoring (Cranial Nerve, Auditory)
A. Unit Objective:
a. At the completion of this unit the resident understands the indication,
technique and pitfalls of intraoperative cranial nerve monitoring.
B. Learner Objective:
a. Understands the technique for facial nerve and intraoperative ABR
testing.
b. Understands the technique for lower cranial nerve monitoring (IX, X,
XI, XII).
c. Knows the clinical indications for intraoperative monitoring.
C. Contents:
a. Physiologic basis of ABR and electromyography.
b. Intraoperative monitoring technique.
D. Clinical Skills:
a. Can interpret the result of intraoperative monitoring.
b. Can troubleshoot common sources of inaccurate cranial nerve
monitoring.
10. Physical Examination
A. Unit Objective
1. At the completion of this unit the resident will be able to perform
a complete examination of the auditory and vestibular
systems, and cranial nerves
B. Learner Objectives
1. Recognize normal and abnormal anatomy of the ear, signs of
auditory and vestibular disease and disorders, and signs of
lateral skull base disease and disorders
C. Contents
1. Otoscopy
2. Pneumatic Otoscopy and fistula test
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3. Microscopic Exam and debridement of the ear
4. Tuning Fork Testing
5. Cranial Nerve Exam
6. Exam for nystagmus, including use of Frenzel glasses
7. Halmagyi head thrust testi
8. Fukuda stepping test
9. Cerebellar Testing (Romberg, finger to nose, tandem gait)
10. Hallpike testing and particle repositioning maneuver for BPPV
11. Sensorimotor neurological testing as indicated
12. Oscillopsia test
D. Clinical Skills
1. Perform an appropriate otoscopic exam with the binocular microscope
and make a correct otoscopic diagnosis.
2. Be able to clean and debride the ear canal or mastoid cavity safely
and effectively.
3. Interpret tuning fork tests and correlate with the audiometric results.
4. Identify unilateral and bilateral vestibular lesions and be able to
indicate the level of compensation on clinical grounds.
5. Identify non-vestibular contributions to balance dysfunction by use of
the physical exam.
11. Otology: Imaging Studies
A. Unit objective
a. At the completion of this unit, the resident will be able to select the proper
imaging study and interpret the results of that study for a given disease
process.
B. Learner objectives
b. Recognize normal and abnormal anatomy, of the temporal bone, skull base,
and cerebellopontine angle for the following:
-Congenital abnormalities,
- Acquired pathology, intratemporal
-Retrocochlear/CPA lesions,
-Vascular abnormalities,
-Skull base osteomyelitis.
C. Contents:
a. Computerized tomography
c. Magnetic resonance imaging
d. Magnetic resonance angiogram / venogram
e. Angiography
f. Nuclear medicine studies
D. Clinical skills:
a. Can recognize normal anatomy on the above imaging studies.
b. Can recognize pathologic lesions on the above studies.
12. Anesthesia for otologic surgery
A. Unit objective
a. At the completion of this unit the resident will be able to provide local
anesthesia with sedation for otologic procedures and be aware of special
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considerations for general anesthesia during otologic surgery.
B. Learner objectives:
a. Be able to perform a local field block of the ear canal and postauricular area
for preparation of an otologic procedure.
b. Know the options for providing sedation during a local anesthesia
otologic procedure as well as managing the complications of
oversedation.
c. Be aware of special considerations for general anesthesia and
otologic surgery such as the avoidance of neuromuscular blockade
during cranial nerve monitoring, avoidance of nitrous oxide during middle
ear procedures, use of hyperventilation and mannitol for intracranial
procedures, and the use of hypotensive anesthesia for the control of
blood loss.
C. Contents:
a. Local field block of external auditory canal.
b. Local field block of postauricular area.
c. Intravenous sedation.
d. General anesthesia.
D. Clinical skills
a. Be able to perform otologic surgery under local anesthesia with
sedation.
b. Be able to interact with anesthesia staff in order to perform otologic
surgery under optimal general anesthesia conditions.
II. Diseases, Disorders, and Conditions
A. Unit Objective:
1. At the completion of this unit the resident will be able to recognize,
assess, diagnose and manage diseases and disorders of the external ear,
middle ear, inner ear and lateral skull base.
B. Learner Objective:
1. Recognize the signs and symptoms of diseases and disorders of the
external ear, middle ear, inner ear and lateral skull base.
2. Use the appropriate diagnostic tests to assess diseases and disorders
of the external ear, middle ear, inner ear and lateral skull base.
3. Be able to develop a diagnosis of diseases and disorders of the
external ear, middle ear, inner ear and lateral skull base.
4. Understand the non surgical and surgical management diseases and
disorders of the external ear, middle ear, inner ear and lateral skull base.
C. Content
A. External Ear
1. Congenital Malformations
2. Trauma/Foreign Bodies
3. Infections-Auricle/External Canal
4. Neoplasms-Carcinoma/Cholesteatoma/Other
B. Middle Ear/Eustachian Tube/Mastoid
1. Congenital Malformations
2. Trauma/Foreign Bodies
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3. Infections-Otitis Media-Acute
4. Infections-Otitis Media with Effusion
5. Infections-Otitis Media-Chronic
6. Infections-Otitis Media-Chronic/Cholesteatoma
7. Infections-Mastoiditis
8. Infections-Petrositis
9. Infections-Complications of Acute/Chronic Otitis
Media/Mastoiditis
10. Tympanic Membrane-Trauma/Perforation
11. Ossicular Disorders-Dyscontinuity
12. Ossicular Disorders-Otosclerosis
13. Neoplasms of Middle Ear (Glomus Tumor, Carcinoma, Other)
C. Inner Ear
1, Neurosensory Hearing Loss-Hereditary (Usher Syndrome, Waardenburg
Syndrome, etc)
2. Neurosensory Hearing Loss-Trauma/Noise/Ototoxic
3. Neurosensory Hearing Loss-Autoimmune
4. Neurosensory Hearing Loss-Cogan’s Syndrome
5. Neurosensory Hearing Loss-Age Related
6. Neurosensory Hearing Loss-Sudden Deafness
7. Neurosensory Hearing Loss-Neoplasms (Acoustic
Neuroma, Glomus Jugulare)
8. Tinnitus/Hyperacusis
9. Motion Sickness
10. Vestibular Neuritis
11. Labyrinthitis-Serous/Suppurative/Circumscribed
12. Benign Paroxysmal Positional Vertigo
13. Meniere’s Disease
14. Vertigo/Neurosyphilis
15. Vertigo/Migraine
16. Vertigo/Epilepsy
17. Superior Canal Dehiscence
18. Bilateral Vestibular Hypofunction
19. Cervical Vertigo
20. Labyrinthine fistula
21. Pseudohypacusis
D. Facial Nerve
1. Facial Paralysis-Idiopathic (Viral)
2. Facial Paralysis-Herpes Zoster
3. Facial Paralysis-Traumatic
4. Facial Paralysis-Iatrogenic
5. Facial Paralysis- Neuroma
6. Facial Paralysis- Hemangioma
7. Facial Paralysis- Neoplasm other
8. Facial Paralysis- Congenital
F. Lateral Skull Base
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1. Neuroma Cranial Nerves
2. Acoustic Neuroma
3. Neurofibromatosis II
4. Meningioma
5. Clivus Chordoma
D. Clinical Skills:
1. Upon the completion of this unit the resident can perform a comprehensive
history, focused physical examination, order appropriate laboratory and
diagnostic studies to develop a thorough differential diagnosis, and arrive at a
definitive diagnosis of the above diseases and disorders of the outer ear, middle
ear, inner ear and lateral skull base.
2. The resident can discuss the non surgical as well as surgical management of
the diseases and disorders of the external ear, middle ear, inner ear and lateral
skull base.
3. The resident will be able to discuss the procedures and strategies necessary
to treat the diseases and disorders of the external ear, middle ear, inner ear and
lateral skull base.
III. Surgical Concepts
A. Unit Objective
1. At the completion of this unit the resident will understand in the
treatment strategies and procedures for the surgical management of
diseases and disorders of the external ear, middle ear, inner ear, and
lateral skull base.
B. Learner Objectives
1. The resident will be exposed to the surgical strategies necessary to treat
diseases and disorders of the outer ear, middle ear, inner ear, and lateral skull
base.
2. The resident will be able perform surgical strategies to treat diseases and
disorders of the outer ear, middle ear, inner ear, and lateral skull base in the
temporal bone laboratory prior to performing the procedures in the patient.
C. Content
1. Preoperative and Postoperative Care
A. Unit Objective
a. At the completion of this unit the resident will be able to assess
a perspective surgical patient for fitness for undergoing
anesthesia as well as be able to manage common
postoperative otologic complications.
B. Learner Objectives:
b. Recognize preoperative abnormalities that may lead to
intraoperative or postoperative complications.
c. Recognize postoperative complications and know their
management.
C. Contents:
a. Abnormalities of hemostasis
b. Sensitivities to anesthetic agents
c. Systemic illnesses (cardiac, respiratory, metabolic)
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d. Need for special perioperative considerations (prophylactic
antibiotics, management of chronic anticoagulants)
e. Management of postoperative complications:
i. Hematoma
ii. CSF leak
iii. Vascular complication
iv. Facial nerve paralysis
v. Meningitis
vi. Intravascular volume depletion
D. Clinical Skills
a. Upon completion of this unit the resident can perform a
preoperative history and physical and order appropriate
laboratory studies to assess a patient’s fitness for anesthesia
during an otologic surgical procedure. The resident will also
recognize the need for consultation with other specialists when
indicated.
b. The resident will be able to recognize and manage
postoperative complications from otologic procedures.
2. Specific Surgical Procedures
Canalplasty
Middle ear exploration
Tympanoplasty
Meatoplasty
Stapedectomy
Mastoidectomy
Tympanomastoidectomy
Endolymphatic Sac Surgery
Perilymph fistula repair
Transtympanic drug therapy
Labyrinthectomy
Cochlear Implantation
Implantable hearing aids
Congenital Middle Ear Reconstruction
Facial Nerve Surgery
Temporal Bone Fracture
Laser Surgery in the ear
CSF leak of temporal bone
Grafts (Autografts, Homografts, Alloplasts)
Incisions, flaps
Prosthetics
D. Clinical Skills
1. At the completion of this unit the resident will have participated
and know how to perform in the surgical strategies and
procedures to manage diseases and disorders of the outer ear,
middle ear, inner ear, and lateral skull base.
2. The resident will be able to select the most appropriate surgical
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procedure in order to treat diseases and disorders of the outer
ear, middle ear, inner ear, and lateral skull base.
IV. Habilitation/Rehabilitation
A. Unit Objective:
a. At the conclusion of this unit the resident will understand the utility of various
prosthesis and therapies for the rehabilitation of hearing or balance deficits.
B. Learner Objectives:
a. The resident will know the available prosthetic options for the treatment of
hearing loss.
b. The resident will know the role of vestibular rehabilitation in the treatment of
chronic balance disorders.
C. Content:
a. Hearing aids
i. Behind the ear
ii. In the ear
iii. Completely in the canal
iv. Open mold
v. CROS hearing aid
b. Assistive listening devices
vi. FM link
vii. Devices for telephone
viii. Devices for television
ix. Devices for alarm clock and fire alarm
c. Vestibular rehabilitation rationale and implications
d. Implantable hearing devices
i. Cochlear implant
ii. Acoustic + Electric Implants
iii. Implantable hearing aid
iv. Bone anchor hearing aid
D. Clinical Skills
a. At the completion of this unit the resident will be able to recommend the
most appropriate hearing aid, implantable hearing device, or assistive
listening device for a hearing impaired individual.
b. The resident will have a general understanding of the fitting these
devices in clinical practice
Head and Neck Curriculum
I. Fundamental Knowledge
1. Anatomy of the Head and Neck
A. Unit Objective
1. At the completion of this unit, the resident understands the anatomy of
the upper aerodigestive tract including the nose, paranasal sinuses, ear
and temporal bone, salivary glands, thyroid, parathyroids, lip, oral
cavity, mandible, oropharynx, nasopharynx, hypopharynx, cervical
esophagus, larynx, tracheobronchial tree and neck contents as each
relates to neoplasms of the head and neck area.
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B. Learning Objectives
1. Upon completion of this unit the resident:
i) understands the anatomy of the upper aerodigestive tract.
ii) knows the surgical anatomy, neurovascular and skeletal
components of the upper aerodigestive tract.
iii) knows the operative approaches to neoplasms of the upper
aerodigestive tract.
C. Contents
1. Skin / surface anatomy
2. Nose / paranasal sinuses
3. Ear and temporal bone
4. Salivary glands
5. Thyroid
6. Parathyroids
7. Lip and oral cavity
8. Mandible
9. Oropharynx
10. Nasopharynx
11. Hypopharynx and cervical esophagus
12. Larynx
13. Neck
14. Cranial Nerves
i) I, II, III, IV, V, VI, VII, VIII, IX, X, XI, XII
15. Osteology of the skull base
16. Associated vascular, neural, muscular and lymphatic structures of the
head and neck
17. Diagnostic imaging: Ultrasound, PET, CT, MRI and plain film x-rays
D. Clinical Skills
1. During the training period, the resident:
i) Recognizes the normal and abnormal anatomy of the head and
neck region
ii) Interprets tests to diagnose anatomical abnormalities of the
head and neck region.
iii) Performs surgical procedures that utilize anatomical knowledge
of the head and neck region.
2. Embryology of the Head and Neck
A. Unit Objective
1. At the completion of this unit, the resident understands the embryology
of the head and neck region.
B. Learner Objectives
1. Knows the normal embryological development and common
embryological development disorders that affect the head and neck
region.
2. Understands how embryological development disorders impact
treatment of these disorders.
C. Contents (excluding cleft lip and palate – see pediatrics under general)
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1. Development of the branchial arch system
2. Development of the thyroid and parathyroids
D. Clinical Skills
1. During the training period the resident:
i) Recognizes the normal and abnormal embryological
development of neck contents and how it influences
management of disorders such as branchial cleft cysts,
thyroglossal duct cysts, thyroid, parathyroid disorders, and cystic
hygromas.
ii) Interprets imaging studies, fine needle aspiration biopsies and
other diagnostic tests that demonstrate disorders of
embryological development of the head and neck region.
iii) Performs surgical procedures that utilize the embryological
knowledge of the head and neck region.
3. Physiology of the Head and Neck
A. Unit Objective
1. At the completion of this unit, the resident understands the normal
physiology of the upper aerodigestive tract region as it relates to
neoplasms of the head and neck.
B. Learner Objective
1. Understands how the upper aerodigestive tract functions during
communication, mastication, respiration, swallowing and digestion.
C. Contents
1. Articulation
2. Phonation
3. Mastication / salivation
4. Mechanics of swallowing
D. Clinical Skills
1. Uses knowledge of normal articulation and phonation to interpret causes
of communication disorders.
2. Uses knowledge of normal mastication, salivation and swallowing to
interpret causes of swallowing disorders.
4. Pathology of the Head and Neck: General Considerations
A. Unit Objective
1. At the completion of this unit, the resident has knowledge of biopsy
techniques (1° tumors, unguided and guided FNAB of parotid, thyroid,
cervical tumors, sentinel node biopsy) and an ability to interpret surgical
pathology reports (tumor size, thickness, differentiation, pattern of
invasion, margins of resection, etc.) in order to make clinical decisions
in the treatment of head and neck tumors.
B. Learner Objectives
1. Understands biopsy techniques and indications for each of the following:
i) Fine needle aspiration biopsy
ii) Punch biopsy
iii) Incisional biopsy
iv) Excisional biopsy
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2. Understands the interpretation of pathology reports
3. Knows the indications for frozen sections, immunohistochemistry,
electron microscopy, flow cytometry and cytogenetics in the evaluation
of pathology specimens.
C. Contents
1. Biopsy techniques
2. Interpretation of pathology reports
3. Indicators for special studies
D. Clinical Skills
1. Can perform routine biopsies including fine-needle aspirations
2. Can interpret pathology reports
3. Knows indicators for special studies
5. History
A. Unit Objective
1. At the completion of this unit, the resident will be able to obtain a clear
understanding of the patients’ symptoms, pertinent co-morbid
conditions, general state of health, previous treatments, nutritional
status, tumor status, probable management and expected outcome.
B. Learner Objective
1. Recognizes the importance of the history of present illness, past medical
history, social history and risk factors, family history, past surgical
history, current medications, significant family members support and
other treating physicians.
C. Contents
1. History of Present Illness
2. Past Medical History
3. Social History
4. Risk factors
5. Family History
6. Surgical / radiation / chemotherapy history
7. Medications
8. Supportive resources / health care providers
D. Clinical Skills
1. Demonstrates ability to obtain a comprehensive history
2. Understands indications for preoperative medical consultations for
preoperative anesthesia clearance
3. Demonstrates appropriate correspondence with referring
physicians
6. Physical Examination
A. Unit Objective
1. At the completion of this unit, the resident will be able to perform a
complete examination of the head and neck including the ears, nose,
oral cavity, pharynx, larynx, neck, face and scalp, cranial nerves II
through XII, a general evaluation of appropriate additional areas
(example: Allen’s test for possible radial / ulnar forearm free flap).
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B. Learner Objective
1. Recognizes normal and abnormal anatomy of the head and neck area.
C. Contents
1. General examination (weight, vital signs, Karnofsky status, etc.)
2. Ears (otoscope, otologic microscope)
3. Nose (including rigid and flexible endoscopy)
4. Oral cavity / oropharynx (including bimanual palpation FOM, BOT)
5. Pharynx / larynx (including endoscopy and mirror examinations), flexible
fiberoptic laryngoscopy, transnasal esophagoscopy
6. Neck / Thyroid gland
7. Face and scalp
8. CN II – XII
9. Misc.
D. Clinical Skills
1. Demonstrates ability to perform a comprehensive physical examination
2. Demonstrates safe and appropriate use of otoscope, indirect
laryngoscopy mirror, flexible fiberoptic laryngoscope, otologic
microscope, rigid nasal and laryngeal endoscope, video stroboscope
7. Diagnostic and Therapeutic Imaging
A. Unit Objective
1. At the completion of this unit the resident will be able to request the
appropriate imaging modality based upon the differential diagnosis
developed from the history and physical examination
B. Learner Objectives
1. Understand current diagnostic and therapeutic imaging modalities and
techniques available for the head and neck area
2. Understand the appropriate indications for each imaging modality and
their limitations as well as their variations (i.e., IV contrast, fat-suppression,
power Doppler)
3. Understand the interpretation of imaging result reports and integration
of that information into patient management
C. Contents
1. Plain x-rays / Panorex
2. CT Scan with / without contrast
3. Diagnostic ultrasound of the thyroid and neck
4. MRI scan with/without contrast, T1 and T2 weighted images
5. PET / CT
6. Angiography/embolization
D. Clinical Skills
During the training period the resident
1. Develops the ability to request the appropriate imaging studies to
assess the underlying pathology.
2. Demonstrates the ability to identify and describe normal radiographic
anatomy of the head and neck
3. Demonstrates the skill to perform real time ultrasound of the thyroid and
identify nodular disease of the gland
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4. Identifies and delineates pathologic lymphadenopathy
8. Staging of Head and Neck Cancer
A. Unit Objective
1. At the completion of this unit, the resident will be able to accurately
stage malignancies of the Head and Neck using the AJCC TNM staging
system
2. In addition, the resident understands the rationale for the AJCC staging
system for malignant tumors of the head and neck and the rules that
govern staging assignment.
B. Learner Objectives
Upon completion of this unit the resident
1. Understands the staging criteria for squamous cell carcinoma
of the upper aerodigestive tract.
2. Based on the staging rules the resident can acquire the data from
clinical and radiographic examinations to assign the appropriate stage
for a squamous cell carcinoma of the upper aerodigestive tract.
3. Can describe the impact of stage on prognosis and treatment options
based on disease site and stage
C. Contents
1. Staging criteria for SCC of the oral cavity, oropharynx, nasopharynx,
larynx and hypopharynx
2. Staging schema for metastatic SCC of the neck
3. Staging criteria for differentiated thyroid cancer
4. Staging criteria for malignant tumors of the major salivary glands
D. Clinical Skills
1. Demonstrates the ability to collate physical examination with
radiographic data to develop a TNM stage and overall stage assignment
for patients with upper aerodigestive tract cancer
9. Anesthesia for Head and Neck Procedures
A. Unit Objective
1. At the completion of this unit the resident understands the medical
evaluation necessary to assess comorbidity for patients undergoing
general anesthesia and the appropriate specialty or subspecialty
evaluations necessary to assess perioperative risk and to optimize the
patient’s medical condition prior to the proposed procedure.
2. At the completion of this unit the resident understands various methods
of airway management and indications for endotracheal intubation,
laryngeal mask anesthesia, and emergency tracheostomy,
cricothyrotomy
3. At the completion of this unit the resident understands the mode of
action of commonly used local anesthetics for topical application and
local infiltration, mode of action, dose ranges, untoward effects,
treatment of toxic reactions, and role of vasoconstrictors.
4. At the completion of this unit the resident can articulate regional
anesthetics blocks commonly used in the head and neck
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B. Learner Objectives
1. Describe the schema used for assessing anesthetic risk based on
comorbidity.
2. Describe the methods for safe tracheal intubation based on the patients
normal or abnormal anatomy and the options available.
3. Describe the commonly used local anesthetics, dose range for adults
and children, common side effects and their management
4. Demonstrate regional blocks for the mental nerve, lingual and inferior
alveolar nerves, greater palatine nerve, cervical plexus
C. Contents
1. Review the current risk assessment schema for general anesthesia
including techniques of tracheal intubation: nasotracheal, endotracheal,
tracheotomy, cricothyrotomy, laryngeal mask anesthesia
2. Pharmacology of commonly used local and topical anesthetics
D. Clinical Skills
1. Various methods of tracheal intubation including fiberoptic and LMA
2. Topical application of local anesthetics for various procedures
3. Successful local anesthetic administration and regional nerve blocks
10. Preoperative and Postoperative Care
A. Unit Objective
1. At the completion of this module the resident will be able to describe the
preoperative risk assessment strategies, appropriate consultation for
management of comorbidity.
2. At the completion of this module the resident will be able to describe the
role of prophylactic antibiotics and their indications and duration based
on the type of procedure.
3. At the completion of this module the resident will be able to describe
fluid and electrolyte management in the perioperative period, strategies
for acute pain management, wound catheter management, glucose
regulation in the diabetic patient, wound management both complicated
and uncomplicated.
B. Learner Objectives
1. Strategies for assessing comorbidity in patients with hypertension,
diabetes, coronary artery disease, cerebrovascular disease
2. Discuss the various types of wounds: clean, clean-contaminated and
dirty. The role for antibiotics in each of these scenarios.
3. Management of common fluid and electrolyte abnormalities, glucose
regulation, blood pressure control, deep venous thrombosis prophylaxis,
enteral feedings and perioperative analgesia.
C. Contents
1. Review the assessment of medical co-morbidities, methods of
optimization and appropriate medical consultative services
2. Anticoagulant therapy for DVT prophylaxis, insulin use to control
postoperative hyperglycemia, antibiotic prophylaxis, fluid replacement,
enteral feedings in patients who are tube fed
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D. Clinical Skills
1. Demonstrate the ability to conduct preoperative risk assessment, obtain
appropriate medical consultations and write perioperative orders
2. Demonstrate the skills to obtain proper informed consent
3. Demonstrate understanding of ICU monitoring equipment and there
appropriate use
4. Demonstrate accurate and legible documentation in the medical record
5. Demonstrate appropriate inter-consultant communication
6. Demonstrate useful communication with nursing and OR staff
II. Diseases, Disorders, and Conditions
A. Unit Objective
1. At the completion of this unit, the resident will be able to recognize,
assess, diagnose and manage diseases and disorders of the head and
neck.
B. Learner Objectives
1. Recognize the signs and symptoms of diseases and disorders of the
scalp and facial skin, nose and paranasal sinuses, ear and temporal
bone, salivary glands, thyroid, parathyroids, lip and oral cavity,
mandible, oropharynx, nasopharynx, hypopharynx and cervical
esophagus, larynx, neck as well as unusual tumors of the head and
neck area.
2. Use the appropriate diagnostic tests to assess diseases and disorders
as listed above.
3. Be able to develop a differential diagnosis of diseases and disorders as
listed above.
4. Understand the non-surgical and surgical management of diseases and
disorders as listed above.
C. Contents (anatomically based)
1. Scalp and facial skin
2. Nose / paranasal sinuses
3. Ear and temporal bone
4. Salivary glands
5. Thyroid
6. Parathyroids
7. Lip and oral cavity
8. Mandible
9. Oropharynx
10. Nasopharynx
11. Hypopharynx and cervical esophagus
12. Larynx
13. Neck mass
14. Unknown primary
15. Cervical metastasis/Lymphoma
16. Unusual tumors of head and neck-vascular
17. Unusual tumors of head and neck-soft tissue sarcomas
18. Unusual tumors of head and neck-bone tumors
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19. Unusual tumors of head and neck-pediatric
III. Surgical Concepts
A. Unit Objective
1. At the completion of this unit, the resident will understand the treatment
strategies and procedures for the surgical management of diseases and
disorders of the head and neck region.
B. Learner Objectives
1. The resident will be exposed to the surgical strategies necessary to
treat diseases and disorders of the head and neck region.
2. The resident will be able to perform surgical strategies to treat diseases
and disorders of the head and neck region.
C. Contents (Specific Surgical Procedures)
1. Salivary glands
i) Parotidectomy
ii) Submandibular gland excision
iii) Sublingual gland excision/Ranula marsupialization
iv) Salivary gland trauma management/ductal repair
v) Sialolith resection
2. Nose and maxilla
i) Rhinectomy / forehead flap reconstruction
ii) Lateral rhinotomy/midfacial degloving/alotomy
iii) Maxillectomy/medial maxillectomy
iv) Craniofacial resection
v) Nasopharyngeal tumor resection
3. Lips
i) Vermilionectomy
ii) Wedge excision / reconstruction
iii) Upper lip resection / reconstruction
iv) Lower lip resection / reconstruction
4. Oral Cavity
i) Partial / total glossectomy (anterior 2/3’s)
ii) Partial / total glossectomy (base of tongue)
iii) Floor of mouth resection
iv) Marginal / partial / total mandibulectomy
v) Mandibulotomy
vi) Mandible plating
vii) Dental extraction
viii) Resection hard / soft palate
ix) Intraoral reconstruction
x) Mandibular reconstruction
5. Ear
i) Auriculectomy / wedge resection / reconstruction
ii) Temporal bone resection
6. Neck
i) Neck incisions
ii) Radical / modified radical neck dissection (including
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posterolateral and supraclavicular dissection)/selective neck
dissections
iii) Cervical / scalene node biopsy
iv) Transsternal mediastinal node dissection
v) Drainage of deep neck abscess
vi) Management of Penetratory Neck Injuries
7. Larynx
i) Endoscopic partial laryngectomy (supraglottic, glottic)
ii) Laryngofissure and cordectomy
iii) Vertical partial laryngectomy
iv) Supraglottic laryngectomy/supracricoid partial laryngectomy
v) Total / near-total laryngectomy
vi) Pharyngolaryngectomy
vii) Tracheoesophageal shunt
viii) Recurrent laryngeal nerve surgery
ix) Laryngeal diversion
x) Arytenoidectomy
8. Thyroid / Parathyroid
i) Thyroid lobectomy / subtotal / total thyroidectomy (including
paratracheal and/or superior mediastinal lymph node dissection)
ii) Parathyroidectomy (with autotransplantation)
iii) Recurrent hyperparathyroidism / cancer of the parathyroid
9. Pharynx, trachea, parapharyngeal space
i) Tracheotomy
ii) Tracheal reconstruction
iii) Cervical esophagectomy
iv) Zenker’s diverticulum surgery (open & endoscopic)
v) Mediastinal exploration / dissection
vi) Cricopharyngeal myotomy / myectomy
vii) Revision stenotic tracheostoma
viii) Partial / total pharyngectomy
ix) Pharyngeal reconstruction
10. Endoscopy
i) Direct laryngoscopy (fiberoptic and rigid)
ii) Nasopharyngoscopy
iii) True vocal fold injection/thyroplasty
iv) Laser / cold knife microlaryngeal surgery / arytenoidectomy
v) Microdebrider endoscopy
vi) Esophagoscopy (diagnostic, foreign body removal, dilation)
vii) Bronchoscopy (diagnostic, foreign body removal, dilation, laser,
fiberoptic)
11. Miscellaneous
i) Incisional / excisional biopsy
ii) Needle biopsy (guided & unguided) / punch biopsy
iii) Endoscopic biopsy
D. Clinical Skills
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1. At the completion of this unit, the resident will have participated and
know how to perform in the surgical strategies and procedures to
manage diseases and disorders of the head and neck region.
2. The resident will be able to select the most appropriate surgical
procedure in order to treat diseases and disorders of the head and neck
region.
IV. Habilitation / Rehabilitation
A. Reconstruction
1. Principles
2. Local / regional flaps
3. Free tissue transfer
4. Prosthetic rehabilitation
B. Rehabilitation
1. Functional rehabilitation
2. Psychosocial rehabilitation
3. Speech pathology/therapy
4. Supportive care
C. Complications / Outcomes / Cost-effectiveness
Facial Plastic and Reconstructive Surgery Curriculum
I. Fundamental Knowledge
1. Facial Anatomy General and Systematic
A. Unit Objective
At the completion of this Unit the resident understands the general and
systematic anatomy of the face and neck to include skeletal, skin, fascia,
motor and sensory innervation, lymphatics and various patterns of
vascular supply.
B. Learner Objectives
Upon completion of this Unit the resident understands the bony and soft
tissue anatomy of the face and neck and their relationships of hard tissue,
soft tissue, vascular and neurological systems.
C. Content
1. Facial Skeleton – Hard Tissue Foundation
2. Skin and Soft Tissue
3. SMAS
4. Facial Musculature
5. Facial Nerve
6. Facial Sensory Innervation
7. Vascular Patterns of the Face
8. Lymphatics of the Face
D. Clinical Skills
1. Uses the anatomy to diagnose and define problems
2. Uses the anatomy to perform cosmetic and reconstructive
procedures of the face and neck
2. Functional Facial Anatomy by Region
A. Unit Objective
At the completion of this Unit the resident understands the detailed
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surgical anatomy of each region and the relevant function and physiology.
B. Learner Objectives
At the completion of this Unit the resident understands the
functional anatomy of each regional area and the surgical applications.
C. Contents
1. Hair and Scalp
2. Forehead and Brow
3. Eyelids, Orbit, Lacrimal System
4. Nose
Nasal airflow to include rhinomanometry
5. Ears
6. Oral Cavity – Dental Alveolar, Lips, Pharynx
To include physiology of speech deglutition
7. Neck – Cervical
D. Clinical Skills
1. Uses the anatomical and functional knowledge to diagnose specific
clinical problems.
2. Uses detailed anatomy to perform surgical procedures to correct
these problems.
3. Embryology
A. Unit Objective
At the completion of this Unit the resident understands embryology of the
face and neck.
B. Learner Objectives
1. Understands the normal development
2. Understands abnormal development in common clinical
syndromes
C. Content
1. General embryology of facial development
2. Detailed embryology of the ears, eyes, nose, and oral cavity to
include lips
D. Clinical Skills
1. During the training period the resident uses his knowledge to
diagnose and recognize syndromes and abnormalities
2. During the training period the resident uses his knowledge to
perform a functional anatomical reconstruction
4. Wound Healing
A. Unit Objective
At the completion of this Unit the resident understands the basic
physiology of normal wound healing.
B. Learner Objectives
1. Understands normal wound healing to include scar
formation and wound mechanisms
2. Understands special characteristics of nerve and bone
repair
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C. Contents
1. Phases and Histology
2. Collagen Formation
3. Biochemistry/Cytokines
4. Nerve Repair
5. Bone Repair
D. Clinical Skills
During the training period the resident:
1. Uses his knowledge to interpret abnormal wound healing
2. Uses his knowledge to initiate pharmacologic or other
interventions
5. Physical Exam/Endoscopy
A. Unit Objective
At the Completion of this Unit the resident will be able to perform a
complete clinical examination of the face and neck
B. Learner Objectives
At the completion of this Unit the resident will be able to:
1. Perform a general physical and aesthetic evaluation of the face
and neck
2. Perform specific focused evaluations of each anatomical
area
C. Contents
1. Face – proportions, symmetry, cranial nerve exam
2. Eyes – lid position, levator excursion, extraocular muscles, Schirmer’s
Test, anterior vector
3. Brow position, shape, symmetry
4. Nose – visual examination, palpation, intranasal and endoscopic
examination
5. Oral – occlusion, velopharyngeal competence
6. Ear – cephalometrics measurements
D. Clinical Skills
During the training period the resident uses these skills to diagnose
diseases, disorders and conditions
6. Facial Analysis and Cephalometrics
A. Unit Objective
At the completion of this Unit the resident will understand the
normal facial proportions and basic methods to analyze them.
B. Learner Objectives
At the completion of this Unit the resident will:
1. Understand basic facial proportions
2. Understand basic soft and hard tissue cephalometrics
3. Recognize common abnormalities
C. Contents
1. Angles classification
2. Facial Proportions
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3. Frankfort horizontal
4. Soft Tissue Cephalometrics
5. Hard Tissue Cephalometrics
D. Clinical Skills
During the training period the resident uses these skills to:
1. Diagnose facial abnormalities and precisely plan reconstruction
2. To make appropriate referrals
7. Photography
A. Unit Objective
At the completion of this Unit the resident will understand the
essentials of medical photograph relevant to facial plastic and
reconstructive surgery
B. Learner Objectives
Upon completion of this Unit the resident will understand:
1. The importance of quality and consistent photography
2. The standard facial views for specific procedures
3. The basic aspects of equipment and technology
C. Contents
6. Standard facial views
7. Equipment
8. Imaging - Computer
D. Clinical Skills
During the training period the residents uses these skills to accurately
document clinical cases.
8. Imaging
A. Unit Objective
At the completion of this Unit the resident will understand the
effective utilization of available imaging techniques
B. Learner Objectives
At the completion of this Unit the resident will understand:
1. The basic characteristics of available imaging technologies.
2. How to select the most appropriate imaging study
3. Interpret imaging studies for relevant clinical information
C. Contents
1. Plain Radiograph/Tomography
2. Panorex
3. CT scans
4. MRI
5. Ultrasound
6. Arteriography
7. Bone Scans
8. Lymphoscintigraphy
D. Clinical Skills
During the training period the resident uses this knowledge to diagnose
patients in a precise, thoughtful, and cost effective manner.
9. Psychological and Social Assessment
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A. Unit Objective
At the completion of this Unit the resident will understand normal
psychological reaction to surgery and recognize the signs and symptoms
of abnormal psychology.
B. Learner Objectives
1. At the completion of this Unit the resident will understand the
psychological significance of physical deformities and normal
reactions to them.
2. Recognize abnormal psychological behavior
3. Understand the importance of integrating social issues into
the treatment plan
C. Content
1. Normal psychology of the five life cycles
2. The normal reactions to grief and loss
3. Psychopathology – neurosis, psychosis, personality disorders
4. Specific relevant disorders such as body dysmorphic syndrome
and narcissistic personality
D. Clinical Skills
During the training period the resident uses knowledge to:
1. Identify patients may need added support either psychological or
social
2. Recognize patients with significant psychological problems who
are not candidates for surgery
3. Refer patients appropriately for social support or psychological
evaluation and treatment
10. Implants and Biomaterials
A. Unit Objective
At the completion of this Unit the resident will understand the properties
and utilization of commonly available implants and biomaterials
B. Learner Objectives
At the completion of this Unit the resident will:
1. Understand the advantages and disadvantages of
autogenous, autologous and alloplastic materials
2. Describe and recommend utilization of each material
C. Content
1. Homograft (AlloDerm)
2. Xenograft (Surgisis)
3. Alloplastic (Silastic, Gortex)
D. Clinical Skills
During the training period the resident uses this knowledge:
1. To recommend the optimal material for a given problem
2. To provide effective informed consent to the patient
11. Laser Principles
A. Unit Objective
At the completion of this Unit the resident will understand basic laser
physics and physiology to include laser selection for specific lesions.
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B. Learner Objectives
1. At the completion of this Unit the resident will understand
basic laser principles and terminology
2. Will understand the principles of laser selection for specific clinical
problems
3. Will understand the principles of laser safety
C. Content
1. Laser biophysics
2. Laser tissue interaction to include chromophores
3. Laser characteristics (C02, KTP, Erbium, etc.)
D. Clinical Skills
During the training period the resident will use this knowledge to:
1. Select the appropriate laser for a specific clinical problem
2. Perform laser procedures safely
12. Evaluation and Management of Surgical Patient
A. Unit Objective
At the completion of this Unit the resident will understand the general
concepts relevant to management of the facial plastic surgery patient.
B. Learner Objectives
At the completion of this Unit the resident will understand information
necessary to evaluate and safely manage a facial plastic surgery patient.
C. Content
1. Pre and postoperative evaluation and care
2. Universal Precautions
3. Infection Control
4. Coagulation Evaluation
D. Clinical Skills
During the training period the resident will use this knowledge to:
1. Provide appropriate and safe preoperative evaluation and
postoperative care
13. Anesthesia
A. Unit Objective
At the completion of this Unit the resident will understand the basic types
of anesthesia and their potential problems
B. Learner Objectives
At the completion of this Unit the resident will:
1. Understand the preop evaluation for anesthesia
2. Understand anesthesia selection
3. Understand potential complications and treatment
C. Contents
1. Classification of patients
2. Local anesthesia
a. Regional blocks
3. General anesthesia
a. Laryngeal mask
b. Endotracheal
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4. Complications
a. Malignant hyperthermia
b. Fire
c. Drug toxicity
D. Clinical Skills
1. During the training period the resident will use this information to
recommend the most appropriate anesthesia for a specific
patient’s needs.
2. Provide informed consent
3. Prevent and treat complications
14. Surgical Facilities
A. Unit Objective
At the completion of this Unit the resident will understand the types of
facilities and required standards
B. Learner Objectives
At the completion of this Unit the resident will understand the levels of
surgical facilities and their appropriate utilization
C. Content
1. Facility levels
a. Hospital
b. Certified Surgical Centers (ASC)
c. Office operating suites
2. Staff training including ACLS
3. Operating and Recovery Room Equipment
4. Certification and Formal Agreements
D. Clinical Skills
During the training period the resident will use his knowledge to:
1. Select the most appropriate surgical facility for a given patient
II. Diseases, Disorders, and Conditions (from New Classification System)
A. Unit Objective:
1. At the completion of this unit the resident will be able to recognize, assess,
diagnose and manage diseases, disorders and conditions of the face and neck to
include congenital, traumatic, neoplastic, and cosmetic.
B. Learner Objective:
1. Recognize the signs and symptoms of congenital, traumatic, neoplastic and
cosmetic diseases, disorders, and conditions of the face and neck.
2. Use the appropriate diagnostic tests to assess these diseases, disorders and
conditions.
3. Be able to develop a diagnosis of these diseases, disorders and conditions.
4. Understand the non-surgical and surgical management of congenital,
traumatic, neoplastic and cosmetic diseases, disorders and conditions of the
face and neck.
C. Content
1. Congenital
1. Cleft lip and palate
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2. Microtia and auricular deformities
3. Syndromes
2. Trauma – General and Soft Tissue Injury
1. Initial evaluations A, B, C’s
2. Imaging Techniques
a. CT Scans
b. Angiogram
c. MRI
3. Skeletal Trauma and Deformities
1. Nasal, mandibular, frontal sinus, zygomatic, dental,
maxillary (LeFort) Fractures
2. Developmental Deformities (microgenia, malar hypoplasia)
4. Neoplasias and Facial Skin Malignancies
1. Benign and Malignant Lesions
2. Histopathology
3. Diagnostic Techniques
4 Treatment
a. Medical
b. Radiotherapy
c. Surgery
d. MOHS
5. Vascular
1. Milliken & Glowacki’s Classification System
2. Classification Hemangioma versus malformation
3. Vascular malformation – slow flow, fast flow
4. Clinical Conditions - Pediatric
a. Strawberry Hemangioma
b. Pyogenic granuloma
c. Port wine stain (vascular malformation)
d. Angiofibroma
e. Spider angioma
f. Lymphatic malformation
5. Clinical Conditions – Adults
a. Pyogenic Granuloma
b. Spider Angioma
c. Telangiectasias
d. Venous Lake
e. Acne Rosacea
f. Poikiloderma of Civatte
g. Cherry Angioma
h. Kaposi’s Sarcoma
6. Facial Nerve
1. Facial Paralysis - Acute
a. Traumatic
b. Iatrogenic
c. Infectious
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2. Facial Paralysis
a. Long-term
7. Hair and Scalp
1. Androgenic, traumatic, iatrogenic, alopecia
2. Chronology and patterns of male
pattern baldness – Norwood System
3. Medical treatment of alopecia
8. Aging Face
1. Skin Changes
2. Regional Changes
a. Brow
b. Lids
c. Nose
d. Mouth
e. Neck
3. Skeletal changes
4. Lipodystrophy
9. Nose
1. Nasal Obstruction
a. Turbinates
b. Septum
c. Internal and External Valve
2. Nasal Deformity
a. Traumatic
b. Congenital cleft lip/nose)
c. Cosmetic
10. Psychogenic
1. Body Dysmorphic Syndrome
2. Narcissistic Personality
1. Neurosis, Psychosis
2. Personality Disorder to include
i. Body __________________
ii. Narcissistic
III. Surgical Concepts
A. Unit Objectives
1. At the completion of this unit the resident will understand the treatment
strategies and procedures for the surgical management of reconstructive and
cosmetic diseases, disorders and conditions of the face and neck.
B. Learner Objectives
1. The resident will be exposed to the surgical strategies necessary to treat
diseases and disorders to treat reconstructive and cosmetic diseases,
disorders and conditions of the face and neck.
2. The resident will be able to perform surgical strategies to treat reconstructive
and cosmetic diseases, disorders and conditions of the face and neck in the
cadaver lab prior to performing them on the patients.
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C. Content
1. General
A. Atraumatic Techniques, Hemostasis, Precise Sutures
B. Healing by Secondary Intention
C. Grafts
1. STSG
2. FTSG
3. Composite Grafts
4. Mucosal Grafts
5. Bones Grafts – Calvarial/iliac/rib
6. Cartilage grafts – auricular/rib/septal
D. Flaps
1. Local Flaps
a. Advancement
b. Rotation
c. Rhomberg
d. Bilobed
e. Transposition/Note Flap
f. Z-plasty
2. Regional Flaps
3. Free Flaps
a. Fasciocutaneous
b. Myocutaneous
c. Osteomyocutaneous
E. Tissue Expansion
2. Specific Surgical Procedures
a. Cranial Facial Anomalies
b. Cleft Lip and Palate
c. Trauma
1. Soft Tissue
d. Trauma
1. Hard Tissue
e. Facial Reconstruction
1. Scalp
2. Forehead
3. Periorbital
4. Nose
5. Cheek
6. Ear
7. Lips and Chin
f. Facial paralysis and reanimation
1. Static
2. Dynamic
g. Rhinoplasty
h. Genioplasty and Mandibular procedures
i. Facial Implants
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j. Scar Revision
k. Otoplasty
l. Browplasty
m. Blepharoplasty
n. Liposuction
o. Rhytidectomy
p. Facial Resurfacing
1. Dermabrasion
2. Chemical Peels
3. Laser
q. Laser Procedures
1. Vascular
2. Tattoos
3. Hair Removal
r. Injectables
1. Botox
2. Fillers
3. Lipostructure
D. Clinical Skills
1. At the completion of this unit the resident will have participated in and
understand how to plan surgical strategies and perform procedures to
manage reconstructive and cosmetic diseases, disorders and conditions of
the face and neck.
2. The resident will be able to select the most appropriate surgical
procedure to reconstruct diseases, disorders and conditions of the face and
neck.
IV. Habilitation/Rehabilitation
Speech Therapy
Osteo Integrated Implants
Prosthetic Devices
Clinical Research Curriculum
I. Medical Biostatistics
A. Unit objective
At the completion of this unit, the resident understands the basics of
medical statistics, including fundamentals of measurement, comparing two
or more groups, interpretation of results from clinical trials, correlation, and
regression.
B. Learner objectives
Upon completion of this unit, the resident:
8. Understands the fundamentals of measurement
9. Understands the common statistical tests for the comparison of
two or more groups
10. Understands the interpretation of results from clinical trials
11. Understands the concept of correlation
12. Understands the concept of regression and multivariable analysis
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C. Contents
1. Fundamentals of Measurement
a. Four different types of variables – dichotomous,
continuous, nominal, and ordinal
b. Concept of the normal distribution of data
c. Measures of central tendency (mean, median, and mode)
and dispersion (range, standard deviation) and the
advantages and disadvantages of each
d. The relationship between standard deviation and standard
error
e. Calculation of confidence intervals and their use in the
interpretation of results from clinical trials
f. The concept of unit-free data
2. Comparison of two groups
g. Mean/median
i. Parametric -- t-test
1. paired
2. unpaired
ii. Non-parametric test – Mann-Whitney U-test
3. Comparison of three or more groups
h. Mean/median
i. Parametric – one-way ANOVA
i. adjustment for multiple comparisons
a. Bonferroni
b. Others
ii. Non-parametric – Kruskal-Wallis test
4. Comparison of proportions: Χ2 test
1. Fisher Exact Probability Test
2. Paired -- McNemar’s Χ2 test
5. Measures of Agreement
iii. Percent agreement
iv. Kappa Index
13. Interpretation of results from clinical trials
a. Confidence Intervals
b. When the experimental treatment reduces the probability
of a bad outcome
i. Relative Risk Reduction
ii. Absolute Risk Reduction
iii. Number Needed To Treat
c. When the experimental treatment increases the probability
of a good outcome
i. Relative Benefit Increase
ii. Absolute Benefit Increase
iii. Number Needed to Treat
d. When the experimental treatment increases the probability
of a bad outcome
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i. Relative Risk Increase
ii. Absolute Risk Increase
iii. Number Needed to Harm
14. Correlation – Nondependent relationship
a. Parametric Pearson’s
b. Nonparametric Spearman’s Rho
15. Regression - Multivariable Analysis
a. Linear Regression
b. Logistic Regression
c. Cox Proportional Hazard analysis
E. Clinical Skill
i. Application of data analysis to review of pertinent data and literature, in
the care of a patient
II. Critical Appraisal of the Medical Literature
A. Unit objective
At the completion of this unit, the resident understands the methodological
criteria used to assess the validity, importance, and applicability of the
medical literature.
B. Learner objectives
Upon completion of this unit, the resident:
1. Understands how to assess the validity, importance, and
applicability of diagnostic articles
2. Understands how to assess the validity, importance, and
applicability of prognostic articles
3. Understands how to assess the validity, importance, and
applicability of harm/etiology articles
4. Understands how to assess the validity, importance, and
applicability of therapeutic articles
5. Understands how to assess the validity, importance, and
applicability of systematic reviews
C. Contents
ii. Reviewing the structure of an article
1. type of study; answering what type of question
2. abstract
3. research methods
4. inclusion, exclusion criteria
5. statistical analysis
6. reports reported
7. discussion in context with other studies
iii. Diagnostic article
1. Are the results of this diagnostic study valid?
a. Study design
b. Inclusion criteria
c. Potential bias
d. Which data are reported, and how
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2. Are the valid results of this diagnostic study important?
a. Statistical analysis
b. Clinical significance
c. Results in context of other studies
d. etc
3. Can you apply this valid, important evidence about a diagnostic
test in caring for your patient?
a. Generalizability
b. Translation to clinic practice
iv. Prognostic article
1. Are the results of this prognostic study valid?
2. Are the valid results of this prognostic study important?
3. Can you apply this valid, important evidence about
prognosis in caring for your patient?
v. Harm/Etiology article
1. Are the results of this harm study valid?
2. Are the valid results of this harm study important?
3. Should these valid, potentially important results of a
critical appraisal about a harmful treatment change the
treatment of your patient?
vi. Therapeutic article
1. Are the results of this single preventive or therapeutic
trial valid?
2. Are the valid results of this randomized trial important?
3. Can you apply this valid, important evidence about a
treatment in caring for your patient?
vii. Systematic Review
1. Are the results of this systematic review valid?
2. Are the valid results of this systematic review important?
3. Can you apply this valid, important evidence about a
treatment in caring for your patient?
viii. Systematic review vs. meta-analysis
1. Difference in review and meta-analysis
2. Interpretation of meta-analysis
a. Homogeneity
b. Confidence intervals
c. Odds ratio, relative risk
D. Clinical skill
ix. The resident can review an article, and understand and report its findings,
strengths and weaknesses.
x. The resident can apply the results of their literature appraisal to clinical
care of a patient, in different scenarios.
III. Evidence-Based Medicine
A. Unit objective
a. At the completion of this unit, the resident understands the concepts of
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evidence-based medicine, and can integrate the results of an evidence-based
review with their own experience and the patient’s wishes, to provide
evidence-based care.
B. Learner objectives
a. Upon completion of this unit, the resident understands:
i. The “three-legged stool” of evidence based medicine
ii. The 5 levels of evidence, applied to individual studies
iii. The 4 grades of evidence, and applying a grade based on individual
study levels.
iv. Assessment of the “number needed to treat.”
C. Contents
a. Background and history of evidence-based medicine
b. Three parts of evidence-based medicine (EBM)
i. Best available evidence from the literature
ii. Physician’s clinical experience
iii. Wishes of the patient and/or society
c. Formulating a focused clinical question
i. Patient
ii. Intervention
iii. Comparison
iv. Outcome
d. Obtaining the evidence
i. Systematic, computerized searches
ii. EBM databases (i.e., Cochrane, NHRQ)
iii. Clinical research, human subjects only
e. Grading the evidence
i. Individual studies are assigned a level
1. based on study methodology
2. based on study quality
ii. Levels 1 through 5
iii. Review the results of individual studies, and assign an overall grade,
based on the compilation of evidence.
iv. Grades are A, B, C, D
f. Making an evidence-based recommendation
i. Grade of evidence
ii. Characteristics of patient and situation
g. Understanding analysis of evidence-based review
i. Number need to treat/harm
ii. Clinical vs. statistical significance
D. Clinical skills
a. Formulating a question for an evidence-based review
b. Retrieving, evaluating, and grading the best evidence
c. Understanding the recommendations from the best evidence.
d. Incorporating the evidence into the care of an individual patient
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IV.
Research Program
A. Director
The research program director, Dr. Thomas Eby, [with assistance of the residency program
director] is in charge of the resident research program and all submissions must go through them
as well as your research mentor.
B. Statistics
All research residents must read the short text “Statistical Analysis for Decision Makers in
Healthcare” by Jeffrey Bauer, PhD. This book describes the scientific method and principles of
statistical analysis in a very concise format. The book can be borrowed from Dr. Stringer. A
brief exam will be given following this rotation to assess learning.
C. Project Requirements
Each resident is required to complete a minimum of two projects suitable for presentation at a
scientific meeting and/or suitable for publication. The requirements for these projects are
outlined below. During your PGY-3 and PGY-4 year, you are allowed a dedicated rotation for
research. Any research tasks that are not completed by the end of this block time must be done
during your free time.
D. Project Selection
1. Basic Science Project
a)
Each resident must complete at least one basic science project.
b)
All projects must be performed in concert with one of our designated labs:
Vestibular Physiology (Dr. Zhou), Vestibular Pharmacology (Dr. Zhu), Vestibular
and Oculomotor Neurophysiology (Dr. Chen), Allergy and Immunology (Dr.
Marshall), or Oncology (Dr. Duhe).
(1)
A list of acceptable projects will be maintained by the research director and program
director for your convenience.
(2)
You may seek other labs or projects if you wish. Exceptions must be approved by the
program director, the research director, and the faculty.
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2. Second Project
Your second project may be clinical or basic science in nature. Case reports do not
qualify. Simple, retrospective reviews are discouraged.
a)
A list of acceptable projects will be maintained by the research director and the
program director for your convenience. Faculty members will forward their
proposed projects to the program director and research director for posting.
b)
Residents may discuss projects with any faculty member, but prior to
commencing on any project, approval should first be obtained from the program
director and the research meeting faculty.
3. Additional Projects
You may do other studies or case reports if you wish. No prior approval is required
unless funding is requested.
E. Guidelines
1. The deadlines that follow are the latest possible dates acceptable. You are
strongly encouraged to start on this process in advance so that you are eligible to
submit your proposal for a Core grant from the Academy which generally has a
deadline in December each year. This is beneficial for the entire department in general
but also is beneficial to you in terms of your future fellowship and possible academic
plans.
2. You must first identify a tentative research area and research sponsor. You should
complete a one-page statement of research intention which identifies an area of
proposed research and its significance. The letter must be signed by the research
mentor. This must be formally submitted to the research review meeting in July of your
PG-3 year. A copy of this letter should go to all faculty members via the research
director on or before July 1st. Any requested revisions are due on or before August 1st.
3. Each resident will complete a research proposal using the EXACT format provided
in this manual. This proposal must be presented to the research review group in
September of your PG3 year. Copies are to be provided to all faculty members via the
research director on or before September 1st. All projects should be submitted for at
least one external funding source if appropriate after initial approval.
4. Any suggested revisions should be investigated, and a revised proposal will be
presented at the October research review meeting. The revised proposal is due
October 1st with a similar distribution schedule as above.
5. In order to effect a more organized compilation of data and to focus research goals,
you must arrange a regular meeting with your research sponsor.
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6. Within one month after the completion of the research rotation, a summary (one
page or less) of progress made to date must be presented at the research meeting
along with plans to complete unfinished tasks including a timeline. This summary will
be distributed in the same fashion as above.
7. The approval process for the second project should follow the same format but the
timing will vary according to the expected date of commencement and completion.
8. All research projects that have you listed as being the Primary Investigator must be
satisfactory completed with a summary, closing report to the IRB (if applicable—ie, if
IRB approval was required in any fashion) prior to graduation. If projects are still
ongoing or having no reached full completion that have you listed as being the Primary
Investigator, arrangements for transfer of PI status or other arrangements must be
completed to the satisfaction of your research mentor prior to your official graduation
from the program.
F. Research Proposal Format
1. SPECIFIC AIMS - Identify research objectives and describe succinctly what specific
research you intend to be conducted and the hypothesis to be tested. One page is
recommended.
2. BACKGROUND AND SIGNIFICANCE - Identify the background of the research
proposal. Evaluate critically existing knowledge, and specifically note areas that the
project is intended to address. State the importance of the research described by
relating the specific aims to the objectives. Two to three pages are recommended.
3. EXPERIMENTAL DESIGN AND METHODS - Outline the experimental design and
the procedures that will be used to accomplish the specific aims of the project. Include
means by which the data will be collected, analyzed, and interpreted. Discuss the
potential difficulties and limitations of the proposed procedures and alternative
approaches to achieve the specific aims. Provide a timetable for the investigation.
Ten pages or less is recommended.
4. SPONSORS/COLLABORATORS - Provide a letter of sponsorship.
5. FACILITIES & MAJOR EQUIPMENT - Describe where your research will be
performed, including the use of large or specialized equipment that will be needed to
complete your project.
6. BUDGET - List any cost that may be incurred.
7. LITERATURE CITATIONS - Identify literature citations. Each literature citation
must include authors, title of article, journal or book, volume, page numbers, and year
of publication.
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G. Submissions and Awards
Research projects are eligible for the annual resident research award. Residents must submit
manuscripts and present their work to the appropriate meeting and/or publication as described
previously. In addition, residents must present at least one of their research projects in both
their PG4 and PG5 years at the annual resident research forum as designated. Other residents
may present other research projects they have completed if they wish. The winner will be
determined by the faculty or the visiting professor.
H. Funding
Funding for resident research projects is available if needed from the department at a maximum
of $4,000 per resident, but every effort will be made to submit requests for outside funding when
available and appropriate.
I. Submission of Proposals and Presentations
No grant applications, IRB proposals, abstracts, or manuscripts are to be submitted without
written permission of the primary faculty mentor, all authors, and the resident research
coordinator(s).
J. Failure to Comply
Failure to comply with these guidelines will result in forfeiture of your research time and
potential for probationary status. This does not release you from the responsibility of completing
your research project.
V.
Additional Educational Programs
In addition to the clinical rotations described above, additional educational training will be
provided in the following formats:
A. Communicative Sciences
Otolaryngology residents are assigned time during their PGY-1 year on the ENT Diagnostics
rotation, and have time throughout their PGY-2 through PGY-5 year on various rotations to
spend with the Communicative Sciences faculty learning about audiometry and impedance
testing, ABR’s, otoacoustic emissions, voice and swallowing evaluation and treatment, and
hearing aids. Residents on all services will be expected to gain similar experience when faculty
members are out. Residents are assigned time throughout the training program to learn to
perform vestibular testing and additional audiologic exposure is provided as well. Additional
experience in these areas, including more advanced exposure to the business and management
aspects of these areas, can be obtained through PGY-5 elective time.
B. Journal Club
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Each month in Journal Club we will primarily review 3 journals and selected articles based on
the faculty member’s instructions. This will usually be done in 1 session. Every resident will be
responsible for having read all articles in the appropriate journals except as directed by the lead
faculty member for the month. During Journal Club, a faculty member will select the
appropriate articles for discussion, and you may be expected to present, very concisely, what
level of evidence this study provides:
Level 1. Randomized controlled trials or a systematic review (meta-analysis) of randomized
controlled trials.
Level 2. Prospective (cohort or outcomes) study with an internal control group or a systematic
review of prospective, controlled trials.
Level 3. Retrospective (case-control) study with an internal control group or a systematic review
of retrospective, controlled studies.
Level 4. Case series without an internal control group (retrospective reviews; uncontrolled
cohort or outcome studies).
Level 5. Expert opinion without explicit critical appraisal, or recommendation based on
physiology/bench research.
You will then summarize the high points of each article. Finally, you may offer a critique of the
study design or the conclusions. The floor will then be open for discussion.
We will cover OTOLARYNGOLOGY-HEAD AND NECK SURGERY, ARCHIVES OF
OTOLARYNGOLOGY-HEAD AND NECK SURGERY, and LARYNGOSCOPE. The
first journal is given to residents free of charge with Academy Membership; the
LARYNGOSCOPE is free to resident members of the Triological Society. The other one can be
obtained at a discounted rate. If you are not on the list, we will be happy to help you make
arrangements. Selected articles may be distributed as well. We will always review the journal
from two months prior (i.e. in September’s Journal Club meeting, we will review issues from the
month of July). You are responsible for obtaining and maintaining subscriptions to these
journals. The residency program coordinator will not be responsible for making copies of these
journals for you.
In recent years, the white journal OTOLARYNGOLOGY-HEAD AND NECK SURGERY
has ceased mailing hard copies of the journal to residents. However, residents are still
responsible for reading their online issues received through their subscription. It may be
necessary to print out designated articles from this journal that are to be reviewed during journal
club. Faculty members are encouraged not to have residents print out entire copies of the
journal; however, this is left up to the discretion of the individual faculty member.
In order to maintain such a high level of reading, you will need to be extremely organized in
your approach. Please do not attempt to read every single article as if you are memorizing them.
The point is to rapidly read each article so that you are efficient in scanning the literature.
Covering such a wide variety of articles will allow you to be efficient and informed in your
literature review skills. I realize this is very demanding; however, I also realize this is your only
opportunity to become an educated otolaryngologist.
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C. Reading Assignments
It is essential, in order to progress in your otolaryngology residency, that you pursue an active
course of independent reading. You will, of course, be reading for Journal Club and for Home
Study Course. You need, however, to form a firm foundation for these readings from standard
texts.
1. During the junior years you are required to read Bailey’s otolaryngology text.
2. In your last two years you should read from the following types of texts: head and
neck cancer, otology, pediatrics, laryngology, and facial plastics.
3. Read for individual surgical cases and patient management issues.
You should focus on committing yourself to your personal education over your residency years
rather than worrying about being disciplined for not completing the above stated reading
curriculum. There will be no formal mechanism for documenting your compliance. However, if
it is apparent from your annual training examination scores, you will be assigned specific reading
assignments with follow-up testing. If you follow these reading guidelines, you will emerge as
one of the best-educated residents in the country. This will serve you well throughout your
career and will, indeed, be your last chance to learn otolaryngology in a structured manner.
D. Temporal Bone Lab
A temporal bone anatomy and dissection course will be provided every year for the appropriate
level residents. Residents will be assigned laboratory sessions based on their level of training and
satisfactory completion of fundamental exercises. All residents are expected to utilize the lab to
refine their dissection techniques throughout their training.
A House dissection manual will be provided to you at the beginning of the course. This
delineates the course objectives and provides guidelines on how to meet these objectives. Please
be aware that these House dissection manuals are out of print and were specially and specifically
reprinted just for our program. Please take good care of them as they are extremely difficult to
replace.
Residents that are assigned to the temporal bone laboratory will be freed from their clinical
assignments during the scheduled sessions. Second call (senior residents) will take first call for
residents whose attendance is required at temporal bone dissection laboratory sessions. Conflicts
that arise should be addressed with the dissection instructor.
E. Conferences
Conferences will be held each week according to a published schedule to provide didactic and
interactive teaching. All residents are expected to attend and to arrive early enough so that we
can start exactly on time. This does not mean that you should arrive right at the starting time
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but rather means you arrive before the starting time. You should stay until the end of conference
unless you are given prior approval to leave early from the faculty member in charge. One
resident per operating service is allowed to leave 10 minutes prior to the scheduled start of the
OR on operating days. Non-emergency patient care is not an acceptable reason for being late to
or leaving conference. You are to complete and turn in evaluations of lectures. The conference
room should be left clean and in order after each use. No equipment is to be removed from the
conference room without permission from the faculty.
If you are late for conference without an emergent patient care issue more than twice per quarter,
you will be required to prepare a five-page single-spaced typed manuscript in addition to
references on a subject assigned by the program director for each instance of tardiness. It is your
responsibility to contact the program director if you are late and have a legitimate reason by the
end of that working day. Otherwise, it will be assumed that it was unexcused.
Head and Neck Tumor Conference is a multidisciplinary teaching and disposition conference
attended by those residents on the Head and Neck service.
The quarterly Multidisciplinary Facial Trauma Conference will be attended by all residents, not
just those on the Facial Plastics/Otology/Laryngology rotation.
F. Annual Cadaver Sinus/Soft Tissue/Flap/Sleep Surgery Course
Annually, all residents will be provided cadaver dissection instruction in sinus surgery including
the use of image guidance. Each resident or pair of residents has their own fresh cadaver head
to perform various sinus procedures on with sinonasal instruments, including the use of one or
more image guidance systems. Residents will also be provided instruction in soft tissue surgery,
including both cosmetic (rhytidectomy, blepharoplasty, etc.) and non-cosmetic (parotidectomy,
neck dissections, etc.) procedures and pedicled and non-pedicled regional and distant free flaps
harvests. There will also be a sleep surgical portion of the course.
G. APSO Mini-Mentorship Program
Our program now participates in The American Society of Pediatric Otolaryngology
Mini-Mentorship Program. The purpose of the program is to increase the number of residents
who are exposed to the wide range of complex care that is provided by pediatric
otolaryngologists. The program targets junior residents within the first 3 years of their residency
at programs that do not have a Pediatric Otolaryngology fellowship available, and where there
are fewer than 3 faculty members practicing exclusively pediatric otolaryngology. Our program
does have a very active, tertiary care pediatric otolaryngology practice with two very
experienced pediatric otolaryngologists. However, we feel that this program compliments our
current practice by providing residents that we identify as being interested in pursuing a pediatric
otolaryngology fellowship by increasing their exposure to a program that does have a pediatric
otolaryngology fellowship, allows them to formally meet and become familiar with a fellowship
director, and allows them to discover on a first hand basis if pursuing a fellowship is the right
choice for them.
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If you think you may be interested in pursuing a pediatric otolaryngology fellowship and
would be interested in participating in the APSO mini-mentorship program, here are the steps to
follow:
1. Check the APSO website for the timeframe for application. In the past,
applications/nominations were submitted by November of the current year, but this is subject to
change without notice per the APSO.
2. Identify yourself to the Program Director and the Program Coordinator as being
interested in the APSO mini-mentorship. Junior residents are eligible to apply, but priority is
given to applications from PGY-3 level residents.
3. Submit the application and any other required paperwork by APSO deadlines.
4. Once approved, coordinate MMP dates with the Program Director.
5. The APSO MMP does provide a travel grant to cover most costs, but not all costs.
Please be aware there may be some cost to you; however, should you have money in your CME
fund and if you have already attended your required annual national meeting, you may submit
your travel receipts to get reimbursed.
H. Humanitarian Mission Trips
Our department is excited about new opportunities our program has added. Our upper
level residents may take mission trips to areas faced with social, economic, and health
challenges. While assessing and providing the healthcare needs of an international community
can present challenges and obstacles, it also provides unique and rewarding opportunities. We
strongly feel that experiences from these trips will not only enhance their education, but also will
have a significant positive impact on the lives of people and communities in desperate need of
medical care. Specialists are particularly welcomed as they bring a level of care rarely accessible
to these populations. They are often in demand to care for unique cases and to provide a higher
level of training through education for the staff and local medical community.
To further support and encourage our residents in this endeavor, our program has created
an Otolaryngology Resident Humanitarian Fund. The fund was started to help defray or
eliminate any financial barriers residents may have to participating in humanitarian mission trips
by reimbursing the residents’ trip expenses and purchasing a small instrument set for use on the
trips. Our fund began in July of 2010 and our goal is to continue fundraising annually so that
residents who wish to take mission trips can do so with no or minimal financial impact.
If you think you may be interested in pursuing a mission trip during your upper level
years, here are the steps to follow:
1. Identify your interest in a trip with the Program Coordinator and Program Director at
least 6 months ahead of any planned trips, or earlier if possible. This is to allow time for
scheduling, fundraising, and any other necessary preparation.
2. Decide which organization/area of the world your mission trip will be through. There
are a multitude of local, national, and international humanitarian organizations; however, there is
also a wide range of quality and reliability. Our recommendations are to go with a well known,
well established group, preferably one that another resident has gone with so you can discuss
experiences and expectations.
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3. Plan your trip—ideally, the trip will fall during a research or elective block. While
accommodations might be made to allow for trips outside these rotations, there is no guarantee
this will happen.
4. Understand that UMC doesn’t provide insurance or malpractice on international
mission trips. These trips are at your own risk and the department does not assume any liability
for any injuries, accidents, or other situations you may encounter.
5. All arrangements for these trips are your own responsibility. However, submit receipts
so that you can be reimbursed should the Humanitarian Mission Fund have available funds to
cover.
I. Biostatistics and Bioinformatics
Free consulting services are offered through the Center for Biostatistics and
Bioinformatics in the Guyton Building. We strongly encourage you to take advantage of these
services for your research projects, both when planning the project [particularly if you need a
power analysis] and during data analysis. While appointments can be scheduled [and this is
encouraged], there are also walk-in hours available every Friday morning from around 10 AM
until Noon on a first come, first serve basis on the 6th floor.
J. Anatomic Dissections
All PGY2 residents will perform a comprehensive head and neck cadaver dissection and present
this information to the other residents and faculty. In preparation for the last session, the PGY-2
residents will tag various anatomic structures to challenge the knowledge of the other residents
[and possibly faculty]. The challenge will take place in a similar format to a gross anatomy
practical, with similar requirements to identify sidedness [right vs. left] and be as specific as
possible in relationship to the anatomic structure.
VI.
Resident Evaluation Process
A. Expectations
1. Perform all assigned operating room, clinic and ward duties for your level of training
in a reasonable fashion.
2. Participate in all otolaryngology teaching conferences. Arrive early in order to start
on time.
3. Complete at least two research projects of appropriate levels following the
guidelines of the research rotation and submit for publication and presentation during
your residency
4. Present at least two papers at the annual resident research forum during their
tenure, one each in the PG4 and PG5 years.
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5. Meet all mutually agreed upon deadlines for manuscript preparation and
submission.
6. PGY2-5 residents must read the entire Home Study Course, complete the exam in
its entirety exclusively by yourself, and submit it on time for the first grading, achieving
a grade of at least 80% correct. Failure to submit the Home Study Course or repeated
late submissions will require a meeting with the Program Director. Continued failures
will result in serious repercussions.
7. We encourage you to achieve a score of at least the 5th stanine for your year on
the Annual Otolaryngology Training Examination. If you do not achieve this goal, you
will meet with the Program Director and we will offer assistance by encouraging an
individualized instruction/reading program or any other guidance as needed. PGY2-5
residents are required to take this examination.
8. Pursue an active course of independent reading.
9. Research and present a topic (approved by the residency director) in a written and
oral presentation format to the faculty and residents once per academic year.
10. Be responsible for checking your departmental e-mail at least once every day of the
work week.
11. Keep an up-to-date (weekly), complete, and accurate operative case log on the
ACGME web site. Special emphasis should be given to documenting resident
assistant and resident supervisor at surgery cases. These logs will be reviewed at
least semi-annually with the program director. It is strongly recommended that each
resident keep his/her own personal log of performed surgery cases for future needs,
such as hospital privileging requirements, but also as a check and balance to the
official ACGME web case log, in case data is inadvertently lost. It is also strongly
recommended that each resident document participation in any laser cases, recording
the type of laser and how it was used.
12. Stay current with your medical records. Each resident is required to review, edit,
and sign completed dictations on the ESA system on at least a weekly basis. Each
resident is also required to sign the documentation sheet at Incomplete Medical
Records weekly, regardless of rotation. Failure to stay current on medical records and
sign the documentation sheet will require a meeting with the Program Director.
Continued failures will result in serious repercussions.
13. Complete all assigned Healthstream Modules on time. This is an institutional
requirement which is tracked by our Department and UMC. Failure to complete the
Healthstream modules or repeated late completions will be addressed by the Program
Director. Continued failures will result in serious repercussions, some of which may be
institutional and outside the control of the Program Director.
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14. Obtain and maintain appropriate licensure and credentials.
15. Follow the policies and procedures outlined in this manual.
16. Keep the resident work/consult rooms clean and tidy at all times.
17. Achieve and demonstrate competencies in:
a)
Patient care
b)
Medical knowledge
c)
Practice-based learning and improvement
d)
Interpersonal and communication skills
e)
Professionalism
f)
Systems-based practice
18. Be sure to review the educational objectives for M3/M4 courses at the start of each
year. These are located on the G drive in the Residency folder.
19. Review each year the Criteria for Advancement or Graduation applicable to your
PGY level. PGY-1 level residents also have institutional requirements which must be
met prior to advancement to the PGY-2 level. Failure to meet these requirements will
prevent PGY level advancement, and may have institutional repercussions outside the
control of the program director.
20. Each resident will be expected to complete projects assigned by the program
director addressing each competency throughout his/her five years. Completed and
ongoing projects will be placed in a portfolio. Each resident is expected to complete
his/her portfolio project following any deadlines delineated by the program director or
other faculty member sponsoring the portfolio project. Each resident is expected to
participate in the Observed Simulated Clinical Examination specifically designed for
his/her level of training, which will also assess all six competencies. At the completion
of five years, it is expected that each resident will complete at least one to two project
addressing each of the six competencies.
B. Evaluation Criteria
1. Competency: Patient Care
Goal: To provide patient care that is compassionate, appropriate, and effective for the treatment
of health problems and the promotion of health.
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a)
b)
c)
gather essential and accurate information about their patients
(1)
Efficiently performs a complete history relevant to the clinical situation (Tools:
Observation, patient simulation, case scenario discussions, quarterly medical record
audit, 360, portfolio projects)
(2)
Performs an appropriate physical examination and recognizes relevant findings (Tools:
Observation, patient simulation, case scenario discussions, quarterly medical record
audit, 360, portfolio projects)
(3)
Completes medical records assignments in a logical, complete, and timely manner
(visits medical records once a week at a minimum) (Tools: Quarterly medical records
review, weekly medical records reports, weekly sign in sheet, faculty review weekly)
(4)
Dictates consultation, operative, and clinic notes the same day as they are performed
and consistently follows the established guidelines for such (Tools: Weekly medical
records reports, quarterly medical records review, faculty review weekly)
develop and carry out patient management plans
(1)
Develops an appropriate treatment plan for the clinical situation (Tools: Observation,
patient simulation, case scenario discussions, 360, portfolio projects)
(2)
Follows patient management plans through to implementation (Tools: Observation,
360, portfolio projects)
counsel and educate patients and their families
(1)
d)
e)
Provides patients clear information about treatment programs and options, health
maintenance, and illness prevention (Tools: Observation, patient simulation, case
scenario discussions, patient questionnaires, 360, portfolio projects)
perform competently all medical and invasive procedures considered essential
for the area of practice
(1)
Incorporates new surgical techniques into clinical practice. (Tools: Observation,
biannual case log review)
(2)
Uses surgical instrumentation appropriately (Tools: Observation, cadaver dissections)
(3)
Can complete graduate level relevant procedures using a correct sequence and
demonstrating appropriate tissue handling (Tools: Observation, cadaver dissections,
surgical check lists)
provide health care services aimed at preventing health problems or maintaining
health
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(1)
Values patient education as the foundation of compliance, and disease management and
treatment (Tools: Observation, 360, portfolio projects)
2. Competency: Medical Knowledge
Goal: Demonstrates appropriate knowledge about established and evolving biomedical, clinical,
and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this
knowledge to patient care
a)
b)
demonstrate an investigatory and analytic thinking approach to clinical situations
(1)
Takes an organized and rational approach incorporating relevant medical knowledge
into recognizing clinical conditions and formulating therapeutic plans (Tools:
Observation, patient simulation, case scenario discussions, 360, portfolio projects)
(2)
Seeks out opportunities to do extra research, attain new skills, or to be involved in all
phases of patient care (Tools: Observation, 360)
know and apply the basic and clinically supportive sciences which are
appropriate to their discipline
(1)
Pursues an active, independent reading program to develop and improve his/her
knowledge base (Tools: Observation, participation in conferences, annual examination
scores, portfolio projects)
(2)
Actively engages in departmental educational conferences (Tools: Observation, 360,
attendance records)
(3)
Arrives at conferences in time to start on time, is present throughout except for
unavoidable situations, and behaves in a professional and respectful manner (Tools:
Observation, 360, attendance records)
(4)
Attends and participates in learning at regional and national educational conferences
(Tools: Observation, travel records, 360)
(5)
Displays appropriate knowledge of relevant anatomy, physiology, and pathophysiology
(Tools: Observation, case scenario discussions, departmental conferences, clinical
interactions, annual examination scores, 360, portfolio projects)
(6)
Performs above the 50th percentile for level on the Annual Otolaryngology
Examination (Tools: Examination scores)
(7)
Independently completes and submits the Home Study Course and Self-Test on time
and with a score above 80% (Tools: Observation, quarterly report)
3. Competency: Practice-Based Learning and Improvement
Goal: Learns and demonstrates practice-based learning and improvement that involves
investigation and evaluation of their own patient care, appraisal and assimilation of scientific
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evidence, and improvements in patient care
a)
b)
analyze practice experience and perform practice-based improvement activities
using a systematic methodology
(1)
Able to describe the process of practice assessment: identifying key issues for
improvement, analysis, implementing change, analysis of change (Tools: Observation,
case scenario discussions, 360, portfolio projects)
(2)
Develops and maintains a willingness to learn from prior experience (Tools:
Observation, 360)
(3)
Uses feedback to identify areas for improvement (Tools: Observation, 360, portfolio
projects)
(4)
Seeks opportunities to strengthen deficits in knowledge/skills (Tools: Observation, 360)
locate, appraise, and assimilate evidence from scientific studies related to their
patients’ health problems
(1)
c)
d)
Locates, appraises, and assimilates evidence from scientific studies related to his/her
patients’ health problems and effectively counsels and educates patients and their
families (Tools: Observation, journal club discussions, presentations, performance
improvement conference, 360, portfolio projects)
obtain and use information about their own population of patients and the larger
population from which their patients are drawn
(1)
Applies knowledge of established clinical guidelines and procedural standards to
his/her practice (Tools: Observation, journal club discussions, presentations, case
scenario discussions, performance improvement conference, 360, portfolio projects)
(2)
Describes and applies epidemiologic information to assess risk/prognosis and to assist
in health maintenance and disease management (Tools: Observation, journal club
discussions, presentations, case scenario discussions, performance improvement
conference, 360, portfolio projects)
apply knowledge of study designs and statistical methods to the appraisal of
clinical studies and other information on diagnostic and therapeutic effectiveness
(1)
Applies knowledge of study designs and statistical methods to the appraisal of clinical
studies and other information on diagnostic and therapeutic effectiveness (Tools:
Observation, journal club discussions, presentations, case scenario discussions,
performance improvement conference, 360, portfolio projects)
(2)
Actively participates in Journal Club and displays an increasing understanding of the
medical literature (Tools: Observation, 360)
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e)
f)
use information technology to manage information, access on-line medical
information; and support their own education
(1)
Uses information technology to manage information and access the latest on-line
medical information and actively encourages the patient team to incorporate new
information (Tools: Observation, research program participation, performance
improvement conference, resident presentation, 360, portfolio projects)
(2)
Performs critical appraisal of the literature utilizing basic biostatistical techniques and
principles of evidence based medicine (Tools: Observation, research program
participation, performance improvement conference, resident presentation, journal club,
360, portfolio projects)
(3)
Researches and presents a clinical topic (approved by the residency director) in a
written and presentation format to the department once per academic year (Tools:
Observation)
(4)
Makes progress toward and completes two scholarly activities as prescribed and
submits them for national presentation and/or publication as well as the Annual
Resident Research Day (Tools: Observation, resident records)
(5)
Meet all mutually agreed upon deadlines for research proposals, presentations, and
manuscript preparation and submission (Tools: Observation, 360)
facilitate the learning of students and other health care professionals
(1)
Demonstrates responsibility and leadership in engaging learners in the educational
process (Tools: Observation, resident and medical student evaluations, 360)
(2)
Teaches effectively by providing learner-appropriate content, supervision, and
coaching/feedback (Tools: Observation, resident and medical student evaluations, 360)
(3)
Consistently acknowledged as an excellent teacher (Tools: Observation, resident and
medical student evaluations, 360)
4. Competency: Interpersonal and Communication Skills
Goal: Develops and uses interpersonal and communication skills that result in effective
information exchange and teaming with patients, their families, and professional associates
a)
b)
create and sustain a therapeutic and ethically sound relationship with patients
(1)
Observed to develop an effective patient-physician relationship (Tools: Observation,
patient questionnaires, 360, portfolio projects)
(2)
Communicates concern for others (Tools: Observation, 360, portfolio projects)
use effective listening skills and elicit and provide information using effective
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nonverbal, explanatory, questioning, and writing skills
c)
(1)
Performs effective patient and family interviews (Tools: Observation, patient
simulation, patient questionnaires, 360, portfolio projects)
(2)
Conveys bad news in a manner that supports the emotional needs of the recipients of
the information (Tools: Observation, patient simulation, case scenario discussions, 360,
portfolio projects)
(3)
Listens well (Tools: Observation, patient simulation, 360, portfolio projects)
(4)
Effectively adapts communication style with patients to maximize accurate
understanding (Tools: Observation, 360, portfolio projects)
(5)
Checks e-mail and departmental mail box at a minimum of twice a week and responds
in a timely fashion when appropriate (Tools: Observation, quarterly audits, 360)
work effectively with others as a member or leader of a health care team or other
professional group
(1)
Communicates effectively verbally with peers, other members of the health care team,
and the community at large (Tools: Observation, 360, portfolio projects)
(2)
Produces clear medical notes, requests for consultation, and responses to requests for
consultation (Tools: Observation, weekly and quarterly medical record reviews, 360)
(3)
Actively fosters collaboration among team members and other disciplines (Tools:
Observation, 360)
(4)
Asks others on patient care team to share ideas and viewpoints. (Tools: Observation,
360)
(5)
Works effectively in team settings by identifying roles and assignments, planning and
prioritizing, accepting responsibilities and assisting others (Tools: Observation, 360)
(6)
Resolves conflict by listening and explaining, giving feedback, and establishing
respect, trust, and consensus (Tools: Observation, 360)
(7)
Keeps the faculty informed about relevant patient care issues in a timely fashion
(Tools: Observation, 360)
5. Competency: Professionalism
Goal: Manifests a commitment to carrying out professional responsibilities, adherence to ethical
principles, and sensitivity to a diverse patient population
a)
demonstrate respect, compassion, and integrity; a responsiveness to the needs
of patients and society that supersedes self-interest; accountability to patients,
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society, and the profession; and a commitment to excellence and on-going
professional development
b)
(1)
Demonstrates respect and compassion for the patients and staff (Tools: Observation,
360, portfolio projects)
(2)
Provides needed care with the same standards of quality for all patients, regardless of
type of reimbursement or ability to pay (Tools: Observation, 360)
(3)
Demonstrates knowledge of the health care needs of the community (Tools:
Observation, 360, portfolio projects)
(4)
Recognizes his/her responsibility to the patient and society (Tools: Observation, 360,
portfolio projects)
(5)
Is neatly dressed and presents a professional image (Tools: Observation, 360, portfolio
projects)
(6)
Is punctual and available when appropriate (Tools: Observation, 360)
(7)
Is aware of the benefits of a healthy lifestyle (Tools: Observation, 360)
(8)
Displays an understanding of effective time management (Tools: Observation, 360)
(9)
Strives to maintain professional and mutually respectful working relationships with
both peers and subordinates. (Tools: Observation, 360)
(10)
Completes all assigned academic, clinical, and administrative tasks as outlined in the
residency manual in a timely fashion (Tools: Observation, documented completion of
assigned tasks, 360)
(11)
Keeps an up-to-date, complete, and accurate operative case log on the format provided
by the ACGME (Tools: Observation, semiannual review)
(12)
Obtains and maintains all appropriate licensure and credentialing meeting assigned
deadlines (Tools: Observation, confirmation of completion)
(13)
Maintains personal composure, patience, professionalism in all situations (Tools:
Observation, 360)
(14)
Seen as a role model as a physician (Tools: Observation, 360)
demonstrate a commitment to ethical principles pertaining to provision or
withholding of clinical care, confidentiality of patient information, informed
consent, and business practices
(1)
Displays sound moral/ethical judgment in patient care and business practice (Tools:
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Observation, 360, portfolio projects)
c)
(2)
Keeps patient information confidential (Tools: Observation, 360)
(3)
Acts in a trustworthy manner (Tools: Observation, 360)
demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and
disabilities
(1)
Demonstrates sensitivity and responsiveness to patients’ culture, age, gender, and
disabilities. (Tools: Observation, 360, portfolio projects)
(2)
Demonstrates appropriate knowledge and displays proper behaviors regarding gender
discrimination, racial discrimination, and sexual harassment issues (Tools:
Observation, 360, portfolio projects)
(3)
Demonstrates knowledge of issues of impairment, including alcohol and substance
abuse, and reporting obligations for impaired physicians as well as the resources
available for assistance (Tools: Observation, 360)
(4)
Serves as the patient’s advocate (Tools: Observation, 360)
(5)
Shows interest in and concern for patients in daily interactions (Tools: Observation,
360)
6. Competency: Systems-Based Practice
Goal: Manifests actions that demonstrate an awareness of and responsiveness to the larger
context and system of health care and the ability to effectively call on system resources to
provide care that is of optimal value
a)
understands how their patient care and other professional practices affect other
health care professionals, the health care organization, and the larger society
and how these elements of the system affect their own practice
(1)
b)
Displays such understanding in group discussions and practice (Tools: Observation,
journal club discussions, participation in socioeconomic discussions, case scenario
discussions, 360, portfolio projects)
knows how types of medical practice and delivery systems differ from one
another, including methods of controlling health care costs and allocating
resources
(1)
Differentiates between various health care delivery organizations and payer systems
(Tools: Observation, journal club discussions, participation in socioeconomic
discussions, case scenario discussions, 360)
(2)
Able to discuss common reimbursement methodologies (Tools: Observation,
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participation in socioeconomic discussions, 360)
c)
d)
e)
(3)
Displays an understanding of documentation criteria for different levels of care (Tools:
Observation, participation in socioeconomic discussions, 360)
(4)
Understands precepts of compliance and privacy regulations (Tools: Observation,
participation in socioeconomic discussions, 360)
(5)
Identifies factors that contribute to rising health care costs and strives to lessen these
when appropriate (Tools: Observation, participation in socioeconomic discussions,
360)
practices cost-effective health care and resource allocation that does not
compromise quality of care
(1)
Practices cost-effective health care and resource allocation without compromising
patient care (Tools: Observation, case scenario discussions, 360)
(2)
Considers cost/benefit analysis in providing clinical care (Tools: Observation, case
scenario discussions, 360)
advocates for quality patient care and assists patients in dealing with system
complexities
(1)
Recognizes potential conflicts of interest between the individual patients and their
health care organizations (Tools: Observation, 360)
(2)
Anticipates problems patients/caregivers may face in negotiating the health care system
and advocates when appropriate on the patient’s behalf (Tools: Observation, 360)
knows how to partner with health care managers and health care providers to
assess, coordinate, and improve health care and know how these activities can
affect system performance
(1)
Partners with health care managers and health care providers to improve patient care
(Tools: Observation, case scenario discussions, 360)
(2)
Identifies ways in which the physician may interact with health-care professionals,
health administrators, and community groups to positively impact the health and well
being of the community (Tools: Observation, case scenario discussions, 360, portfolio
projects)
(3)
Functions as the coordinator of a health-care team to manage complex patient issues
(Tools: Observation, 360, portfolio projects)
7. Overall
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a)
Appears to have the potential of becoming an independent and competent
practicing Otolaryngologist-Head and Neck Surgeon
C. Feedback of Results
A quorum of the entire departmental faculty will meet semi-annually to assess the resident’s
progress in meeting the above performance criteria and assess progress in the resident’s
surgical/procedural competency. Faculty and external reviewers will complete 360 degree
evaluations of each resident. Residents will also complete self-evaluations and peer evaluations
semi-annually. The results will be collated and reviewed with each resident individually by the
program director. Residency operative experience will be reviewed as well to allow adjustments
in resident rotations to achieve balance in case-load. The resident will have the opportunity to
provide feedback about their progress at that time. A written summary will be reviewed with the
resident and kept in their file. End of rotation evaluations by the faculty will be provided to
residents on the alternate quarters such that the resident will receive an evaluation after every
rotation.
The program director will also meet with each resident on alternate quarters to allow the resident
to provide feedback about the program and the resident’s individual progress. Progress towards
goals will be assessed at that time and adjustments in resident training made as required.
The chair will meet at least annually to discuss career planning with each senior resident, and
any junior resident who so desires.
D. Promotion of Residents
The progress of the residents will be reviewed on a biannual basis or more frequently as
necessary. This will consist of a meeting of the faculty at which time the residents’ progress and
achieving the goals and objectives of the residency program will be evaluated. In addition,
specific criteria have been defined by the Department faculty for advancement and promotion
from each PGY level and for graduations from the PGY-5 year to independent practice. Those
residents that have been successful in reaching these goals and fulfilling all the designated
criteria for his/her applicable PGY level at the end of the year will be promoted to the next level
as appropriate. Those residents that are not judged to have met these standards will be subject to
the procedure described for probationary status, grievance, suspension, non-renewal or dismissal.
E. Probationary Status, Suspension, and Dismissal
The position of the resident presents the dual aspect of a student in graduate training while
participating in the delivery of patient care. The Department of Otolaryngology &
Communicative Sciences is committed to the maintenance of a supportive educational
environment in which residents are given the opportunity to learn and grow. Inappropriate
behavior in any form in this professional setting is not permissible. A resident’s continuation in
the training program is dependent upon satisfactory performance as a student, including the
maintenance of satisfactory professional standards in the care of patients and interactions with
others on the health care team. The resident’s academic evaluation will include assessment of
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behavioral components, including conduct that reflects poorly on professional standards, ethics,
and collegiality. Disqualification of a resident as a student or as a member of the health care
team from patient care duties disqualifies the resident from further continuation in the program.
1. Probationary Status
Failure to comply with departmental rules and guidelines or failure to meet the goals and
objectives outlined for the given stage of training in the expected manner will result in a
probationary status for the resident. In addition to other behaviors listed herein and in general,
unsatisfactory performance rating in two or more competency areas will be grounds for
probationary status. A “needs improvement” rating in four or more competency areas will also
be grounds for probationary status. The resident will be notified verbally and in writing.
The goal of probation is to provide a learning environment that will allow the resident to focus
on and improve deficient areas. To achieve this goal the following will be implemented.
a)
Written identification of areas of deficiency and expectations for improvement.
b)
Assignment of a mentor.
c)
Monthly meetings of the resident and the Program Director to evaluate progress
d)
Additional didactic programs and individualized tutorials as determined by the
program director
Probationary status will be reviewed every 3 months, and the resident’s progress will be
reviewed. The faculty may return the resident to regular status, recommend an extended period
of probation, or recommend termination. The failure to remedy documented deficiencies while
on probation constitutes grounds for dismissal from the residency program.
2. Suspension
The Chief of Staff of a participating and/or affiliated hospital where the resident is assigned, the
Dean, the President of the Hospital, the Chair or Program Director may at any time suspend a
resident from patient care responsibilities. The resident will be informed of the reasons for the
suspension and will be given an opportunity to provide information in response.
The resident suspended from patient care may be assigned to other duties as determined and
approved by the Chair. The resident will either be reinstated (with or without the imposition of
academic probation or other conditions) or dismissal proceedings will commence by the
University against the resident.
Any suspension and reassignment of the resident to other duties may continue until final
conclusion of the decision-making or appeal process. The resident will be afforded due process
and may appeal as set forth below.
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3. Nonrenewal
In the event that the Program Director decides not to renew a resident’s appointment, the resident
will be provided written notice four months prior to the termination of their current contract
which will include a statement specifying the reason(s) for non-renewal.
If requested in writing by the resident, the Chair will meet with the resident; this meeting should
occur within 10 working days of the written request. The resident may present relevant
information regarding the proposed non-renewal decision. The resident may be accompanied by
an advisor during any meeting held pursuant to these procedures, but the advisor may not speak
on behalf of the resident. If the Chair determines that the non-renewal is appropriate, he or she
will use their best efforts to present the decision in writing to the resident within 10 working days
of the meeting. The resident will be informed of the right to appeal as described below.
4. Dismissal
In the event the Program Director of a training program concludes a resident should be dismissed
prior to completion of the program, the Program Director will inform the Chair in writing of this
decision and the reason(s) for the decision. The resident will be notified and provided a copy of
the letter of proposed dismissal; and, upon request, will be provided previous evaluations,
complaints, counseling, letters and other documents that related to the decision to dismiss the
resident. If requested in writing by the resident, the Chair will meet with the resident; this
meeting should occur within 10 working days of the written request. The resident may present
relevant information regarding the proposed dismissal. The resident may be accompanied by an
advisor during any meeting held pursuant to these procedures, but the advisor may not speak on
behalf of the resident. If the Chair determines that dismissal is appropriate, he or she will use
their best efforts to present the decision in writing to the resident with in 10 working days of the
meeting. The resident will be informed of the right to appeal as described below.
5. The following items are some but not all grounds for immediate suspension,
probation, or dismissal:
a)
Abandonment of a patient or patient care duties.
b)
Illegal or grossly unprofessional conduct.
c)
Malperformance of duties with potential for serious harm to patients.
d)
Performance of duties while under the influence of drugs or alcohol.
e)
Insubordination to faculty members or staff.
f)
Absence from the program without prior approved leave.
g)
Breach of contract.
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h)
Excessive moonlighting that interferes with the performance of resident duties.
i)
Misconduct as listed in the UMMC Employee Handbook Rules and Regulations.
F. Procedure for Appeal and Grievance
House staff shall have the rights of grievance procedures as detailed in the Handbook for
Employees of the University Medical Center, the Medical Staff Bylaws, Rules, and Regulations
of the University Hospitals and Clinics, and in the University of Mississippi Medical Center
Graduate Medical Education Evaluation Policy and Grievance Algorithm.
All trainees at the University of Mississippi Medical Center will receive both formative and
summative evaluation on a periodic basis. Attending physicians are expected to provide feedback
and constructive criticism on all aspects of the trainee’s performance, including but not limited
to, clinical judgment, medical knowledge base, data gathering skills (history taking, physical
exam, old record review, lab follow-up), procedural skills, humanistic attributes,
professionalism, over-all patient care skills as well as all behaviors defined within the six
ACGME descriptive areas of competency. Trainees should expect direct constructive criticism
and suggestions for improvement. The Training Program Director or his/her designee will meet
individually at least semiannually to review each house officer’s overall performance and
progress in the training program.
The details of the process of resident evaluation and grievance will vary appropriate to the
requirements of the RRC or other accrediting agency for the resident’s specialty or subspecialty.
The process will typically include the elements described below.
The appeals process is as follows:
1. Attending Physician
If the trainee is performing at a low satisfactory or unsatisfactory level, the substandard
performance should be brought to the trainee’s attention as soon as possible. Performance
problems should be documented with clear suggestions regarding appropriate conduct for such
situations in the future. In addition to discussing the problem directly with the trainee, the
attending physician should notify the program director (preferably in writing) of the nature of the
problem as soon as possible. In some cases, changes in routine supervision on patient care
services may be warranted. If a trainee is unhappy with an evaluation or feels it is unfair, he/she
is encouraged to discuss the evaluation in detail with the attending physician. It is advisable that
the resident initial and date all documentation to signify his/her awareness of the opinions and
actions recorded.
2. Program Director
If after additional discussion, the trainee feels the evaluation is unjustified, he is asked to put his
complaint in writing and discuss the evaluation in detail with the program director, who will
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serve as a mediator. In most cases, after seeking input from all involved parties and reviewing
the situation in detail with both the attending physician and the trainee, the program director will
dictate a report to be included in the trainee’s file along with the original evaluation and the
trainee’s rebuttal and explanation. In some cases, the attending physician may wish to file an
amended evaluation. In all cases, the trainee is asked to define specific ways in which the
behavior can be changed or improved. In the setting of continued marginal or unsatisfactory
performance, a house officer may have clinical privileges revoked by the program director, and
be asked to function in a remedial role in which all aspects of patient care must be immediately
supervised by another physician including countersignature of all patient orders and notes. In
general, a remedial program will be established which includes reading assignments and didactic
conference attendance, (and in some cases language classes) in an effort to improve
performance. A specific probationary period will be defined.
3. Department Chairman
Unsatisfactory trainee performance may result in the dismissal from the program of the House
Officer. This decision will be made by the Program Director in consultation with the Chairman
of the Department. If a House Officer wishes to contest the Program Director’s decision for
termination from the training program, appeal for review can be addressed to a constituted
Departmental Grievance Committee composed of selected peers and faculty.
4. Appeal from Departmental Chair
House Officers may appeal grievable matters by petitioning in writing to the Vice Chancellor for
Health Affairs within fourteen calendar days of notice of termination from the program director
or chairman exclusive of University of Mississippi Medical Center holidays. Upon receipt of a
formal written request from a resident for review of a Department Chair’s / Program Director’s
action, the Vice Chancellor will select a member of the Graduate Medical Education Committee
to chair an appeals committee. The appeals committee chair will appoint an appeals committee
of four (4) additional GMEC or RRSC members, including at least one (1) member of the House
Staff. The appeals committee chair will promptly convene the committee to hear the appeal,
generally within ten (10 business days of the Vice Chancellor’s appointment of the appeals
committee chair. The decision of the appeals committee will be submitted to the Vice
Chancellor. The decision of the Vice Chancellor shall be final in accordance with the by-laws
and policies of the Board of Trustees of State Institutions of Higher Learning.
5. Grievable Issues
a)
Per the University of Mississippi Medical Center, the following issues are
considered “grievable”:
(1)
Complaints against faculty;
(2)
Disciplinary actions, including dismissals, demotions and suspensions;
(3)
Application of personnel policies, procedures, rules and regulations, ordinances and
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statutes;
b)
(4)
Acts of reprisal against employees using the grievance procedure;
(5)
Complaints of discrimination on the basis of race, color, creed, political affiliation,
religion; age, disability, national origin, sex, marital status, veteran status; or
(6)
Any matter of concern or dissatisfaction to an employee if the matter is subject to the
control of institutional management.
Likewise, the following issues are considered “nongrievable”:
(1)
Scheduling and staffing requirements;
(2)
Issues which are pending or have been concluded by direct appeal through an
administrative or judicial procedure;
(3)
Temporary work assignments which do not exceed 90 calendar days;
(4)
Budget and organizational structure, including the number of assignment of employees
or positions in any organizational unit;
(5)
The measurement and assessment of work through performance appraisal, except
where the employee can show that the evaluation was discriminatory, capricious, or not
job related;
(6)
The selection of an individual by a department head or designee to fill a position
through promotion, transfer, demotion, or appointment unless it is a violation of
UMMC or Board of Trustees policy;
(7)
Internal security practices established by the institution, department head or designee;
(8)
Termination or layoff from duties because of lack of work, reduction of the work force,
or job elimination;
(9)
Voluntary resignation by an employee bars action under the grievance procedures;
(10)
Any matter not within jurisdiction or control of the institution;
(11)
Content of published UMMC polices or procedures;
(12)
An action by the institution pursuant to federal or state law or directions from the
Board of Trustees of State Institutions of Higher Learning; or
(13)
Establishment and revision of wages and salaries, position classification and general
benefits.
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VII.
Program and Faculty Evaluation
The faculty will review the success of the program in meeting its goals and objectives in its
regular monthly meetings and during a single session devoted exclusively to this once a year. A
resident representative will attend all meetings. Crucial to this review will be the annual
confidential written review of the program by the residents, as well as by the faculty. The results
of this review will be discussed with the entire faculty as well as the residents after the results are
confidentially collated. Additional material considered will include: board pass rates; Annual
Otolaryngology Examination scores; attainment of fellowships, academic positions, and suitable
private practice positions; and operative case experiences.
In addition to the residents anonymously evaluating both the faculty and program once a year,
the program director will annually evaluate the academic faculty and approve or disapprove
faculty members continued participation in the program. Faculty members are annually provided
with the minimum criteria required to receive approval for continued participation in the
residency program.
VIII. Policies
In addition to the policies outlined below, you are to comply with all applicable policies and
procedures of the University of Mississippi Medical Center, the VA Medical Center, and any
other affiliated clinical facilities.
A. Duty Hours
As per ACGME program requirements, our program works to ensure a culture of
professionalism that supports patient safety and personal responsibility.
Residents and faculty members must demonstrate an understanding and
acceptance of their personal role in the following:
a) assurance of the safety and welfare of patients entrusted to their care;
b) provision of patient- and family-centered care;
c) assurance of their fitness for duty;
d) management of their time before, during, and after clinical assignments;
e) recognition of impairment, including illness and fatigue, in themselves and in their
peers;
f) attention to lifelong learning;
g) the monitoring of their patient care performance improvement indicators; and,
h) honest and accurate reporting of duty hours, patient outcomes, and clinical
experience data.
All residents and faculty members must demonstrate responsiveness to patient needs that
supersedes self-interest. Physicians must recognize that under certain circumstances, the best
interests of the patient may be served by transitioning that patient’s care to another qualified and
rested provider.
1. All residents will have at least one day in seven free from patient care
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responsibilities averaged over a four-week period and at home call cannot be assigned
during those free days.
2. Residents will not be scheduled for more than 80 duty hours per week, averaged
over a four-week period, inclusive of all in-house time and all moonlighting. Only time
actually spent in the hospital when on call will count towards the weekly duty hour limit.
All moonlighting, whether internal or external, is counted towards duty hours.
3. Call is taken from home except when prescribed for specific cases at the discretion
of the attending physician in consultation with the program director. First call will be no
more than every third night, averaged over a four-week period.
4. Duty periods for PGY-1 residents must not exceed 16 hours in duration.
5. For PGY-2 residents and above, duty periods (actual time in the hospital) will be
limited to a 24-hour period of continuous in-house duty. Any resident that exceeds this
limitation or any resident that becomes unable to take or continue taking call due to any
reason should notify the program director or the on-call physician so that the call back
up plan can be instituted in the order outlined as required.
a)
Strategic napping, especially after 16 hours of continuous duty and between the
hours of 10:00 p.m. and 8:00 a.m., is strongly suggested.
b)
It is essential for patient safety and resident education that effective transitions in
care occur. Residents may be allowed to remain on-site in order to accomplish
these tasks; however, this period of time must be no longer than an additional
four hours.
c)
The interval for rest and personal activities after a call period should consist of a
10 hour time period.
d)
The second call resident will relieve the first call resident.
e)
The attending will relieve the second call resident if the second call resident
exceeds the limits.
6. Residents are actively encouraged to tell the program director if they exceed any of
the duty hour guidelines or have any concerns regarding this issue. In order to ensure
compliance, a log of a typical trauma call week will be compiled by all residents each
quarter and reviewed by the program director. In the event that any resident exceeds
80 hours for that week, the monitoring period will be extended for the entire month. If
any problem is encountered with the limit after the month long monitoring, weekly logs
will be continued until an acceptable and steady state workload has been comfortably
reached. Quarterly monitoring will then be resumed.
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The Institutional Policy for Duty Hours, Patient Hand-offs, and Resident Supervision is
on the G Drive, in addition to any supplemental policies for the Department on Duty
Hours and Resident Supervision. A Global Preferences list is on the G drive to serve as
guidance on communication with faculty, but as a general rule, when in doubt, please
contact your supervising or on-call attending physician. Individual Physician
Preferences are posted on the G drive as well.
B. Lab Coats
All residents may get two lab coats at the start of each year; the GME office provides the PGY-1
residents with three lab coats. Lab coats must be clean and present a professional appearance.
Lab coats will display the appropriate monogramming and departmental identifiers. The
department will provide laundry service for lab coats. Additional lab coats will be provided on a
case-by-case basis.
C. Professional Attire
1. Men and women shall dress professionally when seeing patients in the outpatient
setting. This will include a tie for men. This attire is required at all times when in the
institution. However, exceptions can be made for this depending on the individual
faculty member running a particular clinic. In some cases, clinics where procedures are
common or for any other reason, scrubs may be worn at the discretion of the faculty
member.
2. Scrubs should not be worn in the outpatient setting for regularly scheduled sessions
[see above exception]. They are permissible outside the OR on days when the
resident is in the OR and is not scheduled to see patients in the outpatient setting. Lab
coats should be worn over scrubs when seeing patients in the hospital.
3. Operating room head covers, masks, and shoe covers should not be worn outside
of the OR.
D. Benefits (A complete description is available from Human Resources)
1. Medical and liability coverage are provided for the house staff free of charge.
There is an additional charge for family medical coverage.
2. Optional Benefits (other less common benefits are available as well)
a)
Life Insurance
(1)
Term Life
(2)
Supplemental Term Life
(3)
Whole Life
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(4)
Universal Life
b)
Accidental Death and Dismemberment
c)
Disability: Short Term & Long Term
d)
Dental & Vision
e)
Tax Sheltered Annuities
f)
Deferred Compensation Plans
g)
Flexible Benefits Plan (Allows certain insurance benefits and parking to be taken
as pretax dollars)
E. Meals
The UMMC and Wiser cafeterias give a 20% discount to UMMC employees. The GME office
provides meal tickets for those residents on call. Each ticket
F. Work Environment
1. Patient support services, such as, intravenous services, phlebotomy services and
laboratory services, as well as messenger and transporter services are provided for
patient care.
2. An effective laboratory, medical records, and radiologic information retrieval system
is in place to provide for appropriate conduct of the educational programs and quality
and timely patient care.
3. Appropriate security measures are provided to residents in all locations including
but not limited to parking facilities, on-call quarters, hospital and institutional grounds,
and related clinical facilities. Any concerns in this regard should be brought to the
attention of the program director.
G. Sexual Harassment
Sexual harassment is covered under the policies of the University of Mississippi Medical Center.
Sexual harassment is defined as unwelcome sexual advances, requests for sexual favors, and
other verbal or physical conduct of a sexual nature when: submission to such conduct is made
either explicitly or implicitly a term or condition of an individuals employment or academic
performance; submission to or rejection of such conduct by an individual is used as the basis for
employment or academic decisions affecting such individual, or; such conduct has the purpose or
effect of unreasonable interfering with an individual’s work or academic performance or creating
an intimidating, hostile or offensive working or educational environment.
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Any such conduct should be reported to the program director and/or the departmental chairman.
If you are uncomfortable discussing this issue with either of these individuals or you do not feel
your complaints have been or will be adequately addressed, contact the director for equal
opportunity employment at 601-984-1131.
H. Substance Abuse and Mental Health
1. The University of Mississippi Medical Center Faculty and Staff Handbook outline
the details of this policy.
2. Substance abuse interferes with the skills and judgment required for appropriate
patient care.
3. The faculty members and program director are responsible for monitoring residents
for signs of impairment from substance abuse as well as signs of stress, emotional
disturbance, or mental impairment. The faculty members have been educated
regarding this responsibility and the tenets of such monitoring. Any concerns are to be
reported to the program director immediately.
4. Any resident suspecting that they or any member of the faculty or staff may have a
problem with substance abuse should report this to the program director. All reports
will be confidential, and the department will be fully supportive of recovery efforts.
5. Any resident with a substance abuse problem will be offered rehabilitation
assistance to be arranged via the UMMC Human Resources office.
6. A resident with a current substance abuse problem will not be allowed to participate
in patient care until the situation has been resolved.
I. Counseling
The Director of Student/Employee Health is available to meet with residents regarding issues
pertaining to health, emotional or mental stress, substance abuse, or other related issues. The
Director will make further referrals if necessary. The UMMC Employee Assistance Program is
through LifeSynch and is available to all employees and their families.
J. Emergency Loans
There is an emergency loan service available to residents via the Alumni House. Call 984-1729
for applications and details on the different loan types available.
K. Library
No books are allowed to leave the Otolaryngology resident work room library for any purpose.
Books should be put back in the bookcases when you are not using them.
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L. Non-programmatic Activities (Moonlighting)
The ACGME Common Program Requirements reads as follows:
“Patient care activities that are external to the educational program (moonlighting) and that
exceed the weekly limit on resident duty hours are often inconsistent with sufficient time for rest
and restoration to promote the resident’s educational experience and safe patient care.
Therefore, these activities require prospective permission from the program director and
sponsoring institution. Their effect on resident performance must be monitored, and permission
be withdrawn if the activities adversely affect resident performance. “
The UMMC GMEC policy is as follows:
“In Mississippi, it is illegal and/or grounds for loss of temporary or limited medical licensure for
any resident or fellow in training to engage in moonlighting unless in possession of an
unrestricted license to practice medicine in the State. Residents are not required to engage in
moonlighting; further, the University of Mississippi Medical Center (UMMC) discourages
moonlighting or professional activity by residents or fellows apart from full-time UMMCsponsored or ACGME-sanctioned postgraduate educational programs because these activities
tend to interfere with the educational process and health of the physician-in-training. The
program director must acknowledge in writing that a resident or fellow is moonlighting, and the
information made a part of the resident’s folder. The effects of moonlighting on performance in
the residency program will be monitored and adverse effects may lead to withdrawal of
permission to engage in moonlighting activities.
The University of Mississippi Medical Center professional liability program for residents only
applies to those professional activities within the course and scope of their employment while at
UMMC and/or on official rotation at other hospitals or clinics. It does not apply to outside
professional activities such as moonlighting.
The UMMC institutional DEA number must not be used while moonlighting.”
The Department will abide by these guidelines. Moonlighting is strongly discouraged.
Moonlighting may potentially interfere with resident education. Failure to abide by the policies
in this handbook or to perform at the level outlined in this manual are grounds for suspension of
moonlighting privileges at the discretion of the Program Director and the Chairman.
If you do choose to moonlight, a non-programmatic activity form, available from the housestaff
office, must be obtained, completed, and updated as prescribed. In addition, an outside activities
form is required. This is the sole responsibility of the participating resident. These documents
require the signature of the program director. Failure to do so in a timely or regular fashion,
without prompting, will result in immediate termination of this privilege.
Hours spent moonlighting must be counted towards the 80 hour work week and reported
accurately by the resident. Failure to do so will have serious consequences, some of which may
be institutional and outside the control of the program director. In addition, according to
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ACGME Duty Hours regulations and institutional policy, residents must report to work rested
and “fit for duty.” Failure to follow these regulations and policies will require investigation by
the program director and may result in action by the program director, department, or institution.
M. Licensure, Credentials, and Memberships
1. Licensure
Appropriate Mississippi medical licensure must be maintained at all times so that the resident has
all rights and privileges to practice medicine and prescribe medications in all departmental
practice settings. Currently, an institutional medical license satisfies these requirements.
The University of Mississippi Medical Center Graduate Medical Education Office has discussed
the possibility that all residents should sit for USMLE Step 3 and get their permanent medical
license by the end of PGY-3. While this policy is now left to the discretion of the department,
we strongly encourage residents to follow this course.
2. Credentials
Credentials at participating and affiliated clinical institutions must be obtained and maintained.
3. Memberships
Residents will obtain and maintain resident membership in the American Academy of
Otolaryngology Head and Neck Surgery and the Triological Society.
N. Subscriptions
Residents will obtain in a timely fashion and maintain subscriptions to Laryngoscope, Archives
of Otolaryngology-Head and Neck Surgery, and Otolaryngology-Head and Neck Surgery. For
those journals requiring a subscription, residency education fund monies may be used. Journals
reviewed may be changed with prior notice.
O. Research Studies
Your complete cooperation is expected with all research protocols in the department. You must
complete and maintain all applicable institutional educational programs regarding proper conduct
of research.
P. Leave
1. Total Leave Allowable
All forms of leave (medical, family, annual, administrative) may be granted to residents at the
discretion of the Program Director in accordance with UMMC rules. The total of such leaves and
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vacation may not exceed 30 working days in any one year. If a longer leave of absence is
granted in any year, the required period of graduate medical education will be extended
accordingly. (Modified from the American Board of Otolaryngology booklet of information.)
2. Allocation of Leave
a)
Residents are granted 15 days of annual leave.
b)
PG4s and PG5s will be granted up to five days of personal leave for interviewing
or moving purposes only subject to the policy below (if you need more than this,
plan your personal leave accordingly). The granting of such leave is solely at the
discretion of the program director.
c)
Up to five days of personal/administrative leave will be granted for the purpose of
attending a meeting without presentation. Time for taking Step 3 of the USMLE
can be taken from these days.
d)
Up to five days of additional personal/administrative days may be granted on a
case-by-case basis for educational purposes if the meeting is deemed to be of
benefit to the resident or a presentation is being made. Other possibilities may
include undertaking a humanitarian mission trip.
e)
Under no circumstances can the total working days out exceed 30 days,
including sick leave or family medical leave, without resulting in an
extension in the required period for training.
3. Scheduling of Leave
In order to provide timely and reasonable care to patients and to promote resident
education, a policy for scheduling leave is developed for PGY 2-5 residents. Leave
scheduling for PG1 residents will be coordinated with the appropriate department in
which they are rotating.
a)
Leave can only be granted by permission in writing normally or verbally for
emergencies by the program director or his/her designee.
b)
Requests for scheduling any leave no matter what the type, even if assigned,
must be submitted on the appropriate form to the program coordinator for
approval by the program director thirty days in advance.
c)
Annual leave must be taken in five-day blocks. Exceptions may be allowed with
approval of the Residency Director particularly in the case of chief residents
needing to interview for a position.
d)
The requests for the three 5-day blocks of annual leave per resident will be
compiled, coordinated and completed by July 15th of each year, by the chief
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residents subject to the following guidelines:
e)
(1)
Annual leave must be assigned in proportion to the number of residents rotating on a
service, e.g. no more than 6 weeks from the H&N service. PG1 residents rotating on
otolaryngology services will need to have at least one week off from the service to
which they are assigned during that time.
(2)
No two residents may be gone on vacation from the same institution at the same time.
Exceptions will not be made for this except in the instance of the major otolaryngology
meetings when a large number of the faculty will be gone as well, emergencies, or in
the case of chief residents interviewing.
(3)
No vacations will be allowed in July, in the last week of June, or during major
otolaryngology meetings. PGY 2 residents may not take vacation during the anatomy
dissection or temporal bone courses. Exceptions will be considered for emergencies.
(4)
The vacation schedule is not final until all of the above criteria have been met and the
program director has signed off on it.
(5)
Changes later in the year will only be considered by the program director if they fall
within the guidelines outlined.
For scheduling of interview dates or extra days of annual leave if you had your
vacation during a holiday week, the following criteria will be considered:
(1)
Urgency of the need
(2)
No other residents or PEs out
(3)
Attending physicians on your service are out
(4)
Will be assigned if the criteria cannot be met.
f)
Graduating residents will be expected to work through June 30th. Graduating
residents required to start a fellowship on July 1st may leave early based on
need with approval by the program director.
g)
All residents are expected to be present for visiting professor related events
unless leave has been approved in advance regardless of the day or time of the
week.
4. Holidays will be granted to those residents who are not on call according to the
policy of the institution at which the resident is rotating on the day of the holiday.
5. Applicable leave, for purposes of residency training only, cannot be carried over to
the next year.
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6. Weekends
a)
From time to time educational events will be scheduled on weekends. Resident
attendance at these events is required.
b)
You may assume that your weekends are free:
c)
(1)
If you have not been given 90 calendar days notice that your attendance is required.
(2)
All resident call is covered.
(3)
If the weekend does not conflict with the annual otolaryngology examination, the
Academy meeting, the COSM meetings, visiting professor related activities, or the
holiday schedule.
Otherwise, you should not assume that you are free without asking specific
written permission for having the days free from duty.
7. Sick Leave
If, for whatever reason, you take sick leave, please inform the residency coordinator and program
director. When you return, you will need to submit the appropriate paperwork detailing the exact
dates that you were out. The full sick leave policy is available from the in the Faculty And Staff
Handbook.
Q. Educational Fund
1. Each PGY 2-5 resident receives up to 5 working days per year for educational
travel. You must attend at least one meeting each year. These should be taken as a
single block when possible.
2. Each PGY 2-5 resident receives a $1500 educational allowance. This is intended
to be used for travel to educational meetings. Balances remaining may not be carried
over to the next year. After attendance at an approved meeting(s), requests to use any
remaining money for other educational purposes, such as books, journals, and
educational equipment, will be considered on an individual basis. The request must be
submitted by June 1. PGY 1 residents receive an educational fund of $500 per year
and do not have to attend a meeting.
3. All travel requests must be submitted 6 weeks in advance.
4. All hotel and airlines reservations must be arranged according to UMMC policies to
ensure reimbursement.
5. Reimbursement is limited to registration, hotel, airfare or car allowance, and state
per diem. Reasonable parking and local transportation costs such as taxi and subway
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may be reimbursed as well. Receipts are required for these items. Meals will not be
reimbursed above the state per diem for any resident travel.
6. Priority for attending desired meetings will be given based on seniority and whether
or not you went the year before.
7. For PG2 and PG3 residents, it is strongly suggested that you attend either the
Academy or combined otolaryngology spring meetings (COSM). Exceptions will be
considered on an individual basis.
8. PG4 and PG5 may attend courses of their choice approved by the Residency
Director. Appropriate courses would include allergy, temporal bone, facial plastic,
practice management, sinus, and facial trauma courses. This list is not all-inclusive.
Courses sponsored by one of our societies are usually the best.
9. When attending educational meetings, you are expected to attend the meeting
sessions in their entirety with minimal exception.
10. If you independently obtain travel funds via a noncompetitive process or via your
own initiative, these funds will be sent directly to the department and the amount
placed in your individual travel/educational fund for you to use as under the current
guidelines. If you independently obtain funds or travel funds via a competitive process,
such as a research award, you may choose to have these funds directly mailed to you,
without need to have them go through your educational fund. Be aware, however, that
you will be responsible for any applicable taxes on this additional income taxes; this is
your responsibility, and the program is not responsible for any additional applicable
taxes, fees, or obligations. (Research grants, if awarded, will be used to fund
research.) If the travel funds are offered to us without your initiative, we will determine
on a case by case basis whether those funds should be placed in the group resident
fund which pays for all other resident expenses including presentation travel, inservice, home study, etc. or in your individual educational account.
R. Presentation Travel
1. Resident presentations may be reimbursed by the department subject to the
limitations under Educational Fund above if travel funds are available. Within
standards of reason, you should arrange the lowest airfare. These will be considered
on an individual basis regarding the merits of the presentations. Podium and poster
presentations at national meetings and podium presentations at regional and state
meetings are eligible.
2. Time off and reimbursement will be limited for presentations to the day before, the
day of, and the day after the presentation. You may use your own educational or
personal leave and your educational fund if you wish to stay longer.
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3. If other residents room with the resident traveling off presentation funds, all room
expenses must be split evenly among those residents staying in the room.
S. Resident Selection
1. Applications will be accepted via ERAS.
2. Technical standards for Otolaryngology have been established to allow the resident
candidate to determine their ability to perform the required duties in compliance with
the Americans with Disabilities Act. An otolaryngology resident must have abilities and
skills in five categories: observation, communication, motor, intellectual, behavioral and
social. However, it is recognized that degrees of ability vary widely between
individuals.
a)
Observation: A candidate must be able to observe a patient accurately at a
distance and close at hand. In detail, observation necessitates the functional use
of the sense of vision and other sensory modalities. Full color vision and
binocular vision are necessary for the successful performance of otolaryngologic
surgery.
b)
Communications: A candidate must be able to communicate effectively and
sensitively with patients. The focus of this communication is to elicit information,
describe changes in mood, activity, and posture, and perceive nonverbal
communications. Communication includes not only speech, but also reading and
writing. The candidate must be able to communicate effectively and efficiently in
oral and written formats with all members of the health care team.
c)
Motor: Candidates must have sufficient motor function to elicit information from
patients by palpation, auscultation, percussion, and other diagnostic maneuvers.
A candidate must be able to execute motor movements reasonably required to
provide general care and emergency treatments to patients. Such actions
require coordination of both gross and fine muscular movements, equilibrium,
and functional use of the senses of the touch and vision.
d)
Intellectual-Conceptual, Integrative and Quantitative Abilities: These abilities
include measurement, calculation, reasoning, analysis, and synthesis of complex
information.
e)
Behavioral and Social Attributes: A candidate must possess the emotional health
required for full utilization of his or her intellectual abilities, the exercise of good
judgment, the prompt completion of all responsibilities attendant to the diagnosis
and care of patients, and the development of mature, sensitive, and effective
relationships with patients. Candidates must be able to tolerate physically taxing
workloads and to function effectively under stress. They must be able to adapt to
changing environments, to display flexibility, and learn to function in the face of
uncertainties inherent in the clinical problems of many patients. Compassion,
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integrity, interpersonal skills, interest and motivation are all personal qualities that
are assessed during the selection and education process.
3. Applicants will be invited for interview based on a review of the following factors:
a)
performance on standardized tests,
b)
medical school performance,
c)
letters of recommendation,
d)
personal statement,
e)
extracurricular activities,
f)
and research activities.
4. Applicants will be ranked on the basis of the preceding factors in combination with a
subjective evaluation of the interview by the faculty.
5. Residents will be accepted via the National Residency Matching Program.
6. If the program does not fill through the usual matching process, the position will be
filled outside the match from available applicants. The most qualified individuals based
on the above factors will be invited for interview. The position will be offered based on
a vote of the faculty.
T. Conflict of Interest
Any gifts from corporate sponsors accepted by residents individually should primarily entail a
benefit to patients and should not be of substantial value. Accordingly, textbooks and other gifts
which serve a genuine educational function are appropriate. Cash payments should not be
accepted. Individual gifts of minimal value are permissible as long as the gifts are related to the
resident's work (e.g., pens and note pads).
Subsidies to underwrite the costs of resident conferences or professional meetings can contribute
to the improvement of patient care and therefore are permissible. Since the giving of a gift
directly to a resident by a company's sales representative creates a relationship which could
influence the use of the company's products, subsidies will be accepted by the program director
only who in turn will deposit the money into the resident education fund to improve the quality
of the conference. Payments to defray the costs of a conference should not be accepted directly
from the company by the residents attending the conference. Subsidies should not be accepted to
pay for the costs of travel, lodging or other personal expenses, nor should they be accepted to
compensate for the resident's time. All such support should be arranged via the program director
and the use of such funds will be assigned to resident activities designated by the program
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director.
No gifts should be accepted if there are strings attached. For example, residents should not
accept gifts if they are given in relation to the resident's prescribing practices. In addition, when
companies underwrite conferences or lectures other than their own, responsibility for selection of
content, faculty, educational methods and materials should belong to the organizers of the
conference or lectures, who should act independently.
IX.
Clinical Issues
A. Resident Duties
Team Rounding Policy: Regardless of PGY level or rotation, each team will round with
all PGY levels together that are assigned to that particular team. Patients within each
team will not be split up among the residents of an individual team, but will be rounded
on by the team as a whole. This is to improve patient care, foster a sense of team
“ownership” of patient care, reduce handoffs, and improve continuity. This does not
preclude individual residents breaking off from rounds to facilitate other aspects of
patient care, such as impending discharges.
1. Junior
a)
Responsible for the daily care of the inpatient services
b)
Performs medical histories and physical examinations in the outpatient clinics,
emergency departments, and for consultations
c)
Sees and evaluates consults as requested and discusses the case with the
senior resident and attending physicians
d)
Performs common procedures as required such as blood drawing, IV access,
and wound care
e)
Rounds with attending physicians
f)
Assures that patients are ready to go to the operating room
g)
Participates in all assigned surgical cases in the operating room
h)
Follows up on patient care data and issues
i)
Communicates with patients and family members if assigned this duty by
attending physicians
j)
Shares relevant patient data with senior residents and attending physicians
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k)
Presents cases at multidisciplinary patient management conferences
2. Senior
a)
Same duties as junior residents above
b)
Assists with the supervision and teaching of junior residents and medical
students
c)
Assists with the coordination and scheduling of the activities of the service
d)
Develops the resident call schedules in concert with the program director
B. Resident Distribution
1. Each faculty group will be assigned a group of residents. These residents will be
available for these physicians for all scheduled clinical activities. They will be assigned
to other services on days when there are no regularly scheduled activities. It is up to
the attending physicians on a service as to how they want to split their assigned
residents especially if they are at two different locations.
2. When there are residents with no assigned duties, those residents will be used in
the following order of priority:
a)
Cover UMMC vacations including PEs
b)
Consults
c)
Cases outside normal schedule
d)
OR for regularly scheduled services
e)
Clinic
3. If a case is added on or patients are seen in clinic on a day other than regularly
scheduled, there will not be residents available unless there is an excess available. All
other regularly scheduled activities will have first priority.
4. Resident distribution conflicts will be handled solely between attending
physicians. The residents should not be expected to resolve any such conflicts
should they arise.
5. Schedules will be adjusted accordingly when large numbers of residents and faculty
are out to facilitate coverage.
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6. Preoperative evaluations will be done by the designated resident of the service for
which the patient is being operated. If preoperative evaluations are scheduled to come
in on a day other than your own clinic days, please provide a resident from the
responsible service to perform the examination.
7. Clinical use of the research resident must be approved by the program director.
This must be done in advance to avoid conflict with scheduled experiments. Extreme
need must be demonstrated to justify this so as to preserve the integrity of the rotation.
8. Depending on the need for additional coverage, individual residents may be
temporarily reassigned to another service. Any time residents are not actively
engaged in the primary clinical care duties of your service, it is your
responsibility to help out the other services without being called.
9. All residents are expected to make weekday morning rounds at the individual
hospitals unless there are no patients in the hospital for that particular service.
10. Weekend rounds may be performed for all services by the on-call team if a
complete and thorough check out procedure is used.
11. No resident or PE will be swung from another service to cover any vacations on
another service except when residents or PEs are otherwise unoccupied or the
schedule delineates such coverage. Therefore, it is the responsibility of the senior
resident on each service to remain apprised of days out for residents and PE providers.
The senior resident should make changes in clinic or OR schedules as needed after
consultation with the affected attending.
12. In order to facilitate coverage, a PGY 5 resident at UMMC will be designated on a
schedule to be determined by the residents to serve as the chief resident in this regard.
This resident will be responsible at the end of each week at the latest for reviewing
relevant information including days out and clinic and OR schedules for the next week
to determine the availability of residents to fill in for all services which need resident
coverage. This chief resident will then coordinate among the other senior residents on
other services and the departmental chair to facilitate coverage. If coverage cannot be
arranged, the affected attending will be notified as far in advance as possible. Any
conflicts or unresolved issues should be referred to the departmental chair for advice
and direction.
13. Unless you are on official leave (which requires the standard UMMC forms to be
completed and signed by the program director), then you are to be in the greater
Jackson area and constantly accessible by pager during normal work hours 8AM5PM. If you are on call or actively engaged in patient care, you should of course be
available. You are also to be available until you have turned over all check out issues
to the next resident on call or rounding for you. Even if you are not directly assigned
to patient care issues, you are to check with your fellow residents to make sure
that they don't need you before you leave campus.
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14. The non-otolaryngology intern is assigned to the H&N service except when
otherwise specified. The senior resident on that service is responsible for directing the
intern to maximize educational experience.
C. Continuity of Care
Continuity of care is important for both patients and health care providers. First and foremost,
continuity of care results in better care. Second, continuity of care leads to a better
understanding of what patients are going through, how to better help them, and subtleties about
the disease processes. Therefore, we must insure that continuity of care is maintained. The
following policy has been drawn up to insure that continuity of care is maintained at the
residents' level.
1. Residents for each team are expected to personally round on each of their service's
patients every weekday morning. Attending rounds will be done at the time agreed
upon with each individual attending physician. At the end of every day, a
representative of the service will sign out all inpatients (both on service and consults, if
active issues exist) to the primary on-call resident.
2. The primary service(s) may check out weekend and holiday rounds to the on-call
team if desired. This communication must occur at both the junior and senior resident
level. Failure to appropriately transfer all pertinent information on a recurring basis will
result in suspension of this privilege. Individual cases may require that a
representative of the primary service round on the weekend at the discretion of the
attending physician.
3. All residents will call or email the on-call faculty member about all patient
encounters (significant phone conversation’s, ER evals, etc) while he/she is on call.
The on-call resident will be expected to dictate a note detailing the nature of the
encounter.
4. If primary call is transferred to another resident on a weekend (e.g., Friday to
Saturday), all inpatients and pending outpatient issues must be verbally signed out to
the new call resident in accordance with Institutional and Departmental Patient Handoff
policies.
5. Each regular weekday, the primary on-call residents for the previous day will
verbally sign out to the residents of the appropriate service(s) in accordance with
Institutional and Departmental Patient Handoff policies. The senior residents may
assign this task to the junior residents involved but will ultimately be responsible for
knowing all transferred information.
6. If you are the primary surgeon on any case that will require postoperative follow-up
it is your responsibility to either perform that care or to check this care out explicitly to
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another resident or PE. Nasal packing removal is an example.
7. You are here to help take care of patients rather than assume complete control of
their care. Attending physicians should be notified of all major treatment changes or
issues on their patients at all times.
D. Record Completion
All residents must continue to go to medical records, sign in, and complete every
medical record including ESA notes available to them every week only until all paper
charts are complete. Residents are expected to keep their “In basket” in Epic up-todate. All operative notes, discharge summaries, history and physicals, and clinic visits
will be dictated within 24 hours of the event. Tumor staging sheets must be completed
at the time of evaluation or prior to discharge.
Failure to stay in compliance will result in a warning. After two warnings, you will be
placed on probation. Two further warnings will be grounds for termination.
E. Appointment Scheduling and ER Follow-ups
1. Do not send anyone to clinic without letting the clinic staff know the name, date,
clinic site, and approximate time of arrival. A note or e-mail will suffice.
2. Also, you are not to overbook clinics without faculty permission. Instead have
patients call the clinic for their appointments when at all possible, particularly in the
case of ER follow-up patients. Patients that need follow-up care for treatment you
rendered will be given appointments. It is helpful if you call, send a note, or e-mail the
appointment scheduler so that they know that you have approved the patient being
seen. They will work with the attending if an overbook is required. Other patients will
be required to go through normal Departmental screening procedures. You don’t need
to worry about it once they have been given the appropriate instructions to call the
clinic.
3. Trauma is not to be sent to the clinic for scheduling without permission of the
attending.
4. Post-op appointments are to be made at the time of pre-op whenever possible.
F. Surgery Scheduling
1. Surgery posting sheets are to be filled out completely and accurately and turned in
immediately.
2. If the chief resident is running the schedule, the scheduler should be given the
dates within 2-3 days of the time of the posting slip except in unusual circumstances.
G. Dictations
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1. Please limit your dictation to the minimum necessary to provide good patient care.
2. All patient care incidents including phone calls and lab/radiology follow-up must be
documented by dictation.
3. Dictations must be done on the same day as you see the patient. If there is
pending information, dictate an addendum later.
4. UMMC hospital based services
a)
All H&P’s, consults (after checking with an attending), operative notes, discharge
summaries, and any letters to doctors about hospital based activity will be
dictated under the hospital code (1). This includes ED consultations and
procedures.
b)
An attending physician’s name should be dictated on every note. It is the
physician taking care of that patient, the one on call, or the one designated to
cover consults depending on the situation
c)
Progress notes and brief initial consults while waiting for attending input may be
written.
5. Methodist Rehabilitation Center based services
Due to the limited number of services performed there, these can be handwritten except
for operative notes.
6. Departmental based services
a)
All clinic notes, clinic based referral letters, or clinic based procedures regardless
of the location will be dictated under the department code (8).
b)
Referral letters should be used only when a clinic visit does not occur on the
same day or at the specific instructions of the attending physician.
c)
Procedures may be included for within the body of the clinic note.
d)
It is permissible to simultaneously use your initial clinic visit as an H&P copy by
telling the transcriptionist to do so. You may also simultaneously take a return
clinic visit and tell the transcriptionist to add in the additional information required
to make it a full H&P when surgery is scheduled.
7. Referring physician
You are to ask that a copy to be sent to all referring physicians. This requires dictating the name
and address, which should be provided to you on the dictation sheet or on the last note. If the
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information is not there, dictate as much as you have. You can stop doing this only when the
patient no longer sees the referring physician. If you cannot find the information, ask the patient.
H. Identification
Inform the patient as to whom you are when you see them, and let them know the attending will
be in shortly.
I. Hand Cleansing
You are to wash your hands or use a hand sanitizer before seeing and in between seeing patients.
J. Billing issues
You are not to be involved in billing issues in any way. Do not discuss contract or billing issues
with the patients. Refer them to the surgery schedulers, front desk, clinic manager, or attending
physician. You are not to circle diagnoses codes or E&M levels.
K. Follow-up issues
It is your responsibility to follow-up on all labs and imaging on any patient you see in the clinic,
any patient that you care for in the hospital, or any patient upon which you perform a procedure.
You are to notify the attending of the results and document the results and plans.
L. Employee counseling
Please do not discipline or counsel any employee regarding their job performance. Bring any
issues to the program director instead.
M. Phone message return
All phone messages must be returned by the end of the day with appropriate documentation.
Phone calls with patients are to be documented in the medical record.
N. New patients
All new patients should have complete head and neck histories and exams appropriate for age.
O. Sample pharmaceuticals
You are not to sign for any sample delivery to the clinic except for your personal use which you
should take with you immediately. Attending physicians will sign for medications for the clinics
when required.
P. Consult Protocol
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1. All consults will ultimately be seen or reviewed by an attending. Except for
specified ED consults, no dictation should occur until the attending has reviewed the
case. It is the responsibility of the otolaryngology resident to make sure that the note
contains the appropriate information even if the intern dictates it. A brief note may be
written in the progress notes stating that the patient has been seen and leaving a
working assessment if available prior to the attending reviewing the case.
2. Normal workday (7AM to 5 PM) consults will be given to the consult intern or
resident by a direct page through either the Adult ENT or Pediatric ENT consult pager.
Order of consult responsibility is: intern, junior resident of the consult attending’s
service, senior resident of the consult attending’s service, on call attending. It is
extremely important that this pager be on and attended during normal work hours. It is
important that this pager get passed from the correct person to the next correct person
without fail. Monday AMs may be particularly difficult so plan ahead on Friday. The
Pediatric ENT service will carry the Pediatric ENT consult pager and will not address
Adult ENT consult, except under emergency or disaster situations. The Adult ENT
consult pager will rotation between the three adult ENT services at UMC [Head and
Neck, Facial Plastics/Otology/Laryngology, Rhinology/Head and Neck Endocrine] by a
predetermined scheduled rotation. The Adult ENT services will not address Pediatric
ENT Consults, except under emergency or disaster situations. The Adult and Pediatric
Consult pagers are only under operation on weekdays from 8AM to 5PM.
3. The intern will see the consult at the first convenient opportunity. After being
contacted, the intern will review the case with the consult attending’s service at that
time if urgent or at the end of the day if not. If there is no intern that month, the junior
resident on the service of the consult attending is responsible for consults. If that
resident is on vacation, the senior resident on the consult attending’s service will be
responsible. If that service is off campus, the resident called will work with the
attending physicians on the assigned consult team to find a resident or PE on campus
and free to see the patient.
4. The office number is given as a back up number in case the pager is down. If there
is a call to the office staff, they will use the order above to contact the responsible
party.
5. Consults will be followed by the initial consulting service of record until the case is
no longer active unless the case is transferred by mutual agreement of the attending
physicians.
6. Calls from outside physicians should be given to a faculty member directly during
work hours unless they specifically tell you otherwise.
7. Weekend and Night Consult Protocol
a)
The first call resident will take the initial calls and determine if the patient needs
to be seen in the ED. When in doubt, come in. This resident will first call the
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senior resident to make sure no issues have been missed before proceeding with
recommendations or therapy. The senior resident will come in if there is any
question at all, if an intern in seeing a consult and has yet been determined to be
competent to certain activities or procedures, if a lower level resident is
performing a procedure he/she has never done before or is not competent to do
unsupervised, or any other situation as dictated in ACGME Duty Hour
requirements, Institutional and Departmental policies. One of the two residents
(determined by the senior resident) will call the attending physician for input on
any admissions, emergent cases, or anticipated interventional cases other than
straight forward simple lacerations, simple nosebleeds, or peritonsillar
abscesses.
b)
Urgent airway cases require that the senior resident and staff be called
immediately.
c)
Level of autonomy for the consulting resident will be based on the on-call
attending physicians judgment and preference as well as the current “Approved
Procedures for Residents Without Immediate Supervision” document, ACGME
Duty Hour requirements, and Institutional and Departmental Policies.
d)
Non-urgent or non-emergent issues can wait until the next day but still must be
discussed.
8. All transfer decisions will be made by the attending physician, but may happen in
concert with the attending physician. All transfer calls should go directly to the
attending and should ideally be received through the Patient Transfer Call Center.
Occasionally, this system breaks down, and a transfer call maybe directed to a
resident. In this case, it is acceptable for the resident who received the transfer
request to refer the call to the attending physician directly.
Q. Supervision of Patient Care
1. All patients at any participating institution are the private patients of an attending
regardless of payer status. The attending physician will ultimately be responsible for all
aspects of the patient’s care. Residents assist attending physicians and are actively
participating learners in the care of these patients. Residents should discuss all cases
with attending physicians prior to instituting significant changes in patient management.
2. An attending will be present or immediately available for all scheduled clinics and
OR sessions. If the attending is temporarily absent, they will be available by a
published pager or phone number.
3. The on-call attending will be available by pager or phone (as listed by the monthly
schedule) for all emergencies or urgent unscheduled visits/consults. The attending will
assist the residents directly in the event that the level of expertise required is beyond
the skills of the participating resident. Otherwise, the case may simply be discussed
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with the attending by phone to determine the management plan and the degree of
supervision necessary.
4. The departmental chair or his/her designee is available for additional coverage as
needed.
5. All consults will be discussed or seen with an attending as outlined previously.
6. Billing for patient care involving residents alone will conform to institutional and
departmental policies.
7. Our program has established guidelines for circumstances and events in which
residents must communicate with appropriate supervising faculty. These are available
on the G drive as Common or Group/Global Physician Preferences. In addition, each
faculty member may have his/her own preferences which will also be available on the
G drive.
8. Levels of Supervision:
To ensure oversight of resident supervision and graded authority and
responsibility, the following classification of supervision is used:
Direct Supervision – the supervising physician is physically present with the
resident and patient.
Indirect Supervision:
(1) with direct supervision immediately available – the supervising physician is
physically within the hospital or other site of patient care, and is immediately available to
provide Direct Supervision.
(2) with direct supervision available – the supervising physician is not physically
present within the hospital or other site of patient care, but is immediately available by
means of telephonic and/or electronic modalities, and is
available to provide Direct Supervision.
Oversight – The supervising physician is available to provide review of
procedures/encounters with feedback provided after care is delivered.
The privilege of progressive authority and responsibility, conditional independence, and
a supervisory role in patient care delegated to each resident is assigned jointly by the
program director and faculty members.
In particular, PGY-1 residents are supervised either directly or indirectly with direct
supervision immediately available.
Otolaryngology residents (PGY-1 through PGY-5) are granted graded responsibility to
perform all basic medical and surgical procedures related to the field of OtolaryngologyHead and Neck Surgery, in keeping with the institutional GME supervision policy. The
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level of supervision will be that which is determined to be appropriate for each individual
resident, and will be determined on a case by case basis by the supervising attending
faculty physician. These privileges will be directly based on each faculty members’
individual clinical privileges.
R. Call Schedule
1. Junior residents will on average take primary call from home, which may range from
every fourth weekday and every fourth weekend to every sixth weekday and sixth
weekend. This number will vary with any residents out on vacation or on leave.
2. Senior residents will on average take every fourth weekday and every fourth
weekend to every sixth weekday and every sixth weekend of secondary call from
home. Again, this number will vary with any residents out on vacation or on leave.
3. Holiday and trauma call will be equally distributed among junior and senior
residents respectively. Only in the case of a relatively equal number of holiday and
trauma call days will seniority be allowed to determine the designation of call.
4. It is the responsibility of the chief residents to coordinate the call schedule and have
it turned in to the program director’s secretary on or before the 20th of each preceding
month.
5. In the rare event that it is necessary for a resident to stay in-house, the PICU
surgery call room has been designated for use by the ENT resident on call or the
resident room may be used.
S. ICU Bed Requests
It is the responsibility of the senior resident on the service to make sure that planned
ICU bed requests have been submitted prior to the day of the surgery.
T. Communications with Outside Physicians
1. All transfer decisions will be made by the attending physician, but may happen in
concert with the attending physician. All transfer calls should go directly to the
attending and should ideally be received through the Patient Transfer Call Center.
Occasionally, this system breaks down, and a transfer call maybe directed to a
resident. In this case, it is acceptable for the resident who received the transfer
request to refer the call to the attending physician directly.
2. It is preferred that communication with outside, referring, and attending physicians
be done primarily by faculty members when possible. If the communication is in
regards to the transfer of a patient from an outside facility, it must be done primarily by
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faculty members. However, resident physicians can assist in the transfer
arrangements to facilitate the process, if needed.
U. Compliance
Residents are responsible for understanding and cooperating with all departmental
compliance issues as detailed in the departmental and UMMC policies, which will be
periodically reviewed with the residents. Further details are provided in the Department
Compliance document.
The dictated operative record should reflect exactly the same procedures and
diagnoses as written by the attending on the charge sheet. If you have an ethical
problem with any aspect of this or note any deviation from our Compliance policies,
please bring it to my attention immediately.
V. Resident Case Distribution
In general, cases are to be done by residents on the service of the attending physician
of the patient. The level of the resident is determined by the complexity of the case in
concert with the attending physician and the senior resident. Taking cases from
residents on other services is not permitted without prior approval of the residency
program director and only if there is a documented need for additional training for a
senior resident for that particular case type.
W. Criteria for Advancement and Graduation
Criteria for Advancement to PGY-2 Level from PGY-1 Level
Successful completion of all ACGME required PGY-1 rotations as assigned by the Program Director of
Otolaryngology in conjunction with the Departments of Surgery, Anesthesiology, Emergency Medicine,
and Neurosurgery
Leave time not exceeding a combined total of 30 days
Achievement of a minimum of satisfactory on all faculty evaluations (performs at expectations for
PGY level)
Timely completion of all required medical records at UMC and VA
On-time attendance at all scheduled conferences (excepting leave periods and excused absences)
Completion of all Institutional requirements for PGY-1 promotion, including invasive procedures
credentialing
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Criteria for Advancement to PGY-3 Level from PGY-2 Level
Successful completion of all ACGME required PGY-2 rotations as assigned by the Program Director of
Otolaryngology
Leave time not exceeding a combined total of 30 days
Achievement of a minimum of satisfactory on all faculty evaluations (performs at expectations for
PGY level)
Adequate performance on all faculty completed procedural evaluations (attainment of at least 50%
of the time a particular behavior is performed)
Attendance at a minimum of one national or regional otolaryngology conference
Successful completion of the PGY-2 anatomy dissection course
Timely completion of all required medical records at UMC and VA
On-time attendance at all scheduled morning conferences (excepting leave periods and excused
absences)
Criteria for Advancement to PGY-4 Level from PGY-3 Level
Successful completion of all ACGME required PGY-3 rotations as assigned by the Program Director of
Otolaryngology
Leave time not exceeding a combined total of 30 days
Achievement of a minimum of satisfactory on all faculty evaluations (performs at expectations for
PGY level)
Adequate performance on all faculty completed procedural evaluations (attainment of at least 50%
of the time a particular behavior is performed)
Attendance at a minimum of one national or regional otolaryngology conference
Timely completion of all required medical records at UMC and VA
On-time attendance at all scheduled morning conferences (excepting leave periods and excused
absences)
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Criteria for Advancement to PGY-5 Level from PGY-4 Level
Successful completion of all ACGME required PGY-4 rotations as assigned by the Program Director of
Otolaryngology
Leave time not exceeding a combined total of 30 days
Achievement of a minimum of satisfactory on all faculty evaluations (performs at expectations for
PGY level)
Adequate performance on all faculty completed procedural evaluations (attainment of at least 50%
of the time a particular behavior is performed)
Attendance at a minimum of one national or regional otolaryngology conference
Timely completion of all required medical records at UMC and VA
On-time attendance at all scheduled morning conferences (excepting leave periods and excused
absences)
Presentation of one research project at the UMC ENT graduation ceremony
Criteria for Graduation from PGY-5 Level
Successful completion of all ACGME required PGY-5 rotations as assigned by the Program Director of
Otolaryngology
Leave time not exceeding a combined total of 30 days
Achievement of a minimum of satisfactory on all faculty evaluations (performs at expectations for
PGY level)
Attendance at a minimum of one national or regional otolaryngology conference
Timely completion of all required medical records at UMC and VA
On-time attendance at all scheduled morning conferences (excepting leave periods and excused
absences)
Presentation of one research project at the UMC ENT graduation ceremony
Successful completion of two research projects (one of the two projects must be a suitable basic
science project) that are suitable for presentation and/or publication
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Achievement of the ability to practice independently as determined by all physician faculty members
of the Department of Otolaryngology (excluding the division of Dermatology).
--The ability to practice independently includes the ability to competently practice outpatient
clinical otolaryngology and perform procedures representative of the specialty of general
otolaryngology as defined by the ACGME and the American Board of Otolaryngology
“To laugh often and much, to win the respect of intelligent people and the affection of children, to earn the
appreciation of honest critics and endure the betrayal of false friends, to appreciate beauty, to find the best
in others, to leave the world a bit better, whether by a healthy child, a garden patch… to know even one life
has breathed easier because you have lived. This is to have succeeded!”
Ralph Waldo Emerson